bluuebunny/crossref_metadata_2025 huggingface dataset:
Head Louse Feces: Chemical Analysis and Behavioral Activity
Authors: Galassi F G , Picollo M I , Gonzalez-Audino P
Published: October 2019

Human head lice Pediculus humanus capitis (De Geer) (Phthiraptera: Pediculidae) are insect parasites closely associated with humans, feeding on the blood of their hosts and causing them skin irritation and probable secondary infections. Despite being a severe nuisance, very few studies have reported on intraspecific chemical communication in head lice. Here, we evaluated the attractive response of head lice to the volatile compounds and solvent extracts from their feces. We also chemically analyzed the main volatile components of these feces and those of the feces’ extracts. Head lice were attracted to the methanol extract of their feces but not to the hexane or dichloromethane extracts, suggesting the polar nature of bioactive chemicals present in head louse feces. Follow-up chemical identifications, in fact, showed the presence of hypoxanthine, uric acid, and another purine tentatively identified as either guanine or iso-guanine. Additionally, head lice were significantly attracted by volatiles emitted from samples containing feces. The volatiles emanated from feces alone contained 19 identified substances: 2-pentanone, hexanal, heptanal, 3-methyl-3-buten-1-ol, octanal, sulcatone, nonanal, acetic acid, 2-ethyl-1-hexanol, decanal, 1-octanol, butyric acid, 1-nonanol, hexanoic acid, octanoic acid, 2,6-dimethyl-7-octen-2-ol, 2-undecanone, geranylacetone, and hexadecane. The major compounds found were decanal, nonanal, hexanal, and acetic acid, together representing approximately 60% of the identified compounds. This work represents the first chemical evidence of intraspecies communication among head lice. The results support the existence of active substances present in the feces of P. humanus capitis that may be involved in its aggregation behavior.
Amendments, annexations, alternatives: Nord Stream 2’s contemporary status under EU and international law
Authors: Jeutner Valentin
Published: October 2019

Nord Stream 2 is a highly controversial megaproject. This text shows that the political controversy surrounding Nord Stream 2 does not necessarily translate to legal controversy. The text does so by considering three controversially discussed European and international legal aspects of the Nord Stream 2 project. The article commences by evaluating whether and how [whether and how] the recent amendment to the European Union (EU) Directive 2009/73/EC concerning common rules for the internal market in natural gas affects the legal status of Nord Stream 2. The text concludes that Directive 2009/73/EC (as amended) makes it considerably more difficult to operate Nord Stream 2. It will also be established that legal uncertainty remains concerning the amended Directive’s compliance with European and international law, and that bilateral relations between Russia and Germany are, in any case, unaffected by changes in EU law. The article then proceeds to evaluate the argument that Germany’s involvement with Nord Stream 2, in light of Russia’s annexation of Crimea and Sevastopol, violates international law since Germany, by doing so, violates the obligation not to recognize or support annexation by an aggressor state. This argument is rejected. Even if one assumes that Russia’s annexation of Crimea and Sevastopol was unlawful, Germany’s support of Nord Stream 2 cannot be legally construed as support for Russia’s activities concerning Crimea and Sevastopol. Finally, the article considers the international legal framework conditioning the currently still outstanding permission by Denmark to lay Nord Stream 2 pipelines through the Danish territorial sea/the Danish Exclusive Economic Zone. In this regard, it is concluded that the legal scope for Denmark to reject Nord Stream 2’s application for permission to lay the pipeline through Danish waters is very limited.
The Year of the Rat: The Rat Genome Database at 20: a multi-species knowledgebase and analysis platform
Authors: Smith Jennifer R , Hayman G Thomas , Wang Shur-Jen , Laulederkind Stanley J F , Hoffman Matthew J , Kaldunski Mary L , Tutaj Monika , Thota Jyothi , Nalabolu Harika S , Ellanki Santoshi L R , Tutaj Marek A , De Pons Jeffrey L , Kwitek Anne E , Dwinell Melinda R , Shimoyama Mary E
Published: October 2019

Formed in late 1999, the Rat Genome Database (RGD, https://rgd.mcw.edu) will be 20 in 2020, the Year of the Rat. Because the laboratory rat, Rattus norvegicus, has been used as a model for complex human diseases such as cardiovascular disease, diabetes, cancer, neurological disorders and arthritis, among others, for >150 years, RGD has always been disease-focused and committed to providing data and tools for researchers doing comparative genomics and translational studies. At its inception, before the sequencing of the rat genome, RGD started with only a few data types localized on genetic and radiation hybrid (RH) maps and offered only a few tools for querying and consolidating that data. Since that time, RGD has expanded to include a wealth of structured and standardized genetic, genomic, phenotypic, and disease-related data for eight species, and a suite of innovative tools for querying, analyzing and visualizing this data. This article provides an overview of recent substantial additions and improvements to RGD’s data and tools that can assist researchers in finding and utilizing the data they need, whether their goal is to develop new precision models of disease or to more fully explore emerging details within a system or across multiple systems.
Hyperkalemia in patients with chronic renal failure
Authors: Seliger Stephen L
Published: October 2019

Although hyperkalemia is much more common in patients with chronic kidney disease (CKD), the reported frequency of hyperkalemia varies markedly across studies, primarily due to differences in the ascertainment of hyperkalemia and the severity of CKD. Major risk factors for hyperkalemia among CKD patients include lower estimated glomerular filtration rate (eGFR), use of renin–angiotensin–aldosterone system inhibitors (RAASis), diabetes, older age and male gender. The use of two drugs to inhibit RAAS in diabetic CKD markedly increases the risk of hyperkalemia, as demonstrated in large multicenter clinical trials. Hyperkalemia has consistently been associated with an increased risk of adverse events compared with normokalemia, including all-cause mortality and cardiovascular morbidity and mortality. This risk is not explained by differences in comorbidity or estimated GFR, nor concomitant metabolic abnormalities such as acidosis among those with hyperkalemia. Sodium polystyrene sulfonate has been used commonly for decades to treat hyperkalemia in CKD patients, but without any high-quality clinical data to support its efficacy and with an increased risk of rare but serious colonic complications. The newer oral potassium-binding agents, patiromer and sodium zirconium cyclosilicate, have been shown to be effective and safe for the non-emergent treatment of hyperkalemia in CKD patients, including patients treated with RAASis. Although the long-term use of these medications may permit continuation of RAASis in CKD patients with hyperkalemia, the overall impact of this approach (as compared with down-titration of RAASis and/or up-titration of diuretics) on long-term morbidity, mortality and quality of life remains uncertain.
The urinary proteomics classifier chronic kidney disease 273 predicts cardiovascular outcome in patients with chronic kidney disease
Authors: Verbeke Francis , Siwy Justyna , Van Biesen Wim , Mischak Harald , Pletinck Anneleen , Schepers Eva , Neirynck Nathalie , Magalhães Pedro , Pejchinovski Martin , Pontillo Claudia , Lichtinghagen Ralf , Brand Korbinian , Vlahou Antonia , De Bacquer Dirk , Glorieux Griet
Published: October 2019

Background

The urinary proteomic classifier chronic kidney disease 273 (CKD273) is predictive for the development and progression of chronic kidney disease (CKD) and/or albuminuria in type 2 diabetes. This study evaluates its role in the prediction of cardiovascular (CV) events in patients with CKD Stages G1–G5.

Methods

We applied the CKD273 classifier in a cohort of 451 patients with CKD Stages G1–G5 followed prospectively for a median of 5.5 years. Primary endpoints were all-cause mortality, CV mortality and the composite of non-fatal and fatal CV events (CVEs).

Results

In multivariate Cox regression models adjusting for age, sex, prevalent diabetes and CV history, the CKD273 classifier at baseline was significantly associated with total mortality and time to fatal or non-fatal CVE, but not CV mortality. Because of a significant interaction between CKD273 and CV history (P = 0.018) and CKD stages (P = 0.002), a stratified analysis was performed. In the fully adjusted models, CKD273 classifier was a strong and independent predictor of fatal or non-fatal CVE only in the subgroup of patients with CKD Stages G1–G3b and without a history of CV disease. In those patients, the highest tertile of CKD273 was associated with a >10-fold increased risk as compared with the lowest tertile.

Conclusions

The urinary CKD273 classifier provides additional independent information regarding the CV risk in patients with early CKD stage and a blank CV history. Determination of CKD273 scores on a random urine sample may improve the efficacy of intensified surveillance and preventive strategies by selecting patients who potentially will benefit most from early risk management.
DAY-LENGTH-DEPENDENT DELAYED-GREENING1, the Arabidopsis Homolog of the Cyanobacterial H+-Extrusion Protein, Is Essential for Chloroplast pH Regulation and Optimization of Non-Photochemical Quenching
Authors: Harada Kyohei , Arizono Takatoshi , Sato Ryoichi , Trinh Mai Duy Luu , Hashimoto Akira , Kono Masaru , Tsujii Masaru , Uozumi Nobuyuki , Takaichi Shinichi , Masuda Shinji
Published: October 2019

Plants convert solar energy into chemical energy through photosynthesis, which supports almost all life activities on earth. Because the intensity and quality of sunlight can change dramatically throughout the day, various regulatory mechanisms help plants adjust their photosynthetic output accordingly, including the regulation of light energy accumulation to prevent the generation of damaging reactive oxygen species. Non-photochemical quenching (NPQ) is a regulatory mechanism that dissipates excess light energy, but how it is regulated is not fully elucidated. In this study, we report a new NPQ-regulatory protein named Day-Length-dependent Delayed-Greening1 (DLDG1). The Arabidopsis DLDG1 associates with the chloroplast envelope membrane, and the dldg1 mutant had a large NPQ value compared with wild type. The mutant also had a pale-green phenotype in developing leaves but only under continuous light; this phenotype was not observed when dldg1 was cultured in the dark for ≥8 h/d. DLDG1 is a homolog of the plasma membrane-localizing cyanobacterial proton-extrusion-protein A that is required for light-induced H+ extrusion and also shows similarity in its amino-acid sequence to that of Ycf10 encoded in the plastid genome. Arabidopsis DLDG1 enhances the growth-retardation phenotype of the Escherichia coli K+/H+ antiporter mutant, and the everted membrane vesicles of the E. coli expressing DLDG1 show the K+/H+ antiport activity. Our findings suggest that DLDG1 functionally interacts with Ycf10 to control H+ homeostasis in chloroplasts, which is important for the light-acclimation response, by optimizing the extent of NPQ.
Nudging Emergency Care Providers to Reduce Opioid Prescribing Using Peer Norm Comparison Feedback: A Pilot Randomized Trial
Authors: Suffoletto Brian , Landau Aaron
Published: October 2019

Objective

To determine the feasibility, acceptability, and potential impact of using audit and feedback (A&F) with or without peer norm comparison on opioid prescribing by emergency medicine providers.

Methods

A convenience sample of 37 emergency medicine providers were recruited from 16 emergency departments in Western Pennsylvania for a pilot randomized controlled trial. Participants completed a baseline survey, were randomly allocated to A&F (N = 17) or A&F with peer norm comparison (N = 20), and were asked to complete a postintervention survey. We matched each participant 1:1 to a control who was not exposed to either intervention.

Results

At baseline, 57% of participants perceived that they prescribed opioids at the same frequency as their peers, whereas 32% perceived prescribing less than and 11% perceived prescribing more than their peers. Most participants rated the interventions as helpful, with no differences between conditions. For the A&F with peer norm comparison condition, from pre- to postintervention, there was a relative increase of 20% in the percentage of participants who perceived that they prescribed more opioids than their peers but no change in the A&F condition (P = 0.02). 56.8% of controls, 52.9% of A&F participants, and 75.5% of A&F with peer norm comparison participants reduced their opioid prescribing (P = 0.33). The mean reduction in opioid prescriptions (SD) was 3.3. (9.6) for controls, 3.9 (10.5) for A&F, and 7.3 (7.8) for A&F with peer norm comparison (P = 0.31).

Conclusions

Audit and feedback interventions with peer norm comparisons are helpful to providers, can alter perceptions about prescribing norms, and are a potentially effective way to alter ED providers’ opioid prescribing behavior.
Trends in Home Care—the Coming Resource Crisis
Authors: Nelson Roxanne
Published: October 2019

Nursing and other workforce shortages are among the challenges.
New Esophageal Cancer Indication for Pembrolizumab
Authors: Aschenbrenner Diane S.
Published: October 2019

Pembrolizumab (Keytruda) is now approved for patients with recurrent, locally advanced or metastatic squamous cell carcinoma of the esophagus whose tumors express programmed death ligand 1. A special diagnostic test to determine patient eligibility has also been approved.

The drug carries the same adverse effects and warnings for this new indication as it did for previous indications.
CE: Implementing Guidelines for Treating Chronic Pain with Prescription Opioids
Authors: Maloy Patricia E. , Iacocca Megan O. , Morasco Benjamin J.
Published: October 2019

Chronic pain, stemming primarily from musculoskeletal conditions and severe headaches, is a growing problem in the United States, affecting as many as 43% of adults. Opioids are frequently prescribed to manage chronic pain despite limited data on their long-term efficacy and the potential risks of long-term use. In 2017, more than 47,000 people died as a result of an opioid overdose involving illicit opioids (such as heroin), illicitly manufactured opioids, diverted opioids, prescription opioids, or some combination thereof. Although it's been more than three years since the nationwide opioid crisis prompted the Centers for Disease Control and Prevention (CDC) to release a guideline outlining safe practices for prescribing opioids to patients with chronic pain (unrelated to active cancer or palliative and end-of-life care), opioid misuse remains a significant concern. Historically, physicians have been tasked with the primary responsibility for implementing opioid safety measures, but nurses in the primary care setting are being increasingly relied on to incorporate these measures as part of their practice. In this article, we discuss the use of five tools outlined in the CDC guideline: prescription opioid treatment agreements, urine drug screening, prescription drug monitoring program databases, calculation of morphine milligram equivalents, and naloxone kits. Primary care nurses can use these tools to promote opioid safety among patients receiving opioid therapy for chronic pain.
CE: Gestational Hypertension, Preeclampsia, and Peripartum Cardiomyopathy: A Clinical Review
Authors: Maheu-Cadotte Marc-André , Pépin Catherine , Lavallée Andréane , Hupé Catherine , Mailhot Tanya , Duchaine Caroline , Fontaine Guillaume
Published: October 2019

Gestational hypertension, preeclampsia, and peripartum cardiomyopathy are among the most common and often severe pregnancy-specific cardiovascular diseases (CVDs) and causes of complications in pregnancy. This clinical review provides nurses with an overview of pregnancy-specific CVDs, outlines their pathophysiology, and discusses risk factors and assessment. It describes management interventions according to timing: the antepartum, intrapartum, and postpartum phases are each addressed.
The Elements of a Nursing Malpractice Case, Part 3A: Causation
Authors: Brous Edie
Published: October 2019

A plaintiff must prove not only that a provider departed from acceptable standards of practice—but that this departure caused an injury.
Cost Effectiveness of Interval Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy in Stage III Ovarian Cancer on the Basis of a Randomized Phase III Trial
Authors: Koole Simone N. , van Lieshout Christiaan , van Driel Willemien J. , van Schagen Evi , Sikorska Karolina , Kieffer Jacobien M. , Schagen van Leeuwen Jules H. , Schreuder Henk W. R. , Hermans Ralph H. , de Hingh Ignace H. , van der Velden Jacobus , Arts Henriette J. , Massuger Leon F. A. G. , Aalbers Arend G. , Verwaal Victor J. , van de Vijver Koen K. , Aaronson Neil K. , van Tinteren Harm , Sonke Gabe S. , van Harten Wim H. , Rete'l Valesca P.
Published: October 2019

(Abstracted from J Clin Oncol 2019;37:2041–2050)

Despite advancements in treatment modalities, the 10-year survival rate of women diagnosed with advanced-stage ovarian cancer has remained between 10% and 15% for the past 20 years. This is in part due to the majority of cases being diagnosed when disease has reached International Federation of Gynecology and Obstetrics stages III to IV.
Promoting Parent Partnership in Developmentally Supportive Care for Infants in the Pediatric Cardiac Intensive Care Unit
Authors: Klug Janie , Hall Christine , Delaplane Emily A. , Meehan Caitlin , Negrin Karli , Mieczkowski Dana , Russell Sarah K. , Hamilton Bridy O. , Hehir David A. , Sood Erica
Published: October 2019

Background:

Limited opportunities for parents to care for their critically ill infant after cardiac surgery can lead to parental unpreparedness and distress.

Purpose:

This project aimed to create and test a bedside visual tool to increase parent partnership in developmentally supportive infant care after cardiac surgery.

Methods:

The Care Partnership Pyramid was created by a multidisciplinary team and incorporated feedback from nurses and parents. Three Plan-Do-Study-Act (PDSA) cycles tested its impact on parent partnership in care. Information about developmentally supportive care provided by parents during each 12-hour shift was extracted from nursing documentation. A staff survey evaluated perceptions of the tool and informed modifications.

Results:

Changes in parent partnership during PDSA 1 did not reach statistical significance. Staff perceived that the tool was generally useful for the patient/family but was sometimes overlooked, prompting its inclusion in the daily goals checklist. For PDSA 2 and 3, parents were more often observed participating in rounds, asking appropriate questions, providing environmental comfort, assisting with the daily care routine, and changing diapers.

Implications for Practice:

Use of a bedside visual tool may lead to increased parent partnership in care for infants after cardiac surgery.

Implications for Research:

Future projects are needed to examine the impact of bedside care partnership interventions on parent preparedness, family well-being, and infant outcomes.
Surgical Implant Generation Network Implant Follow-up: Assessment of Squat and Smile and Fracture Healing
Authors: Alves Kristin M. , Lerner Ariel , Silva Genevieve S. , Katz Jeffrey N.
Published: October 2019

Objectives:

To evaluate the reliability, sensitivity, and specificity of the Squat and Smile (S&S) test, a clinical photographic follow-up, in determination of fracture healing and to assess the extent of continued fracture healing beyond 1-year postoperation.

Design:

Retrospective review of the Surgical Implant Generation Network (SIGN) database.

Setting:

The S&S test is utilized in low-resource settings where the SIGN intramedullary nail is used due to unavailability of intraoperative fluoroscopy.

Patients/Participants:

One hundred fifty patients undergoing fracture fixation utilizing SIGN intramedullary nails with data available at least 1 year (9–16 months) after surgery.

Intervention:

None.

Main Outcome Measures:

We extracted clinical data and calculated scores for the S&S photographs and radiographs at the 1-year (9–16 month postoperative) follow-up and last follow-up available beyond that. We analyzed the sensitivity of S&S scoring, using Radiographic Union Scale for Tibia fracture scores as the gold standard for fracture union.

Results:

Of the 126 patients analyzed, 21% were found to have incomplete healing at 1 year, whereas 17% of the 64 patients with further follow-up past 1 year had incomplete healing. We found that both S&S and radiographic fracture healing scores had good interrater reliability (k = 0.73–0.78 for S&S and 0.94 for radiographs). The S&S test had poor sensitivity (0.11) and specificity (0.85) in determining fracture healing at the 1-year follow-up.

Conclusions:

The S&S scoring method was reliable but neither sensitive nor specific for determining fracture healing at 1 year. Fractures deemed incompletely healed by radiographic evaluation at 1 year after SIGN implant may still have the potential to heal over time.

Level of Evidence:

Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
In-toeing gait in children with clubfoot and the effect of tibial rotation osteotomy
Authors: Westberry David E. , Davis Roy B. , Binkley-Vance Rachel , Westberry Andrew , Westberry Alison , Wack Linda I.
Published: October 2019

In-toeing gait is common after treatment for clubfoot deformity and is often secondary to residual internal tibial torsion. The purpose of the current study was to characterize the gait pattern in children with an intoeing gait pattern associated with talipes equinovarus (TEV) deformity, identify secondary changes at the hip that occur with intoeing, and determine if these secondary effects resolve after correction of tibial torsion. Patients with a diagnosis of TEV deformity, in-toeing gait secondary to residual internal tibial torsion corrected with tibial rotation osteotomy (TRO) and complete preoperative and postoperative motion analysis studies obtained approximately 1 year apart, were included in the study. Nineteen children (19 left extremities) with a TRO at a mean age of 8.2 years met inclusion criteria. Clinical examination showed improvement in tibial torsion assessment by measure of the thigh foot axis and transmalleolar axis. Kinematically, an abnormal internal FPA was present in all cases preoperatively, was corrected to normal in 12 (63%), remained internal in 5 (26%), and was abnormally external in 2 (11%). External hip rotation was identified in 13 (68%) cases preoperatively. Hip rotation was normalized postoperatively in 7 (54%), and was unchanged in the remaining 6 (46%). TRO provides effective correction of excessive internal tibial torsion, resolution of kinematic internal knee rotation, and normalization of the internal foot progression angle in the majority of patients with TEV deformity. External hip rotation resolved in approximately 50% of cases. Overcorrection of the internal FPA is possible when secondary changes at the hip do not resolve.
Making the Learning Continuum a Reality: The Critical Role of a Graduate Medical Education–Continuing Medical Education Partnership
Authors: Whitehurst Kelley E. , Carraway Mildred , Riddick Alyson , Basnight L. Lorraine , Garrison Herbert G.
Published: October 2019

A true continuum of learning in physician education, envisioned as the seamless integration of undergraduate, graduate, and continuing medical education that results in lifelong learning, has yet to be realized. Rapid clinical change, evolving systems of health care, and a shift to competency-based training make the continuum and lifelong learning even more critical. Because they function independently, the efforts of Graduate Medical Education (GME) and Continuing Medical Education (CME) have fallen short of the integrated ideal. The complementary threads of accreditation requirements, expertise, resources, and scholarly activities provide an opportunity for GME and CME to operate in a more integrated and coordinated fashion. Our local GME–CME partnership model demonstrates that these complimentary threads can be tied together to effectively facilitate lifelong learning and promote an integrated learning continuum.
Associations of telomerase reverse transcriptase rs10069690 and rs2736100 polymorphisms with papillary thyroid carcinoma
Authors: Liu Ying , Shi Feng
Published: October 2019

Papillary thyroid carcinoma is one of the most common endocrine malignancies. Telomerase reverse transcriptase rs10069690 and rs2736100 polymorphisms have been studied in thyroid carcinomas with different ethnicity, but the results were inconsistent. Therefore, we evaluated the relationship between rs10069690 and rs2736100 polymorphisms and papillary thyroid carcinoma risk and furtherly investigated the associations of these polymorphisms with stimulated thyroglobulin (sTg) positivity and adverse reactions of 131I treatment in papillary thyroid carcinoma. Four hundred thirty-six papillary thyroid carcinoma patients and 345 controls of Chinese Han population were included in our study. Rs10069690 and rs2736100 were genotyped using improved multiple ligase detection reactions. Analysis of inheritance model was performed using the unconditional logistic regression. In our study, rs10069690 and rs2736100 were associated with papillary thyroid carcinoma risk, especially in females over 45 years of age (P = 0.002 and P = 0.032, respectively). Rs10069690 was associated with sTg positivity and with an rs10069690-related occurrence risk order of thyroglobulin antibody (Tg-Ab)(+) + Tg(+) > Tg-Ab(+) + sTg(−) > Tg-Ab(−) + sTg(+). Patients with the homozygous TT genotype of rs10069690 had an increased risk of neck discomfort (P = 0.033), while the homozygous CC genotype of rs2736100 had a decreased risk of gastrointestinal toxicity (P = 0.048). Our data demonstrated that rs10069690 and rs2736100 might be bio-indicators related to papillary thyroid carcinoma risk in females over 45 years of age and 131I treatment-related toxicity. In addition, rs10069690 may be a predictor of bad clinicopathological features and poor prognosis from a serological point of view.
Usability Assessment of an Electronic Handoff Tool to Facilitate and Improve Postoperative Communication Between Anesthesia and Intensive Care Unit Staff
Authors: Benton Samuel Edison , Hueckel Rémi M. , Taicher Brad , Muckler Virginia C.
Published: October 2019

The handoff or handover is the exchange of pertinent medical information from one provider to another. Inadequate handoff communication between healthcare providers can negatively impact patient outcomes. In an effort to improve handoff communication, many studies have developed and evaluated the use of a handoff tool such as a handoff checklist or handoff form to facilitate handoff communication. Recently, the use of the IPASS handoff form, based on the mnemonic for the process, has been associated with a reduction in the rate of adverse events and improvement in information transfer and nurse satisfaction. This quality improvement project adapted the IPASS handoff form for postoperative use in an iterative approach over a series of four phases: (1) requirements/information gathering, (2) adaptation/development, (3) evaluation and modification, and (4) usability testing. Results of this project show that participants viewed the postoperative IPASS handoff form to be easy to use (87.5%), satisfactory (75.0%), and user-friendly (75.0%), which can facilitate its widespread adoption. The key feature identified in making the handoff form user-friendly was its customization feature, which allowed the handoff report to be shortened or expanded to meet the provider- or unit-specific needs.
Combination Therapy of Ipilimumab and Nivolumab-associated Toxic Epidermal Necrolysis (TEN) in a Patient With Metastatic Melanoma: A Case Report and Literature Review
Authors: Logan Ian T. , Zaman Saman , Hussein Lama , Perrett Conal M.
Published: October 2019

Ipilimumab and nivolumab are immune checkpoint inhibitors used in the treatment of metastatic melanoma. The authors report the case of a 62-year-old white male individual with metastatic choroidal melanoma who had commenced adjuvant systemic treatment with combination checkpoint inhibitor therapy of intravenous ipilimumab (anti-cytotoxic T-lymphocyte antigen-4) and nivolumab (anti-programmed cell death-1) at 3-week cycle intervals. On day 4 after the second cycle, he developed an acute widespread rash. On examination there was confluent erythema with bullae and epidermal loss over 60% of the body surface area, with severe oral mucosal ulceration. A clinical diagnosis of toxic epidermal necrolysis (TEN) was made and he was transferred to the intensive care unit. Despite active treatment, he deteriorated systemically and died from multiorgan failure. This is the first reported case of TEN associated with nivolumab and ipilimumab dual therapy for metastatic uveal melanoma. Monotherapy improves survival in metastatic melanoma, but dual therapy has shown a greater mortality benefit at 3 years. Although the literature demonstrates case reports of Stevens-Johnson syndrome and TEN in association with nivolumab, ipilimumab has generally been regarded as a “safe” treatment with regard to severe cutaneous adverse reactions. With the increased use of immunotherapies, it is important to plan the management and early recognition of drug-related skin toxicity. This is of greatest concern during treatment initiation and with the higher risk associated with combination therapy. Reporting of adverse events and infrequently encountered complications with systemic biologic treatments will augment pharmacovigilance and improve the stratification of patients to treatments.
Blinded, Randomized, Controlled Trial Evaluating the Effects of Light-Emitting Diode Photomodulation on Lower Extremity Wounds Left to Heal by Secondary Intention
Authors: Perper Marina , Eber Ariel , Lindsey Scott F. , Nouri Keyvan
Published: October 2019

BACKGROUND

Light-emitting diode (LED) has been used for wound healing because of its stimulatory effects on fibroblast proliferation, matrix synthesis, angiogenesis, and downmodulation of inflammatory reactions.

OBJECTIVE

The aim of the authors' study was to investigate the effects of red LED (wavelength 633 nm) photomodulation on lower extremity surgical defects left to heal by secondary intention.

MATERIALS AND METHODS

Fourteen subjects with surgical defects of the lower leg were irradiated with a 633 ± 3-nm light source for 20 minutes (105 mW/cm2, 126 J/cm2) at 4 weekly sessions.

RESULTS

The number of days required for wounds to heal was greater in the treatment group (63.2 ± 12.2 days) than in the control group (48.67 ± 11.1 days), although this difference was not statistically significant (p = .07). The percentage of the original wound remaining was not statistically different between treatment and control groups between Weeks 1 and 2 (p = .71) and Weeks 3 and 4 (p = .56). It was significant between Weeks 2 and 3 (p = .01).

CONCLUSION

This study revealed that red LED photomodulation at a wavelength of 633 nm did not result in clinical improvement in wound healing of surgical defects on the lower extremities.
Ambient air pollution and lung cancer risk among never-smokers in the Women's Health Initiative
Authors: Gowda Shilpa N. , DeRoos Anneclaire J. , Hunt Rebecca P. , Gassett Amanda J. , Mirabelli Maria C. , Bird Chloe E. , Margolis Helene G. , Lane Dorothy , Bonner Matthew R. , Anderson Garnet , Whitsel Eric A. , Kaufman Joel D. , Bhatti Parveen
Published: October 2019

Background:

Ambient air pollution is classified as a human carcinogen by the International Agency for Research on Cancer (IARC). However, epidemiologic studies supporting this classification have focused on lung cancer mortality rather than incidence, and spatial and temporal resolutions of exposure estimates have varied considerably across studies.

Methods:

We evaluated the association of outdoor air pollution and lung cancer incidence among never-smoking participants of the Women’s Health Initiative (WHI) study, a large, US-based cohort of postmenopausal women (N = 65,419; 265 cases). We used geospatial models to estimate exposures to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) based on residential addresses at baseline and throughout follow-up. We also characterized exposures to traffic-related air pollution by proximity to major roadways. We estimated hazard ratios (HRs) for the risk of lung cancer in association with these exposure metrics using Cox proportional hazards regression models.

Results:

No compelling associations of PM2.5 and NO2 exposures with lung cancer risk were observed. An increased risk of lung cancer was observed when comparing those individuals with residences <50 versus ≥200 meters from a primary limited access highway (HR = 5.23; 95% confidence interval = 1.94, 14.13).

Conclusions:

Our results do not exclude lung cancer risk estimates observed in association with PM2.5 and NO2 exposures identified in previous studies. Our results suggest that residential proximity to major roadways may be a proxy for carcinogenic exposures not correlated with PM2.5 or NO2 levels. New studies of air pollution and lung cancer incidence should characterize additional aspects of proximity to major roadways.
Pharmacogenomics implications of population diversity in Latin America: TPMT and NUDT15 polymorphisms and thiopurine dosing
Authors: Suarez-Kurtz Guilherme , Araújo Gilderlanio Santana de , de Sousa Sandro José
Published: October 2019

TPMT and NUDT15 polymorphisms are major determinants of tolerance to thiopurine drugs used in leukemias and nonmalignant immunologic disorders. We adopted an extreme discordant phenotype approach to explore the impact of Native American versus European ancestry on the distribution of TPMT and NUDT15 polymorphisms, and inferred metabolic phenotypes in the 1000 Genomes Ad Mixed American superpopulation. Significant differences were observed in the distribution of TPMT and NUDT15 haplotypes (star alleles) between individuals with predominant (>70%) European versus Native ancestry. The largest difference is related to NUDT15 rs116855232. Based on the combined TPMT/NUDT15 metabolic phenotypes, the Clinical Pharmacogenetics Implementation Consortium recommendations for thiopurine dose adjustment applies to 40.1% of individuals with major Native American ancestry, compared to 12.8% of individuals with predominantly European ancestry. These findings may be relevant to the adoption and interpretation of pharmacogenetic tests for thiopurine drugs across Latin America peoples with different European and Native-American ancestries.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IMAGING OF CHOROIDAL NEOVASCULARIZATION SECONDARY TO CHOROIDAL RUPTURE TREATED BY INTRAVITREAL RANIBIZUMAB
Authors: Benillouche Jennifer , Astroz Polina , Ohayon Avi , Srour Mayer , Amoroso Francesca , Pedinielli Alexandre , Mouallem Alexandra , Souied Eric H.
Published: October 2019

Purpose:

To describe optical coherence tomography angiography findings at baseline and during the follow-up of choroidal neovascularization secondary to choroidal rupture (CR) in a patient with kidney transplant treated by a single intravitreal injection of ranibizumab.

Methods:

The clinical course, conventional multimodal imaging findings including ultra-widefield fundus color photography and fundus autofluorescence (Optos California, Marlborough, MA), spectral-domain optical coherence tomography (SD-OCT Spectralis; Heidelberg Engineering, Heidelberg, Germany), fluorescein angiography (FA; Heidelberg Engineering, Heidelberg, Germany), indocyanine green angiography ,and optical coherence tomography angiography (Plex-Elite, Carl Zeiss Meditec, Inc, Dublin, CA) findings at baseline and during the follow-up of a patient with choroidal neovascularization secondary to CR.

Results:

A 19-year-old young man with a history of blunt trauma presented with acute visual decline of the right eye. He had a systemic history of kidney transplant. His best-corrected visual acuity was 20/200 in the right eye and 20/20 in the left eye at baseline. Funduscopic examination and ultra-widefield fundus autofluorescence imaging revealed a double vertical macular lesion corresponding to a CR in the right eye. Spectral-domain optical coherence tomography, fluorescein angiography, and indocyanine green angiography revealed active Type 2 choroidal neovascularization secondary to the CR. Optical coherence tomography angiography showed a high-flow neovascular network consistent with conventional multimodal imaging. One month after intravitreal injection of ranibizumab, bestcorrected visual acuity was 20/100, optical coherence tomography angiography showed a contraction and remodeling of the neovascular flow, and exudative signs disappeared on multimodal imaging. No side effect was detected.

Conclusion:

Optical coherence tomography angiography is able to detect choroidal neovascularization secondary to CR at baseline and during the follow-up after a single intravitreal injection of ranibizumab. Ranibizumab was effective in the treatment of this sight-threatening lesion in a patient with a history of kidney transplant.
The diagnostic utility of fibrosis-4 or nonalcoholic fatty liver disease fibrosis score combined with liver stiffness measurement by fibroscan in assessment of advanced liver fibrosis: a biopsy-proven nonalcoholic fatty liver disease study
Authors: Jafarov Fuad , Kaya Eda , Bakir Alev , Eren Fatih , Yilmaz Yusuf
Published: October 2019

Background/aim:

The clinical guidelines recommend the use of nonalcoholic fatty liver disease fibrosis score and fibrosis-4 score for estimating the advanced liver fibrosis in nonalcoholic fatty liver disease. However, these scores are used confidently in eliminating advanced fibrosis, rather than detecting it. Therefore, paired combination with liver stiffness measurement by transient elastography is recommended. In this study, we aimed to validate this combined algorithm in our study population.

Methods:

A total of 139 consecutive biopsy-proven nonalcoholic fatty liver disease patients were enrolled in the study. We calculated the noninvasive scores and performed liver stiffness measurement examination for each patient.

Results:

The optimal cutoff of liver stiffness measurement for advanced fibrosis was 11.0 kPa (area under curve: 0.856) with a sensitivity of 84% and a specificity of 78%. Using the fibrosis-4 score (< 1.45 for low risk of advanced fibrosis and > 3.25 for high risk of advanced fibrosis) in combination with the liver stiffness measurement cutoffs revealed the best diagnostic performance (< 8.8 kPa for low risk of advanced fibrosis and > 10.9 kPa for high risk of advanced fibrosis). This paired combination had the positive predictive value of 0.735 at a sensitivity of 89% and the negative predictive value of 0.932 at a specificity of 82%.

Conclusion:

A paired combination of the fibrosis-4 score and liver stiffness measurement (< 8.8 kPa for exclusion of advanced fibrosis and > 10.9 kPa for inclusion of advanced fibrosis) is able to diagnose the patients with advanced fibrosis with the highest diagnostic accuracy.
Family studies of warts, hypogammaglobulinemia, immunodeficiency, myelokathexis syndrome
Authors: Dale David C. , Dick Emily , Kelley Merideth , Makaryan Vahagn , Connelly Jim , Bolyard Audrey Anna
Published: October 2019

Purpose of review

WHIM syndrome (warts, hypogammaglobulinemia, immunodeficiency, myelokathexis, or WHIMs) is a very rare autosomal dominant immunodeficiency disorder attributable to mutations in CXCR4. We reviewed clinical manifestations in 24 patients in 9 families to expand understanding of this syndrome.

Recent findings

Warts, cellulitis and respiratory infections are common in patients with WHIMs. Less commonly these patients have congenital heart disease, human papilloma virus-associated malignancies (cervical and vulvular) and lymphomas. Hearing loss because of recurrent otitis media is another important complication. Treatment with granulocyte colony-stimulating factor is controversial; this review indicates that it is effective to prevent and treat infections based upon long-term observations of patients enrolled in the Severe Chronic Neutropenia International Registry. Understanding the natural history and diversity of this syndrome are important for ongoing clinical trials of novel agents to treat WHIMs.

WHIM syndrome has diverse manifestations; some features occur consistently in almost all patients, for example, neutropenia, lymphocytopenia and mild hypogammaglobulinemia. However, the clinical consequences are quite variable across patient cohorts and within families. Each complication is important as a cause for morbidity and a source for patient and family concerns.
Laryngeal amyloidosis
Authors: Burns Hannah , Phillips Nicholas
Published: October 2019

Purpose of review

Laryngeal amyloidosis is a rare hematological disorder of plasma cells. The cause is still considered idiopathic. The otolaryngology literature predominantly comprises case reports and short series. The present review summarizes the amyloid literature more generally in order to assist the otolaryngologist managing this disorder.

Recent findings

Distinguishing localized amyloidosis from systemic disease continues to be challenging. Both radiological and hematological investigations may assist. Surgery continues to be the predominant modality for treatment, but radiation and potentially medical approaches are on the horizon.

When localized, this benign laryngeal disease carries an excellent prognosis. Clinicians should however be aware of systemic presentations and ensure patients receive long-term follow-up.
Early Obesity
Authors: Cuzmar Valeria , Alberti Gigliola , Uauy Ricardo , Pereira Ana , García Cristián , De Barbieri Florencia , Corvalán Camila , Santos José L. , Mericq Verónica , Villarroel Luis , Gana Juan Cristóbal
Published: October 2019

Nonalcoholic fatty liver disease (NAFLD), defined as fat accumulation greater than 5% in hepatocytes, may progress to fibrosis or cirrhosis later in life. NAFLD prevalence in adolescents has increased significantly in direct relation with obesity prevalence. Fatty liver has become the most frequent indication for liver transplantation in adults.

Objective:

The aim of the study was to identify anthropometric variables during the first 10 years of life associated to the risk of developing NAFLD in adolescence.

Methods:

Longitudinal cohort study 'Growth and Obesity Chilean Cohort Study’ (GOCS) consisting of 513 children born in 2002 to 2003, with yearly anthropometric data collected over a 10‐year period. The presence of intrahepatic fat in the livers of subjects 14 to 16 years of age was determined using abdominal ultrasound. In addition, elastography was performed on all participants with ultrasound evidence of NAFLD.

Results:

9.7% of the participants presented findings compatible with NAFLD. After 2 years of age, obesity significantly and progressively increased the probability of NAFLD occurrence in adolescence. Obesity at 5 years of age was associated with the highest OR for NAFLD, reaching values of 8.91 (95% CI 3.03–16.11). Among participants with NAFLD, those with altered liver elasticity (≥7 kPa) had greater weight, BMI z‐score, waist and hip circumference, and altered liver enzymes (P < 0.05).

Conclusion:

The risk of developing NAFLD in adolescence increases progressively with early obesity starting at age 2 years.
Pregnant African American Women's Perceptions of Neighborhood, Racial Discrimination, and Psychological Distress as Influences on Birth Outcomes
Authors: Dove-Medows Emily , Deriemacker Amanda , Dailey Rhonda , Nolan Timiya S. , Walker Deborah S. , Misra Dawn P. , Kavanaugh Karen , Giurgescu Carmen
Published: October 2019

Background:

African American women are more likely to experience preterm birth compared with White women. Social factors such as neighborhood disorder and experiences of racial discrimination, which disproportionately affect African American women, may partially explain these disparities.

Purpose:

The purpose of this study was to examine pregnant African American women's perceptions of neighborhood disorder, racial discrimination, and psychological distress and whether these concepts were viewed as influences on birth outcomes.

Study Design and Methods:

Using a mixed-methods approach, seven pregnant African American women completed questionnaires including scales for neighborhood disorder (Ross Neighborhood Disorder Scale), racial discrimination (Experiences of Discrimination), and psychological distress (Center for Epidemiological Studies Depression Scale; Psychological General Well-Being Index). All constructs were also assessed by semistructured interviews. Within- and across-case analyses were conducted to compare agreement and discordance between the data sources for each construct and to note patterns in the data.

Results:

The qualitative interviews provided data about women's experiences that were not captured by questionnaires alone. All of the women disclosed concerns about neighborhood conditions, experiences of discrimination, and psychological distress either reported on the questionnaires, during the qualitative interviews, or both. The mixed-methods approach provided a rich source of data that brought into focus the depth of the perceptions around these constructs.

Clinical Implications:

Maternal–child nurses should assess perceptions of neighborhood environment, racial discrimination, and psychological distress, as these factors may increase the risk for adverse pregnancy and birth outcomes.
Unleashing the Power of Nurse Innovators
Authors: Marshall David R.
Published: October 2019

In this month’s Magnet® Perspectives column, guest author Dr David Marshall, JD, DNP, RN, CENP, NEA-BC, FAAN, system chief nursing and patient care services executive at the University of Texas Medical Branch (UTMB), explores nursing’s proud history of innovation and looks at ways we can give nurses the means, opportunity, and motivation to unleash innovation and transformation. Dr Marshall shares details of UTMB’s successful medical makerspace, where nurses and others bring ideas to life.
The Relationship Between Experiential Learning and Nursing Management Competency
Authors: Kuraoka Yumiko
Published: October 2019

OBJECTIVE

This study aimed to examine the relationship between experiential learning and nursing management competency among nurse managers (NMs) in the early years of a supervisory role.

BACKGROUND

The relevance of experiential learning to the development of NMs has been explored in an effort to harvest the knowledge embedded in shared NM practice narratives. However, the relationship between experiential learning and nursing management competency has not been empirically measured.

METHODS

The author developed an experiential learning-based program for NMs in the initial 3 years of a supervisory role. Sixty-three NMs were enrolled. The relationship between experiential learning and nursing management competency was evaluated using multiple regression analysis after completing this program.

RESULTS

The results of multiple regression analysis revealed a significant relationship between experiential learning and nursing management competency (P < .001).

CONCLUSIONS

A significant relationship was identified between experiential learning and nursing management competence.