bluuebunny/crossref_metadata_2025 huggingface dataset:
Theory spectra and classes of theories
Authors: Andrews Uri , Cai Mingzhong , Diamondstone David , Lempp Steffen , Miller Joseph
Published: August 2016

We analyze the spectra of theories that are

ω
\omega

-stable, theories whose spectra include almost every degree, and theories with uniformly arithmetical

n
n

-quantifier fragments. We answer a question from Andrews and Miller (2015) by showing that there are

ω
\omega

-stable theories whose spectra are not structure spectra. We show that the spectrum created by Andrews and Knight (2013) is not the spectrum of an

ω
\omega

-stable theory, but is the minimal spectrum of any theory with uniformly arithmetical

n
n

-quantifier fragments. In addition, we give examples of theory spectra that contain almost every degree, including ones that are known not to be structure spectra.
Elevated mitochondria-coupled NAD(P)H in endoplasmic reticulum of dopamine neurons
Authors: Tucker Kristal R. , Cavolo Samantha L. , Levitan Edwin S.
Published: August 2016

Pyridine nucleotides are redox coenzymes that are critical in bioenergetics, metabolism, and neurodegeneration. Here we use brain slice multiphoton microscopy to show that substantia nigra dopamine neurons, which are sensitive to stress in mitochondria and the endoplasmic reticulum (ER), display elevated combined NADH and NADPH (i.e., NAD(P)H) autofluorescence. Despite limited mitochondrial mass, organellar NAD(P)H is extensive because much of the signal is derived from the ER. Remarkably, even though pyridine nucleotides cannot cross mitochondrial and ER membranes, inhibiting mitochondrial function with an uncoupler or interrupting the electron transport chain with cyanide (CN−) alters ER NAD(P)H. The ER CN− response can occur without a change in nuclear NAD(P)H, raising the possibility of redox shuttling via the cytoplasm locally between neuronal mitochondria and the ER. We propose that coregulation of NAD(P)H in dopamine neuron mitochondria and ER coordinates cell redox stress signaling by the two organelles.
Timing of growth zone formations in otoliths of the snapper, Chrysophrys auratus, in subtropical and temperate waters differ and growth follows a parabolic relationship with latitude
Authors: Wakefield Corey B. , Potter Ian C. , Hall Norman G. , Lenanton Rodney C. J. , Hesp Sybrand A.
Published: August 2016

Chrysophrys auratus was collected from one sub-tropical and two temperate regions spanning >2400 km along the coast of Western Australia (∼23.5–35.5° S). Marginal increment analysis demonstrated that, while a single opaque zone is formed in the otoliths of C. auratus each year, the period of deposition varies among regions. An opaque zone was formed in May to early September in the sub-tropical upper west coast, and thus when water temperatures were declining to their minima. In contrast, opaque zone formation occurred 3 months later in August to December in the temperate lower west and south coasts, when water temperatures were rising from their minima. The length and age distributions differed markedly among populations of C. auratus, with the strongest year classes varying among the three regions. Thus, it is likely that year class strength of C. auratus throughout its distribution along the coast of Western Australian is mostly related to local environmental conditions. Chrysophrys auratus grew far less rapidly and attained a smaller size in the warmer upper west coast than in the cooler temperate regions of the lower west and south coasts. A collation of data on C. auratus from ten populations in Australia and three in New Zealand showed that growth is greatest towards the mid-latitudes of its geographic range, i.e. at ∼31° S. Estimates of mean lengths at specified ages thus exhibit a parabolic relationship with latitude, with reduced growth (i.e. edge-of-range effects) occurring towards the latitudinal margins of the distribution of this sparid.
Ecosystem indicators—accounting for variability in species’ trophic levels
Authors: Reed Jodie , Shannon Lynne , Velez Laure , Akoglu Ekin , Bundy Alida , Coll Marta , Fu Caihong , Fulton Elizabeth A. , Grüss Arnaud , Halouani Ghassen , Heymans Johanna J. , Houle Jennifer E. , John Emma , Le Loc'h François , Salihoglu Baris , Verley Philippe , Shin Yunne-Jai
Published: August 2016

Trophic level (TL)-based indicators are commonly used to track the ecosystem effects of fishing as the selective removal of organisms from the food web may result in changes to the trophic structure of marine ecosystems. The use of a fixed TL per species in the calculation of TL-based indicators has been questioned, given that species’ TLs vary with ontogeny, as well as over time and space. We conducted a model-based assessment of the performance of fixed TL-based indicators vs. variable TL-based indicators for tracking the effects of fishing pressure. This assessment considered three TL-based indicators (the trophic level of the landed catch (TLc), the marine trophic index (MTI) and the trophic level of the surveyed community (TLsc)), three fishing scenarios that targeted specific model groups (the low TL scenario (LTL), the high TL scenario (HTL) and a scenario encompassing broad-scale exploitation (ALL)) and ten contrasting marine ecosystems with four types of ecosystem modelling approaches that differ in their structure and assumptions. Results showed that, overall, variable TL-based indicators have a greater capacity for detecting the effects of fishing pressure than fixed TL-based indicators. Across TL-based indicators, TLsc displayed the most consistent response to fishing whether fixed or variable species' TLs were used, as well as the highest capacity for detecting fishing effects. This result supports previous studies that promote the use of survey-based indicators over catch-based indicators to explore the impacts of fishing on the structure of marine ecosystems. Across fishing scenarios, the low trophic level fishing scenario (LTL) resulted in the lowest consistency between fixed and variable TL-based indicator responses and the lowest capacity of TL-based indicators for detecting fishing effects. Overall, our results speak to the need for caution when interpreting TL-based indicator trends, and knowledge of the broader context, such as fishing strategies and exploitation history.
The riceYABBY4gene regulates plant growth and development through modulating the gibberellin pathway
Authors: Yang Chao , Ma Yamei , Li Jianxiong
Published: August 2016

YABBY genes encode seed plant-specific transcription factors that play pivotal roles in diverse aspects of leaf, shoot, and flower development. Members of the YABBY gene family are primarily expressed in lateral organs in a polar manner and function to specify abaxial cell fate in dicotyledons, but this polar expression is not conserved in monocotyledons. The function of YABBY genes is therefore not well understood in monocotyledons. Here we show that overexpression of the rice ( Oryza sativa L.) YABBY4 gene ( OsYABBY4 ) leads to a semi-dwarf phenotype, abnormal development in the uppermost internode, an increased number of floral organs, and insensitivity to gibberellin (GA) treatment. We report on an important role for OsYABBY4 in negative control of the expression of a GA biosynthetic gene by binding to the promoter region of the gibberellin 20-oxidase 2 gene ( GA20ox2 ), which is a direct target of SLR1 (the sole DELLA protein negatively controlling GA responses in rice). OsYABBY4 also suppresses the expression level of SLR1 and interacts with SLR1 protein. The interaction inhibits GA-dependent degradation of SLR1 and therefore leads to GA insensitivity. These data together suggest that OsYABBY4 serves as a DNA-binding intermediate protein for SLR1 and is associated with the GA signaling pathway regulating gene expression during plant growth and development.
Linking fluid and kinetic scales in solar wind turbulence
Authors: Telloni Daniele , Bruno Roberto
Published: August 2016

We investigate possible links between the large-scale and small-scale features of solar wind fluctuations across the frequency break separating fluid and kinetic regimes. The aim is to correlate the magnetic field fluctuations polarization at dissipative scales with the particular state of turbulence within the inertial range of fluctuations. We found clear correlations between each type of polarization within the kinetic regime and fluid parameters within the inertial range. Moreover, for the first time in literature, we showed that left-handed and right-handed polarized fluctuations occupy different areas of the plasma instabilities–temperature anisotropy plot, as expected for Alfvén ion cyclotron and kinetic Alfvén waves, respectively.
Do sound waves transport the AGN energy in the Perseus cluster?
Authors: Fabian A. C. , Walker S. A. , Russell H. R. , Pinto C. , Sanders J. S. , Reynolds C. S.
Published: August 2016

The level of random motions in the intracluster gas lying between 20 and 60 kpc radius in the core of the Perseus cluster has been measured by the Hitomi Soft X-ray Spectrometer (SXS) at 164 ± 10 km s−1. The maximum energy density in turbulent motions on that scale is therefore low. If dissipated as heat, the turbulent energy will be radiated away in less than 80 Myr and cannot spread across the core. A higher velocity is needed to prevent a cooling collapse. Gravity waves are shown to travel too slowly in a radial direction. Here we investigate propagation of energy by sound waves. The energy travels at ∼ 1000 km s−1 and can cross the core in a cooling time. We show that the displacement velocity amplitude of the gas required to carry the power is consistent with the Hitomi result and that the inferred density and temperature variations are consistent with Chandra observations.
CD4 Variability in Malawi: Implications for Use of a CD4 Threshold of 500 Cells/mm3 Versus Universal Eligibility for Antiretroviral Therapy
Authors: Schooley Alan L. , Kamudumuli Pocha Samuel , Vangala Sitaram , Tseng Chi-hong , Soko Chifundo , Parent Julie , Phiri Khumbo , Jahn Andreas , Namarika Dan , Hoffman Risa M.
Published: August 2016

Background.  Given the uncertainty about the ability of a single CD4 count to accurately classify a patient as antiretroviral therapy (ART) eligible, we sought to understand the extent to which CD4 variability results in misclassification at a CD4 threshold of 500 cells/mm3.

Methods.  We performed a prospective study of CD4 variability in Malawian human immunodeficiency virus-infected, ART-naive, World Health Organization (WHO) stage 1 or 2, nonpregnant adults. CD4 counts were performed daily for 8 days. We fit a Bayesian linear mixed-effects model of log-transformed CD4 cell counts to the data. We used Monte Carlo approximations to estimate misclassification rates for different observed values of CD4. The misclassification rate was calculated based on the conditional probability of true CD4 given the geometric mean of observed CD4 measurements.

Results.  Fifty patients were enrolled from 2 sites. The median age was 33.5 years (interquartile range, 27.5–40.0) and 34 (68%) were female. Misclassification rates were <1% when the observed CD4 counts were ≤250 or ≥750 cells/mm3. Rates of misclassification were high at observed CD4 counts between 350 and 650 cells/mm3, particularly when a single measurement was used (up to 46.7%).

Conclusions.  Our data show that ART eligibility based on a single CD4 count results in highest risk of misclassification when observed CD4 counts are in the range of 350–650 cells/mm3. Given the benefits of early ART, countries should weigh the costs and complexity of CD4 testing using a 500 cell/mm3 threshold against the cost savings and public health benefits of universal eligibility.
Risk Factors for Influenza A(H7N9) Disease in China, a Matched Case Control Study, October 2014 to April 2015
Authors: Zhou Lei , Ren Ruiqi , Ou Jianming , Kang Min , Wang Xiaoxiao , Havers Fiona , Huo Xiang , Liu Xiaoqing , Sun Qianlai , He Yongchao , Liu Bo , Wu Shenggen , Wang Yali , Sui Haitian , Zhang Yongjie , Tang Shaopei , Chang Caiyun , Xiang Lunhui , Wang Dong , Zhao Shiguang , Zhou Suizan , Chen Tao , Xiang Nijuan , Greene Carolyn M. , Zhang Yanping , Shu Yuelong , Feng Zijian , Li Qun
Published: August 2016

Background.  Human infections with avian influenza A(H7N9) virus have been associated with exposure to poultry and live poultry markets (LPMs). We conducted a case-control study to identify additional and more specific risk factors.

Methods.  Cases were laboratory-confirmed A(H7N9) infections in persons in China reported from October 1, 2014 to April 30, 2015. Poultry workers, those with insufficient data, and those refusing participation were excluded. We matched up to 4 controls per case by sex, age, and residential community. Using conditional logistic regression, we examined associations between A(H7N9) infection and potential risk factors.

Results.  Eighty-five cases and 334 controls were enrolled with similar demographic characteristics. Increased risk of A(H7N9) infection was associated with the following: visiting LPMs (adjusted odds ratio [aOR], 6.3; 95% confidence interval [CI], 2.6–15.3), direct contact with live poultry in LPMs (aOR, 4.1; 95% CI, 1.1–15.6), stopping at a live poultry stall when visiting LPMs (aOR, 2.7; 95% CI, 1.1–6.9), raising backyard poultry at home (aOR, 7.7; 95% CI, 2.0–30.5), direct contact with backyard poultry (aOR, 4.9; 95% CI, 1.1–22.1), and having ≥1 chronic disease (aOR, 3.1; 95% CI, 1.5–6.5).

Conclusions.  Our study identified raising backyard poultry at home as a risk factor for illness with A(H7N9), suggesting the need for enhanced avian influenza surveillance in rural areas.
Continued Sensitivity of Plasmodium falciparum to Artemisinin in Guyana, With Absence of Kelch Propeller Domain Mutant Alleles
Authors: Rahman Reyaud , Martin Maria Jesus Sanchez , Persaud Shamdeo , Ceron Nicolas , Kellman Dwayne , Musset Lise , Carter Keith H. , Ringwald Pascal
Published: August 2016

Because of concerns about possible emergence of artemisinin resistance strains of Plasmodium falciparum in mining areas of the interior of Guyana, a 7-day artesunate trial was conducted from March to December 2014. The day-3 parasite clearance rate, the efficacy of artesunate at day 28, and polymorphism of Kelch 13 (PfK13)—the marker of artemisinin resistance—were assessed. The study confirmed the continued sensitivity of P falciparum to artemisinin. A 7-day course of artesunate was 100% efficacious with only 2% (95% confidence interval, .1%–10.9%) of enrolled subjects positive at day 3. All day-0 parasite samples were wild type. Continued resistance monitoring is nevertheless recommended, given the widespread availability and uncontrolled use of artemisinin drugs in mining areas of Guyana.
Influenza Virus Detection Following Administration of Live-Attenuated Intranasal Influenza Vaccine in Children With Cystic Fibrosis and Their Healthy Siblings
Authors: Boikos Constantina , Joseph Lawrence , Martineau Christine , Papenburg Jesse , Scheifele David , Lands Larry C. , De Serres Gaston , Chilvers Mark , Quach Caroline
Published: August 2016

Background.  We aimed to explore the detection profile of influenza viruses following live-attenuated intranasal influenza vaccination (LAIV) in children aged 2–19 years with and without cystic fibrosis (CF).

Methods.  Before the 2013–2014 influenza season, flocked nasal swabs were obtained before vaccination and 4 times in the week of follow-up from 76 participants (nCF: 57; nhealthy: 19). Influenza was detected by reverse transcription polymerase chain reaction (RT-PCR) assays. A Bayesian hierarchical logistic regression model was used to estimate the effect of CF status and age on influenza detection.

Results.  Overall, 69% of the study cohort shed influenza RNA during follow-up. The mean duration of RT-PCR detection was 2.09 days (95% credible interval [CrI]: 1.73–2.48). The odds of influenza RNA detection on day 1 following vaccination decreased with age in years (odds ratio [OR]: 0.82 per year; 95% CrI: 0.70–0.95), and subjects with CF had higher odds of influenza RNA detection on day 1 of follow-up (OR: 5.09; 95% CrI: 1.02–29.9).

Conclusion.  Despite the small sample size, our results indicate that LAIV vaccine strains are detectable during the week after LAIV, mainly in younger individuals and vaccinees with CF. It remains unclear whether recommendations for avoiding contact with severely immunocompromised patients should differ for these groups.
Angelman syndrome in an infant boy
Authors: Fitzgerald Marcie , Turner Sara M.
Published: August 2016

This article reviews the case of an infant with Angelman syndrome, a genetic disorder caused by a chromosomal mutation. The patient's mother was concerned about his flat head and preference for turning his head to the right, which led to a referral and eventual correct diagnosis.
An uncommon cause of acute pulmonary edema
Authors: Nepal Santosh , Giri Smith , Bhusal Mohan , Siwakoti Krishmita , Pathak Ranjan
Published: August 2016

Acute cardiogenic pulmonary edema secondary to catecholamine-induced cardiomyopathy is a very uncommon and fatal initial presentation of pheochromocytoma. However, with early clinical suspicion and aggressive management, the condition is reversible. This case report describes a patient who presented with hypertension, dyspnea, and cough with bloody streaks, and who recovered within 48 hours after appropriate treatment.
Colorectal cancer screening
Authors: Dickerson Lisa , Varcak Susan Combs
Published: August 2016

Recommended screening options for colorectal cancer are divided into noninvasive stool-based options, and invasive procedure-based options. Because multiple screening strategies are effective, efforts to reduce deaths from colorectal cancer should focus on maximizing the number of patients who are screened. This article reviews noninvasive stool-based screening options.
Pain Catastrophizing, Mindfulness, and Pain Acceptance
Authors: Elvery Nichola , Jensen Mark P. , Ehde Dawn M. , Day Melissa A.
Published: August 2016

Objectives:

It is not known whether psychosocial chronic pain treatments produce benefits through the unique mechanisms specified by theory. Fundamental to gaining an accurate understanding of this issue is to first determine whether the most widely used process measures assess unique constructs and predict unique variance in pain outcomes. This study examined the associations between the Pain Catastrophizing Scale (PCS), Five-Facet Mindfulness Questionnaire (FFMQ-SF), and the Chronic Pain Acceptance Questionnaire (CPAQ-8), and determined their unique contributions to the prediction of pain intensity, pain interference, and depression.

Methods:

A cross-sectional study was conducted with undergraduate students (N=260) reporting chronic or intermittent pain. Correlations, regression models, and multiple mediation models were performed. Relevant covariates were included.

Results:

The PCS, FFMQ-SF scales, and CPAQ-8 were correlated in mostly expected directions, but not so highly as to indicate redundancy. The PCS significantly predicted pain intensity, interference, and depression. The FFMQ-SF Observing and Describing scales predicted pain intensity; Nonreactivity and Nonjudging significantly predicted interference and depression, respectively. The CPAQ-8 was not a significant predictor in any of the regression models. The PCS was a comparatively stronger mediator than the FFMQ-SF scales in the intensity to interference, and intensity to depression mediation models.

Discussion:

The findings indicate that pain catastrophizing, mindfulness, and pain acceptance are related, but unique constructs. The PCS and select FFMQ-SF scales were uniquely associated with the criterion measures. However, the PCS emerged as the most robust process, highlighting the importance of targeting this cognitive domain in streamlining pain treatments to optimize outcome.
Lateralization of Interaural Level Differences with Multiple Electrode Stimulation in Bilateral Cochlear-Implant Listeners
Authors: Stakhovskaya Olga A. , Goupell Matthew J.
Published: August 2016

Objective:

There is currently no accepted method of mapping bilateral cochlear-implant (BiCI) users to maximize binaural performance, but the current approach of mapping one ear at a time could produce spatial perceptions that are not consistent with a sound’s physical location in space. The goal of this study was to investigate the perceived intracranial lateralization of bilaterally synchronized electrical stimulation with a range of interaural level differences (ILDs) and to determine a method to produce relatively more centered auditory images when provided multielectrode stimulation.

Design:

Using direct stimulation, lateralization curves were measured in nine BiCI listeners using 1000-pulses per second (pps), 500-msec constant-amplitude pulse trains with ILDs that ranged from −20 to +20 clinical current units (CUs). The stimuli were presented bilaterally at 70 to 80% of the dynamic range on single or multiple electrode pairs. For the multielectrode pairs, the ILD was applied consistently across all the pairs. The lateralization response range and the bias magnitude at 0 CU ILD (i.e., the number of CUs needed to produce a centered auditory image) were computed. Then the levels that elicit a centered auditory image with single-electrode stimulation were used with multielectrode stimulation to determine if this produced fewer significant biases at 0 CU ILD. Lastly, a multichannel ILD processing model was used to predict lateralization for the multielectrode stimulation from the single-electrode stimulation.

Results:

BiCI listeners often perceived both single- and multielectrode stimulation at 0-CU ILD as not intracranially centered. For single-electrode stimulation, 44% of the lateralization curves had relatively large (≥5 CU) bias magnitudes. For the multielectrode stimulation, 25% of the lateralization curves had large bias magnitudes. After centering the single-electrode pairs, the percentage of multielectrode combinations that produced large biases significantly decreased to only 4% (p < 0.001, McNemar’s test). The lateralization with multielectrode stimulation was well predicted by a model that used unweighted or weighted average single-electrode lateralization percepts across electrode pairs (87 or 90%, respectively).

Conclusion:

Current BiCI mapping procedures can produce an inconsistent association between a physical ILD and the perceived location across electrodes for both single- and multielectrode stimulation. Explicit centering of single-electrode pairs using the perceived centered intracranial location almost entirely corrects this problem and such an approach is supported by our understanding and model of across-frequency ILD processing. Such adjustments might be achieved by clinicians using single-electrode binaural comparisons. Binaural abilities, like sound localization and understanding speech in noise, may be improved if these across-electrode perceptual inconsistencies are removed.
Comparison Between Minimally Invasive Surgery and Conventional Open Surgery for Patients With Spinal Metastasis
Authors: Hansen-Algenstaedt Nils , Kwan Mun Keong , Algenstaedt Petra , Chiu Chee Kidd , Viezens Lennart , Chan Teik Seng , Lee Chee Kean , Wellbrock Jasmin , Chan Chris Yin Wei , Schaefer Christian
Published: August 2016

Study Design.

Prospective propensity score-matched study.

Objective.

To compare the outcomes of minimal invasive surgery (MIS) and conventional open surgery for spinal metastasis patients.

Summary of Background Data.

There is lack of knowledge on whether MIS is comparable to conventional open surgery in treating spinal metastasis.

Methods.

Patients with spinal metastasis requiring surgery from January 2008 to December 2010 in two spine centers were recruited. The demographic, preoperative, operative, perioperative and postoperative data were collected and analyzed. Thirty MIS patients were matched with 30 open surgery patients using propensity score matching technique with a match tolerance of 0.02 based on the covariate age, tumor type, Tokuhashi score, and Tomita score.

Results.

Both groups had significant improvements in Eastern Cooperative Oncology Group (ECOG), Karnofsky scores, visual analogue scale (VAS) for pain and neurological status postoperatively. However, the difference comparing the MIS and open surgery group was not statistically significant. MIS group had significantly longer instrumented segments (5.5 ± 3.1) compared with open group (3.8 ± 1.7). Open group had significantly longer decompressed segment (1.8 ± 0.8) than MIS group (1.0 ± 1.0). Open group had significantly more blood loss (2062.1 ± 1148.0 mL) compared with MIS group (1156.0 ± 572.3 mL). More patients in the open group (76.7%) needed blood transfusions (with higher average units of blood transfused) compared with MIS group (40.0%). Fluoroscopy time was significantly longer in MIS group (116.1 ± 63.3 s) compared with open group (69.9 ± 42.6 s). Open group required longer hospitalization (21.1 ± 10.8 days) compared with MIS group (11.0 ± 5.0 days).

Conclusion.

This study demonstrated that MIS resulted in comparable outcome to open surgery for patients with spinal metastasis but has the advantage of less blood loss, blood transfusions, and shorter hospital stay.

Level of Evidence:3
Evolving Alignment in International Continuing Professional Development Accreditation
Authors: McMahon Graham T. , Aboulsoud Samar , Gordon Jennifer , McKenna Mindi , Meuser James , Staz Mark , Campbell Craig M.
Published: August 2016

Several of the world's accreditation systems for continuing professional development (CPD) are evolving to encourage continuous improvement in the competence and performance of health care providers and in the organizations in which they provide patient care. Clinicians learn best when they can to choose from a diverse array of activities and formats that are relevant and meet their needs. Since choice and diversity are key to meeting clinicians' needs, several CPD accreditors have been engaging in deliberate, concerted efforts to identify a core set of principles that can serve as the basis for determining substantive equivalency between CPD accreditation systems. Substantive equivalency is intended to support the mobility of learners, allowing them to access accredited learning activities that are recognized by various CPD accreditation systems in a manner that maximizes the value of those accreditation systems, while minimizing the burden of adhering to their requirements. In this article, we propose a set of core principles that all CPD accreditation systems must express as the basis for determining substantive equivalency between CPD accreditation systems. The article will illustrate how five CPD accreditation systems (two in the USA, two in Canada, and one in Qatar), differing in focus (activity-based versus provider-based), context, and culture, express these values and metrics, and concludes by identifying the value of substantive equivalency for learners, medical regulators, and CPD accreditation systems.
Ensuring Competent Care by Senior Physicians
Authors: Hawkins Richard E. , Welcher Catherine M. , Stagg Elliott Victoria , Pieters Richard S. , Puscas Liana , Wick Paul H.
Published: August 2016

The increasing number of senior physicians and calls for increased accountability of the medical profession by the public have led regulators and policymakers to consider implementing age-based competency screening. Some hospitals and health systems have initiated age-based screening, but there is no agreed upon assessment process. Licensing and certifying organizations generally do not require that senior physicians pass additional assessments of health, competency, or quality performance. Studies suggest that physician performance, on average, declines with increasing years in medical practice, but the effect of age on an individual physician's competence is highly variable. Many senior physicians practice effectively and should be allowed to remain in practice as long as quality and safety are not endangered. Stakeholders in the medical profession should consider the need to develop guidelines and methods for monitoring and/or screening to ensure that senior physicians provide safe and effective care for patients. Any screening process needs to achieve a balance between protecting patients from harm due to substandard practice, while at the same time ensuring fairness to physicians and avoiding unnecessary reductions in workforce.
Creation of a Tool for Assessing Knowledge in Evidence-Based Decision-Making in Practicing Health Care Providers
Authors: Spurr Kathy , Dechman Gail , Lackie Kelly , Gilbert Robert
Published: August 2016

Introduction:

Evidence-based decision-making (EBDM) is the process health care providers (HCPs) use to identify and appraise potential evidence. It supports the integration of best research evidence with clinical expertise and patient values into the decision-making process for patient care. Competence in this process is essential to delivery of optimal care. There is no objective tool that assesses EBDM across HCP groups. This research aimed to develop a content valid tool to assess knowledge of the principles of evidence-based medicine and the EBDM process, for use with all HCPs.

Methods:

A Delphi process was used in the creation of the tool. Pilot testing established its content validity with the added benefit of evaluating HCPs' knowledge of EBDM. Descriptive statistics and multivariate mixed models were used to evaluate individual survey responses in total, as well as within each EBDM component.

Results:

The tool consisted of 26 multiple-choice questions. A total of 12,884 HCPs in Nova Scotia were invited to participate in the web-based validation study, yielding 818 (6.3%) participants, 471 of whom completed all questions. The mean overall score was 68%. Knowledge in one component, integration of evidence with clinical expertise and patient preferences, was identified as needing development across all HCPs surveyed.

Discussion:

A content valid tool for assessing HCP EBDM knowledge was created and can be used to support the development of continuing education programs to enhance EBDM competency.
The Health Impacts of Climate Change: A Continuing Medical Education Needs Assessment Framework
Authors: Valois Pierre , Blouin Patrick , Ouellet Claudine , Renaud Jean-Sébastien , Bélanger Diane , Gosselin Pierre
Published: August 2016

Introduction:

As the health consequences of climate change (CC) will likely become more manifest in the future, family physicians have to be knowledgeable about these impacts and the ways in which they can affect their patients. The main aim of this study was to propose a competency framework and questionnaire used to conduct a needs analysis to identify and prioritize family physicians' real educational needs regarding the health impacts of CC.

Methods:

A mixed method combining a qualitative interview and a quantitative online questionnaire was used (n = 24 physicians). The interview assessed key beliefs related to participating in an online continuing medical education (eCME) activity on the health impacts of climate change, and the perception of the key factors or conditions required to ensure the family physicians' satisfaction with this eCME activity. The questionnaire assessed the current and desired levels of competency on five general training themes: general knowledge about CC; heat-related illnesses; CC, extreme weather events and modification of vector-borne and zoonotic diseases; CC, extreme weather events and modification of water-borne diseases; and mental health impacts of natural disasters.

Results:

Results revealed the need for improved medical education on climate change and health. Results also add to the literature by showing that a 3-hour eCME activity covering these topics would be useful and would allow family physicians to use this knowledge in their daily practice, notably through prevention and counseling.

Discussion:

Introducing a CME needs assessment framework and a generic instrument that reflects family physicians' needs regarding the health impacts of CC has the added advantage of standardizing the assessment procedure.
What Do We Need to Protect, at All Costs, During the 21st Century? Reflections From a Curated, Interactive Co-Created Intellectual Jazz Performance
Authors: Jadad Alejandro R. , Davis Dave
Published: August 2016

The question that forms the title of this article, “What do we need to protect, at all costs, during the 21st century?,” speaks to the sizable changes in health care systems and settings that surround the continuing professional development (CPD) provider, and the need to establish a core set of principles and practices as the field moves forward from both theoretical and practical aspects. It also provided the focus for one of the five keynote lectures presented during the 2016 World Congress on Continuing Professional Development. As the planners of this keynote session, we sought to evoke answers to the question, not from the speaker, but from the audience itself, a process enabled by a highly engaging presentation style and powered by interactive digital technologies. Further, we believed that the session would not directly lead to suggestions to improve the theory and practice of CPD, but rather to create the biopsychosocial context—a sort of platform—on which such discussions can occur.
Using Interprofessional Learning for Continuing Education: Development and Evaluation of the Graduate Certificate Program in Health Professional Education for Clinicians
Authors: Henderson Saras , Dalton Megan , Cartmel Jennifer
Published: August 2016

Introduction:

Health professionals may be expert clinicians but do not automatically make effective teachers and need educational development. In response, a team of health academics at an Australian university developed and evaluated the continuing education Graduate Certificate in Health Professional Education Program using an interprofessional learning model.

Methods:

The model was informed by Collins interactional expertise and Knowles adult learning theories. The team collaboratively developed and taught four courses in the program. Blended learning methods such as web-based learning, face-to-face workshops, and online discussion forums were used. Twenty-seven multidisciplinary participants enrolled in the inaugural program. Focus group interview, self-report questionnaires, and teacher observations were used to evaluate the program.

Results:

Online learning motivated participants to learn in a collaborative virtual environment. The workshops conducted in an interprofessional environment promoted knowledge sharing and helped participants to better understand other discipline roles, so they could conduct clinical education within a broader health care team context. Work-integrated assessments supported learning relevance. The teachers, however, observed that some participants struggled because of lack of computer skills.

Discussion:

Although the interprofessional learning model promoted collaboration and flexibility, it is important to note that consideration be given to participants who are not computer literate. We therefore conducted a library and computer literacy workshop in orientation week which helped. An interprofessional learning environment can assist health professionals to operate outside their “traditional silos” leading to a more collaborative approach to the provision of care. Our experience may assist other organizations in developing similar programs.
Observations on the 2016 World Congress on Continuing Professional Development: Advancing Learning and Care in the Health Professions
Authors: Turco Mary G. , Baron Robert B.
Published: August 2016

The 2016 World Congress on Continuing Professional Development: Advancing Learning and Care in the Health Professions took place in San Diego, California, March 17–19, 2016. Hosts were the Association for Hospital Medical Education (AHME), Alliance for Continuing Education in the Health Professionals (ACEhp), and Society for Academic Continuing Medical Education (SACME). The target audience was the international community working to improve medical (CME), nursing (CNE), pharmacy (CPE), and interprofessional (CIPE) continuing education (CE) and continuing professional development (CPD). Goals included: addressing patients' concerns and needs; advancing global medical and interprofessional health sciences education; utilizing learning to address health disparities; and promoting international cooperation. The five keynote speakers were: patient advocate Alicia Cole (“Why What We Do Matters: The Patients Voice”); linguist Lorelei Lingard (“Myths about Healthcare Teamwork and Their Implications for How We Understand Competence”); futurist and philosopher Alex Jadad (“What Do We Need to Protect at All Costs in the 21st Century?”); ethicist and change agent Zeke Emanuel (“Learn to Change: Teaching Toward a Shifting Healthcare Horizon”); and technology innovator Stephen Downes (“From Individual to Community: The Learning Is in the Doing”). Organizers announced the new Dave Davis Distinguished Award for Excellence in Mentorship in Continuing Professional Development to honor the career of David Davis, MD, in CME/CPD scholarship in Canada, the United States, and beyond. Participants valued the emphasis on interprofessional education and practice, the importance of integrating the patient voice, the effectiveness of flipped classroom methods, and the power of collective competency theories. Attendee-respondents encouraged Congress planners to continue to strive for a broad global audience and themes of international interest.
Imaging Approaches for Contact Lens Deposition
Authors: Panthi Shyam , Nichols Jason J.
Published: August 2016

Deposition on contact lenses (CLs) starts quickly after their application to the ocular surface. Deposits may be composed of tear film components or other extraneous substances. These deposits have been related to various adverse conditions of the eye, leading to reduced biocompatibility between the CLs and the ocular surface. Analysis of these deposits is essential to better elucidate the relationship between these deposits and their adverse reactions so that better methods of increasing biocompatibility can be developed. Although methods such as enzymatic assays are available for quantitative analysis, they do not provide a complete picture of the deposition (e.g., lack of morphological details), and therefore, the use of imaging methods that can provide both qualitative and quantitative information about the deposits may be more preferable. Therefore, a search of the peer-reviewed literature that focused on imaging methods in the analysis of deposits on CLs was conducted. Various methods of imaging deposits in-vitro, in-vivo, or ex-vivo have been described along with the associated results. Imaging methods using fluorescence-based techniques and scanning electron microscopy appear to be the most frequently used methods. Some of the described methods not only provided morphologies but also identified the types of various deposits that were attached to the CLs. Various CL materials possessed different deposition morphologies and different quantities of the attached deposits. Further imaging studies performed in conjunction with other methods that could identify and quantify the deposits at a molecular level are recommended.
Brain white matter changes associated with urological chronic pelvic pain syndrome: multisite neuroimaging from a MAPP case–control study
Authors: Huang Lejian , Kutch Jason J. , Ellingson Benjamin M. , Martucci Katherine T. , Harris Richard E. , Clauw Daniel J. , Mackey Sean , Mayer Emeran A. , Schaeffer Anthony J. , Apkarian A. Vania , Farmer Melissa A. ,   on behalf of the MAPP Research Network
Published: August 2016

Clinical phenotyping of urological chronic pelvic pain syndromes (UCPPSs) in men and women have focused on end organ abnormalities to identify putative clinical subtypes. Initial evidence of abnormal brain function and structure in male pelvic pain has necessitated large-scale, multisite investigations into potential UCPPS brain biomarkers. We present the first evidence of regional white matter (axonal) abnormalities in men and women with UCPPS, compared with positive (irritable bowel syndrome, IBS) and healthy controls. Epidemiological and neuroimaging data were collected from participants with UCPPS (n = 52), IBS (n = 39), and healthy sex- and age-matched controls (n = 61). White matter microstructure, measured as fractional anisotropy (FA), was examined by diffusion tensor imaging. Group differences in regional FA positively correlated with pain severity, including segments of the right corticospinal tract and right anterior thalamic radiation. Increased corticospinal FA was specific and sensitive to UCPPS, positively correlated with pain severity, and reflected sensory (not affective) features of pain. Reduced anterior thalamic radiation FA distinguished patients with IBS from those with UCPPS and controls, suggesting greater microstructural divergence from normal tract organization. Findings confirm that regional white matter abnormalities characterize UCPPS and can distinguish between visceral diagnoses, suggesting that regional axonal microstructure is either altered with ongoing pain or predisposes its development.
Survey of herbal cannabis (marijuana) use in rheumatology clinic attenders with a rheumatologist confirmed diagnosis
Authors: Ste-Marie Peter A. , Shir Yoram , Rampakakis Emmanouil , Sampalis John S. , Karellis Angela , Cohen Martin , Starr Michael , Ware Mark A. , Fitzcharles Mary-Ann
Published: August 2016

Cannabinoids may hold potential for the management of rheumatic pain. Arthritis, often self-reported, is commonly cited as the reason for the use of medicinal herbal cannabis (marijuana). We have examined the prevalence of marijuana use among 1000 consecutive rheumatology patients with a rheumatologist-confirmed diagnosis and compared in an exploratory manner the clinical characteristics of medicinal users and nonusers. Current marijuana use, medicinal or recreational, was reported by 38 patients (3.8%; 95% CI: 2.8-5.2). Ever use of marijuana for medical purposes was reported by 4.3% (95% CI: 3.2-5.7), with 28 (2.8%; 95% CI: 1.9-4.0) reporting current medicinal use. Current medicinal users had a spectrum of rheumatic conditions, with over half diagnosed with osteoarthritis. Medicinal users were younger, more likely unemployed or disabled, and reported poorer global health. Pain report and opioid use was greater for users, but they had similar physician global assessment of disease status compared with nonusers. Medicinal users were more likely previous recreational users, with approximately 40% reporting concurrent recreational use. Therefore, less than 3% of rheumatology patients reported current use of medicinal marijuana. This low rate of use in patients with a rheumatologist-confirmed diagnosis is in stark contrast to the high rates of severe arthritis frequently reported by medicinal marijuana users, especially in Canada. Familiarity with marijuana as a recreational product may explain use for some as disease status was similar for both groups.
The Use of the Addiction Severity Index Psychiatric Composite Scores to Predict Psychiatric Inpatient Admissions
Authors: Drymalski Walter M. , Nunley Michael R.
Published: August 2016

The high prevalence of co-occurring mental health and substance use disorders indicates a need for integrated behavioral health treatment that addresses both types of disorder simultaneously. One component of this integrated treatment is the use of an assessment process that can concurrently identify the presence of each class of disorder. The Addiction Severity Index (ASI) has been extensively used and researched in the field of substance use disorders for over 30 years. The ASI has seven sections, including a section on substance use disorders and a section on psychiatric symptoms, making it a potential candidate for a co-occurring screen during intake. The following study utilized a receiver operating characteristic curve analysis to determine an optimal cutoff score on the ASI psychiatric composite score to identify which individuals seeking substance use disorder treatment were admitted to the Milwaukee County Behavioral Health Division’s psychiatric hospital in the year subsequent to their ASI administration. Of the 19,320 individuals who completed an initial ASI in our system, 343 had an inpatient admission. The receiver operating characteristic curve was statistically significant, with an area under the curve of 0.75. A cutoff of 0.27 had a sensitivity of 0.77 and a specificity of 0.61, such that over 60% (11,963/19,320) of the sample was excluded. These results suggest that the ASI psychiatric composite score may be a useful initial screen to identify those with potential mental health problems/needs in a behavioral health system attempting to integrate addiction and mental health services.
Smoking Cessation 1 Year or More
Authors: DiPiazza Jennifer T. , Naegle Madeline
Published: August 2016

There is a paucity of research focused on the experience of maintaining cessation for a year or longer, and recidivism rates for smoking cessation are estimated at 50% to 97%. As cigarette smoking is one of the leading causes of death worldwide, there is a critical need for more knowledge about maintaining smoking cessation. Therefore, this study was undertaken to explore the lived experience of maintaining cigarette smoking cessation for a year or more. Using Streubert’s nurse-developed descriptive phenomenological method, seven adults who sustained cessation for 1.5 to 18 years, after repeated relapses, were interviewed about their experience of sustaining cessation. Data collection included interviews, field notes, and a reflexive journal. Phenomenological analysis involved dwelling intensely with the data, extracting parts of the transcript, and identifying codes and themes, defined by Streubert as essences, common to all participants’ descriptions of the experience of sustained cessation. Through this inductive process, the investigator ascertained relationships among the essences, forming the basis for a formalized, exhaustive description of the experience. Six essences captured participants’ experiences of maintaining cigarette smoking cessation: (a) breaking free, (b) developing an olfactory aversion, (c) reframing, (d) learning through relapse, (e) reclaiming acceptance, and (f) self-transformation. The findings suggest that maintaining cessation for a year or more is shaped by biological, psychological, and social conditions, as reflected in the essences. The essences coalesced to a tipping point of motivation and conditions leading to sustained behavior change, allowing participants to maintain cessation.
Alcohol and Substance Use Disorder Screening, Brief Intervention, and Referral to Treatment Among People Living With HIV/AIDS
Authors: Savage Christine L. , Sanchez Michael
Published: August 2016

Purpose

The purpose of this review is to inform nurses on the prevalence of substance use screening with screening, brief intervention, and referral to treatment; its use in the primary care setting; and its effectiveness on HIV-related risk behaviors to prevent adverse health consequences among people living with HIV/AIDS (PLWH).

Review

For PLWH, identification of at-risk substance use is important because of the association between substance use and HIV infection both in terms of acquiring HIV and in further transmission of HIV.

Conclusion

Alcohol and substance use disorders continue to be a burden for PLWH and are associated with poor health outcomes. Implementation of screening, brief intervention, and referral to treatment in the primary care setting is critical for promoting positive health outcomes in this population and provides an opportunity for nurses to intervene.