bluuebunny/crossref_metadata_2025 huggingface dataset:
Determinants of Intercountry Prison Incarceration Rates and Overcrowding in Latin America and the Caribbean
Authors: Limoncelli Katherine E. , Mellow Jeff , Na Chongmin
Published: February 2019

Research on prison population rates and prison overcrowding has largely been limited to U.S. populations. While these studies offer valuable insight into the broader-level factors affecting rates of imprisonment, along with correlates associated with pervasive levels of crowding, less is known about the macro-level causes of elevated imprisonment rates and increasingly high levels of prison crowding across Latin America and the Caribbean. A modified version of negative binomial random-effects model with between- and within-country transformations of time-varying covariates was utilized to test the influence of political, social, and economic factors on the prison population rate between countries and within countries over multiple time points. An ordinary least squares regression model was adopted to analyze the extent to which countries’ levels of political stability, government effectiveness, intentional homicide rates, and unemployment are related to national levels of prison overcrowding percentages. Findings demonstrate that government effectiveness and political stability are significantly and positively associated with increased prison population rates both between countries and within countries over time, while government effectiveness is simultaneously negatively related to prison overcrowding across countries.
New Jersey Home Health Care Aides Survey Results
Authors: Ridenour Marilyn Lou , Hendricks Scott , Hartley Daniel , Blando James D.
Published: February 2019

The objective of the study was to report on what violence-based training home health care aides received, their participation in health promotion classes, and home health care aides’ experience with workplace violence. In 2013, a mail survey was completed by 513 home health care aides in the state of New Jersey. Ninety-four percent of the respondents were female. Respondents whose agency was part of a hospital were more likely to receive violence-based safety training than respondents whose agency was not part of a hospital ( p = .0313). When the perpetrator of violence was a patient or family member, the respondents experienced verbal abuse the most (26%), then physical assault (16%) and exposure to bodily fluids (13%). Home health care aides whose agency was part of a hospital were more likely to receive violence-based safety training. Training is an important component of a workplace violence prevention program.
An Examination of Investigative Practices of Homicide Units in Florida
Authors: Hough Richard , McCorkle Kimberly D. , Harper Sarah
Published: February 2019

The study examined Florida law enforcement agency homicide investigation practices previously identified in the literature as best (or most frequent). Departments handling at least 25 homicides per year and those that handle fewer were surveyed, a comparison not previously examined. The agencies had similar clearance rates. Smaller agencies and those handling fewer homicides tended to use an outside agency for crime scene services, did not have a cold case function, were less likely to use a computerized case management system, and did not view public cooperation as a barrier to homicide investigations to the degree that larger agencies did.
The Value of Anthropometric Measures in Nutrition and Metabolism: Comment on Anthropometrically Predicted Visceral Adipose Tissue and Blood-Based Biomarkers: A Cross-Sectional Analysis
Authors: Brown Justin C , Harhay Michael O , Harhay Meera N
Published: February 2019

Visceral adipose tissue (VAT)—fat stored deep in the abdominal cavity that surrounds vital organs—is associated with a variety of chronic health conditions. Computed tomography and magnetic resonance imaging are the gold standards to quantify VAT. However, the high cost, limited accessibility, and potential exposure to radiation limit the use of these imaging modalities. In this commentary, we review the application of a previously validated regression equation that estimates anthropometrically predicted VAT (apVAT) to explain variance in blood-based biomarkers and predict mortality in a large sample of adults. In our first study (Brown et al. 2018 Eur J Nutr; doi:10.1007/s00394-016-1308-8), apVAT accounted for more variance in biomarkers of glucose homeostasis, inflammation, and lipid metabolism, than body mass index (BMI), waist circumference (WC), or the combination of BMI + WC. In our second study (Brown et al. 2017 Am J Hum Biol; doi:10.1002/ajhb.22898), compared with BMI, WC, and BMI + WC, apVAT more accurately predicted mortality from all causes, cardiovascular disease, and cancer. These studies demonstrate that apVAT can be used in clinical practice and in clinical nutrition and metabolism research when imaging modalities to quantify VAT may not be feasible.
What determines whale watching tourists’ expenditure? A study from Hervey Bay, Australia
Authors: Mitra Jyoti , Wilson Clevo , Managi Shunsuke , Kler Parvinder , Prayaga Prabha , Khanal Uttam
Published: February 2019

In Australia, whale watching has become a popular tourist attraction at a number of sites along the east coast of Australia and contributes significantly to their regional economies. This study assesses the determinants of whale watching tourism expenditure at Hervey Bay located on the Fraser Coast in Queensland. A survey was conducted which derived individual micro-level data from tourists on whale watching tours at Hervey Bay during the months of July to October. Using both linear and quantile regression models, the main determinants of tourism expenditure are revealed. The results show that, in addition to income and origin, tourism expenditure is significantly driven by socio-economic, trip-related and psychographic characteristics.
An Exploration of Collegiate Outdoor Recreation Professionals’ Personality Traits and Job Task Affect
Authors: Turnis Brittany , Jordan Debra
Published: February 2019

The present study investigated the Big Five personality traits of 94 collegiate outdoor recreation (COR) professionals employed within a campus recreation setting and examined those in relation to their job satisfaction. An e-mail with a link to an online survey was sent to 233 campus recreation professional members of the Association of Outdoor Recreation and Education. Using the five-factor model (FFM) of personality, the researchers explored the relationship between personality traits (neuroticism, extroversion, openness, agreeableness, and conscientiousness) and level of affect toward common COR program duties (general office, personnel management, interpersonal, and program-specific). Results indicated that COR professionals ascribed the highest level of affect to personnel management tasks followed by interpersonal, program-specific, and then general office tasks. Extroversion was positively correlated with interpersonal job task affect as were agreeableness and openness to experience. Study results suggest that individuals with a higher rating on extroversion would be well suited to work in a COR setting. Such professionals would be creative problem solvers who work well within a group. The overall scoring patterns found indicate that COR professionals are less interested in typical “desk work” as they prefer the fieldwork and interpersonal/social aspects of the job. As interpersonal skills are vital to success in the COR profession, results suggest that when hiring, employers may wish to focus on those applicant traits. Since the necessary organization and administrative tasks are more easily taught to new hires, those skill sets may be taught on the job. To learn about applicant personality traits, employers may wish to integrate a personality assessment into the typical hiring practices to best match new staff with required job skills.
Challenging Dogma: Optimal Treatment of the “Fight Bite”
Authors: Harper Carl M. , Dowlatshahi Arriyan Samandar , Rozental Tamara D.
Published: February 2019

Background: The optimal treatment of human bites to the dorsal metacarpophalangeal region (ie, “fight bite”) in the absence of gross purulence is controversial. Few studies have compared the outcomes of operative debridement with expectant wound care and oral antibiotics. Methods: We performed a retrospective chart review of all patients evaluated at a Level 1 trauma center over a 10-year period. We compared demographic and clinical characteristics of patients across treatment and outcome groups using the Fisher exact test. Logistic regression models were used to describe the relationships between the outcome and treatment variables. Results: We identified 115 patients with a mean age of 29 years. The mean follow-up was 51.8 days. Seventy-two (63%) patients were treated with antibiotics only. Thirty-two (28%) patients were treated with irrigation in the emergency department (ED) and expectant wound care. Eleven (9%) patients were treated with irrigation and debridement in the operating room. No demographic variables were found to correlate with the treatment selected. A 12% complication rate (major and minor) was observed. After adjusting for duration of follow-up and days to presentation, neither the treatment rendered nor the antibiotics selected influenced the rate of complications. Time to presentation >24 hours was the only variable associated with higher complication rate ( P = .003). Conclusions: Not all fight bites require operative intervention. Irrigation in the ED with expectant wound care and oral antibiotics can be sufficient for patients presenting within 24 hours of injury in the absence of gross purulence.
Transmission of Acceleration From a Synchronous Vibration Exercise Platform to the Head During Dynamic Squats
Authors: Caryn Robert C. , Dickey James P.
Published: February 2019

Many research studies have evaluated the effects of whole-body vibration exercise on muscular strength, standing balance, and bone density, but relatively few reports have evaluated safety issues for vibration exercises. Knee flexion reduces acceleration transmission to the head during static exercise. However, few studies have evaluated dynamic exercises. The purpose of this investigation was to evaluate the transmission of acceleration to the head during dynamic squats. Twelve participants performed dynamic squats (0°-40° of knee flexion) on a synchronous vertical whole-body vibration platform. Platform frequencies from 20 to 50 Hz were tested at a peak-to-peak nominal displacement setting of 1 mm. Transmissibilities from the platform to head varied depending on platform frequency and knee flexion angle. We observed amplification during 20 and 25 Hz platform vibration when knee flexion was <20°. Vibration from exercise platforms can be amplified as it is transmitted through the body to the head during dynamic squats. Similarly, this vibration energy contributes to observed injuries such as retinal detachment. It is recommended that knee flexion angles of at least 20° and vibration frequencies above 30 Hz are used when performing dynamic squat exercises with whole-body vibration.
Decompression of Ludwig’s angina in a pregnant patient under bilateral superficial cervical plexus block
Authors: Rahman Tabishur , Ahmed Syed , Rahman Sajjad
Published: February 2019

Ludwig’s angina is defined as a potentially lethal, rapidly spreading cellulitis, involving the sublingual and submandibular spaces, and is manifested by a brawny suprahyoid induration, tender swelling in the floor of the mouth, and elevation and posterior displacement of the tongue. During a life-threatening infection such as Ludwig’s angina, the mother and foetus are vulnerable to septicemia and asphyxia. We describe a case of decompression of Ludwig’s angina in a 28 weeks pregnant patient under bilateral superficial cervical plexus block. The block, coupled with bilateral mandibular nerve block, provided ample anaesthesia to perform a thorough incision and drainage, including transection of mylohyoid with lowering of the floor of mouth and rapid relief of respiratory obstruction.
Sex determination of Neotropic cormorant (Phalacrocorax brasilianus) by molecular sexing
Authors: Rodrigues Pedro , Campos Elena , Micael Joana , Verdugo Claudio
Published: February 2019

Neotropic cormorant ( Phalacrocorax brasilianus) is a monomorphic species widely distributed along the American Continent. We used a rapid and efficient molecular technique centred on the chromo-helicase-DNA-binding gene in order to differentiate male and female sex chromosomes based on the size of introns. Males presented a Z chromosome with a single band of 664 base pairs, and females presented the same band plus a shortest one corresponding to the W chromosome with 459 base pairs.
Polypoidal choroidal vasculopathy: a comprehensive clinical update
Authors: Kumar Atul , Kumawat Devesh , Sundar M Dheepak , Gagrani Meghal , Gupta Barkha , Roop Prakhyat , Hasan Nasiq , Sharma Anu , Chawla Rohan
Published: February 2019

Polypoidal choroidal vasculopathy as a disease is yet to be comprehended completely. The clinical features consisting of huge serosanguineous retinal pigment epithelial and neurosensory layer detachments, although unique may closely mimick neovascular age-related macular degeneration and other counterparts. The investigative modalities starting from indocyanine angiography to optical coherence tomography angiography provide diagnostic challenges. The management strategies based on the available therapies are plenty and not vivid. A detailed review with clarifying images has been compiled with an aim to help the readers in getting a better understanding of the disease.
Transfusion-related red blood cell alloantibodies: induction and consequences
Authors: Tormey Christopher A. , Hendrickson Jeanne E.
Published: February 2019

Blood transfusion is the most common procedure completed during a given hospitalization in the United States. Although often life-saving, transfusions are not risk-free. One sequela that occurs in a subset of red blood cell (RBC) transfusion recipients is the development of alloantibodies. It is estimated that only 30% of induced RBC alloantibodies are detected, given alloantibody induction and evanescence patterns, missed opportunities for alloantibody detection, and record fragmentation. Alloantibodies may be clinically significant in future transfusion scenarios, potentially resulting in acute or delayed hemolytic transfusion reactions or in difficulty locating compatible RBC units for future transfusion. Alloantibodies can also be clinically significant in future pregnancies, potentially resulting in hemolytic disease of the fetus and newborn. A better understanding of factors that impact RBC alloantibody formation may allow general or targeted preventative strategies to be developed. Animal and human studies suggest that blood donor, blood product, and transfusion recipient variables potentially influence which transfusion recipients will become alloimmunized, with genetic as well as innate/adaptive immune factors also playing a role. At present, judicious transfusion of RBCs is the primary strategy invoked in alloimmunization prevention. Other mitigation strategies include matching RBC antigens of blood donors to those of transfusion recipients or providing immunomodulatory therapies prior to blood product exposure in select recipients with a history of life-threatening alloimmunization. Multidisciplinary collaborations between providers with expertise in transfusion medicine, hematology, oncology, transplantation, obstetrics, and immunology, among other areas, are needed to better understand RBC alloimmunization and refine preventative strategies.
Molecular characterization of immune responses of Helicoverpa armigera to infection with the mermithid nematode Ovomermis sinensis
Authors: Wang Gui-Jie , Zhuo Xiao-Rong , Wang Wen-Wen , Liu Xu-Sheng , Wang Guo-Xiu , Wang Jia-Lin
Published: February 2019

Background

Mermithid nematodes, such as Ovomermis sinensis, display a broad host range including some lepidopteran pests. Infective juveniles penetrate their host through the cuticle, complete their growth within the hemocoel and eventually kill the host upon their emergence. Hence, mermithid nematodes are considered potential biological control agents of insect pests. Our previous data indicate that the infection rate of O. sinensis on cotton bollworm (Helicoverpa armigera) is low, which may be largely due to the strong immune system of the host. However, current knowledge on the interactions of mermithid nematodes with their hosts and the mechanisms employed by hosts to defend themselves against mermithid nematodes is limited.

Results

Here, we investigated the response of H. armigera to O. sinensis infection. Parasitism by O. sinensis caused a sharp decline in the survival rate of H. armigera. The hemocytic phagocytosis ability, antibacterial activity, and phenoloxidase (PO) activity in plasma of H. armigera increased at 1 d post parasitism (dpp) but decreased at 3 dpp. Further, we investigated gene expression in the fat body of parasitized and non-parasitized H. armigera larvae at 1, 3, and 5 dpp using a digital gene expression system. In total, 41, 60 and 68 immune-related differentially expressed genes were identified at 1, 3, and 5 dpp, respectively. These genes encoded pattern recognition receptors (PRRs), antimicrobial peptides (AMPs), serine proteases (SPs), SP inhibitors, mucins and other immune-related proteins. The expression of most PRRs, AMPs, SPs, and mucins was upregulated in the fat body of larvae at 1 dpp, downregulated at 3 dpp, and then again upregulated at 5 dpp by O. sinensis. The increased expression of SP inhibitors may contribute to the inhibited PO activity at 5 dpp.

Conclusions

This study demonstrates that parasitism by O. sinensis modulates the immune reaction of the host H. armigera by altering the expression of immune-related genes. Our data provide a basis for future investigation of the molecular mechanisms employed by the mermithid nematode O. sinensis to modulate the immunity of the host H. armigera. These data will also likely facilitate the improvement of success in parasitism of H. armigera by O. sinensis.
Osteoblasts are “educated” by crosstalk with metastatic breast cancer cells in the bone tumor microenvironment
Authors: Kolb Alexus D. , Shupp Alison B. , Mukhopadhyay Dimpi , Marini Frank C. , Bussard Karen M.
Published: February 2019

Introduction

In a cancer-free environment in the adult, the skeleton continuously undergoes remodeling. Bone-resorbing osteoclasts excavate erosion cavities, and bone-depositing osteoblasts synthesize osteoid matrix that forms new bone, with no net bone gain or loss. When metastatic breast cancer cells invade the bone, this balance is disrupted. Patients with bone metastatic breast cancer frequently suffer from osteolytic bone lesions that elicit severe bone pain and fractures. Bisphosphonate treatments are not curative. Under ideal circumstances, osteoblasts would synthesize new matrix to fill in erosion cavities caused by osteoclasts, but this is not what occurs. Our prior evidence demonstrated that osteoblasts are diverted from laying down bone matrix to producing cytokines that facilitate breast cancer cell maintenance in late-stage disease. Here, we have new evidence to suggest that there are subpopulations of osteoblasts in the tumor niche as evidenced by their protein marker expression that have distinct roles in tumor progression in the bone.

Methods

Tumor-bearing tibia of mice was interrogated by immunofluorescent staining for the presence of osteoblasts and alterations in niche protein expression. De-identified tissue from patients with bone metastatic breast cancer was analyzed for osteoblast subpopulations via multi-plex immunofluorescent staining. Effects of breast cancer cells on osteoblasts were recapitulated in vitro by osteoblast exposure to breast cancer-conditioned medium. Triple-negative and estrogen receptor-positive breast cancer proliferation, cell cycle, and p21 expression were assessed upon contact with “educated” osteoblasts.

Results

A subpopulation of osteoblasts was identified in the bone tumor microenvironment in vivo of both humans and mice with bone metastatic breast cancer that express RUNX2/OCN/OPN but is negative for IL-6 and alpha-smooth muscle actin. These tumor “educated” osteoblasts (EOs) have altered properties compared to “uneducated” osteoblasts and suppress both triple-negative and estrogen receptor-positive breast cancer cell proliferation and increase cancer cell p21 expression. EO effects on breast cancer proliferation were mediated by NOV and decorin. Importantly, the presence of EO cells in the tibia of mice bearing tumors led to increased amounts of alkaline phosphatase and suppressed the expression of inflammatory cytokines in vivo.

Conclusions

Our work reveals that there is a subpopulation of osteoblasts in the bone tumor microenvironment that demonstrate a functional role in retarding breast cancer cell growth.
Evaluation of Two Dosing Regimens for Nivolumab in Combination With Ipilimumab in Patients With Advanced Melanoma: Results From the Phase IIIb/IV CheckMate 511 Trial
Authors: Lebbé Celeste , Meyer Nicolas , Mortier Laurent , Marquez-Rodas Ivan , Robert Caroline , Rutkowski Piotr , Menzies Alexander M. , Eigentler Thomas , Ascierto Paolo A. , Smylie Michael , Schadendorf Dirk , Ajaz Mazhar , Svane Inge Marie , Gonzalez Rene , Rollin Linda , Lord-Bessen Jennifer , Saci Abdel , Grigoryeva Elena , Pigozzo Jacopo
Published: February 2019

PURPOSE

Nivolumab 1 mg/kg plus ipilimumab 3 mg/kg (NIVO1+IPI3) is approved for first-line treatment of patients with advanced melanoma in several countries. We conducted a phase IIIb/IV study (CheckMate 511) to determine if nivolumab 3 mg/kg plus ipilimumab 1 mg/kg (NIVO3+IPI1) improves the safety profile of the combination.

PATIENTS AND METHODS

Patients (N = 360) age 18 years or older with previously untreated, unresectable stage III or IV melanoma were randomly assigned 1:1 to NIVO3+IPI1 or NIVO1+IPI3 once every 3 weeks for four doses. After 6 weeks, all patients received NIVO 480 mg once every 4 weeks until disease progression or unacceptable toxicity. The primary end point was a comparison of the incidence of treatment-related grade 3 to 5 adverse events (AEs) between groups. Secondary end points included descriptive analyses of objective response rate, progression-free survival, and overall survival. The study was not designed to formally demonstrate noninferiority of NIVO3+IPI1 to NIVO1+IPI3 for efficacy end points.

RESULTS

At a minimum follow-up of 12 months, incidence of treatment-related grade 3 to 5 AEs was 34% with NIVO3+IPI1 versus 48% with NIVO1+IPI3 ( P = .006). In descriptive analyses, objective response rate was 45.6% in the NIVO3+IPI1 group and 50.6% in the NIVO1+IPI3 group, with complete responses in 15.0% and 13.5% of patients, respectively. Median progression-free survival was 9.9 months in the NIVO3+IPI1 group and 8.9 months in the NIVO1+IPI3 group. Median overall survival was not reached in either group.

CONCLUSION

The CheckMate 511 study met its primary end point, demonstrating a significantly lower incidence of treatment-related grade 3-5 AEs with NIVO3+IPI1 versus NIVO1+IPI3. Descriptive analyses showed that there were no meaningful differences between the groups for any efficacy end point, although longer follow up may help to better characterize efficacy outcomes.
Clinical Use of Epidermal Growth Factor Receptor Testing in Patients With Advanced Lung Cancer by Physicians: Survey of US and International Patterns
Authors: Peters Matthew , Kim Edward S. , Hirsch Vera
Published: February 2019

PURPOSE

Guidelines recommend testing for EGFR mutation at diagnosis of advanced non–small-cell lung cancer to guide treatment. Two surveys, 18 months apart, aimed to identify changes in EGFR mutation testing and treatment practices in non–small-cell lung cancer.

METHODS

The first survey of 562 physicians from Canada, France, Germany, Italy, Japan, South Korea, Spain, Taiwan, the United Kingdom, and the United States was conducted between December 2014 and January 2015. The second, between July and August 2016, surveyed 707 physicians in the same countries with the addition of China; China was excluded from year-on-year comparisons.

RESULTS

Globally (excluding China), physicians requested EGFR mutation testing in 80% (excluding China; 2015: 81%) of patients before first-line therapy. In 2016, 18% of results were not received before initiating treatment, a significant improvement over 2015 (23%). Reasons for not testing included tumor histology, insufficient tissue, poor performance status, and long turnaround time, although this had significantly improved in 2016 from 2015. Prolonging of survival/extending life was deemed the most important therapy goal in first-line treatment of both cohorts.

CONCLUSION

Improvements in availability of test results before first-line therapy were seen, but incomplete implementation of guidelines is still observed, resulting in a large proportion of patients not receiving tyrosine kinase inhibitor treatment on the basis of mutation status. The reasons for not testing remained the same, year-on-year: tumor histology, insufficient tissue, poor performance status, and long test turnaround time. Receiving timely results must be addressed, if treatment parity for eligible patients can be achieved. Physician education and closer guideline concordance are key steps to improve outcomes.
Kwisin in Chosŏn Literati Writings: Multilayered Recognition, Cultural Sensibility, and Imagination
Authors: Choe Keysook
Published: February 2019

This paper investigates Confucian literati’s multilayered recognition of kwisin in the Chosŏn dynasty by focusing on three distinct genres: philosophical writings, ritual writings, and fictionalized writings. Multifaceted concepts of kwisin in these three genres are analyzed through interpretive lenses such as philosophical thought, cultural sensibilities, and literary imagination. In the context of philosophy, Chosŏn literati developed the traditional concept of kwisin as spiritual beings in accordance with the Confucian paradigms. In the context of empirical cultural fields, however, sadaebu collected fantastic stories as contemporary cultural research with the aim of publishing encyclopedic collections. In such works, Chosŏn intelligentsia exhibited a dual position: one criticizing the worship of kwisin by the lower classes, the other recognizing such as a cultural tradition. Although literati criticized fictional stories containing ghosts, they penned their own versions with female apparitions, maintaining their patriarchal Confucian ideology by “otherizing” these ghosts of unclear familial lineage. Fictional narratives in which kwisin appeared fostered communication across ideology, folk knowledge, and experiential sensibility and embraced the metaphysical recognition and everyday sense of kwisin. Gendered kwisin stories played the cultural roles of criticizing and reflecting social paradox and received a wide range of social sympathy, from the elite class to commoners.
Transcriptomic analyses highlight the likely metabolic consequences of colonization of a cnidarian host by native or non-native Symbiodinium species
Authors: Lin Mei-Fang , Takahashi Shunichi , Forêt Sylvain , Davy Simon K. , Miller David J.
Published: February 2019

Reef-building corals and some other cnidarians form symbiotic relationships with members of the dinoflagellates family Symbiodinaceae. As Symbiodinaceae is a highly diverse taxon, the physiological interactions between its members and their hosts are assumed to differ between associations. The presence of different symbiont types is known to affect expression levels of specific host genes, but knowledge of the effects on the transcriptome more broadly remains limited. In the present study transcriptome profiling was conducted on the tropical corallimorpharian, Ricordea yuma, following the establishment of symbiosis with either the “homologous” symbiont Symbiodinium goreaui (also known as Cladocopium goreaui; ITS2 type C1) or “heterologous” symbionts (predominantly S. trenchii , which is also known as Durusdinium trenchii; ITS2 type D1a) isolated from a different corallimorpharian host (Rhodactis indosinensis). Transcriptomic analyses showed that genes encoding host glycogen biosynthesis pathway components are more highly induced during colonization by the homologous symbiont than by the heterologous symbiont. Similar patterns were also observed for several other genes thought to facilitate symbiotic nutrient exchange, including those involved in lipid translocation / storage and metabolite transport. The gene expression results presented here imply that colonization by homologous or heterologous Symbiodinium types may have very different metabolic consequences for the Ricordea host, supporting the notion that even though some cnidarians may be able to form novel symbioses after bleaching, the metabolic performance of these may be compromised.
TheToxoplasma gondiidense granule protein TgGRA3 interacts with host Golgi and dysregulates anterograde transport
Authors: Deffieu Maika S. , Alayi Tchilabalo Dilezitoko , Slomianny Christian , Tomavo Stanislas
Published: February 2019

After entry into the host cell, the intracellular parasite Toxoplasma gondii resides within a membrane-bound compartment, the parasitophorous vacuole (PV). The PV defines an intracellular, parasite-specific niche surrounded by host organelles, including the Golgi apparatus. The mechanism by which T. gondii hijacks the host Golgi and subverts its functions remains unknown. Here, we present evidence that the dense granule protein TgGRA3 interacts with host Golgi, leading to formation of tubules and entry of host Golgi material into the PV. Targeted disruption of the TgGRA3 gene delays this engulfment of host Golgi. We also demonstrate that TgGRA3 oligomerizes and binds directly to host Golgi membranes. In addition, we show that TgGRA3 dysregulates anterograde transport in the host cell, thereby revealing one of mechanisms employed by T. gondii to recruit host organelles and divert their functions.
Leishmania amazonensis hijacks host cell lysosomes involved in plasma membrane repair to induce invasion in fibroblasts
Authors: Cavalcante-Costa Victor Soares , Costa-Reginaldo Mariana , Queiroz-Oliveira Thamires , Oliveira Anny C. S. , Couto Natália Fernanda , dos Anjos Danielle Oliveira , Lima-Santos Jane , Andrade Luciana Oliveira , Horta Maria Fátima , Castro-Gomes Thiago
Published: February 2019

Intracellular parasites of the genus Leishmania are the causative agents of leishmaniasis. The disease is transmitted by the bite of a sand fly vector, which inoculates the parasite into the skin of mammalian hosts, including humans. During chronic infection the parasite lives and replicates inside phagocytic cells, notably the macrophages. An interesting, but overlooked finding, is that other cell types and even non-phagocytic cells have been found to be infected by Leishmania spp. Nevertheless, the mechanisms by which Leishmania invades such cells had not been previously studied. Here, we show that L. amazonensis can induce their own entry into fibroblasts independently of actin cytoskeleton activity, and, thus, through a mechanism that is distinct from phagocytosis. Invasion involves subversion of host cell functions, such as Ca2+ signaling and recruitment and exocytosis of host cell lysosomes involved in plasma membrane repair.

This article has an associated First Person interview with the first author of the paper.
Reducing Unnecessary Treatment of Asymptomatic Elevated Blood Pressure with Intravenous Medications on the General Internal Medicine Wards: A Quality Improvement Initiative
Authors: Jacobs Zachary G , Najafi Nader , Fang Margaret C , Prasad Priya A , Abe‐Jones Yumiko , Auerbach Andrew D , Patel Sajan
Published: February 2019

BACKGROUND

Asymptomatic elevated blood pressure (BP) is common in the hospital. There is no evidence supporting the use of intravenous (IV) antihypertensives in this setting.

OBJECTIVE

To determine the prevalence and effects of treating asymptomatic elevated BP with IV antihypertensives and to investigate the efficacy of a quality improvement (QI) initiative aimed at reducing utilization of these medications.

DESIGN

Retrospective cohort study.

SETTING

Urban academic hospital.

PATIENTS

Patients admitted to the general medicine service, including the intensive care unit (ICU), with ≥1 episode of asymptomatic elevated BP (>160/90 mm Hg) during hospitalization.

INTERVENTION

A two‐tiered, QI initiative.

MEASUREMENTS

The primary outcome was the monthly proportion of patients with asymptomatic elevated BP treated with IV labetalol or hydralazine. We also analyzed median BP and rates of balancing outcomes (ICU transfers, rapid responses, cardiopulmonary arrests).

RESULTS

We identified 2,306 patients with ≥1 episode of asymptomatic elevated BP during the 10‐month preintervention period, of which 251 (11%) received IV antihypertensives. In the four‐month postintervention period, 70 of 934 (7%) were treated. The odds of being treated were 38% lower in the postintervention period after adjustment for baseline characteristics, including length of stay and illness severity (OR = 0.62; 95% CI 0.47‐0.83; P = .001). Median SBP was similar between pre‐ and postintervention (167 vs 168 mm Hg; P = .78), as were the adjusted proportions of balancing outcomes.

CONCLUSIONS

Hospitalized patients with asymptomatic elevated BP are commonly treated with IV antihypertensives, despite the lack of evidence. A QI initiative was successful at reducing utilization of these medications.
Deimplementation of Routine Chest X‐rays in Adult Intensive Care Units
Authors: Trumbo Silas P , Iams Wade T , Limper Heather M , Goggins Kathryn , Gibson Jayme , Oliver Lauren , Leverenz David L , Samuels Lauren R , Brady Donald W , Kripalani Sunil
Published: February 2019

BACKGROUND

Choosing Wisely® is a national initiative to deimplement or reduce low‐value care. However, there is limited evidence on the effectiveness of strategies to influence ordering patterns.

OBJECTIVE

We aimed to describe the effectiveness of an intervention to reduce daily chest X‐ray (CXR) ordering in two intensive care units (ICUs) and evaluate deimplementation strategies.

DESIGN

We conducted a prospective, nonrandomized study with control data from a historical period. Qualitative evaluation was guided by the Consolidated Framework for Implementation Research.

SETTING

The study was performed in the medical intensive care unit (MICU) and cardiovascular intensive care unit (CVICU) of an academic medical center in the United States from October 2015 to June 2016.

PARTICIPANTS

The initiative included the staff of the MICU and CVICU (physicians, surgeons, nurse practitioners, fellows, residents, medical students, and X‐ray technologists).

INTERVENTION COMPONENTS

We utilized provider education, peer champions, and weekly data feedback of CXR ordering rates.

MEASUREMENTS

We analyzed the CXR ordering rates and factors facilitating or inhibiting deimplementation.

RESULTS

Segmented linear time‐series analysis suggested a small but statistically significant decrease in CXR ordering rates in the CVICU (P < .001) but not in the MICU. Facilitators of deimplementation, which were more prominent in the CVICU, included engagement of peer champions, stable staffing, and regular data feedback. Barriers included the need to establish goal CXR ordering rates, insufficient intervention visibility, and waning investment among medical residents in the MICU due to frequent rotation and competing priorities.

CONCLUSIONS

Intervention modestly reduced CXRs ordered in one of two ICUs evaluated. Understanding why adoption differed between the two units may inform future interventions to deimplement low‐value diagnostic tests.
Improving Patient Flow: Analysis of an Initiative to Improve Early Discharge
Authors: Destino Lauren , Bennett Denise , Wood Matthew , Acuna Christy , Goodman Stephanie , Asch Steven M. , Platchek Terry
Published: February 2019

BACKGROUND

Discharge delays adversely affect hospital bed availability and thus patient flow.

OBJECTIVE

We aimed to increase the percentage of early discharges (EDCs; before 11 am). We hypothesized that obtaining at least 25% EDCs would decrease emergency department (ED) and postanesthesia care unit (PACU) hospital bed wait times.

DESIGN

This study used a pre/postintervention retrospective analysis.

SETTING

All acute care units in a quaternary care academic children's hospital were included in this study.

PATIENTS

The patient sample included all discharges from the acute care units and all hospital admissions from the ED and PACU from January 1, 2014, to December 31, 2016.

INTERVENTION

A multidisciplinary team identified EDC barriers, including poor identification of EDC candidates, accountability issues, and lack of team incentives. A total of three successive interventions were implemented using Plan–Do‐Check‐Act (PDCA) cycles over 10 months between 2015 and 2016 addressing these barriers. Interventions included EDC identification and communication, early rounding on EDCs, and modest incentives.

MEASUREMENTS

Calendar month EDC percentage, ED (from time bed requested to the time patient left ED) and PACU (from time patient ready to leave to time patient left PACU) wait times were measured.

RESULTS

EDCs increased from an average 8.8% before the start of interventions (May 2015) to 15.8% after interventions (February 2016). Using an interrupted time series, both the jump and the slope increase were significant (3.9%, P = .02 and 0.48%, P < .01, respectively). Wait times decreased from a median of 221 to 133 minutes (P < .001) for ED and from 56 to 36 minutes per patient (P = .002) for PACU.

CONCLUSION

A multimodal intervention was associated with more EDCs and decreased PACU and ED bed wait times.
Patient, Caregiver, and Clinician Perspectives on Expectations for Home Healthcare after Discharge: A Qualitative Case Study
Authors: Jones Christine D , Jones Jacqueline , Bowles Kathryn H , Schroeder Shara , Masoudi Frederick A , Coleman Eric A , Falvey Jason , Levy Cari R , Boxer Rebecca S
Published: February 2019

BACKGROUND

Patients discharged from the hospital with skilled home healthcare (HHC) services have multiple comorbidities, high readmission rates, and multiple care needs. In prior work, HHC nurses described that patients often express expectations for services beyond the scope of skilled HHC.

OBJECTIVE

The objective of this study is to evaluate and compare expectations for HHC from the patient, caregiver, and HHC perspectives after hospital discharge.

DESIGN/PARTICIPANTS

This was a descriptive qualitative case study including HHC patients, caregivers, and clinicians. Patients were discharged from an academic medical center between July 2017 and February 2018.

RESULTS

The sample (N = 27) included 11 HHC patients, eight caregivers, and eight HHC clinicians (five nurses and three physical therapists). Patient mean age was 66 years and the majority were female, white, and had Medicare. We observed main themes of clear and unclear expectations for HHC after discharge. Clear expectations occur when the patient and/or caregiver have expectations for HHC aligned with the services received. Unclear expectations occur when the patient and/or caregiver expectations are uncertain or misaligned with the services received. Patients and caregivers with clear expectations for HHC frequently described prior experiences with skilled HHC or work experience within the healthcare field. In most cases with unclear expectations, the patient and caregiver did not have prior experience with HHC.

CONCLUSIONS

To improve HHC transitions, we recommend actively engaging both patients and caregivers in the hospital and HHC settings to provide education about HHC services, and assess and address additional care needs.
Clinical Guideline Highlights for the Hospitalist: The Use of Intravenous Fluids in the Hospitalized Adult
Authors: Gottenborg Emily , Pierce Read
Published: February 2019

GUIDELINE TITLE

Intravenous Fluid Therapy in Adults in Hospital

RELEASE DATE

December, 2013

PRIOR VERSION

Not Applicable

DEVELOPER

Multidisciplinary Guideline Development Group within the United Kingdom's National Clinical Guideline Centre

FUNDING SOURCE

National Institute for Health and Care Excellence

TARGET POPULATION

Hospitalized adult patients
Initiatives and evaluations: the life of a lymphoedema researcher
Authors: Humphreys Ioan
Published: February 2019

Ioan Humphreys, Research Assistant, College of Human and Health Sciences, Swansea University ( i.humphreys@swansea.ac.uk ), describes his involvement in evaluating some exciting initiatives to improve care
Limitations of track and trigger systems and the National Early Warning Score. Part 3: cultural and behavioural factors
Authors: Grant Steven
Published: February 2019

This article discusses the evidence in relation to preventable deaths and a reported culture of suboptimal care. It warns of the dangers of over-relying on track and trigger systems (TTS) in place of clinical judgement. The article explores cultural and behavioural factors, the effects of short staffing and inappropriate skill mix, which all increase the risk of human error. It emphasises a key message that registered nurses must reflect on the need to change their individual and team approaches to the recognition and assessment of the deteriorating patient.
Control of a multidrug-resistant Acinetobacter baumannii outbreak
Authors: Warde Elizabeth , Davies Emma , Ward Andrew
Published: February 2019

This article describes the management of an outbreak of multidrug-resistant Acinetobacter baumannii (MDR-Ab) at an acute NHS Foundation Trust. The outbreak affected two respiratory wards and the initial outbreak lasted 9 months, with the first patient (index case) being identified in April 2015 and the final, tenth case, in September 2015. The outbreak was declared closed in January 2016, but a further two cases were identified in July and August 2016. Of the 12 identified patients, eight were colonised with the bacterium and four were infected. The four infections were of the respiratory tract with MDR-Ab, of identical variable number tandem repeat, isolated from sputum in all cases. All 12 patients were decolonised and this continued throughout the outbreak. Some negative rescreening results were achieved. At the time of the outbreak, decolonisation using octenidine had not been reported in any guidelines. The sensitivity of MDR-Ab to octenidine was microbiologically tested and antibacterial action of octenidine against this organism was demonstrated. The use of octenidine appeared to be one element in helping to control this testing situation. This report seeks to demonstrate not only the complexity of managing and containing an outbreak of MDR-Ab but also how, with the use of a range of effective infection prevention measures, the spread of this pathogen can be successfully controlled. It is hoped that this article will increase awareness among healthcare providers and infection prevention and control (IPC) teams of the threat posed by this organism in the healthcare environment.
Government plans to reduce death by suicide in England
Authors: Glasper Alan
Published: February 2019

Emeritus Professor Alan Glasper, from the University of Southampton, discusses a new cross-government initiative to reduce the incidence of suicide in the country
Avoiding hospital readmission of a person with dementia
Authors: Mendes Aysha
Published: February 2019

People with dementia can be confused or distressed by hospital admission, which can then impact on their physical health. Aysha Mendes considers ways to reduce distress and enhance wellbeing
Preparing nursing professionals fit for the evolving healthcare landscape
Authors: Hill Barry
Published: February 2019

The revised Nursing and Midwifery Council education curriculum, which came into force in January, has the potential to revolutionise nursing, says Barry Hill, Senior Lecturer, Northumbria University ( barry.hill@northumbria.ac.uk )
Not just needles: alternative approaches to skin rejuvenation
Authors: Kunde Olivia
Published: February 2019

Dermal fillers and botulinum toxin A are among the most popular skin rejuvenation treatments worldwide, and it is therefore understandable that many aesthetic practitioners choose to focus their attention on providing these treatments. However, there are several other options when it comes to rejuvenating the skin that are sometimes overlooked. In this article, Olivia Kunde explores some of these alternative approaches to skin rejuvenation, and explains why these treatments are an asset to an aesthetic practitioner's armamentarium
Establishing a miscrosclerotherapy practice: the questions you've never asked
Authors: Furber Hilary
Published: February 2019

In this article, nurse prescriber Emma Davies shares her expertise in establishing and growing a miscrosclerotherapy practice within a nurse-led aesthetic clinic
Are you franchise wise?
Authors: Hool Claire
Published: February 2019

If you have always wanted to open your own aesthetic clinic, but are put off by today's uncertain economic times, then joining a franchise could well be the answer for you. In this article, Claire Hool draws on her own experiences in the industry and discusses the advantages and disadvantages of franchising in medical aesthetics
The secret to achieving great referral rates: five-star service
Authors: Singh Harry
Published: February 2019

Useful as they may be in acquiring new patients for your clinic, marketing campaigns can be expensive and time consuming. Ultimately, the ideal scenario for most aesthetic practitioners would be a system whereby satisfied patients recommend you to their friends. In this article, Harry Singh explores the key to increasing your referral rates, by giving your patients something to tell their friends about
The productivity issue: how to get more done in less time
Authors: Ratcliffe Jason
Published: February 2019

Although habits can be a good thing, they can also destroy our attention span and lead to procrastination, expanding the time taken to complete a given task. In this article, Jason Ratcliffe looks at some of the common triggers for procrastination and time-wasting, and provides some techniques that can be used to help you focus more on your brand
Radiofrequency technologies: applications for body contouring
Authors: Glancey Lucy
Published: February 2019

Many patients seek help with body contouring, and in recent years, several non-invasive methods of contouring the body have emerged. These techniques are popular with patients due to their reduced downtime and risks. One such technique is radiofrequency. This article will explore how body sculpting using radiofrequency works, available techniques, outcomes and safety and training
Laser lipolysis: evolution of a non-invasive procedure
Authors: Freeman Donna
Published: February 2019

Despite eating healthily and exercising regularly, many patients present to the clinic with stubborn pockets of fat that they are unable to eradicate. One of the procedures that has been developed to tackle such issues in a minimally-invasive way is laser lipolysis. In this comment piece, Donna Freeman outlines the development and evolution of this procedure
High intensity focused ultrasound (HIFU) technology for body contouring
Authors: Karkhi Alexandru
Published: February 2019

Non-invasive body contouring is an area of aesthetic medicine that is becoming increasingly sought after. In this article, Alexandru Karkhi and Rumi Kisyova explore high intensity focused ultrasound (HIFU) technology and its application in body contouring treatments
Mapping the way: non-invasive body contouring treatments and aftercare
Authors: Dutta Ashish
Published: February 2019

Non-invasive body contouring solutions can achieve patients' body ideals without the downtime and risks associated with traditional methods of fat reduction. In this article, Dr Ashish Dutta provides a summary of the types of treatment available, the duties of the healthcare professional, and aftercare requirements