bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing Trainee and Staff Perceptions of Patient Safety Culture
Authors: Bump Gregory M. , Coots Nordisha , Liberi Cindy A. , Minnier Tamra E. , Phrampus Paul E. , Gosman Gabriella , Metro David G. , McCausland Julie B. , Buchert Andrew
Published: June 2016

Purpose

The Accreditation Council for Graduate Medical Education implemented the Clinical Learning Environment Review (CLER) program to evaluate and improve the learning environment in teaching hospitals. Hospitals receive a report after a CLER visit with observations about patient safety, among other domains, the accuracy of which is unknown. Thus, the authors set out to identify complementary measures of trainees’ patient safety experience.

Method

In 2014, they administered the Hospital Survey on Patient Safety Culture to residents and fellows and general staff at 10 hospitals in an integrated health system. The survey measured perceptions of patient safety in 12 domains and incorporated two outcome measures (number of medical errors reported and overall patient safety). Domain scores were calculated and compared between trainees and staff.

Results

Of 1,426 trainees, 926 responded (65% response rate). Of 18,815 staff, 12,015 responded (64% response rate). Trainees and staff scored five domains similarly—communication openness, facility management support for patient safety, organizational learning/continuous improvement, teamwork across units, and handoffs/transitions of care. Trainees scored four domains higher than staff—nonpunitive response to error, staffing, supervisor/manager expectations and actions promoting patient safety, and teamwork within units. Trainees scored three domains lower than staff—feedback and communication about error, frequency of event reporting, and overall perceptions of patient safety.

Conclusions

Generally, trainees had comparable to more favorable perceptions of patient safety culture compared with staff. They did identify opportunities for improvement though. Hospitals can use perceptions of patient safety culture to complement CLER visit reports to improve patient safety.
Neonates and Infants Discharged Home Dependent on Medical Technology
Authors: Toly Valerie Boebel , Musil Carol M. , Bieda Amy , Barnett Kimberly , Dowling Donna A. , Sattar Abdus
Published: June 2016

Background:

Preterm neonates and neonates with complex conditions admitted to a neonatal intensive care unit (NICU) may require medical technology (eg, supplemental oxygen, feeding tubes) for their continued survival at hospital discharge. Medical technology introduces another layer of complexity for parents, including specialized education about neonatal assessment and operation of technology. The transition home presents a challenge for parents and has been linked with greater healthcare utilization.

Purpose:

To determine incidence, characteristics, and healthcare utilization outcomes (emergency room visits, rehospitalizations) of technology-dependent neonates and infants following initial discharge from the hospital.

Methods:

This descriptive, correlational study used retrospective medical record review to examine technology-dependent neonates (N = 71) upon discharge home. Study variables included demographic characteristics, hospital length of stay, and type of medical technology used. Analysis of neonates (n = 22) with 1-year postdischarge data was conducted to identify relationships with healthcare utilization. Descriptive and regression analyses were performed.

Findings:

Approximately 40% of the technology-dependent neonates were between 23 and 26 weeks' gestation, with birth weight of less than 1000 g. Technologies used most frequently were supplemental oxygen (66%) and feeding tubes (46.5%). The mean total hospital length of stay for technology-dependent versus nontechnology-dependent neonates was 108.6 and 25.7 days, respectively. Technology-dependent neonates who were female, with a gastrostomy tube, or with longer initial hospital length of stay were at greater risk for rehospitalization.

Implications for Practice:

Assessment and support of families, particularly mothers of technology-dependent neonates following initial hospital discharge, are vital.

Implications for Research:

Longitudinal studies to determine factors affecting long-term outcomes of technology-dependent infants are needed.
Compliance With a Comprehensive Antibiotic Protocol Improves Infection Incidence in Pediatric Spine Surgery
Authors: Vandenberg Curt , Niswander Cameron , Carry Patrick , Bloch Nikki , Pan Zhaoxing , Erickson Mark , Garg Sumeet
Published: June 2016

Background:

A multidisciplinary task force, designated Target Zero, has developed protocols for prevention of surgical site infection (SSI) for spine surgery at our institution. The purpose of this study was to evaluate how compliance with an antibiotic bundle impacts infection incidences in pediatric spine surgery.

Methods:

After institutional review board approval, a consecutive series of 511 patients (517 procedures) who underwent primary spine procedures from 2008 to 2012 were retrospectively reviewed to identify patients who developed SSI. Patients were followed for a minimum of 90 days postoperatively. Compliance data were collected prospectively in 511 consecutive patients and a total of 517 procedures. Three criteria were required for antibiotic bundle compliance: appropriate antibiotics completely administered within 1 hour before incision, antibiotics appropriately redosed intraoperatively for blood loss and time, and antibiotics discontinued within 24 hours postoperatively. A multivariable logistic regression analysis was used to test the association between compliance and the development of an infection.

Results:

Overall antibiotic bundle compliance rate was 85%. After adjusting for risk category, estimated blood loss, and study year, the likelihood of an infection was increased in the noncompliant group compared with the compliant group (adjusted odds ratio: 3.0, 95% CI, 0.96-9.47, P=0.0587). When expressed as the number needed to treat, strict adherence to antibiotic bundle compliance prevented 1 SSI within 90 days of surgery for every 26 patients treated with the antibiotic bundle. Reasons for noncompliance included failure to infuse preoperative antibiotics 1 hour before incision (10.3%), failure to redose antibiotics intraoperatively based on time or blood loss (5.5%), and failure to discontinue antibiotics within 24 hours postoperatively (1.9%).

Conclusions:

Compliance with a comprehensive antibiotic protocol can lead to meaningful reductions in SSI incidences in pediatric spine surgery. Institutions should focus on improving compliance with prophylactic antibiotic protocols to decrease SSI in pediatric spine surgery.

Level of Evidence:

Level III—retrospective cohort study.
Osteochondral Autograft Transfer for Treatment of Metacarpophalangeal and Interphalangeal Cartilage Defects
Authors: Micev Alan J. , Gaspar Michael P. , Culp Randall W.
Published: June 2016

There is no general consensus regarding the optimal surgical treatment for cartilage defects of the metacarpophalangeal and interphalangeal joints in active patients who wish to preserve motion and functionality. We describe our technique of arthroscopically harvested femoral osteochondral autograft for treatment of metacarpophalangeal and interphalangeal cartilage defects.
Retrospective Analysis of Cisplatin Nephrotoxicity in Patients With Head and Neck Cancer Receiving Outpatient Treatment With Concurrent High-dose Cisplatin and Radiotherapy
Authors: Faig Jennifer , Haughton Michael , Taylor Richard C. , D’Agostino Ralph B. , Whelen Megan J. , Porosnicu Rodriguez Kori A. , Bonomi Marcelo , Murea Mariana , Porosnicu Mercedes
Published: June 2016

Objectives:

Cisplatin remains the pivotal chemotherapy in squamous cell carcinoma of the head and neck (SCCHN), with nephrotoxicity considered the dose-limiting toxicity. The purpose of our study was to propose an outpatient high-dose cisplatin protocol aimed at preventing nephrotoxicity and to analyze the results of its utilization in patients with SCCHN treated with concurrent radiotherapy.

Materials and Methods:

We retrospectively evaluated 82 SCCHN patients treated with outpatient high-dose cisplatin concurrent with radiotherapy at our institution. Acute kidney injury (AKI) and chronic kidney disease were defined by Kidney Disease Improving Global Outcomes criteria. Associated factors were identified using analysis of covariance models for categorical variables and adjusted Pearson correlations for continuous variables.

Results:

The incidence of AKI during treatment was 34.2%. With a median follow-up of 25.7 months, the average decrease in estimated glomerular filtration rate was 12.57 mL/min/1.73 m2 (SD=18.58). At 1 year and at last follow-up, 5.4% and 4.4% of patients had estimated glomerular filtration rate <60 mL/min/1.73 m2. Predictors associated with AKI and chronic kidney disease were: lower baseline weight and creatinine, higher baseline creatinine clearance, smoking, female sex, African American race, hypertension, and increased hydration and magnesium replacement requirements.

Conclusions:

We encountered limited early and late nephrotoxicity. Importantly, nephrotoxicity was not the main dose-limiting toxicity. Our results emphasize the importance of close monitoring and additional replacement of water and electrolytes as needed. A consistent method of measuring and reporting chemotherapy-induced nephrotoxicity would be a valuable contribution to the literature.
Real-Time Indocyanine Green Fluorescence Imaging–Guided Complete Mesocolic Excision in Laparoscopic Flexural Colon Cancer Surgery
Authors: Watanabe Jun , Ota Mitsuyoshi , Suwa Yusuke , Ishibe Atsushi , Masui Hidenobu , Nagahori Kaoru
Published: June 2016

INTRODUCTION:

Laparoscopic surgery for colon cancer located in the hepatic flexure or splenic flexure is not standardized, because lymphatic drainage at this site may vary and the precise site of lymphatic dissection is uncertain.

TECHNIQUE:

Indocyanine green was injected into the submucosal layer around the tumor at 2 points with a 23-gauge localized injection before lymph node dissection and the lymph flow was observed using a near-infrared camera system 30 minutes after injection. In addition, a complete mesocolic excision with central vascular ligation guided the region where the lymph flow was fluorescently observed.

RESULTS:

A total of 20 consecutive patients (hepatic flexure, 10 patients; splenic flexure, 10 patients) were enrolled in this study. All of the procedures were safely performed without any complications. The lymph flow was visualized in 19 patients (95%) intraoperatively. Modification of the operative methods was required for 5 patients (modification in the separation line of the mesocolon and vessel selection for central vascular ligation) because the area of lymph flow observed during surgery differed from that of the preoperative diagnosis.

CONCLUSION:

Intraoperative real-time visualization of the lymph flow using indocyanine green fluorescence imaging during laparoscopic colon cancer surgery, especially flexural colon cancer surgery, is feasible and a helpful technique for identifying appropriate central vessels to be dissected and for determining an appropriate separation line of the mesentery.
Colorectal Surgery Outcomes in Chronic Dialysis Patients
Authors: Sirany Anne-Marie E. , Chow Christopher J. , Kunitake Hiroko , Madoff Robert D. , Rothenberger David A. , Kwaan Mary R.
Published: June 2016

BACKGROUND:

More than 450,000 US patients with end-stage renal disease currently dialyze. The risk of morbidity and mortality for these patients after colorectal surgery has been incompletely described.

OBJECTIVE:

We analyzed the 30-day morbidity and mortality rates of chronic dialysis patients who underwent colorectal surgery.

DESIGN:

This was a retrospective analysis.

SETTINGS:

Hospitals that participate in the American College of Surgeons National Surgical Quality Improvement Program were included.

PATIENTS:

The study included adult patients who underwent emergency or elective colon or rectal resection between 2009 and 2014.

MAIN OUTCOME MEASURES:

Baseline characteristics were compared by dialysis status. The impact of chronic dialysis on 30-day mortality and serious postoperative morbidity was examined using multivariate logistic regression.

RESULTS:

We identified 128,757 patients who underwent colorectal surgery in the American College of Surgeons National Surgical Quality Improvement Program database. Chronic dialysis patients accounted for 1% (n = 1285) and were more likely to be older (65.4 vs 63.2 years; p < 0.0001), black (27.2% vs 8.7%; p < 0.0001), preoperatively septic (22.1% vs 7.1%; p < 0.0001), require emergency surgery (52.0% vs 14.7%; p < 0.0001), have ischemic bowel (15.7% vs 1.6%; p < 0.0001), or have perforation/peritonitis (15.5% vs 4.2%; p < 0.0001). Chronic dialysis patients were also less likely to have a laparoscopic procedure (17.3% vs 45.0%; p < 0.0001). Chronic dialysis patients had higher unadjusted mortality (22.4% vs 3.3%; p < 0.0001), serious postoperative morbidity (47.9% vs 18.8%; p < 0.0001), and median length of stay (9 vs 6 days; p < 0.0001). In emergent cases (n = 19,375), multivariate logistic regression models demonstrated a higher risk of mortality for dialysis patients (OR = 1.73 (95% CI, 1.38–2.16)) but not for serious morbidity. Models for elective surgery demonstrated a similar effect on mortality (OR = 2.47 (95% CI, 1.75–3.50)) but also demonstrated a higher risk of serious morbidity (OR = 1.28 (95% CI, 1.04–1.56)).

LIMITATIONS:

The postoperative 30-day window may underestimate the true incidence of serious morbidity and mortality.

CONCLUSIONS:

Chronic dialysis patients undergoing elective or emergent colorectal procedures have a higher risk-adjusted mortality.
Repair of Fingertip Defect Using an Anterograde Pedicle Flap Based on the Dorsal Perforator
Authors: Wei Peng , Chen Weiwei , Mei Jin , Ding Maochao , Yu Yaling , Xi Shanshan , Zhou Renpeng , Tang Maolin
Published: June 2016

Background:

The purposes of this article are to introduce and assess the results of a long-term follow-up of using anterograde pedicle flap based on the dorsal branches of proper digital neurovascular bundles from the dorsum of the middle phalanx for the fingertip defect.

Methods:

Between February 2011 and December 2012, 31 patients underwent reconstruction of fingertip defects using a homodigital flap based on the dorsal perforator in the middle phalanx. The defect size ranged from 1.3 cm × 1.5 cm to 2.4 cm × 3.0 cm. During surgery, the flap was designed on the dorsal middle phalangeal region. The pedicle was a neurovascular bundle consisting of an artery, vein, and sensory nerve; the rotation of pedicle was <90 degrees.

Results:

The clinical results were satisfactory after 3 to 9 months of follow-up. The flaps were considered cosmetically acceptable by both patients and doctors. The sensory recovery was excellent, 2-point discrimination was 4.96 ± 1.47 mm, and the recovery of range of motion of the interphalangeal joints was very good.

Conclusions:

The anterograde island flap based on the dorsal branches of proper digital neurovascular bundles is an ideal aesthetic reconstruction method for fingertip defect. A 90-degree rotated island pedicle flap was very versatile, easy to design, and had good survival. This technique is simple with less damage to the donor site, without sacrificing the branch of the digital artery and nerve. The reliable source of blood supply and satisfactory recovery of sensation can be achieved without affecting the interphalangeal joint activity.
INTRAVITREAL TRIAMCINOLONE IN SUSAC SYNDROME
Authors: Yepez Juan B. , Murati Felipe A. , Pettito Michele , Arevalo J. Fernando
Published: June 2016

Purpose:

To report the use of intravitreal triamcinolone for Susac Syndrome in one patient.

Methods:

Case report.

Results:

A 23-year-old woman presented with presented with sudden visual loss in the left eye with associated neurologic symptoms. Ophthalmic examination and fluorescein angiography showed multiple areas of branch retinal artery occlusion, bilaterally. Magnetic resonance imaging showed dot-like, diffusion-restricted lesions in the corpus callosum, and audiometry showed low-frequency sensory hearing loss, compatible with Susac Syndrome. The patient received a single intravitreal injection of triamcinolone (4 mg) in the left eye. One week later, before beginning systemic corticosteroids, all signs and symptoms resolved in the left eye only.

Conclusion:

In cases of delayed systemic corticosteroid therapy, intravitreal triamcinolone resolves the ocular manifestations of Susac Syndrome.
RITONAVIR-ASSOCIATED TOXICITY MIMICKING RETINITIS PIGMENTOSA IN AN HIV-INFECTED PATIENT ON HIGHLY ACTIVE ANTIRETROVIRAL THERAPY
Authors: Papavasileiou Evangelia , Younis Saad , Zygoura Vasiliki , Quijano Claudia , Jackson Timothy L.
Published: June 2016

Purpose:

To report ritonavir-associated retinal pigment epithelium toxicity in a patient infected with the HIV on highly active antiretroviral therapy including ritonavir.

Methods:

Retrospective single case report. The authors describe a case of gradual onset of blurry vision in both eyes in an HIV-positive male. Visual acuity, clinical examination findings, and functional testing (electroretinogram and Goldmann perimetry) were reviewed. Diagnostic imaging, including fundus photography, spectral domain optical coherence tomography, fluorescein angiography, and fundus autofluorescence were assessed.

Results:

59-year-old HIV-infected male, treated with ritonavir for eight years, presented with a history of decreased night vision and peripheral field loss. Ophthalmologic examination confirmed the diagnosis of retinal toxicity. Goldmann perimetry showed areas of central and para-central scotomas. Electroretinograms demonstrated mild to moderate photoreceptor dysfunction. Fundus examination revealed a diffuse pattern of retinal pigment epithelium mottling in both eyes. Spectral domain optical coherence tomography confirmed the presence of choroidal thinning, whereas fundus autofluorescence showed mottled hypoautofluorescence.

Conclusion:

Although ritonavir-associated retinal toxicity is clinically uncommon, the clinical features of our findings support this diagnosis. Consideration of highly active antiretroviral therapy–associated retinal toxicity should be given to the differential diagnosis in HIV-positive patients with retinopathy of unclear etiology. This report also highlights the need for constant monitoring of patients using the ritonavir for early detection of possible retinal toxicity.
A Pilot Evaluation Assessing the Ease of Use and Accuracy of the New Self/Home-Tonometer IcareHOME in Healthy Young Subjects
Authors: Noguchi Asuka , Nakakura Shunsuke , Fujio Yuki , Fukuma Yasuko , Mori Etsuko , Tabuchi Hitoshi , Kiuchi Yoshiaki
Published: June 2016

Purpose:

We investigated the ease of use and accuracy of a new self/home-tonometer (IcareHOME) versus Goldmann applanation tonometry (GAT) and the Icare tonometer (Icare) by measuring the diurnal intraocular pressure (IOP).

Patients and Methods:

The right eyes of 43 healthy young subjects were studied. The IOP was measured using the IcareHOME, GAT, and Icare 6 times a day, every 2 hours, from 8:00 to 18:00. The coincidence of the diurnal curves among all tonometers was analyzed using a linear mixed model. The intradevice and interdevice agreement was evaluated using the intraclass correlation coefficients (ICC) and Bland-Altman method. The subjects’ perception of the IcareHOME was evaluated using a questionnaire.

Results:

The liner mixed model showed similar diurnal IOP curves for all tonometers (P=0.543); however, significant differences were observed between the tonometers over time (P<0.001). The intradevice repeatability was ICC>0.8 among all tonometers, although the interdevice agreement was lowest between the IcareHOME and GAT (ICC=0.641). The IOP values were significantly lower for the IcareHOME than for the GAT at 12:00, 16:00, and 18:00 (P<0.05, Tukey-Kramer test). The mean differences between the Icare and IcareHOME and GAT and IcareHOME were 0.83 and 1.03 mm Hg, respectively (95% limit of agreement: −4.17 to 5.84 mm Hg and −3.91 to 5.98 mm Hg, respectively). Regarding the subjects’ perception of handling the IcareHOME, 17 (39.5%) subjects answered “easy to use,” 20 (46.5%) answered “normal,” and six (13.9%) answered “difficult to use.”

Conclusions:

The IcareHOME can be used as a self/home-tonometer; however, it may result in lower IOP values.
Safety of Intravenous Methamphetamine Administration During Ibudilast Treatment
Authors: DeYoung Dustin Z. , Heinzerling Keith G. , Swanson Aimee-Noelle , Tsuang John , Furst Benjamin A. , Yi Yi , Wu Ying Nian , Moody David E. , Andrenyak David M. , Shoptaw Steven J.
Published: June 2016

Background

Methamphetamine dependence is a significant public health concern without any approved medications for treatment. We evaluated ibudilast, a nonselective phosphodiesterase inhibitor, to assess the safety and tolerability during intravenous methamphetamine administration. We conducted a randomized, double-blind, placebo-controlled, within-subjects crossover clinical trial.

Methods

Participants received ibudilast (20 mg twice daily followed by 50 mg twice daily) and placebo, with order determined by randomization, and then underwent intravenous methamphetamine challenges (15 and 30 mg). We monitored cardiovascular effects, methamphetamine pharmacokinetics, and reported adverse events.

Results

Ibudilast treatment had similar rates of adverse events compared with placebo, and there was no significant augmentation of cardiovascular effects of methamphetamine. Pharmacokinetic analysis revealed no clinically significant change in maximum concentration or half-life of methamphetamine with ibudilast.

Conclusions

Methamphetamine administration during ibudilast treatment was well tolerated without additive cardiovascular effects or serious adverse events, providing initial safety data to pursue ibudilast's effectiveness for the treatment of methamphetamine dependence.
Burden of disease and increasing prevalence of inflammatory bowel disease in a population-based cohort in the Netherlands
Authors: de Groof E. Joline , Rossen Noortje G.M. , van Rhijn Bram D. , Karregat Evert P.M. , Boonstra Kirsten , Hageman Ishtu , Bennebroek Evertsz Floor , Kingma Paul J. , Naber Anton H.J. , van den Brande Jan H.M. , Mallant-Hent Rosalie C. , Mundt Marco W. , D’Haens Geert R.A.M. , Ponsioen Cyriel Y.
Published: June 2016

Background

Reported epidemiology and phenotype distributions vary widely and disease burden of inflammatory bowel disease (IBD) is poorly described. Our aim was to establish these features in a population-based cohort covering 319 976 inhabitants. Furthermore, differences between tertiary referral and peripheral hospital patients were quantified.

Methods

IBD patients in the adherence area of three peripheral hospitals (2004–2012) were included. Medical and surgical treatment data were obtained. Quality of life and disease activity were evaluated. An outpatient cohort from a tertiary referral centre was accrued.

Results

A total of 1461 patients were included: 761 (52.1%) with ulcerative colitis (UC), 579 (39.5%) with Crohn’s disease (CD) and 121 (8.3%) with IBD-unspecified. Point prevalence of IBD was 432.1 per 100 000 inhabitants in 2010, which increased significantly over time, P-value of less than 0.0001. The mean annual incidence was 17.2 for UC, 10.5 for CD and 2.2 for IBD-unspecified. Tertiary referral Crohn’s patients used thiopurines and biological therapy and underwent surgery significantly more often than patients in peripheral hospitals (P<0.0001). Disease activity correlated negatively with quality of life (P<0.0001) in UC and CD.

Conclusion

The prevalence of IBD is still increasing. Burden of disease was significantly more severe, mainly in Crohn’s patients, in the referral centre, highlighting the importance of population-based studies to accurately describe phenotype distribution and disease burden.
Sodium Intake Requirements for Preterm Neonates
Authors: Bischoff Adrianne R. , Tomlinson Christopher , Belik Jaques
Published: June 2016

It is widely accepted that sodium is an essential nutritional electrolyte and its deficiency is associated with neurological sequelae and poor growth. The provision of an adequate sodium intake to preterm neonates is hampered by the technical difficulty in clinically assessing total body sodium content. As addressed in this review, there is a lack of consensus on the definition of hyponatremia early in life, but there is no evidence that it should deviate from the widely accepted normative data for adult subjects. A low urinary sodium content is accepted by many as reflecting total body sodium deficiency, yet spot urinary sodium measurements are of questionable clinical value. The hormonal regulation of sodium homeostasis is here reviewed and the mechanism accounting for sodium deficiency–induced growth impairment in preterm infants addressed. Lastly, we provide evidence‐based gestational and postnatal age‐dependent recommendations for the provision of adequate sodium intake to preterm neonates.
Lactulose Breath Test Gas Production in Childhood IBS Is Associated With Intestinal Transit and Bowel Movement Frequency
Authors: Chumpitazi Bruno P. , Weidler Erica M. , Shulman Robert J.
Published: June 2016

Objectives:

In adults with irritable bowel syndrome (IBS), bacterial gas production (colonic fermentation) is related to both symptom generation and intestinal transit. Whether gas production affects symptom generation, psychosocial distress, or intestinal transit in childhood IBS is unknown.

Methods:

Children (ages 7–17 years) with pediatric Rome III IBS completed validated psychosocial questionnaires and a 2‐week daily diary capturing pain and stooling characteristics. Stool form determined IBS subtype. Subjects then completed a 3‐hour lactulose breath test for measurement of total breath hydrogen and methane production. Carmine red was used to determine whole intestinal transit time.

Results:

A total of 87 children (mean age 13 ± 2.6 [standard deviation] years) were enrolled, of whom 50 (57.5%) were girls. All children produced hydrogen and 51 (58.6%) produced methane. Hydrogen and methane production did not correlate with either abdominal pain frequency/severity or psychosocial distress. Hydrogen and methane production did not differ significantly by IBS subtype. Methane production correlated positively with whole intestinal transit time (r = 0.31, P < 0.005) and inversely with bowel movement frequency (r = −0.245, P < 0.05). Methane production (threshold 3 ppm) as a marker for identifying IBS‐C had a sensitivity of 60% and specificity of 42.9%.

Conclusions:

Lactulose breath test total methane production may serve as a biomarker of whole intestinal transit time and bowel movement frequency in children with IBS. In children with IBS, lactulose breath test hydrogen and methane production did not, however, correlate with abdominal pain, IBS subtype, or psychosocial distress.
Evaluation of the Multimodal Strategy for Improvement of Hand Hygiene as Proposed by the World Health Organization
Authors: Pereira Eliana B. S. , Jorge Miguel T. , Oliveira Elias J. , Júnior Alberto Lopes Ribeiro , Santos Lauro R. L. , Mendes-Rodrigues Clesnan
Published: June 2016

Hand hygiene has the biggest impact and is the least expensive way to prevent and control health care–associated infections. In this study, we assessed the effectiveness of the multimodal strategy of the World Health Organization to improve health care–associated infection rates, hand hygiene compliance, and the related knowledge of health care professionals in a Brazilian university hospital. We observed the necessity for an alternative approach in hospitals with high staff turnover and low attendance of educational sessions.
Predicting Sepsis Risk Using the “Sniffer” Algorithm in the Electronic Medical Record
Authors: Olenick Evelyn M. , Zimbro Kathie S. , D'Lima Gabrielle M. , Ver Schneider Patricia , Jones Danielle
Published: June 2016

The Sepsis “Sniffer” Algorithm (SSA) has merit as a digital sepsis alert but should be considered an adjunct to versus an alternative for the Nurse Screening Tool (NST), given lower specificity and positive predictive value. The SSA reduced the risk of incorrectly categorizing patients at low risk for sepsis, detected sepsis high risk in half the time, and reduced redundant NST screens by 70% and manual screening hours by 64% to 72%. Preserving nurse hours expended on manual sepsis alerts may translate into time directed toward other patient priorities.
Eye Movements and Road Hazard Detection: Effects of Blur and Distractors
Authors: Lee Samantha Sze-Yee , Black Alex A. , Lacherez Philippe , Wood Joanne M.
Published: June 2016

Purpose

To examine the effects of optical blur, auditory distractors, and age on eye movement patterns while performing a driving hazard perception test (HPT).

Methods

Twenty young (mean age 27.1 ± 4.6 years) and 20 older (73.3 ± 5.7 years) drivers with normal vision completed a HPT in a repeated-measures counterbalanced design while their eye movements were recorded. Testing was performed under two visual (best-corrected vision and with +2.00DS blur) and two distractor (with and without auditory distraction) conditions. Participants were required to respond to road hazards appearing in the HPT videos of real-world driving scenes and their hazard response times were recorded.

Results

Blur and distractors each significantly delayed hazard response time by 0.42 and 0.76 s, respectively (p < 0.05). A significant interaction between age and distractors indicated that older drivers were more affected by distractors than young drivers (response with distractors delayed by 0.96 and 0.60 s, respectively). There were no other two- or three-way interaction effects on response time. With blur, for example, both groups fixated significantly longer on hazards before responding compared to best-corrected vision. In the presence of distractors, both groups exhibited delayed first fixation on the hazards and spent less time fixating on the hazards. There were also significant differences in eye movement characteristics between groups, where older drivers exhibited smaller saccades, delayed first fixation on hazards, and shorter fixation duration on hazards compared to the young drivers.

Conclusions

Collectively, the findings of delayed hazard response times and alterations in eye movement patterns with blur and distractors provide further evidence that visual impairment and distractors are independently detrimental to driving safety given that delayed hazard response times are linked to increased crash risk.
Nosocomial influenza: encouraging insights and future challenges
Authors: Vanhems Philippe , Bénet Thomas , Munier-Marion Elodie
Published: June 2016

Purpose of review

The prevalence and incidence of viral nosocomial influenza infections in healthcare settings are underestimated. Nosocomial influenza outbreaks are frequent, and control remains challenging in acute care and long-term healthcare settings. This review examines recent publications on the determinants of nosocomial influenza prevention and control.

Recent findings

Nosocomial influenza outbreaks occur in various healthcare settings, especially among the frail and elderly. The correct diagnosis is commonly missed because a substantial proportion of asymptomatic cases can transmit infections. Rapid diagnosis will facilitate rapid identification of cases and the implementation of control measures but needs confirmation in some circumstances, such as the description of transmission chains. Links between patients and healthcare personnel (HCP) have been well explored by phylogenetic virus characterization and need additional refinement and study. The preventive role of HCP vaccination in influenza incidence among patients should be investigated further in various settings to take into account different strategies for vaccination (i.e. voluntary or mandatory vaccination policies). Indeed, in Europe, influenza vaccination remains modest, whereas in North America hospitals and some states and provinces are now mandating influenza vaccination among HCP. The variability of vaccine effectiveness by seasonal epidemics is also an important consideration for control strategies.

When influenza cases occur in the community, the risk of transmission and nosocomial cases increase in healthcare settings requiring vigilance among staff. Surveillance and early warning systems should be encouraged. Outbreak control needs appropriate identification of cases and transmission chains, and rapid implementation of control measures. Vaccination policies in conjunction with appropriate infection control measures could reduce virus spreading in hospitals. HCP vaccination coverage must be improved.
HLA Matching Trumps Donor Age: Donor-Recipient Pairing Characteristics That Impact Long-Term Success in Living Donor Kidney Transplantation in the Era of Paired Kidney Exchange
Authors: Milner John , Melcher Marc L. , Lee Brian , Veale Jeff , Ronin Matthew , D'Alessandro Tom , Hil Garet , Fry Phillip C. , Shannon Patrick W.
Published: June 2016

Background

We sought to identify donor characteristics influencing long-term graft survival, expressed by a novel measure, kidney life years (KLYs), in living donor kidney transplantation (LDKT).

Methods

Cox and multiple regression analyses were applied to data from the Scientific Registry for Transplant Research from 1987 to 2015. Dependent variable was KLYs.

Results

Living donor kidney transplantation (129 273) were performed from 1987 to 2013 in the United States. To allow sufficient time to assess long-term results, outcomes of LDKTs between 1987 and 2001 were analyzed. After excluding cases where a patient died with a functioning graft (8301) or those missing HLA data (9), 40 371 cases were analyzed. Of 18 independent variables, the focus became the 4 variables that were the most statistically and clinically significant in that they are potentially modifiable in donor selection (P <0.0001; ie, HLA match points, donor sex, donor biological sibling and donor age). HLA match points had the strongest relationship with KLYs, was associated with the greatest tendency toward graft longevity on Cox regression, and had the largest increase in KLYs (2.0 year increase per 50 antigen Match Points) based on multiple regression.

Conclusions

In cases when a patient has multiple potential donors, such as through paired exchange, graft life might be extended when a donor with favorable matching characteristics is selected.
Behavioural effects of temperature on ectothermic animals: unifying thermal physiology and behavioural plasticity
Authors: Abram Paul K. , Boivin Guy , Moiroux Joffrey , Brodeur Jacques
Published: June 2016

Temperature imposes significant constraints on ectothermic animals, and these organisms have evolved numerous adaptations to respond to these constraints. While the impacts of temperature on the physiology of ectotherms have been extensively studied, there are currently no frameworks available that outline the multiple and often simultaneous pathways by which temperature can affect behaviour. Drawing from the literature on insects, we propose a unified framework that should apply to all ectothermic animals, generalizing temperature's behavioural effects into (1) Kinetic effects, resulting from temperature's bottom-up constraining influence on metabolism and neurophysiology over a range of timescales (from short-to long-term), and (2) Integrated effects, where the top-down integration of thermal information intentionally initiates or modifies a behaviour (behavioural thermoregulation, thermal orientation, thermosensory behavioural adjustments). We discuss the difficulty in distinguishing adaptive behavioural changes due to temperature from behavioural changes that are the products of constraints, and propose two complementary approaches to help make this distinction and class behaviours according to our framework: (i) behavioural kinetic null modeling and (ii) behavioural ecology experiments using temperature-insensitive mutants. Our framework should help to guide future research on the complex relationship between temperature and behaviour in ectothermic animals.
Identification of Novel and Differentially Expressed MicroRNAs in Goat Enzootic Nasal Adenocarcinoma
Authors: Wang Bin , Ye Ni , Cao San-jie , Wen Xin-tian , Huang Yongxs , Yan Qi-gui
Published: June 2016

Enzootic nasal adenocarcinoma (ENA), an epithelial tumor induced in goats and sheep by enzootic nasal tumor virus (ENTV), is a chronic, progressive,contact transmitted disease. This study aimed to identify novel and differentially expressed miRNAs in the tumor and para-carcinoma nasal tissuesofNanjiang yellow goats with ENA. Small RNA Illumina high-throughput sequencing was used to construct a goat nasal miRNA library.

406 known miRNAs and 29 novel miRNAs were identified. A total of 116 miRNAs were significantly differentially expressed in para-carcinoma nasal tissues and ENA; Target gene prediction and functional analysis revealed that 6176 non-redundancy target genes, 1792 significant GO and 97 significant KEGG pathway for 121 miRNAs were predicted.
Dynamics Affecting the Risk of Silent Circulation When Oral Polio Vaccination Is Stopped
Authors: Koopman J.S. , Henry C.J , Park J.H. , Eisenberg M.C. , Ionides E.L. , Eisenberg J.N.
Published: June 2016

Silent circulation of polioviruses without poliomyelitis cases could threaten eradication when oral polio vaccine (OPV) use is stopped worldwide. Waning immunity promotes silent circulation by increasing poliovirus transmission from individuals not at risk of paralytic polio. There is limited data on temporal patterns of waning. Accordingly, we modeled a range of waning patterns, scaled from fast but shallow to slow but deep, while keeping constant the effect of waning on transmission dynamics before vaccination begins. Besides waning, we varied overall transmissibility, the delay from beginning vaccination to reaching specified infection levels, and type specific virus characteristics. We observed an increasing range of vaccination levels that resulted in long periods of silent circulation after eliminating paralytic polio cases as the delay in reaching final vaccination levels increased. The extent of silent circulation was higher when waning was slower and deeper, when transmissibility was higher, and when virus was type 3. In our model, modest levels of vaccination of adults reduce silent circulation risks. These modeled patterns are consistent with very long silent circulation mainly emerging as a threat to OPV cessation in the last places from which polio cases are eliminated. Our analyses indicate why previous modeling studies have not seen the threat of silent circulation. They used models with no or very short duration waning and they lacked identifiability of waning effects on silent circulation because they fit models only to paralytic polio case counts. Our analyses show that nearly identical polio case count patterns can be generated by a range of waning patterns that in turn generate diverse silent circulation risks. We conclude that the risks of prolonged silent circulation are real but unquantified, that vaccinating adults with waned immunity will reduce those risks, and that intensive environmental surveillance will be needed to detect this risk before stopping OPV.
Haplotype block dynamics in hybrid populations
Authors: Janzen Thijs , Nolte Arne W. , Traulsen Arne
Published: June 2016

When species originate through hybridization, the genomes of the ancestral species are blended together. Over time genomic blocks that originate from either one of the ancestral species accumulate in the hybrid genome through genetic recombination. Modeling the accumulation of ancestry blocks can elucidate processes and patterns of genomic admixture. However, previous models have ignored ancestry block dynamics for chromosomes that consist of a discrete, finite number of chromosomal elements. Here we present an analytical treatment of the dynamics of the mean number of blocks over time, for continuous and discrete chromosomes, in finite and infinite populations. We describe the mean number of haplotype blocks as a universal function dependent on population size, the number of genomic elements per chromosome, the number of recombination events, and the initial relative frequency of the ancestral species.
Crystal structures of organoplatinum complexes containing alkyleugenoxyacetate andp-chloroaniline
Authors: Le Thi Hong Hai , Dao Thi Bich Diep , Nguyen Bich Ngan , Van Meervelt Luc
Published: June 2016

In the title complexes,trans-dichlorido(4-chloroaniline-κN){3-methoxy-4-methoxycarbonylmethoxy-1-[(2,3-η)-prop-2-en-1-yl]benzene}platinum(II) 0.1-hydrate, [PtCl2(C6H6ClN)(C13H16O4)]·0.1H2O, (I), andtrans-dichlorido(4-chloroaniline-κN){4-ethoxycarbonylmethoxy-3-methoxy-1-[(2,3-η)-prop-2-en-1-yl]benzene}platinum(II), [PtCl2(C6H6ClN)(C14H18O4)], (II), the PtIImetal atom displays a slightly distorted square-planar coordination geometry defined by the aniline N atom, two chloride anions (trans-positioned) and one ethylenic double bond. The least-squares planes through the two aromatic ring systems make an angle of 47.3 (3)° for (I) and 38.6 (2)° for (II). Both structures show disorder for the PtCl2fragment, in the case of (I) even further extended towards the CH2—CH=CH2ligand. An intramolecular C—H...Cl hydrogen bond occurs in (I). In the crystal packing of (I), which is dominated by N—H...O and C—H...Cl interactions, a partially occupied water molecule is observed on a twofold rotation axis with a refined site occupancy of 0.10 (1). A C—H...π interaction is also present. In (II), inversion dimers form chains along theb-axis direction by N—H...O hydrogen bonds.
Cyclohexane-1,4-diammonium dithiocyanate
Authors: Mague Joel T. , Akkurt Mehmet , Mohamed Shaaban K. , Abdelhamid Antar A. , Albayati Mustafa R.
Published: June 2016

In the title salt, C6H16N22+·2CNS−, the cyclohexane ring adopts a chair conformation. In the crystal, N—H...N hydrogen bonds encloseR42(8) rings involving two N atoms from the cyclohexane-1,4-diammonium cations as donors with the N atoms of two thiocyanate anions as acceptors. The crystal structure is further stabilized by intermolecular N—H...S hydrogen bonds that combine with these contacts to form a three-dimensional network.
5-Chloro-1-methylindoline-2,3-dione
Authors: Tribak Zineb , Kandri Rodi Youssef , Haoudi Amal , Essassi El Mokhtar , Capet Frédéric , Zouihri Hafid
Published: June 2016

The title molecule, C9H6ClNO2, is almost planar, with an r.m.s. deviation of the fitted non-hydrogen atoms of 0.0922 (19) Å. In the crystal, molecules are connected through methyl-C—H...O(carbonyl) interactions into supramolecular helical chains along thebaxis. Inter-chain π–π interactions lead to layers parallel to theabplane [centroid–centroid distances = 3.4861 (13) to 3.9767 (12) Å]. The crystal studied was a non-merohedral twin with a ratio of the twin components of 0.8612 (12): 0.1388 (12).
Linking disaster risk reduction, climate change and development
Authors: Schipper E. Lisa F. , Thomalla Frank , Vulturius Gregor , Davis Marion , Johnson Karlee
Published: June 2016

Purpose

The purpose of this paper is to advance the dialogue between the disaster risk reduction (DRR) and adaptation community by investigating their differences, similarities and potential synergies. The paper examines how DRR and adaptation can inform development to tackle the underlying drivers of disaster risk.

Design/methodology/approach

Based on a risk-based approach to the management of climate variability and change, the paper draws from a critical review of the literature on DRR and adaptation. The study finds that known and emerging risk from disasters continues to increase dramatically in many parts of the world, and that climate change is a key driver behind it. The authors also find that underlying causes of social vulnerability are still not adequately addressed in policy or practice. Linking DRR and adaptation is also complicated by different purposes and perspectives, fragmented knowledge, institutions and policy and poor stakeholder coordination.

Findings

The author’s analysis suggests that future work in DRR and adaptation should put a much greater emphasis on reducing vulnerability to environmental hazards, if there is truly a desire to tackle the underlying drivers of disaster and climate risks.

Originality/value

This will require coherent political action on DRR and adaptation aimed at addressing faulty development processes that are the main causes of growing vulnerability. The study concludes with a first look on the new Sendai Framework for Disaster Risk Reduction and how it aims to connect with adaptation and development.
Antecedents of Chinese adolescents’ purchase intention for local brands: the moderating influence of materialistic values
Authors: Shi Bing , Zhang Dan , Xie Hongling , Zhou Yinghui
Published: June 2016

Purpose

This study aims to examine factors affecting Chinese adolescents’ purchase intention for local brands; this study focuses on the effects of perceived social status value and materialistic values.

Design/methodology/approach

A theoretical model relating perceived social status value of brands to purchase intention, including materialistic values as a moderator, was developed and tested, using a sample of 587 Chinese adolescent respondents. Another experimental study examined the variability of the moderation of materialistic values across different levels of peer pressure in a product usage occasion.

Findings

Perceived social status value associated with local and foreign brands significantly influences purchase intention for local brands. Moreover, influence of perceived social status value of local versus foreign brands on local brand purchase intention is greater for materialistic adolescents. Additionally, the moderation of materialistic values is found in a product usage occasion with high peer pressure, but not in an occasion with low peer pressure.

Research limitations/implications

The findings show that perceived social status value associated with brands shapes purchase intention for local brands. The moderating effect of materialistic values is complex and suggests further research. The study’s scope is limited to Chinese adolescents.

Practical implications

The findings provide understanding of the drivers of purchase intention, and thus serve as a guideline for Chinese firms and foreign marketers seeking to enter the growing Chinese market, as well as consumer educators in China.

Originality/value

This study contributes to the limited empirical research into the factors shaping country-of-origin effects. Moreover, the findings suggest the need to consider the moderating role of materialistic values on purchase intention for local brands.