bluuebunny/crossref_metadata_2025 huggingface dataset:
Calneuron 1 Increased Ca
2+
in the Endoplasmic Reticulum and Aldosterone Production in Aldosterone-Producing Adenoma
Authors: Kobuke Kazuhiro , Oki Kenji , Gomez-Sanchez Celso E. , Gomez-Sanchez Elise P. , Ohno Haruya , Itcho Kiyotaka , Yoshii Yoko , Yoneda Masayasu , Hattori Noboru
Published: November 2017

Aldosterone production is initiated by angiotensin II stimulation and activation of intracellular Ca
2+
signaling. In aldosterone-producing adenoma (APA) cells, the activation of intracellular Ca
2+
signaling is independent of the renin–angiotensin–aldosterone systems. The purpose of our study was to clarify molecular mechanisms of aldosterone production related to Ca
2+
signaling. Transcriptome analysis revealed that the
CALN1
gene encoding calneuron 1 had the strongest correlation with
CYP11B2
(aldosterone synthase) among genes encoding Ca
2+
-binding proteins in APA.
CALN1
modulation and synthetic or fluorescent compounds were used for functional studies in human adrenocortical carcinoma (HAC15) cells.
CALN1
expression was 4.4-fold higher in APAs than nonfunctioning adrenocortical adenomas. CALN1 expression colocalized with CYP11B2 expression as investigated using immunohistochemistry in APA and zona glomerulosa of male rats fed by a low-salt diet. CALN1 expression was detected in the endoplasmic reticulum (ER) by using GFP-fused CALN1, CellLight ER-RFP, and the corresponding antibodies.
CALN1
-overexpressing HAC15 cells showed increased Ca
2+
in the ER and cytosol fluorescence-based studies. Aldosterone production was potentiated in HAC15 cells by
CALN1
expression, and dose-responsive inhibition with TMB-8 showed that CALN1-mediated Ca
2+
storage in ER involved sarcoendoplasmic reticulum calcium transport ATPase. The silencing of
CALN1
decreased Ca
2+
in ER, and abrogated angiotensin II– or KCNJ5 T158A–mediated aldosterone production in HAC15 cells. Increased CALN1 expression in APA was associated with elevated Ca
2+
storage in ER and aldosterone overproduction. Suppression of CALN1 expression prevented angiotensin II– or KCNJ5 T158A–mediated aldosterone production in HAC15 cells, suggesting that CALN1 is a potential therapeutic target for excess aldosterone production.
Clutch size influences embryonic stages at oviposition in a lizard with prolonged egg retention
Authors: Foucart Thomas , Heulin Benoit , Lourdais Olivier
Published: November 2017

We examined the possible interaction between reproductive effort and embryonic stages at oviposition in oviparous form of the lizardZootoca vivipara. Our results reveal that the percentage of total embryonic development time (%TEDT) reached at oviposition is negatively correlated to clutch size (adjusted to maternal body size). We found no influence of reproductive burden of female (relative clutch mass, RCM) on %TEDT. The significant effect of fecundity supports the hypothesis that a resource limitation such as oxygen may exist for developing embryos in oviducts. The absence of RCM effect suggests that the available space (abdominal burdening of the mother) does not limit the embryonic stages at oviposition.
Implementers? The role of international organisations in EU funding for external migration policy
Authors: Den Hertog
Published: November 2017

The EU is a major funder of migration projects around the world. There is a relationship of interdependence between the EU and international organizations, with the former offering funding and the latter offering implementation capacity. This paper explores this relationship in more detail. In particular, it explores how these international organizations are involved in the EU funds beyond implementation. This paper employs an organization theory approach to explain this central role of international organizations. This article argues that these organizations carefully navigate between the 'company' and 'political' organizational types. Moreover, the Commission and these organizations can be better conceptualized as forming a 'partial' organization. This holds implications for transparency and accountability in this area of growing spending. Three organizations are looked at in the context of this paper: The International Organization for Migration (IOM), the UN High Commissioner for Refugees (UNHCR), and the International Centre for Migration Policy Development (ICMPD).
On the taxonomy of the genus Acronicta (Lepidoptera, Noctuidae). IV. Acronicta digna species-complex
Authors: VOLYNKIN ANTON V. , MATOV ALEXEJ YU. , HAN HUI-LIN
Published: November 2017

The present paper is the fourth in a series of articles on the genus Acronicta Ochsenheimer (Volynkin et al. 2015; Volynkin 2015; Volynkin et al. 2016). In here, we revive A. metaxantha (Hampson 1909) stat. n., which was synonymized with A. digna (Butler, 1881) by Han & Kononenko (2010) to the species level, designate the neotype for Acronycta agnata Draudt, 1937 and revise the synonymy of A. digna and A. agnata.
Revision of the genus Centrophorus (Squaliformes: Centrophoridae): Part 2—Description of two new species of Centrophorus and clarification of the status of Centrophorus lusitanicus Barbosa du Bocage & de Brito Capello, 1864
Authors: WHITE WILLIAM T. , EBERT DAVID A. , NAYLOR GAVIN J.P.
Published: November 2017

Centrophorus specimens with a distinctive long-based first dorsal fin (long-finned species) have previously been considered to be Centrophorus lusitanicus first described from Portugal. Critical examination of the original description and illustration reveal that C. lusitanicus should be considered a junior synonym of C. granulosus. However, the specimen considered to be the syntype of C. lusitanicus in the Natural History Museum in London is clearly a long-finned species and not conspecific with C. granulosus. A more detailed investigation revealed that this specimen should not be considered a syntype and was likely not originally collected off the coast of Portugal. Investigation of long-finned specimens of Centrophorus from the Indo-West Pacific and Eastern Atlantic revealed that two undescribed species exist and are herein formally described as C. lesliei and C. longipinnis. The two species are similar morphologically and belong to the long-snout Centrophorus group (e.g. C. isodon and C. harrissoni) but are clearly separable based on their very long first dorsal fins. The two species differ in relative length of the first dorsal fin and several other characters. They also differ genetically. Nonmetric multidimensional ordination based on morphometric data reveals both species level and ontogenetic differences. A short erratum is also provided for Part 1 of this revision of the Centrophorus due to two figure related errors which may cause some confusion.
Formulary Drug Review: Betrixaban
Authors: Baker Danial E.
Published: November 2017

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are available online to subscribers. Monographs can be customized to meet the needs of a facility. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866-397-3433.
Women and Men of the Past, Present, and Future: Evidence of Dynamic Gender Stereotypes in Ghana
Authors: Bosak Janine , Eagly Alice , Diekman Amanda , Sczesny Sabine
Published: November 2017

People represent social groups by their trajectories through time, producing dynamic stereotypes. To the extent that these stereotypes derive from observations of group members’ behaviors in their typical roles, change in the roles of women and men over time should fuel beliefs that the sexes adopt traits associated with their new roles. Thus, earlier studies have found that stereotypes about the past, present, and future traits of women and men are consistent with beliefs about changes in their social roles. To examine such dynamic stereotypes in an African context, 150 participants from Ghana rated the likelihood of gender-stereotypic personality, cognitive, and physical characteristics of women or men of the past, present, or future in their society. Among the major findings were perceptions of increases over time in women’s masculine characteristics and men’s feminine characteristics. Also, both sexes increased in masculine and feminine cognitive characteristics. Comparison of these Ghanaian findings with those obtained earlier from five other countries revealed both similarities and differences.
Black Deaths Matter: Race, Relationship Loss, and Effects on Survivors
Authors: Umberson Debra
Published: November 2017

Close relationships are a resource for mental and physical health that, like other social resources, is unequally distributed in the population. This article focuses on racial disparities in the loss of relationships across the life course. Racial disparities in life expectancy in the United States mean that black Americans experience the deaths of more friends and family members than do white Americans from childhood through later life. I argue that these losses are a unique type of stress and adversity that, through interconnected biopsychosocial pathways, contribute to disadvantage in health over the life course. I focus particularly on how the interconnected pathways associated with loss undermine opportunities for and increase risks to social ties throughout life, adding to disadvantage in health. I call on social scientists and policy makers to draw greater attention to this unique source of disadvantage for black children, adults, and families.
Twenty-five years of French jurisprudence in criminal medical liability
Authors: Faisant Maxime , Papin-Lefebvre Frédérique , Rerolle Camille , Saint-Martin Pauline , Rougé-Maillart Clotilde
Published: November 2017

We report on a comprehensive 25-year study on criminal medical liability in France, undertaken to establish trends in the number of cases being brought before the criminal courts. We did this by interrogating the database on the Légifrance website using a Boolean equation (‘ pénal’ (criminal) AND ‘ médecin’ (physician) OR ‘ docteur’ (doctor)). In total 539 cases were selected, in which the status of the physician either influenced the punishment imposed, or was a prerequisite for the commission of the offence. The results of the search produced two outcomes: offences and the dates of the most recent criminal judgements (which had been left blank). Further data were also collected: references to court cases, hearing dates, offence dates, procedural time limits, numbers of accused parties, types of punishments and physician characteristics. The number of court hearings increased from the 1980s until the late 1990s. Since then, it has remained stable at around 25 cases per year. Of the defendants appearing before the courts, 39.2% have been found guilty. On average, 10 to 13 physicians every year – that is, one per month – are punished. Those most often punished are obstetrician-gynaecologists (13%), followed by intensive care anaesthetists (11%) and then by general practitioners (6.7%). The offences most frequently occurring are manslaughter (36.5%), illegal profits (12%), unintentional injuries (11.5%) and sexual offences (10.1%). The results are most reassuring in terms of the risks posed by the practice of medicine in France. Such a risk does indeed exist; however, it is at a low level and stable.
Reflections on the Epistemological Malady of the Discipline of Economics
Authors: Oommen M. A.
Published: November 2017

People pursue scientific study to learn about the riddle of the world we live. Assuming that the ontological vocation of the academic profession is to transform the world for better living, economics as a scientific discipline will have to develop theories and tools to understand social reality and work towards its creative transformation. This article tries to argue that mainstream economics that reduces social life into exchange value calculus or mathematical formalism rules out such a process of building a better society. It has dismissed vital issues like structural inequalities, social injustices and the like as central issues of development economics. This may be seen as an effort to draw attention towards rethinking the domain of the discipline of economics and set its epistemological foundation on a more relevant footing.
Differential Social Network Effects on Scholarly Productivity
Authors: Gaughan Monica , Melkers Julia , Welch Eric
Published: November 2017

Academic productivity is realized through resources obtained from professional networks in which scientists are embedded. Using a national survey of academic faculty in Science, Technology, Engineering, and Mathematics (STEM) fields across multiple institution types, we examine how the structure of professional networks affects scholarly productivity and how those effects may differ by race, ethnicity, and gender. We find that network size masks important differences in composition. Using negative binomial regression, we find that both the size and composition of professional networks affect scientific productivity, but bigger is not always better. We find that instrumental networks increase scholarly productivity, while advice networks reduce it. There are important interactive effects that are masked by modeling only direct effects. We find that white men are especially advantaged by instrumental networks, and women are especially advantaged by advice networks.
A Brief Overview of the STP 36th Annual Symposium: Musculoskeletal System
Authors: Gropp Kathryn E. , Boyle Michael C.
Published: November 2017

The title of the 2017 Society of Toxicologic Pathology symposium was “Musculoskeletal System.” A brief overview of the General Scientific Symposium is presented herein and describes the topics presented by each speaker. Symposium speakers addressed subjects pertinent to musculoskeletal system toxicologic pathology and drug development ranging from molecular biology of bone homeostasis to regulatory agency requirements and considerations for registration of bone therapeutics. This overview serves to summarize sessions and is intended as a guide to the individual submissions by speakers and symposium contributors.
Power Distance Orientation Dilutes the Effect of Abusive Supervision on Workplace Deviance
Authors: Hussain Imran , Sia Surendra Kumar
Published: November 2017

Deviant behaviour in workplace has become an issue of concern in today’s corporate world. As a result of hard costs, the negative impact of deviant behaviour leaves a devastating effect on overall productivity and performance of the organization. We assumed that abusive supervision will be positively related to employee’s interpersonal and organizational deviance. Moreover, we also hypothesized that this relationship of abusive supervision with both interpersonal and organizational deviance will be moderated by power distance. We verified the formulated hypotheses using data collected from 256 mid-level managerial employees working in IT and software companies based in Delhi (India). Data analysis was done through confirmatory factor analysis (CFA) and moderated regression analysis. Results reveal significant and positive contribution of abusive supervision towards employee’s workplace deviance. Power distance orientation significantly moderates the relationship between abusive supervision and employee’s interpersonal and organizational deviance. The implications for the result obtained are discussed.
Capitalism and the sea: Sovereignty, territory and appropriation in the global ocean
Authors: Campling Liam , Colás Alejandro
Published: November 2017

This paper introduces the term ‘terraqueous territoriality’ to analyse a particular relationship between capitalism as a social formation, and the sea as a natural force. It focuses on three spaces – exclusive economic zones, the system of ‘flags of convenience’ and multilateral counter-piracy initiatives – as instances of capitalist states and firms seeking to transcend the geo-physical difference between firm land and fluid sea. Capital accumulation, it is argued here, seeks to territorialise the sea through forms of sovereignty and modes of appropriation drawn from experiences on land, but in doing so encounters particular tensions thereby generating distinctive spatial effects. By exploring the articulation between sovereignty, territory and appropriation in the organisation of spaces where land meets sea, the article seeks to demonstrate the value of an analytical framework that underlines the terraqueous nature of contemporary capitalism.
Lesion location matters: The relationships between white matter hyperintensities on cognition in the healthy elderly
Authors: Lampe Leonie , Kharabian-Masouleh Shahrzad , Kynast Jana , Arelin Katrin , Steele Christopher J , Löffler Markus , Witte A Veronica , Schroeter Matthias L , Villringer Arno , Bazin Pierre-Louis
Published: November 2017

White matter hyperintensities (WMH) are associated with cognitive decline. We aimed to identify the spatial specificity of WMH impact on cognition in non-demented, healthy elderly. We quantified WMH volume among healthy participants of a community dwelling cohort ( n = 702, age range 60 – 82 years, mean age = 69.5 years, 46% female) and investigated the effects of WMH on cognition and behavior, specifically for executive function, memory, and motor speed performance. Lesion location influenced their effect on cognition and behavior: Frontal WMH in the proximity of the frontal ventricles mainly affected executive function and parieto-temporal WMH in the proximity of the posterior horns deteriorated memory, while WMH in the upper deep white matter—including the corticospinal tract—compromised motor speed performance. This study exposes the subtle and subclinical yet detrimental effects of WMH on cognition in healthy elderly, and strongly suggests a causal influence of WMH on cognition by demonstrating the spatial specificity of these effects.
Addressing the Wicked Problem of American Gun Violence
Authors: Huff Aimee Dinnin , Barnhart Michelle , McAlexander Brandon , McAlexander Jim
Published: November 2017

Building on work on social and macro-social marketing, we provide an empirical account of ways in which American gun violence prevention groups (GVPGs) act as macro-social marketers as they address the wicked problem of gun violence, which they define as deaths and injuries with firearms. We find that, as a collective, GVPGs attempt to change the culture related to guns by targeting up-, mid-, and downstream agents. We contribute to theory by (1) expanding the concept of macro-social marketing beyond government entities to include consumer interest groups and collectives; (2) introducing internal marketing as a macro-social marketing tool critical for macro-social marketers dependent largely on volunteers; (3) elucidating ways that macro-social marketers can accomplish upstream changes indirectly, by encouraging consumers and citizens to influence policy makers; and (4) revealing marketing tactics that can be leveraged across up-, mid-, downstream, and internal efforts.
Macro-Social Marketing Research
Authors: Kennedy Ann-Marie
Published: November 2017

Macro-social marketing is the use of social marketing – up, mid and downstream – to affect holistic systemic change (Kennedy 2016). Presently, fragmented views within macro-social marketing threaten to divide the field. Much of this fragmentation is due to a confusion between systems thinking and systems theory, the basis for macro-social marketing. This article presents an explanation of the key facets of systems literature, a macro-social marketing philosophy and a macro-social marketing methodology to show the benefits of combining systems thinking and systems theory, thus alleviating conflict within the field.
Pharmacy Students and Pharmacy Technicians in Medication Reconciliation: A Review of the Current Literature
Authors: Champion Heather M. , Loosen Julia A. , Kennelty Korey A.
Published: November 2017

Objective:

A literature review was conducted to examine how pharmacy students and technicians have been utilized in medication reconciliation processes in an effort to evaluate expanded roles for pharmacy students and technicians. Data were summarized on accuracy of obtaining medication histories, time requirements, discrepancy identification, and cost savings. Limitations and areas for future research also were identified.

Data Sources:

A search of PubMed, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO and a manual searching of bibliographies were performed.

Study Selection:

Articles were included in this literature review if they focused on medication reconciliation with pharmacy student or technician outcomes independent of pharmacist involvement, they are available in English from any country, and the outcomes were empirical.

Data Synthesis:

Of 2112 identified studies, 32 met the inclusion criteria. The literature review revealed pharmacy technicians or students were involved in several medication reconciliation activities. Trained pharmacy students and technicians were able to obtain thorough medication histories as well as identify medication history discrepancies and take appropriate action to correct these discrepancies. Through the use of pharmacy students and technicians in the medication reconciliation process, hospitals experienced cost savings and other health-care professionals had more time for other patient care activities as well as an increased trust in the accuracy of medication histories.

Conclusion:

These findings suggest that pharmacy students and technicians are accurate, time efficient, decrease costs, and provide support to other health-care professionals when they are included in the medication reconciliation process.
Part-time employment, the gender wage gap and the role of wage-setting institutions: Evidence from 11 European countries
Authors: Matteazzi Eleonora , Pailhé Ariane , Solaz Anne
Published: November 2017

We examine how far the over-representation of women in part-time jobs can explain the gender gap in hourly earnings, and also investigate how far wage-setting institutions are correlated with the overall gender wage gap and the female part-time wage gap. Using European Union Statistics on Income and Living Conditions (EU-SILC) 2009 data for 11 European countries, we implement a double decomposition of the gender wage gap: between men and women employed full-time and between full-time and part-time working women. This shows that the wage penalty of women employed part-time occurs mainly through the segregation of part-time jobs, but the full-time gender pay gap remains mostly unexplained. At the macro level, the gender wage gap tends to be higher in countries where part-time employment is more widespread. Some wage-setting institutions seem to reduce the female full-time/part-time pay gap and the gender gap among full-time workers.
Comparison of disease activity between tacrolimus and mycophenolate mofetil in lupus nephritis: a randomized controlled trial
Authors: Kamanamool N , Ingsathit A , Rattanasiri S , Ngamjanyaporn P , Kasitanont N , Chawanasuntorapoj R , Pichaiwong W , Anutrakulchai S , Sangthawan P , Ophascharoensuk V , Avihingsanon Y , Sumethkul V
Published: November 2017

We conducted a prospective multicenter, opened-label, parallel, randomized, controlled trial to compare tacrolimus (TAC) and mycophenolate mofetil (MMF) for induction and maintenance therapy in lupus nephritis (LN). Adult patients with biopsy-proven LN International Society of Nephrology/Renal Pathology Society classes III–V and active nephritis were to receive prednisolone (0.7–1.0 mg/kg/day for four weeks of run-in period and tapered) and randomly assigned to receive TAC (0.1 mg/kg/day) or MMF (1.5–2 g/day) as induction therapy for six months. All patients who had remission received azathioprine (AZA) 1–2 mg/kg/day as standard treatment in the maintenance phase. The primary outcome was Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2K) at six and 12 months, and the secondary outcomes included renal SLEDAI, non-renal SLEDAI, modified SLEDAI-2K, immunity SLEDAI, and disease activity remission. Eighty-four patients were randomized. One patient who was randomized to the TAC group withdrew from the study immediately after randomization. Therefore, 42 patients received MMF and 41 patients received TAC. Disease activity remission rate and time to disease activity remission were similar in both groups. Twelve patients (28.57%) in the MMF group and 10 patients (24.39%) in the TAC group achieved disease activity remission. For disease activity scores, both regimens significantly improved SLEDAI-2K during induction and maintenance therapy. Overall, SLEDAI-2K score in the MMF group decreased more compared with the TAC group. In the MMF group, mean SLEDAI-2K decreased from 11.6 ± 4.8 to 6.3 ± 3.9 after induction therapy and to 5.4 ± 4.4 after maintenance therapy. In the TAC group, mean SLEDAI-2K decreased from 9.0 ± 3.7 to 6.3 ± 5.1 after induction therapy and to 7.1 ± 5.4 after maintenance therapy. Renal SLEDAI and modified SLEDAI-2K showed a similar pattern with SLEDAI-2K. In non-renal SLEDAI and immunity SLEDAI, both regimens also resulted in decreased disease activity scores during the first two months. After that the scores were slightly increased. In the MMF group, the scores were still lower than baseline but in the TAC group were not. In conclusion, disease activity remission rate was similar in the MMF and TAC groups. For disease activity score as measured by SLEDAI-2K, TAC was comparable with MMF during induction but MMF was more effective on disease activity of active LN classes III and IV at 12 months, especially in the renal system.
Modelling breast cancer tumour growth for a stable disease population
Authors: Isheden Gabriel , Humphreys Keith
Published: November 2017

Statistical models of breast cancer tumour progression have been used to further our knowledge of the natural history of breast cancer, to evaluate mammography screening in terms of mortality, to estimate overdiagnosis, and to estimate the impact of lead-time bias when comparing survival times between screen detected cancers and cancers found outside of screening programs. Multi-state Markov models have been widely used, but several research groups have proposed other modelling frameworks based on specifying an underlying biological continuous tumour growth process. These continuous models offer some advantages over multi-state models and have been used, for example, to quantify screening sensitivity in terms of mammographic density, and to quantify the effect of body size covariates on tumour growth and time to symptomatic detection. As of yet, however, the continuous tumour growth models are not sufficiently developed and require extensive computing to obtain parameter estimates. In this article, we provide a detailed description of the underlying assumptions of the continuous tumour growth model, derive new theoretical results for the model, and show how these results may help the development of this modelling framework. In illustrating the approach, we develop a model for mammography screening sensitivity, using a sample of 1901 post-menopausal women diagnosed with invasive breast cancer.
High Versus Low Consumer Attitude and Intention Towards Adoption of Mobile Banking in India: An Empirical Study
Authors: Chawla Deepak , Joshi Himanshu
Published: November 2017

Although factors influencing adoption of technology-enabled banking has been studied by many researchers, the construct perceived usefulness had been analysed as a single construct. Moreover, the measurement of perceived usefulness by researchers does not discuss sub-dimensions or sub-factors, which could contribute to perceived usefulness associated with a particular technological innovation. This article empirically examines the influence of various factors on user attitude and intention towards adopting mobile banking. Based on focus-group discussion and personal interview with bankers, technology acceptance model (TAM) and studies on technology adoption, we propose a mobile banking adoption model in Indian context. We also examine the impact of demographics on user attitude and intention. Exploratory factor analysis (EFA) on a sample of 367 respondents resulted in seven factors which were found to be reliable. Confirmatory factor analysis demonstrated significant convergent and discriminant validity. Logistic regression equation was used to estimate the degree of correct prediction of user attitude and intention towards mobile banking adoption. Perceived trust, perceived ease of use (PEOU), perceived lifestyle compatibility, perceived efficiency and perceived convenience significantly impacted user attitude. However, user attitude was not found to differ significantly between demographic variables. Similarly, perceived trust, PEOU, perceived lifestyle compatibility and perceived efficiency were found to positively and significantly affect user intention. User intention was found to significantly vary across demographic groups based on gender and household income.
Molecular survey of infectious agents associated with bovine respiratory disease in a beef cattle feedlot in southern Brazil
Authors: Headley Selwyn A. , Okano Werner , Balbo Luciana C. , Marcasso Rogério A. , Oliveira Thalita E. , Alfieri Alice F. , Negri Filho Luiz C. , Michelazzo Mariana Z. , Rodrigues Silvio C. , Baptista Anderson L. , Saut João Paulo E. , Alfieri Amauri A.
Published: November 2017

We investigated the occurrence of infectious pathogens during an outbreak of bovine respiratory disease (BRD) in a beef cattle feedlot in southern Brazil that has a high risk of developing BRD. Nasopharyngeal swabs were randomly collected from steers ( n = 23) and assessed for the presence of infectious agents of BRD by PCR and/or RT-PCR assays. These included: Histophilus somni, Mannheimia haemolytica, Pasteurella multocida, Mycoplasma bovis, bovine respiratory syncytial virus (BRSV), bovine coronavirus (BCoV), bovine viral diarrhea virus (BVDV), bovine alphaherpesvirus 1 (BoHV-1), and bovine parainfluenza virus 3 (BPIV-3). Pulmonary sections of one steer that died with clinical BRD were submitted for pathology and molecular testing. The frequencies of the pathogens identified from the nasopharyngeal swabs were: H. somni 39% (9 of 23), BRSV 35% (8 of 23), BCoV 22% (5 of 23), and M. haemolytica 13% (3 of 23). PCR or RT-PCR assays did not identify P. multocida, M. bovis, BoHV-1, BVDV, or BPIV-3 from the nasopharyngeal swabs. Single and concomitant associations of infectious agents of BRD were identified. Fibrinous bronchopneumonia was diagnosed in one steer that died; samples were positive for H. somni and M. haemolytica by PCR. H. somni, BRSV, and BCoV are important disease pathogens of BRD in feedlot cattle in Brazil, but H. somni and BCoV are probably under-reported.
The Influence of Palliative Care Consultation on Health-Care Resource Utilization During the Last 2 Months of Life: Report From an Integrated Palliative Care Program and Review of the Literature
Authors: Dunn Edward J. , Markert Ronald , Hayes Kathleen , McCollom Joseph , Bains Loveleen , Kahlon Damanjeet , Kumar Geetika
Published: November 2017

Background:

We reviewed 104 consecutive deaths of veterans receiving care in the Dayton VA Medical Center from October 10, 2015 to April 11, 2016. The purpose of our study was to test our hypothesis that palliative care consultation would be associated with reduced health care resource utilization for individuals approaching end of life.

Methods:

Medical records were reviewed and data entry recorded on a spreadsheet. Non-parametric statistical methods were used to compare four outcome variables from veterans with palliative care consultation (PCC) vs. those without PCC. These variables included the number of ED visits, hospitalizations, hospital days, and ICU days all during the last two months of life. Predictor variables included PCC vs. no PCC and PCC before vs. PCC during the last two months of life. The study sample was comprised of 102 patients after excluding two outlier cases with ethical challenges in surrogate decision-making.

Results:

Of the 102 consecutive veteran deaths, palliative care consultation was associated with a lower number of ICU days during the last two months of life. For 96 veterans with PCC, the frequency of ED visits and acute care hospitalizations, as well as the number of ICU and hospital days, were all significantly less after PCC compared to before PCC during the last two months of life. The timing of PCC had no effect on the outcomes of interest.

Conclusion:

Palliative care consultation has a notable effect on health care resource utilization during the last two months of life.
Palliative Workforce Development and a Regional Training Program
Authors: O’Mahony Sean , Levine Stacie , Baron Aliza , Johnson Tricia J. , Ansari Aziz , Leyva Ileana , Marschke Michael , Szmuilowicz Eytan , Deamant Catherine
Published: November 2017

Aims:

Our primary aims were to assess growth in the local hospital based workforce, changes in the composition of the workforce and use of an interdisciplinary team, and sources of support for palliative medicine teams in hospitals participating in a regional palliative training program in Chicago.

Methods:

PC program directors and administrators at 16 sites were sent an electronic survey on institutional and PC program characteristics such as: hospital type, number of beds, PC staffing composition, PC programs offered, start-up years, PC service utilization and sources of financial support for fiscal years 2012 and 2014.

Results:

The median number of consultations reported for existing programs in 2012 was 345 (IQR 109 – 2168) compared with 840 (IQR 320 – 4268) in 2014. At the same time there were small increases in the overall team size from a median of 3.2 full time equivalent positions (FTE) in 2012 to 3.3 FTE in 2013, with a median increase of 0.4 (IQR 0-1.0). Discharge to hospice was more common than deaths in the acute care setting in hospitals with palliative medicine teams that included both social workers and advanced practice nurses ( p < .0001).

Conclusions:

Given the shortage of palliative medicine specialist providers more emphasis should be placed on training other clinicians to provide primary level palliative care while addressing the need to hire sufficient workforce to care for seriously ill patients.
Outpatient Palliative Care and Aggressiveness of End-of-Life Care in Patients with Metastatic Colorectal Cancer
Authors: Lee Si Won , Jho Hyun Jung , Baek Ji Yeon , Shim Eun Kyung , Kim Hyun Mi , Ku Ji Yeon , Nam Eun Jung , Chang Yoon-Jung , Choi Hye Jin , Kim Sun Young
Published: November 2017

Background:

Palliative care in outpatient setting has been shown to promote better symptom management and transition to hospice care among patients with advanced cancer. Nevertheless, specialized palliative care is rarely provided at cancer centers in Korea. Herein, we aimed to assess aggressiveness of end-of-life care for patients with metastatic colorectal cancer according to the use of outpatient palliative care (OPC) at a single cancer center in Korea.

Methods:

We performed a retrospective medical record review for 132 patients with metastatic colorectal cancer who died between 2011 and 2014. Fifty patients used OPC (OPC group), while 82 patients did not (non-OPC group). Indicators of aggressiveness of end-of-life care including chemotherapy use, emergency department visits, hospitalization, and utilization of hospice care were analyzed according to the use of OPC.

Results:

More patients in the OPC group were admitted to hospice than those in the non-OPC group (32% vs 17%, P = .047). The mean of inpatient days within 30 days of death was shorter for the OPC group than the non-OPC group (4.02 days vs 7.77 days, respectively, P = .032). There were no differences in the proportions of patients who received chemotherapy and visited the emergency department within 30 days from death.

Conclusion:

Among patients with metastatic colorectal cancer, OPC was associated with shorter inpatient days near death and greater hospice utilization. Further prospective studies are needed to evaluate the impact of OPC on end-of-life care in Korea.
Effect of a Whole-Person Model of Care on Patient Experience in Patients With Complex Chronic Illness in Late Life
Authors: Shippee Nathan D. , Shippee Tetyana P. , Mobley Patrick D. , Fernstrom Karl M. , Britt Heather R.
Published: November 2017

Background:

Patients with serious chronic illness are at a greater risk of depersonalized, overmedicalized care as they move into later life. Existing intervention research on person-focused care for persons in this transitional period is limited.

Objective:

To test the effects of LifeCourse, a team-based, whole-person intervention emphasizing listening to and knowing patients, on patient experience at 6 months.

Design:

This is a quasi-experimental study with patients allocated to LifeCourse and comparison groups based on 2 geographic locations. Robust change-score regression models adjusted for baseline differences and confounding.

Setting/Participants:

Patients (113 intervention, 99 comparison in analyses) were individuals with heart failure or other serious chronic illness, cancer, or dementia who had visits to hospitals at a large multipractice health system in the United States Midwest.

Measurements:

Primary outcome was 6-month change in patient experience measured via a novel, validated 21-item patient experience tool developed specifically for this intervention. Covariates included demographics, comorbidity score, and primary diagnosis.

Results:

At 6 months, LifeCourse was associated with a moderate improvement in overall patient experience versus usual care. Individual domain subscales for care team, communication, and patient goals were not individually significant but trended positively in the direction of effect.

Conclusion:

Person-focused, team-based interventions can improve patient experience with care at a stage fraught with overmedicalization and many care needs. Improvement in patient experience in LifeCourse represents the sum effect of small improvements across different domains/aspects of care such as relationships with and work by the care team.
Palliative Care in New York State Nursing Homes: A Descriptive Study
Authors: Lester Paula E. , Kawai Fernando , Rodrigues Lucan , Lolis James , Martins-Welch Diana , Shalshin Alexander , Fazzari Melissa J. , Pan Cynthia X.
Published: November 2017

Objective:

To describe the current landscape of palliative care (PC) in nursing homes (NHs) in New York State (NYS).

Measurements:

A statewide survey was completed by 149 respondents who named 61 different NHs as their workplace. Questions were related to presence, type, and composition of PC programs; perceptions of PC; barriers to implementing PC; and qualifying medical conditions.

Results:

Hospice is less available than palliative or comfort care programs, with three-fourths of NYS NH responded providing a PC program. In general, medical directors and physicians were more similar in perspective about the role/impact of PC compared to nursing and others. There was general agreement about the positive impact and role of PC in the NH. Funding and staffing were recognized as barriers to implementing PC.

Conclusion:

There is growing penetration of PC programs in NH facilities in NYS, with good perception of the appropriate utilization of PC programs. Financial reimbursement and staffing are barriers to providing PC in the NH and need to be addressed by the health-care system.
Speaking a Different Language: A Qualitative Analysis Comparing Language of Palliative Care and Pediatric Intensive Care Unit Physicians
Authors: Ciriello Anne G. , Dizon Zoelle B. , October Tessie W.
Published: November 2017

Background:

Family conferences in the pediatric intensive care unit (ICU) often include palliative care (PC) providers. We do not know how ICU communication differs when the PC team is present.

Aim:

To compare language used by PC team and ICU physicians during family conferences.

Design:

A retrospective cohort review of ICU family conferences with and without the PC team.

Setting:

Forty-four bed pediatric ICU in a tertiary medical center.

Participants:

Nine ICU physicians and 4 PC providers who participated in 18 audio-recorded family conferences.

Results:

Of the 9 transcripts without the PC team, we identified 526 ICU physician statements, generating 10 thematic categories. The most common themes were giving medical information and discussing medical options. Themes unique to ICU physicians included statements of hopelessness, insensitivity, and “health-care provider challenges.” Among the 9 transcripts with the PC team, there were 280 statements, generating 10 thematic categories. Most commonly, the PC team offered statements of support, giving medical information, and quality of life. Both teams promoted family engagement by soliciting questions; however, the PC team was more likely to use open-ended questions, offer support, and discuss quality of life.

Conclusion:

Pediatric ICU physicians spend more time giving medical information, whereas the PC team more commonly offers emotional support. The addition of the PC team to ICU family conferences may provide a balanced approach to communication.
The Oncology Specialist’s Role in POLST Form Completion
Authors: Lammers Austin J. , Zive Dana M. , Tolle Susan W. , Fromme Erik K.
Published: November 2017

Introduction:

Patients with cancer and oncology professional societies believe that advance care planning is important, but we know little of who actually has this conversation. Physician Orders for Life-Sustaining Treatment (POLST) forms can help to document these important conversations to ensure patients receive the level of treatment they want. We therefore sought to determine the specialty of those signing POLST forms for patients who died of cancer to better understand who is having this discussion with patients.

Methods:

Retrospective cohort study including all deaths due to cancer in Oregon between January 1, 2010, and December 31, 2011. Death certificates were matched to POLST forms in the Oregon POLST Registry, and the signing physician’s specialty was determined using the Oregon Medical Board’s database.

Results:

A total of 14 979 people died of cancer in Oregon in 2010 to 2011. Of which, 6145 (41.0%) had at least 1 POLST form in the Registry. Oncology specialists signed 14.9% of POLST forms, compared to 53.7% by primary care, 15.3% by hospice/palliative care, 12.8% by advanced practice providers, and 2.7% by other specialists; 51.8% of oncology specialists did not sign a POLST form, whereas 12.5% completed 10 or more.

Conclusion:

Oncology specialists play a central role in caring for patients with cancer through the end of their lives, but not in POLST completion. Whether or not they actually sign their patients’ POLST forms, oncology specialists in the growing number of POLST states should integrate POLST into their goals of care conversations with patients nearing the end of life.
Examining Posttraumatic Growth Among Bereaved Family Members of Patients With Cancer Who Received Palliative Care at Home
Authors: Hirooka Kayo , Fukahori Hiroki , Taku Kanako , Togari Taisuke , Ogawa Asao
Published: November 2017

Objective:

The present study examines the factor structure of the Japanese version of the Posttraumatic Growth Inventory (PTGI-J) among bereaved family members who lost loved ones to cancer after home-based palliative care in Japan. It evaluates the relationships between total score, each PTGI-J domain, and participants’ having a religious belief, gender, age, relationship to the patient, and time since patient death.

Procedure:

Bereaved family members (n = 849) completed the PTGI-J and a demographic questionnaire. The factor structure was tested using confirmatory factor analysis (CFA), and univariate analysis was used to test hypotheses.

Results:

Confirmatory factor analysis showed that the current sample moderately fitted to both 4-factor and 5-factor models. Univariate analysis revealed that having a religious belief and gender were associated with all domains and total PTGI-J score. Age, time since patient death, and relationship to the patient showed significant differences with the domains of PTGI-J.

Conclusion:

Clinicians may be able to adjust the support they provide based on patients’ personal characteristics. Future research should look at the mechanisms of PTG by examining the role of rumination, social support, and emotional distress among bereaved family members of patients with cancer.
Palliative Care Training in Cardiology Fellowship: A National Survey of the Fellows
Authors: Dabbouseh Noura M. , Kaushal Shivtej , Peltier Wendy , Johnston Fabian M.
Published: November 2017

Objectives:

To address perspectives of cardiology fellows on the current state of palliative education and palliative and hospice resource utilization within their fellowship experiences.

Methods:

We conducted an online national survey of cardiology fellows during the 2015 to 2016 academic year. Survey questions aimed to assess perceived importance of palliative care education, level of palliative care education during fellowship, and the structure of palliative care support at respondent institutions. Responses were collected anonymously. A total of 519 programs, including subspecialty programs, were contacted.

Results:

We received 365 responses, a number that represents roughly 14% of all cardiology fellows nationwide during the 2015 to 2016 academic year. Fellows reported discordance in the quality of education between general cardiology and palliative care principles as it relates to care of the patient approaching the end of life. Fellows infrequently received explicit training nor were observed or mentored in delivering end-of-life discussions. Respondents reported an underutilization of palliative care and hospice resources during fellowship training and also a perception that attending faculty were not routinely addressing goals of care.

Conclusions:

Our survey results highlight a need for enhanced palliative care and end-of-life training experiences for cardiology fellows and also suggest underutilization of hospice and palliative care resources for patients with advanced cardiac diseases. These findings create a platform for future work that might: (1) confirm this training deficit, (2) lead to exploration of educational models that could reconcile this deficit, and (3) potentially help improve palliative care support for patients and families facing advanced heart disease.