bluuebunny/crossref_metadata_2025 huggingface dataset:
Spatio-temporal models reveal subtle changes to demersal communities following the Exxon Valdez oil spill
Authors: Shelton Andrew O , Hunsicker Mary E , Ward Eric J , Feist Blake E , Blake Rachael , Ward Colette L , Williams Benjamin C , Duffy-Anderson Janet T , Hollowed Anne B , Haynie Alan C
Published: May 2017

Toxic pollutants such as crude oil have direct negative effects for a wide array of marine life. While mortality from acute exposure to oil is obvious, sub-lethal consequences of exposure to petroleum derivatives for growth and reproduction are less evident and sub-lethal effects in fish populations are obscured by natural environmental variation, fishing, and measurement error. We use fisheries independent surveys in the Gulf of Alaska to examine the consequences of the 1989 Exxon Valdez oil spill (EVOS) for demersal fish. We delineate areas across a range of exposure to EVOS and use spatio-temporal models to quantify the abundance of 53 species-groups over 31 years. We compare multiple community metrics for demersal fish in EVOS and Control areas. We find that areas more exposed to EVOS have more negative trends in total groundfish biomass than non-EVOS areas, and that this change is driven primarily by reductions in the abundance of the apex predator guild. We show no signature of increased variability or increased levels of synchrony within EVOS areas. Our analysis supports mild consequences of EVOS for groundfish communities, but suggests that long time-series and assessments of changes at the community level may reveal sub-lethal effects in marine communities.
Deep thinking: a systematic review of mesophotic coral ecosystems
Authors: Turner Joseph A , Babcock Russell C , Hovey Renae , Kendrick Gary A
Published: May 2017

Mesophotic coral ecosystems (MCEs) occur at depths beyond those typically associated with coral reefs. Significant logistical challenges associated with data collection in deep water have resulted in a limited understanding of the ecological relevance of these deeper coral ecosystems. We review the trends in this research, covering the geographic spread of MCE research, the focus of these studies, the methods used, how MCEs differ in terms of species diversity and begin to assess connectivity of coral populations. Clear locational biases were observed, with studies concentrated in a few discrete areas mainly around the Atlantic region. The focus of MCE studies has diversified in recent years and more detailed aspects of MCE ecology are now being investigated in particular areas of research. Advances in technology are also reflected in the current range of research, with a wider variety of methods now employed. However, large information gaps are present in entire regions and particularly in relation to the threats, impacts and subsequent management of MCEs. Analysis of species diversity shows that initial definitions based on depth alone may not be appropriate globally, while further taxonomic resolution may also be required to deduce the full biodiversity of major groups in certain regions. Genetic studies to date show species-specific results, although distinct deeper populations do appear to exist, which raises questions regarding the potential of MCEs to act as refugia.
Validation of deep-sea coral and sponge distribution models in the Aleutian Islands, Alaska
Authors: Rooper Christopher N , Wilborn Rachel , Goddard Pamela , Williams Kresimir , Towler Richard , Hoff Gerald R
Published: May 2017

Spatial management of vulnerable benthic ecosystem components such as deep-sea corals and sponges requires adequate maps of their distribution. These maps are often based on statistical models of survey data. The objective of this project was to validate the predictions of existing presence or absence and abundance models of deep-sea corals and sponges in the Aleutian Islands that were based on bottom trawl survey data. Model validation was conducted by comparing bottom trawl survey model predictions to the observations of an in situ camera survey conducted at randomly selected locations. The measures of goodness of fit (area-under-the-receiver-operator-curve, AUC) for the bottom trawl survey model predictions of camera survey observations ranged from 0.59 to 0.77 (for sponges and coral, respectively) and indicated that the bottom trawl survey models predicted the probability of presence for corals accurately across the Aleutian Islands. The bottom trawl survey models explained as little as 3% of the variability in Stylasteridae density and up to 17% of the variability in coral density. These results indicate that models of deep-sea coral distributions based on presence and absence data from bottom trawl surveys can be accurate and can provide useful information for spatial management of these vulnerable taxa. However, for some other taxa, such as sponges, care should be taken interpreting the results of bottom trawl survey models. An interesting finding of this study was that the residuals from the bottom trawl survey model-camera density relationships were negative in areas that remained open to fishing after 2005, possibly indicating an effect of continued bottom trawling on the abundance of corals in these areas. This study highlights the importance of validating models of species distribution using independent surveys, so that the results can be used with confidence to support decision-making processes.
Silicon-bearing molecules in the shock L1157-B1: first detection of SiS around a Sun-like protostar
Authors: Podio L. , Codella C. , Lefloch B. , Balucani N. , Ceccarelli C. , Bachiller R. , Benedettini M. , Cernicharo J. , Faginas-Lago N. , Fontani F. , Gusdorf A. , Rosi M.
Published: May 2017

The shock L1157-B1 driven by the low-mass protostar L1157-mm is a unique environment to investigate the chemical enrichment due to molecules released from dust grains. IRAM-30m and Plateau de Bure Interferometer observations allow a census of Si-bearing molecules in L1157-B1. We detect SiO and its isotopologues and, for the first time in a shock, SiS. The strong gradient of the [SiO/SiS] abundance ratio across the shock (from ≥180 to ∼25) points to a different chemical origin of the two species. SiO peaks where the jet impacts the cavity walls ([SiO/H2] ∼ 10−6), indicating that SiO is directly released from grains or rapidly formed from released Si in the strong shock occurring at this location. In contrast, SiS is only detected at the head of the cavity opened by previous ejection events ([SiS/H2] ∼ 2 × 10−8). This suggests that SiS is not directly released from the grain cores but instead should be formed through slow gas-phase processes using part of the released silicon. This finding shows that Si-bearing molecules can be useful to distinguish regions where grains or gas-phase chemistry dominates.
Technique of Minimally Invasive Cervical Foraminotomy
Authors: Ross Donald A , Bridges Kelly J
Published: May 2017

BACKGROUND

Posterior cervical foraminotomy is a long utilized and commonly performed procedure, but has been supplanted in many cases by anterior procedures. With the advent of minimally invasive techniques, posterior foraminotomy may again deserve a prominent place in the treatment of cervical foraminal stenosis.

OBJECTIVE

To report in detail a successfully utilized minimally invasive technique and the results in a large series of patients, by a single author.

METHODS

The technique is described and illustrated in detail. A retrospective review of the use of this technique in a large series is reported.

RESULTS

Precise details of the technique are described with specific attention to complication avoidance. In over 360 cases, there have been no nerve root injuries other than idiopathic C5 palsies, no wound infections, and a single durotomy that required no specific treatment.

CONCLUSION

Minimally invasive posterior cervical foraminotomy is a well-tolerated and effective procedure which can be performed with minimal complications when attention to detail is maintained.
Refining Operative Strategies for Optic Nerve Decompression: A Morphometric Analysis of Transcranial and Endoscopic Endonasal Techniques Using Clinical Parameters
Authors: Gogela Steven L , Zimmer Lee A , Keller Jeffrey T , Andaluz Norberto
Published: May 2017

BACKGROUND

Various approaches can be considered for decompression of the intracanalicular optic nerve. Although clinical experience has been reported, no quantitative study has yet compared the extent of decompression achieved by an endoscopic endonasal versus transcranial approach.

OBJECTIVE

Toward this aim, our morphometric analysis compared both approaches by quantifying the circumferential degree of optic canal decompression that is possible before any meningeal violation, which would result in cerebrospinal fluid (CSF) leak.

METHODS

From 10 cadaver heads, 20 optic canals were sequentially decompressed using an endoscopic endonasal approach and pterional craniotomy with extradural clinoidectomy. Dissections ended before violation of the sphenoid sinus during the transcranial approach, and before intracranial transgression from the endonasal corridor. Based on our study criteria, decompressions were not maximal for either approach, but were maximal before violating the other compartment. Decompression achieved from each approach was quantified using CT scans for each stage.

RESULTS

Greater circumferential bony optic canal decompression was obtained from transcranial (245.2°) than endonasal (114.8°) routes (P < .001). By endonasal perspective, the anatomical point where the optic nerve traverses intracranially was approximated by the medial border of the anterior ascending cavernous internal carotid artery.

CONCLUSION

Our morphometric analysis comparing optic canal decompression for endonasal and transcranial corridors provides important guidance for this location. Ample visualization and wide exposure can be achieved via a transcranial approach with limited risk of CSF leak. A landmark, where the intracanalicular segment ends and optic nerve traverses intracranially, can mark the extent of decompression safely obtained before risking CSF leak.
An effectiveness hierarchy of preventive interventions: neglected paradigm or self-evident truth?
Authors: Capewell Simon , Capewell Ann
Published: May 2017

Non-communicable disease prevention strategies usually target the four major risk factors of poor diet, tobacco, alcohol and physical inactivity. Yet, the most effective approaches remain disputed. However, increasing evidence supports the concept of an effectiveness hierarchy. Thus, ‘downstream’ preventive activities targeting individuals (such as 1:1 personal advice, health education, ‘nudge’ or primary prevention medications) consistently achieve a smaller population health impact than interventions aimed further ‘upstream’ (for instance, smoke-free legislation, alcohol minimum pricing or regulations eliminating dietary transfats). These comprehensive, policy-based interventions reach all parts of the population and do not depend on a sustained ‘agentic’ individual response. They thus tend to be more effective, more rapid, more equitable and also cost-saving. This effectiveness hierarchy is self-evident to many professionals working in public health. Previously neglected in the wider world, this effectiveness hierarchy now needs to be acknowledged by policy makers.
Effect of Salt Reduction on Dough Handling and the Breadmaking Quality of Canadian Western Red Spring Wheat Varieties
Authors: Yovchev Aleksandar G. , Briggs Connie , Stone Andrea K. , Hucl Pierre , Nickerson Michael T. , Scanlon Martin G.
Published: May 2017

The effect of salt (NaCl) on the breadmaking quality of 37 varieties of Canadian Western Red Spring wheat (Triticum aestivum L.) was investigated along with dough stickiness for a 20 variety subset. A principal components analysis indicated that dough development time (DDT), mixing tolerance index (MTI), and stability (STA) were highly correlated. DDT showed an inverse relationship with MTI (r = –0.73) and a positive relationship with STA (r = 0.89). STA was also negatively related to MTI (r = –0.76). A reduction of salt from 2.0 to 1.1% (based on flour weight) was considered from a practical perspective. Each variety responded differently to salt reduction. Obtaining an optimal dough consistency with less salt required less work input and shorter mixing time. Overall, decreasing loaf volume with reducing salt content was observed, although certain varieties produced the opposite effect. This suggests that for a particular flour, depending on the inherent flour strength, there is a level of NaCl that produces an optimum between gluten strength and gas‐holding capacity of the dough, resulting in a loaf with good crumb texture and an even distribution of bubble sizes. A stickiness test was performed on selected varieties to evaluate the dough handling properties at 1.1 and 2.0% salt levels. The overall trend showed an increase in stickiness with a decrease in the salt content; however, certain varieties showed no change.
Reliability of Radiographic Assessments of Adolescent Midshaft Clavicle Fractures by the FACTS Multicenter Study Group
Authors: Li Ying , Donohue Kyna S. , Robbins Christopher B. , Pennock Andrew T. , Ellis Henry B. , Nepple Jeffrey J. , Pandya Nirav , Spence David D. , Willimon Samuel Clifton , Heyworth Benton E. ,   Function After Adolescent Clavicle Trauma and Surgery (FACTS) Multicenter Study Group
Published: May 2017

Objectives:

There is a recent trend toward increased surgical treatment of displaced midshaft clavicle fractures in adolescents. The primary purpose of this study was to evaluate the intrarater and interrater reliability of clavicle fracture classification systems and measurements of displacement, shortening, and angulation in adolescents. The secondary purpose was to compare 2 different measurement methods for fracture shortening.

Methods:

This study was performed by a multicenter study group conducting a prospective, comparative, observational cohort study of adolescent clavicle fractures. Eight raters evaluated 24 deidentified anteroposterior clavicle radiographs selected from patients 10–18 years of age with midshaft clavicle fractures. Two clavicle fracture classification systems were used, and 2 measurements for shortening, 1 measurement for superior–inferior displacement, and 2 measurements for fracture angulation were performed. A minimum of 2 weeks after the first round, the process was repeated. Intraclass correlation coefficients were calculated.

Results:

Good to excellent intrarater and interrater agreement was achieved for the descriptive classification system of fracture displacement, direction of angulation, presence of comminution, and all continuous variables, including both measurements of shortening, superior–inferior displacement, and degrees of angulation. Moderate agreement was achieved for the Arbeitsgemeinschaft für Osteosynthesefragen classification system overall. Mean shortening by 2 different methods were significantly different from each other (P < 0.0001).

Conclusions:

Most radiographic measurements performed by investigators in a multicenter, prospective cohort study of adolescent clavicle fractures demonstrated good-to-excellent intrarater and interrater reliability. Future consensus on the most accurate and clinically appropriate measurement method for fracture shortening is critical.
Effects of Tibial Rotational–guided Growth on the Geometries of Tibial Plateaus and Menisci in Rabbits
Authors: Sevil-Kilimci Figen , Cobanoglu Mutlu , Ocal Mehmet K. , Korkmaz Deniz , Cullu Emre
Published: May 2017

Background:

There are studies on the use of oblique plate over epiphyses for rotational deformities but the effects of this method on bone are not yet known. The purpose of this study was to determine the effect and rebound effect of rotational-guided growth on the geometries of the tibial plateaus and menisci in a rabbit model of tibial axial rotation.

Methods:

Thirty male rabbits were 6 weeks old when medial and lateral plates were applied to the proximal tibias of the left side. After 4 weeks, 15 rabbits were euthanized (group 1), and the plates from the tibias of the remaining 15 rabbits (group 2) were removed. The rabbits in group 2 were euthanized 4 weeks later.

Results:

In the rabbits of group 1, the most striking differences were a decrease in the lateral tibial slope (from 28.3 to 10.8 degrees) and decrease in the ratio of the lateral plateau covered by the meniscus (from 71.9% to 61.3%). After removing the plates (group 2), the observed values of the rebound effects were 25.9 and 29.8 degrees for the lateral tibial slope, and 76.5% and 77.2% for the ratio of the lateral plateau covered by the meniscus. However, the meniscal geometries continued to change.

Conclusions:

The rotational-guided growth provided by using plates caused a change in the tibial plateau geometry, and the rebound effect, except in the meniscal geometry, was observed after removing the plates in the growing period of the rabbits. Rotational-guided growth for the restoration of tibial axial rotation deformities may be suggested after determining the clinical effects of the increasing meniscal variables.

Level of Evidence:

Clinical relevance: the rotational-guided growth needs close follow-up because of possible changes in anatomy of the bone.
Soft Tissue Repair in Supination-External Rotation IV Ankle Fractures
Authors: Donders Johanna C.E. , Gausden Elizabeth B. , Levack Ashley E. , Helfet David L. , Lorich Dean G.
Published: May 2017

Achieving optimal functional outcomes while preventing posttraumatic ankle arthritis in patients with unstable ankle fractures remains challenging for orthopedic surgeons. The rate of syndesmotic malreduction is alarmingly high after transsyndesmotic screw fixation. The senior author introduced an alternative to transsyndesmotic screw fixation with anatomic approach to bone and ligament repair. Here we review the development of this approach and present the technique of repairing soft tissue structures in unstable ankle fractures.
Prospective Evaluation of a Multifaceted Intervention to Improve Outcomes in Intensive Care: The Promoting Respect and Ongoing Safety Through Patient Engagement Communication and Technology Study*
Authors: Dykes Patricia C. , Rozenblum Ronen , Dalal Anuj , Massaro Anthony , Chang Frank , Clements Marsha , Collins Sarah , Donze Jacques , Fagan Maureen , Gazarian Priscilla , Hanna John , Lehmann Lisa , Leone Kathleen , Lipsitz Stuart , McNally Kelly , Morrison Conny , Samal Lipika , Mlaver Eli , Schnock Kumiko , Stade Diana , Williams Deborah , Yoon Catherine , Bates David W.
Published: May 2017

Objectives:

Studies comprehensively assessing interventions to improve team communication and to engage patients and care partners in ICUs are lacking. This study examines the effectiveness of a patient-centered care and engagement program in the medical ICU.

Design:

Prospective intervention study.

Setting:

Medical ICUs at large tertiary care center.

Patients:

Two thousand one hundred five patient admissions (1,030 before and 1,075 during the intervention) from July 2013 to May 2014 and July 2014 to May 2015.

Interventions:

Structured patient-centered care and engagement training program and web-based technology including ICU safety checklist, tools to develop shared care plan, and messaging platform. Patient and care partner access to online portal to view health information, participate in the care plan, and communicate with providers.

Measurements and Main Results:

Primary outcome was aggregate adverse event rate. Secondary outcomes included patient and care partner satisfaction, care plan concordance, and resource utilization. We included 2,105 patient admissions, (1,030 baseline and 1,075 during intervention periods). The aggregate rate of adverse events fell 29%, from 59.0 per 1,000 patient days (95% CI, 51.8–67.2) to 41.9 per 1,000 patient days (95% CI, 36.3–48.3; p < 0.001), during the intervention period. Satisfaction improved markedly from an overall hospital rating of 71.8 (95% CI, 61.1–82.6) to 93.3 (95% CI, 88.2–98.4; p < 0.001) for patients and from 84.3 (95% CI, 81.3–87.3) to 90.0 (95% CI, 88.1–91.9; p < 0.001) for care partners. No change in care plan concordance or resource utilization.

Conclusions:

Implementation of a structured team communication and patient engagement program in the ICU was associated with a reduction in adverse events and improved patient and care partner satisfaction.
Extracorporeal Membrane Oxygenation for Acute Decompensated Heart Failure
Authors: Dangers Laurence , Bréchot Nicholas , Schmidt Matthieu , Lebreton Guillaume , Hékimian Guillaume , Nieszkowska Ania , Besset Sébastien , Trouillet Jean-Louis , Chastre Jean , Leprince Pascal , Combes Alain , Luyt Charles-Edouard
Published: May 2017

Objective:

Long-term outcomes of patients treated with venoarterial-extracorporeal membrane oxygenation for acute decompensated heart failure (i.e., cardiogenic shock complicating chronic cardiomyopathy) have not yet been reported. This study was undertaken to describe their outcomes and determine mortality-associated factors.

Design:

Retrospective analysis of data prospectively collected.

Setting:

Twenty-six–bed tertiary hospital ICU.

Patients:

One hundred five patients implanted with venoarterial-extracorporeal membrane oxygenation for acute decompensated heart failure.

Intervention:

None.

Measurements and Main Results:

From March 2007 to January 2015, 105 patients were implanted with venoarterial-extracorporeal membrane oxygenation for acute decompensated heart failure in our ICU (67% of them had an intraaortic balloon pump to unload the left ventricle). Their 1-year survival rate was 42%; most of the survivors were transplanted either directly or after switching to central bilateral centrifugal pump, ventricular-assist device, or total artificial heart. Most deaths occurred early after multiple organ failure. Multivariable analyses retained (odds ratio [95% CI]) pre–extracorporeal membrane oxygenation Sequential Organ Failure Assessment score of more than 11 (3.3 [1.3–8.3]), idiopathic cardiomyopathy (0.4 [0.2–1]), cardiac disease duration greater than 2 years pre–extracorporeal membrane oxygenation (2.8 [1.2–6.9]), and pre–extracorporeal membrane oxygenation blood lactate greater than 4 mmol/L (2.6 [1.03–6.4]) as independent predictors of 1-year mortality. Only 17% of patients with pre–extracorporeal membrane oxygenation Sequential Organ Failure Assessment scores of 14 or more survived, whereas 52% of those with scores less than 7 and 60% of those with scores 7 or more and less than 11 were alive 1 year later.

Conclusions:

Among this selected cohort of 105 patients implanted with venoarterial-extracorporeal membrane oxygenation for acute decompensated heart failure, 1-year survival was 42%, but better for patients with pre–extracorporeal membrane oxygenation Sequential Organ Failure Assessment scores of less than 11. Venoarterial-extracorporeal membrane oxygenation should be considered for patients with acute decompensated heart failure, but timing of implantation is crucial.
REPEATABILITY OF AUTOMATED VESSEL DENSITY AND SUPERFICIAL AND DEEP FOVEAL AVASCULAR ZONE AREA MEASUREMENTS USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Yanik Odabaş Özge , Demirel Sibel , Özmert Emin , Batioğlu Figen
Published: May 2017

Purpose:

To evaluate the repeatability of vessel density and superficial and deep foveal avascular zone measurements using optical coherence tomography angiography, and to specify a diurnal change range.

Methods:

Forty-six eyes of 25 healthy individuals were included. Optical coherence tomography angiography measurements were planned for three consecutive sessions, with 3 hours in between them. AngioVue software of the RTVue XR Avanti was used. Superficial and deep retinal layer vessel density values, including the whole retina, fovea, and each parafoveal zone, were obtained from the software. The intraclass correlation, coefficient of variation, and coefficient of repeatability were calculated for each parameter.

Results:

The whole image intraclass correlation value was 0.81 for the superficial and 0.86 for the deep layer among the three consecutive sessions. The smallest real difference (coefficient of repeatability) value of whole image measurements was 7.72% for the superficial and 9.84% for the deep retinal layer. Foveal avascular zone area intraclass correlation value was 0.97 for the superficial and 0.83 for the deep retinal layer.

Conclusion:

The optical coherence tomography angiography analysis provides quantitative data about the retinal microvasculature, which could be used to distinguish between normal and pathology. Changes in superficial vessel density >8% and deep vessel density >10% may be considered as real clinical change rather than variation.
Endoscopic Corneal Neurotization: Cadaver Feasibility Study
Authors: Leyngold Ilya , Weller Christopher , Leyngold Mark , Espana Edgar , Black Kaelan D. , Hall Kathryn L. , Tabor Mark
Published: May 2017

Purpose:

The authors describe a cadaver feasibility study investigating a minimally invasive technique for corneal neurotization with the supraorbital nerve harvested endoscopically.

Methods:

A cadaver study was performed to investigate the technical feasibility of corneal neurotization via endoscopic supraorbital nerve transfer to the corneoscleral limbus.

Results:

Endoscopic corneal neurotization was successfully performed on each cadaveric hemiface.

Conclusion:

The use of an endoscope allows for a minimally invasive approach to corneal neurotization with the supraorbital nerve.
Syndromic and Nonsyndromic Systemic Associations of Congenital Lacrimal Drainage Anomalies: A Major Review
Authors: Ali Mohammad Javed , Paulsen Friedrich
Published: May 2017

Purpose:

To review and summarize the syndromic, nonsyndromic, and systemic associations of congenital lacrimal drainage anomalies.

Methods:

The authors performed a PubMed search of all articles published in English on congenital lacrimal anomalies (1933–2016). Patients of these articles were reviewed along with the literature of direct references to syndromes and other systemic associations. Data reviewed included syndromic descriptions, systemic details, demographics, lacrimal presentations, management, and outcomes.

Results:

Syndromic and systemic associations with congenital lacrimal drainage disorders are not known to be common. Although familial presentations have been reported, the inheritance patterns are unclear for most anomalies. There is an increasingly growing evidence of a genetic basis to many lacrimal anomalies. However, few syndromes have either widespread or are frequently associated with lacrimal anomalies. Few sequences of distinct lacrimal presentations and intraoperative findings are seen. Surgical challenges in these patients are distinct and a thorough pre and intraoperative anatomical assessment, detailed imaging when indicated, and assessment and correction of associated periocular and facial abnormalities may facilitate good outcomes.

Conclusions:

Lacrimal drainage anomalies associated with syndromic and nonsyndromic systemic conditions have certain unique features of their own and their surgical and anesthesia challenges are distinct. Diagnosis of congenital lacrimal drainage anomalies should prompt consideration of the possible presence of associated systemic abnormalities.
Stratifying patients with peripheral neuropathic pain based on sensory profiles: algorithm and sample size recommendations
Authors: Vollert Jan , Maier Christoph , Attal Nadine , Bennett David L.H. , Bouhassira Didier , Enax-Krumova Elena K. , Finnerup Nanna B. , Freynhagen Rainer , Gierthmühlen Janne , Haanpää Maija , Hansson Per , Hüllemann Philipp , Jensen Troels S. , Magerl Walter , Ramirez Juan D. , Rice Andrew S.C. , Schuh-Hofer Sigrid , Segerdahl Märta , Serra Jordi , Shillo Pallai R. , Sindrup Soeren , Tesfaye Solomon , Themistocleous Andreas C. , Tölle Thomas R. , Treede Rolf-Detlef , Baron Ralf
Published: May 2017

In a recent cluster analysis, it has been shown that patients with peripheral neuropathic pain can be grouped into 3 sensory phenotypes based on quantitative sensory testing profiles, which are mainly characterized by either sensory loss, intact sensory function and mild thermal hyperalgesia and/or allodynia, or loss of thermal detection and mild mechanical hyperalgesia and/or allodynia. Here, we present an algorithm for allocation of individual patients to these subgroups. The algorithm is nondeterministic—ie, a patient can be sorted to more than one phenotype—and can separate patients with neuropathic pain from healthy subjects (sensitivity: 78%, specificity: 94%). We evaluated the frequency of each phenotype in a population of patients with painful diabetic polyneuropathy (n = 151), painful peripheral nerve injury (n = 335), and postherpetic neuralgia (n = 97) and propose sample sizes of study populations that need to be screened to reach a subpopulation large enough to conduct a phenotype-stratified study. The most common phenotype in diabetic polyneuropathy was sensory loss (83%), followed by mechanical hyperalgesia (75%) and thermal hyperalgesia (34%, note that percentages are overlapping and not additive). In peripheral nerve injury, frequencies were 37%, 59%, and 50%, and in postherpetic neuralgia, frequencies were 31%, 63%, and 46%. For parallel study design, either the estimated effect size of the treatment needs to be high (>0.7) or only phenotypes that are frequent in the clinical entity under study can realistically be performed. For crossover design, populations under 200 patients screened are sufficient for all phenotypes and clinical entities with a minimum estimated treatment effect size of 0.5.
The effects of diet and lifestyle interventions on insulin resistance in patients with nonalcoholic fatty liver disease: a systematic review
Authors: Paris Tonya , George Elena S. , Roberts Stuart K. , Tierney Audrey C.
Published: May 2017

Nonalcoholic fatty liver disease (NAFLD) results from excessive fat accumulation in the liver in the absence of excessive alcohol consumption. Insulin resistance (IR) is proposed to be an underlying pathogenic factor in the development and progression of disease. There are currently no proven pharmacotherapies and weight loss is the only prescribed treatment despite a lack of evidence to support a specific diet or lifestyle therapy. The aim of this review is to evaluate the efficacy of dietary lifestyle interventions on IR measured by Homeostasis model assessment in patients with NAFLD. A systematic electronic search of Medline, Scopus, The Cochrane Library, CINAHL and PubMed databases (1999–2015) was performed by two independent reviewers. Randomized control trials evaluating the efficacy of diet and lifestyle interventions on IR in adults diagnosed with NAFLD were included. A total of 6441 articles were identified; eight randomized control trials fulfilled the inclusion criteria. Three studies involved dietary interventions and five incorporated diet and exercise. The majority of intervention groups resulted in significant reductions in IR, with no significant changes observed in the control groups. Lifestyle interventions compared with controls reduced IR measured by homeostasis model assessment. All diet and diet and lifestyle intervention trials were efficient in reducing IR in participants with NAFLD. A lack of literature and variation across interventions warrants the need for extensive research to establish firm dietary lifestyle recommendations.
Nonalcoholic fatty liver disease can be predicted by retinal vascular changes in patients with obesity without hypertension or diabetes
Authors: Romero-Ibarguengoitia Maria E. , Herrera-Rosas Arturo , Domínguez-Mota Alfredo A. , Camas-Benitez Jinny T. , Serratos-Canales María F. , León-Hernández Mireya , González-Chávez Antonio , López-Ortiz Eduardo , Mummidi Srinivas , Duggirala Ranvidranth , López-Alvarenga Juan C.
Published: May 2017

Objective

To evaluate the utility of predicting nonalcoholic fatty liver disease (NAFLD) and obesity by retinal vascular changes (RVC) found in fundoscopy and to determine whether this is related to a low-grade inflammatory process.

Methods

We carried out a cross-sectional analysis that included 152 (ages 18–45 years) patients divided into four groups: NAFLD and BMI less than 25, absence of NAFLD and BMI less than 25, NAFLD and BMI more than 30, and absence of NAFLD and BMI more than 30. Retinal fundoscopy, hepatic ultrasound, metabolic profile, and cytokine measurement were performed. We calculated odds ratio [95% confidence interval (CI)], performed diagnostic utility tests, and carried out a 2
k
factorial analysis.

Results

Obesity was associated with RVC (odds ratio: 21.25; 95% CI: 8.79–51.4) and NAFLD [25 (9.07–72.6)]. NAFLD was associated with RVC [11.24 (4.98–26.48)], and the prediction of NAFLD showed a sensitivity of 75% (95% CI: 68–82) and a specificity of 81% (75–86); when RVC-obesity were combined, sensitivity increased to 90% (88–91.7), with a specificity of 85% (84–85.8). C-reactive protein was associated with the three factors, suggesting an independent contribution. Thin patients with RVC and NAFLD had higher concentrations of interleukin-2, interleukin-6, tumor necrosis factor-α, and interferon-γ.

Conclusion

NAFLD in patients with obesity without diabetes or hypertension can be predicted by RVC, a noninvasive technique carried out by eye fundoscopy. NAFLD alone can drive inflammatory conditions in the absence of obesity that manifests as RVC.
Epidemiology of pancreatic cancer in France: descriptive study from the French national hospital database
Authors: Maire Frédérique , Cibot Jean-Olivier , Compagne Catherine , Hentic Olivia , Hammel Pascal , Muller Nelly , Ponsot Philippe , Levy Philippe , Ruszniewski Philippe
Published: May 2017

Introduction

Although indirect evidence suggests that the incidence of pancreatic adenocarcinoma has increased in the last decade, few data are available in European countries. The aim of the present study was to update the epidemiology of pancreatic cancer in France in 2014 from the French national hospital database (Programme de Médicalisation des Systèmes d’Information).

Patients and methods

All patients hospitalized for pancreatic cancer in France in 2014 in public or private institutions were included. Patient and stays (length, type of support, institutions) characteristics were studied. The results were compared with those observed in 2010.

Results

A total of 13 346 (52% men, median age 71 years) new patients were treated for pancreatic cancer in 2014, accounting for a 12.5% increase compared with 2010. Overall, 22% of patients were operated on. Liver metastases were present in 60% of cases. The disease accounted for 146 680 hospital stays (+24.8% compared with 2010), 76% of which were related to chemotherapy (+32%). The average annual number and length of stay were 7 and 2.6 days, respectively. In 2014, 11 052 deaths were reported (+15.8%).

Conclusion

Approximately 13 350 new cases of pancreatic cancer were observed in France in 2014. The increase in incidence was associated with a marked increase in hospital stays for chemotherapy.
Increased Fat Absorption From Enteral Formula Through an In‐line Digestive Cartridge in Patients With Cystic Fibrosis
Authors: Freedman Steven , Orenstein David , Black Philip , Brown Perry , McCoy Karen , Stevens John , Grujic Danica , Clayton Russell
Published: May 2017

Objectives:

Supplemental enteral nutrition (EN) is used by approximately 12% of people with cystic fibrosis (CF). The objective of this study was to evaluate the safety, tolerability, and fat absorption of a new in‐line digestive cartridge (Relizorb) that hydrolyzes fat in enteral formula provided to patients with CF.

Methods:

Patients with CF receiving EN participated in a multicenter, randomized, double‐blind, crossover trial with an open‐label safety evaluation period. Plasma omega‐3 fatty acid (FA) concentrations were measured and used as markers of fat absorption. Gastrointestinal symptoms were recorded to evaluate safety and tolerability. Information regarding the effect of EN on appetite and breakfast consumption was also collected.

Results:

Before study entry, participants had received EN for a mean of 6.6 years at a mean volume of approximately 800 mL, yet had a mean body mass index of only 17.5 kg/m2 and omega‐3 FA plasma concentrations were only 60% of levels found in normal healthy subjects. Compared with placebo, cartridge use resulted in a statistically significant 2.8‐fold increase in plasma omega‐3 FA concentrations. There were no adverse experiences associated with cartridge use, and a decrease in the frequency and severity of most symptoms of malabsorption was observed with cartridge use. Participants reported increased preservation of appetite and breakfast consumption with cartridge use compared with their pre‐study regimen.

Conclusions:

Use of this in‐line digestive cartridge was safe and well tolerated, and resulted in significantly increased levels of plasma omega‐3 FA used with enteral formula, suggesting an overall increased fat absorption.
Effect of Synbiotic on the Gut Microbiota of Cesarean Delivered Infants
Authors: Chua Mei Chien , Ben‐Amor Kaouther , Lay Christophe , Goh Anne E.N. , Chiang Wen Chin , Rao Rajeshwar , Chew Charmaine , Chaithongwongwatthana Surasith , Khemapech Nipon , Knol Jan , Chongsrisawat Voranush
Published: May 2017

We determined the effect of short‐chain galacto‐oligosaccharides (scGOS), long‐chain fructo‐oligosaccharides (lcFOS) and Bifidobacterium breve M‐16V on the gut microbiota of cesarean‐born infants. Infants were randomized to receive a standard formula (control), the same with scGOS/lcFOS and B. breve M‐16V (synbiotic), or with scGOS/lcFOS (prebiotic) from birth until week 16, 30 subjects born vaginally were included as a reference group. Synbiotic supplementation resulted in a higher bifidobacteria proportion from day 3/5 (P < 0.0001) until week 8 (P = 0.041), a reduction of Enterobacteriaceae from day 3/5 (P = 0.002) till week 12 (P = 0.016) compared to controls. This was accompanied with a lower fecal pH and higher acetate. In the synbiotic group, B. breve M‐16V was detected 6 weeks postintervention in 38.7% of the infants. This synbiotic concept supported the early modulation of Bifidobacterium in C‐section born infants that was associated with the emulation of the gut physiological environment observed in vaginally delivered infants.
Evaluation of a Low-Light Intervention—Starlight Therapy—for Agitation, Anxiety, Restlessness, Sleep Disturbances, Dyspnea, and Pain at End of Life
Authors: Emerson Kathleen , Murphy Mary , Quinlin Linda , O'Malley Patricia , Hayes Kathleen
Published: May 2017

Negative symptoms at the end of life are distressing for both the patient and family. Effective management of both physical and psychological symptoms improves quality of life and well-being, but intervention strategies are not always effective or feasible and often are exclusively pharmacologic. Developing treatment plans to meet symptom management needs is critical. A 2-site research study was conducted in southwest Ohio assessing effectiveness of Starlight Therapy in treating the negative symptoms associated with end of life. The study of 40 patients found the Starlight Therapy effective in treating the symptoms of anxiety, agitation, dyspnea, insomnia, and pain in 90% of the patients within a 30-minute period. The therapy was ineffective in only 4 patients. Physiological symptoms were measured upon initiating Starlight Therapy, 30 minutes after therapy, and 2 hours after therapy. Results found heart rate and respiratory rate significantly different from baseline to 30 minutes and from baseline to 2 hours (P < .05). Heart rate and respiratory rate were not significantly different from 30 minutes to 2 hours (P > .05). Further research is required to explore additional types of care, subjects, and sites, which could benefit from Starlight Therapy.
Hospice-Appropriate Universal Precautions for Opioid Safety
Authors: Covington-East Catherine
Published: May 2017

Universal precautions for opioid safety, analogous to universal precautions for infection control, is one approach to managing the epidemic of prescription pain medication misuse that has been used in pain clinics, primary care practices, and in some hospices. In this project, a set of hospice-appropriate universal precautions was designed, drawing on hospice nursing strengths, and implemented in a midsize hospice agency.
Evaluating End-of-Life Care Education Within Nursing Programs
Authors: Lippe Megan , Volker Deborah , Jones Terry , Carter Patricia
Published: May 2017

Many nurses report feeling ill prepared through their formal education to competently care for dying patients and their families. These deficits signal a need for curricular reform; however, current practices in the provision of palliative and end-of-life (EOL) care education must first be systematically evaluated to guide these reforms. This article will share the findings of a pilot study in which the context, input, process, and product evaluation model was used to guide a detailed evaluation of palliative and EOL care education within a baccalaureate nursing program. Critical aspects of palliative and EOL care education were identified from a decomposition of the End-of-Life Nursing Education Consortium (ELNEC) core curriculum. From the decomposition, a new instrument was developed and completed by nursing faculty members teaching in 1 baccalaureate program. Faculty members identified the ELNEC topics that were taught, the courses within which the content was provided, and the associated teaching methods used. Overall, 95.3% of ELNEC core curriculum content was included in the program; however, great interinstructor variability was noted. Clinical conference discussion/debriefing and lecture were most frequently used to teach ELNEC content. The content was addressed throughout the curriculum, particularly in ethics and aging didactic courses. Implications of the findings for future educational research are discussed.
The Doctrine of Double Effect
Authors: Wholihan Dorothy , Olson Ellen
Published: May 2017

Nurses on the front lines of palliative care are frequently presented with ethically challenging situations involving the use of palliative sedation and increasing opioids at the end of life. The doctrine of double effect is an ethical principle dating back to the 13th century that explains how the bad consequences of an action can be considered ethically justified if the original intent was for good intention. This article examines the doctrine of double effect through case examples and presents supporting and opposing opinions about its relevance to clinical practice. Implications for nursing care are discussed.
Reframing Nursing Preceptor Development
Authors: Senyk Johanna , Staffileno Beth A.
Published: May 2017

High preceptor turnover and mandates for cost efficiency in a rapidly changing healthcare environment require innovative approaches for developing and supporting nurse preceptors. Responding to new organizational strategic and cost containment initiatives, a quality improvement project was initiated that combined several evidence-based approaches to align traditional processes and programs. The resultant preceptor development program decreased costs and standardized processes. It also showed improved learning and preceptor satisfaction and increased educational, networking, and recognition opportunities.
Scope It Out
Authors: Price M. Greta
Published: May 2017

It has been nearly a year since the third edition of the Nursing Professional Development: Scope and Standards of Practice was released. During that time, many nursing professional development (NPD) departments across the nation have incorporated this foundational document into their practice. This column describes the activities of one NPD department to align their scope of practice with the NPD scope and standards and optimize their contributions to their organization.
Creating a Novel Online Digital Badge-Awarding Program in Patient Navigation to Address Healthcare Access
Authors: Rohan Annie J. , Fullerton Judith , Escallier Lori A. , Pati Susmita
Published: May 2017

A novel, sustainable digital badge-awarding online course was developed to prepare learners with familiarity of patient navigation. Learners offered favorable endorsement of essentially all elements of the program, especially the utility of the Blackboard learning management software program. Quality Matters standards provided a rigorous framework for the challenges of designing, implementing, and evaluating online curricula. Online education is an effective method for meeting the professional development needs of those seeking careers in care coordination/patient navigation.
Diagnostic confounders of chronic widespread pain: not always fibromyalgia
Authors: Häuser Winfried , Perrot Serge , Sommer Claudia , Shir Yoram , Fitzcharles Mary-Ann
Published: May 2017

Introduction:

Chronic widespread pain (CWP) is the defining feature of fibromyalgia (FM), a worldwide prevalent condition. Chronic widespread pain is, however, not pathognomonic of FM, and other conditions may present similarly with CWP, requiring consideration of a differential diagnosis.

Objectives:

To conduct a literature search to identify medical conditions that may mimic FM and have highlighted features that may differentiate these various conditions from FM.

Methods:

A comprehensive literature search from 1990 through September 2016 was conducted to identify conditions characterized by CWP.

Results:

Conditions that may mimic FM may be categorized as musculoskeletal, neurological, endocrine/metabolic, psychiatric/psychological, and medication related. Characteristics pertaining to the most commonly identified confounding diagnoses within each category are discussed; clues to enable clinical differentiation from FM are presented; and steps towards a diagnostic algorithm for mimicking conditions are presented.

Conclusion:

Although the most likely reason for a complaint of CWP is FM, this pain complaint can be a harbinger of illness other than FM, prompting consideration of a differential diagnosis. This review should sensitize physicians to a broad spectrum of conditions that can mimic FM.