bluuebunny/crossref_metadata_2025 huggingface dataset:
Rituals of recognition: Interactions and interaction rules in sheltered workshops in the Netherlands
Authors: Sebrechts Melissa , Tonkens Evelien , Bröer Christian
Published: May 2018

Recent decades have witnessed mounting attention to the theme of recognition, both in public policy and in the academic world. Scholarly debate on recognition is dominated by philosophers, while the policy debate is dominated by political and educational perspectives. A sociological perspective has scarcely been developed. In this article, we approach recognition as a sociological phenomenon with the aid of Collins’ theory of Interaction Ritual Chains. Our research is located in three Dutch sheltered workshops that aim to provide recognition through work to young men with mild intellectual disabilities. While Collins provides an interesting interactional perspective to distinguish between different situations of recognition, we add an institutional dimension by showing how individualising labour-market policies and care practices articulate a set of ‘interaction rules’ that encourage some recognition rituals and foreclose others. This demonstrates the importance of a sociological contribution to the debate on recognition, and points to ‘unintended consequences’ of policies that aim to strengthen recognition in ways that in fact cannot be achieved by those involved. Such a sociological perspective can bring out more practical and nuanced accounts of recognition, and enrich both scholarly and policy debates on this topic.
A Type-2 Fuzzy Based Interval-Stochastic Risk Management Programming Model for Identifying Sustainable Water Resources Allocation Policies
Authors: Liu J , Li Y P
Published: May 2018

In this study, a type-2 fuzzy based interval-stochastic risk management programming (TISRM) method is proposed for optimal irrigation water resources allocation associated with multiple uncertainties expressed as interval numbers, probability distributions, and type-2 fuzzy sets. TISRM can also reflect authorities’ attitudes towards system risk using a financial risk management measure by controlling the variability of the recourse cost. The developed method is applied to irrigation water resources allocation for the Zhangweinan River Basin in China. Solutions of irrigation water allocation under different probability distributions and confidence levels are generated. Results reveal that system benefit and satisfaction degree would decrease with the raised λ levels; the CVaR values would change with the increment of λ and β levels as well as the varied cases; the irrigation targets of all crops in all subareas are reach their lower bounds; the irrigation deficits would be different with risk levels and cases. The results can help the local authority to adjust the current food security policy.
Estimating the Impact of Drought on Agriculture Using the U.S. Drought Monitor
Authors: Kuwayama Yusuke , Thompson Alexandra , Bernknopf Richard , Zaitchik Benjamin , Vail Peter
Published: May 2018

We estimate the impacts of drought, as defined by the U.S. Drought Monitor (USDM), on crop yields and farm income in the United States during the 2001–2013 time period. Our empirical strategy relies on panel data models with fixed effects that exploit spatial and temporal variability in drought conditions and agricultural outcomes at the county level. We find negative and statistically significant effects of drought on crop yields equal to reductions in the range of 0.1% to 1.2% for corn and soybean yields for each additional week of drought in dryland counties, and 0.1% to 0.5% in irrigated counties. Region‐specific results vary, with some regions experiencing no yield impacts from drought, while yield reductions as high as 8.0% are observed in dryland counties in the Midwest for every additional week of drought in the highest USDM severity category. Despite this impact on crop yields, we find that additional weeks of drought have little to no effect on measures of farm income. While precipitation and temperature explain most of the variability in crop yields, we find that the USDM captures additional negative impacts of drought on yields.
Jwalk and MNXL web server: model validation using restraints from crosslinking mass spectrometry
Authors: Bullock Joshua M A , Thalassinos Konstantinos , Topf Maya
Published: May 2018

Motivation

Crosslinking Mass Spectrometry generates restraints that can be used to model proteins and protein complexes. Previously, we have developed two methods, to help users achieve better modelling performance from their crosslinking restraints: Jwalk, to estimate solvent accessible distances between crosslinked residues and MNXL, to assess the quality of the models based on these distances.

Results

Here, we present the Jwalk and MNXL webservers, which streamline the process of validating monomeric protein models using restraints from crosslinks. We demonstrate this by using the MNXL server to filter models made of varying quality, selecting the most native-like.

Availability and implementation

The webserver and source code are freely available from jwalk.ismb.lon.ac.uk and mnxl.ismb.lon.ac.uk.

Supplementary information

Supplementary data are available at Bioinformatics online.
Development and evaluation of a deep learning model for protein–ligand binding affinity prediction
Authors: Stepniewska-Dziubinska Marta M , Zielenkiewicz Piotr , Siedlecki Pawel
Published: May 2018

Motivation

Structure based ligand discovery is one of the most successful approaches for augmenting the drug discovery process. Currently, there is a notable shift towards machine learning (ML) methodologies to aid such procedures. Deep learning has recently gained considerable attention as it allows the model to ‘learn’ to extract features that are relevant for the task at hand.

Results

We have developed a novel deep neural network estimating the binding affinity of ligand–receptor complexes. The complex is represented with a 3D grid, and the model utilizes a 3D convolution to produce a feature map of this representation, treating the atoms of both proteins and ligands in the same manner. Our network was tested on the CASF-2013 ‘scoring power’ benchmark and Astex Diverse Set and outperformed classical scoring functions.

Availability and implementation

The model, together with usage instructions and examples, is available as a git repository at http://gitlab.com/cheminfIBB/pafnucy.

Supplementary information

Supplementary data are available at Bioinformatics online.
Ocular Chlamydia trachomatis Infection Under the Surgery, Antibiotics, Facial Cleanliness, and Environmental Improvement Strategy in Amhara, Ethiopia, 2011–2015
Authors: Nash Scott D , Stewart Aisha E P , Zerihun Mulat , Sata Eshetu , Gessese Demelash , Melak Berhanu , Endeshaw Tekola , Chanyalew Melsew , Chernet Ambahun , Bayissasse Belay , Moncada Jeanne , Lietman Thomas M , Emerson Paul M , King Jonathan D , Tadesse Zerihun , Callahan E Kelly
Published: May 2018

Background

World Health Organization (WHO) recommendations for starting and stopping mass antibiotic distributions are based on a clinical sign of trachoma, which is indirectly related to actual infection with the causative agent, Chlamydia trachomatis.

Methods

This study aimed to understand the effect of SAFE (surgery, antibiotics, facial cleanliness, and environmental improvement) interventions on ocular chlamydia in Amhara, Ethiopia, by describing the infection prevalence in a population-based sample of children aged 1–5 years. Trachoma surveys were conducted in all districts of Amhara, from 2011 to 2015 following approximately 5 years of SAFE. Ocular swabs were collected from randomly selected children to estimate the zonal prevalence of chlamydial infection. The Abbott RealTime polymerase chain reaction assay was used to detect C. trachomatis DNA.

Results

A total of 15632 samples were collected across 10 zones of Amhara. The prevalence of chlamydial infection in children aged 1–5 years was 5.7% (95% confidence interval, 4.2%–7.3%; zonal range, 1.0%–18.5%). Chlamydial infection and trachomatous inflammation–intense (TI) among children aged 1–9 years were highly correlated at the zonal level (Spearman correlation [r] = 0.93; P < .001), while chlamydial infection and trachomatous inflammation–follicular were moderately correlated (r = 0.57; P = .084).

Conclusions

After 5 years of SAFE, there is appreciable chlamydial infection in children aged 1–5 years, indicating that transmission has not been interrupted and that interventions should continue. The sign TI was highly correlated with chlamydial infection and can be used as a proxy indicator of infection.
Association of Cutibacterium avidum Colonization in the Groin With Obesity: A Potential Risk Factor for Hip Periprosthetic Joint Infection
Authors: Böni Laura , Kuster Stefan P , Bartik Bianka , Zbinden Reinhard , Zingg Patrick O , Achermann Yvonne
Published: May 2018

Background

An increase in the incidence of hip periprosthetic joint infections caused by Cutibacterium avidum has recently been detected after hip arthroplasty with an anterior surgical approach. We raised the question of whether skin colonization with C. avidum differs between the anterior and the lateral thigh as areas of surgical incision fields.

Methods

Between February and June 2017, we analyzed skin scrapings from the groin and the anterior and lateral thigh in patients undergoing a primary hip arthroplasty. We anaerobically cultured plated swab samples for Cutibacterium spp. for ≥7 days. Univariate logistic regression analysis was used to explore associations between body mass index (BMI) and colonization rate at different sites.

Results

Twenty-one of 65 patients (32.3%) were colonized with C. avidum at any site, mainly at the groin (n = 16; 24.6%), which was significantly higher at the anterior (n = 5; 7.7%; P = .009) or lateral (n = 6; 9.2%; P = .02) thigh. Patients colonized with C. avidum did not differ from noncolonized patients in age or sex, but their BMIs were significantly higher (30.1 vs 25.6 kg/m2, respectively; P = .02). Furthermore, increased BMI was associated with colonization at the groin (odds ratio per unit BMI increase, 1.15; 95% confidence interval; 1.03–1.29; P = .01).

Conclusions

The groin, rather than the anterior thigh, showed colonization for C. avidum in obese patients. Further studies are needed to evaluate current skin disinfection and draping protocols for hip arthroplasty, particularly in obese patients.
Benefits of Caloric Restriction in Longevity and Chemical-Induced Tumorigenesis Are Transmitted Independent of NQO1
Authors: Diaz-Ruiz Alberto , Di Francesco Andrea , Carboneau Bethany A , Levan Sophia R , Pearson Kevin J , Price Nathan L , Ward Theresa M , Bernier Michel , de Cabo Rafael , Mercken Evi M
Published: May 2018

Caloric restriction (CR) is the most potent nonpharmacological intervention known to both protect against carcinogenesis and delay aging in laboratory animals. There is a growing number of anticarcinogens and CR mimetics that activate NAD(P)H:quinone oxidoreductase 1 (NQO1). We have previously shown that NQO1, an antioxidant enzyme that acts as an energy sensor through modulation of intracellular redox and metabolic state, is upregulated by CR. Here, we used NQO1-knockout (KO) mice to investigate the role of NQO1 in both the aging process and tumor susceptibility, specifically in the context of CR. We found that NQO1 is not essential for the beneficial effects of CR on glucose homeostasis, physical performance, metabolic flexibility, life-span extension, and (unlike our previously observation with Nrf2) chemical-induced tumorigenesis.
eHealth and adolescents in Serbia: psychometric properties of eHeals questionnaire and contributing factors to better online health literacy
Authors: Gazibara Tatjana , Cakic Jelena , Cakic Milica , Pekmezovic Tatjana , Grgurevic Anita
Published: May 2018

Internet is important resource of health-related information and health services. Factors associated with higher level of online health (eHealth) literacy among adolescence have been understudied. The aim of this study was to assess psychometric properties of the eHealth Literacy Scale (eHEALS) in Serbian language and to evaluate eHealth literacy among adolescents in Serbia. The study was carried out in four high schools in Belgrade, Serbia in the period December 2016 to January 2017. A total of 702 students comprised the study sample. The eHEALS was translated according to internationally accepted methodology and its psychometric properties were analyzed. The Cronbach’s alpha coefficient for the entire eHEALS was 0.849. On exploratory factor analysis we obtained two-factorial structure. Our adolescents reported low confidence in knowing what health resources are available online. High confidence was observed for knowing how to use and how to find health information online. There was no difference in eHEALS score between genders or between school years. After adjustment for gender, type of school program, parental marital status, fathers’ education level and household income, being female was associated with higher eHealth literacy (B = 1.12, 95% confidence interval 0.07–2.18; p = 0.036). Serbian version of the eHEALS is a valid instrument in assessment of online health literacy and can be further used in evaluation of eHealth literacy in other population groups in Serbian language. It is advised that some classes in school are dedicated to appraisal and use of online health websites. This could be achieved through peer-education.
Components of Affine Springer Fibers
Authors: Tsai Cheng-Chiang
Published: May 2018

Let G be a connected split reductive group over a field of characteristic zero or sufficiently large characteristic, $\gamma _0\in (\operatorname{Lie}\mathbf{G})((t))$ be any topologically nilpotent regular semisimple element, and $\gamma =t\gamma _0$. Using methods from p-adic orbital integrals, we show that the number of components of the Iwahori affine Springer fiber over $\gamma$ modulo $Z_{\mathbf{G}((t))}(\gamma )$ is equal to the order of the Weyl group.
Perioperative Multimodal Evaluation and Surgical Tactics of Tumor-Related Epilepsy: 2-Dimensional Operative Video
Authors: Ma Chengxin , Feng Rui , Hameed N U Farrukh , Zhang Jie , Zhuang Dongxiao , Wu Jinsong
Published: May 2018

Treatment of tumor-related epilepsy (TRE), especially for tumors near critical areas, requires surgeons to strike a balance between the epileptic benefit and functional outcome after surgery. Here, we present a case in which multimodal evaluation facilitated the achievement of such surgical balance. Informed patient consent was obtained.

 A 17-yr-old female presented with seizure attacks for 2 yr. Magnetic resonance imaging (MRI) revealed a right parietal mass lesion with hypointense signal on T1W imaging, hyperintense signal on T2W imaging, and homogeneous enhancement. Carbamazepine and valproate administration were unable to control the intermittent seizures. From the patient's history and imaging, the initial diagnosis was refractory TRE.

 Whether lesionectomy would achieve seizure freedom in this case was not certain. Therefore, dESI (dense array EEG source imaging) was used to localize the epileptic zone preoperatively; results showed that the epileptic zone was very close to the lesion in the primary motor cortex. Surgery was carried out under awake-anesthesia, with the aid of multimodal neuronavigation, intraoperative neurophysiological monitoring, and intraoperative MRI evaluation. A gross total lesion resection was achieved while preserving critical motor areas. Histopathology revealed ganglioglioma grade I diagnosis. No motor deficits following surgery were detected except slight increase of muscle tension in the right lower limb. At 6-mo follow-up, the patient was without any motor impairment or any other neurological deficits and completely seizure-free with the antiepileptic drug Carbamazepine 1200 mg/day.
Early Rainfall Shocks and Later-Life Outcomes: Evidence from Colombia
Authors: Carrillo Bladimir
Published: May 2018

This paper uses birth cohorts spanning several hundred locations over 40 years to examine the long-term consequences of in utero exposure to abnormal rainfall events in Colombia. The identification strategy exploits exogenous variation in extreme droughts or floods experienced by individuals while in utero in their birth location. The results indicate that individuals prenatally exposed to adverse rainfall shocks are more likely to report serious mental illness, have fewer years of schooling, display increased rates of illiteracy, and are less likely to work. These results are larger in magnitude for individuals born in areas with a higher risk of malaria, which is consistent with the notion that exposure to infectious and parasitic diseases may play an important role.
Evaluation of the TOM-CAST Forecasting Model in Asparagus for Management of Stemphylium Leaf Spot in Ontario, Canada
Authors: Foster Jennifer M. , McDonald Mary Ruth
Published: May 2018

In the last 5 years, asparagus acreage in Canada has increased by over 25%. Stemphylium leaf spot, caused by Stemphylium vesicarium, has emerged as the predominant foliar pathogen of asparagus. Typically, contact fungicides are applied every 14 days; however, regardless of the number of applications, growers are not achieving adequate control of the disease. The TOM-CAST forecasting model is used widely in Michigan asparagus fields, but it has never been assessed for suitability in Ontario or in the popular cultivar, Guelph Millennium. Six field trials were conducted in 2012 and 2013 to evaluate the TOM-CAST forecasting model in two asparagus cultivars. The fungicides chlorothalonil or azoxystrobin/difenoconazole were applied according to the forecasting model or on a 14-day interval. The effectiveness of the forecasting model differed between sites and cultivars. Even though TOM-CAST is used in all cultivars in Michigan, TOM-CAST was not effective on Guelph Millennium. In the cultivar Jersey Giant, however, TOM-CAST with a 20 disease severity value spray interval improved control of Stemphylium leaf spot without increasing the number of sprays, compared with a 14-day treatment. The results in Guelph Millennium differed between sites. At one site, TOM-CAST maintained similar levels of Stemphylium leaf spot, but increased the number of applications, compared with a 14-day application interval. Of more concern, none of the fungicide treatments differed greatly from the untreated control at the other site. Our results show that forecasting models need to be validated locally in asparagus cultivars relevant to production today.
Resistance of Potato Breeding Clones and Cultivars to Three Species of Potato Cyst Nematode
Authors: Whitworth Jonathan L. , Novy Richard G. , Zasada Inga A. , Wang Xiaohong , Dandurand Louise-Marie , Kuhl Joseph C.
Published: May 2018

In the United States, potato cyst nematodes Globodera rostochiensis and G. pallida are quarantined pests. A new cyst nematode species, Globodera ellingtonae, discovered in Oregon and Idaho, reproduces well on potato but is not currently a quarantine pest. Identifying resistance to all three Globodera spp. would provide a valuable management tool. Thirteen breeding clones and nine cultivars were evaluated in Oregon, Idaho, and New York laboratories where the nematode populations are maintained. Minitubers or tissue culture plants were planted into pots and inoculated with eggs in replicated experiments. Results indicated that five entries were partially resistant or resistant to all three species, while another five were resistant or partially resistant to G. rostochiensis and G. ellingtonae. Resistance to G. rostochiensis pathotypes Ro1 and Ro4 is controlled by the H1 gene and this study suggests that H1 may confer resistance to G. ellingtonae as well. Observed resistance to G. pallida was lower relative to the levels of resistance observed for G. rostochiensis and G. ellingtonae. Germplasm with G. pallida or G. ellingtonae resistance will be used in hybridizations to develop russet-skinned cultivars with long tubers which represent the predominant market class in western U.S. production, and to further explore the basis of potato resistance to Globodera spp.
Development of Infectious cDNA Clones of Citrus Yellow Vein Clearing Virus Using a Novel and Rapid Strategy
Authors: Cui Tiantian , Bin Yu , Yan Jianhong , Mei Pengying , Li Zhongan , Zhou Changyong , Song Zhen
Published: May 2018

Yellow vein clearing disease (YVCD) causes significant economic losses in lemon and other species of citrus. Usually, citrus yellow vein clearing virus (CYVCV) is considered to be the causal agent of YVCD. However, mixed infection of CYVCV and Indian citrus ringspot virus (ICRSV) or other pathogens is often detected in citrus plants with YVCD. In this study, we re-examined the causal agent of YVCD to fulfill Koch’s postulates. First, the full-length genome of CYVCV isolate AY (CYVCV-AY) was amplified by long-distance RT-PCR from a Eureka lemon (Citrus limon) tree with typical YVCD symptoms. The genomic cDNAs were then cloned into a ternary Yeast-Escherichia coli-Agrobacterium tumefaciens shuttle vector, pCY, using transformation-associated recombination (TAR) strategy, and 15 full-length cDNA clones of CYVCV-AY were obtained. Subsequently, four of these clones were selected randomly and inoculated on Jincheng (C. sinensis) seedlings through Agrobacterium-mediated vacuum-infiltration, and it was found that 80 to 100% of inoculated plants were infected with CYVCV by RT-PCR at 20 to 40 days postinoculation (dpi) and by direct tissue blot immunoassay at 60 dpi. The progeny of CYVCV-AY from cDNA clones caused typical symptoms of YVCD such as yellow vein clearing, leaf distortion, and chlorosis, which were the same as that elicited by wild-type virus. Finally, the regeneration of CYVCV-AY genome was confirmed by long-distance RT-PCR in lemon trees inoculated with the infectious cDNA clone. These results proved that CYVCV was the primary causal agent of YVCD. This is the first report on the development of infectious cDNA clones of CYVCV, which lays the foundation for further studies on viral gene functions and virus−host interactions.
Ecological Regulation of Black Leaf Streak Disease Driven by Plant Richness in Banana Agroecosystems
Authors: Poeydebat Charlotte , Carval Dominique , Tixier Philippe , Daribo Marie-Odette , De Bellaire Luc De Lapeyre
Published: May 2018

Black leaf streak disease (BLSD), caused by the fungus Mycosphaerella fijiensis, is an important threat to banana production. Although its control relies on costly and unsustainable use of fungicides, ecological regulation of BLSD linked to field-scale plant diversity has received little attention. We monitored banana phytometers in plots in banana-based fields where no fungicides were applied. Within each plot, we measured plant richness in three strata, canopy openness, necrotic leaf removal, Musa abundance and richness. We quantified ecological regulation of five BLSD parameters (inoculum sources, spore abundance, lesion density, incubation time, and the area under the disease progression curve) and identified, using structural equation modeling, the characteristics of the plant community and the mechanisms likely responsible for the regulation. Regulation occurred, but most effectively before lesion formation, and was mainly related to plant richness between 1.5 and 5m high. A barrier effect, rather than a dilution effect, more likely limited spore abundance. Our results support the hypothesis that the potential effects of plant richness on leaf-scale microclimate variability and on the diversity of epiphyllic microorganisms are involved in the regulation of incubation time and lesion density. Field-scale management of plant diversity may be a promising lever to foster ecological regulation of BLSD.
Mortality Measures to Profile Hospital Performance for Patients With Septic Shock*
Authors: Walkey Allan J. , Shieh Meng-Shiou , Liu Vincent X. , Lindenauer Peter K.
Published: May 2018

Objectives:

Sepsis care is becoming a more common target for hospital performance measurement, but few studies have evaluated the acceptability of sepsis or septic shock mortality as a potential performance measure. In the absence of a gold standard to identify septic shock in claims data, we assessed agreement and stability of hospital mortality performance under different case definitions.

Design:

Retrospective cohort study.

Setting:

U.S. acute care hospitals.

Patients:

Hospitalized with septic shock at admission, identified by either implicit diagnosis criteria (charges for antibiotics, cultures, and vasopressors) or by explicit International Classification of Diseases, 9th revision, codes.

Interventions:

None.

Measurements and Main Results:

We used hierarchical logistic regression models to determine hospital risk–standardized mortality rates and hospital performance outliers. We assessed agreement in hospital mortality rankings when septic shock cases were identified by either explicit International Classification of Diseases, 9th revision, codes or implicit diagnosis criteria. Kappa statistics and intraclass correlation coefficients were used to assess agreement in hospital risk–standardized mortality and hospital outlier status, respectively. Fifty-six thousand six-hundred seventy-three patients in 308 hospitals fulfilled at least one case definition for septic shock, whereas 19,136 (33.8%) met both the explicit International Classification of Diseases, 9th revision, and implicit septic shock definition. Hospitals varied widely in risk-standardized septic shock mortality (interquartile range of implicit diagnosis mortality: 25.4–33.5%; International Classification of Diseases, 9th revision, diagnosis: 30.2–38.0%). The median absolute difference in hospital ranking between septic shock cohorts defined by International Classification of Diseases, 9th revision, versus implicit criteria was 37 places (interquartile range, 16–70), with an intraclass correlation coefficient of 0.72, p value of less than 0.001; agreement between case definitions for identification of outlier hospitals was moderate (kappa, 0.44 [95% CI, 0.30–0.58]).

Conclusions:

Risk-standardized septic shock mortality rates varied considerably between hospitals, suggesting that septic shock is an important performance target. However, efforts to profile hospital performance were sensitive to septic shock case definitions, suggesting that septic shock mortality is not currently ready for widespread use as a hospital quality measure.
Barriers to implementation of long-acting reversible contraception: A systematic review
Authors: Phillips Jessamyn , Sandhu Prabjot
Published: May 2018

Background and purpose:

Long-acting reversible contraception (LARC) is one of the most effective forms of contraception available. The utilization of LARC remains low despite being recommended by major health organizations such as Centers for Disease Control and Prevention, American Congress of Obstetricians and Gynecologists, American Academy of Pediatrics, American Academy of Family Physicians, and the National Committee for Quality Assurance. Health care professionals play an essential role in the potential increased use of LARC. This review aims to highlight key barriers to the utilization of LARC and discuss interventions to address this issue.

Methods:

A systematic review of 14 peer-reviewed articles focused on LARC utilization rates that help identify barriers to the utilization of LARC in current education and practice. Articles were evaluated for strength of research design using the Johns Hopkins Nursing Evidence-Based Practice Research Evidence Appraisal tool.

Conclusions:

Three categories affecting LARC utilization emerged: deficits in provider education/competency, lack of hands-on training, and barriers to practice.

Implications for practice:

The importance of including LARC training and education in the advanced practice nursing curriculum and providing opportunities for continuing education with LARC is demonstrated.
American Association of Nurse Practitioners National Nurse Practitioner sample survey: Update on acute care nurse practitioner practice
Authors: Kleinpell Ruth , Cook Michelle L. , Padden Diane L.
Published: May 2018

Background and purpose:

Data from national surveys on the practice of nurse practitioners (NPs) provides valuable information on aspects of practice, demographic characteristics of providers and patients, plans for continued employment, and role satisfaction. The American Association of Nurse Practitioners (AANP) has been conducting the AANP Sample Survey since 1988.

Methods:

The most recent AANP Sample Survey was conducted in 2016 with a random stratified survey of 40,000 NPs. Data were collected bimodally, by internet and mail surveys. Responses were received from 3,970 respondents (9.9% response rate), with 335 respondents reporting NP certification in acute care as adult-gerontology acute care and/or pediatric acute care.

Results:

Almost all acute care nurse practitioners (ACNPs) reported that they were clinically practicing in 2016 (99.3%), with the top three areas encompassing cardiovascular (20.5%), critical care (12.1%), and hospitalist roles (6.3%). More than 1 in 4 ACNPs worked in a hospital inpatient setting, with 16.1% reporting work in a hospital outpatient clinic, 7.7% in a private group practice, 6.5% at a public university, and some in combined roles covering both inpatient and outpatient care, or on consultation service or specialty-based teams. On average, 34.1% of the patients ACNPs saw were between the ages of 66 and 85 years, and 11.2% were 85 years and older. The top 3 medication classes in which ACNPs regularly prescribe were diuretics (31.9%), analgesic narcotics (31.2%), and antibiotics (27.3%). Majority (88%) report satisfaction with the role, and approximately one third (31.1%) expect to continue to work in their current practice for more than 10 years.

Implications for practice:

The findings of the 2016 AANP National NP Sample Survey data related to ACNP practice identify expansion of work settings, practice consistent with acute care scope of practice, role satisfaction, and intent to continue working. Continued monitoring of practice components and employment is indicated to track ACNP workforce trends.
Maximizing your “nutrition minute”: Bridging nutritional gaps across the life span
Authors: Wright Wendy L. , Zelman Kathleen M.
Published: May 2018

Background and Purpose:

Poor diet quality has been associated with increased mortality and an increased risk of chronic disease. Given the shortfalls in the typical American diet and the prevalence of nutrition-related chronic disease among US adults, the need for nutrition education is paramount. Nurse practitioners (NPs) are well placed to provide basic nutrition counseling but often face challenges to making this a reality. In a typical office visit, the time available to discuss diet and nutrition can be as little as one minute or less.

Methods:

Nutritional issues of concern facing specific age and risk groups are reviewed. The “Nutrition Minute,” a tool comprising 5 questions that enable NPs to identify patients at higher risk of nutritional shortfalls, has been developed.

Conclusions:

Nutrition counseling includes discussion of not only fat, carbohydrate, and protein intake, but also micronutrient intake. Although a food-first approach to nutrition is preferred, nutritional shortfalls exist even in the best diets. Supplementation with a multivitamin is an effective approach to bridge many nutritional gaps and can be recommended for many patients with poor diet quality. In addition to shortfalls apparent from a patient's diet, nutritional needs change across the life span (e.g., women of childbearing age and older persons) and in those with certain medical conditions such as diabetes and obesity.

Implications for practice:

Although NPs clearly have an important role to play in the nutrition management of many patients, they should work in collaboration with registered dietitians wherever possible, especially for medical nutrition therapy in those patients needing specialist counseling, such as those with diabetes, obesity, cardiovascular disease, and renal disease.
The primary care provider and the patient living in poverty: Applying the Bridges to Health and Healthcare model to NP practice
Authors: Wise Barbara , Dreussi-Smith Terie
Published: May 2018

Background and purpose:

There is a much recent emphasis on the social determinants of health, and poverty is the most influential of these. It is not enough merely to understand the influence of poverty on health—the primary care provider must understand how to effectively treat patients who live in poverty.

Methods:

This article applies the Bridges to Health and Healthcare model for understanding poverty to primary care practice from an individual provider's perspective. The article walks the reader through the implications of generational poverty for the primary care clinician in a typical office visit from history taking to following up.

Conclusions:

Most primary care practitioners approach patients from a middle-class perspective. Awareness of the challenges and different perspectives of those in generational poverty can enhance care and outcomes.

Implications for practice:

The individual provider can use the understanding of driving forces, resources, language and cognition, environment, and relationships provided by the Bridges to Health and Healthcare model to benefit patients in generational poverty.
Predictors of nurse practitioner retention
Authors: Hagan Joseph , Curtis Derek L.
Published: May 2018

Background and Purpose:

Increased utilization of nurse practitioners (NPs) has been proposed to reduce the shortage of primary care providers, so identifying factors related to retention of NPs is important for health care organizations. The purpose of this study was to examine the relationship of Misener Nurse Practitioner Job Satisfaction Scale factors and nurse demographic characteristics with NP retention, as defined by the number of years at the current position and intention to leave the current position within 5 years.

Methods:

A survey was distributed via email to members of the Texas NP Organization.

Conclusions:

Three hundred fifteen NPs participated in the study. Years of experience (p< .001), salary (p= .018), and benefits (p= .007) were significantly associated with longer duration of employment at the current position, after controlling for the other variables in the linear regression model. After adjusting for the other variables in the logistic regression model, higher challenge/autonomy factor scores (p= .016) and higher annual salary (p= .032) were associated with significantly lower odds of intention to leave the current position within 5 years.

Implications for practice:

Interventions to increase NP autonomy and facilitate employment in positions with more competitive salaries are likely to improve NP retention.
Controlled attenuation parameter for steatosis grading in chronic hepatitis C compared with digital morphometric analysis of liver biopsy: impact of individual elastography measurement quality
Authors: Mendes Leandro C. , Ferreira Paulo A. , Miotto Noelle , Zanaga Letícia , Lazarini Maria S. , Gonçales Eduardo S.L. , Pedro Marcelo N. , Gonçales Fernando L. , Stucchi Raquel S.B. , Vigani Aline G.
Published: May 2018

Background and objective

Controlled attenuation parameter (CAP) diagnostic performance for steatosis grading has been controversial and considerable observer-related variability in liver biopsy has been reported. This is a subanalysis of a larger chronic hepatitis C study on noninvasive fibrosis staging.

Materials and methods

Patients were prospectively enrolled for paired liver biopsy and transient elastography. Biopsy fragments were subjected to digital morphometric steatosis quantification. Associated patient and technical factors, including a newly described elastogram quality score, were evaluated.

Results

A total of 312 patients were included in the final analysis. The mean liver stiffness was 8.7±2.1 kPa. Morphometry showed S0 in 19.2% of patients, S1 in 28.5%, S2 in 31.1%, and S3 in 21.2%. CAP showed S0 in 11.2% of patients, S1 in 26.6%, S2 in 56.7%, and S3 in 5.4%. Spearman coefficient showed a positive and independent correlation between CAP and morphometric analysis (r=0.48, P<0.05), except for distinguishing S1 and S2 (P=0.11). Area under the receiver operating characteristic curves for the presence or absence of steatosis was 0.944; differentiation between levels I, II, and III were 0.776, 0.812, and 0.879. Elastogram quality independently predicted accuracy [odds ratio (OR): 6.95, 95% confidence interval (95%CI): 4.45–9.06 as well as CAP interquartile range OR: 2.81, 95%CI: 1.67–3.99] and liver stiffness (OR: 0.78, 95%CI: 0.51–0.80).

Conclusion

We present an external validation for CAP against the objective steatosis quantification provided by digital morphometry. Fairly good performance indicators were found, except for S1 versus S2 differentiation. Variability and higher liver stiffness were associated with lower performance. Achieving higher quality measurements, however, overcame such limitations with excellent accuracy.
Evaluation of accuracy of elastography point quantification versus other noninvasive modalities in staging of fibrosis in chronic hepatitis C virus patients
Authors: Fouad Rabab , Elbaz Tamer , Abdel Alem Shereen , Elsharkawy Aisha , Negm Mohamed , Khairy Marwa , Hassany Mohamed , Cordie Ahmed , El Akel Wafaa , Esmat Gamal
Published: May 2018

Background

Elastography point quantification (ElastPQ) is a newly noninvasive method incorporated into a conventional ultrasound system for staging of liver fibrosis in patients with chronic liver diseases.

Aim

The aim was to evaluate ElastPQ reproducibility and its accuracy in staging of liver fibrosis in hepatitis C virus (HCV) patients in comparison with transient elastography (TE) and fibrosis scores [FIB-4 and aspartate aminotransferase-to-platelet ratio index (APRI)] using liver biopsy as a reference standard and also to predict the sensitivity and specificity of ElastPQ as well as proposing a cut-off for advanced fibrosis.

Patients and methods

A single-center, cross-sectional study enrolled 72 chronic HCV patients. Baseline demographic and laboratory data were recorded. ElastPQ and TE were performed. Fibrosis scores were calculated. The performance of ElastPQ was compared with that of TE and noninvasive methods (FIB-4, APRI) using liver biopsy as a reference standard using receiver operating characteristic curve analysis.

Results

ElastPQ is a valuable diagnostic tool for the diagnosis of F≥1, F≥2, and F≥3, with area under the receiver operating characteristic curve of 0.79, 0.74, and 0.83, respectively. The best cut-off values for ElastPQ were 4.9, 6.6, and 10.7 kPa for mild fibrosis, significant fibrosis, and advanced fibrosis, respectively. ElastPQ correlated positively with all other fibrosis indices (TE, APRI, and FIB-4) as well as liver biopsy. Area under the curve for the diagnosis of advanced fibrosis (F3/F4) using ElastPQ was 0.83 at a cut-off value of 10.7 kPa (P<0.01).

Conclusion

ElastPQ is a promising noninvasive US-based method for assessing liver fibrosis in HCV-related chronic liver disease patients with good diagnostic performance comparable to that of liver biopsy and TE.
Human mesenchymal stem cells for hepatitis B virus-related acute-on-chronic liver failure: a systematic review with meta-analysis
Authors: Chen Bin , Wang Yong-Hong , Qian Jin-Qin , Wu Dong-Bo , Chen En-Qiang , Tang Hong
Published: May 2018

Background and aim

Acute-on-chronic liver failure (ACLF) is a condition with high mortality. New strategies are urgently required. The present review aims to provide a comprehensive understanding of the efficacy and safety of mesenchymal stem cells (MSC) treatment in patients with ACLF associated with hepatitis B virus infection.

Materials and methods

The MEDLINE, Embase, and Cochrane Library databases were searched for the relevant publications. If appropriate, a meta-analysis was carried out for the following outcomes: survival rate, model for end-stage liver disease score, and liver function.

Results

Three studies were eligible for the present systematic review. A total of 198 hepatitis B virus-ACLF patients were enrolled for this review. Ninety-one patients were treated with MSC and 107 patients were treated with standard medical therapy (SMT) as controls. Pooled results showed that MSC treatment could significantly reduce the mortality rate at week 12 [risk ratio: 0.50; 95% confidence interval (CI): 0.33, 0.76; P=0.00009] and the mortality rate at the final follow-up (risk ratio: 0.54; 95%CI: 0.37, 0.78; P=0.001) compared with the SMT group. Furthermore, pooled estimates showed that MSC treatment could significantly reduce the total bilirubin level at week 4 (mean difference: 58.89; 95%CI: 14.47, 103.32; P=0.009) compared with the SMT group. No severe complication associated with MSC treatment was observed.

Conclusion

Our pooled results suggested that MSC treatment could significantly reduce the mortality rate, without increasing the incidence of severe complications.
Predictive ability of shear wave elastography for pruritus in chronic hepatitis C patients with sustained virological response
Authors: Tachi Yoshihiko , Hirai Takanori , Kojima Yuko , Ishizu Yoji , Honda Takashi , Kuzuya Teiji , Hayashi Kazuhiko , Ishigami Masatoshi , Goto Hidemi , Katano Yoshiaki
Published: May 2018

Background and aims

Pruritus is one of the complications with chronic liver disease and markedly worsens quality of life. However, the current status of pruritus in chronic hepatitis C patients who have achieved a sustained virological response (SVR) has not been clarified sufficiently. The aim of this study was to investigate the predictors of pruritus in post-SVR patients treated with direct-acting antivirals (DAA).

Patients and methods

In this retrospective study, we enrolled 110 hepatitis C patients with SVR who underwent serial shear wave elastography before DAA therapy and at the end of treatment. The severity of pruritus was evaluated using Kawashima’s pruritus scores and a visual analog scale.

Results

The prevalence of pruritus before treatment and after SVR was 28.2 and 25.5%. Multivariate logistic regression analysis confirmed that a history of hepatocellular carcinoma [odds ratio (OR): 9.72; 95% confidence interval (CI): 2.05–46.15; P=0.004], high γ-glutamyl transpeptidase levels at baseline (OR: 5.77; 95% CI: 1.83–18.21; P=0.003), low serum albumin at the end of treatment (OR: 4.85; 95% CI: 1.31–17.99; P=0.018), and high liver stiffness measurement assessed by shear wave elastography at the end of treatment (OR: 3.16; 95% CI: 1.19–11.01; P=0.024) were significant independent factors associated with pruritus in patients who had achieved an SVR following DAA therapy.

Conclusions

In chronic hepatitis C patients with SVR after DAA therapy, the incidence of pruritus is not uncommon. Liver stiffness measurement is useful for predicting the incidence of pruritus. Thus, even if SVR is achieved, patients with higher liver stiffness at the end of treatment must be monitored carefully for pruritus.
Role of Immune Checkpoint Inhibitors in Small Cell Lung Cancer
Authors: Cooper Maryann R. , Alrajhi Abdullah M. , Durand Cheryl R.
Published: May 2018

Background:

Small cell lung cancer (SCLC) accounts for approximately 13% of all lung cancer diagnoses each year. SCLC is characterized by a rapid doubling time, early metastatic spread, and an unfavorable prognosis overall.

Areas of Uncertainty:

Most patients with SCLC will respond to initial treatment; however, the majority will experience a disease recurrence and response to second-line therapies is poor. Immune checkpoint inhibitors may be an option given the success in other diseases.

Data Sources:

A literature search was conducted using Medline (1946–July week 1, 2017) and Embase (1996–2017 week 28) with the search terms small cell lung cancer combined with nivolumab or ipilimumab or pembrolizumab or atezolizumab or tremelimumab or durvalumab. Five clinical trials, including extended follow-up for 2, that evaluated immune checkpoint inhibitors in limited stage or extensive stage SCLC were included.

Results:

In 2 phase 2 trials, ipilimumab was added to upfront chemotherapy. In both trials, an improvement in progression-free survival was seen. Toxicity, when combined with a platinum and etoposide, was significant. In a confirmatory phase 3 trial, ipilimumab did not prolong overall survival when added to first-line chemotherapy. Overall, response rates were similar between the placebo and ipilimumab groups. A phase 1/2 trial evaluated nivolumab alone or in combination with ipilimumab in recurrent SCLC. Results revealed that nivolumab monotherapy and the combination of nivolumab and ipilimumab were relatively safe and had antitumor activity. Pembrolizumab has been evaluated in a multicohort, phase 1b trial. Preliminary data showed a durable response in the second-line setting.

Conclusion:

Given the lack of overall survival data and significant toxicity associated with the combination of ipilimumab with first-line chemotherapy, this treatment is not a reasonable option at this time. Nivolumab alone or in combination with ipilimumab is a valid option for recurrent SCLC.
Rheumatoid Meningitis
Authors: Parsons Angela M. , Zuniga Leslie A. , Hoxworth Joseph M. , Lyons Mark , Aslam Fawad , Goodman Brent P.
Published: May 2018

Introduction:

Rheumatoid meningitis (RM) is a rare complication of rheumatoid arthritis (RA) and has a high mortality rate. It can present as a first diagnosis of RA, in long-standing disease, or in active or well-controlled disease. Neurological manifestations vary widely.

Case Report:

A patient with a 30-year history of RA, well controlled with methotrexate therapy, presented with new-onset seizures. Magnetic resonance imaging showed leptomeningeal and pachymeningeal enhancement. A de novo workup resulted in diagnosis of RM.

Conclusions:

Cerebrospinal fluid findings for RM are nonspecific, typically lymphocytic pleocytosis; however, they can be neutrophilic, as in this case. Magnetic resonance imaging findings consist of leptomeningeal and pachymeningeal enhancement but can also involve the parenchyma. The diagnosis is typically confirmed with meningeal biopsy. Treatment involves high-dose corticosteroids or immunomodulatory therapy, or both. Long-term follow-up with radiologic surveillance typically ranges from improvement to resolution.
Ongoing Photosensitivity in An Elderly Patient With Jeavons Sydrome
Authors: Gülen Abanoz Yeşim , Abanoz Yasin , Özkara Çiğdem
Published: May 2018

Introduction:

Photosensitivity, which is a main feature of Jeavons syndrome, can be seen in other types of idiopathic or genetic epilepsies with focal or generalized seizures and tends to disappear spontaneously usually in the second decade. Although it responds well to antiepileptic treatment, especially to valproic acid, it may continue into adulthood in rare cases.

Case Report:

We describe a 63-year-old male patient with eyelid myoclonia with absences, generalized tonic-clonic seizures, and severe photosensitivity accompanied by eyelid myoclonia. Seizures were treated with antiepileptic treatment, whereas photosensitivity still continued on electroencephalogram without clinical findings.

Conclusion:

Our elderly patient with Jeavons syndrome with ongoing remarkable photosensitivity demonstrated that it may continue to older ages, although it is uncommon.