bluuebunny/crossref_metadata_2025 huggingface dataset:
Transtheoretical Model of Change
Authors: Craig Shelley L. , D'Souza Sandra
Published: June 2018

The Transtheoretical Model (TTM) outlines the process of altering behavior by integrating leading principles and theories on behavior change. The TTM is comprised of a number of core constructs that include the Stages of Change, Processes of Change, Decisional Balance, Self-Efficacy, and Temptation. The previously identified Stages of Change (or readiness to change) construct is an important dimension of the TTM, as it reflects the model’s critical assumption—behavior change occurs through a series of six stages: precontemplation, contemplation, preparation, action, maintenance, and termination. The Processes of Change construct outlines the ten activities that individuals use to progress from stage to stage. Interventions that employ the TTM for behavior change should aim to accurately identify and match an individual’s specific processes of change to their stage of change to maximize efficacy. The Decisional Balance construct refers to an individual’s weighing of the pros and cons of their behavior change. Lastly, the Self-Efficacy construct outlines an individual’s confidence in their ability to not relapse when in high-risk situations that tempt them to engage in a specific behavior. Although the majority of the applications of TTM have focused on smoking cessation, the model has also been applied to other problem behaviors such as alcohol and substance abuse, eating disorders, and domestic violence. In addition to providing a comprehensive overview of the model, this article discusses the various applications of the TTM. This annotated bibliography contains a comprehensive summary of literature on TTM outlining its empirical evidence, effectiveness in various settings, limitations, and future research directions with an emphasis on resources that are relevant to social work practice.
Characterization and Fungicide Sensitivity of Colletotrichum spp. from Different Hosts in Shandong, China
Authors: He Lifei , Li Xiaoxu , Gao Yangyang , Li Beixing , Mu Wei , Liu Feng
Published: June 2018

Anthracnose, caused by Colletotrichum species, can severely infect the fruits and leaves of more than 30 plants and thus results in great yield and quality losses. To identify the major Colletotrichum species infecting walnut fruits, strawberry leaves, grape fruits, and tea leaves in Shandong Province, China, 101 strains were collected and isolated. The morphological characteristics of all isolates were observed, and multilocus phylogenetic analyses (ITS, GAPDH, ACT, TUB2, CAL, CHS-1, and HIS3) were conducted on the representative isolates. The strains were identified as five Colletotrichum species, namely, C. gloeosporioides sensu stricto, C. fructicola, C. camelliae, C. acutatum sensu stricto, and C. viniferum. Among them, C. viniferum was reported for the first time from walnut fruits and strawberry leaves in Shandong Province, China. Corresponding leaves or fruits were used as a model to clarify the pathogenicity of these isolates. The results showed that C. fructicola obtained from strawberry leaves was more aggressive than C. viniferum. All of the isolates obtained from various hosts were highly sensitive to pyraclostrobin, difenoconazole, fludioxonil, tebuconazole, pyrisoxazole, and tetramycin in terms of mycelial growth inhibition (EC50 values of 0.07 to 1.63 mg/liter). The fastest mycelial growth was observed in the temperature range of 25–28°C for all isolates. In addition, anthracnose symptoms occur frequently under these conditions. Overall, this study can improve the understanding of Colletotrichum species causing anthracnose in walnut fruits, strawberry leaves, grape fruits, and tea leaves and can provide a solid foundation for the effective control of this disease in different hosts.
Effect of Thoracic Epidural Anesthesia in a Rat Model of Phrenic Motor Inhibition after Upper Abdominal Surgery
Authors: Chae Won-Seok , Choi Soron , Sugiyama Daisuke , Richerson George B. , Brennan Timothy J. , Kang Sinyoung
Published: June 2018

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

One important example of impaired motor function after surgery is diaphragmatic dysfunction after upper abdominal surgery. In this study, the authors directly recorded efferent phrenic nerve activity and determined the effect of the upper abdominal incision. The authors hypothesized that phrenic motor output would be decreased after the upper abdominal incision; it was also hypothesized that blocking sensory input from the incision using thoracic epidural anesthesia would diminish this incision-induced change in phrenic motor activity.

Methods

Efferent phrenic activity was recorded 1 h to 10 days after upper abdominal incision in urethane-anesthetized rats. Ventilatory parameters were measured in unanesthetized rats using whole-body plethysmography at multiple time points after incision. The authors then determined the effect of thoracic epidural anesthesia on phrenic nerve activity and ventilatory parameters after incision.

Results

Phrenic motor output remained reduced by approximately 40% 1 h and 1 day after incision, but was not different from the sham group by postoperative day 10. One day after incision (n = 9), compared to sham-operated animals (n = 7), there was a significant decrease in spike frequency area-under-the-curve (median [interquartile range]: 54.0 [48.7 to 84.4] vs. 97.8 [88.7 to 130.3]; P = 0.0184), central respiratory rate (0.71 [0.63 to 0.79] vs. 0.86 [0.82 to 0.93]/s; P = 0.0460), and inspiratory-to-expiratory duration ratio (0.46 [0.44 to 0.55] vs. 0.78 [0.72 to 0.93]; P = 0.0023). Unlike humans, a decrease, not an increase, in breathing frequency has been observed after the abdominal incision in whole-body plethysmography. Thoracic epidural anesthesia attenuated the incision-induced changes in phrenic motor output and ventilatory parameters.

Conclusions

Upper abdominal incision decreased phrenic motor output and ventilatory parameters, and this incision-induced impairment was attenuated by thoracic epidural anesthesia. The authors’ results provide direct evidence that afferent inputs from the upper abdominal incision induce reflex inhibition of phrenic motor activity.
Flexor hallucis longus tendon transfer: a definitive procedure for Achilles tendon tear in Achilles tendinopathy. A 2-year prospective study
Authors: Hassan Ahmed , Aziz Ahmed M.K.
Published: June 2018

Background:

Flexor hallucis longus (FHL) tendon transfer aims to relieve pain and restore function after Achilles tendon rupture in patients with Achilles tendinopathy. The choice of operative treatment for chronic Achilles tendon disease is based on the size of the tendon rupture. Our aim was to convey our experience in treating Achilles tendon rupture using FHL tendon transfer.

Methods:

This study included 22 patients (22 ankles) with Achilles tendon rupture after a history of Achilles tendinopathy in the form of ankle pain and edema for a mean period of 1 yr before trauma. Patients were followed for a mean period of 2 yr. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score was used for outcome measurement.

Results:

Twenty-two patients (22 ankles) had FHL tendon transfer (mean age 50.3 yr, follow-up period 2 yr). The AOFAS score improved from 68.9 to 88 (P<0.001), revealing significant improvement in ankle pain, function, and stability.

Conclusions:

This study supports the concept that FHL tendon transfer for Achilles tendon rupture in patients with Achilles tendinopathy is the procedure of choice and provides excellent clinical and functional results.

Level of Evidence:

Level IV, prospective cohort study.
Second Place: Dismounted complex blast injuries: patterns of remaining limb injuries in patients with single-limb lower extremity amputations
Authors: Dupaix John P. , Wilding CPT Steven R. , Tubb COL Creighton C. , Oh COL John S. , Ryan LTC Paul M.
Published: June 2018

Background:

The conflict tactic of the Afghanistan theater of operations utilizes blast weapons while most patrols are on foot, leading to a pattern of injuries associated with lower extremity amputation termed “dismounted complex blast injury” (DCBI). The purpose of this study was to better define and describe the injuries occurring to the nonamputated extremities in patients injured as the result of DCBI.

Methods:

A retrospective review was conducted of data from the United States and United Kingdom Joint Theater Trauma Registries of injuries resulting from a dismounted improvised explosive device (IED) blast. CT and radiographs were used to characterize injuries. Fisher’s exact test was used to compare categorical data, and binomial logistic regression was used to compare proportions of types of injuries by traumatic amputation level observed.

Results:

Of the 295 patients with lower extremity injuries, 201 had traumatic lower extremity amputations (140 with bilateral lower extremity and 61 with single-leg amputations). All were male, with a mean age 23.38+/-3.77. Below-knee amputation was most common (55.7%), followed by through-knee (25%), and least frequently through-ankle amputation. Hindfoot-level amputation was associated with an 8.1% increase in the odds of the presence of a skeletal foot injury in the nonamputated lower extremity. An association of above-knee amputation with bilateral distal upper extremity injury was found. There was a 10.9% increase in odds for the ipsilateral hand/wrist fracture given an AKA.

Conclusions:

Proximal lower extremity amputation levels are significantly associated with distal upper extremity skeletal injury. Hindfoot-level amputation is significantly associated with contralateral foot fractures. Amputation levels proximal to the ankle often presented with associated genitourinary injuries.
The natural history of acromial stress fracture after reverse total shoulder arthroplasty
Authors: Merlin Gabriel , Louise Fowler Mary , Dashe Jesse , Smiley Paul , Lemos Mark
Published: June 2018

Background:

The purpose of our study was to observe the natural history of acromial stress fracture after reverse total shoulder arthroplasty.

Methods:

In a two-surgeon, single academic institution, seven patients with acromial fractures after reverse total shoulder arthroplasty were identified and evaluated for pain and functional outcome based on a visual analog scale (VAS), Disability of the Arm, Shoulder, and Hand (DASH) score, and range of motion to compare with results after uncomplicated reverse total shoulder arthroplasty. Outcomes of the acromial stress fracture group were broken down by Levy classification.

Results:

There was no significant difference in VAS, DASH score, or range of motion between Levy 1 and 2 and uncomplicated reverse total shoulder arthroplasty. Levy 3 had significantly decreased forward flexion compared with Levy 1 and 2. Multivariate logistic regression did not show any association between fracture and smoking status, hand dominance, gender, or age. Levy 3 acromial fractures fared worse in this series than the other fracture types, eventually requiring open reduction internal fixation.

Conclusions:

The natural history of patients after reverse total shoulder arthroplasty with an acromial fracture is similar to patients without acromial fracture regarding pain and function on a DASH score. Nonoperative treatment should be attempted for Levy 1 and Levy 2 acromial fractures before offering the patient operative treatment after reverse total shoulder arthroplasty. Levy 3 fractures potentially need operative fixation. Multicenter, prospective studies should be carried out to increase the sample size of patients with acromial stress fracture after reverse total shoulder arthroplasty to assess long-term outcome.

Level of Evidence:

Level III, therapeutic study.
Minimally invasive percutaneous plating of complex metaphyseal-diaphyseal proximal humeral fractures
Authors: Singer Mohamed S. , Moussa Waleed Mohamed Fathy
Published: June 2018

Background:

Many anatomic, cadaver studies have shown safe anterior and anterolateral percutaneous plating of the humerus; however, there is paucity of information on this in clinical case series. The aim of the current study was to assess outcome of minimally invasive plate osteosynthesis in complex metaphyseal-diaphyseal humeral fractures.

Methods:

Eighteen patients with acute, complex, proximal humeral fractures with diaphyseal extension were operated on using a long proximal humeral plate through a percutaneous minimally invasive technique.

Results:

Union was obtained in all patients with good alignment and good shoulder and elbow function. The average time to union was 15 wk (range, 9-21 wk). Two patients developed postoperative radial nerve palsy that recovered after 3 wk in the first and 9 wk in the second patient. There were no obvious neurovascular injuries or major complications.

Conclusions:

Mini-invasive percutaneous plating of complex metaphyseal-diaphyseal humeral fractures is feasible and safe and has good clinical outcomes.
Musculoskeletal coccidioidomycosis
Authors: Belthur Mohan V. , Blair Janis E. , Shrader Michael W. , Malone Jason B.
Published: June 2018

Coccidioidomycosis is an invasive fungal infection caused by the inhalation of aerosolized spores of Coccidioides spp., which reside in the arid soil of the southwestern United States and northern Mexico. The primary infection occurs in the lungs; however, less than 40% of patients are symptomatic. Dissemination of coccidioidomycosis is rare (1-5%), but can lead to extra pulmonic disease involving any organ. Skeletal coccidioidomycosis occurs in 10% to 50% of disseminated infections. Skeletal coccidioidomycosis is a chronic and progressive infection that eventually results in bone destruction and loss of function and often involves adjacent structures such as joints, muscles, tendons and other soft tissues. This infection is frequently multifocal with axial skeletal involvement. Although radiographs and other imaging methods identify relevant abnormalities, histopathologic examination with culture of the involved bone is the only means to confirm the diagnosis. Serologic testing is adjunctive, and complement fixation titers can be evaluated serially to assess response to treatment. Skeletal coccidioidomycosis is difficult to treat, and a combination of medical therapy and surgical debridement often is needed. Early diagnosis and treatment are critical to avoid long-term problems.
Critical Friends: Health Professionals' Experiences of Collegial Feedback in a Clinical Setting
Authors: Carlson Elisabeth , Nygren Frida , Wennick Anne
Published: June 2018

Introduction:

A critical friend is a trusted person who asks provocative questions, provides data to be examined through another lens, and offers critique of a person's work as part of collegial feedback. However, empirical evidence presenting the use of collegial feedback to develop health professionals' competence in clinical settings seems to be scarce. The aim of this study was to explore health professionals' experiences of observing each other as critical friends in a clinical setting, as part of a continuous professional development initiative.

Methods:

The study was designed as a qualitative inductive study. Reflective journals written by health professionals (n = 57) were analyzed using thematic networks. The health professionals represented registered nurses and registered nurses with different specialist education (eg, in pediatrics, mental health, intensive care, and anesthesiology), biomedical scientists, occupational therapists, physiotherapists, and dental hygienists.

Results:

Health professionals can successfully use collegial feedback and benefit from critical friendships in clinical settings as it offers ample opportunities for reflection before, during, and after the observation. A key finding was that to incorporate changes to professional practice, each individual needs to not only act as a critical friend but also experience being observed by a critical friend.

Discussion:

Based on the results of this study, it seems worthwhile to implement and further develop opportunities for health professionals to act as critical friends. We suggest that future research explore not only how professional competence develops over time but also how it impacts on health-related outcomes for patients.
MULTIMODAL IMAGING OF FOCAL CHOROIDAL EXCAVATION COMPLICATED BY CHOROIDAL NEOVASCULARIZATION IN A PATIENT WITH ANGIOID STREAKS AND PSEUDOXANTHOMA ELASTICUM
Authors: Ferreira Bruno Fortaleza de Aquino , Preti Rony Carlos , Schmidt Marina Brandão , Zacharias Leandro Cabral , Takahashi Walter Yukihiko , Monteiro Mário Luiz Ribeiro
Published: June 2018

Purpose:

To describe a case of focal choroidal excavation (FCE) complicated with Type-2 choroidal neovascularization (CNV) in a patient with angioid streaks secondary to pseudoxanthoma elasticum before and after treatment with bevacizumab.

Methods:

Fundus photography, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, spectral-domain optical coherence tomography (SD-OCT) and SD-OCT angiography were performed in a 60-year-old white woman with angioid streaks and bilateral FCE. Spectral domain OCT images were taken before and after three-monthly intravitreal injections of bevacizumab. Histopathological analysis of the dermis established the diagnosis of pseudoxanthoma elasticum.

Results:

Multimodal imaging revealed bilateral FCE and CNV. Spectral domain OCT diagnosed bilateral FCE and Type-1 and Type-2 CNV in the right eye, and irregular vascular network, along macular streak, in both eyes, which were not observed on fluorescein neither on indocyanine green angiography, but only on SD-OCT angiography. Patient presented good anatomical and functional response to intravitreal injections of bevacizumab.

Conclusion:

Focal choroidal excavation is a rare condition detected mainly by SD-OCT, which may be associated with angioid streaks secondary to pseudoxanthoma elasticum and complicated by CNV. Multimodal imaging is important for diagnosis and follow-up of such patients, even in the absence of signs of CNV, and anatomical and functional response to anti–vascular endothelial growth factor therapy is good.
Evaluation of Pupil Fields Using a Newly Developed Head-mounted Perimeter in Healthy Subjects
Authors: Asakawa Ken , Nanno Mami , Ishikawa Hitoshi , Shoji Nobuyuki
Published: June 2018

Purpose:

The purpose of this study was to evaluate the accuracy of pupil fields and determine the normative pupillary response data by age using a newly developed head-mounted perimeter.

Methods:

A total of 100 healthy subjects (age, 20 to 68 y) were enrolled. The newly developed head-mounted perimeter “imo” was used to measure the percentage pupil constriction (PPC) as response to a stimulus at all 36 test points of the visual field. Goldmann size III and V stimuli at 0, 8, and 11 decibels (dB) under 31.4, 6, and 3 apostilbs (asb) background were presented. The PPC correlations (r) of the right and left eyes were examined. Reproducibility was determined with the coefficient of variation (CV) and a Bland-Altman plot. By a simple bootstrap method, the mean PPC were analyzed as normative data in all 36 test points.

Results:

Excellent correlation between both eyes was obtained for Goldmann size V stimuli, target luminance of 0 dB, and a background luminance of 31.4 asb (r=0.83; P<0.001). From the test-retest CV peripheral areas have low reproducibility compared with central areas. With a Goldmann size V target, there was a steeper decline of the PPC from the center field to the periphery field, and the temporal field PPC was larger than the nasal field. No major differences were observed between the PPC data and the age groups by decade (eg, center 3 degrees; P=0.223-0.913).

Conclusions:

Normative PPC data might well be useful for assessing objective visual fields with the newly developed head-mounted perimeter.
A multiplex real-time PCR technique for simultaneous detection of Listeria monocytogenes and Streptococcus agalactiae among asymptomatic pregnant women
Authors: Ghasemian Abdolmajid , Nojoomi Farshad , Heidari Abhari Mina , Fallah Mehrabadi Jalil
Published: June 2018

Objective:

Listeria monocytogenes and Streptococcus agalactiae are important causes of urogenital and infantile infections. This study was performed to design a multiplex-real-time PCR technique for simultaneous detection of L. monocytogenes and S. agalactiae.

Methods:

A total of 233 vaginal samples from pregnant patients (35–37 weeks of pregnancy) were collected. For L. monocytogenes, after swab lawn the plates were incubated at 37 °C for up to 48 h and after bacterial growth, 50 ml of broth medium was inoculated to blood agar. The isolates were also identified by phenotypic tests. The PCR and real-time PCR techniques were performed to amplify the hly and cfo genes from L. monocytogenes and S. agalactiae, respectively.

Results:

In the PCR technique, 17 (7.29%) and 25 (10.72%) isolates were identified as L. monocytogenes and S. agalactiae by amplification of hly and cfo genes, respectively, and similarly in the culture method 16 (6.68%) and 23 (9.87%) isolates were obtained and identified, respectively. By the real-time PCR, L. monocytogenes and S. agalactiae were detected in 24 (10.30%) and 34 (14.60%) samples, respectively. Real-time PCR demonstrated the highest the sensitivity and specificity results.

Conclusion:

The real-time PCR was the most advantageous method due to its higher sensitivity and specificity and rapidity in results, especially among asymptomatic patients. L. monocytogenes and S. agalactiae infections need to be diagnosed rapidly because of complications occurred among infants and asymptomatic pregnant women.
Physical Findings Mimicking Sexual Abuse in a Drowning Patient Who Was Treated in the Intensive Care Unit
Authors: Sener Mustafa Talip , Vural Talip , Sahpaz Ahmet
Published: June 2018

Specific or nonspecific findings of sexual abuse may be observed upon examination of a child. Examination of the genital area is extremely important for the identification of child sexual abuse (CSA). However, medical conditions detected in the child's genital area may be misinterpreted as signs of CSA. Herein, we present a case of a child with suspected CSA who was treated in the intensive care unit. The following incidental findings were obtained upon anal examination: dilatation, ecchymosis, laceration, and hemorrhage. This report aims to discuss the anal examination findings that can mimic CSA.
Prostatic Adenocarcinoma With Focal Pleomorphic Giant Cell Features
Authors: Alharbi Abdullah M. , De Marzo Angelo M. , Hicks Jessica L. , Lotan Tamara L. , Epstein Jonathan I.
Published: June 2018

Prostatic adenocarcinoma with focal pleomorphic giant cell features is rare with the only prior series consisting of 6 cases. From 2005 to 2018, we identified 29 cases from our consult service and 1 case from our own institution. Men ranged in age from 39 to 90 years (median=75.5). Diagnostic specimens consisted of needle biopsies (n=13); transurethral resections (n=7), urethral/bladder biopsies (n=8), radical prostatectomy (n=1), and orchiectomy (n=1). In all cases, there was usual acinar prostatic adenocarcinoma, where the highest grade in all cases was Gleason score 9 to 10 (Grade Group 5). On average, 68% of the involved cores had cancer with a maximum percent of cancer averaging 55%; on average, transurethral resections had 85% of the area involved by cancer. Areas of cancer showing pleomorphic giant cell features were focal (<5%). Two of the needle biopsies showed extraprostatic extension. The radical prostatectomy had seminal vesicle invasion and positive margins with lymphovascular invasion. Prostatic adenocarcinoma with focal pleomorphic giant cell features is always accompanied by extensive usual acinar prostate adenocarcinoma where the highest grade in all cases was Gleason score 9 to 10 (Grade Group 5). Although the pleomorphic component is focal, it can mimic urothelial carcinoma. IHC can be misleading as PSA staining is often negative or focal in both the pleomorphic and usual prostatic adenocarcinoma components. NKX3.1 is the most sensitive prostate marker, but was still focal in 1 usual prostatic adenocarcinoma and negative in 2 pleomorphic components. Prostatic adenocarcinoma with focal pleomorphic giant cell features has a dismal prognosis. In men with no prior diagnosis of prostate adenocarcinoma and >1-year follow-up, 7/19 (37%) were dead at a median of 8 months after diagnosis. Of the 7 men with a prior history of prostate adenocarcinoma, 4/7 (57%) were dead at a median of 7 months after diagnosis of recurrent prostate adenocarcinoma with pleomorphic giant cell features.
The Psychiatry Morbidity and Mortality Incident Reporting Tool Increases Psychiatrist Participation in Reporting Adverse Events
Authors: Kroll David S. , Shellman Andrea D. , Gitlin David F.
Published: June 2018

Objectives

Although the reporting of adverse events (AEs) is widely thought to be a key first step to improving patient safety in hospital systems, underreporting remains a common problem, particularly among physicians. We aimed to increase the number of safety reports filed by psychiatrists in our hospital system.

Methods

We piloted an online survey for psychiatry-specific AE reporting, the Psychiatry Morbidity and Mortality Incident Reporting Tool (PMIRT) for a 1-year period. An e-mail prompt containing a link to the survey was sent on a weekly basis to all psychiatry department clinical staff. The primary outcome was the total number of events reported by psychiatrists through PMIRT; secondary outcomes were the total number of AEs and the number of serious harm events filed by psychiatrists in our hospital's formal event reporting system before and after implementation of the new protocol.

Results

Psychiatrists filed 65 reports in PMIRT during the study period. The average number of AEs reported by psychiatrists in the hospital's formal event reporting system significantly increased after the intervention (P = 0.0251), and the average number of serious harm events reported by psychiatrists increased nonsignificantly (P = 0.1394).

Conclusions

The combination of an increase in awareness of event reporting with a psychiatry-specific AE reporting tool resulted in a significant improvement in the number of reports by psychiatrists.
Preoperative Autologous Blood Collection in Adult Living Liver Donors: Are We Wasting Donor Blood and Increasing Exposure to Risk?
Authors: Manuel Solmaz Poorsattar , Roberts John P. , Bakhtary Sara
Published: June 2018

Background

Despite waning indications in the general population for preoperative autologous blood donation (PABD), it is a procedure that continues to be offered to healthy living liver donor (LLD). In this study, we sought to understand the impact of PABD on the LLD population.

Methods

We retrospectively reviewed charts of one institution's LLDs over a 2-year period. Per institutional protocol, all accepted LLDs donated 1 unit of autologous blood before living donor hepatectomy.

Results

Sixty-six LLDs underwent PABD and 59 of these donors underwent living donor hepatectomy. In this cohort, there was a significant 1.2 g/dL drop in hemoglobin (HB) from baseline (before PABD) to the evening before surgery. Mean (standard deviation [SD]) procedure estimated blood loss was 260 mL (±100), mean (SD) resected graft weight was 592 g (±174). No allogeneic blood was transfused. Forty-two percent of LLD received autologous transfusion. Mean (SD) pretransfusion HB of transfused LLDs was 11.7 g/dL (±1.2). All LLDs had negative antibody screens. Sixty-three percent of donated autologous units were discarded.

Conclusions

Preoperative autologous blood donation in our population is associated with decreased preoperative HB, increased exposure of healthy LLD to unnecessary transfusion-related risks and high rates of discarded blood product. We encourage further investigation and reconsideration of the practice of PABD and autologous transfusion in LLDs.
Barriers and Enablers to Organ Donation After Circulatory Determination of Death: A Qualitative Study Exploring the Beliefs of Frontline Intensive Care Unit Professionals and Organ Donor Coordinators
Authors: Squires Janet E. , Graham Nicole , Coughlin Mary , Chassé Michaël , Linklater Stefanie , Greenough Megan , Grimshaw Jeremy M. , Shemie Sam D. , Dhanani Sonny , Knoll Gregory A.
Published: June 2018

Background

A shortage of transplantable organs is a global problem. The purpose of this study was to explore frontline intensive care unit professionals' and organ donor coordinators' perceptions and beliefs around the process of, and the barriers and enablers to, donation after circulatory determination death (DCDD).

Methods

This qualitative descriptive study used a semistructured interview guide informed by the Theoretical Domains Framework to interview 55 key informants (physicians, nurses, and organ donation coordinators) in intensive care units (hospitals) and organ donation organizations across Canada.

Results

Interviews were analyzed using a 6-step systematic approach: coding, generation of specific beliefs, identification of themes, aggregation of themes into categories, assignment of barrier or enabler and analysis for shared and unique discipline barriers and enablers. Seven broad categories encompassing 29 themes of barriers (n = 21) and enablers (n = 4) to DCDD use were identified; n = 4 (14%) themes were conflicting, acting as barriers and enablers. Most themes (n = 26) were shared across the 3 key informant groups while n = 3 themes were unique to physicians. The top 3 shared barriers were: (1) DCDD education is needed for healthcare professionals, (2) a standardized and systematic screening process to identify potential DCDD donors is needed, and (3) practice variation across regions with respect to communication about DCDD with families. A limited number of differences were found by region.

Conclusions

Multiple barriers and enablers to DCDD use were identified. These beliefs identify potential individual, team, organization, and system targets for behavior change interventions to increase DCDD rates which, in turn, should lead to more transplantation, reducing patient morbidity and mortality at a population level.
Nuclear Factor of Activated T Cell-regulated Cytokine Gene Expression for Adjustment of Tacrolimus in Kidney Transplant Recipients: A Randomized Controlled Pilot Trial
Authors: Webber Allison B. , Tatapudi Vasishta , Maw Thin T. , Peralta Carmen , Leung Joey C.Y. , Vincenti Flavio
Published: June 2018

Background

The aim of this pilot study was to assess the feasibility of a pharmacodynamics assay that measures Nuclear Factor of Activated T Cell–dependent cytokines expressed as % mean residual expression (MRE) to adjust tacrolimus (tac) dose (intervention [INT] arm) in comparison with the standard of care of tac trough levels (control [CTL] arm).

Methods

We conducted a single-center randomized controlled trial involving 40 stable kidney transplant recipients over 1 year. In the INT arm, the dose of tac was reduced by 15% if the MRE was less than 20% and was increased by 15% if the MRE was greater than 60%. Controls were adjusted based on tac trough levels.

Results

There was a median of 2 tac dose changes per arm. Ten subjects had 1 or more infections in the INT arm and 6 subjects had 1 or more infection in the CTL arm. Rates for hospitalizations, rejections, malignancies and death were similar in both arms. In subjects whose tac dose was not adjusted in the first 6 months, those with infections had a lower MRE at enrollment compared with those without infections (P = 0.049). This was not true for tac trough levels (P = 0.80). There was no correlation between MRE and rejection.

Conclusions

Our study suggests that adjusting tac based on this pharmacodynamics assay is feasible. Quantitative analysis of nuclear factor of activated T-regulated gene expression may serve as a reliable assay to lower tac dosing. Further studies with larger populations are needed.
Transcranial Direct Current Stimulation as a Therapeutic Tool for Chronic Pain
Authors: Pinto Camila Bonin , Teixeira Costa Beatriz , Duarte Dante , Fregni Felipe
Published: June 2018

Transcranial direct current stimulation (tDCS) modulates spontaneous neuronal activity that can generate long-term neuroplastic changes. It has been used in numerous therapeutic trials showing significant clinical effects especially when combined with other behavioral therapies. One area of intensive tDCS research is chronic pain. Since the initial tDCS trials for chronic pain treatment using current parameters of stimulation, more than 60 clinical trials have been published testing its effects in different pain syndromes. However, as the field moves in the direction of clinical application, several aspects need to be taken into consideration regarding tDCS effectiveness and parameters of stimulation. In this article, we reviewed the evidence of tDCS effects for the treatment of chronic pain and critically analyzed the literature pertaining its safety and efficacy, and how to optimize tDCS clinical effects in a therapeutic setting. We discuss optimization of tDCS effects in 3 different domains: (i) parameters of stimulation, (ii) combination therapies, and (iii) subject selection. This article aims to provide insights for the development of future tDCS clinical trials.
Histology of the endothermic opah (
Lampris
sp.) suggests a new structure–function relationship in teleost fish bone
Authors: Davesne Donald , Meunier François J. , Friedman Matt , Benson Roger B. J. , Otero Olga
Published: June 2018

Endothermy, production and retention of heat by the body, appeared convergently in mammals, birds and four spiny-rayed teleost fish lineages. Of these, red-muscle endothermy over most or all of the body has only appeared in two groups: tunas and the opah (
Lampris
). Hitherto, tunas have been the only spiny-rayed fishes known to have bones containing embedded osteocyte cells; others have acellular bone. We examined bone histology in
Lampris
for the first time, demonstrating the presence of cellular bone very similar to that of tunas. This contrasts with the acellular condition of its ectothermic close relatives. The distribution of this character suggests that it co-evolved with red-muscle endothermy, hinting at a common physiological mechanism that would link bone histology to endothermy in these distantly related teleost lineages.
Flying in reverse: kinematics and aerodynamics of a dragonfly in backward free flight
Authors: Bode-Oke Ayodeji T. , Zeyghami Samane , Dong Haibo
Published: June 2018

In this study, we investigated the backward free flight of a dragonfly, accelerating in a flight path inclined to the horizontal. The wing and body kinematics were reconstructed from the output of three high-speed cameras using a template-based subdivision surface reconstruction method, and numerical simulations using an immersed boundary flow solver were conducted to compute the forces and visualize the flow features. During backward flight, the dragonfly maintained an upright body posture of approximately 90° relative to the horizon. The upright body posture was used to reorient the stroke plane and the flight force in the global frame; a mechanism known as ‘force vectoring’ which was previously observed in manoeuvres of other flying animals. In addition to force vectoring, we found that while flying backward, the dragonfly flaps its wings with larger angles of attack in the upstroke (US) when compared with forward flight. Also, the backward velocity of the body in the upright position enhances the wings' net velocity in the US. The combined effect of the angle of attack and wing net velocity yields large aerodynamic force generation in the US, with the average magnitude of the force reaching values as high as two to three times the body weight. Corresponding to these large forces was the presence of a strong leading edge vortex (LEV) at the onset of US which remained attached up until wing reversal. Finally, wing–wing interaction was found to enhance the aerodynamic performance of the hindwings (HW) during backward flight. Vorticity from the forewings’ trailing edge fed directly into the HW LEV to increase its circulation and enhance force production.
Ratiometric fluorescent test paper based on silicon nanocrystals and carbon dots for sensitive determination of mercuric ions
Authors: Guo Xinfeng , Liu Cui , Li Nian , Zhang Shudong , Wang Zhenyang
Published: June 2018

Classical dye absorption-based pH test papers are widely used to measure the degree of acidity of media for quantification or semi-quantification by the observation of the naked eye on the variation of colour. However, it remains a challenging task to extend portable and cheap methods to a wide range of analytes for accurate quantification. Here, we report a dosage-sensitive test paper for the assay of mercury ions (Hg
2+
) with wide colour evolution. The ratiometric fluorescent probe was prepared by mixing blue-emission silicon nanocrystals (Si NCs) and red-emission carbon dots (r-CDs). The Si NCs serve as the reaction site and the r-CDs as the internal reference. Upon the addition of Hg
2+
, the blue fluorescence of the Si NCs was quenched, while the red fluorescence of the r-CDs remained constant, resulting in the consecutive fluorescence colour changes from blue to orange red. The probe demonstrates high selectivity and sensitivity of the visualization assay of Hg
2+
with a detection limit of 7.63 nM. Moreover, we printed the ratiometric fluorescence probe result onto a piece of filter paper to prepare a test paper, which represents an on-site, sensitive, rapid and cost-effective method for the visual determination of Hg
2+
by the naked eye.
Analysis of the regulation networks in grapevine reveals response to waterlogging stress and candidate gene-marker selection for damage severity
Authors: Zhu Xudong , Li Xiaopeng , Jiu Songtao , Zhang Kekun , Wang Chen , Fang Jinggui
Published: June 2018

Owing to the climate change impacts, waterlogging is one of the most hazardous abiotic stresses to crops, which also can result in a serious reduction in the quantity and quality of grape berry and wine production during the rainy season. Therefore, the exploration of the response mechanism of grape to waterlogging is necessary, for which the analysis of the transcriptomic regulation networks of grapevine leaves in response to waterlogging stress was carried out. In this study, 12 634 genes were detected in both waterlogging stress and control grapevine plants, out of which 6837 genes were differentially expressed. A comparative analysis revealed that genes functioning in the antioxidant system, glycolysis and fermentation pathway, chlorophyll metabolism, amino acid metabolism and hormones were activated to reduce injury to grapes under the waterlogging stress. Meanwhile, genes encoding class-2 non-symbiotic haemoglobin were determined as important in waterlogging acclimation. Additionally, the expression variations of three marker genes were found to be informative and can be used to predict the viability of the grapevines subjected to waterlogging. This research not only probes the molecular mechanism underlying grapevine waterlogging tolerance but also puts forward an idea about the application of gene expression information to practical management.
A method for rapid testing of social learning in vampire bats
Authors: Vrtilek Julia K. , Carter Gerald G. , Patriquin Krista J. , Page Rachel A. , Ratcliffe John M.
Published: June 2018

Designing experiments on social learning using an untested behaviour or species requires baseline knowledge of how the animals will perform. We conducted a pilot study of a procedure for rapidly testing social learning in the highly social common vampire bat (Desmodus rotundus) using a simple maze. To create demonstrators, we allowed captive bats to learn to exit a three-dimensional maze, which reunited them with their colony as a reward. We then filmed naive bats in the same maze, comparing their ability to exit the maze before, during and after the addition of a trained demonstrator. The presence of a demonstrator increased the exit rates of naive bats, presumably by attracting the attention of the naive bats to the maze exit. Four of the five naive bats that exited in the presence of a demonstrator retained the ability to exit without the demonstrator. No naive bat exited during trials without a potential demonstrator present. This experimental procedure appears to be a promising approach for efficient tests of social learning in vampire bats because maze difficulty can be manipulated to adjust learning rates and each trial requires only 15 min.
A lateral flow strip based on gold nanoparticles to detect 6-monoacetylmorphine in oral fluid
Authors: Liu Jia , Hu Xiaolong , Cao Fangqi , Zhang Yurong , Lu Jianzhong , Zeng Libo
Published: June 2018

We used lateral flow strips based on gold nanoparticles to detect 6-monoacetylmorphine (6-MAM; heroin's unique metabolite) in oral fluid samples. In this competitive lateral chromatographic immunoassay, the 6-MAM was chemically synthesized and conjugated to bovine serum albumin. The results were qualitatively detected via the colour change of the test line. By using a proper sample pad, a suitable nitrocellulose membrane and a customized sponge device adsorbed the oral fluid directly from the mouth; the total test time was 3 min. The sensitivity of the assay was 4.0 ng ml
−1
without any cross-reactivity with 10 normal drugs, which are widely subject to abuse, including morphine and codeine. This test could be easily used on site to detect heroin in oral fluid, and it could be a promising product in the future including for driving under the influence.
Energetics and electronic structures of perylene confined in carbon nanotubes
Authors: Nagasawa Yuya , Koyama Takeshi , Okada Susumu
Published: June 2018

The energetics and geometries of perylene encapsulated in carbon nanotubes (CNTs) have been investigated employing density functional theory using the generalized gradient approximation combined with the van der Waals correction. Our calculations show that the encapsulated perylene molecules possess two metastable molecular conformations with respect to the CNT wall, which are almost degenerate with each other. A standing conformation, with respect to the CNT wall, is the ground state conformation for a semiconducting (19,0)CNT, while a lying conformation is the ground state for a metallic (11,11)CNT. Cooperation and competition between perylene–perylene and perylene–CNT interactions cause these possible perylene conformations inside CNTs. However, the electronic structure of the CNT encapsulating the perylene molecules is found to be insensitive to the molecular conformation.
Effects of thermal treatments on 10 major phenolics and their antioxidant contributions in
Acer truncatum
leaves and flowers
Authors: Yang Lingguang , Yin Peipei , Ho Chi-Tang , Yu Miao , Sun Liwei , Liu Yujun
Published: June 2018

This study aimed to investigate effects of thermal treatments on major phenolics and their antioxidant contributions in
Acer truncatum
leaves and flowers (ATL and ATF, respectively). With ultra performance liquid chromatography-diode array detector-quadrupole time-of-flight-mass spectrometer/mass spectrometer, phenolic compositions of ATF were first characterized and compared with those of ATL. An optimized high performance liquid chromatography fingerprint was then established, and 10 major phenolics existing in both ATL and ATF were quantified. Gallic acid derivatives and flavonol-3-
O
-glycosides were found to be their dominant phenolic constituents, with the former being key constituents which was affected by thermal treatments and further influencing the variations of total phenols. Moreover, the mechanism underlining the changes of phenolics in ATL and ATF by the treatments was characterized as a thermolhydrolysis process. During thermal treatments, polymerized gallotannins were hydrolysed to 1,2,3,4,6-pentakis-
O
-galloyl-β-
d
-glucose, ethyl gallate and gallic acid, resulting in more than fivefold and twofold increase of their contents in ATL and ATF, respectively. By contrast, contents and antioxidant contributions of flavonol-3-
O
-glycosides gradually decreased during the process.\absbreak Overall, this is, to our knowledge, the first report on the effects of thermal treatments on phenolics and their antioxidant contributions in ATL and ATF, and the three gallic acid derivatives with potentially higher bioactivity could be efficiently achieved by thermal treatments.
A no-go theorem for theories that decohere to quantum mechanics
Authors: Lee Ciarán M. , Selby John H.
Published: June 2018

To date, there has been no experimental evidence that invalidates quantum theory. Yet it may only be an effective description of the world, in the same way that classical physics is an effective description of the quantum world. We ask whether there exists an operationally defined theory superseding quantum theory, but which reduces to it via a decoherence-like mechanism. We prove that no such post-quantum theory exists if it is demanded that it satisfy two natural physical principles:
causality
and
purification
. Causality formalizes the statement that information propagates from present to future, and purification that each state of incomplete information arises in an essentially unique way due to lack of information about an environment. Hence, our result can be viewed either as evidence that the fundamental theory of Nature is quantum or as showing in a rigorous manner that any post-quantum theory must abandon causality, purification or both.
Bond graph modelling of the cardiac action potential: implications for drift and non-unique steady states
Authors: Pan Michael , Gawthrop Peter J. , Tran Kenneth , Cursons Joseph , Crampin Edmund J.
Published: June 2018

Mathematical models of cardiac action potentials have become increasingly important in the study of heart disease and pharmacology, but concerns linger over their robustness during long periods of simulation, in particular due to issues such as model drift and non-unique steady states. Previous studies have linked these to violation of conservation laws, but only explored those issues with respect to charge conservation in specific models. Here, we propose a general and systematic method of identifying conservation laws hidden in models of cardiac electrophysiology by using bond graphs, and develop a bond graph model of the cardiac action potential to study long-term behaviour. Bond graphs provide an explicit energy-based framework for modelling physical systems, which makes them well suited for examining conservation within electrophysiological models. We find that the charge conservation laws derived in previous studies are examples of the more general concept of a ‘conserved moiety’. Conserved moieties explain model drift and non-unique steady states, generalizing the results from previous studies. The bond graph approach provides a rigorous method to check for drift and non-unique steady states in a wide range of cardiac action potential models, and can be extended to examine behaviours of other excitable systems.