bluuebunny/crossref_metadata_2025 huggingface dataset:
Building Italianità in Northern Adriatic: The case of organized migration of population from Pola/Pula
Authors: Kosmač Miha
Published: August 2017

The article analyzes the process of buildingitalianitàin the case of migration of population from Pola/Pula that started as early as May 1945 and culminated in an organized process that officially began on 23 January 1947 and lasted until 20 March that same year. The article sheds light on the premises of that identity by analyzing complex activities of the Italian authorities who wanted to “defend Italianism” in Pola/Pula, as well as in other border areas of former Venezia Giulia. At the state level, they were mainly carried out by the Office for the Julian March/Ufficio per la Venezia Giuliaand following reorganization beginning at the end of 1946 by the Office for Border Areas/Ufficio per le Zone di Confine, and at the local level by a network of pro-Italian organizations and groups. Analysis contributes to the understanding of the top-down and bottom-upitalianitàbuilding process. On the local level, common identity was built upon the myth of thepatria, reiteration of traumatic/“wounded” memories and victim presentation of the “Italian” population, fear to be separated from thepatria, and unjust peace treaty propaganda. Simultaneously, the “Italian” population understood the Italian state as their defender.
From a cosmopolitan to a fascist land: Adriatic irredentism in motion
Authors: Capano Fabio
Published: August 2017

This article explores Adriatic irredentism, a complex political, cultural, and social movement, by specifically analyzing the unique role it played in the legitimization of Italian territorial claims over “language frontiers” such as Trieste and its hinterland. Through a close reading of first-hand sources, it examines how Italian irredentist intellectuals, public press, and associations purposefully utilized anti-Slav and anti-German arguments to shape public perception of both the Italian nation as well as Trieste's Italian identity or “Italianità.” Although recent historiographical interpretations have emphasized continuities in local understandings of “Italianità,” this article examines the discontinuities in the debate over its identity. It suggests that although Italian identity was first conceived as an expression of cultural and linguistic autonomy within the broader intellectual framework of Adriatic multi-nationalism, this idea gradually vanished amidst the structural crisis triggered by the Ausgleich or Compromise of 1867 and then inexorably faded on the eve of the Great War. Thus, notions of Italian national identity took an exclusionary and sometimes xenophobic meaning that was publicly used by a wide set of political actors to justify the territorial reincorporation of the “unredeemed” land within the borders of the new Italian state. The fascist regime, especially, utilized Italianness to further its aggressive and chauvinist agenda toward the Adriatic borderland. Consequently, Italian language and culture became instruments as well as symbols of repression and imperialism that were used to fulfill the regime's ambitions of “fascistization” of the Slavic population living in the region.
Simulated Effects of YY-Male Stocking and Manual Suppression for Eradicating Nonnative Brook Trout Populations
Authors: Schill Daniel J. , Meyer Kevin A. , Hansen Michael J.
Published: August 2017

Eradication of nonnative Brook Trout Salvelinus fontinalis populations is difficult to achieve with standard techniques, such as electrofishing removal or piscicides; new approaches are needed. A novel concept is to stock “supermale” hatchery fish with wild conspecifics. Supermales (MYY) have two Y-chromosomes, resulting in offspring that are all males; over time, successful supermale reproduction could eradicate the wild population. We constructed an age-structured stochastic model to investigate the effects of manually suppressing wild fish and stocking MYY fingerlings on the long-term viability of hypothetical nonnative Brook Trout populations. In streams, an annual stocking rate of supermales equivalent to 50% of wild age-0 Brook Trout density combined with an annual selective suppression rate equivalent to 50% of wild Brook Trout density resulted in a time to extirpation of only 2–4 years if supermale fitness was equivalent to wild male fitness. However, time to extirpation in streams was 5–15 years if supermale fitness was 80% lower than wild male fitness. In alpine lakes, higher supermale stocking rates and nonselective gillnetting were required to eradicate Brook Trout populations. If supermales were assumed to be as fit as wild males, however, any supermale stocking rate greater than 49% in alpine lakes or 60% in streams achieved eradication in 10 years or less, regardless of the suppression rate. Because manual suppression and the stocking of MYY fingerlings can readily be conducted at the levels assumed in our simulations, use of such an integrated pest management (IPM) approach could extirpate undesirable Brook Trout populations within reasonably short periods of time. Given the recent successful development of an MYY Brook Trout broodstock capable of producing large numbers of MYY fingerlings and given the positive results of the present simulations for both streams and alpine lakes, field testing of MYY stocking is warranted within an IPM program that includes manual suppression for eradicating undesirable Brook Trout populations.

Received October 14, 2016; accepted June 10, 2017 Published online August 22, 2017
Identification and characterization of a sulfoglycosidase from Bifidobacterium bifidum implicated in mucin glycan utilization
Authors: Katoh Toshihiko , Maeshibu Takako , Kikkawa Kei-ichi , Gotoh Aina , Tomabechi Yusuke , Nakamura Motoharu , Liao Wei-Hsiang , Yamaguchi Masanori , Ashida Hisashi , Yamamoto Kenji , Katayama Takane
Published: August 2017

Human gut symbiont bifidobacteria possess carbohydrate-degrading enzymes that act on the O-linked glycans of intestinal mucins to utilize those carbohydrates as carbon sources. However, our knowledge about mucin type O-glycan degradation by bifidobacteria remains fragmentary, especially regarding how they decompose sulfated glycans, which are abundantly found in mucin sugar-chains. Here, we examined the abilities of several Bifidobacterium strains to degrade a sulfated glycan substrate and identified a 6-sulfo-β-d-N-acetylglucosaminidase, also termed sulfoglycosidase, encoded by bbhII from Bifidobacterium bifidum JCM 7004. A recombinant BbhII protein showed a substrate preference toward 6-sulfated and 3,4-disulfated N-acetylglucosamines over non-sulfated and 3-sulfated N-acetylglucosamines. The purified BbhII directly released 6-sulfated N-acetylglucosamine from porcine gastric mucin and the expression of bbhII was moderately induced in the presence of mucin. This de-capping activity may promote utilization of sulfated glycans of mucin by other bacteria including bifidobacteria, thereby establishing the symbiotic relationship between human and gut microbes.
Yaron Fuchs: Exploring the mysterious mixture of life and death
Authors: O’Donnell Marie Anne
Published: August 2017

Fuchs studies how cell death controls stem cell–driven processes.
Cbfβ2 deficiency preserves Langerhans cell precursors by lack of selective TGFβ receptor signaling
Authors: Tenno Mari , Shiroguchi Katsuyuki , Muroi Sawako , Kawakami Eiryo , Koseki Keita , Kryukov Kirill , Imanishi Tadashi , Ginhoux Florent , Taniuchi Ichiro
Published: August 2017

The mouse Langerhans cell (LC) network is established through the differentiation of embryonic LC precursors. BMP7 and TGFβ1 initiate cellular signaling that is essential for inducing LC differentiation and preserving LCs in a quiescent state, respectively. Here we show that loss of Cbfβ2, one of two RNA splice variants of the Cbfb gene, results in long-term persistence of embryonic LC precursors after their developmental arrest at the transition into the EpCAM+ stage. This phenotype is caused by selective loss of BMP7-mediated signaling essential for LC differentiation, whereas TGFβR signaling is intact, maintaining cells in a quiescent state. Transgenic Cbfβ2 expression at the neonatal stage, but not at the adult stage, restored differentiation from Cbfβ2-deficient LC precursors. Loss of developmental potential in skin-residential precursor cells was accompanied by diminished BMP7–BMPR1A signaling. Collectively, our results reveal an essential requirement for the Cbfβ2 variant in LC differentiation and provide novel insight into how the establishment and homeostasis of the LC network is regulated.
Propane in nitrogen, 1000 μmol/mol
Authors: Konopelko L A , Kustikov Y A , Kolobova A V , Pankratov V V , Pankov A A , Efremova O V , Rozhnov M S , Melnyk D M , Petryshyn P V , Levbarg O S , Kisel S P , Shpilnyi S A , Yakubov S Ye , Bakovec N V , Mironchik A M , Aleksandrov V V
Published: August 2017

This article presents the report on the COOMET key comparison COOMET.QM-K111, which is linking to the appropriate CCQM comparison—CCQM-K111 'Propane in nitrogen 1000 μmol/mol'. CCQM-K111 was carried out in 2014–2016 and it was one of a series of key comparisons in the gas analysis area assessing core competences.

Main text

To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.

The final report has been peer-reviewed and approved for publication by the CCQM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).
A Pivotal Randomized Clinical Trial Evaluating the Safety and Effectiveness of a Novel Hydrogel Dural Sealant as an Adjunct to Dural Repair
Authors: Tew John M. , Strong Michael J. , West G. Alexander , Woo Henry , Couture Daniel E. , Wilson John A. , Munoz Lorenzo F. , Rosen Charles L. , Greenlee Jeremy D. , van Loveren Harry R. , Iantosca Mark , Baird Clinton J. , Smith Mark , McGirt Matt , Parish Jonathan , Asher Anthony L.
Published: August 2017

BACKGROUND: A watertight dural repair is critical to minimizing the risk of postoperative complications secondary to cerebrospinal fluid (CSF) leaks.

OBJECTIVE: To evaluate the safety and efficacy of a novel hydrogel, Adherus Dural Sealant, when compared with control, DuraSeal Dural Sealant System, as an adjunct to standard methods of dural repair.

METHODS: In this 17-center, prospective, randomized clinical trial designed as a noninferiority, single-blinded study, 124 patients received Adherus Dural Sealant (test sealant) and 126 received DuraSeal (control). The primary composite endpoint was the proportion of patients who were free of any intraoperative CSF leakage during Valsalva maneuver after dural repair, CSF leak/pseudomeningocele, and unplanned retreatment of the surgical site. Each component was then analyzed individually as a secondary endpoint. Patients were followed for 4 mo after surgery.

RESULTS: The primary composite endpoint at the 120-d follow-up was achieved in 91.2% of the test sealant group compared with 90.6% of the control, thus showing that the test sealant was statistically significantly noninferior to DuraSeal (P = .0049). Post hoc analysis of the primary composite endpoint at 14 d demonstrated superiority of the test sealant over the control (P = .030). Primary endpoint failures in the control group tended to occur early in follow-up period, while a majority of test dural sealant failures were identified through protocol-required radiographic imaging at the 120-d follow-up visit.

CONCLUSION: The test sealant, Adherus Dural Sealant, is a practical, safe, and effective adjunct to achieving a watertight dural closure after primary dural closure in cranial procedures.
Diversity of Neopestalotiopsis and Pestalotiopsis spp., Causal Agents of Guava Scab in Colombia
Authors: Solarte Fernando , Muñoz Carlos German , Maharachchikumbura Sajeewa S. N. , Álvarez Elizabeth
Published: August 2017

Common guava (Psidium guajava L.) is a fruit tree of global economic importance. It is grown in Asia, South and Central America, and Hawaii for its exquisite aroma and flavor, and nutritional and medical properties. However, guava production is limited by guava scab, caused by fungi in the Pestalotiopsis genus. Characteristic symptoms of guava scab are corky, ovoid or round lesions on fruit surfaces. These lesions may thicken, affecting the flesh below and reducing fruit quality and commercial value. We characterized 81 isolates isolated from guava scab lesions on guava leaves and fruit in different regions of Colombia, and identified them as Pestalotiopsis and Neopestalotiopsis spp. We analyzed the morphology, pathogenicity, and genetic diversity of the isolates based on the sequences of the internal transcribed spacer, β-tubulin, and elongation factor genes. Isolates were morphologically, pathogenically, and genetically diverse but the diversity did not correlate with geographical origin, or guava cultivar or tissue from which the isolates were recovered. Selected monosporic isolates included in the multiple-gene analysis were identified as belonging to two genera: Neopestalotiopsis (65 isolates with versicolorous conidia) and Pestalotiopsis (4 isolates with concolorous conidia).
A Narrative Review of Adherence to Subarachnoid Hemorrhage Guidelines
Authors: Gritti Paolo , Akeju Oluwaseun , Lorini Ferdinando L. , Lanterna Luigi A. , Brembilla Carlo , Bilotta Federico
Published: August 2017

Over the past 2 decades, a large number of guidelines for aneurysmal subarachnoid hemorrhage (aSAH) management have been proposed. The primary aim of these “evidence-based” guidelines is to improve the care of aSAH patients by summarizing and making current knowledge readily available to clinicians. However, an investigation into aSAH guidelines, their changes along time and their successful translation into clinical practice is still lacking.

We performed a literature search of historical events and subarachnoid hemorrhage guidelines using the Entrez PubMed NIH, Embase, and Cochrane databases for articles published up to November of 2016. Data were summarized for guidelines on aSAH management and cross-sectional studies of their application. A total of 11 guidelines and 10 cross-sectional studies on aSAH management were analyzed. The use of nimodipine for the treatment of SAH is the only recommendation that remained consistent across guidelines over time (r=0.82; P<0.05). A shift in the definitive treatment for aneurysms from open surgical clipping to endovascular coiling was also noted (r=−0.91; r=0.96; P<0.005). In addition, definitive treatment for aneurysm is being performed earlier. The use of triple-H therapy and the long-term administration of anticonvulsive therapy has decreased. Finally, written protocols for aSAH management were not consistently used across tertiary care institutions (r=−0.46; P=0.43; confidence interval, −0.95 to −0.70).

We conclude that guidelines related to the management of patients with SAH have evolved from a consensus-based approach into an evidence-based approach. Nevertheless, the translation into clinical practice is limited, suggesting that personalized approaches to care is inherent, and perhaps necessary for aSAH management.
Cerebral Oxygen Saturation During Electroconvulsive Therapy: A Secondary Analysis of a Randomized Crossover Trial
Authors: Sriganesh Kamath , Jadhav Tanmay , Venkataramaiah Sudhir , Naveen Kumar Channaveerachari , Armugham Shyamsundar , Philip Mariamma , Madhusudan Reddy KR , Thirthalli Jagadisha , Umamaheswara Rao GS
Published: August 2017

Background:

Electroconvulsive therapy (ECT) causes acute changes in cerebral perfusion and oxygenation. Near-infrared spectroscopy is a novel, noninvasive technique to assess cerebral oxygen saturation (cSO2). We hypothesized that cSO2 increases during ECT and more so with atropine premedication and decreases when systemic desaturation (peripheral oxygen saturation <90%) occurs during ECT.

Methods:

We performed a secondary analysis of a randomized trial of patients undergoing ECT for psychiatric illness during a 6-month period. During the second ECT session, patients were randomly assigned to receive either 0.01 mg/kg IV atropine or no atropine. During the third ECT session, patients were crossed over. Standard anesthetic management was performed. Data with regard to heart rate, blood pressure, peripheral oxygen saturation, and cSO2 were collected at baseline and continuously examined for 5 minutes from delivery of ECT stimulus.

Results:

Forty-one patients underwent 82 ECT sessions. ECT resulted in significant increase in cSO2 during both the atropine and the no-atropine sessions (P<0.001 for both) but no between-session difference was observed (mean difference, 1.9±2.0; 95% confidence interval, −2.0, 5.9; P=0.337). The cSO2 values were lower in patients who developed systemic desaturation when compared with the cSO2 values in those who did not (mean difference, 5.0±2.6; 95% confidence interval −0.1, 10.2; P=0.054). However, the mean cSO2 was >60% at any measured time point, even in those with systemic desaturation.

Conclusions:

ECT increased cSO2 irrespective of atropine premedication. cSO2 was lower when systemic desaturation occurred. Future studies should explore the effect of cerebral oxygenation changes during ECT on outcome of psychiatric conditions.
Selecting the LSTV as the Lower Instrumented Vertebra in the Treatment of Lenke Types 1A and 2A Adolescent Idiopathic Scoliosis
Authors: Bai Jinyi , Chen Kai , Wei Qiang , Chen Ziqiang , Chen Yu , Ni Haijian , Zhao Yingchuan , Li Ming
Published: August 2017

Study Design.

Retrospective study.

Objective.

The purpose of this study was to verify the last substantially touched vertebra (LSTV) as the ideal lower instrumented vertebra (LIV) and to identify predictive factors of adding-on in patients with Lenke type 1A and 2A curve patterns when LSTV was chosen as the LIV.

Summary of Background Data.

Although several studies have indicated that the use of the LSTV as the LIV can obtain favorable outcomes in Lenke 1A and 2A curves, the factors identifying patients with Lenke 1A and 2A curve patterns who should undergo a fusion extending beyond the LSTV have not been identified.

Methods.

A total of 120 patients with Lenke 1 and 2 curves after posterior instrumentation and fusion to the LSTV were evaluated. All patients had a minimum 3-year follow-up. Patients were grouped based on the occurrence of the distal adding-on phenomenon: an adding-on group and a no adding-on group. We analyzed the significant independent factors associated with adding-on via univariate analysis and then via stepwise logistic regression analysis.

Results.

Distal adding-on was observed in 16 patients (13.33%). Binary logistic regression analysis showed that the Risser sign (OR = 0.592, P = 0.033), preoperative distance between the LIV and the center sacral vertical line (CSVL) (LIV-CSVL) (OR = 1.286, P = 0.002), and postoperative thoracic kyphosis (T5–T12) (OR = 0.784, P = 0.002) were primary factors for distal adding-on.

Conclusion.

Selecting the LSTV as the LIV simplifies the selection of the LIV and is an effective operation strategy in patients with Lenke 1A and 2A curve types. Patients with lower Risser sign, larger preoperative LIV-CSVL, and postoperative thoracic hypokyphosis are more likely to develop distal adding-on at 3-year follow-up.

Level of Evidence: 4
Clinical Practice Guideline: Safe Medication Use in the ICU
Authors: Kane-Gill Sandra L. , Dasta Joseph F. , Buckley Mitchell S. , Devabhakthuni Sandeep , Liu Michael , Cohen Henry , George Elisabeth L. , Pohlman Anne S. , Agarwal Swati , Henneman Elizabeth A. , Bejian Sharon M. , Berenholtz Sean M. , Pepin Jodie L. , Scanlon Mathew C. , Smith Brian S.
Published: August 2017

Objective:

To provide ICU clinicians with evidence-based guidance on safe medication use practices for the critically ill.

Data Sources:

PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, and ISI Web of Science for relevant material to December 2015.

Study Selection:

Based on three key components: 1) environment and patients, 2) the medication use process, and 3) the patient safety surveillance system. The committee collectively developed Population, Intervention, Comparator, Outcome questions and quality of evidence statements pertaining to medication errors and adverse drug events addressing the key components. A total of 34 Population, Intervention, Comparator, Outcome questions, five quality of evidence statements, and one commentary on disclosure was developed.

Data Extraction:

Subcommittee members were assigned selected Population, Intervention, Comparator, Outcome questions or quality of evidence statements. Subcommittee members completed their Grading of Recommendations Assessment, Development, and Evaluation of the question with his/her quality of evidence assessment and proposed strength of recommendation, then the draft was reviewed by the relevant subcommittee. The subcommittee collectively reviewed the evidence profiles for each question they developed. After the draft was discussed and approved by the entire committee, then the document was circulated among all members for voting on the quality of evidence and strength of recommendation.

Data Synthesis:

The committee followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation system to determine quality of evidence and strength of recommendations.

Conclusions:

This guideline evaluates the ICU environment as a risk for medication-related events and the environmental changes that are possible to improve safe medication use. Prevention strategies for medication-related events are reviewed by medication use process node (prescribing, distribution, administration, monitoring). Detailed considerations to an active surveillance system that includes reporting, identification, and evaluation are discussed. Also, highlighted is the need for future research for safe medication practices that is specific to critically ill patients.
Acceptability of Group Visits for Attention-Deficit Hyperactivity Disorder in Pediatric Clinics
Authors: Bauer Nerissa S. , Azer Nina , Sullivan Paula D. , Szczepaniak Dorota , Stelzner Sarah M. , Downs Stephen M. , Carroll Aaron E.
Published: August 2017

Objective:

Children with attention-deficit hyperactivity disorder (ADHD) have ongoing needs that impair home and school functioning. Group visit models are a promising way to deliver timely parenting support but family and provider acceptance has not previously been examined. The objective was to describe the acceptability of ADHD group visits in busy pediatric clinics based on caregivers, child participants and facilitators.

Methods:

Data were analyzed from school-age children and caregivers who participated in one of two 12-month long randomized controlled studies of the ADHD group visit model from 2012 to 2013 or 2014 to 2015. Feedback was obtained using semi-structured questions at each study end, by telephone or at the last group visit. Sessions were audio-recorded, transcribed and themes were extracted by participant type.

Results:

A total of 34 caregivers, 41 children and 9 facilitators offered feedback. Caregivers enjoyed the “support group” aspect and learning new things from others. Caregivers reported improved understanding of ADHD and positive changes in the relationship with their child. Children were able to recall specific skills learned including how skills helped at home or school. Facilitators acknowledged systems-level challenges to offering group visits but felt the group format helped increase understanding of families' needs, improved overall care, and provided innovative ways to engage with families.

Conclusion:

The majority of comments from families and facilitators highlighted a variety of benefits of the use of a group visit model for ADHD chronic care. Despite systems-level barriers to implementation, families and facilitators felt the benefits outweighed the challenges.
INTRAVITREAL INJECTION OF AFLIBERCEPT IN PATIENTS WITH POLYPOIDAL CHOROIDAL VASCULOPATHY
Authors: Maruyama-Inoue Maiko , Sato Shimpei , Yamane Shin , Kadonosono Kazuaki
Published: August 2017

Purpose:

To compare the 3-year follow-up results of intravitreal injections of aflibercept between fixed dosing (FD) regimen and a pro re nata (PRN) regimen after three initial monthly doses for the treatment of polypoidal choroidal vasculopathy and to analyze factors influencing improvement in visual acuity.

Methods:

We retrospectively studied all treatment-naive patients with polypoidal choroidal vasculopathy who were scheduled to receive intravitreal aflibercept injections FD or PRN after induction treatment between March 2013 and May 2014. Best-corrected visual acuity was evaluated before treatment and at 4, 12, 24, and 36 months after initial treatment. Factors that influence improvement in visual acuity were also investigated.

Results:

Thirty-three eyes were assessed at the 3-year follow-up examination. Twenty-three eyes were treated with intravitreal aflibercept injections every 2 months for at least 1 year after three initial monthly doses (FD group), and 10 eyes were treated PRN after loading doses (PRN group). In the FD group, during the follow-up period from 1 to 3 years, quarterly dosing with capped PRN or a treat and extend regimen were selected. The mean number of administered intravitreal aflibercept was 15.3 ± 4.6 in the FD group and 9.0 ± 8.9 in the PRN group, with a significant difference between the two groups (P = 0.004). Significant improvement of the mean logarithm of the minimum angle of resolution values for best-corrected visual acuity was shown at 36 months, as compared to baseline values (P = 0.019). No significant difference in the improvement of best-corrected visual acuity between the two groups was observed at baseline or at 4, 12, 24, and 36 months after treatment (all P > 0.05), although there was a trend toward better results in the FD group. Multiple regression analysis showed that the FD group had better visual acuity at 36 months and greater improvement in visual acuity than the PRN group (P = 0.031 for both comparisons).

Conclusion:

Intravitreal aflibercept was effective in improving the vision of patients with polypoidal choroidal vasculopathy, as evaluated at the 3-year follow-up. Fixed treatment might be an important factor influencing improvement in visual acuity.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FOR THE DETECTION OF SECONDARY CHOROIDAL NEOVASCULARIZATION IN VITELLIFORM MACULAR DYSTROPHY
Authors: Stattin Martin , Ahmed Daniel , Glittenberg Carl , Krebs Ilse , Ansari-Shahrezaei Siamak
Published: August 2017

Purpose:

Optical coherence tomography angiography (OCTA) is used to assess vascular abnormality in advanced stage vitelliform macular dystrophy (VMD2).

Methods:

Multimodal imaging including spectral domain (SD) OCT, autofluorescence (AF), fluorescein (FA) and indocyanine green angiography (ICGA) as well as optical coherence tomography angiography were performed.

Patients:

Two eyes in one young patient with diagnosed vitelliform macular dystrophy were investigated for progressive visual dysfunction.

Results:

Optical coherence tomography angiography identified neovascular formation within the outer retina and the choriocapillaris respectively while all other imaging methods were inconclusive.

Conclusion:

Optical coherence tomography angiography was superior to conventional angiography in the detection of choroidal neovascularization (CNV) in advanced retinal disorders like vitelliform macular dystrophy.
Treatment of Diabetic Ketoacidosis Associated With Antipsychotic Medication
Authors: Vuk Antonia , Baretic Maja , Osvatic Martina Matovinovic , Filipcic Igor , Jovanovic Nikolina , Kuzman Martina Rojnic
Published: August 2017

Background

The second-generation antipsychotics (SGAs) are associated with metabolic disturbances. Diabetic ketoacidosis (DKA) is a rare, but potentially fatal sign of acute glucose metabolism dysregulation, which may be associated with the use of SGAs. This study aims to review published reports of patients with schizophrenia and antipsychotic drug–associated DKA, focusing on the effective management of both conditions.

Methods

Using a predefined search strategy, we searched PubMed and EMBASE from their inception to July 2016. The search terms were related to “diabetic ketoacidosis” and “antipsychotic medication.” Case reports, case series, and reviews of case series written in English language were included in the review.

Results

Sixty-five reports were analyzed. In most patients who developed antipsychotic-associated DKA, 1 or more suspected antipsychotic medications were discontinued. In 5 cases, a rechallenge test was trialed, and in only 1 case, it resulted in the elevation of blood glucose. The majority was subsequently treated with a different SGA in combination with insulin/oral hypoglycemic agents; although approximately a third of patients had a complete resolution of symptoms or could control diabetes with diet only at the point of discharge.

Conclusions

Patients taking antipsychotic medications should be regularly screened for insulin resistance and educated about potential complications of antipsychotic medications. This will allow clinicians to individualize treatment decisions and reduce iatrogenic contribution to morbidity and mortality. To achieve best treatment outcomes, antipsychotic-induced DKA should be treated jointly by psychiatry and endocrinology teams.
Lichen Nitidus Photo Quiz
Authors: Liu Jesse , Lake Eden Pappo
Published: August 2017

This article discusses lichen nitidus in an adult patient with human immunodeficiency virus. The patient is compliant with antiviral therapy and otherwise healthy. Features characteristic of lichen nitidus are emphasized, including the appearance of the lesions, Koebner phenomenon, and distribution of the lesions on the forearm, abdomen, and glans penis. A multiple-choice question is presented, and answers are discussed. After the multiple-choice question is a discussion of the clinical features, characteristic histological findings including the “ball-in-claw” appearance, and management of lichen nitidus.
Nurse Practitioner Lead Pediatric Baclofen Pump Program: Impact on Safety and Quality of Care
Authors: Buxton Kristin , Morgan Ann , Rogers Jayne
Published: August 2017

Children with cerebral palsy experience spasticity that can be debilitating and cause significant pain and contractures. Intrathecal baclofen (ITB) therapy can help relieve this spasticity and improve the quality of life for these patients, but it comes with risk. Withdrawal from the medication in case of abrupt discontinuation of delivery can be life-threatening. Regular maintenance of the system is mandatory. Having a program in place to manage the device and support patients helps to ensure their safety. Toward this end, we developed a program with a nurse practitioner (NP) leader to secure the safety and quality of care for patients using ITB therapy. As the program grew, the NP role as an expert in the care and management of ITB pumps became essential to the safety and care of these patients. In addition to the basic outpatient and inpatient management of the baclofen pump, the NP developed a detailed educational program for the patients and leads the quality and safety initiative for the program. The NP is also in a unique position to have intimate knowledge of the patient’s condition and build a strong relationship with the patient/family. The NP is able to use this knowledge and relationship as concerns arise that could be related to the ITB therapy. This has greatly improved the safety and quality of care for patients using ITB therapy at our institution.
Interprovider Communication Using a Scheduled Provider Alert-Response Communication System in 3 Inpatient Neurology Units
Authors: Siegler James E. , Finegan Dan , Kasner Scott E. , Price Raymond S.
Published: August 2017

Background: Nonemergent communications between nursing staff and residents often occur randomly throughout the workday at teaching institutions, resulting in inefficiency and interruptions of scheduled resident educational conferences or periods of overnight rest. Objective: The aim of this study was to determine whether a quality improvement communication strategy can reduce interruptive notifications during scheduled resident didactic sessions. Methods: We conducted a prospective, mixed-methods trial of a communication strategy between nurses and residents in 3 neurology units of an academic institution. We measured content and volume of notifications from nurses to residents during scheduled conferences and overnight and categorized these notifications according to levels of urgency. We implemented an intervention requiring multidisciplinary evening work rounds between the on-call resident and charge nurse and batching of nonemergent communications. Survey data were collected. Results: The total census during the 6-month study period was 728 patients. Of the 704 resident-reported nursing notifications, 50% could be safely deferred until change of shift. After the intervention, there was a 52% decrement of notifications (0.52 vs 0.25 notifications per patient, P < .01). The preintervention survey response rate was 65% for nurses (46/71) and 100% for residents (26/26), whereas postintervention response rates were 51% for nurses (36/71) and 96% for residents (24/25). Both nurses and residents responded more favorable in the postintervention period across multiple items that addressed patient safety, utility, and satisfaction (P < .01 for comparisons). Conclusions: A scheduled nurse-resident communication system reduced interruptive calls during educational conferences and overnight by half. This intervention was perceived as safe and effective and resulted in higher satisfaction among participants.
Stroke-Related Disease Comorbidity and Secondary Stroke Prevention Practices Among Young Stroke Survivors
Authors: Magwood Gayenell S. , White Brandi M. , Ellis Charles
Published: August 2017

Background: Although ischemic stroke incidence has been in decline over the past 60 years, the same has not been observed among individuals younger than 55 years. Recent reports have shown a substantial increase in young stroke incidence, yet little is known about young stroke survivors. Objective: The aim of this study was to examine the disease comorbidity profile and secondary prevention practices in stroke survivors younger than 50 years. Methods: This study used a retrospective data analysis of secondary stroke prevention practices among young stroke survivors using data from the 2015 National Health Interview Survey. Results: Approximately 57% of the sample reported having hypertension; 33%, high cholesterol; 13%, diabetes; and 7%, heart disease. In the past 12 months, more than 60% had seen a general doctor, neurologist, or specialist, and more than 75% were following low-dose aspirin advice or taking prescribed medications for blood pressure or cholesterol. Similarly, 84% had their blood pressure checked, and 66% had their cholesterol checked, but only 50% had a fasting test for their blood sugar in the past 12 months. Conclusions: Many young stroke survivors exhibit comorbid disease conditions that are similar to older stroke survivors. A large percentage are engaged in general chronic disease and secondary stroke prevention practices, yet less than two-thirds had seen a general doctor in the past 12 months. Primary care doctors and other health professionals are critical to the implementation of disease management strategies that consider their age, secondary stroke risk, expected life spans, and other issues that differ from older adult stroke survivors.
Minimum operational standards for 24/7 available emergency departments in the Netherlands: a first step taken by emergency physicians using an e-Delphi approach
Authors: Gaakeer Menno I. , Veugelers Rebekka , Patka Peter , Huijsman Robbert
Published: August 2017

Objective

The objective of this study was to effectuate a consensus of emergency physicians on minimum requirements for facility, diagnostic, and medical specialist availability as a first step toward minimum operational standards for 24/7 available emergency departments (EDs) in the Netherlands.

Patients and methods

A two-part e-Delphi through online survey was performed between January 2015 and May 2016, using a panel of 20 experts in emergency medicine. The aim of part I was to reach an agreement on a list of possible ED elements and their definitions. The second part addressed the actual study objective to reach consensus on operational standards. Successive rounds were submitted to the members of the panel online using SurveyMonkey. Results of each survey round were discussed and interpreted in agreement with all authors in preparation for the next round. Reaching consensus, defined as 70% or more agreement or disagreement among the panel, on the level of all items was the endpoint of this study.

Results

Both parts I and II required five rounds. The dropout rate of the expert panel remained zero. The availability of 52 facilities and diagnostic functionalities and the manner in which 17 medical specialties should be available to every 24/7 ED were agreed upon by the expert panel.

Conclusion

An expert panel agreed upon minimum operational standards for EDs in the Netherlands. These results are helpful as a first step toward a more widely supported standard for future 24/7 available EDs in the Netherlands and in addition to this other urgent care facilities.
Effect of Citalopram for the Treatment of Neurocardiogenic Syncope
Authors: Kadri Amer N. , Nusairat Leen , Kadri Samah , Alqaid Ammar , Hernandez Adrian V. , Kadri Nazih N.
Published: August 2017

Background:

Neurocardiogenic syncope (NCS) is a common form of syncope. Although selective serotonin reuptake inhibitors and other medications have been used to treat NCS with variable success, there is no consensus regarding a first-line therapy.

Study Question:

To assess the effects of citalopram in NCS and to examine the effect of diagnostic use of the head-up tilt table (HUTT) versus empirical diagnosis on patient outcome.

Study Design:

A retrospective case series of 1000 consecutive patients who were diagnosed with NCS and treated with citalopram.

Measures and Outcomes:

The primary outcome measure was well-being score (WS) recorded at each outpatient visit.

Results:

After excluding patients who had other comorbidities, were taking daily medication, or did not attend a follow-up visit within 1 month after treatment initiation, data from 186 patients were included. Thirty-five patients were diagnosed empirically, and 151 patients were diagnosed with the HUTT. All 186 patients were followed up within 1 month (early follow-up); of these, 92 patients attended a second follow-up after 1 month (late follow-up). The early follow-up group showed a significant improvement in mean WS (7.35 vs. 4.46, P < 0.001) and only 5 patients discontinued therapy because of intolerability. The late follow-up group also showed significant improvements in mean WS at the early follow-up (7.42 vs. 4.43, P < 0.001) and late follow-up (7.42 vs. 4.26, P < 0.001). Of 186 patients who were treated with citalopram, only 11 reported the development of undesirable side effects. There was no significant difference in the outcome of patients who were diagnosed empirically versus those who were diagnosed with the HUTT.

Conclusions:

Citalopram seems to have desirable effects on NCS and patient well-being. Diagnostic use of the HUTT is useful for confirming diagnoses of NCS but is not likely to improve patient outcome.
The importance of natural killer cell killer immunoglobulin-like receptor-mismatch in transplant outcomes
Authors: Stringaris Kate , Barrett Austin J.
Published: August 2017

Purpose of review

In recent years, the rules of engagement between natural killer (NK) cells and their targets have become better defined with the identification of an array of NK surface molecules, notably the killer immunoglobulin-like (KIR) receptors and their ligands on target cells through which signals of activation or suppression of NK function are mediated. After allogeneic stem cell transplantation (SCT), the opportunity for NK cell activation can occur both in human leucocyte antigen (HLA) matched and HLA mismatched pairs. Although less well explored in HLA identical transplants, many studies confirm the importance of NK KIR mismatching in the graft-versus-leukemia effect in haploidentical (haplo) SCT and this has stimulated recent research to better define the role of NK mismatching on transplant outcome. In this review, we describe recent progress in identifying favorable and unfavorable NK matching in SCT.

Recent findings

Recent studies focus less on KIR-HLA mismatching and more on KIR genes as tools to predict alloreactivity via NK licensing and activating KIR.

Current results show that transplant outcomes could be improved by judicious selection of favorable donors.
Bevacizumab-associated Bowel Microperforation in a Patient With Neuroblastoma
Authors: Glincher Rachel , Price Anita P. , LaQuaglia Michael P. , Kushner Brian H. , Modak Shakeel
Published: August 2017

The antivascular endothelial growth factor antibody, bevacizumab, is effective against several malignancies in adults but unproven in pediatric oncology. In early phase pediatric studies toxicities were similar to those in adults. Bowel perforation in adults is a rare but serious toxicity, but has not been hitherto reported in children. A 5-year-old boy with chemoresistant neuroblastoma treated with bevacizumab plus radioimmunotherapy developed acute abdominal pain. Computed tomography scan showed free abdominal air and pneumatosis coli. Emergency laparotomy and bowel diversion were performed leading to complete recovery and timely continuation of antineuroblastoma therapy. Early recognition and rapid intervention can prevent a catastrophic outcome in bevacizumab-related bowel perforation.
Acute Sickle Cell Orbitopathy Masquerading as Orbital Cellulitis
Authors: Stewart Christopher M. , Sipkova Zuzana , Hildebrand Goran D. , Norris Jonathan H.
Published: August 2017

Sickle cell orbitopathy is a rare manifestation of a sickle cell crisis and can closely mimic orbital cellulitis, both clinically and radiologically. We present a case where a child presented with what was thought to be orbital cellulitis and was treated accordingly. Subtle radiologic features of sickle cell orbitopathy were initially overlooked, resulting in an incorrect diagnosis and a treatment delay for the patient. Correctly treated most cases resolve with no adverse affects, highlighting how important it is to consider acute sickle cell orbitopathy in the differential diagnosis of acute periorbital swelling in children with sickle disease.
Development of a Mobile App for Family Planning Providers
Authors: Halsall Viannella , Rogers Jennifer , Witt Jacki , Song Sejun , Nguyen Hoang Duc Huy , Kelly Patricia
Published: August 2017

Purpose:

To provide an overview of lessons learned during the development process of an app for iOS and Android based on national recommendations for providing quality family planning services.

Study and Design:

After a review of existing apps was conducted to determine whether an app of clinical recommendations for family planning existed, a team of clinicians, training specialists, and app developers created a resource app by first drafting a comprehensive content map. A prototype of the app was then pilot tested using smart tablets by a volunteer convenience sample of women's healthcare professionals. Outcomes measured included usability, acceptability, download analytics, and satisfaction by clinicians as reported through an investigator-developed tool.

Results:

Sixty-nine professionals tested a prototype of the app, and completed a user satisfaction tool. Overall, user feedback was positive, and a zoom function was added to the final version as a result of the pilot test. Within 3 months of being publicly available, the app was downloaded 677 times, with 97% of downloads occurring on smart phones, 76% downloads occurring on iOS devices, and 24% on Android devices. This trend persisted throughout the following 3 months.

Clinical Implications:

Clinicians with an interest in developing an app should consider a team approach to development, pilot test the app prior to wider distribution, and develop a web-based version of the app to be used by clinicians who are unable to access smart devices in their practice setting.
Influences on Infant Feeding
Authors: Majee Wilson , Thullen Matthew J. , Davis Alexandra N. , Sethi Tarunjot K.
Published: August 2017

Purpose:

The purpose of this study was to examine interrelational-, organizational-, and community-level influences on how coparents collaborate about infant and toddler feeding.

Study Design and Sample:

Using qualitative methods, we interviewed mother–father parent dyads to explore the potential influences on infant and toddler feeding. Participants were purposively recruited from two Midwest, rural, university-system pediatric clinics. Thematic analysis was used to code the data.

Measures:

Mother–father dyadic interviews were conducted using a semistructured interview schedule. Twenty-four mother–father dyads who had a child between the ages of 6 and 36 months were interviewed together.

Results:

Major themes include interpersonal factors (peer behavior reinforcement, dyad and important others infant feeding conflict, conflict resolution proactiveness), organizational factors (healthcare provider infant-feeding support, workplace flexibility), and community factors (public perception on breastfeeding and social media influence).

Clinical Implications:

Community-based collaboration can be a platform for mother–father dyads, researchers, public health nurses, and other healthcare providers to proactively create interventions that include opportunity for building coparenting skills and infant-feeding knowledge that promote team management of common early childhood feeding challenges.
Nurses' Knowledge and Teaching of Possible Postpartum Complications
Authors: Suplee Patricia D. , Bingham Debra , Kleppel Lisa
Published: August 2017

Purpose:

The purpose of this study was to assess postpartum nurses' knowledge of maternal morbidity and mortality, and information they shared with women before discharge about identifying potential warning signs of postpartum complications.

Study Design & Methods:

Registered nurses (RNs) who care for women during postpartum (N = 372) completed an electronic survey. Descriptive statistics and bivariate analyses were used for data analysis.

Results:

Fifty-four percent of nurse participants were aware of the rising rates of maternal mortality in the United States and 12% accurately reported the correct percentage of deaths that occurred during the postpartum period. Ninety-three percent of nurses were more likely to identify hemorrhage as a leading cause of maternal mortality. On the day of discharge, 67% of RNs spent less than 10 minutes focusing on potential warning signs. Ninety-five percent of RNs reported a correlation between postpartum education and mortality; however, only 72% strongly agreed it was their responsibility to provide this education. Nurse respondents who were over the age of 40 were significantly more likely to report feeling very competent when providing education on all of the postpartum complication variables measured (p values <0.001-0.003).

Clinical Implications:

The majority of nurses in this study were not up-to-date on the rates and timing of maternal mortality during the postpartum period in the United States. They did not always provide comprehensive education to all women prior to discharge from the hospital after childbirth. There is a need for nurses to provide consistent messages about potential warning signs that may ultimately reduce maternal death and severity of maternal complications.