bluuebunny/crossref_metadata_2025 huggingface dataset:
CrossPlan: systematic planning of genetic crosses to validate mathematical models
Authors: Pratapa Aditya , Adames Neil , Kraikivski Pavel , Franzese Nicholas , Tyson John J , Peccoud Jean , Murali T M
Published: February 2018

Motivation

Mathematical models of cellular processes can systematically predict the phenotypes of novel combinations of multi-gene mutations. Searching for informative predictions and prioritizing them for experimental validation is challenging since the number of possible combinations grows exponentially in the number of mutations. Moreover, keeping track of the crosses needed to make new mutants and planning sequences of experiments is unmanageable when the experimenter is deluged by hundreds of potentially informative predictions to test.

Results

We present CrossPlan, a novel methodology for systematically planning genetic crosses to make a set of target mutants from a set of source mutants. We base our approach on a generic experimental workflow used in performing genetic crosses in budding yeast. We prove that the CrossPlan problem is NP-complete. We develop an integer-linear-program (ILP) to maximize the number of target mutants that we can make under certain experimental constraints. We apply our method to a comprehensive mathematical model of the protein regulatory network controlling cell division in budding yeast. We also extend our solution to incorporate other experimental conditions such as a delay factor that decides the availability of a mutant and genetic markers to confirm gene deletions. The experimental flow that underlies our work is quite generic and our ILP-based algorithm is easy to modify. Hence, our framework should be relevant in plant and animal systems as well.

Availability and implementation

CrossPlan code is freely available under GNU General Public Licence v3.0 at https://github.com/Murali-group/crossplan

Supplementary information

Supplementary data are available at Bioinformatics online.
A Relationship Primer for the Workplace
Authors: Brown Andrew , Flinton Christopher T. , Gibson Josh , Grant Brian , Greiff Barrie , Hagen Duane , Heidel Stephen , Hunter Ben , Larsen Robert , Long Barbara , “Daven” Morrison David E. , Morrison David E. , Sassano-Higgins Sean , Post Jerrold , Sperry Len
Published: February 2018

Psychiatrists must understand the conceptual frames used for within business as these frames interfere with the support of people at work. In seeking to find a common ground, the case is made in this chapter of how these frames undermine seeing the human being and in particular critical relationships at work The credibility cross is explained as a conceptual model for understanding these relationships for the typical manager. Relationships that tie to performance including financial performance and the viability of the organization. The psychological contract is explored as it relates to understanding how the average worker approaches important relationships. The chapter emphasizes how the manager must appreciate and support the workplace relationships to defend against threat of rupture from stresses. These stresses include change and devaluation of people. Ruptures which harm performance. Discussion of the needs of human beings with specific references to the brain demonstrate the costs of disrupted relationships in order to focus both the general manager and the consulting psychiatrist to the challenges.
The Broken Contract
Authors: Brown Andrew , Flinton Christopher T. , Gibson Josh , Grant Brian , Greiff Barrie , Hagen Duane , Heidel Stephen , Hunter Ben , Larsen Robert , Long Barbara , “Daven” Morrison David E. , Morrison David E. , Sassano-Higgins Sean , Post Jerrold , Sperry Len
Published: February 2018

Broken relationships develop over time and with repetition and have a corroding effect on loyalty and commitment, which are the glue that holds people together enough to accomplish mutual goals. Managers need to know if someone important to their work is feeling that way, particularly if the person feels that way about them. A key part of understanding such ruptures is to understand the implicit interpersonal promises, better known as the psychological contract. The psychological contract has five essential components: predictability versus confusion, dependence versus independence, distance versus intimacy, change versus stability, and danger versus safety. This chapters explores these elements in cases about business performance and relationships between supervisors and employees.
Review Performance Honestly and Compassionately
Authors: Brown Andrew , Flinton Christopher T. , Gibson Josh , Grant Brian , Greiff Barrie , Hagen Duane , Heidel Stephen , Hunter Ben , Larsen Robert , Long Barbara , “Daven” Morrison David E. , Morrison David E. , Sassano-Higgins Sean , Post Jerrold , Sperry Len
Published: February 2018

This chapter demonstrates how well-managed performance evaluations can deepen the sense of engagement with the company and restore healthy workplace relationships. Technology, litigation, and globalization disrupt the psychological contract and drive the earnest and capable employee apart from the organization. Managing these concerns is generally outside the typical manager’s comfort zone and formal education, but it is a core competency that most organizations should expect of their managers. How can the integrity of the contract be maintained over time? How can the insidious misunderstandings be uncovered? There is perhaps no better point of intervention than performance discussions. People with performance gaps preoccupy the manager. Commonly one or two people make up a significant amount of the manager’s performance concerns and is therefore a significant distraction. Using a well-developed case example of a performance review is provided to explain how a manager can unearth and address issues that threaten to damage the psychological contract.
Use Technology Wisely
Authors: Brown Andrew , Flinton Christopher T. , Gibson Josh , Grant Brian , Greiff Barrie , Hagen Duane , Heidel Stephen , Hunter Ben , Larsen Robert , Long Barbara , “Daven” Morrison David E. , Morrison David E. , Sassano-Higgins Sean , Post Jerrold , Sperry Len
Published: February 2018

This chapter provides information on the wise use of technology in the workplace. In a world where electronic communication is ubiquitous, face-to-face interactions are critical. Technology can be used to promote depth in relationships, but the use of technology needs to be tailored to the individual. Relationship problems and difficult feelings have always been present in the workplace, but with electronic communication they now present more quickly, at unpredictable times, in larger numbers, and often with greater urgency. Managers face relationship repercussions from technology on a daily basis. Generally speaking, in many of the relationships in which difficulties arise, coworkers and managers have only a superficial understanding of the other party’s emotional needs due to decreased face-to-face interaction.
Vascular aetiology
Authors: Fromm Annette
Published: February 2018

Vascular aetiology of young ischaemic stroke covers a broad spectrum of causes. It includes the risk factor-mediated causes considered more common among the elderly on one hand, and a large number of rather rare disorders and conditions typical for younger ages on the other hand. This chapter is focused on atherosclerotic aetiology and comorbidity, small vessel disease and arterial dissection, which account for a majority of young ischaemic strokes worldwide, are treatable, and need to be considered as overall or contributing causes early during investigation. Specific and rare causes of young ischaemic stroke will be presented elsewhere.
Stroke in women
Authors: Rantanen Kirsi , Aarnio Karoliina
Published: February 2018

Young women who suffer from stroke face multiple challenges regarding child rearing, future pregnancies, and ability to return to work or education. Women in general have a higher lifetime risk of stroke than men (1 in 5 vs 1 in 6), which is partly explained by longer life expectancy in the female population. The incidence of ischaemic stroke in non-pregnant women aged 15–44 years has been around 5 per 100,000 women-years. Women have lower stroke mortality than men except in the older age groups. Women have unique stroke risk factors such as oral contraception, pregnancy, puerperium, and menopausal hormone therapy. It remains unresolved why oestrogen, thought to be neuroprotective, actually can turn out to be harmful in regard to stroke risk. A number of major stroke risk factors such as hypertension, migraine with aura, obesity, metabolic syndrome, and atrial fibrillation are more common in women than men.
Acute treatment
Authors: Lorenzano Svetlana , Toni Danilo
Published: February 2018

Young adults may benefit from intravenous thrombolysis with tissue plasminogen activator and the treatment is safe. Several important outcome predictors have been identified and can be used for an optimal selection of eligible patients. Intravenous thrombolysis should not be denied a priori in patients with stroke due to craniocervical artery dissection or illicit drug use, or young menstruating/pregnant women. It is recommended to discuss treatment risks and benefits and decisions should be made on an individual basis. Young patients may benefit from endovascular treatment despite larger infarcts. In case of malignant middle cerebral artery infarction, decompressive hemicraniectomy should be considered. Due to under-representation of young patients in past randomized controlled trials, analyses from these trials and prospective studies on this age group are needed.
Secondary prevention
Authors: Ferro José M. , Fonseca Ana Catarina
Published: February 2018

There are no specific guidelines regarding secondary stroke prevention in young adult stroke patients. Recommendations for secondary prevention are mainly extrapolated from data obtained from older individuals, because young adults were excluded or under-represented in most secondary stroke prevention clinical trials. Secondary stroke prevention includes (a) screening and control of vascular risk factors, that is, hypertension, diabetes mellitus, hyperlipidaemia, atrial fibrillation, hormonal contraception, infections, trauma, physical inactivity, obesity, poor nutrition, smoking, alcohol, and illicit drug use; and (b) identification and treatment of specific causes of ischaemic stroke, that is, cardioembolism, large vessel extra- and intracranial atherosclerotic disease, small vessel disease, dissection, antiphospholipid syndrome, moyamoya disease, sickle cell disease, and some rare diseases. There is then an opportunity for lifelong prevention of vascular events after stroke in a young adult.
The great outdoors: forests, wilderness, and public health
Authors: Li Qing , Bell Simon
Published: February 2018

Forests and other areas are considered by many people to represent natural landscapes with the appearance of minimal human intervention or few human elements, far removed from where most people live nowadays. While some nature reserves and significant forests lie close to various urban areas, providing opportunities for a daily escape from the stresses of urban life, many lie at a distance. The contrast in the character and qualities of forests and wilderness offers many special opportunities and benefits to human health and well-being. The clean, oxygen-rich atmosphere free of pollution, the enveloping depths of a silent forest, or the chance for solitary engagement with nature all combine to provide physiological, psychological, and physical health benefits, the evidence for which has been gradually accumulating in recent decades. Our understanding of some of the mechanisms facilitating this is beginning to evolve, but more work is needed to confirm many tentative findings.
Children and nature
Authors: Wells Nancy M. , Jimenez Francesqca E. , Mårtensson Fredrika
Published: February 2018

Children’s disconnection from nature has urgent ramifications, as nature is associated with a wide variety of positive human health outcomes and, conversely, disconnection from nature is linked to negative health outcomes. This chapter first considers factors (e.g. screen time, recess policies) that have contributed to children spending less time outdoors. Issues of equity are also discussed; the fact that income and race-based disparities in nature access can exacerbate effects on health. The chapter then outlines linkages between the natural environment and children’s health, reviewing evidence that connects nature to children’s health, function, and well-being. It includes aspects of both mental and physical health, and addresses outcomes such as: social interaction and social cohesion; cognitive restoration and academic performance; symptoms of attention deficit hyperactivity disorder; myopia; physical activity and obesity; and vitamin D deficiency. Future research and implications for public health are considered. Lastly, promising intervention programmes are described.
Ecosystem services and health benefits—an urban perspective
Authors: Lindgren Elisabet , Almqvist My S. , Elmqvist Thomas
Published: February 2018

Ecosystem services provide water, food, shelter, fuelwood, fibres, and medicinal plants, and contribute to local and global climate regulation, moderation of extreme events, run-off mitigation, erosion prevention, waste treatment, air purification, noise reduction, pollination, biological control, and biodiversity—conditions that all directly and indirectly influence human health. In addition, ecosystem services provide recreation, mental and physical health, and aesthetic and spiritual considerations. A rapidly urbanizing world in combination with global changes are creating new health risks or enhancing existing health concerns. Possible impacts on human health of ecosystem services were evaluated in three different urban environments (i.e. affluent mature, affluent growing, and low-income growing). The outcomes suggest that several health concerns in cities worldwide can be reduced or avoided by acknowledging and integrating beneficial impacts on health from ecosystem services in urban planning.
Africa and environmental health trends
Authors: Boon Emmanuel K. , Ahenkan Albert
Published: February 2018

Environmental health issues are of major concern in the world today, especially in developing countries. Across Africa, environmental resources remain central to rural people’s livelihoods and health. The rich environmental resources of the continent significantly impact population health. During the past decades, many African countries have initiated sustainable natural resources management approaches to ensure environmental health. For example, there has been a shift from the predominantly centralized natural resource management approach to models including joint forest management, community-based natural resources management, collaborative forest management, and participatory forest management. Although some gains have been achieved, fundamental challenges remain to be redressed. The frequent outbreaks of infectious diseases such as malaria and the Ebola pandemic symbolize the complexity of environmental and human health challenges on the continent. The formulation and effective implementation of appropriate environmental health policies and programmes, including broad and in-depth stakeholder consultations will significantly help to address these challenges.
Latin America and the environmental health movement
Authors: Faggi Ana , Nail Sylvie , Zanette Carolina C. Sgobaro , Corzo Germán Tovar
Published: February 2018

Although Latin American cities, on the whole, suffer from haphazard urbanism and environmental inequalities, concern around public health and nature has begun to emerge. Different ongoing initiatives relating to the ecosystem services of urban green attempt, among other things, to mitigate the effects of air pollution on respiratory problems. Green infrastructure across the subcontinent today offers opportunities—and represents challenges—for the implementation of policies promoting health and well-being which are emblematic of the urban revitalization process. This chapter shows some ongoing trends from Bogotá, Buenos Aires, and Curitiba, three representative cities in the region, that reflect the role of green spaces for the health and well-being of urban-dwellers in Latin American cities.
The role of environmental law
Authors: Carlarne Cinnamon P. , Bielicki Jeffrey M.
Published: February 2018

Analysing and developing environmental law requires a broad analysis of the interplay of many factors. This chapter explores some of the many ways in which environmental law influences the connections between nature and people. The chapter does not explore these connections in minute detail, but instead: (i) examines what is meant by ‘environmental law’; (ii) pushes for a broader understanding of the interactions between law, nature, and human well-being; and (iii) provides two examples of the complex relationship between environmental law and human well-being. It provides an overview of environmental law and its origins. It also presents the motivations for environmental law. Finally, hydraulic fracturing and US national parks are used as examples of environmental law and human well-being contexts. These examples highlight some of complicated ways in which environmental law affects human well-being, and demonstrates the need for an expansive view of what well-being entails.
The human–animal bond and animal-assisted intervention
Authors: Fine Aubrey H. , Weaver Shawna J.
Published: February 2018

Animal-assisted interventions (AAI) are increasing in mental and physical healthcare and education. These interventions include a range of structures and objectives. AAI is the umbrella term that includes the practice of animal-assisted therapy (AAT) and animal-assisted education (AAE). The interventions are developed on the premise that humans are inherently inclined to bond with other species, known as the human–animal bond. While empirical research on AAI continues to develop, related fields are contributing to its theoretical justification, including theories that support the human–animal bond phenomenon. This chapter introduces both AAI and its supporting theories, and describes best practices in this developing field.
Biological mechanisms and neurophysiological responses to sensory impact from nature
Authors: Hägerhäll Caroline , Taylor Richard , Cerwén Gunnar , Watts Greg , van den Bosch Matilda , Press Daniel , Minta Steven
Published: February 2018

The biological mechanisms behind nature’s specific health impact are intriguing. This chapter gives an overview of existing knowledge of how our sensory organs perceive and process input from nature and how this affects our brains and well-being. Visually, people seem to prefer certain types of fractal patterns, abundant in nature. Such patterns put our brains into a wakefully, relaxed state, as indicated by electroencephalogram (EEG). Similarly, sounds of nature can induce a sense of tranquillity, demonstrated in fMRI-experiments. Olfaction has been crucial for our survival. This may explain our particular sensitivity to odours of nature, some of which are essential to our health and well-being. Altogether, this kind of basic research is crucial for providing a solid evidence base around nature and health, it can also be directly applied in health design for optimizing soundscape, smell, and visual input.
Promoting physical activity—reducing obesity and non-communicable diseases
Authors: Giles-Corti Billie , Bull Fiona , Christian Hayley , Koohsari Mohammad Javad , Sugiyama Takemi , Hooper Paula
Published: February 2018

Regular participation in physical activity is known to promote good health, prevent disease, and enhance well-being. Physical activity promotion requires a whole-of-government approach, not simply efforts of the health sectors. This chapter first provides a brief overview of non-communicable disease trends and the importance of physical activity in reducing the risks of these diseases. It then considers the association between access to public open space (land reserved for the provision of green space and natural environments that is freely accessible and intended for active or passive recreation) and physical activity patterns across the life course. The extent to which policy can be used to increase access to public open space is then discussed before some concluding comments about the important role played by planners, urban designers, and landscape architects in creating active living friendly environments, and researchers in addressing policy-relevant research priorities that could help move the agenda forward.
Pressure injuries
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on pressure sores, compression mononeuropathy, and rhabdomyolysis.
Genitourinary medicine
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on the ageing genitourinary system, presentation of benign prostatic hyperplasia, treatment of benign prostatic hyperplasia, presentation of prostatic cancer, prostate-specific antigen, treatment of prostatic cancer, post-menopausal vaginal bleeding, vaginal prolapse, illustrations of prolapse, vulval disorders, sexual function, and HIV in older people.
Infection and immunity
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on the ageing immune system, an overview of infection in older people, antibiotic use in older patients, meticillin-resistant Staphylococcus aureus (MRSA), disease caused by MRSA, Clostridium difficile-associated diarrhoea, near-patient urine tests, asymptomatic bacteriuria, urinary tract infection, treatment of urinary tract infection, recurrent urinary tract infection, and varicella-zoster infection.
Bone
Authors: Devlin Hugh , Craven Rebecca
Published: February 2018

Bone in relation to dentistry is the topic of this chapter. This chapter describes the mineral, cells, vascular and matrix components of bone. Throughout the chapter, the clinical relevance of these features and how they interact in health and disease are emphasized. The later parts of the chapter describe bone healing, bone grafts, healing of the extraction socket, orthodontic tooth movement, periodontal bone loss in chronic periodontitis, and the effect of bisphosphonates. A final section summarizes age changes in bone and bone cells.
Awareness of autism in adulthood
Authors: Brugha Traolach S.
Published: February 2018

In its milder forms, autism is widespread, but often not considered as an explanation for odd, egocentric, rigid, and/or potentially socially problematic behaviour. The reader is encouraged in this chapter to consider how autism might present in the world in which (s)he works and lives. A series of case vignettes are then used (in this chapter), drawn from ordinary life settings (work, college, neighbourhood, family, etc.) to illustrate and inform awareness, and possible consideration of autism that has been missed earlier in the person’s life. Questions are posed following each case vignette that the reader is asked to try to answer. Care recommendations then follow.
Initial assessment (‘Triage’)
Authors: Brugha Traolach S.
Published: February 2018

Chapter 6 considers ways of determining if and when a detailed diagnostic assessment is necessary, what are the benefits and risks for the patient, including considering their viewpoint? If autism is obvious at a first short meeting, one might ask why delay diagnosis any further? With regard to decisions to seek a detailed assessment, what is the value of a diagnosis? What motivates people to seek diagnosis? Are there alternative ways of addressing their problems? What ethical issues are there? How does consent come in to play, particularly in relation to the involvement of other as informants? Questions for the patient (more closed than open-ended) are considered, including selecting those questions designed to determine if more detailed assessment is needed. Questions for parents and non-parental carers are also discussed including asking what is the value of lifelong informants? Finally, how does one decide on next steps (discharge or full assessment)?
Choices in life, and the awareness, knowledge, and skills to support them
Authors: Brugha Traolach S.
Published: February 2018

This concluding chapter reflects on professional training and its importance for the adult psychiatrist. It also makes the point that this is a process that should continue in the future, throughout ones career. A list of competencies, which are suggested for psychiatrists to seek to attain, is provided. The chapter reflects on the multiple perspectives on autism covered in this book, but particularly in the case of the adult patient. Grounds for realism and for optimism for the future are expressed. Acknowledging the substantial gap in evidence to guide us on autism in adult psychiatric practice priorities for research are outlined and the chapter concludes with recommendations for further reading.
The Second Domain of Palliative Care
Authors: Strada E. Alessandra
Published: February 2018

This chapter proposes palliative psychology competencies in the second domain of palliative care: physical aspects of care. It discusses the importance of interdisciplinary work in assessment and management of pain and other physical symptoms. Palliative psychologists with the necessary knowledge, skills, and attitudes can contribute greatly to team work by identifying and managing psychological factors that can contribute to the patient’s physical suffering. This chapter also briefly describes relevant approaches to dyspnea and constipation. Clinical examples of pain assessment and intervention are provided based on real case scenarios. The basics of pharmacological approaches to pain management in advanced illness are discussed, in order to facilitate the role of palliative psychologists in promoting communication and treatment adherence. The use of integrative medicine modalities to improve physical symptoms is highlighted.
Congenital Cervical Spine Stenosis in a Multicenter Global Cohort of Patients With Degenerative Cervical Myelopathy: An Ambispective Report Based on a Magnetic Resonance Imaging Diagnostic Criterion
Authors: Nouri Aria , Tetreault Lindsay , Nori Satoshi , Martin Allan R , Nater Anick , Fehlings Michael G
Published: February 2018

BACKGROUND

Congenital spinal stenosis (CSS) of the cervical spine is a risk factor for acute spinal cord injury and development of degenerative cervical myelopathy (DCM).

OBJECTIVE

To develop magnetic resonance imaging (MRI)-based criteria to diagnose preexisting CSS and evaluate differences between patients with and without CSS.

METHODS

A secondary analysis of international prospectively collected data between 2005 and 2011 was conducted. We examined the data of 349 surgical DCM patients and 27 controls. Spinal canal and cord anteroposterior diameters were measured at noncompressed sites to calculate spinal cord occupation ratio (SCOR). Torg–Pavlov ratios and spinal canal diameters from radiographs were correlated with SCOR. Clinical and MRI factors were compared between patients with and without CSS. Surgical outcomes were also assessed.

RESULTS

Calculation of SCOR was feasible in 311/349 patients. Twenty-six patients with CSS were identified (8.4%). Patients with CSS were younger than patients without CSS (P = .03) and had worse baseline severity as measured by the modified Japanese Orthopedic Association score (P = .04), Nurick scale (P = .05), and Neck Disability Index (P < .01). CSS patients more commonly had T2 cord hyperintensity changes (P = .09, ns) and worse SF-36 Physical Component scores (P = .06, ns). SCOR correlated better with Torg–Pavlov ratio and spinal canal diameter at C3 than C5. Patients with SCOR ≥ 65% were also younger but did not differ in baseline severity.

CONCLUSION

SCOR ≥ 70% is an effective criterion to diagnose CSS. CSS patients develop myelopathy at a younger age and have greater impairment and disability than other patients with DCM. Despite this, CSS patients have comparable duration of symptoms, MRI presentations, and surgical outcomes to DCM patients without CSS.
Mycobacterium abscessus Complex Infections: A Retrospective Cohort Study
Authors: Sfeir Maroun , Walsh Marissa , Rosa Rossana , Aragon Laura , Liu Sze Yan , Cleary Timothy , Worley Marylee , Frederick Corey , Abbo Lilian M
Published: February 2018

Background

Infections caused by Mycobacterium abscessus group strains are usually resistant to multiple antimicrobials and challenging to treat worldwide. We describe the risk factors, treatment, and clinical outcomes of patients in 2 large academic medical centers in the United States.

Methods

A retrospective cohort study of hospitalized adults with a positive culture for M. abscessus in Miami, Florida (January 1, 2011, to December 31, 2014). Demographics, comorbidities, the source of infection, antimicrobial susceptibilities, and clinical outcomes were analyzed. Early treatment failure was defined as death and/or infection relapse characterized either by persistent positive culture for M. abscessus within 12 weeks of treatment initiation and/or lack of radiographic improvement.

Results

One hundred eight patients were analyzed. The mean age was 50.81 ± 21.03 years, 57 (52.8%) were females, and 41 (38%) Hispanics. Eleven (10.2%) had end-stage renal disease, 34 (31.5%) were on immunosuppressive therapy, and 40% had chronic lung disease. Fifty-nine organisms (54.6%) were isolated in respiratory sources, 21 (19.4%) in blood, 10 (9.2%) skin and soft tissue, and 9 (8.3%) intra-abdominal. Antimicrobial susceptibility reports were available for 64 (59.3%) of the patients. Most of the isolates were susceptible to clarithromycin, amikacin, and tigecycline (93.8%, 93.8%, and 89.1%, respectively). None of the isolates were susceptible to trimethoprim/sulfamethoxazole, and only 1 (1.6%) was susceptible to ciprofloxacin. Thirty-six (33.3%) patients early failed treatment; of those, 17 (15.7%) died while hospitalized. On multivariate analysis, risk factors significantly associated with early treatment failure were disseminated infection (odds ratio [OR], 11.79; 95% confidence interval [CI], 1.53–81.69; P = .04), acute kidney injury (OR, 6.55; 95% CI, 2.4–31.25; P = .018), organ transplantation (OR, 2.37; 95% CI, 2.7–23.1; P = .005), immunosuppressive therapy (OR, 2.81; 95% CI, 1.6–21.4; P = .002), intravenous amikacin treatment (OR, 4.1; 95% CI, 0.9–21; P = .04), clarithromycin resistance (OR,79.5; 95% CI, 6.2–3717.1, P < .001), and presence of prosthetic device (OR, 5.43; 95% CI, 1.57–18.81; P = .008). Receiving macrolide treatment was found to be protective against early treatment failure (OR, 0.13; 95% CI, 0.002–1.8; P = .04).

Conclusions

Our cohort of 108 M. abscessus complex isolates in Miami, Florida, showed an in-hospital mortality of 15.7%. Most infections were respiratory. Clarithromycin and amikacin were the most likely agents to be susceptible in vitro. Resistance to fluoroquinolone and trimethoprim/sulfamethoxazole was highly common. Macrolide resistance, immunosuppression, and renal disease were significantly associated with early treatment failure.
The Perioperative Efficacy and Safety of Antifibrinolytics in Adult Spinal Fusion Surgery
Authors: Lu Victor M. , Ho Yam-Ting , Nambiar Mithun , Mobbs Ralph J. , Phan Kevin
Published: February 2018

Study Design.

Systematic review and meta-analysis.

Objective.

Compare outcomes of adult patients undergoing spinal fusion surgery who receive and do not receive perioperative antifibrinolytics to reduce operative blood loss.

Summary of Background Data.

The clinical potential for antifibrinolytics such as tranexamic acid and epsilon aminocaproic acid to significantly reduce blood loss during adult spinal fusion surgery remains underexplored. Outcomes for assessment included operative blood loss, and other surgical, clinical, and haematological outcomes.

Methods.

We followed the recommended Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews. Electronic database searches identified 2041 for screening. Data were extracted and analyzed using meta-analysis of proportions.

Results.

A total of 11 randomized controlled trials with a total of 937 adult spinal fusion surgery patients were included for analysis. There were 472 (50%) patients who were treated with antifibrinolytics, with 345 of 472 (73%) and 127 of 472 (27%) receiving tranexamic acid and epsilon aminocaproic acid respectively. The use of antifibrinolytics was associated with significantly lower intraoperative (MD −127.08 mL; P = 0.002) and total blood loss (MD −229.76 mL; P < 0.00001), as well as incidence of blood transfusion (OR 0.58; P = 0.04). There was no significant difference with antifibrinolytic use in terms of many surgical parameters, including surgery duration (P = 0.50), overall complications (P = 0.21), and length of stay (P = 0.88). Finally, postoperative haemoglobin was significantly greater (MD 0.30 g/dL; P = 0.02) following antifibrinolytic use, with other haematological parameters mostly unaffected.

Conclusion.

Based on the highest level comparative evidence available, the possibility for blood loss reduction in adult spinal fusion surgery with the use of perioperative antifibrinolytics is not unreasonable, as it appears both efficacious and safe. In addition to further, larger investigations to validate the associations found in this study, practical aspects such as cost-benefit analysis, and long-term follow-up will further enhance our understanding.

Level of Evidence: 1
Spine Trauma From Personal Watercraft Usage
Authors: Donnally Chester J. , Metser Gil , Roth Eric S. , Moo Young Justin P. , Rush Augustus J. , Al Maaieh Motasem A.
Published: February 2018

Study Design.

Retrospective cohort study.

Objective.

To identify patient characteristics and associated injuries in those sustaining a spine fracture from personal watercraft (PWC) usage.

Summary of Background Data.

There are few studies regarding PWC use and injuries, and even more scarce are studies evaluating PWC usage and spine injuries. Identifying high-risk actions and individuals can help to effectively treat them, reduce mortality, and possibly avoid certain spine fractures.

Methods.

Retrospective analysis of 142 patients admitted from the emergency department with PWC-related injuries at a single-level I trauma center from January 1, 2004 to May 1, 2017. Twenty-six (18.3%) sustained a spine fracture, totaling 71 fractures. Statistical analysis was used to investigate the patient characteristics, specific mechanisms of injury, injury severity score (ISS), and associated injuries. Patients expiring (12) had incomplete evaluations and were excluded from most reported results.

Results.

Spine fractures were not associated with age, race, or sex, but were associated with a higher ISS, intensive care unit length, in-patient length of stay, cerebral injury, and abdominal/genitourinary (GU) injury. There were 8 cervical fractures, 22 thoracic fractures, 33 lumbar, and 8 sacral fractures. Axial load injuries were associated with vertebral body fractures and specifically burst fractures. Being a driver or passenger did not influence likelihood of a spine fracture, but did correlate with abdominal/GU injury. Five (19.2%) of patients with spine fractures required eight spine surgeries during admission. Mortality was associated with females, severe systemic injuries (ISS ≥ 15), direct collision mechanism of injury, and the spring season.

Conclusion.

PWC usage may result in spine fractures with a moderate percentage requiring orthopedic surgery. Additional studies should examine how hull or seat modifications can lessen the risk of axial loads leading to spine fractures. PWC patients with spine fractures should also be evaluated for abdominal/GU and cerebral injuries at presentation.

Level of Evidence: 4
Quantification of Phosphatidylethanols in Whole Blood as a Proxy for Chronic Alcohol Consumption, Using Ultra Performance Convergence Chromatography Tandem Mass Spectrometry
Authors: van der Nagel Bart C. H. , Wassenaar Sophie , Bahmany Soma , Koch Birgit C. P.
Published: February 2018

Background:

Detection of alcohol consumption after a longer period can be useful in certain patient groups. To monitor chronic alcohol consumption, a novel analytical method for the quantification of phosphatidylethanols (PEths) was developed and validated using ultra performance convergence chromatography–tandem mass spectrometry.

Methods:

The main phosphatidylethanols like palmitoyl-2-oleoyl-sn-glycero-3-phosphoethanol (POPEth), 1-palmitoyl-2-linoleoyl-sn-glycero-3-phosphoethanol, and 1,2-dioleoyl-sn-glycero-3-phosphoethanol were analyzed using a simple and fast sample preparation protocol followed by chromatographic separation using ultra performance convergence chromatography, a novel kind of supercritical fluid chromatography. Mass spectrometric detection was conducted by applying negative electrospray ionization and multiple reaction monitoring mode. Only 50 μL of whole blood is needed for the simultaneous quantification of all 3 compounds within 5-minute run-to-run analysis time. POPEth-d5 was applied as internal standard.

Results:

The method was validated according to the Food and Drug Administration guidelines. Correlation coefficients were higher than 0.995 for all 3 compounds. Intraday and interday inaccuracies were <15% for all analytes in the established linear range. Intraday and interday imprecision were <15% for all analytes. Lower limit of quantification for 1,2-dioleoyl-sn-glycero-3-phosphoethanol, palmitoyl-2-linoleoyl-sn-glycero-3-phosphoethanol, and POPEth are, respectively, 3, 6, and 6 mcg/L. Sample stability at −80°C was 1 year. Extracts were stable for 1 day in the autosampler and 2 days at 2–8°C in a closed Eppendorf tube. Samples were tested after 3 freeze–thaw cycles and considered stable. Patient samples have been analyzed with this new method. In a cohort of 248 pregnant women, 17 patients (6.9%) scored positive for PEth.

Conclusions:

The described method is suitable for the simultaneous quantitative analysis of the most abundant PEth homologues. Major advantages are low LLOQs, minimal sample volume and clean-up, and a short run time. The method is now available to monitor alcohol consumption in patients and has been incorporated in clinical practice and research.
Systemic hemodynamic response to terlipressin predicts development of hepatorenal syndrome and survival in advanced cirrhosis
Authors: Kalambokis Georgios N. , Tsiakas Ilias , Christaki Maria , Koustousi Christina , Christou Leonidas , Baltayiannis Gerasimos , Christodoulou Dimitrios
Published: February 2018

Background

The aim of this study was to predict the occurrence of hepatorenal syndrome (HRS) and death in patients with advanced cirrhosis and ascites.

Patients and methods

We retrospectively evaluated 2-year data of 78 patients with cirrhosis and ascites (Child–Pugh B/C: 45/43). The mean arterial pressure (MAP) and cardiac output (CO) were measured in all patients just before administration of 2 mg of terlipressin and 30 min later. Systemic vascular resistance (SVR) was calculated as MAP/CO. ΔMAP, and ΔCO, and ΔSVR were defined as the percentage change of MAP, CO, and SVR, respectively, after terlipressin injection. Plasma renin activity (PRA) and plasma aldosterone were evaluated at baseline. Two multivariate models were used: one excluding (model 1) and one including (model 2) the Model of End-stage Liver Disease score.

Results

Higher ΔSVR, Model of End-stage Liver Disease score, and PRA were related independently to the severity of cirrhosis. Independent predictors of HRS at 12 and 24 months were ΔSVR (models 1/2: P=0.008/0.01 and 0.01/0.02, respectively), ΔCO (models 1/2: P=0.01/0.03 and 0.03/0.04, respectively), and PRA (models 1/2: P=0.04 and model 1: P=0.04, respectively). ΔSVR at 12 and 24 months (models 1/2: P=0.005/0.01 and 0.01/0.03, respectively) and ΔCO at 24 months (models 1/2: P=0.02/0.01, respectively) were related independently to survival. Patient groups with significantly higher probability of HRS and mortality were identified by certain cutoffs of ΔSVR (20.6 and 22.8%, respectively) and ΔCO (−10.6 and −11.8%, respectively). ΔSVR and ΔCO independently predicted survival in patients with the most advanced cirrhosis and infection-related survival.

Conclusion

An increase in SVR by at least 20% and a decrease in CO at least 10% in response to terlipressin could predict HRS and mortality in patients with advanced cirrhosis.
Effectiveness of a single session of dual-transcranial direct current stimulation in combination with upper limb robotic-assisted rehabilitation in chronic stroke patients: a randomized, double-blind, cross-over study
Authors: Dehem Stéphanie , Gilliaux Maxime , Lejeune Thierry , Delaunois Emmanuelle , Mbonda Paul , Vandermeeren Yves , Detrembleur Christine , Stoquart Gaëtan
Published: February 2018

The impact of transcranial direct current stimulation (tDCS) is controversial in the neurorehabilitation literature. It has been suggested that tDCS should be combined with other therapy to improve their efficacy. To assess the effectiveness of a single session of upper limb robotic-assisted therapy (RAT) combined with real or sham-tDCS in chronic stroke patients. Twenty-one hemiparetic chronic stroke patients were included in a randomized, controlled, cross-over double-blind study. Each patient underwent two sessions 7 days apart in a randomized order: (a) 20 min of real dual-tDCS associated with RAT (REAL+RAT) and (b) 20 min of sham dual-tDCS associated with RAT (SHAM+RAT). Patient dexterity (Box and Block and Purdue Pegboard tests) and upper limb kinematics were evaluated before and just after each intervention. The assistance provided by the robot during the intervention was also recorded. Gross manual dexterity (1.8±0.7 blocks, P=0.008) and straightness of movement (0.01±0.03, P<0.05) improved slightly after REAL+RAT compared with before the intervention. There was no improvement after SHAM+RAT. The post-hoc analyses did not indicate any difference between interventions: REAL+RAT and SHAM+RAT (P>0.05). The assistance provided by the robot was similar during both interventions (P>0.05). The results showed a slight improvement in hand dexterity and arm movement after the REAL+RAT tDCS intervention. The observed effect after a single session was small and not clinically relevant. Repetitive sessions could increase the benefits of this combined approach.
A Mixed Program of Psychoeducational and Psychological Rehabilitation for Patients With Bipolar Disorder in a Day Hospital Setting
Authors: Camardese Giovanni , Vasale Massimo , D'Alessandris Lucio , Mazza Marianna , Serrani Riccardo , Travagliati Federico , Walstra Coco , Zaninotto Leonardo , Leone Beniamino , Di Nicola Marco , Franza Raffaella , Marano Giuseppe , Rinaldi Lucio , Janiri Luigi
Published: February 2018

The present study describes a new mixed program of psychoeducational and psychological interventions for bipolar patients, applicable during everyday practice. Thirty-two bipolar patients recruited at a psychiatric day-hospital service have been admitted to a program consisting of 30 meetings and 2 follow-ups at 6 and 12 months. The psychoeducational support determined a general improvement of all included patients. At baseline, patients with residual depression had higher Hamilton Depression Rating Scale (HDRS) scores than euthymic patients (mean score ± SD: 21.25 ± 3.92 vs. 7.00 ± 2.95, respectively). After psychoeducation sessions, the HDRS scores of euthymic patients remained stable (mean ± SD: 7.00 ± 3.74), whereas the HDRS scores of depressed patients demonstrated a statistically significant improvement (mean ± SD: 14.00 ± 6.72, t = 2.721, p = 0.03). Results of the Connor-Davidson Resilience scale and specifically constructed questionnaire Questionario per la Valutazione della Conoscenza e dell'Apprendimento per il Disturbo Bipolare showed a statistically significant improvement in resilience and insight in all recruited patients. Psychoeducational intervention as adjunctive treatment to pharmacotherapy seems to be very effective in bipolar patients, not only for those in the euthymic phase, but this model could also be extended to patients with an ongoing mild or moderate depressive episode.
Self-monitoring Lifestyle Behavior in Overweight and Obese Pregnant Women
Authors: Shieh Carol , Draucker Claire Burke
Published: February 2018

Background:

Excessive maternal gestational weight gain increases pregnancy and infant complications. Self-monitoring has been shown to be an effective strategy in weight management. Literature, however, is limited in describing pregnant women’s engagement in self-monitoring.

Aim:

This qualitative study explored the experiences of overweight and obese pregnant women who self-monitored their eating, walking, and weight as participants in an intervention for excessive gestational weight gain prevention.

Methods:

Thirteen overweight and obese pregnant women participated in semistructured interviews. Reflexive iteration data analysis was conducted.

Findings:

Five themes were identified: making self-monitoring a habit, strategies for self-monitoring, barriers to self-monitoring, benefits of self-monitoring, and drawbacks of self-monitoring. The women viewed self-monitoring as a “habit” that could foster a sense of self-control and mindfulness. Visual or tracing aids were used to maintain the self-monitoring habit. Forgetting, defective tracking aids, complexities of food monitoring, and life events could impede self-monitoring. Being unable to keep up with self-monitoring or to achieve goals created stress.

Conclusions:

Self-monitoring is a promising approach to weight management for overweight and obese pregnant women. However, healthcare providers should be aware that, although women may identify several benefits to self-monitoring, for some women, consistently trying to track their behaviors is stressful.
Role Transition After Clinical Nurse Specialist Education
Authors: Ares Terri L.
Published: February 2018

Purpose:

This study explored the transition of clinical nurse specialists into new roles after completion of their graduate education.

Design:

A quantitative longitudinal survey was used to measure certification, employment, career commitment, and the imposter phenomenon.

Methods:

An online survey was sent to 113 participants from a previous national study that agreed to follow-up. The Student Nurse Anesthetist Experience Questionnaire and Clance Imposter Phenomenon Scale instruments were used. Each case (N = 68) was matched with data from the primary study, and 2 comparison groups were formed based on employment status as a clinical nurse specialist.

Results:

The advanced practice certification rate was 66.7%, and 48.5% were employed as a clinical nurse specialist. The employed group perceived more autonomy, a more positive view of the clinical nurse specialist lifestyle, and upset life plans if not able to practice in the role when compared with the not-employed group. Self-image was significantly different based on employment, but career commitment was not particularly strong regardless of employment status. The prevalence of imposter phenomenon experiences was 74.6% in this sample.

Conclusion:

Recent graduates are struggling with their transition into practice as clinical nurse specialists.