bluuebunny/crossref_metadata_2025 huggingface dataset:
Open versus arthroscopic anterior cruciate ligament reconstruction: a systematic review of randomized controlled trials
Authors: Levy David M. , Erickson Brandon J. , Bach Bernard R.
Published: August 2017

Background:

The purpose of this paper was to determine if significant differences exist between open and arthroscopic anterior cruciate ligament reconstruction (ACLR). We have hypothesized that patients would experience less pain, fewer complications, and fewer reoperations after arthroscopic ACLR.

Methods:

A systematic review of multiple medical databases was performed. Randomized controlled trials with a minimum of 6 mo follow-up were included. Study quality was analyzed using the Modified Coleman Methodology Score (MCMS) and Jadad Scale.

Results:

Three studies met the inclusion criteria (212 subjects; 212 knees). The MCMS rating was fair at 60.7±1.5, and the mean Jadad score was fair at 2.7±1.5. One study reported long-term outcomes (mean 12 yr) of 53 patients (25 open, 28 arthroscopic) and noted no differences in pain, strength, functional testing, or prevalence of osteoarthritis between groups. Two studies reported short-term outcomes of a combined 125 patients (58 open, 67 arthroscopic) with an average follow-up of 6 mo. In these studies, there were no differences in operative time, Lysholm scores, knee range of motion, laxity, complications, or reoperations between groups. Immediate postoperative analgesic use was higher in the open group. Average thigh atrophy ranged from 1.5 to 2.8 cm in the open group and 1.4 to 1.5 cm in the arthroscopic group.

Conclusions:

Based on the examined studies, there are no differences in operative time, knee range of motion, laxity, Lysholm scores, complications, or reoperations between open and arthroscopic ACLR techniques. Immediate postoperative pain appears decreased in patients undergoing arthroscopic ACLR.
Facial Soft Tissue Augmentation in Males: An Anatomical and Practical Approach
Authors: Rossi Anthony M. , Fitzgerald Rebecca , Humphrey Shannon
Published: August 2017

BACKGROUND

Soft tissue augmentation is increasingly being performed to treat male facial aging.

OBJECTIVE

To review anatomical consideration specific for the male face and define an approach to male soft tissue augmentation that creates harmonious and natural results.

CONCLUSION

Addressing aesthetic concerns in the upper face, midface, and lower face should be performed in concert with a combinatorial and pan facial approach. Correct filler placement at different areas of concern is important to achieve desired and natural results. Dermal and subcutaneous fillers can be used successfully in the male patient to enhance facial features, correct volume loss, and improve features of aging.
Ahmed Valve Upstream Obstruction Caused by Fibrous Ingrowth: Surgical Approach
Authors: Medeiros Pinto Joana , Pinto Ferreira Nuno , Abegão Pinto Luis
Published: August 2017

Glaucoma secondary to penetrating keratoplasty can be challenging and multiple surgeries may be needed to control the intraocular pressure (IOP), including the use of glaucoma drainage implants. However, late failure of these drainage implant surgery is common, mostly because of excessive scarring or bleb encapsulation which may require further surgical intervention. We present a case of a young patient referred for advanced glaucoma secondary to penetrating keratoplasty and chronic uveitis. He presented with elevated IOP under maximal therapy, already with 2 failed trabeculectomies and a nonfunctional Ahmed Valve. As no bleb was seen overlying the plate of the valve, an exploratory surgical revision was scheduled. The cause for defective aqueous humour drainage was identified as a fibrovascular ingrowth into the valve’s plate slit. We proceeded with removal of this membrane, as well as confirmation of patency with trypan blue and application of mitomycin C to prevent recurrence of the fibrous ingrowth. With a 6 month follow-up, a diffuse bleb exists over the plate, with IOP values within the target values for this patient (<16 mm Hg). This exploratory procedure identified an unusual cause for drainage device failure, as well as reporting its management without explanting the device.
Case of Infantile Legionella Pneumonia After Bathing in Reheated and Reused Water
Authors: Tomari Kouki , Morino Saeko , Horikoshi Yuho
Published: August 2017

A 1-month-old girl developed respiratory failure due to bilateral interstitial pneumonia after bathing in reheated and reused water. A molecular test for sputum and an environmental culture detected Legionella pneumophila serotype 1. This is the first report of infantile legionellosis contracted from a bathtub at home.
State of the Science in Heart Failure Symptom Perception Research
Authors: Lee Solim , Riegel Barbara
Published: August 2017

Background:

Heart failure (HF) is a common condition requiring self-care to maintain physical stability, prevent hospitalization, and improve quality of life. Symptom perception, a domain of HF self-care newly added to the Situation-Specific Theory of HF Self-Care, is defined as a comprehensive process of monitoring and recognizing physical sensations and interpreting and labeling the meaning of the sensations.

Objective:

The purpose of this integrative review was to describe the research conducted on HF symptom perception to further understanding of this new concept.

Method:

A literature search was conducted using 8 databases. The search term of HF was combined with symptom, plus symptom perception subconcepts of monitoring, somatic awareness, detection, recognition, interpretation, and appraisal. Only peer-reviewed original articles published in English with full-text availability were included. No historical limits were imposed. Study subjects were adults. Twenty-one studies met the inclusion criteria. Each study was categorized into either symptom monitoring or symptom recognition and interpretation.

Results:

Although daily weighing and HF-related symptom–monitoring behaviors were insufficient in HF patients, use of a symptom diary improved HF self-care, symptom distress and functional class, and decreased mortality, hospital stay, and medical costs. Most HF patients had trouble recognizing an exacerbation of symptoms. Aging, comorbid conditions, and gradual symptom progression made it difficult to recognize and correctly interpret a symptom exacerbation. Living with others, higher education, higher uncertainty, shorter symptom duration, worse functional class, and an increased number of previous hospitalizations were positively associated with symptom recognition.

Conclusions:

Existing research fails to capture all of the elements in the theoretical definition of symptom perception.
Bimatoprost Topical
Authors: Vu Clara , Luke Janiene
Published: August 2017

The purpose of this column is to highlight common medications in clinical dermatology—specifically, their usage, efficacy, side effects, and available alternatives. In this article, we discuss the mechanism of action, clinical use, secondary effects, and principle alternatives of topical bimatoprost 0.03% (trade name, Latisse).
Rate of Nonsurveillance and Advanced Hepatocellular Carcinoma at Diagnosis in Chronic Liver Disease
Authors: Huang Yi , Wallace Michael C. , Adams Leon A. , MacQuillan Gerry , Garas George , Ferguson John , Samuelson Shaun , Tibballs Jonathan , Jeffrey Gary P.
Published: August 2017

Aims:

Ultrasound surveillance for hepatocellular carcinoma (HCC) is recommended in cirrhotic patients to allow early diagnosis. This study investigated risk factors for nonsurveillance and advanced HCC at diagnosis and their effect on survival.

Materials and Methods:

Two hundred seventy HCC patients were included. Clinical data were collected from hospital databases.

Results:

One hundred twenty-eight (47.1%) patients had 6-monthly ultrasound surveillance before HCC diagnosis. Ninety-two (34.1%) patients had advanced HCC (multifocal or total diameter ≥6 cm) at diagnosis. The nonsurveillance rate was significantly higher in nonalcoholic fatty liver disease (NAFLD) (79%) compared with other causes of chronic liver disease (31.6% to 58.1%, P<0.001). Nonrecognition of NAFLD was significantly higher (68.4%) compared with other causes of chronic liver disease (0% to 23.2%, P<0.001). In NAFLD HCC patients, 23.7% were noncirrhotic and smoking was significantly associated HCC in this noncirrhotic group (P=0.041). No-surveillance for HCC was significantly associated with advanced HCC at diagnosis with an odds ratio (OR) of 8.1. Compared with nondrinkers, heavy alcohol consumption was significantly associated with advanced HCC (OR=7.6). In the surveillance group, diagnosis using computed tomography rather than magnetic resonance imaging was significantly associated with advanced HCC (OR=3.36). Patients without HCC surveillance had a significantly shorter median survival compared with those who had HCC surveillance (27.4 vs. 52.0 mo, P=0.0006).

Conclusions:

The lack of HCC surveillance is associated with advanced HCC at diagnosis and decreased survival. NAFLD patients with HCC have a significantly lower rate of diagnosis of chronic liver disease and HCC surveillance compared with the other causes of chronic liver disease.
Hemophagocytic Lymphohistiocytosis: A Dangerous Intruder in Pediatric Acute Lymphoblastic Leukemia
Authors: Martínez-Romera Isabel , Villa Marta , Areal Pilar , Rodrigo Esther , Herrero Blanca , López-Ibor Blanca
Published: August 2017

Hemophagocytic lymphohistiocytosis (HLH) is a condition caused by a pathologic immune activation, which is responsible for its signs and symptoms. It may also appear as a secondary process caused by malignancy. Developing HLH during treatment for acute lymphoblastic leukemia (ALL) is extremely uncommon, but underdiagnosis may be fatal. Two patients with ALL on chemotherapy maintenance treatment who developed HLH triggered by infection are presented here. We emphasize the importance of being aware of this condition when a patient with ALL in complete remission presents with unexplained hepatomegaly, cytopenia, and fever. Early diagnosis and treatment may be lifesaving.
Clinical Profile and Outcome of Influenza A/H1N1 in Pediatric Oncology Patients During the 2015 Outbreak: A Single Center Experience from Northern India
Authors: Verma Nishant , Pooniya Vishal , Kumar Archana
Published: August 2017

Background:

Owing to their immunocompromised status, childhood cancer patients on chemotherapy are at a greater risk for Influenza infection and its associated complications. There is limited data available on the clinical profile and outcome of Influenza A/H1N1 in this subset of patients.

Methods:

A retrospective study was performed of Influenza A/H1N1 cases diagnosed between January 2015 to December 2015 in the in-patients of Pediatric Oncology unit of a tertiary care hospital from Northern India.

Results:

In total, 16 children were diagnosed with laboratory confirmed H1N1. Most frequent symptoms were fever and cough. Oseltamivir was administered to all patients. Complications encountered were delay/interruption of antineoplastic therapy (9), need for respiratory support (5), and air leaks (1). Prolonged viral shedding was encountered in 50% of patients who were retested for H1N1 in their throat swabs. There were 2 deaths, 1 in a child of Acute Lymphoblastic Leukemia on induction therapy and another in a child with anaplastic Wilms tumor.

Conclusions:

Childhood cancer patients infected with Influenza A/H1N1 are at risk of serious illness and higher mortality. Delay of anticancer treatment is a concern in these infected children. Prompt initiation of antivirals and an optimum duration of treatment are warranted to reduce the morbidity and mortality.
An Integrative Review of 21st-Century Roles, Responsibilities, Characteristics, and Competencies of Chief Nurse Executives
Authors: Crawford Cecelia L. , Omery Anna , Spicer Jerry
Published: August 2017

Executive nursing practice is experiencing “head-snapping change.” Health care has transitioned from the managed care era to the disruptive innovation era. As chief nurse executives (CNEs) navigate evolving care delivery models, they must consider retooling their roles and responsibilities related to emergent models. This integrative review's purpose was to examine evidence for the roles, responsibilities, characteristics, and competencies of CNEs and system CNEs to better guide future generations of nurse executives. Ganong and Cooper's integrative review methodology was chosen to guide the evidence synthesis. Seventeen articles were identified that pertained to the clinical inquiry. The evidence is inconsistent for specific CNE roles, responsibilities, characteristics, and competencies due to many areas of overlap and an absence of definitions. The evidence does describe who CNEs are, what they do, and how they articulate executive practice. Embedding evidence regarding emerging roles, responsibilities, characteristics, and competencies into the personal journeys of nurse executives helps articulate shifting paradigms and the CNE's role in transforming health care. Review results have the potential to create a blueprint for the recruitment, development, and retention of the next generation of nurse executives. New knowledge for the ever-changing worlds of CNEs is needed by robust research studies and other evidence.
The Effects of Implementing a Patient Acuity Tool on Nurse Satisfaction in a Pulmonary Medicine Unit
Authors: Firestone-Howard Blaney , Zedreck Gonzalez Judith F. , Dudjak Linda A. , Ren Dianxu , Rader Sandra
Published: August 2017

In response to nurses' concerns of equity and satisfaction with patient assignments in a pulmonary medicine unit, a Patient Acuity Tool (PAT) was implemented. The impact of the PAT on nurse satisfaction and perceived equity of patient assignments was measured using a pre-/postsurvey design. Findings of the investigation indicate that a PAT supports nurse satisfaction and equity. In addition, qualitative data suggested that the PAT improved perceived professional autonomy and nurse-to-nurse communication.
Integrating Substance Use Content in an “Overcrowded” Nursing Curriculum
Authors: Finnell Deborah S. , Savage Christine L. , Hansen Bryan R. , Sanchez Michael , White Kathleen M. , Johnson J. Aaron , Seale J. Paul
Published: August 2017

Various factors have compelled nurse educators to address the lack of substance use–related content in nursing curriculum. Initiatives to add this content are often met with resistance because of an already crowded curriculum. This article describes a 4-phase process that guided the integration of this specialty content into a prelicensure nursing curriculum and a master’s level advanced practice nursing curriculum. Lessons learned and recommendations from those experiences are provided to guide nurse educators undertaking similar efforts.
Communicating Patient Status
Authors: Lanz Amelia S. , Wood Felecia G.
Published: August 2017

Research indicates that nurses lack adequate preparation for reporting patient status. This study compared 2 instructional methods focused on patient status reporting in the clinical setting using a randomized posttest-only comparison group design. Reporting performance using a standardized communication framework and student perceptions of satisfaction and confidence with learning were measured in a simulated event that followed the instruction. Between the instructional methods, there was no statistical difference in student reporting performance or perceptions of learning. Performance evaluations provided helpful insights for the nurse educator.
Nursing Students’ Perceptions of Confidentiality, Accountability, and E-Professionalism in Relation to Facebook
Authors: Barnable Alexia , Cunning Glenda , Parcon Mariel
Published: August 2017

This study examined nursing students’ perceptions of confidentiality, accountability, and e-professionalism in relation to Facebook. All of the students were aware that posting patients’ names and pictures of patients constituted a confidentiality breach. When comparing students based on educational status, there were differing opinions on whether employers should use Facebook profile information for hiring decisions. Nursing programs should provide current education, including clear and up-to-date policies, about social media use.
Effect of Canine Play Interventions as a Stress Reduction Strategy in College Students
Authors: Delgado Cheryl , Toukonen Margaret , Wheeler Corinne
Published: August 2017

Forty-eight students engaged with a therapy dog for 15 minutes during finals week to evaluate the effect on stress. Psychological (Perceived Stress Scale, visual analog scales) and physiologic stress (vital signs, salivary cortisol) measures were collected before and after the intervention. Paired t tests showed significant reductions in all psychological and physiologic measures except diastolic blood pressure. This supports animal-assisted therapy as an effective stress management strategy for nursing and other college students.
Embolic Stroke of Undetermined Source in Latin America
Authors: Cantú-Brito Carlos , Sampaio Silva Gisele , Ameriso Sebastián F.
Published: August 2017

Background:

Stroke is a major health concern throughout Latin America. As elsewhere, no precise cause can be determined for a substantial portion of strokes. In 6 studies since 2010 in the region, 16% to 43% of ischemic strokes were identified as cryptogenic. The term embolic stroke of undetermined source (ESUS) has been proposed as more clinically useful and positively defined than the vague term cryptogenic. The epidemiology of ESUS in Latin America is largely unknown.

Review Summary:

This article aims to provide a description of the epidemiology of ESUS in Latin America and practical information regarding available diagnostic procedures and current guidelines. Atrial fibrillation (AF) is a significant risk factor for stroke, observed in approximately 10% of Mexican and Brazilian stroke patients. Previously unknown AF has been detected through extended monitoring in numerous studies of stroke patients, including 8% of patients in an Argentinian study, and is a possible contributing cause of ESUS. External or implantable outpatient cardiac monitoring has shown increased diagnostic yield for the detection of intermittent AF versus standard cardiac monitoring, but is infrequently used in Latin America.

Conclusions:

Undiagnosed AF is likely to contribute significantly to cryptogenic stroke and ESUS. Research is needed to continue evaluation of the optimum means of identifying clinically relevant occult AF. In view of the thromboembolic mechanism of ESUS, anticoagulant therapy may prove useful in prevention of recurrence. Ongoing trials are evaluating use of dabigatran, rivaroxaban, or apixaban versus aspirin for reducing the risk of recurrent stroke in patients with previous ESUS.
Isolated Third Cranial Nerve Palsy Leading to the Diagnosis of Disseminated Burkitt Lymphoma
Authors: Taga Arens , Russo Marco , Florindo Irene , Pavesi Giovanni
Published: August 2017

Introduction:

Dysfunction of the third cranial nerve can result from lesions anywhere along its course between the midbrain and the orbit. Lymphoma is a rare cause of isolated oculomotor nerve palsy (OMP), with only 19 cases reported in the literature. We describe a case of an isolated OMP leading to the diagnosis of disseminated Burkitt lymphoma (BL).

Case Report:

A 37-year-old man presented with acute onset diplopia and right ptosis and was found to have a right pupillary sparing OMP. The diagnostic workout was unremarkable, including contrast-enhanced brain and orbital magnetic resonance imaging, MR angiography, exhaustive laboratory tests, and cerebrospinal fluid analysis. After a course of high-dose intravenous steroid therapy, the patient recovered almost completely. Three weeks after the discharge, he developed lumbar radicular pain and lower limbs weakness followed by the relapse of the right OMP. A second lumbar puncture revealed the presence of “small monomorphic lymphocytes,” consistent with leptomeningeal lymphomatosis. A whole-body positron emission tomography scan disclosed a mediastinal mass, whose histopathologic “starry sky” appearance was pathognomonic for BL.

Conclusions:

Reviewing the literature, we were able to find only 3 cases of OMP as the presenting manifestation of BL, all occurring in patients with predisposing HIV infection.

Our case of isolated OMP highlights some “red flags” for a lymphomatous etiology, including young age, a progressive course, a response to high-dose steroid therapy, and relapse upon steroid discontinuation; these cases require a comprehensive evaluation, including repeated cytological cerebrospinal fluid analysis and sensitive imaging techniques to detect a possible primary lesion.
Spontaneous Resolution of Venous Aneurysms After Transarterial Embolization of a Variant Superior Sagittal Sinus Dural Arteriovenous Fistula
Authors: Song Weizheng , Sun Hong , Liu Jin , Liu Li , Liu Jia
Published: August 2017

We present a rare case of dural arteriovenous fistula (DAVF) with subarachnoid hemorrhage and intraventricular hemorrhage due to its venous aneurysms. A 63-year-old woman was admitted for a sudden loss of consciousness. Computed tomography angiograph, magnetic resonance imaging angiography, and digital subtraction angiography revealed a superior sagittal sinus DAVF. The fistula was fed by the left middle meningeal artery and left internal carotid artery, and was drained by a right vein of Trolard, the superficial Sylvian vein, deep Sylvian vein, and basal vein to the vein of Galen. The drainage veins were enlarged obviously with 3 aneurysmal venous malformations. There was a stenosis segment on the right basal vein. All the anatomic factors of direct cortical vein drainage, normal deep vein drainage, long tortuous drainage vein, outflow restriction, and multiple venous aneurysms, were contributed to the aggressive presentation of our case. Transarterial complete embolization of the fistula with balloon protection was successfully performed. Nine months later, a follow-up magnetic resonance imaging showed a complete disappearance of the 2 venous aneurysms located in the deep Sylvian vein and basal vein, and an obvious decrease in size of the venous aneurysm of the superficial Sylvian vein. This is the first report of a DAVF with 3 ballooned venous aneurysms and a spontaneous anatomy resolution of the venous aneurysms after the embolization of the fistula. At the same time, the clinical and radiologic characteristics of variant superior sagittal sinus DAVFs were summarized by review of the literatures reported previously.
Early Versus Delayed Initiation of Pharmacological Venous Thromboembolism Prophylaxis After an Intracranial Hemorrhage
Authors: Faust Andrew C. , Finch Christopher K. , Hurdle April C. , Elijovich Lucas
Published: August 2017

Background:

Intracranial hemorrhage (ICH) accounts for up to 20% of all strokes with and carries an approximate 50% 30-day mortality. The risk of venous thromboembolism (VTE) is markedly higher in patients with ICH compared with ischemic strokes, but the optimal time to initiate pharmacological prophylaxis is ill-defined.

Design:

Retrospective analysis.

Setting:

University-affiliated, tertiary care center.

Patients:

Patients admitted for a nontraumatic ICH who received pharmacological VTE prophylaxis during their first 30 hospital days.

Results:

Of the 793 patients evaluated, 400 were included [142 (35.5%) early]. Rebleeding event rates were similar for early versus late [8 (5.6%) vs. 13 (5.0%), P=0.80] and rates of hospital-acquired VTEs were not statistically different [1 (0.7%) vs. 8 (3.1%), P=0.17]. The median time from admission to the first dose of pharmacological prophylaxis was similar in patients who experienced rebleeding versus those that did not [74 h (range, 38 to 110.5 h) vs. 63 h (range, 45 to 90.5 h), P=0.69]. There was a longer median time from admission to the first dose of pharmacological prophylaxis in patients who developed a VTE during the initial hospitalization versus those who did not [108 h (range, 73.3 to 187 h) vs. 63 h (range, 44.5 to 90 h), P=0.005].

Conclusions:

Initiation of early pharmacological prophylaxis in ICH patients did not appear to increase the risk of rebleeding nor decrease the risk of VTE. Among those patients who did develop VTE during hospitalization, there was a longer median time from admission to the first dose of pharmacological prophylaxis.
Correlates of Self-Reported Viral Suppression Among HIV-Positive, Young, Black Men Who Have Sex With Men Participating in a Randomized Controlled Trial of An Internet-Based HIV Prevention Intervention
Authors: Menza Timothy William , Choi Seul-Ki , LeGrand Sara , Muessig Kate , Hightow-Weidman Lisa
Published: August 2017

Background

Young, black men who have sex with men are disproportionately impacted by the US HIV epidemic, and HIV-positive, young, black men who have sex with men face stark disparities in HIV clinical outcomes.

Methods

We performed an observational analysis of the 199 HIV-positive black men aged 18 to 30 years followed up for 12 months in healthMpowerment, a randomized controlled trial of an Internet-based HIV prevention intervention, to identify time-varying correlates of self-reported viral suppression using relative risk (RR) regression.

Results

Retention at the 12-month visit was 84%. One hundred five (65%) of 162 participants reported being undetectable at baseline. At 3, 6, and 12 months, 83 (72%) of 115, 84 (82%) of 103, and 101 (86%) of 117 reported an undetectable viral load, respectively. In a multivariable model, participants who reported homelessness (RR, 0.85; 95% confidence interval [CI], 0.72–0.99), who had clinically significant depressive symptoms (RR, 0.88; 95% CI, 0.79–0.98), and who used methamphetamine or crack (RR, 0.61; 95% CI, 0.38–0.96) were less likely to report an undetectable viral load. Young men who engaged in condomless insertive anal intercourse were more likely to report viral suppression (RR, 1.14; 95% CI, 1.04–1.24).

Conclusion

HIV care for young, black men who have sex with men must be multidimensional to address medical needs in the context of mental health, substance use, and housing insecurity.
State and Local Health Department Activities Related to Abortion: A Web Site Content Analysis
Authors: Berglas Nancy F. , Johns Nicole E. , Rosenzweig Caroline , Hunter Lauren A. , Roberts Sarah C. M.
Published: August 2017

Context:

Recent legislation in states across the United States has required governmental health agencies to take on new and different roles in relation to abortion. While there has been media attention to health department roles in regulating abortion providers, there has been no systematic investigation of the range of activities in which state and local health departments are engaged.

Objective:

To systematically investigate health department activities related to abortion.

Methods:

We searched state health department Web sites of the 50 states and District of Columbia using key words such as “abortion” and “pregnancy termination”. Two trained coders categorized 6093 documents using the 10 Essential Public Health Services (EPHS) framework. We then applied these methods to 671 local health department documents.

Setting:

State and local health department Web sites.

Participants:

N/A.

Results:

On average, states engaged in 5.1 of 10 Essential Services related to abortion. Most (76%-98%) state health departments engaged in activities to Monitor Health Status (EPHS1), Enforce Laws (EPHS6), and Evaluate Effectiveness, Accessibility, and Quality (EPHS9). Many (47%-69%) engaged in activities to Inform and Educate (EPHS3), Develop Policies (EPHS5), and Link to Services (EPHS7). A minority (4%-29%) engaged in activities to Diagnose and Investigate Health Problems (EPHS2), Mobilize Community Partnerships (EPHS4), and Assure Competent Workforce (EPHS8). No state engaged in Innovative Research (EPHS10). Few local health departments engaged in abortion-related activities.

Conclusions:

While most state health departments engage in abortion-related activities, they appear to reflect what the law requires rather than the range of core public health activities. Additional research is needed to assess whether these services meet quality standards for public health services and determine how best to support governmental health agencies in their growing tasks. These findings raise important questions about the role of public health agencies and professionals in defining how health departments should be engaging with abortion.
Applying Decision Science to the Prioritization of Healthcare-Associated Infection Initiatives
Authors: Tsai Terry H. , Gerst Michael D. , Engineer Cyrus , Lehmann Harold P.
Published: August 2017

Objectives

Improving patient quality remains a top priority from the perspectives of both patient outcomes and cost of care. The continuing threat to patient safety has resulted in an increasing number of options for patient safety initiatives, making choices more difficult because of competing priorities. This study provides a proof of concept for using low-cost decision science methods for prioritizing initiatives.

Methods

Using multicriteria decision analysis, we developed a decision support model for aiding the prioritization of the four most common types of healthcare-associated infections: surgical site infections, central line–associated bloodstream infections, ventilator-associated events, and catheter-associated urinary tract infections. In semistructured interviews, we elicited structure and parameter values of a candidate model, which was then validated by six participants with different roles across three urban teaching and nonteaching hospitals in the Baltimore, Maryland area.

Results

Participants articulated the following structural attributes of concern: patient harm, monetary costs, patient mortality, reputational effects, and patient satisfaction. A quantitative decision-making model with an associated uncertainty report for prioritizing initiatives related to the four most common types of healthcare-associated infections was then created.

Conclusions

A decision support methodology such as our proof of concept could aid hospital executives in prioritizing the quality improvement initiatives within their hospital, with more complete data. Because hospitals continue to struggle in improving quality of care with tighter budgets, a formal decision support mechanism could be used to objectively prioritize patient safety and quality initiatives.
Electroencephalogram Abnormalities During Positional Changes in Brain Sagging Syndrome
Authors: Bensam Benziger , Sy Heustein L. , Sotudeh Nadia , Bhalla Paulomi K. , Hwang Sean T. , LeDoux David E.
Published: August 2017

Purpose:

Brain sagging after craniotomy and clipping of a ruptured aneurysm is a rare complication. Clinical and electrographic changes in patients with a final diagnosis of intracranial hypotension are not well described, and can be mistaken on rare occasions for other entities such as nonconvulsive status epilepticus. There may be resulting delay in the diagnosis and treatment of this potentially life-threatening disorder.

Methods:

Case report and imaging.

Results:

We present a case of intracranial hypotension in which concerning continuous electroencephalogram (cEEG) and quantitative EEG (qEEG) findings were noted during active sagging of the brain, which resolved with supine positioning. During upright seating, cEEG showed high-amplitude bilateral rhythmic 2-Hz slow-wave activity, and bilateral increase of spectral delta power on qEEG, in association with neurologic decline in function. When placed in supine position, the cEEG and qEEG abnormalities resolved in conjunction with the recovery of neurologic function.

Conclusions:

Brain sagging can be diagnosed using simple maneuvers such as supine positioning. This case report describes changes seen in cEEG and qEEG monitoring that accompany these maneuvers, which may provide further evidence for the diagnosis of brain sagging. Thus, cEEG and qEEG monitoring may have a role in the early detection and treatment of brain sagging.
Nuclear and mitochondrial RNA editing systems have opposite effects on protein diversity
Authors: Sloan Daniel B.
Published: August 2017

RNA editing can yield protein products that differ from those directly encoded by genomic DNA. This process is pervasive in the mitochondria of many eukaryotes, where it predominantly results in the restoration of ancestral protein sequences. Nuclear mRNAs in metazoans also undergo editing (adenosine-to-inosine or ‘A-to-I’ substitutions), and most of these edits appear to be nonadaptive ‘misfirings’ of adenosine deaminases. However, recent analysis of cephalopod transcriptomes found that many editing sites are shared by anciently divergent lineages within this group, suggesting they play some adaptive role. Recent discoveries have also revealed that some fungi have an independently evolved A-to-I editing mechanism, resulting in extensive recoding of their nuclear mRNAs. Here, phylogenetic comparisons were used to determine whether RNA editing generally restores ancestral protein sequences or creates derived variants. Unlike in mitochondrial systems, RNA editing in metazoan and fungal nuclear transcripts overwhelmingly leads to novel sequences not found in inferred ancestral proteins. Even for the subset of RNA editing sites shared by deeply divergent cephalopod lineages, the primary effect of nuclear editing is an increase—not a decrease—in protein divergence. These findings suggest fundamental differences in the forces responsible for the evolution of RNA editing in nuclear versus mitochondrial systems.
Martin David Kruskal. 28 September 1925—26 December 2006
Authors: Gibbon J. D. , Cowley S. C. , Joshi N. , MacCallum M. A. H.
Published: August 2017

Martin David Kruskal was one of the most versatile theoretical physicists of his generation and is distinguished for his enduring work in several different areas, most notably plasma physics, a memorable detour into relativity and his pioneering work in nonlinear waves. In the latter, together with Norman Zabusky, he invented the concept of the soliton and, with others, developed its application to classes of partial differential equations of physical significance.
Influence of tangential displacement on the adhesion strength of a contact between a parabolic profile and an elastic half-space
Authors: Popov Valentin L. , Lyashenko Iakov A. , Filippov Alexander E.
Published: August 2017

The adhesion strength of a contact between a rotationally symmetric indenter and an elastic half-space is analysed analytically and numerically using an extension of the method of dimensionality reduction for superimposed normal/tangential adhesive contacts. In particular, the dependence of the critical adhesion force on the simultaneously applied tangential force is obtained and the relevant dimensionless parameters of the problem are identified. The fracture criterion used coincides with that suggested by Johnson. In this paper, it is used to develop a method that is applicable straightforwardly to adhesive contacts of arbitrary bodies of revolution with compact contact area.
Export of ice nucleating particles from a watershed
Authors: Larsen Jarl Are , Conen Franz , Alewell Christine
Published: August 2017

Ice nucleating particles (INP) active at a few degrees below 0°C are produced by a range of organisms and released into the environment. They may affect cloud properties and precipitation when becoming airborne. So far, our knowledge about sources of biological INP is based on grab samples of vegetation, soil or water studied in the laboratory. By combining measurements of INP concentrations in river water with river water discharge rates over the course of 16 months, we obtained a lower limit for the production rate of INP in a watershed covering most of Switzerland (4 × 10
5
 INP
−8
 m
−2
 d
−1
). Coincidentally, we found that INP
−8
are likely to retain their potential for catalysing ice formation in the natural environment for at least several months before they are mobilized by an intensive rainfall, washed into the river and exported from the watershed.
Task allocation and site fidelity jointly influence foraging regulation in honeybee colonies
Authors: Mosqueiro Thiago , Cook Chelsea , Huerta Ramon , Gadau Jürgen , Smith Brian , Pinter-Wollman Noa
Published: August 2017

Variation in behaviour among group members often impacts collective outcomes. Individuals may vary both in the task that they perform and in the persistence with which they perform each task. Although both the distribution of individuals among tasks and differences among individuals in behavioural persistence can each impact collective behaviour, we do not know if and how they jointly affect collective outcomes. Here, we use a detailed computational model to examine the joint impact of colony-level distribution among tasks and behavioural persistence of individuals, specifically their fidelity to particular resource sites, on the collective trade-off between exploring for new resources and exploiting familiar ones. We developed an agent-based model of foraging honeybees, parametrized by data from five colonies, in which we simulated scouts, who search the environment for new resources, and individuals who are recruited by the scouts to the newly found resources, i.e. recruits. We varied the persistence of returning to a particular food source of both scouts and recruits and found that, for each value of persistence, there is a different optimal ratio of scouts to recruits that maximizes resource collection by the colony. Furthermore, changes to the persistence of scouts induced opposite effects from changes to the persistence of recruits on the collective foraging of the colony. The proportion of scouts that resulted in the most resources collected by the colony decreased as the persistence of recruits increased. However, this optimal proportion of scouts increased as the persistence of scouts increased. Thus, behavioural persistence and task participation can interact to impact a colony's collective behaviour in orthogonal directions. Our work provides new insights and generates new hypotheses into how variations in behaviour at both the individual and colony levels jointly impact the trade-off between exploring for new resources and exploiting familiar ones.
Social learning in otters
Authors: Ladds Zosia , Hoppitt William , Boogert Neeltje J.
Published: August 2017

The use of information provided by others to tackle life's challenges is widespread, but should not be employed indiscriminately if it is to be adaptive. Evidence is accumulating that animals are indeed selective and adopt ‘social learning strategies’. However, studies have generally focused on fish, bird and primate species. Here we extend research on social learning strategies to a taxonomic group that has been neglected until now: otters (subfamily Lutrinae). We collected social association data on captive groups of two gregarious species: smooth-coated otters (
Lutrogale perspicillata
), known to hunt fish cooperatively in the wild, and Asian short-clawed otters (
Aonyx cinereus
), which feed individually on prey requiring extractive foraging behaviours. We then presented otter groups with a series of novel foraging tasks, and inferred social transmission of task solutions with network-based diffusion analysis. We show that smooth-coated otters can socially learn how to exploit novel food sources and may adopt a ‘copy when young’ strategy. We found no evidence for social learning in the Asian short-clawed otters. Otters are thus a promising model system for comparative research into social learning strategies, while conservation reintroduction programmes may benefit from facilitating the social transmission of survival skills in these vulnerable species.
Diving behaviour of Cuvier's beaked whales exposed to two types of military sonar
Authors: Falcone Erin A. , Schorr Gregory S. , Watwood Stephanie L. , DeRuiter Stacy L. , Zerbini Alexandre N. , Andrews Russel D. , Morrissey Ronald P. , Moretti David J.
Published: August 2017

Cuvier's beaked whales (Ziphius cavirostris) have stranded in association with mid-frequency active sonar (MFAS) use, and though the causative mechanism linking these events remains unclear, it is believed to be behaviourally mediated. To determine whether MFAS use was associated with behavioural changes in this species, satellite tags were used to record the diving and movements of 16 Cuvier's beaked whales for up to 88 days in a region of frequent MFAS training off the coast of Southern California. Tag data were combined with summarized records of concurrent bouts of high-power, surface-ship and mid-power, helicopter-deployed MFAS use, along with other potential covariates, in generalized additive mixed-effects models. Deep dives, shallow dives and surface intervals tended to become longer during MFAS use, with some variation associated with the total amount of overlapping MFAS during the behaviour. These changes in dives and surface intervals contributed to a longer interval between deep dives, a proxy for foraging disruption in this species. Most responses intensified with proximity and were more pronounced during mid-power than high-power MFAS use at comparable distances within approximately 50 km, despite the significantly lower source level of mid-power MFAS. However, distance-mediated responses to high-power MFAS, and increased deep dive intervals during mid-power MFAS, were evident up to approximately 100 km away.
Modelling radicalization: how small violent fringe sects develop into large indoctrinated societies
Authors: Short Martin B. , McCalla Scott G. , D'Orsogna Maria R.
Published: August 2017

We model radicalization in a society consisting of two competing religious, ethnic or political groups. Each of the ‘sects’ is divided into moderate and radical factions, with intra-group transitions occurring either spontaneously or through indoctrination. We also include the possibility of one group violently attacking the other. The intra-group transition rates of one group are modelled to explicitly depend on the actions and characteristics of the other, including violent episodes, effectively coupling the dynamics of the two sects. We use a game theoretic framework and assume that radical factions may tune ‘strategic’ parameters to optimize given utility functions aimed at maximizing their ranks while minimizing the damage inflicted by their rivals. Constraints include limited overall resources that must be optimally allocated between indoctrination and external attacks on the other group. Various scenarios are considered, from symmetric sects whose behaviours mirror each other, to totally asymmetric ones where one sect may have a larger population or a superior resource availability. We discuss under what conditions sects preferentially employ indoctrination or violence, and how allowing sects to readjust their strategies allows for small, violent sects to grow into large, indoctrinated communities.
Model selection for dynamical systems via sparse regression and information criteria
Authors: Mangan N. M. , Kutz J. N. , Brunton S. L. , Proctor J. L.
Published: August 2017

We develop an algorithm for model selection which allows for the consideration of a combinatorially large number of candidate models governing a dynamical system. The innovation circumvents a disadvantage of standard model selection which typically limits the number of candidate models considered due to the intractability of computing information criteria. Using a recently developed sparse identification of nonlinear dynamics algorithm, the sub-selection of candidate models near the Pareto frontier allows feasible computation of Akaike information criteria (AIC) or Bayes information criteria scores for the remaining candidate models. The information criteria hierarchically ranks the most informative models, enabling the automatic and principled selection of the model with the strongest support in relation to the time-series data. Specifically, we show that AIC scores place each candidate model in thestrong support,weak supportorno supportcategory. The method correctly recovers several canonical dynamical systems, including a susceptible-exposed-infectious-recovered disease model, Burgers’ equation and the Lorenz equations, identifying the correct dynamical system as the only candidate model with strong support.
Flexural edge waves generated by steady-state propagation of a loaded rectilinear crack in an elastically supported thin plate
Authors: Nobili Andrea , Radi Enrico , Lanzoni Luca
Published: August 2017

The problem of a rectilinear crack propagating at constant speed in an elastically supported thin plate and acted upon by an equally moving load is considered. The full-field solution is obtained and the spotlight is set on flexural edge wave generation. Below the critical speed for the appearance of travelling waves, a threshold speed is met which marks the transformation of decaying edge waves into edge waves propagating along the crack and dying away from it. Yet, besides these, and for any propagation speed, a pair of localized edge waves, which rapidly decay behind the crack tip, is also shown to exist. These waves are characterized by a novel dispersion relation and fade off from the crack line in an oscillatory manner, whence they play an important role in the far field behaviour. Dynamic stress intensity factors are obtained and, for speed close to the critical speed, they show a resonant behaviour which expresses the most efficient way to channel external work into the crack. Indeed, this behaviour is justified through energy considerations regarding the work of the applied load and the energy release rate. Results might be useful in a wide array of applications, ranging from fracturing and machining to acoustic emission and defect detection.
A father effect explains sex-ratio bias
Authors: Malo Aurelio F. , Martinez-Pastor Felipe , Garcia-Gonzalez Francisco , Garde Julián , Ballou Jonathan D. , Lacy Robert C.
Published: August 2017

Sex ratio allocation has important fitness consequences, and theory predicts that parents should adjust offspring sex ratio in cases where the fitness returns of producing male and female offspring vary. The ability of fathers to bias offspring sex ratios has traditionally been dismissed given the expectation of an equal proportion of X- and Y-chromosome-bearing sperm (CBS) in ejaculates due to segregation of sex chromosomes at meiosis. This expectation has been recently refuted. Here we used
Peromyscus leucopus
to demonstrate that sex ratio is explained by an exclusive effect of the father, and suggest a likely mechanism by which male-driven sex-ratio bias is attained. We identified a male sperm morphological marker that is associated with the mechanism leading to sex ratio bias; differences among males in the sperm nucleus area (a proxy for the sex chromosome that the sperm contains) explain 22% variation in litter sex ratio. We further show the role played by the sperm nucleus area as a mediator in the relationship between individual genetic variation and sex-ratio bias. Fathers with high levels of genetic variation had ejaculates with a higher proportion of sperm with small nuclei area. This, in turn, led to siring a higher proportion of sons (25% increase in sons per 0.1 decrease in the inbreeding coefficient). Our results reveal a plausible mechanism underlying unexplored male-driven sex-ratio biases. We also discuss why this pattern of paternal bias can be adaptive. This research puts to rest the idea that father contribution to sex ratio variation should be disregarded in vertebrates, and will stimulate research on evolutionary constraints to sex ratios—for example, whether fathers and mothers have divergent, coinciding, or neutral sex allocation interests. Finally, these results offer a potential explanation for those intriguing cases in which there are sex ratio biases, such as in humans.