bluuebunny/crossref_metadata_2025 huggingface dataset:
A New Pepstatin-Insensitive Thermopsin-Like Protease Overproduced in Peptide-Rich Cultures of Sulfolobus solfataricus
Authors: Gogliettino Marta , Riccio Alessia , Cocca Ennio , Rossi Mosè , Palmieri Gianna , Balestrieri Marco
Published: February 2014

In this study, we gain insight into the extracellular proteolytic system of Sulfolobus solfataricus grown on proteinaceous substrates, providing further evidence that acidic proteases were specifically produced in response to peptide-rich media. The main proteolytic component was the previously isolated SsMTP (Sulfolobus solfataricus multi-domain thermopsin-like protease), while the less abundant (named SsMTP-1) one was purified, characterized and identified as the sso1175 gene-product. The protein revealed a multi-domain organization shared with the cognate SsMTP with a catalytic domain followed by several tandemly-repeated motifs. Moreover, both enzymes were found spread across the Crenarchaeota phylum and belonging to the thermopsin family, although segregated into diverse phylogenetic clusters. SsMTP-1 showed a 75-kDa molecular mass and was stable in the temperature range 50–90 °C, with optimal activity at 70 °C and pH 2.0. Serine, metallo and aspartic protease inhibitors did not affect the enzyme activity, designating SsMTP-1 as a new member of the pepstatin-insensitive aspartic protease family. The peptide-bond-specificity of SsMTP-1 in the cleavage of the oxidized insulin B chain was uncommon amongst thermopsins, suggesting that it could play a distinct, but cooperative role in the protein degradation machinery. Interestingly, predictions of the transmembrane protein topology of SsMTP and SsMTP-1 strongly suggest a possible contribution in signal-transduction pathways.
Cigarette Smoke Alters the Hematopoietic Stem Cell Niche
Authors: Siggins Robert , Hossain Fokhrul , Rehman Tayyab , Melvan John , Zhang Ping , Welsh David
Published: February 2014

Effects of tobacco smoke on hematologic derangements have received little attention. This study employed a mouse model of cigarette smoke exposure to explore the effects on bone marrow niche function. While lung cancer is the most widely studied consequence of tobacco smoke exposure, other malignancies, including leukemia, are associated with tobacco smoke exposure. Animals received cigarette smoke exposure for 6 h/day, 5 days/week for 9 months. Results reveal that the hematopoietic stem and progenitor cell (HSPC) pool size is reduced by cigarette smoke exposure. We next examined the effect of cigarette smoke exposure on one supporting cell type of the niche, the mesenchymal stromal cells (MSCs). Smoke exposure decreased the number of MSCs. Transplantation of naïve HSPCs into irradiated mice with cigarette smoke exposure yielded fewer numbers of engrafted HSPCs. This result suggests that smoke-exposed mice possess dysfunctional niches, resulting in abnormal hematopoiesis. Co-culture experiments using MSCs isolated from control or cigarette smoke-exposed mice with naïve HSPCs in vitro showed that MSCs from cigarette smoke-exposed mice generated marked expansion of naïve HSPCs. These data show that cigarette smoke exposure decreases in vivo MSC and HSC number and also increases pro-proliferative gene expression by cigarette smoke-exposed MSCs, which may stimulate HSPC expansion. These results of this investigation are clinically relevant to both bone marrow donors with a history of smoking and bone marrow transplant (BMT) recipients with a history of smoking.
In Silico Studies of Quinoxaline-2-Carboxamide 1,4-di-N-Oxide Derivatives as Antimycobacterial Agents
Authors: Radwan Awwad , Abdel-Mageed Wael
Published: February 2014

Molecular modelling studies were performed on some previously reported novel quinoxaline-2-carboxamide 1,4-di-N-oxide derivatives (series 1–9). Using the LigandScout program, a pharmacophore model was developed to further optimize the antimycobacterial activity of this series of compounds. Using the Dock6 program, docking studies were performed in order to investigate the mode of binding of these compounds. The molecular modeling study allowed us to confirm the preferential binding mode of these quinoxaline-2-carboxamide 1,4-di-N-oxide derivatives inside the active site. The obtained binding mode was as same as that of the novobiocin X-ray structure.
Object Recognition and Localization: The Role of Tactile Sensors
Authors: Aggarwal Achint , Kirchner Frank
Published: February 2014

Tactile sensors, because of their intrinsic insensitivity to lighting conditions and water turbidity, provide promising opportunities for augmenting the capabilities of vision sensors in applications involving object recognition and localization. This paper presents two approaches for haptic object recognition and localization for ground and underwater environments. The first approach called Batch Ransac and Iterative Closest Point augmented Particle Filter (BRICPPF) is based on an innovative combination of particle filters, Iterative-Closest-Point algorithm, and a feature-based Random Sampling and Consensus (RANSAC) algorithm for database matching. It can handle a large database of 3D-objects of complex shapes and performs a complete six-degree-of-freedom localization of static objects. The algorithms are validated by experimentation in ground and underwater environments using real hardware. To our knowledge this is the first instance of haptic object recognition and localization in underwater environments. The second approach is biologically inspired, and provides a close integration between exploration and recognition. An edge following exploration strategy is developed that receives feedback from the current state of recognition. A recognition by parts approach is developed which uses the BRICPPF for object sub-part recognition. Object exploration is either directed to explore a part until it is successfully recognized, or is directed towards new parts to endorse the current recognition belief. This approach is validated by simulation experiments.
Agronomic Management under Organic Farming May Affect the Bioactive Compounds of Lentil (Lens culinaris L.) and Grass Pea (Lathyrus communis L.)?
Authors: Menga Valeria , Codianni Pasquale , Fares Clara
Published: February 2014

A two year field experiment was carried out to evaluate the effects of three row and eight row seeding on the total phenolic compound (TPC), total flavonoid content (TFC), hydrolyzed (HTC) and condensed tannin (CTC), antioxidant activity (ABTS assay), protein content and soluble dietary fiber (SDF) and insoluble dietary fiber (IDF) in the extracts of lentil (Lens culinaris L.) and grass pea (Lathyrus communis L.) cultivated under organic farming. The aim of this study was to determine whether row spacing used for seeding in organic farming systems for lentil and grass pea is a suitable method to increase the accumulation of antioxidant compounds in these crops. Grass pea showed the highest mean SDF and protein while lentil varieties showed the greatest and significant content of all of the antioxidant compounds. In lentil, there were increases in TPC (52%), HTC (73%), TFC (85%) and CTC (41%), passing from three rows to eight rows, while in grass pea, the increases were lower, and only significant for TFC and CTC (37%, 13% respectively). In both lentils and grass pea, the highest correlation coefficient was between TPC and HTC, which indicates that the HTC includes the predominant phenolic compounds in lentil as well as in grass pea (r = 0.98, 0.71 p < 0.001, respectively). Regardless of legume species, TPC, HTC, TFC and CTC showed significant (p < 0.001) and linear correlations with the ABTS assay. These data confirm the key role of row spacing for the improvement of the antioxidant properties of lentil in organic farming; moreover, they hint at the major responsiveness and adaptation of lentil to environmental stimulus with respect to grass pea.
Is Tightly Controlled Disease Activity Possible with Online Patient-reported Outcomes?
Authors: Walter Margot J. , Mohd Din S.H. , Hazes Johanna M. , Lesaffre E. , Barendregt P.J. , Luime Jolanda J.
Published: February 2014

Objective.

To evaluate the performance of patient-reported outcomes (PRO) as primary indices for identification and prediction of a 28-joint Disease Activity Score (DAS28) > 3.2 among patients with rheumatoid arthritis (RA).

Methods.

Patients with RA completed monthly online PRO [Health Assessment Questionnaire (HAQ), Rheumatoid Arthritis Disease Activity Index (RADAI), visual analog scale (VAS) fatigue] and were clinically assessed every 3 months using the DAS28. Simple descriptive statistics, logistic regression, and the Bayesian joint modeling approach were used to analyze the data. The Bayesian joint model combines the scores and changes in the scores of 3 PRO to predict a DAS28 > 3.2 at the subsequent timepoint.

Results.

A group of 159 patients with RA participated. Stratified summaries of the PRO by DAS28 categories at baseline provided incremental values of the PRO for more active disease. However, on an individual level, the DAS28 and the PRO fluctuated over time. The prediction of subsequent DAS score by a single instrument at single timepoints resulted in moderate sensitivity and specificity. Using the intercept and slope of the combined PRO of the first 3 measurements to predict the DAS28 state at 3 months resulted in a sensitivity of 0.81 and a specificity of 0.92. After 10-fold cross validation, the model had a sensitivity of 0.61 and specificity of 0.75 to identify patients with a DAS28 > 3.2.

Conclusion.

PRO showed fluctuating levels of disease activity over time, while on a group level disease activity stayed the same. Using the changes in RADAI, HAQ, and VAS fatigue over time to predict future DAS28 > 3.2 resulted in moderate performance after the internal cross-validation of the model (sensitivity 0.61, specificity 0.75).
Retinol-binding Protein 4 in Rheumatoid Arthritis-related Insulin Resistance and β-cell Function
Authors: Ferraz-Amaro Iván , González-Gay Miguel A. , Diaz-González Federico
Published: February 2014

Objective.

Retinol-binding protein 4 (RBP4), an adipokine related to impaired glucose tolerance, has been associated with insulin resistance (IR) and β-cell function in subjects with obesity or diabetes. In our study we assessed RBP4 levels in patients with rheumatoid arthritis (RA). We also determined whether any correlation exists between RBP4 levels and the presence of IR in these patients.

Methods.

Plasma RBP4, insulin, C-peptide concentrations, and homeostasis model assessment (HOMA)-IR were measured in 101 patients with RA and 115 sex-matched and age-matched controls. A multivariable analysis adjusted for IR classic cardiovascular risk factors and body mass index was performed to establish the correlation between RBP4 plasma concentrations and features of IR in RA. Data were adjusted for glucocorticoid intake in patients with RA.

Results.

Patients had higher levels of insulin, C-peptide levels, HOMA-percentage of β-cell secretion (%B) index, and HOMA-IR index than controls. RBP4 levels were significantly lower in the whole group of patients than in controls [13.99 (9.78–19.88) vs 21.50 (10.28–32.59) μg/ml, p < 0.01]. However, only those who were glucocorticoid-naive showed significant difference in RBP4 plasma concentration when compared to controls [11.88 (7.93–17.96) vs 21.50 (10.28–32.59) μg/ml, p < 0.01]. The HOMA-%B [log β coefficient 0.00 (0.00–0.01), p < 0.01] showed positive relationships regarding RBP4 in controls. That was not the case in patients with RA [log β coefficient 0.00 (−0.0–0.00), p = 0.93 for HOMA-%B].

Conclusion.

RBP4 does not correlate with the presence of IR and β-cell function in patients with RA. The mechanisms leading to IR in RA may be different from those occurring in obesity or diabetes.
Colchicine in Behçet Syndrome: A Longterm Survey of Patients in a Controlled Trial
Authors: Hamuryudan Vedat , Hatemi Gulen , Tascilar Koray , Yurdakul Sebahattin , Mat Cem , Ozyazgan Yilmaz , Seyahi Emire , Ugurlu Serdal , Yazici Hasan
Published: February 2014

Objective.

To test the hypothesis that colchicine use during early disease decreases immunosuppressive use in Behçet syndrome (BS) in the long term.

Methods.

Patients with BS who participated in a double-blind, placebo-controlled trial of colchicine 16.6 ± 1.1 years ago were evaluated for immunosuppressive use during the posttrial period.

Results.

We could contact 90/116 patients; 28 (31%) received immunosuppressives during the posttrial period, 14 being from the colchicine arm. Posttrial colchicine use and cumulative duration were similar between patients who received immunosuppressives and those who did not.

Conclusion.

Continuous use of colchicine, even when initiated at an early disease stage, does not seem to decrease the use of immunosuppressives in the long term.
Hemostatic and Fibrinolytic Changes Are Related to Inflammatory Conditions in Patients with Psoriatic Arthritis — Effect of Different Treatments
Authors: Di Minno Matteo Nicola Dario , Iervolino Salvatore , Peluso Rosario , Di Minno Alessandro , Ambrosino Pasquale , Scarpa Raffaele ,   the CaRRDs Study Group
Published: February 2014

Objective.

To prospectively evaluate the effect of tumor necrosis factor (TNF)-α inhibitors on hemostatic and fibrinolytic variables in subjects with psoriatic arthritis (PsA).

Methods.

Among subjects with PsA who were taking traditional disease-modifying antirheumatic drugs (DMARD), 98 patients with active disease who switched to treatment with TNF-α inhibitors were enrolled in this study (Group 1). In parallel, 98 matched subjects with minimal disease activity (MDA) and treated with DMARD were enrolled (Group 2). In all patients, hemostatic and fibrinolytic variables were evaluated at enrollment and after a 6-month followup. Results were stratified according to treatment and to MDA achievement.

Results.

Seventy-six Group 1 and 80 Group 2 subjects completed the 6-month followup. During the followup, significant changes in hemostatic and fibrinolytic variables were found in Group 1, but not in Group 2 subjects. At the end of the followup, patients treated with TNF-α inhibitors showed significantly lower levels of hemostatic and fibrinolytic variables as compared to those treated with traditional DMARD. Among Group 1 subjects, changes in hemostatic and fibrinolytic variable levels were significantly higher in those who achieved MDA versus in those who did not. Multivariate analyses showed that a treatment with TNF-α blockers affected fibrinolytic variables [plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (t-PA)] and some acute-phase proteins (D-dimer, coagulation factor VIII, and von Willebrand factor). In contrast, the MDA achievement during treatment with TNF-α blockers maximally affected fibrinolytic variables (PAI-1 and t-PA).

Conclusion.

TNF-α inhibitors brought about a significant improvement of hemostatic and fibrinolytic balance in subjects with PsA. Maximal changes were found in patients achieving MDA.
Joint Effects of Alcohol Consumption and ABCG2 Q141K on Chronic Tophaceous Gout Risk
Authors: Tu Hung-Pin , Ko Albert Min-Shan , Chiang Shang-Lun , Lee Su-Shin , Lai Han-Ming , Chung Chia-Min , Huang Chung-Ming , Lee Chien-Hung , Kuo Tzer-Min , Hsieh Mei-Jung , Ko Ying-Chin
Published: February 2014

Objective.

To investigate the joint effects of alcohol consumption and ABCG2 gene variants on tophaceous gout occurrence.

Methods.

The V12M (rs2231137), Q126X (rs72552713), and Q141K (rs2231142) of the ABCG2 gene were genotyped among controls, nontophaceous, and tophaceous gout cases in Taiwanese Han (n = 446, 77, 177) and Taiwan Aborigines (n = 1105, 203, 330).

Results.

The missense variations V12M (C) and Q141K (T) significantly associated with tophaceous gout (p trend = 4.08 × 10−2, 9.00 × 10−12 in Han; 1.81 × 10−3, 9.34 × 10−10 in Aborigines). The nonsense variation Q126X (T) exerted a significant effect only in Han (p = 1.10 × 10−2), but not in Aborigines. In the prediction of tophaceous gout, the Q141K (T) OR were 1.51 in Han, 1.50 in Aborigines, and 1.55 (p = 7.84 × 10−5) in pooled analysis when compared to nontophaceous gout. We found the joint effects of alcohol consumption and Q141K (T/T) highly associated with tophaceous gout (adjusted OR ≥ 5.11; p ≤ 7.78 × 10−4); specifically the ever drinkers carrying the Q141K (T/T; adjusted OR 25.05, p = 9.21 × 10−4 in Han; adjusted OR 14.87, p = 1.08 × 10−8 in Aborigines).

Conclusion.

Our findings showed alcohol consumption and ABCG2 Q141K, independently and jointly, associated with the risk of chronic tophaceous gout.
Mortality and Cardiovascular Burden of Systemic Lupus Erythematosus in a US Population-based Cohort
Authors: Bartels Christie M. , Buhr Kevin A. , Goldberg Jerry W. , Bell Carolyn L. , Visekruna Maja , Nekkanti Swapna , Greenlee Robert T.
Published: February 2014

Objective.

To examine the mortality and cardiovascular disease (CVD) burden among a population-based cohort of patients with systemic lupus erythematosus (SLE) with previously described late mean onset and low rates of organ-threatening disease.

Methods.

This retrospective population-based cohort study investigated incident cases of SLE diagnosed from 1991–2008 and followed through March 2009 to examine rates of death and CVD events: myocardial infarction, stroke, or congestive heart failure hospitalization. Cases were identified using the 1997 update of the 1982 American College of Rheumatology SLE criteria. Searches included electronic records, chart audits, and state death matches, with physician review. Age-matched and sex-matched population comparisons facilitated relative event rate calculations.

Results.

Seventy incident SLE cases had late mean onset (52 years), with an incidence of 5 cases per 100,000/year. Matched comparisons showed similar baseline rates of hypertension, hyperlipidemia, and diabetes. However, patients with SLE experienced more CVD in the 2 years preceding SLE diagnosis (OR 3.8, 95% CI 1.8, 8.0). The estimated 10-year mortality rates were 26% for SLE subjects versus 19% for comparisons, hazard ratio (HR) 2.1, p < 0.01. Adjusted for prior CVD, SLE cases still demonstrated increased hazards of mortality (HR 1.9, p = 0.01) and CVD event or death (HR 1.8, p = 0.01).

Conclusion.

This incident SLE cohort demonstrated nearly doubled mortality and CVD event hazards compared to age-matched and sex-matched comparisons, even after accounting for higher CVD events in the 2 years preceding SLE diagnosis. This raises research questions regarding delayed SLE diagnosis versus accelerated CVD prior to SLE, particularly in older-onset SLE.
A Decade in Retrospect
Authors: DeSilets Lynore D. , DeSilets Lynore D.
Published: February 2014

Over the past decade, several events and publications have influenced and refocused continuing nursing education. Several of these are briefly reviewed in this column.

J Contin Educ Nurs
. 2014;45(2):52–53.
Understanding Massively Open Online Courses
Authors: Billings Diane M.
Published: February 2014

Massively open online courses (MOOCs) are an innovative delivery system for educational offerings. MOOCs have been hailed with optimism for making education accessible to many, but at the same time, they have been criticized for poor participant completion rates. Nurse educators are considering whether and how to use MOOCs; this column explains MOOCs and their advantages and disadvantages for nurse educators.

J Contin Educ Nurs.
2014;45(2):58–59.
Mixed-Methods Approach to Understanding Nurses' Clinical Reasoning in Recognizing Delirium in Hospitalized Older Adults
Authors: Rice Karen L. , Bennett Marsha J. , Clesi Tara , Linville Lisa
Published: February 2014

A mixed-methods study was conducted to enhance understanding of nurses' clinical reasoning in recognizing delirium in the hospitalized older adult. Paired nurse and researcher ratings of the confusion assessment method in 103 medical–surgical patients were analyzed to determine the rate of agreement in detecting delirium and to identify a purposive sample of nurses to be interviewed about the patients with delirium who were under their care. Nurses' clinical reasoning in recognizing and underrecognizing delirium was investigated using semistructured interviews. The incidence of delirium was 13%, with poor agreement (95% CI [0.05, 0.64],
p
< 0.05) between the researchers and the nurses in detecting delirium. Sixteen nurses were interviewed and transcripts were analyzed with grounded theory. Confusion was the primary causal factor for recognizing symptoms of delirium. The findings explicated a framework that forms the basis for generating testable assumptions to improve nurses' recognition of delirium.
J Contin Educ Nurs.
2014;45(3):136–148.
Teleneonatology: A Major Tool for the Future
Authors: Minton Stephen , Allan Mark , Valdes Wesley
Published: February 2014

Hospitals have, for centuries, maintained a central position in the health care system, providing care for critically ill patients. Despite being a cornerstone of health care delivery, we are witnessing the beginning of a major transformation in their function. There are several forces driving this transformation, including health care costs, shortage of health care professionals, volume of people with chronic diseases, consumerism, health care reform, and hospital errors.

The neonatal intensive care unit (NICU) at Utah Valley Regional Medical Center in Provo, Utah, began an aggressive redesign/quality improvement effort in 1990. It became obvious that our care processes were designed for health care deliverers and not for the families. An ongoing revamp of our care delivery processes was undertaken using significant input from a parent focus meeting, parental interviews, and development of a parent-to-parent support group.

As a result of this work, it became obvious we needed a new model to truly empower parents. The idea of “NICU is Home” was born. We elected to make a mind shift, not to focus on what families think, but rather on how they think.

Web cams and other video apparatus have been used in a number of NICUs across the country. We decided our equipment requirements would need to include high-resolution cameras, full high-definition video recording, autofocus, audio microphones, automatic noise reduction, and automatic low-light correction. Our conferencing software needed to accommodate multiple users and have multiple-picture capabilities, low band width, and inexpensive technology. It was recognized that a single video camera feed was insufficient to adequately capture the desired amount of information.

Verbal communication between parents and their babies’ principal care providers is critical. Parents loved the idea of expanding the remote NICU web cam of their baby to a two-way physician-parent communication bedside monitor. Doctors at Utah Valley Regional Medical Center now have a mobile desk using a WiFi computer/camera/audio to communicate with the family in real-time or leave a recording.

CME Educational Objectives

Stephen Minton, MD, is Medical Director, Newborn Services, and Chief of Neonatology, Utah Valley Regional Medical Center. Mark Allan, MBA, is Manager, Clinical Information Systems, Urban South Region, Intermountain Healthcare, Utah Valley Regional Medical Center. Wesley Valdes, DO, is Medical Director, Telehealth Services Intermountain Healthcare.

Address correspondence to: Stephen Minton, MD, Department of Neonatology, Utah Valley Regional Medical Center, 1034 N. 500 W. Provo, UT 84604; email:
stephen.minton@imail.org
.

Disclosure: The authors have no relevant financial relationships to report.

doi: 10.3928/00904481-20140127-11
Validity and Reliability of the Geriatric Sexuality Inventory
Authors: Kazer Meredith Wallace , Grossman Sheila , Kerins Gerard , Kris Alison , Tocchi Christine
Published: February 2014

Effective health care for older adults requires that providers assess and manage sexual health needs with high priority. This assessment begins with an effective sexuality assessment tool. A two-step, research approach was undertaken to develop and test the Geriatric Sexuality Inventory (GSI). Literature and expert review resulted in a 34-item instrument that was initially completed by 34 older adults ages 60 to 91 (mean age = 75). The testing was repeated in 19 of the original participants. The sample was 75% women, and 88% Caucasian with 9% single, 27% married, 18% divorced, and 46% widowed participants. Internal consistency reliability was run on all 53 responses and revealed adequate reliability (alpha = 0.74). Test-retest analysis also revealed good initial instrument reliability (
r
= 0.78;
p
< 0.001). Responses to open-ended questions regarding sexual information and care needs supported evidence gathered from the literature. Initial testing of the GSI revealed content validity and good internal consistency and test-retest reliability. [
Journal of Gerontological Nursing, 39
(11), 38–45.]
Potential Benefits to Staff from Humor Therapy with Nursing Home Residents
Authors: Chenoweth Lynnette , Low Lee-Fay , Goodenough Belinda , Liu Zhixin , Brodaty Henry , Casey Anne-Nicole , Spitzer Peter , Bell Jean-Paul , Fleming Richard
Published: February 2014

Life in residential care can be challenging for residents and staff. Bringing humor into this setting may benefit residents, creating a more productive, enjoyable work environment for staff. The potential effect of exposure to humor therapy on staff, both as active and incidental participants, as part of a randomized controlled trial of the effect of humor therapy for aged care residents was investigated in the Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE). The intervention involved a humor program with professional performers (ElderClowns) and trained facility staff (LaughterBosses) for a minimum of nine 2-hour sessions over 12 weeks. Methods included a staff survey at three time points, interviews with LaughterBosses, and a satisfaction rating by facility managers. There were significant positive findings for some staff subgroups, including assistants in nursing/personal care assistants and staff older than 45. LaughterBoss interviews and intervention group manager ratings of staff work enthusiasm were positive. [
Journal of Gerontological Nursing, 40
(2), 47–52.]
Promoting Person-Centeredness in Long-Term Care: An Exploratory Study
Authors: Edvardsson David , Varrailhon Pia , Edvardsson Kristina
Published: February 2014

This study explored how nursing staff promote person-centeredness in long-term care settings. The study used an anthropological free-listing approach to data collection and qualitative content analysis to analyze written self-report descriptions from a convenience sample of Swedish long-term care staff (
N
= 436). The analyses resulted in four themes that illuminate how nursing staff promote person-centeredness: Promoting Decision Making, Promoting a Meaningful Living, Promoting a Pleasurable Living, and Promoting Personhood. The study contributes to the literature by providing concrete descriptions of how person-centeredness was facilitated by staff in their everyday practice and contributes to move person-centeredness from the philosophical, policy, and conceptual domains toward clinical implementation. The study also suggests that promoting pleasure for residents is a dimension central to person-centeredness and to health-promoting gerontological nursing, and that “small talk” is an emerging nursing phenomenon that deserves more research attention. [
Journal of Gerontological Nursing, 40
(4), 46–53.]
Psychiatric Illness and Resident Assaults Among Veterans in Long-Term Care Facilities
Authors: Powers James , Gwirtsman Harry , Erwin Scott
Published: February 2014

This article describes a quality improvement program to reduce the prevalence of physical assaults in a university-affiliated, 234-bed Veterans Affairs (VA) long-term care (LTC) facility, which experienced a rise in the number of physical assaults to >4 per 1,000 bed days of care in four LTC units. Analysis of 55 events (29 patients) at this VA LTC site during 2007 revealed 19 resident assailants (8% total population), 10 victims, and 30% repeat events. Of the residents who exhibited assaultive behavior, 44% had dementia and 32% had schizophrenia as a major diagnosis. Following a process improvement plan, new occurrence assaultive behaviors declined from >4 to <1 per 1,000 bed days and remained low during 5-year follow up. [
Journal of Gerontological Nursing, 40
(4), 25–30.]
Sleep Disorders in Older Adults
Authors: Saccomano Scott J.
Published: February 2014

Sleep pattern changes are considered normal as individuals age. However, changes in sleep patterns can ultimately affect the quality of life of many older adults. In addition, many sleep conditions are associated with an increase in morbidity and mortality. It is essential for clinicians to recognize sleep changes to lead to appropriate treatment. This article will focus on the assessment and interventions of sleep disorders in older adults. [
Journal of Gerontological Nursing, 40
(3), 38–45.]
Medications and Falls: Addressing the Risk through Pharmacist-Led Quality Initiatives
Authors: Li-MacDonald Bonnie X. , Pyhtila Jessica , Brandt Nicole J.
Published: February 2014

Falls in older adults are common in the long-term care setting and are associated with functional decline, isolation, and depression. Increased attention is being given by the Centers for Medicare and Medicaid Services to have nursing homes implement quality assurance programs with the aim to reduce falls. Within the nursing home, pharmacists are expected to conduct at least monthly medication reviews and monitor for therapeutic effectiveness as well as adverse consequences of medications. This article discusses pharmacist-led team interventions to reduce fall risk in residents at a continuing care retirement community. One intervention is a fall risk evaluation form that notifies the assisted living care team of modifiable risk factors for residents who fall frequently. Examples include recommendations on discontinuing psychotropic medications that affect gait or alter mental status. In conjunction with the nursing home care team, the pharmacist also created two other programs that aim to (a) improve bone health by identifying residents who have low vitamin D levels and evaluating their need for calcium and vitamin D supplementation, and (b) educate the nursing staff of specific medication side effects that increase fall risk. [
Journal of Gerontological Nursing, 40
(1), 8–12.]
Chronic Tibialis Anterior Tendon Tear Treated With an Achilles Tendon Allograft Technique
Authors: Palmanovich Ezequiel , Brin Yaron S. , Laver Lior , Ben David Dror , Massrawe Sabri , Nyska Meir , Hetsroni Iftach
Published: February 2014

Tibialis anterior tendon tear is an uncommon injury. Nontraumatic or degenerative tears are usually seen in the avascular zone of the tendon. Treatment can be conservative or surgical. Conservative treatment is adequate for low-demand older patients. For active patients, surgical treatment can be challenging for the surgeon because after debridement of degenerative tissue, a gap may be formed that can make side-to-side suture impossible. The authors present allograft Achilles tendon insertion for reconstruction of chronic degenerative tears. Using Achilles tendon allograft has the advantage of bone-to-bone fixation, allowing rapid incorporation and earlier full weight bearing.
Failure Analysis of Knee Arthrodesis With the Wichita Fusion Nail
Authors: Parcel Ted W. , Levering Melissa , Polikandriotis John A. , Gustke Kenneth A. , Bernasek Thomas L.
Published: February 2014

Arthrodesis is a salvage procedure for failed total knee arthroplasty with the intent to create a stable, pain-free limb on which to ambulate or transfer. For many patients, the alternative to arthrodesis may be an above-knee amputation. Available techniques for knee arthrodesis include compression plating, external fixators, and intramedullary fixation. The purpose of this study was to report the knee fusion rate of consecutive patients at 1 institution using an intramedullary fusion nail and to identify patient risk factors for fusion failure. Between November 1998 and November 2008, twenty-eight patients undergoing knee arthrodesis with an average follow-up of 18 months (range, 3-64 months) were retrospectively studied. Demographic information, presence of fusion, clinical function, pain level, and bone defect data were collected and analyzed. Eighty-two percent (23/28) of patients had radiographic evidence of successful fusion with an average time to fusion of 21 weeks (range, 10–58 weeks). When examining patient variables that could correlate with fusion rates, patients with an Anderson Orthopaedic Research Institute type 3 femoral or type 3 tibial defect had a statistically significant lower fusion rate. The intramedullary fusion nail is an effective device for knee arthrodesis that offers ease of insertion through the knee wound with the advantages of initial bone compression and rigid fixation. Although the use of intramedullary fusion nails leads to a high fusion rate, significant bone deficiency limits successful fusion.
Shared Morphology of Slipped Capital Femoral Epiphysis and Femoroacetabular Impingement in Early-onset Arthritis
Authors: Giles Andrew E. , Corneman N. Alex , Bhachu Sandeep , Rudan John F. , Ellis Randy E. , Grant Heather , Wood Gavin C.A.
Published: February 2014

A subclinical form of slipped capital femoral epiphysis (SCFE) can lead to subtle morphologic abnormalities, such as cam-type femoroacetabular impingement (FAI). Femoroacetabular impingement is a mechanical hip abnormality that typically affects young populations and leads to hip pain and premature osteoarthritis. Imaging is critical to diagnosis, whether by radiograph, magnetic resonance imaging, or computed tomography. The authors investigated the use of imaging to detect characteristics of subclinical SCFE and cam-type FAI in patients undergoing hip resurfacing. They retrospectively assessed computed tomography scans of 81 hips from 75 patients. Measurements were taken of the proximal femur and included the alpha angle, head-neck tilt, and anterior offset taken in both the conventional oblique axial plane and the radial plane. The cohort consisted of 68 men and 13 women with an average age of 52 years. Ninety percent of hips on the oblique axial view and 95% of hips on the radial view were found to have pathologically increased alpha angles. Negative correlations were found between the alpha angle and head-neck tilt and positive correlations between head-neck tilt and anterior offset ratio. Sixty percent and 68% of hips in the oblique axial and radial planes, respectively, were abnormal for the alpha angle, head-neck tilt, and anterior offset ratio, strongly suggesting SCFE morphology. This study’s results show similarity in morphology between cam-type FAI and SCFE, known precursors to osteoarthritis, in an early arthritic patient population.
Syndesmosis and Lateral Ankle Sprains in the National Football League
Authors: Osbahr Daryl C. , Drakos Mark C. , O’Loughlin Padhraig F. , Lyman Stephen , Barnes Ronnie P. , Kennedy John G. , Warren Russell F.
Published: February 2014

Syndesmosis sprains in the National Football League (NFL) can be a persistent source of disability, especially compared with lateral ankle injuries. This study evaluated syndesmosis and lateral ankle sprains in NFL players to allow for better identification and management of these injuries. Syndesmosis and lateral ankle sprains from a single NFL team database were reviewed over a 15-year period, and 32 NFL team physicians completed a questionnaire detailing their management approach. A comparative analysis was performed analyzing several variables, including diagnosis, treatment methods, and time lost from sports participation. Thirty-six syndesmosis and 53 lateral ankle sprains occurred in the cohort of NFL players. The injury mechanism typically resulted from direct impact in the syndesmosis and torsion in the lateral ankle sprain group (
P
=.034). All players were managed nonoperatively. The mean time lost from participation was 15.4 days in the syndesmosis and 6.5 days in the lateral ankle sprain groups (
P
⩽.001). National Football League team physicians varied treatment for syndesmosis sprains depending on the category of diastasis but recommended nonoperative management for lateral ankle sprains. Syndesmosis sprains in the NFL can be a source of significant disability compared with lateral ankle sprains. Successful return to play with nonoperative management is frequently achieved for syndesmosis and lateral ankle sprains depending on injury severity. With modern treatment algorithms for syndesmosis sprains, more aggressive nonoperative treatment is advocated. Although the current study shows that syndesmosis injuries require longer rehabilitation periods when compared with lateral ankle sprains, the time lost from participation may not be as prolonged as previously reported.
Bilateral Quadriceps Rupture: Results With and Without Platelet-rich Plasma
Authors: Lanzetti Riccardo Maria , Vadalà Antonio , Morelli Federico , Iorio Raffaele , Ciompi Alessandro , Vetrano Mario , Argento Giuseppe , Vulpiani Maria Chiara , Di Sanzo Vincenzo , Ferretti Andrea
Published: February 2014

This article presents a 46-year-old man with bilateral atraumatic quadriceps rupture that occurred while he was descending stairs. The patient underwent surgery the day after the accident. In the left knee, quadriceps reinsertion was performed using a conventional technique. In the right knee, platelet-rich plasma (PRP), both in its liquid and semisolid patterns, was added intraoperatively.

Ultrasonography and magnetic resonance imaging evaluations were performed 1, 6, and 24 months postoperatively. At 6 and 24 months postoperatively, clinical and functional evaluations also were performed. Clinical examination showed no differences between the knees, and functional scores were the same for both knees. Ultrasonographic evaluation showed bilateral persistent tendon thickening and gross echotexture abnormalities, with no side-to-side differences. Magnetic resonance imaging showed signals of vascularized granulation tissue in both knees, which was more evident in the right (PRP) knee at 1 month postoperatively, along with a better signal of scar tissue in the right knee at 6 and 24 months postoperatively.

The use of PRP yielded no better clinical or functional results than the lack of its use. However, a more intense and significant reparative healing process occurred where the PRP was used, thus suggesting a more rapid completion of the healing process, although this effect seems to remain only a radiographic finding with no clinical correlation.
Clinical and Economic Impact of TENS in Patients With Chronic Low Back Pain: Analysis of a Nationwide Database
Authors: Pivec Robert , Stokes Michael , Chitnis Abhishek S. , Paulino Carl B. , Harwin Steven F. , Mont Michael A.
Published: February 2014

This study evaluated patients who were given transcutaneous electrical nerve stimulation (TENS) compared with a matched group without TENS prior to intervention and at 1-year follow-up. Patients who were treated with TENS had significantly fewer hospital and clinic visits, used less diagnostic imaging (31 vs 46 events per 100 patients), had fewer physical therapy visits (94 vs 107), and required less back surgery (7.5 vs 9.2 surgeries) than patients receiving other treatment modalities. Total annual costs for chronic low back pain patients without neurological involvement were lower in TENS patients ($17,957 vs $17,986 for non-TENS), even when the cost of the device was taken into account. [
Orthopedics.
2013; 36(12):922–928.]
Osteoporotic Ankle Fractures: An Approach to Operative Management
Authors: McKean Jason , Cuellar Derly O. , Hak David , Mauffrey Cyril
Published: February 2014

The incidence of osteoporosis is increasing as the elderly population grows. Because these patients remain active, fragility fractures of the ankle are becoming more common. The literature indicates a relatively high complication rate for non-operative management of ankle fractures in this patient cohort, leading surgeons to face challenges unique to patients with poor bone and skin quality. This article discusses techniques to address osteoporotic ankle fractures and reviews the current literature relevant to this issue. [
Orthopedics.
2013; 36(12):936–940.]
Can Viscosupplementation Be Used in the Hip? An Italian Perspective
Authors: Rivera Fabrizio
Published: February 2014

Viscosupplementation is the intra-articular administration of preparations containing hyaluronic acid or hyaluronate intended to restore the normal biological properties of hyaluronic acid normally found in synovial fluid. Infiltration of hyaluronic acid in the arthritic hip is a more recent technique than viscosupplementation of the knee due to the greater technical difficulty of infiltration to the hip, which requires fluoroscopic or ultrasound guidance. The introduction of high-molecular-weight hyaluronic acid in the treatment permits a single administration and has helped diffuse hip infiltration treatment. A single infiltration reduces patient discomfort caused by the procedure and allows treatment of a larger number of patients. Although the literature has unequivocally proven the possibility of reducing pain in patients affected by hip arthritis following infiltration, the molecular weight and density, the number of infiltrations required for long-term results, and the most appropriate indications for infiltration treatment have yet to be clarified. Selecting the patient is the first obstacle to be overcome. Therefore, infiltration should be considered as an option for patients with initial pain symptoms who have not yet been listed for joint prosthesis surgery. The radiographic criteria require at least a partly preserved joint space, and the clinical criteria of persistent hip pain and full joint mobility seem to be sufficiently effective for selection. [
Orthopedics.
2014; 37(1):48–55].
Rigid Internal Fixation of Displaced Distal Radius Fractures
Authors: Gunther Stephen B. , Lynch Tennyson L.
Published: February 2014

Distal radius fractures, the most common long bone fracture, are treated in several ways, including closed reduction, percutaneous pinning, external fixation, and open reduction and internal fixation. This article presents a surgical technique and a series of patients treated with a novel minimally invasive intramedullary fixation technique. The implant is a partially flexible intramedullary rod that can be locked in a rigid position once it is implanted in the bone. An awl and reamer are passed through a starter hole in the radial styloid using a 2-cm incision between the 1st and 2nd dorsal compartments. The device is then implanted under the articular surface, and the distal end of the curved implant is placed down the intramedullary canal of the radius. After locking the shaft segment rigidly, screws are placed through the implant under the distal radial articular margin to stabilize the fracture site. The sensory branches of the radial nerve are retracted during the case. Patients are treated in a wrist splint for a short period of time (2 to 4 weeks) depending on fracture type. The case examples demonstrate the minimally invasive nature of this procedure, the surgical technique, methods of fracture reduction and implantation, and surgical outcomes. Radiographic outcomes, postoperative motion, postoperative function, and validated outcome measures are demonstrated. This minimally invasive technique is ideally suited for distal radial fractures that do not involve the articular surface. It is a safe and effective technique that can provide excellent results.
Anterior Decompression and Fusion Versus Posterior Laminoplasty for Multilevel Cervical Compressive Myelopathy
Authors: Liu Xuzhou , Wang Hehui , Zhou Zhilai , Jin Anmin
Published: February 2014

The optimal surgical strategy for anterior or posterior approaches remains controversial for multilevel cervical compressive myelopathy caused by multisegment cervical spondylotic myelopathy (MCSM) or ossification of the posterior longitudinal ligament (OPLL). A systematic review and meta-analysis was conducted evaluating the clinical results of anterior decompression and fusion (ADF) compared with posterior laminoplasty for patients with multilevel cervical compressive myelopathy. PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials and nonrandomized cohort studies conducted from 1990 to May 2013 comparing ADF with posterior laminoplasty for the treatment of multilevel cervical compressive myelopathy due to MCSM or OPLL. The following outcome measures were extracted: Japanese Orthopedic Association (JOA) score, recovery rate, complication rate, reoperation rate, blood loss, and operative time. Subgroup analysis was conducted according to the mean number of surgical segments. Eleven studies were included in the review, all of which were prospective or retrospective cohort studies with relatively low quality indicated by GRADE Working Group assessment. A definitive conclusion could not be reached regarding which surgical approach is more effective for the treatment of multilevel cervical compressive myelopathy. Although ADF was associated with better postoperative neural function than posterior laminoplasty in the treatment of multilevel cervical compressive myelopathy due to MCSM or OPLL, there was no apparent difference in the neural function recovery rate between the 2 approaches. Higher rates of surgery-related complication and reoperation should be taken into consideration when ADF is used for patients with multilevel cervical compressive myelopathy. The surgical trauma associated with corpectomy was significantly higher than that associated with posterior laminoplasty.
Posterior Sternoclavicular Joint Injuries in Skeletally Immature Patients
Authors: Tepolt Frances , Carry Patrick M. , Taylor Michal , Hadley-Miller Nancy
Published: February 2014

The management of sternoclavicular injuries in skeletally immature patients has not been well described. The purpose of this study was to describe the authors’ experience treating this rare and potentially life-threatening injury. All skeletally immature patients who underwent treatment for a medial clavicular physeal fracture or sternoclavicular dislocation between 2003 and 2011 were identified using ICD-9 diagnostic codes. Sternoclavicular injuries with posterior displacement were isolated from this cohort for a thorough chart review. Patients were contacted to complete brief phone surveys and shoulder-specific outcome instruments. A total of 12 boys (mean age, 14.8±2.74 years), followed for an average of 10.3 months (range, 0–54 months), were identified. The incidence of significant associated symptoms was 8.3% (1 of 12). Eight patients were initially treated with closed reduction, 2 (25%) successfully and 6 (75%) requiring subsequent open reduction. Four of the 12 patients underwent an immediate open reduction. Braided composite sutures were used to treat all injuries that underwent open reduction (10 of 12). Complete data were obtained from 6 patients, all of whose injuries had been treated with open reduction. All 6 had returned to their full activity level, and all self-reported perfect Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Simple Shoulder Test scores (0 and 12, respectively). Among skeletally immature patients, medial clavicular physeal fractures and sternoclavicular dislocations can be effectively managed with closed or open reduction. When closed reduction is unsuccessful or is contraindicated, open reduction with braided composite sutures is associated with excellent results.