bluuebunny/crossref_metadata_2025 huggingface dataset:
A proposed multidisciplinary model providing comprehensive breast cancer care.
Authors: Cornell Lauren , Pruthi Sandhya , Mussallem Dawn
Published: May 2018

43

Background: Strategies to detect and treat breast cancer continue to improve, and as such, the number of survivors has grown dramatically. To date, there has not been a well-established model to provide cohesive care for breast cancer survivors. Care often feels fragmented and important issues are overlooked due to lack of continuity. The adoption of Survivorship Care Plans has aimed to fill this gap in care, but the literature still demonstrates that our patients’ needs are not being met. Methods: We present a comprehensive model for breast cancer care, within a multidisciplinary breast center, which incorporates consistent management from time of diagnosis through survivorship. This model utilizes the appointment of a dedicated breast internist that meets with each patient at the time of diagnosis and again assumes care at time of survivorship. The breast internists or “onco-generalists” have specialized training in breast cancer/survivorship and work alongside the entire multidisciplinary team. This unique approach incorporates individualized surveillance, integrative management of late treatment effects, and appropriate risk reducing lifestyle education. Results: The inclusion of a dedicated breast internist into survivorship care has been the standard within our center for over 10 years. With this model, we have found that survivorship care is more holistic with a focus on the patients’ overall needs. There is dedicated time to individualized risk assessment, appropriate surveillance, and modifiable risk factor education. The model also allows for incorporation of integrative medicine including mindfulness, acupuncture, and massage therapy to improve quality of life for patients. With this model, patients do not feel the abandonment that is so often experienced by survivors, but rather they feel empowered to enter their new life as a survivor. Conclusions: Continuity of care during and after breast cancer treatment remains a significant issue. By designating an internist with specialized breast training who initially meets with patients upfront, we have been able to create a more integrative approach to survivorship care, which encompasses the patients’ needs both surrounding and outside of their cancer diagnosis.
Partnership in Cancer Survivorship Optimization (PICASSO) project: An Indian Cancer Society (ICS) initiative for cancer survivorship program in India.
Authors: Kurkure Purna Arun , Dhamankar Vandana Salil , Joshi Shreya , Jha Shekhar , Nair Sheila , Goswami Savita
Published: May 2018

46

Background: Ugam is a support group of childhood cancer survivors from After Completion of Treatment (ACT) clinic at Tata Memorial Hospital (TMH), functioning under umbrella of Indian Cancer Society (ICS), not for profit organisation. Ugam’s mission is empowerment of survivors and advocacy. ACT-Ugam has provided role model for holistic care to cancer survivors.Project PICASSO (Partnership in Cancer Survivorship Optimization) is developed by ICS to promote & facilitate paediatric cancer unit (PCU) based ACT clinic & provide psychosocial support for holistic care of cancer survivors across the country. Methods: A survey was conducted for identifying the survivorship practices in pediatric cancer units (PCU) in Mumbai based hospitals to identify the partners who will setup PCU based ACT clinic. ICS will provide professional and technical assistance to ACT Clinic survivors to enable them to live a productive life. This will include identifying survivor’s need, psycho social counseling, career counseling / aptitude tests, registering them as Ugam members, funding for education if required, soft skills development programme for job readiness, facilitating job placements, survivorship care plan & information material. Ugam database was reviewed for its experience in the field so far to extrapolate the services to partner institutes under PICASSO. Results: Project PICASSO was launched by ICS in May 2016. Among five Mumbai based PCUs who participated in survey, only one (TMH) has organized survivorship program. Communication is ongoing for launch of the project with other units. Total Ugam members- 280 ( 2009 to date), male:female 195:85. Career guidance and aptitude testing provided to > 50 survivors, job placements 9, educational & vocational scholarships through ICS and by referring to other sources > 100. International scholarships to present at conferences: 5. Conclusions: Existing model of Ugam is marching towards fulfillment of its mission of empowerment and advocacy. Expansion of Ugam activities to include more survivors from other partnering units will lead to development of a national care model for cancer survivors.
A community based consultative survivorship program for breast cancer survivors.
Authors: Lu Kit Yu , Lee Theresa M. , Lanigan Megan , Rudge Beth , Torp Lisa
Published: May 2018

47

Background: Many organizations have recognized the importance of longitudinal care for Breast Cancer Survivors (BCS) as they remained at risk for treatment related side effects (TRSE) that can greatly impact their health and quality of life. Various models of Breast Cancer Survivorship Program (BCSP) have been proposed. In October 2016, we implemented a BCSP using a consultative model with the goals to create a systematic approach to capture patients’ concerns, coordinate on-going care, standardize survivorship recommendations, and track care plan delivery compliance. Methods: Our Survivorship Nurse Practitioner (SNP) meets with patients in a one-on- one consultative visit after receiving electronic referral. Patients are given a comprehensive survey to assess symptoms and concerns following their treatment. Based on survey, SNP provides personalized education about their concerns. SNP also makes appropriate interventions and arranges referrals for supportive care services. After the visit, SNP generates a care plan and a consultative letter detailing the patient’s concerns and provides further recommendations for interventions and follow up care. SNP leads a quarterly Multidisciplinary Conference to educate treating providers and supporting staff regarding TRSE management according to standard guidelines and evidenced based approaches. Results: From Oct 2016-Oct 2017, 252 BCS were seen at our BCSP. BCS reported high satisfaction with better understanding and coping with their symptoms after being seen. 100% of oncology providers reported better understanding about BCS's concerns and felt more confident about TRSE management. Primary providers also reported higher satisfaction with communication across specialty. The ability to identify BCS and to track care plan delivery compliance was also more streamlined. Conclusions: We elected for a consultative approach because it allowed for a dedicate time to review all components of survivorship. It also created a formalized way to better understand the needs of our survivors. In addition, this approach empowered the patients to discuss TRSE with their providers and enabled the care team to integrate survivorship care throughout their subsequent visits.
Comparison of two breast cancer survivorship treatment summary and care plan (TSCP) documents.
Authors: Williams Eileen , Borgert Andrew , Peterson Linda Kay , Dietrich Leah L.
Published: May 2018

49

Background: The 2005 Institute of Medicine report recommended providing a cancer TSCP, but barriers including time needed to complete these documents led to limited implementation. In 2014, in order to facilitate delivery, ASCO released a streamlined version of a TSCP. The current prospective, randomized study compares a Breast Cancer ASCO 2014 derived template (concise TSCP) with a facility derived Breast Cancer TSCP template based on the “old” ASCO version and NCCN guideline recommended elements (detailed TSCP). Methods: Female breast cancer survivors who completed therapy at Gundersen Health System were randomized between a concise TSCP and a detailed TSCP. Subjects received a survey prior to their survivorship visit assessing their baseline knowledge of their breast cancer diagnosis and treatment (pre visit knowledge). After the visit, participants completed the same survey (post visit knowledge) and a satisfaction survey. Pre and post visit knowledge survey scores, patient satisfaction scores and time needed to complete the TSCP were compared between the two study groups. Results: Both TSCP groups showed significant improvement in patient-specific disease and treatment knowledge scores (% of applicable knowledge questions answered correctly) after their survivorship visit. There was no significant difference between the concise and detailed groups’ pre-visit knowledge score (mean 78% vs. 79%, p=0.88). Calculated difference between the groups’ post knowledge scores met the pre-determined threshold for non-inferiority (p=0.013). Conclusions: Our study demonstrates the value of a cancer TSCP and Survivorship visit in improving breast cancer survivors’ knowledge of their disease characteristics and treatment. The concise version was found to be non-inferior to the detailed TSCP in terms of patient knowledge and satisfaction and required less time to complete. These results assist us and other institutions in choosing a more streamlined version of TSCP without compromising patient knowledge or satisfaction. [Table: see text]
Expectations for survivorship care among hematology oncology and primary care providers.
Authors: Hansra Damien Mikael , Ramdial Jeremy , Ahn Eugene , Perre Anthony , Masar Lauren , Brock Alora , Walters Tamara , Randolph Kimberly , Alvarez Ricardo H.
Published: May 2018

5

Background: Significant controversy exists between hem/onc & primary care providers regarding various aspects of survivorship care. Here we administer a 23 question survey to address these discrepancies. Methods: A 23 question (Q) electronic survey was created on www.surveymonkey.com and sent to providers at Cancer Treatment Centers of America, & The University of Miami Health Network. Survey included provider demographics (7Qs) and practice preference Qs (16Qs). Survey asked: who should be primary responsible for managing cardiotoxicity (CT), cardiovascular risk reduction (CRD), physical activity assessments (PA), nutrition (N), weight (W), anxiety depression panic disorder PTSD (ADPP), cognitive function (CF), fatigue (F), sexual function (SF), lymphedema (L), side effect of hormonal agents (SEH), side effect of targeted agents (SET), side effect of bone modifying agents (SEB), vaccinations (V), cancer screening (CS), sleep disorders (SD)? Answer choices were 1) Hematologist Oncologist (HO), 2) Primary Care Provider (PCP), 3) Both HO + PCP (BO), 4) Other (O). Results: 55 providers enrolled in the survey (92% physician 6% ARNP 2% other). 56% hem/onc, 7% PCP, 37% subspecialty. 56% hospital based, 20% academic, 16% multispecialty practice, 8% other. Survey results: (CT): HO 29%, PCP 5%, BO 60%, 0 6%, (CRD): HO 7%, PCP 49%, BO 36%, 8% O, (PA): HO 5%, PCP 45%, BO 38%, O 12%, (N): HO 5%, PCP 38%, BO 35%, O 12%, (W): 4%, PCP 47%, BO 31%, O 16%, (ADPP): HO 5%, PCP 33%, BO 38%, O 24%, (CF): HO 5%, PCP 33%, BO 45%, O 17%, (F): HO 4%, PCP 36%, BO 53%, O 7%, (SF): HO 5%, PCP 22%, BO 49%, O 24%, (L): HO 31%, PCP 7%, BO 36%, O 26%, (SEH): HO 62%, PCP 4%, BO 27%, O 7%, (SET): HO 69%, PCP 4%, BO 20%, O 7%, (SEB): HO 62%, PCP 4%, PCP 25%, O 9%, (V): HO 16%, PCP 42%, BO 36%, O 6%, (CS): HO 9%, PCP 38%, BO 47% O 6%, (SD): 3% HO, PCP 51%, BO 31%, O 15%. Conclusions: In our study we found that the majority of providers think PCPs should manage: CRD & SD; HO should manage: SEH, SET, SEB; BO should manage: CT, F. A minority of providers favored combined approach (BO) for: CRD, ADPP, CF, SD, L, CS in survivors.
Breast cancer survivorship care plan: Patient satisfaction with a web-based application.
Authors: Moore Anne , Carlson Anna , Kornhauser Naomi , Schneider Sarah E. , Andreopoulou Eleni , Cigler Tessa , Vahdat Linda T. , Webster Gloria , Guthrie William
Published: May 2018

50

Background: The American College of Surgeons Commission on Cancer Standard 3.3 mandates that by 2018, oncologists provide Survivorship Care Plans (SCPs) to more than 75% of Stage 1-3 breast cancer survivors. Preparation and delivery of SCPs is time-consuming and requires dedicated staff commitment. Working with PatientsWithPower(PWP), a digital health company supporting patient decision-making for breast cancer, we developed a web-based SCP and surveyed patients regarding their satisfaction with the SCP. The objective of this study was to assess patient satisfaction with the PWP SCP. Methods: SCP’s were prepared using data extracted from the electronic medical record (EMR) and PWP software. A one-page SCP was presented to each patient by the Nurse Practitioner (NP) during a routine visit after patients completed active treatment. Results were reviewed after all surveys were completed. Fifty women with Stage 0-3 breast cancer participated in the IRB approved study and reported their satisfaction with the PWP SCP via online survey. Results: Using patient data in the EMR, the PWP plan took about 45 minutes to prepare. Once completed, NPs spent 10-15 minutes with each patient reviewing the SCP. Patient surveys indicated that 98% of patients felt it was important to receive a SCP, 84% planned to use it to plan follow up management, and 75% intended to share the SCP with their primary care physician. According to patients, the most valuable parts of the SCP were diagnosis and treatment history, and the follow up schedule. More than 70% of women requested additional information about future screening for recurrence, nutrition, and long-term side effect management. 92% of women appreciated the electronic “living document” that can be easily updated at subsequent visits. Conclusions: Presenting SCPs to patients is an essential component of high-quality cancer care. PWP’s online platform facilitates the development and delivery of SCPs by organizing and storing on-going patient data to make future SCP updates easy and efficient. Our patient satisfaction survey results underscore the value of SCPs, particularly for follow-up management and communications with primary care doctors.
Adherence to aromatase inhibitors (AIs) in Hispanic patients with early stage breast cancer.
Authors: Philipovskiy Alexander , Campbell Aleli , Heydarian Rosalinda , Lin Krysta , Nahleh Zeina A.
Published: May 2018

70

Background: Adherence to Aromatase Inhibitors (AIs) is essential for the effective prevention of breast cancer recurrence. We sought to evaluate adherence to AIs as well as possible factors behind non-adherence in a large American-Mexican border city with predominantly Hispanic population. Methods: After IRB approval, women with Stages I-III breast cancer treated at the Texas Tech breast care center in El Paso, TX were included if they were receiving adjuvant AI therapy. We utilized the validated Morisky Medication Adherence Scale (MMAS-8) to determine AI compliance. In addition, a question to indicate reasons for noncompliance was added. Results: 87 patients were enrolled, median age was 61 years; 78 (90%) were identified as Hispanic. The majority of participants were women of low socioeconomic status 53 (61%) with an annual income of < $15,000. MMAS-8 results showed 35 (40%) patients admitted to forgetting to take their AI pill. Additionally, 71 (82%) of the patients denied forgetting to take the AI pill within the past two weeks. 11 (13%) patients admitted to sometimes having difficulty remembering to take their AI medication, and 74 (85%) stated never or rarely having difficulty remembering to take their AI medication. 50 (57.5%) patients provided a reason why they did not take their AI pill, 35 (40%) cited forgetfulness, 14 (17%) cited other reasons including cost, limited insurance coverage, lack of transportation involved in obtaining the medication and timely prescription refills, and only 1(1%) due to side effects. Conclusions: Non-adherence to AI appears to be prevalent among Hispanic patients with breast cancer. Main causes of noncompliance are forgetfulness and financial reasons. Healthcare providers could reinforce educating patients about the importance of compliance. Financial assistance may also be helpful in improving AI compliance. Clinical trial information: NCT03144037.
Decision aids and health information technology: One size does not fit all.
Authors: Noyes Katia , Crabtree-Ide Christina , Holub David , Shayne Michelle , Rodriguez Jennifer , Rizvi Irfan , Fleming Fergal J. , Sharda Varsha , Sharda Pradeep , Bellohusen Patricia , Termer Nancy K. , Constine Louis S.
Published: May 2018

74

Background: Nearly 3 million cancer survivors in the US reside in rural areas. Existing survivorship care models were developed mainly at large academic centers, and thus require adaption to meet the challenging needs of the rural community. Rural cancer survivors (RCS) face issues with coordination of care, decision-making, access to specialty services, supportive care resources, and time and resources required for travel. RCS are at greater risk for social isolation and inadequate emotional support. To address these challenges, many studies propose information technology (IT), mobile, and video solutions. We assessed the potential of online and mobile video technology applications to reduce barriers to survivorship care for RCS, families, and caregivers. Methods: We conducted 2 in-person focus groups with rural care managers, providers, and public health professionals, and one virtual cross-disciplinary focus group of patients, caregivers, and provider stakeholders to evaluate acceptability of video modules. Using a Community-Based Participatory Research approach, we worked with community partners to design and develop materials that adequately addressed their needs. Results: Focus group results indicate that video modules added little value for RCS due to sporadic internet access, limited patient IT literacy, vision and memory problems, and patient difficulty interpreting information. Therefore, we designed and piloted a paper RCS Checklist to be taken to appointments, available in waiting areas or through care managers, and to serve as a guide for shared patient-provider decision-making. The resulting checklist includes evidence-based information about survivorship care goals and approaches, care coordination strategies, information about local cancer supportive services, health insurance reimbursement, state disability policies, psychosocial support, and stress-reduction tips. Conclusions: In some special patient populations like RCS, use of health IT for patient empowerment and care coordination may be a poor choice. Engaging relevant stakeholders in the development of location-specific communication and decision aid materials is paramount to successful engagement of patients and caregivers.
The impact of physician communication on diabetes management in cancer survivors.
Authors: Okaka Yvonne , Muellers Kimberly A. , Wisnivesky Juan P. , Lin Jenny J.
Published: May 2018

77

Background: As cancer survivors live longer and many die from other comorbidities, it becomes increasingly important to understand factors associated with self-management behaviors for common comorbidities such as diabetes (DM). Provider guidance and inclusive communication have been found to promote self- management behaviors (SMB) in patients with DM. This study aims to explore the impact of provider communication on DM SMB in cancer survivors with DM. Methods: Patients with pre-existing DM who were newly diagnosed with early-stage breast, prostate, colorectal or lung cancer were enrolled. The Summary of Diabetes Self-Care Activities instrument was used to assess patients’ SMBs. The Patient Reaction Assessment scale was used to assess physician communication. Additional survey questions elicited the range of DM self-care recommendations made by patients’ healthcare providers. Mann-Whitney U test was used to assess the association between provider recommendations and communication and SMBs. Results: Of the 74 patients enrolled, the average age was 62 years and 64% were female. Patients who reported their healthcare providers recommended exercise reported more days of specific physical activity (median 5 vs. 0, p = 0.029). Patients who reported that their providers recommended checking their sugar checked their blood sugar more days out of the last 7 days (median 4 vs. 0, p < 0.001). Patients who reported that is hard to talk to their provider about how their treatment is going reported eating more sweets per week (median 2 vs. 1, p = 0.015) and fewer vegetables (median 0 vs. 1, p = 0.043). Conversely, patients who felt that their providers were interested in them as a person reported following a healthful eating plan for more days in a week (median 5.5 vs. 2, p = 0.016) and checked their feet more often (median 6.5 vs. 0, p = 0.008). Conclusions: Cancer survivors with DM whose healthcare providers recommend specific DM SMBs and who report better provider relationships perform DM SMBs more often. Healthcare providers should recognize that supportive recommendations for diet and exercise may improve survivors’ self-management of comorbidities.
Diabetes outcomes in patients with a history of breast cancer.
Authors: Hinyard Leslie J. , Schoen Martin W , Chen Jiajing , Tu Yifan , Rodin Miriam B.
Published: May 2018

8

Background: While diabetes is known to worsen breast cancer (BC) outcomes, little is known about the effect of BC on diabetes outcomes. This study examined differences in outcomes diabetic patients with and without a history of BC. Methods: Data from NHANES 2010 – 2016 was used to identify female patients self-reporting diabetes mellitus (DM). Comparisons of DM outcomes for persons reporting a history of BC versus without any cancer were made using Chi-Square and separate analyses were conducted for younger (less than 65) and older (65 and older) respondents. Analyses were conducted using SAS survey procedures (Cary, NC) and were weighted to account for the sampling scheme. Results: The analytic cohort consisted of 1347 patients, of which 80 (6.3%, weighted) reported a history of breast cancer. 785 (62.4%, weighted) of the full sample was under age 65. Of those under 65, 3% (weighted) reported history of BC and 11.8% (weighted) of those over 65% reported BC. In diabetics under 65, respondents with BC were more likely to report physical limitations keep them from working and physical, mental, and emotional limitations (p = .001, and p = 0.03, respectively) and were less likely to use insulin (p = .01) than respondents without BC. In respondents 65 and older, women with BC were more likely to report problems with memory and confusion (p = .002) and less likely to rate their general health as excellent or very good (p = .01) compared to those without BC. No differences were found for demographic characteristics, retinopathy, heart disease, or stroke for either age group. Conclusions: In this population of patients with diabetes, history of BC was associated with physical and emotional limitations in younger patients and general health status and memory and confusion in older patients. Understanding the intersection of multiple chronic conditions is important for improving quality of life and clinical outcomes in BC survivors.
Feasibility and fidelity of a reiki intervention for cancer patients by family caregivers.
Authors: Chen Yea-Jyh , Petrinec Amy , Radziewicz Rosanne M.
Published: May 2018

87

Background: Reiki is a complementary therapy that has been reported to decrease symptoms of stress and promote relaxation. Standards for administrating Reiki have not been established. Additionally, patients with advanced cancer and their family caregivers (FCGs) encounter challenges during the illness experience that preclude them from participating in stress reducing therapies offered outside the home. The purpose of this study was to evaluate the feasibility and fidelity of an “at-home” reiki intervention performed by the FCG of patients with cancer. Methods: Twelve cancer patients and their FCGs were recruited from oncology outpatient facilities in the Greater Cleveland area. A certified Reiki educator provided two 4-hour courses for the FCGs to learn the basics and practice. To develop and promote intervention fidelity, the FCG maintained a daily diary recording frequency, interval, time of day, and position of Reiki practice. The Reiki educator called the FCG weekly to monitor usage, protocol adherence (60-minutues daily practice for three weeks) and answer questions. Satisfaction with the intervention was measured on completion of the study. Results: Compliance to the study protocol was high in this sample. The majority of day-to-day practice episodes (110/126; 87%) were delivered and completed by FCGs over a three week period. Diary entries indicated FCGs were prone to practice Reiki 45 minutes (72%) per day, once daily (79-93%), in a lying position (82%) and in the evening (61%). Deterioration in a patients’ health was most frequently cited for lack of adherence to daily Reiki practice. A few patients and FCGs reported practice time duration as a barrier. Both patients and FCGs reported a high satisfaction with the Reiki intervention. Follow-up phone calls by a Reiki educator were described as supportive by the FCGs. Conclusions: At-home Reiki was reported as feasible with high compliance and satisfaction to the study protocol. Findings will inform protocol refinement to address the limitations of Reiki practice barriers. This study provides initial support for the administration of an “at home” Reiki intervention in a larger sample to further validate fidelity criteria and treatment effects.
Almost like a whale – First evidence of suction-feeding in a seabird
Authors: Enstipp Manfred R. , Descamps Sébastien , Fort Jérôme , Grémillet David
Published: May 2018

Little auks (Alle alle) are one of the most numerous seabird species in the world that feed primarily on copepods in arctic waters. Their high daily energy requirements leave them vulnerable to current changes in the arctic plankton community, where a smaller, less profitable copepod species (Calanus finmarchicus) becomes increasingly abundant. Little auks have been estimated to require ∼60,000 copepods per day, necessitating prey capture rates of ∼6 copepods per second underwater. To achieve such performance, it has been suggested that little auks capture their prey by (non-visual) filter-feeding. We tested this hypothesis by exposing little auks to varying copepod densities within a shallow experimental pool and filming their prey capture behaviour. At none of the copepod densities tested did birds filter-feed. Instead, all birds captured copepods by what we identified as visually guided suction-feeding, achieved through an extension of their sub-lingual pouch. Suction-feeding is very common in fish and marine mammals, but to the best of our knowledge, this is the first time that it has been specifically identified in a seabird species. While presumably less efficient than filter-feeding, this behaviour may allow little auks to foster higher resilience when facing the consequences of arctic climate change.
Revised World Health Organization (WHO)’s causality assessment of adverse events following immunization—a critique
Authors: Puliyel Jacob , Naik Pathik
Published: May 2018

The World Health Organisation (WHO) has recently revised how adverse events after immunization (AEFI) are classified. Only reactions that have previously been acknowledged in epidemiological studies to be caused by the vaccine are classified as a vaccine-product–related-reaction. Deaths observed during post-marketing surveillance are not considered as ‘consistent with causal association with vaccine’, if there was no statistically significant increase in deaths recorded during the small Phase 3 trials that preceded it. Of course, vaccines  noted to have caused a significant increase in deaths in the control-trials stage would probably not be licensed. After licensure, deaths and all new serious adverse reactions are labelled as ‘coincidental deaths/events’ or ‘unclassifiable’, and the association with vaccine is not acknowledged. The resulting paradox is evident.

The definition of causal association has also been changed. It is now used only if there is ‘no other factor intervening in the processes’. Therefore, if a child with an underlying congenital heart disease (other factor), develops fever and cardiac decompensation after vaccination, the cardiac failure would not be considered causally related to the vaccine. The Global Advisory Committee on Vaccine Safety has documented many deaths in children with pre-existing heart disease after they were administered the pentavalent vaccine. The WHO now advises precautions when vaccinating such children. This has reduced the risk of death. Using the new definition of causal association, this relationship would not be acknowledged and lives would be put at risk. In view of the above, it is necessary that the AEFI manual be revaluated and revised urgently. AEFI reporting is said to be for vaccine safety. Child safety (safety of children) rather than vaccine safety (safety for vaccines) needs to be the emphasis.
Advanced imaging improves the diagnosis of infective endocarditis
Authors: Harding Daniel , Prendergast Bernard
Published: May 2018

Infective endocarditis is a heterogeneous condition whose incidence is rising. Despite advances in surgery and diagnostic methods, one-year mortality has not changed and it remains at 30%. Patients with prosthetic valve and intra-cardiac device–related endocarditis are being seen more frequently and this condition is difficult to diagnose with conventional microbiological and imaging techniques. The modified Duke criteria lack sensitivity in this group and should be supplemented with newer imaging techniques, including 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) and single-photon emission computed tomography (SPECT). In this article, we discuss these techniques and their role in the diagnosis of infective endocarditis.
Depression, quality of life and cortisol: a cross-sectional study of caregivers of patients with Alzheimer’s disease
Authors: Bernardi Emanuela , de Oliveira Francisco Gabriel Katiuscia , Bernardi Luana , Renée Hilgemberg Gláucia , de Gregório Elizama , Cláudio Francisco Nunes da Silva Weber , Eurich Mazur Caryna , Rabel Corso Etiene , Maria Silva Valério Juliana , Diedrich Camila , Sartori Bonini Juliana
Published: May 2018

Background: Stress can impact human health in multiple ways. Among the related mechanisms are the hormonal systems of the hypothalamic–pituitary–adrenal axis, which produces cortisol. Current research aims to evaluate the relationship between the daily variation of salivary cortisol dosages and the level of stress in caregivers of patients with Alzheimer's disease (AD).

Methods: A sociodemographic questionnaire was applied to 25 caregivers, as well as the 36 Item Short-Form Health Survey and Beck’s Depression Inventory. In the 25 patients of the caregivers, the Instrumental Activities of Daily Living of the patient and Clinical Dementia Rating were assessed. Saliva samples were collected to assess the cortisol level of the caregivers three times over one day for each caregiver, (morning, afternoon and evening) to investigate the correlation of the aforementioned questionnaires with the age and degree of kinship among caregivers of elderly patients to investigate the correlation with the results of the previously described tests, and the age and degree of relatedness of caregivers and elderly patients.

Results: There was a significant positive correlation between daily cortisol levels and increasing caregiver age. However, the daily dosage of salivary cortisol was not significantly associated with the stress level of the caregivers of patients with AD, suggesting that this is not a good neuroendocrine marker of response to mood disorders. This fact can be related to intrinsic and extrinsic factors to the caregiver.

Conclusions: Compared with previous studies that correlate cortisol and stress in humans, our findings suggest that the stress mechanism may be more complex and depend on more factors than the levels of this hormone. Thus, further work is required to delineate possible cortisol modulators, as well as the type of stress that target this population and their ability to adapt and face adversity in their work.
Predicting lithium treatment response in bipolar patients using gender-specific gene expression biomarkers and machine learning
Authors: Eugene Andy R. , Masiak Jolanta , Eugene Beata
Published: May 2018

Background: We sought to test the hypothesis that transcriptiome-level genes signatures are differentially expressed between male and female bipolar patients, prior to lithium treatment, in a patient cohort who later were clinically classified as lithium treatment responders.

Methods: Gene expression study data was obtained from the Lithium Treatment-Moderate dose Use Study data accessed from the National Center for Biotechnology Information’s Gene Expression Omnibus via accession number GSE4548. Differential gene expression analysis was conducted using the Linear Models for Microarray and RNA-Seq (limma) package and the Random Forests machine learning algorithm in R.

Results: In pre-treatment lithium responders, the following genes were found having a greater than 0.5 fold-change, and differentially expressed indicating a male bias: RBPMS2, SIDT2, CDH23, LILRA5, and KIR2DS5; while the female-biased genes were: HLA-H, RPS23, FHL3, RPL10A, NBPF14, PSTPIP2, FAM117B, CHST7, and ABRACL.

Conclusions: Using machine learning, we developed a pre-treatment gender- and gene-expression-based predictive model selective for lithium responders with an ROC AUC of 0.92 for men and an ROC AUC of 1 for women.
­­­A web resource for nutrient use efficiency-related genes, quantitative trait loci and microRNAs in important cereals and model plants
Authors: Kumar Anuj , Pandeya Ajay , Malik Girik , Sharma Mansi , P. Hima Kumari , S. Anil Kumar , Gahlaut Vijay , Gajula M.N.V. Prasad , Singh Krishna Pal , Suravajhala Prashanth , Balyan Harindra Singh , Gupta Pushpendra K.
Published: May 2018

Cereals are key contributors to global food security. Genes involved in the uptake (transport), assimilation and utilization of macro- and micronutrients are responsible for the presence of these nutrients in grain and straw. Although many genomic databases for cereals are available, there is currently no cohesive web resource of manually curated nutrient use efficiency (NtUE)-related genes and quantitative trait loci (QTLs). In this study, we present a web-resource containing information on NtUE-related genes/QTLs and the corresponding available microRNAs for some of these genes in four major cereal crops (wheat (Triticum aestivum), rice (Oryza sativa), maize (Zea mays), barley (Hordeum vulgare)), two alien species related to wheat (Triticum urartu and Aegilops tauschii), and two model species (Brachypodium distachyon and Arabidopsis thaliana). Gene annotations integrated in the current web resource were manually curated from the existing databases and the available literature. The primary goal of developing this web resource is to provide descriptions of the NtUE-related genes and their functional annotation. MicroRNAs targeting some of the NtUE related genes and the QTLs for NtUE-related traits are also included. The genomic information embedded in the web resource should help users to search for the desired information.
Life experience and the asymmetry of the human auditory system: clinical and auditory science laboratory implications
Authors: Hewitt Dale
Published: May 2018

It is now almost 60 years since Doreen Kimura first described the asymmetries of the human auditory system (HAS). It is 30 years since Kenneth Hugdahl, and almost 15 years since David Poeppel, did the same. Our knowledge of these asymmetries is now considerable and detailed.

Here we review some of the literature concerning what is known about the asymmetry of the HAS, and use it to construct a simple model of how the central and peripheral components work together. The model details some of the asymmetry, the life-experience-dependant maturation of this asymmetry throughout the first two decades, possible reasons for the population variance in speech-in-noise perception, the central role of the corpus callosum, the involvement of the efferent auditory pathways, and the corticofugal control of the peripheral auditory system.

Although our knowledge of HAS asymmetry remains incomplete, this should not prevent the introduction of required changes to the current practices of audiologists and auditory science researchers, practices which fail to recognize the existence of any asymmetry in the HAS. The model described here suggests a clear need for: “asymmetry sensitive” hearing test tools that provide normative data for the lifespan, closer childhood and aging-adult hearing monitoring, and the development of a range of auditory training modules. Notably, the model suggests that without such tools our HAS asymmetry knowledge will remain incomplete. The status quo is a preoccupation with understanding hearing through knowledge of the peripheral hearing system, no answers for those with a “normal audiogram” but with an obvious difficulty hearing speech-in-noise, limited success cochlear implant rehabilitation, and missed opportunities to successfully intervene with childhood hearing/speech/language development problems.
Evaluating the impact of integrated development: are we asking the right questions? A systematic review
Authors: Ahner-McHaffie Tessa W , Guest Greg , Petruney Tricia , Eterno Alexandra , Dooley Brian
Published: May 2018

Background: Emerging global transformations - including a new Sustainable Development Agenda - are revealing increasingly interrelated goals and challenges, poised to be addressed by similarly integrated, multi-faceted solutions. Research to date has focused on determining the effectiveness of these approaches, yet a key question remains: are synergistic effects produced by integrating two or more sectors?  We systematically reviewed impact evaluations on integrated development interventions to assess whether synergistic, amplified impacts are being measured and evaluated.

Methods: The International Initiative for Impact Evaluation’s (3ie) Impact Evaluation Repository comprised our sampling frame (n = 4,339). Following PRISMA guidelines, we employed a three-stage screening and review process.

Results: We identified 601 journal articles that evaluated integrated interventions. Seventy percent used a randomized design to assess impact with regard to whether the intervention achieved its desired outcomes. Only 26 of these evaluations, however, used a full factorial design to statistically detect any synergistic effects produced by integrating sectors. Of those, seven showed synergistic effects.

Conclusions: To date, evaluations of integrated development approaches have demonstrated positive impacts in numerous contexts, but gaps remain with regard to documenting whether integrated programming produces synergistic, amplified outcomes. Research on these program models needs to extend beyond impact only, and more explicitly examine and measure the synergies and efficiencies associated with linking two or more sectors. Doing so will be critical for identifying effective integrated development strategies that will help achieve the multi-sector SDG agenda.
Typification of the nameStatice calcarae(Plumbaginaceae), basionym of the threatened endemicLimonium calcarae
Authors: Troia Angelo , Falci Amedeo Alberto , Pasta Salvatore
Published: May 2018

Limonium calcarae(basionymStatice calcarae), a rare diploid species endemic to Sicily, is one of the few members of the genus that occurs in the inland areas of the island. According to IUCN criteria, it has been assessed as critically endangered but recent data on its distribution, demography and threats affecting its populations are lacking. A lectotype is designated, preserved at PAL, and isolectotypes have been traced and verified in other European herbaria.
Use of Short Peripheral Intravenous Catheters: Characteristics, Management, and Outcomes Worldwide
Authors: Alexandrou Evan , Ray‐Barruel Gillian , Carr Peter J. , Frost Steven A. , Inwood Sheila , Higgins Niall , Lin Frances , Alberto Laura , Mermel Leonard , Rickard Claire M. ,   the OMG Study Group
Published: May 2018

BACKGROUND

Peripheral intravenous catheter (PIVC) use in health care is common worldwide. Failure of PIVCs is also common, resulting in premature removal and replacement.

OBJECTIVE

To investigate the characteristics, management practices, and outcomes of PIVCs internationally.

DESIGN

Cross‐sectional study.

SETTING/PATIENTS

Hospitalized patients from rural, regional, and metropolitan areas internationally.

MEASUREMENTS

Hospital, device, and inserter characteristics were collected along with assessment of the catheter insertion site. PIVC use in different geographic regions was compared.

RESULTS

We reviewed 40,620 PIVCs in 51 countries. PIVCs were used primarily for intravenous medication (n = 28,571, 70%) and predominantly inserted in general wards (n = 22,167, 55%). Two‐thirds of all devices were placed in non‐recommended sites such as the hand, wrist, or antecubital veins. Nurses inserted most PIVCs (n = 28,575, 71%); although there was wide regional variation (26% to 97%). The prevalence of idle PIVCs was 14% (n = 5,796). Overall, 10% (n = 4,204) of PIVCs were painful to the patient or otherwise symptomatic of phlebitis; a further 10% (n = 3,879) had signs of PIVC malfunction; and 21% of PIVC dressings were suboptimal (n = 8,507). Over one‐third of PIVCs (n = 14,787, 36%) had no documented daily site assessment and half (n = 19,768, 49%) had no documented date and time of insertion.

CONCLUSIONS

In this study, we found that many PIVCs were placed in areas of flexion, were symptomatic or idle, had suboptimal dressings, or lacked adequate documentation. This suggests inconsistency between recommended management guidelines for PIVCs and current practice.
ECG of the month
Authors: Richley Dave
Published: May 2018

Dave Richley presents an ECG for you to analyse
A bitter pill: dealing with fraud by employees
Authors: Bernstein Adam
Published: May 2018

Care homes are not invulnerable to fraud by employees. Adam Bernstein discusses this painful subject, gives guidelines on how to minimise the risk of fraud occuring and advises on which action to take following a criminal act against the home
-(K)i hiztegian, eta hiztegiaz harantzago / The suffix -(k)i in the lexicon and beyond
Authors: Fernández Beatriz
Published: May 2018

-(K)i morfemari aplikatiboa iritzi izan zaio lan batzuetan (Elordieta 2001, Fernández 2012 2014b beste batzuen artean). Lan honetan, aplikatiboaren hipotesia berrikusiko dut, berez izan ditzakeen zenbait eragozpen tipologiko eztabaidatuz, eta Traski (1981) jarraituz, beste hipotesi berri bat jorratuko dut, hots, -(k)i preposizio bat dela. Bestalde, aditz inflexioan ez, ezbada zenbait aditzen partizipioetan ageri diren beste bi -(k)i morfema ere aztertuko ditut: bat atxiki, eutsi eta jarraiki aditzetan ageri da eta zerikusi estua du -(k)i aplikatibo/preposizioarekin, zeren konfigurazio datibodunetan agertzen da nagusiki, hau da, egiturara datibo bat gaineratuz eta ondorioz, datibo komunztadura ere sartuz. -(K)i hori lexikalizaturik dago, eta horrek azal dezake aditz hauek datiboa hautatzea. Aldiz, bada beste -(k)i izun bat, aditzaren oinarri morfologikoan agertu arren, datibo kasuaren eta komunztaduraren ezarketarekin batere zerikusirik ez duena. -(k)i izunekoak dira eduki zein jakin aditzak, zeinak nagusiki iragankorrak diren eta testu historikoetan, salbuespenak salbuespen (Axular edo Pouvreau adibidez), konfigurazio datibodunetan nekez aurki daitezkeen, batez ere forma sintetikoetan. Alabaina, salbuespenak badira. Horiexek zein mendebaldeko hizkera batzuetan (Gaminde 2004) oraindik ere jaso daitezkeen daukatzut edo dakitzut bezalako forma datibodunak aztertuko ditut lan honetan.
Propuestas para la edición del epitafio en verso de Auspicio: exemtum terris inmiscuit astris
Authors: González-Berdús Victoria
Published: May 2018

El presente trabajo ofrece algunos apuntes para la interpretación del epitafio en verso de Auspicio, procedente de la Galia Bélgica. La pieza destaca entre lo conservado de la epigrafía funeraria de esta provincia por su calidad artística. El enfoque filológico de nuestro análisis será determinante para proponer o descartar restituciones, lo que en última instancia conducirá a una mejor comprensión de los pasajes más oscuros del carmen.
La decretal del papa Honorio I a los obispos hispanos (638): una hipótesis sobre su origen
Authors: Jiménez Sánchez Juan Antonio
Published: May 2018

En el presente trabajo estudiamos la decretal enviada por el papa Honorio I a los obispos reunidos en el Concilio VI de Toledo (638). En ella, el pontífice reprochaba a los hispanos su permisividad con los enemigos de la fe, sobre todo con los judíos bautizados que habían vuelto a sus costumbres judaizantes. No conservamos la misiva, pero resulta posible reconstruirla a partir de la respuesta que Braulio de Zaragoza escribió en nombre del resto de prelados. Esto nos permite centrarnos en las causas que pudieron llevar al papa a redactar su decretal: ésta se originó por los rumores difundidos por unos maledicentes. La cuestión estriba en dilucidar la identidad de estos individuos. En nuestra opinión, serían rebeldes exiliados a otros países; desde allí, para ganarse el favor papal, habrían formulado estas acusaciones contra los obispos y, de manera implícita, contra el rey godo.
Modelagem espacial da evapotranspiração e produtividade hídrica na porção paulista do afloramento do aquífero Guarani entre 2013 e 2015
Authors: Silva Cesar De Oliveira Ferreira , Manzione Rodrigo Lilla , Teixeira Antônio Heriberto de Castro
Published: May 2018

Este artigo teve como objetivo avaliar a distribuição espacial e temporal dos parâmetros da produtividade hídrica (evapotranspiração e produção de biomassa) para a porção paulista do Aquífero Guarani entre os anos de 2013 e 2015, buscando verificar o impacto da estiagem de 2014 na região. O algoritmo utilizado para calcular a evapotranspiração foi o SAFER (Simple Algorithm For Evapotranspiration Retrieving) e a equação de Monteith para estimar os parâmetros da produção de biomassa. Foram utilizados dados de estações agrometeorológicas e imagens digitais sem nuvens do satélite MODIS de dias julianos iguais entre 2013 e 2015. Em valores médios, para toda área paulista do afloramento do Aquífero Guarani, ocorreu diminuição da evapotranspiração e produção de biomassa nos anos de estiagem (2014-5). A produtividade hídrica, quando tomada em referência uma série histórica que permita a análise de tendência, é um potencial indicador de estresse hídrico de vegetação e culturas. A queda expressiva na evapotranspiração em 2014 e 2015 é uma evidência de impactos na recarga de aquífero e diminuição no nível freático. Foram encontradas evidências de que a estiagem teve maior impacto na região rural ao norte do afloramento paulista do Aquífero Guarani (região de Ribeirão Preto) em comparação à região do Paranapanema, sendo uma possível explicação para isso o fato da primeira ter predomínio de plantio de cana-de-açúcar e a segunda de Eucaliptos. Essas informações espaciais geram subsídios para tomada de decisão em gestão ambiental regional.