bluuebunny/crossref_metadata_2025 huggingface dataset:
Ancestral Cults in Ancient Egypt
Authors: García Juan Carlos Moreno
Published: September 2016

The ancestor cult was a common feature of pharaonic society, aiming to provide social cohesion to extended families as well as close intermediaries with the netherworld. As active members of their respective households, ancestors were objects of veneration and care but were also subject to social obligations toward their kin. However, the continuity of such cults was not exempt from threats, from gradual oblivion to destruction of tombs. Furthermore, tensions between individual strategies and customary duties toward one’s kin were another source of instability, especially when officials sought to create their own funerary services and to transfer them to their direct descendants. Such tensions are particularly visible in social sectors close to the king. The assertion of royal authority depended on the elimination of potential sources of political counterweight, and also on the weakening of kin solidarity among members of the elite. As such, the promotion of the cult of royal ancestors, granting individual rewards to selected members of the court and developing personal contact with gods, was part of this strategy. In other cases, “cultural ancestors” provided prestigious links with golden ages of the past, for instance when authorship of sapiential texts was attributed to famous officials of the past or when scribes wrote graffiti in their tombs. Finally, ancestors and ancestral memories were also invented and manipulated for ideological purposes, such as providing legitimacy in periods of political division or prestigious links with the royal palace and the values it promoted.

Ancestor worship thus appears as an active, multifaceted social activity, operating at different levels (individual, domestic/family, community, palace), whose distinctive idiosyncrasies depended on the context in which it operated. Tensions but also mutual influences permeated all these spheres, thus making ancestor cults a dynamic manifestation of social values, political practices, and religious beliefs in pharaonic Egypt.
Precrec: fast and accurate precision–recall and ROC curve calculations in R
Authors: Saito Takaya , Rehmsmeier Marc
Published: September 2016

The precision–recall plot is more informative than the ROC plot when evaluating classifiers on imbalanced datasets, but fast and accurate curve calculation tools for precision–recall plots are currently not available. We have developed Precrec, an R library that aims to overcome this limitation of the plot. Our tool provides fast and accurate precision–recall calculations together with multiple functionalities that work efficiently under different conditions.

Availability and Implementation

Precrec is licensed under GPL-3 and freely available from CRAN (https://cran.r-project.org/package=precrec). It is implemented in R with C ++.

Supplementary information

Supplementary data are available at Bioinformatics online.
Leveraging electronic health record documentation for Failure Mode and Effects Analysis team identification
Authors: Kricke Gayle Shier , Carson Matthew B , Lee Young Ji , Benacka Corrine , Mutharasan R. Kannan , Ahmad Faraz S , Kansal Preeti , Yancy Clyde W , Anderson Allen S , Soulakis Nicholas D
Published: September 2016

Objective: Using Failure Mode and Effects Analysis (FMEA) as an example quality improvement approach, our objective was to evaluate whether secondary use of orders, forms, and notes recorded by the electronic health record (EHR) during daily practice can enhance the accuracy of process maps used to guide improvement. We examined discrepancies between expected and observed activities and individuals involved in a high-risk process and devised diagnostic measures for understanding discrepancies that may be used to inform quality improvement planning.

Methods: Inpatient cardiology unit staff developed a process map of discharge from the unit. We matched activities and providers identified on the process map to EHR data. Using four diagnostic measures, we analyzed discrepancies between expectation and observation.

Results: EHR data showed that 35% of activities were completed by unexpected providers, including providers from 12 categories not identified as part of the discharge workflow. The EHR also revealed sub-components of process activities not identified on the process map. Additional information from the EHR was used to revise the process map and show differences between expectation and observation.

Conclusion: Findings suggest EHR data may reveal gaps in process maps used for quality improvement and identify characteristics about workflow activities that can identify perspectives for inclusion in an FMEA. Organizations with access to EHR data may be able to leverage clinical documentation to enhance process maps used for quality improvement. While focused on FMEA protocols, findings from this study may be applicable to other quality activities that require process maps.
iCONCUR: informed consent for clinical data and bio-sample use for research
Authors: Kim Hyeoneui , Bell Elizabeth , Kim Jihoon , Sitapati Amy , Ramsdell Joe , Farcas Claudiu , Friedman Dexter , Feupe Stephanie Feudjio , Ohno-Machado Lucila
Published: September 2016

Background: Implementation of patient preferences for use of electronic health records for research has been traditionally limited to identifiable data. Tiered e-consent for use of de-identified data has traditionally been deemed unnecessary or impractical for implementation in clinical settings.

Methods: We developed a web-based tiered informed consent tool called informed consent for clinical data and bio-sample use for research (iCONCUR) that honors granular patient preferences for use of electronic health record data in research. We piloted this tool in 4 outpatient clinics of an academic medical center.

Results: Of patients offered access to iCONCUR, 394 agreed to participate in this study, among whom 126 patients accessed the website to modify their records according to data category and data recipient. The majority consented to share most of their data and specimens with researchers. Willingness to share was greater among participants from an Human Immunodeficiency Virus (HIV) clinic than those from internal medicine clinics. The number of items declined was higher for for-profit institution recipients. Overall, participants were most willing to share demographics and body measurements and least willing to share family history and financial data. Participants indicated that having granular choices for data sharing was appropriate, and that they liked being informed about who was using their data for what purposes, as well as about outcomes of the research.

Conclusion: This study suggests that a tiered electronic informed consent system is a workable solution that respects patient preferences, increases satisfaction, and does not significantly affect participation in research.
Clofazimine Enteropathy: A Rare and Underrecognized Complication of Mycobacterial Therapy
Authors: Szeto Winnie , Garcia-Buitrago Monica T. , Abbo Lilian , Rosenblatt Joseph D. , Moshiree Baharak , Morris Michele I.
Published: September 2016

Clofazimine-induced crystal-storing histiocytosis is a rare complication of treatment previously reported in dermatology literature as a complication of leprosy therapy. We report a case of disseminated Mycobacterium abscessus requiring treatment with high-dose oral clofazimine resulting in enteropathy in a patient who presented with abdominal pain, malnutrition, and melena.
Does Reoperation Risk Vary for Different Types of Pediatric Scoliosis?
Authors: Paul Justin C. , Lonner Baron S. , Vira Shaleen , Feldman David , Errico Thomas J.
Published: September 2016

Study Design:

Retrospective cohort study of spine fusion surgery utilizing the New York State Inpatient Database.

Objective:

The objective was to determine whether there were differences in reoperation rates among pediatric scoliosis associated with various etiologies compared with idiopathic scoliosis.

Summary of Background Data:

The incidence of postoperative complications and reoperations is known to vary among patients with diverse scoliosis pathologies. As these are heterogeneous conditions and often with rare occurrence, it is difficult to compare them in a single study. We aimed to assess reoperation events after fusion for several etiologies of pediatric scoliosis.

Methods:

The 2008 to 2011 New York State Inpatient Database was queried using International Classification of Diseases (ICD-9-CM) codes for patients with in-hospital stays including a spine arthrodesis for scoliosis. All approaches, all fusion lengths, and ages 10 to 21 were included. Patient identifiers and linkage variables were used to identify revisits. The relative risk of reoperation was calculated for several rare conditions associated with scoliosis.

Results:

Two thousand three hundred fifty-six pediatric scoliosis fusion surgeries were identified in 2008 in the state of New York. The 1- and 4-year reoperation rate for idiopathic scoliosis was 0.9% and 1.6%, respectively. For nonidiopathic scoliosis, the 1- and 4-year rates were 4.2% and 20.4%, respectively. Of the nonidiopathic scoliosis subtypes, congenital scoliosis (4.7% risk at 1 y, 41.6% at 4 y), the neuromuscular disease arthrogryposis (7.3% risk at 1 y, 28.6% at 4 y), and syndrome neurofibromatosis (9.1% at 1 y, 32.3% at 4 y) showed the highest risk for reoperation. Length of stay and hospital charges were higher for reoperations.

Conclusions:

Using a large administrative database, we identified neuromuscular, syndromic, and congenital forms of scoliosis that have the highest relative risk for a reoperation within 1 year. At-risk populations should be identified and resources allocated and preventative measures instituted accordingly to prevent these costly events.

Level of Evidence:

Level III.
Significance of the Lateral Humeral Line for Evaluating Radiocapitellar Alignment in Children
Authors: Souder Christopher D. , Roocroft Joanna H. , Edmonds Eric W.
Published: September 2016

Background:

The radiocapitellar line (RCL) was originally described for evaluation of the alignment of the RC joint on lateral images of the elbow. Although, many authors have translated the utilization of RCL into coronal imaging, previous studies have not been performed to confirm validity. The purpose of this paper was to identify an accurate way of evaluating pediatric RC alignment in the coronal plane.

Methods:

Thirty-seven anteroposterior (AP) radiographs of 37 children were evaluated to determine the position of the RC joint in the coronal plane. All had acceptable magnetic resonance imaging (MRI) studies available for comparison. The lateral humeral line (LHL), consisting of a line along the lateral edge of the ossified condyle of the distal humerus parallel to the axis of the distal humeral shaft, was studied as it related to the lateral cortex of the radial neck. Three children with a confirmed diagnosis of a Bado III, lateral displaced radius, Monteggia fracture were also evaluated.

Results:

The LHL passed along the edge of or lateral to the radial neck on all AP radiographs and all MRI studies. The RCL failed to intersect the capitellum on 2 AP radiographs. On MRI, the RCL also passed lateral to the capitellar ossification center in 3 patients. In addition, the RCL was seen passing through the capitellum at a mean of the lateral 30% (range, 0% to 64%) on AP radiographs and 26% (range, 0% to 48%) on MRI. For all 3 children with a Bado III Monteggia fracture, the LHL crossed the radial neck and the RCL did not intersect the capitellum.

Conclusions:

The RCL can fail to intersect the capitellar ossification center on AP radiographs and MRI in pediatric elbows without injury. The LHL consistently lies lateral to the radial neck in normal elbows and medial to the lateral aspect of the radial neck on all Bado III fracture-dislocations. It, therefore, can be used as an adjunct in evaluating the RC joint on AP imaging. The RCL most commonly intersects the lateral one third of the ossification center on both plain radiographs and MRIs.

Level of Evidence:

Level III—diagnostic.
Can a Made-for-Consumer Activity Monitor Assess Physical Activity in Adolescents and Young Adults After Lower Extremity Limb Salvage for Osseous Tumors?
Authors: Gundle Kenneth R. , Punt Stephanie E. , Mattioli-Lewis Tressa , Conrad Ernest U.
Published: September 2016

Background:

The purpose of this study was to test the validity of a consumer-oriented activity monitor in adolescents and young adults undergoing limb salvage for primary bone malignancies.

Methods:

A cross-sectional population of participants with an average age of 16 (range 12 to 22) years produced 472 days of activity monitoring during 25 evaluations periods alongside patient-reported outcome measures.

Results:

Average daily steps ranged from 557 to 12,756 (mean=4711) and was moderately associated with the short-form (SF) 36 physical component subscale (r=0.46, P=0.04) as well as the SF6D health state utility measure (r=0.48, P=0.04), but not the SF36 mental component subscale (P=0.66) or Toronto extremity salvage score (P=0.07). Time from surgery was strongly correlated with average daily steps (r=0.7, P<0.001).

Conclusions:

A made-for-consumer activity monitor provided real-world data regarding the outcome of adolescent and young adult limb salvage, and evidence of validity in this population. Such lower cost, user-friendly devices may facilitate assessment of free-living activity and allow novel comparisons of treatment strategies.

Level of Evidence:

Level II—diagnostic.
Outcome of Pelvic Bone Sarcomas in Children
Authors: Laitinen Minna , Parry Michael , Albergo Jose I. , Jeys Lee , Sumathi Vaiyapuri , Grimer Robert
Published: September 2016

Background:

Malignant bone tumors of the pelvis in children are rare and knowledge of their behavior is limited.

Methods:

A total of 113 skeletally immature patients under 16 years of age, comprising 58 females and 55 males were treated between 1983 and 2014. Tumors comprised Ewing’s sarcoma (ES) in 88 (77.9%) or osteosarcoma (OS) in 25 (22.1%). Metastases at diagnosis were present in 36 (31.9%). The mean follow-up was 5.2 years (2 to 16).

Results:

For patients with ES, the overall survival was 37.1% at 5-years and 33.5% at 10-years and 31.7% at 5- and 10-years in patients with OS. Local recurrence occurred in 24 patients with ES (27.3%) and 7 patients with OS (43.7%). Chemotherapy response was a predictor of local recurrence in ES with the lowest incidence seen in those with a good response to chemotherapy treated with a combination of radiotherapy and surgery. In patients with OS, both surgical margin and chemotherapy response influenced local control.

Conclusions:

Attaining a wide surgical margin should be the aim of treatment for all children with primary bone tumors of the pelvis. In ES, chemotherapy response has a greater influence on disease free and overall survival. Patients who demonstrate a poor response to chemotherapy should be considered for subsequent radiotherapy. Effort should be directed toward identifying nonhistologic methods of assessing chemotherapy response.

Level of Evidence:

Level IV—retrospective case study.
In-Transit Metastasis From Squamous Cell Carcinoma
Authors: Ma Joyce H.Y. , Wu Albert , Veness Michael , Estall Vanessa , Hong Angela , Borg Martin , James Craig , Ibbetson Jan , Ooi Colin , Weightman Warren , McColl Ian , Hamann Ian , Grieve Noel , Ozluer Selim , Salmon Paul , Nikitins Markus , Caplash Yugesh , Marshall Nicholas , Edwards Timothy , Patterson Ian , Selva Dinesh , Huilgol Shyamala C.
Published: September 2016

BACKGROUND

In-transit metastasis from cutaneous squamous cell carcinoma (SCC) is an uncommon form of metastasis through lymphatics and occurs more commonly in immunosuppressed patients.

OBJECTIVE

To identify cases of in-transit SCC and determine patient characteristics, tumor features, management, and prognosis.

METHODS AND MATERIALS

A multicenter case series treated by Australian and New Zealand clinicians.

RESULTS

In 31 patients, median age was 72 years (range 52–99) and 68% were immunocompetent. Tumors occurred on the head and neck in 94% of cases, with 71% of all tumors occurring on the scalp, forehead, or temple. The median time to presentation with in-transit SCC from treatment of the initial tumor was 5 months. Management included surgery (94%), radiotherapy (77%), chemotherapy (10%), and reduction of immunosuppression (3%). Median follow-up was 12 months. Overall survival at 3 and 5 years were 27% and 13%, respectively.

CONCLUSION

In-transit metastases are described in 31 patients, of whom the majority was immunocompetent. The scalp, forehead, and temple were the most common sites. New clinical and histological diagnostic criteria are proposed. Prognosis was poor with 5-year survival of 13%. Recommended management is a combination of surgery and adjuvant radiotherapy. Reduction of any iatrogenic immunosuppression should be considered.
The Readability of Online Patient Information About Mohs Micrographic Surgery
Authors: Vargas Christina R. , DePry Jennifer , Lee Bernard T. , Bordeaux Jeremy S.
Published: September 2016

BACKGROUND

Mohs micrographic surgery has become increasingly used in the treatment of cutaneous malignancies over the past decade. Concurrently, more patients are using the Internet as a resource for medical information than ever before. The average American adult reads at an eighth grade level. The American Medical Association and National Institutes of Health have recommended a sixth grade target reading level for patient health materials.

OBJECTIVE

This study evaluates the readability of currently available online information about Mohs micrographic surgery in the context of these recommendations.

METHODS

An Internet search for the term “Mohs surgery” was performed and the first 10 results were identified. Patient information from each primary site was downloaded and formatted into plain text. Readability was assessed using 9 established tests; text was analyzed both overall and by Web site for comparison.

RESULTS

A total of 101 articles were collected from the first 10 Web site search results; the overall average reading level was 14.4. All articles exceeded the recommended sixth grade reading level.

CONCLUSION

Online resources about Mohs micrographic surgery are too difficult for many patients to read. The paucity of appropriately written patient information available on the Internet may hinder informed decision-making, participation, and subsequent postoperative satisfaction.
Scalp Closures With Pulley Sutures Reduce Time and Cost Compared to Traditional Layered Technique—A Prospective, Randomized, Observer-Blinded Study
Authors: Kannan Swati , Mehta Dhwani , Ozog David
Published: September 2016

BACKGROUND

Reconstruction of postsurgical scalp defects can be difficult and time-consuming using a conventional bilayered technique. A specialized closure using a pulley suture can assist in closing wounds under high tension and can decrease time and cost for the surgeon.

OBJECTIVE

To determine if closing scalp defects with a single-layered closure using pulley sutures would result in decreased time but equivalent scar cosmesis compared to bilayered closures.

MATERIALS AND METHODS

A total of 21 patients with postsurgical scalp defects were randomized to a bilayered or a pulley group, and time was measured for each closure. Scar appearance was assessed using the Patient and Observer Scar Assessment Scale at 2 weeks, 2 months, and 6 months postsurgery. Before and after photographs were also assessed by a blinded dermatologist using the visual analog scale.

RESULTS

Compared to a bilayered closure, the pulley technique resulted in significantly reduced closure time (p < .001). Even though patient overall scores at 2 weeks and observer total score at 6 months were superior in the pulley group, the visual analog scale scores were similar between the 2 groups.

CONCLUSION

Scalp reconstructions using a single layer of pulley sutures result in time and cost reduction and similar scar appearance compared to bilayered closures.
Magnetic Resonance Imaging of Cyclodialysis Cleft Before and After Cyclopexy
Authors: Jeong Jae Hoon , Jeoung Jin Wook , Moon Nam Ju
Published: September 2016

Purpose:

To report the magnetic resonance imaging (MRI) appearance of a man with chronic hypotony caused by unexplained cyclodialysis clefts and the change after laser photocoagulation.

Methods:

A 19-year-old man with hypotonous maculopathy caused by cyclodialysis clefts in the right eye presented to our institution. The etiology and time of onset of the cyclodialysis clefts were obscure, and a MRI was performed to assess the possibility of compressive optic neuropathy.

Results:

MRI of the right eye showed a relative decrease in globe volume and diffuse enhancement of the ocular wall compared with the left eye. Conservative management showed no further improvement, and the patient underwent laser photocoagulation within the cyclodialysis clefts. During the 9-month follow-up period, both functional and anatomic reversal and an increase in total globe volume were observed, and the enhancement of the ocular wall was resolved.

Conclusions:

This case demonstrates the specific magnetic resonance appearance of hypotony status caused by a cyclodialysis cleft and the change after laser photocoagulation cyclopexy.
Repeatability and Agreement of Swept Source and Spectral Domain Optical Coherence Tomography Evaluations of Thickness Sectors in Normal Eyes
Authors: Lee Sang Yeop , Bae Hyoung Won , Kwon Hee Jung , Seong Gong Je , Kim Chan Yun
Published: September 2016

Purpose of the Study:

The purpose of the study was to evaluate the clinical efficacy of swept-source optical coherence tomography (SS-OCT), we compared the intradevice repeatability of thickness measurements obtained using SS-OCT to that of measurements obtained using spectral domain OCT (SD-OCT), and assessed the interdevice agreement of thickness measurements.

Materials and Methods:

This cross-sectional prospective study involved 3 consecutive measurements of peripapillary retinal nerve fiber layer (PP-RNFL) and ganglion cell-inner plexiform layer thickness in healthy subjects, using 2 different OCT systems. Intraclass correlation coefficients (ICCs) and coefficients of variability were calculated and compared for repeatability and agreement between study groups. Intradevice ICCs for each OCT system were compared, and Bland-Altman plots were used to evaluate their agreement.

Results:

Fifty-eight eyes from 58 healthy subjects (25 men and 33 women) were analyzed. SS-OCT images yielded larger PP-RNFL thickness values than SD-OCT images in every sector examined. In contrast, SD-OCT images yielded larger macular ganglion cell-inner plexiform layer thickness values than SS-OCT images. For SS-OCT, intradevice ICCs were ≥0.9 for all sectors. However, for SD-OCT, the 3 PP-RNFL measurement sectors had correlation coefficients <0.9. Interdevice ICCs varied more and were lower than intradevice values, because thickness measurement values differed between the OCT devices.

Conclusions:

Measurements differed between systems even for the same subject. SS-OCT had an intradevice repeatability similar to that of SD-OCT. These findings support the clinical application of SS-OCT.
Short-term to Long-term Results of Ahmed Glaucoma Valve Implantation for Uveitic Glaucoma Secondary to Behçet Disease
Authors: Yakin Mehmet , Eksioglu Umit , Sungur Gulten , Satana Banu , Demirok Gulizar , Ornek Firdevs
Published: September 2016

Purpose:

To evaluate short-term to long-term outcomes of Ahmed glaucoma valve (AGV) implantation in the management of uveitic glaucoma (UG) secondary to Behçet disease (BD).

Patients and Methods:

A retrospective chart review of 47 eyes of 35 patients with UG secondary to BD who underwent AGV implantation was conducted. Success was defined as having an intraocular pressure (IOP) between 6 and 21 mm Hg with (qualified success) or without (complete success) antiglaucomatous medications and without need for further glaucoma surgery.

Results:

Mean postoperative follow-up was 57.72±26.13 months. Mean preoperative IOP was 35.40±8.33 mm Hg versus 12.28±2.90 mm Hg at the last follow-up visit (P<0.001). Mean number of preoperative topical antiglaucomatous medications was 2.96±0.29 versus 0.68±1.12 at the last follow-up visit (P<0.001). In all eyes, IOP could be maintained between 6 and 21 mm Hg with or without antiglaucomatous medications during follow-up. The cumulative probability of complete success was 46.8% at 6 months, 40.4% at 12 months, and 35.9% at 36 months, and the cumulative probability of eyes without complication was 53.2% at 6 months, 46.5% at 12 months, and 39.6% at 24 months postoperatively based on Kaplan-Meier survival analysis. No persistent or irreparable complications were observed.

Conclusions:

This study includes one of the largest series of AGV implantation in the management of UG with the longest follow-up reported. AGV implantation can be considered as a primary surgical option in the management of UG secondary to BD with 100% total success rate (with or without medications).
Incidence of renal cell carcinoma in inflammatory bowel disease patients with and without anti-TNF treatment
Authors: Wauters Lucas , Billiet Thomas , Papamichael Konstantinos , Ballet Vera , Joniau Steven , Verschueren Patrick , Silversmit Geert , Van Assche Gert , Vermeire Séverine , Ferrante Marc
Published: September 2016

Objective

We aimed to study the risk of renal cell carcinoma (RCC) with anti-tumor necrosis factor (anti-TNF) therapy in inflammatory bowel disease (IBD) and rheumatic diseases (RD) and calculate standardized incidence ratios (SIRs) in IBD.

Materials and methods

This was a retrospective case–control and cohort study spanning 25 years, including IBD and RD patients with a diagnosis of RCC (1990–2014) identified through the electronic database of a tertiary referral center.

Results

RCC was confirmed in seven anti-TNF-exposed (TNF+) and 21 anti-TNF-naive (TNF−) IBD and one TNF+ and 26 TNF− RD patients. In IBD-RCC, younger age at RCC diagnosis [median (interquartile range) 46 (42–58) vs. 63 (52–75) years; P=0.02], immunosuppressive therapy (100 vs. 24%; P<0.0004), partial nephrectomy (86 vs. 33%; P=0.02), and surgery less than 1 month after diagnosis of RCC (71 vs. 14%; P=0.004) were associated with anti-TNF. Compared with IBD, RD patients were older at RCC diagnosis [70 (60–77) vs. 59 (47–69) years; P=0.02] with less nephron-sparing surgery (26 vs. 54%; P=0.04) and more symptomatic (44 vs. 14%; P=0.02) and advanced tumors (30 vs. 7%; P=0.04). SIRs in IBD-RCC TNF− and TNF+ were 5.4 (95% confidence interval 2.9–9.2) and 7.1 (2.3–16.5) in male patients and 8.5 (3.7–16.8) and 4.8 (0.6–17.3) in female patients, respectively. The risk for RCC associated with anti-TNF in IBD was 0.8 (0.3–2.5) in men and 1.4 (0.2–5.5) in women.

Conclusion

The favorable patient and tumor profiles in IBD with anti-TNF may suggest incidentally discovered RCC on abdominal imaging. SIRs for IBD-RCC were not increased after anti-TNF exposure.
Minimizing Occupational Exposure to Antineoplastic Agents
Authors: Polovich Martha
Published: September 2016

The inherent toxicity of antineoplastic drugs used for the treatment of cancer makes them harmful to healthy cells as well as to cancer cells. Nurses who prepare and/or administer the agents potentially are exposed to the drugs and their negative effects. Knowledge about these drugs and the precautions aimed at reducing exposure are essential aspects of infusion nursing practice. This article briefly reviews the mechanisms of action of common antineoplastic drugs, the adverse outcomes associated with exposure, the potential for occupational exposure from preparation and administration, and recommended strategies for minimizing occupational exposure.
Thyroid Emergencies
Authors: Leung Angela M.
Published: September 2016

Myxedema coma and thyroid storm are thyroid emergencies associated with increased mortality. Prompt recognition of these states—which represent the severe, life-threatening conditions of extremely reduced or elevated circulating thyroid hormone concentrations, respectively—is necessary to initiate treatment. Management of myxedema coma and thyroid storm requires both medical and supportive therapies and should be treated in an intensive care unit setting.
Sharing Your Knowledge: Getting Your Idea Published
Authors: Milner Kerry A.
Published: September 2016

Nurses have a professional and ethical obligation to share best practices to advance nursing knowledge and create better outcomes for patients. Practice-based evidence is as important to advancing evidence-based practice as original research. Infusion nurses are in an excellent position to share local best practices more broadly. Writing for publication is a mechanism for disseminating practice-based evidence. This article reviews the importance of sharing best practices and describes not only how to prepare a manuscript for publication but also resources that will help nurses in this important endeavor.
Pulmonary Arterial Hypertension: A Focus on Infused Prostacyclins
Authors: Stewart Traci
Published: September 2016

Pulmonary arterial hypertension (PAH) is characterized by vasoconstriction and cell proliferation in the pulmonary vasculature. Guideline-driven interventions with infused prostacyclin treatment are the mainstay for patients with advanced symptoms. Infused prostacyclin therapy is complex. It is critical to manage prostacyclin therapy with precision because boluses or interruptions can be fatal. Education of patients and inpatient staff nurses is necessary to prevent negative outcomes. Nurses are an essential part of the multidisciplinary team caring for patients with PAH. The diagnostic evaluation and treatment of PAH are reviewed here, and challenges associated with the care of patients on prostacyclin therapy are discussed.
Leadership Training and the Problems of Competency Development
Authors: Reid W. Michael , Dold Claudia Jennifer
Published: September 2016

Context:

An important workforce development effort during the past 25 years has been developing competency sets. Several of the sets rely on the concepts of Senge's Learning Organization and Burns' Transformational Leadership. The authors' experiences and study in designing and implementing a curriculum for a public health leadership institute based on these concepts raised several important questions about competency development and application.

Objectives:

To summarize the use of the Senge and Burns frameworks in several competency sets and the practice literature and to assess the status of competency development for those frameworks and for competency development generally.

Design:

The authors reviewed several commonly used competency sets and textbooks and searched 3 leading public health practice journals (Journal of Public Health Management and Practice, Public Health Reports, and American Journal of Public Health) for Senge and Burns framework terms. They also reviewed efforts to implement competency sets in public health education and practice.

Main Outcome Measures:

(1) The extent to which the articles and texts demonstrated understanding of the frameworks and reported their implementation and (2) whether competency statements and their uses in the literature contained precise definitions of competencies (knowledge, skills, behaviors, and attitudes associated with them), the standards by which competence is to be measured, and the means for measuring their attainment.

Results:

“Learning Organization” and “Transformational Leadership” terms were used often and viewed favorably. However, the terms were rarely defined as Senge and Burns had, the uses generally did not indicate the complexity and difficulty of implementation, and there was only one report of even partial implementation. The review of competency development efforts found there is virtually no attention to the definitional and measurement issues in the literature.

Conclusion:

Unless public health organizations recognize the need for a common understanding of competencies and how to measure their attainment and act on that understanding, it will be impossible to say with confidence that there is agreement on which individuals are competent, whether public health agencies have competent personnel, or that the public health workforce itself is competent.
Gaps in Adolescent Engagement in Antenatal Care and Prevention of Mother-to-Child HIV Transmission Services in Kenya
Authors: Ronen Keshet , McGrath Christine J. , Langat Agnes C. , Kinuthia John , Omolo Danvers , Singa Benson , Katana Abraham K. , Ng'Ang'A Lucy W. , John-Stewart Grace
Published: September 2016

Background:

Rates of pregnancy and HIV infection are high among adolescents. However, their engagement in prevention of mother-to-child HIV transmission (PMTCT) services is poorly characterized. We compared engagement in the PMTCT cascade between adult and adolescent mothers in Kenya.

Methods:

We conducted a nationally representative cross-sectional survey of mother–infant pairs attending 120 maternal child health clinics selected by probability proportionate to size sampling, with a secondary survey oversampling HIV-positive mothers in 30 clinics. Antenatal care (ANC) attendance, HIV testing, and antiretroviral (ARV) use were compared between adolescent (age ≤19 years) and adult mothers using χ2 tests and logistic regression.

Results:

Among 2521 mothers, 278 (12.8%) were adolescents. Adolescents were less likely than adults to be employed (16.5% vs. 37.9%), married (66.1% vs. 88.3%), have intended pregnancy (40.5% vs. 58.6%), or have disclosed their HIV status (77.5% vs. 90.7%) (P < 0.01 for all). Adolescents were less likely than adults to attend ≥4 ANC visits (35.2% vs. 45.6%, P = 0.002). This effect remained significant when adjusting for employment, household crowding, pregnancy intention, gravidity, and HIV status [adjusted odds ratio (95% confidence interval) = 0.54 (0.37 to 0.97), P = 0.001]. Among 2359 women without previous HIV testing, 96.1% received testing during pregnancy; testing levels did not differ between adolescents and adults. Among 288 HIV-positive women not on antiretroviral therapy before pregnancy, adolescents were less likely than adults to be on ARVs (65.0% vs. 85.8%, P = 0.01) or to have infants on ARVs (85.7% vs. 97.7%, P = 0.005).

Conclusions:

Adolescent mothers had poorer ANC attendance and uptake of ARVs for PMTCT. Targeted interventions are needed to improve retention of this vulnerable population in the PMTCT cascade.
Serial Lung Ultrasonography to Monitor Patient With Diffuse Alveolar Hemorhage
Authors: Buda Natalia , Masiak Anna , Smoleńska Żaneta , Gałecka Katarzyna , Porzezińska Maria , Zdrojewski Zbigniew
Published: September 2016

Diffuse alveolar haemorrhage (DAH) leads to acute respiratory failure. This is why it requires rapid diagnosis and implementation of appropriate treatment. The standard diagnosis of a patient with DAH includes laboratory tests, diagnostic imagining (X-ray of the chest, high-resolution computed tomography), and bronchoscopy with bronchoalveolar lavage. We present a description of 2 patients diagnosed with systemic connective tissue disease and DAH, monitored with the help of lung ultrasound. To our knowledge, this is the first description of the use of lung ultrasound in DAH in adult patients.
Enrichment by hybridisation of long DNA fragments for Nanopore sequencing
Authors: Eckert Sabine E. , Chan Jackie Z.-M. , Houniet Darren ,   the PATHSEEK consortium,, Breuer Judy , Speight Graham
Published: September 2016

Enrichment of DNA by hybridisation is an important tool which enables users to gather target-focused next-generation sequence data in an economical fashion. Current in-solution methods capture short fragments of around 200–300 nt, potentially missing key structural information such as recombination or translocations often found in viral or bacterial pathogens. The increasing use of long-read third-generation sequencers requires methods and protocols to be adapted for their specific requirements. Here, we present a variation of the traditional bait–capture approach which can selectively enrich large fragments of DNA or cDNA from specific bacterial and viral pathogens, for sequencing on long-read sequencers. We enriched cDNA from cultured influenza virus A, human cytomegalovirus (HCMV) and genomic DNA from two strains of Mycobacterium tuberculosis (M. tb) from a background of cell line or spiked human DNA. We sequenced the enriched samples on the Oxford Nanopore MinION™ and the Illumina MiSeq platform and present an evaluation of the method, together with analysis of the sequence data. We found that unenriched influenza A and HCMV samples had no reads matching the target organism due to the high background of DNA from the cell line used to culture the pathogen. In contrast, enriched samples sequenced on the MinION™ platform had 57 % and 99 % best-quality on-target reads respectively.
Comprehensive Analysis of Two Shank3 and the Cacna1c Mouse Models of Autism Spectrum Disorder
Authors: Kabitzke Patricia , Brunner Daniela , He Dansha , Fazio Pamela A. , Cox Kimberly , Sutphen Jane , Thiede Lucinda , Sabath Emily , Hanania Taleen , Alexandrov Vadim , Rasmusson Randall , Spooren Will , Ghosh Anirvan , Feliciano Pamela , Biemans Barbara , Benedetti Marta , Clayton Alice Luo
Published: September 2016

To expand, analyze and extend published behavioral phenotypes relevant to autism spectrum disorder (ASD), we present a study of three ASD genetic mouse models: Feng’s Shank3tm2Gfng model, hereafter Shank3/F, Jiang’s Shank3tm1Yhj model, hereafter Shank3/J, and the Cacna1c deletion model. The Shank3/F and Shank3/J models mimick gene mutations associated with Phelan-Mcdermid syndrome and the Cacna1c model recapitulates the deletion underlying Timothy syndrome. The current study utilizes both standard and novel, computer-vision based behavioral tests, the same methdology used in our previously published companion report on the Cntnap2 null and 16p11.2 deletion models. Overall, some but not all behaviors replicated published findings. Those that replicated, such as social behavior and overgrooming in Shank3 models, also tended to be milder than previous reports. The Shank3/F model, and to a much lesser extent, the Shank3/J and Cacna1c models, showed hypoactivity and a general anxiety-like behavior triggered by external stimuli which pervaded social interactions. We did not detect deficits in a cognitive procedural learning test nor did we observe perseverative behavior in these models. We did, however, find differences in exploratory patterns of Cacna1c mutant mice suggestive of a behavioral effect in a social setting. In addition, Shank3/F but not Shank3/J KO or Cacna1c HET showed differences in sensory-gating. Discrepancies in our current results from previous reports may be dependent on subtle differences in testing conditions, housing enrichment, or background strain. Both positive and negative results from this study will be useful in identifying the most robust and replicable behavioral signatures within and across mouse models of autism. Understanding these phenotypes may shed light of which features to study when screening compounds for potential therapeutic interventions.
The visual white matter: The application of diffusion MRI and fiber tractography to vision science
Authors: Rokem Ariel , Takemura Hiromasa , Bock Andrew , Scherf K. Suzanne , Behrmann Marlene , Wandell Brian , Fine Ione , Bridge Holly , Franco Pestilli
Published: September 2016

Visual neuroscience has traditionally focused much of its attention on understanding the response properties of neurons along the visual pathways. This review focuses instead on the properties of the white matter connections between these neurons. Specifically, we provide an introduction to methods to study the human visual white matter using diffusion MRI (dMRI). This method allows us to measure the white matter connections in individual visual systems in vivo, allows us to trace long-range connections between different parts of the visual system, and to measure the biophysical properties of these connections. We explain the principles underlying dMRI measurements and the basics of modeling these data. We review a range of findings from recent studies on connections between different visual field maps, on the effects of visual impairment on the white matter, and on the properties underlying networks that process visual information that supports visual face recognition. Finally, we discuss a few promising directions for future studies. These include new methods for analysis of MRI data, open data-sets that are becoming available to study brain connectivity and white matter properties, and open-source software for the analysis of these data.
Wolbachiainfections inAedes aegyptidiffer markedly in their response to cyclical heat stress
Authors: Ross Perran A. , Wiwatanaratanabutr Itsanun , Axford Jason K. , White Vanessa L. , Endersby-Harshman Nancy M. , Hoffmann Ary A.
Published: September 2016

Aedes aegyptimosquitoes infected withWolbachiabacteria are currently being released for arbovirus suppression around the world. Their potential to invade populations and persist will depend on interactions with environmental conditions, particularly as larvae are often exposed to fluctuating and extreme temperatures in the field. We rearedAe. aegyptilarvae infected with different types ofWolbachia(wMel,wAlbB andwMelPop) under diurnal cyclical temperatures. RearingwMel andwMelPop-infected larvae at 26-37°C reduced the expression of cytoplasmic incompatibility, a reproductive manipulation induced byWolbachia. We also observed a sharp reduction in the density ofWolbachiain adults. Furthermore, exposure to 26-37°C over two generations eliminated both thewMel andwMelPop infections. In contrast, thewAlbB infection was maintained at a high density, exhibited complete cytoplasmic incompatibility, and was transmitted from mother to offspring with a high fidelity under this temperature cycle. These findings have implications for the success ofWolbachiainterventions across different environments and highlight the importance of temperature control in rearing.
Using high-resolution variant frequencies to empower clinical genome interpretation
Authors: Whiffin Nicola , Minikel Eric , Walsh Roddy , O’Donnell-Luria Anne , Karczewski Konrad , Ing Alexander Y , Barton Paul JR , Funke Birgit , Cook Stuart A , MacArthur Daniel , Ware James S
Published: September 2016

Whole exome and genome sequencing have transformed the discovery of genetic variants that cause human Mendelian disease, but discriminating pathogenic from benign variants remains a daunting challenge. Rarity is recognised as a necessary, although not sufficient, criterion for pathogenicity, but frequency cutoffs used in Mendelian analysis are often arbitrary and overly lenient. Recent very large reference datasets, such as the Exome Aggregation Consortium (ExAC), provide an unprecedented opportunity to obtain robust frequency estimates even for very rare variants. Here we present a statistical framework for the frequency-based filtering of candidate disease-causing variants, accounting for disease prevalence, genetic and allelic heterogeneity, inheritance mode, penetrance, and sampling variance in reference datasets. Using the example of cardiomyopathy, we show that our approach reduces by two-thirds the number of candidate variants under consideration in the average exome, and identifies 43 variants previously reported as pathogenic that can now be reclassified. We present precomputed allele frequency cutoffs for all variants in the ExAC dataset.
Learning improves conscious access at the bottom, but not the top: Reverse hierarchical effects in perceptual learning and metacognition
Authors: Chen Benjamin , Mundy Matthew , Tsuchiya Naotsugu
Published: September 2016

Experience with visual stimuli can improve their perceptual performance, a phenomenon termed visual perceptual learning (VPL), but how does VPL shape our conscious experience of learned stimuli? VPL has been found to improve measures of metacognition, suggesting increased conscious stimulus accessibility. Such studies however, have largely failed to control objective task accuracy, which typically correlates with metacognition. Here, using a staircase method to control this confound, we investigated whether VPL improves the metacognitive accuracy of perceptual judgements. Across three consecutive days, subjects learned to discriminate faces based on either their identity or contrast. Holding objective accuracy constant, perceptual thresholds improved in both tasks, while metacognitive accuracy diverged, with face contrast VPL improving metacognition, and face identity VPL failing to. Our findings can be interpreted in a reverse hierarchy theory-like model of VPL, which counterintuitively predicts that the VPL of low- but not high-level stimulus properties should improve conscious stimulus accessibility.
Sexual dimorphism in theDrosophilametabolome increases throughout development
Authors: Ingleby FC , Morrow Edward H
Published: September 2016

The expression of sexually dimorphic phenotypes from a shared genome between males and females is a longstanding puzzle in evolutionary biology. Increasingly, research has made use of transcriptomic technology to examine the molecular basis of sexual dimorphism through gene expression studies, but even this level of detail misses the metabolic processes that ultimately link gene expression with the whole organism phenotype. We use metabolic profiling in Drosophila melanogaster to complete this missing step, with a view to examining variation in male and female metabolic profiles, or metabolomes, throughout development. We show that the metabolome varies considerably throughout larval, pupal and adult stages. We also find significant sexual dimorphism in the metabolome, although only in pupae and adults, and the extent of dimorphism tends to increase throughout development. We compare this to transcriptomic data from the same population and find that the general pattern of increasing sex differences throughout development is mirrored in RNA expression. We discuss our results in terms of the usefulness of metabolic profiling in linking genotype and phenotype to more fully understand the basis of sexually dimorphic phenotypes.
High throughput sequencing of multiple amplicons for barcoding and integrative taxonomy
Authors: Cruaud Perrine , Rasplus Jean-Yves , Rodriguez Lillian Jennifer , Cruaud Astrid
Published: September 2016

Until now, the potential of NGS has been seldom realised for the construction of barcode reference libraries. Using a two-step PCR approach and MiSeq sequencing, we tested a cost-effective method and developed a custom workflow to simultaneously sequence multiple markers (COI, CytbandEF, altogether 2kb) from hundreds of specimens. Interestingly, primers and PCR conditions used for Sanger sequencing did not require optimisation to construct MiSeq library. After completion of quality controls, 87% of the species and 76% of the specimens had valid sequences for the three markers. Nine specimens (3%) exhibited two divergent (up to 10%) sequence clusters. In 95% of the species, MiSeq and Sanger sequences obtained from the same samplings were similar. For the remaining 5%, species were paraphyletic or the sequences clustered into two divergent groups (>7%) on the final trees (Sanger + MiSeq). These problematic cases are difficult to explain but may represent coding NUMTS or heteroplasms. These results highlight the importance of performing quality control steps, working with expert taxonomists and using more than one marker for DNA-taxonomy or species diversity assessment. The power and simplicity of this method appears promising to build on existing experience, tools and resources while taking advantage of NGS.
Azido{1-[2-(dimethylamino)ethyliminomethyl]naphthalenolato}copper(II). Erratum
Authors: Zhu Qi-Yong , Wei Yi-Jun , Wang Feng-Wu
Published: September 2016

In the paper by Zhu et al. [Acta Cryst. (2006), E62, m983–m985], the metal atom was reported incorrectly.