bluuebunny/crossref_metadata_2025 huggingface dataset:
Cold-induced protein RBM3 orchestrates neurogenesis via modulating Yap mRNA stability in cold stress
Authors: Xia Wenlong , Su Libo , Jiao Jianwei
Published: July 2018

In mammals, a constant body temperature is an important basis for maintaining life activities. Here, we show that when pregnant mice are subjected to cold stress, the expression of RBM3, a cold-induced protein, is increased in the embryonic brain. When RBM3 is knocked down or knocked out in cold stress, embryonic brain development is more seriously affected, exhibiting abnormal neuronal differentiation. By detecting the change in mRNA expression during maternal cold stress, we demonstrate that Yap and its downstream molecules are altered at the RNA level. By analyzing RNA-binding motif of RBM3, we find that there are seven binding sites in 3′UTR region of Yap1 mRNA. Mechanistically, RBM3 binds to Yap1-3′UTR, regulates its stability, and affects the expression of YAP1. RBM3 and YAP1 overexpression can partially rescue the brain development defect caused by RBM3 knockout in cold stress. Collectively, our data demonstrate that cold temperature affects brain development, and RBM3 acts as a key protective regulator in cold stress.
Biological Information as Choice and Construction
Authors: Pocheville Arnaud
Published: July 2018

A causal approach to biological information is outlined. There are two aspects to this approach: information as determining a choice between alternative objects and information as determining the construction of a single object. The first aspect has been developed in earlier work to yield a quantitative measure of biological information that can be used to analyze biological networks. This article explores the prospects for a measure based on the second aspect and suggests some applications for such a measure. These two aspects are not suggested to exhaust all the facets of biological information.
Impacts of Mandatory GE Food Labeling: A Quasi‐Natural Experiment
Authors: Carter Colin A. , Schaefer K. Aleks
Published: July 2018

In July 2016, Vermont became the first U.S. state to require mandatory labeling of foods containing genetically engineered (GE) ingredients. The introduction of the Vermont law serves as a quasi‐natural experiment on the economic effects of mandatory GE labeling. We investigate the market response in the U.S. sugar market. Almost all beet sugar is GE, while cane sugar is GE‐free. Prior to 2016, cane and beet sugar were regarded as homogenous. However, in mid 2016, refined cane sugar began selling at a premium over refined beet sugar. We find the mandatory labeling initiative generated about a 13% price discount for beet sugar and a premium of about 1% for cane. Food manufacturers’ concerns over mandatory labeling caused them to switch inputs. This resulted in a redistribution of welfare in the U.S. sugar industry.
The Effect of Microgravity on Central Aortic Blood Pressure
Authors: Seibert Felix S , Bernhard Fabian , Stervbo Ulrik , Vairavanathan Sinthuya , Bauer Frederic , Rohn Benjamin , Pagonas Nikolaos , Babel Nina , Jankowski Joachim , Westhoff Timm H
Published: July 2018

BACKGROUND

Blood pressure has been traditionally measured at peripheral arteries. In the past decade, evidence has grown that central aortic blood pressure may be a more powerful predictor for cardiovascular events, but data on its regulation are rare. The present work examines the impact of microgravity on central blood pressure for the first time.

METHODS

We performed 7 parabolic flights with 22 seconds of weightlessness in each parabola. Hemodynamic parameters including central systolic blood pressure were measured noninvasively in a free-floating position in 20 healthy subjects (19–43 years of age).

RESULTS

Arterial elasticity at rest was normal in all participants (augmentation index 14% (interquartile range (IQR) 10–22), pulse wave velocity 5.2 m/s (IQR 5.0–5.4)). Transition of 1g to 0g led to a significant increase of central systolic blood pressure from 124 (IQR 118–133) to 127 (IQR 119–133) mm Hg (P = 0.017). Cardiac index augmented significantly from 2.5 (IQR 2.2–2.8) to 2.7 (IQR 2.3–3.0) l/min/m2 (P < 0.001), while peripheral vascular resistance showed a decrease from 1.30 (IQR 1.14–1.48) to 1.25 (IQR 1.15–1.40) s × mm Hg/ml (P = 0.037). Peripheral systolic blood pressure did not change significantly (P > 0.05).

CONCLUSION

Whereas there is a multitude of studies on the effects of microgravity on peripheral blood pressure, this study provides first data on central aortic blood pressure. An acute loss of gravity leads to a central blood volume shift with an augmentation of cardiac output. In healthy subjects with normal arterial stiffness, the compensatory decrease of peripheral resistance does not outweigh this effect resulting in an increase of central blood pressure.
Photospheric carbon, nitrogen, and oxygen abundances of A-type main-sequence stars
Authors: Takeda Yoichi , Kawanomoto Satoshi , Ohishi Naoko , Kang Dong-Il , Lee Byeong-Cheol , Kim Kang-Min , Han Inwoo
Published: July 2018

Based on the spectrum fitting method applied to C i 5380, N i 7486, and O i 6156–8 lines, we determined the abundances of C, N, and O for 100 mostly A-type main-sequence stars (late B through early F at $11000\:\mbox{K}\gtrsim T_{\rm eff} \gtrsim 7000\:\mbox{K}$) comprising normal stars as well as non-magnetic chemically peculiar (CP) stars in the projected rotational velocity range of 0 km s$^{-1} \lesssim v_{\rm e}\sin i \lesssim \:100\:$km s−1, where our aim was to investigate the abundance anomalies of these elements in terms of mutual correlation, dependence upon stellar parameters, and difference between normal and CP stars. We found that CNO are generally underabundant (relative to the standard star Procyon) typically by several tenths dex to ∼1 dex for almost all stars (whether CP or normal), though those classified as peculiar (Am or HgMn) tend to show larger underabundance, especially for C in late Am stars and for N in HgMn stars of late B-type, for which the deficiency even amounts up to ∼2 dex. While the behaviors of these three elements are qualitatively similar to each other, the quantitative extent of peculiarity (or the vulnerability to the physical process causing anomaly) tends to follow the inequality relation of C > N > O. Regarding the considerable star-to-star dispersion observed at any Teff, the most important cause is presumably the difference in rotational velocity. These observational facts appear to be more or less favorably comparable with the recent theoretical calculations based on the model of atomic diffusion and envelope mixing.
In Vitro Fungicide-Insensitive Profiles of Sclerotinia homoeocarpa Populations from Pennsylvania and the Surrounding Region
Authors: Stephens Cameron M. , Kaminski John
Published: July 2018

Repeated fungicide applications are typically required to provide adequate control of dollar spot on golf courses and may shift Sclerotinia homoeocarpa populations from sensitive to insensitive or resistant to an active ingredient. The objective of this study was to characterize the geographic distribution of fungicide-insensitive, fungicide-resistant, and multiple fungicide insensitive (MFI) S. homoeocarpa populations on golf courses in Pennsylvania and the surrounding region. S. homoeocarpa isolates (n = 681) were collected from 45 different golf courses or research facilities. Each isolate was evaluated in vitro against propiconazole, iprodione, boscalid, and thiophanate-methyl using discriminatory concentrations of 0.1, 1.0, 1,000, and 1,000 µg of active ingredient per milliliter of PDA, respectively. Relative mycelial growth (RMG) values were used to determine sensitivity or insensitivity based on comparison with a baseline population. Of the 681 isolates evaluated, 81, 80, and 85% exhibited reduced sensitivity to boscalid, iprodione, and propiconazole, respectively. A total of 41% of the isolates were resistant to thiophanate-methyl. Based on mean RMG of all isolates from each golf course, 16, 35, and 37 of the 45 golf courses exhibited reduced sensitivity to boscalid, iprodione, and propiconazole, respectively. A total of 585 isolates (86%) exhibited an MFI profile in which they were insensitive or resistant to at least two fungicides evaluated. Isolates with reduced sensitivity to boscalid, iprodione, and propiconazole, but sensitive to thiophanate-methyl, were the most common phenotype within the three-MFI profile. Fungicide insensitivity and resistance to commonly used fungicides, as well as MFI profiles, were prevalent in Pennsylvania and the surrounding areas and may cause management challenges.
Hydrogen sulfide upregulates renal AQP‐2 protein expression and promotes urine concentration
Authors: Luo Renfei , Hu Shan , Liu Qiaojuan , Han Mengke , Wang Feifei , Qiu Miaojuan , Li Suchun , Li Xiaosa , Yang Tianxin , Fu Xiaodong , Wang Weidong , Li Chunling
Published: July 2018

Increasing evidence supports the important role of H2S in renal physiology and the pathogenesis of kidney injury. Whether H2S regulates water metabolism in the kidney and the potential mechanism are still unknown. The present study was conducted to determine the role of H2S in urine concentration. Inhibition of both cystathionine‐γ‐lyase (CSE) and cystathionine‐β‐synthase (CBS), 2 major enzymes for endogenous H2S production, with propargylglycine (PPG) and amino‐oxyacetate (AOAA), respectively, caused increased urine output and reduced urine osmolality in mice that was associated with decreased expression of aquaporin (AQP)‐2 in the renal inner medulla. Mice treated with both PPG and AOAA developed a urine concentration defect in response to dehydration that was accompanied by reduced AQP‐2 protein expression. Inhibition of CSE alone was associated with a mild decrease in AQP‐2 protein level in the renal medulla of heterozygous CBS mice. GYY4137, a slow H2S donor, markedly improved urine concentration and prevented the down‐regulation of renal AQP‐2 protein expression in mice with lithium‐induced nephrogenic diabetes insipidus (NDI). GYY4137 significantly increased cAMP levels in cell lysates prepared from inner medullary collecting duct (IMCD) suspensions. AQP‐2 protein expression was also upregulated, but was significantly inhibited by the adenyl cyclase inhibitor MDL12330A or the PKA inhibitor H89, but not the vasopressin 2 receptor (V2R) antagonist tolvaptan. Inhibition of endogenous H2S production impaired urine concentration in mice, whereas an exogenous H2S donor improved urine concentration in lithium‐induced NDI by increasing AQP‐2 expression in the collecting duct principal cells. H2S upregulated AQP‐2 protein expression, probably via the cAMP‐PKA pathway.—Luo, R., Hu, S., Liu, Q., Han, M., Wang, F., Qiu, M., Li, S., Li, X., Yang, T., Fu, X., Wang, W., Li, C. Hydrogen sulfide upregulates renal AQP‐2 protein expression and promotes urine concentration. FASEB J. 33, 469–483 (2019). www.fasebj.org
Optimal Conventional Mechanical Ventilation in Full-Term Newborns
Authors: Solberg Marianne Trygg , Solevåg Anne Lee , Clarke Sara
Published: July 2018

Background:

Most studies examining the best mechanical ventilation strategies in newborn infants have been performed in premature infants with respiratory distress syndrome.

Purpose:

To identify and synthesize the evidence regarding optimal mechanical ventilation strategies in full-term newborns.

Methods:

Systematic review carried out according to the methods described in the PRISMA statement.

Search Strategy:

Searches in MEDLINE, EMBASE, CINAHL, and the Cochrane Library in March 2017, with an updated search and hand searches of reference lists of relevant articles in August 2017.

Study Selection:

Studies were included if they were published between 1996 and 2017, involved newborns with gestational age of 37 to 42 weeks, were randomized controlled trials, intervention or crossover studies, and addressed outcomes affecting oxygenation and/or ventilation, and/or short-term outcomes including duration of mechanical ventilation. Because of the large heterogeneity between the studies, it was not possible to synthesize the results in meta-analyses. The results are presented according to thematic analysis.

Results:

No individual study reported research exclusively in newborns 37 to 42 weeks of gestation. Eight studies fulfilled the inclusion criteria, but the population in all these studies included both premature and term newborns. Evidence about mechanical ventilation tailored exclusively to full-term newborns is scarce.

Implication for Practice:

Synchronized intermittent mandatory ventilation with a 6 mL/kg tidal volume and a positive end-expiratory pressure of 8 cm H2O may be advantageous in full-term newborns.

Implication for Research:

There is an urgent need for high-quality studies, preferably randomized controlled trials, in full-term newborns requiring mechanical ventilation to optimize oxygenation, ventilation, and short-term outcomes, potentially stratified according to the underlying pathology.
Comparative Analysis of Bibliometric, Authorship, and Collaboration Trends Over the Past 30-Year Publication History of the Journal of Orthopaedic Trauma and Injury
Authors: Russell Arielle F. , Nguyen Michelle , Bhuiya Mashuq , Likine Elive F. , Fischer James P. , Grassel Kyle , Groswald Michael , Kabir Ryan , Spagna Sydney , Wright Serena , Whipple Elizabeth C. , Kacena Melissa A. , Loder Randall T.
Published: July 2018

Objectives:

In the scientific and medical field, authorship has become increasingly important for tenure and career advancement in addition to improvement in medical care. It was the purpose of this study to investigate changes in bibliometric variables, authorship, and collaboration trends in the Journal of Orthopaedic Trauma (JOT) and Injury over a 30-year period.

Methods:

A bibliometric analysis was completed for all manuscripts meeting the inclusion criteria and published throughout 1 representative year of each decade over the past 30 years. A total of 444 and 1105 manuscripts for JOT and Injury, respectively, met the inclusion criteria. Standard statistical analyses were performed with nonparametric methods for continuous variables and Pearson χ2 and Cochran linear trend tests for categorical variables. A P < 0.05 was considered statistically significant.

Results:

There were significant increases over time in all bibliometric variables for both journals, except in the number of countries and pages in JOT. For JOT, the overall percentage of female first authors increased 2.3 times from 1987 to 2015 (P = 0.021). The overall percentage of female corresponding authors was 7.3%. For Injury, the overall percentage of female first authors increased 1.5 times (P = 0.007). The overall percentage of female corresponding authors was 13.1%.

Conclusions:

Understanding changes in publishing characteristics over time and by region is critical with the rising demands of publishing in academic medicine. JOT and Injury have showed an increase in most variables analyzed. However, female authorship in JOT is climbing at a higher rate than Injury.
Intraoperative Evaluation of the Anatomic Lateral Distal Femoral Angle and Its Variation due to Positioning
Authors: Bergin Patrick F. , Miles Daniel T. , Mathis Taylor P. , Graves Matthew L. , Spitler Clay A. , Replogle William H. , Jones LaRita C. , Stronach Benjamin
Published: July 2018

Background/Purpose:

Preoperative evaluation of the contralateral anatomic lateral distal femoral angle (aLDFA) at our institution is used to judge coronal plane alignment. In our study, we investigated 4 different techniques for obtaining an anteroposterior intraoperative fluoroscopic image of the distal femur to determine which technique provides (1) the greatest interobserver reliability; (2) the lowest variability from the previously published population mean; and (3) the lowest side-to-side variability.

Methods:

Inclusion criteria included lower extremity injuries needing fixation that required intraoperative fluoroscopy with an intact femur and an intact extensor mechanism (N = 100). Fluoroscopic images were obtained of the distal femur in 4 positions differentiated by the position of the limb and the orientation of the C-arm beam to the femoral shaft.

Results:

All measurement techniques resulted in mean measurements within one degree of 81 degrees. Variance between measurements was small among patients with all views, but images that involved a true anteroposterior with the beam perpendicular to the femur had the lowest rate of measurements that were <78 or >84 degrees.

Conclusion:

Side-to-side differences in patients were <2 degrees on average with every image used. With the best-performing images, 20% of patients had an aLDFA > 3 degrees different from the population mean of 81 degrees and 3% of patients were >5 degrees different. Although restoring aLDFA to 81 degrees will be within 3 degrees of the contralateral side the vast majority of the time, matching the aLDFA to the injured side will be the most accurate reconstruction.
Manipulation Under Anesthesia as a Treatment of Posttraumatic Elbow Stiffness
Authors: Spitler Clay A. , Doty Daniel H. , Johnson Michael D. , Nowotarski Peter J. , Kiner Dirk W. , Swafford Rachel E. , Jemison D. Marshall
Published: July 2018

Objectives:

Evaluate the safety and efficacy of manipulation under anesthesia (MUA) for posttraumatic elbow stiffness.

Design:

Retrospective, case series.

Setting:

Single institution; level 1 trauma center.

Patients/Participants:

Chart review of 45 patients over a 10-year period treated with MUA for posttraumatic elbow stiffness after elbow injuries treated both operatively and nonoperatively.

Intervention:

None.

Main Outcome Measures:

Change in total flexion arc pre- to postmanipulation; time to manipulation; complications.

Results:

Average time from most recent surgical procedure or date of injury to MUA was 115 days. Average premanipulation flexion arc was 57.9 degrees; average flexion arc at the final follow-up was 83.7 degrees. The improvement in elbow flexion arc of motion was statistically significant (P < 0.001). Post hoc analysis of the data revealed 2 distinct groups: 28 patients who underwent MUA within 3 months of their most recent surgical procedure (early manipulation), and 17 patients who underwent MUA after 3 months (late manipulation). Average improvement in elbow flexion arc in the early MUA group was 38.3 degrees (P < 0.001); improvement in the late MUA group was 3.1 degree. Comparison of improvement between the early and late MUA groups found a significant difference (P < 0.001) in mean flexion arc improvement from premanipulation to postmanipulation, favoring the early group. One patient had a complication directly attributable to MUA. Nineteen patients required additional procedures on the injured extremity after MUA.

Conclusions:

MUA is a safe and effective adjunct to improving motion in posttraumatic elbow stiffness when used within 3 months from the original injury or time of surgical fixation. After 3 months, MUA does not reliably increase elbow motion.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Current Practices for Multimodal Pain Management Using Liposomal Bupivacaine in Extracapsular and Intracapsular Hip Fracture Surgery: Expert Panel Opinion
Authors: Amin Nirav H. , Hutchinson Hank L. , Sanzone Anthony G.
Published: July 2018

Background:

Liposomal bupivacaine (LB) has demonstrated efficacy across a range of surgical settings, including shoulder, knee, and hip surgery. However, data are limited on the use of LB as part of a multimodal pain management approach in hip fracture surgery.

Methods:

On April 1, 2017, 4 orthopaedic surgeons and 3 anesthesiologists convened to discuss current practices and develop a consensus statement related to local infiltration analgesia with LB for hip fracture surgical procedures within the context of a multimodal opioid-sparing pain management approach. Separate workshops addressed intracapsular and extracapsular hip fracture surgery.

Results:

Multimodal strategies before, during, and after hip fracture surgery are paramount to optimizing pain control and minimizing opioid requirements. LB infiltration should occur intraoperatively near the time of closing the incision. For both intracapsular and extracapsular procedures, oral or intravenous acetaminophen, a nonsteroidal anti-inflammatory drug (NSAID) of choice, and tramadol should be given preoperatively. Presurgical fascia iliaca block with bupivacaine HCl may help bridge the period before LB takes effect. After both procedures, patients should receive 1 dose of intravenous acetaminophen, an NSAID, and opioid rescue medication as needed, starting with tramadol. Postoperative NSAIDs may help minimize opioid use. Patient and provider education are integral to managing patient expectations and alleviating concerns about pain and opioid use. Standardized, validated, and appropriately timed pain assessments are also necessary to optimize postsurgical pain management.

Conclusions:

These consensus recommendations regarding multimodal pain management protocols incorporating local infiltration analgesia with LB for extracapsular and intracapsular hip fracture procedures serve as a basis for additional research.

Level of Evidence:

Level V.
Infiltration Techniques for Local Infiltration Analgesia With Liposomal Bupivacaine in Extracapsular and Intracapsular Hip Fracture Surgery: Expert Panel Opinion
Authors: Amin Nirav H. , Hutchinson Hank L. , Sanzone Anthony G.
Published: July 2018

Background:

Liposomal bupivacaine (LB) has demonstrated efficacy in improving pain scores and reducing opioid consumption across a variety of surgical settings, including orthopaedic surgery. However, meticulous infiltration techniques combined with a multimodal approach are important to optimizing outcomes.

Methods:

A panel of 4 orthopaedic surgeons and 3 anesthesiologists convened on April 1, 2017, to discuss current practices and develop a consensus statement regarding local infiltration analgesia with LB for extracapsular and intracapsular hip fracture surgery, including LB infiltration techniques.

Results:

Optimizing surgical outcomes with LB in hip fracture surgery requires an understanding of the neuroanatomy of the surgical site and the pharmacology of the drug. Meticulous infiltration technique is critical to achieve optimal results with LB given its viscosity and reduced diffusion compared with bupivacaine HCl. For extracapsular procedures, a total injection volume of 120 mL is recommended, whereas intracapsular procedures typically require a lower volume (∼80 mL). In both cases, infiltration is best achieved using a 22-gauge needle and applying a tracking and/or fanning technique. To ensure optimal placement, LB should be infiltrated using multiple, small-volume (1- to 5-mL) injections spaced at 1.0-cm intervals.

Conclusions:

These consensus recommendations regarding LB infiltration techniques can serve as a resource for designing clinical studies to evaluate outcomes using periarticular infiltration of LB in extracapsular and intracapsular hip fracture surgery as part of a multimodal pain management approach.

Level of Evidence:

Level V.
Multimodal Pain Strategies Including Liposomal Bupivacaine for Isolated Acetabular Fracture Surgery
Authors: Langworthy Michael J. , Sanzone Anthony G.
Published: July 2018

Background:

The incidence of isolated acetabular fractures has been increasing, particularly in older adult patients. These fractures can be debilitating and may require prolonged immobilization and/or complex surgical reconstruction. Liposomal bupivacaine (LB) is a prolonged-release form of bupivacaine demonstrated to be effective in orthopaedic surgery. Defining a multimodal pain management plan, which incorporates optimized techniques for use of LB in acetabular surgery, may improve outcomes for patients.

Methods:

Two orthopaedic surgeons specializing in orthopaedic traumatology discussed best practices for infiltration of LB and recommendations for perioperative use of LB plus other anesthetics/analgesics for isolated acetabular fracture surgery.

Results:

Consensus techniques for isolated posterior and anterior acetabular fractures were developed. LB (266 mg/20 mL) should be expanded with 50 mL of bupivacaine HCl 0.25% and saline to a total volume of 120 or 300 mL for the posterior or anterior techniques, respectively. A 3.5-inch spinal needle is inserted tangentially, infiltrating 1 mL/cm into the fracture site, periosteum, muscle fascia, subcutaneous tissue, and skin. Patients receive acetaminophen, celecoxib, gabapentin, and opioids before surgery, adjusting appropriately for patient comorbidities and potential drug–drug interactions. At the end of the surgery, before closure, LB is infiltrated and patients receive a dose of intravenous acetaminophen. Presurgical medications are continued after surgery for approximately 10–14 days, after which opioids are only considered to treat breakthrough pain.

Conclusions:

These recommendations can be used to optimize and streamline care for patients with isolated acetabular fractures and act as a foundation for additional clinical research.

Level of Evidence:

Therapeutic Level V.
Comparison of the Pain Sensitivity Questionnaire and the Pain Catastrophizing Scale in Predicting Postoperative Pain and Pain Chronicization After Spine Surgery
Authors: Tuna Turgay , Boz Sibel , Van Obbergh Luc , Lubansu Alphonse , Engelman Edgard
Published: July 2018

Study Design:

This was a prospective study evaluating the Pain Sensitivity Questionnaire (PSQ) in 110 patients undergoing spine surgery.

Objective:

The purpose of this study was to compare the ability of the PSQ-total and PSQ-minor scores with the Pain Catastrophizing Scale (PCS) in predicting the immediate postoperative pain of patients after spinal surgery and their risk of developing a chronically painful state.

Summary of Background Data:

Studies evaluating the PSQ as a preoperative determinant for the development of chronic pain are lacking. Therefore, we undertook the following study.

Materials and Methods:

Patients undergoing lumbar or cervical spine surgery were prospectively included in the study. The PSQ-total and PSQ-minor, the PCS and its subscores, the Oswestry Disability Index (ODI) and the Neck Disability Index were used preoperatively. Preoperative and postoperative Visual Analog Scale scores for pain at rest and movement and analgesics were recorded. At 12 months postoperatively, the Neck Disability Index and the ODI were once more assessed to evaluate pain chronicization.

Results:

A total of 110 patients scheduled to undergo surgery at our spine center participated in the study. Our results highlighted that Visual Analog Scale scores were increased for high catastrophizers at rest on the first postoperative day when compared with low catastrophizers. Preoperative use of opioids and a high score on the rumination subscale of the PCS were linked to greater postoperative morphine consumption. At 12 months, the PCS, the PSQ-total, and PSQ-minor showed correlations with the development of a chronically painful state for ODI scores >21, indicating a marked persistent disability.

Conclusions:

Both PSQ and PCS showed an ability to predict a chronically painful state as defined by the persistence of disability after lumbar surgery.
Why a P-Value is Not Enough
Authors: Solla Federico , Tran Antoine , Bertoncelli Domenico , Musoff Charles , Bertoncelli Carlo M.
Published: July 2018

Background:

All doctors know that P-value<0.05 is “the Graal,” but publications require further parameters [odds ratios, confidence interval (CI), etc.] to better analyze scientific data.

Aim:

The aim of this study was to present P-values, CI, and common effect-sizes (Cohen d, odds ratio, and various coefficients) in a simple way.

Description:

The P-value is the probability, when the null hypothesis is true (eg, no difference or no association), of obtaining a result equal to or more extreme than what we actually observed. Simplistically, P-value quantifies the probability that the result is due to chance. It does not measure how big the association or the difference is. The CI on a value describes the probability that the true value is within a given range. A 95% CI means that the CI covers the true value in 95 of 100 performed studies. The test is significant if the CI does not include the null hypothesized difference or association (eg, 0 for difference). The effect-sizes are quantitative measures of the strength of a difference or association. If the P-value is <0.05 but the effect size is very low, the test is statistically significant but probably, clinically not so.

Conclusions:

Scientific publications require more parameters than a P-value. Statistical results should also include effect sizes and CIs to allow for a more complete, honest, and useful interpretation of scientific findings.
Acupuncture-Associated Mycobacterium goodii Infection of Prosthetic Knee Joint
Authors: Kruse Jason P. , Lewis Roshan J. , Smith Hayden L. , Taylor Matthew J.
Published: July 2018

Mycobacterium goodii is rarely associated with prosthetic joint infections. We report a case of M. goodii septic arthritis in an adult with a prosthetic knee–associated diagnosis subsequent to acupuncture. In patients with prosthetic joint replacements receiving acupuncture therapy, one should consider avoiding insertions near these joints.
Left dorsolateral prefrontal cortex repetitive transcranial magnetic stimulation reduces the development of long-term muscle pain
Authors: Seminowicz David A. , de Martino Enrico , Schabrun Siobhan M. , Graven-Nielsen Thomas
Published: July 2018

The left dorsolateral prefrontal cortex (DLPFC) is involved in the experience and modulation of pain, and may be an important node linking pain and cognition. Repetitive transcranial magnetic stimulation (rTMS) to the left DLPFC can reduce chronic and experimental pain. However, whether left DLPFC rTMS can influence the development of chronic pain is unknown. Using repeated intramuscular injection of nerve growth factor to induce the development of sustained muscle pain (lasting weeks), 30 healthy individuals were randomized to receive 5 consecutive daily treatments of active or sham left DLPFC rTMS, starting before the first nerve growth factor injection on day 0. Muscle soreness and pain severity were collected daily for 14 days and disability on every alternate day. Before the first and 1 day after the last rTMS session, anxiety, depression, affect, pain catastrophizing, and cognitive performance on the attention network test were assessed. Left DLPFC rTMS treatment compared with sham was associated with reduced muscle soreness, pain intensity, and painful area (P < 0.05), and a similar trend was observed for disability. These effects were most evident during the days rTMS was applied lasting up to 3 days after intervention. Depression, anxiety, pain catastrophizing, and affect were unchanged. There was a trend toward improved cognitive function with rTMS compared with sham (P = 0.057). These data indicate that repeated left DLPFC rTMS reduces the pain severity in a model of prolonged muscle pain. The findings may have implications for the development of sustained pain in clinical populations.
Healthcare Strategies for Reducing Pregnancy-Related Morbidity and Mortality in the Postpartum Period
Authors: Bingham Debra , Suplee Patricia D. , Morris Melanie Hall , McBride Meredith
Published: July 2018

The majority of pregnancy-related deaths in the United States occur in the postpartum period, after a woman gives birth. Many of these deaths are preventable. Researchers and health care providers have been focusing on designing and implementing strategies to eliminate preventable deaths and ethnic and racial disparities. Six healthcare strategies for reducing postpartum maternal morbidity and mortality will be described. These strategies, if provided in an equitable manner by all providers to all women, will assist in closing the disparity in outcomes between black women and women of all other races and ethnicities who give birth throughout the United States.
Maternal Mortality and Morbidity in the United States
Authors: Troiano Nan H. , Witcher Patricia M.
Published: July 2018

The United States has experienced a steady rise in pregnancy-related deaths over the last 3 decades. The rate of severe maternal morbidity has also increased. It is estimated that approximately 50% of maternal deaths are preventable. National, multidisciplinary, collaborative efforts are required to effectively address this problem. The complex nature of certain conditions and the concomitant risk of significant maternal morbidity and mortality have yielded a subset of women who require obstetric critical care. Institutions and clinicians face challenges as they identify a framework within which to provide this specialized level of care. Systematic, multidisciplinary review of maternal morbidity and mortality events continues to generate meaningful data and recommendations for improvement. The purpose of this article was to describe important concepts related to maternal mortality including the classification and leading causes of maternal death in the United States. The preventability of maternal mortality is also explored including evidence-based best practices and strategies.
An Examination of the Moderating Effect of Proactive Coping in NICU Nurses
Authors: Moore Britan M. , Schellinger Kriston
Published: July 2018

Neonatal intensive care unit (NICU) nurses experience increased risk for depression, secondary traumatic stress, and burnout. This study examined whether the use of problem-solving or support-seeking strategies moderated the relationship between secondary traumatic stress levels, depressive symptomology, and burnout in NICU nurses. Multiple linear regression and a hierarchical stepwise technique were used to conduct moderation analyses. Results indicated that support-seeking coping skills significantly moderated the relationship between secondary traumatic stress symptoms and burnout symptoms. Coping did not moderate the relationship between depression and burnout. These findings can be used to inform the development of programs that could promote the well-being and coping of nurses experiencing mental health difficulties or burnout and foster a healthy work environment for all NICU nurses so that they can provide the best possible intervention to vulnerable infants. Future research should aim to identify interventions that promote coping in NICU nurses.
The sliding set-point: how insulin and diet interact to explain the obesity epidemic (and how to fix it)
Authors: Gower Barbara A. , Goss Amy M.
Published: July 2018

Purpose of review

The current approach to weight loss (intentional energy deficit) is difficult to implement and sustain, and rarely leads to successful long-term weight loss maintenance. The aim of this article is to review recent literature on the role of insulin in obesity propensity, and by extension, the effectiveness of carbohydrate restriction in facilitating weight loss, with particular attention to individual variability in patient response.

Recent findings

A genetic signature for insulin secretion predisposes to elevated BMI. A genetic signature for insulin resistance is a marker for impaired fat storage, is associated with relative leanness, and predisposes to cardiometabolic disease. The largest randomized weight-loss trial ever conducted to examine insulin/diet interactions revealed no interactive effect of insulin phenotype with diet composition on body weight in the context of energy restriction. However, smaller studies revealed unique effects of carbohydrate restriction on energy partitioning that are not reflected in body weight; that is, preferential loss of total and ectopic adipose tissue. Carbohydrate-restricted diets are associated with greater adherence, and with greater total and resting energy expenditure.

For patients with a predisposition to high insulin secretion, carbohydrate restriction may facilitate long-term reductions in body fat, perhaps by reducing hunger, maintaining energy expenditure, and promoting adherence.
The anteromedial thigh free flap: a primary reconstructive option or second best?
Authors: Hoshal Steven G. , Bewley Arnaud F.
Published: July 2018

Purpose of review

This article reviews the recent literature on the anteromedial thigh free flap.

Recent findings

The anteromedial thigh (AMT) free flap is an excellent reconstructive option for head and neck defects. It is often overshadowed by the anterolateral thigh (ALT) free flap. Lack of familiarity with the anatomy of the AMT likely deters many surgeons from considering it as a reliable option. However, as many as one in 20 patients may not have anatomy suitable for ALT free-flap harvest, and in these cases the AMT provides an ideal alternative as it can be harvested through the same incision without added morbidity. Current areas of research include clinical, anatomic, cadaveric, and radiographic studies evaluating the AMT flap anatomy and utility.

The AMT flap has been successfully used to reconstruct the same types of soft tissue head and neck defects as the ALT. However, given that approximately 95% of patients appear to have anatomy favorable to harvest an ALT, the utility of the AMT should be reserved for patients with unfavorable lateral thigh anatomy or when when a chimeric flap is indicated and anatomy permits.
Medical management of aortic disease in children with Marfan syndrome
Authors: Lindsay Mark E.
Published: July 2018

Purpose of review

Marfan syndrome (MFS) is the most common cause of aortic aneurysm in children and is associated with premature mortality. Whereas surgical therapy remains the primary treatment to prevent aortic complications, medical therapy may slow or prevent aortic growth. Pediatricians and pediatric cardiologists should become familiar with the diagnosis and management of MFS. This review focuses on the medical management for the most important life-threatening manifestation of MFS, thoracic aortic disease.

Recent findings

Several large-scale clinical trials and one meta-analysis have been reported comparing angiotensin receptors blockers with the standard therapy, beta blockers.

From the assembled evidence described in this review, beta blockers and angiotensin receptors blockers show clinical equivalence and either class of agent may be an appropriate choice for the medical management of aortic growth in children with MFS.
Transitioning Emerging Leaders Into Nurse Leader Roles
Authors: Sherman Rose O. , Saifman Heather
Published: July 2018

Millennials will soon comprise 50% of the nursing workforce. Leaders in organizations look to this generation to assume leadership roles. This is proving to be challenging in many settings. Learning how to more effectively recruit, transition, and retain these emerging nurse leaders will be critical to organizations and the future of nursing. This article presents academic and organizational practices in emerging leader transition tailored to the needs of the millennial generation.
AONE Foundation Embarks on New Initiatives
Authors: Begley Robyn
Published: July 2018

The AONE Foundation for Nursing Leadership Research and Education has created new grant opportunities and last year funded research projects that will directly assist nurse leaders. This article outlines the foundation’s direction and priorities going forward.
The Development and Validation of an Acuity Tool in a Pediatric Outpatient Burn Clinic
Authors: Swan-Mahony Arlene , Sadler Lois S. , Dixon Jane
Published: July 2018

In outpatient settings, the role of nursing has shifted from episodic, reactive care to management of patients with higher acuity. In a pediatric outpatient clinic specializing in burn injuries, it became apparent that the lack of an acuity tool to measure patient complexity challenged efficient nurse staffing and patient satisfaction. In this quality improvement project, we developed a patient acuity tool to help determine nurse staffing, improve workload efficiencies, and improve the delivery of care.
Relationships Among Nurse Manager Leadership Skills, Conflict Management, and Unit Teamwork
Authors: Grubaugh Martha L. , Flynn Linda
Published: July 2018

OBJECTIVE

The aim of this study is to examine the relationships among staff nurse perceptions of their nurse manager (NM) leadership ability, conflict management, and team backup on medical-surgical units.

BACKGROUND

Team backup, an important component of teamwork, is crucial to patient safety and outcomes. A threat to successful teamwork is ineffective conflict management. There is scant knowledge, however, about NM conflict management skills and unit teamwork through the concept of team backup.

METHODS

Secondary analyses were conducted utilizing data previously collected from a sample of 257 staff nurses. A series of multiple regressions, including a mediation model, were estimated to determine relationships among variables.

RESULTS

Positive relationships were substantiated among the variables of NM leadership ability, conflict management, and team backup. Staff nurse perceptions of NM leadership ability were a significant predictor of conflict management and team backup.

CONCLUSION

Findings support the importance of the NM demonstrating skilled leadership and the ability to manage conflicts and to develop team backup. This study further highlights the importance of conflict management as a leadership competency.
Exploring the Relationship Between Nursing Specialty Certification and Surgical Site Infections
Authors: Bergquist-Beringer Sandra , Cramer Emily , Potter Catima , Stobinski James X. , Boyle Diane K.
Published: July 2018

OBJECTIVE

The aim of this study is to explore the relationship between nursing specialty certification and surgical site infections (SSIs) for colon (COLO) and abdominal hysterectomy (HYST) surgical procedures.

BACKGROUND

SSI following COLO and HYST procedures is a preventable complication now included in the Centers for Medicare & Medicaid Services’ Hospital Inpatient Quality Reporting Program.

METHODS

Data from 69 hospitals, 346 units, and 6585 RNs participating in the National Database of Nursing Quality Indicators and SSI data on 22 188 patient COLO and HYST procedures from the National Healthcare Safety Network were examined in multivariate logistic regression analysis.

RESULTS

Magnet® status was associated with lower SSI occurrence after adjusting for other variables. Higher American Society of Anesthesiologists scores, longer surgical procedure time, and wound class were associated with higher SSI occurrence.

CONCLUSIONS

Future theory-based research should examine the association of nursing specialty certification with patient outcomes and investigate the effect of Magnet status on SSI.
Engagement in HIV Care Among Young Female Sex Workers in Zimbabwe
Authors: Napierala Sue , Chabata Sungai Tafadzwa , Fearon Elizabeth , Davey Calum , Hargreaves James , Busza Joanna , Mushati Phillis , Mtetwa Sibongile , Chiyaka Tarisai , Mugurungi Owen , Hanisch Dagmar , Hatzold Karin , Phillips Andrew , Cowan Frances M.
Published: July 2018

Introduction:

Young female sex workers (FSWs) are at greater HIV risk than their older counterparts. Yet, the extent of their engagement with HIV services is largely unknown. We compared engagement among FSWs aged 18–24 years with those 25 years and older.

Methods:

We used respondent-driven sampling to recruit FSWs from 14 communities in Zimbabwe from November to December 2013. We collected data on demographics, behavior, service uptake, and HIV and viral load testing. Data were pooled and weighted using respondent-driven sampling-2 estimation. We analyzed HIV care cascade variables by age group. To identify potential drivers of younger FSW service use, we explored factors associated with knowing one's HIV status.

Results:

Among 2617 participants, mean age was 31 years and 26% were 18–24 years. Over half of FSWs initiated sex work before the age of 25 years. Overall HIV prevalence was 59% but was lower among younger FSWs (35% vs 67%, P < 0.01). Younger HIV-infected FSWs were significantly less engaged at each step of the care cascade. Among younger FSWs reporting antiretroviral therapy use, 62% had an undetectable viral load compared with 79% in older FSWs. In multivariable regression, young FSWs encouraged to have an HIV test by another FSW (adjusted odds ratio = 2.54; 95% confidence interval: 1.44 to 4.50), and those with no recent clients (adjusted odds ratio = 4.31; 95% confidence interval: 1.30 to 14.33) were more likely to report knowing their status.

Conclusions:

The high proportion of FSWs initiating sex work before the age of 25 years and their lower engagement in HIV services highlights the importance of considering this vulnerable population in HIV programming. Implementing targeted services tailored to the unique needs of young FSWs is a public health imperative.
Unusual Case of Metastatic Intracranial Hemangiopericytoma and Emphasis on Role of 68Ga-PSMA PET in Imaging
Authors: Patro Kanhu Charan , Palla Madhuri , Kashyap Raghava
Published: July 2018

We present a 53 year old woman initially diagnosed as hemangiopericytoma in the posterior fossa on the right side post excision with immunohistochemistry staining for CD34 being positive. Presently, the patient had difficulty in walking due to back pain and pain in left arm. Imaging with 18F-FDG PET showed low glucose avidity in disease sites but 68Ga-PSMA PET unequivocally demonstrated multiple skeletal and liver metastases with intense PSMA avidity. Patient received palliative radiotherapy to bone metastasis and was planned for chemotherapy. This report adds to the list of applications of 68Ga PSMA PET and a possible theranostic target.
Amiodarone-Induced Thyrotoxicosis
Authors: Censi Simona , Bodanza Valentina , Manso Jacopo , Gusella Sara , Watutantrige-Fernando Sara , Cavedon Elisabetta , Barollo Susi , Bertazza Loris , Cecchin Diego , Mian Caterina
Published: July 2018

Purpose of the Report

Distinguishing between amiodarone-induced thyrotoxicosis (AIT) caused by excessive hormone synthesis (AIT-1) or by a destructive process (AIT-2) has important therapeutic implications, but is still difficult and debated. 99mTc-sestaMIBI thyroid scintigraphy (99m-STS) has been proposed as a tool for classifying the two forms.

Material and Methods

30 AIT patients (11 females and 19 males) who underwent 99m-STS were retrospectively assessed for the present study. For each patient, a target-to-background ratio (TBR) was obtained on planar images. The TBR was then correlated with the qualitative assessment of the scans and the final clinical diagnosis.

Results

Considering clinical response to treatment as the gold standard for differential diagnosis, 14 cases of AIT-1, 12 of AIT-2, and 4 mixed forms were identified. 99m-STS was able to qualitatively identify all the mixed forms, while 1/14 AIT-1 and 6/12 AIT-2 cases were misdiagnosed as mixed forms. When the quantitative index (the TBR) was compared with the final clinical diagnosis, ROC curve analysis enabled us to identify an IBR of 0.482 during 99m-STS as a cut-off capable of discriminating between AIT-1 and AIT-2, with 100% specificity and 91.7% sensitivity (P < 0.0001, area under the curve: 0.982).

Conclusions

Taking the TBR into consideration, 99m-STS proved a very useful tool for distinguishing AIT-1 from AIT-2, and thus offering patients appropriate treatment as of their diagnosis. This approach can avoid pointless and potentially dangerous combined overtreatments, and may speed up the return to normal thyroid function, which is crucial in AIT patients suffering from heart disease.