bluuebunny/crossref_metadata_2025 huggingface dataset:
A broad atlas of somatic hypermutation allows prediction of activation-induced deaminase targets
Authors: Álvarez-Prado Ángel F. , Pérez-Durán Pablo , Pérez-García Arantxa , Benguria Alberto , Torroja Carlos , de Yébenes Virginia G. , Ramiro Almudena R.
Published: January 2018

Activation-induced deaminase (AID) initiates antibody diversification in germinal center (GC) B cells through the deamination of cytosines on immunoglobulin genes. AID can also target other regions in the genome, triggering mutations or chromosome translocations, with major implications for oncogenic transformation. However, understanding the specificity of AID has proved extremely challenging. We have sequenced at very high depth >1,500 genomic regions from GC B cells and identified 275 genes targeted by AID, including 30 of the previously known 35 AID targets. We have also identified the most highly mutated hotspot for AID activity described to date. Furthermore, integrative analysis of the molecular features of mutated genes coupled to machine learning has produced a powerful predictive tool for AID targets. We also have found that base excision repair and mismatch repair back up each other to faithfully repair AID-induced lesions. Finally, our data establish a novel link between AID mutagenic activity and lymphomagenesis.
Initiation of inflammatory tumorigenesis by CTLA4 insufficiency due to type 2 cytokines
Authors: Miska Jason , Lui Jen Bon , Toomer Kevin H. , Devarajan Priyadharshini , Cai Xiaodong , Houghton JeanMarie , Lopez Diana M. , Abreu Maria T. , Wang Gaofeng , Chen Zhibin
Published: January 2018

Genetically predisposed CTLA4 insufficiency in humans is associated with gastric cancer development, which is paradoxical to the prototypical role of CTLA4 in suppressing antitumor immunity. CTLA4 is a critical immune checkpoint against autoimmune disorders. Autoimmunity has been implicated in protumor or antitumor activities. Here, we show that CTLA4 insufficiency initiates de novo tumorigenesis in the mouse stomach through inflammation triggered by host-intrinsic immune dysregulation rather than microbiota, with age-associated progression to malignancy accompanied by epigenetic dysregulation. The inflammatory tumorigenesis required CD4 T cells, but not the TH1 or TH17 subsets. Deficiencies in IL-4 and IL-13 or IL-4 receptor α broke the link between inflammation and initiation of tumorigenesis. This study establishes the causality of CTLA4 insufficiency in gastric cancer and uncovers a role of type 2 inflammation in initiating gastric epithelial transformation. These findings suggest possible improvement of immune therapies by blocking tumorigenic type 2 inflammation while preserving antitumor type 1 immunity.
The Role of Metaforces in Cultural Motion
Authors: Urban Greg
Published: January 2018

Exploring interactions among the forces (inertia, entropy, interest, and metaculture) that affect the motion of culture generally, this article focuses on metapragmatic indexicals as well as denotationally explicit metapragmatic signs, whose effects Silverstein dubbed “metaforce.” Pitch raising, as a metapragmatic indexical employed in narration, builds excitement in relationship to an unfolding stretch of mythic discourse, thereby contributing to the interest in that discourse that also impels its future replication. The interest in learning something new that drives the processes of replication underlying ordinary conversation can be aided by questions, as explicit metapragmatic formulations projecting the discourse shape of the desired response, just as explicit metapragmatic statements can be used to block expected replication processes in the flow of conversation, exerting a resistance. Interest can also be channeled from one discursive arena (such as wine talk) to another (such as coffee talk) through the process Silverstein calls “emanation,” based on similarities in the discourse form and content, a kind of metapragmatic iconicity. The article concludes by suggesting that similar processes are at work in disciplinary arenas, where Silverstein’s term “metapragmatics” itself has come to shape the entire field of linguistic anthropology and to be widely replicated elsewhere.
Indexicality’s Ambivalent Ground
Authors: Nakassis Constantine V.
Published: January 2018

Through its theorization and elaboration in the path-breaking work of Michael Silverstein, indexicality has served as a foundational analytic category for linguistic anthropology, both in its ethnographic analyses as well as in its theoretical interventions into key issues in the philosophy of language, linguistics, and sociocultural anthropology. The working out of indexicality’s implications for the study of semiosis—and more particularly, language in culture—has and continues to produce a vital and dynamic theoretical field of scholarly activity. This vitality, I argue, emerges from a foundational ambivalence within the category of indexicality: between, on the one hand, immediacy and presence and, on the other hand, mediation and representation. Productively unresolved, this ambivalence is less a problem than an opportunity and invitation for further ethnographic and analytic refinement of our accounts of (meta)semiosis and social life. A reflexive and deconstructive turn to indexicality’s ambivalent ground, then, is implied and necessitated by the category itself, though this in no way obviates its utility for semiotic and ethnographic theory and analysis; indeed, as I argue, such a turn is critical to indexicality’s ongoing utility to both.
Indexical Disorders and Ritual (De)Centers of Semiosis
Authors: Briggs Charles L.
Published: January 2018

Focusing on Michael Silverstein’s account of relationships between “microcontexts of interaction” and the “macrosociological,” this article takes up his suggestion that news reporting provides particularly clear examples of such links. Examining a mundane ABC World News report on changing recommendations for vitamin intake, it analyzes how leading physician-journalist Richard Besser constructs a ritual center of medical semiosis, projects it as inaccessible to laypersons, and models a circulatory process that requires highly constrained forms of communication. Ethnography in newsrooms, clinical spaces, public health offices, and elsewhere suggests how notions of (1) a ritual center that produces medical knowledge, (2) a primordial space of doctor-patient interaction that affords limited, highly regulated access to laypersons, and (3) what are construed as processes of communication require the continual making of communicable models that attempt to separate projected first and second indexical orders and, just as importantly, generate indexical disorders that create anxiety and seem to require assistance from physician-journalist guides.
On the Pragmatic Poetry of Pose: Gesture, Parallelism, Politics
Authors: Lempert Michael
Published: January 2018

Poetics matters in gestural pragmatics. The recurrent returns of cospeech manual gesture, which appear as “repetitions” and “parallelisms” of handshape and movement pattern, deserve close attention for their pragmatic potential. To appreciate how poetically dimensionalized gestures can contribute to everything from cohesion to speech-act performativity, we need a turn akin to what Michael Silverstein once called a “pragmatic-poetic turn” for discursive interaction. In domains of sociocultural life where persuasion is self-consciously instrumentalized, the poetics of manual gesture can assume additional significance. In the mass mediatized debates and speeches of presidential campaign politics, poetically dimensionalized manual gesture is not only pronounced but has become a basis for enregisterment, for constituting political gesture as a distinct mode of persuasive, embodied communication: the “political” in political gesture is constituted in part by a reflexive, aesthetico-pragmatic sourcing of poetics as a (if not the) measure of rhetorical “effectiveness” and “eloquence.”
Spatial and Temporal Variation in the Value of the Women, Infants, and Children Program's Fruit and Vegetable Voucher
Authors: Çakır Metin , Beatty Timothy K.M. , Boland Michael A. , Park Timothy A. , Snyder Samantha , Wang Yanghao
Published: January 2018

Increasing the consumption of fresh fruits and vegetables among children and low‐income households is a public health policy priority in the United States. We investigate temporal and spatial price patterns for fresh fruits and vegetables to evaluate the extent to which the value of the fruit and vegetable Cash‐Value‐Voucher (CVV) of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) may be affected by unequal price levels and changes in price levels across the United States. Our findings show that price differences over space and time have real and consequential impacts on the purchasing power of the CVV. A WIC Program participant in the highest‐cost Metropolitan Statistical Area (MSA) can buy significantly fewer fruits and vegetables than a participant who receives the same benefit in the lowest‐cost MSA. Further, we find that the value of the CVV has substantially declined across all MSAs since 2009. We discuss the nutritional implications of the variation in the value of the CVV and evaluate potential mechanisms that could be implemented to maintain equal CVV benefits across time and space.
Measuring Potential Rents in the North Sea Herring Fishery
Authors: Arnason Ragnar , Bjørndal Trond , Gordon Daniel V. , Bezabih Mintewab
Published: January 2018

This paper assesses the potential for rent generation in the North Sea herring fishery. The assessment distinguishes between rents and intra‐marginal profits—the sum of which constitutes variable profits in the fishery. A bioeconomic model combining fish population dynamics and the economics of the fishery is constructed to allow the computation of these different components of profits. In order to assess the dynamics of both rents and intra‐marginal profits, the model is computed under various assumptions with regard to price, costs, and discount rates. Potential total profits are measured at £88 to £89 million annually, of which rents make up about £87 million with intra‐marginal profits measured in the order of only £2 million. The study further shows that, in this fishery, rent is dissipated mainly due to excess effort but also due to suboptimal stock size.
TOXsIgN: a cross-species repository for toxicogenomic signatures
Authors: Darde Thomas A , Gaudriault Pierre , Beranger Rémi , Lancien Clément , Caillarec-Joly Annaëlle , Sallou Olivier , Bonvallot Nathalie , Chevrier Cécile , Mazaud-Guittot Séverine , Jégou Bernard , Collin Olivier , Becker Emmanuelle , Rolland Antoine D , Chalmel Frédéric
Published: January 2018

Motivation

At the same time that toxicologists express increasing concern about reproducibility in this field, the development of dedicated databases has already smoothed the path toward improving the storage and exchange of raw toxicogenomic data. Nevertheless, none provides access to analyzed and interpreted data as originally reported in scientific publications. Given the increasing demand for access to this information, we developed TOXsIgN, a repository for TOXicogenomic sIgNatures.

Results

The TOXsIgN repository provides a flexible environment that facilitates online submission, storage and retrieval of toxicogenomic signatures by the scientific community. It currently hosts 754 projects that describe more than 450 distinct chemicals and their 8491 associated signatures. It also provides users with a working environment containing a powerful search engine as well as bioinformatics/biostatistics modules that enable signature comparisons or enrichment analyses.

Availability and implementation

The TOXsIgN repository is freely accessible at http://toxsign.genouest.org. Website implemented in Python, JavaScript and MongoDB, with all major browsers supported.

Supplementary information

Supplementary data are available at Bioinformatics online.
Accurity: accurate tumor purity and ploidy inference from tumor-normal WGS data by jointly modelling somatic copy number alterations and heterozygous germline single-nucleotide-variants
Authors: Luo Zhihui , Fan Xinping , Su Yao , Huang Yu S
Published: January 2018

Motivation

Tumor purity and ploidy have a substantial impact on next-gen sequence analyses of tumor samples and may alter the biological and clinical interpretation of results. Despite the existence of several computational methods that are dedicated to estimate tumor purity and/or ploidy from The Cancer Genome Atlas (TCGA) tumor-normal whole-genome-sequencing (WGS) data, an accurate, fast and fully-automated method that works in a wide range of sequencing coverage, level of tumor purity and level of intra-tumor heterogeneity, is still missing.

Results

We describe a computational method called Accurity that infers tumor purity, tumor cell ploidy and absolute allelic copy numbers for somatic copy number alterations (SCNAs) from tumor-normal WGS data by jointly modelling SCNAs and heterozygous germline single-nucleotide-variants (HGSNVs). Results from both in silico and real sequencing data demonstrated that Accurity is highly accurate and robust, even in low-purity, high-ploidy and low-coverage settings in which several existing methods perform poorly. Accounting for tumor purity and ploidy, Accurity significantly increased signal/noise gaps between different copy numbers. We are hopeful that Accurity is of clinical use for identifying cancer diagnostic biomarkers.

Availability and implementation

Accurity is implemented in C++/Rust, available at http://www.yfish.org/software/.

Supplementary information

Supplementary data are available at Bioinformatics online.
Cytoskeletal Associated Filamin A and RhoA Affect Neural Progenitor Specification During Mitosis
Authors: Lian Gewei , Wong Timothy , Lu Jie , Hu Jianjun , Zhang Jingping , Sheen Volney
Published: January 2018

Neural progenitor proliferation and cell fate decision from self-renewal to differentiation are crucial factors in determining brain size and morphology. The cytoskeletal dependent regulation of these processes is not entirely known. The actin-binding filamin A (FlnA) was shown to regulate proliferation of progenitors by directing changes in cell cycles proteins such as Cdk1 during G2/M phase. Here we report that functional loss of FlnA not only affects the rate of proliferation by altering cell cycle length but also causes a defect in early differentiation through changes in cell fate specification. FlnA interacts with Rho GTPase RhoA, and FlnA loss impairs RhoA activation. Disruption of either of these cytoskeletal associated proteins delays neurogenesis and promotes neural progenitors to remain in proliferative states. Aurora kinase B (Aurkb) has been implicated in cytokinesis, and peaks in expression during the G2/M phase. Inhibition of FlnA or RhoA impairs Aurkb degradation and alters its localization during mitosis. Overexpression of Aurkb replicates the same delay in neurogenesis seen with loss of FlnA or RhoA. Our findings suggest that shared cytoskeletal processes can direct neural progenitor proliferation by regulating the expression and localization of proteins that are implicated in the cell cycle progression and cell fate specification.
Cognitive Behavioral Therapy for Depression, Anxiety, and Stress in Caregivers of Dementia Patients: A Systematic Review and Meta-Analysis
Authors: Hopkinson Michael D , Reavell James , Lane Deirdre A , Mallikarjun Pavan
Published: January 2018

Background and Objectives

There is limited evidence for the efficacy of cognitive behavioral therapy (CBT) in managing psychological morbidities in caregivers of dementia patients. To evaluate changes in dementia caregivers’ depression, anxiety, and stress following CBT. Also to assess quality of life, intervention adherence/satisfaction and therapy effectiveness using different formats, frequencies, and delivery methods.

Research Design and Methods

Studies were identified through electronic bibliographic searches (MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Library) and from gray literature (Conference Proceedings Citation Index and clinicaltrials.gov). Data were pooled for meta-analysis.

Results

Twenty-five studies were included. Depression (standardized mean difference [SMD] = −0.34; 95% confidence interval [CI] −0.47 to −0.21; p < .001) and stress (SMD = −0.36; 95% CI: −0.52 to −0.20; p < .001) were significantly reduced after CBT, relative to comparator groups, while anxiety was not (SMD = 0.10; 95% CI: −0.18 to 0.39; p = .47). A subgroup analysis demonstrated that statistically significant reductions in depression and stress were limited to group, but not individual, formats. An additional subgroup analysis revealed that eight CBT sessions or fewer were equally effective as more than eight sessions at significantly reducing depression and stress, relative to comparator groups. Furthermore, analysis with independent samples t-tests demonstrated no statistically significant differences between mean changes in depression (MD = 0.79; 95% CI: −0.45 to 2.03; p = .21) and stress (MD = 0.21; 95% CI: −1.43 to 1.85; p = .80) when directly comparing CBT groups of ≤8 and >8 sessions.

Discussion and Implications

Group CBT provides small but significant benefits to caregivers’ depression and stress. Therapy cost-effectiveness may be improved by limiting therapy to group formats and eight sessions.
Otolith increments in European plaice (Pleuronectes platessa) reveal temperature and density-dependent effects on growth
Authors: van der Sleen Peter , Stransky Christoph , Morrongiello John R , Haslob Holger , Peharda Melita , Black Bryan A
Published: January 2018

European plaice (Pleuronectes platessa) is a commercially important flatfish species in the North Sea. Yet, the environmental factors that affect the growth of plaice remain unresolved. Here we examine the drivers of plaice growth variation by using a large archive of otoliths from female plaice collected in the northeastern part of the North Sea from 1993 to 2015, providing growth data over the period 1985–2014. We developed a series of increasingly complex mixed-effect models to explore intrinsic (within individual) and extrinsic (environmental factors: bottom temperature and plaice density) sources of growth variation. We analysed juvenile (0 and 1 year) and (sub)adult (≥2 years) growth separately due to different habitat utilization across life stages. Juvenile growth was positively correlated with bottom temperature, whereas growth of adults was negatively correlated with bottom temperature. Correlations for both were strongest during autumn (September to October). For juveniles, the temperature–growth relationship likely reflects a response to growing season length while for adults it could reflect temperature-dependent changes to metabolic rate or food availability. For both juveniles and adults, we also found inverse relationship between population density and growth. We suggest that the approach used in this study can find a much wider application in European waters.
Flatness-based longitudinal vehicle control with embedded torque constraint
Authors: Mounier Hugues , Niculescu Silviu-Iulian , Cela Arben , Stefan Geamanu Marcel
Published: January 2018

This paper aims at establishing a simple yet efficient solution to the problem of trajectory tracking with input constraint of a non-linear longitudinal vehicle model. We make use of differential flatness by embedding the constraint into the reference trajectory design.
On Restriction Estimates for Discrete Quadratic Surfaces
Authors: Henriot Kevin , Hughes Kevin
Published: January 2018

We obtain truncated restriction estimates of an unexpected form for discrete surfaces $$\begin{align*}S_N = \{\, ( n_1 , \dots , n_d , R( n_1 , \dots, n_d ) ) \,,\, n_i \in [-N,N] \cap {\mathbb{Z}} \,\},\end{align*}$$ where $R$ is an indefinite quadratic form with integer matrix.
Dirichlet Uniformly Well-approximated Numbers
Authors: Kim Dong Han , Liao Lingmin
Published: January 2018

Fix an irrational number θ. For a real number τ > 0, consider the numbers y satisfying that for all large number Q, there exists an integer 1 ≤ n ≤ Q, such that ∥nθ − y∥ < Q−τ, where ∥⋅∥ is the distance of a real number to its nearest integer. These numbers are called Dirichlet uniformly well-approximated numbers. For any τ > 0, the Haussdorff dimension of the set of these numbers is obtained and is shown to depend on the Diophantine property of θ. It is also proved that with respect to τ, the only possible discontinuous point of the Hausdorff dimension is τ = 1.
Inflation Risk Premia, Yield Volatility, and Macro Factors
Authors: Berardi Andrea , Plazzi Alberto
Published: January 2018

We incorporate a latent stochastic volatility factor and macroeconomic expectations in an affine model for the term structure of nominal and real rates. We estimate the model over 1999–2016 on U.S. data for nominal and TIPS yields, the realized and implied volatility of T-bonds, and survey forecasts of GDP growth and inflation. We find relatively stable inflation risk premia averaging at 40 basis points at the long-end, and which are strongly related to the volatility factor and conditional mean of output growth. We also document real risk premia that turn negative in the post-crisis period, and a non-negligible variance risk premium.
Unified Protocol for Transdiagnostic Treatment of Emotional Disorders
Authors: Barlow David H. , Farchione Todd J. , Sauer-Zavala Shannon , Murray Latin Heather , Ellard Kristen K. , Bullis Jacqueline R. , Bentley Kate H. , Boettcher Hannah T. , Cassiello-Robbins Clair
Published: January 2018

The Unified Protocol (UP) for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide is a treatment programv applicable to all anxiety and unipolar depressive disorders and potentially other disorders with strong emotional components (e.g., eating disorders, borderline personality disorder). The UP for the Transdiagnostic Treatment of Emotional Disorders addresses neuroticism by targeting the aversive, avoidant reactions to emotions that, while providing relief in the short term, increase the likelihood of future negative emotions and maintains disorder symptoms. The strategies included in this treatment are largely based on common principles found in existing empirically supported psychological treatments—namely, fostering mindful emotion awareness, reevaluating automatic cognitive appraisals, changing action tendencies associated with the disordered emotions, and utilizing emotion exposure procedures. The focus of these core skills has been adjusted to specifically address core negative responses to emotional experiences.
Overview of General Treatment Format and Procedures
Authors: Barlow David H. , Farchione Todd J. , Sauer-Zavala Shannon , Latin Heather Murray , Ellard Kristen K. , Bullis Jacqueline R. , Bentley Kate H. , Boettcher Hannah T. , Cassiello-Robbins Clair
Published: January 2018

Chapter 4 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide outlines the overall session structure and clarifies the therapist’s role within treatment. The chapter explains the importance of homework (and homework review) and out-of-session practice. The chapter also emphasizes the importance of patient commitment and how best to deal with patient ambivalence and resistance.
Module 2: Understanding Emotions
Authors: Barlow David H. , Farchione Todd J. , Sauer-Zavala Shannon , Latin Heather Murray , Ellard Kristen K. , Bullis Jacqueline R. , Bentley Kate H. , Boettcher Hannah T. , Cassiello-Robbins Clair
Published: January 2018

Chapter 7 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide provides psychoeducation on the functional, adaptive nature of emotions and assists patients in developing greater awareness of patterns of emotional responding, including potential maintaining factors (e.g., common triggers, environmental contingencies, and/or the maintaining role of avoidance). Patients also learn how to monitor and track their emotions by focusing on three core components of their emotional experiences (thoughts, physical feelings, and behaviors).
Module 3: Mindful Emotion Awareness
Authors: Barlow David H. , Farchione Todd J. , Sauer-Zavala Shannon , Latin Heather Murray , Ellard Kristen K. , Bullis Jacqueline R. , Bentley Kate H. , Boettcher Hannah T. , Cassiello-Robbins Clair
Published: January 2018

Chapter 8 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide introduces patients to cultivating a nonjudgmental, present-focused stance toward their emotional experiences. The previous module asked patients to monitor to how their emotions unfold over time. This module builds on that work by encouraging patients to incorporate mindful awareness that moves beyond simply paying attention to these experiences. The principles of mindfulness are very consistent with the overall goal of the UP—to develop a more open, approach-oriented relationship with emotions.
Using the UP in a Group Format
Authors: Barlow David H. , Farchione Todd J. , Sauer-Zavala Shannon , Latin Heather Murray , Ellard Kristen K. , Bullis Jacqueline R. , Bentley Kate H. , Boettcher Hannah T. , Cassiello-Robbins Clair
Published: January 2018

Chapter 15 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide looks at providing the UP treatment in a group format. Benefits of group therapy (such as efficiency, patients supporting one another) are discussed. Although the authors always intended for the UP to be a treatment that could be used in either an individual or group format, most of the studies to date have looked at how the UP works in an individual format. Therefore, the authors are still learning the best way to teach the strategies in a group format. Some recommendations for how to adapt the UP for a group format are provided. These look at structure, treatment rationale, flexible application of the UP model, and conducting emotion exposures in a group format.
Unified Protocol for Transdiagnostic Treatment of Emotional Disorders
Authors: Barlow David H. , Farchione Todd J. , Sauer-Zavala Shannon , Murray Latin Heather , Ellard Kristen K. , Bullis Jacqueline R. , Bentley Kate H. , Boettcher Hannah T. , Cassiello-Robbins Clair
Published: January 2018

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook was developed to help people who are struggling with intense emotions like anxiety, sadness, anger, and guilt. A person may have an emotional disorder when his or her emotions are so overwhelming that they get in the way of moving forward in life. Although emotions affect our lives in different ways, there are three features that often occur across emotional disorders. These are (a) frequent, strong emotions; (b) negative reactions to emotions; and (c) avoidance of emotions. The goal of this workbook is to change the way that people with emotional disorders respond to their emotions when they occur. This treatment program is applicable to all anxiety and unipolar depressive disorders and potentially other disorders with strong emotional components. The strategies included in this treatment are largely based on common principles found in existing empirically supported psychological treatments.
About This Treatment
Authors: Barlow David H. , Sauer-Zavala Shannon , Farchione Todd J. , Latin Heather Murray , Ellard Kristen K. , Bullis Jacqueline R. , Bentley Kate H. , Boettcher Hannah T. , Cassiello-Robbins Clair
Published: January 2018

Chapter 2 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook provides an overview of the skills that will be learned in this treatment and discusses the importance of practicing these skills. Specifically, this treatment includes the following skills: Setting Goals and Maintaining Motivation , Understanding Emotions, Mindful Emotion Awareness, Cognitive Flexibility, Countering Emotional Behaviors, Understanding and Confronting Physical Sensations, and Emotion Exposures. The chapter describes how this treatment can be used in combination with other treatments like medication and other types of therapy, and it helps readers determine if now is the right time for them to begin the UP program.
Learning to Record Your Experiences
Authors: Barlow David H. , Sauer-Zavala Shannon , Farchione Todd J. , Latin Heather Murray , Ellard Kristen K. , Bullis Jacqueline R. , Bentley Kate H. , Boettcher Hannah T. , Cassiello-Robbins Clair
Published: January 2018

Chapter 3 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook teaches the importance of monitoring emotions and experiences, as well as about record-keeping. Keeping ongoing records of experiences helps us understand how changing our relationship with our emotions corresponds to the gains made in treatment. The chapter introduces questionnaires to be used throughout treatment to monitor emotions and teaches how to track progress throughout treatment.
Setting Goals and Maintaining Motivation
Authors: Barlow David H. , Sauer-Zavala Shannon , Farchione Todd J. , Latin Heather Murray , Ellard Kristen K. , Bullis Jacqueline R. , Bentley Kate H. , Boettcher Hannah T. , Cassiello-Robbins Clair
Published: January 2018

Chapter 4 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook focuses on identifying ways that your emotional responding is interfering with your lives—the top problems you would like to change and how determine the specific steps needed to address these problems. The importance of maintaining motivation for making these difficult changes is also discussed. The topics covered in this chapter form the necessary foundation for building a healthier relationship with our emotions. The rest of the skills in this book build upon this groundwork. This chapter also explores the costs and benefits of changing and remaining the same.
Understanding Your Emotions—Following the ARC
Authors: Barlow David H. , Sauer-Zavala Shannon , Farchione Todd J. , Latin Heather Murray , Ellard Kristen K. , Bullis Jacqueline R. , Bentley Kate H. , Boettcher Hannah T. , Cassiello-Robbins Clair
Published: January 2018

Chapter 6 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook teaches us to put our emotional experience in context by examining what happens before and after we feel a strong emotion. First, we look for patterns in the situations or events that trigger emotions. Next, we continue to break-down our emotional response into thoughts, physical sensations, and behaviors. Finally, we look at the consequences for how we respond to our emotions, both in the short term and in the long term. The way we respond in the midst of an emotional response can have consequences for the emotions we feel in the future, and this understanding may help motivate us to make changes in the way we’re currently coping.
Cognitive Flexibility
Authors: Barlow David H. , Sauer-Zavala Shannon , Farchione Todd J. , Latin Heather Murray , Ellard Kristen K. , Bullis Jacqueline R. , Bentley Kate H. , Boettcher Hannah T. , Cassiello-Robbins Clair
Published: January 2018

Chapter 8 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook looks at one part of our emotional experiences—our thoughts—and describes how thoughts are very important for influencing how we feel. The chapter describes our tendency to get stuck in automatic patterns of thinking, which we refer to as thinking traps. This treatment describes two specific types of thinking traps: jumping to conclusions and thinking the worst. Next, readers are encouraged to identify their own patterns of negative thinking to generate alternative interpretations. The overall goal is to be more flexible in our thinking, referred to as cognitive flexibility.
Moving UP from Here
Authors: Barlow David H. , Sauer-Zavala Shannon , Farchione Todd J. , Latin Heather Murray , Ellard Kristen K. , Bullis Jacqueline R. , Bentley Kate H. , Boettcher Hannah T. , Cassiello-Robbins Clair
Published: January 2018

Chapter 13 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook reviews the treatment program. (1) All emotions, even the ones that feel negative or uncomfortable, provide important information that can motivate us to take action in helpful ways. (2) Staying present in the moment and taking a nonjudgmental view of emotions can help to prevent emotions from increasing in intensity. The way we think about a situation influences how we feel, and how we feel affects the way we interpret a situation. (3) Although avoiding uncomfortable emotional experiences can work well in the short-term, it isn’t an effective long-term coping strategy. The chapter helps us to evaluate our progress and revisit our treatment goals. The most effective way to maintain progress and to keep improving is to continue to practice the skills learned in this program, and therefore a practice plan is developed in this last chapter.
Kinematic fingerprint of core-collapsed globular clusters
Authors: Bianchini P , Webb J J , Sills A , Vesperini E
Published: January 2018

Dynamical evolution drives globular clusters towards core collapse, which strongly shapes their internal properties. Diagnostics of core collapse have so far been based on photometry only, namely on the study of the concentration of the density profiles. Here, we present a new method to robustly identify core-collapsed clusters based on the study of their stellar kinematics. We introduce the kinematic concentration parameter, ck, the ratio between the global and local degree of energy equipartition reached by a cluster, and show through extensive direct N-body simulations that clusters approaching core collapse and in the post-core collapse phase are strictly characterized by ck > 1. The kinematic concentration provides a suitable diagnostic to identify core-collapsed clusters, independent from any other previous methods based on photometry. We also explore the effects of incomplete radial and stellar mass coverage on the calculation of ck and find that our method can be applied to state-of-art kinematic data sets.
The utility of trough mycophenolic acid levels for the management of lupus nephritis
Authors: Pourafshar Negiin , Karimi Ashkan , Wen Xuerong , Sobel Eric , Pourafshar Shirin , Agrawal Nikhil , Segal Emma , Mohandas Rajesh , Segal Mark S
Published: January 2018

Background

Monitoring of mycophenolic acid (MPA) levels may be useful for effective mycophenolate mofetil (MMF) dosing. However, whether commonly obtained trough levels are an acceptable method of surveillance remains debatable. We hypothesized that trough levels of MPA would be a poor predictor of area under the curve (AUC) for MPA.

Methods

A total of 51 patients with lupus nephritis who were on MMF 1500 mg twice a day and had a 4-h AUC done were included in this study. MPA levels were measured prior to (C0) and at 1 (C1), 2 (C2) and 4 (C4) h, followed by 1500 mg of MMF. The MPA AUC values were calculated using the linear trapezoidal rule. Regression analysis was used to examine the relationship between the MPA trough and AUC. Differences in the MPA trough and AUC between different clinical and demographic categories were compared using t-tests.

Results

When grouped by tertiles there was significant overlap in MPA, AUC 0-4 and MPA trough in all tertiles. Although there was a statistically significant correlation between MPA trough levels and AUC, this association was weak and accounted for only 30% of the variability in MPA trough levels. This relationship might be even more unreliable in men than women. The use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with increased MPA trough levels and AUC at 0-4 h (AUC0–4).

Conclusion

Trough levels of MPA do not show a strong correlation with AUC. In clinical situations where MPA levels are essential to guide therapy, an AUC0–4 would be a better indicator of the adequacy of treatment.
Anterior Reduction and Fusion of Cervical Facet Dislocations
Authors: Theodotou Christian B , Ghobrial George M , Middleton Andrew L , Wang Michael Y , Levi Allan D
Published: January 2018

BACKGROUND

Cervical facet dislocations are among the most common traumatic spinal injuries. Posterior, anterior, and combined surgical approaches have been described and are widely debated.

OBJECTIVE

To demonstrate efficacy in anterior-only surgical management for subaxial cervical facet dislocations.

METHODS

A consistent surgical algorithm for cervical facet dislocation was applied over a 19-yr period and analyzed retrospectively in adults with acute unilateral or bilateral facet dislocation of the subaxial cervical spine. The primary endpoint was maintenance of early cervical alignment. The need for additional posterior instrumented fusion was determined.

RESULTS

A database search identified 96 patients (mean age = 37.9, range = 14-74 yr, 68 (70%) male. The most common affected levels were C4-C5 (30), C5-C6 (29), and C6-C7 (30). Bilateral dislocation occurred in 51 patients (53%). Seventy-eight (81%) patients had neurological deficits, 31 (32%) being complete (Abbreviated Injury Score A) spinal cord injuries. Preoperative closed reduction was attempted in 60 (63%) patients, with 33 (55%) achieving satisfactory alignment. After anterior cervical discectomy, reduction, allograft placement, and instrumentation, a total of 92 (96%) patients had achieved satisfactory realignment. Median time to surgery was 13.27 h. Eight (8%) patients required posterior fixation due to intraoperative determination of incomplete realignment (4; 4%) and development of early progressive deformity (4; 4%). Mean follow-up was 4.5 mo (range 0.5-24 mo) with 33 (34%) patients lost to follow-up.

CONCLUSION

Anterior approaches are viable for reduction and stabilization of cervical facet dislocations. Further prospective studies are required to evaluate clinical and long-term success.
Risk-to-Benefit Ratio of Venous Thromboembolism Prophylaxis for Neurosurgical Procedures at a Quaternary Referral Center
Authors: Agarwal Nitin , Zenonos Georgios A , Agarwal Prateek , Walch Frank J , Roach Eileen , Stokes Sandra J , Friedlander Robert M , Gerszten Peter C
Published: January 2018

BACKGROUND

Pharmacological prophylaxis for venous thromboembolism (VTE) in the neurosurgical population is still a matter of debate, as the risk-to-benefit ratio is not well defined.

OBJECTIVE

To further evaluate the risk-to-benefit ratio of VTE prophylaxis (VTEP) for all neurosurgical procedures.

METHODS

A prospective evaluation was performed after the initiation of a VTEP protocol for 11 436 patients undergoing neurosurgical procedures over 24 mo. Unless a bleeding complication was present, 5000 international units of subcutaneous heparin every 8 h was ordered on postoperative day (POD) 1 for spine, POD2 for cranial, and by POD4 for subdural, intracerebral, and epidural hematoma cases. Incidence of VTE and any subsequent bleeding complications were noted.

RESULTS

A total of 70 VTEs (0.6% overall) were documented (28 deep vein thrombosis, 42 pulmonary embnolism). The highest rates of VTE were associated with deformity (6.7%); open cerebrovascular (6.5%); subdural, intracerebral, and epidural hematoma (3.2%); spinal trauma (2.4%); and craniotomy for tumor (1.6%) cases. Seven cases of deep vein thrombosis progressed to pulmonary embolisms, and 66 of 70 VTEs occurred while on pharmacological VTEP. Fifty-four bleeding complications occurred on or after POD2 following initiation of VTEP. These bleeding complications consisted of any new clinically or radiographically observed hemorrhages. Twenty-eight of the 54 delayed bleeding complications required operative intervention with 1 mortality. Forty-five patients were on anticoagulation when the initial bleeding event occurred. Overall, an estimated 0.5% incidence of delayed bleeding complications was noted with 99.4% of patients within the study cohort remaining VTE free.

CONCLUSION

This VTEP protocol was determined to afford a good risk-to-benefit ratio for a wide variety of neurosurgical procedures.
Nurses at the Bedside—Who Will Be Left to Care?
Authors: Kennedy Maureen Shawn
Published: January 2018

Many experienced RNs plan to leave acute care.
Nurse-Led Health Clinics Show Positive Outcomes
Authors: Sofer Dalia
Published: January 2018

But political and fiscal challenges remain.
Opioid Prescribing in the United States
Authors: Guy Gery P. , Shults Ruth A.
Published: January 2018

Evidence-based information for nurses on the risks and benefits of prescription opioids.
Potential Drug Interactions with Sodium Polystyrene Sulfonate
Authors: Aschenbrenner Diane S.
Published: January 2018

The labeling of sodium polystyrene sulfonate (Kayexalate), a drug used to treat significant hyperkalemia, has been revised to warn that the drug may bind to and render ineffective other oral drugs if given simultaneously.

Only the oral form of sodium polystyrene sulfonate can produce these drug interactions.
Complex Surgical Infants Benefit From Postdischarge Telemedicine Visits
Authors: Willard April , Brown Elizabeth , Masten Marjorie , Brant Marisa , Pouppirt Nicole , Moran Kevin , Lioy Janet , Chuo John
Published: January 2018

Background:

Transition from the neonatal intensive care unit (NICU) to home is challenging for caregivers of complex surgical infants. A prospective, observational cohort pilot study using telemedicine to improve transition was implemented in a quaternary level IV NICU.

Purpose:

(1) To assess, identify, and resolve patient care concerns in the immediate postdischarge period. (2) To improve caregiver knowledge and care practices.

Design Methods:

Caregivers of medically complex infants participated in telemedicine visits with neonatal providers within 1 week of discharge. Providers reviewed infant health, equipment use, and outpatient follow-up. Video was used to visualize the infant, home environment, and care practices. Caregivers completed a postvisit satisfaction survey.

Results:

Ninety-three visits were performed from May 2015 to March 2017. Seventy-six percent of visits were postsurgery patients. Seventy-eight postdischarge issues were identified: medication administration (13%), respiratory (19%), feeding (33%), and surgical site (35%). Fifty percent of caregivers reported that telemedicine visits prevented an additional call or visit to a clinician; 12% prompted an earlier visit (n = 93). Caregiver satisfaction rating was high. Median estimation of total mileage saved by respondents was 1755 miles.

Conclusions:

Postdischarge telemedicine visits with complex surgical NICU graduates identify clinical issues, provide caregivers with support, and save travel time. Advanced practice nurses are instrumental in patient recruitment, with patient visits, and in providing postdischarge continuity of care. Barriers to implementation were identified.

Implication for Practice and Research:

A randomized controlled study is warranted to measure the value of telemedicine visits for specific patient cohorts.
Basic Knowledge of Tracheoesophageal Fistula and Esophageal Atresia
Authors: Lee Sura
Published: January 2018

Background:

Tracheoesophageal fistula (TEF) and esophageal atresia (EA) are rare anomalies in neonates. Up to 50% of neonates with TEF/EA will have Vertebral anomalies (V), Anal atresia (A), Cardiac anomalies (C), Tracheoesophageal fistula (T), Esophageal atresia (E), Renal anomalies (R), and Limb anomalies (L) (VACTERL) association, which has the potential to cause serious morbidity.

Purpose:

Timely management of the neonate can greatly impact the infant's overall outcome. Spreading latest evidence-based knowledge and sharing practical experience with clinicians across various levels of the neonatal intensive care unit and well-baby units have the potential to decrease the rate of morbidity and mortality.

Methods/Search Strategy:

PubMed, CINAHL, Cochrane Review, and Google Scholar were used to search key words— tracheoesophageal fistula, esophageal atresia, TEF/EA, VACTERL, long gap, post-operative management, NICU, pediatric surgery—for articles that were relevant and current.

Findings/Results:

Advancements in both technology and medicine have helped identify and decrease postsurgical complications. More understanding and clarity are needed to manage acid suppression and its effects in a timely way.

Implications for Practice:

Knowing the clinical signs of potential TEF/EA, clinicians can initiate preoperative management and expedite transfer to a hospital with pediatric surgeons who are experts in TEF/EA management to prevent long-term morbidity.

Implications for Research:

Various methods of perioperative management exist, and future studies should look into standardizing perioperative care. Other areas of research should include acid suppression recommendation, reducing long-term morbidity seen in patients with TEF/EA, postoperative complications, and how we can safely and effectively decrease the length of time to surgery for long-gap atresia in neonates.
Sepsis-Associated Coagulopathy Severity Predicts Hospital Mortality*
Authors: Lyons Patrick G. , Micek Scott T. , Hampton Nicholas , Kollef Marin H.
Published: January 2018

Objectives:

To assess whether sepsis-associated coagulopathy predicts hospital mortality.

Design:

Retrospective cohort study.

Setting:

One-thousand three-hundred beds urban academic medical center.

Patients:

Six-thousand one-hundred forty-eight consecutive patients hospitalized between January 1, 2010, and December 31, 2015.

Interventions:

Mild sepsis-associated coagulopathy was defined as an international normalized ratio greater than or equal to 1.2 and less than 1.4 plus platelet count less than or equal to 150,000/µL but greater than 100,000/µL; moderate sepsis-associated coagulopathy was defined with either an international normalized ratio greater than or equal to 1.4 but less than 1.6 or platelets less than or equal to 100,000/µL but greater than 80,000/µL; severe sepsis-associated coagulopathy was defined as an international normalized ratio greater than or equal to 1.6 and platelets less than or equal to 80,000/µL.

Measurements and Main Results:

Hospital mortality increased progressively from 25.4% in patients without sepsis-associated coagulopathy to 56.1% in patients with severe sepsis-associated coagulopathy. Similarly, duration of hospitalization and ICU care increased progressively as sepsis-associated coagulopathy severity increased. Multivariable analyses showed that the presence of sepsis-associated coagulopathy, as well as sepsis-associated coagulopathy severity, was independently associated with hospital mortality regardless of adjustments made for baseline patient characteristics, hospitalization variables, and the sepsis-associated coagulopathy-cancer interaction. Odds ratios ranged from 1.33 to 2.14 for the presence of sepsis-associated coagulopathy and from 1.18 to 1.51 for sepsis-associated coagulopathy severity for predicting hospital mortality (p < 0.001 for all comparisons).

Conclusions:

The presence of sepsis-associated coagulopathy identifies a group of patients with sepsis at higher risk for mortality. Furthermore, there is an incremental risk of mortality as the severity of sepsis-associated coagulopathy increases.