bluuebunny/crossref_metadata_2025_split huggingface dataset:
Telemedicine simulation in online family nurse practitioner education: Clinical competency and technology integration
Authors: Ainslie Marcy , Bragdon Cheryl 
Published: August 2018

ABSTRACT

Background and purpose:
Assessment of clinical competency in distance education programs presents new challenges and yet is imperative to patient safety and continued success of the profession. Furthermore, employers increasingly expect a skill set in current informational technologies. Clinical competence has been assessed using high stakes, standardized patient simulation in traditional, on-campus educational programs. Telemedicine technology integrated with standardized patient simulations may provide a solution for teaching the essentials of information technology and provide a modality for clinical competency assessment in distance education.

Methods:
Telemedicine was introduced to students via a formative, didactic assignment. This preparation facilitated the use of telemedicine technology integrated with standardized patient simulations to assess clinical competency of online students. In addition, this format required students to apply the fundamentals of informational technologies.

Conclusion:
Combining the modality of telemedicine with high stakes, standardized patient simulation to assess clinical competence is innovative and ensures high standards in distant education while addressing the preparation of students in the use of emerging technologies.

Implications for practice:
Telemedicine integrated with human standardized patient simulation is a promising modality for clinical competency assessment and determination of program progression in distance education. In addition, students become accustomed to the informational technologies encountered in the workplace.
Comparing nurse practitioners/physician assistants and physicians in diagnosing adult abdominal pain in the emergency department
Authors: Hoyt Karen Sue , Ramirez Elda , Topp Robert , Nichols Stephen , Agan Donna 
Published: August 2018

ABSTRACT

Background and purpose:
This retrospective study compared nurse practitioners and physician assistants (NPs/PAs) with physicians on their assignment of Emergency Severity Index level 3 (ESI level 3) acute abdominal pain (AAP) in the emergency department (ED).

Methods:
Data obtained from a large ED group staffing four hospitals yielded 12,440 de-identified, adult patients diagnosed on ED admission with AAP ESI level 3 for descriptive analysis with logistic regression.

Conclusions:
Results revealed that the comparison of ESI level 3 AAP diagnoses was consistent between admission and discharge 95.3% for physicians, 92.9% for NPs/PAs, and 97.1% for NP/PA and physician collaboration (χ2 = 46.01, p < .001). Logistic regression suggested that NP/PA had significantly reduced odds (31%) of consistent admitting/discharge diagnoses, whereas collaboration of NP/PA with physicians had significantly increased odds of consistent diagnosis (41%) compared with physicians alone. Two hospitals with similar distributions of NPs/PAs and physicians exhibited greater odds of consistent diagnoses over hospitals with disproportionate distributions; a secondary finding worth exploring. Consistent AAP ESI level 3 diagnoses by outcomes were admissions (>99%), discharges (94%), and left against medical advice/transferred (98%; χ2 = 102.94, p < .001).

Implications for practice:
The highest percentage of consistent AAP ESI level 3 diagnoses between ED admission and discharge was when NPs/PAs and physicians collaborated.
Standardization of mesenchymal stromal cell therapy for perianal fistulizing Crohn’s disease
Authors: Molendijk Ilse , van der Meulen – de Jong Andrea E. , Verspaget Hein W. , Veenendaal Roeland A. , Hommes Daniel W. , Bonsing Bert A. , Peeters Koen C.M.J. 
Published: August 2018

Background
Local administration of mesenchymal stromal cells (MSCs) into the fistula tract seems to improve patient outcome in perianal fistulas due to Crohn’s disease (CD). In this paper we propose a standardized and validated protocol for the local administration of MSCs for CD perianal fistulas to be able to reliably assess efficacy.

Materials and methods
A working group consisting of gastroenterologists and surgeons with expertise in the treatment of perianal CD developed a consensus perianal fistula treatment protocol for local MSC treatment of perianal fistulizing CD. The treatment protocol was validated during a trial of allogeneic bone marrow-derived MSCs for the treatment of refractory perianal Crohn’s fistulas.

Results
Localization and classification of perianal fistulas with MRI and rectoscopy is of crucial importance prior to surgical intervention with local therapy administration. Examination under anesthesia is necessary to incise and drain abscesses when present. Optimization of medical treatment when active luminal CD is present, is the first step before embarking on surgery and local therapy administration. In addition, strictures preventing the surgeon from adequately performing the surgical procedure have to be endoscopically dilated. Curettage of the fistula tract has an important role as long-standing CD perianal fistulas close poorly without removal of their epithelial lining. To diminish bacterial contamination of the fistula, the internal opening has to be closed. The origin of the fistula is the internal opening, therefore, efficacy of MSCs is presumably the highest when they are injected into the tissue around the internal opening.

Conclusion
In this article, we propose a standardized method of local MSC administration for perianal fistulizing CD. The use of this standardized and validated protocol for the administration of local treatment of CD perianal fistulas will allow reliable comparison of the efficacy of local therapies in future.
The utility and validity of pain intensity rating scales for use in developing countries
Authors: Pathak Anupa , Sharma Saurab , Jensen Mark P. 
Published: August 2018

Abstract

Introduction:
Pain intensity is the domain most often assessed in pain research. Although the Numerical Rating Scale is recommended for use in western countries, the utility and validity of this scale, relative to others, has not been established in non–western developing countries, such as Nepal.

Objectives:
Here, we sought to (1) identify which of 4 commonly used pain scales is most preferred by Nepalese, (2) compare error rates, (3) determine whether preference and error rates are influenced by age or education level, and (4) evaluate construct validity of each scale using factor analysis.

Methods:
Two hundred two adults with musculoskeletal pain from Nepal rated their worst and average pain intensity using all 4 scales and selected their most preferred scale.

Results:
The results indicate that the Faces Pain Scale-Revised is the most preferred scale, followed by a Verbal Rating Scale. The Numerical Rating Scale and Visual Analogue Scale were both least preferred and had higher rates of incorrect responses, especially among the older participants. However, all the scales demonstrated adequate construct validity as measures of pain intensity among those participants who could accurately use all 4 scales.

Conclusion:
The findings indicate that the Faces Pain Scale-Revised should be the first choice for assessing pain intensity in Nepalese adults. Research is needed to determine whether these findings replicate in other non–western and developing countries, to identify the pain intensity measure that would be the best choice for use in cross-cultural pain research.
Clinical Correlation of Cytomegalovirus Infection With CMV-specific CD8+ T-cell Immune Competence Score and Lymphocyte Subsets in Solid Organ Transplant Recipients
Authors: Meesing Atibordee , Abraham Roshini S. , Razonable Raymund R. 
Published: August 2018

Background.
Control of cytomegalovirus (CMV) infection after solid organ transplantation (SOT) requires a functional immune system. We assessed the association between quantitation and function of CMV-specific CD8+ T cells and CMV infection in SOT recipients.

Methods.
During a 10-year period, selected kidney, heart, lung, pancreas, liver, and composite tissue recipients were tested for CMV-specific CD8+ T cells immune competence (CMV-CD8+), as measured by enumeration, interferon-gamma production, and CD107a/b degranulation. Quantitative and functional data were used to assemble T-cell immune competence (TIC) score. CMV infection was diagnosed by polymerase chain reaction in blood and other samples or histopathology.

Results.
Of 130 patients tested, 59 had CMV infection or disease. The median onset to CMV infection was 10.5 months (interquartile range [IQR], 5.5–18.7). Gastrointestinal disease (28.8%), pneumonia (20.3%), and CMV syndrome (17%) were most common presentation. An impaired nonspecific or CMV-CD8+ TIC score was associated with tissue-invasive disease (hazard risk, 2.84, 95% confidence interval, 1.03–11.81; P = 0.04). Patients with impaired CMV-CD8+ TIC score had longer viremia duration (42.4 days vs 18.8 d; P < 0.001). Patients with impaired nonspecific or CMV-CD8+ TIC score had higher risk of relapse (68.8% vs 27.9%; hazard risk, 2.56; 95% confidence interval, 1.09–5.89; P = 0.03). Patients with CMV infection or disease had lower median absolute lymphocyte count (380 [IQR, 240–540] vs 940 [IQR, 551–1210] cells/mm3; P < 0.0001) and CD4+ T cell count (29 cells/mm3 [IQR, 1.3–116.0] vs 325.5 cells/mm3 [IQR, 151.5–589.8]; P < 0.0001).

Conclusions.
Nonspecific and CMV-specific CD8+ T-cell function correlated with the course of CMV after SOT, and measuring these has the potential to assist in its clinical management.
Biogeographic study of human gut-associated crAssphage suggests impacts from industrialization and recent expansion
Authors: Honap Tanvi P. , Sankaranarayanan Krithivasan , Schnorr Stephanie L. , Ozga Andrew T. , Warinner Christina , Lewis Cecil M. 
Published: August 2018

AbstractCrAssphage (cross-assembly phage) is a bacteriophage that was first discovered in human gut metagenomic data. CrAssphage belongs to a diverse family of crAss-like bacteriophages thought to infect gut commensal bacteria belonging toBacteroidesspecies. However, not much is known about the biogeography of crAssphage and whether certain strains are associated with specific human populations. In this study, we screened publicly available human gut metagenomic data from 3,341 samples for the presence of crAssphagesensu stricto(NC_024711.1). We found that crAssphage prevalence is low in traditional, hunter-gatherer populations, such as the Hadza from Tanzania and Matses from Peru, as compared to industrialized, urban populations. Statistical comparisons showed no association of crAssphage prevalence with variables such as age, sex, body mass index, and health status of individuals. Phylogenetic analyses show that crAssphage strains reconstructed from the same individual over multiple time-points, cluster together. CrAssphage strains from individuals from the same study population do not always cluster together. Some evidence of clustering is seen at the level of broadly defined geographic regions, however, the relative positions of these clusters within the crAssphage phylogeny are not well-supported. We hypothesize that this lack of strong biogeographic structuring is suggestive of a recent expansion event within crAssphage. Using a Bayesian dating approach, we estimate this expansion has occurred within the past 200 years. Overall, we determine that crAssphage presence is associated with an industrialized lifestyle. The absence of strong biogeographic structuring within global crAssphage strains is likely due to a recent population expansion within this bacteriophage.
Sex overrides mutation in Escherichia coli colonizing the gut
Authors: Frazão N. , Sousa A. , Lässig M. , Gordo I. 
Published: August 2018

AbstractBacteria evolve by mutation accumulation in laboratory experiments, but the tempo and mode of evolution in natural environments are largely unknown. Here we show, by experimental evolution of E. coli in the mouse gut, that the ecology of the gut controls bacterial evolution. If a resident E. coli strain is present in the gut, an invading strain evolves by rapid horizontal gene transfer; this mode precedes and outweighs evolution by point mutations. An epidemic infection by two phages drives gene uptake and produces multiple co-existing lineages of phage-carrying (lysogenic) bacteria. A minimal dynamical model explains the temporal pattern of phage epidemics and their complex evolutionary outcome as generic effects of phage-mediated selection. We conclude that phages are an important eco-evolutionary driving force – they accelerate evolution and promote genetic diversity of bacteria.One Sentence SummaryBacteriophages drive rapid evolution in the gut.
Functional and structural resilience of the active site loop in the evolution of Plasmodium lactate dehydrogenase
Authors: Wirth Jacob D. , Boucher Jeffrey I. , Jacobowitz Joseph R. , Classen Scott , Theobald Douglas L. 
Published: August 2018

AbstractThe malarial pathogen Plasmodium falciparum (Pf) is a member of the Apicomplexa, which independently evolved a highly specific lactate dehydrogenase (LDH) from an ancestral malate dehydrogenase (MDH) via a five-residue insertion in a key active site loop. PfLDH is widely considered an attractive drug target due to its unique active site. Apicomplexan loop conservation suggests that a particular insertion sequence was required to evolve LDH specificity, and we previously showed (Boucher 2014) that a tryptophan in the insertion, W107f, is essential for activity and specificity. However, the roles of other residues in the loop are currently unknown. Here we show that PfLDH activity is remarkably resilient to radical perturbations of both loop identity and length. Thus, alternative insertions could have evolved LDH specificity as long as they contained a tryptophan in the proper location. PfLDH therefore has high potential to develop resistance to drugs that target its distinctive active site.
Alterations in sperm long RNA contribute to the epigenetic inheritance of the effects of postnatal trauma
Authors: Gapp K. , van Steenwyk G. , Germain P.L. , Matsushima W. , Rudolph K.L.M. , Manuella F. , Roszkowski M. , Vernaz G. , Ghosh T. , Pelczar P. , Mansuy I.M. , Miska E.A. 
Published: August 2018

AbstractPsychiatric diseases have a strong heritable component known to not be restricted to DNA sequence-based genetic inheritance alone but to also involve epigenetic factors in germ cells1,2. Initial evidence suggested that sperm RNA is causally linked2,3to the transmission of symptoms induced by traumatic experiences. Here we show that alterations in long RNA in sperm contribute to the inheritance of specific trauma symptoms. Injection of long RNA fraction from sperm of males exposed to postnatal trauma recapitulates the effects on food intake, glucose response to insulin and risk-taking in adulthood whereas the small RNA fraction alters body weight and behavioral despair. Alterations in long RNA are maintained after fertilization, suggesting a direct link between sperm and embryo RNA.
Proliferation of superficial neuromasts during lateral line development in the Round Goby, Neogobius melanostomus
Authors: Dickson J. M. , Janssen J. A. 
Published: August 2018

ABSTRACTMembers of the family Gobiidae have an unusual lateral line morphology in which some of the lateral line canal segments do not develop or enclose. This loss of lateral line canal segments is frequently accompanied by proliferation of superficial neuromasts. Although the proliferation of superficial neuromasts forms intricate patterns that have been used as a taxonomic tool to identify individual gobiid species, there has never been a detailed study that has documented the development of the lateral line system in gobies. The Round Goby, Neogobius melanostomus, is the focus of this study because the absence of the lateral line canal segments below the eye are accompanied by numerous transverse rows of superficial neuromasts. Our results suggest that the origin of some of these superficial neuromast lines could be the result of single presumptive canal neuromasts that have proliferated after canal enclosure is arrested. Many of the intricate patterns of neuromasts observed in gobiids develop from a simplified pattern of neuromast that is very similar among different species of gobies. The proliferation of superficial neuromasts has evolved several times in fish families such as the tetras, gobies, and sculpins, and may provide an adaptive advantage to ‘tune’ the lateral line system for different environments and prey types.SIGNIFICANCE STATEMENTUnderstanding the development of different lateral line morphologies can provide insights into how these morphologies have convergently evolved in many fish taxa. This is the first study to document the progression of the development of the reduced lateral line morphology. This study shows evidence that the developmental origins of orthogonal lines of superficial neuromasts posterior to the eye are not neomorphic lines, but in fact arise from precursor neuromasts that seem to be analogous to presumptive canal neuromasts.
Dendritic spine geometry and spine apparatus organization govern the spatiotemporal dynamics of calcium
Authors: Bell Miriam , Bartol Tom , Sejnowski Terrence , Rangamani Padmini 
Published: August 2018

AbstractDendritic spines are small subcompartments that protrude from the dendrites of neurons and are important for signaling activity and synaptic communication. These subcompartments have been characterized to have different shapes. While it is known that these shapes are associated with spine function, the specific nature of these shape-function relationships is not well understood. In this work, we systematically investigated the relationship between the shape and size of both the spine head and spine apparatus, a specialized endoplasmic reticulum compartment in the spine head, in modulating rapid calcium dynamics using mathematical modeling. We developed a spatial multi-compartment reaction-diffusion model of calcium dynamics in three dimensions with various flux sources including N-methyl-D-aspartate receptors (NMDAR), voltage sensitive calcium channels (VSCC), and different ion pumps on the plasma membrane. Using this model, we make several important predictions – first, the volume-to-surface area ratio of the spine regulates calcium dynamics, second, membrane fluxes impact calcium dynamics temporally and spatially in a nonlinear fashion, and finally the spine apparatus can act as a physical buffer for calcium by acting as a sink and rescaling the calcium concentration. These predictions set the stage for future experimental investigations of calcium dynamics in dendritic spines.
A new model on DNA structure and thermal denaturation
Authors: Liaofu LUO , Guochen YANG 
Published: August 2018

AbstractA quantum model on DNA structure is proposed. By introducing the self-consistent harmonic potential in the X-Y plane vertical to helix axis (z-direction) and the periodic potential along the z-axis we obtain the wave function for the single nucleotide and the many-nucleotide system. The helix distribution of bases is deduced from the solution of wave function under the self-consistent potential. The variation of DNA structure (polymorphism) is related to the periodicity of the potential in Z-axis, the quantum state occurring in harmonic potential and the interaction between helix strands. As Watson-Crick (W-C) interaction is introduced between double helices, the quasi-particle transformation is utilized to solve the interacting many-body problem for DNA. It is proved that the phase-transition (thermal denaturation) temperature is related to the frequency ω of harmonic potential. Through comparison with experimental data a simple relation (N means number of base pairs and V the W-C coupling) is deduced. For a DNA sequence of 1000 bp ω is predicted about (0.9-1.2)×1017/sec. Such a high frequency is necessary for nucleotides of each strand located on a narrow tube. The large temperature fluctuation experimentally observed during DNA thermal denaturation is interpreted by the collective motion of nucleotides.
The ESCRT-III proteins IST1 and CHMP1B assemble around nucleic acids
Authors: Talledge Nathaniel , McCullough John , Wenzel Dawn , Nguyen Henry C. , Lalonde Matthew S. , Bajorek Monika , Skalicky Jack , Frost Adam , Sundqust Wesley I. 
Published: August 2018

ABSTRACTESCRT-III proteins can promote inside-out or outside-in membrane tubulation and fission. In addition, several observations suggest that ESCRT factors may also associate with nucleic acids during development, different stages of the cell cycle, and during retro-transposition of parasitic nucleic acids like LINE1 elements. Two ESCRT-III subunits, IST1 (aka CHMP8) and CHMP1B, can coassemble as an external protein coat around liposomesin vitroand around recycling endosomal tubules in living cells. Here we show that recombinant IST1 and CHMP1B can also copolymerize into double stranded filaments that surround nucleic acids. Electron cryo-microscopy reconstructions of nucleic acid-bound IST1-CHMP1B copolymers revealed that the polynucleotides track along a binding groove formed between filaments of the inner CHMP1B strand. The well-ordered structures also reveal that the C-terminal tails of CHMP1B subunits extrude through the outer IST1 layer to the tube exterior. As a result, the MIT domain binding motifs of both CHMP1B and IST1 are arrayed on the outer surface of the copolymer, where they could bind and recruit MIT domain-containing co-factors, such as the SPASTIN ATPase or the USP8 ubiquitin protease. Our structure raises the possibility that ESCRT-III proteins may form nucleic acid complexes in mammalian cells.
Identification, Genotyping, and Pathogenicity ofTrichosporonspp. Isolated from Giant Pandas
Authors: Ma Xiaoping , Jiang Yaozhang , Wang Chengdong , Gu Yu , Cao Sanjie , Huang Xiaobo , Wen Yiping , Zhao Qin , Wu Rui , Wen Xintian , Yan Qigui , Han Xinfeng , Zuo Zhicai , Deng Junliang , Ren Zhihua , Yu Shumin , Shen Liuhong , Zhong Zhijun , Peng Guangneng , Liu Haifeng , Zhou Ziyao 
Published: August 2018

ABSTRACTTrichosporonis the dominant genus of epidermal fungi in giant pandas and causes local and deep infections. To provide the information needed for the diagnosis and treatment of trichosporosis in giant pandas, the sequence of ITS, D1/D2, and IGS1 loci in 29 isolates ofTrichosporonspp. which isolated from the body surface of giant pandas were combination to investigate interspecies identification and genotype. Morphological development was examined via slide culture. Additionally, mice were infected by skin inunction, intraperitoneal injection, and subcutaneous injection for evaluation of pathogenicity. The twenty-nine isolates ofTrichosporonspp. were identified as belonging to 11 species, andTrichosporon jiroveciiandT. asteroideswere the commonest species. Four strains ofT. laibachiiand one strain ofT. moniliiformewere found to be of novel genotypes, andT. jiroveciiwas identified to be genotype 1.T. asteroideshad the same genotype which involved in disseminated trichosporosis. The morphological development processes of theTrichosporonspp. were clearly different, especially in the processes of single-spore development. Pathogenicity studies showed that 7 species damaged the liver and skin in mice, and their pathogenicity was stronger than other 4 species.T. asteroideshad the strongest pathogenicity and might provoke invasive infection. The pathological characteristics of liver and skin infections caused by differentTrichosporonspp. were similar. So it is necessary to identify the species ofTrichosporonon the surface of giant panda. Combination of ITS, D1/D2, and IGS1 loci analysis, and morphological development process can effectively identify the genotype ofTrichosporonspp.