bluuebunny/crossref_metadata_2025_split huggingface dataset:
Jordanian nurses' knowledge and responsibility for enteral nutrition in the critically ill
Authors: Al Kalaldeh Mahmoud , Watson Roger , Hayter Mark 
Published: November 2013

ABSTRACTBackgroundPoor nursing adherence to evidence‐based guidelines has negative consequences leading to higher mortality rates, delayed recovery and longer length of stay. Evidence‐based practice has the potential to minimize complications and discrepancies between nurses.AimThis study aimed to assess nurses' practice and perception of their knowledge and responsibility in relation to enteral nutrition (EN) in the critically ill.Design and methodsThis descriptive correlational design was applied to nurses working in intensive care units (ICUs) from three health care sectors in Jordan (Governmental, Military and Private sectors). Nurses were recruited using a stratified sampling technique. A pre‐prepared questionnaire focusing on nurses' practice and perception towards EN was used.ResultsA total of 253 ICU nurses completed the questionnaire. Nurses revealed a tendency to undertake nutritional care despite the recognition clinical nutrition is a secondary role. In terms of nursing processes, nurses showed greater levels of knowledge and responsibility for ‘preventing complications’ and ‘evaluation’ more than ‘assessment’ and ‘identifying goals’. Nurses inadequately assess both gastric residuals and tube placement before feeding. Diarrhoea was the most frequent complication followed by abdominal pain, vomiting, tube dislodgment and weight loss. However, nurses realized that the incidences of complications is less likely when applying evidence‐based protocol.ConclusionIt is necessary to establish a preliminary assessment for patients' nutritional needs prior to using EN. Aspiration reduction measures are still deficient and need further attention. An evidence‐based protocol for EN should be adopted in the critically ill.Relevance to clinical practiceThis article provides insight into the current practice of Jordanian intensive care nurses in different health care sectors. The study can contribute to redirect the perception of nurses towards nutrition in the critically ill in addition to enhance positive adherence to evidence base.
Electronic Opioid Risk Assessment Program for Chronic Pain Patients: Barriers and Benefits of Implementation
Authors: Butler Stephen F. , Zacharoff Kevin , Charity Sadaf , Lawler Kristen , Jamison Robert N. 
Published: November 2013

AbstractObjectivesA preliminary electronic pain assessment program known as Pain Assessment Interview Network, Clinical Advisory System (painCAS), was implemented in 2 pain centers over the course of 10 months to understand the tool's impact on opioid risk assessment documentation and clinical workflow. The program contains validated electronic versions of screeners for opioid misuse risk (SOAPP‐R and Current Opioid Misuse Measure).MethodsCharts of patients with an initial and 2 follow‐up visits were randomly selected for review of presence of opioid risk assessments before and after implementation of the electronic assessment program. Clinical and administrative staff members were interviewed to gain their perceptions of the impact of the program.ResultsSignificant increases were observed in the documentation of opioid risk assessments between the baseline patient chart reviews before implementation of the program (n = 66) and the postintervention patient chart reviews after the implementation of the program (n = 39), for both initial and follow‐up clinic visits (P < 0.001). Specific benefits of the program identified by 7 clinicians and 8 administrators included ease of use, reduced paperwork, completion of the assessment before the clinic visit, and incorporation of information directly into an electronic medical record (EMR). Perceived barriers to implementation included poor patient compliance, changes in administration workflow, and difficulties associated with patients with no email addresses, and limited computer skills.ConclusionsImplementation of an opioid risk electronic pain assessment program significantly increased the likelihood that a risk assessment would be included in the medical record, which has implications for improvement of quality of care.
Role of Ozone in UV‐C Disinfection, Demonstrated by Comparison between Wild‐Type and Mutant Conidia of Aspergillus niger
Authors: Liu Jing , Zhou Lin , Chen Ji‐Hong , Mao Wang , Li Wen‐Jian , Hu Wei , Wang Shu‐Yang , Wang Chun‐Ming 
Published: November 2013

AbstractThis study aimed to investigate the tolerance of a melanized wild‐type strain of Aspergillus niger (CON1) and its light‐colored mutant (MUT1) to UV–C light and the concomitantly generated ozone. Treatments were segregated into four groups based on whether UV irradiation was used and the presence or absence of ozone: (−UV, −O3), (−UV, +O3), (+UV, −O3) and (+UV, +O3). The survival of CON1 and MUT1 conidia under +UV decreased as the exposure time increased, with CON1 showing greater resistance to UV irradiation than MUT1. Ozone induced CON1 conidium inactivation only under conditions of UV radiation exposure. While, the inactivation effect of ozone on MUT1 was always detectable regardless of the presence of UV irradiation. Furthermore, the CON1 conidial suspension showed lower UV light transmission than MUT1 when examined at the same concentration. Compared with the pigment in MUT1, the melanin in CON1 exhibited more potent radical‐scavenging activity and stronger UV absorbance. These results suggested that melanin protected A. niger against UV disinfection via UV screening and free radical scavenging. The process by which UV–C disinfection induces a continual decrease in conidial survival suggests that UV irradiation and ozone exert a synergistic fungicidal effect on A. niger prior to reaching a plateau.
Evaluating complications during intraoral administration of local anesthetics in a rural, portable special needs dental clinic
Authors: Boynes Sean , Riley Amah , Milbee Sarah 
Published: November 2013

ABSTRACTThe aim of this study was to identify and quantify complications with local anesthetic administration on consecutive patients seen for dental care in a portable dental clinic providing care to patients with special needs. This prospective study includes data on the patients seen by the portable dental team. A standardized form is used to determine complications and associated information for 172 dental visits in which local anesthetic is administered. After statistical analysis of 172 consecutive cases, the overall complication rate is 8.1%. All of the complications are considered to be mild or moderate; there are no reports of severe events. The complications encountered most frequently are associated with self‐inflicted soft tissue injury or inadequate anesthesia. Comprehensive care with local anesthesia delivered by a portable dental clinic has a low risk of complication. The administration of an inferior alveolar nerve block or body‐mass status appears to affect the incidence of complications.
Inhibitor of Cysteine Proteases Is Critical for Motility and Infectivity of
Plasmodium
Sporozoites
Authors: Boysen Katja E. , Matuschewski Kai 
Published: November 2013

ABSTRACT

Malaria is transmitted when motile sporozoites are injected into the dermis by an infected female
Anopheles
mosquito. Inside the mosquito vector, sporozoites egress from midgut-associated oocysts and eventually penetrate the acinar cells of salivary glands. Parasite-encoded factors with exclusive vital roles in the insect vector can be studied by classical reverse genetics. Here, we characterized the
in vivo
roles of
Plasmodium berghei
falstatin/ICP (inhibitor of cysteine proteases). This protein was previously suggested to act as a protease inhibitor during erythrocyte invasion. We show by targeted gene disruption that loss of ICP function does not affect growth inside the mammalian host but causes a complete defect in sporozoite transmission. Sporogony occurred normally in
icp
(−) parasites, but hemocoel sporozoites showed a defect in continuous gliding motility and infectivity for salivary glands, which are prerequisites for sporozoite transmission to the mammalian host. Absence of ICP correlates with enhanced cleavage of circumsporozoite protein, in agreement with a role as a protease regulator. We conclude that ICP is essential for only the final stages of sporozoite maturation inside the mosquito vector. This study is the first genetic evidence that an ICP is necessary for the productive motility of a eukaryotic parasitic cell.

IMPORTANCE
Cysteine proteases and their inhibitors are considered ideal drug targets for the treatment of a wide range of diseases, including cancer and parasitic infections. In protozoan parasites, including
Leishmania
,
Trypanosoma
, and
Plasmodium
, cysteine proteases play important roles in life cycle progression. A mouse malaria model provides an unprecedented opportunity to study the roles of a parasite-encoded inhibitor of cysteine proteases (ICP) over the entire parasite life cycle. By precise gene deletion, we found no evidence that ICP influences disease progression or parasite virulence. Instead, we discovered that this factor is necessary for parasite movement and malaria transmission from mosquitoes to mammals. This finding in a fast-moving unicellular protozoan has important implications for malaria intervention strategies and the roles of ICPs in the regulation of eukaryotic cell migration.
Low-Dose Laser Acupuncture for Non-Specific Chronic Low Back Pain: A Double-Blind Randomised Controlled Trial
Authors: Glazov Gregory , Yelland Michael , Emery Jon 
Published: November 2013

Objective To determine if infrared laser acupuncture (LA) may have a specific effect in reducing pain and disability in treatment of chronic low back pain (LBP). Methods This was a double-blind sham laser controlled trial performed in general practices in Perth, Western Australia. The participants were 144 adults with chronic non-specific LBP. They were randomised to receive eight once-weekly treatments. Laser machines (20 mW, 840 nm diode, power density 0.1 W/cm2) stimulated points in three treatment groups: sham (0 joules/point), low dose (0.2 J/point) and high dose (0.8 joules/point). Participants were followed-up at 1 and 6 weeks, and 6 and 12 months post treatment. Primary outcomes were pain (Numerical Pain Rating Scale (NPRS)) and disability (Oswestry Disability Inventory (ODI)) at 6 weeks post treatment. Secondary outcomes included numerical rating scale for limitation of activity, global assessment of improvement, analgesic usage and adverse effects after treatment. Results The analysis showed no difference between sham and the laser groups at 6 weeks for pain or disability. There was a significant reduction in mean pain and disability in all groups at 6 weeks (p<0.005); NPRS: sham (−1.5 (95% CI −2.1 to −0.8)), low dose (−1.3 (−2.0 to −0.8)), high dose (−1.1 (−1.7 to −0.5)). ODI: sham (−4.0 (−7.1 to −1.0)), low dose (−4.1, (−6.7 to −1.5)), high dose (−2.6 (−5.7 to 0.5)). All secondary outcomes also showed clinical improvement over time but with no differences between groups. Conclusions LA using energy density range (0–4 J/cm2) for the treatment of chronic non-specific LBP resulted in clinical improvement unrelated to laser stimulation. Trial Registration http://www.anzctr.org.au ACTRN12610000043033.
Randomised Clinical Trials on Acupuncture in the Korean Literature: Bibliometric Analysis and Methodological Quality
Authors: Kim Sina , Sagong Hye Seon , Kong Jae Cheol , Choi Jun-Yong , Lee Myeong Soo , Wieland L Susan , Manheimer Eric , Shin Byung-Cheul 
Published: November 2013

Objective Acupuncture systematic reviewers have increasingly searched Chinese databases and journals to identify eligible randomised clinical trials (RCTs). However, reviewers have infrequently searched for eligible RCTs in Korean databases and journals. This study aimed to identify difficult to locate acupuncture RCTs in Korean databases and journals and to assess the characteristics and quality of the identified RCTs. Methods Eleven electronic databases and seven journals were searched up to December 2012. All RCTs using needle acupuncture were considered for inclusion. Key study characteristics were extracted and risk of bias was assessed using the Cochrane Collaboration tool. Results One hundred and forty-three publications met our inclusion criteria. Acupuncture RCTs in the Korean literature emerged in the mid-1990s and increased in the mid-2000s. Diverse methods of acupuncture were used, including some methods unique to Korea (eg, Saam acupuncture). The largest proportion of trials evaluated acupuncture for musculoskeletal conditions (27.3%). The mean sample size was 44.3±25.3 per trial. Random sequence generation methods were reported in 44.8% of the RCTs, whereas only 11.9% reported methods of allocation concealment. A low proportion of trials reported participant blinding (32.9%) and outcome assessment blinding (18.9%). Conclusions Korean acupuncture trials, many of which evaluate acupuncture styles unique to Korea, are typically omitted from systematic reviews of acupuncture, resulting in the potential for language bias. The development of this database of difficult to locate Korean trials, which includes English language translations of abstracts, will enable these trials of varying quality to be assessed for inclusion in future acupuncture systematic reviews.
Reduction in myocardial infarction admissions in Liverpool after the smoking ban: potential socioeconomic implications for policymaking
Authors: Liu Andrew , Guzman Castillo Maria , Capewell Simon , Lucy John , O'Flaherty Martin 
Published: November 2013

ObjectivesTo analyse the trends and trend changes in myocardial infraction (MI) and coronary heart disease (CHD) admissions, to investigate the effects of the 2007 smoke-free legislation on these trends, and to consider the policy implications of any findings.Design settingLiverpool (city), UK.ParticipantsHospital episode statistics data on all 56 995 admissions for CHD in Liverpool between 2004 and 2012 (International Classification of Diseases codes I20–I25 coded as an admission diagnosis within the defined dates).Primary and secondary outcome measuresTrend gradient and change points (by trend regressions analysis) in age-standardised MI admissions in Liverpool between 2004 and 2012; by sex and by socioeconomic status. Secondary analysis on CHD admissions.ResultsA significant and sustained reduction was seen in MI admissions in Liverpool beginning within 1 year of the smoking ban. Comparing 2005/2006 and 2010/2011, the age-adjusted rates for MI admissions fell by 42% (39–45%) (41.6% in men and by 42.6% in women). Trend analysis shows that this is significantly greater than the background trend of decreasing admissions. These reductions appeared consistent across all socioeconomic groups. Interestingly, admission rates for total CHD (including mild to severe angina) increased by 10% (8–12%).ConclusionsA dramatic reduction in MI admissions in Liverpool has been observed coinciding with the smoking ban in 2007. Furthermore, the benefits were apparent across the socioeconomic spectrum. Health inequalities were not affected and may even have been reduced. The rapid effects observed with this top-down, environmental policy may further increase its value to policymakers.
Improving adherence to guidelines for extended venous thromboembolism prophylaxis in patients with colorectal cancer
Authors: Patel Markand , Harris Mark , Tapply Ian , Longman Rob 
Published: November 2013

AbstractExtended venous thromboembolism prophylaxis (EVTEP) with low-molecular weight heparin such as enoxaparin for 28 days following surgery for cancer significantly reduces venous thromboembolic events compared to a standard 6-10 day course. National Institute of Clinical Excellence (NICE) guidelines suggest EVTEP should be offered to patients undergoing colorectal cancer surgery. Local EVTEP prescribing and monitoring guidelines in a busy inner city teaching hospital colorectal surgery unit, were devised to ensure NICE guidelines are followed. Adherence to local EVTEP guidelines was recorded through a retrospective audit of patients undergoing elective colorectal cancer surgery during February 2011 (n=19). Prospective re-audit cycles were undertaken during April-May (n=17) and September-December 2012 (n=17). The first audit cycle revealed that overall standards were not being met with just 11% of ‘at risk’ patients being correctly identified in pre-operative assessment clinic and continued low adherence to guidelines on the ward with only 44% of patients being prescribed EVTEP at discharge. Following each audit cycle, educational interventions were directed towards the multi-disciplinary team involved in the care of patients undergoing colorectal cancer surgery. This involved education of the team members regarding EVTEP, presentation of the audit results with instruction for improvement. Results of the second and third audit cycles showed improvements in guideline adherence with 100% of patients in these cohorts having been prescribed EVTEP at discharge. Marked improvements were also seen in the correct identification of ‘at risk’ patients, patient education in pre-operative assessment clinic, and warning of potential side-effects. This project has shown a significant global improvement in EVTEP-related patient care and adherence to local guidelines following education of the multi-disciplinary team involved, which consequently reduced the risk of venous thromboembolism within this patient cohort.
The impact of the Iraq War on neonatal polio immunisation coverage: a quasi-experimental study
Authors: Cetorelli Valeria 
Published: November 2013

BackgroundThe public health consequences of the Iraq War (2003–2011) have remained difficult to quantify, mainly due to a scarcity of adequate data. This paper is the first to assess whether and to what extent the war affected neonatal polio immunisation coverage.MethodThe study relies on retrospective neonatal polio vaccination histories from the 2000, 2006 and 2011 Iraq Multiple Indicator Cluster Surveys (N=64 141). Pooling these surveys makes it possible to reconstruct yearly trends in immunisation coverage from 1996 to 2010. The impact of the war is identified with a difference-in-difference approach contrasting immunisation trends in the autonomous Kurdish provinces, which remained relatively safe during the war, with trends in the central and southern provinces, where violence and disruption were pervasive.ResultsAfter controlling for individual and household characteristics, year of birth and province of residence, children exposed to the war were found to be 21.5 percentage points (95% CI −0.341 to −0.089) less likely to have received neonatal polio immunisation compared with non-exposed children.ConclusionsThe decline in neonatal polio immunisation coverage is part of a broader war-induced deterioration of routine maternal and newborn health services. Postwar strategies to promote institutional deliveries and ensure adequate vaccine availability in primary health facilities could increase dramatically the percentage of newborns immunised.
Blocking SDF-1α/CXCR4 Downregulates PDGF-B and Inhibits Bone Marrow–Derived Pericyte Differentiation and Tumor Vascular Expansion in Ewing Tumors
Authors: Hamdan Randala , Zhou Zhichao , Kleinerman Eugenie S. 
Published: November 2013

Abstract
Bone marrow cells (BMC) are critical to the expansion of the tumor vessel network that supports Ewing sarcoma growth. BMCs migrate to the tumor and differentiate into endothelial cells and pericytes. We recently demonstrated that stromal-derived growth factor 1α (SDF-1α) regulates platelet-derived growth factor B (PDGF-B) and that this pathway plays a critical role in bone marrow–derived pericyte differentiation in vitro. We investigated the role of SDF-1α/PDGF-B in the tumor microenvironment in vivo in promoting bone marrow–derived pericyte differentiation in Ewing tumors. The CXCR4 antagonist AMD 3100 was used to disrupt the SDF-1α/CXCR4 axis in vivo in two xenograft Ewing tumor models. BMCs from GFP+ transgenic mice were transplanted into lethally irradiated nude mice to track BMC migration to the tumor site. Following BMC engraftment, tumor-bearing mice received daily subcutaneous injections of either PBS or AMD 3100 for 3 weeks. Tumors were resected and tumor sections were analyzed by immunohistochemistry. AMD 3100 inhibited BMC differentiation into desmin+ and NG2+ pericytes, affected the morphology of the tumor vasculature, decreased perfusion, and increased tumor cell apoptosis. We observed smaller vessels with tiny lumens and a decrease in the microvessel density. AMD 3100 also inhibited PDGF-B protein expression in vitro and in vivo. SDF-1α in the tumor microenvironment plays a critical role in promoting pericyte formation and Ewing sarcoma tumor neovascularization by regulating PDGF-B expression. Interfering with this pathway affects tumor vascular morphology and expansion. Mol Cancer Ther; 13(2); 483–91. ©2013 AACR.
Regular Aspirin Use and Risk of Multiple Myeloma: A Prospective Analysis in the Health Professionals Follow-up Study and Nurses' Health Study
Authors: Birmann Brenda M. , Giovannucci Edward L. , Rosner Bernard A. , Colditz Graham A. 
Published: November 2013

Abstract
Multiple myeloma is a lethal malignancy with an unknown etiology and no prevention strategy. Aspirin inhibits several pathways mediated by NF-κB, COX-2, or their targets that are important in multiple myeloma pathogenesis. We conducted prospective analyses in the Health Professionals Follow-up Study and Nurses' Health Study cohorts to examine whether regular aspirin use influences multiple myeloma risk. We used biennially updated data to characterize aspirin use from baseline through a cancer diagnosis, death, or 2008. We applied a 4-year lag in exposure classification to diminish the influence of preclinical multiple myeloma on aspirin use habits. We obtained HRs and 95% confidence intervals (CI) from multivariable proportional hazard models to assess the association of aspirin use with multiple myeloma risk. We tested for trend across increasing quantity and duration of use. During 2,395,458 person-years, we confirmed 328 incident multiple myeloma diagnoses, including 265 with prospective information on typical aspirin dose and frequency. Participants with a cumulative average of ≥5 adult strength (325 mg) tablets per week had a 39% lower multiple myeloma risk than nonusers (HR; 95% CI, 0.61, 0.39–0.94; tablets per week, Ptrend = 0.06). Persons with ≥11 years of continuous regular aspirin use also had a lower multiple myeloma risk (HR; 95% CI, 0.63, 0.41–0.95; duration, Ptrend = 0.17). The associations appeared stronger in men than in women, possibly reflecting gender differences in aspirin use patterns. This prospective study of aspirin use and multiple myeloma supports an etiologic role for aspirin-inhibited (i.e., NF-κB- or COX-2 mediated) pathways. The utility of aspirin for multiple myeloma chemoprevention warrants further evaluation. Cancer Prev Res; 7(1); 33–41. ©2013 AACR.