bluuebunny/crossref_metadata_2025_split huggingface dataset:
No More “Fumbling Alone”: Effect of a Nurse-Led Academic Advising Service in a Magnet
®
Hospital
Authors: Wendler M. Cecilia , Fyans Paula M. , Kirkbride Geri 
Published: March 2013

Background:

A nurse-led, hospital-based academic advising service (AAS) was developed at a large Magnet
®
hospital. The AAS aided nurses and aspiring nurses as they considered advancing education. This research project was developed to evaluate the AAS.

Methods:
This qualitative study used a web-based survey to gather information from those who had accessed the service; there were 80 participants. Satisfaction was determined quantitatively, and qualitative data analysis was completed with naturalistic inquiry approaches and standards of rigor.

Results:
A total of 347 codes were isolated from the data and collapsed into nine categories. One comment, “I did not have to fumble through this alone,” suggested the idea of coaching within a context of football as the overarching metaphor. Quantitative results indicated that advisees were satisfied, with 61 of 80 respondents taking specific action after the session.

Conclusion:
Nurses and aspiring nurses found academic advising at work helpful, and the AAS facilitated a return to formal education for some of the participants.

J Contin Educ Nurs
2013;44(5):218–224.
Preceptors’ Perceptions of Their Role in a Pediatric Acute Care Setting
Authors: Chang Ann , Douglas Mary , Breen-Reid Karen , Gueorguieva Vera , Fleming-Carroll Bonnie 
Published: March 2013

Background:
This study explored preceptors’ perceptions of the benefits, rewards, and supports associated with the preceptor role and their commitment to the role in a pediatric acute care setting.

Method:
A survey with a quantitative and semi-qualitative design was used.

Results:
The survey was completed by 266 preceptors, who reported that their experience was mainly positive. They perceived the preceptor role as preparation for other leadership opportunities. The preceptors reported that they experienced pride in the role of preceptor and described the challenges they faced, such as workload and the need to adapt to different learning styles. Years of nursing experience and age were significant factors that influenced their perceptions of enjoyable aspects of the role and the types of support that they needed as preceptors.

Conclusion:
Preceptors perceived sufficient benefits and rewards to remain committed to the role and identified workload as a significant challenge. Further research is needed to explore whether additional supports or recognition tailored to level of experience and age may be beneficial.

J Contin Educ Nurs
2013;44(5):211–217.
Dose-Dependent Effects of IL-17 on IL-13–Induced Airway Inflammatory Responses and Airway Hyperresponsiveness
Authors: Kinyanjui Margaret W. , Shan Jichuan , Nakada Emily M. , Qureshi Salman T. , Fixman Elizabeth D. 
Published: March 2013

Abstract
The Th2 cytokine IL-13 regulates several aspects of the asthmatic phenotype, including airway inflammation, airway hyperresponsiveness, and mucus production. The Th17 cytokine IL-17A is also implicated in asthma and has been shown to both positively and negatively regulate Th2-dependent responses in murine models of allergic airways disease. Our objective in this study was to better understand the role of IL-17 in airway inflammation by examining how IL-17 modifies IL-13–induced airway inflammatory responses. We treated BALB/c mice intranasally with IL-13 or IL-17 alone or in combination for 8 consecutive days, after which airway hyperresponsiveness, inflammatory cell influx into the lung, and lung chemokine/cytokine expression were assessed. As expected, IL-13 increased airway inflammation and airway hyperresponsiveness. IL-13 also increased numbers of IL-17–producing CD4+ and γδ T cells. Treating mice with a combination of IL-13 and IL-17 reduced infiltration of IL-17+ γδ T cells, but increased the number of infiltrating eosinophils. In contrast, coadministration of IL-13 with a higher dose of IL-17 decreased all IL-13–induced inflammatory responses, including infiltration of both IL-17+CD4+ and γδ T cells. To examine the inhibitory activity of IL-17–expressing γδ T cells in this model, these cells were adoptively transferred into naive recipients. Consistent with an inhibitory role for γδ T cells, IL-13–induced infiltration of eosinophils, lymphocytes, and IL-17+CD4+ T cells was diminished in recipients of the γδ T cells. Collectively, our data indicate that allergic airway inflammatory responses induced by IL-13 are modulated by both the quantity and the cellular source of IL-17.
Coordinated Changes in DNA Methylation in Antigen-Specific Memory CD4 T Cells
Authors: Hashimoto Shin-ichi , Ogoshi Katsumi , Sasaki Atsushi , Abe Jun , Qu Wei , Nakatani Yoichiro , Ahsan Budrul , Oshima Kenshiro , Shand Francis H. W. , Ametani Akio , Suzuki Yutaka , Kaneko Shuichi , Wada Takashi , Hattori Masahira , Sugano Sumio , Morishita Shinichi , Matsushima Kouji 
Published: March 2013

Abstract
Memory CD4+ T cells are central regulators of both humoral and cellular immune responses. T cell differentiation results in specific changes in chromatin structure and DNA methylation of cytokine genes. Although the methylation status of a limited number of gene loci in T cells has been examined, the genome-wide DNA methylation status of memory CD4+ T cells remains unexplored. To further elucidate the molecular signature of memory T cells, we conducted methylome and transcriptome analyses of memory CD4+ T cells generated using T cells from TCR-transgenic mice. The resulting genome-wide DNA methylation profile revealed 1144 differentially methylated regions (DMRs) across the murine genome during the process of T cell differentiation, 552 of which were associated with gene loci. Interestingly, the majority of these DMRs were located in introns. These DMRs included genes such as CXCR6, Tbox21, Chsy1, and Cish, which are associated with cytokine production, homing to bone marrow, and immune responses. Methylation changes in memory T cells exposed to specific Ag appeared to regulate enhancer activity rather than promoter activity of immunologically relevant genes. In addition, methylation profiles differed between memory T cell subsets, demonstrating a link between T cell methylation status and T cell differentiation. By comparing DMRs between naive and Ag-specific memory T cells, this study provides new insights into the functional status of memory T cells.
CD62L Is Critical for Maturation and Accumulation of Murine Hepatic NK Cells in Response to Viral Infection
Authors: Peng Hui , Sun Rui , Tang Ling , Wei Haiming , Tian Zhigang 
Published: March 2013

Abstract
NK cells play critical roles in the first line of defense against viruses and other pathogens. However, the factors that control NK cell recruitment into local sites to exert effector functions during viral infection remain poorly understood. In this study, we found that murine NK cells in various organs could be divided into CD62L− and CD62L+ subsets, the latter of which were less abundant in the liver and exhibited a relatively mature NK cell phenotype and a stronger cytotoxic function. Moreover, NK cells acquired CD62L expression after birth, and the frequency of CD62L+ NK cells gradually increased during postnatal development. In models of polyinosinic-polycytidylic acid administration and adenovirus infection in vivo, CD62L+ NK cell frequency and absolute numbers in the liver rapidly and markedly increased as a result of the augmented differentiation of CD62L− to CD62L+ NK cells and recruitment of peripheral mature NK cells to the liver. However, blocking CD62L prior to administering viral stimuli in vivo abolished viral stimulation–induced NK cell accumulation and maturation in the liver. Collectively, these data suggest that CD62L marks a mature NK cell subset, as well as affects the magnitude of the local NK cell response to viral infection.
Altered T-bet Dominance in IFN-γ–Decoupled CD4+ T Cells with Attenuated Cytokine Storm and Preserved Memory in Influenza
Authors: Dutta Avijit , Miaw Shi-Chuen , Yu Jhang-Sian , Chen Tse-Ching , Lin Chun-Yen , Lin Yung-Chang , Chang Chia-Shiang , He Yueh-Chia , Chuang Sheng-Hao , Yen Ming-I , Huang Ching-Tai 
Published: March 2013

Abstract
Cytokine storm has been postulated as one of the major causes of mortality in patients with severe respiratory viral infections such as influenza. With the help of an influenza Ag- specific mouse experimental system, we report that CD4+ T cells contribute effector cytokines leading to lung inflammation in acute influenza. Although virus can no longer be detected from tissues 14 d postinfection, virus-derived Ag continues to drive a CD4+ T cell response after viral clearance. Ag-specific CD4+ T cells proliferate and evolve into memory CD4+ T cells efficiently, but the production of effector cytokines is seriously hampered during this phase. This decoupling of proliferation and effector cytokine production doesn’t appear in conjunction with increased suppression by regulatory T cells or decreased induction of transcription factors. Rather, GATA-3 and ROR-γt levels are elevated when compared with cells that have effector cytokine production. T-bet dominance over GATA-3 and ROR-γt decreases with the disarmament of effector cytokine production. Importantly, upon reinfection, these decoupled cells produce elevated levels of IFN-γ and were effective in virus eradication. These results provide a mechanism through altered T-bet dominance to dampen the cytokine storm without impeding the generation of memory T cells in influenza virus infection.
Stepwise Epigenetic and Phenotypic Alterations Poise CD8+ T Cells To Mediate Airway Hyperresponsiveness and Inflammation
Authors: Jia Yi , Takeda Katsuyuki , Han Junyan , Joetham Anthony , Marcus Roland A. , Lucas Joseph J. , O’Connor Brian P. , Gelfand Erwin W. 
Published: March 2013

Abstract
The functional plasticity of CD8+ T cells in an atopic environment, encompassing a spectrum from IFN-γ– to IL-13–producing cells, is pivotal in the development of allergic airway hyperresponsiveness and inflammation, and yet remains mechanistically undefined. We demonstrate that CD8+ T cell IL-13 induction proceeded through a series of distinct IL-4/GATA3–regulated stages characterized by gene expression and epigenetic changes. In vivo, CD8+ T cells exposed to an environment rich in IL-4 displayed epigenetic changes at the GATA3 and IL-13 promoter indicative of transcriptional activation and IL-13 production. In vitro, IL-4 triggered the stepwise molecular conversion of CD8+ T cells from IFN-γ to IL-13 production. During the initial stage, IL-4 suppressed T-bet and induced GATA3 expression, characterized by enhanced activating histone modifications and RNA polymerase II (Pol II) recruitment to the GATA3 locus. Notably, recruitment of GATA3 and RNA Pol II to the IL-13 promoter was also detected at this initial stage. However, enhanced IL-13 transcription only occurred at a later stage after TCR stimulation, indicating that IL-4–induced GATA3 recruitment poises the IL-13 locus for TCR-mediated transcription. Thus, both in vivo and in vitro, an atopic (IL-4) environment poises CD8+ T cells via stepwise epigenetic and phenotypic mechanisms for pathogenic conversion to IL-13 production, which is ultimately triggered via an allergen-mediated TCR stimulus.
A New Model for CD8+ T Cell Memory Inflation Based upon a Recombinant Adenoviral Vector
Authors: Bolinger Beatrice , Sims Stuart , O’Hara Geraldine , de Lara Catherine , Tchilian Elma , Firner Sonja , Engeler Daniel , Ludewig Burkhard , Klenerman Paul 
Published: March 2013

Abstract
CD8+ T cell memory inflation, first described in murine CMV (MCMV) infection, is characterized by the accumulation of high-frequency, functional Ag-specific CD8+ T cell pools with an effector-memory phenotype and enrichment in peripheral organs. Although persistence of Ag is considered essential, the rules underpinning memory inflation are still unclear. The MCMV model is, however, complicated by the virus’s low-level persistence and stochastic reactivation. We developed a new model of memory inflation based on a β-galactosidase (βgal)–recombinant adenovirus vector. After i.v. administration in C57BL/6 mice, we observed marked memory inflation in the βgal96 epitope, whereas a second epitope, βgal497, undergoes classical memory formation. The inflationary T cell responses show kinetics, distribution, phenotype, and functions similar to those seen in MCMV and are reproduced using alternative routes of administration. Memory inflation in this model is dependent on MHC class II. As in MCMV, only the inflating epitope showed immunoproteasome independence. These data define a new model for memory inflation, which is fully replication independent, internally controlled, and reproduces the key immunologic features of the CD8+ T cell response. This model provides insight into the mechanisms responsible for memory inflation and, because it is based on a vaccine vector, also is relevant to novel T cell–inducing vaccines in humans.
Military Exercises, Knee and Ankle Joint Position Sense, and Injury in Male Conscripts: A Pilot Study
Authors: Mohammadi Farshid , Azma Kamran , Naseh Iman , Emadifard Reza , Etemadi Yasaman 
Published: March 2013

Context:
The high incidence of lower limb injuries associated with physical exercises in military conscripts suggests that fatigue may be a risk factor for injuries. Researchers have hypothesized that lower limb injuries may be related to altered ankle and knee joint position sense (JPS) due to fatigue.

Objective:
To evaluate if military exercises could alter JPS and to examine the possible relation of JPS to future lower extremity injuries in military service.

Design:
Cohort study.

Setting:
Laboratory.

Patients or Other Participants:
A total of 50 male conscripts (age = 21.4 ± 2.3 years, height = 174.5 ± 6.4 cm, mass = 73.1 ± 6.3 kg) from a unique military base were recruited randomly.

Main Outcome Measure(s):
Participants performed 8 weeks of physical activities at the beginning of a military course. In the first part of the study, we instructed participants to recognize predetermined positions before and after military exercises so we could examine the effects of military exercise on JPS. The averages of the absolute error and the variable error of 3 trials were recorded. We collected data on the frequency of lower extremity injuries over 8 weeks. Next, the participants were divided into 2 groups: injured and uninjured. Separate 2 × 2 × 2 (group-by-time-by-joint) mixed-model analyses of variance were used to determine main effects and interactions of these factors for each JPS measure. In the second part of the study, we examined whether the effects of fatigue on JPS were related to the development of injury during an 8-week training program. We calculated Hedges effect sizes for JPS changes postexercise in each group and compared change scores between groups.

Results:
We found group-by-time interactions for all JPS variables (F range = 2.86–4.05, P &lt; .01). All participants showed increases in JPS errors postexercise (P &lt; .01), but the injured group had greater changes for all the variables (P &lt; .01).

Conclusions:
Military conscripts who sustained lower extremity injuries during an 8-week military exercise program had greater loss of JPS acuity than conscripts who did not sustain injuries. The changes in JPS found after 1 bout of exercise may have predictive ability for future musculoskeletal injuries.
On Diffuse Interface Modeling and Simulation of Surfactants in Two-Phase Fluid Flow
Authors: Engblom Stefan , Do-Quang Minh , Amberg Gustav , Tornberg Anna-Karin 
Published: March 2013

AbstractAn existing phase-fieldmodel of two immiscible fluids with a single soluble surfactant present is discussed in detail. We analyze the well-posedness of the model and provide strong evidence that it is mathematically ill-posed for a large set of physically relevant parameters. As a consequence, critical modifications to the model are suggested that substantially increase the domain of validity. Carefully designed numerical simulations offer informative demonstrations as to the sharpness of our theoretical results and the qualities of the physical model. A fully coupled hydrodynamic test-case demonstrates the potential to capture also non-trivial effects on the overall flow.
Optical Magnification Should Be Mandatory for Microsurgery: Scientific Basis and Clinical Data Contributing to Quality Assurance
Authors: Schoeffl Harald , Lazzeri Davide , Schnelzer Richard , Froschauer Stefan M. , Huemer Georg M. 
Published: March 2013

Background Microsurgical techniques are considered standard procedures in reconstructive surgery. Although microsurgery by itself is defined as surgery aided by optical magnification, there are no guidelines for determining in which clinical situations a microscope or loupe should be used. Therefore, we conducted standardized experiments to objectively assess the impact of optical magnification in microsurgery.
Methods Sixteen participants of microsurgical training courses had to complete 2 sets of experiments. Each set had to be performed with an unaided eye, surgical loupes, and a regular operating microscope. The first set of experiments included coaptation of a chicken femoral nerve, and the second set consisted of anastomosing porcine coronary arteries. Evaluation of the sutured nerves and vessels were performed by 2 experienced microsurgeons using an operating microscope.
Results The 16 participants of the study completed all of the experiments. The nerve coaptation and vascular anastomoses exercises showed a direct relationship of error frequency and lower optical magnification, meaning that the highest number of microsurgical errors occurred with the unaided eye. For nerve coaptation, there was a strong relationship (P<0.05) between the number of mistakes and magnification, and this relationship was very strong (P<0.01) for vascular anastomoses.
Conclusions We were able to prove that microsurgical success is directly related to optical magnification. The human eye's ability to discriminate potentially important anatomical structures is limited, which might be detrimental for clinical results. Although not legally mandatory, surgeries such as reparative surgery after hand trauma should be conducted with magnifying devices for achieving optimal patient outcomes.
Patient costs associated with accessing HIV/AIDS care in Malawi
Authors: Pinto Andrew D , van Lettow Monique , Rachlis Beth , Chan Adrienne K , Sodhi Sumeet K 
Published: March 2013

IntroductionThe decentralization of HIV services has been shown to improve equity in access to care for the rural poor of sub‐Saharan Africa. This study aims to contribute to our understanding of the impact of decentralization on costs borne by patients. Such information is valuable for economic evaluations of anti‐retroviral therapy programmes that take a societal perspective. We compared costs reported by patients who received care in an urban centralized programme to those in the same district who received care through rural decentralized care (DC).MethodsA cross‐sectional survey on patient characteristics and costs associated with accessing HIV care was conducted, in May 2010, on 120 patients in centralized care (CC) at a tertiary referral hospital and 120 patients in DC at five rural health centres in Zomba District, Malawi. Differences in costs borne by each group were compared using χ2 and t‐tests, and a regression model was developed to adjust for confounders, using bootstrapping to address skewed cost data.ResultsThere was no significant difference between the groups with respect to sex and age. However, there were significant differences in socio‐economic status, with higher educational attainment (p<0.001), personal income (p=0.007) and household income per person (p=0.005) in CC. Travel times were similar (p=0.65), as was time waiting at the clinic (p=0.63) and total time spent seeking care (p=0.65). There was a significant difference in travel‐related expenses (p<0.001) related to the type of travel participants noted that they used. In CC, 60% of participants reported using a mini‐bus to reach the clinic; in DC only 4% reported using a mini‐bus, and the remainder reported travelling on foot or by bicycle. There were no significant differences between the groups in the amount of lost income reported or other out‐of‐pocket costs. Approximately 91 Malawi Kwacha (95% confidence intervals: 1–182 MKW) or US$0.59 represents the adjusted difference in total costs per visit between CC and DC.ConclusionsEven within a system of HIV/AIDS care where patients do not pay to see clinicians or for most medications, they still incur costs. We found that most costs are travel related. This has important implications for poorer patients who live at a distance from health facilities for whom these costs may be significant.
Clinical Decision Support and Closed‐Loop Control for Intensive Care Unit Sedation
Authors: Haddad Wassim M. , Bailey James M. , Gholami Behnood , Tannenbaum Allen R. 
Published: March 2013

AbstractCritical care patients undergoing surgery require drug administration to regulate physiological variables such as blood pressure, cardiac output, heart rate, and degree of consciousness. The rate of infusion of each administered drug is critical, requiring constant monitoring and frequent adjustments. Patients in the intensive care unit who require mechanical ventilation due to acute respiratory failure also frequently require the administration of sedative agents. Open‐loop control (manual control) by clinical personnel can be tedious, imprecise, time‐consuming, and sometimes of poor quality, depending on the skills and judgment of the clinician. Dynamical system pharmacokinetic and pharmacodynamic modeling and closed‐loop control system design methodologies can significantly advance our understanding of the wide effects of pharmacological agents and anesthetics, as well as advance the state‐of‐the‐art in active control of drug delivery systems for clinical pharmacology. In this paper, we discuss the challenges and opportunities of clinical decision support and closed‐loop control for intensive care unit sedation.
Crucifixion and median neuropathy
Authors: Regan Jacqueline M. , Shahlaie Kiarash , Watson Joseph C. 
Published: March 2013

AbstractCrucifixion as a means of torture and execution was first developed in the 6th century B.C. and remained popular for over 1000 years. Details of the practice, which claimed hundreds of thousands of lives, have intrigued scholars as historical records and archaeological findings from the era are limited. As a result, various aspects of crucifixion, including the type of crosses used, methods of securing victims to crosses, the length of time victims survived on the cross, and the exact mechanisms of death, remain topics of debate. One aspect of crucifixion not previously explored in detail is the characteristic hand posture often depicted in artistic renditions of crucifixion. In this posture, the hand is clenched in a peculiar and characteristic fashion: there is complete failure of flexion of the thumb and index finger with partial failure of flexion of the middle finger. Such a “crucified clench” is depicted across different cultures and from different eras. A review of crucifixion history and techniques, median nerve anatomy and function, and the historical artistic depiction of crucifixion was performed to support the hypothesis that the “crucified clench” results from proximal median neuropathy due to positioning on the cross, rather than from direct trauma of impalement of the hand or wrist.