Bioindicators of severe ocean acidification are absent from the end-Permian mass extinction.

The role of ocean acidification in the end-Permian mass extinction is highly controversial with conflicting hypotheses relating to its timing and extent. Observations and experiments on living molluscs demonstrate that those inhabiting acidic settings exhibit characteristic morphological deformities and disordered shell ultrastructures. These deformities should be recognisable in the fossil record, and provide a robust palaeo-proxy for severe ocean acidification. Here, we use fossils of originally aragonitic invertebrates to test whether ocean acidification occurred during the Permian-Triassic transition. Our results show that we can reject a hypothesised worldwide basal Triassic ocean acidification event owing to the absence of deformities and repair marks on bivalves and gastropods from the Triassic Hindeodus parvus Conodont Zone. We could not, however, utilise this proxy to test the role of a hypothesised acidification event just prior to and/or during the mass extinction event. If ocean acidification did develop during the mass extinction event, then it most likely only occurred in the latest Permian, and was not severe enough to impact calcification.

RNs' Perceptions of Engagement and Communication in the Workplace.

OBJECTIVE: This study examines nurses' perceptions of communication and engagement in the workplace. BACKGROUND: Work engagement and communication are both important concepts in the healthcare environment. METHODS: Inferential analyses were conducted using the Utrecht Work Engagement Scale and Farley's Communication Assessment Questionnaire, along with descriptive and bivariate analyses. RESULTS: Job vigor was negatively associated with the level of informed communication and indirect communication, whereas greater job dedication was found to be associated with more informed communication. Additionally, a statistically significant correlation between years of experience and vigor and absorption was noted, although age did not demonstrate the same relationship. Ultimately, nurse characteristics played an important role in the perception of communication in the work environment and in job enthusiasm. CONCLUSIONS: Nurse administrators must create a culture that values communication and communicate skillfully using various methods to meet the needs of different employees.

Congenital dysfibrinogenaemia presented with preterm premature rupture of the membranes and vaginal bleeding.

A 26-year-old woman was found to have congenital dysfibrinogenaemia after presenting to our hospital with premature rupture of the membranes and vaginal bleeding. Given the absence of clear guidelines for the management of pregnancy complicated by dysfibrinogenaemia, we followed expert consensus that exists among published works, with some modifications. This case was managed by a multidisciplinary team of obstetrics-gynaecology, haematology and paediatric haematology. Here we review how the patient presented, the investigations that led to the diagnosis and the treatment options.

A standardized head-fixation system for performing large-scale, in vivo physiological recordings in mice.

BACKGROUND: The Allen Institute recently built a set of high-throughput experimental pipelines to collect comprehensive in vivo surveys of physiological activity in the visual cortex of awake, head-fixed mice. Developing these large-scale, industrial-like pipelines posed many scientific, operational, and engineering challenges. NEW METHOD: Our strategies for creating a cross-platform reference space to which all pipeline datasets were mapped required development of 1) a robust headframe, 2) a reproducible clamping system, and 3) data-collection systems that are built, and maintained, around precise alignment with a reference artifact. RESULTS: When paired with our pipeline clamping system, our headframe exceeded deflection and reproducibility requirements. By leveraging our headframe and clamping system we were able to create a cross-platform reference space to which multi-modal imaging datasets could be mapped. COMPARISON WITH EXISTING METHODS: Together, the Allen Brain Observatory headframe, surgical tooling, clamping system, and system registration strategy create a unique system for collecting large amounts of standardized in vivo datasets over long periods of time. Moreover, the integrated approach to cross-platform registration allows for multi-modal datasets to be collected within a shared reference space. CONCLUSIONS: Here we report the engineering strategies that we implemented when creating the Allen Brain Observatory physiology pipelines. All of the documentation related to headframe, surgical tooling, and clamp design has been made freely available and can be readily manufactured or procured. The engineering strategy, or components of the strategy, described in this report can be tailored and applied by external researchers to improve data standardization and stability.

Open-path multi-species remote sensing with a broadband optical parametric oscillator.

Open-path remote sensing is critical for monitoring fugitive emissions from industrial sites, where a variety of volatile organic compounds may be released. At ranges of only a few tens of metres, spatially coherent broadband mid-infrared sources can access sufficiently large absorption cross-sections to quantify hydrocarbon gas fluctuations above ambient background levels at high signal:noise ratios. Here we report path-integrated simultaneous concentration measurements of water, methane and ethane implemented in the 3.1-3.5-µm range using 0.05-cm-1-resolution Fourier-transform spectroscopy with an ultrafast optical parametric oscillator and a simple, non-compliant target. Real-time concentration changes were observed at a range of 70 m by simulating a fugitive emission with a weak localized release of 2% methane in air. Spectral averaging yielded a methane detection sensitivity of 595 ppb·m, implying a system capability to resolve few-ppb concentrations of many volatile organic compounds at observation ranges of 50-100 m.

Transanal endoscopic microsurgery for rectal lesions in a specialist regional early rectal cancer centre: the Mersey experience.

AIM: Organ-preserving local excision by transanal endoscopic microsurgery (TEM) for early rectal cancer offers significantly lower morbidity as compared to formal rectal cancer resection with acceptable outcomes. This study presents our 6-year experience of TEM for rectal lesions referred to a specialist early rectal cancer centre in the UK. METHOD: Data were collected for all patients referred for TEM of suspected early rectal cancer to a regional specialist early rectal cancer multidisciplinary team (MDT) over a 6-year period. RESULTS: One hundred and forty-one patients who underwent full-thickness TEM for suspected or confirmed early rectal cancer were included. Thirty patients were referred for TEM following incomplete endoscopic polypectomy. Final pathology was benign in 77 (54.6%) cases and malignant in 64 (45.4%). Of the 61 confirmed adenocarcinomas, TEM resections were pT0 in 17 (27.9%), pT1 in 32 (51.7%), pT2 in 11 (18.0%) and pT3 in 1 (1.6%). Thirty-eight of 61 patients (62.3%) had one or more poor histological prognostic features and these patients were offered further treatment. Twenty-three of 61 (37.7%) patients with rectal adenocarcinoma required no further treatment following TEM. Forty-three cases of rectal adenocarcinoma were available for establishing recurrence rates. Two of 43 patients (4.7%) developed a recurrence at a median follow-up of 28.7 months (12.1-66.5 months). The overall estimated 5-year overall survival rate was 87.9% and the disease-free survival rate was 82.9%. CONCLUSION: Acceptable outcomes are possible for TEM surgery with appropriate patient selection, effective technique, expert histopathology, appropriate referral for adjuvant treatment and meticulous follow-up. This can be achieved through an early rectal cancer MDT in a dedicated specialist regional centre.

The Multiple Sclerosis Severity Score: fluctuations and prognostic ability in a longitudinal cohort of patients with MS.

BACKGROUND: The Multiple Sclerosis Severity Score (MSSS), combining the Expanded Disability Status Scale (EDSS) and disease duration, attempts to stratify multiple sclerosis (MS) patients based on their rate of progression. Its prognostic ability in the individual patient remains unproven. OBJECTIVES: To assess the stability of MSSS within individual persons with MS in a longitudinal cohort, to evaluate whether certain factors influence MSSS variability, and to explore the ability of MSSS to predict future ambulatory function. METHODS: A single-center retrospective review was performed of patients following a single provider for at least 8 years. Mixed model regression modeled MSSS over time. A Kaplan-Meier survival plot was fitted, using change of baseline MSSS by at least one decile as the event. Cox modeling assessed the influence of baseline clinical and demographic factors on the hazard of changing MSSS by at least one decile. Linear models evaluated the impact of baseline EDSS, baseline MSSS, and other factors on the Timed 25-Foot Walk (T25FW). RESULTS: Out of 122 patients, 68 (55.7%) deviated from baseline MSSS by at least one decile. Final T25FW had slightly weaker correlation to baseline MSSS than to baseline EDSS, which was moderately strongly correlated with future log T25FW. CONCLUSION: Individual MSSS scores often vary over time. Clinicians should exercise caution when using MSSS to prognosticate.

Suicidal thoughts in low-income adolescents: a longitudinal analysis.

OBJECTIVES: The aim of this study was to identify whether suicidal ideation in low-income adolescents is influenced by social environment and social support. METHODS: We performed a growth curve model using a sample of 6687 low-income adolescents living in the Mobile, AL Metropolitan Statistical Area. The outcome for the present study was whether the participant had thought about suicide in the past 12 months. RESULTS: From 1998 to 2011, an average of 14.3% of the study participants indicated that they had considered killing themselves in the past 12 months on an annual basis (11.2-17.6%). Accounting for confounding factors, positive peer support, inevitability of violence, and having moved in the past year resulted in an increased risk, though the effect of inevitability of violence decreased over time. Meanwhile, elevated perceptions of contextual safety and increased parental warmth resulted in reduced risk. These findings suggest that social support and social context are important indicators of suicidal ideation in adolescents. CONCLUSIONS: Suicidal ideation is an important predictor of suicidal behavior. If suicidal ideation can be prevented, or predicted, then it is possible that suicidal behavior can be reduced.

Interrelationships Among Resilience, Posttraumatic Stress Disorder, Traumatic Brain Injury, Depression, and Academic Outcomes in Student Military Veterans.

Resilience, depression, posttraumatic stress disorder (PTSD), and traumatic brain injury (TBI) are important factors to consider as student military Veterans work to reintegrate into society. The impact of these factors on academic success is not fully understood, but is important for rehabilitation professionals, student advisors, and counselors. The current study examined the impact of resilience, depression, PTSD, and TBI on student Veteran academic outcomes, and whether the amount of student Veterans' military experience moderated the effect of these factors on academic performance. Seventy-seven student Veterans completed measures that assessed resilience, grade point average, academic disruptions, and symptoms of depression, PTSD, and TBI. Path analysis was used to determine the manner in which the variables influenced academic performance. Results indicate that student Veterans should not be viewed as a homogeneous group and their needs differ based on level of military experience. Academic disruption among less experienced Veterans was most associated with symptoms of depression, whereas academic disruption among more experienced Veterans was most associated with symptoms of TBI. [Journal of Psychosocial Nursing and Mental Health Services, 57(2), 35-43.].

Small Bowel Obstruction.

Identifying patients with small bowel obstruction who need operative intervention and those who will fail nonoperative management is a challenge. Without indications for urgent intervention, a computed tomography scan with/without intravenous contrast should be obtained to identify location, grade, and etiology of the obstruction. Most small bowel obstructions resolve with nonoperative management. Open and laparoscopic operative management are acceptable approaches. Malnutrition needs to be identified early and managed, especially if the patient is to undergo operative management. Confounding conditions include age greater than 65, post Roux-en-Y gastric bypass, inflammatory bowel disease, malignancy, virgin abdomen, pregnancy, hernia, and early postoperative state.

Can acoustic radiation force imaging of the liver and spleen predict the presence of gastroesophageal varices?

AIM: To determine whether acoustic radiation force imaging (ARFI) of the liver/spleen could be used in patients with cirrhosis to predict the presence of gastroesophageal varices (GOVs). MATERIALS AND METHODS: Fifty-eight patients with cirrhosis who were undergoing 6-monthly ultrasound examinations for hepatoma surveillance and who were due to have oesophagogastroduodenoscopy (OGD) within 6 months of their ultrasound were recruited. During routine ultrasound, the patient's liver and spleen were also assessed using ARFI. Other clinical parameters (platelet count, spleen size, and transient elastography measurements) were also collected. Logistic regression was used to determine which variables were significantly associated with presence or absence of varices univariably and multivariably RESULTS: Fourteen patients (24%) had GOVs. Patients with GOVs had higher ARFI measurements in the liver and spleen than patients without GOVs (liver: 2.39 versus 2.13, spleen: 2.89 versus 2.82), but these results were not statistically significant (odds ratio=1.75, 95% confidence interval [CI]=0.82, 3.91 and odds ratio=1.12, 95% CI=0.33, 3.97, respectively). The platelet/splenic ratio, in comparison, was associated with the presence or absence of GOVs in multivariate analysis (odds ratio=0.32, 95% CI=0.008, 0.91). CONCLUSION: Although patients with GOVs had overall higher ARFI liver and spleen results, this was not statistically significant. As such, ARFI cannot yet replace OGD in predicting GOVs in this patient group.

Clinical impact of rapid molecular detection of respiratory pathogens in patients with acute respiratory infection.

BACKGROUND: Acute respiratory infections (ARI) are a leading cause of morbidity and mortality worldwide. There is a need to demonstrate the clinical impact of using the new, rapid and sensitive molecular assays in prospectively designed studies. OBJECTIVES: To study the impact on medical management of a rapid molecular assay in patients with respiratory infections. STUDY DESIGN: A prospective, randomized, non-blinded study was performed in patients presenting to the Emergency Department during two respiratory seasons (2016-2017). Diagnosis was performed by FilmArray Respiratory Panel (FilmArray-RP) or by immunofluorescence assay (IFA). RESULTS: A total of 432 patients (156 children and 276 adults) were analyzed. Diagnosis with FilmArray-RP was associated with significant changes in medical management including withholding antibiotic prescriptions (OR:15.52, 95%CI:1.99-120.83 in adults and OR:12.23, 95%CI:1.56-96.09 in children), and reduction in complementary studies in children (OR:9.64, 95%CI:2.13-43.63) compared to IFA. Decrease in oseltamivir prescriptions was significantly higher in adults in the FilmArray-RP group (p = 0.042; OR:1.19, 95%CI:0.51-2.79) compared to adults managed with IFA. Diagnostic yield was significantly higher by FilmArray-RP (81%) than by IFA (31%)(p < 0.001). The median time from sample collection to reporting was 1 h 52 min by FilmArray-RP and 26 h by IFA (p < 0.001). CONCLUSIONS: The high respiratory viruses' detection rate and availability of results within two hours when using FilmArray-RP were associated with decreases in antibiotic prescriptions and complementary studies and more accurate use of oseltamivir.

Tree water-use strategies to improve stormwater retention performance of biofiltration systems.

Biofiltration systems are highly valued in urban landscapes as they remove pollutants from stormwater runoff whilst contributing to a reduction in runoff volumes. Integrating trees in biofilters may improve their runoff retention performance, as trees have greater transpiration than commonly used sedge or herb species. High transpiration rates will rapidly deplete retained water, creating storage capacity prior to the next runoff event. However, a tree with high transpiration rates in a biofilter system will likely be frequently exposed to drought stress. Selecting appropriate tree species therefore requires an understanding of how different trees use water and how they respond to substrate drying. We selected 20 tree species and quantified evapotranspiration (ET) and drought stress (leaf water potential; Ψ) in relation to substrate water content. To compare species, we developed metrics which describe: (i) maximum rates of ET under well-watered conditions, (ii) the sensitivity of ET and (iii) the response of Ψ to declining substrate water content. Using these three metrics, we classified species into three groups: risky, balanced or conservative. Risky and balanced species showed high maximum ET, whereas conservative species always had low ET. As substrates dried, the balanced species down-regulated ET to delay the onset of drought stress; whereas risky species did not. Therefore, balanced species with high ET are more likely to improve the retention performance of biofiltration systems without introducing significant drought risk. This classification of tree water use strategies can be easily integrated into water balance models and improve tree species selection for biofiltration systems.

A systematic review of the prevalence of comorbid cancer and dementia and its implications for cancer-related care.

OBJECTIVES: A comorbid diagnosis of cancer and dementia (cancer-dementia) may have unique implications for patient cancer-related experience. The objectives were to estimate prevalence of cancer-dementia and related experiences of people with dementia, their carers and cancer clinicians including cancer screening, diagnosis, treatment and palliative care. METHOD: Databases were searched (CINAHL, Psychinfo, Medline, Embase, BNI) using key terms such as dementia, cancer and experience. Inclusion criteria were as follows: (a) English language, (b) published any time until early 2016, (c) diagnosis of cancer-dementia and (d) original articles that assessed prevalence and/or cancer-related experiences including screening, cancer treatment and survival. Due to variations in study design and outcomes, study data were synthesised narratively. RESULTS: Forty-seven studies were included in the review with a mix of quantitative (n = 44) and qualitative (n = 3) methodologies. Thirty-four studies reported varied cancer-dementia prevalence rates (range 0.2%-45.6%); the others reported reduced likelihood of receiving: cancer screening, cancer staging information, cancer treatment with curative intent and pain management, compared to those with cancer only. The findings indicate poorer cancer-related clinical outcomes including late diagnosis and higher mortality rates in those with cancer-dementia despite greater health service use. CONCLUSIONS: There is a dearth of good-quality evidence investigating the cancer-dementia prevalence and its implications for successful cancer treatment. Findings suggest that dementia is associated with poorer cancer outcomes although the reasons for this are not yet clear. Further research is needed to better understand the impact of cancer-dementia and enable patients, carers and clinicians to make informed cancer-related decisions.

Canadian Guidelines for Controlled Pediatric Donation After Circulatory Determination of Death-Summary Report

OBJECTIVES: Create trustworthy, rigorous, national clinical practice guidelines for the practice of pediatric donation after circulatory determination of death in Canada. METHODS: We followed a process of clinical practice guideline development based on World Health Organization and Canadian Medical Association methods. This included application of Grading of Recommendations Assessment, Development, and Evaluation methodology. Questions requiring recommendations were generated based on 1) 2006 Canadian donation after circulatory determination of death guidelines (not pediatric specific), 2) a multidisciplinary symposium of national and international pediatric donation after circulatory determination of death leaders, and 3) a scoping review of the pediatric donation after circulatory determination of death literature. Input from these sources drove drafting of actionable questions and Good Practice Statements, as defined by the Grading of Recommendations Assessment, Development, and Evaluation group. We performed additional literature reviews for all actionable questions. Evidence was assessed for quality using Grading of Recommendations Assessment, Development, and Evaluation and then formulated into evidence profiles that informed recommendations through the evidence-to-decision framework. Recommendations were revised through consensus among members of seven topic-specific working groups and finalized during meetings of working group leads and the planning committee. External review was provided by pediatric, critical care, and critical care nursing professional societies and patient partners. RESULTS: We generated 63 Good Practice Statements and seven Grading of Recommendations Assessment, Development, and Evaluation recommendations covering 1) ethics, consent, and withdrawal of life-sustaining therapy, 2) eligibility, 3) withdrawal of life-sustaining therapy practices, 4) ante and postmortem interventions, 5) death determination, 6) neonatal pediatric donation after circulatory determination of death, 7) cardiac and innovative pediatric donation after circulatory determination of death, and 8) implementation. For brevity, 48 Good Practice Statement and truncated justification are included in this summary report. The remaining recommendations, detailed methodology, full Grading of Recommendations Assessment, Development, and Evaluation tables, and expanded justifications are available in the full text report. CONCLUSIONS: This process showed that rigorous, transparent clinical practice guideline development is possible in the domain of pediatric deceased donation. Application of these recommendations will increase access to pediatric donation after circulatory determination of death across Canada and may serve as a model for future clinical practice guideline development in deceased donation

Ultrasound surveillance for hepatocellular carcinoma: service evaluation of a radiology-led recall system in a tertiary-referral centre for liver diseases in the UK.

AIM: To review the radiology-led ultrasound (US) surveillance programme for the detection of hepatocellular carcinoma (HCC) in cirrhotic patients in a UK tertiary-referral centre. MATERIALS AND METHODS: The radiology information system was searched for patients who had undergone US for surveillance of cirrhosis from September 2009 to May 2013. Patient demographics and cirrhosis aetiology were documented. Data including numbers of surveillance scans, abnormal findings suspicious for HCC, subsequent radiological investigations, numbers of HCC and survival for HCC patients were recorded. Service performance data, such as rates of attendance and rebooking, were also recorded. RESULTS: Eight hundred and four patients entered surveillance and 2,366 surveillance US examinations were performed; 368 (46%) underwent follow-up (6-monthly US). Abnormalities leading to further radiological investigations were found in 81 patients. Reasons for incomplete surveillance included non-attendance and radiology failure to re-book appointments. HCC was diagnosed in 22 patients. Fourteen had HCC diagnosed on a surveillance scan, eight had HCC diagnosed on a scan performed for other reasons. Patients diagnosed with HCC on a surveillance scan were more likely to be treated with curative intent and had longer survival. CONCLUSION: Even with a radiology-led recall service for HCC surveillance, the proportion of patients receiving scans 6-monthly was low, due in part to the lack of organisational support that is available for other screening programmes. This study gives a realistic representation of the implementation of surveillance in a UK hospital at the current time and of the rates of HCC proceeding to treatment.

A prospective, multicentre, open-label, single-arm clinical trial for treatment of chronic complex diabetic foot wounds with exposed tendon and/or bone: positive clinical outcomes of viable cryopreserved human placental membrane.

Complex diabetic foot ulcers (DFUs) with exposed tendon or bone remain a challenge. They are more susceptible to complications such as infection and amputation and require treatments that promote rapid development of granulation tissue and, ultimately, reepithelialisation. The clinical effectiveness of viable cryopreserved human placental membrane (vCHPM) for DFUs has been established in a level 1 trial. However, complex wounds with exposed deeper structures are typically excluded from randomised controlled clinical trials despite being common in clinical practice. We report the results of a prospective, multicentre, open-label, single-arm clinical trial to establish clinical outcomes when vCHPM is applied weekly to complex DFUs with exposed deep structures. Patients with type 1 or type 2 diabetes and a complex DFU extending through the dermis with evidence of exposed muscle, tendon, fascia, bone and/or joint capsule were eligible for inclusion. Of the 31 patients enrolled, 27 completed the study. The mean wound area was 14·6 cm2 , and mean duration was 7·5 months. For patients completing the protocol, the primary endpoint, 100% wound granulation by week 16, was met by 96·3% of patients in a mean of 6·8 weeks. Complete wound closure occurred in 59·3% (mean 9·1 weeks). The 4-week percent area reduction was 54·3%. There were no product-related adverse events. Four patients (13%) withdrew, two (6·5%) for non-compliance and two (6·5%) for surgical intervention.

The impact of sexuality concerns on teenage pregnancy: a consequence of heteronormativity?

In countries such as the USA, a substantial percentage of teenage pregnancies are intentional, and desire for pregnancy increases risk. Black US Americans have been found to be less accepting of homosexuality than their non-Black peers, which may result in minority ethnic teenagers demonstrating heterosexual orientation through attempting pregnancy. Young, socioeconomically disadvantaged African Americans were surveyed longitudinally regarding attitudes about their sexuality, pregnancy intentions and other psychosocial factors. Young people who reported being somewhat concerned about their sexual orientation were nearly four times more likely to report attempting pregnancy compared to those who were not at all concerned. This relationship held true while accounting for the significant effect of religion, sense of community, hopelessness and numerous demographic factors. The current study suggests that uncertainty regarding sexual orientation, potentially due to social stigma, may impact pregnancy attempts among young Black people from disadvantaged communities.