International Perspective on Extremity Vascular Trauma in Children: A Scoping Review.

OBJECTIVE: Extremity vascular trauma in children can result in significant morbidity and mortality. Most published studies have focused on supracondylar humeral fracture related injuries, with little focus on other injuries. This scoping review describes the current state of knowledge on paediatric vascular injuries in the upper and lower limbs, excluding injuries related to supracondylar humeral fractures. METHODS: MEDLINE, PubMed, Web of Science, and Cochrane databases were searched for relevant studies evaluating the epidemiology, diagnosis, management, and outcomes of upper and lower limb vascular trauma in those aged under 18 years. Studies related to supracondylar humeral fractures were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews was used. RESULTS: A total of 39 studies was included, all of which were retrospective, and 74% of which were based in North America or Europe. Extremity vascular trauma was reported to cause 0.6 - 4.4% of all paediatric trauma admissions, with penetrating mechanisms and upper limb injuries being the most common. Operative intervention was reported in 80 - 100% of children in the included studies. Primary repair was the most commonly reported operative intervention, followed by interposition graft and bypass graft. Synthetic graft use was less commonly reported (incidence range 0.5 - 33%). Lower limb fasciotomies and amputations were not commonly reported (incidence range 0 - 23% and 0 - 13%, respectively). The mortality rate appeared low, with 23 studies reporting no deaths (incidence range 0 - 4%). Complications were reported inconsistently, with no uniform outcome or follow up measures used. CONCLUSION: The incidence of extremity vascular trauma appears low in children, with penetrating mechanisms and upper extremity injuries appearing to dominate. Most studies are from high income countries, with probable selection bias towards those treated by operative intervention. Prospective studies are required focusing on patterns of injury, rates of operative and endovascular intervention, and long term outcomes.

Haplosporidium acetes n. sp. infecting the hepatopancreas of jelly prawns Acetes sibogae australis from Moreton Bay, Australia.

Wild Acetes sibogae australis from northern Moreton Bay, Australia displaying opacity of the hepatopancreas were sampled and examined histologically, revealing infection by multinucleate plasmodia of a haplosporidian-like parasite in the epithelial cells of the hepatopancreas. A morphological and phylogenetic investigation identified the parasite as a novel species of the order Haplosporida, and the parasite is described as Haplosporidium acetes n. sp. This is the first report of disease caused by a haplosporidian in wild Australian decapod crustaceans, and the first record of haplosporidiosis in sergestid shrimp. Infections of H. acetes were observed in all cell types (R, B, F and E) within the hepatopancreas. Infected epithelial cells became hypertrophied as they filled with haplosporidian parasites and, in heavy infections, caused almost complete displacement of normal hepatopancreas tissue. Although sporulation was not observed, infected jelly prawns appeared terminally diseased. Infections became grossly evident in around 5% of wild prawns during early autumn at a time of year when jelly prawn populations decline rapidly with decreasing water temperatures, however histopathology indicated at least 13% of apparently normal jelly prawns were also infected. Further studies are required in order to determine if this parasite influences jelly prawn population dynamics. In addition, we report co-infection of a novel microsporidian parasite in the Enterocytozoon Group Microsporidia (EGM) infecting nuclei of hepatopancreatic epithelial cells. The microsporidian was phylogenetically distinct from Enterocytozoon hepatopenaei (EHP) known to infect penaeid shrimp in Asia.

Bonamia exitiosa in farmed native oysters Ostrea angasi in Australia: optimal epidemiological qPCR cut-point and clinical disease risk factors.

Bonamiosis has developed as a problem in Australian native oysters Ostrea angasi since the parasite Bonamia spp. was first detected in Port Phillip Bay, Victoria, in the early 1990s. At that time, large-scale mortalities in both farmed and wild oysters saw the demise of the pilot native oyster culture industry. More recent attempts to farm the species resulted in subclinical infections that progressed over time to clinical disease. The aim of this work was to establish what environmental factors result in the clinical manifestation of disease; determine the diagnostic sensitivity and diagnostic specificity of histopathological examination and a quantitative polymerase chain reaction (qPCR) test for the diagnosis of B. exitiosa infection in clinically diseased farmed native oysters; and calculate the optimal qPCR threshold cycle (CT) epidemiological cut-point for classification of positive and negative cases. After applying a range of stressors to tank-held oysters, results indicated a 58% increased risk (95% CI: 16%, 99%) of a Bonamia-infected oyster dying if the oyster was held at a higher temperature (p = 0.048). Starving and tumbling oysters, in isolation, was not significantly associated with clinical bonamiosis, but a Bonamia-infected oyster was at the greatest risk of death when increased water temperature was combined with both starvation and increased motion (p = 0.02; odds ratio = 3.47). The diagnostic sensitivity and specificity of the World Organisation for Animal Health qPCR protocol were calculated for increasing CT value cut-points from ≤25 to ≤40, with an optimal cut-point identified at ≤34.5 (specificity: 92.2; 95% posterior credible intervals [PCI]: 76.2, 99.8; Sensitivity: 93.5; 95% PCI: 84.7, 99.1).

Meta-analysis of randomized clinical trials of early versus delayed cholecystectomy for mild gallstone pancreatitis.

BACKGROUND: Gallstones account for 30-50 per cent of all presentations of acute pancreatitis. While the management of acute pancreatitis is usually supportive, definitive treatment of gallstone pancreatitis is cholecystectomy. Guidelines from the British Society of Gastroenterology suggest definitive treatment on index admission or within 2 weeks of discharge, whereas joint recommendations from the International Association of Pancreatology and the American Pancreatic Association recommend definitive treatment on index admission. Evidence suggests that uptake of these guidelines is low. METHODS: Embase, MEDLINE and Cochrane databases were searched for RCTs investigating early versus delayed cholecystectomy in patients with a confirmed diagnosis of mild gallstone pancreatitis. The pooled synthesis was undertaken using a random-effects meta-analysis of the primary outcome of recurrent biliary complications causing hospital readmission. Secondary outcomes included intraoperative and postoperative complications, and total length of hospital stay (LOS). All analyses were performed using RevMan5 software. RESULTS: Five RCTs were identified, which included 629 patients (318 in the early cholecystectomy (EC) group and 311 in the delayed cholecystectomy (DC) group). Recurrent biliary events that required readmission were reduced in patients undergoing EC compared with the number in patients having DC (odds ratio (OR) 0·17, 95 per cent c.i. 0·09 to 0·33). There was no difference in the rate of intraoperative (OR 0·58, 0·17 to 1·92) or postoperative (OR 0·78, 0·38 to 1·62) complications. CONCLUSION: EC following mild gallstone pancreatitis does not increase the risk of intraoperative or postoperative complications, but reduces the readmission rate for recurrent biliary complications.

ANTECEDENTES: Los cálculos biliares son el factor etiológico en el 30-50% de todas las formas de pancreatitis aguda. Si bien el tratamiento de la pancreatitis aguda suele ser de soporte, el tratamiento definitivo de la pancreatitis por litiasis biliar es la colecistectomía. La guía de la British Society of Gastroenterology sugiere efectuar el tratamiento definitivo en el mismo ingreso o dentro de las 2 semanas posteriores al alta, mientras que la International Association of Pancreatology y la American Pancreatic Association recomiendan de forma conjunta el tratamiento definitivo en el mismo ingreso. Los datos disponibles sugieren que el seguimiento de estas guías es bajo. MÉTODOS: Se realizó una búsqueda en las bases de datos EMBASE, MEDLINE y Cochrane. de los ensayos clínicos aleatorizados y controlados (randomized clinical trials, RCTs) que analizaron la colecistectomía precoz frente a la tardía en pacientes con una pancreatitis leve por litiasis biliar. Se efectuó un metaanálisis de efectos aleatorios en el que la variable principal era la recidiva de complicaciones biliares que motivasen el reingreso hospitalario. Como variables secundarias se analizaron las complicaciones intraoperatorias y postoperatorias. Así como la duración de la estancia hospitalaria (length of stay, LOS). Los análisis se realizaron utilizando el programa RevMan5. RESULTADOS: Se incluyeron 5 RCTs con 629 pacientes (grupo de colecistectomía temprana (early cholecystectomy, EC), n = 318; grupo de colecistectomía tardía (delayed cholecystectomy, DC); n = 311). La recidiva de la enfermedad biliar que requiriese reingreso hospitalario fue menor en los pacientes sometidos a EC en comparación con DC, (cociente de oportunidades, odds ratio, OR) 0,17 (i.c. del 95% 0,09-0,33). No hubo diferencias en la tasa de complicaciones intraoperatorias, OR 0,58 (i.c. del 95% 0,17-1,92) o postoperatorias, OR 0,78 (i.c. del 95% 0,38-1,62). CONCLUSIÓN: La EC después de una pancreatitis leve por litiasis biliar no aumenta el riesgo de complicaciones intraoperatorias o postoperatorias, pero reduce la tasa de reingreso por la recidiva de complicaciones biliares.

Design standards for experimental and field studies to evaluate diagnostic accuracy of tests for infectious diseases in aquatic animals.

Design and reporting quality of diagnostic accuracy studies (DAS) are important metrics for assessing utility of tests used in animal and human health. Following standards for designing DAS will assist in appropriate test selection for specific testing purposes and minimize the risk of reporting biased sensitivity and specificity estimates. To examine the benefits of recommending standards, design information from published DAS literature was assessed for 10 finfish, seven mollusc, nine crustacean and two amphibian diseases listed in the 2017 OIE Manual of Diagnostic Tests for Aquatic Animals. Of the 56 DAS identified, 41 were based on field testing, eight on experimental challenge studies and seven on both. Also, we adapted human and terrestrial-animal standards and guidelines for DAS structure for use in aquatic animal diagnostic research. Through this process, we identified and addressed important metrics for consideration at the design phase: study purpose, targeted disease state, selection of appropriate samples and specimens, laboratory analytical methods, statistical methods and data interpretation. These recommended design standards for DAS are presented as a checklist including risk-of-failure points and actions to mitigate bias at each critical step. Adherence to standards when designing DAS will also facilitate future systematic review and meta-analyses of DAS research literature.

Development and application of molecular methods (PCR) for detection of Tasmanian Atlantic salmon reovirus.

Molecular (PCR) diagnostic tests for the detection and identification of aquareovirus in general, and Tasmanian Atlantic salmon reovirus (TSRV) specifically, were developed, and their diagnostic sensitivity and specificity were determined and compared with virus isolation in cell culture. Intralaboratory and interlaboratory comparison of PCR (conventional hemi-nested RT-PCR & RT-qPCR) and virus isolation in cell culture using finfish cell lines, CHSE-214 and EPC, was carried out for the detection and identification of TSRV using field samples of farmed Atlantic salmon Salmo salar, L. from various aquaculture sites around Tasmania. The interlaboratory comparison of diagnostic methods was carried out between two laboratories, AAHL-CSIRO and DPIPWE-Tasmania. A total of 144 fish from nine sites (12-33 fish per site) were sampled from two regions of Tasmania (Tamar River estuary in the north and Huon River estuary in the south-east) during late spring to early summer of 2009, and the data were analysed using different statistical approaches. The prevalence of TSRV ranged from 6% to 22% in both regions. All the diagnostic methods (data from both laboratories) had high specificity, while the estimated sensitivity varied between tests with RT-qPCR being the most sensitive (95.2%) method followed by virus isolation and then conventional hemi-nested RT-PCR.

Isolation and characterisation of a novel Bohle-like virus from two frog species in the Darwin rural area, Australia.

Twelve captive magnificent tree frogs Litoria splendida and 2 green tree frogs L. caerulea on a property in the Darwin rural area (Northern Territory, Australia) either died or were euthanased after becoming lethargic or developing skin lesions. Samples from both species of frog were submitted for histopathology and virus isolation. An irido-like virus was cultured from tissue samples taken from both species and was characterised using electron microscopy, restriction enzyme digests and nucleic acid amplification and sequencing. The isolates were determined to belong to the genus Ranavirus, were indistinguishable from each other and shared a 98.62% nucleotide similarity and a 97.32% deduced amino acid homology with the Bohle iridovirus over a 1161 bp region of the major capsid gene. This is the first isolation of a ranavirus from amphibians in the Northern Territory and the first report of natural infection in these 2 species of native frog. The virus is tentatively named Mahaffey Road virus (MHRV).

Validation of an influenza virus A 5'Taq nuclease assay for the detection of equine influenza virus A RNA in nasal swab samples.

OBJECTIVE: Describe the in-house validation of a previously reported influenza virus type A 5'Taq nuclease assay for detecting equine influenza virus A RNA in nasal swab material. METHODS: The validation compares the 5'Taq nuclease assay with a gel-based reverse transcription nested polymerase chain reaction (PCR) previously reported by the Irish Equine Centre for detection of H3N8 and H7N7 equine influenza viruses. This test was chosen because it targets a different region of the viral genome to the real-time test, so it is not merely a repeat of the same test in a different format. Moreover, nested PCRs are commonly considered to have similar sensitivity to real-time PCRs and are therefore ideal for evaluation comparisons. RESULTS: The sensitivity of the nested PCR was comparable to the 5'Taq nuclease test. Known positive samples and known negative samples reacted with both tests with 100% correlation. Parallel testing of 276 nasal swab samples showed 98% agreement. CONCLUSION: The specificity of the nested amplicons was confirmed by nucleotide sequencing and showed >99.5% identity with the same region of previously published equine influenza virus A sequences. The results of this work are appropriate validation for the acceptance of the real-time PCR for equine influenza A virus in equine nasal swabs.

Phylogenetic analysis of betanodavirus isolates from Australian finfish.

In Australia, disease caused by betanodavirus has been reported in an increasing number of cultured finfish since the first report of mortalities in 1990. Partial coat protein gene sequences from the T2 or T4 regions of 8 betanodaviruses from barramundi Lates calcarifer, sleepy cod Oxyeleotris lineolata, striped trumpeter Latris lineata, barramundi cod Cromileptes altivelis, Australian bass Macquaria novemaculata and gold-spotted rockcod Epinephelus coioides from several Australian states were determined. Analysis of the 606 bp nucleotide sequences of the T2 region of 4 isolates demonstrated the close relationship with isolates from the red-spotted grouper nervous necrosis virus (RGNNV) genotype and the Cluster Ia subtype. Comparison of a smaller 289 bp sequence from the T4 region identified 2 distinct groupings of the Australian isolates within the RGNNV genotype. Isolates from barramundi from the Northern Territory, barramundi, sleepy cod, barramundi cod and gold-spotted rockcod from Queensland, and striped trumpeter from Tasmania shared a 96.2 to 99.7% nucleotide identity with each other. These isolates were most similar to the RGNNV genotype Cluster Ia. Isolates from Australian bass from New South Wales and from barramundi from South Australia shared a 98.6% sequence identity with each other. However, these isolates only shared an 85.8 to 87.9% identity with the other Australian isolates and representative RGNNV isolates. The closest nucleotide identity to sequences reported in the literature for the New South Wales and South Australian isolates was to an Australian barramundi isolate (Ba94Aus) from 1994. These 2 Australian isolates formed a new subtype within the RGNNV genotype, which is designated as Cluster Ic.

A view through a different lens ... strategies for increasing the number of African American nurses.

These strategies emphasize nursing as a viable career option comparable to other careers often selected by African American students. Psychosocial issues as well as academic issues related to recruitment and retention were addressed by concentrating efforts on individuals interested in nursing, and academically prepared for the rigors of a university program. These strategies offer short-term and long-term remedies to the problem of shortage of African American professional nurses. A new paradigm for increasing the number of African American nurses is needed. To be effective, it is time for colleges of nursing to view recruitment and retention of African American individuals into the profession of nursing through a different lens.

Client characteristics and practice patterns of nurse practitioners and physicians.

This study's purpose was to describe the practice patterns of nurse practitioners (NPs) in Tennessee--specifically, the demographic characteristics and health problems of their clients and the therapeutic services they provide. A random sample of NPs practicing 20 or more hours per week in primary care in Tennessee provided data on a total of 680 clients seen during one selected day of care. An instrument adapted from the National Ambulatory Medical Care Survey (NAMCS) allowed comparison of the NP findings with a national survey of office-based physicians in five areas: client demographics, client health status, diagnostic tests ordered, therapeutic interventions provided, and client disposition. Although many similarities were seen, differences included the tendency of NPs to care for more younger and female clients, to perform fewer office surgical procedures, and to provide more health teaching/counseling interventions.

Brain-derived neurotrophic factor induces phosphorylation of fibroblast growth factor receptor substrate 2.

Brain-derived neurotrophic factor (BDNF) promotes neuronal survival. Gaining an understanding of how BDNF, via the tropomyosin-related kinase B (TRKB) receptor, elicits specific cellular responses is of contemporary interest. Expression of mutant TrkB in fibroblasts, where tyrosine 484 was changed to phenylalanine, abrogated Shc association with TrkB, but only attenuated and did not block BDNF-induced phosphorylation of mitogen-activated protein kinase (MAPK). This suggests there is another BDNF-induced signaling mechanism for activating MAPK, which compelled a search for other TrkB substrates. BDNF induces phosphorylation of fibroblast growth factor receptor substrate 2 (FRS2) in both fibroblasts engineered to express TrkB and human neuroblastoma (NB) cells that naturally express TrkB. Additionally, BDNF induces phosphorylation of FRS2 in primary cultures of cortical neurons, thus showing that FRS2 is a physiologically relevant substrate of TrkB. Data are presented demonstrating that BDNF induces association of FRS2 with growth factor receptor-binding protein 2 (GRB2) in cortical neurons, fibroblasts, and NB cells, which in turn could activate the RAS/MAPK pathway. This is not dependent on Shc, since BDNF does not induce association of Shc and FRS2. Finally, the experiments suggest that FRS2 and suc-associated neurotrophic factor-induced tyrosine-phosphorylated target are the same protein.

Brain derived neurotrophic factor protects human neuroblastoma cells from DNA damaging agents.

Neurotrophins are required for survival of neurons during development and may act as survival factors to cells undergoing stress. We tested whether brain derived neurotrophic factor (BDNF) protects neuroblastoma (NB) cells from cytotoxic agents using a model NB cell line, NB 1643, which expresses functional tropomyosin related kinase B (TRKB) following treatment with all-trans-retinoic acid. TRKB is the receptor for BDNF. BDNF increases the EC50 values in survival assays for cisplatin, doxorubicin, and topotecan by two to three fold. Thus, BDNF does indeed protect cells drugs that damage DNA. Cisplatin and doxorubicin are used to treat NB. Topotecan is in clinical studies for the treatment of NB. Since these drugs induce DNA damage, we also investigated whether BDNF might afford protection from gamma irradiation. BDNF also induces more than a two fold resistance to gamma irradiation. Since BDNF protects cells from agents with different mechanisms of damaging DNA and resistance, it seems likely that BDNF may alter a common signaling pathway required for cell death initiation by DNA damaging agents.

Antidepressant prescribing practices of nurse practitioners.

Depression is considered a highly treatable illness, yet often it is inadequately treated by physicians in primary care settings. The economic and human cost of inadequate treatment is well documented. The purpose of this pilot study was to explore the antidepressant prescribing practices among a convenience sample of nurse practitioners (NPs) and to use the findings to refine the antidepressant therapy questionnaire for further use. A self-administered questionnaire was completed by 26 NPs. Results of the survey revealed that NPs in primary care settings frequently treat a wide variety of common mental health problems and prescribe antidepressant medications for a number of these disorders as well as for nonpsychiatric problems. Factors that influence the NPs' decision-making process in the selection of a particular antidepressant were found to vary among the NPs surveyed. Although 65% of the NPs felt that they were sufficiently informed about the available antidepressants to select the most appropriate drug for their clients, 77% believed they needed additional education on antidepressant medications, and all but one respondent reported willingness to attend continuing educational offerings on antidepressant medications.

Proactive changes in nursing work force development in Tennessee.

Problems to be addressed by the CIC grant have been identified and defined, and a coalition has been formalized to address nursing work force development in Tennessee. The THCN, composed of consumers, nursing educators, policy makers, healthcare providers, and representatives of professional organizations and regulatory boards, is enthusiastically tackling the implementation phase of the project. These members are demonstrating open communication, teamwork, and interdependent decision making. Results are being achieved through persuasion, negotiation, seeking input from others, showing political sensitivity, and a willingness to share rewards and recognition.

Nurse faculty job satisfaction: a national survey.

Faculty dissatisfaction and fewer qualified recruits choosing a career in academia threaten the integrity of the higher education system. Retention of highly qualified nurse faculty affects the reputation of the school of nursing, the faculty commitment to the organization, and the learning environment for students. Through use of a system's framework derived from Neuman and Kast and Rosenzweig, the purpose of this survey was to ascertain the relationship between job satisfaction among nurse faculty and selected demographic variables, organizational characteristics, and role orientation. Approximately 80 per cent of the schools of nursing in the target population of universities offering a doctorate in nursing participated in the study. The overall subject response rate was 60 per cent. Instruments used for data collection included three researcher-developed tools and two standardized instruments to measure job satisfaction (the Job Descriptive Index and the Job in General Scale). Significant correlations (P < .05) emerged between each of the demographic variables and at least one of the criterion measures of job satisfaction. In addition to descriptive statistics and correlation analysis, a stepwise linear regression-correlation analysis showed that salary, degree level of nursing students taught, and length of annual contract were significant indicators of nurse faculty job satisfaction.