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Background: Cardiac conditions are a significant cause of maternal morbidity and mortality, significantly exacerbated during the hemodynamic demands of pregnancy. Mitral stenosis in pregnancy (MSp) is rare in the USA however, it has a high risk for maternal complications., Methods: We aim to outline the burden of MSp hospitalizations nationally. A retrospective review of HCUP/NIS data from 2002-2014 was conducted., Results: There were 2014 weighted discharges for both pregnancy and mitral stenosis (MS). Patients diagnosed with MS had a more considerable mean cost per discharge than the comparison group. Pulmonary Hypertension (PH), Atrial Arrhythmias (AA), Stroke, and Heart Failure (HF) were respectively reported in 25.71%, 7.14%, 0.95%, and 19.28% of the discharges. Our study identified a low incidence of MS in the US over the 12-year period; no deaths were identified., Conclusion: Our results substantiate MSp as a risk factor for PH, AA, HF, and stroke in pregnancy. Even though the mortality is low, it is essential that clinicians be aware of this diagnosis due to higher associated morbidity and costs., Competing Interests: None., (AJCD Copyright © 2023.)

This study aims to determine the feasibility of using a digital tool and net promoter scores to measure real-time employee engagement. Participation rates with the digital tool had a statistically significant improvement when teams were able to see their engagement score in real time. The team's interaction with the digital tool may have served as a positive distraction during the pandemic., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Management of distal femur fractures can be challenging, particularly in the aged female population. This retrospective study aims to analyze the surgical outcomes of aged female patients with non-periprosthetic distal femur fractures treated with a locking plate., Methods: This is an IRB approved retrospective review conducted at a level 1 trauma center. Fifty-five female patients (mean age of 71 years) with non-periprosthetic distal femur fractures underwent open reduction internal fixation using a locking plate from 2005 to 2019. The average follow-up time was 67 weeks from the date of injury. Criteria used for diagnosis of nonunion included one or more of the following: (I) three consecutive months without progression of healing on postoperative radiographs, (II) a total of nine months postoperative without complete healing, or (III) the physician diagnosed nonunion using clinical judgement. Outcome data was analyzed and compared amongst patients with and without obesity or diabetes. Statistical analysis was performed utilizing Microsoft Excel 2022 Data Analysis ToolPak with a standard statistically significant P value of <0.05., Results: Thirty-two patients (58%) with distal femur fractures achieved union after initial treatment while 23 patients (42%) were diagnosed with nonunion. Fourteen patients (61%) underwent revision with 9 of these patients (64%) achieving union while 5 patients (36%) had persistent nonunion. Average healing time from initial treatment to union was 29 weeks, while average time from definitive treatment to union was 22 weeks. Obese patients [body mass index (BMI) >30 kg/m 2 ] had a nonunion rate of 65%, while non-obese patients had a nonunion rate of 28%. Patients with diabetes had a nonunion rate of 65%, while patients without diabetes had a nonunion rate of 28%., Conclusions: Union can be successfully achieved in aged female patients with distal femur fractures treated with locking plates; however, the risks for nonunion and revision remain high. Patients with obesity and diabetes appear to be at an increased risk of nonunion (P=0.008 and 0.008, respectively). However, further research should be conducted with a prospective study or multivariate analysis and increased number of patients to reaffirm this data., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://aoj.amegroups.com/article/view/10.21037/aoj-22-15/coif). JL serves as an unpaid editorial board member of Annals of Joint from April 2022 to March 2024. The other authors have no conflicts of interest to declare., (2022 Annals of Joint. All rights reserved.)

Background: There is not a prevailing consensus on appropriate antibiotic choice, route, and duration in the treatment of bacterial pleural empyema after appropriate source control. Professional society guidelines note the lack of comparative trials with which to guide recommendations. We assessed clinical outcomes in the treatment of known and suspected empyema based upon three aspects of antibiotic use: (1) total duration, (2) duration of intravenous (IV) antibiotics, and (3) duration of anti-anaerobic antibiotics., Methods: We performed a hypothesis-generating retrospective chart review analysis of 355 adult inpatients who had pleural drainage, via either chest tube or surgical intervention, for known or suspected empyema. The primary outcome variable was clinician assessment of resolution or lack thereof. The secondary outcomes were death within 90 days, hospital readmission within 30 days for empyema, and all-cause hospital readmission within 30 days. Mann-Whitney U test was used to compare outcomes with regard to these variables., Results: None of the independent variables was significantly associated with a difference in clinical resolution rate despite trends for total antibiotic duration and anti-anaerobic antibiotic duration. None of the independent variables was associated with mortality. Longer total antibiotic duration was associated with lower readmission rate for empyema (median 17 [interquartile range 11-28] antibiotic days in non-readmission group vs. 13 [6-15] days in readmission group), with a non-significant trend for all-cause readmission rate (17 [11-28] days vs. 14 [9-21] days). IV antibiotic duration was not associated with a difference in any of the defined outcomes. Longer duration of anti-anaerobic antibiotics was associated with both lower all-cause readmission (8.5 [0-17] vs. 2 [0-11]) and lower readmission rate for empyema (8 [0-17] vs. 2 [0-3])., Conclusion: Our data support the premise that routine use of anti-anaerobic antibiotics is indicated in the treatment of pleural empyema. However, our study casts doubt on the benefits of extended IV rather than oral antibiotics in the treatment of empyema. This represents a target for future investigation that could potentially limit complications associated with the excessive use of IV antibiotics., (© 2022. The Author(s).)

Aim: To characterize nurses' engagement in Centers for Disease Control and Prevention promoted personal protective behaviors (PPBs) outside the work setting during the COVID-19 pandemic and factors that inform engagement in these behaviors., Background: Nurses' health is of vital importance to the functioning of the healthcare system. Little is known as to what informs nurses' use of PPBs outside the work setting., Design: Cross-sectional survey study., Settings: A large healthcare system in the southeastern region of the United States., Participants: Nine hundred fifty eight registered nurses., Methods: Participants surveyed during the week of September 14th. Survey contained questions regarding factors that may be linked to nurses' compliance with PPBs., Results: The most frequently reported behavior practiced outside work was "cover mouth with cough or sneeze." Concern for COVID-19 infection and confidence in masks to control the spread of COVID-19 were positively related to both frequency and number of protective behaviors engaged in (p < .01), while fatigue was inversely related to engagement with PPBs (p = .01). There was some evidence that viewing self as role model may predict behavior., Conclusions: Personal factors drive engagement with protective behaviors outside the work setting. Implications for nursing management and education are explored., (© 2021 Wiley Periodicals LLC.)

Background: Medical literature on the prevalence of genetic liver disease is lacking. In this study, we investigated the in-hospital healthcare and economic burden from genetic causes of non-alcoholic chronic liver disease (NACLD) and non-alcoholic liver cirrhosis (NALC) in the USA., Methods: Data were abstracted from the National Inpatient Sample database between 2002 and 2014 using ICD9 codes for patients discharged with NACLD and NALC secondary to genetic diseases including alpha-1 antitrypsin deficiency (A1ATd), cystic fibrosis (CF), Wilson disease (WD), hereditary hemochromatosis (HHC), glycogen storage disease, and disorders of aromatic amino-acid metabolism (DAAAM)., Results: Throughout the study period, there were 19,332 discharges for NACLD associated with the six genetic diseases including 14,368 for NALC. There were $1.09 billion in hospital charges, 790 in-hospital deaths, and 955 liver transplants performed. Overall, A1ATd was associated with 8,983 (62.52%) hospitalizations for NALC followed by WD, CF, and HHC. The highest in-hospital mortality was seen with HHC. The greatest frequency of liver transplants was seen with DAAAM., Conclusion: The number of hospitalizations for genetic liver diseases continues to increase. With increased funding and directed research efforts, we can aim to improve medical treatments and the quality of life for patients at risk for liver deterioration., (© The Author(s) 2021. Published by Oxford University Press and Sixth Affiliated Hospital of Sun Yat-sen University.)

Cardiac neoplasms are uncommon tumors. For epidemiological purposes, they can be divided into benign and malignant subtypes, with the former occurring at a significantly higher rate than the latter. Due to their uncommon nature, there are few data-driven studies examining the characteristics and trends of benign cardiac neoplasms. Our retrospective HCUP-NIS data review purports to illuminate some of the trends surrounding benign cardiac neoplasms and their associated co-occurrences. The data consisted of 482,872,274 weighted discharges. There were 45,568 weighted discharges that included a benign cardiac neoplasm. Benign cardiac neoplasms were more often observed in women (64.33%), and the average age was 63.8 years. The most common cardiovascular co-occurrences in patients with benign cardiac neoplasm were atrial tachyarrhythmias (28.93%), heart failure (19.61%), and embolic events such as stroke, myocardial infarct, or pulmonary embolism (19.82%). Other co-occurrences included pulmonary hypertension (7.55%), ventricular arrhythmias (3.23%), and other EKG abnormalities (3.70%). Procedures were numerous in patients with benign cardiac neoplasms. 43% of patients with this diagnosis had some form of cardiac surgery during their hospitalization. Overall, this study found low incidence of benign cardiac neoplasms in the USA during this 13-year study period. However, in the presence of benign cardiac neoplasms, our study showed that cardiovascular co-occurrences are not uncommon and may help to illuminate this otherwise rare diagnosis., (© 2021 The Author(s). Published by S. Karger AG, Basel.)

The contribution of positional asphyxia in opioid-related deaths is currently unknown. Diagnostic criteria for positional asphyxia include finding the decedent in a position that does not allow for adequate respiration and an inability to extricate themselves from the position due to various conditions. Our primary objective was to assess whether positional asphyxia and the resulting airway compromise were a contributing factor to death due to the toxic effects of opioids. We evaluated 225 deaths where the death scene investigation contained adequate information to evaluate for positional asphyxia and performed a Pearson chi-square test to determine if the proportion of deaths found in an airway compromising position was higher when opioid(s) caused the death. The proportion of decedents found in a potential airway compromising position was greater when the death was related to opioid use (p < 0.0001). Further, narrowing the dataset to decedents who were definitely in an airway compromising position [Yes (24.49%) vs. No (11.02%)] showed a statistically significant association between positional asphyxia and deaths related to opioid use (p = 0.0021). Carefully documenting the position in which the decedent was initially found may be a significant factor in accurate reporting and in harm reduction efforts to decrease the opioid mortality rate., (© 2020 American Academy of Forensic Sciences.)

Cardiac disease is still the leading cause of non-pregnancy related maternal morbidity and mortality. Valvular disease is one of the most concerning cardiac conditions in pregnancy. Aortic stenosis (AS) is rare in young populations but deadly complications have been reported in pregnant women. This study is a retrospective review of data from the HCUP-NIS Database from 2002-2014. There were 1108 weighted discharges for both pregnancy and AS. The data contained ten or fewer unweighted discharges with AS in pregnancy that underwent a cardiac intervention: open heart surgery or percutaneous cardiac intervention. Patients who had at least one diagnosis for AS had a greater mean cost per discharge than the comparison groups. No deaths were identified in this group. We found a statistically significant increase in the billing codes for pulmonary hypertension and heart failure. Conditions commonly associated with AS such as atrial arrhythmias, ventricular arrhythmias, diastolic dysfunction, ischemic heart disease and stroke were poorly reported. Our study identified a low incidence of AS and its complications in pregnancy in the USA over our 13-year study period. Even though, the morbidity and mortality are low, it is important that clinicians be aware of this diagnosis due higher costs and risk of complications., Competing Interests: None., (AJCD Copyright © 2020.)

Clinical and preclinical studies have revealed that local administration of opioid agonists into peripheral tissue attenuates inflammatory pain. However, few studies have examined whether peripherally restricted opioids are effective in reducing mechanical allodynia and hyperalgesia that usually follows nerve injury. The aim of the present study was to determine whether the mechanical responsiveness of C-fiber mechanical nociceptors innervating skin under neuropathic pain conditions is depressed by direct activation of delta opioid receptors (DORs) on their peripheral terminals. A murine model of peripheral neuropathic pain was induced with a spared nerve (tibial) injury, in which mice survived 7 or 28 days after surgery before electrophysiological testing began. Control groups comprised naïve and sham-operated animals. An ex vivo preparation of mouse plantar skin with attached tibial nerve was used to examine electrophysiologically the effects of the selective DOR agonist, deltorphin II, on the response properties of individual cutaneous C-fiber nociceptors. In contrast to naïve and sham-operated animals, deltorphin II induced an inhibition of the mechanical responsiveness of C-fiber mechanical nociceptors innervating skin under neuropathic conditions. The effects of deltorphin II were concentration-dependent and prevented by pretreatment with naltrindole indicating DOR-mediated inhibitory effects of deltorphin II. Our results provide the first direct evidence for expression of functional DORs on mechanical nociceptors innervating skin in an animal model of neuropathic pain., (Copyright © 2020 Joukal, Vulchanova, Huffman, Dubový and Honda.)

Background: Because living arrangements have many implications for the well-being of older adults, knowledge regarding typical age-related developmental changes in living arrangements is of a major concern for public health policymakers, particularly in low- and middle-income countries dealing with growing aging populations. However, the much-needed empirical analysis of living arrangement dynamics is hindered by a lack of proper data., Objective: To exploit often-available short-term longitudinal data in the study of long-term phenomena, in this paper we accelerate the Mexican Health and Aging Study (MHAS) panel as a means to explore, over a broad age span, the household dynamics of Mexican older adults., Methods: Instead of working with a priori definitions of different household structures when analyzing transitions between them, we introduce a novel approach that estimates latent classes of developmental trends in the household composition of older people as they age., Results: We show how accelerated longitudinal designs, coupled with latent class analysis, can offer new insights into living arrangement dynamics. Our findings suggest that in Mexico the typical living arrangements at 50 years old serve as an important predictor of future living arrangements, and that typical living-arrangement trajectories are strongly gendered in Mexico. This new approach may prove to be indispensible when determining the social support needed by high-risk population groups and as a means to better anticipate the necessary financial resources to do so.

Congenital Zika virus (ZIKV) infection was first linked to birth defects during the American outbreak in 2015/2016. It has been proposed that mutations unique to the Asian/American-genotype explain, at least in part, the ability of Asian/American ZIKV to cause congenital Zika syndrome (CZS). Recent studies identified mutations in ZIKV infecting humans that arose coincident with the outbreak in French Polynesia and were stably maintained during subsequent spread to the Americas. Here we show that African ZIKV can infect and harm fetuses and that the S139N substitution that has been associated with the American outbreak is not essential for fetal harm. Our findings, in a vertical transmission mouse model, suggest that ZIKV will remain a threat to pregnant women for the foreseeable future, including in Africa, Southeast Asia, and the Americas. Additional research is needed to better understand the risks associated with ZIKV infection during pregnancy, both in areas where the virus is newly endemic and where it has been circulating for decades., Competing Interests: The authors have declared that no competing interests exist.

Background: We analyze the effects of the Mexican universal health insurance program, Seguro Popular, on key variables associated with the provision of healthcare services. Given that the program was introduced gradually over a period that lasted more than a decade, the dynamics of the roll-out of the program and its reaction to the expansion of healthcare services it caused should be accounted for when evaluating the program., Methods: We present a new semiparametric procedure to analyze time-varying continuous interventions. This is accomplished by bringing together the literatures on continuous and on dynamic treatments. Our approach allows the researcher to estimate mean and quantile dose-response functions by applying local regression methods to appropriately weighted samples that control for time-dependent confounding., Results: Using administrative data, we show compelling evidence that Seguro Popular has incremented the human and physical resources available for healthcare services over the period 2001-2013. Moreover, we show that these effects have been heterogeneously distributed., Conclusions: The program has proven most helpful in less vulnerable territories, leaving behind those in greater need.

Neuroplasticity in the dorsal horn after peripheral nerve damage contributes critically to the establishment of chronic pain. The neurosecretory protein VGF (nonacronymic) is rapidly and robustly upregulated after nerve injury, and therefore, peptides generated from it are positioned to serve as signals for peripheral damage. The goal of this project was to understand the spinal modulatory effects of the C-terminal VGF-derived peptide TLQP-62 at the cellular level and gain insight into the function of the peptide in the development of neuropathic pain. In a rodent model of neuropathic pain, we demonstrate that endogenous levels of TLQP-62 increased in the spinal cord, and its immunoneutralization led to prolonged attenuation of the development of nerve injury-induced hypersensitivity. Using multiphoton imaging of submaximal glutamate-induced Ca responses in spinal cord slices, we demonstrate the ability of TLQP-62 to potentiate glutamatergic responses in the dorsal horn. We further demonstrate that the peptide selectively potentiates responses of high-threshold spinal neurons to mechanical stimuli in singe-unit in vivo recordings. These findings are consistent with a function of TLQP-62 in spinal plasticity that may contribute to central sensitization after nerve damage.

Introduction: There is a lack of knowledge in women's and men's experience of miscarriage. The Revised Impact of Miscarriage Scale (RIMS) has been used in United States to measure the experiences after miscarriage. The first objective was to test the consistency of RIMS for Swedish conditions. The second purpose of this study was to compare Swedish and American couples' experience of miscarriage by use of the RIMS., Methods: Forward and back translation was used for translating RIMS into Swedish. This is a hospital-based comparative study including Swedish couples (n = 70) and American couples (n = 70). The couples were matched by the women's age, week of miscarriage and number of children. All participants answered socio-demographic, fertility and depression-scale questions in addition to RIMS., Results: Cronbach's alpha analysis was above 0.650, the mean value was 0.824. There was no significant difference between the Swedish and American participants on the factors 'Isolation/Guilt' and 'Devastating event', but the Swedish women and men scored significantly lower on the factor 'Loss of baby' than the American women and men. The men, Swedish and American combined, scored lower than the women in all factors but the correlation within the couples was similar for both Swedish and American couples., Conclusions: The high consistency between the countries suggests that the RIMS questionnaire is reliable for both women and men to be used in both countries and two of three factors were similar between the two countries.

Problem: Significant off-campus domestic study away experiences have been shown to be a transformative active learning environment for students and achieve similar learning outcomes as study abroad programs., Methods: This manuscript describes the conception, development, and pedagogical approach of a faculty-led domestic study away experience in New York City for pre-licensure and post-licensure nursing students as an active learning strategy for developing cultural competence. Students participated in service-learning activities that illuminated the realities and challenges persons from other cultures face as they interact with health care in a culture that is not their own., Findings: In partnership with New York Cares©, students were immersed in well-established ongoing sustainable community-based projects. These experiences fostered reflective conversations between community members, student participants, and faculty regarding social factors, cultural issues and needs, and global issues and trends., Conclusions: Through the New York study away program, students were able to broaden their perspectives about social factors and culture beyond geographic or ethnic boundaries and apply these service experiences to their nursing practice. Study away programs are an excellent strategy for nursing educators to prepare students for care of multicultural populations and for proficiency in cultural competency within the globalization of the United States., (© 2016 Wiley Periodicals, Inc.)

In the current healthcare environment, nurses must have a basic understanding of research to lead change and implement evidence-based practice. The purpose of this study was to evaluate the effectiveness of an educational intervention formulated on the framework of the Great American Cookie Experiment measuring nurses' research knowledge, attitudes, and practice using mobile device gaming. This multisite quantitative study provides insight into promotion of research and information about best practices on innovative teaching strategies for nurses.

Objectives: To evaluate pregabalin's efficacy and safety versus placebo to reduce pain in patients with diabetic peripheral neuropathy (DPN) using a concomitant nonsteroidal anti-inflammatory drug., Materials and Methods: In a randomized, double-masked, 14-week, 2-period, crossover study, patients with painful DPN using a nonsteroidal anti-inflammatory drug for non-DPN-related pain received 150 to 300 mg/d pregabalin or placebo (period 1); 14-day washout; then, the opposite therapy (period 2). Endpoints included weekly change in DPN pain score, sleep interference, adverse events, and patient-reported outcomes., Results: Patients with similar baseline characteristics were randomized (period 1) to 1 of the 2 following possible sequences: pregabalin→placebo (n=154) or placebo→pregabalin (n=147). Results of the primary efficacy measure, mean weekly DPN pain at endpoint, showed no significant difference between pregabalin and placebo. However, 1 sensitivity analysis (mixed-model repeated measures) found greater pain score reductions with pregabalin than placebo at weeks 2 to 4 and overall (all P<0.05). One secondary endpoint analysis, mean treatment difference in DPN-related sleep interference, favored pregabalin over placebo (P=0.0009). Other sensitivity and secondary analyses were nonsignificant. Treatment-emergent adverse events were consistent with the known safety profile of pregabalin., Discussion: Pregabalin (vs. placebo) showed overall improvements in sleep, pain reduction in 1 sensitivity analysis, and was well tolerated. Potential factors that may have confounded the ability to detect a treatment difference in DPN pain reduction (high placebo response, carryover effect, short washout period, or pregabalin dose) are discussed in the context of future studies.

The Warrior Renew sexual trauma treatment program proposes to target perceived attachment style and the internal working models of interpersonal relationships. This study examined scores on the Relationships Scales Questionnaire and Brief Symptom Inventory pre- and posttreatment in a sample of 62 female veterans who graduated the program. Findings revealed that graduates of Warrior Renew reported significant decreases in fearful and dismissive insecure attachment and significant increases in secure attachment. Scores were significantly correlated with symptoms. Findings lend support to an upward spiral hypothesis associated with long-term positive outcomes found in previous research on Warrior Renew.

Objectives: This randomized, double-blind, placebo-controlled, multicenter, 2-period crossover study (two 6-week treatment periods separated by a 2-week washout period) evaluated the efficacy and safety of pregabalin (150 to 300 mg/d) for treatment of pain and pain on walking in patients with painful diabetic peripheral neuropathy (DPN) who experienced pain while walking., Methods: Co-primary efficacy endpoints were: (1) mean pain score (last 7 daily pain diary scores, 0 to 10 numeric rating scale at end of each treatment period) and (2) DPN pain on walking (0 to 10 numeric rating scale immediately after walking 50 feet [15.2 m] on flat surface). Secondary endpoints included other pain parameters, patient-reported sleep, health-related quality of life, and safety measures., Results: Two hundred three patients were treated (pregabalin, n=198; placebo, n=186), with no statistically significant treatment difference for pregabalin versus placebo in the co-primary efficacy endpoints, mean DPN pain (P=0.0656) and mean DPN pain on walking (P=0.412). A carryover effect was observed. Analysis of co-primary endpoints for period 1 showed significant treatment difference for DPN pain (P=0.034) and DPN pain on walking (P=0.001). Treatment with pregabalin resulted in significant improvements versus placebo on prespecified patient global impression of change (end of period 1; P=0.002), and sleep interference rating scale (end of period 2; P=0.011). Adverse events were more frequent with pregabalin than with placebo and caused discontinuation in 13 (6.6%) pregabalin patients versus 5 (2.7%) placebo patients., Discussion: Failure to meet the co-primary objectives may be related to carryover effect from period 1 to period 2, lower pregabalin dose (150 to 300 mg/d), and/or placebo response in painful DPN.

Aortic stenosis (AS) is associated with an increased risk of bleeding, but little is known about the risk of bleeding during percutaneous coronary intervention (PCI) in patients with AS. In the era of transcutaneous aortic valve implantation, understanding the bleeding risks associated with AS is critical. This retrospective study included 7,926 patients who underwent PCI from 2004 to 2013. Patients were categorized according to the presence of significant AS: moderate or severe AS (n = 354) and mild or no AS (n = 7,572). The National Cardiovascular Data Registry (NCDR) definition of a bleeding event (transfusion, prolonged hospital stay, or decrease in hemoglobin >3.0 mg/dl) was used as the primary outcome, and the NCDR PCI Bleeding Risk Score was used to control for the underlying risk of bleeding because of baseline characteristics. Patients with AS had significantly higher NCDR PCI Bleeding Risk Scores and higher rates of bleeding events. Logistic regression showed that the NCDR PCI Bleeding Risk Score did predict bleeding outcomes. There was not, however, an independent association between AS and bleeding outcomes. The addition of AS to the risk score using net reclassification improvement did not enhance the model's ability to predict bleeding (p = 0.71). These data suggest that the NCDR PCI Bleeding Risk Score appropriately adjusts for bleeding risks in patients with AS. In conclusion, although patients with AS are more likely to have bleeding complications after PCI, the increased risk of bleeding is driven by the patients' baseline co-morbidities rather than their AS., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Two-dimensional (2D) metal dichalcogenides like molybdenum disulfide (MoS2) may provide a pathway to high-mobility channel materials that are needed for beyond-complementary metal-oxide-semiconductor (CMOS) devices. Controlling the thickness of these materials at the atomic level will be a key factor in the future development of MoS2 devices. In this study, we propose a layer-by-layer removal of MoS2 using the atomic layer etching (ALET) that is composed of the cyclic processing of chlorine (Cl)-radical adsorption and argon (Ar)(+) ion-beam desorption. MoS2 etching was not observed with only the Cl-radical adsorption or low-energy (<20 eV) Ar(+) ion-beam desorption steps; however, the use of sequential etching that is composed of the Cl-radical adsorption step and a subsequent Ar(+) ion-beam desorption step resulted in the complete etching of one monolayer of MoS2. Raman spectroscopy, X-ray photoelectron spectroscopy (XPS), and atomic force microscopy (AFM) indicated the removal of one monolayer of MoS2 with each ALET cycle; therefore, the number of MoS2 layers could be precisely controlled by using this cyclical etch method. In addition, no noticeable damage or etch residue was observed on the exposed MoS2.

Objective: Safety and efficacy of a once daily controlled-released (CR) formulation of pregabalin was evaluated in patients with fibromyalgia using a placebo-controlled, randomized withdrawal design., Research Design and Methods: This multicenter study included 6 week single-blind pregabalin CR treatment followed by 13 week double-blind treatment with placebo or pregabalin CR. The starting dose of 165 mg/day was escalated during the first 3 weeks, up to 495 mg/day based on efficacy and tolerability. Patients with ≥50% reduction in average daily pain score at the end of the single-blind phase were randomized to continue pregabalin CR at the optimized dose (330-495 mg/day) or to placebo. The primary endpoint was time to loss of therapeutic response (LTR), defined as <30% pain reduction relative to single-blind baseline or discontinuation owing to lack of efficacy or adverse event (AE). Secondary endpoints included measures of pain severity, global assessment, functional status, tiredness/fatigue, and sleep., Clinical Trial Registration: ClinicalTrials.gov NCT01271933., Results: A total of 441 patients entered the single-blind phase, and 63 were randomized to pregabalin CR and 58 to placebo. The median time to LTR (Kaplan-Meier analysis) was significantly longer in the pregabalin CR group than placebo (58 vs. 22 days, p = 0.02). By trial end, 34/63 (54.0%) pregabalin CR and 41/58 (70.7%) placebo patients experienced LTR. Significantly more patients reported 'benefit from treatment' (Benefit, Satisfaction, and Willingness to Continue Scale) in the pregabalin CR group; no other secondary endpoints were statistically significant. Most AEs were mild to moderate in severity (most frequent: dizziness, somnolence). The percentage of pregabalin CR patients discontinuing because of AEs was 12.2% and 4.8% in the single-blind and double-blind phases, respectively (placebo, 0%)., Conclusions: Time to LTR was significantly longer with pregabalin CR versus placebo in fibromyalgia patients who initially showed improvement with pregabalin CR, indicating maintenance of response. Pregabalin CR was well tolerated in most patients. Generalizability may be limited by study duration and selective population.

Background: The Evaluate Patient OutComes (ClinicalTrials.gov Identifier: NCT01216072) study was conducted in North America to assess patient- and physician-reported treatment satisfaction in patients with relapsing multiple sclerosis (MS) who received oral fingolimod for 6 months after switching from an injectable disease-modifying therapy (iDMT), without an intervening washout., Methods: In this open-label, multicenter study, patients were randomized 3:1 to once-daily fingolimod 0.5mg or iDMT. The primary study objective was to evaluate differences in satisfaction measured using the Treatment Satisfaction Questionnaire for Medication v1.4., Results: Of 1053 patients randomized, 790 patients received fingolimod and 263 patients received iDMT. Treatment satisfaction improved significantly in patients who switched to fingolimod compared with those who continued iDMT. Patients also reported significant improvements in health-related quality of life, reduced depression, and reduced fatigue severity after a switch to fingolimod. No difference between the treatment groups was detected on the Patient Reported Indices for MS Activities scale. The safety profile of fingolimod was consistent with that reported in the pivotal phase 3 studies. The most commonly reported adverse events were more prevalent in patients who switched to fingolimod than in those who continued iDMT (headache: 12% vs 3%; fatigue: 12% vs 6%). No significant relationship between lymphocyte counts and infection rates was observed and there was no evidence of additive immune-system effects, which might be expected when switching to a different class of immunomodulatory therapy with no intervening washout., Conclusion: Patients who switched from iDMT to fingolimod had significant improvements in most self-reported outcomes compared with those who continued iDMT., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objectives: This study used a randomized withdrawal design to evaluate the efficacy of pregabalin versus placebo for pain relief in patients with painful diabetic peripheral neuropathy inadequately treated by other therapies., Methods: A total of 665 patients received pregabalin in a 6-week single-blind phase. Two hundred ninety-four patients who achieved a ≥ 30% pain response were randomized to receive pregabalin or placebo in a double-blind phase for a further 13 weeks. The primary endpoint was the change in mean pain score from single-blind baseline to double-blind endpoint for pregabalin versus placebo (last observation carried forward [LOCF]). Secondary endpoints included a baseline observation carried forward (BOCF) analysis of mean pain score; time to loss of pain response; and other assessments of pain, sleep, function, and quality of life (QOL)., Results: Pregabalin numerically improved all measures assessed during the single-blind phase. At the end of the double-blind withdrawal phase, there was no significant difference in the primary endpoint of mean pain score (LOCF) between pregabalin and placebo (least squares mean difference, -0.32), although there was a significant difference in the BOCF analysis (least squares mean difference, -0.51). Pregabalin was associated with a significantly longer time to loss of pain response versus placebo during double-blind treatment, and some aspects of sleep and QOL also showed significant improvements with pregabalin., Discussion: This is the first reported placebo-controlled trial of pregabalin in patients with inadequately treated painful diabetic peripheral neuropathy. Although the primary endpoint was not met, pregabalin was associated with clinically relevant improvements versus placebo in this difficult-to-treat population.

Objective: This pilot study examines iRest, a form of guided mindfulness meditation, and its ability to reduce symptoms associated with sexual trauma, including military sexual trauma (MST), in a sample of women seeking psychotherapy services at a Department of Veterans Affairs (VA) medical center., Methods: 90-minute sessions were held 19 times, twice a week for 10 weeks, except for the week with a holiday. Participants completed self-report measures Brief Symptom Inventory-18 (BSI), Posttraumatic Cognitions Inventory (PTCI), and the Post-traumatic Stress Disorder Check List (PCL) pre- and post-treatment. Sixteen women were recruited: 15 enrolled, 5 dropped due to transportation issues, and 10 completed the protocol., Results: Completers reported significant decreases in symptoms of posttraumatic stress disorder (PCL, t (9) = 3.17, p < 0.01, d = 0.66), negative thoughts of self-blame (PTCI t (9) = 2.96, p < 0.05, d = 0.52), and depression (BSI, t (9) = 2.33, p < 0.05, d = 0.64). Participants also offered verbal reports of decreased body tension, improved quality of sleep, improved ability to handle intrusive thoughts, improved ability to manage stress, and an increased feeling of joy. Participants also enthusiastically endorsed the class and stated they would take it again and recommend it to others., Conclusions: This small pilot study showed promising results for delivering iRest to women with sexual trauma in a VA medical center. Further research is warranted.

Unlabelled: Remifentanil hydrochloride is an ultra-short-acting opioid that undergoes rapid metabolism by tissue and plasma esterases. We aimed to characterize the pharmacokinetics and determine the hemodynamic profile of remifentanil after a single-bolus dose in children aged 0 to 18 yr. Forty-two children undergoing elective surgical procedures received remifentanil 5 microg/kg infused over 1 min. Patients were divided into age groups as follows: young infants (< or =2 mo), older infants (> 2 mo to < 2 yr), young children (2 to < 7 yr), older children (7 to < 13 yr), adolescents (13 to < 16 yr), and young adults (16 to < 18 yr). Arterial blood samples were collected and analyzed by mass spectroscopy to determine remifentanil pharmacokinetic profiles. Hemodynamic measurements for remifentanil's effect were made after the infusion. Methods of statistical analysis included analysis of variance and linear regression, with significance at P < or = 0.05. Complete remifentanil pharmacokinetic data were obtained from 34 patients. The volume of distribution was largest in the infants < 2 mo (mean, 452 mL/kg) and decreased to means of 223 to 308 mL/kg in the older patients. There was a more rapid clearance in the infants < 2 mo of age (90 mL. kg(-1). min(-1)) and infants 2 mo to 2 yr (92 mL. kg(-1). min(-1)) than in the other groups (means, 46 to 76 mL. kg(-1). min(-1)). The half-life was similar in all age groups, with means of 3.4 to 5.7 min. Seven subjects (17%) developed hypotension related to the remifentanil bolus. Remifentanil showed an extremely rapid elimination similar to that in adults. The fast clearance rates observed in neonates and infants, as well as the lack of age-related changes in half-life, are in sharp contrast to the pharmacokinetic profile of other opioids. Remifentanil in a bolus dose of 5 microg/kg may cause hypotension in anesthetized children., Implications: The pharmacokinetics of remifentanil were studied in children from birth to 18 yr. Remifentanil was found to have age-related changes in clearance and volume of distribution, but not half-life. The increased clearance observed in young infants is in contrast to other opioids.

Single-walled nanotubes (SWNTs) produced by plasma laser vaporization (PLV) and containing oxidized surface functional groups have been studied for the first time with NEXAFS. Comparisons are made to SWNTs made by catalytic synthesis over Fe particles in high-pressure CO, called HiPco material. The results indicate that the acid purification and cutting of single-walled nanotubes with either HNO3/H2SO4 or H2O2/H2SO4 mixtures produces the oxidized groups (O/C = 5.5-6.7%), which exhibit both pi*(CO) and sigma*(CO) C K-edge NEXAFS resonances. This indicates that both carbonyl (C=O) and ether C-O-C functionalities are present. Upon heating in a vacuum to 500-600 K, the pi*(CO) resonances are observed to decrease in intensity; on heating to 1073 K, the sigma*(CO) resonances disappear as the C-O-C functional groups are decomposed. Raman spectral measurements indicate that the basic tubular structure of the SWNTs is not perturbed by heating to 1073 K, based on the invariance of the ring breathing modes upon heating. The NEXAFS studies agree well with infrared studies which show that carboxylic acid groups are thermally destroyed first, followed by the more difficult destruction of ether and quinone groups. Single-walled nanotubes produced by the HiPco process, and not treated with oxidizing acids, exhibit an O/C ratio of 1.9% and do not exhibit either pi*(CO) or sigma*(CO) resonances at the detection limit of NEXAFS. It is shown that heating (to 1073 K) of the PLV-SWNTs containing the functional groups produces C K-edge NEXAFS spectra very similar to those seen for the HiPco material. The NEXAFS spectra are calibrated against spectra measured for a number of fused-ring aromatic hydrocarbon molecules containing various types of oxidized functional groups present on the oxidized SWNTs.

We report on an infant with Weaver syndrome, neoplasia and cardiovascular anomalies. Stage 4S neuroblastoma underwent spontaneous resolution. Three neoplasms have been reported in Weaver syndrome: another stage 4S neuroblastoma [Muhonen and Menezes, 1990: J Pediatr 116:596-599], an ovarian endodermal sinus tumor [Derry et al., 1999: J Med Genet 36:725-728], and a sacrococcygeal teratoma [Kelly et al., 2000: Am J Med Genet 95:492-495]. No case was associated with cardiovascular anomalies. Our patient had VSD and PDA, and although several other patients with Weaver syndrome have had cardiovascular anomalies, they were shown not to have neoplasia., (Copyright 2001 Wiley-Liss. Inc.)

Zolmitriptan is a potent selective 5HT1B/1D receptor agonist for acute migraine therapy. Zolmitriptan has vasoconstrictor activity in cerebral vessels and may cause slight elevations of blood pressure in subjects without hypertension. Therefore, the pharmacokinetics and pharmacodynamics of zolmitriptan (5, 10, and 20 mg) were evaluated in 16 patients with mild to moderate hypertension (controlled by hydrochlorothiazide 50 mg once daily) and 17 healthy age- and sex-matched control subjects in a randomized, placebo-controlled, double-blind, four-period crossover study. The pharmacokinetics of zolmitriptan and its metabolites were dose proportional. Although area under the concentration-time curve (AUC0-infinity) and maximum concentration (Cmax) were slightly higher in patients with hypertension at all doses, this was only statistically significant for AUC at the 20-mg dose. Differences between subjects with and without hypertension were not clinically significant. Zolmitriptan produced a small increase in blood pressure, but this was similar in subjects with and without hypertension and was of no clinical significance. Zolmitriptan was well tolerated in both groups. Zolmitriptan plasma concentrations were higher in women than in men, with higher values of AUC and Cmax and lower total clearance in women. These results indicate that zolmitriptan can be administered for treatment of migraine in patients with controlled hypertension without dose adjustment.

Zolmitriptan (Zomig, formerly 311C90) is a selective 5-hydroxytryptamine (5-HT)1B/1D-receptor agonist with central and peripheral activity for the acute treatment of migraine. This randomized, placebo-controlled, crossover study investigated the effects of fluoxetine administration on the pharmacokinetics and pharmacodynamics of zolmitriptan. Twenty volunteers were given single doses of fluoxetine 20 mg or an identical placebo daily for 28 days prior to receiving a single 10 mg oral dose of zolmitriptan. Sixteen volunteers completed the two treatment phases. The pharmacokinetic parameters of zolmitriptan and its metabolites were not significantly affected by fluoxetine pretreatment. The pharmacodynamic effects of zolmitriptan were also unaffected by fluoxetine pretreatment. There were small, clinically insignificant increases in blood pressure following zolmitriptan which were unaltered by fluoxetine. Zolmitriptan was well tolerated when given alone or concomitantly with fluoxetine. These results indicate that there is no contraindication to the use of zolmitriptan in patients treated concurrently with selective serotonin reuptake inhibitors and that no adjustment of the zolmitriptan dose is required in these circumstances.

Objective: To examine the nurse-technology relationship via a case study of ultrasonography in women's health nursing practice., Design: Exploratory case study using ethnographic methods., Setting: Outpatient obstetric and gynecology clinic of a large teaching hospital., Participants: Three nurses, two technicians, and one physician., Results: Two of the nurses and the physician were very "nurse-like" in their use of the technology of ultrasonography to fulfill the traditional nursing purposes of observation, teaching, and comforting. The third nurse was nurse-like in talk, but at times "technician-like" in performance, allowing the technology to pull her away from nursing purposes., Conclusions: The expert nurses bent the technology to nursing purposes. Sonographers performed in accordance with professional training and experience, rather than with gender expectations. The subtle differences between expert nurse use and technical use (by novice nurses or technicians) of ultrasonography may provide a strong rationale against current efforts to substitute technically trained or technically oriented personnel for expert nurses.

If high visual imagery is a component of successful autobiographical recall for personal episodes, then those participants who have high imagery should have greater autobiographical recall for personal episodes. This hypothesis was tested by giving 30 selected participants, 15 who had high and 15 low visual imagery, 90 sec. to recall personal episodic information from three time periods in their lives. Also assessed were the effects of visual imagery on autobiographical recall for personal semantic and nonpersonal semantic information (vegetables and adjectives). Level of visual imagery was significantly related only for the group with lower visual imagery, who recalled more adjectives. The implications of the results for the semantic and episodic memory distinction within autobiographical memory were discussed.

Purpose: Our purpose was to determine the pituitary response to minidose follicular-phase GnRHa and see if a second flare can be achieved., Method: A prospective, consecutive series of 12 couples with tubal-factor infertility underwent 14 cycles of minidose GnRHa. Women were given a 25- or 50-migrograms dose of leuprolide acetate (LA) on cycle days 2 and 5. On cycle days 3 and 4 no LA was given but 2 ampoules of pure follicle stimulating hormone (FSH) was administered. Beginning day 6, a combination of LA and FSH was administered., Results: Following a dose of only 25 micrograms of LA on cycle day 2, mean FSH, LH, and E2 levels were significantly elevated over the baseline levels. Following no LA on cycle day 3 or 4, a repeat dose of 25 micrograms LA caused a second flare of LH and E2 on cycle day 6. Of the 14 cycles, 6 were canceled because of poor stimulation. Two of the eight patients who underwent retrieval delivered a live birth., Conclusions: This is the first study to examine both the pituitary response and the recovery time from minidose follicular-phase GnRHa. An extremely small dose of LA is needed to cause a pituitary flare of gonadotropins. Following a flare from 25 micrograms of LA on cycle day 2, the pituitary is able to recover and respond with a repeat flare on cycle day 5.

Four experiments explored on-line encoding strategies and memory for high imagery and low imagery texts. Results consistently indicated that concreteness effects in memory for text depend on how materials are presented in several different respects. Most importantly, the experiments clarified apparently contradictory results of previous studies by indicating that concreteness effects generally do not occur in memory for prose when imageability is manipulated between-subjects, and that their occurrence when imageability is manipulated within-subjects depends on the order occurrence when imageability is manipulated within-subjects depends on the order of presentation. In addition, moving window analyses of text processing strategies indicated that differential strategies observed in previous studies when subjects listened to high vs low imagery text do not generalize to reading of the same materials. Potential explanations for the pattern of results are evaluated, and implications for theories of mental imagery and memory are considered.

1. Cigarette smoking has been identified as the single most important source of preventable morbidity and premature mortality in the United States for each of the past 25 years. Despite a smoking rate of 50% to 84%, persons with psychiatric illness have not been the target of any documented smoking health risk education in current literature. 2. Most nurses view smoking health risk education as a nursing function, but few actually provide this care for patients due to perceived ineffectiveness of health risk education, belief that smoking is not a health risk, and lack of knowledge base to provide the care. 3. Data from the study reported on in the article reflected that nurses were providing smoking health risk information to less than 50% of patients. Nurses were not identifying nicotine dependence as a nursing problem and therefore were making no plans to provide nursing interventions to resolve it.

The nonlinear mixed-effects modeling (NONMEM) computer program was used to investigate the variability in the duration of doxacurium-induced neuromuscular block in 408 patients enrolled in phase II and phase III clinical trials of doxacurium. Spontaneous recovery data in the 10% to 90% block range from all patients were pooled and fitted to a linear model. Two parameters were estimated: (1) the slope, which is related to the pharmacokinetics and to the steepness of the dose-response curve, and (2) the intercept, which is linearly related to dose but has no physiologic meaning. The primary goal was to determine the factors affecting the slope by use of univariate and multivariate analyses techniques. Estimates of the slope ranged from 0.67% to 1.1% block/min (interindividual variability, 39%). Factors with clinically significant effects on the slope included the following: age, obesity, and anesthesia type. Thus these factors influence the time course of doxacurium-induced block and may require individualization of dose.

The syntheses of seven anthracene amino alcohols with one, two, or three additional substituents are described. These compounds include three 1-aminoethanols, two 9-aminoethanols, and two 9-aminopropanols, prepared from substituted anthraquinones or from 10-chloro-9-anthraldehydes. The antimalarial activity of these compounds, as well as tentative structure-activity relationships, is discussed in the light of previously published work.

Five pharmacokinetic methods for estimating maintenance dosage requirements of lithium carbonate were compared retrospectively in 20 inpatients with acute bipolar illness. Specific pharmacokinetic methods tested included the method of Cooper, the multiple-point method of Perry, the single-point method of Perry, the method of Zetin, and the method of Pepin. Data analysis was based on evaluation of prediction error or the difference between the predicted steady-state lithium concentration and the measured steady-state lithium concentration at equivalent daily doses. Each dosing method was assessed in regard to accuracy and bias of predicted steady-state serum lithium concentrations. Bias was assessed by comparison of the median value of the prediction error with zero. The dosing recommendation based on the Cooper nomogram resulted in a significant positive bias (p less than or equal to 0.05). Intermethod accuracy was assessed by comparison of the absolute prediction errors of each dosing method. Significant differences in accuracy were observed between the method of Pepin when compared with the single-point method of Perry (p less than or equal to 0.05, k-sample sign test). All other comparisons were nonsignificant.

A rich diversity of ancient sea urchin lineages survives to the present. These include several advanced orders as well as the cidaroids, which represent the group ancestral to all other sea urchins. Here we show that all advanced groups of sea urchins examined possess in their eggs a class of maternal messenger RNA (mRNA) encoded by the evolutionarily highly conserved alpha-subtype histone genes. The maternal histone mRNAs are unique in their time of accumulation in oogenesis, their localization in the egg nucleus and their delayed timing of translation after fertilization. Cidaroid sea urchins as well as other echinoderm classes, such as starfish and sea cucumbers, possess the genes but do not have maternal alpha-subtype histone mRNAs in their eggs. Thus, although all the echinoderms examined transcribe alpha-subtype histone genes during embryogenesis, the expression of these genes as maternal mRNAs is confined to advanced sea urchins. The fossil record allows us to pinpoint the evolution of this mode of expression of alpha-histone genes to the time of the splitting of advanced sea urchin lineages from the ancestral cidaroids in a radiation which occurred in a relatively brief interval of time approximately 190-200 Myr ago. The origin of a unique gene regulatory mechanism can thus be correlated with a set of macroevolutionary events.

Three methods for estimating maintenance dosage requirements of lithium carbonate were retrospectively evaluated in 20 inpatients who met criteria of the Diagnostic and Statistical Manual, Third Edition, for "bipolar disorder, manic phase." Dosing methods evaluated included a pharmacokinetic method, the single-point method of Perry et al.; a population-based nomogram approach, the Zetin et al. method; and a physician-based empirical dosing procedure. The ability of each dosing procedure to produce dosing recommendations that resulted in a targeted steady-state serum lithium concentration was evaluated. The empirical dosing procedure demonstrated a significant tendency (bias) to underestimate the dose necessary to produce a desired steady-state serum lithium concentration. Comparison of the predictive accuracy of the various dosing methods failed to demonstrate any statistically significant differences among the dosing procedures. There was a strong trend, however, for the Perry method to produce predictions of steady-state lithium levels that were more frequently within 0.2 mEq/L of actual levels.