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Background: In institutional dementia care, person-centered care improves care processes and the quality of life of residents. However, communication gaps impede the implementation of person-centered care in favor of routinized care., Objective: We evaluated whether self-organizing knowledge management reduces communication gaps and improves the quality of person-centered dementia care., Method: We implemented a self-organizing knowledge management system. Eight significant others of residents with severe dementia and six professional caregivers used a mobile application for six months. We conducted qualitative interviews and focus groups afterward., Main Findings: Participants reported that the system increased the quality of person-centered care, reduced communication gaps, increased the task satisfaction of caregivers and the wellbeing of significant others., Conclusions: Based on our findings, we develop the following hypotheses: self-organizing knowledge management might provide a promising tool to improve the quality of person-centered care. It might reduce communication barriers that impede person-centered care. It might allow transferring content-maintaining tasks from caregivers to significant others. Such distribution of tasks, in turn, might be beneficial for both parties. Furthermore, shared knowledge about situational features might guide person-centered interventions., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: The aim of this study was to determine whether downstream [peroxisome proliferator-activated-receptor alpha (PPARα) and the G-protein coupled receptor, GPR119] and upstream (a fatty acid translocase, CD36) signaling targets of N-oleoylethanolamide (OEA) were necessary for weight loss, metabolic improvements, and diet preference following vertical sleeve gastrectomy (VSG)., Summary Background Data: OEA is an anorectic N-acylethanolamine produced from dietary fats within the intestinal lumen that can modulate lipid metabolism, insulin secretion, and energy expenditure by activating targets such as PPARα and GPR119., Methods: Diet-induced obese mice, including wild-type or whole body knockout (KO) of PPARα, GPR119, and CD36, were stratified to either VSG or sham surgery before body weight, body composition, diet preference, and glucose and lipid metabolic endpoints were assessed., Results: We found increased duodenal production of OEA and expression of both GPR119 and CD36 were upregulated in wild-type mice after VSG. However, weight loss and glucose tolerance were improved in response to VSG in PPARαKO, GPR119KO, and CD36KO mice. In fact, VSG corrected hepatic triglyceride dysregulation in CD36KO mice, and circulating triglyceride and cholesterol levels in PPARαKO mice. Lastly, we found PPARα-mediated signaling contributes to macronutrient preference independent of VSG, while removal of CD36 signaling blunts the VSG-induced shift toward carbohydrate preference., Conclusions: In the search for more effective and less invasive therapies to help reverse the global acceleration of obesity and obesity-related disease OEA is a promising candidate; however, our data indicate that it is not an underlying mechanism of the effectiveness of VSG.

We investigated the role of copy number alterations to refine risk stratification in adult Philadelphia chromosome positive (Ph) + acute lymphoblastic leukemia (ALL) treated with tyrosine kinase inhibitors (TKIs) and allogeneic stem cell transplantation (aSCT). Ninety-seven Ph + ALL patients (median age 41 years; range 18-64 years) within the prospective multicenter German Multicenter ALL Study Group studies 06/99 (n = 8) and 07/2003 (n = 89) were analyzed. All patients received TKI and aSCT in first complete remission (CR1). Copy number analysis was performed with single nucleotide polymorphism arrays and validated by multiplex ligation-dependent probe amplification. The frequencies of recurrently deleted genes were: IKZF1, 76%; CDKN2A/2B, 45%; PAX5, 43%; BTG1, 18%; EBF1, 13%; ETV6, 5%; RB, 14%. In univariate analyses, the presence of CDKN2A/2B deletions had a negative impact on all endpoints: overall survival ( P = .023), disease-free survival ( P = .012), and remission duration ( P = .036). The negative predictive value of CDKN2A/2B deletions was retained in multivariable analysis along with other factors such as timing of TKI therapy, intensity of conditioning, achieving remission after induction phase 1 and BTG1 deletions. We therefore conclude that acquired genomic CDKN2A/2B deletions identify a subgroup of Ph + ALL patients, who have an inferior prognosis despite aSCT in CR1. Their poor outcome was attributable primarily to a high relapse rate after aSCT., (© 2018 by The American Society of Hematology.)

Background: The first 2 years of a child's life are a particularly critical time period for obesity prevention., Aim: An increasing amount of research across the world is aimed at understanding factors that impact early childhood obesity and developing interventions that target these factors effectively. With this growing interest, new and interdisciplinary research teams are developing to meet this research need. Due to rapid growth velocity during this phase of the lifespan, typical assessments used in older populations may not be valid or applicable in infants, and investigators need to be aware of the pros and cons of specific methodological strategies., Methods: This paper provides an overview of methodology available to assess obesity-related factors in the areas of anthropometry and body composition, nutrient intake, and energy expenditure in infants aged 0-2 years., Results: Gold standard measures for body composition, such as dual-energy X-ray absorptiometry (DXA) or other imaging techniques, are costly, require highly trained personnel, and are limited for research application. Nutrient intake methodology primarily includes surveys and questionnaires completed via parent proxy report. In terms of energy expenditure, methods of calorimetry are expensive and may not differentiate between different activities. Questionnaires or physical activity sensors offer another way of energy expenditure assessment. However, questionnaires have a certain recall bias, while the sensors require further validation., Conclusions: Overall, in addition to understanding the pros and cons of each assessment tool, researchers should take into consideration the experience of the interdisciplinary team of investigators, as well as the cost and availability of measures at their institution.

Background: Cytogenetic aberrations such as deletion of chromosome 5q (del(5q)) represent key elements in routine clinical diagnostics of haematological malignancies. Currently established methods such as metaphase cytogenetics, FISH or array-based approaches have limitations due to their dependency on viable cells, high costs or semi-quantitative nature. Importantly, they cannot be used on low abundance DNA. We therefore aimed to establish a robust and quantitative technique that overcomes these shortcomings., Methods: For precise determination of del(5q) cell fractions, we developed an inexpensive multiplex-PCR assay requiring only nanograms of DNA that simultaneously measures allelic imbalances of 12 independent short tandem repeat markers., Results: Application of this method to n=1142 samples from n=260 individuals revealed strong intermarker concordance (R²=0.77-0.97) and reproducibility (mean SD: 1.7%). Notably, the assay showed accurate quantification via standard curve assessment (R²>0.99) and high concordance with paired FISH measurements (R²=0.92) even with subnanogram amounts of DNA. Moreover, cytogenetic response was reliably confirmed in del(5q) patients with myelodysplastic syndromes treated with lenalidomide. While the assay demonstrated good diagnostic accuracy in receiver operating characteristic analysis (area under the curve: 0.97), we further observed robust correlation between bone marrow and peripheral blood samples (R²=0.79), suggesting its potential suitability for less-invasive clonal monitoring., Conclusions: In conclusion, we present an adaptable tool for quantification of chromosomal aberrations, particularly in problematic samples, which should be easily applicable to further tumour entities., Competing Interests: Competing interests: CH declares part ownership of the MLL Munich Leukemia Laboratory GmbH., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Clonal evolution is believed to be a main driver for progression of various types of cancer and implicated in facilitating resistance to drugs. However, the hierarchical organization of malignant clones in the hematopoiesis of myelodysplastic syndromes (MDS) and its impact on response to drug therapy remain poorly understood. Using high-throughput sequencing of patient and xenografted cells, we evaluated the intratumoral heterogeneity (n= 54) and reconstructed mutational trajectories (n = 39) in patients suffering from MDS (n = 52) and chronic myelomonocytic leukemia-1 (n = 2). We identified linear and also branching evolution paths and confirmed on a patient-specific level that somatic mutations in epigenetic regulators and RNA splicing genes frequently constitute isolated disease-initiating events. Using high-throughput exome- and/or deep-sequencing, we analyzed 103 chronologically acquired samples from 22 patients covering a cumulative observation time of 75 years MDS disease progression. Our data revealed highly dynamic shaping of complex oligoclonal architectures, specifically upon treatment with lenalidomide and other drugs. Despite initial clinical response to treatment, patients' marrow persistently remained clonal with rapid outgrowth of founder-, sub-, or even fully independent clones, indicating an increased dynamic rate of clonal turnover. The emergence and disappearance of specific clones frequently correlated with changes of clinical parameters, highlighting their distinct and far-reaching functional properties. Intriguingly, increasingly complex mutational trajectories are frequently accompanied by clinical progression during the course of disease. These data substantiate a need for regular broad molecular monitoring to guide clinical treatment decisions in MDS., (© 2016 by The American Society of Hematology.)

Purpose: The purpose of this study was to describe the range and frequency of behaviors in neonates 24-30 weeks postconceptional age (PCA) using the Newborn Individualized Developmental Care Assessment Program (NIDCAP)., Design: A prospective design with convenience sampling was used., Sample: Starting 24-72 hours postnatally and continuing through 30 weeks PCA, 8,144 two-minute observations of 85 NIDCAP behaviors were collected and analyzed from 42 neonates born at 24-29 weeks gestation., Main Outcome Variable: The main outcome variables were the frequencies of the 85 neonatal behaviors measured by the NIDCAP. Frequencies were organized first by subsystem (autonomic, motor, or state) and were categorized further based on week of PCA. Comparisons of behavioral frequencies by number of weeks PCA were completed using correlation and regression analyses., Results: The most frequently observed behaviors were irregular respirations, pink color, postured flexion of the extremities, immature light sleep, and drowsiness. Least frequently observed behaviors consisted of burps, bowel movement, grunting, smooth motor movements, cooing, and speech movement. Regression analysis illustrated that the pattern of behavior was significantly similar week to week.

An index of transient mechanical birth trauma (TMBT), consisting of the presence or absence of molding, cephalohematoma, subconjunctival hemorrhage, body bruising, facial bruising, petechiae, forceps marks, diminished arm movements, and sensitivity to sudden position changes, was measured on a convenience sample of 196 healthy newborns. Six dimensions of the Neonatal Behavioral Assessment Scale (NBAS) and other newborn measures also were assessed. Vaginally delivered newborns had more TMBT than those delivered by cesarean section and of newborns delivered vaginally, macrosomics had more TMBT than nonmacrosomics. TMBT positively correlated with range of state, individual reflex items of resistance to left and right arm movement, predominant state during the NBAS exam, and time to complete the NBAS exam. TMBT negatively correlated with newborn state instability and 1- and 5-minute Apgars. The results supported the measure's validity and are discussed in terms of implications for practice and further research to explore TMBT's usefulness.

The purpose of this study was to compare the behavioral responses of term newborns of insulin-dependent diabetic mothers (NDMs) with newborns of nondiabetic, healthy mothers. The research design involved matched controls with repeated measures. Participants included 40 NDMs matched with 40 newborns of nondiabetic, healthy mothers. The main outcome measures were the seven dimensions of the Neonatal Behavioral Assessment Scale (NBAS) and the modal response score. The results showed that NDMs performed significantly poorer than their matched controls on motor processes and reflex functioning. For all newborns, motor processes, autonomic stability, reflex functioning, and the modal performance score were better on Day 2 than Day 1. It was concluded that although NDMs' behavioral responses improved by Day 2, their overall pattern of responses could be described as listless or sluggish. Due to their poorer motor and reflex responses, NDMs may require increased efforts to facilitate sensitive maternal responding during their first days of life.

The purpose of this study was to compare results found using a total summative score of abnormal reflex responses with the results found using individual reflex scores. The 20 reflexes included as part of the Brazelton Neonatal Behavioral Assessment Scale (NBAS) were assessed on 196 neonates on the 1st and 2nd days postnatally. Differences due to of type of delivery, birth weight, whether their mothers were insulin-dependent diabetics or nondiabetics, and day of testing were assessed by using analysis of variance. The key results were that all effects found using the total reflex score were replicated with individual reflex scores and that individual reflex scores also revealed effects not shown using the total score. It was concluded that the individual reflex scores, rather than the total score, should be used when evaluating newborn reflex performance.

The neurologic examination of the newborn infant is not easy. The nurse or physician must have technical skill in handling infants and be familiar with eliciting, scoring, and interpreting reflexes. Because it is too costly to conduct full neurologic exams on all newborns, a screening can be performed to help select infants for whom detailed examination is indicated. Given the trend to discharge term newborns within 12 to 24 hours following delivery and the importance of being sure that abnormalities have not been overlooked prior to discharge, completing a neurologic screen during this early time period is warranted. Although professionals have been trained and certified to conduct Neonatal Behavioral Assessment Scale (NBAS) exams for more than 20 years at NBAS Training Centers, the NBAS text does not adequately explain how to perform reflex assessments so they can be administered reliably across multiple examiners. This article describes how to perform these reflex assessments so they can be used consistently by nurses and physicians as a neurologic screen in a variety of settings.

Objective: To compare the behavior of macrosomic newborns who were vaginally delivered of healthy mothers without diabetes with that of non-macrosomic, appropriate-for-gestational-age (AGA) newborns., Design/setting: Newborns were recruited conveniently from a tertiary hospital. Newborns were examined at 12-24 and 36-48 hours of age, using the Brazelton Neonatal Behavioral Assessment Scale (NBAS)., Participants: Thirty macrosomic newborns who were delivered vaginally were matched with AGA newborns for ethnicity, maternal education, parity, and obstetric medications., Main Outcome Measures: Dimensions scores derived from the individual NBAS items measured reflex functioning, response decrement, orientation, motor processes, range of state, autonomic stability, and regulation of state., Results: Macrosomic newborns performed weaker than AGA newborns on the reflex and motor dimensions. Both groups displayed improved motor scores on Day 2, but regulation of state scores were weaker. For orientation, AGA newborns scored higher on Day 1, and macrosomic newborns scored higher on Day 2., Conclusions: Increased head, limb, and body mass of macrosomic newborns, compared with adjacent and overall muscle strength, might have interfered with the execution of coordinated movements. Nurses can inform mothers of changes they can expect in their newborns' behavior.

After the publication of Ernest Boyer's book on Scholarship Reconsidered in 1990, campuses across the nation began debating how scholarship is recognized and rewarded. The current system mainly recognizes and rewards faculty for their scholarly achievements in research. However, Boyer's book has called attention to the need for a paradigm for evaluating scholarship that better articulates with the world of an academician. According to Boyer (1990), it is time to recognize the full range of faculty talent that includes research as well as three other equally important areas of scholarship: teaching, integration, and application (practice). The emergence of nursing science as an independent academic discipline valued by society and health consumers parallels the professional and social demands to assume full responsibility for nursing decisions, actions, and outcomes. The scholarly mission of VUSN is based on the values shared by the faculty that excellence and innovation in preserving and advancing the science, art, philosophy, and history of nursing is accomplished through the components of theory, research, and practice. The faculty believe the interrelatedness of the three components forms the basis for the development of scholarliness in both its students and faculty.

Newborn macrosomia has been shown to be significantly related to weaker reflex functioning, poorer motor behavior, and decreased state regulation during the first 2 days of life. Macrosomic newborns' behavior patterns suggest that special strategies are indicated in order to decrease the effects that limb and body mass have on the execution of coordinated movements and spontaneous motor patterns. This article highlights techniques that have been found to be effective in handling, arousing, and quieting macrosomic newborns during interactions involving the Brazelton Neonatal Assessment Scale.