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An unimmunized 19-month-old child presented with a retropharyngeal abscess and coincident varicella infection. The abscess resolved with operative drainage. This is the first published report of this connection, although varicella is known to be associated with abscesses in general. Practitioners should be aware that cervical abscesses may complicate varicella infections.

The ability of the human body to maintain arterial blood pressure (BP) during orthostatic stress is determined by several reflex neural mechanisms. Renal vasoconstriction progressively increases during graded elevations in lower body negative pressure (LBNP). This sympathetically mediated response redistributes blood flow to the systemic circulation to maintain BP. However, how healthy aging affects the renal vasoconstrictor response to LBNP is unknown. Therefore, 10 young (25 ± 1 yr; means ± SE) and 10 older (66 ± 2 yr) subjects underwent graded LBNP (-15 and -30 mmHg) while beat-to-beat renal blood flow velocity (RBFV; Doppler ultrasound), arterial BP (Finometer), and heart rate (HR; electrocardiogram) were recorded. Renal vascular resistance (RVR), an index of renal vasoconstriction, was calculated as mean BP/RBFV. All baseline cardiovascular variables were similar between groups, except diastolic BP was higher in older subjects (P < 0.05). Increases in RVR during LBNP were greater in the older group compared with the young group (older: -15 mmHg Δ10 ± 3%, -30 mmHg Δ20 ± 5%; young: -15 mmHg Δ2 ± 2%, -30 mmHg Δ6 ± 2%; P < 0.05). RBFV tended to decrease more (P = 0.10) and mean BP tended to decrease less (P = 0.09) during LBNP in the older group compared with the young group. Systolic and diastolic BP, pulse pressure, and HR responses to LBNP were similar between groups. These findings suggest that aging augments the renal vasoconstrictor response to orthostatic stress in humans., (Copyright © 2015 the American Physiological Society.)

Allergic fungal sinusitis (AFS) or rhinosinusitis (AFRS) is a form of polypoid chronic rhinosinusitis that is believed to be due to hypersensitivity to fungal antigens. The disease is characterized by type 1 hypersensitivity to fungal allergens, dramatically elevated total serum IgE, accumulation of thick eosinophil-laden mucin with non-invasive fungal hyphae within the paranasal sinuses, nasal polyposis, and sinus bony remodeling. Because of many clinicopathologic similarities to allergic bronchopulmonary aspergillosis (ABPA), these conditions can be considered analogous examples of disease in the unified airway. However, these conditions rarely occur together and their treatment differs. The treatment of AFRS relies upon surgical removal of fungal hyphae in eosinophilic mucin, while antifungal therapy is used to clear fungi from the airways in ABPA. Several uncontrolled studies suggest there may be some benefit to antifungal agents in AFRS, but randomized trials of topical and systemic antifungal therapies have not shown beneficial results in chronic rhinosinusitis (CRS). Antifungal treatment within the sinonasal cavities does not appear to be an effective approach for most chronic sinusitis, and antifungal therapy for AFRS is unproven.

The aim of this study was to examine the impact of psychomotor operative video demonstrations on first-year dental students who are performing specific procedures for the first time in a preclinical setting. The class was randomly divided into two groups, and three restorative procedures were selected. On the date on which each procedure was to be performed in the preclinical laboratory for the first time, one group (experimental, n=50) was shown a technique video for that specific procedure immediately before commencing the exercise; the control cohort (n=50) did not view the video. Technical performance on procedures was evaluated by students and two calibrated and blinded examiners. The students' perceptions of the experience were also collected in a survey. All first-year students participated in the study, for a 100% response rate. A Mann-Whitney U test did not show any group differences in technical performance (mean values on preparation: 77.1 vs. 77.8; amalgam: 82.7 vs. 82.8; composite: 79.7 vs. 78.0). A Spearman rho test revealed a significantly higher correlation in 13 out of 25 evaluation categories between student self-assessment and blinded examiner assessment for the experimental group. A chi-square test of questionnaire responses revealed a positive student perception of administering these videos for the preparation (X(2)=4.8, p<0.03), the amalgam restoration (X(2)=12.4, p<0.001), and the composite restoration (X(2)=11.3, p<0.001). The psychomotor video demonstrations did not immediately improve student performance on preclinical operative procedures, but they were well received by students and augmented self-assessment ability. These findings suggest that videos can be a useful teaching aid in a preclinical environment, especially regarding comprehension of concepts.

Background: Academic incivility is a serious challenge for nursing education, which needs to be empirically measured and fully addressed., Method: A convenience sample of nursing faculty and students from 20 schools of nursing in the United States participated in a mixed-methods study to test the psychometric properties of the Incivility in Nursing Education-Revised (INE-R) Survey., Results: A factor analysis and other reliability analyses support the use of the INE-R as a valid and reliable measurement of student and faculty perceptions of incivility in nursing education., Conclusion: The INE-R is a psychometrically sound instrument to measure faculty and student perceptions of incivility; to examine differences regarding levels of nursing education, program type, gender, age, and ethnicity; to compare perceptions of incivility between and among adjunct, clinical, teaching, and research faculty; and to conduct pre- and postassessments of the perceived levels of faculty and student incivility in nursing programs to inform evidence-based interventions., (Copyright 2015, SLACK Incorporated.)

We describe the hybridization of our previously reported acyclic and cyclic CC chemokine receptor 2 (CCR2) antagonists to lead to a new series of dual antagonists of CCR2 and CCR5. Installation of a γ-lactam as the spacer group and a quinazoline as a benzamide mimetic improved oral bioavailability markedly. These efforts led to the identification of 13d, a potent and orally bioavailable dual antagonist suitable for use in both murine and monkey models of inflammation.

MDMA is a stimulant with unique "prosocial" effects, the physiological and pharmacological mechanisms of which are unknown. Here, we examine the relationship of measures of parasympathetic and sympathetic nervous system activity to the prosocial effects of MDMA. Parasympathetic activity was measured using respiratory sinus arrhythmia (RSA) and sympathetic activity using pre-ejection period (PEP). Over three sessions, 33 healthy volunteers received placebo, 0.75 mg/kg, and 1.5 mg/kg MDMA under counterbalanced, double-blind conditions, while we measured subjective feelings, RSA, and PEP. RSA and PEP data were available for 26 and 21 participants, respectively. MDMA increased prosocial and stimulated feelings, decreased RSA, and decreased PEP. At 1.5 mg/kg, subjective prosocial effects correlated with stimulated feelings and PEP, but not RSA. This suggests sympathetic, rather than parasympathetic, effects relate to the prosocial effects of MDMA., (© 2014 Society for Psychophysiological Research.)

Ten years ago, Griffin wrote an article on the use of cognitive rehearsal as a shield for lateral violence. Since then, cognitive rehearsal has been used successfully in several studies as an evidence-based strategy to address uncivil and bullying behaviors in nursing. In the original study, 26 newly licensed nurses learned about lateral violence and used cognitive rehearsal techniques as an intervention for nurse-to-nurse incivility. The newly licensed nurses described using the rehearsed strategies as difficult, yet successful in reducing or eliminating incivility and lateral violence. This article updates the literature on cognitive rehearsal and reviews the use of cognitive rehearsal as an evidence-based strategy to address incivility and bullvina behaviors in nursing.

Regulated calcium signals play conserved instructive roles in neuronal repair, but how localized calcium stores are differentially mobilized, or might be directly manipulated, to stimulate regeneration within native contexts is poorly understood. We find here that localized calcium release from the endoplasmic reticulum via ryanodine receptor (RyR) channels is critical in stimulating initial regeneration following traumatic cellular damage in vivo. Using laser axotomy of single neurons in Caenorhabditis elegans, we find that mutation of unc-68/RyR greatly impedes both outgrowth and guidance of the regenerating neuron. Performing extended in vivo calcium imaging, we measure subcellular calcium signals within the immediate vicinity of the regenerating axon end that are sustained for hours following axotomy and completely eliminated within unc-68/RyR mutants. Finally, using a novel optogenetic approach to periodically photo-stimulate the axotomized neuron, we can enhance its regeneration. The enhanced outgrowth depends on both amplitude and temporal pattern of excitation and can be blocked by disruption of UNC-68/RyR. This demonstrates the exciting potential of emerging optogenetic technology to beneficially manipulate cell physiology in the context of neuronal regeneration and indicates a link to the underlying cellular calcium signal. Taken as a whole, our findings define a specific localized calcium signal mediated by RyR channel activity that stimulates regenerative outgrowth, which may be dynamically manipulated for beneficial neurotherapeutic effects., (Copyright © 2014 the authors 0270-6474/14/3415947-10$15.00/0.)

Purpose: To report a unique case of delayed topiramate-induced bilateral angle closure., Methods: A case report of a 40-year-old woman who experienced bilateral acute angle-closure glaucoma and induced myopia on a standard and consistent dose of topiramate for 262 days before the onset of symptoms. Initial and follow-up examination findings were reviewed., Results: Initial examination revealed finger counting at one foot OU, intraocular pressures of 38 mm Hg OD and 37 mm Hg OS, and bilaterally closed angles with no view of anterior trabecular meshwork (Shaffer grade 0). Discontinuation of topiramate and administration of topical drops were able to break the attack. At 3 months of follow-up, the patient was 20/25 OU with deep angles open to the scleral spur (Shaffer grade III) and had intraocular pressures of 14 mm Hg in both the eyes., Conclusions: This case provides evidence of delayed bilateral angle closure from topiramate and raises questions as to the cellular mechanism of topiramate-induced angle closure, both immediate and delayed.

Many classic examples of adaptive radiations take place within fragmented systems such as islands or mountains, but the roles of mosaic landscapes and variable gene flow in facilitating species diversification is poorly understood. Here we combine phylogenetic and landscape genetic approaches to understand diversification in Darwin's finches, a model adaptive radiation. We combined sequence data from 14 nuclear introns, mitochondrial markers, and microsatellite variation from 51 populations of all 15 recognized species. Phylogenetic species-trees recovered seven major finch clades: ground, tree, vegetarian, Cocos Island, grey and green warbler finches, and a distinct clade of sharp-beaked ground finches (Geospiza cf. difficilis) basal to all ground and tree finches. The ground and tree finch clades lack species-level phylogenetic structure. Interisland gene flow and interspecies introgression vary geographically in predictable ways. First, several species exhibit concordant patterns of population divergence across the channel separating the Galápagos platform islands from the separate volcanic province of northern islands. Second, peripheral islands have more admixed populations while central islands maintain more distinct species boundaries. This landscape perspective highlights a likely role for isolation of peripheral populations in initial divergence, and demonstrates that peripheral populations may maintain genetic diversity through outbreeding during the initial stages of speciation., (© 2014 The Author(s). Evolution © 2014 The Society for the Study of Evolution.)

An organism's ability to thrive in changing environmental conditions requires the capacity for making flexible behavioral responses. Here we show that, in the nematode Caenorhabditis elegans, foraging responses to changes in food availability require nlp-12, a homolog of the mammalian neuropeptide cholecystokinin (CCK). nlp-12 expression is limited to a single interneuron (DVA) that is postsynaptic to dopaminergic neurons involved in food-sensing, and presynaptic to locomotory control neurons. NLP-12 release from DVA is regulated through the D1-like dopamine receptor DOP-1, and both nlp-12 and dop-1 are required for normal local food searching responses. nlp-12/CCK overexpression recapitulates characteristics of local food searching, and DVA ablation or mutations disrupting muscle acetylcholine receptor function attenuate these effects. Conversely, nlp-12 deletion reverses behavioral and functional changes associated with genetically enhanced muscle acetylcholine receptor activity. Thus, our data suggest that dopamine-mediated sensory information about food availability shapes foraging in a context-dependent manner through peptide modulation of locomotory output.

Dopaminergic neurons provide value signals in mammals and insects. During Drosophila olfactory learning, distinct subsets of dopaminergic neurons appear to assign either positive or negative value to odor representations in mushroom body neurons. However, it is not known how flies evaluate substances that have mixed valence. Here we show that flies form short-lived aversive olfactory memories when trained with odors and sugars that are contaminated with the common insect repellent DEET. This DEET-aversive learning required the MB-MP1 dopaminergic neurons that are also required for shock learning. Moreover, differential conditioning with DEET versus shock suggests that formation of these distinct aversive olfactory memories relies on a common negatively reinforcing dopaminergic mechanism. Surprisingly, as time passed after training, the behavior of DEET-sugar-trained flies reversed from conditioned odor avoidance into odor approach. In addition, flies that were compromised for reward learning exhibited a more robust and longer-lived aversive-DEET memory. These data demonstrate that flies independently process the DEET and sugar components to form parallel aversive and appetitive olfactory memories, with distinct kinetics, that compete to guide learned behavior., (Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Previous literature has indicated abnormalities in facial emotion recognition abilities, as well as deficits in basic visual processes in major depression. However, the literature is unclear on a number of important factors including whether or not these abnormalities represent deficient or enhanced emotion recognition abilities compared to control populations, and the degree to which basic visual deficits might impact this process., Methods: The present study investigated emotion recognition abilities for angry versus neutral facial expressions in a sample of undergraduate students with Beck Depression Inventory-II (BDI-II) scores indicative of moderate depression (i.e., ≥20), compared to matched low-BDI-II score (i.e., ≤2) controls via the Bubbles Facial Emotion Perception Task., Results: Results indicated unimpaired behavioural performance in discriminating angry from neutral expressions in the high depressive symptoms group relative to the minimal depressive symptoms group, despite evidence of an abnormal pattern of visual facial information usage., Limitations: The generalizability of the current findings is limited by the highly structured nature of the facial emotion recognition task used, as well as the use of an analog sample undergraduates scoring high in self-rated symptoms of depression rather than a clinical sample., Conclusions: Our findings suggest that basic visual processes are involved in emotion recognition abnormalities in depression, demonstrating consistency with the emotion recognition literature in other psychopathologies (e.g., schizophrenia, autism, social anxiety). Future research should seek to replicate these findings in clinical populations with major depression, and assess the association between aberrant face gaze behaviours and symptom severity and social functioning., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Academic incivility can increase student stress, jeopardize learning, damage relationships, and negatively impact the academic environment. This 3-year longitudinal study measured a cohort of prelicensure nursing students' progressive perceptions of stress, coping, student-student and faculty-student relationships, and levels of academic civility. While civility scores remained mild to moderately high overall, there was a slightly declining trend over the 3-year period. Perceived stressors and coping strategies and ways to improve academic civility are identified and discussed.

Background: Basal cell carcinoma (BCC) is the most common skin cancer. Surgical excision remains the standard of treatment, but several alternative treatment modalities exist., Objectives: This review aims to provide a current analysis of evidence for the treatment of BCC; specifically, which treatments have the lowest recurrence rates and the best cosmetic outcomes., Methods: We searched PubMed (January 1946 to August 2013), Ovid MEDLINE (2003-August 2013), the Cochrane Central Register of Controlled Trials (January 1993 to August 2013), and the Cochrane Database of Systematic Reviews (The Cochrane Library Issue 9, 2013) databases for randomized controlled trials, systematic reviews, or comparative studies for the treatment of BCC., Results: We found 615 potential articles. Two independent reviewers selected 40 studies: 29 randomized controlled trials (RCTs), seven systematic reviews, and four nonrandomized prospective trials. Treatment modalities reviewed include surgical therapy, radiotherapy and cryotherapy, photodynamic therapy (PDT), topical imiquimod, topical 5-fluorouracil (5-FU), topical solasodine glycoalkaloids, topical ingenol mebutate, intralesional 5-FU, intralesional interferon (IFN), and oral hedgehog pathway inhibitors., Conclusions: The available data suggest that surgical methods remain the gold standard in BCC treatment, with Mohs micrographic surgery typically utilized for high-risk lesions. Suitable alternate treatment options for appropriately selected primary low-risk lesions may include PDT, cryotherapy, topical imiquimod, and 5-FU. Radiotherapy is a suitable alternate for surgical methods for treatment in older patient populations. Electrodesiccation and curettage (ED&C) is a commonly used primary treatment option for low-risk lesions; however, there were no RCTs examining ED&C that met our inclusion criteria. New hedgehog pathway inhibitors are promising for the management of advanced BCC; however, side effects are a concern for some patients, and much remains to be learned regarding optimal treatment length, risk of recurrence, and potential development of resistance. There is insufficient evidence at present to make recommendations on topical solasodine glycoalkaloids, topical ingenol mebutate, and intralesional 5-FU and IFN-α. Overall continued research on the efficacy of treatment modalities is needed. In particular, studies should include histologic ascertainment of clearance, long-term follow-up, stratification based on tumor subtype, and comparison with surgical outcomes.

Understanding how an organism's nervous system transforms sensory input into behavioral outputs requires recording and manipulating its neural activity during unrestrained behavior. Here we present an instrument to simultaneously monitor and manipulate neural activity while observing behavior in a freely moving animal, the nematode Caenorhabditis elegans. Neural activity is recorded optically from cells expressing a calcium indicator, GCaMP3. Neural activity is manipulated optically by illuminating targeted neurons expressing the optogenetic protein Channelrhodopsin. Real-time computer vision software tracks the animal's behavior and identifies the location of targeted neurons in the nematode as it crawls. Patterned illumination from a DMD is used to selectively illuminate subsets of neurons for either calcium imaging or optogenetic stimulation. Real-time computer vision software constantly updates the illumination pattern in response to the worm's movement and thereby allows for independent optical recording or activation of different neurons in the worm as it moves freely. We use the instrument to directly observe the relationship between sensory neuron activation, interneuron dynamics and locomotion in the worm's mechanosensory circuit. We record and compare calcium transients in the backward locomotion command interneurons AVA, in response to optical activation of the anterior mechanosensory neurons ALM, AVM or both.

Several studies have described a wide spectrum of hyperandrogenism diseases, many of which are difficult to distinguish from each other. In order to better understand diseases of hyperandrogenism, the authors performed a retrospective study of the cutaneous features and metabolic findings in women with hyperandrogenism. A retrospective chart analysis compiled by three dermatologists in both academic and private settings was performed, including patients presenting with > or = 2 manifestations of hyperandrogenism. Relevant dermatologic and associated manifestations and laboratory and imaging study findings were reviewed. Moderate to severe acne was the most common manifestation. Other common manifestations that patients first presented with include hirsutism, acanthosis nigricans, androgenic alopecia, and skin tags. Oligomenorrhea was the most common systemic presenting sign. Statistical analysis of various clinical markers revealed correlations with hyperandrogenemia. Acanthosis nigricans and hirsutism were found to be useful clinical markers for hyperandrogenism, whereas androgenic alopecia was not. This study provides some insights into the presentation and diverse manifestations seen in hyperandrogenism.

Neuropathologic heterogeneity is often present among Alzheimer disease (AD) patients. We sought to determine whether amyloid imaging measures of AD are affected by concurrent pathologies. Thirty-eight clinically and pathologically defined AD and 17 nondemented patients with quantitative florbetapir F-18 (F-AV-45) positron emission tomography (PET) imaging during life and postmortem histological β-amyloid quantification and neuropathologic examination were assessed. AD patients were divided on the basis of concurrent pathologies, including those with Lewy bodies (LBs) (n = 21), white matter rarefaction (n = 27), severe cerebral amyloid angiopathy (n = 11), argyrophilic grains (n = 5), and TAR DNA binding protein-43 inclusions (n = 18). Many patients exhibited more than 1 type of concurrent pathology. The ratio of cortical to cerebellar amyloid imaging signal (SUVr) and immunohistochemical β-amyloid load were analyzed in 6 cortical regions of interest. All AD subgroups had strong and significant correlations between SUVr and histological β-amyloid measures (p μ 0.001). All AD subgroups had significantly greater amyloid measures versus nondemented patients, and mean amyloid measures did not significantly differ between AD subgroups. When comparing AD cases with and without each pathology, AD cases with LBs had significantly lower SUVr measures versus AD cases without LBs (p = 0.002); there were no other paired comparison differences. These findings indicate that florbetapir-PET imaging is not confounded by neuropathological heterogeneity within AD.

Objective: To evaluate the performance characteristics of florbetapir F18 positron emission tomography (PET) in patients with Alzheimer's disease (AD), mild cognitive impairment (MCI), and healthy control subjects (HCs)., Methods: Florbetapir PET was acquired in 184 subjects (45 AD patients, 60 MCI patients, and 79 HCs) within a multicenter phase 2 study. Amyloid burden was assessed visually and quantitatively, and was classified as positive or negative., Results: Florbetapir PET was rated visually amyloid positive in 76% of AD patients, 38% of MCI patients, and 14% of HCs. Eighty-four percent of AD patients, 45% of MCI patients, and 23% of HCs were classified as amyloid positive using a quantitative threshold. Amyloid positivity and mean cortical amyloid burden were associated with age and apolipoprotein E ε4 carrier status., Conclusions: : The data are consistent with expected rates of amyloid positivity among individuals with clinical diagnoses of AD and MCI, and indicate the potential value of florbetapir F18 PET as an adjunct to clinical diagnosis., (Copyright © 2013 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.)

Although nitrogen (N) deposition is a significant threat to herbaceous plant biodiversity worldwide, it is not a new stressor for many developed regions. Only recently has it become possible to estimate historical impacts nationally for the United States. We used 26 years (1985-2010) of deposition data, with ecosystem-specific functional responses from local field experiments and a national critical loads (CL) database, to generate scenario-based estimates of herbaceous species loss. Here we show that, in scenarios using the low end of the CL range, N deposition exceeded critical loads over 0.38, 6.5, 13.1, 88.6, and 222.1 million ha for the Mediterranean California, North American Desert, Northwestern Forested Mountains, Great Plains, and Eastern Forest ecoregions, respectively, with corresponding species losses ranging from < 1% to 30%. When we ran scenarios assuming ecosystems were less sensitive (using a common CL of 10 kg x ha(-1) x yr(-1), and the high end of the CL range) minimal losses were estimated. The large range in projected impacts among scenarios implies uncertainty as to whether current critical loads provide protection to terrestrial plant biodiversity nationally and urge greater research in refining critical loads for U.S. ecosystems.

Faculty incivility can have lasting and devastating effects on individuals and organizations, including low morale, high turnover, increased absenteeism, isolation and alienation, diminished quality of work, and increased illness and health issues. To assess the nature and impact of faculty-to-faculty incivility, the author discusses a national study, its outcomes, and several evidence-based strategies to affectively address the problem.

Deficits in facial emotion perception have been linked to poorer functional outcome in schizophrenia. However, the relationship between abnormal emotion perception and functional outcome remains poorly understood. To better understand the nature of facial emotion perception deficits in schizophrenia, we used the Bubbles Facial Emotion Perception Task to identify differences in usage of visual facial information in schizophrenia patients (n = 20) and controls (n = 20), when differentiating between angry and neutral facial expressions. As hypothesized, schizophrenia patients required more facial information than controls to accurately differentiate between angry and neutral facial expressions, and they relied on different facial features and spatial frequencies to differentiate these facial expressions. Specifically, schizophrenia patients underutilized the eye regions, overutilized the nose and mouth regions, and virtually ignored information presented at the lowest levels of spatial frequency. In addition, a post hoc one-tailed t test revealed a positive relationship of moderate strength between the degree of divergence from "normal" visual facial information usage in the eye region and lower overall social functioning. These findings provide direct support for aberrant patterns of visual facial information usage in schizophrenia in differentiating between socially salient emotional states., (© 2013 American Psychological Association)

Background: The correlation between neuropathological lesions and cognition is modest. Some individuals remain cognitively intact despite the presence of significant Alzheimer's disease (AD) pathology, whereas others manifest cognitive symptoms and dementia in the same context. The aim of the present study was to examine cognitive and cerebral reserve factors associated with resilient functioning in the setting of AD pathology., Methods: University of Pennsylvania Alzheimer's Disease Center research participants with biochemical biomarker evidence of AD pathology (cerebrospinal fluid amyloid-β1-42 <192 pg/mL) and comparable medial temporal lobe atrophy were categorized by Clinical Dementia Rating Scale-Sum of Boxes (CDR-SOB) score as AD dementia (CDR-SOB >1) or AD resilient (CDR-SOB ≤0.5). Groups were compared for a variety of demographic, clinical, and neuroimaging variables to identify factors that are associated with resilience to AD pathology., Results: A univariate model identified education and intracranial volume (ICV) as significant covariates. In a multivariate model with backward selection procedure, ICV was retained as a factor most significantly associated with resilience. The interaction term between ICV and education was not significant, suggesting that larger cranial vault size is associated with resilience even in the absence of more education., Conclusions: Premorbid brain volume, as measured through ICV, provided protection against clinical manifestations of dementia despite evidence of significant accumulations of AD pathology. This finding provides support for the brain reserve hypothesis of resilience to AD., (Copyright © 2013 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.)

This is the first-known quantitative study to measure nursing faculty perceptions of faculty-to-faculty incivility. A total of 588 nursing faculty representing 40 states in the United States participated in the study. Faculty-to-faculty incivility was perceived as a moderate to serious problem. The behaviors reported to be most uncivil included setting a coworker up to fail, making rude remarks or put-downs, and making personal attacks or threatening comments. The most frequently occurring incivilities included resisting change, failing to perform one's share of the workload, distracting others by using media devices during meetings, refusing to communicate on work-related issues, and making rude comments or put-downs. Stress and demanding workloads were two of the factors most likely to contribute to faculty-to-faculty incivility. Fear of retaliation, lack of administrative support, and lack of clear policies were cited as the top reasons for avoiding addressing the problem of incivility., (Copyright 2013, SLACK Incorporated.)

Background: Laser resurfacing in patients with Fitzpatrick skin phototypes (SPT) IV to VI is associated with a higher risk of pigmentary alteration. There is a paucity of studies evaluating optimum treatment parameters for fractional lasers in darkly pigmented skin types., Methods: This is a retrospective review of medical records for patients with SPT IV to VI who were treated with a 1,550 nm erbium-doped fractional nonablative laser (Fraxel Re:Store SR 1550; Solta Medical, Hayword, CA). Data were collected from patient charts and the clinic laser logbook from January 2008 to January 2012. The frequency of treatment-associated postinflammatory hyperpigmentation (PIH) and treatment settings used were evaluated., Results: A total of 115 total laser sessions (45 patients) were included in our analysis. Five of the sessions (4%) were accompanied by PIH, 2 of which occurred in a single patient. Only 1 episode of PIH lasted longer than 1 month (2 months). Two of the 5 cases had only transient PIH (≤7 days), one of which was reported by the patient and not clinically evident on examination., Conclusion: The 1,550 nm erbium-doped fractional laser is well tolerated in SPT IV to VI. Fractional laser resurfacing, with the settings used and pretreatment and posttreatment hydroquinone 4% cream, was associated with a low risk of PIH in darker skin types.

The objective of this study was to evaluate the relationship of amyloid burden, as assessed by florbetapir F 18 ((18)F-AV-45) amyloid positron emission tomography, and cognition in healthy older control (HC) subjects. Seventy-eight HC subjects were assessed with a brief cognitive test battery and positron emission tomography (PET) imaging with (18)F-AV-45. A standard uptake value ratio was computed for mean data from 6 cortical regions using a whole cerebellum reference region. Scans were also visually rated as amyloid positive or amyloid negative by 3 readers. Higher standard uptake value ratio correlated with lower immediate memory (r = -0.33; p = 0.003) and delayed recall scores (r = -0.25; p = 0.027). Performance on immediate recall was also lower in the visually rated amyloid positive compared with amyloid negative HC (p = 0.04), with a similar trend observed in delayed recall (p = 0.06). These findings support the hypothesis that higher amyloid burden is associated with lower memory performance among clinically normal older subjects. Longitudinal follow-up is ongoing to determine whether (18)F-AV-45 may also predict subsequent cognitive decline., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: The goal of this study was to examine cross-sectional and longitudinal associations between cognitive performance and beta amyloid (Aβ) load determined by florbetapir F18 positron emission tomography (PET) in nondemented oldest-old., Methods: Thirteen nondemented (normal or cognitively impaired nondemented) participants (median age, 94.2 years) from The 90+ Study underwent florbetapir-PET scanning within 3 months of baseline neuropsychological testing. Amyloid load was measured with a semi-automated quantitative analysis of average cortical-to-cerebellar standardized uptake value ratio (SUVr) and a visual interpretation (Aβ- or Aβ+). Neuropsychological testing was repeated every 6 months., Results: At baseline, SUVr correlated significantly with tests of global cognition and memory. During follow-up (median, 1.5 years), the Aβ+ group had steeper declines on most cognitive tests, particularly global cognitive measures., Conclusion: This preliminary study suggests that greater amyloid load is associated with poorer cognition and faster cognitive decline in nondemented oldest-old. Amyloid load may identify individuals at increased risk of developing Alzheimer's disease., (Copyright © 2013 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.)

Monoamines provide chemical codes of behavioral states. However, the neural mechanisms of monoaminergic orchestration of behavior are poorly understood. Touch elicits an escape response in Caenorhabditis elegans where the animal moves backward and turns to change its direction of locomotion. We show that the tyramine receptor SER-2 acts through a Gαo pathway to inhibit neurotransmitter release from GABAergic motor neurons that synapse onto ventral body wall muscles. Extrasynaptic activation of SER-2 facilitates ventral body wall muscle contraction, contributing to the tight ventral turn that allows the animal to navigate away from a threatening stimulus. Tyramine temporally coordinates the different phases of the escape response through the synaptic activation of the fast-acting ionotropic receptor, LGC-55, and extrasynaptic activation of the slow-acting metabotropic receptor, SER-2. Our studies show, at the level of single cells, how a sensory input recruits the action of a monoamine to change neural circuit properties and orchestrate a compound motor sequence., Competing Interests: The authors have declared that no competing interests exist.

Objectives: Investigate apolipoprotein E ε4 (APOE4) gene and aging effects on florbetapir F18 positron emission tomography (PET) in normal aging and Alzheimer's disease (AD)., Methods: Florbetapir F18 PET images were analyzed from 245 participants, 18-92 years of age, from Avid Radiopharmaceutical's multicenter registered trials, including 86 younger healthy control volunteers (yHC), 61 older healthy control volunteers (oHC), 53 mild cognitive impairment (MCI) patients, and 45 AD dementia patients (DAT). Mean florbetapir standard uptake value ratios (SUVRs) were used to evaluate the effects of APOE4 carrier status, older age, and their interaction in each of these groups., Results: In comparison with non-carriers, the APOE4 carriers in each of the oHC, MCI, and DAT groups had higher mean cortical-to-cerebellar florbetapir SUVRs, patterns of florbetapir PET elevations characteristic of DAT, and a higher proportion meeting florbetapir PET positivity criteria. Only the oHC group had a significant association between mean cortical florbetapir SUVRs and age. In cognitively normal adults, without regards to APOE4 genotype, amyloid began to increase at age 58 (95% confidence interval [CI]: 52.3-63.7), with a predicted typical age of florbetapir positivity occurring around age 71 years. Presence of the APOE4 gene reduced the age of predicted florbetapir positivity in normal aging to around age 56 years, approximately 20 years younger than non-carriers., Interpretation: Cerebral amyloid deposition is associated with APOE4 carrier status in older healthy control subjects and symptomatic AD patients, and increases with age in older cognitively normal individuals. Amyloid imaging positivity appears to begin near age 56 years in cognitively intact APOE4 carriers and age 76 years in APOE4 non-carriers., (Copyright © 2013 Elsevier Inc. All rights reserved.)

5,6-Dimethylbenzofurazan 1-oxide (Me2BF), C(8)H(8)N(2)O(2), occurs in four polymorphic forms that are polytypes of each other. Each polymorph of Me2BF contains molecules disordered about pseudo-twofold axes and arranged head-to-tail in ribbons, with the ribbons forming approximately planar layers held together by weak C-H···N and C-H···O interactions. Adjacent layers interact in different ways in the different polymorphs. In addition to twinning in the individual polymorphs, four examples of allotwining, that is, oriented overgrowths between different polymorphs, were found.

This is the second article of a two-part series regarding nursing faculty and student perceptions of incivility in nursing education in the People's Republic of China (PRC). Nursing faculty from the United States of America (USA) and the PRC collaborated to conduct this empirical study. A sample of 382 Chinese nursing faculty and students responded to 4 open-ended questions on the Incivility in Nursing Education (INE) Survey. Both groups reported similar perceptions of uncivil behaviors, contributors to incivility, and ways to address the problem. A conceptual model for fostering civility in nursing education was adapted to illustrate the findings.

The appeal of online learning has increased dramatically among nurses who are pursuing higher-education opportunities. However, online learning has created potential avenues for uncivil behaviors that can affect student satisfaction, performance, and retention. This is the second of 2 articles detailing a study to empirically measure nursing faculty and student perceptions of an online learning environment (OLE). Part 1, in the July/August 2012 issue, described the quantitative results including the types and frequency of uncivil behaviors and the extent to which they are perceived to be a problem in online courses. In this portion of the study, the authors discuss the qualitative findings, including the challenges and advantages of the OLE, specific ways to foster civility, and strategies to promote student success and retention.

Background: Amyloid imaging provides in vivo detection of the fibrillar amyloid-β (Aβ) plaques of Alzheimer's disease (AD). The positron emission tomography (PET) ligand, Pittsburgh Compound-B (PiB-C11), is the most well studied amyloid imaging agent, but the short half-life of carbon-11 limits its clinical viability. Florbetapir-F18 recently demonstrated in vivo correlation with postmortem Aβ histopathology, but has not been directly compared with PiB-C11., Methods: Fourteen cognitively normal adults and 12 AD patients underwent PiB-C11 and florbetapir-F18 PET scans within a 28-day period., Results: Both ligands displayed highly significant group discrimination and correlation of regional uptake., Conclusion: These data support the hypothesis that florbetapir-F18 provides comparable information with PiB-C11.

Nutrient addition to grasslands consistently causes species richness declines and productivity increases. Competition, particularly for light, is often assumed to produce this result. Using a long-term dataset from North American herbaceous plant communities, we tested whether height and clonal growth form together predict responses to fertilization because neither trait alone predicted species loss in a previous analysis. Species with a tall-runner growth form commonly increased in relative abundance in response to added nitrogen, while short species and those with a tall-clumped clonal growth form often decreased. The ability to increase in size via vegetative spread across space, while simultaneously occupying the canopy, conferred competitive advantage, although typically only the abundance of a single species within each height-clonal growth form significantly responded to fertilization in each experiment. Classifying species on the basis of two traits (height and clonal growth form) increases our ability to predict species responses to fertilization compared to either trait alone in predominantly herbaceous plant communities. Electronic supplementary material The online version of this article (doi:10.1007/s00442-012-2264-5) contains supplementary material, which is available to authorized users.

Background: Results of previous studies have shown associations between PET imaging of amyloid plaques and amyloid-β pathology measured at autopsy. However, these studies were small and not designed to prospectively measure sensitivity or specificity of amyloid PET imaging against a reference standard. We therefore prospectively compared the sensitivity and specificity of amyloid PET imaging with neuropathology at autopsy., Methods: This study was an extension of our previous imaging-to-autopsy study of participants recruited at 22 centres in the USA who had a life expectancy of less than 6 months at enrolment. Participants had autopsy within 2 years of PET imaging with florbetapir ((18)F). For one of the primary analyses, the interpretation of the florbetapir scans (majority interpretation of five nuclear medicine physicians, who classified each scan as amyloid positive or amyloid negative) was compared with amyloid pathology (assessed according to the Consortium to Establish a Registry for Alzheimer's Disease standards, and classed as amyloid positive for moderate or frequent plaques or amyloid negative for no or sparse plaques); correlation of the image analysis results with amyloid burden was tested as a coprimary endpoint. Correlation, sensitivity, and specificity analyses were also done in the subset of participants who had autopsy within 1 year of imaging as secondary endpoints. The study is registered with ClinicalTrials.gov, number NCT 01447719 (original study NCT 00857415)., Findings: We included 59 participants (aged 47-103 years; cognitive status ranging from normal to advanced dementia). The sensitivity and specificity of florbetapir PET imaging for detection of moderate to frequent plaques were 92% (36 of 39; 95% CI 78-98) and 100% (20 of 20; 80-100%), respectively, in people who had autopsy within 2 years of PET imaging, and 96% (27 of 28; 80-100%) and 100% (18 of 18; 78-100%), respectively, for those who had autopsy within 1 year. Amyloid assessed semiquantitatively with florbetapir PET was correlated with the post-mortem amyloid burden in the participants who had an autopsy within 2 years (Spearman ρ=0·76; p<0·0001) and within 12 months between imaging and autopsy (0·79; p<0·0001)., Interpretation: The results of this study validate the binary visual reading method approved in the USA for clinical use with florbetapir and suggest that florbetapir could be used to distinguish individuals with no or sparse amyloid plaques from those with moderate to frequent plaques. Additional research is needed to understand the prognostic implications of moderate to frequent plaque density., Funding: Avid Radiopharmaceuticals., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objective: To evaluate whether antioxidant supplements presumed to target specific cellular compartments affected cerebrospinal fluid (CSF) biomarkers., Design: Double-blind, placebo-controlled clinical trial., Setting: Academic medical centers., Participants: Subjects with mild to moderate Alzheimer disease., Intervention: Random assignment to treatment for 16 weeks with 800 IU/d of vitamin E (α-tocopherol) plus 500 mg/d of vitamin C plus 900 mg/d of α-lipoic acid (E/C/ALA); 400 mg of coenzyme Q 3 times/d; or placebo., Main Outcome Measures: Changes from baseline to 16 weeks in CSF biomarkers related to Alzheimer disease and oxidative stress, cognition (Mini-Mental State Examination), and function (Alzheimer's Disease Cooperative Study Activities of Daily Living Scale)., Results: Seventy-eight subjects were randomized; 66 provided serial CSF specimens adequate for biochemical analyses. Study drugs were well tolerated, but accelerated decline in Mini-Mental State Examination scores occurred in the E/C/ALA group, a potential safety concern. Changes in CSF Aβ42, tau, and P-tau(181) levels did not differ between the 3 groups. Cerebrospinal fluid F2-isoprostane levels, an oxidative stress biomarker, decreased on average by 19% from baseline to week 16 in the E/C/ALA group but were unchanged in the other groups., Conclusions: Antioxidants did not influence CSF biomarkers related to amyloid or tau pathology. Lowering of CSF F2-isoprostane levels in the E/C/ALA group suggests reduction of oxidative stress in the brain. However, this treatment raised the caution of faster cognitive decline, which would need careful assessment if longer-term clinical trials are conducted., Trial Registration: clinicaltrials.gov Identifier: NCT00117403.

Online learning has created another potential avenue for incivility. Cyber-bullying, a form of incivility that occurs in an electronic environment, includes posting rumors or misinformation, gossiping, or publishing materials that defame and humiliate others. This is the first of 2 articles detailing a study to empirically measure nursing faculty and student perceptions of incivility in an online learning environment (OLE). In this article, the authors discuss the quantitative results including the types and frequency of uncivil behaviors and the extent to which they are perceived to be a problem in online courses. Part 2 in the September/October issue will describe challenges and advantages of the OLE, discuss specific ways to foster civility, and present strategies to promote student success and retention.

Background: The first year of nursing practice is critical to developing new graduate nurses into safe practitioners. Many new graduate nurses leave the profession because of job stress, lack of organizational support, poor nurse-physician relations, unreasonable workloads, uncivil work environments, and difficulty transitioning into practice. In response, Nurse Residency programs reflect an organizational commitment to support new nurses, allowing them time and support to become competent professional nurses., Purpose and Method: Thirty-seven new graduate nurses employed in a hospital in a northwestern state participated in a descriptive qualitative study to examine the "lived experience" as new nurses and to assess the level of job satisfaction during the first year of their nursing practice., Results: New graduate nurses described themes related to their first year of nursing practice including rhythm in the chaos, feeling valued, stress from 'not knowing', life-long learning, and preserving the profession., Conclusions: Having supportive preceptors and nursing staff, feeling valued by the health care team, and being perceived as a vital member of the organization contributed to job satisfaction and overall commitment to the profession., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: This study measured distortions of memory during short-term memory (STM) and long-term memory (LTM) versions of a semantically associated word list learning paradigm. Performance of patients with mild-to-moderate Alzheimer's disease (AD; MMSE ≥16) was compared with performance of age-matched, healthy older adult participants., Method: In a STM version of the Deese-Roediger-McDermott (DRM) task, participants viewed four-word lists and were prompted for recall after a brief interval. The LTM task tested recall memory for 12-word lists., Results: Compared with the healthy group, the AD participants show greater impairment on the LTM task than on the STM task, although veridical recall is significantly reduced on both tasks. Furthermore, on both memory tasks, (1) participants with AD generate more nonsemantic intrusions than healthy older adult participants, and (2) semantic intrusion rate, when computed as a proportion of total recall, does not differ between groups. Notably, nonsemantic intrusions are consistently high for AD participants across both STM and LTM despite a marked difference in recall accuracy (65% and 23%, respectively)., Conclusions: STM impairment with some preserved semantic processing is evident in AD. The extent and variety of intrusions reported by AD participants indicates a breakdown in their ability to monitor and constrain their recall responses, even within seconds of initial learning.

Background: Idiopathic normal pressure hydrocephalus (iNPH) is a potentially reversible cause of dementia and gait disturbance that is typically treated by operative placement of a ventriculoperitoneal shunt. The outcome from shunting is variable, and some evidence suggests that the presence of comorbid Alzheimer's disease (AD) may impact shunt outcome. Evidence also suggests that AD biomarkers in cerebrospinal fluid (CSF) may predict the presence of AD. The aim of this study was to investigate the relationship between the phosphorylated tau/amyloid beta 1-42 (ptau/Aβ1-42) ratio in ventricular CSF and shunt outcome in patients with iNPH., Methods: We conducted a prospective trial with a cohort of 39 patients with suspected iNPH. Patients were clinically and psychometrically assessed prior to and approximately 4 months after ventriculoperitoneal shunting. Lumbar and ventricular CSF obtained intraoperatively, and tissue from intraoperative cortical biopsies were analyzed for AD biomarkers. Outcome measures included performance on clinical symptom scales, supplementary gait measures, and standard psychometric tests. We investigated relationships between the ptau/Aβ1-42 ratio in ventricular CSF and cortical AD pathology, initial clinical features, shunt outcome, and lumbar CSF ptau/Aβ1-42 ratios in the patients in our cohort., Results: We found that high ptau/Aβ1-42 ratios in ventricular CSF correlated with the presence of cortical AD pathology. At baseline, iNPH patients with ratio values most suggestive of AD presented with better gait performance but poorer cognitive performance. Patients with high ptau/Aβ1-42 ratios also showed a less robust response to shunting on both gait and cognitive measures. Finally, in a subset of 18 patients who also underwent lumbar puncture, ventricular CSF ratios were significantly correlated with lumbar CSF ratios., Conclusions: Levels of AD biomarkers in CSF correlate with the presence of cortical AD pathology and predict aspects of clinical presentation in iNPH. Moreover, preliminary evidence suggests that CSF biomarkers of AD may prove useful for stratifying shunt prognosis in patients being evaluated and treated for this condition.

Unlabelled: The objectives of this study were to examine the effective dose range and the test-retest reliability of florbetapir F 18 using, first, visual assessment by independent raters masked to clinical information and, second, semiautomated quantitative measures of cortical target area to cerebellum standardized uptake value ratios (SUVr) as primary outcome measures. Visual ratings of PET image quality and tracer retention or β-amyloid (Aβ) binding expressed as SUVrs were compared after intravenous administration of either 111 MBq (3 mCi) or 370 MBq (10 mCi) of florbetapir F 18 in patients with Alzheimer's disease (AD) (n = 9) and younger healthy controls (YHCs) (n = 11). In a separate set of subjects (AD, n = 10; YHCs, n = 10), test-retest reliability was evaluated by comparing intrasubject visual read ratings and SUVrs for 2 PET images acquired within 4 wk of each other., Results: There were no meaningful differences between the 111-MBq (3-mCi) and 370-MBq (10-mCi) dose in the visual rating or SUVr. The difference in the visual quality across 111 and 370 MBq showed a trend toward lower image quality, but no statistical significance was achieved (t test; t(1) = -1.617, P = 0.12) in this relatively small sample of subjects. At both dose levels, visual ratings of amyloid burden identified 100% of AD subjects as Aβ-positive and 100% of YHCs as Aβ-negative. Mean intrasubject test-retest variability for cortical average SUVrs with the cerebellum as a reference over the 50- to 70-min period was 2.4% ± 1.41% for AD subjects and 1.5% ± 0.84% for controls. The overall SUVr test-retest correlation coefficient was 0.99. The overall κ-statistic for test-retest agreement for Aβ classification of the masked reads was 0.89 (95% confidence interval, 0.69-1.0)., Conclusion: Florbetapir F 18 appears to have a wide effective dose range and a high test-retest reliability for both quantitative (SUVr) values and visual assessment of the ligand. These imaging performance properties provide important technical information on the use of florbetapir F 18 and PET to detect cerebral amyloid aggregates.

Despite rapid growth in biofuel production worldwide, it is uncertain whether decision-makers possess sufficient information to fully evaluate the impacts of the industry and avoid unintended consequences. Doing so requires rigorous peer-reviewed data and analyses across the entire range of direct and indirect effects. To assess the coverage of scientific research, we analyzed over 1600 peer-reviewed articles published between 2000 and 2009 that addressed 23 biofuels-related topics within four thematic areas: environment and human well-being, economics, technology, and geography. Greenhouse gases, fuel production, and feedstock production were well-represented in the literature, while trade, biodiversity, and human health were not. Gaps were especially striking across topics in the Southern Hemisphere, where the greatest potential socio-economic benefits, as well as environmental damages, may co-occur. There was strong asymmetry in the connectedness of research topics; greenhouse gases articles were twice as often connected to other topics as biodiversity articles. This could undermine the ability of scientific and economic analyses to adequately evaluate impacts and avoid significant unintended consequences. At the least, our review suggests caution in this developing industry and the need to pursue more interdisciplinary research to assess complex trade-offs and feedbacks inherent to an industry with wide-reaching potential impacts.

A positive organizational culture and climate is closely associated with an affirming workplace and job satisfaction. Especially during a time of faculty shortages, academic leaders need to be cognizant of the culture and climate in schools of nursing. The culture of an organization affects employees, systems, and processes, and if the culture becomes problematic, transformational leadership is essential to create change. The purpose of this article is to describe an 8-year journey to change the culture and climate of a school of nursing from one of dissatisfaction and distrust to one of high employee satisfaction and trust. Kotter's model for transformational change was used to frame a longitudinal study using the Cultural and Climate Assessment Scale to transform the organizational culture and climate of a school of nursing., (Copyright 2012, SLACK Incorporated.)

This article describes the development, implementation, and preliminary psychometric testing of the Culture/Climate Assessment Scale (CCAS), designed and used by a school of nursing. The CCAS comprises 37 items arranged into five scales of communication, decision support, level of conflict, teamwork, and general work satisfaction, as well as three additional items that measure personal level of stress, perceived level of change, and overall level of morale. Faculty and staff completed the CCAS in three progressive administrations over a 5-year period to provide empirical data to chart the progress to improve the organizational culture and climate of one school of nursing. Preliminary testing of the CCAS supports its continued use in nursing education and other academic environments., (Copyright 2012, SLACK Incorporated.)