Implementing a nursing civility code: implications for education.

This article provides an overview of one nursing department's experience with implementation of a formalized civility code to address increasing incidents of incivility within the classroom and educational environment. The plan-do-study-act improvement model is used as a framework to describe the process. Discussion of next steps in the improvement process relates to three key elements: theoretical and technical aspects, faculty modeling, and policy and procedure development.

BRAF alterations in primary glial and glioneuronal neoplasms of the central nervous system with identification of 2 novel KIAA1549:BRAF fusion variants.

Recent studies highlight the importance of BRAF alterations resulting in mitogen activated protein kinase (MAK/ERK) pathway activation in low-grade CNS tumors. We studied 106 low-grade CNS neoplasms in a cohort of primarily pediatric patients to identify the prevalence and clinicopathologic significance of these alterations. Polymerase chain reaction testing identified KIAA1549:BRAF fusions in 51 (48%) tumors overall, including 42 (60%) pilocytic astrocytomas, 4 (17%) unclassifiable low-grade gliomas, 4 (36%) low-grade glioneuronal/neuroepithelial tumors, 0 (of 5) pleomorphic xanthoastrocytomas, 0 (of 4) diffuse astrocytomas (World Health Organization grade II), and 1 (of 3, 33%) pilomyxoid astrocytoma. KIAA1549:BRAF gene fusions confirmed by sequencing included the previously reported ones involving exons 1-16/9-18 (49%), 1-15/9-18 (35%), and 1-16/11-18 (8%) and 2 fusions with novel breakpoints: 1-15/11-18 (6%) and 1-17/10-18 (1%). DNA sequencing identified BRAF mutations in 8% of tumors. BRAF mutations were absent. KIAA1549:BRAF fusions were significantly more frequent in infratentorial (57%) and optic pathway (59%) tumors versus supratentorial (19%) tumors (p = 0.001). We did not identify significantly improved progression-free survival in tumors with fusions. In summary, KIAA1549:BRAF fusions predominate in pilocytic astrocytomas but are also present in some low-grade unclassifiable gliomas and glioneuronal tumors. The prognostic and therapeutic significance of this alteration is unclear and merits further study.

When the air hits your brain: cerebral autoregulation of brain oxygenation during aerobic exercise allows transient hyperoxygenation: case report.

OBJECTIVE: Cerebral autoregulation maintains a relatively stable cerebral blood flow over a range of perfusion pressures. During exercise, regional cerebral blood flow may be elevated in particular areas of the brain. This case report presents the impact of aerobic exercise on intracranially measured pressure and brain tissue oxygenation in an adult human. CLINCIAL PRESENTATION: A 30-year-old man with idiopathic intracranial hypertension treated with cerebrospinal fluid diversion was monitored with a Licox intracranial brain oxygen and pressure monitor (Integra NeuroSciences Corporation, Plainsboro, New Jersey) for refractory nonpostural headaches exacerbated after exercise. He performed trials of running and bicycling to provoke his headaches. The patient's mean intracranial pressure remained stable during exercise despite elevated cerebral perfusion pressures. Regional cerebral oxygen tension levels were strictly regulated to a level of approximately 39 mm Hg during steady state aerobic exercise, with transient increases up to 90 mm Hg at the onset and termination of activity. CONCLUSION: Our results suggest that cerebral autoregulation appears to maintain constant cerebral oxygen tension during exercise. Further, we note transient cerebral hyperoxygenation at the onset of exercise as autoregulation "turns on" and at the termination of exercise. We present a quantitative interpretation of the post-exercise hyperoxygenation phase based on Fick's principle. We are the first to demonstrate cortical hyperoxygenation in a human breathing natural air without oxygen supplementation.