bluuebunny/crossref_metadata_2025 huggingface dataset:
On-chip generation and control of the vortex beam
Authors: Liu Aiping , Zou Chang-Ling , Ren Xifeng , Wang Qin , Guo Guang-Can
Published: May 2016

A method to generate and control the amplitude and phase distributions of an optical vortex beam is proposed. By introducing a holographic grating on the top of a dielectric waveguide, the free space vortex beam and the in-plane guiding wave can be converted to each other. This microscale holographic grating is very robust against the variation of geometry parameters. The designed vortex beam generator can produce the target beam with a fidelity up to 0.93, and the working bandwidth is about 175 nm with the fidelity larger than 0.80. In addition, a multiple generator composed of two holographic gratings on two parallel waveguides is studied, which can perform an effective and flexible modulation on the vortex beam by controlling the phase of the input light. Our work opens an available avenue towards the integrated orbital angular momentum devices with multiple degrees of optical freedom, which can be used for optical tweezers, micronano imaging, information processing, and so on.
Electrowetting-on-dielectric assisted bubble detachment in a liquid film
Authors: Wang S. , Chen H. H. , Chen C. L.
Published: May 2016

Drawing inspiration from electrowetting-controlled droplets, the potential advantages of electrowetting for bubble dynamics are investigated experimentally. In this study, we present and characterize an open electrowetting-on-dielectric (EWOD) system for studying the bubble behavior. Both detachment and non-detachment processes of a small single bubble in a thick liquid film under EWOD were experimentally observed. The measurement of contact angle changes of the small air bubble shows relatively good agreement with Young-Lippmann's equation within the majority of the test voltage range, except for the saturation region. Meanwhile, we have experimentally demonstrated both the characteristics of single- and double-bubble detachment within a thin liquid film. Direct bubble detachment may occur when it touches the gas-liquid interface during the process of contact angle change, while indirect bubble detachment is highly possible due to the dramatic oscillation resulting from the detachment of adjacent bubbles. The experimental results demonstrate that EWOD can effectively facilitate the detachment of small air bubble in a thin liquid film.
Regulation of oxygen vacancy types on SnO2 (110) surface by external strain
Authors: Zhou Z. H. , Min Y. M. , Liu X. X. , Ding J. Q. , Guo J. H. , Hu F. R. , Liu L. Z.
Published: May 2016

In tin dioxide nanostructures, oxygen vacancies (OVs) play an important role in their optical properties and thus regulation of both OV concentration and type via external strain is crucial to exploration of more applications. First-principle calculations of SnO2 (110) surface disclose that asymmetric deformations induced by external strain not only lead to its intrinsic surface elastic changes, but also result in different OV formation energy. In the absence of external strain, the energetically favorable oxygen vacancies(EFOV) appear in the bridging site of second layer. When -3.5% external strain is applied along y direction, the EFOV moves into plane site. This can be ascribed that the compressed deformation gives rise to redistribution of electronic wave function near OVs, therefore, formation of newly bond structures. Our results suggest that different type OVs in SnO2 surface can be controlled by strain engineering.
Effect of fabrication conditions on phase formation and properties of epitaxial (PbMg1/3Nb2/3O3)0.67-(PbTiO3)0.33 thin films on (001) SrTiO3
Authors: Boota Muhammad , Houwman Evert P. , Nguyen Minh D. , Lanzara Giulia , Rijnders Guus
Published: May 2016

The pulsed laser deposition process of 300nm thick films of Pb(Mg1/3Nb2/3)O3)0.67-(PbTiO3)0.33 on (001)-oriented SrTiO3 was studied by varying deposition pressure, substrate deposition temperature, laser fluence on the target and target-substrate distance. Perovskite phase pure, (001)-oriented, epitaxial smooth films were obtained in a narrow range of deposition parameters. The ferroelectric and dielectric properties of films fabricated within this parameter range still vary significantly. This shows the sensitivity of the system for growth conditions. The best film has a polarization value close to that expected for a (001) poled, stress free single crystal film. All films show deposition conditions dependent variations in the self-bias field. The self-bias is very stable during long cycling for films made at optimum deposition conditions. The piezoelectric coefficients of the films are strongly reduced with respect to bulk single crystal values due to the film clamping. The properties variations are ascribed to changes in the grain boundary properties in which film defects are expected to accumulate. Notably slight off-stoichiometry may cause localized screening charges, affecting specifically the polarization and dielectric constant.
Modeling and simulation of bulk gallium nitride power semiconductor devices
Authors: Sabui G. , Parbrook P. J. , Arredondo-Arechavala M. , Shen Z. J.
Published: May 2016

Bulk gallium nitride (GaN) power semiconductor devices are gaining significant interest in recent years, creating the need for technology computer aided design (TCAD) simulation to accurately model and optimize these devices. This paper comprehensively reviews and compares different GaN physical models and model parameters in the literature, and discusses the appropriate selection of these models and parameters for TCAD simulation. 2-D drift-diffusion semi-classical simulation is carried out for 2.6 kV and 3.7 kV bulk GaN vertical PN diodes. The simulated forward current-voltage and reverse breakdown characteristics are in good agreement with the measurement data even over a wide temperature range.
Characterisation of smallholding dairy farms in southern Brazil
Authors: Balcão Lucas F. , Longo Cibele , Costa João H. C. , Uller-Gómez Cintia , Filho Luiz C. P. Machado , Hötzel Maria J.
Published: May 2016

Smallholder dairy farmers that are responsible for 90% of the milk produced in Santa Catarina State, in southern Brazil, transitioned in recent decades from milk production for self-consumption to commercial dairying. The objective of this study was to identify groups sharing common characteristics, potentials and limitations and compare their main management practices, milk production and milk quality. We collected data from 124 farms distributed in 24 municipalities, using semi-structured interviews, inspection of the housing and milking environment, and live observations during one complete milking. Multivariate analyses revealed three groups of farmers: ‘Semi-Intensive’ (n = 51), ‘Pasture-Based’ (n = 50), and ‘Extensive’ (n = 23). Group differences included land and herd size (both larger in Semi-Intensive, P < 0.002); feeding management of dairy cows (e.g. greater use of pasture improvement techniques in Extensive and Pasture-Based, and more efficient rotational grazing management in Pasture-Based, P < 0.04); use of external inputs (e.g. lower use of concentrate and silage in Pasture-Based, P < 0.001); milking infrastructure and hygiene practices (better in Semi-Intensive, P < 0.04), and milk productivity (greater in Semi-Intensive, P < 0.001). The Extensive group conserves several features of the subsistence, traditional mode of milk production, and makes inefficient use of costly feeding practices, which threatens its sustainability. The two other groups of farms took different, almost opposite directions to deal with the limitations in farm area: the Semi-Intensive group have adopted an entrepreneurial farming style and the Pasture-Based, a more agroecological path. These results highlight the need to develop specific strategies and policies to help these different types of producers to coexist in the dairy production chain.
Effects of dietary active dried yeast (Saccharomyces cerevisiae) supply at two levels of concentrate on energy and nitrogen utilisation and methane emissions of lactating dairy cows
Authors: Muñoz C. , Wills D. A. , Yan T.
Published: May 2016

Twenty early lactation dairy cows were used to evaluate the effects of the dietary addition of an active dried yeast product at two levels of concentrate on productive performance, nutrient digestibility, methane (CH4) emissions and energy and nitrogen utilisation. This study was a replicated 4 × 4 Latin square design with a two (concentrate level) × two (yeast supplement) factorial treatment arrangement, with four periods (6 week/period) and a 3-week interval between each period. Cows were offered grass silage-based diets consisting of two levels of concentrate (300 and 600 g/kg), with or without supplement of 0.5 g/day of an active dry yeast (Saccharomyces cerevisiae strain) with a specification of 2 × 1010 cfu/g. Feed dry matter intake, milk yield, milk composition, bodyweight and body condition score were similar between yeast treatments at both concentrate levels. Nutrient digestibility was not affected by yeast supplementation. Energy intake and faecal, urinary, CH4 and milk energy outputs were also not affected by yeast supplementation. Yeast supplementation had no effects on energy partitioning but tended to increase heat production and decreased energy retention. Yeast supplementation at two levels of concentrate had no effect on total CH4 emissions, but tended to increase CH4 per unit of feed intake and CH4 energy output per unit of gross energy intake. There were no effects of yeast supplementation on CH4 per unit of milk yield. Yeast supplementation had no effect on any variable of nitrogen intake, output or utilisation. Overall, the dietary addition of an active dried yeast product at two concentrate feeding levels had no effects on feed intake, milk production, milk composition, nutrient digestibility, or nitrogen utilisation efficiency and only tended to increase heat production, CH4 per unit of feed intake and CH4 energy output per unit of gross energy intake in lactating dairy cows.
Greenhouse gas emission intensity based on lifetime milk production of dairy animals, as affected by ration-balancing program
Authors: Garg M. R. , Sherasia P. L. , Phondba B. T. , Makkar H. P. S.
Published: May 2016

Smallholder dairying in India and other developing countries relies on low- and medium-productive animals, and the feeding is mainly based on crop residues and other agro-industrial by-products. The diets are generally nutritionally imbalanced, resulting in productive and reproductive inefficiencies. This also negatively affects the emission intensity (Ei). For the past 3 years, the National Dairy Development Board of India has been implementing large-scale ration-balancing (RB) program in field animals. The effect of feeding balanced rations on Ei was explored. A cradle to farm-gate life-cycle assessment, taking into account the lifespan milk production, was conducted on 163 540 lactating cows and 163 550 buffaloes in northern, southern, eastern and western India. The life-cycle assessment boundary included feed production, enteric fermentation and manure management during various stages of life. On the basis of economic allocation, emissions of methane (CH4) from enteric fermentation, CH4 from manure management, nitrous oxide from manure management and greenhouse gas (GHG), i.e. carbon dioxide (CO2), CH4 and nitrous oxide from feed production, contributed 69.9%, 6.3%, 9.6% and 14.2% in cows, and 71.6%, 7.4%, 12.6% and 8.4% in buffaloes, respectively, to the baseline (before RB) lifetime total GHG emissions. Average Ei based on economic, mass and digestibility allocation for ‘baseline versus after RB’ were 1.6 versus 1.1, 1.8 versus 1.2 and 1.7 versus 1.2 kg CO2-equivalent/kg fat and protein-corrected milk in cows and 2.3 versus 1.5, 2.5 versus 1.6 and 2.4 versus 1.5 kg CO2-equivalent/kg fat and protein-corrected milk in buffaloes, respectively. Feeding-balanced rations significantly improved milk production, but reduced Ei of milk on lifetime basis by 31.2% and 34.7% in cows and buffaloes, respectively. Implementation of RB program has shown considerable potential to reduce GHG emission intensity under smallholding dairy production system of India.
A picture's worth a thousand words: a food‐selection observational method
Authors: Carins Julia E. , Rundle‐Thiele Sharyn R. , Parkinson Joy E.
Published: May 2016

Issue addressed

Methods are needed to accurately measure and describe behaviour so that social marketers and other behaviour change researchers can gain consumer insights before designing behaviour change strategies and so, in time, they can measure the impact of strategies or interventions when implemented. This paper describes a photographic method developed to meet these needs.

Methods

Direct observation and photographic methods were developed and used to capture food‐selection behaviour and examine those selections according to their healthfulness. Four meals (two lunches and two dinners) were observed at a workplace buffet‐style cafeteria over a 1‐week period. The healthfulness of individual meals was assessed using a classification scheme developed for the present study and based on the Australian Dietary Guidelines.

Results

Approximately 27% of meals (n = 168) were photographed. Agreement was high between raters classifying dishes using the scheme, as well as between researchers when coding photographs. The subset of photographs was representative of patterns observed in the entire dining room. Diners chose main dishes in line with the proportions presented, but in opposition to the proportions presented for side dishes.

Conclusions

The present study developed a rigorous observational method to investigate food choice behaviour. The comprehensive food classification scheme produced consistent classifications of foods. The photographic data collection method was found to be robust and accurate. Combining the two observation methods allows researchers and/or practitioners to accurately measure and interpret food selections. Consumer insights gained suggest that, in this setting, increasing the availability of green (healthful) offerings for main dishes would assist in improving healthfulness, whereas other strategies (e.g. promotion) may be needed for side dishes.

So what?

Visual observation methods that accurately measure and interpret food‐selection behaviour provide both insight for those developing healthy eating interventions and a means to evaluate the effect of implemented interventions on food selection.
Concealed
d
-wave pairs in the
s
±
condensate of iron-based superconductors
Authors: Ong Tzen , Coleman Piers , Schmalian Jörg
Published: May 2016

Significance

Inspired by the hidden spin entanglement in superfluid Helium-3B, we propose that orbitally entangled Cooper pairs of
d
-wave character lie within the
s
-wave condensate of iron-based superconductors. This order is revealed when the topologically nontrivial helical nature of the band structure is taken into account. The hidden d-wave character lowers the Coulomb repulsion energy and accounts for the observed phase transition from a fully gapped
s
-wave to a nodal octet superconductor within a single pairing mechanism. We predict that this entangled superconductor will display a shift in the orbital character of its quasiparticles on pair condensation, and will form Andreev edge states at the domain wall between its
s
-wave and an octet phase.
Cortical thickness of the dorsolateral prefrontal cortex predicts strategic choices in economic games
Authors: Yamagishi Toshio , Takagishi Haruto , Fermin Alan de Souza Rodrigues , Kanai Ryota , Li Yang , Matsumoto Yoshie
Published: May 2016

Significance

Is human prosociality a consequence of cognitive control of selfish impulses? Alternatively, is it a default option that most people use unless they are cognitively persuaded that a given situation does not require them to behave prosocially? Our results support the latter argument. Participants with weaker cognitive control fairly shared a reward with another participant even when there was no chance of punishing unfair behavior, whereas those more capable of cognitive control behaved selfishly in the same situation. These findings demonstrate that participants’ intuitive choices in economic games are prosocial.
Light-induced actuating nanotransducers
Authors: Ding Tao , Valev Ventsislav K. , Salmon Andrew R. , Forman Chris J. , Smoukov Stoyan K. , Scherman Oren A. , Frenkel Daan , Baumberg Jeremy J.
Published: May 2016

Significance

Scientists have dreamt of nanomachines that can navigate in water, sense their environment, communicate, and respond. Various power sources and propulsion systems have been proposed but they lack speed, strength, and control. We introduce here a previously undefined paradigm for nanoactuation which is incredibly simple, but solves many problems. It is optically powered (although other modes are also possible), and potentially offers unusually large force/mass. This looks to be widely generalizable, because the actuating nanotransducers can be selectively bound to designated active sites. The concept can underpin a plethora of future designs and already we produce a dramatic optical response over large areas at high speed.
Decades of field data reveal that turtles senesce in the wild
Authors: Warner Daniel A. , Miller David A. W. , Bronikowski Anne M. , Janzen Fredric J.
Published: May 2016

Significance

Turtles are icons of longevity, popularly characterized as lacking aging and remaining robust as they get older. Indeterminate growth and a positive relationship between body size and fecundity suggest that a greater proportion of reproductive output could come from older, rather than younger, individuals. However, studies of turtle populations are typically too short to empirically test these assertions. We tracked >1,000 painted turtles for >20 y in a population in northwest Illinois, United States. Contrary to traditional thought, successful reproduction and survival declined as the turtles aged. Consistent with life-history theory, the observed senescence in reproduction and survival in this population may be attributable to relatively high extrinsic mortality as a result of human disruption.
Express saccades and superior colliculus responses are sensitive to short-wavelength cone contrast
Authors: Hall Nathan J. , Colby Carol L.
Published: May 2016

Significance

It is widely believed that the superior colliculus (SC) is unable to use input from short-wavelength–sensitive cones (S-cones) in the retina. If this idea were true, the role of the SC in nearly any visual-oculomotor behavior could be tested by using an S-cone stimulus to eliminate involvement of the SC. Contrary to this assumption, we show that express saccades, an SC-dependent behavior, are sensitive to S-cone contrast. This finding demonstrates that the SC is able to use input from S-cones to guide behavior, and that S-cone stimuli cannot be used to infer SC contributions to behavior.
TGF-β signaling in insects regulates metamorphosis via juvenile hormone biosynthesis
Authors: Ishimaru Yoshiyasu , Tomonari Sayuri , Matsuoka Yuji , Watanabe Takahito , Miyawaki Katsuyuki , Bando Tetsuya , Tomioka Kenji , Ohuchi Hideyo , Noji Sumihare , Mito Taro
Published: May 2016

Significance

Insects undergo a morphological transformation from nymph/larva to adult with or without pupal formation, processes referred to as “hemimetamorphosis” and “holometamorphosis,” respectively. Both processes are regulated by common mechanisms involving the hormones 20-hydroxyecdysone and juvenile hormone (JH). However, it remains unclear how synthesis of JH is regulated in the corpora allata (CA). Here, we report that inGryllus bimaculatusthe TGF-β ligands Myoglianin (Gb’Myo) (GDF8/11 homolog) and Decapentaplegic/Glass-bottom boat/60A (Gb’Dpp/Gbb) regulate JH synthesis via expression of the JH acidO-methyltransferase in the CA. Furthermore, loss ofGb’Myo function preserves the status quo action of JH and prevents metamorphosis. These findings elucidate regulatory mechanisms that provide endocrine control of insect life cycles and provide a model of GDF8/11 function.
Intercellular signaling through secreted proteins induces free-energy gradient-directed cell movement
Authors: Kravchenko-Balasha Nataly , Shin Young Shik , Sutherland Alex , Levine R. D. , Heath James R.
Published: May 2016

Significance

We demonstrate the role of free energy in determining the direction of motion in a biological process. A thermodynamics-motivated approach is used to show that free-energy changes in cell–cell signaling determine the force gradient for directed cell motion. Using isolated cell pairs and assays of secreted protein levels, we compute the free energy of the cell–cell signaling network as a function of cell–cell separation. The changes in free energy as a function of separation correspond to a potential-energy gradient that can influence cell–cell motion. Recordings of cell motion trajectories were compared with the direction of the gradient. Neutralizing the secreted proteins most involved in establishing the free-energy gradient cancels the directed motion.
Extensive graft-derived dopaminergic innervation is maintained 24 years after transplantation in the degenerating parkinsonian brain
Authors: Li Wen , Englund Elisabet , Widner Håkan , Mattsson Bengt , van Westen Danielle , Lätt Jimmy , Rehncrona Stig , Brundin Patrik , Björklund Anders , Lindvall Olle , Li Jia-Yi
Published: May 2016

Significance

Parkinson’s disease is the most common movement disorder. Here we describe the histopathological analysis of a unique patient with Parkinson’s disease who underwent unilateral cell transplantation in the putamen with human embryonic mesencephalic tissue at 24 y before death. The patient enjoyed major clinical benefits for at least a decade after transplantation. After a quarter of a century, complete graft-derived dopaminergic reinnervation was still evident in the transplanted putamen. α-Synuclein–positive inclusions, some with the appearance of typical Lewy bodies, were present in 11–12% of the grafted dopaminergic neurons, reflecting spread of pathology from the host brain to the transplant. The clinical improvements were gradually lost from 14 y posttransplantation, indicating that even extensive graft-derived dopaminergic reinnervation loses its efficacy in a severely degenerating brain.
Bi-directional cross-linguistic influence in bilingual Russian-Hebrew children
Authors: Meir Natalia , Walters Joel , Armon-Lotem Sharon
Published: May 2016

This study examines cross-linguistic influence of L1 on L2 and L2 on L1 and the extent to which age of L2 onset (L2 AoO) is linked to the acquisition of morpho-syntactic properties in both languages of bilingual children who acquire L1-Russian as a heritage language and L2-Hebrew as a majority language. Our investigation of L1-L2 influence focuses on morpho-syntactic features, whose configurations vary in Russian and Hebrew. Definiteness is realized in Hebrew (but not in Russian), aspect is selected in Russian (but not in Hebrew), and [ACC] case is realized in both languages (but the mapping is different across the two languages); finally, the features of [Person], [Number] and [Gender] are mapped onto verbal inflections in both languages. A total of 110 Russian-Hebrew bilingual children aged 5;5–6;5 with varying ages of L2-Hebrew onset (0–60 months), 20 Hebrew-speaking monolinguals and 20 Russian-speaking monolinguals participated. Results demonstrate cross-linguistic influence, showing that it is bi-directional (L1 on L2 and L2 on L1). The patterns of cross-linguistic influence were similar: bilinguals performed similarly to monolinguals on features, with similar configurations in L1 and L2 (i.e., subject-verb agreement) but performed lower for properties realized differently in L1 and L2 (i.e., [DEF] articles in L2-Hebrew; [PERF] aspect and [ACC] case inflections in L1-Russian). The results also showed an effect of L2 AoO on the acquisition of both L1 and L2. Children with earlier AoO to L2-Hebrew (before 24 months) achieve better mastery in L2-Hebrew and performed lower in L1-Russian. Conversely, later AoOs to L2, led to better mastery of L1 and weaknesses in the acquisition of L2. Findings are discussed in light of the Feature Re-assembly Hypothesis.
A Systematic Review and Meta‐Analysis of Trials Using Statins in Pulmonary Arterial Hypertension
Authors: Anand Vidhu , Garg Sushil , Duval Sue , Thenappan Thenappan
Published: May 2016

Statins improve pulmonary vascular remodeling and right ventricular hypertrophy in animal models of pulmonary arterial hypertension (PAH). However, clinical trials assessing the efficacy of statins in patients with PAH have reported mixed results. In this systematic review and meta‐analysis, we assess the efficacy of statins in patients with PAH. We included randomized controlled clinical trials (RCTs) that evaluated the efficacy of statins in patients with PAH. Primary outcomes were mortality and change in 6‐minute walk distance (6MWD). Data are presented as odds ratio (OR) and weighted mean difference (WMD), with 95% confidence intervals (CIs), for binary and continuous variables, respectively. We included 4 RCTs of high quality. The mean age of participants was 42 ± 13 years, and 70% were women. The statins used were simvastatin at 40–80 mg in two trials, atorvastatin 10 mg in one trial, and rosuvastatin 10 mg in the other. In the pooled‐data analysis, there was no statistically significant improvement in mortality (OR: 0.75 [95% CI: 0.32–1.74]), 6MWD (WMD: −9.27 [95% CI: −27.73 to 9.20]), or cardiac index (WMD: 0.11 [95% CI: −0.04 to 0.27]) with statin therapy when compared to placebo. There was no difference in adverse events leading to withdrawal of therapy between statin and placebo groups. These data suggest that statins are not beneficial in the treatment of PAH. There is a need for large, well‐conducted clinical trials assessing the effects of statins in patients with PAH. Future trials should include homogeneous patient populations and should be long‐term, event‐driven trials with combined morbidity and mortality end points.
Fracture at the Ischio-Pubic Junction After Periacetabular Osteotomy in the Adolescent Population
Authors: Swann Matthew , Sucato Daniel J. , Romero Jose , Podeszwa David A.
Published: May 2016

Introduction:

The Ganz periacetabular osteotomy (PAO) is a well-accepted surgical intervention for hip dysplasia. In the adolescent population it is performed in patients who are skeletally mature with symptoms related to acetabular dysplasia. Redistribution of stresses through the hemipelvis after PAO can lead to a fracture at the ischio-pubic junction (IPJ).

Methods:

This is an IRB-approved, retrospective analysis of adolescent patients treated with a PAO for acetabular dysplasia from 1999 to 2012 at a single institution. Radiographic measurements were performed to include the lateral center-edge angle, Sharp acetabular index, and acetabular index of the weight-bearing zone. These were measured preoperatively and at 6-weeks and 1 year postoperatively from a standing anterior posterior pelvis radiograph. Postoperative modified Harris hip scores (mHHS) were also analyzed. Patients over the age of 21 at time of surgery and those with <2 years of follow-up were excluded.

Results:

One hundred sixty-six patients (187 operated hips) at an average age of 15.6±2.5 were included. Twelve (6.4%) fractures at the IPJ were identified in 12 patients. Seven were identified on the initial postoperative films, whereas 5 were identified after the 6-week visit. Seven (58.3%) fractures had an associated superior posterior ramus nonunion. Six (50%) healed by 2 years after surgery; the remaining 6 (50%) went on to nonunion. Compared with those without a fracture, there was no significant difference in preoperative, 6 weeks postoperative, and final center-edge angle (P=0.94, 0.29, 0.27), Sharp acetabular index (P=0.95, 0.38, 0.16), or AIBWZ (P=0.37, 0.21, 0.54). There was no difference in postoperative mean modified Harris hip scores (P=0.63). Analysis of predisposing factors demonstrated that patients with Charcot-Marie-Tooth (CMT) disease were more likely to develop an IPJ fracture (P=0.001). Patients with an IPJ fracture were older (17.1 vs. 15.5, P=0.05). There was no difference based on patient sex (P=0.22).

Discussion and Conclusions:

The incidence of fracture at the IPJ after PAO in the adolescent population is 6.4% with some occurring at the time of surgery. These fractures are also associated with a nonunion at the superior posterior ramus cut and an underlying diagnosis of Charcot-Marie-Tooth. These fractures are not clinically significant and in this series did not merit further intervention when identified.

Level of Evidence:

Level III.
Mapping the Road to Recovery: Shorter Stays and Satisfied Patients in Posterior Spinal Fusion
Authors: Rao Rameshwar R. , Hayes MaryAnn , Lewis Cathy , Hensinger Robert N. , Farley Frances A. , Li Ying , Caird Michelle S.
Published: May 2016

Background:

Adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF) experience variations in their hospital care, which may lead to differences in objective and patient-reported outcomes. The purpose of this study was to demonstrate that using plan of care—educating families preoperatively and standardizing some aspects of care—would decrease time to mobility and time to discharge while maintaining pain control and patient satisfaction.

Methods:

Chart review was conducted in 3 groups—preprotocol (December 2008 to December 2009, n=51), first protocol (December 2, 2009 to July 24, 2013, n=100), and second protocol (July 25, 2013 to June 1, 2014, n=39)—to track pain scores (0 to 10), time to regular diet, Foley catheter removal, epidural catheter removal, mobility, and discharge. Patient satisfaction surveys (0 to 10) were administered before discharge. Statistical analysis was performed using a 1-way analysis of variance test with Tukey post hoc analysis.

Results:

Average pain scores were similar in all groups. Time to sitting was significantly reduced in both first protocol (27.2±9.8 h, P=1×10−8) and second protocol (28.4±13.6 h, P=3×10−5) compared with preprotocol (40.2±15.4 h). Time to discharge was significantly lower in second protocol (84.3±27.2 h, P=0.036) compared with first protocol (98.4±27.8 h). Patient satisfaction with care was significantly higher in first protocol (9.1/10, P=2×10−6) and second protocol (8.6/10, P=5×10−4) compared with preprotocol (6.5/10).

Conclusions:

By educating families preoperatively and standardizing portions of postoperative care in PSF for AIS, pain scores were significantly reduced while overall satisfaction remained high. Specifically, by removing the epidural and Foley catheters on postoperative day 2, time to discharge was dramatically decreased by 15 hours. The application of a multidisciplinary, evidence-driven plan of care for AIS patients undergoing PSF improves throughput and has beneficial effects on objective and patient-reported outcomes.

Level of Evidence:

Level III—retrospective case series.
Growth Patterns of the Neurocentral Synchondrosis (NCS) in Immature Cadaveric Vertebra
Authors: Blakemore Laurel , Schwend Richard , Akbarnia Behrooz A. , Dumas Megan , Schmidt John
Published: May 2016

Study Design:

Gross anatomic study of osteological specimens.

Objectives:

To evaluate the age of closure for the neurocentral synchondrosis (NCS) in all 3 regions of the spine in children aged 1 to 18 years old.

Summary of Background Data:

The ossification of the human vertebra begins from a vertebral body ossification center and a pair of neural ossification centers located within the centrum called the NCS. These bipolar cartilaginous centers of growth contribute to the growth of the vertebral body, spinal canal, and posterior elements of the spine. The closure of the synchondroses is dependent upon location of the vertebra and previous studies range from 2 to 16 years of age. Although animal and cadaveric studies have been performed regarding NCS growth and early instrumentation’s effect on its development, the effects of NCS growth disturbances are still not completely understood.

Methods:

The vertebrae of 32 children (1 to 18 y old) from the Hamann-Todd Osteological collection were analyzed (no 2 or 9 y old specimens available). Vertebrae studied ranged from C1 to L5. A total of 768 vertebral specimens were photographed on a background grid to allow for measurement calibration. Measurements of the right and left NCS, pedicle width at the NCS, and spinal canal area were taken using Scandium image-analysis software (Olympus Soft Imaging Solutions, Germany). The percentage of the growth plate still open was found by dividing the NCS by the pedicle width and multiplying by 100. Data were analyzed with JMP 11 software (SAS Institute Inc., Cary, NC).

Results:

The NCS was 100% open in all 3 regions of the spine in the 1- to 3-year age group. The cervical NCS closed first with completion around 5 years of age. The lumbar NCS was nearly fully closed by age 11. Only the thoracic region remained open through age 17 years. The left and right NCS closed simultaneously as there was no statistical difference between them. In all regions of the spine, the NCS appeared to close sooner in males than in females. Spinal canal area increased with age up to 12 years old in the cervical and thoracic spine but did not significantly change after age 3 in the lumbar spine.

Conclusions:

In conclusion, closure of the NCS differed among the cervical, thoracic, and lumbar spine regions. The NCS reached closure in males before females even though females mature faster and reach skeletal maturity sooner than males. However, it is not determined whether the continued open NCS in females to a later age may be a factor in their increased rate of scoliosis.
Immune-mediated respiratory adverse events of checkpoint inhibitors
Authors: Tabchi Samer , Messier Christine , Blais Normand
Published: May 2016

Purpose of review

Immune checkpoint inhibitors have demonstrated remarkable efficacy with durable responses in the treatment of various malignancies. This new class of therapeutic agents is associated with a toxicity profile that differs from conventional cytotoxic therapy. The present review is focused on one of these toxicities affecting the respiratory system.

Recent findings

Many types of immune-related adverse events (irAEs) have been identified since the emergence of checkpoint inhibitors including colitis, nephritis, myasthenia gravis-like syndromes, acute interstitial nephritis, pneumonitis, and endocrinopathies. Although pneumonitis is relatively less frequent than other irAEs, this toxicity is by no means inconsequential as it has led to treatment-related deaths during the initial testing phases.

Immune-mediated pneumonitis is a potentially serious but relatively infrequent adverse event associated with the use of immune checkpoint inhibitors. IrAEs can be challenging for oncologists who are still unfamiliar with the early presenting symptoms and subsequent management of these toxicities, especially in the context of a rapidly expanding science. A high index of suspicion for pneumonitis must be maintained in patients receiving checkpoint inhibitors and who present new onset respiratory symptoms because this type of toxicity can be severe and potentially fatal.
Will clinical heterogeneity of neuroendocrine tumors impact their management in the future? Lessons from recent trials
Authors: Cives Mauro , Soares Heloisa P. , Strosberg Jonathan
Published: May 2016

Purpose of review

Neuroendocrine tumors (NETs) are a group of biologically and clinically heterogeneous neoplasms arising from the diffuse neuroendocrine system. In the last few years, advances in our understanding of the biology of these tumors have translated into an expansion of treatment options for patients with NETs. Current treatment modalities include somatostatin analogs (SSAs), radiolabeled SSAs, targeted agents, cytotoxic drugs and liver-directed therapies for the management of metastatic disease.

Recent findings

Recent studies have expanded the role of SSAs in gastroenteropancreatic (GEP)-NETs, and everolimus has shown robust antitumor activity across a broad range of NETs of the lung and GEP tract. The radiolobeled SSA 177Lu-DOTATATE has been investigated in a randomized phase III trial, and has demonstrated exceptional efficacy and tolerability in patients with progressive midgut NETs. The new serotonin inhibitor telotristat etiprate has shown significant activity in the palliation of symptoms of carcinoid syndrome, and its approval by regulatory authorities is expected soon.

The field of NETs has been transformed from one dominated by limited treatment options to one characterized by an increasing number of therapeutic agents and active clinical trials. Navigating the current therapeutic algorithm may be challenging, and requires an understanding both of the heterogeneity of NETs and of characteristics that are shared by NETs across tumor subtypes.
A case of acute paraneoplastic neurological syndrome in BRAF mutant metastatic melanoma
Authors: Lee Shu F. , Atkinson Victoria
Published: May 2016

A 58-year-old man with indolent metastatic BRAF mutant melanoma presented with several days’ history of progressive ataxia and dysdiadochokinesia. His PET/computed tomography restaging scan indicated two new fluorine-18-fluorodeoxyglucose-avid mesenteric lymph nodes. Meanwhile, his MRI brain and whole spine were within normal limits. A lumbar puncture indicated an elevated protein level with a normal cell count and negative paraneoplastic antibodies. Because of the lack of an alternative differential, the diagnosis of paraneoplastic syndrome was made. He was started on high-dose corticosteroids as well as dabrafenib and trametinib. Despite this, his neurological symptoms continued to progress. Consequently, he was trialed on a course of intravenous immunoglobulin, which stabilized his symptoms. He continued to improve over several weeks, with near-complete resolution of all his neurological symptoms, and showed a complete radiological response of his disease. To our knowledge, this is the first reported case of paraneoplastic neurological syndrome with mixed neurology associated with BRAF mutant cutaneous melanoma that responded to BRAF targeted therapy.
The slow-pull capillary technique increases the quality of endoscopic ultrasound fine needle biopsy samples in solid pancreatic lesions
Authors: El Haddad Rana , Barret Maximilien , Beuvon Frédéric , Grabar Sophie , Leblanc Sarah , Terris Benoit , Coriat Romain , Chaussade Stanislas , Prat Frédéric
Published: May 2016

Introduction

Endoscopic ultrasound-guided sampling is used routinely for the diagnosis of solid pancreatic masses. We aimed to compare the standard suction technique with the recently described ‘slow-pull’ technique.

Patients and methods

Patients with a solid pancreatic mass of more than 2 cm undergoing endoscopic ultrasound-guided fine needle biopsy with the same endoscopist using a 22 G core biopsy needle were included in the study. Patients had a first suction pass, followed by either another suction pass or a slow-pull pass. The rate of samples contributive to the diagnosis, cellularity, presence of tissue microfragments, and blood contamination were assessed and compared between each pass and each technique.

Results

A total of 98 patients with a lesion diameter of 33.1±10 mm were analyzed. Lesions were adenocarcinomas in 83%, neuroendocrine tumors in 6%, and benign lesions in 11% of the cases. The rate of contributive samples of the first suction pass, the slow-pull pass, and the second suction pass were 96.9, 97.9, and 90.2%, respectively (P=NS). The slow-pull capillary technique, compared with the suction technique, provided samples with better cellularity, higher proportion of representative and tumor cells, and more tissue microfragments (P=0.002, 0.0004, 0.006, and 0.005, respectively).

Conclusion

Endoscopic ultrasound-guided fine needle biopsy sampling of solid pancreatic lesions using the slow-pull technique yielded overall outcomes similar to the standard suction technique in terms of diagnostic performance. However, the slow-pull capillary technique improved the histological quality of the samples, mainly through a higher proportion of tissue microfragments and tumor cells.
Update on mandibular condylar fracture management
Authors: Weiss Joshua P. , Sawhney Raja
Published: May 2016

Purpose of review

Fractures of the mandibular condyle have provided a lasting source of controversy in the field of facial trauma. Concerns regarding facial nerve injury as well as reasonable functional outcomes with closed management led to a reluctance to treat with an open operative intervention. This article reviews how incorporating new technologies and surgical methods have changed the treatment paradigm.

Recent findings

Multiple large studies and meta-analyses continue to demonstrate superior outcomes for condylar fractures when managed surgically. Innovations, including endoscopic techniques, three-dimensional miniplates, and angled drills provide increased options in the treatment of condylar fractures. The literature on pediatric condylar fractures is limited and continues to favor a more conservative approach.

There continues to be mounting evidence in radiographic, quality of life, and functional outcome studies to support open reduction with internal fixation for the treatment of condylar fractures in patients with malocclusion, significant displacement, or dislocation of the temporomandibular joint. The utilization of three-dimensional trapezoidal miniplates has shown improved outcomes and theoretically enhanced biomechanical properties when compared with traditional fixation with single or double miniplates. Endoscopic-assisted techniques can decrease surgical morbidity, but are technically challenging, require skilled assistants, and utilize specialized equipment.
Correction of saddle and short noses
Authors: Lee Ho Jun , Jang Yong Ju
Published: May 2016

Purpose of review

The review summarizes the basic concepts and recent updates on the management of saddle and short noses, with a particular focus on the selection of septal reconstruction techniques and dorsal augmentation material.

Recent findings

Different techniques have been reported for septal cartilage reconstruction, including various combinations of extended spreader and caudal septal extension grafts, as well as L-strut grafts. For dorsal augmentation, materials that help avoid costal cartilage warping including, diced costal cartilage with or without fascia, costal cartilage obtained by oblique cutting, diced conchal cartilage with perichondrial attachments, and lipofilling of the nasal dorsum have been reported.

The article highlights the importance of rebuilding the septal cartilage support system by the proper use of costal cartilage and selection of an appropriate technique for the successful management of saddle and short noses. In addition, the importance of selecting suitable dorsal augmentation materials and other adjunctive maneuvers are emphasized.
Tendon Regeneration with Tendon Hydrogel–Based Cell Delivery: A Comparison of Fibroblasts and Adipose-Derived Stem Cells
Authors: Chattopadhyay Arhana , Galvez Michael G. , Bachmann Michael , Legrand Anais , McGoldrick Rory , Lovell Alberto , Jacobs Mollie , Crowe Chris , Umansky Elise , Chang James
Published: May 2016

Background:

Tendon hydrogel is a promising biomaterial for improving repair strength after tendon injury. This study compares the capacity of fibroblasts and adipose-derived stem cells to proliferate, survive, and acquire tenogenic properties when seeded into tendon hydrogel in vitro and in vivo.

Methods:

The effect of cell density on hydrogel contraction was measured macroscopically. To assess tenogenic properties, RNA was isolated from cells seeded in vitro in hydrogel, and tenocyte markers were quantified. To assess in vitro proliferation and survival, MTS and live-dead assays were performed. Finally, to assess the in vivo survival of cells in hydrogel, subcutaneous injections were performed on rats and in vivo imaging was performed.

Results:

At 0.5 million cells/ml, both the fibroblasts and adipose-derived stem cells induced minimal hydrogel contraction compared with higher cellular concentrations. Fibroblasts and adipose-derived stem cells seeded at 0.5 million cells/ml in tendon hydrogel up-regulated several tenocyte markers after 1 week. On MTS assay, fibroblasts and adipose-derived stem cells proliferated in hydrogel at similar rates. On live-dead assay, fibroblasts survived longer than adipose-derived stem cells. With use of the in vivo imaging system and histologic evaluation, fibroblasts survived longer than adipose-derived stem cells in hydrogel in vivo.

Conclusions:

Tendon healing is mediated by the proliferation, survival, and tenogenic differentiation of cells at the site of injury. Tendon hydrogel delivering dermal fibroblasts may improve and stimulate this process compared with adipose-derived stem cells. Future studies will be needed to evaluate the effects of this hydrogel-based cell delivery on chronic tendon injuries.
Why Do Patients Return to the Emergency Department?
Authors: Proud Matthew E. , Howard Patricia Kunz
Published: May 2016

Review of recent evidence with translation to practice for the advanced practice nurse (APN) role is presented using a case study module for “Return Visits to the Emergency Department: The Patient Perspective.” This qualitative inquiry performed 60 semistructured interviews of patients who returned to the emergency department within 9 days of their primary visit for the same complaint. Patients most often returned because of concerns that their initial visit did not adequately address their complaint, and they needed assurance from providers that their clinical condition was not a serious health concern. Patients also expressed a lack of contact with a provider between the 2 visits either to answer questions or to address ongoing concerns. This study highlights the important role of the APN in providing quality care, reassurance, and communication related to follow-up care.
Exploring the Relationship Among Moral Distress, Coping, and the Practice Environment in Emergency Department Nurses
Authors: Zavotsky Kathleen Evanovich , Chan Garrett K.
Published: May 2016

Emergency department (ED) nurses practice in environments that are highly charged and unpredictable in nature and can precipitate conflict between the necessary prescribed actions and the individual's sense of what is morally the right thing to do. As a consequence of multiple moral dilemmas, ED staff nurses are at risk for experiencing distress and how they cope with these challenges may impact their practice. To examine moral distress in ED nurses and its relationship to coping in that specialty group. Using survey methods approach. One hundred ninety-eight ED nurses completed a moral distress, coping, and demographic collection instruments. Advanced statistical analysis was completed to look at relationships between the variables. Data analysis did show that moral distress is present in ED nurses (M = 80.19, SD = 53.27), and when separated into age groups, the greater the age, the less the experience of moral distress. A positive relationship between moral distress and some coping mechanisms and the ED environment was also noted. This study's findings suggest that ED nurses experience moral distress and could receive some benefit from utilization of appropriate coping skills. This study also suggests that the environment in which ED nurses practice has a significant impact on the experience of moral distress. Because health care is continuing to evolve, it is critical that issues such as moral distress and coping be studied in ED nurses to help eliminate human suffering.