bluuebunny/crossref_metadata_2025 huggingface dataset:
Thrust performance, propellant ionization, and thruster erosion of an external discharge plasma thruster
Authors: Karadag Burak , Cho Shinatora , Funaki Ikkoh
Published: April 2018

It is quite a challenge to design low power Hall thrusters with a long lifetime and high efficiency because of the large surface area to volume ratio and physical limits to the magnetic circuit miniaturization. As a potential solution to this problem, we experimentally investigated the external discharge plasma thruster (XPT). The XPT produces and sustains a plasma discharge completely in the open space outside of the thruster structure through a magnetic mirror configuration. It eliminates the very fundamental component of Hall thrusters, discharge channel side walls, and its magnetic circuit consists solely of a pair of hollow cylindrical permanent magnets. Thrust, low frequency discharge current oscillation, ion beam current, and plasma property measurements were conducted to characterize the manufactured prototype thruster for the proof of concept. The thrust performance, propellant ionization, and thruster erosion were discussed. Thrust generated by the XPT was on par with conventional Hall thrusters [stationary plasma thruster (SPT) or thruster with anode layer] at the same power level (∼11 mN at 250 W with 25% anode efficiency without any optimization), and discharge current had SPT-level stability (Δ < 0.2). Faraday probe measurements revealed that ion beams are finely collimated, and plumes have Gaussian distributions. Mass utilization efficiencies, beam utilization efficiencies, and plume divergence efficiencies ranged from 28 to 62%, 78 to 99%, and 40 to 48%, respectively. Electron densities and electron temperatures were found to reach 4 × 1018 m−3 (∂ne/ne = ±52%) and 15 eV (∂Te/Te = ±10%–30%), respectively, at 10 mm axial distance from the anode centerline. An ionization mean free path analysis revealed that electron density in the ionization region is substantially higher than the conventional Hall thrusters, which explain why the XPT is as efficient as conventional ones even without a physical ionization chamber. Our findings propose an alternative approach for low power Hall thruster design and provide a successful proof of concept experiment of the XPT.
1 mm3-sized optical neural stimulator based on CMOS integrated photovoltaic power receiver
Authors: Tokuda Takashi , Ishizu Takaaki , Nattakarn Wuthibenjaphonchai , Haruta Makito , Noda Toshihiko , Sasagawa Kiyotaka , Sawan Mohamad , Ohta Jun
Published: April 2018

In this work, we present a simple complementary metal-oxide semiconductor (CMOS)-controlled photovoltaic power-transfer platform that is suitable for very small (less than or equal to 1–2 mm) electronic devices such as implantable health-care devices or distributed nodes for the Internet of Things. We designed a 1.25 mm × 1.25 mm CMOS power receiver chip that contains integrated photovoltaic cells. We characterized the CMOS-integrated power receiver and successfully demonstrated blue light-emitting diode (LED) operation powered by infrared light. Then, we integrated the CMOS chip and a few off-chip components into a 1-mm3 implantable optogenetic stimulator, and demonstrated the operation of the device.
Solution processed flexible organic thin film back-gated transistors based on polyimide dielectric films
Authors: Park Janghoon , Min Yoonki , Lee Dongjin
Published: April 2018

An organic thin film back-gated transistor (OBGT) was fabricated and characterized. The gate electrode was printed on the back side of substrate, and the dielectric layer was omitted by substituting the dielectric layer with the polyimide (PI) film substrate. Roll-to-roll (R2R) gravure printing, doctor blading, and drop casting methods were used to fabricate the OBGT. The printed OBGT device shows better performance compared with an OTFT device based on dielectric layer of BaTiO3. Additionally, a calendering process enhanced the performance by a factor of 3 to 7 (mobility: 0.016 cm2/V·s, on/off ratio: 9.17×103). A bending test was conducted to confirm the flexibility and durability of the OBGT device. The results show the fabricated device endures 20000-cyclic motions. The realized OBGT device was successfully fabricated and working, which is meaningful for production engineering from the viewpoint of process development.
Observation of Kondo behavior in the single crystals of Mn-doped Bi2Se3 topological insulator
Authors: Urkude R. R. , Sagdeo Archna , Rawat R. , Choudhary R. J. , Asokan K. , Ojha S. , Palikundwar U. A.
Published: April 2018

The Bi2Se3 and Mn doped Bi2Se3 (i.e. Bi1.5Mn0.5Se3, referred as BiMnSe) single crystals were grown using a melt growth method and characterized for their structural, electrical and magnetic properties. These crystals were found to be of single phase having rhombohedral structure with the space group (R3¯m). The magnetoresistance measurements have been carried out in the temperature range 5-50 K, under magnetic fields up to 8 T. The variation of resistivity with temperature shows the Metallic behavior in case of Bi2Se3, and up-turn at low temperatures in the BiMnSe. Metallic behavior was observed up to T > 40 K, whereas below 40K, Kondo effect has been observed. A saturating resistance upturn at low temperatures is observed in the BiMnSe, indicating the presence of Kondo effect due to the existence of localized impurity spins. While the Bi2Se3 is diamagnetic, the BiMnSe is in ferromagnetic state at 5 K. This study opens up a new direction to investigate the physics and device applications of magnetically tunable topological insulators.
Giant enhancement in Goos-Hänchen shift at the singular phase of a nanophotonic cavity
Authors: Sreekanth Kandammathe Valiyaveedu , Ouyang Qingling , Han Song , Yong Ken-Tye , Singh Ranjan
Published: April 2018

In this letter, we experimentally demonstrate thirtyfold enhancement in Goos-Hänchen shift at the Brewster angle of a nanophotonic cavity that operates at the wavelength of 632.8 nm. In particular, the point-of-darkness and the singular phase are achieved using a four-layered metal-dielectric-dielectric-metal asymmetric Fabry-Perot cavity. A highly absorbing ultra-thin layer of germanium in the stack gives rise to the singular phase and the enhanced Goos-Hänchen shift at the point-of-darkness. The obtained giant Goos-Hänchen shift in the lithography-free nanophotonic cavity could enable many intriguing applications including cost-effective label-free biosensors.
Highly conductive PdCoO2 ultrathin films for transparent electrodes
Authors: Harada T. , Fujiwara K. , Tsukazaki A.
Published: April 2018

We report on the successful synthesis of highly conductive PdCoO2 ultrathin films on Al2O3 (0001) by pulsed laser deposition. The thin films grow along the c-axis of the layered delafossite structure of PdCoO2, corresponding to the alternating stacking of conductive Pd layers and CoO2 octahedra. The thickness-dependent transport measurement reveals that each Pd layer has a homogeneous sheet conductance as high as 5.5 mS in the samples thicker than the critical thickness of 2.1 nm. Even at the critical thickness, high conductivity exceeding 104 S cm−1 is achieved. Optical transmittance spectra exhibit high optical transparency of PdCoO2 thin films particularly in the near-infrared region. The concomitant high values of electrical conductivity and optical transmittance make PdCoO2 ultrathin films promising transparent electrodes for triangular-lattice-based materials.
Effect of thermal annealing on carrier localization and efficiency of spin detection in GaAsSb epilayers grown on InP
Authors: Zhang Bin , Chen Cheng , Han Junbo , Jin Chuan , Chen Jianxin , Wang Xingjun
Published: April 2018

The effect of the thermal annealing on the optical and spin properties in GaAs0.44Sb0.56 epilayers grown on InP was investigated via photoreflectance, power-dependent and time-resolved photoluminescence spectroscopy as well as optical orientation measurement. The carrier’s localization and the optical spin detection efficiency increase with an increase of annealing temperature up to 600 °C. The enhancement of the spin detection efficiency is attributed to both the shortening of the electron lifetime and the prolonging of the spin lifetime as a result of the enhanced carriers’ localization induced by the annealing process. Our results provided an approach to enhance spin detection efficiency of GaAsSb with its PL emission in the 1.55 μm region.
Letter: The link between the Reynolds shear stress and the large structures of turbulent Couette-Poiseuille flow
Authors: Gandía-Barberá Sergio , Hoyas Sergio , Oberlack Martin , Kraheberger Stefanie
Published: April 2018

The length and width of the long and wide structures appearing in turbulent Couette flows are studied by means of a new dataset of direct numerical simulation covering a stepped transition from pure Couette flow to pure Poiseuille one, at Reτ ≈ 130, based on the stationary wall. The existence of these structures is linked to the averaged Reynolds stress, uv¯: as soon as in any part of the channel uv¯ changes its sign, the structures disappear. The length and width of the rolls are found to be, approximately, 50h and 2.5h, respectively. For this Reynolds number, simulations with a domain shorter than 100h cannot properly describe the behaviour of the longest structures of the flow.
Indigenous plant-growth-promoting rhizobacteria and chemical fertilisers: impact on wheat (Triticum aestivum) productivity and soil properties in North Western Himalayan region
Authors: Sood Gaurav , Kaushal Rajesh , Chauhan Anjali , Gupta Shaweta
Published: April 2018

High levels of crop productivity cannot be sustained by chemical fertiliser application alone. In order to mitigate this, a 2-year study was conducted to test the effects of combined application of indigenous plant-growth-promoting rhizobacteria (PGPR) and chemical fertilisers on productivity of wheat and soil properties. Ten morphologically distinct indigenous PGPR isolates from wheat roots and rhizosphere were evaluated at Solan, Himachal Pradesh, India, during 2013–14. Three PGPR isolates (B2, SIR1 and BIS2) with maximum PGP traits were screened at different doses of nitrogen (N) and phosphorus (P) (80%, 60% and 40% of recommended fertiliser dose, RFD) under net-house conditions. Two isolates, B2 (Serratia sp.) and SIR1 (Bacillus subtilis), along with the optimum NP dose (i.e. 80% RFD) were selected for field experimentation, which was performed over two consecutive years, 2014–16. Combined application of 80% RDF of NP with PGPR (B2) significantly increased wheat yield by 9.4%, number of tillers per plant by 28.03%, grain number per spike by 19.61%, 1000-grain weight by 10.5%, and biomass by 9.2% relative to the uninoculated control with 100% RFD. Soil properties in the terms of available N, P and potassium, microbial biomass carbon, soil enzyme activities and population of phosphate-solubilising bacteria in the wheat crop were significantly increased by the combined application of bacterial inoculants with 80% RFD of NP in both years over the uninoculated control. Therefore, the results revealed the potential of indigenous PGPR isolates to supplement ~20% of NP fertilisers without hampering the soil fertility and productivity of wheat.
The Hebrew version of the Eustachian tube dysfunction questionnaire-7
Authors: Ungar Omer J. , Cavel Oren , Golan Gilad S. , Oron Yahav , Wasserzug Oshri , Handzel Ophir
Published: April 2018

Background:

Eustachian tube (ET) dysfunction is a common condition that can lead to significant morbidity, yet few reliable instruments are available to measure ET function. History, physical examination and tympanometry are the mainstay tools, with video endoscopy, manometry and sonotubometry used less frequently. Even when combined together, these may be unable to accurately estimate ET function. Questionnaires for assessing pain, organ function and quality of life are considered useful measurements, and they are used routinely in a variety of medical fields, including otolaryngology. The English-language Eustachian Tube Dysfunction Questionnaire, ETDQ-7, was developed in 2012 and was subsequently included in the assessment of ET function.

Objective:

To validate a Hebrew version of the ETDQ-7 questionnaire.

Methods:

The ETDQ-7 questionnaire was translated into Hebrew by a validated method. Native Hebrew speakers with and without ETD were asked to fill in the Hebrew version on 3 separate occasions, and the results were analysed and interpreted.

Results:

A total of 115 patients filled in the questionnaires. Internal consistency (alpha Cronbach's coefficient) of the first, second and third questionnaires was 0.918, 0.922 and 0.890, respectively. The Interclass Correlation Coefficient for consistency between the first and second questionnaires was 0.930. The area under the ROC curve for the first and second questionnaires was 0.956, representing an excellent discrimination capability.

Conclusion:

The Hebrew version of the ETDQ-7 showed significant consistency and clinical relevance. It was validated and can now be helpful in the assessment of ET function and the effects of ET manipulations.
Commentary: Three decades after Cathleen Synge Morawetz’s paper “The mathematical approach to the sonic barrier”
Authors: Gamba Irene
Published: April 2018

Immediately following the commentary below, this previously published article is reprinted in its entirety: Cathleen Synge Morawetz, “The mathematical approach to the sonic barrier”, Bull. Amer. Math. Soc. (N.S.) 6 (1982), no. 2, 127–145.
Rational approximation of 𝐱ⁿ
Authors: Nakatsukasa Yuji , Trefethen Lloyd
Published: April 2018

Let

E

k
k

(
n
)

E_{kk}^{(n)}

denote the minimax (i.e., best supremum norm) error in approximation of

x
n

x^n

on

[
0
,
1
]

[0,1]

by rational functions of type

(
k
,
k
)

(k,k)

with

k
>
n

k>n

. We show that in an appropriate limit

E

k
k

(
n
)

∼
2

H

k
+
1

/

2

E_{kk}^{(n)} \sim 2 H^{k+1/2}

independently of

n
n

, where

H
≈
1

/

9.28903

H \approx 1/9.28903

is Halphen’s constant. This is the same formula as for minimax approximation of

e
x

e^x

on

(
−
∞
,
0
]

(-\infty ,0]

.
Phase-field descriptions of two-phase compressible fluid flow: Interstitial working and a reduction to Korteweg theory
Authors: Freistühler Heinrich , Kotschote Matthias
Published: April 2018

The Navier-Stokes-Allen-Cahn (NSAC), the Navier-Stokes-Cahn-Hilliard (NSCH), and the Navier-Stokes-Korteweg (NSK) equations have been used in the literature to model the dynamics of two-phase fluids. In their previous article Phase-field and Korteweg-type models for the time-dependent flow of compressible two-phase fluids, Arch. Rational Mech. Anal. 224 (2017), 1–20, the authors showed that both NSAC and NSCH reduce to versions of NSK, when one makes the (unphysical) assumption that microforces are absent. The present paper shows that the same reduction property holds without that assumption.
Quantization for low-rank matrix recovery
Authors: Lybrand Eric , Saab Rayan
Published: April 2018

We study Sigma–Delta $(\varSigma\!\varDelta) $ quantization methods coupled with appropriate reconstruction algorithms for digitizing randomly sampled low-rank matrices. We show that the reconstruction error associated with our methods decays polynomially with the oversampling factor, and we leverage our results to obtain root-exponential accuracy by optimizing over the choice of quantization scheme. Additionally, we show that a random encoding scheme, applied to the quantized measurements, yields a near-optimal exponential bit rate. As an added benefit, our schemes are robust both to noise and to deviations from the low-rank assumption. In short, we provide a full generalization of analogous results, obtained in the classical setup of band-limited function acquisition, and more recently, in the finite frame and compressed sensing setups to the case of low-rank matrices sampled with sub-Gaussian linear operators. Finally, we believe our techniques for generalizing results from the compressed sensing setup to the analogous low-rank matrix setup is applicable to other quantization schemes.
Student and Preceptor Advancement in a Dedicated Education Site: Innovation in Clinical Education for Advanced Practice Nurses
Authors: Hall Katherine C. , Diffenderfer Sandy K. , Stidham April , Mullins Christine M.
Published: April 2018

In the 1990s, dedicated education units transformed undergraduate preceptorships, but graduate preceptorships remain static. The dyadic nurse practitioner preceptorship model supports an environment where faculty, students, and preceptors may overlook nuances that affect the teaching-learning process. This article describes an innovative clinical education model, Student and Preceptor Advancement in a Dedicated Education Site, designed to improve preceptorships for advanced practice nurses. The focus is on adaptations made to facilitate use in advanced practice nursing programs.
Total Ankle Replacement With Advanced Varus and Valgus Deformities
Authors: Saito Guilherme H. , Sanders Austin E. , Demetracopoulos Constantine A.
Published: April 2018

Severe deformity in patients with end-stage ankle arthritis has long been considered a relative contraindication for total ankle replacement. However, advancements in surgical techniques and a better understanding of the importance of correcting foot deformity in conjunction with ankle deformity have led to satisfactory outcomes in this group of patients. Management of these deformities is contingent upon identifying all sources of deformities in the limb both proximal and distal, addressing the deformity in a systematic manner, achieving ligamentous stability at the ankle, and assuring dynamic stability with proper soft tissue balancing procedures. The authors discuss the main challenges while addressing ankles with severe deformities, and describe the preferred techniques for correction of the advanced varus and valgus ankle deformities.

Level of Evidence: Diagnostic Level V, expert opinion. See Instructions for Authors for a complete description of levels of evidence.
IL-21 Increases the Reactivity of Allogeneic Human Vγ9Vδ2 T Cells Against Primary Glioblastoma Tumors
Authors: Joalland Noémie , Chauvin Cynthia , Oliver Lisa , Vallette François M. , Pecqueur Claire , Jarry Ulrich , Scotet Emmanuel
Published: April 2018

Glioblastoma multiforme (GBM) remains the most frequent and deadliest primary brain tumor in adults despite aggressive treatments, because of the persistence of infiltrative and resistant tumor cells. Nonalloreactive human Vγ9Vδ2 T lymphocytes, the major peripheral γδ T-cell subset in adults, represent attractive effectors for designing immunotherapeutic strategies to track and eliminate brain tumor cells, with limited side effects. We analyzed the effects of ex vivo sensitizations of Vγ9Vδ2 T cells by IL-21, a modulating cytokine, on their cytolytic reactivity. We first showed that primary human GBM-1 cells were naturally eliminated by allogeneic Vγ9Vδ2 T lymphocytes, through a perforin/granzyme-mediated cytotoxicity. IL-21 increased both intracellular granzyme B levels and cytotoxicity of allogeneic human Vγ9Vδ2 T lymphocytes in vitro. Importantly, IL-21-enhanced cytotoxicity was rapid, which supports the development of sensitization(s) of γδ T lymphocytes before adoptive transfer, a process that avoids any deleterious effect associated with direct administrations of IL-21. Finally, we showed, for the first time, that IL-21-sensitized allogeneic Vγ9Vδ2 T cells significantly eliminated GBM tumor cells that developed in the brain after orthotopic administrations in vivo. Altogether our observations pave the way for novel efficient stereotaxic immunotherapies in GBM patients by using IL-21-sensitized allogeneic human Vγ9Vδ2 T cells.
Eltrombopag-Induced Acute Liver Failure in a Pediatric Patient: A Pharmacokinetic and Pharmacogenetic Analysis
Authors: Marano Marco , Serafinelli Jessica , Cairoli Sara , Martinelli Diego , Pisani Mara , Palumbo Giuseppe , Cefalo Maria G. , Cecchetti Corrado , Di Nardo Matteo , Falvella Felicia S. , Goffredo Bianca M.
Published: April 2018

Eltrombopag is an oral thrombopoietin receptor agonist approved for the treatment of patients with chronic idiopathic thrombocytopenic purpura (ITP), who are more than 1 year old, and show poor response to first-line therapy. ITP is a hematological disorder characterized by isolated thrombocytopenia in the absence of secondary causes or disorders. Eltrombopag is generally well tolerated in the pediatric population; therefore, therapeutic drug monitoring (TDM) is not usually performed in clinical practice.

We presented the case study of a 3-year-old girl with chronic ITP. She arrived in the pediatric intensive care unit with acute liver failure due to eltrombopag toxicity despite taking the standard drug dosage. A very high eltrombopag plasma concentration, indicating drug toxicity, was found through TDM. The patient also carried the allelic variations that are involved in drug metabolism [CYP2C8 and UDP glucuronosyltransferase (UGT) 1A1 (UGT1A1)] and drug cellular transportation [ABCG2 (ATP-binding cassette G2)]. This observation highlights the importance of using TDM and pharmacogenetic approaches to manage patients' unusual complications associated with standard pharmacological treatment regimens.
Benefits of Pulmonary Rehabilitation in Idiopathic Pulmonary Fibrosis
Authors: Perrotta Fabio , Bianco Andrea , Cioffi Giovanni , Cennamo Antonio , Mazzarella Gennaro
Published: April 2018

Clinical Case:

We describe the case of a 50-y-old man with idiopathic pulmonary fibrosis (IPF) who underwent pulmonary rehabilitation (PR). The 8-wk training program, including resistance training and aerobic exercises, was conducted 3 d/wk under physiotherapist supervision. Clinical and functional assessment was performed prior to and following the program. At the end of the training program, meaningful improvements in primary outcomes, including spirometry values and exertional parameters, were noted.

Discussion:

Pulmonary rehabilitation may represent a valid treatment in the management of symptoms in patients with IPF. Although the current guidelines for diagnosis and management of IPF recommend the use of PR programs, patients are not routinely referred to PR centers and exercise training for these patients is not standardized.

Idiopathic pulmonary fibrosis is a progressive and fatal disease characterized by the loss of lung function, which results in a severe impairment of daily activities. Prospective studies testing the effectiveness of PR programs in larger cohorts of patients are still lacking. Furthermore, a standardization of pulmonary training programs should be developed to better understand the benefit of PR.
SLCO1B1 Polymorphism Is a Drug Response Predictive Marker for Advanced Pancreatic Cancer Patients Treated With Gemcitabine, S-1, or Gemcitabine Plus S-1
Authors: Sato Yasunori , Ueno Hideki , Ioka Tatsuya , Ohkawa Shinichi , Ikeda Masafumi , Shimamura Tomotaka , Tsuji Akihito , Tsuchiya Yoshiaki , Furuse Junji , Ishii Hiroshi , Furuya Ken , Iguchi Haruo , Saito Yoshihiro , Kaniwa Nahoko , Sawada Jun-ichi , Sakamoto Hiromi , Sekine Akihiro , Okusaka Takuji , Yoshida Teruhiko
Published: April 2018

Objectives

The aim of this study was to evaluate the effects of single-nucleotide polymorphisms (SNPs) on advanced pancreatic cancer risk and overall survival (OS) in a candidate-gene approach.

Methods

Overall, 5438 SNPs in 219 candidate genes encoding several drug-metabolizing enzymes or transporters were analyzed. In the screening study, 3 SNPs were found associated with OS (P≤ 0.0005). We validated these SNPs as part of the randomized phase 3 study (GEST study). The associations between OS and SNPs were investigated using log-rank test and Cox proportional hazards model.

Results

From the GEST study, the SNP rs4149086 in the 3′ UTR of the solute carrier organic anion transporter family member 1B1 (SLCO1B1) gene showed significant interaction with treatment (P= 0.02). In the gemcitabine group, the SNP was associated with short OS (hazard ratio [HR], 3.75; 95% confidence interval [CI], 1.30–10.8;P= 0.008) even after multiple-comparisons adjustment. In contrast, the SNP was not associated with OS in S-1 (HR, 0.77; 95% CI, 0.33–1.81;P= 0.55) or gemcitabine plus S-1 groups (HR, 1.18; 95% CI, 0.46–3.00;P= 0.72).

Conclusions

Patients with advanced pancreatic cancer with the rs4149086 AG or GG genotype may obtain good clinical results when treated with S-1–containing regimens.
Malignant Peripheral Nerve Sheath Tumors in Neurofibromatosis: Impact of Family History
Authors: Malbari Fatema , Spira Menachem , B. Knight Pamela , Zhu Chong , Roth Michael , Gill Jonathan , Abbott Rick , Levy Adam S.
Published: April 2018

Objective:

The main objective of this study was to determine if family history of malignant peripheral nerve sheath tumor (MPNST) increases risk of developing an MPNST in patients with neurofibromatosis-1 (NF-1).

Materials and Methods:

Individuals with NF-1 registered with the Children’s Tumor Foundation’s Neurofibromatosis Registry were emailed an anonymous 15-minute survey with regard to personal and family history of NF-1, MPNST, ages of onset, and symptomatology. Participation was voluntary and information was self-reported.

Results:

The survey was sent to 4801 registrants, 878 responded. Presence of a family history of MPNST was found to be a risk factor for the development of MPNST; 19.4% of respondents confirming a family history of MPNST developed MPNST compared with 7.5% of respondents with no family history (odds ratio, 2.975; 95% confidence interval, 1.232-7.187; P=0.021). NF-1 patients with a positive family history developed MPNST at a younger age than those with no family history (8.3% vs. 0.5% P=0.003 and 13.9% vs. 2.4% P=0.003, for onset before 10 and 20, respectively). In the MPNST population with a known family history, onset prior to age 10 was significantly more prevalent (42.9% vs. 7% P=0.029).

Conclusions:

These results suggest a positive family history of MPNST represents a risk factor for the development and early onset of MPNST in individuals with NF-1.
Excessive Treatment Failures in Patients With Parameningeal Rhabdomyosarcoma With Reduced-dose Cyclophosphamide and Delayed Radiotherapy
Authors: Lucas John T. , Pappo Alberto S. , Wu Jianrong , Indelicato Daniel J. , Krasin Matthew J.
Published: April 2018

Pediatric patients with parameningeal rhabdomyosarcoma and high-risk features are recommended to receive radiotherapy at initiation of protocol therapy due to concerns about the increased risk of local and leptomeningeal failure from treatment delay. We report our early experience on a multi-institutional prospective trial incorporating delayed primary site radiation and reduced dose cyclophosphamide in all patients with parameningeal tumors. We observed an excessive number of locoregional treatment failures following this approach and have subsequently amended our trial to move radiation therapy upfront for those patients with high-risk features. We suggest that investigators should be vigilant for treatment failure given our early prospective experience with delayed radiotherapy and reduced dose cyclophosphamide.
Top-of-License Nursing Practice
Authors: Buck Jacalyn , Loversidge Jacqueline , Chipps Esther , Gallagher-Ford Lynn , Genter Lynne , Yen Po-Yin
Published: April 2018

OBJECTIVE

The aims of this study were to describe nurses’ perceptions of nursing activities and analyze for consistency with top-of-license (TOL) practice.

BACKGROUND

The Advisory Board Company expert panel proposed 8 TOL core nursing responsibilities representing practice at its potential. Thus far, no empirical work has examined nursing practices relative to TOL, from staff nurses’ points of view.

METHODS

This qualitative study used focus groups to explore perceptions of typical nursing activities. We analyzed activities for themes that described nurses’ work during typical shifts.

RESULTS

Nurses’ full scope of work included TOL-consistent categories, as well as categories that did not exemplify TOL practice, such as nonnursing care. A proposed model was developed, which depicts nurses’ total scope of work, inclusive of all activity categories. In addition, hindrances to TOL practice were also identified.

CONCLUSIONS

Findings from this study can inform leadership imperatives and the development of innovative, sustainable nursing practice models that support nursing practice at TOL.
Accommodative Behavior of Young Eyes Wearing Multifocal Contact Lenses
Authors: Altoaimi Basal H. , Almutairi Meznah S. , Kollbaum Pete S. , Bradley Arthur
Published: April 2018

SIGNIFICANCE

The effectiveness of multifocal contact lenses (MFCLs) at slowing myopia progression may hinge on the accommodative behavior of young eyes fit with these presbyopic style lenses. Can they remove hyperopic defocus? Convergence accommodation as well as pupil size and the zonal geometry are likely to contribute to the final accommodative responses.

PURPOSE

The aim of this study was to examine the accommodation behavior of young adult eyes wearing MFCLs and the effectiveness of these MFCLs at removing foveal hyperopic defocus when viewing near targets binocularly.

METHODS

Using a high-resolution Shack-Hartmann aberrometer, accommodation and pupil behavior of eight young adults (27.25 ± 2.05 years) were measured while subjects fixated a 20/40 character positioned between 2 m and 20 cm (0.50 to 5.00 diopters [D]) in 0.25-D steps. Refractive states were measured while viewing binocularly and monocularly with single-vision and both center-distance and center-near +2.00 D add MFCLs. Refractive state was defined using three criteria: the dioptric power that would (1) minimize the root mean square wavefront error, (2) focus the pupil center, and (3) provide the peak image quality.

RESULTS

Refractive state pupil maps reveal the complex optics that exist in eyes wearing MFCLs. Reduced accommodative gain beyond the far point of the near add revealed that young subjects used the added plus power to help focus near targets. During accommodation to stimuli closer than the far point generated by the add power, a midperipheral region of the pupil was approximately focused, resulting in the smallest accommodative errors for the minimum root mean square–defined measures of refractive state. Paraxial images were always hyperopically or myopically defocused in eyes viewing binocularly with center-distance or center-near MFCLs, respectively. Because of zone geometry in the concentric MFCLs tested, the highly aberrated transition zone between the distance and near optics contributed a significant proportion and sometimes the majority of light to the resulting images.

CONCLUSIONS

Young eyes fit with MFCLs containing significant transition zones accommodated to focus pupil regions between the near and distance optics, which resulted in less than optimal retinal image quality and myopic or hyperopic defocus in either the pupil center or pupil margins.
Can the Farnsworth D15 Color Vision Test Be Defeated through Practice?
Authors: Ng Jason S. , Liem Sophia C.
Published: April 2018

SIGNIFICANCE

This study suggests that it is possible for some patients with severe red–green color vision deficiency to do perfectly on the Farnsworth D15 test after practicing it.

PURPOSE

The Farnsworth D15 is a commonly used test to qualify people for certain occupations. For patients with color vision deficiency, there may be high motivation to try to pass the test through practice to gain entry into a particular occupation. There is no evidence in the literature on whether it is possible for patients to learn to pass the D15 test through practice.

METHODS

Ten subjects with inherited red–green color vision deficiency and 15 color-normal subjects enrolled in the study. All subjects had anomaloscope testing, color vision book tests, and a Farnsworth D15 at an initial visit. For the D15, the number of major crossovers was determined for each subject. Failing the D15 was determined as greater than 1 major crossover. Subjects with color vision deficiency practiced the D15 as long as desired to achieve a perfect score and then returned for a second visit for D15 testing. A paired t test was used to analyze the number of major crossovers at visit 1 versus visit 2.

RESULTS

Color-normal subjects did not have any major crossovers. Subjects with color vision deficiency had significantly (P < .001) fewer major crossovers on the D15 test at visit 2 (mean/SD = 2.5/3.0), including five subjects with dichromacy that achieved perfect D15 performance, compared to visit 1 (mean/SD = 8.7/1.3).

CONCLUSIONS

Practice of the Farnsworth D15 test can lead to perfect performance for some patients with color vision deficiency, and this should be considered in certain cases where occupational entry is dependent on D15 testing.
Primary and Metastatic Melanoma With NTRK Fusions
Authors: Lezcano Cecilia , Shoushtari Alexander N. , Ariyan Charlotte , Hollmann Travis J. , Busam Klaus J.
Published: April 2018

A number of oncogenic driver mutations have been identified in melanocytic nevi and melanoma, but translocations also play a role in tumorigenesis and provide potential therapeutic targets for malignant lesions. Various translocations, such as those involving the anaplastic lymphoma kinase (ALK), neurotrophic tropomyosin receptor kinase 1 (NTRK1), and NTRK3 have been reported in spitzoid melanocytic neoplasms leading to kinase-fusion proteins that result in immunohistochemically detectable ALK or NTRK expression. We have previously reported that ALK expression can be found in nonspitzoid primary and metastatic cutaneous melanomas. In this study we report that nonspitzoid metastasizing melanomas of adults may also harbor NTRK fusions and that NTRK expression can be immunohistochemically detected in these tumors. Of 751 melanomas analyzed by next-generation sequencing, 4 metastatic melanomas were identified with NTRK fusions, 3 involving NTRK1, 1 involving NTRK2. They occurred in 3 women and 1 man. Two of the corresponding primary tumors were from the trunk, 1 from an extremity and 1 tumor arose in anal skin. One primary tumor displayed features of superficial spreading melanoma and 3 were nodular melanomas. All tumors were cytologically characterized by the presence of large epithelioid melanocytes. All tumors were immunoreactive with anti-Trk antibody. Next-generation sequencing documented that the NTRK1 fusion partners included TRIM63, DDR2, and GON4L. One tumor harbored an NTRK2-TRAF2 fusion. Thus, our findings document that NTRK kinase fusions can occur in nonspitzoid metastasizing melanomas of adults. The presence of an NTRK family fusion in these tumors may provide a therapeutic opportunity in a small subset of patients with metastatic melanoma.
Brief Report: Systemic Inflammation, Immune Activation, and Impaired Lung Function Among People Living With HIV in Rural Uganda
Authors: North Crystal M. , Muyanja Daniel , Kakuhikire Bernard , Tsai Alexander C. , Tracy Russell P. , Hunt Peter W. , Kwon Douglas S. , Christiani David C. , Okello Samson , Siedner Mark J.
Published: April 2018

Background:

Although both chronic lung disease and HIV are inflammatory diseases common in sub-Saharan Africa, the relationship between systemic inflammation and lung function among people living with HIV (PLWH) in sub-Saharan Africa is not well described.

Methods:

We measured lung function (using spirometry) and serum high sensitivity C-reactive protein, interleukin 6 (IL-6), soluble CD14 (sCD14), and soluble CD163 (sCD163) in 125 PLWH on stable antiretroviral therapy (ART) and 109 age- and sex-similar HIV-uninfected control subjects in rural Uganda. We modeled the relationship between lung function and systemic inflammation using linear regression, stratified by HIV serostatus, controlled for age, sex, height, tobacco, and biomass exposure.

Results:

Half of subjects [46% (107/234)] were women, and the median age was 52 years (interquartile range: 48–55). Most PLWH [92% (115/125)] were virologically suppressed on first-line ART. Median CD4 count was 472 cells/mm3. In multivariable linear regression models stratified by HIV serostatus, an interquartile range increase in IL-6 and sCD163 were each inversely associated with lung function (mL, 95% confidence interval) among PLWH [IL-6: forced expiratory volume in 1 second (FEV1) −18.1 (−29.1 to −7.1), forced vital capacity (FVC) −17.1 (−28.2 to −5.9); sCD163: FVC −14.3 (−26.9 to −1.7)]. High sensitivity C-reactive protein (>3 vs. <1 mg/L) was inversely associated with lung function among both PLWH and HIV-uninfected control subjects [PLWH: FEV1 −39.3 (−61.7 to −16.9), FVC −44.0 (−48.4 to −6.4); HIV-uninfected: FEV1 −37.9 (−63.2 to −12.6), FVC −58.0 (−88.4 to −27.5)]. sCD14 was not associated with lung function, and all interaction terms were insignificant.

Conclusions:

Macrophage activation and systemic inflammation are associated with lower lung function among PLWH on stable ART in rural Uganda. Future work should focus on underlying mechanisms and public health implications.
Enhanced Recovery After Surgery (ERAS) Pathway in Esophagectomy
Authors: Parise Paolo , Ferrari Carlo , Cossu Andrea , Puccetti Francesco , Elmore Ugo , De Pascale Stefano , Garutti Leonardo , Fumagalli Uberto Romario , Di Serio Mariaclelia Stefania , Rosati Riccardo
Published: April 2018

Objective:

To assess whether perioperative variables or deviation from enhanced recovery after surgery (ERAS) items could be associated with delayed discharge after esophagectomy, and to convert them into a scoring system to predict it.

Summary Background Data:

ERAS perioperative pathways have been recently applied to esophageal resections. However, low adherence to ERAS items and high rates of protocol deviations are often reported.

Methods:

All patients who underwent esophagectomy between April 2012 and March 2017 were managed with a standardized perioperative pathway according to ERAS principles. The target length of stay was set at eighth postoperative day (POD). All significant variables at bivariate analysis were entered into a logistic regression to produce a predictive score. An initial validation of the score accuracy was carried out on a separate patient sample.

Results:

Two hundred eighty-six patients were included in the study. Multivariate regression analysis showed that American Society of Anesthesiology score ≥ 3, surgery duration > 255 min, “nonhybrid” esophagectomy, and failure to mobilize patients within 24 h from surgery were associated with delayed discharge. The logistic regression model was statistically significant (P < 0.001) and correctly classified 81.9% of cases. The sensitivity was 96.6%, and the specificity was 17.6%. The prediction score applied to 23 patients correctly identified 100% of those discharged after eighth POD.

Conclusions:

The results of this study seem to be clinically meaningful and in line with those from other studies. The initial validation revealed good predictive properties.
Sentiment Analysis of Web Sites Related to Vaginal Mesh Use in Pelvic Reconstructive Surgery
Authors: Hobson Deslyn T.G. , Meriwether Kate V. , Francis Sean L. , Kinman Casey L. , Stewart J. Ryan
Published: April 2018

Objectives

The purpose of this study was to utilize sentiment analysis to describe online opinions toward vaginal mesh. We hypothesized that sentiment in legal Web sites would be more negative than that in medical and reference Web sites.

Methods

We generated a list of relevant key words related to vaginal mesh and searched Web sites using the Google search engine. Each unique uniform resource locator (URL) was sorted into 1 of 6 categories: “medical”, “legal”, “news/media”, “patient generated”, “reference”, or “unrelated”. Sentiment of relevant Web sites, the primary outcome, was scored on a scale of −1 to +1, and mean sentiment was compared across all categories using 1-way analysis of variance. Tukey test evaluated differences between category pairs.

Result

Google searches of 464 unique key words resulted in 11,405 URLs. Sentiment analysis was performed on 8029 relevant URLs (3472 legal, 1625 “medical”, 1774 “reference”, 666 “news media”, 492 “patient generated”). The mean sentiment for all relevant Web sites was +0.01 ± 0.16; analysis of variance revealed significant differences between categories (P < 0.001). Web sites categorized as “legal” and “news/media” had a slightly negative mean sentiment, whereas those categorized as “medical,” “reference,” and “patient generated” had slightly positive mean sentiments. Tukey test showed differences between all category pairs except the “medical” versus “reference” in comparison with the largest mean difference (−0.13) seen in the “legal” versus “reference” comparison.

Conclusions

Web sites related to vaginal mesh have an overall mean neutral sentiment, and Web sites categorized as “medical,” “reference,” and “patient generated” have significantly higher sentiment scores than related Web sites in “legal” and “news/media” categories.
“Well, You Are the One Who Decides”
Authors: Isaksen Jytte
Published: April 2018

Clinical borderlands manifest themselves through encounters between people deemed to be in need of health care and health care providers (Mattingly, 2010). This article addresses the problem of inherent asymmetry in the clinical discourse between clinical providers, such as speech–language pathologists (SLPs), and persons with aphasia. Speech–language pathologists, communicating as experts, tend to dominate the discourse regarding the course of treatment, particularly with clients with aphasia who may lack the necessary communicative skills to participate in decision making. Such patterns of communication were apparent in a study reported here that involved thematic analysis of the views of 12 SLPs regarding involving people with aphasia in shared decision making and in analysis of 33 video recordings of these 12 SLPs and 28 people with aphasia during clinical interactions. Although the SLPs stated that they wanted to involve their clients in decision making and took steps to do so, the discourse sample analysis revealed that the SLPs controlled the interaction through their initiations, topic selection, and presentation of limited choices. Alternatives for supporting greater decision-making participation among people with aphasia with their clinicians are discussed.
Measured Glomerular Filtration Rate After Kidney Donation: No Evidence of Accelerated Decay
Authors: Berglund Danielle M. , Zhang Lei , Matas Arthur J. , Ibrahim Hassan N.
Published: April 2018

Background

The rate of measured glomerular filtration rate (GFR) change in kidney donor years after donation has not been adequately addressed. Whether this change is accelerated in the setting of 1 kidney is also understudied.

Methods

Two hundred fourteen randomly selected donors underwent serial GFR measurements of nonradioactive iohexol. Estimated GFR at each visit was calculated using the Chronic Kidney Disease Epidemiology Collaboration and Modification of Diet in Renal Disease study equations.

Results

Glomerular filtration rate visits were 4.8 ± 1.3 years apart and the second occurring 16.9 ± 9.1 years after donation. Most (97.7%) were white, 60.8% female, and 78.5% were related to their recipient. Most, 84.6%, had a GFR of 60 mL/min per 1.73 m2 or higher, 14.0% had a GFR between 45 and 60 mL/min per 1.73 m2, and 1.4% had a GFR less than 45 mL/min per 1.73 m2. Between visits 1 and 2, 56.5% had a GFR decline, 36.0% increase, and in 7.5%, there was no change. Overall, GFR declined at a rate of −0.42 mL/min per 1.73 m2 per year. Of GFR estimating models, only Chronic Kidney Disease Epidemiology Collaboration-Creatinine equation produced a slope that was steeper than measured GFR.

Conclusions

Nearly 2 decades postdonation GFR declined at a rate similar to that seen in the general population, and in one third, GFR continues to increase.
How Should Social Media Be Used in Transplantation? A Survey of the American Society of Transplant Surgeons
Authors: Henderson Macey L. , Adler Joel T. , Van Pilsum Rasmussen Sarah E. , Thomas Alvin G. , Herron Patrick D. , Waldram Madeleine M. , Ruck Jessica M. , Purnell Tanjala S. , DiBrito Sandra R. , Holscher Courtenay M. , Haugen Christine E. , Alimi Yewande , Konel Jonathan M. , Eno Ann K. , Garonzik Wang Jacqueline M. , Gordon Elisa J. , Lentine Krista L. , Schaffer Randolph L. , Cameron Andrew M. , Segev Dorry L.
Published: April 2018

Background.

Social media platforms are increasingly used in surgery and have shown promise as effective tools to promote deceased donation and expand living donor transplantation. There is a growing need to understand how social media-driven communication is perceived by providers in the field of transplantation.

Methods.

We surveyed 299 members of the American Society of Transplant Surgeons about their use of, attitudes toward, and perceptions of social media and analyzed relationships between responses and participant characteristics.

Results.

Respondents used social media to communicate with: family and friends (76%), surgeons (59%), transplant professionals (57%), transplant recipients (21%), living donors (16%), and waitlisted candidates (15%). Most respondents (83%) reported using social media for at least 1 purpose. Although most (61%) supported sharing information with transplant recipients via social media, 42% believed it should not be used to facilitate living donor-recipient matching. Younger age (P = 0.02) and fewer years of experience in the field of transplantation (P = 0.03) were associated with stronger belief that social media can be influential in living organ donation. Respondents at transplant centers with higher reported use of social media had more favorable views about sharing information with transplant recipients (P < 0.01), increasing awareness about deceased organ donation (P < 0.01), and advertising for transplant centers (P < 0.01). Individual characteristics influence opinions about the role and clinical usefulness of social media.

Conclusions.

Transplant center involvement and support for social media may influence clinician perceptions and practices. Increasing use of social media among transplant professionals may provide an opportunity to deliver high-quality information to patients.
Biomarkers to Assess Right Heart Pressures in Recipients of a Heart Transplant: A Proof-of-Concept Study
Authors: Huang Qi-Fang , Trenson Sander , Zhang Zhen-Yu , Van Keer Jan , Van Aelst Lucas N.L. , Yang Wen-Yi , Nkuipou-Kenfack Esther , Thijs Lutgarde , Wei Fang-Fei , Mujaj Blerim , Ciarka Agnieszka , Droogné Walter , Vanhaecke Johan , Janssens Stefan , Van Cleemput Johan , Mischak Harald , Staessen Jan A.
Published: April 2018

Background

This proof-of-concept study investigated the feasibility of using biomarkers to monitor right heart pressures (RHP) in heart transplanted (HTx) patients.

Methods

In 298 patients, we measured 7.6 years post-HTx mean pressures in the right atrium (mRAP) and pulmonary artery (mPAP) and capillaries (mPCWP) along with plasma high-sensitivity troponin T (hsTnT), a marker of cardiomyocyte injury, and the multidimensional urinary classifiers HF1 and HF2, mainly consisting of dysregulated collagen fragments.

Results

In multivariable models, mRAP and mPAP increased with hsTnT (per 1-SD, +0.91 and +1.26 mm Hg; P < 0.0001) and with HF2 (+0.42 and +0.62 mm Hg; P ≤ 0.035), but not with HF1. mPCWP increased with hsTnT (+1.16 mm Hg; P < 0.0001), but not with HF1 or HF2. The adjusted odds ratios for having elevated RHP (mRAP, mPAP or mPCWP ≥10, ≥24, ≥17 mm Hg, respectively) were 1.99 for hsTnT and 1.56 for HF2 (P ≤ 0.005). In detecting elevated RHPs, areas under the curve were similar for hsTnT and HF2 (0.63 vs 0.65; P = 0.66). Adding hsTnT continuous or per threshold or HF2 continuous to a basic model including all covariables did not increase diagnostic accuracy (P ≥ 0.11), whereas adding HF2 per optimized threshold increased both the integrated discrimination (+1.92%; P = 0.023) and net reclassification (+30.3%; P = 0.010) improvement.

Conclusions

Correlating RHPs with noninvasive biomarkers in HTx patients is feasible. However, further refinement and validation of such biomarkers is required before their clinical application can be considered.