bluuebunny/crossref_metadata_2025 huggingface dataset:
The Development of Auditory Feedback Monitoring: I. Delayed Auditory Feedback Studies on Infant Cry
Authors: Cullen John K. , Fargo Nancy , Chase Richard A. , Baker Peggy
Published: July 2016

Vocal cry samples of 20 normal newborn infants were recorded under two test conditions: synchronous auditory feedback and a 200 msec delay in auditory feedback (DAF). Averages for cry duration, pause time, and maximum sound pressure level were obtained for 16 of the 20 subjects. An analysis of variance showed significant effects for cry duration and amplitude (p < 0.05) but not for pause time. Subjects tended to decrease the average duration of cry bursts by more than 100 msec during the DAF test conditions. The resus, while not conclusive, indicate that cry behavior may be under closed-loop auditory feedback control. It is suggested that the auditory monitoring of cry behavior be further investigated by the use of several delay times. If the magnitude and character of changes in crying behavior show consistent variation as a function of delay time, more persuasive evidence for an auditory feedback monitoring system will have been adduced.
Development of the Prosodic Features of Infant Vocalizing
Authors: Sheppard W. C. , Lane H. L.
Published: July 2016

Developmental changes in the prosodic features of infant vocalizing were studied with novel electroacoustic techniques. Complete and continuous recordings of all the vocalizations of two infants during the first five months of life were collected, beginning with the birth cries and continuing uninterrupted as the infants were moved into plexiglass “air-cribs” at home. These recordings were systematically sampled for analysis. The prosodic features of vocalizing were analyzed by extracting three acoustic parameters: fundamental frequency (Hz), amplitude (dB), and duration (msec) during each of the 108 samples. The outputs of the parameter extractors (analog electronic devices) were measured every 25 msec by an analog-to-digital converter, then processed by an on-line digital computer. Composite statistics, describing the three prosodic features of the vocalizing in each sample, were plotted separately as a function of age at the time of sample. Parameter values and trends in the prosodic features of infant vocalization are reported.
Analysis of 2D singularities for mammographic mass classification
Authors: Rabidas Rinku , Chakraborty Jayasree , Midya Abhishek
Published: July 2016

Masses are one of the prevalent early signs of breast cancer, visible in mammogram. However, its variation in shape, size, and appearance often creates hazards in proper diagnosis of mammographic masses. This study analyses the 2D singularities of masses and their surrounding regions with Ripplet‐II transform to classify them as benign and malignant. Since benign and malignant masses may change the orientation patterns of normal breast tissues differently, several textural features including Ripplet‐II coefficients and statistical co‐variates, derived from the Ripplet‐II transformed images, are extracted to quantify the texture information of mammographic regions. The important features are then selected using stepwise logistic regression technique and evaluated using linear discriminant analysis and support vector machine with a ten‐fold cross‐validation. The best performance in terms of the area under the receiver operating characteristic curve of 0.91 ± 0.01 and 0.83 ± 0.01 and accuracy of 87.28 ± 0.02 and 75.60 ± 0.01 are obtained with the proposed method while experimenting with 58 images from the mini‐MIAS and 200 images from the Digital Database for Screening Mammography database, respectively.
Current recovery for the RWG‐based method of moments
Authors: Strydom Willem J. , Botha Matthys M.
Published: July 2016

Derivative recovery through local smoothing, is a well‐known approach to obtain an estimate of a solution field's derivative, to one polynomial order higher than its direct representation. In the finite element method context, this is often referred to as ‘gradient recovery’. The method of moments (MoM) is routinely used to solve electromagnetic field integral equations in terms of the electric surface current density, which is often represented by mixed first‐order, Rao–Wilton–Glisson (RWG) basis functions upon a mesh of triangle elements. A procedure for recovering a mixed second‐order, approximate solution from an RWG‐based MoM solution is presented. Recovery of the solution itself rather than its derivative, is made possible by exploiting specific properties of the mixed‐order, surface divergence‐conforming function spaces. The procedure is not strictly local, however, only sparse, positive‐definite global linear systems must be solved. The procedure is independent of the integral operator. Computational complexity is lower than that of existing residual‐based MoM error estimators. Results are shown with the recovered solution being a better approximation than the original solution. The procedure is useful for post‐processing and for local or global a posteriori error estimation. It can be incorporated into any RWG‐based MoM code.
Excitation-energy dependence of solvation dynamics in room-temperature ionic liquids
Authors: Kim Daekeon , Park Sang-Won , Shim Youngseon , Kim Hyung J. , Jung YounJoon
Published: July 2016

Influence of the excitation energy of a probe solute molecule on its solvation dynamics and emission spectrum in 1-ethyl-3-methylimidazolium hexafluorophosphate (EMI+PF6−) is studied via molecular dynamics simulations using a coarse-grained model description. By exciting the probe at different energies, each with an extremely narrow distribution, ensuing solvent relaxation and its dynamic variance are monitored using the isoconfigurational ensemble method. Resulting Stokes shift function, S(t), indicates that long-time solvent relaxation becomes slower with the decreasing excitation energy and approaches the equilibrium correlation function, C(t), of solvent fluctuations. This suggests that the system excited at the red-edge of the spectrum observes linear response better than that at the blue-edge. A detailed analysis of nonequilibrium trajectories shows that the effect of initial configurations on variance of relaxation dynamics is mainly confined to short times; it reaches a maximum around 0.1 ≲ t ≲ 1 ps and diminishes as time further increases. The influence of the initial velocity distribution, on the other hand, tends to grow with time and dominates the long-time variations of dynamics. The emission spectrum shows the red-edge effect in accord with previous studies.
Fine- and hyperfine-structure effects in molecular photoionization. II. Resonance-enhanced multiphoton ionization and hyperfine-selective generation of molecular cations
Authors: Germann Matthias , Willitsch Stefan
Published: July 2016

Resonance-enhanced multiphoton ionization (REMPI) is a widely used technique for studying molecular photoionization and producing molecular cations for spectroscopy and dynamics studies. Here, we present a model for describing hyperfine-structure effects in the REMPI process and for predicting hyperfine populations in molecular ions produced by this method. This model is a generalization of our model for fine- and hyperfine-structure effects in one-photon ionization of molecules presented in Paper I [M. Germann and S. Willitsch, J. Chem. Phys. 145, 044314 (2016)]. This generalization is achieved by covering two main aspects: (1) treatment of the neutral bound-bound transition including the hyperfine structure that makes up the first step of the REMPI process and (2) modification of our ionization model to account for anisotropic populations resulting from this first excitation step. Our findings may be used for analyzing results from experiments with molecular ions produced by REMPI and may serve as a theoretical background for hyperfine-selective ionization experiments.
Three-dimensional particle-in-cell simulation on gain saturation effect of microchannel plate
Authors: Wang Qiangqiang , Yuan Zheng , Cao Zhurong , Deng Bo , Chen Tao , Deng Keli
Published: July 2016

We present here the results of the simulation work, using the three-dimensional particle-in-cell method, on the performance of the lead glass microchannel plate under saturated state. We calculated the electron cascade process with different DC bias voltages under both self-consistent condition and non-self-consistent condition. The comparative results have demonstrated that the strong self-consistent field can suppress the cascade process and make the microchannel plate saturated. The simulation results were also compared to the experimental data and good agreement was obtained. The simulation results also show that the electron multiplication process in the channel is accompanied by the buildup process of positive charges in the channel wall. Though the interactions among the secondary electron cloud in the channel, the positive charges in the channel wall, and the external acceleration field can make the electron-surface collision more frequent, the collision energy will be inevitably reduced, thus the electron gain will also be reduced.
Direct observation of unimolecular decay of CH3CH2CHOO Criegee intermediates to OH radical products
Authors: Fang Yi , Liu Fang , Klippenstein Stephen J. , Lester Marsha I.
Published: July 2016

The unimolecular decay of carbonyl oxide intermediates, known as Criegee intermediates, produced in alkene ozonolysis is a significant source of OH radicals in the troposphere. Here, the rate of appearance of OH radical products is examined directly in the time-domain for a prototypical alkyl-substituted Criegee intermediate, CH3CH2CHOO, following vibrational activation under collision-free conditions. Complementary statistical Rice–Ramsperger–Kassel–Marcus calculations of the microcanonical unimolecular decay rate for CH3CH2CHOO are also carried out at energies in the vicinity of the barrier for 1,4 hydrogen atom transfer that leads to OH products. Tunneling through the barrier, derived from high level electronic structure calculations, contributes significantly to the decay rate. Infrared transitions of CH3CH2CHOO are identified in the CH stretch overtone region, which are detected by ultraviolet laser-induced fluorescence of the resultant OH products. The features observed are attributed to CH vibrational excitations and conformational forms utilizing insights from theory. Both experiment and theory yield unimolecular decay rates for CH3CH2CHOO of ca. 107 s−1, which are slower than those obtained for syn-CH3CHOO or (CH3)2COO reported previously [Fang et al., J. Chem. Phys. 144, 061102 (2016)] at similar energies. Master equation modeling is also utilized to predict the thermal decay rate of CH3CH2CHOO under atmospheric conditions, giving a rate of 279 s−1 at 298 K.
A silicon-on-insulator surface plasmon interferometer for hydrogen detection
Authors: Le Khai Q. , Ngo Quang Minh
Published: July 2016

A compact and integrated optical gas sensor on a silicon-on-insulator platform based on surface plasmon interference for hydrogen detection is theoretically introduced in this paper. The basic sensor element consists of a thin layer of palladium (Pd) embedded in a silicon waveguide. Two decoupled surface plasmon polariton waves propagate simultaneously on either side of the Pd layer, which combine and interfere at the end of the Pd layer. The interference mode can be either constructive or destructive, which is highly sensitive to volumetric hydrogen concentration. The proposed sensor is of great potential as a basic building block for lab-on-chip-scale devices owing to its high integration and compactness.
Novel magnetic indenter for rheological analysis of thin biological sheet for regenerative medicine
Authors: Kageshima Masami , Maruyama Toshiro , Akama Tomoya , Nakamura Tomoyuki
Published: July 2016

A novel method is proposed for analyzing the mechanical properties of a thin sheet of cells or extracellular matrix cultured for regenerative medicine. A steel sphere is mounted onto the center of the sheet sample, placed over a circular aperture, and a loading force is exerted via an electromagnet with well-regulated current while the displacement of the sample center is optically detected. Details of the instrument and its performance are described. Loading and unloading experiment with stepwise magnetic force revealed that creep response of each of the cell sheet and matrix sheet can be expressed as a combination of a quasi-instantaneous deformation and two delayed elastic responses having different retardation times. The retardation time exhibited an increasing trend with the loading force. Close analysis of loading-force dependence and reversibility of the derived mechanical parameters revealed that these deformation modes are not independent but flexibly switches to each other depending on load magnitude and loading history. The cell sheet sample exhibited remarkable irreversibility between loading and unloading responses, which is attributed to response of the live cells to the sustained loading.
Effect of filler alignment on percolation in polymer nanocomposites using tunneling-percolation model
Authors: Kale Sohan , Sabet Fereshteh A. , Jasiuk Iwona , Ostoja-Starzewski Martin
Published: July 2016

In this study, we examine the effect of filler alignment on percolation behavior of polymer nanocomposites using Monte Carlo simulations of monodisperse prolate and oblate hard-core soft-shell ellipsoids representing carbon nanotubes and graphene nanoplatelets, respectively. The percolation threshold is observed to increase with increasing extent of alignment as expected. For a highly aligned system of rod-like fillers, the simulation results are shown to be in good agreement with the second virial approximation based predictions. However, for a highly aligned system of disk-like fillers, the second virial approximation based results are observed to significantly deviate from the simulations, even for higher aspect ratios. The effect of filler alignment on anisotropy in percolation behavior is also studied by predicting the percolation threshold along different directions. The anisotropy in percolation threshold is found to vanish even for highly aligned systems of fillers with increasing system size.
Simultaneous observation of up/down conversion photoluminescence and colossal permittivity properties in (Er+Nb) co-doped TiO2 materials
Authors: Tse Mei-Yan , Tsang Ming-Kiu , Wong Yuen-Ting , Chan Yi-Lok , Hao Jianhua
Published: July 2016

We have investigated the optical and dielectric properties of rutile TiO2 doped with Nb and Er, i.e., (Er0.5Nb0.5)xTi1-xO2. The up/downconversion photoluminescence was observed in the visible and near-infrared region from the materials under 980 nm laser diode excitation. The upconversion emissions are attributed to the energy transfer between Er ions in the excited states. Moreover, the dielectric measurements indicate that the fabricated materials simultaneously present colossal permittivity properties with relatively low dielectric loss. Our work demonstrates the coexistence of both interesting luminescence and attractive dielectric characteristics in (Er+Nb) co-doped TiO2, showing the potential for multifunctional applications.
Agronomic responses of grain sorghum to DMPP-treated urea on contrasting soil types in north-eastern Australia
Authors: Lester David W. , Bell Michael J. , Bell Kerry L. , De Antoni Migliorati Massimiliano , Scheer Clemens , Rowlings David , Grace Peter R.
Published: July 2016

Grain sorghum grown in north-eastern Australia’s cropping region increasingly requires nitrogen (N) fertiliser to supplement the soil available N supply. The rates of N required can be high when fallows between crop seasons are short (higher cropping intensities) and when yield potentials are high.
Fertiliser N is typically applied before or at crop sowing and is vulnerable to environmental loss in the period between application and significant crop N demand due to potentially intense rainfall events in the summer-dominant rainfall environment.
Nitrification inhibitors added to urea can reduce certain gaseous loss pathways but the agronomic efficacy of these products has not been explored. Urea and urea coated with the nitrification inhibitor DMPP (3,4-dimethylpyrazole phosphate) were compared in sorghum crops grown at five research sites over consecutive summer sorghum growing seasons in south-east Queensland. Products were compared in terms of crop responses in dry matter, N uptake and grain yield, with DMPP found to produce only subtle increases on grain yield. There was no effect on dry matter or N uptake. Outcomes suggest any advantages from use of DMPP in this region are most significant in situations where higher fertiliser application rates (>80kgN/ha) are required.
Vimentin coordinates fibroblast proliferation and keratinocyte differentiation in wound healing via TGF-β–Slug signaling
Authors: Cheng Fang , Shen Yue , Mohanasundaram Ponnuswamy , Lindström Michelle , Ivaska Johanna , Ny Tor , Eriksson John E.
Published: July 2016

Significance

The central concept in this study is that a major cytoskeletal component, vimentin, acts as a signal integrator during wound healing, operating in both signal-triggering and signal-receiving cells. This is a previously unreported concept for intermediate filaments, with an evolving paradigm according to which intermediate filaments emerge as integrators of regeneration with specific functions in the particular tissues for which individual intermediate filaments are characteristic. Our study reveals the underlying molecular and cellular control functions of vimentin in vimentin-dependent epithelial–mesenchymal transition, regeneration, and healing.
Hair cells use active zones with different voltage dependence of Ca
2+
influx to decompose sounds into complementary neural codes
Authors: Ohn Tzu-Lun , Rutherford Mark A. , Jing Zhizi , Jung Sangyong , Duque-Afonso Carlos J. , Hoch Gerhard , Picher Maria Magdalena , Scharinger Anja , Strenzke Nicola , Moser Tobias
Published: July 2016

Significance

We hear sounds varying in intensity over six orders of magnitude using spiral ganglion neurons (SGNs), each of which changes its firing rates over only a fraction of this range. Somehow, the SGNs with different dynamic ranges collectively encode the full range of sound levels represented in the receptor potential of the inner hair cell (IHC) in the mammalian cochlea. Our study, combining subcellular imaging, mouse genetics, and auditory systems physiology, offers a unifying synaptic hypothesis for wide dynamic range sound encoding in the spiral ganglion. We propose that IHCs, from one receptor potential but via presynaptic active zones that vary in the voltage dependence of Ca
2+
influx, generate complementary codes on sound pressure level in functionally distinct SGNs.
What leads to success in the change process from a client perspective? / ¿Qué es lo que conduce al éxito en el proceso de cambio desde la perspectiva del cliente?
Authors: Schürmann Ingeborg , Mühlmeyer-Mentzel Agnes
Published: July 2016

The authors provide a process model which captures how successful clients use and develop resources in the process of counselling and psychotherapy and how these are linked to the overall process. The use and gradual development of resources are integrated into the process model, as well as additional meta-categories such as experiencing positive feelings and internal and external actions of the client. The model is based on a qualitative meta-analysis.
Alterations in autonomic cardiac modulation in response to normobaric hypoxia
Authors: Giles David , Kelly John , Draper Nick
Published: July 2016

Purpose: The present study aimed to determine if autonomic cardiac modulation was influenced by acute exposure to normobaric hypoxia. Method: Ten healthy male lowland dwellers completed five block‐randomised single‐blinded, crossed‐over acute exposures to a normobaric hypoxic environment, each separated by 24 hours’ recovery (20.3%, 17.4%, 14.5%, 12.0% and 9.8% FIO2). Supine recordings were made of arterial oxygen saturation and electrocardiogram (ECG). RR intervals from the ECG trace were analysed for time (SDNN, lnrMSSD), frequency (lnVLF, lnLF, lnHF, lnTP, LFnu, and HFnu), and nonlinear (DFA‐α1 and SampEn) heart rate variability components. Results: A significant reduction in arterial SaO2 occurred with reduced FIO2, along with a rise in heart rate (Cohen's d = 1.16, 95% Confidence Interval [2.64–6.46]), significant at 9.8% FIO2. A decrease in autonomic cardiac modulation was also found as shown by a statistically significant (at 9.8% FIO2) decrease in lnTP (d = 1.84 [1.74–1.94]), and SampEn (d = 0.98 [0.83–1.12]) and an increase in DFA‐α1 (d = 0.72 [0.60–0.84]) from normoxia at 9.8% FIO2. Conclusion: The decrease in variability indicated a reduction in autonomic cardiac modulation. There appears to be a threshold ∼9.8% FIO2 (∼6000 m equiv.), below which significant alterations in autonomic control occur.
The distribution of sandpile groups of random graphs
Authors: Wood Melanie
Published: July 2016

We determine the distribution of the sandpile group (or Jacobian) of the Erdős-Rényi random graph

G
(
n
,
q
)

G(n,q)

as

n
n

goes to infinity. We prove the distribution converges to a specific distribution conjectured by Clancy, Leake, and Payne. This distribution is related to, but different from, the Cohen-Lenstra distribution. Our proof involves first finding the expected number of surjections from the sandpile group to any finite abelian group (the “moments” of a random variable valued in finite abelian groups). To achieve this, we show a universality result for the moments of cokernels of random symmetric integral matrices that is strong enough to handle dependence in the diagonal entries. The methods developed to prove this result include inverse Littlewood-Offord theorems over finite rings and new techniques for studying homomorphisms of finite abelian groups with not only precise structure but also approximate versions of that structure. We then show these moments determine a unique distribution despite their

p

k
2

p^{k^2}

-size growth. In particular, our theorems imply universality of singularity probability and ranks mod

p
p

for symmetric integral matrices.
Towards monitoring critical microscopic parameters for electropermeabilization
Authors: Ammari H. , Widlak T. , Zhang W.
Published: July 2016

Electropermeabilization is a clinical technique in cancer treatment to locally stimulate the cell metabolism. It is based on electrical fields that change the properties of the cell membrane. With that, cancer treatment can reach the cell more easily. Electropermeabilization occurs only with accurate dosage of the electrical field. For applications, a monitoring for the amount of electropermeabilization is needed. It is a first step to image the macroscopic electrical field during the process. Nevertheless, this is not complete, because electropermeabilization depends on critical individual properties of the cells such as their curvature. From the macroscopic field, one cannot directly infer that microscopic state. In this article, we study effective parameters in a homogenization model as the next step to monitor the microscopic properties in clinical practice. We start from a physiological cell model for electropermeabilization and analyze its well-posedness. For a dynamical homogenization scheme, we prove convergence and then analyze the effective parameters, which can be found by macroscopic imaging methods. We demonstrate numerically the sensitivity of these effective parameters to critical microscopic parameters governing electropermeabilization. This opens the door to solving the inverse problem of reconstructing these parameters.
Ursula Mamlok, Panta Rhei, Third Movement (1981)
Authors: Straus Joseph N.
Published: July 2016

The third movement of Ursula Mamlok’s piano trio Panta Rhei (1981) is composed in her distinctive twelve-tone style. Its hexatonic qualities, including its enchaining of triads and forms of set class (014), respond well to a neo-Riemannian analytical approach, suitably modified. Rhythm as well as pitch forms part of the serial design. A close reading of this work provides a context for the refutation of a number of familiar myths about postwar twelve-tone music, including myths regarding orthodoxy, purity, non-repetition, antitonality, and inexpressiveness. Mamlok’s individual practice places her in a varied and eclectic mainstream of twelve-tone composition in postwar America.
Elisabeth Lutyens, Essence of Our Happinesses (1968)
Authors: Parsons Laurel
Published: July 2016

In Essence of Our Happinesses (1968), a three-movement work for tenor, chorus, and orchestra, Elisabeth Lutyens explores the nature of time through settings of texts by Abū Yazīd, John Donne, and Arthur Rimbaud. This essay examines the second movement, Lutyens’s setting of a Donne meditation on the nature of time followed by an orchestral choros entitled “Chronikos.” First, an examination of the tenor’s recurring melody shows how, through orchestration and flexible treatment of the row, Lutyens creates a kind of serial plainchant. Metric analysis of the choros then demonstrates how Lutyens’s juxtaposition of a metrically unpredictable series of motives against a clocklike ostinato provides a wordless commentary on Donne’s text. Finally, the composition is discussed in the context of Lutyens’s many works exploring the paradoxes of human temporal experience.
Dealing with Disasters
Authors: Clarke Daniel J. , Dercon Stefan
Published: July 2016

The world does not turn a blind eye to disasters. In fact, many disasters are followed by an outpouring of generosity. Despite such gestures, disaster responses often seem insufficient, slow, and not well coordinated, and recovery can take years. The main thesis of this book is that the impact of disasters can be dulled if three things are in place beforehand: (1) a coordinated plan for post-disaster action agreed in advance; (2) a fast, evidence-based decision-making process; and (3) financing on standby to ensure that the plan can be implemented. The solutions presented throughout this book are based on pre-agreed, pre-financed, rules-based plans that can be implemented after a disaster without the need for further political decisions or the hand-wringing that often follows a crisis.
Defining the Problem
Authors: Clarke Daniel J. , Dercon Stefan
Published: July 2016

The post-disaster relationships between national and subnational governments, government and farmers, government and homeowners, and government and the international humanitarian system often take the form of a begging bowl, although there are notable exceptions. Begging bowls arise because of benefactors—the people who retain discretion over how to allocate their budgets after a disaster strikes. For beneficiaries, begging-bowl financing of disaster risk is fraught with uncertainty—they do not know what help to expect and when help will arrive. It can also undermine their incentives to invest in disaster risk reduction and preparedness. All of these factors can increase the economic and human costs of catastrophes. Even if a budget can be mobilized, ambiguity over how money will be executed can lead to a slow response and poor targeting.
Planning for Disaster Recovery
Authors: Clarke Daniel J. , Dercon Stefan
Published: July 2016

Rules can promote decisive, timely action, but a rules-based system is only as good as the data that drive it. Because no rule is perfect, there should be some discretion to deal with situations in which the rules fail. The challenge is to allow discretion without allowing people to game the system. The data need to be resistant to manipulation and strike the right balance between cost, speed, and reliability. Any data that could trigger action will depend on investments before a disaster in design of the data-collection system, including an audit function, and in the human and technological capacity to collect data in a timely manner. Three types of data could be used to trigger action: ground data on the damage to or losses of people and buildings, area average index data on damage and losses, or parametric indexes.
Moving forward…
Authors: Clarke Daniel J. , Dercon Stefan
Published: July 2016

Discretionary begging-bowl financing does not work well for disasters—it is too slow, leads to a fragmented response, and encourages underinvestment in risk reduction and preparedness. To get around this problem, generous people and their political leaders should think like are an insurance company. This means making trade-offs over who or what to protect before disasters. This process is not easy, but it is necessary for a system with good incentives. Leaders should focus on providing protection, not relief, and using financial incentives to encourage others to own up to and finance their share up front. The international humanitarian system is still needed, as a back-up when plans fail. It should not be the first line of defence for natural disasters.
Commitment to Change and Challenges to Implementing Changes After Workplace-Based Assessment Rater Training
Authors: Kogan Jennifer R. , Conforti Lisa N. , Yamazaki Kenji , Iobst William , Holmboe Eric S.
Published: July 2016

Purpose

Faculty development for clinical faculty who assess trainees is necessary to improve assessment quality and impor tant for competency-based education. Little is known about what faculty plan to do differently after training. This study explored the changes faculty intended to make after workplace-based assessment rater training, their ability to implement change, predictors of change, and barriers encountered.

Method

In 2012, 45 outpatient internal medicine faculty preceptors (who supervised residents) from 26 institutions participated in rater training. They completed a commitment to change form listing up to five commitments and ranked (on a 1–5 scale) their motivation for and anticipated difficulty implementing each change. Three months later, participants were interviewed about their ability to implement change and barriers encountered. The authors used logistic regression to examine predictors of change.

Results

Of 191 total commitments, the most common commitments focused on what faculty would change about their own teaching (57%) and increasing direct observation (31%). Of the 183 commitments for which follow-up data were available, 39% were fully implemented, 40% were partially implemented, and 20% were not implemented. Lack of time/competing priorities was the most commonly cited barrier. Higher initial motivation (odds ratio [OR] 2.02; 95% confidence interval [CI] 1.14, 3.57) predicted change. As anticipated difficulty increased, implementation became less likely (OR 0.67; 95% CI 0.49, 0.93).

Conclusions

While higher baseline motivation predicted change, multiple system-level barriers undermined ability to implement change. Rater-training faculty development programs should address how faculty motivation and organizational barriers interact and influence ability to change.
Procedural Competence Among Faculty in Academic Health Centers: Challenges and Future Directions
Authors: Vaisman Alon , Cram Peter
Published: July 2016

Increasingly, faculty are taking on more direct responsibilities in patient care because of reductions in resident work hours, increasing admissions, and an endless push for efficiency. Furthermore, the rise of different career tracks in academia (i.e., patient care, research, education, or administration) and a drive for efficiency and subspecialization have placed additional strains on academic health centers. Combined, these factors have led to faculty increasingly being placed in the position of supervising bedside procedures that they may have not performed in years or with tools they have never trained with at all. Despite these challenges, procedural retraining for faculty remains nonstandardized across most academic health centers. The resulting lack of procedural competence among faculty creates a number of challenges for the different parties involved.

In this Perspective, the authors discuss the nature of the current problem of faculty procedural competence and the challenges it poses for faculty and academic health centers, medicolegal ramifications, and the challenges it poses to the faculty–trainee relationship. The authors then suggest several strategies to delineate and resolve this problem. To delineate the problem, they suggest single-center surveys to address the current paucity of data. To resolve the problem, they suggest the consideration of some modest, low-cost interventions such as having backup systems in place for procedure supervision (e.g., procedural service teams or interventional radiologists) and providing faculty with opportunities to retrain.
Assessing the Validity of Online Drug Forums as a Source for Estimating Demographic and Temporal Trends in Drug Use
Authors: Paul Michael J. , Chisolm Margaret S. , Johnson Matthew W. , Vandrey Ryan G. , Dredze Mark
Published: July 2016

Objectives:

Addiction researchers have begun monitoring online forums to uncover self-reported details about use and effects of emerging drugs. The use of such online data sources has not been validated against data from large epidemiological surveys. This study aimed to characterize and compare the demographic and temporal trends associated with drug use as reported in online forums and in a large epidemiological survey.

Methods:

Data were collected from the Web site, drugs-forum.com, from January 2007 through August 2012 (143,416 messages posted by 8087 members) and from the US National Survey on Drug Use and Health (NSDUH) from 2007 to 2012. Measures of forum participation levels were compared with and validated against 2 measures from the NSDUH survey data: percentage of people using the drug in past 30 days and percentage using the drug more than 100 times in the past year.

Results:

For established drugs (eg, cannabis), significant correlations were found across demographic groups between drugs-forum.com and the NSDUH survey data, whereas weaker, nonsignificant correlations were found with temporal trends. Emerging drugs (eg, Salvia divinorum) were strongly associated with male users in the forum, in agreement with survey-derived data, and had temporal patterns that increased in synchrony with poison control reports.

Conclusions:

These results offer the first assessment of online drug forums as a valid source for estimating demographic and temporal trends in drug use. The analyses suggest that online forums are a reliable source for estimation of demographic associations and early identification of emerging drugs, but a less reliable source for measurement of long-term temporal trends.
Technique for 3-Dimesional (3D) Modeling of Osteoarticular Medial Femoral Condyle Vascularized Grafting to Replace the Proximal Pole of Unsalvagable Scaphoid Nonunions
Authors: Houdek Matthew T. , Matsumoto Jane M. , Morris Jonathan M. , Bishop Allen T. , Shin Alexander Y.
Published: July 2016

This study describes a novel technique for the preoperative surgical planning for an osteoarticular medial femoral condyle (MFC) graft to replace the proximal pole of a scaphoid. In cases of proximal pole scaphoid nonunion or in Preiser disease, fragmentation of the articular surface can occur, leading to significant pain and disability. Osteoarticular MFC bone grafting can be used to treat these injuries by providing a vascularized osteoarticular surface. Using 3-dimensional imaging and printing we are able to precisely model the injured scaphoid, and also accurately plan the harvest of MFC osteoarticular graft. This technique allows for accurate preoperative planning of a complex 3-dimensional bone, and has improved our execution of the plan intraoperatively.
Treatment of Coagulopathy Related to Hepatic Insufficiency
Authors: Barton Cassie A.
Published: July 2016

Objectives:

To provide a concise review of the medical management of coagulopathy related to hepatic insufficiency. This review will focus on prevention and management of bleeding episodes in patients with hepatic insufficiency. The treatment and prevention of thromboembolic complications will also be addressed.

Data Sources:

Electronic search of PubMed database using relevant search terms, including hepatic coagulopathy, hemorrhage, liver diseases, blood coagulation disorders, blood transfusion, disseminated intravascular coagulation, and liver failure. Subsequent searches were done on specific issues.

Study Selection:

Articles considered include original articles, review articles, guidelines, consensus statements, and conference proceedings.

Data Extraction:

A detailed review of scientific, peer-reviewed data was performed. Relevant publications were included and summarized.

Data Synthesis:

Available evidence is used to describe and summarize currently available tests of hemostasis, utilization of prohemostatic agents, transfusion strategies, use of prophylactic anticoagulation and treatment of thromboembolic events in patients with hepatic insufficiency.

Conclusions:

Dynamic changes to hemostasis occur in patients with hepatic insufficiency. Routine laboratory tests of hemostasis are unable to reflect these changes and should not be used exclusively to evaluate coagulopathy. Newer testing methods are available to provide data on the entire spectrum of clotting but are not validated in acute bleeding. Prohemostatic agents utilized to prevent bleeding should only be considered when the risk of bleeding outweighs the risk of thrombotic complications. Restrictive transfusion strategies may avoid exacerbation of acute bleeding. Prophylaxis against and treatment of thromboembolic events are necessary and should consider patient specific factors.
Risk-adapted transplant strategies for high-risk Hodgkin lymphoma: are we there?
Authors: Lewalle Philippe , Wittnebel Sebastian
Published: July 2016

Purpose of review

The treatment of high-risk classic Hodgkin lymphoma (cHL) patients remains challenging, especially after autologous stem cell transplant (ASCT) failure. Moreover, the outcome of chemorefractory patients is still poor.

Recent findings

The development of novel targeted therapies has changed the therapeutic options for high-risk patients. To improve outcome, treatment algorithms should integrate up-front, newly established prognostic markers. Tandem ASCT instead of single ASCT has been proposed as an option to improve outcome for high-risk patients. Availability of less toxic reduced intensity conditioning regimens and recent development in haploidentical transplantation have widened applicability and improved outcomes of allo-hematopoietic cell transplantation. Their exact role in cHL is still controversial and there is no consensus on the optimal transplantation strategy. In this context, results of tandem ASCT should also be compared with those of the autologous/reduced intensity conditioning-allo tandem approach. In this review, we discuss how transplantation strategies (auto and allo) can fit into the salvage treatment plan for patients with relapsed/refractory cHL, taking into account the new drugs available and integrating modern risk assessment.

We speculated that improvements could be achieved by transplanting patients in earlier phases of their disease, if necessary after ‘bridging’ using the new drugs, and we propose an algorithm integrating the different treatment options.
Anxiogenic CO2 stimulus elicits exacerbated hot flash-like responses in a rat menopause model and hot flashes in postmenopausal women
Authors: Federici Lauren M. , Roth Sarah Dorsey , Krier Connie , Fitz Stephanie D. , Skaar Todd , Shekhar Anantha , Carpenter Janet S. , Johnson Philip L.
Published: July 2016

Objective:

As longitudinal studies determined that anxiety is a strong risk factor for hot flashes, we hypothesized that an anxiogenic stimulus that signals air hunger (hypercapnic, normoxic gas) would trigger an exacerbated hot flash-associated increase in tail skin temperature (TST) in a rat ovariectomy (OVEX) model of surgical menopause and hot flashes in symptomatic postmenopausal women. We also assessed TST responses in OVEX serotonin transporter (SERT)+/− rats that models a common polymorphism that is associated with increased climacteric symptoms in postmenopausal women and increases in anxiety traits.

Methods:

OVEX and sham-OVEX rats (initial experiment) and wildtype and SERT+/− OVEX rats (subsequent experiment) were exposed to a 5-minute infusion of 20% carbon dioxide (CO2) normoxic gas while measuring TST. Postmenopausal women were given brief 20% and 35% CO2 challenges, and hot flashes were self-reported and objectively verified.

Results:

Compared to controls, OVEX rats had exacerbated increases in TST, and SERT+/− OVEX rats had prolonged TST increases following CO2. Most women reported mild/moderate hot flashes after CO2 challenges, and the hot flash severity to CO2 was positively correlated with daily hot flash frequency.

Conclusions:

The studies demonstrate that this anxiogenic stimulus is capable of inducing cutaneous vasomotor responses in OVEX rats, and eliciting hot flashes in postmenopausal women. In rats, the severity of the response was mediated by loss of ovarian function and increased anxiety traits (SERT+/−), and, in women, by daily hot flash frequency. These findings may provide insights into anxiety-related triggers and genetic risk factors for hot flashes in thermoneutral environments.
Ages at menarche and menopause and reproductive lifespan as predictors of exceptional longevity in women: the Women's Health Initiative
Authors: Shadyab Aladdin H. , Macera Caroline A. , Shaffer Richard A. , Jain Sonia , Gallo Linda C. , Gass Margery L.S. , Waring Molly E. , Stefanick Marcia L. , LaCroix Andrea Z.
Published: July 2016

Objective:

The aim of the present study was to investigate associations between reproductive factors and survival to age 90 years.

Methods:

This was a prospective study of postmenopausal women from the Women's Health Initiative recruited from 1993 to 1998 and followed until the last outcomes evaluation on August 29, 2014. Participants included 16,251 women born on or before August 29, 1924 for whom survival to age 90 during follow-up was ascertained. Women were classified as having survived to age 90 (exceptional longevity) or died before age 90. Multivariable logistic regression models were used to evaluate associations of ages at menarche and menopause (natural or surgical) and reproductive lifespan with longevity, adjusting for demographic, lifestyle, and reproductive characteristics.

Results:

Participants were on average aged 74.7 years (range, 69-81 y) at baseline. Of 16,251 women, 8,892 (55%) survived to age 90. Women aged at least 12 years at menarche had modestly increased odds of longevity (odds ratio [OR], 1.09; 95% CI, 1.00-1.19). There was a significant trend toward increased longevity for later age at menopause (natural or surgical; P
trend = 0.01), with ORs (95% CIs) of 1.19 (1.04-1.36) and 1.18 (1.02-1.36) for 50 to 54 and at least 55 compared with less than 40 years, respectively. Later age at natural menopause as a separate exposure was also significantly associated with increased longevity (P
trend = 0.02). Longer reproductive lifespan was significantly associated with increased longevity (P
trend = 0.008). The odds of longevity were 13% (OR 1.13; 95% CI, 1.03-1.25) higher in women with more than 40 compared with less than 33 reproductive years.

Conclusions:

Reproductive characteristics were associated with late-age survival in older women.
Recurrent Pregnancy Loss: Generally Accepted Causes and Their Management
Authors: KAISER JENNIFER , BRANCH D. WARE
Published: July 2016

Recurrent pregnancy loss (RPL), commonly defined as 3 consecutive losses <10 weeks gestation, affects up to 5% of couples. Well-accepted causes include uterine malformation, antiphospholipid syndrome, and parental chromosomal abnormalities; however, the majority of RPL cases are idiopathic (up to 75%). This chapter covers these accepted causes of RPL and provides diagnosis and management strategies for patients falling within the above categories.
Treatment of Non-ST Elevation Myocardial Infarction: A Process Analysis of Patient and Program Factors in a Teaching Hospital
Authors: Shepple Benjamin I. , Thistlethwaite William A. , Schumann Christopher L. , Akosah Kwame O. , Schutt Robert C. , Keeley Ellen C.
Published: July 2016

As part of a quality improvement project, we performed a process analysis to evaluate how patients presenting with type 1 non-ST elevation myocardial infarction (STEMI) are diagnosed and managed early after the diagnosis has been made. We performed a retrospective chart review and collected detailed information regarding the timing of the first 12-lead electrocardiogram, troponin order entry and first positive troponin result, administration of anticoagulation and antiplatelet medications, and referral for coronary angiography to identify areas of treatment variability and delay. A total of 242 patients with type 1 non-STEMI were included. The majority of patients received aspirin early after presentation to the emergency department; however, there was significant variability in the time from presentation to administration of other medications, including anticoagulation and P2Y12 therapy, even after an elevated troponin level was documented in the chart. Lack of a standardized non-STEMI admission order set, inconsistency regarding whether the emergency department physician or the cardiology admitting team order these medications after the diagnosis is made, and per current protocol, the initial call regarding the patient made to the cardiology fellow, not the admitting house staff, were identified as possible contributors to the delay. Patients who presented during “nighttime” hours had higher rates of atypical symptoms (P = 0.036) and longer delays to coronary angiography (46.5 versus 24 hours, P < 0.001) even in those deemed intermediate to high risk. A process analysis revealed considerable variation in non-STEMI treatment in our teaching hospital and identified specific areas for quality improvement measures.
Development of a Meibomian Gland Dysfunction–Specific Symptom Questionnaire
Authors: Paugh Jerry R. , Kwan Justin , Christensen Michael , Nguyen Andrew Loc , Senchyna Michelle , Meadows David
Published: July 2016

Objectives:

The aim of this study was to develop and evaluate, using psychometric approaches, a meibomian gland dysfunction (MGD)-specific questionnaire in noncontact lens wearers.

Methods:

The MGD subjects were recruited and classified as the MGD dry eye subtype based on accepted tests (e.g., Schein symptom survey, tear breakup time, corneal and conjunctival staining, abnormal meibum or meibomian gland atrophy, and a normal Schirmer test). The MGD questionnaire items were drawn from published and anecdotal sources. The preliminary instrument contained 24 items targeting the frequency and intensity of 12 symptoms. Rasch analysis was used for psychometric evaluation of the survey items.

Results:

Sixty nine MGD subjects completed the survey and clinical testing. Sample severity levels were as follows: none subclinical, 10 minimal, 43 mild, 16 moderate, and none severe. Three iterations of analysis, eliminating INFIT and OUTFIT scores <, and >3.0, and using subject responses reduced the final questionnaire to seven question pairs. Final analysis for the remaining 14 items demonstrated an excellent fit to the Rasch model (e.g., for persons, INFIT MNSQ=0.97; ZSTD=−0.2; OUTFIT MNSQ=0.96; ZSTD=−0.2; item fit statistics were similar). Construct validity also seems good (e.g., correlation to Schein and change with treatment).

Conclusions:

The MGD-specific instrument is a valid quantitative measure of the symptoms stemming from MGD sufferers. Further research is necessary to determine whether diagnostic efficacy is sufficient to differentiate the MGD dry eye subtype in an independent sample of normals and both major dry eye subtypes exhibiting a broad severity range.