bluuebunny/crossref_metadata_2025 huggingface dataset:
On the solid phase crystallization of In2O3:H transparent conductive oxide films prepared by atomic layer deposition
Authors: Macco Bart , Verheijen Marcel A. , Black Lachlan E. , Barcones Beatriz , Melskens J. , Kessels Wilhelmus M. M.
Published: August 2016

Hydrogen-doped indium oxide (In2O3:H) has emerged as a highly transparent and conductive oxide, finding its application in a multitude of optoelectronic devices. Recently, we have reported on an atomic layer deposition (ALD) process to prepare high quality In2O3:H. This process consists of ALD of In2O3:H films at 100 °C, followed by a solid phase crystallization step at 150–200 °C. In this work, we report on a detailed electron microscopy study of this crystallization process which reveals new insights into the crucial aspects for achieving the large grain size and associated excellent properties of the material. The key finding is that the best optoelectronic properties are obtained by preparing the films at the lowest possible temperature prior to post-deposition annealing. Electron microscopy imaging shows that such films are mostly amorphous, but feature a very low density of embedded crystallites. Upon post-deposition annealing, crystallization proceeds merely from isotropic crystal grain growth of these embedded crystallites rather than by the formation of additional crystallites. The relatively high hydrogen content of 4.2 at. % in these films is thought to cause the absence of additional nucleation, thereby rendering the final grain size and optoelectronic properties solely dependent on the density of embedded crystallites. The temperature-dependent grain growth rate has been determined, from which an activation energy of (1.39 ± 0.04) eV has been extracted. Finally, on the basis of the observed crystallization mechanism, a simple model to fully describe the crystallization process has been developed. This model has been validated with a numerical implementation thereof, which accurately predicts the observed temperature-dependent crystallization behaviour.
Enhanced magnetic energy harvesting properties of magneto-mechano-electric generator by tailored geometry
Authors: Annapureddy Venkateswarlu , Lee Ha Young , Yoon Woon-Ha , Woo Hyun-Jae , Lee Ji-Hye , Palneedi Haribabu , Kim Hwee-Jong , Choi Jong-Jin , Jeong Dae-Yong , Yi Sam Nyung , Ryu Jungho
Published: August 2016

By tailoring the truncated shape of a cantilever structured magneto-mechano-electric (MME) generator that is composed of a piezoelectric single crystal fiber composite and a magnetostrictive Ni plate, a superior output harvesting power density of over 680% was obtained as compared to a typical rectangular shaped generator. The effect of the MME generator's shape on the strain distribution induced by magnetostriction and vibration characteristics and harvesting properties were simulated by finite element analysis modeling and confirmed experimentally, respectively. The truncated shape was effective for not only utilizing a more uniform in-plane strain distribution in the active piezoelectric area but also magnifying the flexural vibration amplitude, which in turn can make the generator more powerful under tiny magnetic oscillations.
A centre-triggered magnesium fuelled cathodic arc thruster uses sublimation to deliver a record high specific impulse
Authors: Neumann Patrick R. C. , Bilek Marcela , McKenzie David R.
Published: August 2016

The cathodic arc is a high current, low voltage discharge that operates in vacuum and provides a stream of highly ionised plasma from a solid conducting cathode. The high ion velocities, together with the high ionisation fraction and the quasineutrality of the exhaust stream, make the cathodic arc an attractive plasma source for spacecraft propulsion applications. The specific impulse of the cathodic arc thruster is substantially increased when the emission of neutral species is reduced. Here, we demonstrate a reduction of neutral emission by exploiting sublimation in cathode spots and enhanced ionisation of the plasma in short, high-current pulses. This, combined with the enhanced directionality due to the efficient erosion profiles created by centre-triggering, substantially increases the specific impulse. We present experimentally measured specific impulses and jet power efficiencies for titanium and magnesium fuels. Our Mg fuelled source provides the highest reported specific impulse for a gridless ion thruster and is competitive with all flight rated ion thrusters. We present a model based on cathode sublimation and melting at the cathodic arc spot explaining the outstanding performance of the Mg fuelled source. A further significant advantage of an Mg-fuelled thruster is the abundance of Mg in asteroidal material and in space junk, providing an opportunity for utilising these resources in space.
Electric-field modulation of photoinduced effect in phase-separated Pr0.65 (Ca0.75Sr0.25)0.35MnO3/PMN-PT heterostructure
Authors: Li W. , Dong X. L. , Wang S. H. , Jin K. X.
Published: August 2016

In this letter, we report the photoinduced effect modulated by different electric fields in the Pr0.65 (Ca0.75Sr0.25)0.35MnO3/0.7PbMg1/3Nb2/3O3-0.3PbTiO3 heterostructure. The film exhibits a decrease in the resistance up to five orders of magnitude by enhancing applied electric fields, combined with an electric-field-induced insulator-to-metal transition. More interestingly, a reversible bistability arises in the photoinduced change in resistance at T < 80 K as the voltages are increased. The results can be attributed to the phase separation in manganites, which provides a prototype of photoelectric conversion for electric-field modulation of all-oxide heterostructures.
Technique for the comparison of light spectra from natural and laboratory generated lightning current arcs
Authors: Mitchard D. , Clark D. , Carr D. , Haddad A.
Published: August 2016

A technique was developed for the comparison of observed emission spectra from lightning current arcs generated through self-breakdown in air and the use of two types of initiation wire, aluminum bronze and nichrome, against previously published spectra of natural lightning events. A spectrograph system was used in which the wavelength of light emitted by the lightning arc was analyzed to derive elemental interactions. A lightning impulse of up to 100 kA was applied to a two hemispherical tungsten electrode configuration which allowed the effect of the lightning current and lightning arc length to be investigated. A natural lightning reference spectrum was reconstructed from literature, and generated lightning spectra were obtained from self-breakdown across a 14.0 mm air gap and triggered along initiation wires of length up to 72.4 mm. A comparison of the spectra showed that the generated lightning arc induced via self-breakdown produced a very similar spectrum to that of natural lightning, with the addition of only a few lines from the tungsten electrodes. A comparison of the results from the aluminum bronze initiation wire showed several more lines, whereas results from the nichrome initiation wire differed greatly across large parts of the spectrum. This work highlights the potential use for spectrographic techniques in the study of lightning interactions with surrounding media and materials, and in natural phenomena such as recently observed ball lightning.
Air-coupled method to investigate the lowest-order antisymmetric Lamb mode in stubbed and air-drilled phononic plates
Authors: Zhang Dongbo , Zhao Jinfeng , Bonello Bernard , Li Libing , Wei Jianxin , Pan Yongdong , Zhong Zheng
Published: August 2016

In this work, we applied a robust and fully air-coupled method to investigate the propagation of the lowest-order antisymmetric Lamb (A0) mode in both a stubbed and an air-drilled phononic-crystal (PC) plate. By measuring simply the radiative acoustic waves of A0 mode close to the plate surface, we observed the band gaps for the stubbed PC plate caused by either the local resonance or the Bragg scattering, in frequency ranges in good agreement with theoretical predictions. We measured then the complete band gap of A0 mode for the air-drilled PC plate, in good agreement with the band structures. Finally, we compared the measurements made using the air-coupled method with those obtained by the laser ultrasonic technique.
Thermodynamically controlled crystallization of glucose pentaacetates from amorphous phase
Authors: Wlodarczyk P. , Hawelek L. , Hudecki A. , Wlodarczyk A. , Kolano-Burian A.
Published: August 2016

The α and β glucose pentaacetates are known sugar derivatives, which can be potentially used as stabilizers of amorphous phase of active ingredients of drugs (API). In the present work, crystallization behavior of equimolar mixture of α and β form in comparison to both pure anomers is revealed. It was shown that despite the same molecular interactions and similar molecular dynamics, crystallization from amorphous phase is significantly suppressed in equimolar mixture. Time dependent X-ray diffraction studies confirmed higher stability of the quenched amorphous equimolar mixture. Its tendency to crystallization is about 10 times lower than for pure anomers. Calorimetric studies revealed that the α and β anomers don’t form solid solutions and have eutectic point for xα = 0.625. Suppressed crystallization tendency in the mixture is probably caused by the altered thermodynamics of the system. The factors such as difference of free energy between crystalline and amorphous state or altered configurational entropy are probably responsible for the inhibitory effect.
Discovery of a free-living nematode phylogenetically related to vertebrate parasites of the genus Strongyloides (Nematoda : Strongyloidoidea): morphological, anatomical and molecular characterisation
Authors: Huang Ren-E , Li Runsheng , Zhao Zhongying
Published: August 2016

Nematodes are important, largely because they frequently act as parasites and threaten the health of plants, animals and even humans. Here, we describe an interesting free-living nematode from land snails on Luofu Mountain, Guangdong, China. Alloionema luofuensis, sp. nov. is phylogenetically related to slug-parasite A. appendiculatum and the well-known vertebrate parasites Strongyloides spp. based on small subunit (SSU) and the D2-D3 domain of large subunit (LSU) rDNA sequences. The new species possesses an extremely transparent body and is easily maintained using C. elegans culture media, suggesting a possible application prospect of this free-living nematode as a comparative model system for its related parasites. Morphology and anatomy of the gonochoristic A. luofuensis, sp. nov. adult were described and illustrated. The species is characterised by a filiform tail bisexually, ‘rhabditiform’ oesophagus and ‘rhabditid-like’ female anatomy, but its male caudal region is completely different from that of typical rhabditid nematodes, being absent from an enveloping bursa. It is the first marker taxon characterised morphologically as well as molecularly from the family Alloionematidae, a group of nematodes with hyperdiverse molecular genetic variations underlying highly conserved anatomy. Further molecular and genetic studies on A. luofuensis, sp. nov. populations hold promise to provide insight into evolution of the clade consisting of vertebrate parasites of the heterogonic nematode genus Strongyloides. This is because of its unusual high levels of heterozygosity maintained by the conserved rRNA genes of partial SSU and the D2-D3 domain of LSU for the type isolate of this species.
Reinventing the leaf: multiple origins of leaf-like wings in katydids (Orthoptera : Tettigoniidae)
Authors: Mugleston Joseph , Naegle Michael , Song Hojun , Bybee Seth M. , Ingley Spencer , Suvorov Anton , Whiting Michael F.
Published: August 2016

Insects have developed incredible means to avoid detection by predators. At least five insect orders have species that resemble leaves. Katydids (Orthoptera : Tettigoniidae) are the most diverse and wide-ranging of the leaf-like insects. At least 14 of the 20 extant katydid subfamilies contain species with leaf-like wings. Although it is undisputed that many katydids resemble leaves, methods for delineating the leaf-like from non-leaf-like forms have varied by author and in many cases are not explicitly stated. We provide a simple ratio method that can be used to differentiate the leaf-like and non-leaf-like forms. Geometric morphometrics were used to validate the ratio method. Leaf-like wings have been independently derived in at least 15 katydid lineages. Relative rates of speciation were found to be greater in the non-leaf-like forms, suggesting that leaf-like wings within Tettigoniidae are not a driver of diversification. Likewise, throughout Tettigoniidae, selection seems to be favouring the transition away from leaf-like wings. However, within the large Phaneropterinae subclade, relative speciation and transition rates between the leaf-like and non-leaf-like forms do not differ significantly.
Bifidochaetus, a new Arctic genus of freshwater Chaetonotida (Gastrotricha) from Spitsbergen revealed by an integrative taxonomic approach
Authors: Kolicka Małgorzata , Dabert Miroslawa , Dabert Jacek , Kånneby Tobias , Kisielewski Jacek
Published: August 2016

Gastrotricha is a cosmopolitan phylum of aquatic and semi-terrestrial invertebrates that comprises ~820 described species. To date, freshwater gastrotrichs have not been the subject of faunistic or taxonomic research in the polar regions. In this paper, we present the first species-level description of a freshwater gastrotrich from the Arctic (Svalbard Archipelago). Evidence from morphology, morphometry and molecular analyses reveals that the species represents a new genus in Chaetonotidae: Bifidochaetus arcticus, gen. et sp. nov. Taking into consideration many morphological similarities to Chaetonotus (Primochaetus) veronicae Kånneby, 2013 we propose to include C. (P.) veronicae in the newly established genus under the new combination Bifidochaetus veronicae (Kånneby, 2013), comb. nov. In the phylogenetic analysis based on nuclear 18S rRNA, 28S rRNA and mitochondrial cytochrome c oxidase subunit I sequence data, B. arcticus, gen. et sp. nov. is nested within the family Chaetonotidae, as the sister group to the genus Lepidochaetus Kisielewski, 1991. In this paper we also present new taxonomic characters useful for gastrotrich taxonomy: the pharynx-to-intestine length ratio (I) and the spine bifurcation ratio (B).
Phylogenetic systematics of the land snail Basedowena from the Australian arid zone: taxonomic revision with description of new taxa (Stylommatophora : Camaenidae)
Authors: Criscione Francesco , Köhler Frank
Published: August 2016

The land snail Basedowena Iredale, 1937 currently comprises eight species that inhabit mountain ranges in the central Australian arid zone. By studying the variation in shell and genital anatomy and the differentiation in the mitochondrial markers 16S and COI, we revise the taxonomy of this camaenid and describe new taxa. We demonstrate that the current morphology-based classification has been misled by homoplasy mainly in shell shape. In fact, Basedowena as herein revised contains species with vastly different shells, which have so far been assigned to different genera. By contrast, these species have the same general genital anatomy in common and form a clade in the mitochondrial phylogeny. Based on these findings, we transfer Pleuroxia bethana, P. hinsbyi, P. elfina, P. oligopleura, P. polypleura, P. radiata, Montanomelon angatjana and Minimelon colmani to Basedowena. While Pleuroxia and Montanomelon are maintained as distinct genera, although with fewer species, the monotypic Minimelon becomes a junior synonym of Basedowena. We identify and describe three new Basedowena species (B. bicolor, sp. nov., B. holoserica, sp. nov., B. siparium, sp. nov.). A fourth new species differs substantially from all other arid zone camaenids and is hence placed in a new genus, Xeromelon, gen. nov. The revised delineation of Basedowena renders it now the most widespread camaenid genus in Australia. It is distributed throughout the Australian arid zone from Western Australia, via the Northern Territory and South Australia into New South Wales.
Extracting multistage screening rules from online dating activity data
Authors: Bruch Elizabeth , Feinberg Fred , Lee Kee Yeun
Published: August 2016

Significance

Online activity data—for example, from dating, housing search, or social networking websites—make it possible to study human behavior with unparalleled richness and granularity. However, researchers typically rely on statistical models that emphasize associations among variables rather than behavior of human actors. Harnessing the full informatory power of activity data requires models that capture decision-making processes and other features of human behavior. Our model aims to describe mate choice as it unfolds online. It allows for exploratory behavior and multiple decision stages, with the possibility of distinct evaluation rules at each stage. This framework is flexible and extendable, and it can be applied in other substantive domains where decision makers identify viable options from a larger set of possibilities.
SHAPE reveals transcript-wide interactions, complex structural domains, and protein interactions across the
Xist
lncRNA in living cells
Authors: Smola Matthew J. , Christy Thomas W. , Inoue Kaoru , Nicholson Cindo O. , Friedersdorf Matthew , Keene Jack D. , Lee David M. , Calabrese J. Mauro , Weeks Kevin M.
Published: August 2016

Significance

Long noncoding RNAs (lncRNAs) are important regulators of gene expression, but their structural features are largely unknown. We used structure-selective chemical probing to examine the structure of the
Xist
lncRNA in living cells and found that the RNA adopts well-defined and complex structures throughout its entire 18-kb length. By looking for changes in reactivity induced by the cellular environment, we were able to identify numerous previously unknown hubs of protein interaction. We also found that the
Xist
structure governs specific protein interactions in multiple distinct ways. Our results provide a detailed structural context for
Xist
function and lay a foundation for understanding structure–function relationships in all lncRNAs.
Propagation of trimethylated H3K27 regulated by polycomb protein EED is required for embryogenesis, hematopoietic maintenance, and tumor suppression
Authors: Ueda Takeshi , Nakata Yuichiro , Nagamachi Akiko , Yamasaki Norimasa , Kanai Akinori , Sera Yasuyuki , Sasaki Masato , Matsui Hirotaka , Honda Zen-ichiro , Oda Hideaki , Wolff Linda , Inaba Toshiya , Honda Hiroaki
Published: August 2016

Significance

Polycomb repressive complex 2 (PRC2) is a central regulator in all forms of histone H3 Lys27 (H3K27) methylation. Interaction of embryonic ectoderm development (EED) with trimethylated H3K27 (H3K27me3) is required for the allosteric activation of PRC2. We previously identified a myeloid disorder-associated EED Ile363Met (I363M) mutation with impaired binding ability to H3K27me3. By generating I363M knock-in mice, we demonstrated that I363M preferentially dampened the propagation of H3K27me3 repressive marks in vivo. The homozygotes caused embryonic lethality, whereas the heterozygotes enhanced hematopoietic stem/progenitor cell (HSPC) activity, coupled with susceptibility to leukemia.
Lgals3
, a PRC2 target gene, was derepressed by I363M, which enhanced the stemness of HSPCs. Our findings highlight the significance of the structural integrity of EED in cellular homeostasis and tumor suppression.
RPT2/NCH1 subfamily of NPH3-like proteins is essential for the chloroplast accumulation response in land plants
Authors: Suetsugu Noriyuki , Takemiya Atsushi , Kong Sam-Geun , Higa Takeshi , Komatsu Aino , Shimazaki Ken-ichiro , Kohchi Takayuki , Wada Masamitsu
Published: August 2016

Significance

The photoreceptor phototropin mediates various blue light-induced responses, including phototropism, chloroplast movement, stomatal opening, and leaf flattening. Two BTB/POZ proteins, NONPHOTOTROPIC HYPOCOTYL 3 (NPH3) and ROOT PHOTOTROPISM 2 (RPT2), were identified as early signaling components in phototropin-mediated phototropism and leaf flattening, and a phototropin substrate, BLUE LIGHT SIGNALING1 kinase, specifically mediates the phototropin-mediated stomatal opening. However, early signaling components in the chloroplast movement remain to be determined. We found that RPT2 and the NPH3/RPT2-like (NRL) protein NRL PROTEIN FOR CHLOROPLAST MOVEMENT 1 (NCH1) redundantly mediate the chloroplast accumulation response but not the avoidance response. Our findings indicate that phototropin-mediated phototropism, leaf flattening, and the chloroplast accumulation response, but not the chloroplast avoidance response and stomatal opening, are mediated by NRL proteins.
Understanding the yield behaviour of L12-ordered alloys
Authors: Wang-Koh Y. M.
Published: August 2016

Nickel superalloys exhibit a remarkable characteristic. Their yield stress that required to cause the onset of plastic deformation increases with temperature. This typically occurs up to a temperature of around 800°C. This effect is thought to originate from the precipitates of the microstructure, which have an L12-ordered crystal structure. A number of other L12-based alloys exhibit similar yield properties. It is generally accepted that this is caused by the exhaustion of dislocations by cross-slip from {111} glide planes to {010} planes on which they are sessile. However, the underlying mechanisms that control this cross-slipping process are yet to be fully understood, with little consistency between empirical results and theory. A critical review of the various theories surrounding nickel superalloys is offered.
Retention Rates of Passive Integrated Transponder Tags, Visible Implant Elastomer Tags, and Maxillary Marks in Wild Trout
Authors: Mamer Elizabeth R. J. M. , Meyer Kevin A.
Published: August 2016

Tagging or marking is a common method to identify individuals or groups of fish, but these tools are compromised if tags or marks are shed or deteriorate over time. We evaluated retention rates of passive integrated transponder (PIT) tags, visible implant elastomer (VIE) tags, and maxillary clips in stream-dwelling Yellowstone Cutthroat Trout Oncorhynchus clarkii bouvieri and Rainbow Trout O. mykiss of spawning size. We tagged 2,891 fish ≥150 mm TL with PIT tags in the body cavity, muscle tissue posterior to the cleithrum, or muscle tissue ventral to the dorsal fin. Retention of PIT tags in the body cavity of fish at large for 1 year (72.1%) was lower than those implanted in the dorsal musculature (94.1%) or cleithrum (83.5%) locations. For PIT tags implanted in the body cavity, retention was lower for females (59.4%) than males (89.7%), suggesting that PIT tags implanted in the body cavity were expelled with eggs during spawning events. Retention of PIT tags implanted in the cleithrum and dorsal musculature were unaffected by sex, but retention rates decreased as body size increased for the body cavity tagging location. Annual growth rates were not affected by any PIT tag location. We observed a PIT tag failure rate of 1.7%. The likelihood of a PIT tag being retained in muscle tissue after filleting the fish was highest for the dorsal musculature location (65.1%), followed by the cleithrum (64.9%) and body cavity (4.0%) locations. One-year retention rates were 95.4% for VIE tags and 93.0% for maxillary clips. While our results demonstrate higher PIT tag retention in the musculature than the body cavity, human consumption concerns may prohibit the use of musculature implantation where angler harvest is possible.

Received January 28, 2016; accepted May 11, 2016 Published online August 31, 2016
Comparing Life History Characteristics of Lake Michigan's Naturalized and Stocked Chinook Salmon
Authors: Kerns Janice A. , Rogers Mark W. , Bunnell David B. , Claramunt Randall M. , Collingsworth Paris D.
Published: August 2016

Lake Michigan supports popular fisheries for Chinook Salmon Oncorhynchus tshawytscha that have been sustained by stocking since the late 1960s. Natural recruitment of Chinook Salmon in Lake Michigan has increased in the past few decades and currently contributes more than 50% of Chinook Salmon recruits. We hypothesized that selective forces differ for naturalized populations born in the wild and hatchery populations, resulting in divergent life history characteristics with implications for Chinook Salmon population production and the Lake Michigan fishery. First, we conducted a historical analysis to determine if life history characteristics changed through time as the Chinook Salmon population became increasingly naturalized. Next, we conducted a 2-year field study of naturalized and hatchery stocked Chinook Salmon spawning populations to quantify differences in fecundity, egg size, timing of spawning, and size at maturity. In general, our results did not indicate significant life history divergence between naturalized and hatchery-stocked Chinook Salmon populations in Lake Michigan. Although historical changes in adult sex ratio were correlated with the proportion of naturalized individuals, changes in weight at maturity were better explained by density-dependent factors. The field study revealed no divergence in fecundity, timing of spawning, or size at maturity, and only small differences in egg size (hatchery > naturalized). For the near future, our results suggest that the limited life history differences observed between Chinook Salmon of naturalized and hatchery origin will not lead to large differences in characteristics important to the dynamics of the population or fishery.

Received February 15, 2016; accepted June 6, 2016 Published online August 31, 2016
Residual stresses at weld repairs and effects of repair geometry
Authors: Song S. , Dong P.
Published: August 2016

In this study, an in-depth investigation of repair weld geometry effects on residual stress distributions in terms of both through-thickness membrane and bending content as well as its contribution to fracture driving force is carried out. Some major findings are: A fundamental difference in residual stress distributions between initial and repair welds can be characterised as a significant elevation of membrane and bending content in transverse residual stresses. The dominance of repair-induced residual stresses over those generated by initial welds suggests that initial weld residual stresses can be assumed negligible in repair weld modelling. A weld repair should be designed as long as possible, as narrow as possible and as shallow as possible.
Virtual exploration of early stage atherosclerosis
Authors: Olivares Andy L. , González Ballester Miguel A. , Noailly Jérôme
Published: August 2016

Motivation: Biological mechanisms contributing to atherogenesis are multiple and complex. The early stage of atherosclerosis (AS) is characterized by the accumulation of low-density lipoprotein (LDL) droplets, leading to the creation of foam cells (FC). To address the difficulty to explore the dynamics of interactions that controls this process, this study aimed to develop a model of agents and infer on the most influential cell- and molecule-related parameters.

Results: FC started to accumulate after six to eight months of simulated hypercholesterolemia. A sensitivity analysis revealed the strong influence of LDL oxidation rate on the risk of FC creation, which was exploited to model the antioxidant effect of statins. Combined with an empirical simulation of the drug ability to decrease the level of LDL, the virtual statins treatment led to reductions of oxidized LDL levels similar to reductions measured in vivo.

Availability and Implementation: An Open source software was used to develop the agent-based model of early AS. Two different concentrations of LDL agents were imposed in the intima layer to simulate healthy and hypercholesterolemia groups of ‘virtual patients’. The interactions programmed between molecules and cells were based on experiments and models reported in the literature. A factorial sensitivity analysis explored the respective effects of the less documented model parameters as (i) agent migration speed, (ii) LDL oxidation rate and (iii) concentration of autoantibody agents. Finally, the response of the model to known perturbations was assessed by introducing statins agents, able to reduce the oxidation rate of LDL agents and the LDL boundary concentrations.

Contact:  jerome.noailly@upf.edu

Supplementary information:  Supplementary data are available at Bioinformatics online.
STAT4 is required for the generation of Th1 and Th2, but not Th17 immune responses during monophosphoryl lipid A adjuvant activity
Authors: Varikuti Sanjay , Oghumu Steve , Natarajan Gayathri , Kimble Jennifer , Sperling Rachel H , Moretti Ellen , Kaplan Mark H , Satoskar Abhay R
Published: August 2016

STAT4 is critical for the production of IFN-γ during the generation of Th1 immune responses. We investigated the role of STAT4 in mediating Th1-inducing activity of a vaccine adjuvant monophosphoryl lipid A (MPL-A) using the standard antigen ovalbumin (OVA) in STAT4KO mice. Our results show that splenocytes from STAT4KO mice displayed lower OVA-specific T-cell proliferation and IL-2 production compared with wild-type (WT) mice. Further, IFN-γ production was diminished in STAT4KO-derived splenocytes but the levels of IL-12 and TNF-α were similar compared with WT mice. Interestingly, STAT4 deficiency also led to a decrease in IL-10 and Th2 cytokines such as IL-4 and IL-13 upon MPL-A immunization, although IL-17 production was similar between WT- and STAT4KO-derived splenocytes. Our observations for defective Th1 and Th2 responses in STAT4KO mice were further supported by the low levels of Th1-associated IgG2a and Th2-associated IgG1 in the sera of these mice. Taken together, our results show that STAT4 plays a critical role in mediating both Th1 and Th2 responses upon immunization with MPL-A. Our study provides a better understanding of how MPL-A mediates T-cell activation which will be critical for future vaccine development.
Navigating a ship with a broken compass: evaluating standard algorithms to measure patient safety
Authors: Hefner Jennifer L , Huerta Timothy R , McAlearney Ann Scheck , Barash Barbara , Latimer Tina , Moffatt-Bruce Susan D
Published: August 2016

Objective: Agency for Healthcare Research and Quality (AHRQ) software applies standardized algorithms to hospital administrative data to identify patient safety indicators (PSIs). The objective of this study was to assess the validity of PSI flags and report reasons for invalid flagging.

Material and Methods: At a 6-hospital academic medical center, a retrospective analysis was conducted of all PSIs flagged in fiscal year 2014. A multidisciplinary PSI Quality Team reviewed each flagged PSI based on quarterly reports. The positive predictive value (PPV, the percent of clinically validated cases) was calculated for 12 PSI categories. The documentation for each reversed case was reviewed to determine the reasons for PSI reversal.

Results: Of 657 PSI flags, 185 were reversed. Seven PSI categories had a PPV below 75%. Four broad categories of reasons for reversal were AHRQ algorithm limitations (38%), coding misinterpretations (45%), present upon admission (10%), and documentation insufficiency (7%). AHRQ algorithm limitations included 2 subcategories: an “incident” was inherent to the procedure, or highly likely (eg, vascular tumor bleed), or an “incident” was nonsignificant, easily controlled, and/or no intervention was needed.

Discussion: These findings support previous research highlighting administrative data problems. Additionally, AHRQ algorithm limitations was an emergent category not considered in previous research. Herein we present potential solutions to address these issues.

Conclusions: If, despite poor validity, US policy continues to rely on PSIs for incentive and penalty programs, improvements are needed in the quality of administrative data and the standardized PSI algorithms. These solutions require national motivation, research attention, and dissemination support.
Role of Suppressive Oral Antibiotics in Orthopedic Hardware Infections for Those Not Undergoing Two-Stage Replacement Surgery
Authors: Keller Sara C. , Cosgrove Sara E. , Higgins Yvonne , Piggott Damani A. , Osgood Greg , Auwaerter Paul G.
Published: August 2016

Background.  The use of suppressive antibiotics in treatment of orthopedic hardware infections (OHIs), including spinal hardware infections, prosthetic joint infections, and infections of internal fixation devices, is controversial.

Methods.  Over a 4-year period at 2 academic medical centers, patients with OHI who were treated with debridement and retention of hardware components, with single-stage exchange, or without surgery were studied to determine whether use of oral antibiotics for at least 6 months after diagnosis impacts successful treatment of the infection at 1 year after diagnosis.

Results.  Of 89 patients in the study, 42 (47.2%) were free of clinical infection 1 year after initial diagnosis. Suppressive antibiotics used for at least 6 months after diagnosis was not associated with being free of clinical infection (adjusted odds ratio [aOR], 5.29; 95% confidence interval [CI], .74–37.80), but being on suppressive antibiotics at least 3 months after diagnosis was associated with being free of clinical infection (OR, 3.50; 95% CI, 1.30–9.43). Causative organisms impacted the likelihood of success; patients with methicillin-resistant Staphylococcus aureus as well as with Gram-negative rods were both less likely to have achieved clinical success at 1 year after surgery (aOR = 0.018, 95% CI = .0017–.19 and aOR = 0.20, 95% CI = .039–.99, respectively).

Conclusions.  Oral suppressive antibiotic therapy in treatment of OHI with retention of hardware for 3 months, but not 6 months, postdiagnosis increases the likelihood of treatment success. The organisms implicated in the infection directly impact the likelihood of treatment success.
Clinical Characteristics and Outcomes Among Individuals With Spinal Implant Infections: A Descriptive Study
Authors: Baxi Sanjiv M. , Robinson Makeda L. , Grill Marie F. , Schwartz Brian S. , Doernberg Sarah B. , Liu Catherine
Published: August 2016

Little is known about the clinical presentation and outcomes associated with spinal implant infections. Here, we describe a single center's experience in a retrospective cohort of 109 individuals with spinal implant infections, including clinical, microbiological, therapeutic, and outcome data.
Decreasing Incidence of Skin and Soft Tissue Infections With a Seasonal Pattern at an Academic Medical Center, 2006–2014
Authors: Morgan Ethan , Daum Robert S. , David Michael Z.
Published: August 2016

Background.  The incidence of skin and soft tissue infections (SSTIs) in the United States increased sharply after 2000 with the emergence of USA300 methicillin-resistant Staphylococcus aureus. We examined trends in SSTI incidence in 2006–2014 at the University of Chicago Medicine (UCM).

Methods.  Data were obtained for patient encounters at UCM with an International Classification of Diseases, Ninth Revision-coded SSTI diagnosis between January 1, 2006 and March 31, 2014. Incidence density was calculated per 1000 encounters by quarter and year. Encounters were stratified by inpatient, outpatient clinic and emergency department (ED) encounters and by age group, gender, and race. Poisson regression was used to assess change over time.

Results.  In 2006–2014, data were collected for 38 201 SSTI-associated encounters among 31 869 subjects. Among all patients treated at UCM, there was a decrease of 1% per year in the incidence of SSTIs during 2006–2013, with an overall decrease of 16%. There was a significant decrease in SSTI-related encounters among inpatients (rate ratio [RR] = 0.97; 95% confidence interval [CI], .96–.98), ED patients (RR = 0.98; 95% CI, .97–.98), adults (RR = 0.98; 95% CI, .97–.98), children (RR = 0.96; 95% CI, .95–.97), and African Americans (RR = 0.99; 95% CI, .98–.99). There was an annual seasonal trend, with the peak incidence occurring during the late summer.

Conclusions.  The incidence of SSTIs at UCM decreased in children and adults with seasonal variation, peaking during the summer months. This suggests a reversal of the massive increase in SSTI incidence in the United States after 2000.
An unusual cause of pericardial effusion
Authors: Lamkin Christina , Hamner Lawrence R.
Published: August 2016

A patient who presented with chest pain, shortness of breath, and a purulent pericardial effusion became hemodynamically unstable after recurrent accumulation of fluid in the pericardial sac despite treatment. Surgical exploration revealed an aortic ulcer created by an ingested porcupine quill that perforated the esophagus. Sharp foreign body ingestion is extremely rare but poses devastating complications, and should be considered in the differential diagnosis of patients with otherwise unexplained chest pain.
Can the anticoagulant effects of dabigatran be reversed?
Authors: Bickley Aida Rebecca , Wallace Caleb
Published: August 2016

Idarucizumab is a humanized monoclonal antibody fragment for reversal of the anticoagulant effects of dabigatran. This drug can be used for patients who need emergency surgery or invasive procedures, as well as those with life-threatening or uncontrolled bleeding.
The current state of prostate-specific antigen testing
Authors: Lewis Ryan , Hornberger Brad
Published: August 2016

Since prostate-specific antigen (PSA) testing was approved in 1994, the incidence of metastasis and mortality from prostate cancer have significantly decreased. However, PSA screening for prostate cancer has limitations and few large randomized controlled trials have been conducted to determine the mortality benefit of PSA screening. Two studies that have been conducted are the Prostate, Lung, Colorectal, and Ovarian (PLCO) screening trial and the European Randomized Study of Screening for Prostate Cancer (ERSPC). These were the two main studies the US Preventive Services Task Force (USPSTF) used in its recommendation against prostate cancer screening in 2012. However, new evidence has demonstrated that the PLCO trial had significant limitations and the results of the ERSPC trial were more significant than previously thought. This article describes the strengths and weaknesses of the USPSTF's recommendation, along with current guidelines for prostate cancer screening.
Struggling With Adversities of Life
Authors: Offenbaecher Martin , Dezutter Jessie , Kohls Niko , Sigl Claudia , Vallejo Miguel A. , Rivera Javier , Bauerdorf Felix , Schelling Jörg , Vincent Ann , Hirsch Jameson K. , Sirois Fuschia M. , Webb Jon R. , Toussaint Loren L.
Published: August 2016

Objectives:

We compared the magnitude and direction of associations between forgiveness and pain, mental and physical health, quality of life, and anger in a sample of fibromyalgia syndrome (FM) participants and healthy controls. In addition, we compared FM and controls on mean levels of these variables.

Materials and Methods:

A total of 173 individuals with FM and 81 controls completed this study. FM participants and controls were residents of Germany recruited with the support of the German Fibromyalgia Patient Association and several self-help groups. FM participants and controls were about 53 years of age, mostly married (70%), Christians (81%), with levels of education ranging from 9 to 13+ years. All participants completed assessments of forgiveness, pain, health, quality of life, and anger.

Results:

Analyses revealed that FM participants reported higher pain and anger and poorer health and quality of life. FM participants also reported lower levels of both forgiveness of self and others. Size and direction of associations of forgiveness with pain, health, quality of life, and anger in were not significantly different between healthy individuals and individuals with FM.

Discussion:

Forgiveness of self and others is beneficially associated with pain, health, quality of life, and anger in FM participants at levels that are of similar size and direction as in healthy controls. However, FM participants manifest lower levels of forgiveness of self and others. Therapeutic promotion of forgiveness as a psychosocial coping strategy may help patients with FM to better manage psychological and physical symptoms, thereby enhancing well-being.
Getting Back to Living
Authors: Bruce Barbara K. , Ale Chelsea M. , Harrison Tracy E. , Bee Susan , Luedtke Connie , Geske Jennifer , Weiss Karen E.
Published: August 2016

Objective:

This study examined key functional outcomes following a 3-week interdisciplinary pediatric pain rehabilitation program for adolescents with chronic pain. Maintenance of gains was evaluated at 3-month follow-up.

Methods:

Participants included 171 adolescents (12 to 18 y of age) with chronic pain who completed a hospital-based outpatient pediatric pain rehabilitation program. Participants completed measures of functional disability, depressive symptoms, pain catastrophizing, opioid use, school attendance, and pain severity at admission, discharge, and at 3-month follow-up.

Results:

Similar to other interdisciplinary pediatric pain rehabilitation program outcome studies, significant improvements were observed at the end of the program. These improvements appeared to be maintained or further improved at 3-month follow-up. Nearly 14% of the patients were taking daily opioid medication at admission to the program. All adolescents were completely tapered off of these medications at the end of the 3-week program and remained abstinent at 3-month follow-up.

Discussion:

This study adds to the available data supporting interdisciplinary pediatric pain rehabilitation as effective in improving functioning and psychological distress even when discontinuing opioids. Implications for future research and limitations of the study are discussed.
Esophageal Perforation in a Cervical Fracture Patient With Progressed Ankylosing Spondylitis
Authors: Wang Jianxi , Shi Liangyu , Chen Huajiang , Yuan Wen
Published: August 2016

Study Design.

Case report and review of relevant literature.

Objective.

To report a rare complication of esophageal perforation in cervical fracture patient with progressive ankylosing spondylitis (AS) and review of relevant literature.

Summary of Background Data.

Esophageal perforation in cervical fracture is extremely rare. This complication has never been reported in AS patients. Key points in the early diagnosis and management of this severe complication along with the cervical fracture were presented in detail in this case report.

Methods.

A 61-year-old male with AS, who sustained C6 fracture and dislocation after a vehicle accident. Initial treatment strategy was combined anterior-posterior fixation and fusion. Although esophageal perforation in the dorsal wall of esophagus was detected in anterior surgery. After thorough debridement, the esophageal lesion was closed by resorbable interrupted sutures. Surgical incision was washed by saline and hydrogen peroxide without primary closure. Cervical fracture was treated by long level posterior fixation alone. After surgery, the anterior surgical incision was irrigated with normal saline twice a day and closed 3 weeks later.

Results.

Esophageal perforation was healed completely and neurologic results were improved significantly after surgery. Union of the fracture and segmental stability of cervical spine was confirmed radiologically at 1-year follow up.

Conclusion.

Esophageal perforation in cervical fracture patient with progressed AS is an extremely rare and potentially life-threatening complication. Surgical debridement and drainage with intensive care are essential for good outcome.

Level of Evidence: 5
Co-Creating Quality in Health Care Through Learning and Dissemination
Authors: Holmboe Eric S. , Foster Tina C. , Ogrinc Greg
Published: August 2016

For most of the 20th century the predominant focus of medical education across the professional continuum was the dissemination and acquisition of medical knowledge and procedural skills. Today it is now clear that new areas of focus, such as interprofessional teamwork, care coordination, quality improvement, system science, health information technology, patient safety, assessment of clinical practice, and effective use of clinical decision supports are essential to 21st century medical practice. These areas of need helped to spawn an intense interest in competency-based models of professional education at the turn of this century. However, many of today's practicing health professionals were never educated in these newer competencies during their own training. Co-production and co-creation of learning among interprofessional health care professionals across the continuum can help close the gap in acquiring needed competencies for health care today and tomorrow. Co-learning may be a particularly effective strategy to help organizations achieve the triple aim of better population health, better health care, and lower costs. Structured frameworks, such as the Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines, provide guidance in the design, planning, and dissemination of interventions designed to improve care through co-production and co-learning strategies.
Medical Teachers' Humanistic Perspective on Pedagogy: A New Starting Point for Faculty Development
Authors: Barrett Jenny , Yates Lyn , McColl Geoffrey
Published: August 2016

Introduction:

This study investigated the perspectives on pedagogy held by medical teachers in hospitals.

Methods:

The teachers were interviewed after they had been observed in both clinical and classroom settings.

Results:

The study showed the teachers' reliance on the relational aspects of pedagogy more than on technical pedagogical knowledge. Teachers referred to their aims and approaches as “interactive,” but this does not refer to any deliberate pedagogical design or acts. Asking questions was the technique used most commonly but not always skillfully, and they cited influences from the past rather than the present or the future.

Discussion:

This research suggests the pedagogic approach of these medical teachers is “humanistic.” It emphasizes personal and interpersonal factors, meaningful learning, and the affective, as well as cognitive aspects of clinical knowledge. It also captures a commitment to nonthreatening, nonhumiliating environments. Acknowledgment of this particular pedagogical perspective, it is argued, could better connect the health professional teachers with the education and development missions of universities, professional bodies, and governments. The teachers' expressed values and goals offer a new starting point for faculty development. Their reliance on the relational over the technical and on their own biographical experience, could be more respectfully valued and addressed to advance a more productive balance with the technical pedagogical elements that often concern educationalists, researchers, and administrators.