bluuebunny/crossref_metadata_2025 huggingface dataset:
Sensor fault diagnosis of aero-engine based on divided flight status
Authors: Zhao Zhen , Zhang Jun , Sun Yigang , Liu Zhexu
Published: November 2017

Fault diagnosis and safety analysis of an aero-engine have attracted more and more attention in modern society, whose safety directly affects the flight safety of an aircraft. In this paper, the problem concerning sensor fault diagnosis is investigated for an aero-engine during the whole flight process. Considering that the aero-engine is always working in different status through the whole flight process, a flight status division-based sensor fault diagnosis method is presented to improve fault diagnosis precision for the aero-engine. First, aero-engine status is partitioned according to normal sensor data during the whole flight process through the clustering algorithm. Based on that, a diagnosis model is built for each status using the principal component analysis algorithm. Finally, the sensors are monitored using the built diagnosis models by identifying the aero-engine status. The simulation result illustrates the effectiveness of the proposed method.
Rapid spectro-polarimetry to probe molecular symmetry in multiplex coherent anti-Stokes Raman scattering
Authors: Würthwein Thomas , Brinkmann Maximilian , Hellwig Tim , Fallnich Carsten
Published: November 2017

We present the simultaneous detection of the spectrum and the complete polarization state of a multiplex coherent anti-Stokes Raman scattering signal with a fast division-of-amplitude spectro-polarimeter. The spectro-polarimeter is based on a commercial imaging spectrograph, a birefringent wedge prism, and a segmented polarizer. Compared to the standard rotating-retarder fixed-analyzer spectro-polarimeter, only a single measurement is required and an up to 21-fold reduced acquisition time is shown. The measured Stokes parameters allow us to differentiate between vibrational symmetries and to determine the depolarization ratio ρ by data post-processing.
Extracting dielectric fixed charge density on highly doped crystalline-silicon surfaces using photoconductance measurements
Authors: To A. , Hoex B.
Published: November 2017

A novel method for the extraction of fixed interface charge, Qf, and the surface recombination parameters, Sn0 and Sp0, from the injection-level dependent effective minority carrier lifetime measurements is presented. Unlike conventional capacitance-voltage measurements, this technique can be applied to highly doped surfaces provided the surface carrier concentration transitions into strong depletion or inversion with increased carrier injection. By simulating the injection level dependent Auger-corrected inverse lifetime curve of symmetrically passivated and diffused samples after sequential annealing and corona charging, it was revealed that Qf, Sn0, and Sp0 have unique signatures. Therefore, these important electronic parameters, in some instances, can independently be resolved. Furthermore, it was shown that this non-linear lifetime behaviour is exhibited on both p-type and n-type diffused inverted surfaces, by demonstrating the approach with phosphorous diffused n+pn+ structures and boron diffused p+np+ structures passivated with aluminium oxide (AlOx) and silicon nitride, respectively (SiNx). The results show that the approximation of a mid-gap Shockley-Read-Hall defect level with equal capture cross sections is able to, in the samples studied in this work, reproduce the observed injection level dependent lifetime behaviour.
Microwave transmission efficiency and simulations of electron plasma in ELTRAP device
Authors: Ikram M. , Mushtaq A. , Ali S.
Published: November 2017

A Thomson backscattering experiment has been performed in a Penning-Malmberg device ELTRAP. To estimate the minimum sensitivity of diagnostics, we have computed the signal to noise ratio and found that the present bunch has a number density of 4.3 × 108 cm−3, which is three orders of magnitude less than the desired density of 1011 cm−3. To increase the signal level from the RF studies to the GHz range, the transmission efficiency from the rectangular waveguide orthogonally coupled to a prototype circular waveguide was experimentally analyzed on a test-bench. It is observed that the lengths of waveguides play an important role in the transmission efficiency and return loss. When the length of the optimum rectangular waveguide (>2 λg = 31 cm) is reduced to 7 cm, due to geometrical constraints of the ELTRAP device, consequently, the transmission efficiency is also reduced and shifts away from the maximum 3 GHz operating frequency. The useful frequency band is then reduced with the increasing length of the prototype circular waveguide (102 cm). Using the electromagnetic Particle-In-Cell simulations involving the electron cyclotron resonance heating (ECRH), we have utilized a magnetic field of 0.1 T resonating with 2.8 GHz RF drive during each time step (1 ps) having the power level of 0.04 V to the middle and to the end of the trap. A more efficient increase in the radial and azimuthal temperature profiles is observed as compared to the axial temperature profile. The reason is the use of ECRH to heat electrons in cyclotron motion, which is completely kinetic and magnetron motion which is almost entirely potential based. The axial motion interchanges in between the kinetic and potential with a slight enhancement in axial motion to maintain the total canonical angular momentum conserved. The temperature profile of the confined electron plasma increases with the variation of densities from 5 × 107 m−3 to 1012 m−3. The major heating effect occurs when the RF power is injected from the position close to one end with respect to the middle position of the trap.
Latitudinal structured populations of the Mexican wild squash Cucurbita argyrosperma subsp. sororia revealed by microsatellite markers
Authors: Balvino-Olvera Francisco J. , Sánchez-Gómez Karman F. , Lobo Jorge Arturo , Avila-Sakar Germán , Cruz-Reyes Rogelio , Sánchez-Montoya Gumersindo , Herrerías-Diego Yvonne , González-Rodríguez Antonio , Quesada Mauricio
Published: November 2017

Crop wild relatives represent an important agronomic resource for crop improvement and biodiversity conservation. The wild squash Cucurbita argyrosperma subsp. sororia. (Cucurbitaceae) has been considered the wild ancestor of cultivated forms of C. argyrosperma. In order to characterise the geographic patterns of genetic variation in this wild cucurbit and to identify priority areas for conservation, we analysed the genetic diversity and structure of natural populations along the Mexican Pacific coast. By using 14 polymorphic microsatellites, we genotyped 378 individuals sampled from 61 locations. Standard population genetics analyses and group testing were conducted on the genotypes with the aid of principal coordinate analysis and Bayesian analysis. Overall, we found an average of 12.3 alleles per locus and an expected heterozygosity of 0.756. We found greater genetic diversity in southern populations. The fixation index was 0.113, suggesting a mixed mating system. The Mantel test revealed a minor distance effect on genetic differentiation between individuals (r = 0.321). Finally, we found three main groups of populations arranged in a mostly latitudinal pattern, from Sinaloa (north-west) to Oaxaca–Guerrero (south-east). The greater genetic diversity and heterogeneity among southern populations (Guerrero–Oaxaca), suggests that this region is an important centre of diversity of this wild squash with important implications for conservation.
INF2-mediated actin polymerization at the ER stimulates mitochondrial calcium uptake, inner membrane constriction, and division
Authors: Chakrabarti Rajarshi , Ji Wei-Ke , Stan Radu V. , de Juan Sanz Jaime , Ryan Timothy A. , Higgs Henry N.
Published: November 2017

Mitochondrial division requires division of both the inner and outer mitochondrial membranes (IMM and OMM, respectively). Interaction with endoplasmic reticulum (ER) promotes OMM division by recruitment of the dynamin Drp1, but effects on IMM division are not well characterized. We previously showed that actin polymerization through ER-bound inverted formin 2 (INF2) stimulates Drp1 recruitment in mammalian cells. Here, we show that INF2-mediated actin polymerization stimulates a second mitochondrial response independent of Drp1: a rise in mitochondrial matrix calcium through the mitochondrial calcium uniporter. ER stores supply the increased mitochondrial calcium, and the role of actin is to increase ER–mitochondria contact. Myosin IIA is also required for this mitochondrial calcium increase. Elevated mitochondrial calcium in turn activates IMM constriction in a Drp1-independent manner. IMM constriction requires electron transport chain activity. IMM division precedes OMM division. These results demonstrate that actin polymerization independently stimulates the dynamics of both membranes during mitochondrial division: IMM through increased matrix calcium, and OMM through Drp1 recruitment.
Prostate-specific membrane antigen cleavage of vitamin B9 stimulates oncogenic signaling through metabotropic glutamate receptors
Authors: Kaittanis Charalambos , Andreou Chrysafis , Hieronymus Haley , Mao Ninghui , Foss Catherine A. , Eiber Matthias , Weirich Gregor , Panchal Palak , Gopalan Anuradha , Zurita Juan , Achilefu Samuel , Chiosis Gabriela , Ponomarev Vladimir , Schwaiger Markus , Carver Brett S. , Pomper Martin G. , Grimm Jan
Published: November 2017

Prostate-specific membrane antigen (PSMA) or folate hydrolase 1 (FOLH1) is highly expressed on prostate cancer. Its expression correlates inversely with survival and increases with tumor grade. However, the biological role of PSMA has not been explored, and its role in prostate cancer remained elusive. Filling this gap, we demonstrate that in prostate cancer, PSMA initiates signaling upstream of PI3K through G protein–coupled receptors, specifically via the metabotropic glutamate receptor (mGluR). PSMA’s carboxypeptidase activity releases glutamate from vitamin B9 and other glutamated substrates, which activate mGluR I. Activated mGluR I subsequently induces activation of phosphoinositide 3-kinase (PI3K) through phosphorylation of p110β independent of PTEN loss. The p110β isoform of PI3K plays a particularly important role in the pathogenesis of prostate cancer, but the origin of its activation was so far unknown. PSMA expression correlated with PI3K–Akt signaling in cells, animal models, and patients. We interrogated the activity of the PSMA–PI3K axis through positron emission tomography and magnetic resonance imaging. Inhibition of PSMA in preclinical models inhibited PI3K signaling and promoted tumor regression. Our data present a novel oncogenic signaling role of PSMA that can be exploited for therapy and interrogated with imaging.
𝐹-divided sheaves trivialized by dominant maps are essentially finite
Authors: Tonini Fabio , Zhang Lei
Published: November 2017

By a result of Biswas and Dos Santos on a smooth and projective variety over an algebraically closed field, a vector bundle trivialized by a proper and surjective map is essentially finite; that is, it corresponds to a representation of the Nori fundamental group scheme. In this paper we obtain similar results for nonproper nonsmooth algebraic stacks over arbitrary fields of characteristic

p
>
0

p>0

. As a byproduct we have the following partial generalization of the Biswas–Dos Santos result in positive characteristic: on a pseudo-proper and inflexible stack of finite type over

k
,

k,

a vector bundle which is trivialized by a proper and flat map is essentially finite.
Simple transitive 2-representations of small quotients of Soergel bimodules
Authors: Kildetoft Tobias , Mackaay Marco , Mazorchuk Volodymyr , Zimmermann Jakob
Published: November 2017

In all finite Coxeter types but

I
2

(
12
)

I_2(12)

,

I
2

(
18
)

I_2(18)

, and

I
2

(
30
)

I_2(30)

, we classify simple transitive

2
2

-representations for the quotient of the

2
2

-category of Soergel bimodules over the coinvariant algebra which is associated with the two-sided cell that is the closest one to the two-sided cell containing the identity element. It turns out that, in most of the cases, simple transitive

2
2

-representations are exhausted by cell

2
2

-representations. However, in Coxeter types

I
2

(
2
k
)

I_2(2k)

, where

k
≥
3

k\geq 3

, there exist simple transitive

2
2

-representations which are not equivalent to cell

2
2

-representations.
Groups of central-type, maximal connected gradings and intrinsic fundamental groups of complex semisimple algebras
Authors: Ginosar Yuval , Schnabel Ofir
Published: November 2017

Maximal connected grading classes of a finite-dimensional algebra

A
A

are in one-to-one correspondence with Galois covering classes of

A
A

which admit no proper Galois covering and therefore are key in computing the intrinsic fundamental group

π
1

(
A
)

\pi _1(A)

. Our first concern here are the algebras

A
=

M
n

(

C

)

A=M_n(\mathbb {C})

. Their maximal connected gradings turn out to be in one-to-one correspondence with the Aut

(
G
)

(G)

-orbits of non-degenerate classes in

H
2

(
G
,

C

∗

)

H^2(G,\mathbb {C}^*)

, where

G
G

runs over all groups of central-type whose orders divide

n
2

n^2

. We show that there exist groups of central-type

G
G

such that

H
2

(
G
,

C

∗

)

H^2(G,\mathbb {C}^*)

admits more than one such orbit of non-degenerate classes. We compute the family

Λ
\Lambda

of positive integers

n
n

such that there is a unique group of central-type of order

n
2

n^2

, namely

C
n

×

C
n

C_n\times C_n

. The family

Λ
\Lambda

is of square-free integers and contains all prime numbers. It is obtained by a full description of all groups of central-type whose orders are cube-free. We then establish the maximal connected gradings of all finite-dimensional semisimple complex algebras using the fact that such gradings are determined by dimensions of complex projective representations of finite groups. In some cases we give a description of the corresponding fundamental groups.
GGA1 regulates signal-dependent sorting of BACE1 to recycling endosomes, which moderates Aβ production
Authors: Toh Wei Hong , Chia Pei Zhi Cheryl , Hossain Mohammed Iqbal , Gleeson Paul A.
Published: November 2017

The diversion of the β-secretase BACE1 from the endo-lysosomal pathway to recycling endosomes is important in the regulation of amyloid beta production. Here we define BACE1 transport from early to recycling endosomes and identify essential roles for the SNX4-mediated, signal-independent pathway and for a signal-mediated, GGA1-dependent pathway.
Comparative transcriptomics of 5 high-altitude vertebrates and their low-altitude relatives
Authors: Tang Qianzi , Gu Yiren , Zhou Xuming , Jin Long , Guan Jiuqiang , Liu Rui , Li Jing , Long Kereng , Tian Shilin , Che Tiandong , Hu Silu , Liang Yan , Yang Xuemei , Tao Xuan , Zhong Zhijun , Wang Guosong , Chen Xiaohui , Li Diyan , Ma Jideng , Wang Xun , Mai Miaomiao , Jiang An'an , Luo Xiaolin , Lv Xuebin , Gladyshev Vadim N , Li Xuewei , Li Mingzhou
Published: November 2017

Background

Species living at high altitude are subject to strong selective pressures due to inhospitable environments (e.g., hypoxia, low temperature, high solar radiation, and lack of biological production), making these species valuable models for comparative analyses of local adaptation. Studies that have examined high-altitude adaptation have identified a vast array of rapidly evolving genes that characterize the dramatic phenotypic changes in high-altitude animals. However, how high-altitude environment shapes gene expression programs remains largely unknown.

Findings

We generated a total of 910 Gb of high-quality RNA-seq data for 180 samples derived from 6 tissues of 5 agriculturally important high-altitude vertebrates (Tibetan chicken, Tibetan pig, Tibetan sheep, Tibetan goat, and yak) and their cross-fertile relatives living in geographically neighboring low-altitude regions. Of these, ~75% reads could be aligned to their respective reference genomes, and on average ~60% of annotated protein coding genes in each organism showed FPKM expression values greater than 0.5. We observed a general concordance in topological relationships between the nucleotide alignments and gene expression–based trees. Tissue and species accounted for markedly more variance than altitude based on either the expression or the alternative splicing patterns. Cross-species clustering analyses showed a tissue-dominated pattern of gene expression and a species-dominated pattern for alternative splicing. We also identified numerous differentially expressed genes that could potentially be involved in phenotypic divergence shaped by high-altitude adaptation.

Conclusions

These data serve as a valuable resource for examining the convergence and divergence of gene expression changes between species as they adapt or acclimatize to high-altitude environments.
Cost-Effectiveness Research in Neurosurgery: We Can and We Must
Authors: Stein Sherman C
Published: November 2017

Rapid advancement of medical and surgical therapies, coupled with the recent preoccupation with limiting healthcare costs, makes a collision of the 2 objectives imminent. This article explains the value of cost-effectiveness analysis (CEA) in reconciling the 2 competing goals, and provides a brief introduction to evidence-based CEA techniques. The historical role of CEA in determining whether new neurosurgical strategies provide value for cost is summarized briefly, as are the limitations of the technique. Finally, the unique ability of the neurosurgical community to provide input to the CEA process is emphasized, as are the potential risks of leaving these important decisions in the hands of others.
The role of vitamin D in adipogenesis
Authors: Dix Clare F , Barclay Johanna L , Wright Olivia R L
Published: November 2017

Vitamin D, a secosteroid predominately obtained by endogenous production, has in recent years been linked to obesity and its comorbidities. The purpose of this review is to draw conclusions from animal and human studies on the effects of vitamin D on adipogenesis to identify the molecular links between vitamin D and obesity. The information presented herein was obtained from 4 databases (PubMed, CINAHL, Cochrane Library, Scopus) using predefined search terms, as well as research literature and other reviews. The effects of vitamin D on adipogenesis have been researched in several animal models, and the majority of these studies suggest vitamin D plays an inhibitory role in adipogenesis. Studies into vitamin D status and obesity in humans are limited, with the majority being observational epidemiological studies that provide no conclusions on cause and effect or clear links on the molecular mechanisms. The few cell culture and supplementation studies that have investigated adipogenesis in human cells indicate that, in contrast to findings from rodent studies, vitamin D is proadipogenic. There is insufficient evidence to determine whether 1) vitamin D deficiency is associated with a lean or obese phenotype, 2) vitamin D deficiency is a consequence of obesity, or (3) the effects of vitamin D on fat tissue are due to interactions with calcium.
Feasibility of Training Physical Therapists to Deliver the Theory-Based Self-Management of Osteoarthritis and Low Back Pain Through Activity and Skills (SOLAS) Intervention Within a Trial
Authors: Keogh Alison , Matthews James , Segurado Ricardo , Hurley Deirdre A
Published: November 2017

Background

Provider training programs are frequently underevaluated, leading to ambiguity surrounding effective intervention components.

Objective

The purpose of this study was to assess the effectiveness of a training program in guiding physical therapists to deliver the Self-management of Osteoarthritis and Low back pain through Activity and Skills (SOLAS) group education and exercise intervention (ISRCTN49875385), using a communication style underpinned by self–determination theory (SDT).

Design

This was an assessment of the intervention arm training program using quantitative methods.

Methods

Thirteen physical therapists were trained using mixed methods to deliver the SOLAS intervention. Training was evaluated using the Kirkpatrick model: (1) Reaction—physical therapists’ satisfaction with training, (2) Learning—therapists’ confidence in and knowledge of the SDT-based communication strategies and intervention content and their skills in applying the strategies during training, and (3) Behavior—8 therapists were audio-recorded delivering all 6 SOLAS intervention classes (n = 48), and 2 raters independently coded 50% of recordings (n = 24) using the Health Care Climate Questionnaire (HCCQ), the Controlling Coach Behavior Scale (CCBS), and an intervention-specific measure.

Results

Reaction: Physical therapists reacted well to training (median [IRQ]; min-max = 4.7; [0.5]; 3.7–5.0). Learning: Physical therapists’ confidence in the SDT-based communication strategies and knowledge of some intervention content components significantly improved. Behavior: Therapists delivered the intervention in a needs-supportive manner (median HCCQ = 5.3 [1.4]; 3.9–6.0; median CCBS = 6.6 ([0.5]; 6.1–6.8; median intervention specific measure = 4.0 [1.2]; 3.2–4.9). However, “goal setting” was delivered below acceptable levels by all therapists (median 2.9 [0.9]; 2.0–4.0).

Limitations

The intervention group only was assessed as part of the process evaluation of the feasibility trial.

Conclusions

Training effectively guided physical therapists to be needs-supportive during delivery of the SOLAS intervention. Refinements were outlined to improve future similar training programs, including greater emphasis on goal setting.
The Revised Body Awareness Rating Questionnaire: Development Into a Unidimensional Scale Using Rasch Analysis
Authors: Dragesund Tove , Strand Liv Inger , Grotle Margreth
Published: November 2017

Background

The Body Awareness Rating Questionnaire (BARQ) is a self-report questionnaire aimed at capturing how people with long-lasting musculoskeletal pain reflect on their own body awareness. Methods based on classical test theory were applied to the development of the instrument and resulted in 4 subscales. However, the scales were not correlated, and construct validity might be questioned.

Objective

The primary purpose of this study was to explore the possibility of developing a unidimensional scale from items initially collected for the BARQ using Rasch analysis. A secondary purpose was to investigate the test-retest reliability of a revised version of the BARQ.

Design

This was a methodological study.

Methods

Rasch and reliability analyses were performed for 3 samples of participants with long-lasting musculoskeletal pain. The first Rasch analysis was carried out on 66 items generated for the original BARQ and scored by 300 participants. The items supported by the first analysis were scored by a new group of 127 participants and analyzed in a second Rasch analysis. For the test-retest reliability analysis, 48 participants scored the revised BARQ items twice within 1 week.

Results

The 2-step Rasch analysis resulted in a unidimensional 12-item revised version of the BARQ with a 4-point response scale (scores from 0 to 36). It showed a good fit to the Rasch model, with acceptable internal consistency, satisfactory fit residuals, and no disordered thresholds. Test-retest reliability was high, with an intraclass correlation coefficient of .83 (95% CI = .71–.89) and a smallest detectable change of 6.3 points.

Limitations

The small sample size in the second Rasch analysis was a study limitation.

Conclusions

The revised BARQ is a unidimensional and feasible measurement of body awareness, recommended for use in the context of body-mind physical therapy approaches for musculoskeletal conditions.
Teaching study skills in mathematics service courses—how to cope with students’ refusal?
Authors: Feudel Frank , Dietz Hans M
Published: November 2017

Many freshmen entering university have difficulties with finishing their mathematics courses successfully in the first year due to insufficient study skills and learning strategies, which on the one hand include general skills and strategies and on the other hand context-specific skills and strategies for university mathematics. In mathematics service courses for students of disciplines other than mathematics, for example engineering or economics, the effect of poor study skills is even worse due to large course sizes and great diversity regarding the students’ prior knowledge. Therefore, since 2010, first-year students of economics at the University of Paderborn are offered a methodological support program named CAT, which is integrated into the regular course context. The name CAT emerges from three important support-tools of the program (called instruments): Checklist, Ampel (English: Traffic Lights), Toolbox. Although some students claimed that CAT was helpful from the beginning (and a positive effect on academic achievement had also been proven in an experimental tutorial) the majority of students did not use the strategies provided by CAT at first. This was the initial point for a research project with the aim to raise the acceptance of CAT and thus to get more students to use the effective study skills provided by CAT. With the help of this research project, it was possible to identify reasons why students did not use the skills and strategies of CAT, to draw adequate conclusions concerning the implementation of CAT in the course and to raise the acceptance of CAT considerably in the following year. The results of the research project can be useful especially for developers of similar support programs and for teachers and lecturers, who also try to integrate study skills into mathematics courses at university.
Effectiveness and Safety of a Thermosensitive Hydrogel Cultured Epidermal Allograft for Burns
Authors: Yoon Jaechul , Yang Hyeong-Tae , Yim Haejun , Cho Yong-Suk , Kym Dohern , Hur Jun , Chun Wook , Lee Jong-Wook , Yoon Chunjae
Published: November 2017

OBJECTIVE:

To retest the safety and effectiveness of a thermosensitive hydrogel-type cultured epithelial allograft (KeraHeal-Allo; MCTT, Seoul, South Korea) and identify the subjective experience of patients and doctors with this product.

DESIGN AND SETTING:

Prospective interventional phase 3 study in 3 burn centers near Seoul, South Korea.

PATIENTS:

Thirty-three patients with deep second-degree burns larger than 200 cm2 (for intervention and control sites of 100 cm2 each) were enrolled.

INTERVENTION:

A cultured epithelial allograft containing 2 × 107/1.5 mL keratinocytes was applied to each patient’s intervention site. Three principal investigators (1 in each institution) evaluated the effectiveness of the allograft at their institution and the others’. Researchers administered a subjective satisfaction survey during each patient’s last visit.

MAIN OUTCOME MEASURE:

The primary end point of the study was the re-epithelialization period.

MAIN RESULTS:

The re-epithelialization period for the intervention was 2.8 ± 2.2 days faster than that of control sites at other institutions (P < .001) and 2.5 ± 3.4 days faster than that of control sites in the same institution (P < .001). There were no reported adverse events. Satisfaction scores provided by patients and doctors showed significantly high scores on all items.

CONCLUSUIONS:

This type of cultured epithelial allograft is safe and well received by patients and providers and promotes re-epithelialization.
Optimizing Pregnancy Treatment Interventions for Moms (OPTI-Mom): A Pilot Study
Authors: Cochran Gerald T. , Hruschak Valerie , Abdullah Walitta , Krans Elizabeth , Douaihy Antoine B. , Bobby Stephanie , Fusco Rachel , Tarter Ralph
Published: November 2017

Objectives:

The public health burden of opioid use disorder (OUD) among pregnant women has significantly increased in recent years. The Optimizing Pregnancy Treatment Interventions for Moms study was a pilot project that examined the feasibility of a patient navigation (PN) intervention model to reduce substance use and improve mental health, quality of life, and to increase engagement with treatment services among pregnant women with OUD.

Methods:

A 1-group repeated-measures pilot study was conducted with treatment-seeking pregnant women with opioid dependence initiating buprenorphine maintenance treatment. Participants received the PN intervention delivered as 10 sessions before delivery and 4 sessions postpartum. Participants completed assessments at baseline and after the prenatal and postnatal portions of the intervention. Demographics were assessed using descriptive statistics, and general estimating equation analyses were employed to examine changes in health and service engagement across time.

Results:

in all, 21 women were enrolled and completed the PN intervention and follow-up assessments. Participants reported improvements in abstinence from illicit opioids (B = 0.15, 95% confidence interval [CI] 0.1–0.2), drug use (odds ratio [OR] 5.25, 95% CI 2.1–13.0), and depression (OR 7.70, 95% CI 2.4–25.1). Results also showed nonsignificant trends suggesting enhancements in general health (B = 0.17, 95% CI 0.0–0.3,P = 0.06) and increases in substance use treatment attendance (B = 2.15, 95% CI −0.2 to 4.5,P = 0.07). Most study participants achieved adequate or better prenatal care.

Conclusions:

These findings provide support that PN is a feasible adjunctive intervention that shows promise for health improvements and service engagement among treatment-seeking pregnant women with opioid dependence initiating buprenorphine.
Management of Acute Pain of the War Wounded During Short and Long-distance Transport and “Casevac”
Authors: Gelfand Harold J. , Kent Michael L. , Buckenmaier Chester C.
Published: November 2017

In recent conflicts, advances in acute pain management have been pushed to the forefront of battlefield medical care. With dramatic improvements in battlefield resuscitation, mortality rates have significantly decreased, as a result significant numbers of patients sustaining severe polytraumatic injuries must now be transported from the site of injury and, eventually, to stateside military treatment facilities. A variety of transport platforms are utilized to facilitate this mission. Continued analgesia (especially regional anesthetic techniques) during transport is a critical component of battlefield care as it decreases suffering, minimizes the need for opioids and other sedating analgesics, facilitates earlier transport, and possibly plays a role in preventing chronic pain.
Why Continuous Peripheral Nerve Blocks Fail
Authors: Boezaart André P. , Zasimovich Yury
Published: November 2017

Continuous nerve blocks (CNBs), compared with other forms of postoperative analgesia, are less frequently utilized, although postoperative pain control may be improved with their use. Further, it has been demonstrated that the safety and side-effect profiles of opioids and other analgesics are inferior to well-performed CNBs. For CNB success, however, several principles must be adhered to: application of appropriate indications, selection of the correct nerve to block, performance of correct CNB technique, and utilization of correct equipment. Although these are simple concepts, they are often violated and can result in block failure, especially secondary block failure, which occurs once the primary bolus block has worn off. Almost all secondary block failures and medico-legal challenges originate from the violation of ≥1 of these principles. Hilton Law of Anatomy and Fick Law of Diffusion underpin common reasons for CNB failures. In addition, novel developments in our understanding of the macroneuroanatomy and microneuroanatomy may further explain CNB failures.
The Controversy of Regional Anesthesia, Continuous Peripheral Nerve Blocks, Analgesia, and Acute Compartment Syndrome
Authors: Nin Olga C. , Patrick Matthew R. , Boezaart André P.
Published: November 2017

Acute compartment syndrome (ACS) is an infrequent but true medical emergency caused by an increase in pressure in noncompliant tissue compartments resulting in decreased blood flow, ischemia, and tissue necrosis. At present, it is mainly a clinical diagnosis of pain “out of proportion” to the clinical scenario. Other signs such as paresthesia, paralysis, and the lack of peripheral pulses are, usually, late symptoms. Early diagnosis and treatment can be the difference between preserving function of the affected extremity, permanent functional loss, or even amputation. Regional anesthesia and analgesia are controversial in patients at risk for compartment syndrome due to potential masking of ischemic pain associated with ACS. A recent and growing body of anecdotal case reports and research evidence, however, suggests that ischemic pain pathways are complex and may differ from those of nociceptive or neuropathic pain. That is, ischemic pain most likely has a sympathetic pathway that cannot be completely blocked by peripheral nerve blocks. This article explores the possible role and controversies surrounding the use of regional anesthesia, continuous peripheral nerve blocks, and analgesia in patients at risk of developing ACS.
Positive and Negative Impacts of a Continuing Professional Development Intervention on Pharmacist Practice
Authors: Sidhu Sukhjinder , Gorman Sean K. , Slavik Richard S. , Ramsey Tasha , Bruchet Nicole , Murray Sarah
Published: November 2017

Introduction:

Evaluations of behavior change interventions aimed at improving professional practice are increasingly focused on impacts at the practice and patient outcome levels. Many of these evaluations assume that if the intended changes occur, the result represents an improvement. However, given the systemic nature of clinical practice, a change in one area can produce changes in other areas as well, some of which may adversely affect the patient. Balancing measures are used to determine whether unintended consequences of an intervention have been introduced into other areas of the system. The aims of this study were to evaluate the impact of behavior change intervention-based continuing professional development (CPD) on pharmacist interventions (resolution of drug therapy problems—DTPs) and resolution of quality indicator DTPs and knowledge change for urinary tract infections (UTI) and pneumonia. As a balancing measure, we aimed to determine whether delivery of behavior change interventions targeting pneumonia and UTI practice results in a negative impact on other important pharmacist interventions, specifically the resolution of heart failure DTPs.

Methods:

A quasiexperimental study was conducted at a Canadian health authority that evaluated the impacts of an 8-week multifaceted behavior change intervention delivered to 58 ward-based pharmacists. The primary outcome was change in proportion of UTI and pneumonia DTPs resolved from the 6-month preintervention to 6-month postintervention phase. Secondary outcomes were changes in proportion of UTI and pneumonia quality indicator DTPs resolved, knowledge quiz scores, and proportion of quality indicator DTPs resolved for heart failure as a balancing measure.

Results:

A total of 58 pharmacists were targets of the intervention. The proportion of resolved UTI and pneumonia DTPs increased from 17.8 to 27.2% (relative risk increase 52.8%, 95% confidence interval [CI] 42.8–63.6%; P < 0.05). The proportion of resolved UTI and pneumonia quality indicator DTPs increased from 12.2% to 18.2% (relative risk increase 49.9%, 95% CI 34.5–67.0%; P < 0.05). Resolved heart failure DTPs decreased from 14.3 to 8.5% (RRR 40.4%, 95% CI 33.9–46.2%; P < 0.05). Thirty-six pharmacists completed the pre- and post-quiz. Scores increased from 11.3/20 ± 3.2/20 to 14.8/20 ± 2.9/20 (P < 0.05).

Discussion:

CPD using a multifaceted behavior change intervention improved pharmacist behavior and knowledge for UTI and pneumonia. However, these improvements may be offset by reduced interventions for other disease states, such as heart failure. Strategies to mitigate the unintended effects on other professional behaviors should be implemented when delivering CPD focused on changing one aspect of professional behavior.
Retroprosthetic Membrane Formation in Boston Keratoprosthesis: A Case–Control-Matched Comparison of Titanium Versus PMMA Backplate
Authors: Talati Rushi K. , Hallak Joelle A. , Karas Faris I. , de la Cruz Jose , Cortina M. Soledad
Published: November 2017

Purpose:

Retroprosthetic membrane (RPM) formation is the most common complication after Boston type 1 keratoprosthesis (KPro) implantation. It affects visual acuity and can predispose to corneal melt. Two KPro backplate materials are available: titanium and polymethyl methacrylate (PMMA). This study investigates the influence of the KPro backplate material on visually significant RPM formation.

Methods:

A retrospective case–control-matched study involving 40 patients; 20 eyes implanted with a titanium backplate KPro were case-matched with 20 eyes implanted with a PMMA backplate KPro between 2007 and 2015 with 1-year minimum follow-up.

Results:

The mean follow-up duration was 28.1 ± 8.9 and 53.6 ± 24.3 months in the titanium and PMMA groups, respectively. At 12 months postoperatively, 7 eyes with titanium and 6 eyes with PMMA backplates developed a visually significant RPM. By the end of the study, a total of 11 eyes with titanium and 9 eyes with PMMA KPros developed a visually significant RPM. There was no statistically significant difference between both groups. Three of 11 eyes with titanium KPros that had a visually significant RPM required surgical membranectomy, whereas all eyes with PMMA KPros were successfully treated with the yttrium-aluminum-garnet laser. Recurrence of RPMs was found in 7/11 eyes in the titanium group and 2/9 eyes in the PMMA group with no statistical significance.

Conclusions:

Titanium backplate KPros do not significantly reduce RPM formation compared with PMMA backplate KPros in a case–control-matched setting. A larger prospective study is warranted to evaluate comparative long-term performance and guide newer designs.
Sapovirus in Rectal and Nasopharyngeal Swab Samples of Children with Symptoms of Acute Gastroenteritis
Authors: Silva Thairiny Neres , Dábilla Nathânia , Fiaccadori Fabíola Souza , Cardoso Divina das Dôres de Paula , de Sousa Teresinha Teixeira , Almeida Tâmera Nunes Vieira , Souza Menira
Published: November 2017

The study included 102 hospitalized children 0–72 months of age, with symptoms of acute gastroenteritis. One fecal and one nasopharyngeal swab sample were obtained from each child. Samples were screened for sapovirus and viral loads were determined. Sapovirus was detected in 18.6% of fecal samples and in 36.3% of nasopharyngeal swab samples. High viral loads were detected.
Effect of Long-Term Diving on the Morphology and Growth of the Distal Radial Epiphyseal Plate of Young Divers: A Magnetic Resonance Imaging Study
Authors: Zhang Cici , Shen Si , Zhang Wen , Qiu Lin , Wu Qingying , Wang Fei , Liu Sirun
Published: November 2017

Objective:

To investigate the effects of long-term diving on the morphology and growth of the distal radial epiphyseal plate in young divers.

Study Design:

Cohort study.

Setting:

Guangzhou Sport University.

Participants:

Thirty-eight professional divers, aged 10 to 17 years, and 25 age-matched volunteers.

Interventions:

Each subject received a physical examination at the beginning of the study and underwent bilateral magnetic resonance imaging of the wrist. The divers were divided into 2 groups depending on the status of the epiphyseal plate: group A (positive distal radial epiphyseal plate injury) and group B (no positive distal radial epiphyseal plate injury). A third group, group C, consisted of the 25 volunteers.

Main Outcome Measures:

The frequency of distal radial epiphyseal plate injury and the thickness of the distal radial epiphyseal plate were analyzed across the 3 groups.

Results:

Twenty-nine cases (29/76, 38.15%) of distal radial epiphyseal plate injury were observed in 20 divers (20/38, 52.63%). The incidence of injury to the right hand was higher than that for the left (P = 0.009). There were statistically significant differences (P = 0.000) among the 3 groups in terms of epiphyseal plate thickness; group A > group B > group C.

Conclusions:

Distal radial epiphyseal plate injury is common in divers, and more injuries are seen in the right hand. Moreover, growth of the radius was impaired in divers relative to controls. We consider that loading during diving may influence growth of the epiphyseal plate in either a transient or permanent manner.
Using Simulation to Hardwire Bedside Shift Report
Authors: Connolly Arvis K.
Published: November 2017

Numerous attempts to move nursing handoff to the bedside failed within our organization. Upon retrospect, previous attempts lacked standardization, coordination, and clear expectations. With emphasis on implementing patient- and family-centered care to increase patient experience scores, we developed a standardized staff training methodology using didactic and simulation to address staff barriers to adoption, a standardized implementation process, and a process to hardwire the practice.
Risks and Benefits of Salpingectomy at the Time of Sterilization
Authors: Castellano Tara , Zerden Matthew , Marsh Laura , Boggess Kim
Published: November 2017

Importance

Bilateral salpingectomy reduces the risk ovarian cancer. The Society of Gynecologic Oncology has recommended surgeons discuss salpingectomy with patients desiring sterilization.

Objective

This review summarizes current literature on the benefits and risks of bilateral salpingectomy to reduce ovarian cancer risk. Areas of insufficient evidence and directions for further research are discussed.

Evidence Acquisition

We examined the benefits and risks of bilateral salpingectomy for female surgical sterilization, using a PubMed and EMBASE literature review. Search parameters included articles in English language and keywords “salpingectomy” or “ovarian cancer” combined with “contraception,” “sterilization,” or “tubal ligation.”

Results

We reviewed 4 high-quality studies that investigated the increased risk reduction of bilateral salpingectomy compared with traditional sterilization. Overall, evidence shows that salpingectomy moderately decreases the risk of ovarian cancer compared with traditional sterilization. An additional 4 studies, including a meta-analysis, showed salpingectomy likely does not have significant long-term impact on ovarian reserve. Additional benefits include improved contraceptive efficacy and elimination of subsequent ectopic pregnancies. Risks include need for in vitro fertilization for patients experiencing sterilization regret, increases in operative time, and potential increases in surgical risks.

Conclusions

Bilateral salpingectomy can reduce ovarian cancer risk compared with traditional sterilization; however, research regarding other outcomes is limited. Challenges to implementation include physician concern regarding surgical risks and patient education. Studies investigating patient-based outcomes are lacking.

Relevance

Bilateral salpingectomy for surgical sterilization is a reasonable option when patients are appropriately informed. Ovarian cancer risk reduction should be one of several factors considered when patients choose a surgical sterilization method.

Target Audience

Obstetricians and gynecologists, family physicians

Learning Objectives

After completing this activity, the learner should be better able to discuss the epidemiology and etiology of ovarian cancer and its subtypes, describe the risks and benefits of risk-reducing bilateral salpingectomy at the time of surgical sterilization, and identify challenges associated with the widespread adoption of risk-reducing salpingectomy.
Trends in Ambulatory Management of Urinary Incontinence in Women in the United States
Authors: Forde James C. , Chughtai Bilal , Cea Meagan , Stone Benjamin V. , Te Alexis , Bishop Tara F.
Published: November 2017

(Abstracted from Female Pelvic Med Reconstr Surg 2017;23:250–255)

The importance of urinary incontinence (UI) to quality of life and the substantial costs of its treatment are well known. Guidelines on the assessment and subsequent management of the different types of UI have been published by various professional societies.
Characterization With Scanning Electron Microscopy/Energy-Dispersive X-ray Spectrometry of Microtraces From the Ligature Mean in Hanging Mechanical Asphyxia
Authors: Maghin Francesca , Andreola Salvatore Ambrogio , Boracchi Michele , Gentile Guendalina , Maciocco Francesca , Zoja Riccardo
Published: November 2017

The authors applied scanning electron microscopy with energy-dispersive x-ray spectrometry to the furrow derived from hanging means. The study was conducted with the purpose to detect possible extraneous microtraces, deriving from the ligature, that could have had an interaction with the cutaneous biological matrix, thanks to atransfertmechanism, in the proximities of the lesion.

Fifteen cutaneous samples of the furrow and an equal number of fragments of graphite tape, directly positioned on the lesion produced by the ligature mean and used as a “conductor” of possible traces, were analyzed using scanning electron microscopy with energy-dispersive x-ray spectrometry.

The research of microscopic traces on the furrow using this technique highlights extraneous traces leading to 3 main categories: natural fabrics, and synthetic and metallic materials, excluding possible environmental pollutants. The analysis, run on 7 hanging deaths, made available by the judicial authority, found a morphological and compositional compatibility with the traces found on the cutaneous furrow produced during hanging.

The technique used in this study is innovative in the pathological-forensic field, and can be considered useful in clarifying and studying this typology of asphyxia leading to a specific ligature material, when missing, or attributing the cause of death to hanging when the furrow is not macroscopically obvious.
Decline in 2 Serial Postmortem Tryptase Measurements Beyond 72 Hours After Death in an Antibiotic-Related Anaphylactic Death
Authors: Tse Rexson , Garland Jack , Ahn Yeri
Published: November 2017

Anaphylaxis can be difficult to diagnose in the postmortem setting. Postmortem tryptase is a widely used ancillary test in aiding the diagnosis in which an elevation supports a death from anaphylaxis. Postmortem tryptase can be difficult to interpret, and the effects of postmortem kinetics are not fully understood. Clinically, mast cell tryptase returns to baseline 24 to 72 hours after an anaphylactic stimulus. We report another anaphylactic death from antibiotic administration in which 2 serial postmortem total tryptase measurements at 3 days (72 hours) and 6 days (144 hours) after death declined from 522 μg/L to 300 μg/L (baseline, 5.6 μg/L). The declination appears to be slower than what is expected in the clinical setting. This case highlights yet another example of the difficult and complex interaction of postmortem interval on postmortem tryptase, especially in an anaphylactic death. We suggest that early blood sampling and serial tests be performed if possible in suspected anaphylactic death.