bluuebunny/crossref_metadata_2025 huggingface dataset:
A corpus-based study of contextual factors influencing Korean EFL learners’ dative alternation
Authors: Song Eu-Jong , Sung Min-Chang
Published: May 2017

English datives show two syntactic patterns, the double object dative (DOD) and the prepositional dative (PD). The alternation between DOD and PD is influenced by three contextual factors: lexical verbs, syntactic weights, and information structures. However, it has been observed that English dative alternation by second language (L2) learners significantly deviates from the native norm. Accordingly, this study examines whether the three factors are influential when L2 learners produce dative sentences, by analyzing a learner corpus and a native speaker corpus. Results show that the learners produced PD significantly more frequently than the native speakers did. Even when DOD should be contextually preferred, the learners produced many PD sentences. These results suggest that L2 learners have trouble noticing the contextual factors when structuring English datives. The finding is further discussed as it relates to the major tenets of L2 acquisition such as cross-linguistic transfer, constructional knowledge, and language processing.
Road sign romanization in Oman
Authors: Jamoussi Rafik , Roche Thomas
Published: May 2017

Throughout the Arab Gulf States, bilingual road signs are the norm, employing both Arabic and a romanized counterpart for the large expatriate population. The existing romanization is inconsistent, with potentially misleading variant spellings of place names signposting the region. This study provides a linguistic analysis of signs on the arterial road running from Muscat, Oman, toward Dubai in the United Arab Emirates in an effort to identify linguistic factors leading to discrepant renderings. The authors identify the wavering between transcription and transliteration and the hesitancy between the local and the standard language varieties as the main sources of discrepancies. These findings constitute the groundwork for initiatives intent on addressing the situation. Guidelines are provided for policy makers indicating the various aspects remedial work on signage in Oman should take into account.
Political mobilization in East Central Europe
Authors: Brunnbauer Ulf , Haslinger Peter
Published: May 2017

This article provides an introduction to the special thematic section on political mobilization in East Central Europe. Based on a brief presentation of the main arguments of the individual articles, the authors discuss the recent political volatility in East Central Europe. They highlight the tension between fierce political rhetoric and populist policies on the one hand, and low levels of voter turnout and overall political participation in the region on the other. The authors argue that recent cases of successful as well as unsuccessful political mobilization in East Central Europe point to structural re-alignments in the region's political landscape. In particular, the parties that are successful are those that manage to communicate their visions in new ways and whose messages resonate with nested attitudes and preferences of the electorate. These parties typically rally against the so-called establishment and claim for themselves an anti-hegemonic agenda. The introductory essay also asserts that these developments in East Central Europe deserve attention for their potential Europe-wide repercussions – especially the idea of “illiberal democracy,”which combines populist mobilization and autocratic demobilization and finds adherents also in more established European democracies.
Preparation of Chitosan/Collagen Blend Membranes for Wound Dressing: A Study on FTIR Spectroscopy and Mechanical Properties
Authors: Indrani D J , Lukitowati F , Yulizar Y
Published: May 2017

The effect of different gamma-ray irradiations on the functional groups and the mechanical properties of chitosan, collagen, and chitosan/collagen blend have been studied. Commercially available chitosan and extract of collagen from bovine tendon by acid dissolution method were employed. Chitosan, collagen and chitosan/collagen blend membranes were prepared using the solvent evaporation method. The dried membranes were subjected to gamma-ray irradiation using 0, 15, and 25 kGy. The membranes then characterized by Infrared spectroscopy and measured in tensile and elongation at break. The irradiated chitosan membranes displayed reduced intensity of -OH, -CH, -NH and -C-O-C groups, whereas, the collagen membranes revealed amide I, II and III groups. The irradiated chitosan/collagen (50/50%) blend membranes demonstrated the decreased intensities in the –OH and amide groups. The application of gamma-ray irradiation had produced chitosan/collagen blend membranes with a tensile strength and elongation at break between the chitosan and collagen membranes. It was further determined that the decrease in the mechanical properties of the membranes was likely to be due to some changes of the functional groups.
Fast auxiliary space preconditioners for linear elasticity in mixed form
Authors: Chen Long , Hu Jun , Huang Xuehai
Published: May 2017

A block-diagonal preconditioner with the minimal residual method and an approximate block-factorization preconditioner with the generalized minimal residual method are developed for Hu-Zhang mixed finite element methods for linear elasticity. They are based on a new stability result for the saddle point system in mesh-dependent norms. The mesh-dependent norm for the stress corresponds to the mass matrix which is easy to invert while for the displacement it is spectral equivalent to the Schur complement. A fast auxiliary space preconditioner based on the

H
1

H^1

-conforming linear element of the linear elasticity problem is then designed for solving the Schur complement. For both diagonal and triangular preconditioners, it is proved that the conditioning numbers of the preconditioned systems are bounded above by a constant independent of both the crucial Lamé constant and the mesh size. Numerical examples are presented to support theoretical results. As byproducts, a new stabilized low order mixed finite element method is proposed and analyzed and superconvergence results for the Hu-Zhang element are obtained.
Canonical heights for correspondences
Authors: Ingram Patrick
Published: May 2017

The canonical height associated to a polarized endomorphism of a projective variety, constructed by Call and Silverman and generalizing the Néron–Tate height on a polarized abelian variety, plays an important role in the arithmetic theory of dynamical systems. We generalize this construction to polarized correspondences, prove various fundamental properties, and show how the global canonical height decomposes as an integral of a local height over the space of absolute values on the algebraic closure of the field of definition.
In Silico Probe-Based Detection of Citrus Viruses in NGS Data
Authors: Jooste T. L. , Visser M. , Cook G. , Burger J. T. , Maree H. J.
Published: May 2017

The conservation of plant biosecurity relies on the rapid identification of pathogenic organisms, including viruses. With next-generation sequencing (NGS), it is possible to identify multiple viruses within a metagenomic sample. In this study, we explored the use of electronic probes (e-probes) for the simultaneous detection of 11 recognized citrus viruses. E-probes were designed and screened against raw sequencing data to minimize the bioinformatic processing time required. The e-probes were able to accurately detect their cognate viruses in simulated datasets, without any false negatives or positives. The efficiency of the e-probe-based approach was validated with NGS datasets generated from different RNA preparations: double-stranded RNA (dsRNA) from ‘Mexican’ lime infected with different Citrus tristeza virus (CTV) genotypes, dsRNA from field samples, and small RNA and total RNA from grapefruit infected with the CTV T3 genotype. A set of probes was made available that is able to accurately detect CTV in sequence data regardless of the input dataset or the genotype that plants are infected with.
The rising incidence of nonalcoholic fatty liver disease
Authors: Wisocky Jessica , Paul Sonali
Published: May 2017

Nonalcoholic fatty liver disease (NAFLD) is the leading cause of liver disease in the United States and will soon be the leading indication for liver transplantation. NAFLD can lead to cirrhosis of the liver and is usually asymptomatic. Prompt referral to a hepatologist may halt the morbidity and mortality associated with NAFLD.
SimZones: An Organizational Innovation for Simulation Programs and Centers
Authors: Roussin Christopher J. , Weinstock Peter
Published: May 2017

The complexity and volume of simulation-based learning programs have increased dramatically over the last decade, presenting several major challenges for those who lead and manage simulation programs and centers. The authors present five major issues affecting the organization of simulation programs: (1) supporting both single- and double-loop learning experiences; (2) managing the training of simulation teaching faculty; (3) optimizing the participant mix, including individuals, professional groups, teams, and other role-players, to ensure learning; (4) balancing in situ, node-based, and center-based simulation delivery; and (5) organizing simulation research and measuring value. They then introduce the SimZones innovation, a system of organization for simulation-based learning, and explain how it can alleviate the problems associated with these five issues.

Simulations are divided into four zones (Zones 0–3). Zone 0 simulations include autofeedback exercises typically practiced by solitary learners, often using virtual simulation technology. Zone 1 simulations include hands-on instruction of foundational clinical skills. Zone 2 simulations include acute situational instruction, such as clinical mock codes. Zone 3 simulations involve authentic, native teams of participants and facilitate team and system development.

The authors also discuss the translation of debriefing methods from Zone 3 simulations to real patient care settings (Zone 4), and they illustrate how the SimZones approach can enable the development of longitudinal learning systems in both teaching and nonteaching hospitals. The SimZones approach was initially developed in the context of the Boston Children’s Hospital Simulator Program, which the authors use to illustrate this innovation in action.
Exploring the Relationships Between USMLE Performance and Disciplinary Action in Practice: A Validity Study of Score Inferences From a Licensure Examination
Authors: Cuddy Monica M. , Young Aaron , Gelman Andrew , Swanson David B. , Johnson David A. , Dillon Gerard F. , Clauser Brian E.
Published: May 2017

Purpose

Physicians must pass the United States Medical Licensing Examination (USMLE) to obtain an unrestricted license to practice allopathic medicine in the United States. Little is known, however, about how well USMLE performance relates to physician behavior in practice, particularly conduct inconsistent with safe, effective patient care. The authors examined the extent to which USMLE scores relate to the odds of receiving a disciplinary action from a U.S. state medical board.

Method

Controlling for multiple factors, the authors used non-nested multilevel logistic regression analyses to estimate the relationships between scores and receiving an action. The sample included 164,725 physicians who graduated from U.S. MD-granting medical schools between 1994 and 2006.

Results

Physicians had a mean Step 1 score of 214 (standard deviation [SD] = 21) and a mean Step 2 Clinical Knowledge (CK) score of 213 (SD = 23). Of the physicians, 2,205 (1.3%) received at least one action. Physicians with higher Step 2 CK scores had lower odds of receiving an action. A 1-SD increase in Step 2 CK scores corresponded to a decrease in the chance of disciplinary action by roughly 25% (odds ratio = 0.75; 95% CI = 0.70–0.80). After accounting for Step 2 CK scores, Step 1 scores were unrelated to the odds of receiving an action.

Conclusions

USMLE Step 2 CK scores provide useful information about the odds a physician will receive an official sanction for problematic practice behavior. These results provide validity evidence supporting current interpretation and use of Step 2 CK scores.
The Problem and Goals Are Global, the Solutions Are Local: Revisiting Quality Measurements and the Role of the Private Sector in Global Health Professions Education
Authors: Hamdy Hossam
Published: May 2017

The shortage of a competent health workforce is a global challenge. However, its manifestations and proposed solutions are very much context related (i.e., local). In addition to the shortage of health professionals, the quality of health professions education programs, institutions, and graduates, and how to measure quality, are also problematic. Commonly used metrics like the Credit Hours System and the European Credit Transfer and Accumulation System have limitations (e.g., being more focused on quantity than quality).

In this Invited Commentary, the author discusses the need to revisit quality measurements in health professions education and the issue of whether the private sector has a role to play in narrowing the ever-increasing gap between the demand for health care professionals and the health care workforce shortage.
A Simple Perioperative Technique to Avoid Limb Length Inequality in Patients Undergoing Cemented Hemireplacement Arthroplasty of Hip Joint
Authors: Reddy I.V. , Ashwin Kumar A.H. , Yalamanchili Ranjith K. , Mettu Anil
Published: May 2017

One of the intraoperative challenges in cemented hemiarthroplasty surgeries of hip is preventing limb length inequality (LLI) without compromising hip stability. Although there are many technical methods described in the literature to prevent LLI, each of them has its limitations in cemented hemiarthroplasty of hip for fracture neck of femur. The method of using relationship between tip of the greater trochanter to the center of the femoral head prosthesis, is a simple perioperative method to align the femoral component to achieve stability and avoid LLI. We have retrospectively analyzed LLI in 108 patients who underwent cemented hemiarthroplasty with Austin Moore prosthesis or bipolar prosthesis using this technique at our center. The mean LLI in the study group was+2.81 mm and the range varied from −6.28 to+9.82 mm. In conjunction with preoperative templating of opposite hip, this method can be used as an easily palpable intraoperative guide in positioning the femoral component to avoid significant LLI in hemiarthroplasty of hip.
Factors Affecting the Development and Sustainability of Communities of Practice Among Primary Care Physicians in Hong Kong
Authors: Poon Man Kay , Lam Tai Pong
Published: May 2017

Introduction:

Primary care physicians (PCPs) maintain high standards of medical care by partaking in continuous learning. The learning model of communities of practice (COPs) is increasingly being used in the field of health care. This study explores the establishment and maintenance of COPs among PCPs in Hong Kong.

Methods:

Sequential, semi-structured individual interview and focus group interview were conducted to explore the purposes for partaking in continuous learning, as well as barriers and facilitators for attendance among private nonspecialist PCPs in Hong Kong. Data were drawn from the discourses related to COPs. Thematic analysis with constant comparison was performed until data saturation was reached.

Results:

PCPs voluntarily established COPs to solve clinical problems from the existing networks. Clinical interest, practice orientation, and recruitment of new members through endorsement by the existing members fostered group coherence. Conversation and interaction among members generated the “best” practice with knowledge that was applicable in specific clinical scenarios in primary care setting. COPs rejected commercial sponsorship to minimize corporate influences on learning. Updating medical knowledge, solving clinical problems, maintaining openness, engendering a sense of trust and ownership among members, and fulfilling psychosocial needs were integral to sustainability. Seeking secretariat support to aid in the logistics of meetings, enhancing external learning resources, and facilitation skills training of facilitators from professional bodies may further incentivize members to maintain COPs.

Discussion:

Autonomy of group learning activities, recruiting specialists and allied health professionals, training facilitators, and undertaking discussion in multimedia may achieve the sustainability of COPs.
Spiradenocarcinoma: A Comprehensive Data Review
Authors: Staiger Roxane D. , Helmchen Birgit , Papet Claudia , Mattiello Diana , Zingg Urs
Published: May 2017

Introduction:

Spiradenocarcinomas (SCs) are rare and potentially aggressive skin adnexal tumors. Optimal treatment has not yet been established. Experiences with this carcinoma are mostly presented in case reports and few case series.

Objective:

To generate to a synopsis of published data on SC with regard to diagnostic procedures, treatment, and outcome.

Results:

Median patient age was 60 years and sex distribution was balanced. Tumor manifestations were evenly distributed within the sweat gland carrying skin. The most commonly reported symptom was accelerated growth of a longstanding indolent lesion, typically present for more than 2 years. Metastatic spread to the lung, bone, lymph nodes, liver, kidney, and breast has been documented. For staging computed tomography (CT) and positron emission tomography-CT are recommended, especially for detection of hematogenic metastases and lymph node involvement. Clear resection margins and tumor free regional lymph nodes reduce recurrence and carcinoma related death. Although low-grade SCs were reported over 3 times more often, high-grade carcinomas show a greater likelihood for recurrence and lethal outcome.

Conclusion:

Suspicion of an SC should lead to performance of a magnetic resonance imaging for defining tumor extent, and a fludeoxyglucose positron emission tomography-CT for detection of metastases. Radical tumor excision and resection of tumor involved regional lymph nodes are essential for a curative approach. Histopathological evaluation should involve determination of tumor differentiation grade, because high-grade carcinomas seem to have a much more aggressive behavior. Excision of distant metastases has no therapeutic value. Follow-up needs to be carried out in short intervals with frequent imaging.
Prevention of Surgical Site Infections and Biofilms: Pharmacokinetics of Subcutaneous Cefazolin and Metronidazole in a Tumescent Lidocaine Solution
Authors: Klein Jeffrey A. , Langman Loralie J.
Published: May 2017

Background:

Tumescent anesthesia antibiotic delivery (TAAD) consists of subcutaneous infiltration of antibiotic(s) dissolved tumescent lidocaine anesthesia. Tumescent lidocaine anesthesia contains lidocaine (≤ 1 g/L), epinephrine (≤ 1 mg/L), sodium bicarbonate (10 mEq/L) in 0.9% saline. Our aim was to measure cefazolin and metronidazole concentrations over time in subcutaneous tumescent interstitial fluid (TISF) after TAAD, in serum after TAAD and after intravenous antibiotic delivery (IVAD). We hypothesize that the pharmacokinetic/pharmacodynamic profiles of TAAD + IVAD are superior to IVAD alone for the prevention of surgical site infections and biofilms.

Methods:

Concentrations of cefazolin and metronidazole in TISF and serum following TAAD and in serum following IVAD were compared in 5 female volunteers. Subjects received cefazolin or cefazolin plus metronidazole by IVAD alone and by TAAD alone. One subject also received concomitant IVAD and TAAD of these 2 antibiotics. Sequential samples of serum or subcutaneous TISF were assayed for antibiotic concentration.

Results:

Cefazolin (1 g) by TAAD resulted in an area under the curve of the concentration–time profile and a maximum concentration (Cmax) in subcutaneous tissue that were 16.5 and 5.6 times greater than in serum following 1 g by IVAD. Metronidazole (500 mg) by TAAD resulted in an area under the curve and Cmax that were 8.1 and 24.7 times greater in TISF, than in serum after 500 mg by intravenous delivery. IVAD + TAAD resulted in superior antibiotic concentrations to IVAD alone.

Conclusions:

TAAD + IVAD produced superior antibiotic bioavailability in both subcutaneous interstitial fluid and serum compared with IVAD alone. There was no evidence that TAAD of cefazolin and metronidazole poses a significant risk of harm to patients.
Dramatic Changes in Health Care Professions in the Past 40 Years
Authors: Goldfield Norbert
Published: May 2017

During the forty-year life of the Journal of Ambulatory Care Management, revolutionary transformations have occurred in the roles of existing health professions, as has the emergence of new categories of health professionals. This paper specifies the reasons for these dramatic changes, the new types of health care professions that have emerged, changes in existing professions, and suggestions of future directions. Many of these changes will be impacted by what occurs in Washington, DC in the debate over the Accountable Care Act.
Association between lower air pressure and the onset of ischemic colitis: a case–control study
Authors: Kimura Takefumi , Shinji Akihiro , Tanaka Naoki , Koinuma Masayoshi , Yamaura Maki , Nagaya Tadanobu , Joshita Satoru , Komatsu Michiharu , Umemura Takeji , Horiuchi Akira , Wada Shuichi , Tanaka Eiji
Published: May 2017

Objective

Ischemic colitis (IC) often affects the elderly. Proarteriosclerotic factors, such as hypertension and smoking, and cardiovascular disease are considered major contributors to IC. Although a possible link between certain cerebrocardiovascular disorders and meteorological phenomena has been reported, the relationship between IC onset and weather changes remains uninvestigated. This study examined whether specific meteorological factors were associated with the occurrence of IC.

Patients and methods

We retrospectively enrolled 303 patients who had been diagnosed with IC between January 2003 and June 2010 at Suwa Red Cross Hospital in Nagano Prefecture, Japan. The meteorological data of the days on which IC patients visited the hospital (IC+ days) were compared with those of the days on which IC patients did not (IC− days).

Results

Univariate analysis indicated that IC+ days had significantly lower air pressure (P<0.001), depressed air pressure from the previous day (P<0.001), and fewer daylight hours (P<0.001), as well as higher air temperature (P=0.017), air humidity (P=0.004), wind velocity (P<0.001), and rainfall (P=0.012) compared with IC− days. Multivariate logistic regression analysis of the meteorological data showed that air pressure (odds ratio: 0.935, P<0.001) and change in air pressure from the previous day (odds ratio: 0.934, P<0.001) were related to onset of IC.

Conclusion

Lower air pressure and decrease in air pressure from the previous day are possible novel factors associated with the development of IC.
The Collagen Gel Droplet–embedded Culture Drug Sensitivity Test in Relapsed Hepatoblastoma
Authors: Goto Hiroaki , Kitagawa Norihiko , Sekiguchi Hironobu , Miyagi Yohei , Keino Dai , Sugiyama Masanaka , Sarashina Takeo , Miyagawa Naoyuki , Yokosuka Tomoko , Hamanoue Satoshi , Iwasaki Fuminori , Shiomi Masae , Goto Shoko , Tanaka Yukichi
Published: May 2017

There are few treatment options for patients with unresectable or refractory hepatoblastoma which has failed to respond to the standard treatment. The rarity of the disease and lack of experimental materials have hampered the development of new treatments. In this study, the collagen gel droplet–embedded culture drug sensitivity test was used to evaluate the effectiveness of the multikinase inhibitors sorafenib and sunitinib, and other drugs, in relapsed hepatoblastoma tumor tissues. Tumor samples from 6 patients with relapsed hepatoblastoma were tested for drug sensitivity by the collagen gel droplet–embedded culture drug sensitivity test; evaluable results were obtained from 5 of them. All samples were judged to be sensitive to sorafenib with a 50% growth inhibitory concentration (IC50) of 0.5 to 3.1 μg/mL. Sunitinib did not achieve IC50 in 2 of 3 samples within the tested concentration range based on clinically observed serum concentrations. In the drug combination assay using a hepatoblastoma cell line, sorafenib showed synergistic effects with SN-38, an active metabolite of irinotecan. Our results provide the basic science background warranting future clinical trials of a combination of sorafenib and irinotecan for relapsed or refractory hepatoblastoma.
Epigenetic Combination Therapy for Children With Secondary Myelodysplastic Syndrome (MDS)/Acute Myeloid Leukemia (AML) and Concurrent Solid Tumor Relapse
Authors: Glasser Chana L. , Lee Alice , Eslin Don , Marks Lianna , Modak Shakeel , Glade Bender Julia L.
Published: May 2017

Secondary myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML) is a rare but devastating complication of solid tumor treatment involving high-dose topoisomerase II inhibitor and alkylator chemotherapy. For relapsed or elderly MDS and AML patients ineligible for hematopoietic stem cell transplantation, epigenetic therapies, including DNA methyltransferase inhibitors and histone deacetylase inhibitors, have been utilized as palliative therapy, offering a well-tolerated approach to disease stabilization, prolonged survival, and quality of life. Literature on the use of epigenetic therapies for both primary and relapsed disease is scarce in the pediatric population. Here, we report 2 pediatric patients with secondary AML and MDS, respectively, due to prior therapy for metastatic solid tumors. Both patients were ineligible for hematopoietic stem cell transplantation due to concurrent solid tumor relapse, but were treated with the epigenetic combination therapy, decitabine and vorinostat, and achieved stabilization of marrow disease, outpatient palliation, and family-reported reasonable quality of life.
Kawasaki Disease Complicated With Macrophage Activation Syndrome: A Systematic Review
Authors: García-Pavón Susana , Yamazaki-Nakashimada Marco A. , Báez Milton , Borjas-Aguilar Karla L. , Murata Chiharu
Published: May 2017

Macrophage activation syndrome (MAS), also known as secondary hemophagocytic lymphohistiocytosis, is a rare and potentially fatal complication of Kawasaki disease (KD). We report 2 cases, performed a literature search, and analyze the characteristics of MAS associated with KD. A total of 69 patients were evaluated, 34 reported the date of the diagnosis of MAS and KD, 6% had a diagnosis of MAS before KD, 21% had a simultaneous presentation, and 73% had the diagnosis of MAS after KD. Different treatment approaches were observed with corticosteroids administered in 87%, cyclosporine in 49%, etoposide (VP-16) in 39%, and monoclonal anti-TNF in 6% of cases. Coronary abnormalities were especially high in this group of patients (46%) and 9 patients died (13%). The persistence of fever with splenomegaly, hyperferritinemia, thrombocytopenia, and elevated aspartate aminotransferase (AST) should prompt the consideration of MAS complicating KD.
An Unusual Cause of Fever and Rash in a Child With Severe Aplastic Anemia
Authors: Lee Elis Yuexian , Lian Wen Quan Derrick , Iyer Prasad , Bhattacharyya Rajat
Published: May 2017

A 4-year-old girl with severe aplastic anemia and 2 previous failed T-depleted haploidentical peripheral blood stem cell transplants developed persistent neutropenic fever and multiple erythematous maculopapular rashes 2 days after her third T-replete haploidentical bone marrow transplant. Skin biopsy confirmed the diagnosis of Trichosporon asahii infection. She was on caspofungin prophylaxis which is not effective against Trichosporon. A high index of suspicion, prompt investigation, and appropriate treatment with voriconazole for 4 months was instrumental in controlling the infection and she remains well presently 9 months posttransplant with full donor chimerism and free from infection.
Intravenous Iron Sucrose for Children With Iron Deficiency Anemia
Authors: Kaneva Kristiyana , Chow Erika , Rosenfield Cathy G. , Kelly Michael J.
Published: May 2017

Iron deficiency anemia (IDA) is the most common nutritional deficiency in children. Most children with IDA are treated with oral iron preparations. However, intravenous (IV) iron is an alternative for children with severe IDA who have difficulty in adhering to or absorbing oral iron. We sought to describe the safety and effectiveness of IV iron sucrose for treatment of IDA in children. Pharmacy records of children who received IV iron sucrose at a children’s hospital between 2004 and 2014 were reviewed. Laboratory markers of anemia and iron studies were obtained and preinfusion and postinfusion values were compared. Records were also reviewed for adverse reactions. A total of 142 patients received IV iron sucrose over 10 years. The mean age was 11 years, 9 months. One patient of 142 developed cough and wheezing during the infusion. No other adverse events were found. IV iron sucrose resulted in a statistically significant and clinically meaningful increase in hemoglobin, mean corpuscular volume, serum iron, ferritin, and % iron saturation, with a corresponding decrease in total iron binding capacity. The use of IV iron sucrose in pediatric patients with IDA is safe and leads to a moderate increase in hemoglobin and substantial improvement in iron studies.
Iron Overload in Survivors of Childhood Cancer
Authors: Trovillion Erin Murphy , Schubert Lynn , Dietz Andrew C.
Published: May 2017

Background:

Patients transfused with packed red blood cells (PRBC), including childhood cancer survivors (CCS), experience complications. We describe iron overload (ferritin>500 ng/mL) prevalence and identify risk factors in CCS.

Observations:

Of 116 participants, 3 (2.6%) had elevated ferritin. All were teenagers at cancer diagnosis and received >8000 mL PRBC. Total PRBC volume correlated best with elevated ferritin (r=0.74; P<0.0001). PRBC (8000 mL) had the best positive and negative predictive value (75% and 100%, respectively) for iron overload.

Conclusions:

CCS may have iron overload. Overall prevalence is low. At-risk include teenagers at diagnosis and those receiving higher total PRBC volumes.
Defining Roles and Expectations for Faculty, Nurses, and Students in a Dedicated Education Unit
Authors: Rusch Lorraine , Beiermann Trisha , Schoening Anne M. , Slone Cindy , Flott Beth , Manz Julie , Miller Jacque
Published: May 2017

The dedicated education unit (DEU) model of clinical nursing education is an innovative, evidence-based model for creating a more effective learning environment. Although nursing programs have used this model for years, the literature provides minimal direction to assist faculty in transitioning from traditional clinical teaching to the DEU model. This article reports the development and evaluation of 2 resources to help all involved understand teaching roles and desired learning outcomes in the DEU model.
Evidence-Based Medicine Curriculum Improves Pediatric Emergency Fellows' Scores on In-Training Examinations
Authors: Tavarez Melissa M. , Kenkre Tanya S. , Zuckerbraun Noel
Published: May 2017

Objectives

The aim of this study was to determine if implementation of our evidence-based medicine (EBM) curriculum had an effect on pediatric emergency medicine fellows' scores on the relevant section of the in-training examination (ITE).

Methods

We obtained deidentified subscores for 22 fellows over 6 academic years for the Core Knowledge in Scholarly Activities (SA) and, as a balance measure, Emergencies Treated Medically sections. We divided the subscores into the following 3 instruction periods: “baseline” for academic years before our current EBM curriculum, “transition” for academic years with use of a research method curriculum with some overlapping EBM content, and “EBM” for academic years with our current EBM curriculum. We analyzed data using the Kruskal-Wallis test, the Mann-Whitney U test, and multivariate mixed-effects linear models.

Results

The SA subscore median was higher during the EBM period in comparison with the baseline and transition periods. In contrast, the Emergencies Treated Medically subscore median was similar across instruction periods. Multivariate modeling demonstrated that our EBM curriculum had the following independent effects on the fellows' SA subscore: (1) in comparison with the transition period, the fellows' SA subscore was 21 percentage points higher (P = 0.005); and (2) in comparison to the baseline period, the fellows' SA subscore was 28 percentage points higher during the EBM curriculum instruction period (P < 0.001).

Conclusions

Our EBM curriculum was associated with significantly higher scores on the SA section of the ITE. Pediatric emergency medicine educators could consider using fellows' scores on this section of the ITE to assess the effect of their EBM curricula.
An Ethical Justification for Termination of Resuscitation Protocols for Pediatric Patients
Authors: Muñoz Michael G. , Beyda David H.
Published: May 2017

Objective

The aim of this article was to compare specific characteristics and outcomes among adult and pediatric out-of-hospital cardiac arrest (OHCA) patients to show that the existing literature warrants the design and implementation of pediatric studies that would specifically evaluate termination of resuscitation protocols. We also address the emotional and practical concerns associated with ceasing resuscitation efforts on scene when treating pediatric patients.

Methods

Relevant prospective and retrospective studies were used to compare characteristics and outcomes between adult and pediatric OHCA patients. Characteristics analyzed were nonwitnessed arrests, absence of shockable rhythm, no return of spontaneous circulation, and survival to hospital discharge.

Results

Cases of unwitnessed arrests by emergency medical services providers are substantially the same in pediatric patients (41.0%–96.3%) compared with their adult counterparts (47.4%–97.7%). The adult studies revealed 57.6% to 92.2% of patients without an initial shockable rhythm. The pediatric studies showed a range of 64.0% to 98.0%. The range of adult patients without return of spontaneous circulation was 54.8% to 95.4%, and the range in pediatric patients was 68.2% to 95.6%. Survival rates among the adult studies ranged from 0.8% to 9.3% (mean, 5.0%; median, 5.2%), and in the pediatric studies they were 2.0% to 26.2% (mean, 9.2%; median, 7.7%).

Conclusions

The data compared demonstrate that characteristics and outcomes are virtually identical between adult and pediatric OHCA patients. We also found the 3 chief barriers hindering further research to be invalid impediments to moving forward. This review warrants designing pediatric studies that would specifically correlate termination of resuscitation protocols with patient survival and include predictive values.
Identification and Validation of Clinically Relevant Clusters of Severe Fatigue in Rheumatoid Arthritis
Authors: Basu Neil , Jones Gareth T. , Macfarlane Gary J. , Druce Katie L.
Published: May 2017

Objective

The considerable heterogeneity of rheumatoid arthritis (RA)-related fatigue is the greatest challenge to determining pathogenesis. The identification of homogenous subtypes of severe fatigue would inform the design and analysis of experiments seeking to characterize the likely numerous causal pathways that underpin the symptom. This study aimed to identify and validate such fatigue subtypes in patients with RA.

Methods

Data were obtained from patients recruited to the British Society for Rheumatology Biologics register for RA, as either receiving traditional disease-modifying antirheumatic drugs (DMARD cohort, n = 522) or commencing anti-tumor necrosis factor therapy (anti-TNF cohort, n = 3909). In those reporting severe fatigue (Short-Form 36 vitality ≤ 12.5), this cross-sectional analysis applied hierarchical clustering with weighted-average linkage identified clusters of pain, fatigue, mental health (all Short-Form 36), disability (Health Assessment Questionnaire), and inflammation (erythrocyte sedimentation rate) in the DMARD cohort. K-means clustering sought to validate the solution in the anti-TNF cohort. Clusters were characterized using a priori generated symptom definitions and between-cluster comparisons.

Results

Four severe fatigue clusters, labeled as basic (46%), affective (40%), inflammatory (4.5%), and global (8.9%) were identified in the DMARD cohort. All clusters had severe levels of pain and disability and were distinguished by the presence/absence of poor mental health and high inflammation. The same symptom clusters were present in the anti-TNF cohort, although the proportion of participants in each cluster differed (basic = 28.7%; affective = 30.2%; global = 24.1%; inflammatory = 16.9%).

Conclusions

Among RA patients with severe fatigue, recruited to two diverse RA cohorts, clinically relevant clusters were identified and validated. These may provide the basis for future mechanistic studies and ultimately support a stratified approach to fatigue management.
Renal Adiposity Confounds Quantitative Assessment of Markers of Renal Diffusion With MRI
Authors: Ebrahimi Behzad , Saad Ahmed , Jiang Kai , Ferguson Christopher M. , Tang Hui , Woollard John R. , Glockner James F. , Textor Stephen C. , Lerman Lilach O.
Published: May 2017

Objectives

Recent studies have indicated that excessive fat may confound assessment of diffusion in organs with high fat content, such as the liver and breast. However, the extent of this effect in the kidney, which is not considered a major fat deposition site, remains unclear. This study tested the hypothesis that renal fat may impact diffusion-weighted imaging (DWI) parameters, and proposes a 3-compartment model (TCM) to circumvent this effect.

Methods

Using computer simulations, we investigated the effect of fat on assessment of apparent diffusion coefficient (ADC), intravoxel incoherent motion (IVIM), and TCM-derived pure-diffusivity. We also investigated the influence of magnetic resonance repetition (TR) and echo time (TE) on DWI parameters as a result of variation in the relative contribution of the fat signal. Apparent diffusion coefficient, IVIM and TCM DWI parameters were calculated in domestic pigs fed a high-cholesterol (obese group) or normal diet (lean group), and correlated to renal histology. Intravoxel incoherent motion–derived pure-diffusivity was also compared among 15 essential hypertension patients classified by body mass index (BMI) (high vs normal). Finally, pure-diffusivity was calculated and compared in 8 patients with atherosclerotic renal artery stenosis (ARAS) and 5 healthy subjects using IVIM and TCM.

Results

Simulations showed that unaccounted fat results in the underestimation of IVIM-derived pure diffusivity. The underestimation increases as the fat fraction increases, with higher pace at lower fat contents. The underestimation was larger for shorter TR and longer TE values due to the enhancement of the relative contribution of the fat signal. Moreover, TCM, which incorporates highly diffusion-weighted images (b > 2500 s/mm2), could correct for fat-dependent underestimation. Animal studies in the lean and obese groups confirmed lower ADC and IVIM pure-diffusivity in obese versus lean pigs with otherwise healthy kidneys, whereas pure-diffusivity calculated using TCM were not different between the 2 groups. Similarly, essential hypertension patients with high BMI had lower ADC (1.9 vs 2.1 × 10−3 mm2/s) and pure-diffusivity (1.7 vs 1.9 × 10−3 mm2/s) than those with normal BMI. Pure-diffusivity calculated using IVIM was not different between the ARAS and healthy subjects, but TCM revealed significantly lower diffusivity in ARAS.

Conclusions

Excessive renal fat may cause underestimation of renal ADC and IVIM-derived pure-diffusivity, which may hinder detection of renal pathology. Models accounting for fat contribution may help reduce the variability of diffusivity calculated using DWI.
Natural history of splenic vascular abnormalities after blunt injury: A Western Trauma Association multicenter trial
Authors: Zarzaur Ben L. , Dunn Julie A. , Leininger Brian , Lauerman Margaret , Shanmuganathan Kathirkamanthan , Kaups Krista , Zamary Kirellos , Hartwell Jennifer L. , Bhakta Ankur , Myers John , Gordy Stephanie , Todd Samuel R. , Claridge Jeffrey A. , Teicher Erik , Sperry Jason , Privette Alicia , Allawi Ahmed , Burlew Clay Cothren , Maung Adrian A. , Davis Kimberly A. , Cogbill Thomas , Bonne Stephanie , Livingston David H. , Coimbra Raul , Kozar Rosemary A.
Published: May 2017

BACKGROUND

Following blunt splenic injury, there is conflicting evidence regarding the natural history and appropriate management of patients with vascular injuries of the spleen such as pseudoaneurysms or blushes. The purpose of this study was to describe the current management and outcomes of patients with pseudoaneurysm or blush.

METHODS

Data were collected on adult (aged ≥18 years) patients with blunt splenic injury and a splenic vascular injury from 17 trauma centers. Demographic, physiologic, radiographic, and injury characteristics were gathered. Management and outcomes were collected. Univariate and multivariable analyses were used to determine factors associated with splenectomy.

RESULTS

Two hundred patients with a vascular abnormality on computed tomography scan were enrolled. Of those, 14.5% were managed with early splenectomy. Of the remaining patients, 59% underwent angiography and embolization (ANGIO), and 26.5% were observed. Of those who underwent ANGIO, 5.9% had a repeat ANGIO, and 6.8% had splenectomy. Of those observed, 9.4% had a delayed ANGIO, and 7.6% underwent splenectomy. There were no statistically significant differences between those observed and those who underwent ANGIO. There were 111 computed tomography scans with splenic vascular injuries available for review by an expert trauma radiologist. The concordance between the original classification of the type of vascular abnormality and the expert radiologist’s interpretation was 56.3%. Based on expert review, the presence of an actively bleeding vascular injury was associated with a 40.9% risk of splenectomy. This was significantly higher than those with a nonbleeding vascular injury.

CONCLUSIONS

In this series, the vast majority of patients are managed with ANGIO and usually embolization, whereas splenectomy remains a rare event. However, patients with a bleeding vascular injury of the spleen are at high risk of nonoperative failure, no matter the strategy used for management. This group may warrant closer observation or an alternative management strategy.

LEVEL OF EVIDENCE

Prognostic study, level III.
Reduction of pediatric pedestrian hazardous road conditions in a school drop-off zone using video review
Authors: Abd el-shafy Ibrahim , Savino Jillian , Christopherson Nathan A.M. , Prince Jose M.
Published: May 2017

BACKGROUND

In 2012, 76,000 pedestrians were struck by motor vehicles. This resulted in 20% of all pediatric mortalities between the ages of 5 and 15. We hypothesize that children are exposed to increased risk as pedestrians to motor vehicle injury when arriving to school and that identification of these hazards would improve targeting of injury prevention efforts.

METHODS

Within a county containing 355 public schools, we identified a primary school with 588 students located in an urban setting with concerns for a high-risk traffic environment. Field surveys observed traffic patterns and established an optimal surveillance period 30 minutes before school. Three observation periods, from two discreet and blinded locations, were conducted from January to March 2016. Videos were evaluated by two independent reviewers to identify and score quantifiable hazards. Three controlled observations were conducted on non-school days, followed by three post-intervention observations from October to December 2016. Comparison was made using Student’s t test. Data was analyzed using SAS version 9.4 (SAS Institute Inc., Cary, NC).

RESULTS

We identified nine safety hazards including double parking (29.3 ± 5.5), dropping off in a bus stop (23.3 ± 7.6), and jaywalking (9.3 ± 3.1). Combining all hazards seen in each observation resulted in an overall hazard average of 83.0 ± 3.6 events/period. Comparing control periods to school observation identified significantly increased hazard events on school days (p < 0.0001). Targeted safety intervention demonstrated a 26% reduction in hazard events (p < 0.0005).

CONCLUSION

We identified the most common hazards associated with children arriving at a primary school in an urban setting, used our analysis to develop an intervention, and demonstrated the impact of our intervention. Our novel use of video review to identify hazards provides a metric against which the impact of pedestrian road safety interventions might be measured.

LEVEL OF EVIDENCE

Epidemiological, level II; Therapeutic, level IV.
Behaviour of free ranging wild boar towards their dead fellows: potential implications for the transmission of African swine fever
Authors: Probst Carolina , Globig Anja , Knoll Bent , Conraths Franz J. , Depner Klaus
Published: May 2017

The behaviour of free ranging wild boar (
Sus scrofa
) towards carcasses of their conspecifics potentially infected with African swine fever (ASF) may significantly influence the course of an ASF epidemic. This study aims to better understand the behaviour of wild boar towards their dead fellows. Thirty-two wild boar carcasses on nine study sites in northeast Germany were monitored under field conditions by photo-trapping from October 2015 until October 2016. During this period, a total of 122 160 pictures were taken, thereof 16 111 pictures of wild boar. In both winter and summer, wild boar seemed to be particularly interested in the soil next to and underneath the carcasses. About one third of the visits of wild boar led to direct contact with dead conspecifics. The contacts consisted mostly in sniffing and poking on the carcass. Under the given ecological and climatic conditions, there was no evidence for intra-species scavenging. However, piglets were observed several times chewing bare bones once skeletonization of the carcasses was complete. It must be assumed that all these types of contact may represent a risk of transmission. Both the high tenacity of ASF virus and the long time wild boar carcasses can remain in the environment, allow the persistence of the virus for several months or even years. We therefore consider the rapid detection and removal (or destruction on the spot) of contaminated carcasses as an important control measure against ASF in wild boar.
Nonlinear waves in solids with slow dynamics: an internal-variable model
Authors: Berjamin H. , Favrie N. , Lombard B. , Chiavassa G.
Published: May 2017

In heterogeneous solids such as rocks and concrete, the speed of sound diminishes with the strain amplitude of a dynamic loading (softening). This decrease, known as ‘slow dynamics’, occurs at time scales larger than the period of the forcing. Also, hysteresis is observed in the steady-state response. The phenomenological model by Vakhnenko
et al.
(2004
Phys. Rev. E
70, 015602. (
doi:10.1103/PhysRevE.70.015602
)) is based on a variable that describes the softening of the material. However, this model is one dimensional and it is not thermodynamically admissible. In the present article, a three-dimensional model is derived in the framework of the finite-strain theory. An internal variable that describes the softening of the material is introduced, as well as an expression of the specific internal energy. A mechanical constitutive law is deduced from the Clausius–Duhem inequality. Moreover, a family of evolution equations for the internal variable is proposed. Here, an evolution equation with one relaxation time is chosen. By construction, this new model of the continuum is thermodynamically admissible and dissipative (inelastic). In the case of small uniaxial deformations, it is shown analytically that the model reproduces qualitatively the main features of real experiments.