bluuebunny/crossref_metadata_2025 huggingface dataset:
The Nep1-like protein family of Magnaporthe oryzae is dispensable for the infection of rice plants
Authors: Fang Ya-Li , Peng You-Liang , Fan Jun
Published: June 2017

The necrosis- and ethylene-inducing protein 1 (Nep1)-like proteins (NLPs) are a class of microbe-associated molecular patterns widely distributed across diverse groups of plant-associated microorganisms. In spite of the cytotoxic activity in dicot plants, the role of most NLPs in the virulence of plant pathogens is still largely unknown. We showed that the MoNLP family of rice blast fungus varied very little in amino acid sequence, transient expression of threeMoNLPs induced cell death and the production of reactive oxygen species inNicotiana benthamiana, and the expression ofMoNLPswas induced during infection of susceptible rice plants. To further investigate the biological role of theMoNLPfamily, a marker-free gene replacement vector was developed and used to knock out the whole family inMagnaporthe oryzae. Results showed no significant difference in disease levels caused by wild type and the quadrupleΔMoNLPmutant strains. Likewise, the sporulation and radial growth of the two strains were similar under various unfavorable cultural conditions including malnutrition and abiotic stresses. These observations demonstrated that the MoNLP family is dispensable for the fungal tolerance to the tested adverse cultural conditions, and more importantly, for the virulence of blast fungus on susceptible rice plants.
nr3c1 null mutant zebrafish are viable and reveal DNA-binding-independent activities of the glucocorticoid receptor
Authors: Facchinello N. , Skobo T. , Meneghetti G. , Colletti E. , Dinarello A. , Tiso N. , Costa R. , Gioacchini G. , Carnevali O. , Argenton F. , Colombo L. , Dalla Valle L.
Published: June 2017

Glucocorticoids (GCs) play important roles in developmental and physiological processes through the transcriptional activity of their cognate receptor (Gr). Using CRISPR/Cas9 technology, we established a zebrafish null Gr mutant line and compared its phenotypes with wild type and a zebrafish line with partially silenced gr (grs357/s357). Homozygous gr−/− larvae are morphologically inconspicuous and, in contrast to GR−/− knockout mice, viable through adulthood, although with reduced fitness and early life survival. Mutants gr−/− are fertile, but their reproductive capabilities fall at around 10 months of age, when, together with cardiac and intestinal abnormalities already visible at earlier stages, increased fat deposits are also observed. Mutants show higher levels of whole-body cortisol associated with overstimulated basal levels of crh and pomca transcripts along the HPI axis, which is unresponsive to a mechanical stressor. Transcriptional activity linked to immune response is also hampered in the gr−/− line: after intestinal damage by dextran sodium sulphate exposure, there are neither inflammatory nor anti-inflammatory cytokine gene responses, substantiating the hypothesis of a dual-action of the GC-GR complex on the immune system. Hence, the zebrafish gr mutant line appears as a useful tool to investigate Gr functions in an integrated in vivo model.
A low-frequency chip-scale optomechanical oscillator with 58 kHz mechanical stiffening and more than 100th-order stable harmonics
Authors: Huang Yongjun , Flores Jaime Gonzalo Flor , Cai Ziqiang , Yu Mingbin , Kwong Dim-Lee , Wen Guangjun , Churchill Layne , Wong Chee Wei
Published: June 2017

For the sensitive high-resolution force- and field-sensing applications, the large-mass microelectromechanical system (MEMS) and optomechanical cavity have been proposed to realize the sub-aN/Hz1/2 resolution levels. In view of the optomechanical cavity-based force- and field-sensors, the optomechanical coupling is the key parameter for achieving high sensitivity and resolution. Here we demonstrate a chip-scale optomechanical cavity with large mass which operates at ≈77.7 kHz fundamental mode and intrinsically exhibiting large optomechanical coupling of 44 GHz/nm or more, for both optical resonance modes. The mechanical stiffening range of ≈58 kHz and a more than 100th-order harmonics are obtained, with which the free-running frequency instability is lower than 10−6 at 100 ms integration time. Such results can be applied to further improve the sensing performance of the optomechanical inspired chip-scale sensors.
Comparative single atom heterogeneous catalysts (SAHCs) on different platforms: a theoretical approach
Authors: Fako Edvin , Łodziana Zbigniew , López Núria
Published: June 2017

The nature of SAHC interactions with the matrix is crucial as it controls the electronic structure of the atom, its charge, the coordination pattern and the overall catalytic ensemble. We have checked all these aspects by studying the same single atom in oxides, metals and carbon nitride.
Synthesis and complexation of superbulky imidazolium-2-dithiocarboxylate ligands
Authors: Beltrán Tomás F. , Zaragoza Guillermo , Delaude Lionel
Published: June 2017

Two NHC·CS2zwitterions derived from superbulky N-heterocyclic carbenes were synthesized and coordinated to Re(i) and Ru(ii). The dithiocarboxylate unit of these highly flexible ligands chiefly determined the steric requirements of the imidazolium moieties, irrespective of the metal used for complexation.
Tile-based self-assembly of a triple-helical polysaccharide into cell wall-like mesoporous nanocapsules
Authors: Wu Chaoxi , Wang Xiaoying , Wang Jianjing , Zhang Zhen , Wang Zhiping , Wang Yifei , Tang Shunqing
Published: June 2017

Herein, we report that β-glucan, after modified by two types of acyl groups, can self-assemble into tiles at the interface of two solvents. These tiles can further pack into mesoporous nanocapsules in a stepwise manner.
In situ reactive interfacial compatibilization of polylactide/sisal fiber biocomposites via melt-blending with an epoxy-functionalized terpolymer elastomer
Authors: Hao Mingyang , Wu Hongwu , Zhu Zhihua
Published: June 2017

The in situ reactive interfacial compatibilization and properties of polylactide/sisal fiber biocomposites made via melt blending with an epoxy-functionalized terpolymer elastomer were investigated.
Preparation and characterization of insensitive HMX/rGO/G composites via in situ reduction of graphene oxide
Authors: Niu Chunhuan , Jin Bo , Peng Rufang , Shang Yu , Liu Qiangqiang
Published: June 2017

Composites of 1,3,5,7-tetranitro-1,3,5,7-tetrazocane/reduced graphene oxide/graphite (HMX/rGO/G) were successfully prepared via an in situ chemical reduction coating method.
Flexible, transferable and conformal egg albumen based resistive switching memory devices
Authors: Zhu J. X. , Zhou W. L. , Wang Z. Q. , Xu H. Y. , Lin Y. , Liu W. Z. , Ma J. G. , Liu Y. C.
Published: June 2017

Egg albumen based RRAM devices transferred onto nonconventional substrates demonstrate flexible and conformal applications.
Naphthalimide–coumarin conjugate: ratiometric fluorescent receptor for self-calibrating quantification of cyanide anions in cells
Authors: Shiraishi Yasuhiro , Hayashi Naoto , Nakahata Masaki , Sakai Shinji , Hirai Takayuki
Published: June 2017

A naphthalimide–coumarin conjugate shows invariable green fluorescence and CN−-selective blue fluorescence, and facilitates rapid (within 3 min) and sensitive (1.8 μM) ratiometric detection of CN− in cells.
A multicomponent bicyclization reaction of isocyanide, allenoate, imine and water to synthesize pyrrolidine-fused rings
Authors: Jiang Hui , Tian Yaming , Tian Lumin , Li Jian
Published: June 2017

A multicomponent bicyclization of isocyanide, allenoate, imine, and water has been disclosed. This protocol involves the formation of five chemical bonds (two C–C, two C–N, and one C–O), thus providing a new pathway to fused rings.
Correction: Conformation dynamics of the intrinsically disordered protein c-Myb with the ff99IDPs force field
Authors: Guo Xiang , Han Jincheng , Luo Ray , Chen Hai-Feng
Published: June 2017

Correction for ‘Conformation dynamics of the intrinsically disordered protein c-Myb with the ff99IDPs force field’ by Xiang Guo et al., RSC Adv., 2017, 7, 29713–29721.
Formation and decay of negative ion states up to 11 eV above the ionization energy of the nanofabrication precursor HFeCo3(CO)12
Authors: T P Ragesh Kumar , Bjornsson Ragnar , Barth Sven , Ingólfsson Oddur
Published: June 2017

Dissociative electron attachment, 11 eV above the ionization energy of the focused electron beam induced deposition (FEBID) precursor HFeCo3(CO)12. A unique observation with potential significance for FEBID precursor design.
Ce-doped La0.7Sr0.3Fe0.9Ni0.1O3−δ as symmetrical electrodes for high performance direct hydrocarbon solid oxide fuel cells
Authors: Bian Liuzhen , Duan Chuancheng , Wang Lijun , O'Hayre Ryan , Cheng Jin , Chou Kuo-Chih
Published: June 2017

La0.7Sr0.3Fe0.9Ni0.1O3−δ (LSFNi) and La0.6Ce0.1Sr0.3Fe0.9Ni0.1O3−δ (CLSFNi) are synthesized and applied for use as symmetrical electrodes in direct-methane solid oxide fuel cells (SOFCs).
Survey on Aesthetic Vulvovaginal Procedures: What do Portuguese Doctors and Medical Students Think?
Authors: Vieira-Baptista Pedro , Lima-Silva Joana , Fonseca-Moutinho José , Monteiro Virgínia , Águas Fernanda
Published: June 2017

Objective To assess the medical doctors and medical students' opinion regarding the evidence and ethical background of the performance of vulvovaginal aesthetic procedures (VVAPs).

Methods Cross-sectional online survey among 664 Portuguese medical doctors and students.

Results Most participants considered that there is never or there rarely is a medical reason to perform: vulvar whitening (85.9% [502/584]); hymenoplasty (72.0% [437/607]); mons pubis liposuction (71.6% [426/595]); “G-spot” augmentation (71.0% [409/576]); labia majora augmentation (66.3% [390/588]); labia minora augmentation (58.3% [326/559]); or laser vaginal tightening (52.3% [313/599]). Gynecologists and specialists were more likely to consider that there are no medical reasons to perform VVAPs; the opposite was true for plastic surgeons and students/residents.

Hymenoplasty raised ethical doubts in 51.1% (283/554) of the participants. Plastic surgeons and students/residents were less likely to raise ethical objections, while the opposite was true for gynecologists and specialists.

Most considered that VVAPs could contribute to an improvement in self-esteem (92.3% [613/664]); sexual function (78.5% [521/664]); vaginal atrophy (69.9% [464/664]); quality of life (66.3% [440/664]); and sexual pain (61.4% [408/664]).

Conclusions While medical doctors and students acknowledge the lack of evidence and scientific support for the performance of VVAPs, most do not raise ethical objections about them, especially if they are students or plastic surgeons, or if they have had or have considered having plastic surgery.
Disc Herniation and Cyst Gas: A Rare Association Causing Radicular Compression
Authors: Mandour Cherkaoui , Gazzaz Miloudi , Mostarchid Brahim
Published: June 2017

Introduction Intraspinal gas is a common clinical finding, but an epidural gas pseudocyst in association with lateral disc herniation compressing a nerve root is an exceptional observation.

Case Report A 49-year-old man was admitted to our department presenting with sciatica. The neurological examination demonstrated moderate lumbar pain without neurological deficit. A lumbosacral computed tomography showed the presence of degenerated disc herniation and epidural gas collection.

Discussion The pathological association between the cyst and the hernia is probably due to the migration of gas pumped from the intervertebral space through a breaking point or lower in the annulus fibrosis, involving its contiguity with the herniated disc.

Conclusion An association between a disc herniation and a gas pseudocyst can be a cause of sciatica.
Augmentation bei proximalen Femurfrakturen
Authors: Pfeufer Daniel , Neuerburg Carl , Mehaffey Stefan , Böcker Wolfgang , Kammerlander Christian
Published: June 2017

Hintergrund Die häufigsten und vital bedrohlichsten Fragilitätsfrakturen sind die proximalen Femurfrakturen. Aufgrund der demografischen Entwicklung sind sie von zunehmender Bedeutung. Fragestellung Die hüftgelenksnahen Femurfrakturen sind überwiegend osteoporoseassoziiert und stellen oftmals eine chirurgische Herausforderung dar. Erhalt der Funktion und Selbstständigkeit sind die wesentlichen Behandlungsziele der Therapie von orthogeriatrischen Patienten. Die Stabilität der Osteosynthese kann durch Augmentationstechniken zusätzlich optimiert werden.

Material und Methode Das am häufigsten angewendete Augmentationsverfahren ist die Zementaugmentation des proximalen Femurnagels Antirotation (PFNA) bei pertrochantären Femurfrakturen. Hiermit soll die Voraussetzung zur sofortigen vollbelastenden Mobilisation geschaffen werden.

Ergebnisse Die gute Frakturheilung der PFNA-Marknagelosteosynthese ohne Hinweise auf zementassoziierte Komplikationen konnte in klinisch-prospektiven Studien gezeigt werden.

Schlussfolgerung Die Sekundärprävention stellt neben der optimalen operativen Versorgung den entscheidenden Behandlungspfeiler zur Prävention weiterer Frakturen dar. Auf Basis der aktuellen Literatur soll dieser Artikel einen Überblick über die Zementaugmentation zur Behandlung proximaler Femurfrakturen bieten.
Hohe Prävalenz der Verwendung von Antipsychotika bei Demenzpatienten in deutschen neurologischen und psychiatrischen Praxen
Authors: Bohlken Jens , Booker Anke , Kostev Karel
Published: June 2017

Hintergrund Das Ziel der vorliegenden Studie ist es, sowohl in Pflegeheimen als auch zu Hause lebende Patienten in Bezug auf die Häufigkeit der Verwendung von Antipsychotika zu untersuchen und die Faktoren zu bestimmen, die zur erstmaligen Verwendung von Antipsychotika nach einer Demenzdiagnose führen.

Methoden Diese Studie umfasste Patienten im Alter ab 60 Jahren mit einer Erstdokumentation einer Demenz beliebigen Ursprungs (Indexdatum) durch neuropsychiatrische Fachärzte in der Disease-Analyzer-Datenbank (IMS Health). Der Hauptzielparameter war der Anteil der Patienten, die nach dem Indexdatum zum ersten Mal eine Antipsychotikaverordnung erhielten. Mithilfe von Kaplan-Meier-Analysen wurde die Zeit bis zur Einleitung der Antipsychotikatherapie in Abhängigkeit von Alter und Unterbringung in einem Pflegeheim untersucht. Ein Cox-Proportional-Hazards-Regressionsmodell wurde verwendet, um das Verhältnis zwischen der Wahrscheinlichkeit der Therapieeinleitung und den vordefinierten demografischen und klinischen Variablen abzuschätzen.

Ergebnisse Insgesamt wurden 14 915 Patienten mit Demenz (Durchschnittsalter 80,3 Jahre, 34,7 % männlich, 53,3 % in Pflegeheimen untergebracht) in die Studie eingeschlossen. Innerhalb von zwei Jahren nach dem Indexdatum wurden 47,7 % der Demenzpatienten mit Antipsychotika behandelt. Unterbringung in Pflegeheimen, höheres Alter, organisch bedingte psychische Störungen, organisch bedingte Persönlichkeitsstörungen, vaskuläre Demenz und Privatversicherungsstatus waren positiv mit der Einleitung einer Antipsychotikabehandlung assoziiert.

Schlussfolgerung Die Prävalenz der Verwendung von Antipsychotika bei Demenzpatienten ist, insbesondere bei Patienten in Pflegeheimen, sehr hoch. Weitere Studien, einschließlich qualitativer Untersuchungen, sind nötig, um die Gründe für dieses Verordnungsverhalten zu verstehen und zu erklären.
Neue Aspekte in der Therapie des metastasierten Prostatakarzinoms
Authors: von Amsberg Gunhild , Bokemeyer Carsten
Published: June 2017

Was ist neu?

Hormon-Chemotherapie in der hormonsensitiven Situation Basierend auf den Ergebnissen dreier großer, randomisierter Studien (STAMPEDE, CHAARTED und GETUG15) sollte Patienten mit metastasiertem, hormonsensitivem Prostatakarzinom (PCa) eine kombinierte Hormon-Chemotherapie mit Docetaxel 75 m/qm alle 3 Wochen über 6 Zyklen angeboten werden.

Cabazitaxel bei metastasiertem, kastrationsresistentem Prostatakarzinom (mCRPC) Eine Reduktion der Cabazitaxel-Dosierung von 25 mg/qm auf 20 mg/qm als Zweitlinien-Chemotherapie nach Docetaxel scheint ohne wesentlichen Wirkverlust möglich zu sein, bei zugleich deutlich besserer Verträglichkeit. Die Gabe von Cabazitaxel vor Docetaxel bei kastrationsrefraktärem PCa hat keinen Zusatznutzen.

Androgenrezeptor (AR)-gerichtete Behandlungen bei mCRPC Die AR-gerichteten Medikamente Enzalutamid und Abirateron stellen interessante Behandlungsalternativen zur klassischen Chemotherapie dar, da der AR trotz Kastrationsresistenz eine Schlüsselrolle bei der Tumorprogression innehat.

Einsatz von Radium-223 bei ossär metastasierten Patienten Als erstes Medikament dieser Substanzklasse führte Radium-223 bei Patienten mit rein ossär metastasiertem, kastrationsresistentem Prostatakarzinom zu einer signifikanten Verlängerung des Gesamtüberlebens.

Entscheidungshilfen für die Medikamentenauswahl Erkrankungs- und patientenspezifische Charakteristika sollten bei der Auswahl des richtigen Medikaments berücksichtigt werden.
Auf die innere Haltung kommt es an
Authors: Schröder Jörg-Peter , Stolz Karl-Heinz
Published: June 2017

Konfliktprävention im OP als Führungsaufgabe Unsicherheit, hohe
Belastungen, Stress und mangelhafte Kommunikation im OP führen schnell zu einem
Konflikt: Dies schadet sowohl dem Teamgeist als auch dem Patienten. Damit
Unstimmigkeiten gar nicht erst auftreten, ist eine systemische
Konfliktprävention sinnvoll. Wichtig sind hier vor allem die Aspekte Haltung,
Verhalten und Verhältnisse und eine effektive Kommunikation.
Gelebte Vielfalt
Authors: Welk Ina
Published: June 2017

Einführung Die Zahl von Menschen mit Migrationshintergrund nimmt stetig
zu. Deshalb müssen sich auch Kliniken auf eine interkulturelle
Patientenversorgung und die Integration ausländischer Mitarbeiter einstellen.
Die Herausforderung besteht in einem offenen, respektvollen und toleranten
Umgang miteinander, um insbesondere fachliche, kulturelle und sprachliche
Barrieren zu überwinden. Im Schwerpunkt lesen Sie, wie die interkulturelle
Versorgung und Zusammenarbeit gelingt und eine Kultur der gegenseitigen
Akzeptanz und Wertschätzung entwickelt werden kann.
Safety and efficacy of simultaneous colorectal ESD for large synchronous colorectal lesions
Authors: Chiba Hideyuki , Tachikawa Jun , Kurihara Daisuke , Ashikari Keiichi , Goto Toru , Takahashi Akihiro , Sakai Eiji , Ohata Ken , Nakajima Atsushi
Published: June 2017

Background and study aims Multiple large colorectal lesions are sometimes diagnosed during colonoscopy. However, there have been no investigations of the feasibility of simultaneous endoscopic submucosal dissection (ESD) for multiple lesions. This study aims to reveal the strategy of simultaneous ESD for multiple large colorectal lesions.

Patients and methods 246 patients who underwent ESD for 274 colorectal lesions were retrospectively evaluated in this study. Fifty-one large colorectal lesions among 23 patients were treated by ESD simultaneously (simultaneous group), and 223 patients were treated with ESD for a single lesion (single group).

Results En-bloc resection and curative resection rates did not differ. Compared with the single group, each procedure time was faster (31.8 ± 23.6 min vs. 45.8 ± 44.8, P = 0.002), but total procedure time was significantly longer in the simultaneous group (70.6 ± 33.4 vs. 45.8 ± 44.8 min, P = 0.01). Rates of adverse events including bleeding and perforation were not higher in the simultaneous group but the mean blood pressure, incidence of bradycardia and the amount of sedative drug used during ESD were significantly higher in the simultaneous group. Multiple logistic regression analysis identified non-experienced physician, lesion size ≥ 40 mm and submucosal fibrosis as an independent risk factor for procedure duration (≥ 90 min) (Odds ratio 11.852, 18.280, and 3.672; P < 0.05, respectively).

Conclusions Simultaneous ESD for multiple synchronous colorectal lesions is safe and feasible compared with single ESD and can reduce the burden to patients, length of hospital stay and medical expense. These results need to be elucidated by further studies.
Obliquely propagating electromagnetic excitations in dissipative plasmas with relativistically degenerate electrons
Authors: Rehman M. A. , Jahangir R. , Masood W. , Shah H. A.
Published: June 2017

In this paper, we have investigated the formation of obliquely propagating magnetoacoustic shock structures in dense dissipative plasmas with relativistically degenerate electrons. Using the reductive perturbation technique, we have derived the nonlinear Kadomtsev-Petviashvilli-Burgers (KPB) equation for both fast and slow magnetoacoustic modes. We have explored the non-relativistic and ultrarelativistic limits for degenerate electrons for both the modes and highlighted the differences in propagation characteristics of their respective shock structures. We have also studied the limiting cases of KPB in one dimension for both the fast and slow modes. Interestingly, it has been found that unlike the other cases, the one dimensional Burgers equation for the fast mode changes the nature of the shock waves. It has been explained in the paper that this happens owing to the change of sign of the nonlinearity coefficient.
The Roma as ultimate European minority and ultimate outsider?
Authors: Delcour Chloë , Hustinx Lesley
Published: June 2017

In order to understand the paradoxical position of the Roma as the subject of both European inclusion programmes and persistent exclusionary practices, this chapter focuses on the interaction of both inclusionary and exclusionary frames used in discussions in the Flemish newspaper media following a human-rights violation. The case concerns the Belgian government’s expulsion of Slovak Roma migrants in 1999 (the Čonka case). Proceeding from the sociology of human rights and the principles of critical discourse analysis (CDA), we analyse 212 newspaper articles from the period 1999–2002. Based on this analysis, we identify the following connections between the inclusionary and exclusionary conceptualizations of Roma migrants: (1) an emphasis on the excluded character of the Roma, (2) the possibility that they are “deserving” of expulsion and (3) the dominance of the nation-state model within the context of migration. These results illustrate the complexity with which inclusionary and exclusionary discourses can be intertwined, thereby contributing to sociological research concerning human-rights practices and advancing CDA research on “discursive othering” beyond a sole focus on exclusionary discourses.
Documenting Unserdeutsch
Authors: Maitz Péter , Volker Craig Alan
Published: June 2017

Unserdeutsch, also known as Rabaul Creole German, is the only known German-lexifier creole. This critically endangered language has its origins in an orphanage in German New Guinea for mixed-race children, where Standard German was taught by mission personnel. Unserdeutsch was creolised in one generation, and became the in-group language of a small mixed-race community. It is now spoken by around 100 elderly speakers, nearly all immigrants to Australia. The current project is only the second documentation based on actual fieldwork and has a specific focus on the use and vitality of the language as used by the last generation of speakers. It has the aim of producing an Unserdeutsch corpus that will facilitate both future linguistic research and contact with the language for the descendants of Unserdeutsch speakers. Preliminary findings show variation among speakers along a continuum from heavily creolised basilect to an almost European German acrolect. Most of the lexicon is derived from German, while a number of basilectal grammatical constructions are the result of the loss of marked features in German and possible imperfect second language learning as well as relexification of Tok Pisin, the presumed substrate language.
Trajectories of Work Disability and Economic Insecurity Approaching Retirement
Authors: Shuey Kim M , Willson Andrea E
Published: June 2017

Objectives

In this article, we examine the connection between trajectories of work disability and economic precarity in late midlife. We conceptualize work disability as a possible mechanism linking early and later life economic disadvantage.

Methods

We model trajectories of work disability characterized by timing and stability for a cohort of Baby Boomers (22–32 in 1981) using 32 years of data from the Panel Study of Income Dynamics and latent class analysis. Measures of childhood disadvantage are included as predictors of work disability trajectories, which are subsequently included in logistic regression models predicting four economic outcomes (poverty, asset poverty, home ownership, and pension ownership) at ages 54–64.

Results

Childhood disadvantage selected individuals into five distinct classes of work disability that differed in timing and stability. All of the disability trajectories were associated with an increased risk of economic insecurity in late midlife compared to the never work disabled.

Discussion

This study contributes to the aging literature through its incorporation of the early life origins of pathways of disability and their links to economic outcomes approaching retirement. Findings suggest work disability is anchored in early life disadvantage and is associated with economic insecurity later in life.
Context-Dependent Drivers of Discretionary Debt Decisions: Explaining Willingness to Borrow for Experiential Purchases
Authors: Tully Stephanie M , Sharma Eesha
Published: June 2017

Mental accounting research suggests that consumers prefer borrowing for longer-lasting purchases in order to receive benefits from the purchases as they pay for them. In contrast, two sets of archival data and five lab studies show that consumers are more willing to borrow for experiential versus material purchases, even though experiential purchases tend to have a shorter physical duration. Further, framing the same purchase as more experiential than material increases willingness to borrow. This effect occurs because purchase timing is more important for experiential purchases—a function of consumers’ aversion to missing out on planned consumption. Thus, we moderate the proposed effect by varying whether the borrowing decision impacts planned consumption. Other differences between material and experiential purchases, such as scarcity or expected happiness, cannot similarly explain our results. Moreover, our conceptualization allows us to reconcile the apparent contradiction between the previous and current research by examining the relative impact of purchase-timing importance and payment-benefit duration matching in different contexts (i.e., “purchasing” and “source-of-funding” decisions).
Strong suppression of star formation and spiral arm formation in disc galaxies with counter-rotating gas discs
Authors: Osman Omima , Bekki Kenji
Published: June 2017

Galaxy-wide star formation can be quenched by a number of physical processes such as environmental effects (e.g. ram pressure stripping) and supernova feedback. Using numerical simulations, we here demonstrate that star formation can be severely suppressed in disc galaxies with their gas discs counter-rotating with respect to their stellar discs. This new mechanism of star formation suppression (or quenching) does not depend so strongly on model parameters of disc galaxies, such as bulge-to-disc ratios and gas mass fractions. Such severe suppression of star formation is largely due to the suppression of the gas density enhancing mechanism, i.e. spiral arm formation in disc galaxies with counter-rotating gas. Our simulations also show that molecular hydrogen and dust can be rather slowly consumed by star formation in disc galaxies with counter-rotating gas discs (i.e. long gas depletion time-scale). Based on these results, we suggest that spiral and S0 galaxies with counter-rotation can have rather low star formation rate for their gas densities. Also, we suggest that a minor fraction of S0 galaxies have no prominent spiral arms because they have a higher fraction of counter-rotating gas. We predict that poststarburst ‘E+A’ disc galaxies with cold gas could have counter-rotating gas.
Clinical Updates in Women’s Health Care Summary: Gynecologic and Obstetric Care for Breast Cancer Survivors
Authors: Miller Jennifer Griffin
Published: June 2017

Breast cancer treatment has an impact on the physical, psychologic, sexual, and reproductive aspects of women’s lives. Therefore, it is important for obstetrician–gynecologists to be well versed in the screening, diagnosis, and management of breast cancer. This monograph is an overview of critical issues related to the provision of ongoing care to breast cancer survivors.
Management of 30 infected nonunited tibial fractures by Ilizarov external fixator with acute shortening distraction technique with consideration of the causative organism
Authors: Barakat Ahmed Samir , Elguindy Ahmed , Elazab Mohamed , Hegazy Mohamed , Abdel-Meguid Kamal M.S. , Elbarbary Hassan
Published: June 2017

Background:

Long-standing infected nonunion and gap nonunion tibial fractures are difficult to treat and pose a challenging problem to orthopaedic surgeons. They may lead to residual deformity, persistent infection, knee or ankle contracture, and, at worst, can result in a painful and useless limb requiring amputation.

Methods:

This prospective study involved 30 patients (27 males and three females) with infected tibial nonunions treated by Ilizarov external fixation with acute shortening and distraction. The mean age was 40 yr with an average bone defect of 3.85 cm (range 2.5 cm to 6 cm). The duration of nonunion before treatment ranged from 6 to 48 mo with an average of 14 mo. The average number of prior surgeries was 1.5 (range 1 to 4). Eleven (36.66%) of the 30 patients had overlying soft-tissue compromise. The causative bacteria were identified and treated with the appropriate antibiotic for at least 6 wk (range 6 to 12 wk).

Results:

Most infected nonunited fractures in this series (86.66%) occurred in the productive age (four in the 3rd, eight in the 4th, nine in the 5th, and 5 in the 6th decades of life) indicating the socioeconomic impact of this severe injury. The time to consolidation ranged from 3.5 mo to 9 mo, with an average of 6 mo. All fractures united except one (3.33%), with 19 (63.27%) and eight (26.64%) patients having an excellent and good result and two (6.66%) patients having a fair result when applying the Association for the Study and Application of the Method of Ilizarov (ASAMI) classification. Functional results per ASAMI were 12 (39.96%), and 14 (46.62%) patients had excellent and good results. Twenty-seven (89.91%) had bony consolidation with complete remission of infection. The most common isolated bacteria were Staphylococcus aureus (10 patients) and Staphylococcus epidermis (four patients). The most common complication was pin track infection which occurred in all patients. All were uneventfully treated with proper wire/pin care and the appropriate antibiotics.

Conclusions:

Ilizarov fixation with acute shortening distraction technique is a safe and reliable method for treatment of infected tibial nonunion, however, with the potentially devastating complication of vascular injury during acute compression. The amount of acute shortening is done on an individualized basis as we could not identify safe limits for acute shortening. This technique deals with soft-tissue defects that may require treatment and precludes the need for complex microvascular procedures and secondary bone grafting at the fracture site.
Fibular Nail/Strut Graft for Hindfoot Fusion
Authors: Shah Ashish B. , Araoye Ibukunoluwa , Elattar Osama , Naranje Sameer M.
Published: June 2017

Tibiotalocalcaneal arthrodesis is a salvage procedure for end state pathologies of the hindfoot. Cases of primary failure can be a management challenge especially in failed intramedullary nail fixation. Inlay fibula strut grafting can be useful in such settings; however, many surgeons consider it a challenging approach. We describe our simplified approach for achieving successful fibula inlay strut grafting for hindfoot fusion. Using this approach, we achieved radiographic union in 81% (13/16) of hindfoot fusion revisions.
A High-throughput HPLC-MS/MS Assay for the Detection, Quantification and Simultaneous Structural Confirmation of 136 Drugs and Metabolites in Human Urine
Authors: Klepacki Jacek , Davari Baharak , Boulet Marion , Lizarraga Ryan , Christians Uwe
Published: June 2017

Background:

Because of its superior sensitivity and specificity, multianalyte high-performance liquid chromatography coupled with tandem mass spectrometry has become the gold standard in clinical toxicology. Although several qualitative and quantitative liquid chromatography coupled with tandem mass spectrometry assays on various mass spectrometry platforms have been described in the literature, most methods either analyze only a limited number of compounds and/or require tedious and time-consuming sample preparation.

Methods:

A major challenge in urine toxicology screening is the minimization of false-negative and false-positive results. This was addressed by screening for a comprehensive panel of 136 compounds of importance for pain and drug addiction clinics, using high-end, high-sensitivity, fast-scanning mass spectrometry in combination with simultaneous structural confirmation based on ion ratios. The assay was validated and successfully participated in proficiency challenges.

Results:

The assay met all predefined acceptance criteria. The lower limit of quantifications ranged from 10 to 100 ng/mL. Interday trueness and imprecisions ranged from 73.8% to 116.2% and 2.4%–20.0%, respectively. The total assay run time was 10 minutes.

Conclusions:

We developed and successfully validated a robust, sensitive, and specific liquid chromatography coupled with tandem mass spectrometry-based urine toxicology screening platform that allows for the addition of drugs to quickly adjust to new clinical needs. To date, more than 3000 clinical samples have successfully been analyzed. Our results also indicated that such a quantitative multianalyte assay is pushing against the limits of current fast-scanning MS/MS instrumentation and that the number of analytes and their internal standards must be balanced with acceptable sensitivity, reproducibility, structural confirmation, and the ability to reliably quantify, all of which was achieved.
Weak HIV Antibody Responses in Perinatally Infected Young Adults
Authors: Kirkpatrick Allison R. , Unsal Aylin B. , Blankson Joel N. , Moore Richard D. , Quinn Thomas C. , Hadigan Colleen , Laeyendecker Oliver
Published: June 2017

We compared the antibody response to HIV using 2 serologic cross-sectional incidence assays in adults with perinatally acquired HIV, to elite controllers and individuals exposed to antiretroviral therapy who were all infected as adults. Low antibody responses were seen more frequently in adults with perinatally acquired HIV, both overall and when stratified by viral suppression status.
Outbreak Caused by Escherichia coli O18:K1:H7 Sequence Type 95 in a Neonatal Intensive Care Unit in Barcelona, Spain
Authors: Sáez-López Emma , Bosch Jordi , Salvia Maria Dolors , Fernández-Orth Dietmar , Cepas Virginio , Ferrer-Navarro Mario , Figueras-Aloy Josep , Vila Jordi , Soto Sara M.
Published: June 2017

Background:

Escherichia coli is one of the most frequent causes of late-onset neonatal sepsis. The aim of this study was to characterize an outbreak of neonatal sepsis occurring in the neonatal intensive care unit of the Hospital Clinic of Barcelona from April to August 2013.

Methods:

After presentation of the index case, all E. coli isolates from previously hospitalized neonates, health-care workers and neonates admitted to the neonatal intensive care unit from April to October 2013 were tested for K1 antigen positivity and epidemiologically compared by pulse-field gel electrophoresis. Furthermore, the E. coli K1 strains collected from neonates during this period were analyzed by different methods (serotyping, phylotyping, polymerase chain reaction of virulence factors, antimicrobial resistance and “in vitro” assays in Human Brain Microvascular Endothelial Cells (HBMEC)).

Results:

An E. coli O18:K1:H7 sequence type 95 and phylogenetic group B2 strain was the cause of the outbreak involving 6 preterm neonates: 1 with late septicemia because of a urinary focus and 5 with late-onset septicemia and meningitis, 3 of whom died. All showed the same pulsotype, full resistance to ampicillin and intermediate resistance to gentamicin. The outbreak strain carried the pathogenicity island (PAI) IIJ96-like domain that could explain the high-grade bacteremia necessary to develop meningitis.

Conclusions:

All the E. coli isolates responsible for this outbreak belonged to a single clone suggesting a common source of infection, and it was categorized as O18:K1:H7. Despite the bacteria’s pathogenicity has an important role in the severity of infection, the host-associated factors were crucial for the fatal outcomes.
Congenital Cytomegalovirus Infection: Child Development, Quality of Life and Impact on Daily Life
Authors: Korndewal Marjolein J. , Oudesluys-Murphy Anne Marie , Kroes Aloys C. M. , Vossen Ann C. T. M. , de Melker Hester E.
Published: June 2017

Congenital cytomegalovirus (cCMV) infection is the most common congenital infection worldwide and can lead to long-term impairments such as developmental delay. It is currently unknown how this affects the daily life of children and their parents. Children For this study, children with cCMV were identified by testing stored dried blood spots of 31,484 five-year-old children born in 2008 in the Netherlands. Parents of 133 children with cCMV and 274 children without cCMV participated and filled in questionnaires on the child’s development, the child’s and parents’ quality of life, care provided for the children and consequences of cCMV on daily life. School performance reports at 6 years of age were also investigated. Children with cCMV had delays in general and expressive language development more often, and they attended physical therapists more frequently than children without cCMV. School performance of children with cCMV and symptoms at birth was poorer than that of cCMV-negative children with similar symptoms at birth. The quality of life of children with long-term impairment was lower in children with cCMV than those without cCMV. Parents of children with cCMV and long-term impairments reported more physical and concentration problems than parents of children without cCMV. These findings indicate that cCMV has a considerable impact not only on the child’s development and school performance but also on the daily life of children and their parents. The care for children with cCMV should therefore include support for motor and speech-language development as well as family-centered care.
Spondylodiscitis by Kingella Kingae
Authors: Fernandes Machado Sara Alexandra , Ferreira Freitas Joana Manuel , Alegrete da Silva Nuno Paulo , Coutinho Costa Moreira Jorge Manuel , Peixoto Pinto Rui Alexandre , de Melo Costa Fernando Gilberto
Published: June 2017

In children, greater than 95% of Kingella kingae infections are diagnosed between 6 and 48 months of age. K. kingae has not been systematically investigated, especially in older children. We describe a case of spondylodiscitis by K. kingae in an 8-year-old child.
Cebranopadol, a novel first-in-class analgesic drug candidate: first experience in patients with chronic low back pain in a randomized clinical trial
Authors: Christoph Annette , Eerdekens Marie-Henriette , Kok Maurits , Volkers Gisela , Freynhagen Rainer
Published: June 2017

Chronic low back pain (LBP) is a common condition, usually with the involvement of nociceptive and neuropathic pain components, high economic burden and impact on quality of life. Cebranopadol is a potent, first-in-class drug candidate with a novel mechanistic approach, combining nociceptin/orphanin FQ peptide and opioid peptide receptor agonism. We conducted the first phase II, randomized, double-blind, placebo- and active-controlled trial, evaluating the analgesic efficacy, safety, and tolerability of cebranopadol in patients with moderate-to-severe chronic LBP with and without neuropathic pain component. Patients were treated for 14 weeks with cebranopadol 200, 400, or 600 μg once daily, tapentadol 200 mg twice daily, or placebo. The primary efficacy endpoints were the change from baseline pain to the weekly average 24-hour pain during the entire 12 weeks and during week 12 of the maintenance phase. Cebranopadol demonstrated analgesic efficacy, with statistically significant and clinically relevant improvements over placebo for all doses as did tapentadol. The responder analysis (≥30% or ≥50% pain reduction) confirmed these results. Cebranopadol and tapentadol displayed beneficial effects on sleep and functionality. Cebranopadol treatment was safe, with higher doses leading to higher treatment discontinuations because of treatment–emergent adverse events occurring mostly during titration. Those patients reaching the target doses had an acceptable tolerability profile. The incidence rate of most frequently reported treatment–emergent adverse events during maintenance phase was ≤10%. Although further optimizing the titration scheme to the optimal dose for individual patients is essential, cebranopadol is a new drug candidate with a novel mechanistic approach for potential chronic LBP treatment.
The Wood’s Light’s Diagnostic Use in Dermatology
Authors: Limone Brittanya , Meadows LaVonne
Published: June 2017

The field of dermatology utilizes a wide variety of tools to aid in the determination of a diagnosis. Diagnostic tools are helpful when the cause of a patient’s presentation may not be obvious based on history and physical examination. The purpose of this column is to highlight some of the more commonly encountered diagnostic tools in dermatology, the background and indications for their use, their construct and application, the ways to interpret their results, and their important clinical implications. This article presents the Wood’s light, a useful and cost-effective tool to quickly assess many dermatologic conditions.
The Effect of False-positive Mammograms on Antidepressant and Anxiolytic Initiation
Authors: Segel Joel E. , Balkrishnan Rajesh , Hirth Richard A.
Published: June 2017

Background:

Despite reported increases in anxiety following a false-positive mammogram, there is little evidence the effect rises to the clinical level of initiating medication.

Objective:

To analyze the effect of a false-positive mammogram on antidepressant or anxiolytic initiation and identify subpopulations most at risk.

Subjects:

MarketScan commercial and Medicaid claims databases used to identify women ages 40–64 undergoing screening mammography with no prior antidepressant or anxiolytic claims.

Research Design:

Using a retrospective cohort design, we estimated the effects of a false-positive relative to a negative mammogram on the likelihood of initiating antidepressants or anxiolytics using multivariate logistic models estimated separately by insurance type.

Results:

At 3 months after a false-positive mammogram, the relative risk (RR) for antidepressant or anxiolytic initiation was 1.19 [95% confidence interval (CI), 1.06–1.31] for the commercially insured and 1.13 (95% CI, 0.96–1.29) in the Medicaid population. In addition, 4 subgroups were at particularly elevated risk: commercially insured women ages 40–49 (RR=1.33; 95% CI, 1.13–1.54) or whose false-positive required multiple tests to resolve (RR=1.37; 95% CI, 1.17–1.57), included a biopsy (RR=1.68; 95% CI, 1.18–2.17), or whose resolution took >1 week (RR=1.21; 95% CI, 1.07–1.34).

Conclusions:

False-positive mammograms were associated with significant increases in antidepressant or anxiolytic imitation among the commercially insured. Follow-up resources may be particularly beneficial for cases taking longer to resolve and involving biopsies or multiple tests. The results highlight the need to resolve false-positives quickly and effectively and to monitor depressive symptoms following a positive result.
Incident Reporting in Emergency Medicine: A Thematic Analysis of Events
Authors: Aaronson Emily Loving , Brown David , Benzer Theodore , Natsui Shaw , Mort Elizabeth
Published: June 2017

Background

Incident reporting is a recognized tool for healthcare quality improvement. These systems, which aim to capture near-misses and harm events, enable organizations to gather critical information about failure modes and design mitigation strategies. Although many hospitals have employed these systems, little is known about safety themes in emergency medicine incident reporting. Our objective was to systematically analyze and thematically code 1 year of incident reports.

Methods

A mixed-methods analysis was performed on 1 year of safety reporting data from a large, urban tertiary-care emergency department using a modified grounded theory approach.

Results

Between January 1 and December 31, 2015, there were 108,436 emergency department visits. During this time, 750 incident reports were filed. Twenty-nine themes were used to code the reports, with 744 codes applied. The most common themes were related to delays (138/750, 18.4%), medication safety (136/750, 18.1%), and failures in communication (110/750, 14.7%). A total of 48.8% (366/750) of reports were submitted by nurses.

Conclusions

The most prominent themes during 1 year of incident reports were related to medication safety, delays, and communication. Relative to hospital-wide reporting patterns, a higher proportion of reports were submitted by physicians. Despite this, overall incident reporting remains low, and more is needed to engage physicians in reporting.
A Statewide Surgical Coaching Program Provides Opportunity for Continuous Professional Development
Authors: Greenberg Caprice C. , Ghousseini Hala N. , Pavuluri Quamme Sudha R. , Beasley Heather L. , Frasier Lane L. , Brys Nicole A. , Dombrowski Janet C. , Wiegmann Douglas A.
Published: June 2017

Objective:

We sought to develop and evaluate a video-based coaching program for board-eligible/certified surgeons.

Summary Background Data:

Multiple disciplines utilize coaching for continuous professional development; however, coaching is not routinely employed for practicing surgeons.

Methods:

Peer-nominated surgeons were trained as coaches then paired with participant surgeons. After setting goals, each coaching pair reviewed video-recorded operations performed by the participating surgeon. Coaching sessions were audio-recorded, transcribed, and coded to identify topics discussed. The effectiveness with which our coaches were able to utilize the core principles and activities of coaching was evaluated using 3 different approaches: self-evaluation; evaluation by the participants; and assessment by the study team. Surveys of participating surgeons and coach-targeted interviews provided general feedback on the program. All measures utilized a 5-point Likert scale format ranging from 1 (low) to 5 (high).

Results:

Coach-participant surgeon pairs targeted technical, cognitive, and interpersonal aspects of performance. Other topics included managing intraoperative stress. Mean objective ratings of coach effectiveness was 3.1 ± 0.7, ranging from 2.0 to 5.0 on specific activities of coaching. Subjective ratings by coaches and participants were consistently higher. Coaches reported that the training provided effectively prepared them to facilitate coaching sessions. Participants were similarly positive about interactions with their coaches. Identified barriers were related to audio-video technology and scheduling of sessions. Overall, participants were satisfied with their experience (mean 4.4 ± 0.7) and found the coaching program valuable (mean 4.7 ± 0.7).

Conclusions:

This is the first report of cross-institutional surgical coaching for the continuous professional development of practicing surgeons, demonstrating perceived value among participants, as well as logistical challenges for implementing this evidence-based program. Future research is necessary to evaluate the impact of coaching on practice change and patient outcomes.