bluuebunny/crossref_metadata_2025 huggingface dataset:
Hepatitis E – mehr als nur eine seltene Reisekrankheit!
Authors: Wedemeyer Heiner
Published: May 2017

Was ist neu?

Übertragungswege In Deutschland infizieren sich jedes Jahr wahrscheinlich mehr als 300 000 Menschen mit dem Hepatitis-E-Virus (HEV). Die Hepatitis E ist in Mitteleuropa in der Regel eine durch den zoonotischen HEV-Genotyp-3-verursachte autochthone, d. h. lokal erworbene Infektionskrankheit. Der Verzehr von nicht ausreichend erhitztem Schweine- oder Wildfleisch ist ein Hauptrisikofaktor für HEV-Infektionen, Übertragungen des Virus durch Bluttransfusionen sind aber auch möglich.

Diagnostik Bei Immunkompetenten kann die Diagnose einer akuten Hepatitis E mit dem Nachweis von anti-HEV-IgM gestellt werden. Serologische Tests können bei Immunsupprimierten aber falsch-negativ sein, weshalb in diesen Fällen eine HEV-Infektion nur durch den direkten Nachweis des Erregers mittels PCR im Blut oder Stuhl erfolgen sollte.

Natürlicher Verlauf Eine akute Hepatitis E kann bei Patienten mit anderen chronischen Lebererkrankungen zu einem Leberversagen führen. Chronische Verläufe, definiert durch eine Virämie von mind. 3 Monaten, sind bei Organtransplantierten mit immunsuppressiver Medikation beschrieben, können aber auch bei anderen Immundefizienzen auftreten. Eine chronische Hepatitis E kann innerhalb von Monaten zu einer fortgeschrittenen Leberfibrose oder zur Zirrhose führen.

Extrahepatische Manifestationen Extrahepatische Manifestationen können während und nach einer HEV-Infektion auftreten. Insbesondere Guillain-Barré-Syndrome und die neuralgische Schulteramyotrophie sind mit einer Hepatitis E assoziiert worden.

Therapie Ribavirin hat eine antivirale Wirksamkeit gegen HEV. Bei chronischer Hepatitis E sollte die Behandlung für 3 – 6 Monate durchgeführt werden. Therapieversagen und Rückfälle nach Beendigung einer Behandlung sind möglich. Ein Impfstoff gegen HEV ist bisher nur in China zugelassen.
Wiederaufnahmen nach Akut- und Entwöhnungstherapie: Stationäre Behandlung drei Jahre vor und nach der Indexbehandlung
Authors: Fleischmann Heribert
Published: May 2017

Ziel der Studie Der Ressourcenbedarf reha- und nicht rehafähiger Alkoholabhängiger wurde retrospektiv über 7 Jahre mit klinischen Routinedaten sektorübergreifend untersucht.

Methode Im prä-post-Vergleich wurde nach einer Indexbehandlung (IB) die Inanspruchnahme von stationärer Rehabilitation und Akutbehandlung überprüft.

Ergebnisse Nach der IB nahm die Zahl der Rehabilitanden mit weiterem Behandlungsbedarf um 59% ab, die der Akutpatienten dagegen um 67% zu, die der nicht rehafähigen Patienten sogar um 76%. 23% der Indexpatienten mit qualifiziertem Entzug (QE) und 8% der Patienten mit chronifiziertem Verlauf (CMA) wurden in eine rehabilitative Behandlung übergeleitet. 29% der Reha-, 42% der QE- und 60% der CMA-Patienten wurden in 3 Folgejahren erneut stationär behandelt.

Schlussfolgerungen Rehabilitative Behandlung verringert den stationären Ressourcenverbrauch. Nicht rehafähige Akutpatienten (CMA) haben auf hohem Ausgangsniveau einen weiter steigenden Ressourcenverbrauch.
Asymmetry in mechanical polarization switching
Authors: Lu Haidong , Liu Shi , Ye Ziyu , Yasui Shintaro , Funakubo Hiroshi , Rappe Andrew M. , Gruverman Alexei
Published: May 2017

Recent demonstration of a mechanical 180° switching of ferroelectric polarization has enabled an alternative polarization control mechanism based on the flexoelectric coupling between polarization and strain gradient. Mechanical switching is a highly asymmetric phenomenon associated with the inhomogeneous strain induced by an atomic force microscope (AFM) tip pressed against the ferroelectric surface. Here, we demonstrate the asymmetric domain switching behavior in the vicinity of the 180° domain wall in PbTiO3 thin films with respect to the AFM tip scanning direction. The writing-direction-dependent asymmetric domain response has been modeled by molecular dynamics simulation showing asymmetry in domain wall displacement due to the difference in the volume of mechanically switched domains. The obtained results show that the mechanically induced switching dynamics is very different from the conventional 180° switching realized by an external electric field and has to be exploited differently. In particular, nanoscale domain engineering via the tip-induced flexoelectric effect requires careful consideration of asymmetric interaction between the existing domain structures and the strain gradient.
A low-frequency sound absorbing material with subwavelength thickness
Authors: Chen Changru , Du Zhibo , Hu Gengkai , Yang Jun
Published: May 2017

We propose a sound absorbing material efficient for low frequency. This material is mainly composed of two axially coupled tubes in series, which are co-planarly coiled in a plane perpendicular to incident waves. By carefully designing the geometric parameters of the coupled tubes, we can overlap the absorption coefficient curves of each individual tube and are therefore able to broaden the frequency bandwidth within which the absorption coefficient is larger than a designed value. A material with an absorption coefficient greater than 0.8 over a frequency bandwidth of 36 Hz for a low frequency of around 100 Hz can be designed, and the wavelength to thickness ratio reaches as high as 38.5. The experiment measurement with the sample made by the 3D printing technique is also conducted to validate the proposed design method. This work may stimulate the research studies on and applications for low frequency sound absorption.
Temperature measurement using frequency comb absorption spectroscopy of CO2
Authors: Hänsel A. , Reyes-Reyes A. , Persijn S. T. , Urbach H. P. , Bhattacharya N.
Published: May 2017

Absorption spectroscopy on CO2 for the determination of gas temperature is reported. Direct absorption of a frequency comb laser through a gas cell at atmospheric conditions is analysed with a virtually imaged phased array spectrometer. Several measurement and analysis techniques are investigated to find the parameters most sensitive to changes in the temperature. Some of these show qualitative agreement with theoretical predictions where the trend is similar to the calculated values.
Weak coupling between bright and dark resonators with electrical tunability and analysis based on temporal coupled-mode theory
Authors: Fu Quanhong , Zhang Fuli , Fan Yuancheng , Dong Jiajia , Cai Weiqi , Zhu Wei , Chen Shuang , Yang Ruisheng
Published: May 2017

We investigate the electrically tunable Electromagnetic induced transparency (EIT)-like effect of active metamaterial structures composed of a wire and a split ring resonator by the simulation, experiment, and temporal coupled-mode theory. It is illustrated that an EIT-like effect appears as a result of weak coupling between bright and dark resonators. Around the EIT-like peak frequency, the superradiant resonance mode of the bright resonator is highly suppressed by the subradiant resonance mode of the dark resonator, and high transmittance as well as large group delay is manifested. By integrating a varactor diode into the EIT structure and altering the bias voltage, the EIT-like effect can be dynamically tuned. As the bias voltage ranges from 0 V to 8 V, the EIT-like peak frequency exhibits a prominent blueshift of 0.22 GHz and the transmittance experiences a modulation with a modulation depth up to 98%. Using the temporal coupled-mode theory, the transmission spectrum of the EIT structure is predicted and the parameters of the resonator system are retrieved.
Impacts of renewable energy resources and energy storage systems on the flow-gate prices under deregulated environment
Authors: Hemmati Reza , Hooshmand Rahmat-Allah
Published: May 2017

This paper investigates the impacts of renewable energy resources and energy storage systems (ESS) on flow-gate marginal pricing (FMP) and locational marginal pricing (LMP) in a deregulated environment. Renewable energy resources including wind turbines and photovoltaic solar cells are modeled and discussed. Also, ESS are defined and mathematically modeled. Then, the mathematical formulation of LMP and FMP and their relationship are discussed. An IEEE six bus test system is considered as a case study. Several simulations are carried out to investigate the impacts of renewable energy resources and ESS on LPM and FMP. Furthermore, a comprehensive sensitivity analysis is conducted. It is demonstrated that renewable energy resources and their related uncertainty have a great impact on both LMP and FMP. Also, charging and discharging states of ESS significantly change LMP and FMP. It is also demonstrated that the reactive power of loads and line capacities are highly important in the FMP analysis.
Lateral carrier diffusion in InGaAs/GaAs coupled quantum dot-quantum well system
Authors: Pieczarka M. , Syperek M. , Biegańska D. , Gilfert C. , Pavelescu E. M. , Reithmaier J. P. , Misiewicz J. , Sęk G.
Published: May 2017

The lateral carrier diffusion process is investigated in coupled InGaAs/GaAs quantum dot-quantum well (QD-QW) structures by means of spatially resolved photoluminescence spectroscopy at low temperature. Under non-resonant photo-excitation above the GaAs bandgap, the lateral carrier transport reflected in the distorted electron-hole pair emission profiles is found to be mainly governed by high energy carriers created within the 3D density of states of GaAs. In contrast, for the case of resonant excitation tuned to the QW-like ground state of the QD-QW system, the emission profiles remain unaffected by the excess kinetic energy of carriers and local phonon heating within the pump spot. The lateral diffusion lengths are determined and present certain dependency on the coupling strength between QW and QDs. While for a strongly coupled structure the diffusion length is found to be around 0.8 μm and monotonically increases up to 1.4 μm with the excitation power density, in weakly coupled structures, it is determined to ca. 1.6 μm and remained virtually independent of the pumping power density.
Combined foliar application of nutrients and 5-aminolevulinic acid (ALA) improved drought tolerance in Leymus chinensis by modulating its morpho-physiological characteristics
Authors: Song Ji-Xuan , Anjum Shakeel Ahmad , Zong Xue-Feng , Yan Rong , Wang Ling , Yang Ai-Jie , Ashraf Umair , Zohaib Ali , Lv Jun , Zhang Yan , Dong Yu-Feng , Wang San-Gen
Published: May 2017

Water deficit is an environmental constraint restricting plant growth and productivity, and is further worsened by reduced soil fertility. Plant growth-regulating substances ameliorate damaging effects of abiotic stresses, and their efficacy is improved by application of adequate nutrients. An experiment was undertaken to investigate the influence of foliar-applied nutrients (nitrogen, phosphorus, potassium: NPK) and 5-aminolevulinic acid (ALA) alone and in combination on morpho-physiological indices of the perennial grass Leymus chinensis (Trin.) Tzvel under drought and well-watered conditions. Drought stress caused a reduction in growth and photosynthetic pigments while increasing the accumulation of malondialdehyde (MDA) and osmolytes compared with well-watered conditions. However, application of NPK and ALA improved plant height, fresh and dry weights, and chlorophyll content. Production of soluble proteins and sugars, proline content, and antioxidant enzyme activities (superoxide dismutase, peroxidase, catalase, ascorbate peroxidase and glutathione reductase) were increased and MDA accumulation was lowered by application of NPK and ALA relative to the control (no application). Combined application of NPK and ALA proved more advantageous than NPK or ALA alone in exerting ameliorative effect on L. chinensis under drought-stressed conditions. The results suggest that combined application of NPK and ALA improves the growth and development of L. chinensis by modulating physiological processes and aids in sustaining drought.
New Australian Paronellidae (Collembola) reveal anomalies in existing tribal diagnoses
Authors: Zhang Feng , Ma Yitong , Greenslade Penelope
Published: May 2017

We describe here two new species, Zhuqinia jingwanae, gen. & sp. nov. and Paronellides praefectus, sp. nov., both from Mount Twynam, New South Wales, Australia. The systematic position of Zhuqinia, gen. nov. in relation to other paronellids is not clear because the new genus possesses pointed, heavily striated scales similar to species of Callyntrurini. However, unlike species in that tribe, it lacks dental scales. Instead, Zhuqinia, gen. nov. is more similar to the unscaled genus Paronellides (Cremastocephalini) in other characters (abundant tergal macrochaetae, 2, 2|1, 2, 2, ?, 3 tergal S-chaetae, moderately long mucro with two teeth, etc.) but body scales are absent in all species of Paronellides. Multilocus phylogeny shows Zhuqinia, gen. nov. clustering with Paronellides rather than Callyntrurini or other Cremastocephalini genera. This study provides new information on the relationships between paronellid taxa, and changes the current higher classification of the family, particularly that of the tribes Cremastocephalini and Callyntrurini. As the new genus is known only from two peaks in the Snowy Mountain range, our data emphasise the role of montane areas as refugia for short-range endemic taxa.
Response time in economic games reflects different types of decision conflict for prosocial and proself individuals
Authors: Yamagishi Toshio , Matsumoto Yoshie , Kiyonari Toko , Takagishi Haruto , Li Yang , Kanai Ryota , Sakagami Masamichi
Published: May 2017

Significance

Prosocial and proself predispositions dictate economic game players’ fast decisions but exert limited influence when game players take a longer time in making decisions. Prosocially predisposed individuals use the extended time to contemplate the risk of being exploited. Selfishly predisposed individuals are suggested to behave according to the immediate incentives of the games when they make decisions quickly and become behaviorally less selfish as they spend more time assessing the long-term strategic implications of always behaving according to immediate incentives. Different strategies are needed to promote prosocial behavior and to design institutions depending on the constitution of the population.
Positive association between population genetic differentiation and speciation rates in New World birds
Authors: Harvey Michael G. , Seeholzer Glenn F. , Smith Brian Tilston , Rabosky Daniel L. , Cuervo Andrés M. , Brumfield Robb T.
Published: May 2017

Significance

The causes of differentiation among populations are well circumscribed, but it remains unclear if they impact the proliferation of organisms over deep time. If, as some recent theory and observations suggest, population differentiation is not a rate-limiting control on species diversification, then the causes of population differentiation are unlikely to have macroevolutionary effects. We provide a large-scale test of the link between standardized estimates of rates of differentiation from population genetic data and speciation rates. Population differentiation rates predict speciation rates across New World birds, confirming the potential macroevolutionary importance of causes of differentiation. We also find that population differentiation and speciation rates are more tightly linked in the Tropics, which may help explain latitudinal differences in diversification dynamics.
A helicase-independent activity of eIF4A in promoting mRNA recruitment to the human ribosome
Authors: Sokabe Masaaki , Fraser Christopher S.
Published: May 2017

Significance

Recruitment of messenger RNA (mRNA) into the decoding site of the eukaryotic 40S ribosomal subunit is a critical step in the process of mRNA selection for translation. This step is known to require an open conformation of the decoding site to be induced, but the opening mechanism has not yet been determined. We generated a quantitative assay to monitor conformation changes that occur during mRNA recruitment using a reconstituted system. We show that, unexpectedly, mRNA recruitment is dependent on both the eukaryotic initiation factor (eIF) 4A DEAD-box helicase and ATP. This function of eIF4A is completely independent of its unwinding activity and thus functions as a regulator of translation initiation regardless of mRNA secondary structure content.
Decision Making in Neonatal End-of-Life Scenarios in Low-Income Settings1
Authors: McTavish James
Published: May 2017

The challenge of decision making in end-of-life scenarios is exacerbated when the patient is a newborn and in a low-income setting. The principle of proportionate care is a helpful guide but needs to be applied. The complex interplay of benefit, burden, and cost of various treatments all need to be considered. In patients with severe neonatal encephalopathy, prognosis can be hard to determine, and a team approach to decision making can help. In low-income settings, or where there are limited resources, the ideal care needs to be incarnated in the real context. Issues of social justice also arise as finite resources need to be used prudently.

Decisions regarding medical care become difficult when the patient is a seriously ill newborn baby. In the developing world, scarce medical facilities and minimal economic resources also limit possible treatment options. The Catholic Church offers practical ethical principles which can help the medical team and family to strive to do what is morally best in these difficult situations.
A tale in stone and bronze: old/new strategies for political mobilization in the Republic of Macedonia
Authors: Stefoska Irena , Stojanov Darko
Published: May 2017

The redesign of Skopje's main square and the wider central area in the last six years has been a top priority of the Macedonian government. The project, called Skopje 2014, provoked intense domestic debate and controversy as well as international reaction and concern. Although officials say that project's aim is to unify ethnic Macedonians, it has produced several lines of political, intra-ethnic/interethnic as well as intra-cultural/intercultural divisions in the fragile Macedonian society. The aim of the paper is to offer reflections about its mobilizing potential among ethnic Macedonians in a set of social, economic, and political contexts. In that sense, four areas of mobilization are suggested: (1) around new identity markers; (2) around the name dispute and against threats (real or imagined) to the ethnic and national identity; (3) against the internal Other, that is, the ethnic Albanian community, as well as critics of these identity politics; and (4) in reaction to the global financial crisis and problems within the EU.
The 2015 general elections in Nigeria: new media, party politics and the political economy of voting
Authors: Mustapha Mala
Published: May 2017

This Briefing argues that social media evidently did not provide the platforms for democratic struggles and the transformation of the political economy of voting during the 2015 general elections in Nigeria. Arguably, only the trade union movements such as the Nigerian Labour Congress formed a vibrant vanguard for democratic struggles challenging neoliberal policy and state hegemony.
Enzymatic lipid oxidation by eosinophils propagates coagulation, hemostasis, and thrombotic disease
Authors: Uderhardt Stefan , Ackermann Jochen A. , Fillep Tobias , Hammond Victoria J. , Willeit Johann , Santer Peter , Mayr Manuel , Biburger Markus , Miller Meike , Zellner Katie R. , Stark Konstantin , Zarbock Alexander , Rossaint Jan , Schubert Irene , Mielenz Dirk , Dietel Barbara , Raaz-Schrauder Dorette , Ay Cihan , Gremmel Thomas , Thaler Johannes , Heim Christian , Herrmann Martin , Collins Peter W. , Schabbauer Gernot , Mackman Nigel , Voehringer David , Nadler Jerry L. , Lee James J. , Massberg Steffen , Rauh Manfred , Kiechl Stefan , Schett Georg , O’Donnell Valerie B. , Krönke Gerhard
Published: May 2017

Blood coagulation is essential for physiological hemostasis but simultaneously contributes to thrombotic disease. However, molecular and cellular events controlling initiation and propagation of coagulation are still incompletely understood. In this study, we demonstrate an unexpected role of eosinophils during plasmatic coagulation, hemostasis, and thrombosis. Using a large-scale epidemiological approach, we identified eosinophil cationic protein as an independent and predictive risk factor for thrombotic events in humans. Concurrent experiments showed that eosinophils contributed to intravascular thrombosis by exhibiting a strong endogenous thrombin-generation capacity that relied on the enzymatic generation and active provision of a procoagulant phospholipid surface enriched in 12/15-lipoxygenase–derived hydroxyeicosatetraenoic acid–phosphatidylethanolamines. Our findings reveal a previously unrecognized role of eosinophils and enzymatic lipid oxidation as regulatory elements that facilitate both hemostasis and thrombosis in response to vascular injury, thus identifying promising new targets for the treatment of thrombotic disease.
Identification of Taeniothrips eucharii (Thysanoptera: Thripidae) as a Vector of Hippeastrum chlorotic ringspot virus in Southern China
Authors: Xu Ye , Gao Xue , Jia Zhiqiang , Li Wengui , Hu John , Li Yajin , Li Yongzhong , Liu Yating
Published: May 2017

Hippeastrum chlorotic ringspot virus (HCRV) is a putative new member of the genus Tospovirus, which was first identified infecting Hymenocallis littoralis in Yunnan Province, southwestern China. Taeniothrips eucharii, the dominant thrips species found on H. littoralis, was tested for its efficiency as a vector of the virus. We used Western blot analysis of adult thrips to detect the N protein. Transmission experiments demonstrated an average acquisition efficiency of 43.7 ± 3.4% (AAP = 24 h) for the first larval stage and a transmission efficiency of 19.1 ± 2.4% (IAP = 24 h) for adult thrips. This study reports T. eucharii as a new genus and species of thrips transmitting a Tospovirus, HCRV.
Genetic counseling for hereditary cancer
Authors: McReynolds Kate , Lewis Sara
Published: May 2017

Many patients have concerns regarding their family's cancer history and may be appropriate for referral to genetic counseling. This article examines indications for referral for genetic counseling for hereditary cancer, the process of genetic counseling and testing, and ways for NPs to collaborate with genetics providers.
Mixed Messages or Miscommunication? Investigating the Relationship Between Assessors’ Workplace-Based Assessment Scores and Written Comments
Authors: Sebok-Syer Stefanie S. , Klinger Don A. , Sherbino Jonathan , Chan Teresa M.
Published: May 2017

Purpose

The shift toward broader, programmatic assessment has revolutionized the approaches that many take in assessing medical competence. To understand the association between quantitative and qualitative evaluations, the authors explored the relationships that exist among assessors’ checklist scores, task ratings, global ratings, and written comments.

Method

The authors collected and analyzed, using regression analyses, data from the McMaster Modular Assessment Program. The data were from emergency medicine residents in their first or second year of postgraduate training from 2012 through 2014. Additionally, using content analysis, the authors analyzed narrative comments corresponding to the “done” and “done, but needs attention” checklist score options.

Results

The regression analyses revealed that the task ratings, provided by faculty assessors, are associated with the use of the “done, but needs attention” checklist score option. Analyses also identified that the “done, but needs attention” option is associated with a narrative comment that is balanced, providing both strengths and areas for improvement. Analysis of qualitative comments revealed differences in the type of comments provided to higher- and lower-performing residents.

Conclusions

This study highlights some of the relationships that exist among checklist scores, rating scales, and written comments. The findings highlight that task ratings are associated with checklist options while global ratings are not. Furthermore, analysis of written comments supports the notion of a “hidden code” used to communicate assessors’ evaluation of medical competence, especially when communicating areas for improvement or concern. This study has implications for how individuals should interpret information obtained from qualitative assessments.
Continuing Professional Development for Faculty: An Elephant in the House of Academic Medicine or the Key to Future Success?
Authors: Davis David A. , Rayburn William F. , Smith Gary A.
Published: May 2017

The scope of change required by academic medical centers (AMCs) to maintain their viability and achieve their tripartite mission in the future is large; such reform is affected by numerous global, national, and local forces. Most AMCs focus their transformational efforts on organizational infrastructure (e.g., undertaking payment reform, developing new organizational structures, investing in information technology) and educational programs (with subsequent changes in undergraduate and graduate medical education curricula). Although useful, these efforts have failed to produce the kind of change required for AMCs to succeed in the future.

The authors of this Invited Commentary describe a key element missing from most of these reform efforts—the preparation of faculty for new models of health care and educational practice. To address this issue, they call for the effective, system-aligned presence of continuing professional development (CPD) programs. CPD combines continuing medical education, with its focus on content knowledge, and faculty development, with its focus on evidence-based learning methodologies, across the institution to produce a more robust, system- and outcomes-oriented program to facilitate both individual and organizational learning. If sufficiently supported, CPD programs can provide a platform for the human changes necessary to ensure the smooth transition of AMCs to new models of education, clinical research, and ultimately patient care.
Mother's Lived Experience During Repair of Long-Gap Esophageal Atresia
Authors: Fleck Patricia , Kenner Carole , Board Rhonda , Mott Sandra
Published: May 2017

Background:

Infants born with long-gap esophageal atresia (LGEA) pose unique physiologic risks in the newborn period. Anatomic and physiologic anomalies require an extended hospitalization with procedural analgesia and sedation that impact the mother's experience of birth, maternal response, and nurturing of her infant.

Purpose:

The aim of this study was to understand the meaning of experiences that mothers of infants born with LGEA encounter in the neonatal intensive care unit while their infant undergoes esophageal repair.

Methods:

A hermeneutical phenomenological design was used to guide this inquiry. Three mothers were interviewed on 3 separate occasions. The conversations were audio-recorded and transcribed verbatim. The findings were analyzed using fundamental existential lifeworld themes.

Results:

The essence that conceptualized the study was “making connections: day-by-day.” Themes that emerged are (a) the many phases; (b) the long and winding road; (c) a new me, my purpose; and (d) our new community.

Implications for Practice:

Nurses' knowledge and understanding of maternal experiences of having an infant with LGEA will enable for increased physical closeness, optimizing time spent together to learn their infant's unique personality. Creating partnerships with mothers can enhance our understanding of their perspectives, concerns, needs, and guide interventions.

Implications for Research:

Further exploration of family dynamics including fathers, siblings, and contextual factors may illuminate interventions to enhance relationships and communication that may influence developmental outcomes for families of infants with LGEA.
Congenital pseudarthrosis of the tibia in children: should we defer surgery until 3 years old?
Authors: Liu Yaoxi , Mei Haibo , Zhu Guanghui , Liu Kun , Wu Jiangyan , Tang Jin , He Rongguo
Published: May 2017

Currently, the timing of surgery for congenital pseudarthrosis of the tibia (CPT) remains controversial. The aim of this study was to investigate the results of treatment of pseudarthrosis of the tibia in children younger than 3 years of age. A retrospective study was carried out to explore the relationship between postoperative complications and the age of surgery in children with CPT. The analysis was carried out on 42 patients with Crawford type IV CPT treated with a combined surgical technique between 2008 and 2012. Patients were divided into two groups according to their age: group A (<3 years) and group B (>3 years). The incidence rates of refracture, ankle valgus, tibial valgus, and limb-length discrepancy of the two groups were evaluated. Primary bone union was achieved in 28 out of 29 (97%) patients in group A and 12 out of 13 (92%) patients in group B (P>0.05). In group A, six (21%) patients developed a refracture; 14 (48%) patients had ankle valgus with a mean degree of 11° (range: 5°–25°); 11 (38%) patients had tibial valgus with a mean tibial valgus deformity of 8.6° (range: 5°–20°); and 12 (41%) patients had limb-length discrepancy with a mean limb length of 2.9 cm (range: 0.5–4 cm). In group B, five (38%) patients developed refracture; seven (54%) patients had ankle valgus with a mean degree of 14° (range: 5°–30°); seven (54%) patients had tibial valgus with a mean tibial valgus deformity of 10.7° (range: 5°–20°); and 10 (77%) patients had limb-length discrepancy with a mean limb length of 2.8 cm (range: 1.5–3 cm). Groups A and B were significantly different in limb-length discrepancy (P=0.033). This study suggests that there is no need to defer surgery for pseudarthrosis of the tibia until the child is older than 3 years of age.
Can Source Triangulation Be Used to Overcome Limitations of Self-Assessments? Assessing Educational Needs and Professional Competence of Pharmacists Practicing in Qatar
Authors: Kheir Nadir , Al-Ismail Muna Said , Al-Nakeeb Reem
Published: May 2017

Introduction:

Continuing professional development activities should be designed to meet the identified personal goals of the learner. This article aims to explore the self-perceived competency levels and the professional educational needs of pharmacists in Qatar and to compare these with observations of pharmacy students undergoing experiential training in pharmacies (students) and pharmacy academics, directors, and managers (managers).

Methods:

Three questionnaires were developed and administered to practicing pharmacists, undergraduate pharmacy students who have performed structured experiential training rotations in multiple pharmacy outlets in Qatar and pharmacy managers. The questionnaires used items extracted from the National Association of Pharmacy Regulatory Authorities (NAPRA) Professional competencies for Canadian pharmacists at entry to practice and measured self- and observed pharmacists' competency and satisfaction with competency level.

Results:

Training and educational needs were similar between the pharmacists and observers, although there was trend for pharmacists to choose more fact-intensive topics compared with observers whose preferences were toward practice areas. There was no association between the competency level of pharmacists as perceived by observers and as self-assessed by pharmacists (P ≤ .05). Pharmacists' self-assessed competency level was consistently higher than that reported by students (P ≤ .05).

Discussion:

The results suggest that the use of traditional triangulation might not be sufficient to articulate the professional needs and competencies of practicing pharmacists as part of a strategy to build continuing professional development programs. Pharmacists might have a limited ability to accurately self-assess, and observer assessments might be significantly different from self-assessments which present a dilemma on which assessment to consider closer to reality. The processes currently used to evaluate competence may need to be enhanced through the use of well-designed rubrics or other strategies to empower and to better inform respondents and subsequently improve their ability to self-assess their competencies.
Rebooting Kirkpatrick: Integrating Information System Theory Into the Evaluation of Web-based Continuing Professional Development Interventions for Interprofessional Education
Authors: Shen Nelson , Yufe Shira , Saadatfard Omid , Sockalingam Sanjeev , Wiljer David
Published: May 2017

Introduction:

Information system research has stressed the importance of theory in understanding how user perceptions can motivate the use and adoption of technology such as web-based continuing professional development programs for interprofessional education (WCPD-IPE). A systematic review was conducted to provide an information system perspective on the current state of WCPD-IPE program evaluation and how current evaluations capture essential theoretical constructs in promoting technology adoption.

Methods:

Six databases were searched to identify studies evaluating WCPD-IPE. Three investigators determined eligibility of the articles. Evaluation items extracted from the studies were assessed using the Kirkpatrick–Barr framework and mapped to the Benefits Evaluation Framework.

Results:

Thirty-seven eligible studies yielded 362 evaluation items for analysis. Most items (n = 252) were assessed as Kirkpatrick–Barr level 1 (reaction) and were mainly focused on the quality (information, service, and quality) and satisfaction dimensions of the Benefits Evaluation. System quality was the least evaluated quality dimension, accounting for 26 items across 13 studies. WCPD-IPE use was reported in 17 studies and its antecedent factors were evaluated in varying degrees of comprehensiveness.

Discussion:

Although user reactions were commonly evaluated, greater focus on user perceptions of system quality (ie, functionality and performance), usefulness, and usability of the web-based platform is required. Surprisingly, WCPD-IPE use was reported in less than half of the studies. This is problematic as use is a prerequisite to realizing any individual, organizational, or societal benefit of WCPD-IPE. This review proposes an integrated framework which accounts for these factors and provides a theoretically grounded guide for future evaluations.
Primary Cutaneous Small Cell Variant of Anaplastic Large Cell Lymphoma: A Case Series and Review of the Literature
Authors: Magro Cynthia M. , Momtahen Shabnam , Kiuru Maija
Published: May 2017

Primary cutaneous anaplastic large cell lymphoma (ALCL), similar to systemic ALCL, has as its histomorphologic hallmarks cohesive sheets of large lymphoid cells expressing CD30. Several morphologic variants of systemic ALCL have been reported, including the common (classic) type, lymphohistiocytic, and small cell variants. The small cell variant of ALCL is characterized by a predominant cytomorphology which is unexpected for ALCL, being in the context of a small- to medium-sized hyperchromatic atypical lymphocyte. Although well recognized in its systemic form including cases with secondary cutaneous involvement, it is less well characterized as a form of primary cutaneous ALCL. In this study, we collected 8 cases of primary cutaneous small cell variant of ALCL and examined their clinical, histologic, and phenotypic features. All patients were middle aged to older adult men; the youngest patient was a 46-year-old man with underlying hepatitis C. In one case, there was a history of lymphomatoid papulosis. In all patients, the disease was in the context of a local regional presentation. Patients were treated with complete excision and/or radiation except in one in whom chemotherapy was administered. In all but one patient, the cutaneous presentation was a regionally confined process; however, in 2 cases, recurrent disease occurred, and in 25% of cases, extracutaneous dissemination specifically to regional lymph nodes was observed. Although there was nodal involvement, there was no dissemination to bone marrow or peripheral blood; no patient has died because of disseminated lymphoma. In all cases, there was a predominance of small atypical hyperchromatic cells with a variable background of larger hallmark cells typical of ALCL. Epidermotropism was seen in half of the cases, and in one case, there was striking pseudoepitheliomatous hyperplasia. The smaller cells demonstrated CD30 positivity, and the neoplastic cells showed a CD4-positive phenotype with a variable expression of cytotoxic proteins in about half of the cases, whereas in the remaining cases, a double negative phenotype was observed. Epithelial membrane antigen expression was observed in the cases tested. In our literature review, similar demographics were observed with a comparable percent of cases with extracutaneous dissemination; one case manifested an aggressive clinical course eventuating in death. In summation, the small cell variant of primary cutaneous ALCL exhibits distinctive features clinically and histologically. While exhibiting an overall higher incidence of extracutaneous dissemination, the prognosis fairs better compared with other forms of cutaneous T-cell lymphoma associated with extracutaneous dissemination, an event that defines a harbinger of aggressive disease.
Reinforcing effects of abused ‘bath salts’ constituents 3,4-methylenedioxypyrovalerone and α-pyrrolidinopentiophenone and their enantiomers
Authors: Gannon Brenda M. , Rice Kenner C. , Collins Gregory T.
Published: May 2017

Synthetic cathinones found in abused ‘bath salts’ preparations are chiral molecules. Racemic 3,4-methylenedioxypyrovalerone (MDPV) and α-pyrrolidinopentiophenone (α-PVP) are two common constituents of these preparations that have been reported to be highly effective reinforcers; however, the relative contribution of each enantiomer toward these effects has not been determined. Thus, male Sprague-Dawley rats were trained to respond for racemic MDPV or α-PVP (n=9/drug), with full dose–response curves for the racemate and the S and R enantiomers of MDPV and α-PVP generated under a progressive ratio schedule of reinforcement. Racemic mixtures of both MDPV and α-PVP as well as each enantiomer maintained responding in a dose-dependent manner, with racemic MDPV and α-PVP being equipotent. The rank order of potency within each drug was S enantiomer>racemate ≫ R enantiomer. Although both enantiomers of α-PVP were as effective as racemic α-PVP, R-MDPV was a slightly less effective reinforcer than both S and racemic MDPV. The results of these studies provide clear evidence that both enantiomers of MDPV and α-PVP function as highly effective reinforcers and likely contribute toward the abuse-related effects of ‘bath salts’ preparations containing racemic MDPV and/or α-PVP.
The effect of litter separation on methamphetamine-conditioned place preference in post-partum dams
Authors: Lewis Candace R. , Baker Allison N. , Fennig Paulette , Conrad Phoebe , Hess Lyndsay , Bastle Ryan M. , Olive M. Foster
Published: May 2017

Methamphetamine (METH) abuse among women has recently increased to levels comparable to those observed in men. Although studies using animal models of addiction have begun to include more female subjects, examination of the effects of drugs of abuse on post-partum females is currently lacking. This is especially important in light of the significant hormonal and neurobiological changes that accompany pregnancy and rearing experiences. Furthermore, stress in a known factor in addiction vulnerability and the post-partum experience in the clinical population can be highly stressful. Here, we utilized the conditioned place preference paradigm to investigate the conditioned rewarding effects of METH either in virgin rats or in dams exposed to brief separation (15 min) or long separation (180 min) from the litter. We found that females in the brief separation group showed significantly greater METH conditioned place preference compared with both the long separation and virgin groups. No differences were found in locomotor activity during the conditioning sessions. These findings suggest that peripartum experience and brief litter separation may enhance the rewarding effects of METH.
Current Practices for Therapeutic Drug Monitoring of Biopharmaceuticals in Pediatrics
Authors: Murias Sara , Magallares Lorena , Albizuri Fatima , Pascual-Salcedo Dora , Dreesen Erwin , Mulleman Denis
Published: May 2017

Biopharmaceuticals have recently emerged as effective treatments for refractory pediatric autoimmune conditions. Several reports have shown a relationship between drug concentration, antidrug antibodies, and clinical response in these patients, strongly suggesting the potential interest, usefulness, and reliability of therapeutic drug monitoring (TDM) in children. This article reviews the current state of research in juvenile idiopathic arthritis, pediatric inflammatory bowel disease, and pediatric psoriasis from a TDM point of view. There is a remarkable lack of evidence-based data in pediatric patients, which is reflected throughout the article. Most investigations of TDM are focused on research of tumor necrosis factor alpha antagonists in inflammatory bowel disease, albeit preliminary publications are emerging from pediatric rheumatologists and dermatologists. To date, immunogenicity has been a primary concern, particularly regarding infliximab and adalimumab therapy in children, as it may lead to a loss of therapeutic response. Preliminary investigations show that adjusting the dose according to blood drug concentrations improves disease outcomes by overcoming antidrug antibodies, suggesting a crucial role for TDM. Patients who receive other drugs, such as etanercept, abatacept, or tocilizumab, could benefit from TDM because dosage can be optimized by adjusting it to the minimum effective dose.
HANDHELD SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY IMAGING THROUGH THE UNDILATED PUPIL IN INFANTS BORN PRETERM OR WITH HYPOXIC INJURY OR HYDROCEPHALUS
Authors: Tran-Viet Du , Wong Brittany M. , Mangalesh Shwetha , Maldonado Ramiro , Cotten C. Michael , Toth Cynthia A.
Published: May 2017

Purpose:

The authors investigated feasibility of undilated handheld spectral domain optical coherence tomography (SDOCT) retinal imaging in preterm infants and children with neurologic abnormalities.

Methods:

Under an institutional review board–approved protocol, the authors attempted handheld SDOCT imaging of the retina, choroid, and optic nerve in infants and young children without pupil dilation. Scans were analyzed for quality and successful capture of foveal, optic nerve, and retinal structural parameters and abnormalities.

Results:

The authors obtained images through an undilated pupil of 11 infants/children over 28 eye imaging sessions, 27 at the bedside without sedation, and one under anesthesia. Infants had retinopathy of prematurity (n = 8), hypoxic ischemic encephalopathy (n = 2), or obstructive hydrocephalus (n = 1 child). Pupil sizes ranged from 1.0 mm to 3.5 mm. The authors captured fovea and optic nerve scans in 25/28 eye imaging sessions, with scans of adequate quality to discern prespecified foveal and optic nerve morphology, and of the 25 sessions, the choroidal–scleral junction was visible in all but 6 sessions.

Conclusion:

Undilated, handheld SDOCT imaging is a potential alternative method to evaluate the retina and optic nerve in patients with relative contraindication to pharmacological pupil dilation. This approach will enable the study of the eye–brain connection and ocular manifestations of neurologic diseases.
The Perceval Sutureless Aortic Valve
Authors: Powell Ramsey , Pelletier Marc P. , Chu Michael W. A. , Bouchard Denis , Melvin Kevin N. , Adams Corey
Published: May 2017

Surgical aortic valve replacement with a stented prosthesis has been the standard of care procedure for aortic stenosis. The Perceval (LivaNova, London, United Kingdom) is a sutureless aortic valve bioprosthesis currently implanted in more than 20,000 patients. The purpose of this article was to review the literature available after 9 years of clinical experience of the Perceval aortic valve. PubMED, Embase, and the Cochrane Library databases were searched. A meta-analysis of summary statistics from individual studies was conducted. A total of 333 studies were identified and 84 studies were included. Thirty-day mortality and 5-year survival ranged from 0% to 4.9% and 71.3% to 85.5%, respectively. Compared with stented prosthesis, pooled analysis demonstrated a statistically significant reduction in aortic cross-clamp and cardiopulmonary bypass times (minutes) with Perceval (38.6 vs 63.3 and 61.4 vs 84.9, P < 0.00001, respectively). Compared with transcatheter aortic valve implantation, pooled analysis demonstrated a statistically significant reduction with Perceval in paravalvular leakage (1.26% vs 14.31%) and early mortality (2.3% vs 6.9%). Favorable hemodynamics, acceptable valve durability, and ease of implantation in minimally invasive cases were reported as benefits. A trend toward increased rates of permanent pacemaker implantation and low postoperative platelet count were identified. Special use and off-label procedures described included bicuspid aortic valves, valve-in-valve for homo-graft and stentless prosthesis failure, concomitant valvular procedures, porcelain aorta, and endocarditis. The Perceval valve has shown safe clinical and hemodynamic outcomes. Outcomes support its continued usage and potential expansion.
Chronic discrimination and bodily pain in a multiethnic cohort of midlife women in the Study of Women's Health Across the Nation
Authors: Dugan Sheila A. , Lewis Tené T. , Everson-Rose Susan A. , Jacobs Elizabeth A. , Harlow Siobán D. , Janssen Imke
Published: May 2017

A growing literature links discrimination to key markers of biobehavioral health. While racial or ethnic differences in pain are seen in experimental and clinical studies, the authors were interested in how chronic discrimination contributes to pain within multiple racial or ethnic groups over time. Participants were 3056 African American, Caucasian, Chinese, Hispanic, and Japanese women from the Study of Women's Health Across the Nation. The Everyday Discrimination Scale was assessed from baseline through 13 follow-up examinations. The bodily pain subscale of the MOS 36-Item Short-Form Health Survey (SF-36) was assessed annually. There were large racial or ethnic differences in reports of discrimination and pain. Discrimination attributions also varied by race or ethnicity. In linear mixed model analyses, initially adjusted for age, education, and pain medications, chronic everyday discrimination was associated with more bodily pain in all ethnic groups (beta = −5.84; P < 0.002 for Japanese; beta = −6.17; P < 0.001 for African American; beta = −8.74; P < 0.001 for Chinese; beta = −10.54; P < 0.001 for Caucasians; beta = −12.82; P < 0.001 for Hispanic). Associations remained significant in all ethnic groups after adjusting for additional covariates in subsequent models until adding depressive symptoms as covariate; in the final fully-adjusted models, discrimination remained a significant predictor of pain for African American (beta = −4.50; P < 0.001), Chinese (beta = −6.62; P < 0.001), and Caucasian (beta = −7.86; P < 0.001) women. In this longitudinal study, experiences of everyday discrimination were strongly linked to reports of bodily pain for the majority of women. Further research is needed to determine if addressing psychosocial stressors, such as discrimination, with patients can enhance clinical management of pain symptoms.