bluuebunny/crossref_metadata_2025 huggingface dataset:
Novel pair‐wise relative energy function for transient stability analysis and real‐time emergency control
Authors: Gou Jing , Liu Youbo , Liu Junyong , Taylor Gareth A. , Alamuti Mohsen M.
Published: July 2017

In recent years, situation awareness and risk mitigation have become the challenging issues in large‐scale power grids. This study presents a novel pair‐wise relative energy function for real‐time transient stability analysis and emergency control. The proposed energy function is able to accurately identify the clusters of critical and non‐critical generators significantly faster when compared with previous methods. Additionally, a new emergency control criterion is proposed in order to stabilise the identified critical generators within a comparatively short interval after fault clearance. The emergency control scheme computes the capacity of the requisite generation curtailment using the pre‐calculated relative energy of the equivalent post‐fault system. Finally, the relative energy oscillation trajectories that occur in the critical cluster are utilised in order to locate the most appropriate generator to launch the emergency control. When compared with the existing methods, it is evident that the novel approach can be applied practically for power systems transient stability analysis and emergency control. The effectiveness of the proposed method is demonstrated and evaluated using the New England 10 machines 39‐bus and 16 machines 68‐bus systems.
Was trägt zur Verbesserung der gesundheitlichen Situation von Lehrkräften (LK) am Arbeitsplatz Schwerpunktgrundschule (SPGS) bei? Ein Mixed-Methods-Ansatz
Authors: Riechmann-Wolf Merle , Claus Matthias , Kimbel Renate , Schöne Klaus , Claus Annika , Letzel Stephan , Rose Dirk-Matthias
Published: July 2017

Ziel Für SPGS wurde inhaltsanalytisch und unter Berücksichtigung personen- bzw. tätigkeitsbezogener Belastungs- und Beanspruchungsmerkmale erfasst, welche Maßnahmen aus Sicht von LK zur Verbesserung der gesundheitlichen Situation am Arbeitsplatz beitragen können.

Methodik Die Daten stammen aus einer vom Institut für Lehrergesundheit (IFL) von August 2013 bis April 2015 an 14 SPGS in Rheinland-Pfalz durchgeführten schriftlichen Querschnittserhebung. Die Teilnahmequote liegt bei 46,3% (143/309 LK). Antworten auf die offene Frage „Welche konkreten berufsbezogenen Maßnahmen würden zu einer Verbesserung Ihres Wohlbefindens oder Ihrer gesundheitlichen Situation am Arbeitsplatz beitragen?“ wurden kategorisiert und quantifiziert. Es erfolgte eine Item-Non-Responder-Analyse. Logistische Regressionsanalysen dienten dazu, Belastungs- oder Beanspruchungsmerkmale zu identifizieren, die mit der Benennung spezifischer Kategorien in Zusammenhang stehen.

Ergebnisse Es wurden die Angaben von 143 LK ausgewertet. 79 LK machten insgesamt 362 Vorschläge zur Verbesserung der gesundheitlichen Situation am Arbeitsplatz. Die Abgabe eines Vorschlags wurde nicht von soziodemografischen Variablen beeinflusst. 33,6% der LK thematisierten die baulichen/physikalischen Arbeitsbedingungen, bspw. klimatische oder akustische, oder die Schaffung bislang fehlender Rückzugsräume. 29,4% der LK machten Vorschläge zu personalstrukturellen Maßnahmen (Stichwort: „Doppelbesetzung“). 9,1% der LK führten Aspekte der kollegialen Zusammenarbeit an. Den Regressionsanalysen zufolge steht die Benennung einzelner Kategorien in Zusammenhang mit spezifischen tätigkeitsbezogenen Belastungsmerkmalen. Zudem weisen LK, die sich stärker beansprucht fühlen, hier: ihre Arbeit als (sehr) stark gesundheitsgefährdend wahrnehmen, eine signifikant höhere Chance (Odd) auf, Vorschläge der Kategorie „KollegInnen“ (aOR 3,71; 95%KI 1,00–13,76) oder „Externe Unterstützung“ (z. B. Supervision) (aOR 3,92; 95%KI 1,15–13,41) zu machen als weniger stark beanspruchte LK.

Schlussfolgerungen An SPGS tätige LK zeigen sich bereit, sich aktiv an der gesundheitsbezogenen Organisationsentwicklung zu beteiligen. Die kombinierte Auswertung qualitativer und quantitativer Daten erleichtert die Entwicklung problem- und zielgruppenspezifischer Interventionsansätze.
Kochleaimplantatversorgung von Kindern und Erwachsenen
Authors: Zahnert Thomas , Mürbe Dirk
Published: July 2017

In Deutschland werden jährlich etwa 4000 Patienten mit einem Kochleaimplantat versorgt. Während noch vor Jahren schwerhörige ältere Menschen mit konventionellen Hörgeräten und progredientem Hörverlust bei unzureichendem Sprachverständnis mit dem Risiko der sozialen Isolation leben mussten, können heute Cochleaimplantate als Folgeglied in der Hörsystemversorgung mit hoffnungsvollen Ergebnissen auch bei im fortgeschrittenen Alter angesehen werden. Auch bei Kindern ergeben sich neue Indikationen, mit besonderen Anforderungen in der Rehabilitation.
Kommentar der Schriftleitung
Authors: Guntinas-Lichius O.
Published: July 2017

Liebe Leserinnen und Leser,

in Referiert + Diskutiert starten wir mit einer wegweisenden Arbeit aus dem New England Journal of Medicine, dass es bei einer Antibiotikatherapie der kindlichen Otitis media acuta wichtig ist auch konsequent über 10 Tage zu behandeln 1; eine Kurzzeittherapie ist dem eindeutig unterlegen. Dann geht es um die Effektivität von Dehnungsimplantaten bei Septorhinoplastiken und dann um radiologische Befundung von Fazialisanomalien bei Innenohranomalien, was auch für CI Implantationen relevant ist, siehe weiter unten 2.
Prävalenz, Risikofaktoren und Diagnostik von Hörstörungen bei Frühgeborenen
Authors: Franck C. , Vorwerk W. , Köhn A. , Rißmann A. , Vorwerk U.
Published: July 2017

Einleitung: Die Frühgeburt bringt ein deutlich gesteigertes Risiko der Ausbildung einer konnatalen Hörstörung mit sich. Der postnatalen Kontrolle der Hörfunktion muss daher bei allen Frühgeborenen besondere Aufmerksamkeit zuteil werden. Die vorgestellte Arbeit untersucht, inwieweit die aktuellen wissenschaftlichen Erkenntnisse hinsichtlich Prävalenz, Diagnostik, Therapie und in Bezug auf die Risikofaktoren von Hörstörungen bei Frühgeborenen praktische Anwendung finden.

Material und Methoden: Die Behandlungsdaten von 126 im Arbeitsbereich Phoniatrie und Pädaudiologie der HNO-Universitätsklinik Magdeburg in den Jahren 2006–2011 untersuchten und behandelten ehemaligen Frühgeborenen wurden retrospektiv ausgewertet. Die zusätzliche Analyse aller Datensätze der Screeningzentrale (n=67 640) aus diesem Zeitraum ermöglicht Rückschlüsse auf die Gesamtanzahl und Prävalenz von Hörstörungen bei Frühgeborenen in Sachsen-Anhalt.

Ergebnisse: Nahezu alle Frühgeborene erhalten, wie Reifgeborene, ein beidseitiges postnatales Hörscreening. Die Datenauswertung zeigt jedoch, dass die praktische Umsetzung im Detail oft nicht den in der G-BA-Richtlinie festgelegten Qualitätszielen entspricht. Bspw. erfolgt je nach Geburtsklinik keine regelhafte Anwendung der bei Frühgeborenen empfohlenen Screeningmethode (AABR) oder der richtliniengemäße Screening-und Therapiezeitpunkt wird nicht eingehalten.

Diskussion: Die Evaluation der praktischen Umsetzung des universellen Neugeborenenhörscreenings wurde bereits zum Zeitpunkt der Einführung des Screeningprogrammes durch den G-BA geplant. Im Rahmen dieser Untersuchung sollte der praktischen Versorgung von Risikogruppen wie Frühgeborenen besondere Beobachtung gewidmet werden, um auf Basis der erhobenen Daten das Hörscreening – sowie die anschließende Diagnostik und Therapie-weiter zu vereinheitlichen. Unabhängig von der Geburtsklinik sollte gleichermaßen die Chance auf rechtzeitige Diagnostik und damit auf frühzeitige, prognostisch günstigere Therapie einer konnatalen Hörstörung bestehen. Durch schnelle postnatale Hörgerätversorgung können die Hörbahnreifung stimuliert und so potentiell Entwicklungsprobleme hinsichtlich der Hör-und Sprachentwicklung vermieden werden.
Cannabis und Schadensminderung in Deutschland
Authors: Manthey Jakob , Stöver Heino , Meyer-Thompson Hans-Günter
Published: July 2017

Aktuelle drogenpolitische Diskussionen über Cannabis drehen sich v. a. darum, wie diese Substanz in Zukunft rechtlich reguliert werden soll. Angesichts des anhaltend weit verbreiteten Konsums und der damit verbundenen Risiken, sollten jedoch mögliche Strategien zur Reduzierung der potenziellen Schäden für Konsumierende und die Gesellschaft bei der Gestaltung einer adäquaten Cannabispolitik berücksichtigt werden. Dieser Beitrag gibt einen Überblick über verschiedene Möglichkeiten zur Reduzierung der Konsumrisiken und illustriert, inwieweit diese bereits in Deutschland implementiert sind.

Es lassen sich sowohl individuelle als auch strukturelle Ansätze zur Reduzierung cannabisbezogener Risiken identifizieren. Individuelle Ansätze zielen durch die Vermittlung von Informationen darauf ab, dass Individuen durch eine risikoarme Konsumpraxis selbstständig die Risiken reduzieren und somit potenziell Schäden vermeiden. Strukturelle Ansätze dagegen sollen das Konsumumfeld so gestalten, dass der Konsum mit möglichst geringen negativen Folgen einhergeht. In Deutschland sind sowohl individuelle als auch strukturelle Ansätze zur Schadensminderung von Cannabiskonsum nicht in ausreichendem Maße umgesetzt. Mögliche Gründe für eine mangelhafte Implementierung werden diskutiert und Potenzial für die Anwendung von schadensmindernden Strategien für Cannabis identifiziert.
Qualitätsindikatoren für Primary-Health-Care-Einrichtungen in Österreich
Authors: Semlitsch Thomas , Abuzahra Muna , Stigler Florian , Jeitler Klaus , Posch Nicole , Siebenhofer Andrea
Published: July 2017

Hintergrund Die Stärkung der Primärversorgung ist ein wesentliches Ziel der aktuellen österreichischen Gesundheitsreform. In diesem Zusammenhang wurde im Jahr 2014 ein Konzept zur interdisziplinären Primärversorgung in Österreich beschlossen, worin Strukturen für und Anforderungen an zukünftige Primary-Health-Care-Einrichtungen festgelegt wurden.

Ziel der Studie Die Entwicklung bzw. Auswahl von Qualitätsindikatoren zur übergeordneten Evaluation der in Österreich geplanten Primary-Health-Care-Einrichtungen, welche den Anforderungen des neuen Konzepts für die Primärversorgung in Österreich entsprechen war Ziel dieses Projekts.

Methodik Das Vorgehen erfolgte auf Basis der RAND/NPCRDC Methode. Dazu wurden systematische Recherchen nach bestehenden Qualitätsindikatoren für die Primärversorgung in internationalen Indikatordatenbanken sowie bibliografischen Datenbanken durchgeführt. Die ermittelten Qualitätsindikatoren wurden in einem 2-stufigen Panelverfahren von einem Expertengremium hinsichtlich Relevanz und Praktikabilität bewertet.

Ergebnisse Insgesamt konnten im Rahmen der Literaturrecherche aus den unterschiedlichen Quellen 281 potenziell relevante Qualitätsindikatoren für den Primary-Health-Care Bereich identifiziert werden, welche zu 65 unterschiedlichen Indikatoren zusammengefasst werden konnten. Im Zuge des Panelverfahrens wurden daraus 30 Qualitätsindikatoren als relevant sowie praktikabel für die Anwendung in Österreich erachtet. Darunter fanden sich 5 Indikatoren zur Struktur-, 14 zur Prozess- und 11 zur Ergebnisqualität. Die Indikatoren wurden auf Basis der im Primärversorgungskonzept beschriebenen Funktionen folgenden 5 Domänen zugeteilt: Zugang zur Versorgung (5 Indikatoren); Qualität der Versorgung (15 Indikatoren); Kontinuität der Versorgung (5 Indikatoren); Koordination der Versorgung (4 Indikatoren) und Sicherheit (1 Indikator).

Schlussfolgerung Mit dem Indikatorset können die 4 definierten Funktionen von Primary-Health-Care weitgehend abgedeckt werden. Das Set ermöglicht eine einheitliche Evaluation von Primary-Health-Care-Einrichtungen in Österreich sowohl im Hinblick auf die Umsetzung des neuen Konzepts für die Primärversorgung als auch auf eine verbesserte Gesundheitsversorgung für die Bevölkerung.
The relevance of Husserl’s phenomenological exploration of interiority to contemporary epistemology
Authors: Tassone Biagio G.
Published: July 2017

Phenomenology represents a detailed and systematic attempt to understand the structures of first person lived experience. This article examines the relevance of Husserl’s writings and their introduction of the “phenomenological reduction” as the distinguishing characteristic of his transcendental form of phenomenology. A close examination of Husserl’s writings is given to highlight the centrality of the reduction for the justification of basic beliefs. It is subsequently shown how Husserl’s analyses of intentional acts have ongoing implications for the knowledge internalism versus knowledge externalism debate. This debate revolves around how knowledge is justified and how belief claims are warranted. Although the debate, in its modern form, can be traced back to the mid-twentieth century, Husserl’s methods were not introduced in dealing with internalist and externalist accounts of knowledge attainment until recently. Modern externalists, who for the most part are not phenomenologists, have subsequently largely condemned Husserl’s methods as promoting a strict Cartesian internalist justification of belief claims. These criticisms were met by attempts to characterize transcendental phenomenology as actually promoting something closer to externalism in epistemology. The following article attempts to show how Husserl’s phenomenology actively engages with problems related to the interiority of knowledge claims but in a radically different way from non-phenomenological approaches promoting internalism. Nonetheless, it is argued that transcendental phenomenology cannot be regarded as anything approaching a mainstream or even reworked “externalist” account of securing knowledge. Highlighting what Husserl calls “the paradox of subjectivity,” it is shown how his transcendental phenomenology develops a sui generis form of internalism. Since few modern internalists make use of Husserl’s texts, and post-Husserlian phenomenology has taken something like an externalist turn (as witnessed, for example, in recent interpretations of the writings of Heidegger and Sartre), it is argued that Husserl’s transcendental phenomenology should be taken more seriously by contemporary philosophers interested in knowledge internalism. These conclusions, subsequently, are relevant to promoting a better understanding of the justification of knowledge claims, both within and outside of the phenomenological program. Husserl’s writings are important to contemporary issues such as the theoretical understanding of the relationship between epistemology and philosophy of science (broadly conceived), as well as the relation of phenomenology to contemporary philosophy of mind.
A molecular dynamics study of nuclear quantum effect on diffusivity of hydrogen molecule
Authors: Nagashima H. , Tsuda S. , Tsuboi N. , Hayashi A. K. , Tokumasu T.
Published: July 2017

In this paper, the nuclear quantum effect of the hydrogen molecule on its diffusivity was analyzed using the molecular dynamics (MD) method. The centroid MD (CMD) method was applied to reproduce the time evolution of the molecules. The diffusion coefficient of hydrogen was calculated using the Green-Kubo method over a wide temperature region, and the temperature dependence of the quantum effect of the hydrogen molecule on its diffusivity was addressed. The calculated results were compared with classical MD results based on the principle of corresponding state (PCS). It was confirmed that the difference in the diffusion coefficient calculated in the CMD and classical MD methods was small, and the PCS appears to be satisfied on the temperature dependence of the diffusion coefficient, even though the quantum effect of the hydrogen molecules was taken into account. It was clarified that this result did not suggest that the quantum effect on the diffusivity of the hydrogen molecule was small but that the two changes in the intermolecular interaction of hydrogen due to the quantum effect offset each other. Moreover, it was found that this tendency was related to the temperature dependence of the ratio of the kinetic energy of the quantum fluctuational motion to the classical kinetic energy.
Evaluation of repeatability and pre-structured repeatability models for genetic analyses of repeated records of fat and protein contents of milk in Iranian Holstein cows
Authors: Fozi M. Asadi
Published: July 2017

Fat and protein content of milk measurements from first to fifth lactations of Iranian Holstein cows were analysed using repeatability and several pre-structured repeatability models that varied in additive genetic variance structure and fitted heterogeneous residual co (variance). For this research, a total of 257 197 fat and 218 688 protein records were used. The records were measured on 116 531 cows born between 2010 and 2014. The animals originated from 2355 sires and 91 212 dams. Pre-structured repeatability models with heterogeneous residual co (variance) and the respective genetic variance structure were the best models for genetic analysis of the fat and protein data. The results derived from these models showed that heritability of both fat and protein are decreased from first to fifth lactations. Heritability of fat measured at first, second, third, fourth and fifth locations were between 0.10 and 0.19 and those for protein were between 0.07 and 0.24. Moderate to high phenotypic correlations were estimated between the repeated records of the fat and protein. Values of 0.13 and 0.16 were estimated for heritability of fat and protein using repeatability model. Phenotypic correlations among the repeated records of fat and protein were estimated to be 0.30 and 0.33, respectively when this model was applied. The results showed the genetic variance, heritability and phenotypic correlation of the fat and protein are changed over the lactations but the genetic parameters derived from the repeatability model are homogenous whereas in both models unity genetic correlations are assumed among the repeated records. The results of this study show that the repeatability model is not an appropriate model for genetic analysis of the repeated records of fat and protein in the population investigated and can be improved when pre-structured repeatability model is used. In the present study homogenous genetic covariance was assumed among the fat and protein taken at the different lactations which can be modelled in future studies for more improving the models.
On the debris-level origins of adhesive wear
Authors: Aghababaei Ramin , Warner Derek H. , Molinari Jean-François
Published: July 2017

Significance

Wear causes a huge amount of material and energy losses annually, with serious environmental, economic, and industrial consequences. Despite considerable progress in the 19th century, the scientific understanding of wear remains mainly empirical. This study reveals the long-standing microscopic origins of material detachment from solids surface, at the most fundamental level, i.e., wear particles. It discloses that the detached particle volume can be estimated without any empirical factor, via the frictional work. This study unifies previously disconnected and not understood experimental observations. The results open the possibility for developing new wear models with drastically increased predictive ability, with applications to geophysics, physics, and engineering.
Modeling adsorption properties of structurally deformed metal–organic frameworks using structure–property map
Authors: Jeong WooSeok , Lim Dae-Woon , Kim Sungjune , Harale Aadesh , Yoon Minyoung , Suh Myunghyun Paik , Kim Jihan
Published: July 2017

Significance

Modeling amorphous materials using the conventional molecular simulation method is exceedingly difficult because structural information of the material is absent. Here, we present a way to indirectly model structurally deformed metal–organic frameworks using a large number of simulation data for crystalline metal–organic frameworks. Our experimental/computational results demonstrate that computed adsorption properties of crystalline metal–organic frameworks can be transferred onto those of structurally deformed, amorphous metal–organic frameworks. This opens up a way to understand adsorption properties of amorphous materials.
tsRNA signatures in cancer
Authors: Balatti Veronica , Nigita Giovanni , Veneziano Dario , Drusco Alessandra , Stein Gary S. , Messier Terri L. , Farina Nicholas H. , Lian Jane B. , Tomasello Luisa , Liu Chang-gong , Palamarchuk Alexey , Hart Jonathan R. , Bell Catherine , Carosi Mariantonia , Pescarmona Edoardo , Perracchio Letizia , Diodoro Maria , Russo Andrea , Antenucci Anna , Visca Paolo , Ciardi Antonio , Harris Curtis C. , Vogt Peter K. , Pekarsky Yuri , Croce Carlo M.
Published: July 2017

Significance

We found that tRNA-derived small RNAs (tsRNAs) are dysregulated in many cancers and that their expression is modulated during cancer development and staging. Indeed, activation of oncogenes and inactivation of tumor suppressors lead to a dysregulation of specific tsRNAs, and tsRNA-KO cells display a specific change in gene-expression profile. Thus tsRNAs could be key effectors in cancer-related pathways. These results indicate active crosstalk between tsRNAs and oncogenes and suggest that tsRNAs could be useful markers for diagnosis or targets for therapy. Additionally,ts-46andts-47affect cell growth in lung cancer cell lines, further confirming the involvement of tsRNAs in cancer pathogenesis.
Social isolation and older men – learning from research
Authors: Devine Paula , Montgomery Lorna , Carter Anand Janet , Ní Dhónaill Caoimhe
Published: July 2017

Due to an increase in life expectancy and other demographic factors, there is now a larger number of older men and women in our society. At the same time, loneliness and social isolation are increasing. This article draws upon a research project undertaken in 2014 to explore existing services for socially isolated older men in Belfast, and outlines key messages. Firstly, the paper highlights some of the experiences of isolated older men in one region of the UK. Secondly, it provides a review of service provision, providing ‘expert’ knowledge about how these services can affect men’s lives in different ways. Finally, the paper offers recommendations for enhancing the provision of services for socially isolated older men, based on the information gathered throughout the project.
Activating Aging Stereotypes Increases Source Recollection Confusions in Older Adults: Effect at Encoding but Not Retrieval
Authors: Wong Jessica T , Gallo David A
Published: July 2017

Objectives

Activating aging stereotypes can impair older adult performance on episodic memory tasks, an effect attributed to stereotype threat. Here, we report the first study comparing the effects of explicitly activating aging stereotypes at encoding versus retrieval on recollection accuracy in older adults.

Method

During the encoding phase, older adults made semantic judgments about words, and during the retrieval phase, they had to recollect these judgments. To manipulate stereotype activation, participants read about aging-related decline (stereotype condition) or an aging-neutral passage (control condition), either before encoding or after encoding but before retrieval. We also assessed stereotype effects on metacognitive beliefs and two secondary tasks (working memory, general knowledge) administered after the recollection task.

Results

Stereotype activation at encoding, but not retrieval, significantly increased recollection confusion scores compared to the control condition. Stereotype activation also increased self-reports of cognitive decline with aging, but it did not reliably impact task-related metacognitive assessments or accuracy on the secondary tasks.

Discussion

Explicitly activating aging stereotypes at encoding increases the likelihood of false recollection in older adults, potentially by diminishing encoding processes. Stereotype activation also influenced global metacognitive assessments, but this effect may be unrelated to the effect of stereotypes on recollection accuracy.
National Partnership for Maternal Safety
Authors: Bernstein Peter S. , Martin James N. , Barton John R. , Shields Laurence E. , Druzin Maurice L. , Scavone Barbara M. , Frost Jennifer , Morton Christine H. , Ruhl Catherine , Slager Joan , Tsigas Eleni Z. , Jaffer Sara , Menard M. Kathryn
Published: July 2017

Complications arising from hypertensive disorders of pregnancy are among the leading causes of preventable severe maternal morbidity and mortality. Timely and appropriate treatment has the potential to significantly reduce hypertension-related complications. To assist health care providers in achieving this goal, this patient safety bundle provides guidance to coordinate and standardize the care provided to women with severe hypertension during pregnancy and the postpartum period. This is one of several patient safety bundles developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care. These safety bundles outline critical clinical practices that should be implemented in every maternity care setting. Similar to other bundles that have been developed and promoted by the Partnership, the hypertension safety bundle is organized into four domains:Readiness, Recognition and Prevention, Response, andReporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. This commentary provides information to assist with bundle implementation.
Video Colposcopy for Reducing Patient Anxiety During Colposcopy
Authors: Hilal Ziad , Alici Ferizan , Tempfer Clemens B. , Seebacher Veronika , Rezniczek Günther A.
Published: July 2017

OBJECTIVE:

To test whether video colposcopy reduces anxiety among patients undergoing colposcopy.

METHODS:

In a prospective, randomized multicenter trial, we compared video colposcopy and no video colposcopy in a one-to-one ratio. Situation-specific anxiety was measured before (S1) and after (S2) colposcopy using the State-Trait Anxiety Inventory. The primary endpoint was the reduction of the situation-specific anxiety scores (ΔS=S2–S1). Secondary endpoints were pain during and 10 minutes after colposcopy, general unpleasantness, anxiety during colposcopy, satisfaction with the information about the procedure, and overall satisfaction (11-item visual analog scales). Analysis was by intention to treat. A sample size of 104 per group (n=208) was planned to achieve 80% power to detect a difference of 4.8 with a SD of 12.3 in the primary outcome.

RESULTS:

Between August 2016 and March 2017, 225 women were randomized. The mean ΔS was −10.3±11.3 SD in 111 women in the video colposcopy group and −10.3±11.0 SD in 105 women without video colposcopy (P=.50). The secondary endpoints pain during examination (median 2 [interquartile range 1–3] compared with 2 [1–4]; P=.91), pain 10 minutes after examination (1 [0–3] compared with 1 [0–2.5]; P=.24), general unpleasantness (3 [1–5] compared with 3 [1–5]; P=.90), anxiety during examination (3 [1–5] compared with 3 [1–5]; P=.61), satisfaction with the information about the procedure (10 [9–10] compared with 10 [9–10]; P=.88), and overall satisfaction (10 [9–10] compared with 10 [9–10]; P=.54) were also not different between the two study groups. In a multivariate linear regression analysis, study center (P=.028), body mass index (P=.033), and smoking status (P=.025) independently affected the reduction of anxiety.

CONCLUSION:

Video colposcopy does not reduce anxiety in women undergoing colposcopy.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02697175.
Finding Middle Ground in Constructing a Clinically Useful Expanded Carrier Screening Panel
Authors: Stevens Blair , Krstic Nevena , Jones Malorie , Murphy Lauren , Hoskovec Jennifer
Published: July 2017

Expanded carrier screening for autosomal-recessive conditions effectively identifies more carrier couples than traditional guideline-based carrier screening. However, clinically available expanded carrier screening panels include numerous conditions, some of which have questionable clinical utility as a result of very low carrier frequency, low or unknown testing sensitivity, and mild or incompletely penetrant phenotypes. Using the 2013 American College of Medical Genetics and Genomics Position Statement on Prenatal and Preconception Expanded Carrier Screening and the 2017 American College of Obstetricians and Gynecologists' Committee Opinion on Carrier Screening in the Age of Genomic Medicine as guidance, we propose specific criteria for the development of expanded carrier screening panels that will maximize clinical utility and minimize patient stress, unnecessary cost of follow-up testing, and clinician time spent facilitating and performing follow-up counseling and testing. We identified 96 conditions that meet our proposed criteria, far more than current guidelines recommend. On the other hand, a considerable percentage (73%) of conditions on current expanded carrier screen panels does not meet our proposed criteria. The purpose of this commentary is to acknowledge the benefits of expanded panels, but to also recognize that in their current state, we are putting patients at risk for undue stress and spending excessive time and money on follow-up testing for remarkably rare or mild conditions and conditions with low screening performance. We encourage laboratories and clinicians to work together to create the most clinically useful screening panels for patients desiring reproductive risk information.
Paracervical Block for Laminaria Insertion Before Second-Trimester Abortion
Authors: Soon Reni , Tschann Mary , Salcedo Jennifer , Stevens Katelyn , Ahn Hyeong Jun , Kaneshiro Bliss
Published: July 2017

OBJECTIVE:

To evaluate the efficacy of a paracervical block to decrease pain during osmotic dilator insertion before second-trimester abortion.

METHODS:

In this double-blind, randomized trial, 41 women undergoing Laminaria insertion before a second-trimester abortion received either a paracervical block with 18 mL 1% lidocaine and 2 mL sodium bicarbonate or a sham block. Women were between 14 and 23 6/7 weeks of gestation. The primary outcome was pain immediately after insertion of Laminaria. Women assessed their pain on a 100-mm visual analog scale. Secondary outcomes included assessment of pain at other times during the insertion procedure and overall satisfaction with pain control. To detect a 25-mm difference in pain immediately after Laminaria insertion, at an α of 0.05 and 80% power, we aimed to enroll 20 patients in each arm.

RESULTS:

From May 2015 to December 2015, 20 women received a paracervical block and 21 received a sham block. Groups were similar in demographics, including parity, history of surgical abortion, and number of Laminaria placed. The paracervical block reduced pain after Laminaria insertion (median scores 13 mm [interquartile range 2–39] compared with 54 mm [interquartile range 27–61], P=.01, 95% CI −47.0 to −4.0). Women who received a paracervical block also reported higher satisfaction with overall pain control throughout the entire Laminaria insertion procedure (median scores 95 mm [interquartile range 78–100] compared with 70 mm [interquartile range 44–90], P=.05, 95% CI 0.0–37.0).

CONCLUSION:

Paracervical block is effective at reducing the pain of Laminaria insertion. Additionally, a paracervical block increases overall patient satisfaction with pain control during Laminaria placement.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02454296.
Retrograde Femoral Nailing Using Percutaneous Reduction Techniques
Authors: Pettett Brett J. , Avery Matthew C. , Ostrum Robert F.
Published: July 2017

Femoral shaft fractures are commonly treated with closed reduction and reamed intramedullary nailing. However, some reductions are difficult to obtain or maintain, especially in muscular or large patients. When closed methods fail to achieve reduction, percutaneous techniques are extremely useful. In addition, the use of either permanent or temporarily placed blocking implants offer a minimally invasive option for improving sagittal and coronal plane alignment. In the accompanying video, we describe our method of percutaneous reduction techniques in the setting of a comminuted femoral shaft fracture treated with a retrograde femoral intramedullary nail.
Femoral Nonunion With Iliac Crest Bone Graft
Authors: Konda Sanjit R. , Christiano Anthony , Fisher Nina , Leucht Philipp , Egol Kenneth A.
Published: July 2017

Purpose:

Fracture nonunion is a common problem for today's orthopaedic surgeon. However, many techniques are currently available for the treatment of long-bone nonunion. This video demonstrates the use of iliac crest bone graft and plate stabilization in the setting of a hypertrophic femoral nonunion.

Methods:

Treatment of femoral nonunion after intramedullary nail fixation using compression plating and bone grafting is a reliable technique for reducing pain, improving function, and achieving radiographic union. Furthermore, the use of autologous bone graft, in particular iliac crest bone graft, has provided reliable clinical results.

Results:

In this video, we present the case of a hypertrophic femoral nonunion treated with supplemental bone grafting in addition to plate and screw fixation.

Conclusions:

Although femoral nonunions are a relatively rare occurrence, they can be reasonably treated using stabilization and supplemental bone grafting. Iliac crest bone graft provides for excellent results when used for treatment of a fracture nonunion.
Multiple Rib Nonunion: Open Reduction and Internal Fixation and Iliac Crest Bone Graft Aspirate
Authors: Kaplan Daniel J. , Begly John , Tejwani Nirmal
Published: July 2017

Purpose:

Rib fractures are a common chest injury that can typically be treated nonoperatively. However, a percentage of these will go on to nonunion, either because of unique characteristics of the fracture itself or because of a variety of poor healing factors of the host. If a patient has continued symptomology beyond 3 months, surgeons may consider operative management.

Methods:

Although isolated resection of fibrous scar tissue from the nonunion site may be sufficient in some cases, it may also be necessary to provide additional structural integrity to the rib depending on the extent of the fracture pattern and resection. This goal can be achieved operatively with rib plating and bone grafting to promote healing.

Results:

This video demonstrates the use of plating in the treatment of rib nonunion. It begins with relevant background information on rib fractures and nonunions, then details the approach, open reduction and internal fixation of 3 ribs using plates and bone graft aspirate. Pearls and pitfalls are included during the surgical technique aspect of the video to both help guide surgeons new to the procedure and provide potentially advantageous technical details to more experienced surgeons.
Retiform Purpura After Transcatheter Arterial Chemoembolization: A Case Report
Authors: Hansen Trevor , Olsen Keith , White Kevin , Keller Jesse
Published: July 2017

Cutaneous complications secondary to transcatheter arterial chemoembolization (TACE) are exceptionally rare and may occur because of nontarget embolization of terminal vessels supplying the skin. We present a patient who developed painful retiform purpura on the right flank shortly after TACE for treatment of hepatocellular carcinoma. Biopsy revealed intravascular tan to yellow amorphous spherical structures within the dermis, confirming the presence of foreign material within these vessels. The authors review the literature and discuss previous cases of skin lesions manifesting after TACE, as well as potential factors influencing the probability of cutaneous complications. Histopathologic findings described in similar cases are presented. Prophylactic measures and attempted treatments to reduce likelihood of long-term injury are also reviewed. An awareness that cutaneous injury is a rare, but potential complication of transcatheter arterial embolization, as well as an understanding of management options is important for any provider using this procedure.
Does physician leadership affect hospital quality, operational efficiency, and financial performance?
Authors: Tasi Michael C. , Keswani Aakash , Bozic Kevin J.
Published: July 2017

Background:

With payers and policymakers’ focus on improving the value (health outcomes achieved per health care dollar spent) of health care delivery, physicians are increasingly taking on senior leadership/management positions in health care organizations (Carsen & Xia, 2006). Little research has been done to understand the impact of physician leadership on the delivery of care.

Purpose:

The aim of this study was to examine whether hospital systems led by physicians were associated with better U.S. News and World Report (USNWR) quality ratings, financial performance, and operating efficiency as compared with those led by nonphysician managers.

Methodology:

Cross-sectional analysis of nationally representative data from Medicare Cost Reports and the USNWR on the 115 largest U.S. hospitals was performed. Bivariate analysis of physician-led and non-physician-led hospital networks included three categories: USNWR quality ratings, hospital volume, and financial performance. Multivariate analysis of hospital leadership, percent operating margin, inpatient days per hospital bed, and average quality rating was subsequently performed.

Results:

Hospitals in physician-led hospital systems had higher quality ratings across all specialties and more inpatient days per hospital bed than did non-physician-led hospitals; however, there were no differences in the total revenue or profit margins between the groups. Physician leadership was independently associated with higher average quality ratings and inpatient days per bed.

Conclusions:

Large hospital systems led by physicians in 2015 received higher USNWR ratings and bed usage rates than did hospitals led by nonphysicians, with no differences in financial performance. This study suggests that physician leaders may possess skills, qualities, or management approaches that positively affect hospital quality and the value of care delivered.

Practice Implications:

Hospital quality and efficiency ratings vary significantly and can impact consumer decisions. Hospital systems may benefit from the presence of physician leadership to improve the quality and efficiency of care delivered to patients. In addition, medical education should help prepare physicians to take on leadership roles in hospitals and health systems.
Quantitative sensory testing response patterns to capsaicin- and ultraviolet-B–induced local skin hypersensitization in healthy subjects: a machine-learned analysis
Authors: Lötsch Jörn , Geisslinger Gerd , Heinemann Sarah , Lerch Florian , Oertel Bruno G. , Ultsch Alfred
Published: July 2017

The comprehensive assessment of pain-related human phenotypes requires combinations of nociceptive measures that produce complex high-dimensional data, posing challenges to bioinformatic analysis. In this study, we assessed established experimental models of heat hyperalgesia of the skin, consisting of local ultraviolet-B (UV-B) irradiation or capsaicin application, in 82 healthy subjects using a variety of noxious stimuli. We extended the original heat stimulation by applying cold and mechanical stimuli and assessing the hypersensitization effects with a clinically established quantitative sensory testing (QST) battery (German Research Network on Neuropathic Pain). This study provided a 246 × 10-sized data matrix (82 subjects assessed at baseline, following UV-B application, and following capsaicin application) with respect to 10 QST parameters, which we analyzed using machine-learning techniques. We observed statistically significant effects of the hypersensitization treatments in 9 different QST parameters. Supervised machine-learned analysis implemented as random forests followed by ABC analysis pointed to heat pain thresholds as the most relevantly affected QST parameter. However, decision tree analysis indicated that UV-B additionally modulated sensitivity to cold. Unsupervised machine-learning techniques, implemented as emergent self-organizing maps, hinted at subgroups responding to topical application of capsaicin. The distinction among subgroups was based on sensitivity to pressure pain, which could be attributed to sex differences, with women being more sensitive than men. Thus, while UV-B and capsaicin share a major component of heat pain sensitization, they differ in their effects on QST parameter patterns in healthy subjects, suggesting a lack of redundancy between these models.
Mandatory Reporting of Intimate Partner Violence: An Ethical Dilemma for Forensic Nurses
Authors: Walker Rosalyn M.
Published: July 2017

Nearly all states and provinces have laws mandating licensed healthcare professionals to report to law enforcement suspicions and allegations of the abuse of children, older adults, and disabled persons and all incidents of violence by a deadly weapon. However, a few states in the United States additionally mandate providers to report all injuries resultant from reported or suspected domestic/intimate partner violence. This can present a challenge to forensic nurses seeking to protect patient confidentiality and autonomy. This challenge becomes further compounded when a patient desiring to remain anonymous reports sexual assault by their partner, accompanied by bodily injury. This case report explores one such scenario that occurred in a rural Colorado Emergency Department, the issues this presents to forensic nurses, and possible responses.
Long-term Outcome of Short Metallic Stents for Lobar Airway Stenosis
Authors: Fruchter Oren , Abed El Raouf Bayya , Rosengarten Dror , Kramer Mordechai R.
Published: July 2017

Background:

Whereas stents are considered an excellent treatment for proximal central major airway stenosis, the value of stenting for distal lobar airway stenosis is still controversial. Our aim was to explore the short-term and long-term outcome of metallic stents placed for benign and malignant lobar airway stenosis.

Methods:

Between July 2007 and July 2014, 14 patients underwent small airway stent insertion. The clinical follow-up included serial semiannual physical examinations, pulmonary function tests, imaging, and bronchoscopy.

Results:

The etiologies for airway stenosis were: early post-lung transplantation bronchial stenosis (N=5), sarcoidosis (N=1), amyloidosis (N=1), anthracofibrosis (N=1), right middle lobe syndrome due to external lymph node compression (N=1), lung cancer (N=4), and stenosis of the left upper lobe of unknown etiology (N=1). Stents were placed in the right upper lobe bronchus (N=2), right middle lobe bronchus (N=6), left upper lobe bronchus (N=4), linguar bronchus (N=1), and left lower lobe bronchus (N=1). The median follow-up period ranged from 2 to 72 months (median 18 mo). Immediate relief of symptoms was achieved in the vast majority of patients (13/14, 92%). Out of 10 patients with benign etiology for stenosis, 9 (90%) experienced sustained and progressive improvement in pulmonary function tests and clinical condition.

Conclusions:

We describe our positive experience with small stents for lobar airway stenosis; further prospective trials are required to evaluate the value of this novel modality of treatment.
The expanding role of scapular free-flaps
Authors: Tang Alice L. , Bearelly Shethal , Mannion Kyle
Published: July 2017

Purpose of review

The review evaluates the expanding role of scapular free flaps and its application in various complex head and neck defects.

Recent findings

The recent literature published focuses on the use of three-dimensional modeling for maxillectomy defects, expanded uses in both the megaflap, the various application of the scapular tip flap, and the feasibility of osseointegrated implants.

The subscapular system of flaps remains a versatile option in head and neck reconstruction. It continues to be one of the best options for large defects requiring generous soft tissue, muscle, and bone. Three-dimensional modeling is currently being applied to complex maxillary defects resulting in increased accuracy and efficiency of reconstruction. Expanded uses have also adopted the latissimus dorsi muscle in conjunction with the scapular bony flap to be used in large defects with resulting decreased fistula rates. Finally, there is sufficient evidence that supports the use of dental implantation into the scapula bone with successful retention rates.
Evaluation and management of syndromic congenital hearing loss
Authors: Casazza Geoffrey , Meier Jeremy D.
Published: July 2017

Purpose of review

The purpose of this review is to review the evaluation and management of children with syndromic hearing loss. Specific syndromes and the impact of those syndromes on managing hearing loss will be discussed.

Recent findings

Improved molecular testing has increased the ability to identify syndromes-associated hearing loss. Accurate diagnosis of syndromic hearing loss can guide discussions regarding prognosis and appropriate management options for the hearing impairment.

A significant portion of childhood hearing loss is associated with a syndrome. Depending on the syndrome, surgical intervention including a bone-anchored hearing aid or cochlear implant may be helpful. In the future, targeted gene therapies may become a viable option for treating syndromic hearing loss.
A Rare Case of Pancreatic Tuberculosis
Authors: Catalya Stephen , Tulpule Sunil , Arshed Sabrina , Nai Qiang , Sen Shuvendu
Published: July 2017

Tuberculosis remains a major public health concern, although it has reportedly shown a decline in prevalence both in the United States and abroad in recent years. The focus on diagnosing and treating tuberculosis is on pulmonary tuberculosis. Meanwhile, pancreatic tuberculosis remains exceedingly rare, accounting for less than 5% (Gastroenterol Rep (Oxf), 2014;2:154–157) of all tuberculosis cases in the developing world. A literature review shows that the head is primarily affected in pancreatic tuberculosis (Gastroenterol Rep (Oxf), 2014;2:154–157).
The Emerging Role of Endoscopists in Treating Unresectable Pancreatic Cancer
Authors: Tsen Adrianne , Van Norman Matthew , Atluri Sreedevi , Rosenkranz Laura
Published: July 2017

Pancreatic adenocarcinoma is the eighth leading cause of cancer deaths worldwide in men and ninth leading cause in women. Surgical resection offers the only chance of potential cure; however, only 9.4% of patients present at the localized, resectable stage, whereas the rest present at the locally advanced or metastatic, unresectable stages. Because of the guarded outcomes following systemic chemoradiation and the associated systemic toxicities, locoregional therapies have recently gained popularity. Various endoscopic techniques (endoscopic ultrasound [EUS]–guided ablative therapies, fine-needle instillation of antitumor agents, stereotactic body radiation therapy with EUS-guided fiducial marker placement, and EUS-guided brachytherapy) have been explored over the past several years. Endoscopic therapy plays a role in the treatment of unresectable pancreatic adenocarcinoma. Its minimal invasiveness and increased precision of delivering oncologic treatments under EUS guidance render it as a favorable option for patients who do not benefit from surgical resection. New endoscopic therapies are currently under investigation, and the emerging role of the endoscopist in the treatment of unresectable pancreatic cancer continues to grow.
Accurate PD-L1 Protocols for Non–Small Cell Lung Cancer can be Developed for Automated Staining Platforms With Clone 22C3
Authors: Røge Rasmus , Vyberg Mogens , Nielsen Søren
Published: July 2017

Treatment using immunotherapy against PD-L1 or PD-1 has become one of the hottest topics in Pathology and Oncology. Correct selection of patients eligible for treatment requires optimal immunohistochemical staining protocols. Treatment with pembrolizumab requires diagnostic examination of the patient's tumour using the companion diagnostic Ready-To-Use pharmDx kit from Dako Agilent based on the mAb 22C3 clone on the Autostainer platform. However, not all diagnostic pathology labs have access to this staining platform. This purpose of this study was to develop and validate protocols for PD-L1 detection for all major staining platforms using the concentrated format of 22C3 that would give similar staining result (equal Tumour Proportion Scores) to the pharmDx kit.