bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of Structured Teacher Adaptations to an Evidence‐Based Summer Literacy Program
Authors: Kim James S. , Burkhauser Mary A. , Quinn David M. , Guryan Jonathan , Kingston Helen Chen , Aleman Kirsten
Published: March 2017

The authors conducted a cluster‐randomized trial to examine the effectiveness of structured teacher adaptations to the implementation of an evidence‐based summer literacy program that provided students with (a) books matched to their reading level and interests and (b) teacher scaffolding for summer reading in the form of end‐of‐year comprehension lessons and materials sent to students’ homes in the summer months. In this study, 27 high‐poverty elementary schools (75–100% eligibility for free or reduced‐price lunch) were matched by prior reading achievement and poverty level and randomly assigned to one of two implementation conditions: a core treatment condition that directly replicated implementation procedures used in previous experiments, or a core treatment with structured teacher adaptations condition. In the adaptations condition, teachers were organized into grade‐level teams around a practical improvement goal and given structured opportunities to use their knowledge, experience, and local data to extend or modify program components for their students and local contexts. Students in the adaptations condition performed 0.12 standard deviation higher on a reading comprehension posttest than students in the core treatment. An implementation analysis suggests that fidelity to core program components was high in both conditions and that teachers in the adaptations condition primarily made changes that extended or modified program procedures and activities in acceptable ways. Adaptations primarily served to increase the level of family engagement and student engagement with summer books. These results suggest that structured teacher adaptations may enhance rather than diminish the effectiveness of an evidence‐based summer literacy program.
Moose survey app for population monitoring
Authors: Boyce Mark S. , Corrigan Rob
Published: March 2017

We developed a smart phone app for hunters to report the number of moose (Alces alces) observed while hunting in Alberta, Canada, during 2012–2014. Excessive costs of aerial surveys often result in infrequent estimates of moose abundance, whereas hunter observations can be obtained for minimal expense. Correlations of the number of moose observed by hunters with hunter success, moose harvests, and aerial survey estimates of abundance suggest that the method offers promise as an alternative to aerial ungulate surveys. Engaging hunters with the Moose Survey app has potential to increase the spatial extent and temporal frequency of monitoring with benefits for harvest management. © 2017 The Wildlife Society.
Evaluación del rol del tutor: comparación de percepción de estudiantes de las carreras de la salud
Authors: Navarro H. Nancy , Zamora S. José
Published: March 2017

Objetivo: Comparar el desempeño de tutores en diferentes niveles curriculares de las carreras de la salud, desde la perspectiva del estudiantado.

Método: Se realizó una investigación cuantitativa descriptiva de corte transversal. La población correspondió a estudiantes de Enfermería, Kinesiología, Medicina, Nutrición, Obstetricia, Tecnología Médica, con experiencia en ABP de diferentes niveles curriculares. Se aplicó un instrumento de 23 ítems ( Cronbach 0.91) agrupados en tres factores: Tareas del tutor; dominio metodológico/aspecto actitudinal; ambiente de aprendizaje, a 1,541 estudiantes previo consentimiento informado. Para las respuestas se utilizó una escala tipo Likert (1 nunca a 5 siempre). Se realizó análisis de estadística descriptiva, comparación de medias con test de Scheffe.

Resultados: En factor I se concentran ítems con menores medias en todos los niveles curriculares: estimula la autoevaluación y evaluación de pares de los estudiantes; ayuda a desarrollar habilidades individuales de comunicación en los estudiantes. En factor II el ítem con menor media fue demuestra responsabilidad en proceso tutorial y mayor demuestra compromiso en su rol de tutor/a. El factor III corresponde al mejor evaluado del instrumento, las mayores medias fueron estimula las buenas relaciones entre estudiantes; logra crear un ambiente de confianza y respeto en el tutorial. El factor I tiene diferencia significativa (p < 0.05) entre primer nivel y clínico (p 0.002), el II entre primer nivel y preclínico (p 0.002); primer nivel y clínico (p 0.000). El factor III muestra diferencias entre primer nivel y clínico (p 0.000) y preclínico y clínico (p 0.027).
Early-Career Scientists Explore Newly Discovered Methane Seeps
Authors: Dekas Anne , Skarke Adam
Published: March 2017

UNOLS Deep Submergence Training Cruise 2016; Woods Hole, Massachusetts, 28 July to 7 August 2016
Exploring Ancient Ocean Acidification in the Rock Record
Authors: Branscombe Alexandra
Published: March 2017

Scientists studying Earth's ancient oceans use a new method to measure ocean acidification and its effect on extinction events.
New Images of Pan, Saturn's Walnut Moon, in Unprecedented Detail
Authors: Wendel JoAnna
Published: March 2017

The finely detailed images can help future scientists study small bodies with weak gravity.
FE65 and FE65L1 share common synaptic functions and genetically interact with the APP family in neuromuscular junction formation
Authors: Strecker Paul , Ludewig Susann , Rust Marco , Mundinger Tabea A. , Görlich Andreas , Krächan Elisa G. , Mehrfeld Christina , Herz Joachim , Korte Martin , Guénette Suzanne Y. , Kins Stefan
Published: March 2017

The FE65 adaptor proteins (FE65, FE65L1 and FE65L2) bind proteins that function in diverse cellular pathways and are essential for specific biological processes. Mice lacking both FE65 and FE65L1 exhibit ectopic neuronal positioning in the cortex and muscle weakness. p97FE65-KO mice, expressing a shorter FE65 isoform able to bind amyloid precursor protein family members (APP, APLP1, APLP2), develop defective long-term potentiation (LTP) and aged mice display spatial learning and memory deficits that are absent from young mice. Here, we examined the central and peripheral nervous systems of FE65-KO, FE65L1-KO and FE65/FE65L1-DKO mice. We find spatial learning and memory deficits in FE65-KO and FE65L1-KO mice. Severe motor impairments, anxiety, hippocampal LTP deficits and neuromuscular junction (NMJ) abnormalities, characterized by decreased size and reduced apposition of pre- and postsynaptic sites, are observed in FE65/FE65L1-DKO mice. As their NMJ deficits resemble those of mutant APP/APLP2-DKO mice lacking the FE65/FE65L1 binding site, the NMJs of APLP2/FE65-DKO and APLP2/FE65L1-DKO mice were analyzed. NMJ deficits are aggravated in these mice when compared to single FE65- and FE65L1-KO mice. Together, our data demonstrate a role for FE65 proteins at central and peripheral synapses possibly occurring downstream of cell surface-associated APP/APLPs.
Low‐complexity user pairing and power allocation algorithm for 5G cellular network non‐orthogonal multiple access
Authors: He J. , Tang Z.
Published: March 2017

Non‐orthogonal multiple access (NOMA) is a candidate technology for the 5th generation cellular networks to reduce the big gap between network capacity and fast growing traffic. It applies superposition coding in transmitters and successive interference cancellation at the receivers to cancel intra‐cell interference. The same frequency resource can be allocated simultaneously to multiple intra‐cell users, holding large potentials on improving network performance. A major technical challenge of NOMA is on user pairing and power allocation (UPPA). Most of existing UPPA algorithms are based on exhaustive search with extensive computation. A new algorithm, which has the lowest computation complexity achievable for NOMA UPPA is proposed. The main idea is to pair the first users having the highest proportional fairness priority coefficient with potential second users having the highest channel conditions. A fixed power allocation strategy is adopted. The proposed algorithm is significantly faster than existing algorithms without sacrificing NOMA throughput gain.
Thin‐film heterojunction field‐effect transistors with multiple subthreshold swings for large‐area/flexible electronics and displays
Authors: Hekmatshoar B.
Published: March 2017

This Letter presents a technique for implementing circuits with multiple subthreshold swings. Such circuits are of particular interest to large‐area and flexible electronics, including active matrix displays and sensors. In these circuits, devices with large swings may be used for high‐precision analogue driving, whereas steep subthreshold devices may be used for fast and low‐power switching. This Letter demonstrates that large swings may be obtained by the series connection of diode structures to the source terminals of steep subthreshold devices. In principle, this technique is applicable to a wide range of thin‐film transistors, but it is particularly well suited for heterojunction field‐effect transistors where the gate heterojunctions may be readily utilised as diodes without altering the fabrication process or increasing the number of mask steps. Implementation of multiple subthreshold swings is demonstrated experimentally and described by a first‐order model.
Robust transmit beampattern matching synthesis for MIMO radar
Authors: Cheng Ziyang , He Zishu , Li Ruiyang , Wang Zhilei
Published: March 2017

A robust transmit beampattern matching synthesis approach is described for a multiple‐input and multiple‐output radar with manifold vectors perturbation. This synthesis technique minimises the worst‐case matching performance between the transmit beampattern and the desired beampattern (in a least absolute deviations sense), through designing the waveform covariance matrix. Also, the resulting minimax problem can be translated into a convex problem is showed. Finally, simulation results verify good performance of the proposed robust transmit beampattern synthesis approach.
Design of a compact dualband quasi‐isotropic antenna
Authors: Kim J.‐H. , Nam S.
Published: March 2017

A dualband quasi‐isotropic antenna is presented. It is based on the split‐ring‐resonators (SRRs), which provide a quasi‐isotropic radiation pattern with an electrically small size. For the dualband operation, the SRRs are placed orthogonally to reduce the mutual coupling between the elements. A folded dipole structure is applied to the SRR, therefore, the input impedance at each band can be easily tuned. Both simulated and measured results are presented. The results show dualband operation (792 and 1124 MHz), high efficiency (higher than 86 and 85.5%), compact size (ka = 0.47 at 792 MHz), moderate gain deviation (4.42 and 5.76 dB) with simple direct feed.
LR algorithm based on MED for multi‐input–multi‐output LDs
Authors: Song Yunchao , Liu Chen , Lu Feng
Published: March 2017

Recently, lattice reduction (LR)‐aided linear detectors (LDs) are shown to be very effective in multi‐input–multi‐output systems for low‐complexity and small bit‐error‐rate (BER) performance. However, the LR algorithms in the previous LR‐aided LDs mainly aim to improve the orthogonality of the channel matrix where only channel state information is used. In this study, the authors design a novel LR algorithm to enhance the BER performance of the LR‐aided LDs. Unlike the previous LR algorithms, the proposed LR algorithm aims to decrease the modified Euclidean distance (MED) in the LR‐aided LDs, whereas the MED utilises the received signal as well as the channel matrix. Note that the MED is directly related to the BER performance of the LR‐aided LDs, thus decreasing the MED in the LR‐aided LDs can help to reduce the BER of the LR‐aided LDs. In the proposed LR algorithm, the partial column addition operation is used. The simulation results indicate that their LR‐aided LDs exhibit smaller BER than the previous LR‐aided LDs. Moreover, the computational complexity is also shown in the simulation results.
Observer design for Boolean control networks with unknown inputs
Authors: Possieri Corrado , Giovanni Busetto Alberto
Published: March 2017

In this paper, multi‐input multi‐output Boolean control networks are considered as polynomial discrete‐time systems in the Galois field . Two algorithms are proposed to design observers, able to recognise the state and the input of the system in finite time, without any requirement on the structure of the Boolean control network. It is shown that such procedures can be used, in a wholly probabilistic framework, to estimate the state and the input, even when random noise is superimposed to the available measures. The interest in these methods relies on biological applications, as, for instance, regulatory networks, where the state and the input of the system need to be estimated from scarce and noisy data.
Minimisation of torque ripple in slotless axial flux BLDC motors in terms of design considerations
Authors: Pahlavani Mohammad R.A. , Ayat Yusef Shahbazi , Vahedi Abolfazl
Published: March 2017

This study presents an analytical method to calculate instantaneous electromagnetic torque in slotless axial flux brushless DC (BLDC) motors. This method is based on Lorentz force theorem and using phase induced back electro‐magnetic force (EMF) and phase current. A new analytical method was introduced to compute induced back EMF. 3D finite element computations validate the proposed method. This method requires much less computation time than conventional 3D finite elements, and is therefore suitable for optimisation purposes. Due to practical limitation, phase current approximated by the trapezoidal function. Torque ripple dependency on design parameters was studied and optimum parameters were extracted for slotless axial flux BLDC motor.
Partial discharge and noise separation in combined cable–OHLs based on three‐phase power ratios
Authors: Chen Xiaoxin , Qian Yong , Xu Yongpeng , Sheng Gehao , Jiang Xiuchen
Published: March 2017

Partial discharge (PD) detection has been proved as an effective tool for monitoring the insulation condition of high‐voltage cables. However, the detection can be seriously affected by pulse‐shaped interference from overhead lines (OHLs) when carried out at the cable termination of a combined cable–OHL. In this study, a novel scheme is presented for separating the PD pulses and interference in a combined cable–OHL. First, the characteristics of the currents from different pulse sources are investigated mathematically. On the basis of these characteristics, separation of multiple pulse sources can be realised by projecting the three‐phase power ratios extracted from detected signals onto a ternary plot and then constructing maps using the power ratios of the defective phase. The performance of the scheme is subsequently evaluated by both numerical simulations and field applications. Furthermore, a comparison with the well‐known time–frequency mapping method is provided. The results demonstrate that by using the proposed scheme, different pulse sources can be effectively identified without requiring stable pulse shapes and a better separation could be achieved compared with the conventional waveform‐based approaches.
Multitrait successional forest dynamics enable diverse competitive coexistence
Authors: Falster Daniel S. , Brännström Åke , Westoby Mark , Dieckmann Ulf
Published: March 2017

Significance

Walking through any forest, one is struck by the variety of plant forms coexisting. Given that all plants compete for the same basic resources, why is there not a single winner? Our study shows that when key ingredients common to all forests are accounted for—including disturbance events, competition for light, and two widely observed trait-based tradeoffs—models of niche differentiation predict forests of considerably greater diversity than was previously thought possible. In particular, our model accurately predicts the proliferation of species occupying niche space in low light, a feature of tropical forests that motivated the so-called neutral theory of biodiversity and biogeography. The presented results thereby provide a platform for understanding diversity in forests worldwide.
LIGO and the opening of a unique observational window on the universe
Authors: Kalogera Vassiliki , Lazzarini Albert
Published: March 2017

A unique window on the universe opened on September 14, 2015, with direct detection of gravitational waves by the Advanced Laser Interferometer Gravitational-Wave Observatory (LIGO) detectors. This event culminated a half-century effort around the globe to develop terrestrial detectors of adequate sensitivity to achieve this goal. It also happened appropriately only a few months before the centennial of Einstein’s final paper introducing the general theory of relativity. This detection provided the surprising discovery of a coalescing pair of “heavy” black holes (more massive than

≃
25

 M

๏

) leading to the formation of a spinning

≃

62 solar mass black hole. One more binary black-hole detection and a significant candidate event demonstrated that a population of such merging binaries is formed in nature with a broad mass spectrum. This unique observational sample has already provided concrete measurements on the coalescence rates and has allowed us to test the theory of general relativity in the strong-field regime. As this nascent field of gravitational-wave astrophysics is emerging we are looking forward to the detection of binary mergers involving neutron stars and their electromagnetic counterparts, as well as continuous-wave sources, supernovae, a stochastic confusion background of compact-object mergers, known sources detected in unexpected ways, and completely unknown sources.
Exhaustion-associated regulatory regions in CD8
+
tumor-infiltrating T cells
Authors: Mognol Giuliana P. , Spreafico Roberto , Wong Victor , Scott-Browne James P. , Togher Susan , Hoffmann Alexander , Hogan Patrick G. , Rao Anjana , Trifari Sara
Published: March 2017

Significance

Cancer cells can be recognized and attacked by CD8
+
cytolytic T cells, but tumor-infiltrating T cells often become functionally incompetent (“exhausted”) and fail to destroy tumor cells. We show that T-cell exhaustion requires antigen recognition by tumor-infiltrating T cells. By examining the transcriptional and chromatin accessibility profiles of antigen-reactive and -unreactive tumor-infiltrating cells, we confirm our previous conclusion that the transcription factor NFAT promotes CD8
+
T-cell exhaustion and we identify Nr4a transcription factors as new targets for future investigation. We show that anti–PD-L1 treatment, a clinically relevant checkpoint blockade therapy that counteracts T-cell exhaustion, has modest but functionally important effects on gene expression in exhausted cells, without causing major changes in patterns of chromatin accessibility.
Alcohol consumption, sinus tachycardia, and cardiac arrhythmias at the Munich Octoberfest: results from the Munich Beer Related Electrocardiogram Workup Study (MunichBREW)
Authors: Brunner Stefan , Herbel Rebecca , Drobesch Cathrine , Peters Annette , Massberg Steffen , Kääb Stefan , Sinner Moritz F.
Published: March 2017

Aims

Alcohol is a risk factor for cardiac arrhythmias. Retrospective analyses suggest supraventricular arrhythmias consecutive to acute alcohol consumption, but prospective data are limited. We intended to prospectively associate acute alcohol consumption with cardiac arrhythmias.

Methods and results

At the 2015 Munich Octoberfest, we enrolled 3028 voluntary participants who received a smartphone-based ECG and breath alcohol concentration (BAC) measurements. ECGs were analysed for cardiac arrhythmias (sinus tachycardia, sinus arrhythmia, premature atrial/ventricular complexes, atrial fibrillation/flutter) and respiratory sinus arrhythmia. By multivariable adjusted logistic regression we associated BACs with cardiac arrhythmias. Similarly, we analysed 4131 participants of the community-based KORA S4 Study (Co-operative Health Research in the Region of Augsburg) and associated cardiac arrhythmias with chronic alcohol consumption. In our acute alcohol cohort (mean age 34.4 ± 13.3 years, 29% women), mean BAC was 0.85 ± 0.54 g/kg. Cardiac arrhythmias occurred in 30.5% (sinus tachycardia 25.9%; other arrhythmia subtypes 5.4%). Breath alcohol concentration was significantly associated with cardiac arrhythmias overall (odds ratio (OR) per 1-unit change 1.75, 95% confidence interval (CI) 1.50–2.05; P < 0.001) and sinus tachycardia in particular (OR 1.96, 95%CI 1.66–2.31; P < 0.001). Respiratory sinus arrhythmia measuring autonomic tone was significantly reduced under the influence of alcohol. In KORA S4, chronic alcohol consumption was associated with sinus tachycardia (OR 1.03, 95%CI 1.01–1.06; P = 0.006).

Conclusions

Acute alcohol consumption is associated with cardiac arrhythmias and sinus tachycardia in particular. This partly reflects autonomic imbalance as assessed by significantly reduced respiratory sinus arrhythmia. Such imbalance might lead to sympathetically triggered atrial fibrillation resembling the holiday heart syndrome.

ClinicalTrials.org accession number

NCT02550340.
Optimizing drug-dose alerts using commercial software throughout an integrated health care system
Authors: Saiyed Salim M , Greco Peter J , Fernandes Glenn , Kaelber David C
Published: March 2017

All default electronic health record and drug reference database vendor drug-dose alerting recommendations (single dose, daily dose, dose frequency, and dose duration) were silently turned on in inpatient, outpatient, and emergency department areas for pediatric-only and nonpediatric-only populations. Drug-dose alerts were evaluated during a 3-month period. Drug-dose alerts fired on 12% of orders (104 098/834 911). System-level and drug-specific strategies to decrease drug-dose alerts were analyzed. System-level strategies included: (1) turning off all minimum drug-dosing alerts, (2) turning off all incomplete information drug-dosing alerts, (3) increasing the maximum single-dose drug-dose alert threshold to 125%, (4) increasing the daily dose maximum drug-dose alert threshold to 125%, and (5) increasing the dose frequency drug-dose alert threshold to more than 2 doses per day above initial threshold. Drug-specific strategies included changing drug-specific maximum single and maximum daily drug-dose alerting parameters for the top 22 drug categories by alert frequency. System-level approaches decreased alerting to 5% (46 988/834 911) and drug-specific approaches decreased alerts to 3% (25 455/834 911). Drug-dose alerts varied between care settings and patient populations.
Unemployment Insurance and Unemployment Accounts: The Best of Both Worlds
Authors: Setty Ofer
Published: March 2017

Unemployment accounts are mandatory individual savings accounts that can be used only during unemployment or retirement. Unlike unemployment insurance, unemployment accounts solve the moral hazard problem but provide no public insurance to workers. I study a hybrid system that borrows from concepts of both unemployment insurance and unemployment accounts, in which workers are mandated to save when employed and can withdraw from the account when unemployed. Once the account is exhausted, the unemployed worker receives unemployment benefits. This hybrid policy provides insurance to workers more efficiently than an unemployment insurance system because it provides government benefits selectively. As a consequence, young workers can reduce their precautionary savings and better smooth their consumption over the life cycle. Calibrating the model to the US economy, I find that, relative to an optimal unemployment insurance system, the optimal hybrid policy leads to a welfare gain of 2.4%, measured as consumption equivalent variation.
Colonized subjects and their emigration experiences. The case of Iranian students and their integration strategies in Western Europe
Authors: Karimi Aryan , Bucerius Sandra M
Published: March 2017

During the past decade, Iranian students made up a major immigration wave to European countries. A systematic study of their immigration situation, however, seems absent in the academic literature. In this paper, we are examining Iranian students’ emigration decisions and their chosen integration strategies into their new host societies (Germany, the Netherlands, and Sweden) through the concepts of ‘colonial mentality’ and ‘Anglo-conformity’. Based on fieldwork and qualitative interviews with Iranian students, our findings suggest that religio-cultural performances and language skills are the main strategies that Iranian students employ to associate themselves with Westerners before and after emigration. We conclude that the processes of immigration and integration begin long before emigration actually takes place and that the specific historico-political background of Iranian students plays an important role in these processes.
A Neglected Cause of Iatrogenic Brachial Plexus Injuries in Psychiatric Patients
Authors: Guedes-Corrêa José Fernando , Pereira Maristella Reis da Costa , Torrão-Junior Francisco José Lourenço , Martins José Vicente , Barbosa Daniel Alves Neiva
Published: March 2017

BACKGROUND

Psychiatric patients are often kept immobilized during hospitalization to avoid self-inflicted injuries and danger to third parties. Inadequate positioning can lead to brachial plexus injuries (BPI).

OBJECTIVE

To present a series of 5 psychiatric patients with BPI after being left sedated and restrained for prolonged periods of time during hospitalization.

METHODS

We retrospectively reviewed the charts of 5 psychiatric patients with iatrogenic BPI referred by other institutions to our service. The restraint technique adopted by those institutions consisted of a high-thoracic restraint. All patients underwent complete clinical and neurological examination at our center. Information concerning patient demographics, BPI characteristics, treatment choice, and ultimate outcome was recorded.

RESULTS

Three patients were male. The age of our patients ranged from 25 to 61 years old (mean: 41.2; median: 43). Three patients had a diagnosis of bipolar disorder while 2 had schizophrenia. Duration of immobilization ranged from 5 to 168 h (mean: 77.8; median: 72). Four patients presented with a unilateral right-sided lesion. Time to presentation ranged from 1 to 9 mo (mean: 4.2; median: 4). All patients also had intense pain and axillary lesions. Four patients received conservative treatment with partial or full functional recovery and complete pain resolution. The remaining patients underwent surgical repair and experienced good functional outcome.

CONCLUSION

Psychiatric patients who need to be sedated and immobilized must be monitored closely, as BPI can occur from high-thoracic restraints. When such an injury occurs, the patient must be referred to a center specialized in peripheral nerve surgery and rehabilitation.
Stereoelectroencephalography Using Magnetic Resonance Angiography for Avascular Trajectory Planning: Technical Report
Authors: Minkin Krasimir , Gabrovski Kaloyan , Penkov Marin , Todorov Yuri , Tanova Rositsa , Milenova Yoana , Romansky Kiril , Dimova Petia
Published: March 2017

BACKGROUND

Stereoelectroencephalography (SEEG) requires high-quality angiographic studies because avascular trajectory planning is a prerequisite for the safety of this procedure. Some epilepsy surgery groups have begun to use computed tomography angiography and magnetic resonance T1-weighted sequence with contrast enhancement for this purpose.

OBJECTIVE

To present the first series of patients with avascular trajectory planning of SEEG based on magnetic resonance angiography (MRA).

METHODS

Thirty-six SEEG explorations for drug-resistant focal epilepsy were performed from January 2013 to December 2015. A retrospective analysis of this consecutive surgical series was then performed. Magnetic resonance imaging included MRA with a modified contrast-enhanced magnetic resonance venography (MRV) protocol with a short acquisition delay, which allowed simultaneous arterial and venous visualization. Our criteria for satisfactory MRA were the visualization of at least first-order branches of the angular artery, paracentral and calcarine artery, and third-order tributaries of the superficial Sylvian vein, vein of Labbe, and vein of Trolard.

RESULTS

Thirty-four patients underwent 36 SEEG explorations with 369 electrodes carrying 4321 contacts. Contrast-enhanced MRA using the MRV protocol was judged satisfactory for SEEG planning in all explorations. Postoperative complications were not observed in our series of 36 SEEG explorations, which included 50 transopercular insular trajectories.

CONCLUSION

MRA using an MRV protocol may be applied for avascular trajectory planning during SEEG procedures. This technique provides a simultaneous visualization of cortical arteries and veins without the need for additional radiation exposure or intra-arterial catheter placement.
Does the radial–tangential macroturbulence model adequately describe the spectral line broadening of solar-type stars?
Authors: Takeda Yoichi , UeNo Satoru
Published: March 2017

In incorporating the effect of atmospheric turbulence in the broadening of spectral lines, the so-called radial–tangential macroturbulence (RTM) model has been widely used in the field of solar-type stars, which was devised from intuitive appearance of the granular velocity field of the Sun. Since this model assumes that turbulent motions are restricted to only radial and tangential directions, it has a special broadening function with notably narrow width due to the projection effect, the validity of which has not yet been confirmed in practice. With the aim of checking whether this RTM model adequately represents the actual solar photospheric velocity field, we carried out an extensive study on the non-thermal velocity dispersion along the line of sight (Vlos) by analyzing spectral lines at various points of the solar disk based on locally averaged as well as high-spatial-resolution spectra, and found the following results. First, the center-to-limb run of Vlos derived from ground-based low-resolution spectra is simply monotonic with a slightly increasing tendency, which contradicts the specific trend (an appreciable peak at θ ≃ 45°) predicted from RTM. Second, the Vlos values derived from a large number of spectra based on high-resolution space observation were revealed to follow a nearly normal distribution, without any sign of the peculiar distribution expected for the RTM case. These two observational facts indicate that the actual solar velocity field is not simply dichotomous as assumed in RTM, but directionally more chaotic. We thus conclude that RTM is not an adequate model, at least for solar-type stars, as it would significantly overestimate the turbulent velocity dispersion by a factor of ∼2. The classical Gaussian macroturbulence model should be more reasonable in this respect.
Family Income and Material Deprivation: Do They Matter for Sleep Quality and
Quantity in Early Life? Evidence From a Longitudinal Study
Authors: Barazzetta Marta , Ghislandi Simone
Published: March 2017

Introduction:

The aim of this article is to investigate the determinants of sleeping patterns in children up to age 9 on a large and geographically homogeneous sample of British children and parents, focusing in particular on the role of economic and social factors, specifically on income.

Aims and Methods:

The data of this study come from the Avon Longitudinal Study of Parents and Children, a long-term health research project that recruited over 14000 pregnant women who were due to give birth between April 1991 and December 1992 in Bristol and its surrounding areas, including some of Somerset and Gloucestershire. Logistic regression models for the sleep problem dummies and log-linear models for the sleep quantity.

Results:

One additional item in the material deprivation index is associated to an increase of around 10–20% in the odds of having at least 1 sleep problem. Similarly, children from the richest families are less likely to have any sleep problem up to 115 months (around 20% reduction in the odds). Mother’s characteristics (i.e., education and mental health in the pregnancy period) are also significant predictors. Sleep quantity does not vary much and is not sensitive to socioeconomic factors.

Conclusion:

Exposure to income-related inequalities affects child sleep. Further research is needed to understand if sleep in early life influences future health and economic trajectories.
Pain Management Modalities after Total Knee Arthroplasty
Authors: Terkawi Abdullah Sulieman , Mavridis Dimitris , Sessler Daniel I. , Nunemaker Megan S. , Doais Khaled S. , Terkawi Rayan Sulieman , Terkawi Yazzed Sulieman , Petropoulou Maria , Nemergut Edward C.
Published: March 2017

Background

Optimal analgesia for total knee arthroplasty remains challenging. Many modalities have been used, including peripheral nerve block, periarticular infiltration, and epidural analgesia. However, the relative efficacy of various modalities remains unknown. The authors aimed to quantify and rank order the efficacy of available analgesic modalities for various clinically important outcomes.

Methods

The authors searched multiple databases, each from inception until July 15, 2016. The authors used random-effects network meta-analysis. For measurements repeated over time, such as pain, the authors considered all time points to enhance reliability of the overall effect estimate. Outcomes considered included pain scores, opioid consumption, rehabilitation profile, quality of recovery, and complications. The authors defined the optimal modality as the one that best balanced pain scores, opioid consumption, and range of motion in the initial 72 postoperative hours.

Results

The authors identified 170 trials (12,530 patients) assessing 17 treatment modalities. Overall inconsistency and heterogeneity were acceptable. Based on the surface under the cumulative ranking curve, the best five for pain at rest were femoral/obturator, femoral/sciatic/obturator, lumbar plexus/sciatic, femoral/sciatic, and fascia iliaca compartment blocks. For reducing opioid consumption, the best five were femoral/sciatic/obturator, femoral/obturator, lumbar plexus/sciatic, lumbar plexus, and femoral/sciatic blocks. The best modality for range of motion was femoral/sciatic blocks. Femoral/sciatic and femoral/obturator blocks best met our criteria for optimal performance. Considering only high-quality studies, femoral/sciatic seemed best.

Conclusions

Blocking multiple nerves was preferable to blocking any single nerve, periarticular infiltration, or epidural analgesia. The combination of femoral and sciatic nerve block appears to be the overall best approach. Rehabilitation parameters remain markedly understudied.
Comparison of Surgical Outcomes Between a Triplane Proximal Femoral Osteotomy and the Modified Dunn Procedure for Stable, Moderate to Severe Slipped Capital Femoral Epiphysis
Authors: Sikora-Klak Jakub , Bomar James D. , Paik Christina N. , Wenger Dennis R. , Upasani Vidyadhar
Published: March 2017

Background:

Recent studies have demonstrated the intra-articular cartilage and labral damage that can occur from the proximal femoral cam-like deformity of a moderate to severe slipped capital femoral epiphysis (SCFE). The approach to treating this deformity in a symptomatic Loder stable hip is controversial. The purpose of this study was to compare radiographic outcomes, complication rates, and revision rates between Imhauser type triplane proximal femoral osteotomy (TPFO) and the modified Dunn procedure (MDP).

Methods:

Twenty-six subjects with minimum 1-year follow-up were included (12 treated with a TPFO, and 14 treated with the MDP). A chart review was performed to capture data related to complications, revision procedures, surgical time, and body mass index. Radiographs were measured preoperatively and at final follow-up to evaluate epiphyseal-slip angle, neck-shaft angle, articular surface to trochanter distance, and medial proximal femoral angle.

Results:

Surgical time was shorter for the TPFO group (150.0±57.4 min) compared with the MDP group (203.8±30 min) (P=0.005). All preoperative and postoperative radiographic measures were similar between the 2 groups except postoperative neck-shaft angle, which was significantly less in the TPFO group (129.7±8.6 vs. 140.9±9.4 degrees) (P=0.005). There were no cases of femoral head avascular necrosis (AVN) in the TPFO group. The modified Dunn group had a 29% AVN rate (P=0.1). The overall complication rate was similar between the TPFO (33%) and modified Dunn (36%) groups (P=1.0) and the reoperation rate was slightly greater in the TPFO group (33%) as compared with the modified Dunn group (21%) (P=0.67).

Conclusions:

The complex 3-dimensional proximal femoral deformity of a moderate to severe SCFE can be difficult to treat with relatively high complication/reoperation rates observed in both TPFO and MDP groups. All 4 instances of AVN in this study of stable slips, however, were in the MDP group. As this can be a devastating complication leading to early total hip arthroplasty, we advise against the MDP in stable SCFE patients.

Level of Evidence:

Level III—retrospective comparative study.
Idiopathic Genu Valgum and Its Association With Obesity in Children and Adolescents
Authors: Walker Janet L. , Hosseinzadeh Pooya , White Hank , Murr Kevin , Milbrandt Todd A. , Talwalkar Vishwas J. , Iwinski Henry , Muchow Ryan
Published: March 2017

Background:

Obesity as a cause of lower extremity deformity in children has been well established. This deformity is most often seen as tibia vara, however, at our institution we have observed more obese children and adolescents over age 7 years with excessive or progressive idiopathic genu valgum. Our hypothesis is that children with idiopathic genu valgum have high rates of obesity which impact the severity of their disease.

Methods:

Retrospective review of existing data was performed on 66 consecutive children/112 limbs over age 7 years with idiopathic genu valgum, seen from 2010 to 2013. Children with known metabolic or skeletal disease were excluded. Genu valgum was defined as mechanical axis in zone II or III and mechanical tibiofemoral angle ≥4 degrees on standing anteroposterior radiograph of the lower extremities. Body mass index (BMI) was calculated and classified by Center for Disease Control percentiles. Skeletal maturation was rated by closure of pelvic and peri-genu physes. Severity of genu valgum was also assessed by femoral and tibial mechanical axes and the mechanical axis deviation.

Results:

Mean patient age was 12.2±2.2 years. 47% of patients had BMI≥30 and 71% were categorized as obese (>95th percentile). No sex differences were identified. Skeletal maturation explained 25% of the variance in the mechanical axis deviation and 22% of the mechanical tibiofemoral angle. BMI predicted 9.8% of the tibial valgus. Because of its skewed distribution, BMI percentile was a less useful parameter for assessment.

Conclusions:

The 71% obesity rate found in our children with idiopathic genu valgum is significantly higher than the normal population. Higher BMI is associated with more tibial valgum but skeletal maturation was the main predictor of overall valgus severity. This suggests that obesity may play a role in the etiology of idiopathic genu valgum which progresses with skeletal maturation, thereby increasing the risk of osteoarthritis in adulthood.

Level of Evidence:

Level III.
Management of Pediatric Type I Open Fractures in the Emergency Department or Operating Room: A Multicenter Perspective
Authors: Godfrey Jenna , Choi Paul D. , Shabtai Lior , Nossov Sarah B. , Williams Amy , Lindberg Antoinette W. , Silva Selina , Caird Michelle S. , Schur Mathew D. , Arkader Alexandre
Published: March 2017

Background:

The management of pediatric type I open fractures remains controversial. The aim of this study is to compare outcomes in type I open fractures managed with superficial wound debridement and antibiotics in the emergency department (ED) (nonoperative management) to patients managed with operative debridement and antibiotics (operative management).

Methods:

A multicenter retrospective review was performed of all pediatric type I open forearm, wrist, and tibia fractures treated at 4 high volume pediatric centers between 2000 and 2015. Patients with multiple traumatic injuries, immunocompromised patients, or those without final radiographs indicating healing were excluded.

Results:

In total, 219 patients met inclusion criteria. A total of 170 fractures were treated operatively (77.6%), 49 fractures were treated nonoperatively (22.4%). There was 1 infection in the nonoperative group (2.0% infection rate), and no infections in the operatively managed group (P=0.062). Cefazolin was the most commonly administered antibiotic (88.1% of patients). Duration of hospital-administered antibiotics was significantly different, with a mean of 10.9 hours in the nonoperative group and 41.6 hours in the operative group (P<0.001). Length of stay averaged 16.3 hours for nonoperative patients and 48.6 hours for the operatively treated patients (P<0.001). In the nonoperative group, 44/49 had documented superficial wound debridement in the ED utilizing, on an average, 1500 mL of irrigant. There were 10 other complications, 9 in the operative group (5.4%) and 2 in the nonoperative group (4.1%, P=0.107), including 2 compartment syndromes and 1 acute carpal tunnel syndrome all requiring immediate surgical release (1.8%) in the operative group.

Conclusions:

There was no significant difference in infection rate or complication rate in those managed with antibiotics and operative debridement versus those managed with superficial wound debridement and antibiotics in the ED. Consideration should be given to the similar safety profiles for these 2 treatment modalities when managing pediatric patients with type I open fractures.

Level of Evidence:

Level III.
The Obesity Paradox Is Not Observed in Critically Ill Patients on Early Enteral Nutrition*
Authors: Harris Kimberley , Zhou Jiachen , Liu Xinggang , Hassan Erkan , Badawi Omar
Published: March 2017

Objectives:

To investigate the association between body mass index and mortality in a large, ICU population and determine if the relationship is observed among a subgroup of patients ordered early enteral nutrition.

Design:

Retrospective cohort study within a national clinical mixed ICU database of patients admitted between January 1, 2008, and June 30, 2015.

Setting:

Initial ICU admissions among patients monitored by tele-ICU programs and recorded in the Philips eICU Research Institute database.

Patients:

A total of 1,042,710 adult patient stays with ICU length of stay more than 24 hours, of which 74,771 were ordered enteral nutrition within the first 48 hours.

Intervention:

None.

Measurements and Main Results:

Patient stays from 409 ICUs were included. The average age, Acute Physiology and Chronic Health Evaluation IV score, and hospital mortality were 63.6 years, 56.7, and 9.0%, respectively. Hospital mortality among body mass index categories was estimated by multivariable modified Poisson regression models. Compared with the body mass index category 25.0–29.9 kg/m2, hospital mortality was higher among underweight (body mass index, < 18.5; relative risk, 1.35; 95% CI, 1.32–1.39), normal weight (body mass index, 18.5–24.9; relative risk, 1.10; 95% CI, 1.09–1.12), and the extremely obese (body mass index, ≥ 50.0; relative risk, 1.10; 95% CI, 1.05–1.15). However, the risk was not statistically different from patients with body mass index 30.0–49.9 kg/m2. Among patients ordered early enteral nutrition, the risk of mortality in the body mass index category 25.0–29.9 kg/m2 was not statistically different from those in the normal weight or extremely obese groups.

Conclusions:

A survival advantage for overweight and obese patients was observed in this large cohort of critically ill patients. However, among those ordered early enteral nutrition, the survival disadvantage for body mass index categories less than 25.0 kg/m2 was minimal or unobservable when compared with higher body mass index categories.
Parity and increased risk of insulin resistance in postmenopausal women: the 2010 Korean National Health and Nutrition Examination Survey
Authors: Kim Jin Hwi , Lee Sung Jong
Published: March 2017

Objective:

The objective of this study was to assess the association between parity and insulin resistance in nondiabetic, postmenopausal women.

Methods:

This cross-sectional study was conducted using data from the 2010 Korean National Health and Nutrition Examination Survey administered by the Korean Ministry of Health and Welfare. A total of 1,243 nondiabetic postmenopausal women were included in this study and subdivided into three groups according to parity (1-2, 3-4, and ≥5 live births). Insulin resistance was measured using the homeostasis model assessment of insulin resistance (HOMA-IR) index. The relationship between parity and insulin resistance was investigated using analysis of covariance.

Results:

HOMA-IR showed a positive relationship with parity. Mean HOMA-IR (geometric mean and 95% CI) increased according to increasing parity group (1-2, 3-4, and ≥5 live births) after adjustment for age, smoking, alcohol consumption, exercise, education, income, and body mass index as follows: 2.1 (2.0-2.2) < 2.2 (2.1-2.3) < 2.5 (2.2-2.8) (P = 0.040 and P for trend = 0.012). In addition, this positive association was more apparent when insulin resistance was accompanied by obesity. The mean parity of the obese and insulin-resistant group was significantly higher than that of the nonobese insulin-sensitive group (3.6 ± 0.1 vs 3.2 ± 0.1, P = 0.047).

Conclusions:

Our study provides the first evidence that parity is significantly associated with insulin resistance in nondiabetic postmenopausal women. Further prospective longitudinal studies are needed to confirm the impact of parity on insulin resistance.
Tailoring strategies for the management of depression in midlife years
Authors: Soares Claudio N.
Published: March 2017

Depression affects one in every five adults in North America. Women are more affected than men, possibly because of genetics, coping strategies, and hormone variations. The concept of a menopause-associated depression, however, remains a complex and controversial topic. Although hormone therapy is not recommended as first-line therapy for depression in midlife women, estrogen-based hormone therapy may minimize the need for or enhance the response to antidepressant or behavior-based therapies in select perimenopausal women.
A sex-specific dose-response curve for testosterone: could excessive testosterone limit sexual interaction in women?
Authors: Krapf Jill M. , Simon James A.
Published: March 2017

Testosterone treatment increases sexual desire and well-being in women with hypoactive sexual desire disorder; however, many studies have shown only modest benefits limited to moderate doses. Unlike men, available data indicate women show a bell-shaped dose-response curve for testosterone, wherein a threshold dosage of testosterone leads to desirable sexual function effects, but exceeding this threshold results in a lack of further positive sexual effects or may have a negative impact. Emotional and physical side-effects of excess testosterone, including aggression and virilization, may counteract the modest benefits on sexual interaction, providing a possible explanation for a threshold dose of testosterone in women. In this commentary, we will review and critically analyze data supporting a curvilinear dose-response relationship between testosterone treatment and sexual activity in women with low libido, and also explore possible explanations for this observed relationship. Understanding optimal dosing of testosterone unique to women may bring us one step closer to overcoming regulatory barriers in treating female sexual dysfunction.