bluuebunny/crossref_metadata_2025 huggingface dataset:
Climate warming reduces fish production and benthic habitat in Lake Tanganyika, one of the most biodiverse freshwater ecosystems
Authors: Cohen Andrew S. , Gergurich Elizabeth L. , Kraemer Benjamin M. , McGlue Michael M. , McIntyre Peter B. , Russell James M. , Simmons Jack D. , Swarzenski Peter W.
Published: August 2016

Significance

Understanding how climate change affects ecosystem productivity is critical for managing fisheries and sustaining biodiversity. African lakes are warming rapidly, potentially jeopardizing both their high endemic biodiversity and important fisheries. Using paleoecological records from Lake Tanganyika, we show that declines in commercially important fishes and endemic molluscs have accompanied lake warming. Ongoing declines in fishery species began well before the advent of commercial fishing in the mid-20th century. Warming has intensified the stratification of the water column, thereby trapping nutrients in deep water where they cannot fuel primary production and food webs. Simultaneously, warming has enlarged the low-oxygen zone, considerably narrowing the coastal habitat where most of Tanganyika’s endemic species are found.
Ab initio molecular dynamics of solvation effects on reactivity at electrified interfaces
Authors: Herron Jeffrey A. , Morikawa Yoshitada , Mavrikakis Manos
Published: August 2016

Significance

Low-temperature fuel cells are efficient energy conversion devices that face a number of hurdles toward commercialization, including difficulties in storing hydrogen. Methanol represents a liquid-phase fuel alternative to hydrogen, yet the high cost of Pt-based catalysts limits fuel cells’ economic viability. Toward improved, lower-cost catalyst design, a fundamental understanding of the methanol electrooxidation reaction mechanism is necessary. Density functional theory calculations have become invaluable in elucidating these reaction mechanisms, although the complex reaction environment including solvation of a charged electrode has been a challenge to model. Using ab initio molecular dynamics, via the Blue Moon Ensemble, we have investigated methanol electrooxidation on a solvated and charged Pt(111) surface to understand the effect of solvation and charge on the reaction energetics.
FtsEX acts on FtsA to regulate divisome assembly and activity
Authors: Du Shishen , Pichoff Sebastien , Lutkenhaus Joe
Published: August 2016

Significance

Understanding divisome assembly and activation has become the focus of research on bacterial cytokinesis. However, very little is known about how this process is regulated. Here, we find that FtsEX (an ATP-binding cassette transporter-like complex) acts on the bacterial actin homolog FtsA to regulate divisome assembly and function in
Escherichia coli
. Our results suggest that FtsEX antagonizes FtsA polymerization to promote divisome assembly and continual ATP hydrolysis by FtsEX is needed for the divisome to synthesize septal peptidoglycan. Because FtsEX is also required for cell wall hydrolysis at the septum, our study indicates that FtsEX couples cell wall synthesis and hydrolysis at the septum by acting through FtsA. Our study also implies that unpolymerized FtsA is favored for division and FtsW plays a critical role in divisome activation.
miR-579-3p controls melanoma progression and resistance to target therapy
Authors: Fattore Luigi , Mancini Rita , Acunzo Mario , Romano Giulia , Laganà Alessandro , Pisanu Maria Elena , Malpicci Debora , Madonna Gabriele , Mallardo Domenico , Capone Marilena , Fulciniti Franco , Mazzucchelli Luca , Botti Gerardo , Croce Carlo M. , Ascierto Paolo Antonio , Ciliberto Gennaro
Published: August 2016

Significance

In this paper we identify a previously poorly characterized miRNA, namely miR-579-3p, as a master regulator of melanoma progression and drug resistance. Our results underscore the complexity of adaptive mechanisms that help the establishment of resistance to target therapies and the necessity to identify them to develop more effective combination therapies.
Regulatory evolution of
Tbx5
and the origin of paired appendages
Authors: Adachi Noritaka , Robinson Molly , Goolsbee Aden , Shubin Neil H.
Published: August 2016

Significance

Extant vertebrates include jawless and jawed species. Jawless vertebrates, such as lamprey and hagfish, do not possess paired fins, whereas jawed vertebrates have two pairs of appendages. Although paired appendages are important in performing complex movements, including swimming, burrowing, and flying, their evolutionary origin remains elusive. In this study, we compare jawless and jawed vertebrate embryos and identify fundamental differences in the expression and regulation of a gene that is essential for the pectoral fin and girdle formation. Our data suggest that modification of the expression and regulation of this gene is coincident with the origin of paired appendages.
Development of the Q  =  10 scenario for ITER on ASDEX Upgrade (AUG)
Authors: Schweinzer J. , Beurskens M. , Frassinetti L. , Joffrin E. , Bobkov V. , Dux R. , Fischer R. , Fuchs C. , Kallenbach A. , Hopf C. , Lang P.T. , Mlynek A. , Pütterich T. , Ryter F. , Stober J. , Tardini G. , Wolfrum E. , Zohm H.
Published: August 2016

The development of the baseline H-mode scenario foreseen for ITER on the ASDEX Upgrade tokamak, i.e. discharges at q
95  =  3, relatively low β
N ~ 1.8, high normalized density n/n
GW ~ 0.85 and high triangularity δ  =  0.4, focused on the integration of elements foreseen for ITER and available on ASDEX Upgrade, such as ELM mitigation techniques and impurity seeding in combination with a metallic wall. Values for density and energy confinement simultaneously came close to the requirements of the ITER baseline scenario as long as β
N stayed above 2. At lower heating power and thus lower β
N normalized energy confinement H
98y2 ~ 0.85 is obtained. It has been found that stationary discharges are not easily achieved under these conditions due to the low natural ELM frequency occurring at the low q
95/high δ operational point. Up until now the ELM parameters were uncontrollable with the tools developed in other scenarios. Therefore studies on an alternative operational point at higher β
N and q
95 have been conducted. In order to prepare for the ITER first non-activation operational phase, Helium operation has been investigated as well.
Controlling the half-metallicity of Heusler/Si(1 1 1) interfaces by a monolayer of Si–Co–Si
Authors: Nedelkoski Zlatko , Kepaptsoglou Demie , Ghasemi Arsham , Achinuq Barat , Hasnip Philip J , Yamada Shinya , Hamaya Kohei , Ramasse Quentin M , Hirohata Atsufumi , Lazarov Vlado K
Published: August 2016

By using first-principles calculations we show that the spin-polarization reverses its sign at atomically abrupt interfaces between the half-metallic Co2(Fe,Mn)(Al,Si) and Si(1 1 1). This unfavourable spin-electronic configuration at the Fermi-level can be completely removed by introducing a Si–Co–Si monolayer at the interface. In addition, this interfacial monolayer shifts the Fermi-level from the valence band edge close to the conduction band edge of Si. We show that such a layer is energetically favourable to exist at the interface. This was further confirmed by direct observations of CoSi2 nano-islands at the interface, by employing atomic resolution scanning transmission electron microscopy.
Political Culture Paradigm
Authors: Welzel Christian
Published: August 2016

The concept of political culture plays a critical role in the comparative study of democracy. Its major contribution is understanding the societal roots of democracy and how these roots transform through cultural change. Various cultural changes in post-industrial societies converge in a fundamental transformation of democratic ideals: the notion of the model citizen shifts from an “allegiant” to an “assertive” participant in politics. This cultural shift has far-reaching consequences, making democratic politics more mass-driven. Recent evidence suggests that non-democratic regimes also depend on their political culture: these regimes are stable as long as emancipatory desires for freedoms remain limited to small segments of the population. If, however, such desires spread throughout large parts of the population, non-democracies run into trouble and become more likely to undergo a transition to democracy.
Protest and Music
Authors: Damodaran Sumangala
Published: August 2016

The relationship between music and politics and specifically that between music and protest has been relatively under-researched in the social sciences in a systematic manner, even if actual experiences of music being used to express protest have been innumerable. Further, the conceptual analysis that has been thrown up from the limited work that is available focuses mostly on Euro-American experiences with protest music. However, in societies where most music is not written down or notated formally, the discussions on the distinct role that music can play as an art form, as a vehicle through which questions of artistic representation can be addressed, and the specific questions that are addressed and responded to when music is used for political purposes, have been reflected in the music itself, and not always in formal debates. It is only in using the music itself as text and a whole range of information around its creation—often, largely anecdotal and highly context dependent—that such music can be understood. Doing so across a whole range of non-Western experiences brings out the role of music in societal change quite distinctly from the Euro-American cases. Discussions are presented about the informed perceptions about what protest music is and should be across varied, yet specific experiences. It is based on the literature that has come out of the Euro-American world as well as from parts that experienced European colonialism and made the transition to post-colonial contexts in Asia, Africa, and Latin America.
Salafism
Authors: Wagemakers Joas
Published: August 2016

Salafism is a branch of Sunni Islam whose modern-day adherents claim to emulate “the pious predecessors” (al-salaf al-ṣāliḥ; often equated with the first three generations of Muslims) as closely and in as many spheres of life as possible. Different scholars of Islam throughout time have striven to emulate the early Muslim generations in the legal sphere, in theological matters, or in both. The ideas espoused by these scholars have more or less culminated in the Wahhabi movement that started on the Arabian Peninsula in the 18th century, which in turn helped spread a Salafi message to the rest of the Arab and Muslim worlds and even beyond. As such, the trend now referred to as Salafism came about, expressing itself ideologically in teachings that are meant to present the trend as exclusively and meticulously adhering to the example of the salaf, while rejecting all other sources of influence. Practically, Salafism can be divided into three branches: quietist Salafism, whose adherents shun political activism and concentrate on “cleansing” and teaching Islam in all its “purity”; political Salafism, which does concentrate on political commitment as an integral part of Islam through contentious debates, parliamentary participation, and founding political parties; and Jihadi-Salafism, whose followers seek to overthrow supposedly apostate regimes in the Muslim world through violent jihad. Although the term “Salafism” is heavily contested among Salafis—with adherents of one branch often not allowing the application of the label to be applied to the other branches—its various ideas and manifestations show that Salafism is quite a diverse phenomenon.
Public Health in Mexico, 1870–1943
Authors: Agostoni Claudia
Published: August 2016

The prevention of communicable diseases, the containment of epidemic disorders, and the design of programs and the implementation of public health policies went through important transformations in Mexico, as in other Latin American nations, between the final decades of the 19th century and first half of the 20th century. During that period not only did the advances in medical science make possible the identification and containment of numerous contagious diseases; it was also a time when the consolidation of formal medical institutions and their interaction with both national and international actors contributed to shape the definitions and solutions of public health problems. Disease prevention strategies were influenced by medical, scientific, and technical innovations and by the political values and commitments of the period, and Mexico experienced profound and far-reaching political, economic, and social transformations: the apogee, crisis, and downfall of the long Porfirio Díaz regime (1876–1910), the armed phase of the Mexican Revolution (1910–1920), and the period of national reconstruction (1920–1940). Thus, during the period under consideration, and alongside the consolidation of an official medical apparatus as an integral part of public power, the promotion of public health became a crucial element to reinforce the political unification and the social and economic strength of the country.
The Women of Guadalajara in Mexico’s History
Authors: Fernández Aceves María Teresa
Published: August 2016

From the War of Independence until the recognition of female suffrage in Mexico in 1953, the women of Guadalajara witnessed different forms of activism that touched upon national and local issues, causing them to take to the streets in order to defend their families, their neighborhoods, and their communities: their political and religious ideals. Their active participation upended traditional notions of femininity within the Catholic Church and the liberal state of the 19th century, as well as the postrevolutionary state (1920–1940). The tasks they undertook over this lengthy period of time were highly diversified and encompassed welfare, education, war, politics, religion, and social endeavors.
Dene-Yeniseian
Authors: Vajda Edward
Published: August 2016

Dene-Yeniseian is a proposed genealogical link between the widespread North American language family Na-Dene (Athabaskan, Eyak, Tlingit) and Yeniseian in central Siberia, represented today by the critically endangered Ket and several documented extinct relatives. The Dene-Yeniseian hypothesis is an old idea, but since 2006 new evidence supporting it has been published in the form of shared morphological systems and a modest number of lexical cognates showing interlocking sound correspondences. Recent data from human genetics and folklore studies also increasingly indicate the plausibility of a prehistoric (probably Late Pleistocene) connection between populations in northwestern North America and the traditionally Yeniseian-speaking areas of south-central Siberia. At present, Dene-Yeniseian cannot be accepted as a proven language family until the purported evidence supporting the lexical and morphological correspondences between Yeniseian and Na-Dene is expanded and tested by further critical analysis and their relationship to Old World families such as Sino-Tibetan and Caucasian, as well as the isolate Burushaski (all earlier proposed as relatives of Yeniseian, and sometimes also of Na-Dene), becomes clearer.
SRinversion: a tool for detecting short inversions by splitting and re-aligning poorly mapped and unmapped sequencing reads
Authors: Chen Ruoyan , Lau Yu Lung , Zhang Yan , Yang Wanling
Published: August 2016

Motivation: Rapid development in sequencing technologies has dramatically improved our ability to detect genetic variants in human genome. However, current methods have variable sensitivities in detecting different types of genetic variants. One type of such genetic variants that is especially hard to detect is inversions. Analysis of public databases showed that few short inversions have been reported so far. Unlike reads that contain small insertions or deletions, which will be considered through gap alignment, reads carrying short inversions often have poor mapping quality or are unmapped, thus are often not further considered. As a result, the majority of short inversions might have been overlooked and require special algorithms for their detection.

Results: Here, we introduce SRinversion, a framework to analyze poorly mapped or unmapped reads by splitting and re-aligning them for the purpose of inversion detection. SRinversion is very sensitive to small inversions and can detect those less than 10 bp in size. We applied SRinversion to both simulated data and high-coverage sequencing data from the 1000 Genomes Project and compared the results with those from Pindel, BreakDancer, DELLY, Gustaf and MID. A better performance of SRinversion was achieved for both datasets for the detection of small inversions.

Availability and Implementation: SRinversion is implemented in Perl and is publicly available at http://paed.hku.hk/genome/software/SRinversion/index.html.

Contact:  yangwl@hku.hk

Supplementary information:  Supplementary data are available at Bioinformatics online.
A man with worsening gastrointestinal and neurologic symptoms
Authors: Irving David
Published: August 2016

A Coast Guardsman deployed to a remote island in the Bahamas contacted his primary care office about worsening gastrointestinal and neurologic complaints. This article describes the telemedicine consultation to determine the cause of his symptoms, whether he needed emergency evacuation, and how treatment was handled.
The ‘omics’ revolution: redefining the understanding and treatment of allergic skin diseases
Authors: Oliva Margeaux , Renert-Yuval Yael , Guttman-Yassky Emma
Published: August 2016

Purpose of review

To evaluate how the genomic, transcriptomic, and proteomic profiles of allergic skin diseases, like atopic dermatitis and allergic contact dermatitis, contribute to their understanding and promote their therapeutic development.

Recent findings

The ‘-omics’ revolution has facilitated the quantification of inflammatory skin diseases at the molecular level, expanding our understanding of disease pathogenesis. It has also greatly expanded once-limited treatment options and improved the ability to define posttreatment improvements, beyond clinical scores. The findings on the genomic/transcriptomic level are also complemented by proteomic data, contributing to the understanding of the later changes taking place in the final stages of protein formation. Atopic dermatitis is defined as a Th2/Th22 polarized disease with some contributions of Th17 and Th1 pathways. In atopic dermatitis, studies of biologics and small molecules, targeting specific pathways upregulated in atopic dermatitis, seem to provide well tolerated alternatives to conventional immunosuppressive therapies (i.e. corticosteroids and cyclosporine A), particularly for severe patients. Allergic contact dermatitis is defined as having Th1/Th17-centered inflammation, especially with nickel-induced disease, but additional pathways, including Th2 and Th22, are upregulated with other allergens (i.e. fragrance).

Supplementing studies of allergic skin diseases with ‘-omics’ approaches are transforming the pathogenic understanding, diagnosis and, perhaps, also the treatment of these diseases.
Population Health Science: A Core Element of Health Science Education in Sub-Saharan Africa
Authors: Hiatt Robert A. , Engmann Natalie J. , Ahmed Mushtaq , Amarsi Yasmin , Macharia William M. , Macfarlane Sarah B. , Ngugi Anthony K. , Rabbani Fauziah , Walraven Gijs , Armstrong Robert W.
Published: August 2016

Sub-Saharan Africa suffers an inordinate burden of disease and does not have the numbers of suitably trained health care workers to address this challenge. New concepts in health sciences education are needed to offer alternatives to current training approaches.

A perspective of integrated training in population health for undergraduate medical and nursing education is advanced, rather than continuing to take separate approaches for clinical and public health education. Population health science educates students in the social and environmental origins of disease, thus complementing disease-specific training and providing opportunities for learners to take the perspective of the community as a critical part of their education.

Many of the recent initiatives in health science education in sub-Saharan Africa are reviewed, and two case studies of innovative change in undergraduate medical education are presented that begin to incorporate such population health thinking. The focus is on East Africa, one of the most rapidly growing economies in sub-Saharan Africa where opportunities for change in health science education are opening. The authors conclude that a focus on population health is a timely and effective way for enhancing training of health care professionals to reduce the burden of disease in sub-Saharan Africa.
Internationally Educated Health Professionals in Canada: Navigating Three Policy Subsystems Along the Pathway to Practice
Authors: Paul Robert , Martimianakis Maria Athina (Tina) , Johnstone Julie , McNaughton Nancy , Austin Zubin
Published: August 2016

The integration of internationally educated health professionals (IEHPs) into the health workforces of their adopted countries is an issue that has challenged policy makers and policy scholars for decades. In this article, the authors explore the implications of the ideological underpinnings of the policy subsystems that IEHPs must navigate in seeking employment in Canada, with a focus on Ontario.

Using a policy subsystem approach, in 2015 the authors analyzed a large preexisting data set composed of articles, governmental reports, Web sites, and transcripts of interviews and focus groups conducted in Ontario with IEHPs, health care executives, human resource managers, and job counselors to IEHPs. Through this analysis, they identified three policy subsystems—the immigration system, the educational and licensure/regulatory system, and the health human resources system—that conflict ideologically and, as a result, create barriers to IEHP integration.

To make substantive progress on IEHP integration in Canada, four questions should be considered. First, how can researchers bring new research methods to bear to explore why no jurisdiction has been able to create an integrated pathway to practice for IEHPs? Second, how and to what end are the institutions within the three policy subsystems regulating the IEHP pathway to practice? Third, how might the educational and licensure/regulatory policy subsystem create alternative health care employment options for IEHPs? Finally, how might health professions educators pursue a leadership role in the creation of an overarching institution to manage the pathway to practice for IEHPs?
The Availability of Ancillary Counseling in the Practices of Physicians Prescribing Buprenorphine
Authors: Barry Declan T. , Fazzino Tera , Necrason Emily , Ginn Joel , Fiellin Lynn E. , Fiellin David A. , Moore Brent A.
Published: August 2016

Objective:

We set out to examine physicians’ perceptions of the provision of ancillary services for opioid dependent patients receiving buprenorphine.

Methods:

An e-mail invitation describing the study was sent out by the American Society of Addiction Medicine to its membership (approximately 3700 physicians) and other entities (for a total of approximately 7000 e-mail addresses). E-mail recipients were invited to participate in a research study funded by the National Institutes on Drug Abuse involving completion of an online survey; 346 physicians completed the survey.

Results:

The majority of the 346 respondents were internal or family medicine (37%), or addiction medicine providers (30%), who were practicing in urban (57%) or suburban settings (27%). Most respondents reported either offering (66%) or referring patients for ancillary counseling (31%). Interventions that were most frequently offered or referrals provided were individual counseling (51%) and self-help groups (63%), respectively. Counseling availability differed significantly by provider specialization for any, individual, group, family or couples, and self-help groups.

Conclusions:

Generally, respondents reported compliance with ancillary counseling requirements for buprenorphine treatment of opioid use disorder. In addition to examining the efficacy of a variety of ancillary counseling services for patients receiving opioid agonist treatment, further research should examine physicians’ attitudes toward the role of such counseling in buprenorphine treatment. Although the study sample was relatively large, the generalizability of the findings is unclear, suggesting that further investigation of the availability of ancillary counseling in buprenorphine treatment among a larger nationally representative sample of providers may be warranted.
Articular Gap and Step-off Revisited: 3D Quantification of Operative Reduction for Posterior Malleolar Fragments
Authors: de Muinck Keizer Robert-Jan O. , Meijer Diederik T. , van der Gronde Bonheur A. T. D. , Teunis Teun , Stufkens Sjoerd A. S. , Kerkhoffs Gino M. , Goslings J. Carel , Doornberg Job N.
Published: August 2016

Objectives:

Despite advanced imaging techniques, classic measurements of fracture reduction have not been revisited to date. The purpose of this study was to evaluate the reliability of innovative measurement techniques to quantify operative fragment reduction of posterior malleolar fractures by quantification of three-dimensional computed tomography (Q3DCT).

Methods:

Twenty-eight ankle fractures including a posterior malleolar fragment (AO/OTA type 44) were evaluated using 2DCT and Q3DCT to postoperatively quantify fragment reduction. “Classic” maximum gap and step-off of the posterior fragment were measured on 2DCT and Q3DCT. In addition, 2 innovative Q3DCT parameters were introduced and their reliability was tested using intraclass correlations (ICCs): gap surface (mm2) and multidirectional 3D-displacement (mm).

Results:

“Classic” measurements showed a median maximum step-off of 1.1 mm [interquartile range (IQR) 0.0–1.8 mm] on 2DCT versus a median step-off of 0.6 mm (IQR 0.0–1.1) on Q3DCT. Median maximum gap was 1.2 mm (IQR 0.0–3.8) on 2DCT, and its equivalent on Q3DCT showed no median displacement. Q3DCT measurements revealed a median gap surface of 14.5 mm2 (IQR 4.7–30.0) and a median multidirectional 3D-displacement of 0.7 mm (IQR 0.0–1.1). Interrater reliability of these new Q3DCT parameters of displacement was excellent (ICC 0.92, 95% CI 0.79–0.98) for gap surface and good (ICC 0.64, 95% CI 0.28–0.88) for 3D-displacement.

Conclusions:

Q3DCT is a reliable and promising technique for postoperative evaluation of fracture fragment reduction. In addition to “classic” gap and step-off measurements, we propose to explore total gap surface and 3D-displacement as innovative radiographic measurements in future clinical studies.

Level of Evidence:

Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Spontaneous healing of fractures and osteotomy within intercalary allograft reconstruction after distal femur osteosarcoma resection in a child
Authors: Kowalczyk Bart , Miklaszewski Krzysztof , Feluś Jarosław
Published: August 2016

Intercalary biologic reconstructions using allogenic bone grafts remain a useful option in orthopedic oncology; however, these reconstructions are prone to fractures, and treatment is usually required involving surgical interventions. Biologic activity of the implanted allografts remains minimal, but in some cases, spontaneous healing of the graft may occur. We present a report and discussion on two fractures and corrective osteotomy within the implanted allograft that healed with abundant callus without the need for additional surgery. In selected patients, allograft incorporation can be completed to a degree allowing for its biologic activity and spontaneous healing of fractures or osteotomy.
Outcome of Conservative Versus Surgical Treatment of Humeral Shaft Fracture in Children and Adolescents: Comparison Between Nonoperative Treatment (Desault’s Bandage), External Fixation and Elastic Stable Intramedullary Nailing
Authors: Canavese Federico , Marengo Lorenza , Cravino Mattia , Giacometti Vanessa , Pereira Bruno , Dimeglio Alain , Origo Carlo , Andreacchio Antonio
Published: August 2016

Background:

The main objective of this study was to retrospectively evaluate the clinical and radiographic outcomes of displaced humeral shaft fractures in children treated by Desault’s bandage (DB), external fixation (EF), and elastic stable intramedullary nailing (ESIN).

Methods:

During the study period, 36 consecutive children with displaced humeral shaft fracture were treated by DB (Group A), EF (Group B) or ESIN (Group C). All the patients underwent full-length preoperative and postoperative anteroposterior and lateral radiographs of the injured humerus. One year after the index surgery, patients were asked to answer the short version of the Disabilities of the Arm, Shoulder and Hand outcome questionnaire (Quick DASH).

Results:

Ten patients (27.8%) were in Group A, 11 (30%) in Group B, and 15 (41.7%) in Group C. Mean age at the time of injury was 10.8±2.3 years (range, 8 to 15.2 y), 11.7±2.5 years (range, 6.8 to 15.9 y), and 12.7±2.2 years (range, 6.9 to 15.3 y) in Groups A, B, and C, respectively (P=0.08). Groups A, B, and C did not differ significantly in their demographics (P>0.05).

Surgical treatment (Groups B and C) provided a better radiologic outcome than nonoperative treatment (Group A) (P=0.05). No statistically significant differences were observed for preoperative, postoperative and at last follow-up mean displacement between Groups B and C (P>0.05).

Overall, 9 of 36 patients developed a complication: 2 in Group A (20%), 4 in Group B (37%), and 3 in Group C (20.1) (P=0.92).

Mean Quick DASH score was 3±8.6 (range, 0 to 27.3), 1.4±2.9 (range, 0 to 9), and 1.2±4.7 (range, 0 to 18.2) in Groups A, B, and C, respectively. All the patients were able to resume previous physical and sport activities 4 to 6 months after the last fracture reduction procedure.

Conclusions:

Surgery is not contraindicated in children with displaced humeral shaft fractures. EF and ESIN provide a better radiologic outcome, less posttreatment pain and faster mobilization than DB. However, numerical differences, although statistically significant, were not clinically relevant for all variables but immobilization time. Nonoperative treatment was as efficacious as surgical treatment apart from the length of time for immobilization.

Level of Evidence:

Level III.
Life Expectancy After Cervical En Bloc Laminoplasty
Authors: Kawaguchi Yoshiharu , Nakano Masato , Yasuda Taketoshi , Seki Shoji , Hori Takeshi , Suzuki Kayo , Makino Hiroto , Kanamori Masahiko , Kimura Tomoatsu
Published: August 2016

Study Design.

Case series.

Objective.

To clarify the following questions How long after cervical laminoplasty did the patients die? What were the causes of the death? Was the severity of the neurological dysfunction related to early death?

Summary of Background Data.

Life expectancy in patients with cervical myelopathy is unclear. Cervical laminoplasty was performed in 216 patients between 1981 and 1994. It was possible to follow 148 patients for more than 20 years. We used the data of the 68 survivors and the 80 patients had already died.

Methods.

As for the patients who died by the final follow-up, the survival rate was analyzed by a Kaplan-Meier plot; the results were compared between the patients with cervical spondylosis (CS) and the patients with ossification of the posterior longitudinal ligament (OPLL). The causes of the death were assessed. The neurological evaluation was graded using the score devised by the Japanese Orthopaedic Association (JOA). The pre- and postoperative scores were compared between the patients in the died group (D group) and the surviving patients group (S group).

Results.

The mean period from surgery to death was 13.4 ± 7.4 years. There was no difference in the survival rate between patients with CS and patients with OPLL. The most frequent cause of death was malignant tumor followed by ischemic heart disease. Preoperative JOA score in the D group was lower than that in the S group. There was no statistical difference in postoperative JOA score between the two groups.

Conclusion.

The patients who underwent cervical laminoplasty caused by compression myelopathy due to CS and OPLL had a long life expectancy, averaging more than 13 years. Life expectancy did not differ between patients with CS and patients with OPLL. Neurological deficit did not directly affect the life expectancy.

Level of Evidence: 4
Mindfulness and Coping Are Inversely Related to Psychiatric Symptoms in Patients and Informal Caregivers in the Neuroscience ICU: Implications for Clinical Care
Authors: Shaffer Kelly M. , Riklin Eric , Jacobs Jamie M. , Rosand Jonathan , Vranceanu Ana-Maria
Published: August 2016

Objective:

To assess the correlation of psychosocial resiliency factors (mindfulness and coping) with symptoms of posttraumatic stress, anxiety, and depression in patients recently admitted to the neuroscience ICU and their primary informal caregivers.

Design:

A descriptive, cross-sectional correlational study.

Setting:

Neuroscience ICU in a major medical center.

Participants:

A total of 78 dyads of patients (total n = 81) and their primary caregivers (total n = 92) from June to December 2015. Study enrollment occurred within the first 2 weeks of patient admission to the neuroscience ICU.

Intervention:

None.

Measurements and Main Results:

Dyads completed self-report measures of mindfulness (Cognitive and Affective Mindfulness Scale-Revised), coping (Measure of Coping Status-A), posttraumatic stress (Posttraumatic Checklist–Specific Stressor), anxiety (Hospital Anxiety and Depression Scale-A), and depression (Hospital Anxiety and Depression Scale-D). Rates of clinically significant posttraumatic stress, anxiety, and depressive symptoms were high and comparable between patient and caregiver samples. Own psychological resilience factors and psychiatric symptoms were strongly correlated for both patients and caregivers. Depressive symptoms were interdependent between patients and their caregivers, and one’s own mindfulness was independently related to one’s partner’s depressive symptoms.

Conclusions:

Rates of clinically significant psychiatric symptoms were high, equally prevalent in patients and caregivers, and interdependent between patients and their caregivers. For both patients and caregivers, psychological resiliency factors were associated with both self and partner psychiatric symptoms. Findings suggest that attending to the psychiatric health of both patients and caregivers in the neuroscience ICU is a priority and that patients and their caregivers must be considered together in a system to fully address either individual’s psychiatric symptoms.
Functional Status Score for the ICU: An International Clinimetric Analysis of Validity, Responsiveness, and Minimal Important Difference
Authors: Huang Minxuan , Chan Kitty S. , Zanni Jennifer M. , Parry Selina M. , Neto Saint-Clair G. B. , Neto Jose A. A. , da Silva Vinicius Z. M. , Kho Michelle E. , Needham Dale M.
Published: August 2016

Objectives:

To evaluate the internal consistency, validity, responsiveness, and minimal important difference of the Functional Status Score for the ICU, a physical function measure designed for the ICU.

Design:

Clinimetric analysis.

Settings:

Five international datasets from the United States, Australia, and Brazil.

Patients:

Eight hundred nineteen ICU patients.

Intervention:

None.

Measurements and Main Results:

Clinimetric analyses were initially conducted separately for each data source and time point to examine generalizability of findings, with pooled analyses performed thereafter to increase power of analyses. The Functional Status Score for the ICU demonstrated good to excellent internal consistency. There was good convergent and discriminant validity, with significant and positive correlations (r = 0.30–0.95) between Functional Status Score for the ICU and other physical function measures, and generally weaker correlations with nonphysical measures (|r| = 0.01–0.70). Known group validity was demonstrated by significantly higher Functional Status Score for the ICU scores among patients without ICU-acquired weakness (Medical Research Council sum score, ≥ 48 vs < 48) and with hospital discharge to home (vs healthcare facility). Functional Status Score for the ICU at ICU discharge predicted post-ICU hospital length of stay and discharge location. Responsiveness was supported via increased Functional Status Score for the ICU scores with improvements in muscle strength. Distribution-based methods indicated a minimal important difference of 2.0–5.0.

Conclusions:

The Functional Status Score for the ICU has good internal consistency and is a valid and responsive measure of physical function for ICU patients. The estimated minimal important difference can be used in sample size calculations and in interpreting studies comparing the physical function of groups of ICU patients.
Visual Fixation in the ICU: A Strong Predictor of Long-Term Recovery After Moderate-to-Severe Traumatic Brain Injury*
Authors: Arbour Caroline , Baril Andrée-Ann , Westwick Harrison J. , Potvin Marie-Julie , Gilbert Danielle , Giguère Jean-François , Lavigne Gilles J. , Desautels Alex , Bernard Francis , Laureys Steven , Gosselin Nadia
Published: August 2016

Objective:

Posttraumatic amnesia is superior to the initial Glasgow Coma Scale score for predicting traumatic brain injury recovery, but it takes days/weeks to assess. Here, we examined whether return of visual fixation—a potential marker of higher cognitive function—within 24 hours of ICU admission could be used as an early predictor of traumatic brain injury recovery.

Design:

Two-phase cohort study.

Setting:

Level-I trauma ICU.

Patients:

Moderate-to-severe traumatic brain injury discharged alive between 2010 and 2013.

Interventions:

None.

Measurements and Main Results:

Return of visual fixation was assessed through standard behavioral assessments in 181 traumatic brain injury patients who had lost the ability to fixate at ICU admission (phase 1) and compared with posttraumatic amnesia duration and the initial Glasgow Coma Scale score to predict performance on the Glasgow Outcome Scale-Extended 10–40 months after injury (n = 144; phase 2a). A subgroup also completed a visual attention task (n = 35; phase 2b) and a brain MRI after traumatic brain injury (n = 23; phase 2c). With an area under the curve equal to 0.85, presence/absence of visual fixation at 24 hours of ICU admission was found as performant as posttraumatic amnesia (area under the curve, 0.81; difference between area under the curve, 0.04; p = 0.28) for predicting patients' Glasgow Outcome Scale-Extended score. Conversely, the initial Glasgow Coma Scale score was not (area under the curve, 0.63). Even when controlling for age/medication/CT scan findings, fixation remained a significant predictor of Glasgow Outcome Scale-Extended scores (β, –0.29; p < 0.05). Poorer attention performances and greater regional brain volume deficits were also observed in patients who could not fixate at 24 hours of ICU admission versus those who could.

Conclusions:

Visual fixation within 24 hours of ICU admission could be as performant as posttraumatic amnesia for predicting traumatic brain injury recovery, introducing a new variable of interest in traumatic brain injury outcome research.
Functional Neurologic Outcomes Change Over the First 6 Months After Cardiac Arrest
Authors: Tong Julia T. , Eyngorn Irina , Mlynash Michael , Albers Gregory W. , Hirsch Karen G.
Published: August 2016

Objectives:

To determine the longitudinal changes in functional outcome and compare ordinal outcome scale assessments in comatose cardiac arrest survivors.

Design:

Prospective observational study of comatose cardiac arrest survivors. Subjects who survived to 1 month were included.

Setting:

Academic medical center ICU.

Patients:

Ninety-eight consecutive patients who remained comatose after resuscitation from cardiac arrest; 45 patients survived to 1 month.

Interventions:

None.

Measurements and Main Results:

Patients’ functional neurologic outcomes were assessed by phone call or in-person clinic visit at 1, 3, 6, and 12 months postcardiac arrest using the modified Rankin Scale, Glasgow Outcome Scale, and Barthel Index. A “good” outcome was defined as modified Rankin Scale 0–3, Barthel Index 70–100, and Glasgow Outcome Scale 4–5. Changes in dichotomized outcomes and shifts on each outcome scale were analyzed. The mean age of survivors was 51 ± 19 years and 18 (40%) were women. Five (19%) out of 26 patients with data available at all timepoints improved to good modified Rankin Scale outcome and none worsened to poor outcome between postarrest months 1 and 6 (p = 0.06). Thirteen patients (50%) improved on the modified Rankin Scale by 1–3 points and four (15%) worsened by 1–2 points between months 1 and 6 (overall improvement by 0.5 points; 95% CI, 0–1; p = 0.04). From postarrest months 6 to 12, there was no change in the number of patients with good versus poor outcomes. The modified Rankin Scale and Barthel Index were more sensitive to detecting changes in outcome than the Glasgow Outcome Scale.

Conclusions:

In initially comatose cardiac arrest survivors, improvements in functional status occur over the first 6 months after the event. There was no significant change in outcome between postarrest months 6 and 12. The modified Rankin Scale is a sensitive outcome scale in this population.
A Comparison of the Ability of the Physiologic Components of Medical Emergency Team Criteria and the U.K. National Early Warning Score to Discriminate Patients at Risk of a Range of Adverse Clinical Outcomes*
Authors: Smith Gary B. , Prytherch David R. , Jarvis Stuart , Kovacs Caroline , Meredith Paul , Schmidt Paul E. , Briggs Jim
Published: August 2016

Objective:

To compare the ability of medical emergency team criteria and the National Early Warning Score to discriminate cardiac arrest, unanticipated ICU admission and death within 24 hours of a vital signs measurement, and to quantify the associated workload.

Design:

Retrospective cohort study.

Setting:

A large U.K. National Health Service District General Hospital.

Patients:

Adults hospitalized from May 25, 2011, to December 31, 2013.

Interventions:

None.

Measurements and Main Results:

We applied the National Early Warning Score and 44 sets of medical emergency team criteria to a database of 2,245,778 vital signs sets (103,998 admissions). The National Early Warning Score’s performance was assessed using the area under the receiver-operating characteristic curve and compared with sensitivity/specificity for different medical emergency team criteria. Area under the receiver-operating characteristic curve (95% CI) for the National Early Warning Score for the combined outcome (i.e., death, cardiac arrest, or unanticipated ICU admission) was 0.88 (0.88–0.88). A National Early Warning Score value of 7 had sensitivity/specificity values of 44.5% and 97.4%, respectively. For the 44 sets of medical emergency team criteria studied, sensitivity ranged from 19.6% to 71.2% and specificity from 71.5% to 98.5%. For all outcomes, the position of the National Early Warning Score receiver-operating characteristic curve was above and to the left of all medical emergency team criteria points, indicating better discrimination. Similarly, the positions of all medical emergency team criteria points were above and to the left of the National Early Warning Score efficiency curve, indicating higher workloads (trigger rates).

Conclusions:

When medical emergency team systems are compared to a National Early Warning Score value of greater than or equal to 7, some medical emergency team systems have a higher sensitivity than National Early Warning Score values of greater than or equal to 7. However, all of these medical emergency team systems have a lower specificity and would generate greater workloads.
Functional Outcome Trajectories After Out-of-Hospital Pediatric Cardiac Arrest
Authors: Silverstein Faye S. , Slomine Beth S. , Christensen James , Holubkov Richard , Page Kent , Dean J. Michael , Moler Frank W.
Published: August 2016

Objectives:

To analyze functional performance measures collected prospectively during the conduct of a clinical trial that enrolled children (up to age 18 yr old), resuscitated after out-of-hospital cardiac arrest, who were at high risk of poor outcomes.

Design:

Children with Glasgow Motor Scale score less than 5, within 6 hours of resuscitation, were enrolled in a clinical trial that compared two targeted temperature management interventions (THAPCA-OH, NCT00878644). The primary outcome, 12-month survival with Vineland Adaptive Behavior Scale, second edition, score greater or equal to 70, did not differ between groups.

Setting:

Thirty-eight North American PICUs.

Participants:

Two hundred ninety-five children were enrolled; 270 of 295 had baseline Vineland Adaptive Behavior Scale, second edition, scores greater or equal to 70; 87 of 270 survived 1 year.

Interventions:

Targeted temperatures were 33.0°C and 36.8°C for hypothermia and normothermia groups.

Measurements and Main Results:

Baseline measures included Vineland Adaptive Behavior Scale, second edition, Pediatric Cerebral Performance Category, and Pediatric Overall Performance Category. Pediatric Cerebral Performance Category and Pediatric Overall Performance Category were rescored at hospital discharges; all three were scored at 3 and 12 months. In survivors with baseline Vineland Adaptive Behavior Scale, second edition scores greater or equal to 70, we evaluated relationships of hospital discharge Pediatric Cerebral Performance Category with 3- and 12-month scores and between 3- and 12-month Vineland Adaptive Behavior Scale, second edition, scores. Hospital discharge Pediatric Cerebral Performance Category scores strongly predicted 3- and 12-month Pediatric Cerebral Performance Category (r = 0.82 and 0.79; p < 0.0001) and Vineland Adaptive Behavior Scale, second edition, scores (r = –0.81 and –0.77; p < 0.0001). Three-month Vineland Adaptive Behavior Scale, second edition, scores strongly predicted 12-month performance (r = 0.95; p < 0.0001). Hypothermia treatment did not alter these relationships.

Conclusions:

In comatose children, with Glasgow Motor Scale score less than 5 in the initial hours after out-of-hospital cardiac arrest resuscitation, function scores at hospital discharge and at 3 months predicted 12-month performance well in the majority of survivors.