bluuebunny/crossref_metadata_2025 huggingface dataset:
Negative capacitance δ ‐bulk planar junctionless transistor for low power applications
Authors: Bhagat Khemnand B. , Patil Ganesh C.
Published: June 2019

The impact of substrate doping on the short‐channel effects (SCEs) of bulk‐planar junctionless transistor (BPJLT) has been studied. It has been found that increasing substrate doping in bulk region reduces off‐state leakage current (IOFF) and the sub‐threshold slope (SS) of the device. To further reduce the SCEs of BPJLT heavily doped δ ‐layer of thickness 10 nm has been added below the channel. Despite the presence of δ ‐layer in BPJLT reduces SCEs, the SCE, mainly SS, is still limited by the fundamental limit of 60 mV/decade. Therefore, to reduce SS below 60 mV/decade, negative capacitance (NC) δ ‐BPJLT has been proposed by adding the layer of ferroelectric material at gate stack. It has been found that in comparison with conventional BPJLT and δ ‐BPJLT, the insertion of ferroelectric layer in NC‐δ ‐BPJLT not only reduces the IOFF and the SS but also improves ION/IOFF ratio of the device. Thus, embedding heavily doped δ ‐layer in the bulk region and the ferroelectric layer at the gate stack of BPJLT makes it a promising device for low‐power applications.
Glucocorticoid receptor modulators CpdX and CpdX-D3 exhibit the same in vivo antiinflammatory activities as synthetic glucocorticoids
Authors: Hua Guoqiang , Zein Naimah , Daubeuf François , Chambon Pierre
Published: June 2019

Significance

For 70 y, glucocorticoids (GCs) have been used to combat inflammatory and allergic disorders. Unfortunately, multiple undesirable side effects are associated with long-term GC treatments, thereby limiting their therapeutic usefulness. We reported that a nonsteroidal compound, CpdX, selectively activates the tethered transrepression function of the glucocorticoid receptor (GR), which contributes to the glucocorticoid beneficial antiinflammatory properties, while not inducing the GR-mediated direct transactivation nor the direct transrepression to which GC undesirable side effects are attributed. We now demonstrate that both CpdX and its deuterated form CpdX-D3 selectively trigger GR-mediated tethered transrepression, and are as efficient as the synthetic glucocorticoid Dexamethasone at curing several major inflammatory diseases in the mouse, indicating that they could be of great interest as antiinflammatory drugs.
Aided cortical auditory evoked measures with cochlear implantees
Authors: Choi Sandy M. S. , Wong Eddie C. M. , McPherson Bradley
Published: June 2019

Purpose:

Cortical auditory evoked potential (CAEP) procedures are a useful way of estimating behavioural thresholds without active participant cooperation. They are becoming more common in hearing aid fitting, especially for those who cannot give reliable responses during evaluation. Speech stimuli are used in CAEP assessment to better understand listener performance when listening to speech. A commercial system, HEARLab (Frye Electronics, Tigard OR), detects and automatically analyses aided CAEPs elicited by speech stimuli. Aided CAEPs are also helpful in cochlear implant evaluation. However, there are few studies in this area, primarily due to electrical artefacts elicited by such devices. This study determined average CAEP waveform latency for CI users, and compared aided HEARLab cortical assessment (ACA) outcomes with behavioural speech detection results, using modified recording electrodes designed to reduce artefacts.

Method:

Custom CAEP electrodes were used to reduce recording artefacts, and test outcomes compared with those obtained with standard electrodes. Recordings from participants using two types of cochlear implant device (Cochlear and Advanced Bionics) were also compared. Twenty adult cochlear implantees were assessed using ACA with both types of electrodes, and behavioural free field speech detection was also conducted.

Results:

Average P1 latencies for the cochlear implant users were within the normative range of the general, non-implant population. The percentage of matches for positive results between ACA and behavioural speech detection test results was low, and the number of CAEPs recorded without artefacts was also low for both types of electrodes. More CAEPs could be recorded without artefacts with Cochlear devices regardless of the type of electrodes used. However, the artefact amplitudes recorded with Cochlear devices were greater than those produced by Advanced Bionics devices.

Conclusion:

Custom electrodes were not effective in reducing the prevalence of CI-related artefacts, and the artefact amplitude recorded was slightly greater than for the original electrodes. Alternative methods should be trialled to reduce the effects of electrical artefacts on CAEP recordings with cochlear implant users.
Women Benefit from the Affordable Care Act
Authors: Potera Carol
Published: June 2019

Poorest women gain the most.
Mental Health Care Is Lacking in Children and Adolescents
Authors: Nelson Roxanne
Published: June 2019

Integrating mental health consultants and providers into schools and primary care could help.
Rising to the Challenge: Re-Embracing the Wald Model of Nursing
Authors: Pittman Patricia
Published: June 2019

By the 1920s, Lillian Wald's model of care, with nurses working side by side with social workers at the intersection of medicine and society, had become an important component of the U.S. health care system. Over subsequent decades, however, a confluence of historic forces resulted in its marginalization. Today, people are recognizing that medical cures alone, although important, will not reduce the epidemic of diseases of despair or the growing challenges involved in achieving health equity. Wald's approach, extended to a broader range of settings in which nurses work today, could be the missing ingredient.

To provide background for the National Academy of Medicine Committee on the Future of Nursing 2020-2030, as it develops its follow-up to the Institute of Medicine's 2010 Future of Nursing: Leading Change, Advancing Health, the Robert Wood Johnson Foundation commissioned a report on nursing's historic role in advancing health. This article summarizes that report, which can be found in its entirety at www.rwjf.org/content/dam/farm/reports/reports/2019/rwjf452706.
Graduate Nursing Telehealth Education: Assessment of a One-Day Immersion Approach
Authors: Chike-Harris Katherine E. , Harmon Elizabeth , van Ravenstein Kathryn
Published: June 2019

The ability to effectively understand and utilize telehealth technologies is an important skill for health care providers. Currently there is limited literature on integrating telehealth education into health care curricula. This article describes a one-day telehealth immersion event for graduate nursing students that combined lectures with hands-on training. Feedback from students was positive, and all participants expressed a need for telehealth education before graduating with an advanced practice nursing degree.
Simulation Strategies Used in the Transition From Expert Clinician to Novice Educator
Authors: Dunker Kimberly Silver , Duprey Melissa D. , Ross Jennifer Gunberg
Published: June 2019

As the demand for nurses increases across the United States, nursing programs are challenged to increase enrollment. Thus, expert clinicians without teaching experience are often hired as clinical faculty. Using simulation to train novice clinical faculty is one method to bolster the clinical faculty workforce. For this project, six Quality and Safety Education for Nurses (QSEN)-focused simulation-based learning experiences (SBLEs) were developed to train novice clinical faculty. Master’s-level nurse educator students participated in the SBLEs. The SBLEs were found to be valuable for learning the clinical faculty role and debriefing increased understanding of the QSEN competencies.
Discovering a New Purpose: Veterans’ Transition to Nursing Education
Authors: Patterson Barbara J. , Elliott Brenda , Chargualaf Katie A.
Published: June 2019

With the downsizing of military forces and the support of GI Bill benefits, a growing number of veterans are returning to college. Using a qualitative descriptive approach, the researchers sought to understand the transition experiences of 11 veterans enrolled in baccalaureate nursing programs. Data suggest the transition process is challenging, marked by significant change in structure and culture from one context to the next. Veterans return to school to learn and seek meaning and purpose in the pursuit of a nursing degree. Faculty understanding of military culture is a first step in guiding the student veteran to success in nursing education.
Challenges encountered using Fassier-Duval rods in osteogenesis imperfect
Authors: Landrum Matthew , Birch Craig , Richards Benjamin Stephens
Published: June 2019

Background:

Intramedullary fixation remains a mainstay in the management of deformity and fracture in patients with osteogenesis imperfecta (OI). Fassier-Duval telescoping intramedullary rods were introduced in 2003 and have substantially replaced the use of Bailey-Dubow rods in the treatment of OI patients. The purpose of this study was to identify limitations, if any, of the Fassier-Duval rod in this condition.

Methods:

A retrospective chart and radiograph review was performed of all OI patients treated with Fassier-Duval telescoping rods between the years 2005 and 2017 at a single institution. The clinical records and radiographic studies were reviewed to identify technical challenges intraoperatively and postoperative problems.

Results:

Twenty procedures were identified in which Fassier-Duval rods were placed in nine patients. Intraoperative technical challenges occurred in six (distal migration of epiphyseal fixation, rod prominence in the knee, distal guidewire protrusion, and fracture). Postoperatively, nine of the 20 Fassier-Duval rods (45%) had failure of epiphyseal fixation and lost their telescoping feature. Three (15%) long bones fractured with the device in place with the rods bending and subsequently requiring revision. One (5%) long bone fractured distal to the rod after loss of epiphyseal fixation. There were no infections.

Conclusions:

In OI long bone deformities, the goal of the Fassier-Duval rod is to provide realignment with intramedullary stabilization, reduce the number of fractures, and limit reoperations due to the expansion of the telescoping devices. Although the FD rod has the potential to accomplish these goals, challenges remain in this condition.

Level of Evidence:

Therapeutic level IV.
Cardiovascular and Pulmonary Research: The Year (2018) in Review
Authors: Ricard Paul E. H. , Cahalin Lawrence P.
Published: June 2019

Practitioners need access to and the ability to openly discuss advanced in practice and concepts as they apply to the practice of cardiovascular and pulmonary physical therapy (PT). Lack of accessibility to research literature, limited personal time, or insufficient knowledge to adequately review the breadth of literature published each year can hinder this process. This article provides an overview of cardiovascular and pulmonary research published in 2018 that the authors believe most important and relevant or speaks to the volume or trend of current topics in the clinical practice of cardiovascular and pulmonary PT. Two methods of research presentation used this year give either a broad overview of a research topic or a select article meant to describe the theme of research in a given topic area. Both were followed by brief overview of clinical relevance and open to discussion with the participants present at the 2019 Combined Sections Meeting in Washington, DC.
Osteochondral flap fracture of the coronoid in pediatric humeral lateral condyle
Authors: Wang Jinkui , Wang ZhongLiang
Published: June 2019

Rationale:

Osteochondral flap fractures of the elbow are rare in children. To the best of our knowledge, only 12 cases are reported in the literature. Only 1 case was accompanied with lateral condyle fracture classified as Milch I, which was nondisplaced. The mechanism of these injuries is not explained in detail, and the treatment methods are not discussed. Here, we present 3 cases of osteochondral flap fracture of the ulnar coronoid process with accompanying obvious displacement of the lateral condyle fracture.

Patient concerns:

All patients fell into one of their outstretched arms, which caused elbow pain and functional limitation.

Diagnosis:

All 3 patients were diagnosed with lateral condyle fracture of the humerus and osteochondral flap fracture of the ulnar coronoid process.

Interventions:

All patients underwent open reduction and internal fixation.

Outcomes:

At 3 months after the operation, they regained full range of motion of the limb and had no elbow instability.

Lessons:

Osteochondral flap fracture should be considered when there is a bone mass in the elbow space with accompanying displacement of the humeral lateral condyle fracture.
The role of CXCR3 and its ligands CXCL10 and CXCL11 in the pathogenesis of celiac disease
Authors: Haghbin Mahrokh , Rostami-Nejad Mohammad , Forouzesh Flora , Sadeghi Amir , Rostami Kamran , Aghamohammadi Elham , Asadzadeh-Aghdaei Hamid , Masotti Andrea , Zali Mohammad Reza
Published: June 2019

The chemokine receptor CXCR3 and its ligands CXCL10 and CXCL11 have been suggested to give rise to the most relevant chemokine axis able to facilitate the entrance of immune cells into inflamed tissues and be activated in different inflammatory disorders, such as celiac disease (CD).

The aim of this study was to investigate the expression level of CXCR3, CXCL10, and CXCL11 genes in celiac patients compared to healthy controls. Both cohorts have been recruited from the Iranian population.

In this case–control study, biopsy specimens were collected from 71 celiac patients (60.5% female) and 90 control subjects (57% female) during 2016. Total RNA was extracted and mRNA expression levels of CXCR3, CXCL10, and CXCL11 genes were investigated by SYBR green qPCR.

Based on qPCR and relative quantification method, the mRNA expression levels of CXCR3, CXCL10, and CXCL11 were significantly higher in duodenal biopsies of celiac patients compared to healthy controls in the study population (P = .038, P = .021, and P = .012 respectively).

The result of this study showed that CXCR3/CXCL10/CXCL11 signaling axis is overexpressed in the small intestinal mucosa of CD patients compared to controls. This finding might explain the specific enrollment of the main cell populations that infiltrate the epithelium.
The relationship between the percent of euploid embryo and the tolerance of embryo biopsy in preimplantation genetic screening
Authors: Jiang Xinglu , Zhao Chenggui , Xu Wei , Zhang Rui
Published: June 2019

The aim of this study was to analyze the relationship between the percent of euploid embryo and the tolerance of embryo biopsy in preimplantation genetic screening (PGS).

PubMed and trial registers were searched for clinical studies that patients were randomized to the PGS group or the control group from 1995 to October 2017. The patients of advanced maternal age, repeated implantation failure, and good prognosis with or without PGS in randomized controlled trials (RCTs) were collected.

Original data from 9 RCT studies comparing in-vitro fertilization with and without PGS including 1642 patients were obtained and they were divided into 3 subgroups according to the percent of euploid embryo. PGS significantly increased live birth babies per embryo transferred (risk ratio: 2.98, 95% confidence interval: 1.54–5.75) in ≤30% of euploid embryo subgroups and but in other 2 groups, PGS has no effect. Significant negative correlation was found between the percent of euploid embryo and the tolerance of embryo biopsy in PGS (r = 0.80, P = 0.010)

The tolerance of embryo biopsy in PGS was associated negatively with the percent of euploid embryo. There was a beneficial effect when PGS was used in the patients with the lowest percent of euploid embryo.
Management and clinical outcomes of periprosthetic fractures after total knee arthroplasty with a stem extension
Authors: Shin Jae Hoon , Chang Moon Jong , Kang Seung-Baik , Chang Chong Bum , Kim Dong Hwi , Lee Seung Ah , Mok Su Jung
Published: June 2019

There is little information about the management and clinical outcomes of the periprosthetic fracture after total knee arthroplasty (TKA) with a stem extension. The purposes of this study were to demonstrate management of the periprosthetic fractures after TKA with a stem extension, to report treatment outcomes, and to determine whether dual-plate fixation is superior to single-plate fixation regarding the radiographic bone union time and incidence of metal failure.

This retrospective study included 15 knees with periprosthetic fractures after TKA using a stem extension. We demonstrated the fracture characteristics and management according to the fracture location and implant stability. The radiographic union time was determined. Complications, range of motion, and functional outcomes, including Western Ontario and McMaster Universities Osteoarthritis Index and Knee Society Score were assessed. Periprosthetic fractures after TKA with stem extension were 1 metaphyseal fracture without implant loosening, 7 diaphyseal fractures adjacent to the stem without implant loosening, 3 diaphyseal fractures away from the stem without implant loosening, and 4 fractures with implant loosening.

Treatment included immobilization using a long leg cast, open reduction and internal fixation (ORIF), and re-revision TKA. There was no difference in functional outcomes and range of motion pre- and posttreatment. The complications included 2 cases of subsequent implant loosening. Patients in the dual-plating required a shorter bony union time than those in the single-plating (2.4 ± 1.1 vs 7.4 ± 2.2 months; P = .003).

Periprosthetic fractures after TKA with stem extension could be managed individually according to the fracture location and implant stability. Complications were not uncommon even if patients were able to return to their preinjury functional level posttreatment. To avoid complications after ORIF, the dual plate was superior to the single plate, and subtle implant loosening should not be overlooked.
The effects of repetitive transcranial magnetic stimulation on the whole-brain functional network of postherpetic neuralgia patients
Authors: Pei Qian , Zhuo Zhizheng , Jing Bin , Meng Qianqian , Ma Xiangyu , Mo Xiao , Liu Han , Liang Wei , Ni Jiaxiang , Li Haiyun
Published: June 2019

The effects of repetitive transcranial magnetic stimulation (rTMS), the clinical treatment for postherpetic neuralgia (PHN), on whole-brain functional network of PHN patients is not fully understood.

To explore the effects of rTMS on the whole-brain functional network of PHN patients.

10 PHN patients (male/female: 5/5 Age: 63–79 years old) who received rTMS treatment were recruited in this study. High-resolution T1-weighted and functional Magnetic Resonance Imaging (fMRI) were acquired before and after 10 consecutive rTMS sessions. The whole-brain functional connectivity networks were constructed by Pearson correlation. Global and node-level network parameters, which can reflect the topological organization of the brain network, were calculated to investigate the characteristics of whole-brain functional networks. Non-parametric paired signed rank tests were performed for the above network parameters with sex and age as covariates. P < .05 (with FDR correction for multi-comparison analysis) indicated a statistically significant difference. Correlation analysis was performed between the network parameters and clinical variables.

The rTMS showed significant increase in characteristic path length and decrease of clustering coefficient, global, and local efficiency derived from the networks at some specific network sparsity, but it showed no significant difference for small-worldness. rTMS treatment showed significant differences in the brain regions related to sensory-motor, emotion, cognition, affection, and memory, as observed by changes in node degree, node betweenness, and node efficiency. Besides, node-level network parameters in some brain areas showed significant correlations with clinical variables including visual analog scales (VAS) and pain duration.

rTMS has significant effects on the whole-brain functional network of PHN patients with a potential for suppression of sensory-motor function and improvement of emotion, cognition, affection, and memory functions.
Encephalitis caused by Listeria monocytogenes in a healthy adult male in China
Authors: Li Na , Huang Hua qiong , Zhang Gen sheng , Hua Wen , Shen Hua hao
Published: June 2019

Rationale:

Listeria monocytogenes rarely affects immunocompetent adults, and only a few cases of encephalitis caused by L monocytogenes in humans have been reported in China.

Patient concerns

: A 37-year-old male patient presented with headache and fever of 38°C to 39°C for 2 days and dysphoria and dystrophy for 1 day.

Diagnosis:

The patient was diagnosed as having encephalitis, and his cerebrospinal fluid (CSF) and blood cultures tested positive for L monocytogenes.

Interventions:

The patient was treated with intravenous vancomycin, meropenem, mannitol, methylprednisolone, and enteral nutrition. The computed tomography (CT) scan showed swelling of the brain and hydrocephalus. The patient was treated with emergent surgery, a ventricular drainage tube was inserted, and the CSF was drained daily.

Outcomes:

Despite adequate therapy, the illness was severe and progressed rapidly. The patient died 2 weeks after admission.

Lessons:

We report a rare case of L monocytogenes encephalitis in a previously healthy immunocompetent adult in China. The patient's CT scans showed increasing brain swelling and hydrocephalus, and the patient's condition progressively deteriorated.
Preoperative computerized tomography-guided blue dye localization for metastatic lymphadenopathy and peritoneal tumor implants during laparoscopic surgery
Authors: Yang Bi Li , Chen Kuo Chang , Wu Chin Chu
Published: June 2019

Rationale:

Computerized tomography (CT)-guided blue dye localization has been widely discussed for preoperative localization of pulmonary nodules. However, few studies have investigated this technique for intra-abdominal lesions. Although preoperative localization is not commonly required in laparotomy, it may assume importance with advancements in the field of laparoscopic surgery.

Patient concerns:

Herein, we report the cases of 2 patients diagnosed with colon cancer who underwent hemicolectomy with extended lymphadenectomy and subsequent chemotherapy.

Diagnoses:

Follow-up CT scans showed newly developed metastatic lymphadenopathy and peritoneal tumor implants.

Interventions:

Considering the difficulty in identification of and access to the target lesions during laparoscopic surgery, preoperative CT-guided blue dye localization was performed in both cases.

Outcomes:

All the target lesions were identified by the dye marker and removed successfully. The pathologic results revealed adenocarcinoma.

Lessons:

We established the following strategy for preoperative CT-guided dye localization of intra-abdominal lesions:

Intra-abdominal lesions that are hard to identify due to their size or morphology, and difficult to approach due to their location or surrounding structures, maybe the candidates for this procedure, especially in cases of laparoscopic surgery.

Operators should adjust their localization planning based on the surgery method, cutting path, and location of port sites. The target dye marker should be clearly visible in the presumed intra-operative field of view.

A second dye marker should be made to ensure surgical success when the target dye marker is obscured by the surrounding structures in the presumed intra-operative field of view.
Total and Differential White Blood Cell Counts, Cocaine, and Marijuana Use in Patients With Schizophrenia
Authors: Goetz Ryan L. , Miller Brian J.
Published: June 2019

Schizophrenia is associated with blood inflammatory marker abnormalities. Illicit drug use, which is common in schizophrenia, may modulate inflammatory marker levels. We examined effects of marijuana and cocaine use on white blood cell (WBC) counts in acutely ill, hospitalized patients with schizophrenia using a within-subjects and between-groups design. Mean total and differential WBC counts were first compared in acutely ill patients with schizophrenia for hospitalizations with and without either marijuana (n = 18) or cocaine (n = 24) use. Mean total and differential WBC counts were then compared between patients with schizophrenia with either marijuana or cocaine use and patients with a negative urine drug screen (UDS; n = 43). Patients with schizophrenia had significantly higher total WBC, lymphocytes, and monocytes during hospitalizations with (vs. without) cocaine use. Patients with cocaine use also had significantly higher monocytes and eosinophils than those with a negative UDS. Our findings suggest that substance use, particularly of cocaine, may modulate inflammatory marker levels in acutely ill, hospitalized patients with schizophrenia.
Daily Functioning in Schizophrenia
Authors: Buonocore Mariachiara , Bosinelli Francesca , Bechi Margherita , Spangaro Marco , Cocchi Federica , Bianchi Laura , Guglielmino Carmelo , Baraldi Maria Alice , Anchora Lavinia , Bringheli Serena , Cavallaro Roberto , Bosia Marta
Published: June 2019

The present study aims at evaluating the impact of anxiety on functional outcome in patients with schizophrenia, also taking into account the other main predictors of functioning identified by literature, to disentangle specific subcomponents which contribute to functional outcome. One hundred five patients with DSM-IV-TR schizophrenia were recruited and underwent a broad functional, psychopathological, and clinical-neuropsychological battery. A forward stepwise regression model was used to assess the predictive effect of anxiety and other factors on daily functioning, showing significant results only for global neurocognitive status and anxiety. These results confirm the role of neurocognition and are also in line with the hypothesis that trait anxiety has a direct impact on functional outcome. Overall, the findings support the role of anxiety as a core feature of schizophrenia pathology, with important implications for both research and clinical settings.
Superiority of Dynamic Needle Tip Positioning for Ultrasound-Guided Peripheral Venous Catheterization in Patients Younger Than 2 Years Old: A Randomized Controlled Trial*
Authors: Takeshita Jun , Yoshida Takayuki , Nakajima Yasufumi , Nakayama Yoshinobu , Nishiyama Kei , Ito Yukie , Shimizu Yoshiyuki , Takeuchi Muneyuki , Shime Nobuaki
Published: June 2019

Objectives:

This study evaluated whether the dynamic needle tip positioning technique increased the success rate of ultrasound-guided peripheral venous catheterization in pediatric patients with a small-diameter vein compared with the static ultrasound-guided technique.

Design:

Randomized controlled study.

Setting:

Single institution, Osaka Women’s and Children’s Hospital.

Patients:

The study population included 60 pediatric patients less than 2 years old who required peripheral venous catheterization in the PICU.

Interventions:

Patients were randomly divided into the dynamic needle tip positioning (n = 30) or static group (n = 30). Each group received ultrasound-guided peripheral venous catheterization with or without dynamic needle tip positioning, respectively. The Fisher exact test, Kaplan-Meier curve plots, log-rank tests, and Mann-Whitney U test were used in the statistical analysis.

Measurements and Main Results:

The first-attempt success rate was higher in the dynamic needle tip positioning group than in the static group (86.7% vs 60%; p = 0.039; relative risk = 1.44; 95% CI, 1.05–2.0). The overall success rate within 10 minutes was higher in the dynamic needle tip positioning group than in the static group (90% vs 63.3%; p = 0.03; relative risk = 1.42; 95% CI, 1.06–1.91). Significantly fewer attempts were made in the dynamic needle tip positioning group than in the static group (median [interquartile range, range] = 1 [1–1, 1–2] vs 1 [1–2, 1–3]; p = 0.013]). The median (interquartile range) catheterization times were 51.5 seconds (43–63 s) and 71.5 seconds (45–600 s) in the dynamic needle tip positioning and static groups, respectively (p = 0.01).

Conclusions:

Dynamic needle tip positioning increased the first-attempt and overall success rates of ultrasound-guided peripheral venous catheterization in pediatric patients less than 2 years old.
Healthcare Provider Perceptions of Cardiopulmonary Resuscitation Quality During Simulation Training*
Authors: Troy Lindsey , Knight Lynda , Olson Michelle , Chen Michael , Gonzales Ralph , Berg Marc , Su Felice ,   on behalf of the Revive Initiative at Stanford Children’s Health
Published: June 2019

Objectives:

To assess the relationship between quantitative and perceived cardiopulmonary resuscitation performance when healthcare providers have access to and familiarity with audiovisual feedback devices.

Design:

Prospective observational study.

Setting:

In situ simulation events throughout a pediatric quaternary care center where the use of continuous audiovisual feedback devices during cardiopulmonary resuscitation is standard.

Subjects:

Healthcare providers who serve as first responders to in-hospital cardiopulmonary arrest.

Interventions:

High-fidelity simulation of resuscitation with continuous audiovisual feedback.

Measurements and Main Results:

Objective data was collected using accelerometer-based measurements from a cardiopulmonary resuscitation defibrillator/monitor. After the simulation event but before any debriefing, participants completed self-evaluation forms to assess whether they believed the cardiopulmonary resuscitation performed met the American Heart Association guidelines for chest compression rate, chest compression depth, chest compression fraction, chest compression in target, and duration of preshock pause and postshock pause. An association coefficient (kappa) was calculated to determine degree of agreement between perceived performance and the quantitative performance data that was collected from the CPR defibrillator/monitor. Data from 27 mock codes and 236 participants was analyzed. Average cardiopulmonary resuscitation performance was chest compression rate 106 ± 10 compressions per minute; chest compression depth 2.05 ± 0.6 in; chest compression fraction 74% ± 10%; chest compression in target 22% ± 21%; preshock pause 8.6 ± 7.2 seconds; and postshock pause 6.4 ± 8.9 seconds. When all healthcare providers were analyzed, the association coefficient (κ) for chest compression rate (κ = 0.078), chest compression depth (κ = 0.092), chest compression fraction (κ = 0.004), preshock pause (κ = 0.321), and postshock pause (κ = 0.40) was low, with no variable achieving moderate agreement (κ > 0.4).

Conclusions:

Cardiopulmonary resuscitation performance during mock codes does not meet the American Heart Association’s quality recommendations. Healthcare providers have poor insight into the quality of cardiopulmonary resuscitation during mock codes despite access to and familiarity with continuous audiovisual feedback.
High Rates of PrEP Eligibility but Low Rates of PrEP Access Among a National Sample of Transmasculine Individuals
Authors: Golub Sarit A. , Fikslin Rachel A. , Starbuck Lila , Klein Augustus
Published: June 2019

Background:

Transmasculine individuals have been largely ignored in HIV prevention research, and there is a lack of data regarding this population's eligibility for and utilization of HIV pre-exposure prophylaxis (PrEP).

Setting:

National online survey conducted in the United States.

Methods:

Between May and July 2017, we surveyed 1808 transmasculine individuals (aged 18–60 years; 30% people of color and/or Latinx), asking questions about sexual behavior and receipt of sexual health care, including PrEP. We examined the number of individuals who would meet eligibility criteria for PrEP and then used log-linked Poisson regression with robust variance estimation to examine predictors of PrEP eligibility.

Results:

Almost one-quarter of the sample (n = 439; 24.3%) met one or more criterion for PrEP eligibility. PrEP eligibility did not differ by age, race/ethnicity, education, or binary gender identity. PrEP eligibility was lower among heterosexual-identified and higher income participants, and was higher among participants who were in open relationships and reported substance use. Among PrEP-eligible individuals, 64.9% had received an HIV test in the past year, 33.9% had received PrEP information from a provider, and 10.9% (n = 48) had received a PrEP prescription. PrEP-eligible individuals who had received a PrEP prescription were more likely to have a binary gender identity, identify as gay, and be taking testosterone.

Conclusions:

A substantial proportion of transmasculine individuals meet PrEP eligibility criteria, but few are receiving adequate PrEP services. Enhanced efforts should be made by providers, programs, and systems to assess HIV-related risk in transmasculine patients and engage them in comprehensive sexual health care.
Implications of Demographics and Socioeconomic Factors in Breast Cancer Reconstruction
Authors: Zahedi Sanam , Colvill Kayla , Lopez Mariela , Phillips Linda G.
Published: June 2019

Background

Not all women undergo breast reconstruction despite its vital role in the recovery process. Previous studies have reported that women who are ethnically diverse and of lower socioeconomic status are less likely to undergo breast reconstruction, but the reasons remain unclear. The purpose of this study is to evaluate the demographic characteristics of our patient population and their primary reason for not undergoing breast reconstruction.

Methods

An institutional review board-approved, single-institution study was designed to evaluate all female breast cancer patients of all stages who underwent mastectomy but did not undergo breast reconstruction from 2008 to 2014. Patients were contacted via telephone and asked to participate in a validated, prompted survey. Data regarding their demographic information and primary reason for not undergoing breast reconstruction were collected.

Results

Inclusion criteria were met by 181 patients, of which 61% participated in the survey. Overall, the most common reason for not undergoing breast reconstruction (26%) was unwillingness to undergo further procedures. However, the most common reason for patients that identified as Hispanic, Spanish-speaking, high school graduates, or having an annual income less than US $25,000 (P < 0.05) was insufficient information received.

Conclusions

This study demonstrates that ethnicity and socioeconomic factors play a key role in determining why patients forego breast reconstruction. Ethnicity, language, education, income, and employment status are associated with patients not receiving appropriate education regarding their reconstructive options. Breast surgeons with a diverse patient population should ensure that these patients are adequately educated regarding their options, and if perhaps, more of these patients would decide to partake in the reconstruction process.
Challenges in Microsurgical Reconstruction for Craniofacial Osteomyelitis With Resultant Osteonecrosis
Authors: Couto Rafael A. , Sinclair Nicholas R. , Lamaris Gregory , Durand Paul , Knackstedt Rebecca , Aliotta Rachel , Gastman Brian R.
Published: June 2019

Introduction:

Chronic osteomyelitis is characterized by compromised blood supply and eventual osteonecrosis. Definitive treatment requires aggressive resection of affected bone. The resultant defect poses a unique challenge to reconstructive surgeons. Much of the literature on craniofacial osteomyelitis focuses on infection eradication, rather than subsequent reconstruction. This article reports representative cases from our experience with free flap reconstruction for defects secondary to chronic osteomyelitis of the craniofacial skeleton.

Methods/Results:

The authors selected 5 of the most difficult reconstructive cases of craniofacial osteomyelitis from our experience in a single tertiary referral institution with a follow-up of at least 6 months. Three of the 5 cases arose in the setting of previous head and neck cancer treated with resection and radiation therapy. One case had a previous surgical craniotomy complicated by osteomyelitis and multiple failed alloplastic reconstructions. The final case was due to multiple gunshots to the head, with subsequent cerebral and cranial abscess (>1000cc). In each case, the defect was successfully treated with free tissue transfer. Two cases required creation of recipient vessels with an arteriovenous loop.

Conclusions:

Free tissue transfer provides a versatile and effective tool in the reconstruction of extensive craniofacial osteomyelitis defects. Furthermore, the addition of vascularized tissue can protect against further episodes of osteomyelitis. Finally, arteriovenous loops can be employed successfully when prior radiation and infection of the wound bed precludes the use of local recipient target vessels.
Intraoperative Computed Tomography Scan for Orbital Fracture Reconstruction
Authors: Nazimi Abd Jabar , Khoo Soo Ching , Nabil Syed , Nordin Rifqah , Lan Tan Huann , Rajandram Rama Krsna , Rajaran Jothi Raamahlingam
Published: June 2019

Orbital fractures pose specific challenge in its surgical management. One of the greatest challenges is to obtain satisfactory reconstruction by correct positioning of orbital implant. Intraoperative computed tomography (CT) scan may facilitate this procedure. The aim of this study was to describe the early use of intraoperative CT in orbital fractures repair in our center. The authors assessed the revision types and rates that have occurred with this technique. With the use of pre-surgical planning, optical intraoperative navigation, and intraoperative CT, the impact of intraoperative CT on the management of 5 cases involving a total number of 14 orbital wall fractures were described. There were 6 pure orbital blowout wall fractures reconstructed, involving both medial and inferior wall of the orbit fracturing the transition zone and 8 impure orbital wall fractures in orbitozygomaticomaxillary complex fracture. 4 patients underwent primary and 1 had delayed orbital reconstruction. Intraoperative CT resulted in intraoperative orbital implant revision, following final navigation planning position, in 40% (2/5) of patients or 14% (2/14) of the fractures. In revised cases, both implant repositioning was conducted at posterior ledge of orbit. Intraoperative CT confirmed true to original reconstruction of medial wall, inferior wall and transition zone of the orbit. Two selected cases were illustrated. In conclusion, intraoperative CT allows real-time assessment of fracture reduction and immediate orbital implant revision, especially at posterior ledge. As a result, no postoperative imaging was indicated in any of the patients. Long-term follow-ups for orbital fracture patients managed with intraoperative CT is suggested.
Accelerated Biochemical Kinetic Model Fitting via the Asynchronous, Generalized Island Method
Authors: Medley J Kyle , Asifullah Shaik , Hellerstein Joseph , Sauro Herbert M
Published: June 2019

Mechanistic kinetic models of biological pathways are an important tool for understanding biological systems. Constructing kinetic models requires fitting the parameters to experimental data. However, parameter fitting on these models is a non–convex, non–linear optimization problem. Many algorithms have been proposed to addressing optimization for parameter fitting including globally convergent, population–based algorithms. The computational complexity of the this optimization for even modest models means that parallelization is essential. Past approaches to parameter optimization have focused on parallelizing a particular algorithm. However, this requires re–implementing the algorithm usinga distributed computing framework, which requires a significant investment of time and effort. There are two major drawbacks of this approach: First, the choice of best algorithm may depend on the model. Given the large variety of optimization algorithms available, it is difficult to re–implement every potentially useful algorithm. Second, when new advances are made in a given optimization algorithm, the parallel implementation must be updated to take advantage of these advantages. Thus, there is a continual burden placed on the parallel implementation. The drawbacks of re–implementing algorithms lead us to a different approach to parallelizing parameter optimization. Instead of parallelizing the algorithms themselves, we run many instances of the algorithm on single cores. This provides great flexibility as to the choice of algorithms by allowing us to reuse previous implementations. Also, it does not require the creation and maintenance of parallel versions of optimization algorithms. This approach is known as the island method. To our knowledge, the utility of the island method for parameter fitting in systems biology has not been previously demonstrated. For the parameter fitting problem, we allow islands to exchange information about their “best” solutions so that all islands leverage the discoveries of the few. This turns out to be avery effective in practice, leading to super–linear speedups. That is, if a single processor finds the optimal value of parameters in time t, then N processors exchanging information in this way find the optimal value much faster than t/N. We show that the island method is able to consistently provide good speedups for these problems. We also benchmark the island method against a variety of large, challenging kinetic models and show that it is able to consistently improve the quality of fit in less time than a single–threaded implementation.Our software is available at https://github.com/sys-bio/sabaody under a Apache 2.0 license.

Contact

mailto:medjk@comcast.net
A Multidimensional Array Representation of State-Transition Model Dynamics
Authors: Krijkamp Eline M. , Alarid-Escudero Fernando , Enns Eva A. , Pechlivanoglou Petros , Hunink M.G. Myriam , Jalal Hawre J.
Published: June 2019

Cost-effectiveness analyses often rely on cohort state-transition models (cSTMs). The cohort trace is the primary outcome of cSTMs, which captures the proportion of the cohort in each health state over time (state occupancy). However, the cohort trace is an aggregated measure that does not capture the information about the specific transitions among the health states (transition dynamics). In practice, these transition dynamics are crucial in many applications, such as incorporating transition rewards or computing various epidemiological outcomes that could be used for model calibration and validation (e.g. disease incidence and lifetime risk). In this manuscript we propose modifying the transitional cSTMs cohort trace computation to compute and store cSTMs dynamics that capture both state occupancy and transition dynamics. This approach produces a multidimensional matrix from which both the state occupancy and the transition dynamics can be recovered. We highlight the advantages and potential applications of this approach with an example coded in R to facilitate the implementation of our method.
Novel immune and stromal subtype classification system of lung adenocarcinoma based on tumor microenvironment
Authors: Zeng Zihang , Li Jiali , Zhang Nannan , Jiang Xueping , Gao Yanping , Xu Liexi , Liu Xingyu , Chen Jiarui , Gao Yuke , Han Linzhi , Ren Jiangbo , Gong Yan , Xie Conghua
Published: June 2019

Background

Tumor microenvironment has complex effects on tumorigenesis and metastasis in lung adenocarcinoma (LUAD). However, there is still a lack of comprehensive understanding of the relationship between immune and non-immune stromal characteristics in tumor microenvironment.

Patients and methods

Eight cohort of 1681 lung caner patients were included in this study. The immune and non-immune stromal signatures of tumor microenvironment were identified by eigendecomposition and extraction algorithms. We developed a novel immune and stromal scoring system to quantify anti-tumor immune and promote-metastasis stromal activation, namely PMBT (prognostic model based on tumor microenvironment) as an R package. Tumors were classified into 4 subtypes according to PMBT system. Comprehensive analysis was performed in different subtypes.

Results

The 4 subgroups had different mutation landscape, molecular, cellular characteristics and prognosis, which validated by 7 data sets containing 1175 patients. 19% patients was characterized by highly active anti-tumor reaction with high production of immunoactive mediators, immunocyte, low fibroblasts infiltration, low TGF-β, VEGFA, collagen and glucose catabolic, low immune checkpoint per T cell, tumor mutation burden, and favourable overall survival (all, P < 0.05) named high-immune and low-stromal activation subgroup (HL). Cellular paracrine network showed both high humoral and cellular immune interaction in HL group. The low-immune and high-stromal activation group (19%) had opposite characteristics with HL group. Moreover, the PMBT system showed the value to predict overall survival and immunotherapy responses (all, P < 0.05).

Conclusions

Different molecular, cellular characteristics, mutation landscape and prognosis were discovered in the 4 subgroups. Our classification, PMBT system provided novel insight for clinical monitoring and treatment in LUAD.
Decomposing Retrosynthesis into Reactive Center Prediction and Molecule Generation
Authors: Liu Xianggen , Li Pengyong , Song Sen
Published: June 2019

Chemical retrosynthesis has been a crucial and challenging task in organic chemistry for several decades. In early years, retrosynthesis is accomplished by the disconnection approach which is labor-intensive and requires expert knowledge. Afterward, rule-based methods have dominated in retrosynthesis for years. In this study, we revisit the disconnection approach by leveraging deep learning (DL) to boost its performance and increase the explainability of DL. Concretely, we propose a novel graph-based deep-learning framework, named DeRetro, to predict the set of reactants for a target product by executing the process of disconnection and reactant generation orderly. Experimental results report that DeRetro achieves new state-of-the-art performance in predicting the reactants. In-depth analyses also demonstrate that even without the reaction type as input, DeRetro retains its retrosynthesis performance while other methods show a significant decrease, resulting in a large margin of 19% between DeRetro and previous state-of-the-art rule-based method. These results have established DeRetro as a powerful and useful computational tool in solving the challenging problem of retrosynthetic analysis.
Cortical temporal hierarchy is immature in middle childhood
Authors: Moraczewski Dustin , Nketia Jazlyn , Redcay Elizabeth
Published: June 2019

The development of successful social-cognitive abilities requires one to track, accumulate, and integrate knowledge of other people’s mental states across time. Regions of the brain differ in their temporal scale (i.e., a cortical temporal hierarchy) and those receptive to long temporal windows may facilitate social-cognitive abilities; however, the cortical development of long timescale processing remains to be investigated. The current study utilized naturalistic viewing to examine cortical development of long timescale processing and its relation to social-cognitive abilities in middle childhood – a time of expanding social spheres and increasing social-cognitive abilities. We found that, compared to adults, children exhibited reduced low-frequency power in the temporo-parietal junction (TPJ) and reduced specialization for long timescale processing within the TPJ and other regions broadly implicated in the default mode network and higher-order visual processing. Further, specialization for long timescales within the right dorsal medial prefrontal cortex became more ‘adult-like’ as a function of children’s comprehension of character mental states. These results suggest that cortical temporal hierarchy in middle childhood is immature and may be important for an accurate representation of complex naturalistic social stimuli during this age.