bluuebunny/crossref_metadata_2025 huggingface dataset:
Colossal permittivity and impedance analysis of niobium and aluminum co-doped TiO2 ceramics
Authors: Liu Guocai , Fan Huiqing , Xu Jun , Liu Zhiyong , Zhao Yuwei
Published: May 2016

Niobium and aluminum co-doped TiO2 ceramics, i.e., (Nb0.5Al0.5)xTi1−xO2 (x = 0, 0.01, 0.05, 0.1, 0.15, abbreviated as NAT100x) were synthesized via a solid-state reaction route.
Spectroscopic and microscopic investigation of the effects of bacteria on dental implant surfaces
Authors: Rodrigues Danieli C. , Sridhar Sathyanarayanan , Gindri Izabelle M. , Siddiqui Danyal A. , Valderrama Pilar , Wilson Thomas G. , Chung Kwok-Hung , Wadhwani Chandur
Published: May 2016

The surface morphology and chemical composition of commercially pure titanium dental implants and healing abutments exposed in vitro or in vivo to oral bacteria were studied.
Porous polymer microneedles with interconnecting microchannels for rapid fluid transport
Authors: Liu Liming , Kai Hiroyuki , Nagamine Kuniaki , Ogawa Yudai , Nishizawa Matsuhiko
Published: May 2016

We report a porous polymer microneedle array with continuous micropores that has high mechanical strength and water absorption speed.
A highly effective Ni-modified MnOx catalyst for total oxidation of propane: the promotional role of nickel oxide
Authors: Xie Yujie , Guo Yun , Guo Yanglong , Wang Li , Zhan Wangcheng , Wang Yunsong , Gong Xueqing , Lu Guanzhong
Published: May 2016

Adding Ni (Ni/Mn of 0.2) into an MnOx catalyst greatly enhanced its catalytic performance for propane total oxidation.
Porphyrins bearing corannulene pincers: outstanding fullerene receptors
Authors: Denis Pablo A. , Yanney Michael
Published: May 2016

Porphyrins and corannulenes join forces to trap fullerenes with unprecedented strength!
Calibration of bandgap voltage reference using chopping technique and IIR filter
Authors: Um J.‐Y.
Published: May 2016

A calibration scheme is proposed for a bandgap voltage reference. The proposed scheme calibrates an offset voltage of operational trans‐conductance amplifier (OTA) of a bandgap reference which is the critical source of an output‐voltage deviation of the bandgap reference. The proposed calibration is based on a chopping technique which makes an output voltage of OTA modulate. An infinite impulse response (IIR) filter is used to average out the modulated output voltage of OTA. The output voltage of IIR filter is fed into gate node of a Positive‐channel Metal‐Oxide Semiconductor (PMOS) current source which is located in the final output branch. As a result, the output reference voltage becomes insensitive to the offset voltage of OTA. The proposed circuit was verified through Monte‐Carlo simulations by using thick‐oxide transistors in a 0.13 μm CMOS process. In the simulation results, the proposed calibration suppresses the deviation of output reference voltage up to 1.94 mV for the temperature range between −40°C and 125°C. Also, the deviation of output reference voltage is reduced by 24.5 times through proposed calibration.
Recovering defective Landsat 7 Enhanced Thematic Mapper Plus images via multiple linear regression model
Authors: Sadiq Asmaa , Sulong Ghazali , Edwar Loay
Published: May 2016

Since 2003, the scan line corrector (SLC) of the Landsat 7 Enhanced Thematic Mapper Plus (ETM+) sensor has failed permanently, inhibiting the retrieval or scanning of 22% of the pixels in each Landsat 7 SLC‐off image. This utter failure has seriously limited the scientific applications and usability of ETM+ data. Precise and complete recovery of the missing pixels for the Landsat 7 SLC‐off images is a challenging issue and developing an efficient gap‐fill algorithm with improved ETM+ data usability has been ever‐demanding. In this study, a new gap filling method has been introduced to reconstruct the SLC‐off images via multi‐temporal SLC‐off auxiliary fill images. A correlation is established between the corresponding pixels in the target SLC‐off image and two auxiliary fill images in parallel using the multiple linear regressions model. Both simulated and actual defective Landsat 7 images were tested to assess the performance of the proposed model by comparing with two multi‐temporal data based methods, the local linear histogram matching method and Neighbourhood Similar Pixel Interpolator method. The quantitative evaluations indicate that the proposed method makes an accurate estimate of the missing values even for more temporally distant fill images.
Joint estimation of target state and ionospheric height bias in over‐the‐horizon radar target tracking
Authors: Geng Hang , Liang Yan , Yang Feng , Xu Linfeng , Pan Quan
Published: May 2016

Up to now, all over‐the‐horizon radar‐based tracking methods have the prerequisite that the virtual ionospheric height, as the key ionosphere state, should be known, or should be estimated from the provided ionospheric measurements, or at least the prior statistical information of the ionosphere should be given. However, the ionospheric height is intermittently evolving and hence deviates from its nominal value. Therefore, no matter the virtual ionospheric height is directly given by ionosondes or estimated from the ionospheric measurements or prior statistical information, it may have ionospheric height bias. Here, the authors propose the problem of joint estimation of target state and ionospheric height bias in clutters. The problem is reformulated as the multi‐rate state estimation with random coefficient matrices. Then, the linear minimum mean square error estimator with causality constraints is designed and extended to the non‐linear measurement model via iterative optimisation. The proposed method is shown effective in the simulation about tracking one target in the case of four resolvable propagation modes.
Analyse des Zusammenhangs zwischen regionaler Deprivation und Inanspruchnahme – Ein Diskussionsbeitrag zur Ermittlung des Arztbedarfes in Deutschland
Authors: Kopetsch T. , Maier W.
Published: May 2016

Hintergrund: Bei der anstehenden Neukonzeption der Bedarfsplanung soll die Sozial- und Morbiditätsstruktur der Bevölkerung bei der Ermittlung einer bedarfsgerechten Versorgung Berücksichtigung finden. Das Ziel des Beitrages besteht darin, zu untersuchen, inwiefern der Grad der regionalen Deprivation bei der Berechnung des regionalen fachgruppenspezifischen Ärztebedarfes in Deutschland berücksichtigt werden sollte.

Methoden: Zur Messung des regionalen Deprivationsstatus auf Kreisebene verwendeten wir den im Helmholtz Zentrum München entwickelten „German Index of Multiple Deprivation“ (GIMD). Für die Landkreise und kreisfreien Städte Deutschlands wurden Scores für deren jeweiligen Deprivationsstatus berechnet. Die Berechnung des deprivationsadjustierten Ärztebedarfes erfolgte mittels linearer Regressionsanalysen. Dabei wurden regionalisierte ambulante Abrechnungsdaten und Arztzahldaten zugrunde gelegt. Die Analysen wurden mit dem Software-Paket SPSS, Version 20, durchgeführt.

Ergebnisse: Die Analysen zeigten einen deutlichen positiven Zusammenhang zwischen regionaler Deprivation und der Inanspruchnahme medizinischer Leistungen in Form von ambulanten und stationären Fällen einerseits, sowie Sterblichkeit und Morbidität, gemessen durch den RSA-Risikofaktor, andererseits. Es zeigten sich darüber hinaus Zusammenhänge unterschiedlicher Intensität zwischen dem Grad der Deprivation und der Inanspruchnahme von 12 Arztgruppen der Bedarfsplanung auf Kreisebene. Darauf aufbauend wurde ein Algorithmus entwickelt, mit dessen Hilfe die kreisbezogene Deprivation in eine Erhöhung oder Verringerung der facharztbezogenen Verhältniszahl umgerechnet werden kann.

Diskussion und Schlussfolgerung: Mithilfe des GIMD und diverser Determinanten medizinischer Inanspruchnahme konnte im Modell der gesteigerte medizinische Bedarf bei erhöhter regionaler Deprivation gezeigt werden. Allerdings reicht in dieser Analyse das statistische Niveau (R2) der Zusammenhänge im vertragsärztlichen Bereich für die einzelnen Facharztgruppen nicht aus, um allein darauf ein Planungssystem zu implementieren, das mit Einschränkungen der Berufsfreiheit einhergeht. Im Einzelfall, sprich: Sonderbedarfszulassungen, kann das entwickelte Instrumentarium aufgrund seines geringen Aufwandes und der damit verbundenen Praktikabilität geeignet sein, Mehr- oder Minderbedarfe an Ärzten auf regionaler Ebene auszuweisen.
New procedure to measure simultaneously the surface tension and contact angle
Authors: Champmartin S. , Ambari A. , Le Pommelec J. Y.
Published: May 2016

This paper proposes a new procedure to simultaneously measure the static contact angle and the surface tension of a liquid using a spherical geometry. Unlike the other existing methods, the knowledge of one of both previous parameters and the displacement of the sphere are not mandatory. The technique is based on the measurement of two simple physical quantities: the height of the meniscus formed on a sphere at the very contact with a liquid bath and the resulting vertical force exerted on this object at equilibrium. The meniscus height, whose exact value requires the numerical resolution of the Laplace equation, is often estimated with an approximate 2D model, valid only for very large spheres compared to the capillary length. We develop instead another simplified solution of the Young-Laplace equation based on the work of Ferguson for the meniscus on a cylinder and adapted for the spherical shape. This alternative model, which is less restrictive in terms of the sphere size, is successfully compared to numerical solutions of the complete Young-Laplace equation. It appears to be accurate for sphere radii larger than only two capillary lengths. Finally the feasibility of the method is experimentally tested and validated for three common liquids and two “small” steel spheres.
Mechanism and energetics of O and O2 adsorption on polar and non-polar ZnO surfaces
Authors: Gorai Prashun , Seebauer Edmund G. , Ertekin Elif
Published: May 2016

Polar surfaces of semiconducting metal oxides can exhibit structures and chemical reactivities that are distinct from their non-polar surfaces. Using first-principles calculations, we examine O adatom and O2 molecule adsorption on 8 different known ZnO reconstructions including Zn-terminated (Zn–ZnO) and O-terminated (O–ZnO) polar surfaces, and non-polar surfaces. We find that adsorption tendencies are largely governed by the thermodynamic environment, but exhibit variations due to the different surface chemistries of various reconstructions. The Zn–ZnO surface reconstructions which appear under O-rich and H-poor environments are found to be most amenable to O and O2 adsorption. We attribute this to the fact that on Zn–ZnO, the O-rich environments that promote O adsorption also simultaneously favor reconstructions that involve adsorbed O species. On these Zn–ZnO surfaces, O2 dissociatively adsorbs to form O adatoms. By contrast, on O–ZnO surfaces, the O-rich conditions required for O or O2 adsorption tend to promote reconstructions involving adsorbed H species, making further O species adsorption more difficult. These insights about O2 adsorption on ZnO surfaces suggest possible design rules to understand the adsorption properties of semiconductor polar surfaces.
Rate and temperature dependences of the yield stress of commercial titanium under conditions of shock-wave loading
Authors: Kanel G. I. , Razorenov S. V. , Garkushin G. V.
Published: May 2016

The evolution of elastic-plastic shock waves with the propagation distance has been studied in annealed titanium of commercial purity at temperatures 20 °C and 600 °C. The free surface velocity histories of the shock-loaded samples 0.25–4.0 mm in thickness have been recorded using the Velocity Interferometer System for Any Reflector. The measured decays of the elastic precursor waves have been converted into relationships between the shear stress and the initial plastic strain rate at the Hugoniot elastic limit. It has been found that the temperature practically does not influence on the resistance to high-rate plastic deformation: the plastic strain rate varies with the shear stress as γ̇=2.5×106(τ/τ0)4.8 s−1 at 20 °C and γ̇=2.9×106(τ/τ0)4.9 s−1 at 600 °C. An analysis of the rise times of the plastic shock waves has shown that for the same level of shear stress, the plastic strain rate after small compressive strain is more than by order of magnitude higher than the initial plastic strain rate at the wave's foot. Such acceleration of the plastic deformation seems to be a result of an intense multiplication of the mobile dislocations or twins.
Ultrafast electronic and vibrational dynamics in brominated aluminum corroles: Energy relaxation and triplet formation
Authors: Stensitzki T. , Yang Y. , Berg A. , Mahammed A. , Gross Z. , Heyne K.
Published: May 2016

We combined femtosecond (fs) VIS pump–IR probe spectroscopy with fs VIS pump–supercontinuum probe spectroscopy to characterize the photoreaction of the hexacoordinated Al(tpfc-Br8)(py)2 in a comprehensive way. Upon fs excitation at ∼400 nm in the Soret band, the excitation energy relaxes with a time constant of (250 ± 80) fs to the S2 and S1 electronic excited states. This is evident from the rise time of the stimulated emission signal in the visible spectral range. On the same time scale, narrowing of broad infrared signals in the C=C stretching region around 1500 cm−1 is observed. Energy redistribution processes are visible in the vibrational and electronic dynamics with time constants between ∼2 ps and ∼20 ps. Triplet formation is detected with a time constant of (95 ± 3) ps. This is tracked by the complete loss of stimulated emission. Electronic transition of the emerging triplet absorption band overlaps considerably with the singlet excited state absorption. In contrast, two well separated vibrational marker bands for triplet formation were identified at 1477 cm−1 and at 1508 cm−1. These marker bands allow a precise identification of triplet dynamics in corrole systems.
Resource-use maximisation through legume intercropping with maize in the eastern Himalayan region of India
Authors: Choudhary V. K. , Dixit Anil , Chauhan Bhagirath S.
Published: May 2016

Intercropping provides opportunity to harness available resources. Thus, maize intercropped with soybean or peanut (groundnut) was tested with 1 : 1, 1 : 2, and 1 : 5 row proportions along with sole plantings of each crop to measure resource capture and resource-use efficiency. Results revealed that sole peanut had 60% higher maize-equivalent yield and 55% better production efficiency, followed by the 1 : 5 row proportion of maize–peanut, over sole maize. Intercropping increased land-use efficiency by 17–53% and land-equivalent coefficient by 0.21–0.56. The relative crowding coefficient was 39% higher with 1 : 2 maize–soybean, whereas the monetary advantage index was the highest (US$107) with the 1 : 5 maize–peanut. Nitrogen (N) and potassium (K) uptakes by maize were 42.9% and 38.2%, respectively, higher with 1 : 5 maize–soybean, whereas phosphorus (P) uptake was 64% higher with 1 : 5 maize–peanut. However, the least amounts of N, P and K were mined overall with 1 : 5 of maize–soybean. Soil moisture content was improved by 24% and solar radiation interception by 37.8% with soybean alone over maize alone, and these parameters increased with higher row proportions of soybean. The energy parameters also improved with the 1 : 5 row proportions of maize–soybean or peanut intercropping. This study provides a basis for efficient resource use by maize–soybean (or peanut) intercropping system.
Direct and essential function for Hrd3 in ER-associated degradation
Authors: Vashistha Nidhi , Neal Sonya E. , Singh Amanjot , Carroll Sarah M. , Hampton Randolph Y.
Published: May 2016

Significance

The HRD (HMG-CoA reductase degradation) pathway is a conserved eukaryotic route of protein destruction, removing misfolded proteins by ER-associated degradation (ERAD). Hrd1 and Hrd3 are each required for substrate degradation. Hrd1 is the core E3 ligase of the HRD pathway, but the function of Hrd3 has remained unclear. Loss of Hrd3 causes extreme destabilization and loss of Hrd1. Thus, it had not been possible to ascertain whether Hrd3 had ERAD functions distinct from Hrd1 stabilization. We have leveraged our understanding of Hrd1 degradation to uncouple Hrd1 stability from Hrd3 presence, allowing us to demonstrate unequivocally that Hrd3 has a direct and essential role in ER quality control. This work sets the stage for biologically relevant, translatable studies of this critical stress management pathway.
Managing atrial fibrillation in primary care
Authors: DePalma Sondra M.
Published: May 2016

Primary care providers frequently encounter patients with atrial fibrillation (AF), a dysrhythmia associated with significant morbidity and mortality. This article examines two common treatment strategies, rate control and rhythm control, for regulating AF and managing symptoms.
Lessons From a Care Management Pilot Program for People With Acquired Brain Injury
Authors: Bruner-Canhoto Laney , Savageau Judith , Croucher Deborah , Bradley Kathryn
Published: May 2016

Problem:

From November 2010 to August 2013, 161 adults with acquired brain injury in Massachusetts transitioned from long-term care settings to the community through a Medicaid-funded waiver. Most participants transitioned with minimal risk; for some, the transition resulted in an increase in risk incidents above the rest. Specifically, despite risk mitigation efforts, 11% of the participants accounted for more than 75% of the reported first year incidents.

Solution:

A registered nurse Care Manager was engaged in a pilot program to address the needs of participants at the highest risk. Based on incidents or potential for incidents, 30 participants were enrolled in care management (CM).

Methods:

Secondary data analysis, interviews, and surveys assessed whether CM was associated with a decrease in incidents and to what extent participants and providers were satisfied with CM.

Results:

Care management was significantly associated with a decrease in incidents including hospitalizations and emergency room visits. Participants, Case Managers, and service providers were highly satisfied with the Care Manager.

Conclusions:

Focusing on a specific population with increased risk, clearly explaining the purpose of CM, and remaining flexible when addressing the complex and individual nature of risk management are important strategies to ensure an effective CM program.
An Interdisciplinary Education Initiative to Promote Blood Conservation in Cardiac Surgery
Authors: Goda Tamara S. , Sherrod Brad , Kindell Linda
Published: May 2016

Transfusion practices vary extensively for patients undergoing cardiac surgical procedures, leading to high utilization of blood products despite evidence that transfusions negatively impact outcomes. An important factor affecting transfusion practice is recognition of the importance of teams in cardiac surgery care delivery. This article reports an evidenced-based practice (EBP) initiative constructed using the Society of Thoracic Surgery (STS) 2011 Blood Conservation Clinical Practice Guidelines (CPGs) to standardize transfusion practice across the cardiac surgery team at a large academic medical center. Project outcomes included: a) Improvement in clinician knowledge related to the STS Blood Conservation CPGs; and b) Decreased blood product utilization for patients undergoing cardiac surgical procedures. Participants' scores reflected an improvement in the overall knowledge of the STS CPGs noting a 31.1% (p = 0.012) increase in the number of participants whose practice reflected the Blood Conservation CPGs post intervention. Additionally, there was a reduction in overall blood product utilization for all patients undergoing cardiac surgery procedures post intervention (p = 0.005). Interdisciplinary education based on the STS Blood Conservation CPGs is an effective way to reduce transfusion practice variability and decrease utilization of blood products during cardiac surgery.
Through the Veil of Language: Exploring the Hidden Curriculum for the Care of Patients With Limited English Proficiency
Authors: Kenison Tiffany C. , Madu Andrea , Krupat Edward , Ticona Luis , Vargas Iris M. , Green Alexander R.
Published: May 2016

Purpose

Patients with limited English proficiency (LEP) experience lower-quality health care and are at higher risk of experiencing adverse events than fluent English speakers. Despite some formal training for health professions students on caring for patients with LEP, the hidden curriculum may have a greater influence on learning. The authors designed this study to characterize the hidden curriculum that medical and nursing students experience regarding the care of patients with LEP.

Method

In 2014, the authors invited students from one medical school and one nursing school, who had completed an interprofessional pilot curriculum on caring for patients with LEP 6 to 10 months earlier, to participate in semistructured interviews about their clinical training experiences with LEP patients. The authors independently coded the interview transcripts, compared them for agreement, and performed content analysis to identify major themes.

Results

Thirteen students (7 medical and 6 nursing students) participated. Four major themes emerged: role modeling, systems factors, learning environment, and organizational culture. All 13 students described negative role modeling experiences, and most described role modeling that the authors coded as “indifferent.” Students felt that the current system and learning environment did not support or emphasize high-quality care for patients with LEP.

Conclusions

The hidden curriculum that health professional students experience regarding the care of patients with LEP is influenced by systems limitations and a learning environment and organizational culture that value efficiency over effective communication. Role modeling seems strongly linked to these factors as supervisors struggle with these same challenges.
Race Matters? Examining and Rethinking Race Portrayal in Preclinical Medical Education
Authors: Tsai Jennifer , Ucik Laura , Baldwin Nell , Hasslinger Christopher , George Paul
Published: May 2016

Critical examination of “health disparities” is gaining consideration in medical schools across the United States, often as elective curricula that supplement required education. However, there is disconnect between discussions of race and disparities in these curricula and in core science courses. Specifically, required preclinical science lecturers often operationalize race as a biological concept, framing racialized disparities as inherent in bodies. A three- and five-month sampling of lecture slides at the authors’ medical school demonstrated that race was almost always presented as a biological risk factor.

This presentation of race as an essential component of epidemiology, risk, diagnosis, and treatment without social context is problematic, as a broad body of literature supports that race is not a robust biological category. The authors opine that current preclinical medical curricula inaccurately employ race as a definitive medical category without context, which may perpetuate misunderstanding of race as a bioscientific datum, increase bias among student–doctors, and ultimately contribute to worse patient outcomes.

At the authors’ institution, students approached the medical school administration with a letter addressing the current use of race, urging reform. The administration was receptive to proposals for further analysis of race in medical education and created a taskforce to examine curricular reform. Curricular changes were made as part of the construction of a longitudinal race-in-medicine curriculum. The authors seek to use their initiatives and this article to spark critical discussion on how to use teaching of race to work against racial inequality in health care.
Preliminary Intraoperative Validation of the Nociception Level Index
Authors: Edry Ruth , Recea Vasile , Dikust Yuri , Sessler Daniel I.
Published: May 2016

AbstractAbstract

The nociception level index, based on an algorithmic combination of multiple physiologic measures, was compared with its underlying measures in anesthetized surgical patients. Compared to its individual underlying measures, the multiparametric nociception level index was better able to distinguish nonnoxious and graded noxious stimuli, as well as the response to opioids.

Background

The nociception level (NoL) index is an index of nociception based on nonlinear combination of heart rate, heart rate variability, photoplethysmograph wave amplitude, skin conductance, skin conductance fluctuations, and their time derivatives. The authors evaluated the abilities of the NoL index and other measures of nociception to discriminate between noxious and nonnoxious stimuli, to progressively respond to graded stimuli, and to respond to opioid administration.

Methods

Intraoperative NoL was compared to heart rate, pulse plethysmograph amplitude, noninvasive blood pressure, and the surgical pleth index around five specific stimuli: tetanic stimulation with and without fentanyl analgesia, intubation, first incision/trocar insertion, and a nonnoxious period. The response around first incision was analyzed at two target plasma concentrations of remifentanil.

Results

In 58 patients, the NoL index responded progressively to increased stimulus intensity and remained unchanged in response to nonnoxious stimuli. Compared to other accepted measures of nociception, the NoL index better discriminated noxious from nonnoxious stimuli with an area under the curve of 0.93 (95% CI, 0.89 to 0.97) and a sensitivity of 87% at a specificity of 84%. The NoL index was the only measure that reliably reflected two different analgesic concentrations of remifentanil during initial skin incision or trocar insertion.

Conclusions

The NoL index changes proportionately with patients’ response to various clinical and experimental noxious stimuli and discriminates noxious from nonnoxious stimuli with high sensitivity and specificity. The NoL index also responds progressively to increasing stimuli intensity and is appropriately blunted by analgesic administration. The NoL index was superior to other compared measures and appears to accurately characterize nociception during general anesthesia.
Of Penguins, Pinnipeds, and Poisons
Authors: Firth Paul G.
Published: May 2016

AbstractAbstract

Although Ernest Shackleton’s Endurance Antarctic expedition of 1914 to 1916 is a famous epic of survival, the medical achievements of the two expedition doctors have received little formal examination. Marooned on Elephant Island after the expedition ship sank, Drs. Macklin and McIlroy administered a chloroform anesthetic to crew member Perce Blackborow to amputate his frostbitten toes. As the saturated vapor pressure of chloroform at 0°C is 71.5 mmHg and the minimum alveolar concentration is 0.5% of sea-level atmospheric pressure (3.8 mmHg), it would have been feasible to induce anesthesia at a low temperature. However, given the potentially lethal hazards of a light chloroform anesthetic, an adequate and constant depth of anesthesia was essential. The pharmacokinetics of the volatile anesthetic, administered via the open-drop technique in the frigid environment, would have been unfamiliar to the occasional anesthetist. To facilitate vaporization of the chloroform, the team burned penguin skins and seal blubber under overturned lifeboats to increase the ambient temperature from −0.5° to 26.6°C. Chloroform degrades with heat to chlorine and phosgene, but buildup of these poisonous gases did not occur due to venting of the confined space by the stove chimney. The anesthetic went well, and the patient—and all the ship’s crew—survived to return home.

Ernest Shackleton’s Endurance Antarctic expedition of 1914 to 1916 is a legendary epic of survival. Marooned on Elephant Island after their ship sank, the expedition doctors administered an inhalational chloroform anesthetic in the frigid depths of winter.
Aboriginal Women's Experiences With Gestational Diabetes Mellitus
Authors: Whitty-Rogers Joanne , Caine Vera , Cameron Brenda
Published: May 2016

In Canada, diabetes is 3 to 5 times more common among Aboriginal people than in the general population. Women with a diagnosis of gestational diabetes mellitus have an increased risk of developing glucose intolerance later in life, with almost half developing type II diabetes within 15 years. A participatory action research study using a Two-Eyed Seeing approach was conducted. Conversational interviews with 9 Mi'kmaq women who experienced gestational diabetes mellitus and talking circles were held. Hermeneutic phenomenology was used for data analysis. Themes included life-altering experience; barriers limiting access to health care; social support during pregnancy; and feeling compelled to take action.
The Lived Experience of Pregnancy Among HIV-Positive Refugee Women
Authors: Chulach Teresa , Gagnon Marilou , Holmes Dave
Published: May 2016

Increasingly HIV-positive refugee women are becoming pregnant. The objective of this qualitative study was to describe and explore the meaning and experience of pregnancy from the perspective of HIV-positive refugee women. The phenomenological analysis revealed 4 core themes. “Making up stories” for privacy and protection emerged as the first theme. The second theme illuminates 2 types of isolation: a double isolation based on refugee and HIV statuses, and isolation endured throughout the pregnancy. Being-in-Between describes the third theme. Finally, the fourth theme sheds light on the experience of disconnection: from baby, culture, body/self, and health care providers.
The Mothering Experiences of Women With Substance Use Disorders
Authors: Cleveland Lisa M. , Bonugli Rebecca J. , McGlothen Kelly S.
Published: May 2016

The aim of this qualitative study was to describe the mothering experiences of women with substance use disorders. We conducted semistructured, individual interviews with 15 mothers. Using thematic analysis, 5 themes were identified: (1) facing the reality of a pregnancy complicated by substance use, trauma, and loss, (2) finding a higher meaning, (3) dealing with the consequences, (4) managing the details of daily life, and (5) looking toward a future with my children. Moreover, the women described entering motherhood with uncertainty, fear, shame, and stress. We hope that these findings will lead to more compassionate nursing care for this population.
Targeted treatments of sarcomas and connective tumors beside gastrointestinal stromal tumor
Authors: Martin-Broto Javier , Hindi Nadia
Published: May 2016

Purpose of review

Sarcoma is a heterogeneous group of malignancies historically treated with classic cytotoxic chemotherapy. This review updates the recent advances in targeted therapies in soft-tissue sarcoma, bone sarcoma and other connective diseases with local aggressiveness.

Recent findings

Platelet-derived growth factor receptor (PDGFR) inhibitors, antiangiogenics, cell cycle inhibitors and immunomodulatory agents are the main targeted therapies in development in sarcoma. PDGFRα inhibitor olaratumab is being evaluated in a phase III trial in combination with doxorubicin against doxorubicin in monotherapy and, in case of positive results, it could change the standard in the first-line setting. Immunotherapy is still in the early phases of development, although some data in synovial sarcoma are promising. Targeted agents are also in development in other mesenchymal neoplasms, such as the inhibitor of colony stimulating factor 1 receptor for pigmented villonodular synovitis.

Several targeted therapies are in development in sarcoma and could be added to the therapeutic armamentarium in the near future. However, predictive factors still need to be identified to better select the target population of these new drugs.
Aesthetic Abstracts and Citations
Authors: Briceño César A. , Massry Guy G.
Published: May 2016

In this Aesthetic Abstract and Citations section, we highlight and briefly discuss recently published articles from other peer-reviewed journals that may be of interest to our readership in oculofacial plastic surgery. These are just cursory reviews to pique an interest on subjects, which the individual reader may desire to pursue in more detail by reading the manuscript in full.
Perturbed connectivity of the amygdala and its subregions with the central executive and default mode networks in chronic pain
Authors: Jiang Ying , Oathes Desmond , Hush Julia , Darnall Beth , Charvat Mylea , Mackey Sean , Etkin Amit
Published: May 2016

Maladaptive responses to pain-related distress, such as pain catastrophizing, amplify the impairments associated with chronic pain. Many of these aspects of chronic pain are similar to affective distress in clinical anxiety disorders. In light of the role of the amygdala in pain and affective distress, disruption of amygdalar functional connectivity in anxiety states, and its implication in the response to noxious stimuli, we investigated amygdala functional connectivity in 17 patients with chronic low back pain and 17 healthy comparison subjects, with respect to normal targets of amygdala subregions (basolateral vs centromedial nuclei), and connectivity to large-scale cognitive–emotional networks, including the default mode network, central executive network, and salience network. We found that patients with chronic pain had exaggerated and abnormal amygdala connectivity with central executive network, which was most exaggerated in patients with the greatest pain catastrophizing. We also found that the normally basolateral-predominant amygdala connectivity to the default mode network was blunted in patients with chronic pain. Our results therefore highlight the importance of the amygdala and its network-level interaction with large-scale cognitive/affective cortical networks in chronic pain, and help link the neurobiological mechanisms of cognitive theories for pain with other clinical states of affective distress.
Gabapentin loses efficacy over time after nerve injury in rats: role of glutamate transporter-1 in the locus coeruleus
Authors: Kimura Masafumi , Eisenach James C. , Hayashida Ken-ichiro
Published: May 2016

Despite being one of the first-choice analgesics for chronic neuropathic pain, gabapentin sometimes fails to provide analgesia, but the mechanisms for this lack of efficacy is unclear. Rats with nerve injury including L5-L6 spinal nerve ligation (SNL) respond uniformly and well to gabapentin, but many of these studies are performed within just a few weeks of injury, questioning their relevance to chronic neuropathic pain. In this study, intraperitoneal gabapentin showed a time-dependently reduction in antihypersensitivity after SNL, associated with downregulation of astroglial glutamate transporter-1 (GLT-1) in the locus coeruleus (LC). Consistently, SNL also time-dependently increased basal but masked gabapentin-induced noradrenergic neuronal activity in the LC. In rats 2 weeks after SNL, knock-down of GLT-1 in the LC reduced the antihypersensitivity effect of gabapentin. In rats 8 weeks after SNL, increasing GLT-1 expression by histone deacetylase inhibitor valproate restored the antihypersensitivity effect of gabapentin, associated with restored gabapentin-induced noradrenergic neuronal activity in the LC and subsequent spinal noradrenaline release. Knock-down of GLT-1 in the LC reversed the effect of valproate to restore gabapentin-induced antihypersensitivity. In addition, the antihypersensitivity effect of the intrathecal α2-adrenoceptor agonist clonidine also decreased with time after SNL injury. These results suggest that downregulation of GLT-1 in the LC and reduced spinal noradrenergic inhibition contribute to impaired analgesic efficacy from gabapentin in chronic neuropathic pain and that valproate can rescue this impaired efficacy.
Hospital Characteristics and the Agency for Healthcare Research and Quality Inpatient Quality Indicators: A Systematic Review
Authors: Engineer Lilly D. , Winters Bradford D. , Weston Christine M. , Zhang Allen , Sharma Ritu , Bass Eric , Jones David , Rosen Amy , Yoon Frank B. , Borzecki Ann , Dy Sydney M.
Published: May 2016

Background:

The Agency for Healthcare Research and Quality Inpatient Quality Indicators (IQIs) include inpatient mortality for selected procedures and medical conditions. They have assumed an increasingly prominent role in hospital comparisons. Healthcare delivery and policy-related decisions need to be driven by reliable research that shows associations between hospital characteristics and quality of inpatient care delivered.

Objectives:

To systematically review the literature on associations between hospital characteristics and IQIs.

Methods:

We systematically searched PubMed and gray literature (2000–2012) for studies relevant to 14 hospital characteristics and 17 IQIs. We extracted data for study characteristics, IQIs analyzed, and hospital characteristics (e.g., teaching status, bed size, patient volume, rural vs. urban location, and nurse staffing).

Results:

We included 16 studies, which showed few significant associations. Four hospital characteristics (higher hospital volume, higher nurse staffing, urban vs. rural status, and higher hospital financial resources) had statistically significant associations with lower mortality and selected IQIs in approximately half of the studies. For example, there were no associations between nurse staffing and four IQIs; however, approximately 50% of studies showed a statistically significant relationship between nurse staffing and lower mortality for six IQIs. For two hospital characteristics—higher bed size and disproportionate share percentage—all statistically significant associations had higher mortality. Five hospital characteristics (teaching status, system affiliation, ownership, minority-serving hospitals, and electronic health record status) had some studies with significantly positive and some with significantly negative associations, and many studies with no association.

Conclusions:

We found few associations between hospital characteristics and mortality IQIs. Differences in study methodology, coding across hospitals, and hospital case-mix adjustment may partly explain these results. Ongoing research will evaluate potential mechanisms for the identified associations.
Investigating a Multistakeholder Alliance Approach to Reducing Hospital Readmissions
Authors: Duckett Philethea , Kang Raymond , Hamil Jaime , Harvey Jillian , Goodman David C. , McHugh Megan
Published: May 2016

There is growing appreciation that significant improvements in healthcare quality cannot be achieved by organizations working in isolation. To that end, the Robert Wood Johnson Foundation's Aligning Forces for Quality (AF4Q) initiative provides multistakeholder alliances—groups of payers, purchasers, providers, and consumers that work together—with funding and technical assistance to improve healthcare community wide. Reducing readmissions was one of the several AF4Q goals. Alliances crafted their own interventions, tailored to address the communities' unique needs, and took advantage of local resources. Our objective was to determine whether readmission rates declined more in AF4Q communities than in non-AF4Q communities by year 7 of the 10-year initiative. We conducted a quasiexperimental study using zip code–level demographics and 30-day readmission rates for all medical and surgical discharges using Medicare claims data for 2008 through 2012. This interim analysis found that AF4Q was not associated with significant reductions in medical or surgical readmissions, suggesting that AF4Q's multistakeholder approach was no more effective at reducing readmissions than other national efforts, such as the Hospital Reduction Program under the Affordable Care Act.
Nonspecific abdominal pain in the Emergency Department: malignancy incidence in a nationwide Swedish cohort study
Authors: Ferlander Pia , Elfström Cecilia , Göransson Katarina , von Rosen Anette , Djärv Therese
Published: May 2016

Introduction

The role of emergency physicians is to identify patients in need of immediate treatment, but also to identify symptoms indicative of serious, if not immediately life-threatening conditions.

Aim

To assess whether symptoms described as nonspecific abdominal pain (NSAP) could be the first indication of an abdominal malignancy.

Materials and methods

This was a nationwide registry-based cohort study of all patients discharged with NSAP from Swedish Emergency Departments (EDs) during the year 2011, based on Swedish patient registries of inpatient and outpatient care, and the cause of death registry, studying patients diagnosed with de novo cancer within a year after their NSAP discharge.

Results

Of 24 801 patients discharged with NSAP in 2011, 2.2% were assigned a cancer diagnosis within 12 months. Almost 20% of patients diagnosed with a malignancy died within the year, and 16% of these deaths occurred within a month after the ED visit. The majority of patients with cancer were 60 years of age or older, and thus significantly older than the remaining NSAP patients. Patients with malignancies also had a greater number of comorbidities than the remaining NSAP patients (P<0.01).

Conclusion

A small percentage of patients discharged with NSAP from Swedish EDs are diagnosed with a malignancy within a year. Patients aged 60 years or older and with comorbidities were over-represented in terms of developing malignancies after discharge. Emergency physicians should be aware of the fact that diffuse abdominal symptoms in elderly patients could be the first sign of an underlying malignancy and more liberally refer such patients for follow-up in primary care.
Vorapaxar and Amyotrophic Lateral Sclerosis: Coincidence or Adverse Association?
Authors: Serebruany Victor L. , Fortmann Seth D. , Hanley Daniel F. , Kim Moo Hyun
Published: May 2016

Background:

Vorapaxar, a novel antiplatelet thrombin PAR-1 inhibitor, is currently approved for post myocardial infarction and peripheral artery disease indications with concomitant use of clopidogrel and/or aspirin. The vorapaxar safety profile was acceptable. However, aside from heightened bleeding risks, excesses of solid cancers and diplopia, there were more amyotrophic lateral sclerosis (ALS) diagnoses after vorapaxar.

Study Question:

To assess the Food and Drug Administration (FDA) reviews on the potential association of vorapaxar with ALS.

Study Design:

The review the public FDA records on reported adverse events after vorapaxar.

Measures and Outcomes:

Incidence of ALS after vorapaxar and placebo.

Results:

The ALS risk appears very small, about 1 case per 10,000 treated subjects, but quite probable. Indeed, there were overall 2 placebo and 4 vorapaxar ALS incidences in the Phase III clinical trials.

Conclusions:

Potential adverse association of vorapaxar with ALS risks may be related to off-target neuronal PAR receptor(s) blockade beyond platelet inhibition.
Racial/Ethnic Disparities in Influenza Vaccination of Chronically Ill US Adults
Authors: Bleser William K. , Miranda Patricia Y. , Jean-Jacques Muriel
Published: May 2016

Background:

Despite well-established programs, influenza vaccination rates in US adults are well below federal benchmarks and exhibit well-documented, persistent racial and ethnic disparities. The causes of these disparities are multifactorial and complex, though perceived racial/ethnic discrimination in health care is 1 hypothesized mechanism.

Objectives:

To assess the role of perceived discrimination in health care in mediating influenza vaccination RACIAL/ETHNIC disparities in chronically ill US adults (at high risk for influenza-related complications).

Research Design:

We utilized 2011–2012 data from the Aligning Forces for Quality Consumer Survey on health and health care (n=8127), nationally representative of chronically ill US adults. Logistic regression marginal effects examined the relationship between race/ethnicity and influenza vaccination, both unadjusted and in multivariate models adjusted for determinants of health service use. We then used binary mediation analysis to calculate and test the significance of the percentage of this relationship mediated by perceived discrimination in health care.

Results:

Respondents reporting perceived discrimination in health care had half the uptake as those without discrimination (32% vs. 60%, P=0.009). The change in predicted probability of vaccination given perceived discrimination experiences (vs. none) was large but not significant in the fully adjusted model (−0.185; 95% CI, −0.385, 0.014). Perceived discrimination significantly mediated 16% of the unadjusted association between race/ethnicity and influenza vaccination, though this dropped to 6% and lost statistical significance in multivariate models.

Conclusions:

The causes of persistent racial/ethnic disparities are complex and a single explanation is unlikely to be sufficient. We suggest reevaluation in a larger cohort as well as potential directions for future research.
The curious origins of angioimmunoblastic T-cell lymphoma
Authors: Cortés José R. , Palomero Teresa
Published: May 2016

Purpose of review

Once an obscure disease, recent studies have transformed our understanding of angioimmunoblastic T-cell lymphoma (AITL). In this review, we summarize new major advances in the genetics and biology of AITL.

Recent findings

Genome wide sequencing studies have dissected the repertoire of the genetic alterations driving AITL uncovering a highly recurrent Gly17Val somatic mutation in the small GTPase RHOA and major role for mutations in epigenetic regulators, such as TET2, DNMT3A and IDH2, and signaling factors (e.g., FYN and CD28). These findings support a multistep model of follicular T helper cell transformation in AITL and pinpoint novel candidates for the development of targeted therapies in this disease.

AITL originates from follicular T helper cells and is characterized by the presence of RHOA G17V mutation together with genetic alterations in TET2, DNMT3A, and IDH2. Research efforts now focus on the elucidation of the specific roles and interplay of these genetic alterations in the pathogenesis of AITL.
Cognitive reserve and preinjury educational attainment: effects on outcome of community-based rehabilitation for longer-term individuals with acquired brain injury
Authors: Fortune Dónal G. , Walsh R. Stephen , Richards Helen L.
Published: May 2016

The cognitive reserve hypothesis has been proposed to account for the mismatch between brain pathology and its clinical expression. The aim of the current research was to explore, in a longitudinal data set, the effects of level of educational attainment before brain injury (cognitive reserve) and clinical factors on the level of rehabilitation-induced changes in disability and community integration. Participants in receipt of postacute rehabilitation were assessed at induction to the service and again at between 14 and 18 months of follow-up while still in service on changes in aspects of their abilities, adjustment and participation (Mayo Portland Adaptability Indices) and community integration (Community Integration Questionnaire). Controlling for type and severity of injury, age at onset of injury and duration of time since injury, participants with higher previous educational attainment showed significantly greater changes over the course of rehabilitation on adjustment to their injury and participation, but not on abilities, or community integration following postacute rehabilitation. Level of education would appear to be an important element of cognitive reserve in brain injury that serves to aid responses to postacute rehabilitation in terms of an individual’s adjustment to disability and participation.