bluuebunny/crossref_metadata_2025 huggingface dataset:
Operando
study of Pd(100) surface during CO oxidation using ambient pressure x-ray photoemission spectroscopy
Authors: Yu Youngseok , Kim Dongwoo , Lim Hojoon , Kim Geonhwa , Koh Yoobin E. , Kim Daehyun , Ueda Kohei , Hiwasa Satoru , Mase Kazuhiko , Bournel Fabrice , Gallet Jean-Jacques , Rochet François , Crumlin Ethan J. , Ross Philip N. , Kondoh Hiroshi , Noh Do Young , Mun Bongjin Simon
Published: January 2019

The surface chemical states of Pd(100) during CO oxidation were investigated using ambient pressure x-ray photoelectron spectroscopy and mass spectroscopy. Under the reactant ratio of CO/O2 = 0.1, i.e. an oxygen-rich reaction condition, the formation of surface oxides was observed with the onset of CO oxidation reaction at T = 525 K. As the reactant ratio (CO/O2) increased from 0.1 to 1.0, ∼ 90 % surface oxides remains on surface during the reaction. Upon the formation of surface oxides, the core level shift of oxygen gas phase peak was observed, indicating that change of surface work function. As CO oxidation takes places, i.e. making a transition from CO covered surface to the oxidic surface, the work functions of surface oxide on Pd(100) and Pt(110) display opposite behavior.
A generalized Debye-Hückel theory of electrolyte solutions
Authors: Liu Jinn-Liang , Li Chin-Lung
Published: January 2019

We propose a generalized Debye-Hückel (DH) theory by using a recent Poisson-Fermi model that accounts for the steric, correlation, and polarization effects of ions and water treated as nonuniform spheres with interstitial voids. The generalized DH theory reduces to the classical one when these effects are not considered. The Debye length is also generalized to include the steric effect. The new theory yields an electrolyte (analytical) equation of state for calculating the activity coefficient of aqueous electrolyte solutions, which is of fundamental importance in thermodynamic modeling for a variety of chemical and biological systems. Results obtained by the analytical equation well fit experimental data for eight 1:1 and six 2:1 electrolytes with only three adjustable parameters. By contrast, the DH models extended from the classical DH theory such as the Pitzer model can have several to great many parameters due to explosive combinations of wide ranges of composition, temperature, and pressure.
Multipoint measurements employing a microwave interferometer and a Langmuir probe in the detached linear plasma
Authors: Natsume H. , Tanaka H. , Kajita S. , Yoshikawa M. , Seki M. , Ohshima H. , Ohno N.
Published: January 2019

Multipoint measurements were carried out by employing a microwave interferometer (MI) and a Langmuir probe (LP) in steady-state detached plasmas in the linear plasma device NAGDIS-II to reveal the structure of fluctuations along the magnetic field. We changed the LP position along the magnetic field while the MI was fixed at an upstream position. In addition, a fast framing camera was used to identify an azimuthal mode number, and the predominant mode number was identified as m = 1. By analyzing correlations between signals observed by the LP and the MI, it was found that a time delay of 10–20 kHz fluctuations gradually decreased toward the downstream direction. The results indicate a decrease in the rotation velocity in the E × B direction, and suggest that the 10–20 kHz fluctuation forms a spiral shape.
Nonlinear information data mining based on time series for fractional differential operators
Authors: Wu Shaofei
Published: January 2019

The use of mathematical methods has become an indispensable research tool and method in the establishment and improvement of many disciplines. Therefore, mathematical methods have also been included in the intelligence analysis system of public security information science. Intelligence is a summary of information that exists in all aspects of our lives. This information is distributed according to time based on certain rules. The application of mathematical analysis methods can more accurately extract effective information and predict future trends. As we all know, classical calculus is a powerful tool for dealing with many dynamic processes in the field of applied science. However, there are many complex systems in nature that cannot be characterized by classical integer-order calculus models, especially in information processing analysis. The fractional-order system model can better describe its system performance. This paper introduces the time series analysis method into the public security intelligence analysis system, combines the fractional differential operator to construct the mathematical model, analyzes the network intelligence, predicts the future occurrence of the case, and compares the predicted data with the actual data to verify. The method is predictive of the true credibility of the results.
A 30-year journey from volume-regulated anion currents to molecular structure of the LRRC8 channel
Authors: Strange Kevin , Yamada Toshiki , Denton Jerod S.
Published: January 2019

The swelling-activated anion channel VRAC has fascinated and frustrated physiologists since it was first described in 1988. Multiple laboratories have defined VRAC’s biophysical properties and have shown that it plays a central role in cell volume regulation and possibly other fundamental physiological processes. However, confusion and intense controversy surrounding the channel’s molecular identity greatly hindered progress in the field for >15 yr. A major breakthrough came in 2014 with the demonstration that VRAC is a heteromeric channel encoded by five members of the Lrrc8 gene family, Lrrc8A–E. A mere 4 yr later, four laboratories described cryo-EM structures of LRRC8A homomeric channels. As the melee of structure/function and physiology studies begins, it is critical that this work be framed by a clear understanding of VRAC biophysics, regulation, and cellular physiology as well as by the field’s past confusion and controversies. That understanding is essential for the design and interpretation of structure/function studies, studies of VRAC physiology, and studies aimed at addressing the vexing problem of how the channel detects cell volume changes. In this review we discuss key aspects of VRAC biophysics, regulation, and function and integrate these into our emerging understanding of LRRC8 protein structure/function.
A conserved mechanism for mitochondria-dependent dynein anchoring
Authors: Kraft Lauren M. , Lackner Laura L.
Published: January 2019

Mitochondrial anchors have functions that extend beyond simply positioning mitochondria. In budding yeast, mitochondria drive the assembly of the mitochondrial anchor protein Num1 into clusters, which serve to anchor mitochondria as well as dynein to the cell cortex. Here, we explore a conserved role for mitochondria in dynein anchoring by examining the tethering functions of the evolutionarily distant Schizosaccharomyces pombe Num1 homologue. In addition to its function in dynein anchoring, we find that S. pombe Num1, also known as Mcp5, interacts with and tethers mitochondria to the plasma membrane in S. pombe and Saccharomyces cerevisiae. Thus, the mitochondria and plasma membrane-binding domains of the Num1 homologues, as well as the membrane features these domains recognize, are conserved. In S. pombe, we find that mitochondria impact the assembly and cellular distribution of Num1 clusters and that Num1 clusters actively engaged in mitochondrial tethering serve as cortical attachment sites for dynein. Thus, mitochondria play a critical and conserved role in the formation and distribution of dynein-anchoring sites at the cell cortex and, as a consequence, impact dynein function. These findings shed light on an ancient mechanism of mitochondria-dependent dynein anchoring that is conserved over more than 450 million years of evolution, raising the intriguing possibility that the role mitochondria play in dynein anchoring and function extends beyond yeast to higher eukaryotes.
Tristetraprolin-mediated hexokinase 2 expression regulation contributes to glycolysis in cancer cells
Authors: Kim Dong Jun , Vo Mai-Tram , Choi Seong Hee , Lee Ji-Heon , Jeong So Yeon , Hong Chung Hwan , Kim Jong Soo , Lee Unn Hwa , Chung Hyung-Min , Lee Byung Ju , Cho Wha Ja , Park Jeong Woo
Published: January 2019

Hexokinase 2 (HK2) catalyzes the first step of glycolysis and is up-regulated in cancer cells. The mechanism has not been fully elucidated. Tristetraprolin (TTP) is an AU-rich element (ARE)-binding protein that inhibits the expression of ARE-containing genes by enhancing mRNA degradation. TTP expression is down-regulated in cancer cells. We demonstrated that TTP is critical for down-regulation of HK2 expression in cancer cells. HK2 mRNA contains an ARE within its 3′-UTR. TTP binds to HK2 3′-UTR and enhances degradation of HK2 mRNA. TTP overexpression decreased HK2 expression and suppressed the glycolytic capacity of cancer cells, measured as glucose uptake and production of glucose-6-phosphate, pyruvate, and lactate. TTP overexpression reduced both the extracellular acidification rate (ECAR) and the oxygen consumption rate (OCR) of cancer cells. Ectopic expression of HK2 in cancer cells attenuated the reduction in glycolytic capacity, ECAR, and OCR from TTP. Taken together, these findings suggest that TTP acts as a negative regulator of HK2 expression and glucose metabolism in cancer cells.
Price Discovery in Agricultural Futures Markets: Should We Look beyond the Best Bid‐Ask Spread?
Authors: Arzandeh Mehdi , Frank Julieta
Published: January 2019

Price discovery is the incorporation of information to prices through the actions of traders. Previous studies in financial markets have found evidence that informed traders may submit limit orders instead of market orders as part of their trading strategies. If so, the steps of limit order book (LOB) beyond the best bid and best ask spread (BAS) may contain valuable information and contribute to price discovery of the underlying asset. This is the first attempt to examine the informativeness of the LOB beyond the BAS for agricultural commodities. We reconstruct the LOB using market depth data and use three information share approaches to test to what extent the steps of LOB beyond the BAS contribute to price discovery. This is done for five major agricultural commodities, namely live cattle, lean hogs, corn, wheat, and soybeans, as well as the E‐mini Standard and Poor's 500 Index (S&P 500) futures contracts. The results show that the steps of the LOB beyond the BAS contribute by over 27% to price discovery of futures contracts. Across agricultural commodities, the steps of the LOB beyond the BAS have more information for grains than meats. Moreover, beyond the BAS, the steps closer to the top of the book contain more information for livestock and E‐mini S&P 500. For grains, the steps farther from the BAS are as informative as the steps closer to the BAS. These findings suggest that informed traders in futures electronic markets actively use limit orders with price steps beyond the BAS.
Development of an antimicrobial stewardship program in an integrated healthcare system
Authors: Lane Michael A , Hays Amanda J , Newland Helen , Zack Jeanne E , Guth Rebecca M , Newland Jason G
Published: January 2019

Purpose

The development of an inpatient antimicrobial stewardship program (ASP) in an integrated healthcare system is described.

With increasing national focus on reducing inappropriate antimicrobial use, state and national regulatory mandates require hospitals to develop ASPs. In 2015, BJC HealthCare, a multihospital health system, developed a system-level, multidisciplinary ASP team to assist member hospitals with ASP implementation. A comprehensive gap analysis was performed to assess current stewardship resources, activities and compliance with CDC core elements at each facility. BJC system clinical leads facilitated the development of hospital-specific leadership support statements, identification of hospital pharmacy and medical leaders, and led development of staff and patient educational components. An antimicrobial-use data dashboard was created for reporting and tracking the impact of improvement activities. Hospital-level interventions were individualized based on the needs and resources at each facility. Hospital learnings were shared at bimonthly system ASP meetings to disseminate best practices. The initial gap analysis revealed that BJC hospitals were compliant in a median of 6 ASP elements (range, 4–8) required by regulatory mandates. By leveraging system resources, all hospitals were fully compliant with regulatory requirements by January 2017.

Conclusion

BJC’s ASP model facilitated the development of broad-based stewardship activities, including education modules for patients and providers and clinical decision support, while allowing hospitals to implement activities based on local needs and resource availability.
Coccidioidal Meningitis in New York Traced to Texas by Fungal Genomic Analysis
Authors: Barker Bridget M , Rajan Sujatha , De Melo Teixeira Marcus , Sewnarine Michelle , Roe Chandler , Engelthaler David M , Galgiani John N
Published: January 2019

A child developed hydrocephalus. Sixteen months later, it was discovered to be a complication of coccidioidal meningitis. The infection’s source was uncertain until genomic analysis of the fungal isolate identified its origin to be a visit to Beeville, Texas. Improved national reporting of cases of coccidioidomycosis might reduce diagnostic delays.
Oxalate nephropathy is a major cause of kidney injury in surgically treated pancreatic adenocarcinoma patients
Authors: Desbuissons Geoffroy , Izzedine Hassan , Bardier Armelle , Dubreuil Olivier , Vaillant Jean Christophe , Frochot Vincent , Mercadal Lucile
Published: January 2019

Background

Despite new therapeutics, the prognosis for pancreatic cancer remains poor. Pancreatic surgery is a therapeutic option in non-metastatic forms. The consequences for renal function are poorly described.

Methods

Patients who underwent surgery for pancreatic cancer between 1 January 2010 and 1 January 2017 and who experienced kidney biopsy in the Pitié-Salpêtrière Hospital were analysed.

Results

Two hundred and ninety-four patients had pancreatic surgery during the period of analysis and five of them had a kidney biopsy (mean ± SD 20 months ±13.6 months after surgery) during the post-operative follow-up. Among these patients, three exhibited oxalate nephropathy (ON), indicating that the prevalence of ON in patients with pancreatectomy is at least 1%. ON may be insidious, with chronic renal failure without urinary abnormalities. All patients had a high oxalate-to-creatinine ratio in urine sample. Renal function improved after specific management of ON in two patients. Pancreaticoduodenectomy may represent a higher risk of ON than left pancreatectomy.

Conclusion

Although rare and underestimated, ON appears to be a real risk after pancreatic resection. Early detection may preserve renal function.
A current understanding of drug-induced QT prolongation and its implications for anticancer therapy
Authors: Roden Dan M
Published: January 2019

The QT interval, a global index of ventricular repolarization, varies among individuals and is influenced by diverse physiologic and pathophysiologic stimuli such as gender, age, heart rate, electrolyte concentrations, concomitant cardiac disease, and other diseases such as diabetes. Many drugs produce a small but reproducible effect on QT interval but in rare instances this is exaggerated and marked QT prolongation can provoke the polymorphic ventricular tachycardia ‘torsades de pointes’, which can cause syncope or sudden cardiac death. The generally accepted common mechanism whereby drugs prolong QT is block of a key repolarizing potassium current in heart, IKr, generated by expression of KCNH2, also known as HERG. Thus, evaluation of the potential that a new drug entity may cause torsades de pointes has relied on exposure of normal volunteers or patients to drug at usual and high concentrations, and on assessment of IKr block in vitro. More recent work, focusing on anticancer drugs with QT prolonging liability, is defining new pathways whereby drugs can prolong QT. Notably, the in vitro effects of some tyrosine kinase inhibitors to prolong cardiac action potentials (the cellular correlate of QT) can be rescued by intracellular phosphatidylinositol 3,4,5-trisphosphate, the downstream effector of phosphoinositide 3-kinase. This finding supports a role for inhibition of this enzyme, either directly or by inhibition of upstream kinases, to prolong QT through mechanisms that are being worked out, but include enhanced inward ‘late’ sodium current during the plateau of the action potential. The definition of non-IKr-dependent pathways to QT prolongation will be important for assessing risk, not only with anticancer therapies but also with other QT prolonging drugs and for generating a refined understanding how variable activity of intracellular signalling systems can modulate QT and associated arrhythmia risk.
Association of the coronary artery disease risk gene GUCY1A3 with ischaemic events after coronary intervention
Authors: Kessler Thorsten , Wolf Bernhard , Eriksson Niclas , Kofink Daniel , Mahmoodi Bakhtawar K , Rai Himanshu , Tragante Vinicius , Åkerblom Axel , Becker Richard C , Bernlochner Isabell , Bopp Roman , James Stefan , Katus Hugo A , Mayer Katharina , Munz Matthias , Nordio Francesco , O’Donoghue Michelle L , Sager Hendrik B , Sibbing Dirk , Solakov Linda , Storey Robert F , Wobst Jana , Asselbergs Folkert W , Byrne Robert A , Erdmann Jeanette , Koenig Wolfgang , Laugwitz Karl-Ludwig , ten Berg Jurrien M , Wallentin Lars , Kastrati Adnan , Schunkert Heribert
Published: January 2019

Aim

A common genetic variant at the GUCY1A3 coronary artery disease locus has been shown to influence platelet aggregation. The risk of ischaemic events including stent thrombosis varies with the efficacy of aspirin to inhibit platelet reactivity. This study sought to investigate whether homozygous GUCY1A3 (rs7692387) risk allele carriers display higher on-aspirin platelet reactivity and risk of ischaemic events early after coronary intervention.

Methods and results

The association of GUCY1A3 genotype and on-aspirin platelet reactivity was analysed in the genetics substudy of the ISAR-ASPI registry (n = 1678) using impedance aggregometry. The clinical outcome cardiovascular death or stent thrombosis within 30 days after stenting was investigated in a meta-analysis of substudies of the ISAR-ASPI registry, the PLATO trial (n = 3236), and the Utrecht Coronary Biobank (n = 1003) comprising a total 5917 patients. Homozygous GUCY1A3 risk allele carriers (GG) displayed increased on-aspirin platelet reactivity compared with non-risk allele (AA/AG) carriers [150 (interquartile range 91–209) vs. 134 (85–194) AU⋅min, P < 0.01]. More homozygous risk allele carriers, compared with non-risk allele carriers, were assigned to the high-risk group for ischaemic events (>203 AU⋅min; 29.5 vs. 24.2%, P = 0.02). Homozygous risk allele carriers were also at higher risk for cardiovascular death or stent thrombosis (hazard ratio 1.70, 95% confidence interval 1.08–2.68; P = 0.02). Bleeding risk was not altered.

Conclusion

We conclude that homozygous GUCY1A3 risk allele carriers are at increased risk of cardiovascular death or stent thrombosis within 30 days after coronary stenting, likely due to higher on-aspirin platelet reactivity. Whether GUCY1A3 genotype helps to tailor antiplatelet treatment remains to be investigated.
CLT for Fluctuations of Linear Statistics in the Sine-beta Process
Authors: Leblé Thomas
Published: January 2019

We prove, for any $\beta>0$, a central limit theorem for the fluctuations of linear statistics in the $\textrm{Sine}_{\beta }$ process, which is the infinite volume limit of the random microscopic behavior in the bulk of one-dimensional log-gases at inverse temperature $\beta $. If $\overline{\varphi }$ is a compactly supported test function of class $C^4$, and ${\mathcal{C}}$ is a random point configuration distributed according to $\textrm{Sine}_{\beta }$, the integral of $\overline{\varphi }(\cdot / \ell )$ against the random fluctuation $d{\mathcal{C}} - dx$ converges in law, as $\ell $ goes to infinity, to a centered normal random variable whose standard deviation is proportional to the Sobolev $H^{1/2}$ norm of $\overline{\varphi }$ on the real line. The proof relies on the Dobrushin–Landford–Ruelle equations for $\textrm{Sine}_{\beta }$ established by Dereudre–Hardy–Maïda and the author, the Laplace transform trick introduced by Johansson, and a transportation method previously used for $\beta $-ensembles at macroscopic scale.
Evidence for Household Transmission of Rotavirus in the United States, 2011–2016
Authors: Wikswo Mary E , Parashar Umesh D , Lopman Benjamin , Selvarangan Rangaraj , Harrison Christopher J , Azimi Parvin H , Boom Julie A , Sahni Leila C , Englund Janet A , Klein Eileen J , Staat Mary Allen , McNeal Monica M , Halasa Natasha , Chappell James , Weinberg Geoffrey A , Szilagyi Peter G , Esona Mathew D , Bowen Michael D , Payne Daniel C
Published: January 2019

Background

Rotavirus is a leading cause of acute gastroenteritis (AGE) in children and is highly transmissible. In this study, we assessed the presence of AGE in household contacts (HHCs) of pediatric patients with laboratory-confirmed rotavirus.

Methods

Between December 2011 and June 2016, children aged 14 days to 11 years with AGE were enrolled at 1 of 7 hospitals or emergency departments as part of the New Vaccine Surveillance Network. Parental interviews, medical and vaccination records, and stool specimens were collected at enrollment. Stool was tested for rotavirus by an enzyme immunoassay and confirmed by real-time or conventional reverse transcription-polymerase chain reaction assay or repeated enzyme immunoassay. Follow-up telephone interviews were conducted to assess AGE in HHCs the week after the enrolled child’s illness. A mixed-effects multivariate model was used to calculate odds ratios.

Results

Overall, 829 rotavirus-positive subjects and 8858 rotavirus-negative subjects were enrolled. Households of rotavirus-positive subjects were more likely to report AGE illness in ≥1 HHC than were rotavirus-negative households (35% vs 20%, respectively; P < .0001). A total of 466 (16%) HHCs of rotavirus-positive subjects reported AGE illness. Of the 466 ill HHCs, 107 (23%) sought healthcare; 6 (6%) of these encounters resulted in hospitalization. HHCs who were <5 years old (odds ratio, 2.2 [P = .004]) were more likely to report AGE illness than those in other age groups. In addition, 144 households reported out-of-pocket expenses (median, $20; range, $2–$640) necessary to care for an ill HHC.

Conclusions

Rotavirus-associated AGE in children can lead to significant disease burden in HHCs, especially in children aged <5 years. Prevention of pediatric rotavirus illness, notably through vaccination, can prevent additional illnesses in HHCs.
Environmental impacts on molecular gas in protocluster galaxies at z ∼ 2
Authors: Tadaki Ken-ichi , Kodama Tadayuki , Hayashi Masao , Shimakawa Rhythm , Koyama Yusei , Lee Minju , Tanaka Ichi , Hatsukade Bunyo , Iono Daisuke , Kohno Kotaro , Matsuda Yuichi , Suzuki Tomoko L , Tamura Yoichi , Toshikawa Jun , Umehata Hideki
Published: January 2019

We present the results from ALMA CO(3–2) observations of 66 Hα-selected galaxies in three protoclusters around radio galaxies: PKS 1138−262 ($z$ = 2.16), USS 1558−003 ($z$ = 2.53), and 4C 23.56 ($z$ = 2.49). The pointing areas have an overdensity of ∼100 compared to the mean surface number density of galaxies in field environments. We detect the CO emission line in 16 star-forming galaxies, including six previously published galaxies, to measure the molecular gas mass. In the stellar mass range of 10.5 < log (Mstar/M⊙) < 11.0, the protocluster galaxies have larger gas mass fractions and longer gas depletion timescales compared to the scaling relations established for field galaxies. On the other hand, the amounts of molecular gas in more massive galaxies with log (Mstar/M⊙) > 11.0 are comparable in mass to the scaling relation, or smaller. Our results suggest that the environmental effects on gas properties are mass dependent: in high-density environments, gas accretion through cosmic filaments is accelerated in less massive galaxies, while this is suppressed in the most massive system.
How guideline can shape clinical practice globally: the diagnosis and rationale for action against cow's milk allergy experience
Authors: Dahdah Lamia , Arasi Stefania , Valluzzi Rocco Luigi , Fierro Vincenzo , Fiocchi Alessandro
Published: January 2019

Purpose of review

Allergic diseases are increasing worldwide and are considered an important public health problem causing severe and even life-threatening reactions. The creation of guidelines aims to help clinicians improving the quality of diagnosis and management of such diseases. Clinical practice guidelines alone are not sufficient and there is a need for implementation strategies for their introduction into daily practice. We report here the main international allergy guidelines with a more focused look on the Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guidelines and their effect on clinical practice.

Recent findings

DRACMA guidelines have clearly modified the approach to cow's milk allergy (CMA) from its diagnosis to treatment tailoring the choices for each patient. Although they strongly recommend oral food challenge for diagnosing CMA, they also indicate that it may not be necessary in many cases with the introduction of the pretest probability of CMA. Studies on the implementation of DRACMA guidelines show how they influenced the formula market, making appropriate treatments more affordable.

DRACMA reconciled international differences in the diagnosis and management of CMA. They introduced the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology in the field of food allergy and highlighted the importance for meta-analyses to be able to adapt recommendations to the local context.
Designated Interpreters: A Model to Promote the Diversity and Inclusion of Deaf Professionals in Academic Medicine
Authors: Hall Wyatte C. , Elliott Marlene , Cullen John P.
Published: January 2019

Problem

Deaf professionals who use American Sign Language (ASL) are a growing population in academic medicine. Reasonable accommodations for this group include providing an ASL interpreter. Many institutions contract with external agencies to provide ad hoc interpreters, but this model has hidden costs for deaf professionals and institutions.

Approach

The University of Rochester School of Medicine and Dentistry (URSMD) uses the designated interpreter model in which interpreters are on staff and embedded with deaf professionals so they can learn both the work environment and the deaf professionals’ specialized science and medicine content. This model addresses many of the limitations of the external agency approach and better facilitates the inclusion of deaf professionals in the institution.

Outcomes

This model has been in use at URSMD since 1990 but has seen exponential growth recently (increasing from 3 deaf professionals with designated interpreters in 2011 to a peak of 17 in 2016). Designated interpreters have worked in different research and clinical settings from dentistry and nursing to community and global health. This growth highlights the increasing number of deaf professionals in medicine and the need to train more designated interpreters.

Next Steps

In response to this growing demand, URSMD is developing an ASL Interpreting in Medicine and Science program, a master’s degree–level program to train interpreters who are bilingual in ASL and English to be designated interpreters. The designated interpreter model is one step toward creating an environment that is fully inclusive of deaf professionals to the benefit of the whole institution.
Future Directions of Training Physician–Scientists: Reimagining and Remeasuring the Workforce
Authors: Bensken Wyatt P. , Nath Avindra , Heiss John D. , Khan Omar I.
Published: January 2019

In academic medicine, the attrition of the physician–scientist workforce has been significantly discussed for the past three decades, with substantial attention and funding targeted to stop this attrition and attempt to reinvigorate the workforce. Despite these concerns and efforts, the attrition has not been stopped or even significantly slowed, and thus a further understanding of the physician–scientist workforce is needed with a closer look at how this workforce is measured and quantified. Through reviewing three methods by which physician–scientists are identified and understood, limitations in these definitions arise, leading to the basic question: Who qualifies to be a physician–scientist? Answering this question may lead to developing more comprehensive and less restrictive approaches when qualifying and measuring the physician–scientist workforce and appreciating the varying contributions physicians make to research. Through suggesting an expanded appreciation of these research contributions, recognition of collaboration, and funding models that support both of these aspects, the authors hope to add to the conversation by challenging traditional approaches and encouraging movement toward forward-looking definitions that encourage and promote all physicians to engage with research. This reimagining of physician–scientists will result not just in a remeasuring of the workforce but, subsequently, in strengthening the clinical and translational research continuum as well.
A Trust Initiative in Health Care: Why and Why Now?
Authors: Lynch Timothy J. , Wolfson Daniel B. , Baron Richard J.
Published: January 2019

The authors describe the importance of trust in health care, while noting with concern the documented decline in Americans’ trust in the medical system, its leaders, and to a lesser degree, physicians themselves. They examine a number of reasons for this decline, including both larger societal trends and elements that are specific to health care. They then link trust to medical professionalism, explaining why the ABIM Foundation has decided to champion trust as an issue in the coming years. Finally, they offer thoughts on the specific actions the ABIM Foundation may take, including the launch of a Trust Practice Challenge designed to uncover practices that are currently working to build trust in a variety of practice settings and health care relationships, and the exploration of potential avenues to combat medical misinformation.
Reconstruction of Lumbar Spinal Defects: Case Series, Literature Review, and Treatment Algorithm
Authors: Daly Lauren T. , Amador Ricardo O. , Shin John H. , Bojovic Branko , Eberlin Kyle R.
Published: January 2019

Background:

Lumbar spinal defects present a distinct challenge for the reconstructive surgeon and are often complicated by previous spinal surgery, the presence of hardware, and prior radiation. There are a variety of reconstructive options described but no clear treatment algorithm for these challenging defects.

Methods:

A literature search was performed to review the described treatment options for lumbar spinal soft-tissue defects. Treatments for myelomeningocele or pressure ulcers were excluded. In addition, a retrospective case review was performed for patients with lumbar defects treated with pedicled superior gluteal artery perforator (SGAP) flap reconstruction.

Results:

A literature review revealed 2,022 articles pertaining to lumbar defect reconstruction, of which 56 met inclusion criteria. These articles described 13 individual reconstructive techniques for this anatomic area. The most commonly described techniques were evaluated and a treatment algorithm designed based on patient and wound characteristics. The clinical course of 5 patients with radiated lumbar spinal defects treated with SGAP flaps is presented.

Conclusions:

There are many treatment options for lumbar spinal defects and treatment should be tailored to the patient and the characteristics of the defect. For large or radiated lumbar wounds, the pedicled SGAP flap is an excellent reconstructive choice, as it has reliable anatomy that is outside the zone of injury, adequate bulk, and minimal donor-site deficits.
SUBFOVEAL CHOROIDAL THICKNESS AND VASCULAR ARCHITECTURE IN FELLOW EYES OF PATIENTS WITH CIRCUMSCRIBED CHOROIDAL HEMANGIOMA
Authors: Sobol Ethan K. , Francis Jasmine H. , Abramson David H. , Freund K. Bailey , Spaide Richard F. , Barbazetto Irene
Published: January 2019

Purpose:

To evaluate the subfoveal choroidal thickness (SFCT) and vascular architecture in the fellow eyes of patients with circumscribed choroidal hemangioma (CCH).

Methods:

In this retrospective observational study, patients were selected from outpatient ophthalmology clinics at the Memorial Sloan Kettering Cancer Center and Vitreous Retina Macula Consultants of New York. Subfoveal choroidal thickness was measured using enhanced depth imaging spectral domain optical coherence tomography from the outer portion of Bruch membrane to the choroidal–scleral interface. Choroidal vascular architecture was qualitatively examined. The main outcome measure was SFCT in fellow eyes of patients with CCH, which was compared with an age- and gender-matched control group.

Results:

Thirty-one fellow eyes (15 right eyes and 16 left eyes) of patients with CCH (23 males and 8 females) were examined. The fellow eye had a mean SFCT of 361.2 ± 99.9 μm compared with 252.0 ± 77.6 μm in the control group (P < 0.0001). Vascular architecture was disorganized in 13 (42%) fellow eyes and 1 (3%) control eye (P < 0.0001), with no apparent gradient of vessel sizes or discrete choroidal layers. The normal association between older age and a thinner choroid existed in control eyes but not in fellow eyes. Hemangioma thickness measured by ultrasound and the presence of subfoveal fluid in the CCH eye did not correlate with the fellow-eye SFCT.

Conclusion:

In patients with CCH, fellow eyes had thicker SFCT when compared with age- and gender-matched control eyes. Choroidal architecture was often irregular, without segmented vascular layers. These findings suggest that inherent choroidal changes may exist in patients with CCH.
Analysis of Airway and Midface in Crouzon Syndromes
Authors: Forte Antonio J. , Lu Xiaona , Hashim Peter W. , Steinbacher Derek M. , Alperovich Michael , Persing John A. , Alonso Nivaldo
Published: January 2019

Background

Crouzon syndrome is associated with severe respiratory impairment of the upper airway due in part to midfacial dysmorphology. We calculated the distinctive nasal diameter and pharyngeal airway volume in patients with Crouzon syndrome and compared them with age-matched control subjects.

Methods

Children with computed tomography scans in the absence of surgical intervention were included. Computed tomography scans were digitized and manipulated using Surgicase CMF (Materialise). Craniometric data relating to the midface and airway were collected. For all linear measurements, mean percent increases or decreases were calculated relative to the size of control subjects, and volumetric assessment of the airway was tabulated. Statistical analysis was performed using t test.

Results

Twenty-six computed tomography scans were included (control n = 17, Crouzon n = 9). All children were in early mixed dentition. Pharyngeal airway volume was decreased in patients with Crouzon syndrome relative to control subjects by 46% (P = 0.003). The distance from the posterior tongue to the posterior pharyngeal wall decreased 31% when comparing the Crouzon group versus the control (P = 0.04).

Conclusions

Three-dimensional analysis revealed notably decreased pharyngeal and nasal airway volumes in patients with Crouzon syndrome, but nasal bone tissue and soft tissue measurements showed very little change between patients and control subjects.
Comparison of Costs and Outcomes for In-Office and Operating Room Excision of Nonmelanoma Skin Cancer
Authors: Ovadia Steven A. , Spector Seth A. , Thaller Seth R.
Published: January 2019

Introduction

With increasing health care expenses and limited resources, it is important to evaluate potential means of reducing cost while maintaining efficacy and safety. The purpose of our study was to compare the cost and outcomes of surgical excision of nonmelanoma skin cancer (NMSC) in the operating room versus an outpatient procedure clinic.

Methods

A retrospective review of patients undergoing excision of biopsy-confirmed NMSC at the Miami Veterans Affairs Hospital between December 1, 2015, and December 1, 2016, was completed. Patients treated in the operating room and procedure clinic were included. Treatment outcomes were assessed for all identified patients. Patients undergoing excision and primary closure were included for cost comparison.

Procedure costs were estimated using Current Procedural Terminology codes for treatments provided and the 2017 conversion factor of $35.7751. If a second operation for positive margins was necessary, cost to treat the lesion included costs from both procedures. If multiple lesions were treated, total cost was divided by the number of lesions to calculate cost per lesion treated. Costs per lesion managed in the operating room and clinic were compared using the Student t test.

Results

Sixty-five patients underwent excision of 94 NMSCs in the operating room. Nineteen patients underwent excision of 20 NMSCs in the procedure clinic. One patient treated in the clinic required re-excision in the operating room with frozen section for a positive margin.

Thirty-three patients managed in the operating room and 19 patients managed in the procedure clinic were included for cost analysis. Average costs per lesion excised in the operating room and procedure clinic were calculated to be $1923.43 ± 616.27 and $674.88 ± 575.22, respectively (P < 0.001).

Conclusions

Excellent oncologic outcomes were achieved for both operating room and procedure clinic excision. Excision in the operating room excision was significantly more expensive than in the procedure clinic. Excision in a procedure clinic offers an opportunity to reduce costs while maintaining quality care.
Correction of Tanzer Type IIB Constricted Ears via Z-shaped Double V-Y Advancement Flaps
Authors: Duan Weiqiang , Liu Yong
Published: January 2019

Background

Correction of Tanzer type IIB constricted ears requires sufficient expansion of the auricular skin to cover the reconstructed cartilaginous framework. To obtain an adequately sized skin cover, skin flap transposition from periauricular donor sites has been described; however, it remains challenging to obtain enough skin to enable satisfactory reconstruction. Herein, we describe a novel method that uses 2 local flaps comprising superoauricular, retroauricular, and preauricular soft tissue to expand the skin cover and correct Tanzer type IIB deformity.

Methods

Fifteen constricted ears in 15 patients were treated via this novel method from June 2013 to July 2017. Two adjoining V-Y advancement flaps shaped like a backward “Z” were created to expand the skin envelope of the upper one-third of the ear. The advancement of these 2 flaps toward each other expanded the skin of the upper one-third of the ear by creating a skin arch, which was then used to wrap the reconstructed cartilaginous framework. The auricular cartilage was refashioned via a method that combined several previously reported techniques.

Results

A satisfactory outcome was achieved in all 15 constricted ears, with resultant improvements in size and shape, and an elevated auricular position.

Conclusions

The preauricular, superoauricular, and retroauricular skin areas can be used to successfully expand the skin envelope of the upper auricle via the creation of 2 adjoining V-Y advancement flaps. This results in an ample skin cover with which to accommodate the auricular cartilaginous framework reconstructed by multiple techniques. This novel Z-shaped double V-Y advancement flap method can effectively correct Tanzer type IIB constricted ears.
Health-Related Quality of Life After Ventral Hernia Repair With Biologic and Synthetic Mesh
Authors: Nissen Andreas T. , Henn Dominic , Moshrefi Shawn , Gupta Deepak , Nazerali Rahim , Lee Gordon K.
Published: January 2019

Background

Quality of life (QOL) is an important outcome measure after ventral hernia repair (VHR). The Hernia-Related QOL Survey (HerQLes) is a specific survey tool for QOL after VHR. Studies comparing QOL in patients with biologic mesh repairs (BMRs) and synthetic mesh repairs (SMRs) are lacking.

Study Design

A survey based on the HerQLes was administered via e-mail to 974 patients who had undergone VHR at Stanford Medical Center. From 175 patients who were included in the study, the mean HerQLes scores and postoperative complications were compared between patients with suture repairs (SR), BMR, SMR, with and without component separation, and different types of SMR.

Results

Quality of life was lower in patients with hernias of 50 cm2 or greater, obesity, history of tobacco use, previous abdominal surgeries, hernia recurrences, and postoperative complications (P < 0.05). Patients with SR and SMR had a comparable QOL (71.58 vs 70.12, P = 0.75). In patients with Modified Ventral Hernia Working Group grade 2 hernias, a significantly lower QOL was found after BMR compared with SMR. Postoperative complications did not significantly differ between the groups. Recurrence rates were comparable between MR (10.4%) and SR (8.3%, P = 0.79), but higher in BMR (21.7%) compared with SMR (6.6%, P < 0.05).

Conclusions

Previous abdominal surgeries, previous hernia repairs, tobacco use, and hernia sizes of 50 cm2 or greater negatively affect QOL after VHR. Our data indicate that QOL is comparable between patients with SMR and SR, however, is lower in patients with Modified Ventral Hernia Working Group grade 2 and BMR compared with SMR, raising the benefit of BMR in light of its higher cost into question.
Clinical Utility of Postoperative Computed Tomography Imaging in Orbital Floor Fracture Management
Authors: Sharma Ajay N. , Tiourin Ekaterina , Banyard Derek A. , Sharma Shonit N. , Ng Wendy K. Y.
Published: January 2019

Background

Surgical repair of orbital floor fractures aims to improve visual function and appearance. Postoperative care often involves computed tomography (CT) imaging in addition to physical examination. It has yet to be investigated whether postoperative CT imaging influences treatment of orbital floor fractures.

Methods

A retrospective chart review was conducted for all patients who underwent orbital floor fracture repair at University of California, Irvine, from 2008 to 2017. Demographics, injury characteristics, and presurgical and postsurgical management were retrospectively extracted for 217 cases. Patients who experienced a change of care following postoperative CT (n = 6) were compared with the entire patient cohort.

Results

Postoperative CT imaging influenced orbital floor fracture management in 6 patients (7.2% of patients with imaging). The positive predictive value of a postoperative CT scan was 10.3%, compared with 17.6% for a physical examination. An estimated $2013.76 was spent to obtain a postoperative CT scan that revealed 1 additional patient who needed reoperation (number needed to treat = 14). A multivariate regression model demonstrated no association between postoperative CT scans and change in management (P = 0.995).

Conclusions

In this patient cohort, postoperative CT imaging and its associated costs did not significantly benefit management of orbital floor fracture repair. Careful clinical physical examination should be emphasized over postoperative CT imaging to reliably determine the necessity for reoperation in orbital floor fracture management.
The Diagnostic Utility of Ambulatory EEG Following Nondiagnostic Epilepsy Monitoring Unit Admissions
Authors: Fox Jonah , Ajinkya Shaun , Chopade Pramod , Schmitt Sarah
Published: January 2019

Purpose:

Epilepsy monitoring unit (EMU) admissions provide a definitive diagnosis for approximately three-quarters of patients. However, many patients do not receive a definitive diagnosis following EMU admission. Ambulatory EEG following nondiagnostic EMU admissions was evaluated as a means of providing a diagnosis for these patients.

Methods:

In this retrospective study, we performed a chart review of 62 pediatric and adult patients who had a 72-hour ambulatory EEG following a nondiagnostic EMU admission.

Results:

In total, there were 62 patients with nondiagnostic EMU admissions who subsequently underwent ambulatory EEG. Mean age was 33.8 (SD, 18.5) years. Forty-one patients (66.2%) were female and 46 (74.2%) adult. Fifty patients (80.7%) had an additional comorbid neurologic, somatoform, or psychiatric diagnoses. Of the original 62 patients, 32 (51.6%) had no events, 3 (4.8%) had events with and without EEG changes, 4 (6.5%) had only events with EEG changes, and 23 (37.1%) had only events without EEG changes. Ambulatory EEG thus provided clinically useful information in 30 (48.4%) cases, with 20 (66.7%) reaching diagnosis within 24 hours.

Conclusions:

Ambulatory EEG following a nondiagnostic EMU admission may yield positive results in approximately half of all patients. A substantial proportion of the events that were captured in this setting were without EEG changes. In the absence of video and supportive clinical information, these events not only may represent nonepileptic events but also could represent focal seizures without EEG changes. The presence of particular stressors in the home environment may explain why many patients, specifically those who are nonepileptic, had events relatively quickly following discharge.
The trigger (and the restriction) of Torso RTK activation
Authors: Mineo Alessandro , Furriols Marc , Casanova Jordi
Published: January 2019

The Torso pathway is an ideal model of receptor tyrosine kinase systems, in particular when addressing questions such as how receptor activity is turned on and, equally important, how it is restricted, how different outcomes can be generated from a single signal, and the extent to which gene regulation by signalling pathways relies on the relief of transcriptional repression. In this regard, we considered it pertinent to single out the fundamental notions learned from the Torso pathway beyond the specificities of this system (Furriols and Casanova 2003
EMBO J.
22
, 1947–1952. (
doi:10.1093/emboj/cdg224
)). Since then, the Torso system has gained relevance and its implications beyond its original involvement in morphogenesis and into many disciplines such as oncogenesis, hormone control and neurobiology are now acknowledged. Thus, we believe that it is timely to highlight additional notions supported by new findings and to draw attention to future prospects. Given the late development of research in the field, we wish to devote this review to the events leading to the activation of the Torso receptor, the main focus of our most recent work.