bluuebunny/crossref_metadata_2025 huggingface dataset:
The interaction of NO(X2Π) with H2: Ab initio potential energy surfaces and bound states
Authors: Kłos Jacek , Ma Qianli , Alexander Millard H. , Dagdigian Paul J.
Published: March 2017

We determine from first principles two sets of four-dimensional diabatic potential energy surfaces (PES’s) for the interaction of NO(X2Π) with H2, under the assumption of fixed NO and H2 bond distances. The first set of PES’s was computed with the explicitly correlated multi-reference configuration interaction method [MRCISD-F12 + Q(Davidson)], and the second set with an explicitly correlated, coupled-cluster method [RCCSD(T)-F12a] with the geometry scan limited to geometries possessing a plane of symmetry. The calculated PES’s are then fit to an analytical form suitable for bound state and scattering calculations. The RCCSD(T)-F12a dissociation energies (D0) of the NO–para-H2(ortho-D2) and the NO–ortho-H2(para-D2) complexes are computed to be 22.7 (31.7) and 23.9 (29.2) cm−1, respectively. The values calculated with the MRCISD-F12 + Q PES’s are 21.6 (31.1) and 23.3 (28.4) cm−1, respectively.
Network confinement and heterogeneity slows nanoparticle diffusion in polymer gels
Authors: Parrish Emmabeth , Caporizzo Matthew A. , Composto Russell J.
Published: March 2017

Nanoparticle (NP) diffusion was measured in polyacrylamide gels (PAGs) with a mesh size comparable to the NP size, 21 nm. The confinement ratio (CR), NP diameter/mesh size, increased from 0.4 to 3.8 by increasing crosslinker density and from 0.4 to 2.1 by adding acetone, which collapsed the PAGs. In all gels, NPs either became localized, moving less than 200 nm, diffused microns, or exhibited a combination of these behaviors, as measured by single particle tracking. Mean squared displacements (MSDs) of mobile NPs decreased as CR increased. In collapsed gels, the localized NP population increased and MSD of mobile NPs decreased compared to crosslinked PAGs. For all CRs, van Hove distributions exhibited non-Gaussian displacements, consistent with intermittent localization of NPs. The non-Gaussian parameter increased from a maximum of 1.5 for crosslinked PAG to 5 for collapsed PAG, consistent with greater network heterogeneity in these gels. Diffusion coefficients decreased exponentially as CR increased for crosslinked gels; however, in collapsed gels, the diffusion coefficients decreased more strongly, which was attributed to network heterogeneity. Collapsing the gel resulted in an increasingly tortuous pathway for NPs, slowing diffusion at a given CR. Understanding how gel structure affects NP mobility will allow the design and enhanced performance of gels that separate and release molecules in membranes and drug delivery platforms.
Phonon heat capacity of graphene nanofilms and nanotubes
Authors: Gospodarev I. A. , Grishaev V. I. , Manzhelii E. V. , Syrkin E. S. , Feodosyev S. B. , Minakova K. A.
Published: March 2017

Based on calculations conducted on a microscopic level, the phonon heat capacity of ultrathin graphene nanofilms such as bigraphene and trigraphene, and single-wall graphene nanotubes, is quantitatively described. The nature of the flexural stiffness of graphene monolayers is analyzed, and the temperature intervals at which the shape of the temperature dependence of heat capacity is determined by contributions made by flexural vibrations are identified. The contribution to the phonon heat capacity derived from graphene nanotube flexural waves that propagate along the surface thereof is analyzed, as are the bending vibrations of the tube as a whole one-dimensional object, and the contribution from torsional vibrations.
Inter-track interference mitigation with two-dimensional variable equalizer for bit patterned media recording
Authors: Wang Yao , Vijaya Kumar B. V. K.
Published: March 2017

The increased track density in bit patterned media recording (BPMR) causes increased inter-track interference (ITI), which degrades the bit error rate (BER) performance. In order to mitigate the effect of the ITI, signals from multiple tracks can be equalized by a 2D equalizer with 1D target. Usually, the 2D fixed equalizer coefficients are obtained by using a pseudo-random bit sequence (PRBS) for training. In this study, a 2D variable equalizer is proposed, where various sets of 2D equalizer coefficients are predetermined and stored for different ITI patterns besides the usual PRBS training. For data detection, as the ITI patterns are unknown in the first global iteration, the main and adjacent tracks are equalized with the conventional 2D fixed equalizer, detected with Bahl-Cocke-Jelinek-Raviv (BCJR) detector and decoded with low-density parity-check (LDPC) decoder. Then using the estimated bit information from main and adjacent tracks, the ITI pattern for each island of the main track can be estimated and the corresponding 2D variable equalizers are used to better equalize the bits on the main track. This process is executed iteratively by feeding back the main track information. Simulation results indicate that for both single-track and two-track detection, the proposed 2D variable equalizer can achieve better BER and frame error rate (FER) compared to that with the 2D fixed equalizer.
Magnetic shielding of 3-phase current by a composite material at low frequencies
Authors: Livesey K. L. , Camley R. E. , Celinski Z. , Maat S.
Published: March 2017

Electromagnetic shielding at microwave frequencies (MHz and GHz) can be accomplished by attenuating the waves using ferromagnetic resonance and eddy currents in conductive materials. This method is not as effective at shielding the quasi-static magnetic fields produced by low-frequency (kHz) currents. We explore theoretically the use of composite materials – magnetic nanoparticles embedded in a polymer matrix – as a shielding material surrounding a 3-phase current source. We develop several methods to estimate the permeability of a single magnetic nanoparticle at low frequencies, several hundred kHz, and find that the relative permeability can be as high as 5,000-20,000. We then use two analytic effective medium theories to find the effective permeability of a collection of nanoparticles as a function of the volume filling fraction. The analytic calculations provide upper and lower bounds on the composite permeability, and we use a numerical solution to calculate the effective permeability for specific cases. The field-pattern for the 3-phase current is calculated using a magnetic scalar potential for each of the three wires surrounded by a cylinder with the effective permeability found above. For a cylinder with an inner radius of 1 cm and an outer radius of 1.5 cm and an effective permeability of 50, one finds a reduction factor of about 8 in the field strength outside the cylinder.
Transformer sound level caused by core magnetostriction and winding stress displacement variation
Authors: Hsu Chang-Hung , Huang Yi-Mei , Hsieh Min-Fu , Fu Chao-Ming , Adireddy Shiva , Chrisey Douglas B.
Published: March 2017

Magnetostriction caused by the exciting variation of the magnetic core and the current conducted by the winding wired to the core has a significant result impact on a power transformer. This paper presents the sound of a factory transformer before on-site delivery for no-load tests. This paper also discusses the winding characteristics from the transformer full-load tests. The simulation and the measurement for several transformers with capacities ranging from 15 to 60 MVA and high voltage 132kV to low voltage 33 kV are performed. This study compares the sound levels for transformers by no-load test (core/magnetostriction) and full-load test (winding/displacement ε). The difference between the simulated and the measured sound levels is about 3dB. The results show that the sound level depends on several parameters, including winding displacement, capacity, mass of the core and windings. Comparative results of magnetic induction of cores and the electromagnetic force of windings for no-load and full-load conditions are examined.
Linear magnetoresistance in a topological insulator Ru2Sn3
Authors: Shiomi Y. , Saitoh E.
Published: March 2017

We have studied magnetotransport properties of a topological insulator material Ru2Sn3. Bulk single crystals of Ru2Sn3 were grown by a Bi flux method. The resistivity is semiconducting at high temperatures above 160 K, while it becomes metallic below 160 K. Nonlinear field dependence of Hall resistivity in the metallic region shows conduction of multiple carriers at low temperatures. In the high-temperature semiconducting region, magnetoresistance exhibits a conventional quadratic magnetic-field dependence. In the low-temperature metallic region, however, high-field magnetoresistance is clearly linear with magnetic fields, signaling a linear dispersion in the low-temperature electronic structure. Small changes in the magnetoresistance magnitude with respect to the magnetic field angle indicate that bulk electron carriers are responsible mainly for the observed linear magnetoresistance.
Mathematical model of a novel small magnetorheological damper by using outer magnetic field
Authors: Huang Liutian , Li Junhui , Zhu Wenhui
Published: March 2017

In order to realize small loading and small damping, a mini Magneto-rheological fluid (MRF) damper is suggested by using new method of outer coils, and its physical model is established firstly. It was found that the landing force is only 1.74∼8N, the landing force is the third-order function with the current by polynomial fitting of the experimental data, which shows a force-current model. The results of force-displacement and force-velocity indicate that it has nonlinear hysteretic damping characteristics. Based on the new mini-mode principle and the damping characteristics, an improved nonlinear dynamics model is proposed, and its parameter expressions are obtained by parameter identification and regression fitting. Model curves fit well with experimental curves, and the improved model has fully demonstrated the dynamic characteristics of the mini-MRF damper. It will provide scientific method and physical model for the small MRF damper development.
Design and analysis of a self-biased broadband magnetoelectric cantilever operated at multi-frequency windows
Authors: Ma J. N. , Xin C. Z. , Ma J. , Lin Y. H. , Nan C. W.
Published: March 2017

Magnetoelectric (ME) composites with self-biased and wide resonance frequency band properties are promising candidates for magnetic field sensor and energy harvester. Here, we present a ME cantilever by in-series connecting a few SrFe12O19/Metglas/Pb(Zr,Ti)O3 components. Due to the in-built magnetic bias of SrFe12O19, the ME cantilever shows self-biased property. Meanwhile, by merging the resonance responses of the in-series ME components together, the ME cantilever presents multi-wide resonance bands (i.e., 500 Hz ∼ 700 Hz, 3.3 kHz ∼ 4.4 kHz and 44 kHz ∼ 70 kHz). In these three wide frequency windows, the ME voltage coefficients (αV) of the ME cantilever are higher than 40 mV/Oe, 115 mV/Oe and 400 mV/Oe, respectively.
Understanding the microwave annealing of silicon
Authors: Fu Chaochao , Wang Yan , Xu Peng , Yue Lei , Sun Feng , Zhang David Wei , Zhang Shi-Li , Luo Jun , Zhao Chao , Wu Dongping
Published: March 2017

Though microwave annealing appears to be very appealing due to its unique features, lacking an in-depth understanding and accurate model hinder its application in semiconductor processing. In this paper, the physics-based model and accurate calculation for the microwave annealing of silicon are presented. Both thermal effects, including ohmic conduction loss and dielectric polarization loss, and non-thermal effects are thoroughly analyzed. We designed unique experiments to verify the mechanism and extract relevant parameters. We also explicitly illustrate the dynamic interaction processes of the microwave annealing of silicon. This work provides an in-depth understanding that can expedite the application of microwave annealing in semiconductor processing and open the door to implementing microwave annealing for future research and applications.
Consumer acceptability of beef from two sexes supplemented with essential oil mix
Authors: Guerrero A. , Rivaroli D. C. , Sañudo C. , Campo M. M. , Valero M. V. , Jorge A. M. , Prado I. N.
Published: March 2017

Essential oils are natural extracts from plants which can be included in cattle diets as an alternative to additives, such as ionophores, to improve the shelf life of meat. The aim of this study was to evaluate the sensory acceptability of meat from 57 crossbred (1/2 Angus–1/2 Nellore) animals of different sexes [heifers n = 30, and young bulls n = 27], finished in feedlot with isoenergetic and isonitrogenous diets, which differed in the level of supplementation (0.0, 3.5 or 7.0 g/animal/day) with a commercial mix of essential oils (Mixoil®) from seven plants: oregano, garlic, lemon, rosemary, thyme, eucalyptus and sweet orange. The Longissimus thoracis muscle, aged for 24 h, was evaluated by 120 consumers who scored tenderness acceptability, flavour acceptability and overall acceptability using a hedonic 9-point scale. The inclusion of essential oils affected tenderness acceptability and flavour acceptability (P ≤ 0.01), with a tendency (P < 0.10) for overall acceptability. Meat from heifers was more appreciated by consumers than that from young bulls in all attributes (P ≤ 0.001), however, different groups of consumers had different preferences. The inclusion of a mix of essential oils in beef diets was well accepted by consumers, and could improve the acceptability of meat from young bulls, when is added at a concentration of 3.5 g/animal/day during the last 4 months of fattening.
Balancing water-quality threats from nutrients and production in Australian and New Zealand dairy farms under low profit margins
Authors: McDowell R. W. , Monaghan R. M. , Dougherty W. , Gourley C. J. P. , Vibart R. , Shepherd M.
Published: March 2017

The loss of nitrogen (N) and phosphorus (P) from dairy-farmed land can impair water quality. Efforts to curtail these losses in Australia and New Zealand (Australasia) have involved a mixture of voluntary and regulatory approaches. In the present paper, we summarise the losses of N and P from Australasian dairy farms, examine the policy drivers used for mitigating losses and evaluate the effectiveness of contrasting approaches to implementing mitigations. Median losses for N and P were 27 and 1.6 kg/ha.year respectively, with a wide range of variation (3–153 kg N/ha.year and 0.3–69 kg P/ha.year) caused by a complex array of climate, soil types, flow paths, nutrient surpluses and land management factors. This complexity, coupled with the variable implementation of measures to mitigate losses, means that many voluntary programs to decrease losses have had uncertain or limited success. Although there is little or no formal regulation in Australia, regulation exists in New Zealand that requires regional authorities to implement the best strategy to improve water quality according to regional-specific characteristics. In testing a generalised approach to mitigation (priority given to those that are easy to implement) in four regions in New Zealand, we found that P could be mitigated quite cheaply, but N reductions required more measures, some of which are costly. Conversely, prioritising on the basis of mitigation cost-effectiveness for a specific nutrient will lead to more rapid reductions in losses of the target nutrient, but with fewer co-benefits for the non-target nutrient or other water pollutants, such as faecal microorganisms and sediment. This information will assist farmers in deciding how to meet a catchment target at least cost.
Receptor Mincle promotes skin allergies and is capable of recognizing cholesterol sulfate
Authors: Kostarnoy Alexey V. , Gancheva Petya G. , Lepenies Bernd , Tukhvatulin Amir I. , Dzharullaeva Alina S. , Polyakov Nikita B. , Grumov Daniil A. , Egorova Daria A. , Kulibin Andrey Y. , Bobrov Maxim A. , Malolina Ekaterina A. , Zykin Pavel A. , Soloviev Andrey I. , Riabenko Evgeniy , Maltseva Diana V. , Sakharov Dmitry A. , Tonevitsky Alexander G. , Verkhovskaya Lyudmila V. , Logunov Denis Y. , Naroditsky Boris S. , Gintsburg Alexander L.
Published: March 2017

Significance

Post-traumatic sterile inflammation is the first necessary step of wound healing. In addition, sterile inflammation underlies the pathogenesis of a multitude of common diseases, such as allergies and autoimmune diseases. The molecular mechanisms underlying sterile inflammation are still not fully understood. Here, we show that the receptor Mincle (Clec4e), the expression of which is highly induced in the skin in response to damage, recognizes cholesterol sulfate, a molecule that is abundant in the epidermal layer of the skin, subsequently inducing a pro-inflammatory response. We also identify a role for Mincle as a driving component in the pathogenesis of allergic skin inflammation. The results demonstrate a previously unconsidered important role of Mincle in mediating sterile inflammation.
Coarse graining from variationally enhanced sampling applied to the Ginzburg–Landau model
Authors: Invernizzi Michele , Valsson Omar , Parrinello Michele
Published: March 2017

Significance

A multiscale description is believed to be the only feasible route toward the simulation of complex systems. Yet moving from one scale to another is not a trivial task, and many different approaches can be taken. We propose here a systematic approach to go from a fine scale to a coarser one, based on the recently introduced variationally enhanced sampling method. Contrary to other coarse-graining methods, it combines in the same algorithm the sampling enhancement and the optimization of the coarse-graining parameters. We illustrate the method in the case of the vapor–liquid critical transition of a Lennard–Jones fluid. This is done in the context of the Ginzburg–Landau field theoretical description of second-order phase transitions.
Tunable moiré bands and strong correlations in small-twist-angle bilayer graphene
Authors: Kim Kyounghwan , DaSilva Ashley , Huang Shengqiang , Fallahazad Babak , Larentis Stefano , Taniguchi Takashi , Watanabe Kenji , LeRoy Brian J. , MacDonald Allan H. , Tutuc Emanuel
Published: March 2017

Significance

Accurately controlled, very long wavelength moiré patterns are realized in small-twist-angle bilayer graphene, and studied using electron transport and scanning probe microscopy. We observe gaps in electron transport at anomalous densities equal to ±8 electrons per moiré crystal unit cell, at variance with electronic structure theory, and the emergence of a Hofstadter butterfly in the energy spectrum in perpendicular magnetic fields. These findings open up an avenue to create artificial crystals by manipulating the relative angle between individual layers in a heterostructure.
Bacterial proteostasis balances energy and chaperone utilization efficiently
Authors: Santra Mantu , Farrell Daniel W. , Dill Ken A.
Published: March 2017

Significance

A cell’s proteins must be properly folded. Therefore, cells have chaperones that help other proteins, their clients, fold and not aggregate. The machinery is like a hospital: it assesses the “sickness” of the patient (finds improperly folded proteins), sends the patient to the right doctor (sorts the protein to the right chaperone), and cures the disease (folds or disaggregates the protein). How are sick proteins recognized and routed to the right chaperone? How does the machine handle different growth rates? Here, we model proteostasis. We find that it can handle any arbitrary client protein, that it spends the least energy on least sick proteins, and that the cell produces just enough chaperone to keep the proteome folded but no more.
Distinct recognition of complement iC3b by integrins αXβ2and αMβ2
Authors: Xu Shutong , Wang Jianchuan , Wang Jia-Huai , Springer Timothy A.
Published: March 2017

Significance

Complement is deposited on foreign antigens and particles and marks them for recognition by immune cells and removal by phagocytes. Immune cells have two homologous integrins, αXβ2and αMβ2, that recognize the complement fragment iC3b. Although it might have been suspected that these integrins would bind to the same site on iC3b, direct comparisons here show they do not. Using negative stain electron microscopy and purified integrin fragments and iC3b, we show that αXβ2binds to two distinct sites on iC3b. A single αMβ2integrin binds to two different sites on iC3b, each of which is distinct from those to which αXβ2binds. Our findings reveal remarkable diversity among integrins that recognize complement and suggest possible cooperative responses.
Critical Assessment 25: Friction stir processing, potential and problems
Authors: Gerlich Adrian P.
Published: March 2017

This assessment considers recent work on friction stir processing (FSP), which has been demonstrated to be an effective method for grain refinement and synthesis of new alloys and composites. The grain refinement is attributed to high strain rates leading to recrystallisation, while external cooling suppresses grain growth during cooling. The technique is capable of producing nanocrystalline alloys, and also able to disperse nanoparticles into alloys. The mechanical properties of processed materials agree with a combination of existing models for grain refinement, and precipitate reinforcement theory. Further improvements in the technique may help deal with severe tool wear during the FSP of composites, and reduce the complexity of composite fabrication using novel processing methods and tooling.
First Reproduction by Stocked Bonytail in the Upper Colorado River Basin
Authors: Bestgen Kevin R. , Schelly Robert C. , Staffeldt Richard R. , Breen Matthew J. , Snyder Darrel E. , Jones M. Tildon
Published: March 2017

Bonytail Gila elegans, a large-bodied cyprinid that is endemic to the Colorado River basin of the American Southwest, was historically widespread and abundant in large warmwater streams but is now critically endangered. To increase recovery prospects, over 500,000 Bonytails have been stocked in the upper Colorado River basin since 2000, but adult survival has been low and reproduction has not been detected. We provide the first documented evidence of successful reproduction by stocked Bonytails in the upper Colorado River basin. Adult Bonytails were stocked in the Green River and accessed Stewart Lake and Johnson Bottom (managed floodplain wetlands in the middle Green River, Utah) during high flows in May 2015 (Stewart Lake only) and 2016. Draining of Stewart Lake in September 2015 revealed 19 age-0 individuals of Gila sp. (37–64 mm TL) among over 405,000 fish. Four preserved specimens (41–48 mm TL) were verified as Bonytails by using morphological and molecular techniques. Otolith daily increment analysis confirmed reproduction by Bonytails in Stewart Lake. Bonytail reproduction was also noted during 2016 in Stewart Lake (probable) and Johnson Bottom. Young Bonytails survived despite the presence of abundant nonnative fish predators. Use of floodplain wetlands for reproduction may enhance the recovery of critically endangered Bonytail in the upper Colorado River basin.

Received September 1, 2016; accepted January 2, 2017 Published online March 15, 2017
Pellet‐free isolation of human and bovine milk extracellular vesicles by size‐exclusion chromatography
Authors: Blans Kristine , Hansen Maria S. , Sørensen Laila V. , Hvam Michael L. , Howard Kenneth A. , Möller Arne , Wiking Lars , Larsen Lotte B. , Rasmussen Jan T.
Published: March 2017

Studies have suggested that nanoscale extracellular vesicles (EV) in human and bovine milk carry immune modulatory properties which could provide beneficial health effects to infants. In order to assess the possible health effects of milk EV, it is essential to use isolates of high purity from other more abundant milk structures with well‐documented bioactive properties. Furthermore, gentle isolation procedures are important for reducing the risk of generating vesicle artefacts, particularly when EV subpopulations are investigated. In this study, we present two isolation approaches accomplished in three steps based on size‐exclusion chromatography (SEC) resulting in effective and reproducible EV isolation from raw milk. The approaches do not require any EV pelleting and can be applied to both human and bovine milk. We show that SEC effectively separates phospholipid membrane vesicles from the primary casein and whey protein components in two differently obtained casein reduced milk fractions, with one of the fractions obtained without the use of ultracentrifugation. Milk EV isolates were enriched in lactadherin, CD9, CD63 and CD81 compared to minimal levels of the EV‐marker proteins in other relevant milk fractions such as milk fat globules. Nanoparticle tracking analysis and electron microscopy reveals the presence of heterogeneous sized vesicle structures in milk EV isolates. Lipid analysis by thin layer chromatography shows that EV isolates are devoid of triacylglycerides and presents a phospholipid profile differing from milk fat globules surrounded by epithelial cell plasma membrane. Moreover, the milk EV fractions are enriched in RNA with distinct and diverging profiles from milk fat globules. Collectively, our data supports that successful milk EV isolation can be accomplished in few steps without the use of ultracentrifugation, as the presented isolation approaches based on SEC effectively isolates EV in both human and bovine milk.
‘The age of entitlement has ended’: designing a disability insurance scheme in turbulent times
Authors: Miller Pavla
Published: March 2017

In a period of welfare state retrenchment, Australia's neo-liberal government is continuing to implement an expensive National Disability Insurance Scheme (NDIS). Australia is among the pioneers of welfare measures funded from general revenue. Until recently, however, attempts to establish national schemes of social insurance have failed. The paper reviews this history through the lenses of path dependence accounts. It then presents contrasting descriptions of the NDIS by its Chair, the politician who inspired him, and two feminist policy analysts from a carers’ organisation. Path dependence, these accounts illustrate, has been broken in some respects but consolidated in others. In particular, the dynamics of ‘managed’ capitalist markets, gendered notions of abstract individuals and organisations, and the related difficulties in accounting for unpaid labour are constraining the transformative potential of the NDIS.
Bounds and representations of solutions of planar div-curl problems
Authors: Auchmuty Giles
Published: March 2017

Estimates and representations of solutions of div-curl systems for planar vector fields are described. Potentials are used to represent solutions as the sum of fields that depend on the source terms and harmonic fields dependent on the boundary data. Sharp 2-norm (energy) bounds for the least energy solutions on bounded regions with Lipschitz boundary are found. Prescribed flux, tangential or mixed flux and tangential boundary conditions require different potentials. The harmonic fields are represented and estimated using Steklov eigenfunctions. Some regularity results are obtained.
Percutaneous coronary intervention vs. coronary artery bypass grafting for left main revascularization: an updated meta-analysis
Authors: Bajaj Navkaranbir S. , Patel Nirav , Kalra Rajat , Marogil Peter , Bhardwaj Ashwanikumar , Arora Garima , Arora Pankaj
Published: March 2017

Aims

The optimal revascularization strategy for left main coronary artery disease (LMD) remains controversial, especially with two recent randomized controlled trials showing conflicting results. We sought to address this controversy with our analysis.

Methods and results

Comprehensive literature search was performed. We compared percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for LMD revascularization using standard meta-analytic techniques. A 21% higher risk of long-term major adverse cardiac and cerebrovascular event [MACCE; composite of death, myocardial infarction (MI), stroke, and repeat revascularization] was observed in patients undergoing PCI in comparison with CABG [risk ratio (RR) 1.21, 95% confidence interval (CI) 1.05–1.40]. This risk was driven by higher rate of repeat revascularization in those undergoing PCI (RR 1.61, 95% CI 1.34–1.95). On the contrary, MACCE rates at 30 days were lower in PCI when compared with CABG (RR 0.55, 95% CI 0.39–0.76), which was driven by lower rates of stroke in the PCI arm (RR 0.41, 95% CI 0.17–0.98). At 1 year, lower stroke rates (RR 0.21, 95% CI 0.08–0.59) in the PCI arm were balanced by higher repeat revascularization rates in those undergoing PCI (RR 1.78, 95% CI 1.33–2.37), resulting in a clinical equipoise in MACCE rates between the two revascularization strategies. There was no difference in death or MI between PCI when compared with CABG at any time point.

Conclusion

Outcomes of CABG vs. PCI for LMD revascularization vary over time. Therefore, individualized decisions need to be made for LMD revascularization using the heart team approach.
The common developmental road: tensions among centripetal and centrifugal dynamics
Authors: Xu Zhongmin , Cheng Guodong , Ulanowicz Robert E , Song Xiaoyu , Deng Xiaohong , Zhong Fanglei
Published: March 2017

Western thought since the Enlightenment has been predominantly linear in scope, while Eastern philosophy has focused mostly on the cyclical. Recent advances in complex systems, however, have highlighted the importance of cycles in nature, thereby opening an avenue for new common endeavors. This analysis centers on the role of autocatalytic loops and addresses the evolutionary relationship between competition and cooperation. It posits an evolutionary chain running from individual competition, to individual cooperation, to collective competition, to deep cooperation. We identify the centripetality that is consequent to autocatalysis and define three types of centrifugalities. Development is defined in the context of the tension between these opposing directions. Finally, we propose an evolutionary process consisting of four stages: (i) autognosis, (ii) autocatalytic loop formation, (iii) self-control and (iv) self-realization (sensu Taoism). The developmental narrative promises to become a useful tool for facilitating communication between Eastern and Western cultures.
Informed consent in children and adolescents
Authors: Morton Wendy J , Westwood Michael
Published: March 2017

Confusion persists about when a minor can give informed consent to medical treatment. Physicians may be hesitant to treat minors, even as adolescents, without first obtaining parental or guardian consent for fear of being sued for battery or negligence. However, the common law in Canada is clear that a minor can give informed consent to therapeutic medical treatment, provided heorshe can understand the information regarding the proposed treatment and can appreciate the attendant risks and possible consequences. Courts have accepted that there is no precise age at which a minor can be presumed to have the capacity to give informed consent. Each minor must be individually assessed to determine whether he or she possesses the requisite maturity and level of understanding to comprehend the nature, benefits and risks of the proposed treatment. The responsibility for determining a minor's capacity rests with the physician or another health care provider who is seeking to obtain the informed consent. In the event that legal action is taken against the physician on the grounds the minor lacked the capacity to give informed consent, the court must be satisfied that the minor did have sufficient capacity. Examples of cases where the physician was sued by either the minor or the minor's parents are included. In addition, an overview of existing provincial legislation dealing with minors and informed consent is provided.
Protocol for the investigation of acute flaccid paralysis and suspected paralytic poliomyelitis
Authors:   Working Group on Polio Eradication, Bentsi-Enchill Adwoa
Published: March 2017

Despite the elimination of indigenous wild poliovirus in Canada, ongoing surveillance for poliomyelitis is important because of the risk of wild virus importation from endemic regions. Most recently, importation of wild poliovirus into Canada occurred in 1993 and 1996,inboth instances with no associated clinical illness. Since 1991, the active surveillance of acute flaccid paralysis (AFP) in children less than 15 years old has been carried out in Canada to monitor for suspected cases of paralytic poliomyelitis. AFP surveillance is currently implemented through the Canadian Paediatric Surveillance Program. All suspected cases of paralytic poliomyelitis reported to the Laboratory Centre for Disease Control are evaluated by the national Working Group on Polio Eradication. The proper laboratory and neurological investigation of all AFP cases younger than 15 years old and suspected cases of poliomyelitis of any age is essential for the rapid detection of paralytic poliomyelitis, the most important clinical specimen for laboratory investigation being a stool sample collected within two weeks after the onset of paralysis for viral studies. This paper provides guidelines for investigating all suspected cases of paralytic poliomyelitis, including AFP cases less than 15 years old. Guidelines are also provided for reporting confirmed or suspected cases of paralytic poliomyelitis as well as the incidental finding of wild strain poliovirus, with or without any clinical symptoms.
The importance of infant mental health
Authors: Clinton J , Feller AF , Williams RC
Published: March 2017

A clear understanding of infant mental health will significantly assist a clinician's ability to provide high-quality paediatric care for children and their families, given the new understanding of its role in overall development. The present commentary describes the mental health needs of children <3 years of age and provides practical suggestions for the office setting.
Meeting the needs of adolescent parents and their children
Authors: Thompson Gillian ,   Canadian Paediatric Society,   Adolescent Health Committee
Published: March 2017

Adolescent parents and their children present to health care practitioners as two paediatric patients, each with unique health care needs. Young parents and their children may be at risk for negative health outcomes, not directly as a consequence of maternal age but because of poverty and other inequities in the social determinants of health. The health needs of child and mother are best assessed using a nonjudgmental approach, appropriate screening tools and open questions that address both preventative and acute health issues. The dyad’s co-existing needs may be anticipated as they relate to growth and development, infant and adolescent mental health, nutrition and food security, safety, relationships, parenting, education, sexual health and the facilitation of supports and resources. Care providers who understand adolescent development and integrate medical home elements of a patient-centred ‘medical home’ into their practices are ideally positioned to facilitate positive health outcomes for both mother and child.
Respiratory Effects of the Nociceptin/Orphanin FQ Peptide and Opioid Receptor Agonist, Cebranopadol, in Healthy Human Volunteers
Authors: Dahan Albert , Boom Merel , Sarton Elise , Hay Justin , Groeneveld Geert Jan , Neukirchen Meike , Bothmer John , Aarts Leon , Olofsen Erik
Published: March 2017

Background

Cebranopadol is a novel strong analgesic that coactivates the nociceptin/orphanin FQ receptor and classical opioid receptors. There are indications that activation of the nociceptin/orphanin FQ receptor is related to ceiling in respiratory depression. In this phase 1 clinical trial, we performed a pharmacokinetic-pharmacodynamic study to quantify cebranopadol’s respiratory effects.

Methods

Twelve healthy male volunteers received 600 μg oral cebranopadol as a single dose. The following main endpoints were obtained at regular time intervals for 10 to 11 h after drug intake: ventilation at an elevated clamped end-tidal pressure of carbon dioxide, pain threshold and tolerance to a transcutaneous electrical stimulus train, and plasma cebranopadol concentrations. The data were analyzed using sigmoid Emax (respiration) and power (antinociception) models.

Results

Cebranopadol displayed typical opioid-like effects including miosis, analgesia, and respiratory depression. The blood-effect-site equilibration half-life for respiratory depression and analgesia was 1.2 ± 0.4 h (median ± standard error of the estimate) and 8.1 ± 2.5 h, respectively. The effect-site concentration causing 50% respiratory depression was 62 ± 4 pg/ml; the effect-site concentration causing 25% increase in currents to obtain pain threshold and tolerance was 97 ± 29 pg/ml. The model estimate for minimum ventilation was greater than zero at 4.9 ± 0.7 l/min (95% CI, 3.5 to 6.6 l/min).

Conclusions

At the dose tested, cebranopadol produced respiratory depression with an estimate for minimum ventilation greater than 0 l/min. This is a major advantage over full μ-opioid receptor agonists that will produce apnea at high concentrations. Further clinical studies are needed to assess whether such behavior persists at higher doses.
Measuring Patient Mobility in the ICU Using a Novel Noninvasive Sensor
Authors: Ma Andy J. , Rawat Nishi , Reiter Austin , Shrock Christine , Zhan Andong , Stone Alex , Rabiee Anahita , Griffin Stephanie , Needham Dale M. , Saria Suchi
Published: March 2017

Objectives:

To develop and validate a noninvasive mobility sensor to automatically and continuously detect and measure patient mobility in the ICU.

Design:

Prospective, observational study.

Setting:

Surgical ICU at an academic hospital.

Patients:

Three hundred sixty-two hours of sensor color and depth image data were recorded and curated into 109 segments, each containing 1,000 images, from eight patients.

Interventions:

None.

Measurements and Main Results:

Three Microsoft Kinect sensors (Microsoft, Beijing, China) were deployed in one ICU room to collect continuous patient mobility data. We developed software that automatically analyzes the sensor data to measure mobility and assign the highest level within a time period. To characterize the highest mobility level, a validated 11-point mobility scale was collapsed into four categories: nothing in bed, in-bed activity, out-of-bed activity, and walking. Of the 109 sensor segments, the noninvasive mobility sensor was developed using 26 of these from three ICU patients and validated on 83 remaining segments from five different patients. Three physicians annotated each segment for the highest mobility level. The weighted Kappa (κ) statistic for agreement between automated noninvasive mobility sensor output versus manual physician annotation was 0.86 (95% CI, 0.72–1.00). Disagreement primarily occurred in the “nothing in bed” versus “in-bed activity” categories because “the sensor assessed movement continuously,” which was significantly more sensitive to motion than physician annotations using a discrete manual scale.

Conclusions:

Noninvasive mobility sensor is a novel and feasible method for automating evaluation of ICU patient mobility.
Activation-Associated Accelerated Apoptosis of Memory B Cells in Critically Ill Patients With Sepsis
Authors: Shankar-Hari Manu , Fear David , Lavender Paul , Mare Tracey , Beale Richard , Swanson Chad , Singer Mervyn , Spencer Jo
Published: March 2017

Objective:

Sepsis is life-threatening organ dysfunction due to dysregulated host responses to infection. Current knowledge of human B-cell alterations in sepsis is sparse. We tested the hypothesis that B-cell loss in sepsis involves distinct subpopulations of B cells and investigated mechanisms of B-cell depletion.

Design:

Prospective cohort study.

Setting:

Critical care units.

Patients:

Adult sepsis patients without any documented immune comorbidity.

Interventions:

None.

Measurements and Main Results:

B-cell subsets were quantified by flow cytometry; annexin-V status identified apoptotic cells and phosphorylation of intracellular kinases identified activation status of B-cell subsets. B cell–specific survival ligand concentrations were measured. Gene expression in purified B cells was measured by microarray. Differences in messenger RNA abundance between sepsis and healthy controls were compared. Lymphopenia present in 74.2% of patients on admission day was associated with lower absolute B-cell counts (median [interquartile range], 0.133 [0.093–0.277] 109 cells/L) and selective depletion of memory B cells despite normal B cell survival ligand concentrations. Greater apoptotic depletion of class-switched and IgM memory cells was associated with phosphorylation of extracellular signal-regulated kinases, implying externally driven lymphocyte stress and activation-associated cell death. This inference is supported by gene expression profiles highlighting mitochondrial dysfunction and cell death pathways, with enriched intrinsic and extrinsic pathway apoptosis genes.

Conclusions:

Depletion of the memory B-cell compartment contributes to the immunosuppression induced by sepsis. Therapies targeted at reversing this immune memory depletion warrant further investigation.
A Phase II Study of Ganetespib as Second-line or Third-line Therapy for Metastatic Pancreatic Cancer
Authors: Cardin Dana B. , Thota Ramya , Goff Laura W. , Berlin Jordan D. , Jones Clyde M. , Ayers Gregory D. , Whisenant Jennifer G. , Chan Emily
Published: March 2017

Objectives:

Heat shock protein 90 regulates multiple signaling proteins involved in key pathways of pancreatic cancer pathogenesis. Ganetespib binds to heat shock protein 90 and interferes with its binding to client proteins thus leading to inactivation and degradation of the signaling proteins that promote cancer progression. This phase II study was designed to evaluate the efficacy of ganetespib in patients with refractory metastatic pancreatic cancer (rMPC).

Methods:

Patients with rMPC received 175 mg/m2 ganetespib intravenously once weekly for 3 weeks in 4-week cycles. Primary endpoint was disease control rate at 8 weeks, with a goal of 70%. Secondary endpoints were progression-free survival, overall survival, and safety. Simon’s 2-stage design was used to assess futility and efficacy. Ganetespib was considered inactive if ≤8 patients among the first 15 treated had disease control after 8 weeks of treatment.

Results:

Fourteen patients were treated on study. Grade 3 treatment-related toxicities were diarrhea, abdominal pain, fatigue, nausea, vomiting, and hyponatremia. Disease control rate at 8 weeks was 28.6%, and median progression-free survival and overall survival were 1.58 months and 4.57 months, respectively. Early stopping rules for lack of clinical efficacy led to study closure.

Conclusions:

Single-agent ganetespib was tolerable with only modest disease control in rMPC. This disease is resistant to chemotherapy, and given the emerging data in lung and rectal cancers, as well as in pancreatic cancer cell lines, suggesting improved activity of ganetespib in combination with cytotoxic agents, studies combining this agent with chemotherapy in rMPC are more likely to yield success.
Outcomes for Anaplastic Glioma Treated With Radiation Therapy With or Without Concurrent Temozolomide
Authors: McTyre Emory , Lucas John T. , Helis Corbin , Farris Michael , Soike Michael , Mott Ryan , Laxton Adrian W. , Tatter Stephen B. , Lesser Glenn J. , Strowd Roy E. , Lo Hui-Wen , Debinski Waldemar , Chan Michael D.
Published: March 2017

Objectives:

Postoperative management of anaplastic glioma remains without a clear standard of care—in this study we report outcomes for patients treated with radiotherapy (RT) with and without temozolomide (TMZ).

Materials and Methods:

We identified 71 consecutive patients with World Health Organization grade III glioma treated with either RT alone or with concurrent TMZ (RT+TMZ), between 2000 and 2013. Tumor histology was anaplastic astrocytoma in 42 patients, anaplastic oligodendroglioma in 25 patients, and anaplastic oligoastrocytoma in 4 patients. In total, 26 patients received RT and 45 received RT+TMZ. Adjuvant TMZ was administered to 12/26 (46.1%) patients who received RT and 42/45 (93.3%) patients who received RT+TMZ. Time-to-event endpoints included progression-free survival (PFS) and overall survival (OS).

Results:

Kaplan-Meier estimates revealed that patients receiving RT+TMZ followed by adjuvant TMZ had improved PFS (P=0.04) and OS (P=0.02) as compared with those receiving RT followed by adjuvant TMZ. Cox proportional hazards multivariate analysis revealed improved PFS and OS with RT+TMZ for all patients (PFS: hazard ratio [HR]=0.42, P=0.02; OS: HR=0.41, P=0.03) and for anaplastic astrocytoma patients (PFS: HR=0.35, P=0.03; OS: HR=0.26, P=0.01), regardless of whether patients received further adjuvant TMZ.

Conclusions:

These findings support the use of RT+TMZ in the postoperative management of grade III glioma, and suggest that there is a benefit to concurrent RT+TMZ that is independent of adjuvant monthly TMZ. Further investigation is warranted, both to prospectively validate the benefit of RT+TMZ, as well as to determine if an additional benefit truly exists for adjuvant TMZ following concurrent RT+TMZ.
Nanoskin® Subcutaneous Implant in Guinea Pigs
Authors: Kaminagakura Kryscia Natsuaki , Sato Silvana Sue , Sugino Patricia , Santos Daniela Carvalho , Kataki Laryssa , Padovani Carlos Roberto , Basmaji Pierre , Schellini Silvana A.
Published: March 2017

Purpose:

To evaluate the suitability of Nanoskin®, a biomaterial derived from bacterial cellulose, as an alternate material for repairing the posterior lamellae of the eyelids.

Methods:

Forty guinea pigs received a fragment of Nanoskin®subcutaneously in the dorsal region. The animals received Nanoskin®(group 1) or Nanoskin®coated with a gelatin layer (group 2). The animals were observed daily for over 7, 30, 90, or 180 days with the subcutaneous implants in place. The animals were euthanized at a designated time and the Nanoskin®was removed for histologic, morphometric, and transmission electron microscopy evaluation.

Results:

The results were similar for both groups. The subcutaneously implanted Nanoskin®resulted in good tissue integration, induced mild inflammation, and was surrounded by a delicate pseudocapsule.

Conclusion:

The good tissue integration of Nanoskin®in study indicates that it may be a potential material for application as a substitute of posterior eyelid lamellar tissue. Further clinical studies are required to confirm the preliminary outcomes of this experimental study.
Sepsis in Obstetrics
Authors: Parfitt Sheryl E. , Bogat Mary L. , Hering Sandra L. , Ottley Charlotte , Roth Cheryl
Published: March 2017

Morbidity and mortality associated with sepsis has gained widespread attention on a local, state, and national level, yet, it remains a complicated disorder that can be difficult to identify in a timely manner. Sepsis in obstetric patients further complicates the diagnosis as alterations in physiology related to pregnancy can mask sepsis indicators normally seen in the general population. If early signs of sepsis go unrecognized, septic shock can develop, leading to organ dysfunction and potential death. Maternal early warning tools have been designed to assist clinicians in recognizing early indications of illness. Through use of clinical pathway-specific tools, disease processes may be detected early, subsequently benefitting patients with aggressive treatment management and intervention.

This article is the second in a series of three that discuss the importance of sepsis and septic shock in pregnancy. Risk factors, causes of sepsis, signs and symptoms, and maternal early warning tools are discussed.