bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient and Caregiver Needs in Oncology. An Italian Survey
Authors: Berardi Rossana , Ballatore Zelmira , Bacelli Weruska , Silva Rosa Rita , Menichetti Ettore Tito , Marcellini Massimo , Duca Monia , Giacomini Giusi , Marilungo Katia , Cascinu Stefano
Published: June 2015

Aims and Background

Cancer is a disease that has far-reaching consequences for patients and their families. The present study targets unmet caregiver needs so that better support can be provided and planned for.

Methods

The first phase of the study was to conduct a survey designed to explore basic needs (medical and nursing information, psychological support, social welfare). The survey also investigated the caregiver's personal details (age, sex, degree of kinship). The survey was distributed to caregivers coming to the day hospitals of the 4 oncology departments involved in the study.

Results

A total of 137 relatives of cancer patients completed the survey. Among the explored needs, the most recurrent was the availability of a doctor who provides full information on the treatment choices. A further important request was for consistency between the information provided by doctors and that provided by other health-care workers, with specific reference to a patient-centered approach that can be easily and fully understood, available therapeutic options especially at home, and prognosis.

Conclusions

The study showed that the need for exhaustive and simple information provided by a referral physician is still an unmet need in the Internet age.
Dosimetric Verification of Stereotactic Body Radiation Therapy for Lung Cancer Treatment Plans Using Flattening Filter-free Beams
Authors: Zhang Jiyong , Wu Vincent W. , Lu Jiayang , Hong Danli , Lin Zhixiong
Published: June 2015

Aims

This study aimed to analyze the dose distribution using different dosimetric tools in conducting pretreatment quality assurance for lung cancer stereotactic body radiation therapy (SBRT) plans with flattening filter free (FFF) beams.

Methods

Nine patients with lung cancer treated via SBRT were randomly selected, and their treatment plans were generated using the Eclipse treatment planning system (TPS) with FFF beams. For each patient, the same plan was applied to the Delta4 phantom and MatriXX by the TPS, which calculated the dose distribution. The Delta4 and MatriXX phantoms were then used to measure the actual dose distribution at the linear accelerator, and these measured doses were compared to with the calculated doses. Gamma analysis was employed in verifying the correspondence between the dose distributions. The absolute point doses were measured by a 0.016 mL Microchamber with the RW3 phantom and Thorax phantom.

Results

The absolute point doses measured by the 0.016 mL Microchamber were within ±3% of the calculated results for the central point of the RW3 and Thorax phantoms. The Delta4 and MatriXX dose distributions agreed well with the measured and calculated doses, over 98%, based on the 3% maximum dose and 3 mm gamma criteria.

Conclusions

Both measured and calculated doses for the Delta4 and MatriXX phantoms agreed well for each patient with lung cancer. The absolute point dose measurements using the 0.016 mL Microchamber exhibited excellent agreement with the TPS calculated between the RW3 and Thorax phantoms.
Reirradiation in Head and Neck Recurrent or Second Primary Tumor: Efficacy, Safety, and Prognostic Factors
Authors: Buglione Michela , Maddalo Marta , Mazzeo Ercole , Bonomo Pierluigi , Spiazzi Luigi , Bruni Alessio , Paiar Fabiola , Triggiani Luca , Greto Daniela , Rubino Laura , Livi Lorenzo , Bertoni Filippo , Magrini Stefano Maria
Published: June 2015

Aims and background

We investigated efficacy, safety, and prognostic factors of reirradiation in patients with recurrent or second primary head and neck cancer.

Methods

Records of 75 consecutive patients treated with reirradiation between August 2005 and December 2013 were reviewed.

Results

Median overall survival (OS) and cancer-specific survival (CSS) were 29.5 and 33.6 months. Median local control (LC) and progression-free survival (PFS) were 21.7 and 16.2 months. Univariate analysis showed that patients younger than 70 years, with a Karnofsky Performance Status (KPS) >90 or with 2 or less comorbidities at time of reirradiation, have a better OS; KPS >90 and biological equivalent dose (BED) >72 Gy positively influenced the PFS. At multivariate analysis, KPS at reirradiation was an independent predictive factor for OS, while BED was an independent predictive factor for CSS and OS. At univariate analysis, patients with planning target volume (PTV) >221 mL had worse LC and PFS rates, with results confirmed at multivariate analysis. The rate of fatal treatment-related adverse events was 6.7% (3 carotid blowout, 1 soft tissue necrosis, and 1 thromboembolic event).

Conclusions

This study confirms the role and outcomes of reirradiation. A careful selection of patients could minimize acute and late side effects and influence survival: elderly patients, with significant medical comorbidities or poor KPS, are worse candidate for reirradiation. Total dose delivered with reirradiation and PTV appear to be other potential prognostic factors. Further studies of dose escalation are needed to establish the total dose that could achieve better LC rates with a safer toxicity profile.
Trabectedin plus Pegylated Liposomal Doxorubicin: Retrospective Analysis in Heavily Pretreated Platinum-sensitive Ovarian Cancer
Authors: Nicoletto Maria Ornella , Baldoni Alessandra , Casarin Alessandra , Randon Giovanni , Nardin Margherita , Baretta Zora , Lardelli Pilar , Nieto Antonio , Alfaro Vicente , Rigamonti Claudia , Conte Pier Franco
Published: June 2015

Purpose

This retrospective analysis evaluated treatment with trabectedin plus pegylated liposomal doxorubicin (PLD) in 34 heavily pretreated patients (median number of previous lines, 3; range, 2-10) with platinum-sensitive relapsed ovarian cancer (ROC) at a single center in Italy.

Methods

Trabectedin/PLD treatment consisted of trabectedin administered every 3 weeks as a 3-hour intravenous (i.v.) infusion at a dose of 1.1 mg/m2, immediately after PLD 30 mg/m2 i.v. infusion. Study objectives were the evaluation of the objective response rate (ORR), progression-free survival (PFS) and overall survival (OS).

Results

Three complete responses and 8 partial responses were observed, with an ORR of 32.4% (95% CI, 17.450.5%). Median PFS was 6.1 months (95% CI, 4.4-8.9 months). Median OS was 16.3 months (95% CI, 6.8-23.5). Most responses (9 of 11) were found in patients with partially platinum-sensitive disease (ORR 40.9% in this subset; median PFS 6.8 months and median OS 20.8 months). Grade 3 treatment-related adverse events consisted of nausea/vomiting (n = 5; 14.7%), mucositis (n = 2; 5.9%), alanine aminotransferase increase, anemia and neutropenia (n = 1 each; 2.9%).

Conclusions

The overall findings appear consistent with those previously observed in a randomized controlled clinical trial, and support the use of trabectedin/PLD in heavily pretreated patients with platinum-sensitive ROC, especially those with partially platinum-sensitive disease.
Adjuvant Aromatase Inhibitor Therapy in Early Breast Cancer: What Factors Lead Patients to Discontinue Treatment?
Authors: Moscetti Luca , Fabbri Maria Agnese , Sperduti Isabella , Fabrizio Nelli , Frittelli Patrizia , Massari Annalisa , Pompei Luciano , D'Auria Giuliana , Pofi Enrico , Ruggeri Enzo Maria
Published: June 2015

Background

Aromatase inhibitors (AIs) are standard hormone therapy (HT) for the adjuvant treatment of postmenopausal endocrine-sensitive early breast cancer. Treatment discontinuation due to toxicity is an important issue that may help clinicians identify effective clinical interventions to allow adequate treatment duration. We reviewed the main reasons for interruption of AIs at our institution from 2006 to 2009.

Methods

236 patients treated with adjuvant AIs were eligible for analysis. Median age was 64 years (35-89), median follow-up 53 months (6-60). Prior adjuvant chemotherapy was taxane based in 47 patients and anthracycline based in 43 patients. 118 patients had received letrozole, 101 anastrozole, and 17 exemestane.

Results

Twenty-four patients (10%) needed discontinuation of the first AI assigned as a result of toxicity. Grade 2/3 arthralgia was the main reason for discontinuation in 13/24 patients. No differences in the incidence of arthralgia were noted in patients who had received taxanes or anthracyclines. Headache, alopecia, itching, diffuse skin reaction, allergic reaction with hypertensive crisis, xerostomia and xerophthalmia, insomnia and somnolence were the other reasons for discontinuation. In multivariate logistic regression analysis, age (65 years) and HT were independent factors associated with the onset of arthralgia (p = 0.006 and p = 0.008, respectively; OR 2.65, 95% CI 1.32-5.31). Alternative HT (AI or tamoxifen) was offered to patients who wanted or needed to permanently interrupt the ongoing drug.

Conclusions

In our analysis, 10% of patients discontinued the first AI assigned because of toxicity. Median time course of all adverse events leading to HT discontinuation was 155 days and 135 days for arthralgia. A switch to alternative HT with toxicity monitoring is a recommended option for avoiding premature and permanent interruption of an effective treatment.
Evaluating psychosocial support needs of female cancer patients in the State of Qatar
Authors: Alagraa Razzan , Abujaber Ahmad , Chandra Prem , Doughty Joanne
Published: June 2015

Patient perceived perceptions of psychosocial support are increasingly important to understanding appropriate holistic patient-centred care. Information is scarce regarding the attitudes of female cancer patients in Arab and Muslim populations. This study was undertaken in the State of Qatar among female cancer patients. The aim of this study was to investigate what extent women undergoing cancer treatment in the State of Qatar view the importance of psychosocial support? Another aim of this study was to determine which demographic indicators, if any, may predict for certain preferences in support. The authors hypothesized that a majority of female cancer patients will perceive psychosocial support as an important aspect. This study used English and Arabic questionnaires to glean data from female cancer patients attending clinics at the National Centre for Cancer Care and Research in Doha, Qatar. For the purpose of this study, psychosocial support was defined under four categories: 1) family support, 2) religious/spiritual support, 3) support groups 4) physician referred support. Results showed that 88% of female respondents rated psychosocial support categories as important. There was no significance between patient demographics and specific preferences for the support categories in the study. This study may provide some areas for future research that may shape guidelines for improving holistic patient care and in assisting the Supreme Health Council in meeting its targets for the Qatar National Cancer strategy, which states that cancer treatment should be patient-centred focusing on both medical and psychosocial needs of patients.
A review of drug-induced acute angle closure glaucoma for non-ophthalmologists
Authors: Ah-kee Elliott Yann , Egong Eric , Shafi Ahad , Lim Lik Thai , Yim James Li
Published: June 2015

Acute angle closure glaucoma is an ophthalmic emergency and can lead to blindness if left untreated. Several types of drugs have the potential to precipitate acute angle closure glaucoma. These include adrenergic, cholinergic and anticholinergic, antidepressants, anticoagulants and sulfa-based agents. This article provides a basic overview of the risk factors and pathophysiologic mechanisms involved in angle closure glaucoma and focuses on drug-induced angle closure glaucoma for the non-ophthalmologist. A PubMed search limited to the English language was conducted to find relevant literature for the purpose of this article. Most attacks occur in subjects unaware that they are at risk due to innately narrow iridocorneal angles. Clinicians should always review medications in patients presenting with symptoms of acute angle closure glaucoma. The aim of this article is to bring this ophthalmic condition to the attention of clinicians, particularly those outside the field of ophthalmology who commonly prescribe these medications or see these patients prior to referring to ophthalmologists.
Why is Spot Carbon so Cheap and Future Carbon so Dear? The Term Structure of Carbon Prices
Authors: Bredin Don , Parsons John
Published: June 2015

This study examines carbon spot and futures price relationships and the dynamics of the carbon term structure in the European Union Emission Trading Scheme (ETS) between 2005-2014. Using spot and futures prices, we calculate an implied cost of carry. According to received theory, the cost of carry is—with some ex-ceptions—just the opportunity cost of money, so that the term structure of the cost of carry should exactly equal the term structure interest rates. However, we show that spot carbon allowances were originally expensive relative to futures, but since late 2008 the situation reversed and spot carbon allowances have been persistently cheap relative to futures prices. This dramatic shift coincides with the onset of the global financial crisis in late 2008 and the ongoing European banking crisis of 2010-2013.
Don’t just do something, stand there
Authors: Hoffman Jerome R , Wilkes Michael S
Published: June 2015

Imagine a (hypothetical) screening test which, done in a population of average risk, saves one person from dying from cancer out of every 10,000 people screened.  Imagine as well that every one of those 10,000 pays a price in terms of time and money spent, as well as discomfort, and that some or even many of them will also have to deal with increased anxiety, repeat testing, biopsies, and in a few cases, surgery. Finally, a few will have serious adverse effects like infection or organ failure.
Literatura médica e a ética em pesquisa: desafios para a prevenção quaternária
Authors: Wagner Hamilton Lima , Ramos Soares Cynthia , Moreira João Victor
Published: June 2015

Este artigo discute a qualidade das evidências científicas publicadas no campo da medicina. Atualmente, existe uma dificuldade em avaliar a qualidade dessas publicações, visto que grandes ensaios clínicos são patrocinados pela indústria da saúde, em especial a indústria farmacêutica, a qual exige cláusula de confidencialidade dos dados brutos obtidos nas pesquisas. Isso gera importantes repercussões tanto para a prática dos profissionais de saúde como para a produção de diretrizes de atenção à saúde. Diante dessa incerteza de informações em saúde, a prevenção quaternária surge como uma proposta para fortalecer a relação médico-paciente como espaço para atividades preventivas e outras ações em saúde .
O espaço de entrecruzamento das palavras: a relação médico-paciente
Authors: Norman Armando Henrique
Published: June 2015

A Revista Brasileira de Medicina de Família e Comunidade (RBMFC) nesta edição especial de Volume 10 número 35, aborda o tema da Prevenção Quaternária (P4), que passou a fazer parte dos descritores da Bireme (DeCS) em 06/04/2015, graças a iniciativa da RBMFC.2,3 Assim, novas palavras começam a ganhar forma e força como discurso contra-hegemônico dentro da própria medicina por meio da ‘liderança moral e intelectual’4 de pesquisadores e médicos práticos. A ilustração da capa, intitulada ‘Palavras da Prevenção’ faz referência à importância de certos termos no campo da prevenção, bem como aos vários temas discutidos na presente edição. De certa forma, é por meio da linguagem e do uso das palavras que se sustenta a prática da medicina de família, calcada na relação médico-paciente. Esta se constitui como um dos cernes da especialidade e tem a palavra como potencializadora de atividades de prevenção quaternária. As palavras, muitas vezes, podem causar iatrogenia, ao se rotular ou transformar potenciais riscos em ‘doença’, e assim gerar dúvidas e medos nos pacientes pela produção de pseudodoenças. Mas é também por meio das palavras que se pode tranquilizar e produzir efeitos terapêuticos positivos nos pacientes. Portanto, a palavra como um dos pilares da comunicação, necessita ser adequadamente trabalhada para facilitar o entendimento entre profissionais de saúde e pacientes durante a troca de informações. É a partir da relação médico-paciente, espaço de entrecruzamento das palavras, que se constrói no cotidiano a prevenção quaternária.
O Nietzsche de Foucault, o Foucault de Nietzsche
Authors: Ribas Thiago Fortes
Published: June 2015

Partindo das afirmações de Foucault de que seu o interesse por Nietzsche não está no comentário ou na interpretação fiel de sua obra, o artigo se propõe inicialmente a explicar o sentido daquilo que seria a apropriação foucaultiana de Nietzsche. Para tanto, seguimos as indicações de Foucault segundo as quais o foco de seu interesse residiria na problemática nietzschiana da verdade enquanto possuidora de uma história e como transpassada por uma vontade. Assim, a questão da transformação de si pelos jogos de verdade, noção com a qual Foucault relê retrospectivamente seus livros desde História da loucura, aparece ligada diretamente a Nietzsche. Em seguida, propomos um exercício de pensamento pelo qual a noção de Nietzsche do “filósofo do futuro”, detalhada em Além do bem e do mal como aquele que vai além da tarefa puramente crítica e cética, relaciona-se com a noção de Foucault do filósofo como alguém que está constantemente aberto para realizar “experiências” com si mesmo.
O sol negro da linguagem: Nietzsche, Foucault e a questão do sentido
Authors: Lemos Fabiano
Published: June 2015

O artigo pretende discutir de que modo a filosofia da linguagem de Nietzsche se desdobra em sua genealogia e como, nesse percurso, ela é apropriada por Foucault em seu trabalho. Além disso, procura identificar as diferenças entre esse viés genealógico e a perspectiva metafísica da linguagem de textos como O nascimento da tragédia, investigando até que ponto a leitura de Foucault deixa de lado aspectos universalistas presentes nas primeiras obras de Nietzsche.
Foucault, Nietzsche: teoria do conhecimento, teologia e crítica da modernidade
Authors: Vecchia Ricardo Bazilio Dalla
Published: June 2015

Este artigo objetiva discutir a influência de Nietzsche na renovação político metodológica da obra de Foucault na década de 1970, a partir de três textos: Aulas sobre a vontade de saber: aula sobre Nietzsche (1971), Nietzsche, a genealogia e a história (1971) e A verdade e as formas jurídicas: 1ª conferência (1973). Pretendemos demonstrar que, para além da dissociação filológica entre Ursprung e Erfindung que abaliza os três textos, o argumento da ruptura da teoria do conhecimento com a teologia tematizado em dois deles desempenha uma função de importância capital para o desenvolvimento da genealogia do poder.
Subtype‐independent near full‐length HIV‐1 genome sequencing and assembly to be used in large molecular epidemiological studies and clinical management
Authors: Grossmann Sebastian , Nowak Piotr , Neogi Ujjwal
Published: June 2015

Introduction

HIV‐1 near full‐length genome (HIV‐NFLG) sequencing from plasma is an attractive multidimensional tool to apply in large‐scale population‐based molecular epidemiological studies. It also enables genotypic resistance testing (GRT) for all drug target sites allowing effective intervention strategies for control and prevention in high‐risk population groups. Thus, the main objective of this study was to develop a simplified subtype‐independent, cost‐ and labour‐efficient HIV‐NFLG protocol that can be used in clinical management as well as in molecular epidemiological studies.

Methods

Plasma samples (n=30) were obtained from HIV‐1B (n=10), HIV‐1C (n=10), CRF01_AE (n=5) and CRF01_AG (n=5) infected individuals with minimum viral load >1120 copies/ml. The amplification was performed with two large amplicons of 5.5 kb and 3.7 kb, sequenced with 17 primers to obtain HIV‐NFLG. GRT was validated against ViroSeq™ HIV‐1 Genotyping System.

Results

After excluding four plasma samples with low‐quality RNA, a total of 26 samples were attempted. Among them, NFLG was obtained from 24 (92%) samples with the lowest viral load being 3000 copies/ml. High (>99%) concordance was observed between HIV‐NFLG and ViroSeq™ when determining the drug resistance mutations (DRMs). The N384I connection mutation was additionally detected by NFLG in two samples.

Conclusions

Our high efficiency subtype‐independent HIV‐NFLG is a simple and promising approach to be used in large‐scale molecular epidemiological studies. It will facilitate the understanding of the HIV‐1 pandemic population dynamics and outline effective intervention strategies. Furthermore, it can potentially be applicable in clinical management of drug resistance by evaluating DRMs against all available antiretrovirals in a single assay.
Pheochromocytoma Diagnosis After an Abnormal Stress Test: Case Report and Review of the Literature
Authors: Treyger German , Silver Shawn A. , Sakharova Alla A.
Published: June 2015

Pheochromocytoma is a rare adrenal gland tumor that is often difficult for physicians to diagnose because of its general, nonspecific complaints. Diagnosis is particularly difficult in patients with neurofibromatosis 1, because pheochromocytoma in these patients will mimic other cardiovascular abnormalities. The authors report the case of a 60-year-old woman with an extensive history of hyperlipidemia, malignant hypertension, coronary artery disease, and neurofibromatosis 1 who was referred for an elective cardiac catheterization as a result of an abnormal stress test. The patient returned to the hospital 3 days after the procedure complaining of increased angina and palpitations. While hospitalized, she developed severe episodic hypertension. A computed tomographic scan revealed bilateral adrenal masses. Findings of biochemical and imaging evaluation confirmed the diagnosis of bilateral pheochromocytoma. Early screening of pheochromocytomas in high-risk populations is essential for prompt diagnosis and successful management.
Low‐Energy Ultrasound Treatment Improves Regional Tumor Vessel Infarction by Retargeted Tissue Factor
Authors: Brand Caroline , Dencks Stefanie , Schmitz Georg , Mühlmeister Mareike , Stypmann Jörg , Ross Rebecca , Hintelmann Heike , Schliemann Christoph , Müller-Tidow Carsten , Mesters Rolf M. , Berdel Wolfgang E. , Schwöppe Christian
Published: June 2015

Objectives

To enhance the regional antitumor activity of the vascular‐targeting agent truncated tissue factor (tTF)‐NGR by combining the therapy with low‐energy ultrasound (US) treatment.

Methods

For the in vitro US exposure of human umbilical vein endothelial cells (HUVECs), cells were put in the focus of a US transducer. For analysis of the US‐induced phosphatidylserine (PS) surface concentration on HUVECs, flow cytometry was used. To demonstrate the differences in the procoagulatory efficacy of TF‐derivative tTF‐NGR on binding to HUVECs with a low versus high surface concentration of PS, we performed factor X activation assays. For low‐energy US pretreatment, HT1080 fibrosarcoma xenotransplant‐bearing nude mice were treated by tumor‐regional US‐mediated stimulation (ie, destruction) of microbubbles. The therapy cohorts received the tumor vessel‐infarcting tTF‐NGR protein with or without US pretreatment (5 minutes after US stimulation via intraperitoneal injection on 3 consecutive days).

Results

Combination therapy experiments with xenotransplant‐bearing nude mice significantly increased the antitumor activity of tTF‐NGR by regional low‐energy US destruction of vascular microbubbles in tumor vessels shortly before application of tTF‐NGR (P < .05). Mechanistic studies proved the upregulation of anionic PS on the outer leaflet of the lipid bilayer of endothelial cell membranes by low‐energy US and a consecutive higher potential of these preapoptotic endothelial cells to activate coagulation via tTF‐NGR and coagulation factor X as being a basis for this synergistic activity.

Conclusions

Combining retargeted tTF to tumor vessels with proapoptotic stimuli for the tumor vascular endothelium increases the antitumor effects of tumor vascular infarction. Ultrasound treatment may thus be useful in this respect for regional tumor therapy.
Left Ventricular Ejection Time Derived From the Common Carotid Artery Doppler Waveform
Authors: Polak Joseph F. , Alessi-Chinetti Jean M. , Estes James M. , Patel Ayan R.
Published: June 2015

Objectives

Left ventricular ejection time (LVET) is measured from blood pressure tracings as the interval from end diastole to the dicrotic notch and shows associations with left ventricular ejection fraction (LVEF) and heart failure. LVET can be measured on common carotid artery Doppler waveforms. We therefore studied the possible associations of common carotid artery LVET with LVEF measured by echocardiography and heart failure.

Methods

We performed a retrospective study of 110 patients who had transthoracic echocardiography and carotid Doppler evaluations within 1 day of each other. LVEF was determined by the biplane modified Simpson method. LVET was measured from left common carotid artery Doppler tracings. Linear regression was used to evaluate associations between LVET and LVEF. We also used logistic regression with LVEF of less than 40% as a cut point for heart failure to generate a receiver operating characteristic curve, estimate the area under the curve, and calculate sensitivity and specificity.

Results

LVET was associated with LVEF (P < .0001). The area under the curve of LVET for heart failure was 0.81 (95% confidence interval [CI], 0.72–0.87), and the sensitivity and specificity were 76.9% (95% CI, 65.4%–88.4%) and 65.5% (95% CI, 53.4%–77.8%), respectively, for LVET of 321 milliseconds.

Conclusions

LVET measured on common carotid artery Doppler tracings decreases with LVEF and is strongly associated with prevalent heart failure. Based on what is known of blood pressure–measured LVET, common carotid artery Doppler waveform–derived LVET could be used to serially monitor cardiac function.
Integrating Sonography Training Into Undergraduate Medical Education
Authors: Day James , Davis Joshua , Riesenberg Lee Ann , Heil Daniel , Berg Katherine , Davis Robyn , Berg Dale
Published: June 2015

Objectives

Sonography is a crucial and versatile tool within the field of medicine. Recent advancements in technology have led to increased use of point‐of‐care sonography. We designed a survey to assess prior point‐of‐care sonography training among incoming interns at an academic teaching hospital.

Methods

In 2012 and 2013, we surveyed incoming interns (n = 154 and 145, respectively) regarding point‐of‐care sonography training received during medical school. The survey questions included formal didactic sessions, bedside instruction, and the use of simulation technology.

Results

One‐fourth (26.3% in 2012 and 23.4% in 2013) of responding interns reported having never done an ultrasound scan at the bedside. In 2012 and 2013, 55.0% and 55.6% of respondents reported never having done an ultrasound scan in a simulation center, respectively. Interns agreed that sonography education should be provided during medical school. On average, interns disagreed with the statement that sonography should be taught in residency only. There was no significant difference in the sex or general previous experience with sonography across both intern classes.

Conclusions

Point‐of‐care sonography is inconsistently taught in medical school. The interns in our study also thought that sonography education should begin in medical school, and sonography should be taught by using simulation and at the bedside.
Evaluating the Optimal Definition of Abnormal First‐Trimester Uterine Artery Doppler Parameters to Predict Adverse Pregnancy Outcomes
Authors: Carter Ebony B. , Goetzinger Katherine , Tuuli Methodius G. , Odibo Linda , Cahill Alison G. , Macones George A. , Odibo Anthony O.
Published: June 2015

Objectives

To investigate the optimal definition of abnormal first‐trimester uterine artery Doppler parameters associated with adverse pregnancy outcomes.

Methods

A prospective cohort of women with singleton gestations between 11 and 14 weeks consented to uterine artery Doppler measurements. Doppler parameters were measured bilaterally, and mean pulsatility index (PI) and resistive index (RI) values were calculated. The presence of notching was also determined. Each parameter was evaluated for prediction of preeclampsia, early preeclampsia (<34 weeks), preterm birth (<37 weeks), early preterm birth (<34 weeks), and small for gestational age (SGA; birth weight <10th percentile). Descriptive statistics evaluated the association between abnormal Doppler indices and outcomes. A receiver operating characteristic (ROC) analysis was used to define the best cutoff points for mean PI and RI. The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) were calculated for bilateral notching and mean PI and RI percentiles.

Results

Of 1192 patients with complete outcome data, preeclampsia was seen in 8.4%, early preeclampsia in 1.8%, preterm birth in 12.9%, early preterm birth in 5.6%, and SGA in 8.5%. A mean PI above the 75th percentile (>1.91) was the best index for predicting early preeclampsia (sensitivity, 45.0%; specificity, 75.5%; NPV, 98.7%; ROC area, 0.65). A mean PI above the 75th percentile was also the best index for predictive early preterm birth (sensitivity, 40.0%; specificity, 76.0%; NPV, 95.5%; ROC area, 0.65). None of the parameters were significant for predicting SGA.

Conclusions

A mean uterine PI above the 75th percentile is the most discriminative abnormal uterine artery Doppler parameter for predicting both early preeclampsia and early preterm birth.
Sonography of the Optic Nerve Sheath Diameter for Detection of Raised Intracranial Pressure Compared to Computed Tomography
Authors: Ohle Robert , McIsaac Sarah M. , Woo Michael Y. , Perry Jeffrey J.
Published: June 2015

Objectives

The diagnosis of raised intracranial pressure (ICP) is important in many critically ill patients. The optic nerve sheath is contiguous with the subarachnoid space; thus, an increase in ICP results in a corresponding increase in the optic nerve sheath diameter. The objective of this study was to assess the diagnostic accuracy of sonography of the optic nerve sheath diameter compared to computed tomography (CT) for predicting raised ICP.

Methods

We searched PubMed, EMBASE, and the Cochrane database from 1986 to August 2013 and performed hand searches. Two independent reviewers extracted data. Study quality was assessed by using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. We calculated κ agreement for study selection and evaluated clinical and quality homogeneity before the meta‐analysis.

Results

From 1214 studies, we selected 45 for full review. Twelve studies with 478 participants were included (κ = 0.89). Ocular sonography yielded sensitivity of 95.6% (95% confidence interval [CI], 87.7%–98.5%), specificity of 92.3% (95% CI, 77.9%–98.4%), a positive likelihood ratio of 12.5 (95% CI, 4.16–37.5), and a negative likelihood ratio of 0.05 (95% CI, 0.02–0.14). Average quality according to the QUADAS tool was 7.4 of 11. There was moderate to high heterogeneity based on the prediction ellipse area and variance logit of sensitivity (2.1754) and specificity (2.6720).

Conclusions

Ocular sonography shows good diagnostic test accuracy for detecting raised ICP compared to CT: specifically, high sensitivity for ruling out raised ICP in a low‐risk group and high specificity for ruling in raised ICP in a high‐risk group. This noninvasive point‐of‐care method could lead to rapid interventions for raised ICP, assist centers without CT, and monitor patients during transport or as part of a protocol to reduce CT use.
The Ultrasound‐Only Central Venous Catheter Placement and Confirmation Procedure
Authors: Saul Turandot , Doctor Michael , Kaban Nicole L. , Avitabile Nicholas C. , Siadecki Sebastian D. , Lewiss Resa E.
Published: June 2015

The placement of a central venous catheter remains an important intervention in the care of critically ill patients in the emergency department. We propose an ultrasound‐first protocol for 3 aspects of central venous catheter placement above the diaphragm: dynamic procedural guidance, evaluation for pneumothorax, and confirmation of the catheter tip location.
Multiparametric Sonography of Testicular Hematomas
Authors: Yusuf Gibran , Konstantatou Eleni , Sellars Maria E. , Huang Dean Y. , Sidhu Paul S.
Published: June 2015

We investigated the appearances of intratesticular hematomas on multiparametric sonography combining grayscale, color Doppler, and contrast‐enhanced sonography and strain elastography. Over a 3‐year period, 17 hematomas in 8 patients were analyzed. Blunt trauma (n = 7) and surgery (n = 1) were preceding events. Grayscale sonography showed well‐defined oval or round predominantly hypoechoic and heterogeneous, peripherally (n = 13) or centrally (n = 4) located lesions. Three showed contrast enhancement of septations, and 4 showed peripheral lesion rim enhancement. On strain elastography, the mean strain ratio was 1.19 (range, 0.41–2.36), and elasticity score were 3 or lower (n = 13) and 5 (n = 4). Multiparametric sonography shows nonenhancement with contrast and predominantly “soft” elastographic properties and aids in the interpretation of the benign nature of intratesticular hematomas.
Is the “I‐Sign” in the 3‐Vessel and Trachea View a Valid Tool for Prenatal Diagnosis of d‐Transposition of the Great Arteries?
Authors: Palatnik Anna , Gotteiner Nina L. , Grobman William A. , Cohen Leeber S.
Published: June 2015

Prenatal diagnosis of d‐transposition of the great arteries remains less frequent compared to other major congenital heart defects. In this study, we examined how often the 3‐vessel and trachea view was abnormal in a large series of prenatally diagnosed cases of d‐transposition of the great arteries. We found that an abnormal 3‐vessel and trachea view in the shape of an “I” (“I‐sign”), which represents an anteriorly displaced aorta, was present in all fetuses with d‐transposition of the great arteries when a 3‐vessel and trachea view was successfully obtained. Therefore we believe that the 3‐vessel and trachea view can be used to reliably detect d‐transposition of the great arteries during prenatal sonography.
Imaging three‐dimensional crustal conductivity structures reflecting continental flood basalt effects hidden beneath thick intracratonic sedimentary basin
Authors: Padilha Antonio L. , Vitorello Ícaro , Antunes Cassio E. , Pádua Marcelo B.
Published: June 2015

A large‐scale array of long‐period magnetic data and a deep‐probing magnetotelluric profile were recorded in the intracratonic Paraná sedimentary basin in central eastern South America, which presents a thick and extensive sedimentary‐magmatic sequence that allows its basement to be investigated only by indirect methods. Integration of the results from both methods showed that the crust beneath the basin presents several quasi‐linear highly conductive channeled zones with limited lateral extent, in coincidence with some of the main tectonic structures recognized at the surface, and a moderate but pervasive lithosphere conductivity enhancement beneath its central part. Upward movement of CO2‐bearing volatiles and magmas precipitating highly conducting mineral phases along discrete subvertical fault zones that served as feeder conduits for Early Cretaceous voluminous continental flood basalts was a likely process responsible for the localized conductivity enhancements. Correlation between some of the linear conductive zones and elongated magnetic anomalies and between the maximum depth occurrence of most of these conductive anomalies and the Curie depth at which crustal rocks lose their magnetism gives strong support to interconnected iron oxides (especially magnetite) and iron sulfides (such as pyrrhotite) as the main conductive sources. The moderate bulk conductivity increase in the crust and upper mantle beneath the central part of the basin is unexpected for a postulated cratonic basement and is tentatively associated with impregnation of the lithosphere by conducting minerals related either to widespread tectonic events in the Ordovician or Late Precambrian or to dispersed magmatic residues of an Early Cretaceous magma differentiation contaminating the entire lithosphere.
A chemistry‐climate model study of past changes in the Brewer‐Dobson circulation
Authors: Oberländer‐Hayn Sophie , Meul Stefanie , Langematz Ulrike , Abalichin Janna , Haenel Florian
Published: June 2015

Model simulations indicate an acceleration of the Brewer‐Dobson circulation (BDC) in the past with a direct impact on the exchange of air masses between the troposphere and the stratosphere. However, most observational data sets do not confirm the model results. Bönisch et al. (2011) and Ray et al. (2010) indicate a strengthening of the BDC in its shallow branch and a weakening in its deep branch. In contrast, balloon‐borne measurements and Michelson Interferometer for Passive Atmospheric Sounding satellite observations show no significant acceleration of the BDC at Northern Hemisphere (NH) midlatitudes. In our study, the change of the BDC in the recent past is analyzed from simulations with the chemistry‐climate model ECHAM/MESSy Atmospheric Chemistry. As the sign of change considerably depends on the underlying forcings, namely, changes in concentrations of greenhouse gases (GHGs) and ozone‐depleting substances (ODSs), as well as their interactions, we separate their contributions by using sensitivity simulations. The changes in tropical upward mass flux indicate a strengthening of the BDC between 1960 and 2000 in NH winter season in the lower and a weakening in the upper stratosphere with a change in sign at 10 hPa. While the lower stratospheric increase of about 2%/decade is caused by equal contributions from rising GHGs and ODSs, rising ODS concentrations counteract the GHG effect in the middle and upper stratosphere with a total decrease of about 0.5%/decade. Changes in mean age of air show a decrease of about 0.13 yr/decade in the lower and middle stratosphere and a slight increase in the Arctic upper stratosphere and lower mesosphere, which is induced by interactions between the forcings.
Fault Zone Guided Wave generation on the locked, late interseismic Alpine Fault, New Zealand
Authors: Eccles J. D. , Gulley A. K. , Malin P. E. , Boese C. M. , Townend J. , Sutherland R.
Published: June 2015

Fault Zone Guided Waves (FZGWs) have been observed for the first time within New Zealand's transpressional continental plate boundary, the Alpine Fault, which is late in its typical seismic cycle. Ongoing study of these phases provides the opportunity to monitor interseismic conditions in the fault zone. Distinctive dispersive seismic codas (~7–35 Hz) have been recorded on shallow borehole seismometers installed within 20 m of the principal slip zone. Near the central Alpine Fault, known for low background seismicity, FZGW‐generating microseismic events are located beyond the catchment‐scale partitioning of the fault indicating lateral connectivity of the low‐velocity zone immediately below the near‐surface segmentation. Initial modeling of the low‐velocity zone indicates a waveguide width of 60–200 m with a 10–40% reduction in S wave velocity, similar to that inferred for the fault core of other mature plate boundary faults such as the San Andreas and North Anatolian Faults.
Comparison of wave propagation through ice covers in calm and storm conditions
Authors: Li Jingkai , Kohout Alison L. , Shen Hayley H.
Published: June 2015

Motivated by a dramatic reduction in Arctic sea ice cover, interest in the field of wave‐ice interaction has accelerated over the past few years. Recent observations have identified that large waves (>3 m) have a linear attenuation rate, rather than the previously assumed exponential rate that is found for small waves. This suggests that waves penetrate further into the ice cover than previously expected. To explore this further we tested two exponentially decaying wave models. Contributions from nonlinear and wind generation source terms enabled both models to reproduce the observed regime shift. Essentially, the accumulation of nonlinear and wind energy contributions to long (and thus higher amplitude) waves can offset the ice damping, thus reducing the apparent attenuation. This study highlights the relevance of considering frequency dependence when analyzing wave attenuation in sea ice field data.
High‐latitude intermittent ionospheric scintillations: Exploring the Castaing distribution
Authors: Mezaoui H. , Hamza A. M. , Jayachandran P. T.
Published: June 2015

We present a multiscale analysis of the received amplitude fluctuations of the L1 GPS signal. The analysis consists of constructing a differential amplitude signal by taking the difference between the signal at time t and the signal at time t + τ, where τ represents a time lag. The probability density functions of the measured differential amplitude fluctuations are computed and fitted with Castaing distributions. The fourth normalized moment of the distributions is used to investigate the intermittent nature of the signal. The results reveal direct evidence that the intermittent aspect of the investigated scintillation events is more pronounced at small differential time lags than at long ones.
Impact of the perturbation zonal velocity variation on the spatio/temporal occurrence pattern of L band scintillation—A case study
Authors: Bagiya Mala S. , Sridharan R. , Sunda Surendra , Jose Lijo , Pant Tarun K , Choudhary Rajkumar
Published: June 2015

The earlier evolved method for the forecast of the spatiotemporal variation of L band scintillation based on the expected variation of the perturbations, under favorable ionospheric/thermospheric conditions, has been refined by duly accounting for the local time variation of the zonal velocity of the perturbations. The unique combination of the two geostationary satellites (GSAT‐8 and GSAT‐10) over the Indian zone has been used to estimate the typical local time dependence of the perturbation velocities by closely following identifiable features in the scintillation pattern. The measured velocities, that registered a steady decrease with the progression of night, had been shown to significantly alter the forecast pattern of the scintillations with respect to longitude and local time. The significant improvement in the forecast pattern has been demonstrated through a case study putting the forecast method on a firmer footing.
Solar activity dependency of multiday oscillations in the nighttime thermospheric winds observed by Fabry‐Perot interferometer
Authors: Liu Xiao , Xu Jiyao , Zhang Shun‐Rong , Zhou Qihou , Yuan Wei
Published: June 2015

An 11 year (1989–1995 and 2010–2013) nighttime thermospheric wind (at ~250 km) data set from Fabry‐Perot interferometer at Millstone Hill (42.6°N, 71.5°W) is used to investigate multiday oscillations (6–30 days) in the thermospheric nighttime winds. Dependencies of multiday oscillations on solar radiation (F10.7), solar wind speed (SW), and geomagnetic activity (Kp) are determined. We found that (1) there exist prominent quasi 27 day oscillations in the thermospheric zonal (meridional) wind, which appears to be more correlated to the same periodic oscillations in Kp and SW than in F10.7 during the solar maximum (solar declining phase and minimum); (2) quasi 13.5 day oscillations in the zonal wind occur during the solar maximum and increasing phases and are also more correlated to the same periodic oscillations in Kp and SW; and (3) in general, the correlations of the multiday oscillations in the thermospheric winds are more correlated with Kp and SW than F10.7. Our analyses also show that the zonal wind is more sensitive to SW than the meridional wind. We further find that (4) for high F10.7, the premidnight zonal wind is more westward toward increasing SW; for low F10.7, the postmidnight zonal wind is also more westward toward increasing SW; and (5) meridional winds tend to be more southward with increasing SW for medium and high F10.7.
Charged nanoparticles produced by splashing of raindrops
Authors: Kamra A. K. , Gautam A. S. , Siingh Devendraa
Published: June 2015

The mobility distribution of ions generated by splashing of raindrops is investigated. Our observations show four maxima in the mobility distribution in the small, intermediate, light large, and heavy large ion size ranges. Ion concentration of all categories increases as the rain intensity increases to ~ 50–60 mm h−1 and then tends to level off for higher rain intensities. Negative ion concentration is always more than that of positive ions. However, positive small ions of mobility ≥ 2–3 cm2 V−1 s−1 which are also generated during splashing are more numerous than negative ions. Our observations show that the mechanism responsible for the generation of intermediate ions is more efficient than that for the generation of heavy large ions during periods of high rain intensity. Relative roles of Lenard and Blanchard effects are suggested in generating excess of negative intermediate ions in the initial stages and excess of positive cluster ions, in the later stages of a rain shower, respectively.
Using Polar‐orbiting Environmental Satellite data to specify the radiation environment up to 1200 km altitude
Authors: O'Brien T. P. , Mazur J. E. , Guild T. B. , Looper M. D.
Published: June 2015

Data from the Deal dosimeter payload on the Rapid Pathfinder satellite provide daily maps of the radiation environment on a sphere at 1200 km altitude. Through the use of magnetic coordinates, these dosimeter maps can be projected down to lower altitudes, providing valuable information for satellite anomaly resolution for vehicles in low Earth orbit (LEO). Unfortunately, the Deal data are not widely available, and the mission has a limited lifetime. As an alternative, we present a method to estimate the Deal daily maps using belt index data from NOAA's Polar‐orbiting Environmental Satellite (POES) vehicles. The method addresses only trapped radiation but could readily be supplemented with POES's own measurements of solar particle radiation reaching LEO.
Strongly Anisotropic Thermal Conductivity of Free‐Standing Reduced Graphene Oxide Films Annealed at High Temperature
Authors: Renteria Jackie D. , Ramirez Sylvester , Malekpour Hoda , Alonso Beatriz , Centeno Alba , Zurutuza Amaia , Cocemasov Alexandr I. , Nika Denis L. , Balandin Alexander A.
Published: June 2015

Thermal conductivity of free‐standing reduced graphene oxide films subjected to a high‐temperature treatment of up to 1000 °C is investigated. It is found that the high‐temperature annealing dramatically increases the in‐plane thermal conductivity, K, of the films from ≈3 to ≈61 W m−1 K−1 at room temperature. The cross‐plane thermal conductivity, K⊥, reveals an interesting opposite trend of decreasing to a very small value of ≈0.09 W m−1 K−1 in the reduced graphene oxide films annealed at 1000 °C. The obtained films demonstrate an exceptionally strong anisotropy of the thermal conductivity, K/K⊥ ≈ 675, which is substantially larger even than in the high‐quality graphite. The electrical resistivity of the annealed films reduces to 1–19 Ω □−1. The observed modifications of the in‐plane and cross‐plane thermal conductivity components resulting in an unusual K/K⊥ anisotropy are explained theoretically. The theoretical analysis suggests that K can reach as high as ≈500 W m−1 K−1 with the increase in the sp2 domain size and further reduction of the oxygen content. The strongly anisotropic heat conduction properties of these films can be useful for applications in thermal management.