bluuebunny/crossref_metadata_2025 huggingface dataset:
Humor, laughter, and affect in multilingual comedy performances in Hawai‘i
Authors: Furukawa Toshiaki
Published: September 2016

Informed by interaction-based work on affect and identity in conversation analysis, discursive psychology, membership categorization analysis, and stylization studies, this chapter contributes to contemporary humor research by investigating discursive practices in comedy performances in Hawai‘i. Set within this multilingual and multiethnic context, analysis explicates how stand-up comedy, a popular local institution, not only entertains but functions as a highly collaborative site where performers and their audiences reproduce and challenge social-linguistic ideologies and practices distinguishing “Locals” (those born and raised in Hawai‘i, Hawai‘i Creole speakers) from “non-Locals” (e.g., white, Standard English speakers). By coordinating laughter and affective and epistemic stances around these two identity categories, participants draw on shared history, language, and culture to maintain a Local community in the present.
Ramseyan humility: the response from revelation and panpsychism
Authors: Majeed Raamy
Published: September 2016

David Lewis argues for Ramseyan humility, the thesis that we can’t identify the fundamental properties that occupy the nomological roles at our world. Lewis, however, remarks that there is a potential exception to this, which involves assuming two views concerning qualia (i) panphenomenalism (contemporary panpsychism): all instantiated fundamental properties are qualia and (ii) the identification thesis (revelation): we can know the identities of our qualia simply by being acquainted with them. This paper aims to provide an exposition, as well as an assessment, of this response to the humility thesis.
Nietzsche’s cultural elitism
Authors: Rowthorn David
Published: September 2016

Elitist readers, such as John Rawls, see Nietzsche as concerned only with the flourishing of a few great contributors to culture; egalitarian readers, such as Stanley Cavell, see Nietzschean culture as a universal affair involving every individual’s self-cultivation. This paper offers a compromise, reading Nietzsche as a ‘cultural elitist’ for whom culture demands that a few great individuals be supported in a voluntary, rather than state-mandated way. Rawls, it claims, is therefore misguided in worrying that Nietzsche’s elitism is a threat to justice. The paper focuses on Nietzsche’sSchopenhauer as Educator, the key text in the elitist-egalitarian debate.
Eye movements when reading sentences with handwritten words
Authors: Perea Manuel , Marcet Ana , Uixera Beatriz , Vergara-Martínez Marta
Published: September 2016

The examination of how we read handwritten words (i.e., the original form of writing) has typically been disregarded in the literature on reading. Previous research using word recognition tasks has shown that lexical effects (e.g., the word-frequency effect) are magnified when reading difficult handwritten words. To examine this issue in a more ecological scenario, we registered the participants’ eye movements when reading handwritten sentences that varied in the degree of legibility (i.e., sentences composed of words in easy vs. difficult handwritten style). For comparison purposes, we included a condition with printed sentences. Results showed a larger reading cost for sentences with difficult handwritten words than for sentences with easy handwritten words, which in turn showed a reading cost relative to the sentences with printed words. Critically, the effect of word frequency was greater for difficult handwritten words than for easy handwritten words or printed words in the total times on a target word, but not on first-fixation durations or gaze durations. We examine the implications of these findings for models of eye movement control in reading.
Final report of CCQM-K136 measurement of porosity properties (specific adsorption, BET specific surface area, specific pore volume and pore diameter) of nanoporous Al2O3
Authors: Sobina E , Zimathis A , Prinz C , Emmerling F , Unger W , Neves R de Santis , Galhardo C E , Robertis E De , Wang H , Mizuno K , Kurokawa A
Published: September 2016

CCQM key comparison K-136 Measurement of porosity properties (specific adsorption, BET specific surface area, specific pore volume and pore diameter) of nanoporous Al2O3 has been performed by the Surface Analysis Working Group (SAWG) of the Consultative Committee for Amount of Substance (CCQM). The objective of this key comparison is to compare the equivalency of the National Metrology Institutes (NMIs) and Designated Institutes (DIs) for the measurement of specific adsorption, BET specific surface area, specific pore volume and pore diameter) of nanoporous substances (sorbents, catalytic agents, cross-linkers, zeolites, etc) used in advanced technology.

In this key comparison, a commercial sorbent (aluminum oxide) was supplied as a sample. Five NMIs participated in this key comparison. All participants used a gas adsorption method, here nitrogen adsorption at 77.3 K, for analysis according to the international standards ISO 15901-2 and 9277.

In this key comparison, the degrees of equivalence uncertainties for specific adsorption, BET specific surface area, specific pore volume and pore diameter was established.

Main text

To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.

The final report has been peer-reviewed and approved for publication by the CCQM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).
The G1/S Cyclin Cig2p during Meiosis in Fission Yeast
Authors: Borgne Annie , Murakami Hiroshi , Ayté José , Nurse Paul
Published: September 2016

Cyclin-dependent kinases (CDKs) are important for both mitotic and meiotic cell cycles. In fission yeast, the major CDK, Cdc2p is involved in premeiotic DNA replication and in meiosis II. One of its partners, the mitotic cyclin Cdc13p is known to be required for meiosis, whereas there are no studies on the G1/S cyclin Cig2p. In this article, we have studied the regulation of the Cdc2p/Cdc13p and Cdc2p/Cig2p complexes during synchronous meiosis. We observed that Cdc2p/Cig2p kinase is activated in an unexpected biphasic manner, first at onset of premeiotic S phase and again during meiotic nuclear divisions. The role of Cig2p during meiosis was investigated usingcig2-deleted strains that exhibit delays in onset of both S phase and meiotic divisions as well as an inefficient completion of MII. Furthermore, analysis of cig2 transcripts revealed a meiosis-specific regulation of cig2expression during MI/MII dependent upon the Mei4p transcription factor leading to a different transcription start site at this stage of meiosis.
Distinct Recruitment and Function of Gab1 and Gab2 in Met Receptor-mediated Epithelial Morphogenesis
Authors: Lock Lisa S. , Maroun Christiane R. , Naujokas Monica A. , Park Morag
Published: September 2016

The Gab family of docking proteins (Gab1 and Gab2) are phosphorylated in response to various cytokines and growth factors. Gab1 acts to diversify the signal downstream from the Met receptor tyrosine kinase through the recruitment of multiple signaling proteins, and is essential for epithelial morphogenesis. To determine whether Gab1 and Gab2 are functionally redundant, we have examined the role of Gab2 in epithelial cells. Both Gab1 and Gab2 are expressed in epithelial cells and localize to cell-cell junctions. However, whereas overexpression of Gab1 promotes a morphogenic response, the overexpression of Gab2 fails to induce this response. We show that Gab2 recruitment to the Met receptor is dependent on the Grb2 adapter protein. In contrast, Gab1 recruitment to Met is both Grb2 dependent and Grb2 independent. The latter requires a novel amino acid sequence present in the Met-binding domain of Gab1 but not Gab2. Mutation of these residues in Gab1 impairs both association with the Met receptor and the ability of Gab1 to promote a morphogenic response, whereas their insertion into Gab2 increases Gab2 association with Met, but does not confer on Gab2 the ability to promote epithelial morphogenesis. We propose that the Grb2-independent recruitment of Gab proteins to Met is necessary but not sufficient to promote epithelial morphogenesis.
The interaction of Munc 18 (p67) with the p10 domain of p35 protects in vivo Cdk5/p35 activity from inhibition by TFP5, a peptide derived from p35
Authors: Amin Niranjana D. , Zheng Yali , BK Binukumar , Shukla Varsha , Skuntz Susan , Grant Philip , Steiner Joseph , Bhaskar Manju , Pant Harish C.
Published: September 2016

In a series of studies, we have identified TFP5, a truncated fragment of p35, the Cdk5 kinase regulatory protein, which inhibits Cdk5/p35 and the hyperactive Cdk5/p25 activities in test tube experiments. In cortical neurons, however, and in vivo in Alzheimer’s disease (AD) model mice, the peptide specifically inhibits the Cdk5/p25 complex and not the endogenous Cdk5/p35. To account for the selective inhibition of Cdk5/p25 activity, we propose that the “p10” N-terminal domain of p35, absent in p25, spares Cdk5/p35 because p10 binds to macromolecules (e.g., tubulin and actin) as a membrane-bound multimeric complex that favors p35 binding to Cdk5 and catalysis. To test this hypothesis, we focused on Munc 18, a key synapse-associated neuronal protein, one of many proteins copurifying with Cdk5/p35 in membrane-bound multimeric complexes. Here we show that, in vitro, the addition of p67 protects Cdk5/p35 and has no effect on Cdk5/p25 activity in the presence of TFP5. In cortical neurons transfected with p67siRNA, we also show that TFP5 inhibits Cdk5/p35 activity, whereas in the presence of p67 the activity is protected. It does so without affecting any other kinases of the Cdk family of cyclin kinases. This difference may be of significant therapeutic value because the accumulation of the deregulated, hyperactive Cdk5/p25 complex in human brains has been implicated in pathology of AD and other neurodegenerative disorders.
Syndapin/SDPN-1 is required for endocytic recycling and endosomal actin association in theCaenorhabditis elegansintestine
Authors: Gleason Adenrele M. , Nguyen Ken C. Q. , Hall David H. , Grant Barth D.
Published: September 2016

Syndapin/pascin-family F-BAR domain proteins bind directly to membrane lipids and are associated with actin dynamics at the plasma membrane. Previous reports also implicated mammalian syndapin 2 in endosome function during receptor recycling, but precise analysis of a putative recycling function for syndapin in mammalian systems is difficult because of its effects on the earlier step of endocytic uptake and potential redundancy among the three separate genes that encode mammalian syndapin isoforms. Here we analyze the endocytic transport function of the only Caenorhabditis elegans syndapin, SDPN-1. We find that SDPN-1 is a resident protein of the early and basolateral recycling endosomes in the C. elegans intestinal epithelium, and sdpn-1 deletion mutants display phenotypes indicating a block in basolateral recycling transport. sdpn-1 mutants accumulate abnormal endosomes positive for early endosome and recycling endosome markers that are normally separate, and such endosomes accumulate high levels of basolateral recycling cargo. Furthermore, we observed strong colocalization of endosomal SDPN-1 with the F-actin biosensor Lifeact and found that loss of SDPN-1 greatly reduced Lifeact accumulation on early endosomes. Taken together, our results provide strong evidence for an in vivo function of syndapin in endocytic recycling and suggest that syndapin promotes transport via endosomal fission.
Value Chains and Technology Transfer to Agriculture in Developing and Emerging Economies
Authors: Kuijpers Rob , Swinnen Johan
Published: September 2016

Value chains in the agrifood sector are undergoing a rapid process of modernization, characterized by the emergence of private standards and different systems of vertical value chain governance. In this article, we investigate the technological implications of these developments at the farm level. We model the conditions under which technology transfer and adoption will occur in a value chain setting and review the corresponding evidence on these issues. We find that technology transfer within a value chain can occur in an environment with imperfect credit and technology markets but depends on the surplus generated by the technology and the holdup opportunities within the value chain. We also discuss how these holdup opportunities affect bargaining power and the division of surplus and how the nature of the technology affects technology transfer and the implications for value chain governance.
Concentration, Product Variety, and Entry‐for‐Merger: Evidence from New Product Introductions in the U.S. Food Industry
Authors: Bhattacharya Haimanti , Innes Robert
Published: September 2016

Competing theories in industrial organization predict that more concentrated industries will lead to a smaller and more efficient variety of products or, alternately, a larger and less efficient array of products. This paper presents an empirical study of these competing implications that estimates the impact of market concentration on new product introductions in a panel of nine food processing industries over 1983 to 2004. Controlling for industry‐level unobservables (using fixed effects) and endogeneity of industry market structure, we find that industry concentration promotes the introduction of new products. Preliminary evidence also suggests that new product introductions spur subsequent food industry mergers. Both conclusions are consistent with the “entry‐for‐merger” theory of product variety wherein atomistic innovators introduce new products in anticipation of profitable future mergers with concentrated firms.
Lack of Association Between Subclinical Hypothyroidism and Carotid–Femoral Pulse Wave Velocity in a Cross-Sectional Analysis of the ELSA–Brasil
Authors: Peixoto de Miranda Érique José F. , Bittencourt Márcio Sommer , Goulart Alessandra Carvalho , Santos Itamar Souza , Mill José Geraldo , Schmidt Maria Ines , Lotufo Paulo Andrade , Benseñor Isabela J. Martins
Published: September 2016

BACKGROUND

There is little available data on carotid–femoral pulse wave velocity (cf-PWV) in subjects with subclinical hypothyroidism (SCH). We aimed to analyze the association between SCH and cf-PWV using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA–Brasil).

METHODS

We included subjects with normal thyroid function (thyrotropin (TSH): 0.4–4.0 mIU/l, and normal free thyroxine (FT4: 0.8–1.9ng/dl) and SCH (TSH > 4.0 mIU/l and normal FT4) evaluated for cf-PWV in a cross-sectional analysis. We excluded individuals using medications that interfere in thyroid function, antihypertensives, or diuretics, and subjects with chronic kidney disease or previous cardiovascular disease. Generalized linear and logistic regression models evaluated cf-PWV as a dependent variable and SCH as an independent variable, adjusted for cardiovascular risk factors.

RESULTS

Of 8,341 subjects (52.3% women), 7,878 (94.4%) were euthyroid and 463 (5.6%) showed SCH. The median age was 50 years (interquartile range: 44–56). The groups differed by age, sex, body mass index, glomerular filtration rate, and C-reactive protein. SCH was not associated with cf-PWV in the full-adjusted linear model (β = −0.039; P = 0.562) and with cf-PWV >75th percentile in the full-adjusted logistic model (odds ratio = 0.94; 95% confidence interval = 0.72–1.22).

CONCLUSION

In a large sample, SCH was not associated with increased cf-PWV.
Crucial Effect of Calibration Methods on the Association Between Central Pulsatile Indices and Coronary Atherosclerosis
Authors: Nakagomi Atsushi , Okada Sho , Shoji Toshihiro , Kobayashi Yoshio
Published: September 2016

BACKGROUND

Several studies have reported that central systolic blood pressure (SBP) estimation is affected by calibration methods. However, whether central pulsatile indices, namely pulse pressure (PP) and fractional PP (FPP) (defined as PP/mean arterial pressure (MAP)), also depend on calibration methods remains uninvestigated. This study assessed the accuracy and discriminatory ability of these indices for coronary atherosclerosis using 2 calibration methods.

METHODS

Post-hoc analysis of a previous cross-sectional study (n = 139) that investigated the association between central pulsatile indices and coronary atherosclerosis. A validated-oscillometric device provided PP and FPP at the brachial artery (bPP and bFPP) and central artery using 2 calibration methods: brachial SBP/diastolic BP (DBP) (cPPsd and cFPPsd) and MAP/DBP (cPPmd and cFPPmd). Accuracy was assessed against invasive measurements (cPPinv and cFPPinv). Multivariate logistic and linear regression analyses were performed to assess the association between pulsatile indices and the presence of coronary artery disease (CAD) and SYNTAX score, respectively.

RESULTS

cPPmd and cFPPmd were closer to invasive values than cPPsd (cPPsd: 39.6±12.6; cPPmd: 60.2±20.1; cPPinv: 71.4±22.9). cFPP exhibited similar results (cFPPsd: 0.35±0.09; cFPPmd: 0.55±0.14; cFPPinv: 0.70±0.19). In patients ≥70 years, only cFPPmd was significantly associated with CAD risk (odds ratio: 1.66 (95% confidence interval: 1.05–2.64)). SYNTAX score was significantly correlated with cPPmd, cFPPmd, and bFPP (standardized β: cPPmd 0.39, cFPPmd 0.50, bFPP 0.42, all P < 0.01). No significant association was observed in patients aged <70 years.

CONCLUSIONS

Central pulsatile indices calibrated with brachial MAP/DBP were more accurate and discriminatory for coronary atherosclerosis than SBP/DBP calibration.
Reference point insensitive molecular data analysis
Authors: Altenbuchinger M , Rehberg T , Zacharias H U , Stämmler F , Dettmer K , Weber D , Hiergeist A , Gessner A , Holler E , Oefner P J , Spang R
Published: September 2016

Motivation

In biomedicine, every molecular measurement is relative to a reference point, like a fixed aliquot of RNA extracted from a tissue, a defined number of blood cells, or a defined volume of biofluid. Reference points are often chosen for practical reasons. For example, we might want to assess the metabolome of a diseased organ but can only measure metabolites in blood or urine. In this case, the observable data only indirectly reflects the disease state. The statistical implications of these discrepancies in reference points have not yet been discussed.

Results

Here, we show that reference point discrepancies compromise the performance of regression models like the LASSO. As an alternative, we suggest zero-sum regression for a reference point insensitive analysis. We show that zero-sum regression is superior to the LASSO in case of a poor choice of reference point both in simulations and in an application that integrates intestinal microbiome analysis with metabolomics. Moreover, we describe a novel coordinate descent based algorithm to fit zero-sum elastic nets.

Availability and Implementation

The R-package “zeroSum” can be downloaded at https://github.com/rehbergT/zeroSum. Moreover, we provide all R-scripts and data used to produce the results of this manuscript as Supplementary Material.

Supplementary information

Supplementary material is available at Bioinformatics online.
Linking rising pCO2 and temperature to the larval development and physiology of the American lobster (Homarus americanus)
Authors: Waller Jesica D. , Wahle Richard A. , McVeigh Halley , Fields David M.
Published: September 2016

Few studies have evaluated the joint effects of elevated temperature and pCO2 on marine organisms. In this study we investigated the interactive effects of Intergovernmental Panel on Climate Change predicted temperature and pCO2 for the end of the 21st century on key aspects of larval development of the American lobster, Homarus americanus, an otherwise well-studied, iconic, and commercially prominent species in the northeastern United States and Atlantic Canada. Our experiments showed that larvae (stages I–III) and postlarvae (stage IV) reared in the high temperature treatments (19 °C) experienced significantly lower survival, developed twice as fast, and had significantly higher oxygen consumption rates, than those in ambient treatments (16 °C). Larvae from the ambient temperature/high pCO2 (750 ppm) treatment had significantly longer carapace lengths, greater dry masses in stages I–III and higher C: N ratios in stage IV than larvae from all other treatments. Stage IVs raised in the high pCO2 treatment at 19 °C had significantly higher feeding rates and swimming speeds than stage IVs from the other three treatments. Together these results suggest that projected end-century warming will have greater adverse effects than increased pCO2 on larval survival, and changing pCO2 may have a complex effect on larval metabolism and behaviour. Understanding how the most vulnerable life stages of the lobster life cycle respond to climate change is essential in connecting the northward geographic shifts projected by habitat quality models, and the underlying physiological and genetic mechanisms that drive their ecology.
Ejector and propeller spin-down: how might a superluminous supernova millisecond magnetar become the 6.67 h pulsar in RCW 103
Authors: Ho Wynn C. G. , Andersson Nils
Published: September 2016

The X-ray source 1E 161348−5055 in the supernova remnant RCW 103 recently exhibited X-ray activity typical of magnetars, i.e. neutron stars with magnetic fields ≳ 1014–1015 G. However, 1E 161348−5055 has an observed period of 6.67 h, in contrast to magnetars which have a spin period of seconds. Here we describe a simple model which can explain the spin evolution of 1E 161348−5055, as well as other magnetars, from an initial period of milliseconds that would be required for dynamo generation of magnetar-strength magnetic fields. We propose that the key difference between 1E 161348−5055 and other magnetars is the persistence of a remnant disc of small total mass. This disc caused 1E 161348−5055 to undergo ejector and propeller phases in its life, during which strong torques caused a rapid increase of its spin period. By matching its observed spin period and ≈1–3 kyr age, we find that 1E 161348−5055 has the (slightly) highest magnetic field of all known magnetars, with B ∼ 5 × 1015 G, and that its disc had a mass of ∼1024 g, comparable to that of the asteroid Ceres.
On the existence of accretion-driven bursts in massive star formation
Authors: Meyer D. M.-A. , Vorobyov E. I. , Kuiper R. , Kley W.
Published: September 2016

Accretion-driven luminosity outbursts are a vivid manifestation of variable mass accretion on to protostars. They are known as the so-called FU Orionis phenomenon in the context of low-mass protostars. More recently, this process has been found in models of primordial star formation. Using numerical radiation hydrodynamics simulations, we stress that present-day forming massive stars also experience variable accretion and show that this process is accompanied by luminous outbursts induced by the episodic accretion of gaseous clumps falling from the circumstellar disc on to the protostar. Consequently, the process of accretion-induced luminous flares is also conceivable in the high-mass regime of star formation and we propose to regard this phenomenon as a general mechanism that can affect protostars regardless of their mass and/or the chemical properties of the parent environment in which they form. In addition to the commonness of accretion-driven outbursts in the star formation machinery, we conjecture that luminous flares from regions hosting forming high-mass stars may be an observational implication of the fragmentation of their accretion discs.
Novel Multivalent Wound-Healing Ointment Provides Bioburden Control and Moisture Management
Authors: Serena Thomas , Connell Heather , McConnell Sharon , Patel Keyur , Doner Bryan , Sabo Matthew , Miller Michael , Serena Laura , Le Lam T. , Goldsmith David , Chung Jane
Published: September 2016

OBJECTIVE:

The purpose of this retrospective registry data analysis was to explore the effectiveness of a novel multivalent topical ointment (Terrasil Infection Control Wound Care Ointment; Aspiera Medical, Woonsocket, Rhode Island), containing a patented mineral complex and 0.2% benzethonium chloride in the treatment of nonhealing acute and chronic wounds.

DESIGN:

Aspiera Medical designed a registry to capture physician experiences and treatment results with Terrasil Infection Control Wound Care Ointment. Physicians were asked to enter deidentified patient data into an online registry.

SETTING:

Wound clinics in the United States were asked to participate in the registry.

PATIENTS:

Physicians at 4 wound clinics treated 30 patients (26 of whom completed the treatment) with various chronic wounds that had persisted for an average of 6 months and entered treatment data into the registry.

INTERVENTIONS:

Patients applied the ointment according to physician orders. Concurrent treatments used by patients included offloading, compression wraps, and dressings, such as collagen and calcium alginate. Patients were treated until complete wound closure or lost to follow-up.

MAIN OUTCOME MEASURES:

Physicians calculated each patient’s percentage wound reduction at each visit.

MAIN RESULTS:

Thirty patients were entered into the registry. Pretreatment and posttreatment measurements were available for 26 of them. Patients achieved an average surface area reduction of 84% in a mean of 23 days’ treatment.

CONCLUSION:

The antimicrobial and moisturizing ointment studied appears to be effective in promoting wound closure in a variety of acute and chronic wounds. Wounds studied included diabetic foot ulcers, venous leg ulcers, venous stasis ulcers, surgical infections, burns, and insect bites. The results of this registry data analysis will be used to inform planned clinical trials.
Evaluation of the Healing Progress of Pressure Ulcers Treated with Cathodal High-Voltage Monophasic Pulsed Current: Results of a Prospective, Double-blind, Randomized Clinical Trial
Authors: Polak Anna , Kloth Luther C. , Blaszczak Edward , Taradaj Jakub , Nawrat-Szoltysik Agnieszka , Walczak Anna , Bialek Lidia , Paczula Malgorzata , Franek Andrzej , Kucio Cezary
Published: September 2016

OBJECTIVE:

To investigate the effectiveness of high-voltage monophasic pulsed current (HVMPC) as an adjunct to a standard wound care for the treatment of Stage II and III pressure ulcers (PrUs).

DESIGN:

Prospective, randomized, double-blind, controlled clinical study.

SETTING:

Two nursing and care centers.

PATIENTS:

Patients with PrUs that did not respond to previous treatment for at least 4 weeks were randomly assigned to the electrical stimulation (ES) group (25 patients; mean age of 79.92 ± 8.50 years; mean wound surface area [WSA] of 10.58 ± 10.57 cm2) or to the control group (24 patients; mean age of 76.33 ± 12.74 years; mean WSA of 9.71 ± 6.70 cm2).

INTERVENTIONS:

Both the ES and control groups received standard wound care and respectively, cathodal HVMPC (154 microseconds; 100 pulses per second; 0.24 A; 250 μ/s) applied continuously for 50 minutes once a day, 5 times a week, or sham HVMPC.

MAIN OUTCOME:

Percentage area reduction over 6 weeks of intervention.

MAIN RESULTS:

In the ES group, there was a statistically significant decrease in WSA after 1 week of treatment (35% ± 30.5%) compared with 17.07% ± 34.13% in the control group (P = .032). After treatment, at week 6, percentage area reduction in the ES group was 80.31% ± 29.02% versus 54.65% ± 42.65% in the control group (P = .046).

CONCLUSIONS:

Cathodal HVMPC reduces the WSA of Stage II and III PrUs. The results are consistent with the results of other researchers who used HVMPC to treat PrUs.
Dose-Dependent Protective Effect of Inhalational Anesthetics Against Postoperative Respiratory Complications: A Prospective Analysis of Data on File From Three Hospitals in New England
Authors: Grabitz Stephanie D. , Farhan Hassan N. , Ruscic Katarina J. , Timm Fanny P. , Shin Christina H. , Thevathasan Tharusan , Staehr-Rye Anne K. , Kurth Tobias , Eikermann Matthias
Published: September 2016

Objectives:

Inhalational anesthetics are bronchodilators with immunomodulatory effects. We sought to determine the effect of inhalational anesthetic dose on risk of severe postoperative respiratory complications.

Design:

Prospective analysis of data on file in surgical cases between January 2007 and December 2015.

Setting:

Massachusetts General Hospital (tertiary referral center) and two affiliated community hospitals.

Patients:

A total of 124,497 adult patients (105,267 in the study cohort and 19,230 in the validation cohort) undergoing noncardiac surgical procedures and requiring general anesthesia with endotracheal intubation.

Interventions:

Median effective dose equivalent of inhalational anesthetics during surgery (derived from mean end-tidal inhalational anesthetic concentrations).

Measurements and Main Results:

Postoperative respiratory complications occurred in 6,979 of 124,497 cases (5.61%). High inhalational anesthetic dose of 1.20 (1.13–1.30) (median [interquartile range])-fold median effective dose equivalent versus 0.57 (0.45–0.64)-fold median effective dose equivalent was associated with lower odds of postoperative respiratory complications (odds ratio, 0.59; 95% CI, 0.53–0.65; p < 0.001). Additionally, high inhalational anesthetic dose was associated with lower 30-day mortality and lower cost. Inhalational anesthetic dose increase and reduced risk of postoperative respiratory complications remained significant in sensitivity analyses stratified by preoperative and intraoperative risk factors.

Conclusions:

Intraoperative use of higher inhalational anesthetic doses is strongly associated with lower odds of postoperative respiratory complications, lower 30-day mortality, and lower cost of hospital care. The authors speculate based on these data that sedation with inhalational anesthetics outside of the operating room may likewise have protective effects that decrease the risk of respiratory complications in vulnerable patients.
Chloride Content of Fluids Used for Large-Volume Resuscitation Is Associated With Reduced Survival
Authors: Sen Ayan , Keener Christopher M. , Sileanu Florentina E. , Foldes Emily , Clermont Gilles , Murugan Raghavan , Kellum John A.
Published: September 2016

Objective:

We sought to investigate if the chloride content of fluids used in resuscitation was associated with short- and long-term outcomes.

Design:

We identified patients who received large-volume fluid resuscitation, defined as greater than 60 mL/kg over a 24-hour period. Chloride load was determined for each patient based on the chloride ion concentration of the fluids they received during large-volume fluid resuscitation multiplied by the volume of fluids. We compared the development of hyperchloremic acidosis, acute kidney injury, and survival among those with higher and lower chloride loads.

Setting:

University Medical Center.

Patients:

Patients admitted to ICUs from 2000 to 2008.

Interventions:

None.

Measurements and Main Results:

Among 4,710 patients receiving large-volume fluid resuscitation, hyperchloremic acidosis was documented in 523 (11%). Crude rates of hyperchloremic acidosis, acute kidney injury, and hospital mortality all increased significantly as chloride load increased (p < 0.001). However, chloride load was no longer associated with hyperchloremic acidosis or acute kidney injury after controlling for total fluids, age, and baseline severity. Conversely, each 100 mEq increase in chloride load was associated with a 5.5% increase in the hazard of death even after controlling for total fluid volume, age, and severity (p = 0.0015) over 1 year.

Conclusions:

Chloride load is associated with significant adverse effects on survival out to 1 year even after controlling for total fluid load, age, and baseline severity of illness. However, the relationship between chloride load and development of hyperchloremic acidosis or acute kidney injury is less clear, and further research is needed to elucidate the mechanisms underlying the adverse effects of chloride load on survival.
Healthcare Provider Perceptions of Causes and Consequences of ICU Capacity Strain in a Large Publicly Funded Integrated Health Region: A Qualitative Study
Authors: Bagshaw Sean M. , Opgenorth Dawn , Potestio Melissa , Hastings Stephanie E. , Hepp Shelanne L. , Gilfoyle Elaine , McKinlay David , Boucher Paul , Meier Michael , Parsons-Leigh Jeanna , Gibney R. T. Noel , Zygun David A. , Stelfox Henry T.
Published: September 2016

Objectives:

Discrepancy in the supply-demand relationship for critical care services precipitates a strain on ICU capacity. Strain can lead to suboptimal quality of care and burnout among providers and contribute to inefficient health resource utilization. We engaged interprofessional healthcare providers to explore their perceptions of the sources, impact, and strategies to manage capacity strain.

Design:

Qualitative study using a conventional thematic analysis.

Setting:

Nine ICUs across Alberta, Canada.

Subjects:

Nineteen focus groups (n = 122 participants).

Interventions:

None.

Measurements and Main Results:

Participants’ perspectives on strain on ICU capacity and its perceived impact on providers, families, and patient care were explored. Participants defined “capacity strain” as a discrepancy between the availability of ICU beds, providers, and ICU resources (supply) and the need to admit and provide care for critically ill patients (demand). Four interrelated themes of contributors to strain were characterized (each with subthemes): patient/family related, provider related, resource related, and health system related. Patient/family-related subthemes were “increasing patient complexity/acuity,” along with patient-provider communication issues (“paucity of advance care planning and goals-of-care designation,” “mismatches between patient/family and provider expectations,” and “timeliness of end-of-life care planning”). Provider-related factor subthemes were nursing workforce related (“nurse attrition,” “inexperienced workforce,” “limited mentoring opportunities,” and “high patient-to-nurse ratios”) and physician related (“frequent turnover/handover” and “variations in care plan”). Resource-related subthemes were “reduced service capability after hours” and “physical bed shortages.” Health system–related subthemes were “variable ICU utilization,” “preferential “bed” priority for other services,” and “high ward bed occupancy.” Participants perceived that strain had negative implications for patients (“reduced quality and safety of care” and “disrupted opportunities for patient- and family-centered care”), providers (“increased workload,” “moral distress,” and “burnout”), and the health system (“unnecessary, excessive, and inefficient resource utilization”).

Conclusions:

Engagement with frontline critical care providers is essential for understanding their experiences and perspectives regarding strained capacity and for the development of sustainable strategies for improvement.
Concurrent Radiotherapy and Triweekly Carboplatin for the Definitive Treatment of Locally Advanced Laryngeal Carcinoma
Authors: Lu Sharon M. , Iganej Shawn , Abdalla Iman A. , Buchschacher Gary L.
Published: September 2016

Purpose of the Study:

In 2003, our institution adopted triweekly carboplatin (tCb) area under the curve (AUC) 5 as an alternative to high-dose cisplatin (100 mg/m2) for select patients receiving definitive concurrent chemoradiation for locally advanced laryngeal carcinoma (LALC). Here, we present our experience and outcomes with this definitive concurrent chemoradiation regimen.

Methods:

From January 2003 through December 2013, 53 patients with stage III (60%) or IVA (40%) LALC were treated with tCb AUC 5 and concurrent radiotherapy to 70 Gy without neoadjuvant chemotherapy. Reasons for using carboplatin instead of cisplatin in these patients were: age 70 and older (21%), poor renal function (6%), presence of 1 or more major comorbid condition(s) (36%), and per discretion of the treating medical oncologist (38%). Primary disease site was glottis in 22 (42%) patients and supraglottis in 31 (58%) patients.

Results:

Median follow-up time was 63 months for surviving patients. Out of the 53 patients, 43 (81%) received all 3 cycles of carboplatin and all patients received their intended dose of radiotherapy. Although 17 (32%) patients required a feeding tube during treatment, only 2 (4%) required it long term. There were no acute treatment-related grade 4 or 5 hematologic toxicities. On last follow-up, 14 (26%) patients had died of intercurrent disease. For the subgroup of “RTOG 9111 eligible” patients in our cohort (n=46), 5-year estimates of overall survival, disease-free survival, laryngectomy-free survival, larynx preservation, and locoregional control were: 49%, 42%, 39%, 80%, and 63%, respectively.

Conclusions:

In patients with LALC who are suboptimal candidates for high-dose cisplatin, our experience suggests that tCb AUC 5 with concurrent radiotherapy provides acceptable outcomes with tolerable toxicity.
Aquacel Surgical Dressing after Thigh Lift: A Case–Control Study
Authors: Bocchiotti Maria A. , Baglioni Elisabetta A. , Spaziante Luca , Frenello Ambra , Ruka Erind
Published: September 2016

Background:

The postoperative dressing in patients undergoing thigh lift is often difficult, not very resistant to movement, and uncomfortable for the patient, and often exposes surgical site to infection, maceration, or delay in wound healing.

Methods:

We included 40 patients in a case–control crossover study with no period effects, who were treated both by Aquacel Surgical and a traditional wound dressing. Surveys with a 10-point scale evaluation were used to assess nontraumatic removal level, ease of application, adhesion, and strength of the 2 treatments. We reported the number of days necessary for wound healing, the number of infection cases, and wound-related complications. Costs of the 2 medications were also considered. Ten days after surgery, patients answered a questionnaire with 6 multiple-choice questions to assess comfort, pain at dressing change, pruritus, strength, and number of dressing changes.

Results:

Compared with controls, surveys revealed Aquacel Surgical to be less traumatic to remove, easier to apply, and to be more adherent and stronger. Significant acceleration of the wound healing was also evident with Aquacel Surgical compared with the traditional dressing. Nonsignificant differences were reported about the risk of infection and wound-related complications between the 2 treatments. A statistical analysis of costs revealed that Aquacel Surgical is significantly more expensive than the traditional medication.

Conclusion:

We recommend the use of Aquacel Surgical in all the surgery procedures where the risk of wound dehiscence and maceration is high.
Quality of Life and Aesthetic Plastic Surgery: A Systematic Review and Meta-analysis
Authors: Dreher Rodrigo , Blaya Carolina , Tenório Juliana L.C. , Saltz Renato , Ely Pedro B. , Ferrão Ygor A.
Published: September 2016

Background:

Quality of life (QoL) is an important outcome in plastic surgery. However, authors use different scales to address this subject, making it difficult to compare the outcomes. To address this discrepancy, the aim of this study was to perform a systematic review and a random effect meta-analysis.

Methods:

The search was made in two electronic databases (LILACS and PUBMED) using Mesh and non-Mesh terms related to aesthetic plastic surgery and QoL. We performed qualitative and quantitative analyses of the gathered data. We calculated a random effect meta-analysis with Der Simonian and Laird as variance estimator to compare pre- and postoperative QoL standardized mean difference. To check if there is difference between aesthetic surgeries, we compared reduction mammoplasty to other aesthetic surgeries.

Results:

Of 1,715 identified, 20 studies were included in the qualitative analysis and 16 went through quantitative analysis. The random effect of all aesthetic surgeries shows that QoL improved after surgery. Reduction mammoplasty has improved QoL more than other procedures in social functioning and physical functioning domains.

Conclusions:

Aesthetic plastic surgery increases QoL. Reduction mammoplasty seems to have better improvement compared with other aesthetic surgeries.
SAFETY AND FEASIBILITY OF A NOVEL 25-GAUGE BIODEGRADABLE IMPLANT OF DEXAMETHASONE FOR TREATMENT OF MACULAR EDEMA ASSOCIATED WITH RETINAL VEIN OCCLUSION: A PHASE I CLINICAL TRIAL
Authors: Cunha Renato B. , Siqueira Rubens C. , Messias André , Scott Ingrid U. , Fialho Silvia Ligorio , Cunha-Junior Armando da Silva , Jorge Rodrigo
Published: September 2016

Purpose:

To evaluate the safety and feasibility of a 25-gauge biodegradable implant containing 350 μg of dexamethasone (DDS-25) for the treatment of decreased vision due to macular edema associated with central or branch retinal vein occlusion.

Methods:

Prospective, nonrandomized, open-label, Phase I clinical trial, including 10 patients with decreased vision (best-corrected early treatment diabetic retinopathy study visual acuity of 20/40 or worse) due to macular edema associated with central retinal vein occlusion (n = 4) or branch retinal vein occlusion (n = 6) for more than 4 months. Comprehensive ophthalmic evaluation, including best-corrected visual acuity, spectral domain optical coherence tomography (Spectralis Heidelberg Engineering) for determination of central subfield thickness, full-field electroretinography (ISCEV standard ERG), and fluorescein angiography, was performed at baseline, and 1, 4, 12, and 24 weeks after intravitreal DDS-25 insertion.

Results:

Mean best-corrected visual acuity was 0.72 ± 0.1 logMAR (20/100) at baseline and improved by 7 early treatment diabetic retinopathy study letters to 0.58 ± 0.08 logMAR (20/80 + 1) at 24 weeks (P = 0.049), with 3 central retinal vein occlusion and 3 branch retinal vein occlusion patients improving between 1 and 4 early treatment diabetic retinopathy study lines. Significant central subfield thickness reduction was observed at 24 weeks compared with baseline (P = 0.011); mean ± standard error (range) central subfield thickness (μm) was 461.2 ± 41.3 (288–701) at baseline, and 439.6 ± 40.4 (259–631), 442.5 ± 44.6 (255–632), 354.6 ± 31.2 (228–537), and 316.5 ± 26.4 (226–441) at 1, 4, 12, and 24 weeks, respectively. No significant changes in electroretinography responses or area of retinal nonperfusion were observed during 24 weeks of follow-up. There was no significant change in mean intraocular pressure at any of the study visits compared with baseline. One patient had mild anterior chamber inflammation (1–5 cells) at one week after DDS-25 insertion.

Conclusion:

In this Phase I study demonstrating the feasibility of intravitreal DDS-25 insertion for the treatment of decreased vision due to macular edema associated with retinal vein occlusion, no safety concerns were observed. A larger prospective randomized study with longer follow-up is warranted to confirm these findings.
Bruch’s Membrane Opening-Minimum Rim Width Assessment With Spectral-Domain Optical Coherence Tomography Performs Better Than Confocal Scanning Laser Ophthalmoscopy in Discriminating Early Glaucoma Patients From Control Subjects
Authors: Toshev Anani P. , Lamparter Julia , Pfeiffer Norbert , Hoffmann Esther M.
Published: September 2016

Purpose:

To compare the diagnostic performance and evaluate diagnostic agreement for early glaucoma detection between a confocal scanning laser ophthalmoscope (CSLO) and a spectral-domain optical coherence tomography (SD-OCT).

Patients and Methods:

Fifty-five eyes of 55 open-angle glaucoma patients and 42 eyes of 42 healthy control subjects were enrolled in this observational, cross-sectional study. All participants underwent comprehensive ophthalmic examination, visual field testing, and optic nerve head and retinal nerve fiber layer imaging by CSLO (HRT3) and SD-OCT (Spectralis OCT). The agreements of categorical classifications were evaluated (κ statistics). Area under receiver operating characteristic curves (AUROC) and sensitivity at 95% fixed specificity were computed.

Results:

The agreements of HRT3 and Spectralis OCT categorical classifications were fair to moderate (κ ranged between 0.33 and 0.54), except for Moorfields regression analysis of the HRT3 and the OCT global Bruch’s membrane opening-minimum rim width (BMO-MRW) (criterion 1 κ=0.63, criterion 2 κ=0.67). The AUROC of OCT global BMO-MRW (0.956) was greater than those of HRT3 cup-to-disc area ratio (0.877, P=0.0063), vertical cup-to-disc ratio (0.872, P=0.0072), and cup area (0.845, P=0.0005). At 95% specificity, Spectralis OCT global BMO-MRW attained a higher sensitivity than HRT3 cup-to-disc area ratio (P<0.001).

Conclusions:

The BMO-MRW assessment with SD-OCT performed well in discriminating early glaucoma patients from control subjects and had a better performance than CSLO. The diagnostic classifications of HRT3 and Spectralis OCT may reach good agreement.
A Novel One-Stage Obstruction-Based Endoscopic Approach to Congenital Nasolacrimal Duct Obstruction
Authors: Kashkouli Mohsen Bahmani , Abtahi Mohammad Bagher , Sianati Hamed , Mahvidizadeh Nina , Pakdel Farzad , Kashkouli Pedram Bahmani , Abdolalizadeh Parya
Published: September 2016

Purpose:

To report 10-year results of a 1-stage, obstruction-based, endoscopic approach in children with congenital nasolacrimal duct obstruction (CNLDO) with and without prior failed probing/intubation.

Methods:

In a retrospective study, children with primary CNLDO of >6 months old previously failed probing/intubation, acute dacryocystitis or dacryocele at any age, and at least 6 months follow up. Diagnosis was based on history of tearing and dye disappearance test. Excluded were patients with complete puncto-canalicular obstruction and craniofacial anomaly. Type of CNLDO was confirmed using endonasal endoscopic guided probing. An endoscopic probing was performed for membranous, intubation for incomplete complex, and dacryocystorhinostomy for complete complex CNLDO. They were followed at 1 week, 1, 3, and 6 months, and then after. Success was defined as no or occasional tearing related to noxious stimulus at least 6 months after the procedure.

Results:

There were 226 eyes (200 patients). Mean age was 26.72 months. Previous failed probing/intubation was in 34.1%. Inferior turbinate impaction in 73.5% and septal deviation in 2.7% were noted. Membranous CNLDO was found in 38.9%, incomplete complex in 57.9%, and complete complex in 3.1%. Mean time of tube removal was 11.9 weeks and last follow-up time was 24.3 months. There was no significant effect of any variables on the final success rates (probing: 96.5%, intubation: 95.4%, dacryocystorhinostomy: 100%).

Conclusions:

One-stage, obstruction-based endoscopic approach to CNLDO resulted in a high success rate for different types of CNLDO (membranous, incomplete complex, and complete complex). No variable significantly affected the success rates.