bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating the Impact of the Medical Education Partnership Initiative at the University of Zimbabwe College of Health Sciences Using the Most Significant Change Technique
Authors: Connors Susan C. , Nyaude Shemiah , Challender Amelia , Aagaard Eva , Velez Christine , Hakim James
Published: December 2016

Problem

In medical education, evaluating outcomes from programs intended to transform attitudes or influence career trajectories using conventional methods of monitoring is often difficult. To address this problem, the authors adapted the most significant change (MSC) technique to gain a more comprehensive understanding of the impact of the Medical Education Partnership Initiative (MEPI) program at the University of Zimbabwe College of Health Sciences.

Approach

In 2014–2015, the authors applied the MSC to systematically examine the personal significance and level of positive transformation that individuals attributed to their MEPI participation. Interviews were conducted with 28 participants nominated by program leaders. The authors coded results inductively for prevalent themes in participants’ stories and prepared profiles with representative quotes to place the stories in context. Stakeholders selected 9 themes and 18 stories to illustrate the most significant changes.

Outcomes

Six themes (or outcomes) were expected, as they aligned with MEPI goals—becoming a better teacher, becoming a better clinician, increased interest in teaching, increased interest in research, new career pathways (including commitment to practice in Zimbabwe), and improved research skills. Three themes were unexpected—increased confidence, expanded interprofessional networks, and improved interpersonal interactions.

Next Steps

The authors found the MSC to be a useful and systematic evaluation approach for large, complex, and transformative initiatives like MEPI. The MSC seemed to encourage participant reflection, support values inquiry by program leaders, and provide insights into the personal and cultural impacts of MEPI. Additional trial applications of the MSC technique in academic medicine are warranted.
Perioperative Outcomes and Management in Pediatric Complex Cranial Vault Reconstruction
Authors: Stricker Paul A. , Goobie Susan M. , Cladis Franklyn P. , Haberkern Charles M. , Meier Petra M. , Reddy Srijaya K. , Nguyen Thanh T. , Cai Lingyu , Polansky Marcia , Szmuk Peter ,   the Pediatric Craniofacial Collaborative Group
Published: December 2016

Background

The Pediatric Craniofacial Collaborative Group established the Pediatric Craniofacial Surgery Perioperative Registry to elucidate practices and outcomes in children with craniosynostosis undergoing complex cranial vault reconstruction and inform quality improvement efforts. The aim of this study is to determine perioperative management, outcomes, and complications in children undergoing complex cranial vault reconstruction across North America and to delineate salient features of current practices.

Methods

Thirty-one institutions contributed data from June 2012 to September 2015. Data extracted included demographics, perioperative management, length of stay, laboratory results, and blood management techniques employed. Complications and outlier events were described. Outcomes analyzed included total blood donor exposures, intraoperative and perioperative transfusion volumes, and length of stay outcomes.

Results

One thousand two hundred twenty-three cases were analyzed: 935 children aged less than or equal to 24 months and 288 children aged more than 24 months. Ninety-five percent of children aged less than or equal to 24 months and 79% of children aged more than 24 months received at least one transfusion. There were no deaths. Notable complications included cardiac arrest, postoperative seizures, unplanned postoperative mechanical ventilation, large-volume transfusion, and unplanned second surgeries. Utilization of blood conservation techniques was highly variable.

Conclusions

The authors present a comprehensive description of perioperative management, outcomes, and complications from a large group of North American children undergoing complex cranial vault reconstruction. Transfusion remains the rule for the vast majority of patients. The occurrence of numerous significant complications together with large variability in perioperative management and outcomes suggest targets for improvement.
Economic Impact of Nonmodifiable Risk Factors in Orthopaedic Fracture Care: Is Bundled Payment Feasible?
Authors: Mahure Siddharth A. , Hutzler Lorraine , Yoon Richard S. , Bosco Joseph A.
Published: December 2016

Objectives:

To determine whether bundled payments are feasible in the orthopaedic fracture setting, and the potential economic implications of this reimbursement structure.

Design:

Prospective.

Setting:

Multicenter.

Patients/Participants:

Between 2004 and 2014, a total of 23,643 operatively treated patients with fracture and 544,067 patients with total joint arthroplasty (TJA) were identified using the New York State Statewide Planning and Research Cooperative System database.

Interventions:

Severity of illness (SOI), hospital charges ($USD), length of stay (LOS; days), and discharge disposition (homebound vs. not) were collected.

Main Outcome Measurements:

Patients were subdivided into groups of minor and severe SOI. Differences in hospital charges, LOS, and discharge disposition were analyzed. Differences in charges, LOS, and discharges were further analyzed based on minor and severe SOI.

Results:

The difference in hospital charge between patients with minor or severe SOI undergoing elective TJA ranged between 153% and 211%. In contrast, patients undergoing fracture surgery exhibited differences ranging from 314% to 489% between minor and severe SOI levels. Similar differences were observed regarding mean hospital LOS and homebound discharge disposition, with patients with fracture demonstrating greater sensitivity to increasing SOI.

Conclusions:

Although bundled payments may be a viable option for patients undergoing elective TJA, this payment model requires particular attention when applied to fracture care.
Primary Wound Closure After Open Fracture: A Prospective Cohort Study Examining Nonunion and Deep Infection
Authors: Scharfenberger Angela V. , Alabassi Khaled , Smith Stephanie , Weber Donald , Dulai Sukhdeep K. , Bergman Joseph W. , Beaupre Lauren A.
Published: December 2016

Objectives:

Determine the proportion of subjects developing deep infection or nonunion after primary wound closure of open fractures (humerus, radius/ulna, femur, and tibia/fibula). Secondarily, a matched-series analysis compared outcomes with subjects who underwent delayed wound closure.

Design:

Prospective cohort between 2009 and 2013 of subjects undergoing primary closure.

Setting:

Trauma center.

Participants:

Eighty-three (84 fractures) subjects were enrolled. Eighty-two (99%) subjects (83 fractures) provided follow-up data. Matching (age, sec, fracture location, and grade) was performed using study data of delayed wound closure undertaken at the same center between 2001 and 2009 (n = 68 matched subjects).

Intervention:

Primary wound closure occurred when the fracture grade was Gustilo grade 3A or lower and the wound deemed clean at initial surgery. Standardized evaluations occurred until the fracture(s) healed; phone interviews and chart reviews were also undertaken at 1 year.

Main Outcome Measurements:

Deep infection is defined as infection requiring unplanned surgical debridement and/or sustained antibiotic therapy after wound closure; nonunion is defined as unplanned surgical intervention after definitive wound closure or incomplete radiographic healing 1-year after fracture.

Results:

Three (4%) subjects had deep infections, whereas 10 (12%) subjects developed nonunion in the primary closure cohort. In the matched analyses [n = 68 pairs; (136 subjects)], the primary closure cohort had fewer deep infections [n = 3 (4%) vs. n = 6 (9%)] and nonunions [n = 9 (13%) vs. n = 19 (29%)] than the delayed closure cohort (P < 0.001).

Conclusions:

Primary wound closure after an open fracture appears acceptable in appropriately selected patients and may reduce the risk of deep infection and nonunion compared with delayed closure; a definitive randomized trial is needed.

Level of Evidence:

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Nonunion After Clavicle Osteosynthesis: High Incidence of Propionibacterium acnes
Authors: Gausden Elizabeth B. , Villa Jordan , Warner Stephen J. , Redko Mariya , Pearle Andrew , Miller Andy , Henry Michael , Lorich Dean G. , Helfet David L. , Wellman David S.
Published: December 2016

Objective:

The objective of this study was to review the etiology of clavicle nonunions after osteosynthesis and investigate the outcomes of a treatment with a single-stage revision.

Design:

Retrospective case series.

Setting:

Orthopaedic specialty hospital.

Patients:

Twenty cases of nonunion after osteosynthesis of the clavicle were identified. The average age was 44 years (±13 years). In 9 cases, there was catastrophic implant failure that prompted the revision surgery. In the 18 cases in which cultures were taken, 15 of the 18 (83%) were treated as infections with a course of antibiotics. In 14 cases, the cultures were positive for Propionibacterium acnes.

Results:

Fifteen patients were treated with a prolonged course of antibiotics. Eighteen patients had follow-up, and the average time to radiographic union was 22 weeks. There were no cases of nonunion after revision surgery.

Conclusions:

There is a high rate of positive cultures in cases of nonunion after osteosynthesis of the clavicle. This suggests the etiology of midshaft clavicle nonunions may result from a combination of suboptimal mechanical fixation and latent infection. Our treatment protocol of superior and anterior plating, interfragmentary fixation, bone grafting, and appropriate antimicrobial treatment of latent infections has resulted in 100% union rate.

Level of Evidence:

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Evaluation of Pediatric Questions on the Orthopaedic In-Training Examination—An Update
Authors: Murphy Robert F. , Nunez Leah , Barfield William R. , Mooney James F.
Published: December 2016

Background:

Pediatric orthopaedics is tested frequently on the Orthopaedic In-Training Examination (OITE). The most recent data on the pediatrics section of the OITE were generated from content 10 years old. The purpose of this study is to assess the pediatric orthopaedic questions on the 2011 to 2014 OITE, and to compare question categories and cognitive taxonomy with previous data.

Methods:

Four years (2011 to 2014) of OITE questions, answers, and references were reviewed. The number of pediatric questions per year was recorded, as well as presence of a clinical photo or imaging modality. Each question was categorized and assigned a cognitive taxonomy level. Categories included: knowledge; knowledge-treatment modalities; diagnosis; diagnosis/recognition of associated conditions; diagnosis/further studies; and diagnosis/treatment. Cognitive taxonomy levels included: simple recall, interpretation of data, and advanced problem-solving.

Results:

The 3 most commonly covered topics were upper extremity trauma (17.4%), scoliosis (10.1%), and developmental dysplasia of the hip (5.7%). Compared with previous data, the percentage of pediatric questions was constant (13% vs. 14%). Categorically, the more recent OITE examinations contained significantly fewer questions testing simple knowledge (19% vs. 39%, P=0.0047), and significantly more questions testing knowledge of treatment modalities (17% vs. 9%, P=0.016) and diagnosis with associated conditions (19% vs. 9%, P=0.0034). Regarding cognitive taxonomy, there was a significant increase in the average number of questions that required advanced problem-solving (57% vs. 46%, P=0.048). Significantly more questions utilized clinical photographs and imaging studies (62% vs. 48%, P=0.012). The most common reference materials provided to support correct responses included Lovell and Winter’s Pediatric Orthopaedics (25.7%) and the Journal of Pediatric Orthopaedics (23.4%).

Conclusions:

Although the percentage of pediatric questions on the OITE has remained essentially constant, the percentage of questions requiring advanced problem-solving or interpretation of images has increased significantly in the past 10 years. Knowledge of question type and content may be helpful for those involved in resident education and in the development of didactic pediatric orthopaedic curricula.

Level of Evidence:

Level IV.
Platysma Motor Nerve Transfer for Restoring Marginal Mandibular Nerve Function
Authors: Rodriguez-Lorenzo Andres , Jensson David , Weninger Wolfgang J. , Schmid Melanie , Meng Stefan , Tzou Chieh-Han John
Published: December 2016

Background:

Injuries of the marginal mandibular nerve (MMN) of the facial nerve result in paralysis of the lower lip muscle depressors and an asymmetrical smile. Nerve reconstruction, when possible, is the method of choice; however, in cases of long nerve gaps or delayed nerve reconstruction, conventional nerve repairs may be difficult to perform or may provide suboptimal outcomes. Herein, we investigate the anatomical technical feasibility of transfer of the platysma motor nerve (PMN) to the MMN for restoration of lower lip function, and we present a clinical case where this nerve transfer was successfully performed.

Methods:

Ten adult fresh cadavers were dissected. Measurements included the number of MMN and PMN branches, the maximal length of dissection of the PMN from the parotid, and the distance from the anterior border of the parotid to the facial artery. The PMN reach for direct coaptation to the MMN at the level of the crossing with the facial artery was assessed. We performed histomorphometric analysis of the MMN and PMN branches.

Results:

The anatomy of the MMN and PMN was consistent in all dissections, with an average number of subbranches of 1.5 for the MMN and 1.2 for the PMN. The average maximal length of dissection of the PMN was 46.5 mm, and in every case, tension-free coaptation with the MMN was possible. Histomorphometric analysis demonstrated that the MMN contained an average of 3,866 myelinated fiber counts per millimeter, and the PMN contained 5,025. After a 3-year follow-up of the clinical case, complete recovery of MMN function was observed, without the need of central relearning and without functional or aesthetic impairment resulting from denervation of the platysma muscle.

Conclusions:

PMN to MMN transfer is an anatomically feasible procedure for reconstruction of isolated MMN injuries. In our patient, by direct nerve coaptation, a faster and full recovery of lower lip muscle depressors was achieved without the need of central relearning because of the synergistic functions of the PMN and MMN functions and minimal donor-site morbidity.
Trabecular Micro-Bypass Stent Use in Necrotizing Scleritis
Authors: Sandhu Simrenjeet , Heckler Lisa , Mah Dean , Dorey Michael W.
Published: December 2016

Purpose:

In this case report, we describe the successful implantation of multiple trabecular micro-bypass iStents in a patient with necrotizing scleritis.

Design:

The study design is a case report.

Participants:

The participant was a patient who underwent multiple micro-bypass iStent surgery.

Methods:

A 71-year-old man with primary open-angle glaucoma, diagnosed with necrotizing scleritis and treated with steroids consequently resulting in significantly elevated intraocular pressure in the right eye.

Results:

Following uncomplicated surgery, IOP was reduced from 42 to 12 mm Hg 18 months after surgery on 2 drops and prednisone 40 mg daily

Conclusions:

iStents may be considered as a possible intervention to lower IOP in patients with necrotizing scleritis in whom traditional glaucoma surgery is challenging or contraindicated.
24-Hour Intraocular Pressure Rhythm in Patients With Untreated Primary Open Angle Glaucoma and Effects of Selective Laser Trabeculoplasty
Authors: Aptel Florent , Musson Cécile , Zhou Thierry , Lesoin Antoine , Chiquet Christophe
Published: December 2016

Purpose of the Study:

The purpose of the study was to evaluate the 24-hour nyctohemeral rhythm of intraocular pressure (IOP) in patients with untreated primary open angle glaucoma using a contact lens sensor. To evaluate the effect of selective laser trabeculoplasty (SLT) on the 24-hour rhythm of IOP.

Materials and Methods:

Prospective study conducted in a chronobiology center. Fourteen patients with primary open angle glaucoma underwent three 24-hour IOP measurement sessions after a complete wash-out of the medical treatment: before SLT and 1 and 6 months after, using the contact lens sensor Triggerfish (SENSIMED, Lausanne, Switzerland). IOP and the main parameters of nyctohemeral rhythm (existence of a rhythm, acrophase, bathyphase, midline estimating statistic of rhythm, amplitude, and range) before SLT were compared with the same parameters measured 1 and 6 months later.

Results:

IOP increased from 16.3±3.7 to 22.1±8.4 mm Hg (5.8 mm Hg; 95% confidence interval (CI), 2.41-12.71; P=0.009) after the wash-out procedure. After SLT, IOP significantly decreased by 3.4 mm Hg (95% CI, 0.09-7.89; P=0.041) (14.9%) at 1 month and 1.9 mm Hg (95% CI 0.10-3.84; P=0.044) (8.1%) at 6 months. After medication wash-out, 100% of the subjects had a nyctohemeral IOP rhythm with nocturnal acrophase (01:57±3:32 am, 01:22±3:01 am, and 03:17±2:12 am at inclusion, 1 and 6 mo, respectively). SLT did not significantly change the characteristics of the 24-hour IOP pattern, notably the amplitude and the type of rhythm (persistence of nocturnal acrophase).

Conclusions:

After medical treatment wash-out, patients with open angle glaucoma consistently had a significant 24-hour IOP rhythm with nocturnal acrophase. SLT reduces the absolute IOP value but does not modify the nyctohemeral IOP rhythm.
Is Autophagy Dysfunction a Key to Exfoliation Glaucoma?
Authors: Wolosin J. Mario , Ritch Robert , Bernstein Audrey M.
Published: December 2016

In this short report we review previous work toward the identification of the protein and cellular sources of exfoliation glaucoma and described our recent finding on dysfunction of autophagy in Tenon capsule fibroblasts obtained from exfoliation syndrome glaucoma patients at the time of surgery and discuss the potential implications of these findings for understanding the cellular sources of the disease.
Iridocorneal Endothelial Syndrome Presenting With Large Diurnal Intraocular Pressure Fluctuation
Authors: Mogil Rachel S. , Lee Jung Min , Tirsi Andrew , Tello Celso , Park Sung Chul
Published: December 2016

Purpose of the Study:

The purpose of the study was to report a case of iridocorneal endothelial syndrome with an initial presentation of a large diurnal fluctuation of intraocular pressure (IOP) which peaked early in the morning.

Methods:

A 31-year-old white man had transient blurry vision oculus sinister (OS) upon awakening in the morning for the past 2 months. The blurry vision improved within 1 to 2 hours. Clinical examination, diurnal IOP measurements, and specular microscopy were performed to investigate the cause of his transient blurry vision.

Results:

At 6 am, IOP OS was 38 mm Hg with corneal edema and visual acuity of 20/30. At 8 am, IOP OS decreased to 25 mm Hg with clear cornea and visual acuity of 20/20. Diurnal IOP measurements revealed a large fluctuation OS (18 mm Hg). Specular microscopy revealed pleomorphism, polymegathism, light peripheral borders and light/dark reversal of the corneal endothelium OS. IOP oculus dexter remained within normal limits with clear cornea and stable visual acuity throughout the diurnal measurements.

Conclusions:

In patients with consistent daily episodes of transient blurry vision, clinicians should suspect a large diurnal IOP fluctuation with high peak IOP. If symptoms and signs are unilateral, iridocorneal endothelial syndrome should be included in the differential diagnosis and corneal specular microscopy should be obtained.
Preinvasive and Invasive Cervical Adenocarcinoma: Preceding Low-Risk or Negative Pap Result Increases Time to Diagnosis
Authors: Moukarzel Lea A. , Angarita Ana M. , VandenBussche Christopher , Rositch Anne , Thompson Carol B. , Fader Amanda N. , Levinson Kimberly
Published: December 2016

Objectives

The aims of the study were to investigate screening histories of women with adenocarcinoma in situ (AIS) and adenocarcinoma (AdCa) of the cervix and to further evaluate screening for glandular disease.

Materials and Methods

Screening histories were retrospectively collected for patients with AIS or AdCa at a single large-volume academic institution from 2005 to 2015. Fisher exact and Wilcoxon rank sum tests were used to compare AIS with AdCa patient characteristics, distribution of preceding Pap (i.e., trigger Pap) results, and high-risk human papillomavirus testing. The association between Pap result and time to diagnosis was evaluated.

Results

Eighty-seven cases, 50 AIS and 37 AdCa, met study criteria; median age was 31 and 43 years, respectively. Among the AIS cohort, 52.0% had a negative or low-risk trigger Pap result versus 24.3% of those with AdCa (p = .001). The time to diagnosis of AIS ranged from 8.4 to 18.8 weeks for those with high- versus low-risk or negative trigger Pap results, respectively (p = .002). The time to diagnosis of AdCa ranged from 14.6 to 44.7 weeks for those with high- versus low-risk or negative trigger Pap results, respectively (p = .003). Among those with high-risk human papillomavirus testing, 89.7% tested positive at the time of trigger Pap with 100% positivity among those with low-risk or negative trigger Pap results.

Conclusions

Cervical AIS and AdCa affect many young nulliparous women and commonly preceded by low-risk or negative Pap testing. The interval to diagnosis increases with low-risk and negative Pap results, and therefore, further investigation into optimal screening for glandular lesions is needed.
Loop Electrosurgical Excision Procedure Instead of Cold-Knife Conization for Cervical Intraepithelial Neoplasia in Women With Unsatisfactory Colposcopic Examinations: A Systematic Review and Meta-Analysis
Authors: El-Nashar Sherif A. , Shazly Sherif A. , Hopkins Matthew R. , Bakkum-Gamez Jamie N. , Famuyide Abimbola O.
Published: December 2016

Objectives

This meta-analysis compared loop electrosurgical excision procedure (LEEP) with cold-knife conization (CKC) for treating cervical intraepithelial neoplasia (CIN) in patients with unsatisfactory colposcopic examinations.

Material and Methods

A literature search on MEDLINE, EMBASE, Cochrane Systematic Reviews, CENTRAL, Web of Science, and Scopus databases was conducted from inception until April 2015. We included clinical trials and cohort studies comparing CKC with LEEP for treating CIN. The primary outcome was a combined end point of persistent CIN (<6 months after conization) and recurrent CIN (>6 months). Secondary outcomes included procedural, pathologic, and long-term outcomes. Pooled relative risk (RR) and weighted mean difference (WMD) were used to report binary and continuous outcomes, respectively.

Results

Among 26 studies, the incidence of persistent and recurrent disease after LEEP was comparable with that after CKC (15.6% vs 7.38%; RR = 1.35; 95% CI = 1.00–1.81). Loop electrosurgical excision procedure was faster, caused less intraoperative bleeding, and resulted in shorter hospital stay (WMD, 9.5 minutes [95% CI = 6.4–12.6 minutes]; WMD, 42.4 mL [95% CI = 21.3–106 mL]; and WMD, 1.5 days [95% CI = 1.1–1.8 days], respectively). Loop electrosurgical excision procedure cones were shallower with overall less volume and weight than CKC (WMD, 5.1 mm [95% CI = 3.2–7.1 mm]; 2.6 mm3 [95% CI = 0.6–5.7 mm3]; and 2.6 g [95% CI = 1.4–3.7 g], respectively). During follow-up, LEEP was associated with less cervical stenosis and fewer unsatisfactory examinations; however, this was not statistically significant (RR, 0.5 [95% CI = 0.1–1.5]; RR, 0.7 [95% CI = 0.4–1.2], respectively).

Conclusions

Loop electrosurgical excision procedure is an acceptable alternative to CKC in women with CIN and unsatisfactory colposcopic examinations. Close follow-up is necessary for prompt detection and treatment of persistent or recurrent disease.
Improvement of sleep architecture parameters in cirrhotic patients with recurrent hepatic encephalopathy with the use of rifaximin
Authors: Bruyneel Marie , Sersté Thomas , Libert Walter , van den Broecke Sandra , Ameye Lieveke , Dachy Bernard , Mulkay Jean-Pierre , Moreno Christophe , Gustot Thierry
Published: December 2016

Background and aim

Sleep disorders are frequently reported in patients with cirrhosis and hepatic encephalopathy (HE). This study assessed the effect of rifaximin on sleep architecture parameters in patients with recurrent HE.

Patients and methods

This sequential, prospective, and exploratory study involved all patients with cirrhosis and recurrent HE admitted between June 2014 and September 2015. HE was assessed according to the West-Haven Classification. Patients underwent 24-h polysomnography (PSG) and 7-day actigraphy. Rapid eye movement (REM) sleep was considered to be an indicator of good sleep quality. Patients completed questionnaires assessing the quality of sleep and sleepiness. After a 28-day course of rifaximin, the same assessment was repeated.

Results

Fifteen patients were included (nine men, mean age: 57±11 years). Child–Pugh scores ranged from B7 to C15. Before rifaximin, the mean HE score was 2.7±0.7. Data from PSG analysis indicated long total sleep time (TST): 571±288 min, and limited REM sleep: 2.5% TST (0–19). Seven-day actigraphy showed an impaired number of steps: 1690/24 h (176–6945). Questionnaires indicated that patients experienced impaired sleep quality and excessive daytime sleepiness. After rifaximin, HE scores decreased to 1.7±0.6 (P<0.001). REM sleep increased to 8.5% TST (0–25) (P=0.003). No changes were observed for TST, number of steps, and on questionnaires.

Conclusion

Patients with recurrent HE suffer from poor sleep quality and excessive daytime sleepiness. On 24-h PSG, rifaximin improves objective sleep architecture parameters with no changes in the subjective quality of sleep and sleepiness.
Clinical utility of the 6-min walk test for patients with moderate Parkinson’s disease
Authors: Kobayashi Eiji , Himuro Nobuaki , Takahashi Mitsuhiko
Published: December 2016

The aim of this study was to test the clinical utility of the 6-min walk test (6MWT) for patients with moderate Parkinson’s disease (PD) through a determination of factors related to this test. This was a descriptive, observational study carried out at a General Hospital, in-patients. Twenty-four patients with moderate PD were studied. We used Hoehn and Yahr stage ratings (HY stage), Unified Parkinson Disease Rating Scales (UPDRS) motor examination score, 6MWT, Berg Balance scale, Timed ‘Up & Go’ test (TUG), 10-m walk test (10-m walk speed, 10-m walk steps and cadence), and the energy cost of walking (Ec). The average HY stage was 3.1±0.5 and 6MWT was 340.8±110.9 m. TUG (r=−0.68, P<0.01) and Ec (r=−0.65, P<0.01) were correlated significantly with 6MWT. Multiple regression analysis with age, HY stage, TUG, cadence, and Ec as variables indicated a significant degree of variability in the 6MWT results (R
2=0.77, P<0.001). The TUG (β=−0.47, P<0.01) and Ec (β=−0.4, P<0.01) were correlated independently with the 6MWT results. In contrast, age, HY stage, and cadence were not independently correlated. The 6MWT is a simple tool for assessing walking capacity for patients with PD. In this study, we confirmed the convergent validity and clinical utility of the 6MWT for patients with moderate PD. The 6MWT is useful for clinical assessment to guide the planning of rehabilitation treatment for patients with moderate PD.
Delirium in Children After Cardiac Bypass Surgery*
Authors: Patel Anita K. , Biagas Katherine V. , Clarke Eunice C. , Gerber Linda M. , Mauer Elizabeth , Silver Gabrielle , Chai Paul , Corda Rozelle , Traube Chani
Published: December 2016

Objectives:

To describe the incidence of delirium in pediatric patients after cardiac bypass surgery and explore associated risk factors and effect of delirium on in-hospital outcomes.

Design:

Prospective observational single-center study.

Setting:

Fourteen-bed pediatric cardiothoracic ICU.

Patients:

One hundred ninety-four consecutive admissions following cardiac bypass surgery, 1 day to 21 years old.

Interventions:

Subjects were screened for delirium daily using the Cornell Assessment of Pediatric Delirium.

Measurements and Main Results:

Incidence of delirium in this sample was 49%. Delirium most often lasted 1–2 days and developed within the first 1–3 days after surgery. Age less than 2 years, developmental delay, higher Risk Adjustment for Congenital Heart Surgery 1 score, cyanotic disease, and albumin less than three were all independently associated with development of delirium in a multivariable model (all p < 0.03). Delirium was an independent predictor of prolonged ICU length of stay, with patients who were ever delirious having a 60% increase in ICU days compared with patients who were never delirious (p < 0.01).

Conclusions:

In our institution, delirium is a frequent problem in children after cardiac bypass surgery, with identifiable risk factors. Our study suggests that cardiac bypass surgery significantly increases children’s susceptibility to delirium. This highlights the need for heightened, targeted delirium screening in all pediatric cardiothoracic ICUs to potentially improve outcomes in this vulnerable patient population.
Shock-like haemodynamic responses induced in the primary visual cortex by moving visual stimuli
Authors: Lacy T. C. , Aquino K. M. , Robinson P. A. , Schira M. M.
Published: December 2016

It is shown that recently discovered haemodynamic waves can form shock-like fronts when driven by stimuli that excite the cortex in a patch that moves faster than the haemodynamic wave velocity. If stimuli are chosen in order to induce shock-like behaviour, the resulting blood oxygen level-dependent (BOLD) response is enhanced, thereby improving the signal to noise ratio of measurements made with functional magnetic resonance imaging. A spatio-temporal haemodynamic model is extended to calculate the BOLD response and determine the main properties of waves induced by moving stimuli. From this, the optimal conditions for stimulating shock-like responses are determined, and ways of inducing these responses in experiments are demonstrated in a pilot study.
Socioeconomic correlations and stratification in social-communication networks
Authors: Leo Yannick , Fleury Eric , Alvarez-Hamelin J. Ignacio , Sarraute Carlos , Karsai Márton
Published: December 2016

The uneven distribution of wealth and individual economic capacities are among the main forces, which shape modern societies and arguably bias the emerging social structures. However, the study of correlations between the social network and economic status of individuals is difficult due to the lack of large-scale multimodal data disclosing both the social ties and economic indicators of the same population. Here, we close this gap through the analysis of coupled datasets recording the mobile phone communications and bank transaction history of one million anonymized individuals living in a Latin American country. We show that wealth and debt are unevenly distributed among people in agreement with the Pareto principle; the observed social structure is strongly stratified, with people being better connected to others of their own socioeconomic class rather than to others of different classes; the social network appears to have assortative socioeconomic correlations and tightly connected ‘rich clubs’; and that individuals from the same class live closer to each other but commute further if they are wealthier. These results are based on a representative, society-large population, and empirically demonstrate some long-lasting hypotheses on socioeconomic correlations, which potentially lay behind social segregation, and induce differences in human mobility.
Age-related environmental gradients influence invertebrate distribution in the Prince Charles Mountains, East Antarctica
Authors: Czechowski Paul , White Duanne , Clarke Laurence , McKay Alan , Cooper Alan , Stevens Mark I.
Published: December 2016

The potential impact of environmental change on terrestrial Antarctic ecosystems can be explored by inspecting biodiversity patterns across large-scale gradients. Unfortunately, morphology-based surveys of Antarctic invertebrates are time-consuming and limited by the cryptic nature of many taxa. We used biodiversity information derived from high-throughput sequencing (HTS) to elucidate the relationship between soil properties and invertebrate biodiversity in the Prince Charles Mountains, East Antarctica. Across 136 analysed soil samples collected from Mount Menzies, Mawson Escarpment and Lake Terrasovoje, we found invertebrate distribution in the Prince Charles Mountains significantly influenced by soil salinity and/or sulfur content. Phyla Tardigrada and Arachnida occurred predominantly in low-salinity substrates with abundant nutrients, whereas Bdelloidea (Rotifera) and Chromadorea (Nematoda) were more common in highly saline substrates. A significant correlation between invertebrate occurrence, soil salinity and time since deglaciation indicates that terrain age indirectly influences Antarctic terrestrial biodiversity, with more recently deglaciated areas supporting greater diversity. Our study demonstrates the value of HTS metabarcoding to investigate environmental constraints on inconspicuous soil biodiversity across large spatial scales.
Evolving interactions between diazotrophic cyanobacterium and phage mediate nitrogen release and host competitive ability
Authors: Cairns Johannes , Coloma Sebastián , Sivonen Kaarina , Hiltunen Teppo
Published: December 2016

Interactions between nitrogen-fixing (i.e. diazotrophic) cyanobacteria and their viruses, cyanophages, can have large-scale ecosystem effects. These effects are mediated by temporal alterations in nutrient availability in aquatic systems owing to the release of nitrogen and carbon sources from cells lysed by phages, as well as by ecologically important changes in the diversity and fitness of cyanobacterial populations that evolve in the presence of phages. However, ecological and evolutionary feedbacks between phages and nitrogen-fixing cyanobacteria are still relative poorly understood. Here, we used an experimental evolution approach to test the effect of interactions between a common filamentous, nitrogen-fixing cyanobacterium (Nodulariasp.) and its phage on cellular nitrogen release and host properties. Ecological, community-level effects of phage-mediated nitrogen release were tested with a phytoplankton bioassay. We found that cyanobacterial nitrogen release increased significantly as a result of viral lysis, which was associated with enhanced growth of phytoplankton species in cell-free filtrates compared with phage-resistant host controls in which lysis and subsequent nutrient release did not occur after phage exposure. We also observed an ecologically important change among phage-evolved cyanobacteria with phage-resistant phenotypes, a short-filamentous morphotype with reduced buoyancy compared with the ancestral long-filamentous morphotype. Reduced buoyancy might decrease the ability of these morphotypes to compete for light compared with longer, more buoyant filaments. Together, these findings demonstrate the potential of cyanobacteria–phage interactions to affect ecosystem biogeochemical cycles and planktonic community dynamics.
Genetic diversity of currently circulating rubella viruses: a need to define more precise viral groups
Authors: Rivailler P , Abernathy E , Icenogle J
Published: December 2016

Recent studies have shown that the currently circulating rubella viruses are mostly members of two genotypes, 1E and 2B. Also, genetically distinct viruses of genotype 1G have been found in East and West Africa. This study used a Mantel test to objectively include both genetic diversity and geographic location in the definition of lineages, and identified statistically justified lineages (n=13) and sub-lineages (n=9) of viruses within genotypes 1G, 1E and 2B. Genotype 2B viruses were widely distributed, while viruses of genotype 1E as well as 1G and 1J were much more geographically restricted. This analysis showed that more precise groupings for rubella viruses are possible, which should improve the ability to track rubella viruses worldwide. A year-by-year analysis revealed gaps in surveillance that need to be resolved in order to support the surveillance needed for enhanced control and elimination goals for rubella.
Absence of genome reduction in diverse, facultative endohyphal bacteria
Authors: Baltrus David A. , Dougherty Kevin , Arendt Kayla R. , Huntemann Marcel , Clum Alicia , Pillay Manoj , Palaniappan Krishnaveni , Varghese Neha , Mikhailova Natalia , Stamatis Dimitrios , Reddy T. B. K. , Ngan Chew Yee , Daum Chris , Shapiro Nicole , Markowitz Victor , Ivanova Natalia , Kyrpides Nikos , Woyke Tanja , Arnold A. Elizabeth
Published: December 2016

Fungi interact closely with bacteria, both on the surfaces of the hyphae and within their living tissues (i.e. endohyphal bacteria, EHB). These EHB can be obligate or facultative symbionts and can mediate diverse phenotypic traits in their hosts. Although EHB have been observed in many lineages of fungi, it remains unclear how widespread and general these associations are, and whether there are unifying ecological and genomic features can be found across EHB strains as a whole. We cultured 11 bacterial strains after they emerged from the hyphae of diverse Ascomycota that were isolated as foliar endophytes of cupressaceous trees, and generated nearly complete genome sequences for all. Unlike the genomes of largely obligate EHB, the genomes of these facultative EHB resembled those of closely related strains isolated from environmental sources. Although all analysed genomes encoded structures that could be used to interact with eukaryotic hosts, pathways previously implicated in maintenance and establishment of EHB symbiosis were not universally present across all strains. Independent isolation of two nearly identical pairs of strains from different classes of fungi, coupled with recent experimental evidence, suggests horizontal transfer of EHB across endophytic hosts. Given the potential for EHB to influence fungal phenotypes, these genomes could shed light on the mechanisms of plant growth promotion or stress mitigation by fungal endophytes during the symbiotic phase, as well as degradation of plant material during the saprotrophic phase. As such, these findings contribute to the illumination of a new dimension of functional biodiversity in fungi.
MicroRNA exocytosis by large dense-core vesicle fusion
Authors: Gümürdü Alican , Yildiz Ramazan , Eren Erden , Karakülah Gökhan , Ünver Turgay , Genç Şermin , Park Yongsoo
Published: December 2016

Neurotransmitters and peptide hormones are secreted into outside the cell by a vesicle fusion process. Although non-coding RNA (ncRNA) that include microRNA (miRNA) regulates gene expression inside the cell where they are transcribed, extracellular miRNA has been recently discovered outside the cells, proposing that miRNA might be released to participate in cell-to-cell communication. Despite its importance of extracellular miRNA, the molecular mechanisms by which miRNA can be stored in vesicles and released by vesicle fusion remain enigmatic. Using next-generation sequencing, vesicle purification techniques, and synthetic neurotransmission, we observe that large dense-core vesicles (LDCVs) contain a variety of miRNAs including miR-375. Furthermore, miRNA exocytosis is mediated by the SNARE complex and accelerated by Ca2+. Our results suggest that miRNA can be a novel neuromodulator that can be stored in vesicles and released by vesicle fusion together with classical neurotransmitters.

One Sentence Summary

Using next-generation sequencing (NGS) for microRNA (miRNA) and synthetic neurotransmission, we observed that large dense-core vesicles (LDCVs) contain a variety of miRNA together with classical neurotransmitters, and that miRNA can be released by vesicle fusion mediated by SNARE.
Induced defenses alter the strength and direction of natural selection on reproductive traits in common milkweed
Authors: Thompson Ken A. , Cory Kaitlin A. , Johnson Marc T. J.
Published: December 2016

Evolutionary biologists have long sought to understand the ecological processes that generate plant reproductive diversity. Recent evidence indicates that constitutive antiherbivore defenses can alter natural selection on reproductive traits, but it is unclear whether induced defenses will have the same effect and whether reduced foliar damage in defended plants is the cause of this pattern. In a factorial field experiment using common milkweed,Asclepias syriaca, we induced plant defenses using jasmonic acid (JA) and imposed foliar damage using scissors. We found that JA-induced plants experienced selection for more inflorescences that were smaller in size (fewer flowers), while control plants only experienced a trend toward selection for larger inflorescences (more flowers); all effects were independent of foliar damage. Our results demonstrate that induced defenses can alter both the strength and direction of selection on reproductive traits, and suggest that antiherbivore defenses may promote the evolution of plant reproductive diversity.
Comparative genomics of beetle-vectored fungal pathogens reveals a reduction in genome size and independent evolution of pathogenicity of two tree pathogens
Authors: Schuelke Taruna A , Westbrook Anthony , Woeste Keith , Plachetzki David C. , Broders Kirk , MacManes Matthew D.
Published: December 2016

Geosmithia morbidais an emerging fungal pathogen which serves as a paradigm for examining the evolutionary processes behind pathogenicity because it is one of two known pathogens within a genus of mostly saprophytic, beetle-associated, fungi. This pathogen causes thousand cankers disease in black walnut trees and is vectored into the host via the walnut twig beetle.G. morbidawas first detected in western US and currently threatens the timber industry concentrated in eastern US.

We sequenced the genomes ofG. morbidaand two non-pathogenicGeosmithiaspecies and compared these species to other fungal pathogens and nonpathogens to identify genes under positive selection inG. morbidathat may be associated with pathogenicity.

G. morbidapossesses one of the smallest genomes among the fungal species observed in this study, and one of the smallest fungal pathogen genomes to date. The enzymatic profile is this pathogen is very similar to its relatives.

Our findings indicate that genome reduction is an important adaptation during the evolution of a specialized lifestyle in fungal species that occupy a specific niche, such as beetle vectored tree pathogens. We also present potential genes under selection inG. morbidathat could be important for adaptation to a pathogenic lifestyle.
Nodal secures pluripotency upon embryonic stem cell progression from the ground state
Authors: Mulas Carla , Kalkan Tüzer , Smith Austin
Published: December 2016

Naïve mouse embryonic stem (ES) cells can readily acquire specific fates, but the cellular and molecular processes that enable lineage specification are poorly characterised. Here we investigated progression from the ES cell ground state in adherent culture. We utilised down-regulation ofRex1::GFPd2to track loss of ES cell identity. We found that cells that have newly down-regulated this reporter have acquired competence for germline induction. They can also be efficiently specified for different somatic lineages, responding more rapidly than naïve cells to inductive cues. Nodal is a candidate autocrine regulator of pluripotency. Abrogation of Nodal signalling did not substantially alter kinetics of exit from the ES cell state, but accelerated subsequent adoption of neural fate at the expense of other lineages. This effect was evident if Nodal was inhibited prior to extinction of ES cell identity. We suggest that Nodal is pivotal for non-neural competence in cells departing naïve pluripotency.
Comparative analyses of super-enhancers reveal conserved elements in vertebrate genomes
Authors: Pérez-Rico Yuvia A. , Boeva Valentina , Mallory Allison C. , Bitetti Angelo , Majello Sara , Barillot Emmanuel , Shkumatava Alena
Published: December 2016

Super-enhancers (SEs) are key transcriptional drivers of cellular, developmental, and disease states in mammals, yet the conservational and regulatory features of these enhancer elements in nonmammalian vertebrates are unknown. To define SEs in zebrafish and enable sequence and functional comparisons to mouse and human SEs, we used genome-wide histone H3 lysine 27 acetylation (H3K27ac) occupancy as a primary SE delineator. Our study determined the set of SEs in pluripotent state cells and adult zebrafish tissues and revealed both similarities and differences between zebrafish and mammalian SEs. Although the total number of SEs was proportional to the genome size, the genomic distribution of zebrafish SEs differed from that of the mammalian SEs. Despite the evolutionary distance separating zebrafish and mammals and the low overall SE sequence conservation, ∼42% of zebrafish SEs were located in close proximity to orthologs that also were associated with SEs in mouse and human. Compared to their nonassociated counterparts, higher sequence conservation was revealed for those SEs that have maintained orthologous gene associations. Functional dissection of two of these SEs identified conserved sequence elements and tissue-specific expression patterns, while chromatin accessibility analyses predicted transcription factors governing the function of pluripotent state zebrafish SEs. Our zebrafish annotations and comparative studies show the extent of SE usage and their conservation across vertebrates, permitting future gene regulatory studies in several tissues.
5-Bromo-1,2,4-triazolo[1,5-a]pyrimidine
Authors: Gilandoust Maryam , Harsha K. B. , Madan Kumar S. , Rakesh K. S. , Lokanath N. K. , Byrappa K. , Rangappa K. S.
Published: December 2016

In the title compound, C5H3BrN4, the almost planar triazolopyrimidine ring system (r.m.s. deviation = 0.014 Å) carries a bromo substituent at the 5-position. In the crystal, C—H...N hydrogen bonds form inversion dimers enclosingR22(8) rings and also link molecules intoC(5) chains along thec-axis direction. Br...N halogen bonds [3.185 (4) Å], π–π stacking interactions, centroid-to-centroid separation [3.663 (3) Å] and C—Br...π contacts [Br...Cg= 3.7881 (17) Å] are also found and combine with the C—H...N hydrogen bonds to stack the molecules along thea-axis direction.
Ethyl 3-methyl-1-phenyl-5-(p-tolyl)-1H-pyrazole-4-carboxylate
Authors: Naveen S. , Dileep Kumar A. , Kumara Karthik , Ajay Kumar K. , Lokanath N. K. , Warad Ismail
Published: December 2016

In the title compound, C20H20N2O2, the pyrazole ring makes dihedral angles of 39.74 (8) and 60.35 (8)° with the phenyl and toluene rings, respectively. The dihedral angle between the phenyl and toluene rings is 62.01 (7)°.