bluuebunny/crossref_metadata_2025 huggingface dataset:
Breast MRI at very short TE (minTE): image analysis of minTE sequences on non-fat-saturated, subtracted T1-weighted images
Authors: Wenkel Evelyn , Janka Rolf , Geppert Christian , Kaemmerer Nadine , Hartmann Arndt , Uder Michael , Hammon Matthias , Brand Michael
Published: September 2017

Purpose The aim was to evaluate a minimum echo time (minTE) protocol for breast magnetic resonance imaging (MRI) in patients with breast lesions compared to a standard TE (nTE) time protocol.

Methods Breasts of 144 women were examined with a 1.5 Tesla MRI scanner. Additionally to the standard gradient-echo sequence with nTE (4.8 ms), a variant with minimum TE (1.2 ms) was used in an interleaved fashion which leads to a better temporal resolution and should reduce the scan time by approximately 50 %. Lesion sizes were measured and the signal-to-noise ratio (SNR) as well as the contrast-to-noise ratio (CNR) were calculated. Subjective confidence was evaluated using a 3-point scale before looking at the nTE sequences (1 = very sure that I can identify a lesion and classify it, 2 = quite sure that I can identify a lesion and classify it, 3 = definitely want to see nTE for final assessment) and the subjective image quality of all examinations was evaluated using a four-grade scale (1 = sharp, 2 = slight blur, 3 = moderate blur and 4 = severe blur/not evaluable) for lesion and skin sharpness. Lesion morphology and contrast enhancement were also evaluated.

Results With minTE sequences, no lesion was rated with “definitely want to see nTE sequences for final assessment”. The difference of the longitudinal and transverse diameter did not differ significantly (p > 0.05). With minTE, lesions and skin were rated to be significantly more blurry (p < 0.01 for lesions and p < 0.05 for skin). There was no difference between both sequences with respect to SNR, CNR, lesion morphology, contrast enhancement and detection of multifocal disease.

Conclusion Dynamic breast MRI with a minTE protocol is feasible without a major loss of information (SNR, CNR, lesion morphology, contrast enhancement and lesion sizes) and the temporal resolution can be increased by a factor of 2 using minTE sequences.

Key points
Die Homöopathie und die Geschichte der Skeptikerbewegung in den USA
Authors: Behnke Jens
Published: September 2017

Die weltweite Homöopathiekritik geht maßgeblich von der sogenannten „Skeptikerbewegung“ aus. Diese Weltanschauungsgemeinschaft stützt sich auf ein dogmatisches Wissenschaftsverständnis, um im Rahmen von Medienkampagnen die Homöopathie systematisch zu diskreditieren. Der vorliegende Artikel rekonstruiert die Ursprünge der „Skeptiker“ in den USA. Es werden Verbindungen zu medizinischen Gesellschaften, industriellen Geldgebern und politischen Institutionen analysiert. Die Methoden der Gruppierung erfahren eine kritische Würdigung anhand konkreter historischer Beispiele.
Diagnostic and therapeutic treatment modalities for acute lower gastrointestinal bleeding: a systematic review
Authors: Oakland Kathryn , Isherwood Jennifer , Lahiff Conor , Goldsmith Petra , Desborough Michael , Colman Katherine , Guy Richard , Uberoi Raman , Murphy Michael , East James , Hopewell Sally , Jairath Vipul
Published: September 2017

Background and study aims Investigations for lower gastrointestinal bleeding (LGIB) include flexible sigmoidoscopy, colonoscopy, computed tomographic angiography (CTA), and angiography. All may be used to direct endoscopic, radiological or surgical treatment, although their optimal use is unknown. The aims of this study were to determine the diagnostic and therapeutic yields of endoscopy, CTA, and angiography for managing LGIB, and their influence on rebleeding, transfusion, and hospital stay.

Patients and methods A systematic search of MEDLINE, PubMed, EMBASE, and CENTRAL was undertaken to identify randomized controlled trials (RCTs) and nonrandomized studies of intervention (NRSIs) published between 2000 and 12 November 2015 in patients hospitalized with LGIB. Separate meta-analyses were conducted, presented as pooled odds (ORs) or risk ratios (RR) with 95 % confidence intervals (CIs).

Results Two RCTs and 13 NRSIs were included, none of which examined flexible sigmoidoscopy, or compared endotherapy with embolization, or investigated the timing of CTA or angiography. Two NRSIs (57 – 223 participants) comparing colonoscopy and CTA were of insufficient quality for synthesis but showed no difference in diagnostic yields between the two interventions. One RCT and 4 NRSIs (779 participants) compared early colonoscopy (< 24 hours) with colonoscopy performed later; meta-analysis of the NRSIs demonstrated higher diagnostic and therapeutic yields with early colonoscopy (OR 1.86, 95 %CI 1.12 to 2.86, P = 0.004 and OR 3.08, 95 %CI 1.93 to 4.90, P < 0.001, respectively) and reduced length of stay (mean difference 2.64 days, 95 %CI 1.54 to 3.73), but no difference in transfusion or rebleeding.

Conclusions In LGIB there is a paucity of high-quality evidence, although the limited studies on the timing of colonoscopy suggest increased rates of diagnosis and therapy with early colonoscopy.
Solution processed nanogap organic diodes based on liquid crystalline materials
Authors: Wang Yi-Fei , Iino Hiroaki , Hanna Jun-ichi
Published: September 2017

Co-planar nanogap organic diodes were fabricated with smectic liquid crystalline materials of the benzothienobenzothiophene (BTBT) derivative by a spin-coating technique. A high rectification ratio of the order of 106 at ±3 V was achieved when a liquid crystalline material of 2,7-didecyl benzothieno[3,2-b][1]benzothiophene (10-BTBT-10) was used in a device configuration of Al/10-BTBT-10/pentafluorobenzenethiol-treated Au on a glass substrate, which was 4 orders higher than that of the device based on non-liquid crystalline materials of 2,7-dibutyl benzothieno[3,2-b][1]benzothiophene (4-BTBT-4) and BTBT. Similar results were also observed when another liquid crystalline material of ω, ω′-dioctylterthiophene (8-TTP-8) and a non-liquid crystalline material of terthiophene (TTP) were used. These improved rectifications can be ascribed to the self-assembly properties and controllable molecular orientation of liquid crystalline materials, which made uniform perpendicular oriented polycrystalline films favorable for superior charge transport in nano-channels.
Passive scalar evolution in sheared homogeneous magnetohydrodynamic turbulence
Authors: Rezgui Ghassen , Marzougui Hamed , Lili Taieb
Published: September 2017

We investigate the applicability of a second–order model for the passive scalar transport in sheared Magnetohydrodynamics (MHD) turbulent flows in the case of small magnetic Reynolds number. We combine the Widlund et al. [Phys. Fluids 10, 1987 (1998)] model for the MHD damping effect by the Lorentz force and Joule dissipation with the Launder et al. [J. Fluid. Mech. 68, 537 (1975)] model for the pressure–scalar gradient correlations. We compare the results obtained with direct numerical simulation databases and found that the model predictions agree with Kassinos's direct numerical simulation results in the sheared MHD/non–MHD cases. We show that magnetic force has a crucial impact on the passive scalar transport in cases where the time scale of the mean shear is comparable or long compared to the Joule time.
Coupled oscillators driven with difference-frequency parametric position feedback
Authors: Case William B. , Tjossem Paul J. H. , Abrams Katherine G. , St. Germaine-Fuller James F.
Published: September 2017

We examine theoretically and measure experimentally the instability regions for a pair of parametrically driven mechanical oscillators on an air track. We take the position of the second mass, multiply it by cos (ωDt), and apply it to the first mass. We show that this leads to an instability for both normal modes of the coupled oscillator system when ωD is close to the difference of the normal mode frequencies. Such an instability mechanism is of special interest because the input frequency, ωD, can be much lower than the output frequencies of the system. In addition, we consider the case where cos (ωDt) is replaced by a negative constant, which also leads to instability, but at a single frequency. This study of the difference frequency oscillator system was motivated by the QASER system described in Svidzinsky, Yuan and Scully [Phys. Rev. X 3, 041001 (2013)].
Polarization-entangled photons from an InGaAs-based quantum dot emitting in the telecom C-band
Authors: Olbrich Fabian , Höschele Jonatan , Müller Markus , Kettler Jan , Luca Portalupi Simone , Paul Matthias , Jetter Michael , Michler Peter
Published: September 2017

We demonstrate the emission of polarization-entangled photons from a single semiconductor quantum dot in the telecom C-band (1530 nm–1565 nm). To reach this telecommunication window, the well-established material system of InAs quantum dots embedded in InGaAs barriers is utilized with an additional insertion of an InGaAs metamorphic buffer to spectrally shift the system to the desired wavelengths. For the observation of polarization-entangled photon pairs, the biexciton-exciton cascade of a quantum dot displaying an intrinsically low fine-structure splitting is investigated by means of polarization-dependent cross-correlation measurements. A complete set of tomography measurements enables us to reconstruct the two-photon density matrix and therefore to calculate a corresponding fidelity f+ to the maximally entangled Bell state Ψ+ of 0.61 ± 0.07, a concurrence of 0.74 ± 0.11, a tangle of 0.55 ± 0.14, and a negativity of 0.63 ± 0.12, clearly proving the entanglement of the states. Finally, the development of the concurrence is studied in dependency of the post-selected time-gate of the emission events and the progression of the time-delay dependent fidelity to distinct Bell states is displayed.
Direct laser written polymer waveguides with out of plane couplers for optical chips
Authors: Landowski Alexander , Zepp Dominik , Wingerter Sebastian , von Freymann Georg , Widera Artur
Published: September 2017

Optical technologies call for waveguide networks featuring high integration densities, low losses, and simple operation. Here, we present polymer waveguides fabricated from a negative tone photoresist via two-photon-lithography in direct laser writing, and show a detailed parameter study of their performance. Specifically, we produce waveguides featuring bend radii down to 40 μm, insertion losses of the order of 10  dB, and loss coefficients smaller than 0.81 dB mm−1, facilitating high integration densities in writing fields of 300 μm×300 μm. A novel three-dimensional coupler design allows for coupling control as well as direct observation of outputs in a single field of view through a microscope objective. Finally, we present beam-splitting devices to construct larger optical networks, and we show that the waveguide material is compatible with the integration of quantum emitters.
Exploring the statistics of magnetic reconnection X-points in kinetic particle-in-cell turbulence
Authors: Haggerty C. C. , Parashar T. N. , Matthaeus W. H. , Shay M. A. , Yang Y. , Wan M. , Wu P. , Servidio S.
Published: September 2017

Magnetic reconnection is a ubiquitous phenomenon in turbulent plasmas. It is an important part of the turbulent dynamics and heating of space and astrophysical plasmas. We examine the statistics of magnetic reconnection using a quantitative local analysis of the magnetic vector potential, previously used in magnetohydrodynamics simulations, and now employed to fully kinetic particle-in-cell (PIC) simulations. Different ways of reducing the particle noise for analysis purposes, including multiple smoothing techniques, are explored. We find that a Fourier filter applied at the Debye scale is an optimal choice for analyzing PIC data. Finally, we find a broader distribution of normalized reconnection rates compared to the MHD limit with rates as large as 0.5 but with an average of approximately 0.1.
Swimming at small Reynolds number of a planar assembly of spheres in an incompressible viscous fluid with inertia
Authors: Felderhof B. U.
Published: September 2017

Translational and rotational swimming at small Reynolds numbers of a planar assembly of identical spheres immersed in an incompressible viscous fluid is studied on the basis of a set of equations of motion for the individual spheres. The motion of the spheres is caused by actuating forces and forces derived from a direct interaction potential, as well as hydrodynamic forces exerted by the fluid as frictional and added mass hydrodynamic interactions. The translational and rotational swimming velocities of the assembly are deduced from momentum and angular momentum balance equations. The mean power required during a period is calculated from an instantaneous power equation. Expressions are derived for the mean swimming velocities and the mean power, valid to second order in the amplitude of displacements from the relative equilibrium positions. Hence these quantities can be evaluated for prescribed periodic displacements. Explicit calculations are performed for three spheres interacting such that they form an equilateral triangle in the rest frame of the configuration.
Permeability of wormholes created by CO2-acidized water flow through stressed carbonate rocks
Authors: Selvadurai A. P. S. , Couture Cyrille-B. , Rezaei Niya S. M.
Published: September 2017

Sequestration of CO2 relies on the storage capabilities of the deep geologic setting throughout the lifetime of the storage activity. Preferred storage horizons are largely composed of sandstone, which is considered to be chemically inert to the injected CO2. Carbonate rocks and carbonate zones existing as seams or lenses in sandstone formations are, however, prone to chemical alteration during reactive flows of CO2-acidized water that can be created by the mixing of the injected CO2 with either fresh or saline water present in a storage horizon. Reactive flows can erode the fabric of carbonate rocks leading to the creation of high permeability pathways that are referred to as wormholes. The paper first examines the generation of wormholes in cylindrical samples of calcium carbonate-rich Indiana Limestone that are subjected to geostatic stress states representative of deep sequestration sites. The leakage potential of the wormhole is examined by appeal to computational fluid dynamics simulations of Stokes’ flow in wormhole features and an elementary approach involving Stokes’ flow-based hydraulic diameter concept in cylindrical pathways with deviating segments, representing the passages for flow in a wormhole.
Two-dimensional turbulence cross-correlation functions in the edge of NSTX
Authors: Zweben S. J. , Stotler D. P. , Scotti F. , Myra J. R.
Published: September 2017

The 2D radial vs. poloidal cross-correlation functions of edge plasma turbulence were measured near the outer midplane using a gas puff imaging (GPI) diagnostic on NSTX. These correlation functions were evaluated at radii r = 0 cm, ±3 cm, and ±6 cm from the separatrix and poloidal locations p = 0 cm and ±7.5 cm from the GPI poloidal center line for 20 different shots. The ellipticity ε and tilt angle φ of the positive cross-correlation regions and the minimum negative cross-correlation “cmin” and total negative over positive values “neg/pos” were evaluated for each of these cases. The average results over this dataset were ε = 2.2 ± 0.9, φ = 87° ± 34° (i.e., poloidally oriented), cmin = −0.30 ± 0.15, and neg/pos = 0.25 ± 0.24. Thus, there was a significant variation in these correlation results within this database, with dependences on the location within the image, the magnetic geometry, and the plasma parameters. Possible causes for this variation are discussed, including the misalignment of the GPI view with the local B field line, the magnetic shear of field lines at the edge, the poloidal flow shear of the turbulence, blob-hole correlations, and the neutral density 'shadowing' effect in GPI.
Coherent structures in electrokinetic instability with orthogonal conductivity gradient and electric field
Authors: Dubey Kaushlendra , Gupta Amit , Bahga Supreet Singh
Published: September 2017

Electro-osmotic flow in a configuration with a center stream flowing between two parallel sheath streams with mismatched electrical conductivities is known to exhibit an electrokinetic instability (EKI). This flow instability, with orthogonal conductivity gradient and electric field, is characterized by either wavy or pearl-necklace type structures depending upon the relative conductivities of center and sheath streams. In this paper, we propose a physical mechanism underlying such wavy and pearl-necklace type structures of the EKI. In order to verify the proposed mechanism, we perform EKI experiments in a cross-shaped microchannel at varying electric fields and for two flow configurations wherein the center stream has either higher or lower conductivity than the sheath streams. Using dynamic mode decomposition of time-resolved experimental data, we identify the spatio-temporal coherent structures that represent the dynamics of instability. These coherent structures provide a comprehensive validation of the proposed physical mechanism. In addition, experimentally observed coherent structures provide valuable insight into the dynamics and the spatio-temporal scales of the EKI.
Influential factors on thermoacoustic efficiency of multilayered graphene film loudspeakers for optimal design
Authors: Xing Qianhe , Li Shuang , Fan Xueliang , Bian Anhua , Cao Shi-Jie , Li Cheng
Published: September 2017

Graphene thermoacoustic loudspeakers, composed of a graphene film on a substrate, generate sound with heat. Improving thermoacoustic efficiency of graphene speakers is a goal for optimal design. In this work, we first modified the existing TA model with respect to small thermal wavelengths, and then built an acoustic platform for model validation. Additionally, sensitivity analyses for influential factors on thermoacoustic efficiency were performed, including the thickness of multilayered graphene films, the thermal effusivity of substrates, and the characteristics of inserted gases. The higher sensitivity coefficients result in the stronger effects on thermoacoustic efficiency. We find that the thickness (5 nm–15 nm) of graphene films plays a trivial role in efficiency, resulting in the sensitivity coefficient less than 0.02. The substrate thermal effusivity, however, has significant effects on efficiency, with the sensitivity coefficient around 1.7. Moreover, substrates with a lower thermal effusivity show better acoustic performances. For influences of ambient gases, the sensitivity coefficients of density ρg, thermal conductivity κg, and specific heat cp,g are 2.7, 0.98, and 0.8, respectively. Furthermore, large magnitudes of both ρg and κg lead to a higher efficiency and the sound pressure level generated by graphene films is approximately proportional to the inverse of cp,g. These findings can refer to the optimal design for graphene thermoacoustic speakers.
Anti-inflammatory effect of Euphorbia supina extract in dextran sulfate sodium-induced colitis mice
Authors: Cha Ji-Yun , Jeon Yong-Deok , Xin Mingjie , Kim Do-Kuk , Lee Hoon-Yeon , Kim Bo-Ram , Hwang Sung-Woo , Kim Dae-Ki , Jin Jong-Sik , Lee Young-Mi
Published: September 2017

The aim of this study is to examine the anti-inflammatory effect of Euphorbia supina (ES) ethanol extract in dextran sulfate sodium (DSS)-induced experimental colitis model. ES was per orally administered at different doses of 4 or 20 mg/kg body weight with 5% DSS in drinking water for 7 days. Twenty mg/kg of ES administration regulated body weight decrease, recovered colon length shortening, and increased disease activity index score and myeloperoxidase level in DSS-induced colitis. Histological features showed that 20 mg/kg of ES administration suppressed edema, mucosal damage, and the loss of crypts induced by DSS. Furthermore, ES suppressed the expressions of COX-2, iNOS, NF-kB, IkBα, pIkBα in colon tissue. These findings demonstrated a possible effect of amelioration of ulcerative colitis and could be clinically applied.
Video HIT in adults with cochlear implants
Authors: Balzanelli Cristiano , Zorzi Silvia , Nassif Nader M. , Sorrentino Tommaso , Redaelli de Zinis Luca O.
Published: September 2017

Objective:

To evaluate the high-frequency function of bilateral lateral, posterior and anterior semicircular canals by video head impulse testing (vHIT) in adult patients with profound sensorineural hearing loss subjected to cochlear implant.

Methods:

A group of 19 adult bearers of monolateral cochlear implants for more than one year was assessed by vHIT on both sides with CI-ON modality and CI-OFF modality. The average of the VOR gains in each of the six semicircular canals was assessed. The Mann–Whitney U-test was used to compare VOR of implanted and non-implanted side semicircular canals (independent samples) and the Wilcoxon test was used to compare VOR with CI-ON modality and CI-OFF modality (related samples).

Results:

From a clinical point of view, no vestibular symptoms were observed although the median of VOR gain to vHIT was lower than normal values in most cases. Comparing the VOR in semicircular canals in the implanted side with that in the non-implanted side and each canal in the OFF modality compared to the ON modality, we observed no significant difference in VOR gain values, except in the lateral semicircular canal of the opposite side, in which the median of VOR gain was 0.80 (0.68–0.95) in OFF modality and 0.84 in ON modality (0.76–1.06) (p = .04).

Conclusion:

Even though cochlear implant has no negative impact on clinical vestibular function VOR gain in vHIT recordings is frequently reduced.
DiversePathsJ: diverse shortest paths for bioimage analysis
Authors: Uhlmann Virginie , Haubold Carsten , Hamprecht Fred A , Unser Michael
Published: September 2017

Motivation

We introduce a formulation for the general task of finding diverse shortest paths between two end-points. Our approach is not linked to a specific biological problem and can be applied to a large variety of images thanks to its generic implementation as a user-friendly ImageJ/Fiji plugin. It relies on the introduction of additional layers in a Viterbi path graph, which requires slight modifications to the standard Viterbi algorithm rules. This layered graph construction allows for the specification of various constraints imposing diversity between solutions.

Results

The software allows obtaining a collection of diverse shortest paths under some user-defined constraints through a convenient and user-friendly interface. It can be used alone or be integrated into larger image analysis pipelines.

Availability and implementation

http://bigwww.epfl.ch/algorithms/diversepathsj

Supplementary information

Supplementary data are available at Bioinformatics online.
Using principal component analysis to improve earthquake magnitude prediction in Japan
Authors: Asencio-Cortés G , Martínez-Álvarez F , Morales-Esteban A , Reyes J , Troncoso A
Published: September 2017

Increasing attention has been paid to the prediction of earthquakes with data mining techniques during the last decade. Several works have already proposed the use of certain features serving as inputs for supervised classifiers. However, they have been successfully used without any further transformation so far. In this work, the use of principal component analysis (PCA) to reduce data dimensionality and generate new datasets is proposed. In particular, this step is inserted in a successfully already used methodology to predict earthquakes. Tokyo, one of the cities mostly threatened by large earthquakes occurrence in Japan, is studied. Several well-known classifiers combined with PCA have been used. Noticeable improvement in the results is reported.
Human Energetic Anatomy
Authors: Yang Jingduan , Monti Daniel A.
Published: September 2017

This chapter teaches another essential foundation of acupuncture and Chinese medicine, the theory of Jing Luo, the invisible energy channels known as meridians through which Qi circulates. This chapter presents this complex human energy network as an energetic anatomy that include 12 principal channels (Zheng Jing), 8 extra channels (Qi Jing Ba Mai), 12 associated channels (Jing Bie), 12 peripheral channels (Jin Jing), 12 skin areas (Pi Bou), and 15 connecting channels (Luo Mai). The classification, distribution, and function of each is discussed in detail. There is no modern medicine equivalent to these concepts except for the energetic manifestations of mental and physical function that are well observed and described by clinicians and medical textbooks. Structural parallels to the energetic networks in modern medicine are circulatory systems like the nervous, cardiovascular, and lymphatic systems.
Evaluation of Human Energy
Authors: Yang Jingduan , Monti Daniel A.
Published: September 2017

This chapter describes in detail how the human energetic status is evaluated through inquiry, observation, and palpation, including unique techniques such as tongue and pulse diagnosis. Diagnostic algorithms evaluating imbalances of the human energy system help readers to apply these techniques and utilize all the theories discussed in the previous chapters to effectively formulate a diagnosis, which is the key to successful treatment. The chapter also discusses how the energetic evaluation should and can be an integral part of a medical diagnosis. It also discusses other unique observations for supporting diagnosis, such as body type, posture and movement, the smell of body fluid, and manifestations of the human spirit.
Acupuncture Points of Six Principal Yin Channels
Authors: Yang Jingduan , Monti Daniel A.
Published: September 2017

This chapter describes in detail the location, energetic function, and special features of each point in six principal Yin Channels: Heart, Lungs, Pericardium, Liver, Spleen, and Kidney. It emphasizes that the unique features of each point come from their association with specific organs and five elements, in addition to its connection with other energy channels. The clinical indications for mental and physical dysfunctions due to channel blockages and organ energetic imbalance are only examples of the clinical use of these points. The reader should be able to expand his or her usage based on the features and functions of these points.
Acupuncture Points on the Eight Extra Channels
Authors: Yang Jingduan , Monti Daniel A.
Published: September 2017

This chapter describes in detail the location, energetic functions, and special features of each point in the eight extra channels (known as Qi Jing Ba Mai): Du, Ren, Chong, Dai, Yin Wei, Yang Wei, Yin Qiao, and Yang Qiao. It emphasizes that the unique features of each point come from their associations with specific organs and their connections with other energy channels. The clinical indications for mental and physical dysfunctions due to channel blockages and organic energetic imbalance are only some examples of the clinical use of these points. After reading this chapter, the practitioner should be able to expand his or her usage based on the features and functions of these points.
Acupuncture Therapy
Authors: Yang Jingduan , Monti Daniel A.
Published: September 2017

This chapter describes the final steps for a successful clinical intervention using acupuncture. They include the creation of a healing environment, discussion of the benefits and expectations of treatment outcome, patient commitment, obtaining informed consent from patients, preparations and precautions to avoid the side effects of acupuncture, proper positioning of the patient to maximize the effects of acupuncture treatment, a description of the types and selection of acupuncture needles, and mastering needle insertion techniques to enhance, reduce, or modulate energies. It also discusses the length of each acupuncture session and the frequency and course of acupuncture treatment. It emphasizes the importance for an acupuncture physician of remaining energetically positive, balanced, and focused when administering acupuncture therapy.
Presenting Medical Statistics from Proposal to Publication
Authors: Peacock Janet L. , Kerry Sally M. , Balise Raymond R.
Published: September 2017

Presenting Medical Statistics from Proposal to Publication (second edition) aims to show readers how to conduct a wide range of statistical analyses from sample size calculations through to multifactorial regressions that are needed in the research process. The second edition of ‘Presenting’ has been revised and updated and now includes Stata, SAS, SPSS, and R. The book shows how to interpret each computer output and illustrates how to present the results and accompanying text in a format suitable for a peer-reviewed journal article or research report. All analyses are illustrated using real data and all programming code, outputs, and datasets used in the book are available on a website for readers to freely download and use. ‘Presenting’ includes practical information and helpful tips for software, all statistical methods used, and the research process. It is written by three experienced biostatisticians, Janet Peacock, Sally Kerry, and Ray Balise from the UK and the USA, and is born out of their extensive experience conducting collaborative medical research, teaching medical students, physicians, and other health professionals, and providing researchers with advice.
Major trauma
Authors: Banerjee Ashis , Oliver Clara
Published: September 2017

Trauma management is a major presentation in the Royal College of Emergency Medicine (RCEM) curriculum for both adults and children due its associated morbidity and mortality. Trauma management can appear in any aspect of the Fellowship of the Royal College of Emergency Medicine (FRCEM) examination, including the short-answer question (SAQ) paper. This chapter focuses on adult trauma, in accordance with the advanced trauma life support (ATLS) guidelines. It provides information on the different aspects of trauma including that of the chest/abdomen/pelvis, in keeping with ATLS and national guidelines. In addition, this chapter highlights the criteria for imaging and management, which may appear in the SAQ paper. It also has a detailed section on head and spinal injury and is linked to current NICE guidance. Paediatric trauma is not covered in this chapter, however, as it is reviewed in Chapter 19.
Surgery
Authors: Banerjee Ashis , Oliver Clara
Published: September 2017

Surgery is a large topic to cover and can include numerous presenting complaints. This chapter focuses on key aspects of surgical pathology, including the acute abdomen and differentiating the cause of abdominal pain for which there is a large differential. This chapter provides insight into the key aspects from history and examination to enable candidates to differentiate the cause of a patient presenting with abdominal pain, and thus answer an exam question. In addition, this chapter also covers vascular pathology such as dissection and ischaemic limbs, as well as common urological problems such as haematuria and renal colic, which may all commonly appear in the short-answer question (SAQ) paper.
Neurological emergencies
Authors: Banerjee Ashis , Oliver Clara
Published: September 2017

A number of neurological conditions can present to the emergency department in a variety of presentations. This chapter summarizes the common neurological problems that may be examined in the Intermediate FRCEM short-answer question (SAQ) paper. This chapter includes the pathophysiology and management of an unconscious patient which may commonly appear in the SAQ paper. In addition, it also includes sections of epilepsy, headaches and strokes, and their subclassification and diagnosis. Many individuals find the differentiation of the cause of motor weakness complicated. This chapter summarizes the different causes of motor weakness, in terms of upper and lower motor neurones lesions and the clinical features associated to aid diagnosis. There is also a section on spinal cord pathology and hydrocephalus knowledge of which is essential for the SAQ paper.
Formative case law and litigation
Authors: Jones Mohamedu F.
Published: September 2017

The presence of comprehensive correctional mental health treatment programs and services in any given jail or prison is often due to successful class action litigation. This chapter reviews the legal and constitutional background for correctional mental health care in the United States and addresses many of the critical ways these courts impact policy and care delivery on a daily basis. Several court decisions have shaped modern correctional mental health care delivery. Officials are obligated under the Eighth Amendment to provide convicted prisoners with adequate medical care, which extends to mental health treatment. Pre-trial detainees also have a right to adequate physical and mental health care under the Due Process Clause of the Fourteenth Amendment of the Constitution). Since the Supreme Court proclaimed that inmates have a constitutional right to adequate health care, much has been written about the controlling decisions, their implications and applications by courts, and their implementation in correctional systems. There are, however, discrete issues related to mental health care in corrections that patients and providers in prisons and jails contend with daily that may not yet be resolved as matters of constitutional law. Case law and litigation are driving innovation in standards of care and enhancing the quality of correctional mental health. These reforms are gaining acceptance as preferred and expected standards of correctional mental health care in jails and prisons, and may reflect the present day ‘evolving standard of decency,’ becoming touchstones of constitutionally adequate care across systems.
Community re-entry preparation/coordination
Authors: Dlugacz Henry A.
Published: September 2017

The transition from short-term incarceration in jail or longer-term prison sentences back to the community presents substantial challenges for those with mental illness. Approximately 97 percent of all inmates return to the community. This simple reality makes it in society’s enlightened self-interest to be concerned with the readiness of these former inmates to live a productive life. The criminal justice and correctional treatment systems affect an inmate’s behavior and opportunities upon release. Successful reentry planning considers multiple interrelated issues (entitlements, housing, treatment needs, and so forth) when building an individualized plan to address them. It begins at admission (or even sentencing) and continues after release. Rather than considering incarceration to be an isolated event, reentry planning views incarceration as part of a cycle to be disrupted through targeted intervention. Correctional mental health treatment is seen as part of a continuum of care extending to the community. Reentry planning for people with serious mental illness should be a primary focus of correctional mental health care integrated into the treatment function, not an afterthought to be considered only as release is imminent. While acceptance of personal responsibility is a critical antecedent to leading a lawful life, and self-determination a fundamental principle of recovery, it is unrealistic for service providers to rely on the individual to coordinate fragmented public systems. This is the job of those funded to provide services. This chapter presents the current understanding of transition support needs and practices to optimize successful community reentry.
Responding to prisoner sexual assaults
Authors: Dumond Robert W. , Dumond Doris A.
Published: September 2017

Sexual abuse in detention has been called ‘the most serious and devastating of non-lethal offenses which occur in corrections,’ because its impact upon survivors of such abuse, and ultimately society, is so profound. Given the proper tools, training, and resources, corrections can and will eliminate prisoner sexual violence. However, we must realize that corrections is a subset of the body politic itself. It is subject to budget shortfalls, political pressure, and the broader attitudes of the public. Adequate financial and programmatic resources must be mobilized to ensure appropriate staff skill levels to keep jails and prisons safe. Safe, well-run jails and prisons can, if properly used, help keep communities safe. The general public will have to be convinced to join this dialogue if we are ever to have safe, constitutionally adequate correctional settings. Corrections can, and must, together with its community partners, respond with vision and leadership to make corrections facilities safe places where human rights and dignity are protected, and the most vulnerable among us can emerge stronger and healthier than they went in. This chapter will explore the status of sexual violence in United States correctional settings in the 21st Century; examine what is currently known about sexual victimization in America’s jails, prisons, and juvenile facilities; discuss the successes and promising practices facilitated by the Prison Rape Elimination Act (PREA) of 2003; consider the challenges that continue to exist; and make recommendations for addressing the issues.
Choroid plexus tumours
Authors: Santos Maria , Bouffet Eric , Freeman Carolyn , Souweidane Mark M.
Published: September 2017

Choroid plexus tumours are rare, intraventricular, primary central nervous system tumours derived from the choroid plexus epithelium. They occur predominantly in children and are classified based on histological criteria as choroid plexus papilloma, atypical choroid plexus papilloma, and choroid plexus carcinoma. Choroid plexus carcinomas can occur in the context of Li–Fraumeni syndrome, where the TP53 germline mutation predisposes patients to a wide range of neoplasms. Treatment of these tumours is challenging, due to their high vascularity and the young age of the patients. While surgery is the mainstay of treatment of all choroid plexus tumours, the exact role of adjuvant therapy, particularly in choroid plexus carcinoma, is still unclear. For incompletely resected tumours, there is evidence that neoadjuvant chemotherapy can facilitate second-look surgery and reduce the risk of intraoperative bleeding. However, the role of adjuvant radiation after complete resection remains unclear.
Germ cell tumours
Authors: Alapetite Claire , Yanagisawa Takaaki , Nishikawa Ryo
Published: September 2017

Central nervous system germ cell tumours are mysterious tumours, which are common in young male adults in eastern Asia, and include germinoma, mature and immature teratoma, teratoma with malignant transformation, yolk sac tumour, embryonal carcinoma, choriocarcinoma, and mixed tumours of these components. The aetiological mechanism why they mostly develop in the pineal and neurohypophyseal region is still unknown. Their treatment is also a challenge; surgery is demanding, and sometimes biopsy would be preferred. Radiotherapy is effective, but its dose and field would be better reduced for young adults and children. Chemotherapy is effective but not enough for especially non-germinomatous tumours. This chapter presents a comprehensive discussion about those challenging diseases.
Familial tumour syndromes: neurofibromatosis, schwannomatosis, rhabdoid tumour predisposition, Li–Fraumeni syndrome, Turcot syndrome, Gorlin syndrome, and Cowden syndrome
Authors: Plotkin Scott R. , Biegel Jaclyn A. , Malkin David , Martuza Robert , Evans D. Gareth
Published: September 2017

‘Familial tumour syndromes’ reviews some of the genetic syndromes associated with an increased incidence of nervous system tumours, including neurofibromatosis 1, neurofibromatosis 2, schwannomatosis, rhabdoid tumour predisposition, Li–Fraumeni syndrome, Turcot syndrome, Gorlin syndrome, and Cowden syndrome. The chapter reviews the epidemiology of these rare conditions with discussion of current diagnostic criteria. It reviews the genetic basis and pathogenesis of the conditions as well as the availability of genetic testing. It covers the clinical aspects of these conditions, including clinical presentation, associated nervous system tumours, and recommended management of these syndromes with a discussion of the role of imaging. The review is written for the practising neuro-oncologist and other specialists who care for patients with genetic syndromes affecting the nervous system.
Metastatic brain tumours
Authors: Preusser Matthias , Schackert Gabriele , Baumert Brigitta G.
Published: September 2017

Brain metastasis is a common clinical challenge in cancer patients, particularly those with lung cancer, breast cancer, and melanoma. The prognosis is poor, with median overall survival times measured in months for most patient populations. Established treatments include neurosurgical resection, radiotherapy (including stereotactic radiosurgery and stereotactic radiotherapy, whole-brain radiotherapy, and new radiation techniques), and supportive care measures. Recently, more and more targeted therapies such as EGFR inhibitors, HER2 antagonists, BRAF inhibitors, ALK inhibitors, and immune checkpoint inhibitors are demonstrating some efficacy in brain metastasis patients and should be considered in the clinical setting.
Treatment of Cognitive Impairment
Authors: Rosenberg Paul B.
Published: September 2017

There are lifestyle strategies that may help preserve cognition in old age and in MCI. While the evidence is still suggestive rather than definitive it is strong enough to make suggestions to patients and families. Cognitive interventions such as computer-based cognitive stimulation and brain fitness programs may be helpful, although more generalized cognitive activities such as taking a college course or learning a new skill may be equally helpful. Aerobic exercise has the best track record to date among lifestyle interventions. Having a variety of leisure activities that combine psychological, physical, and social activities is advised. As far as well can tell, diets that are helpful for preventing heart disease such as the Mediterranean diet also may be good for cognition. The mechanisms for many of these strategies likely involve 1) the brain compensating for circuit loss by engaging new circuits to solve problems and 2) improvements in vascular health.
The 26.3-h orbit and multiwavelength properties of the ‘redback’ millisecond pulsar PSR J1306–40
Authors: Linares Manuel
Published: September 2017

We present the discovery of the variable optical and X-ray counterparts to the radio millisecond pulsar (MSP) PSR J1306–40, recently discovered by Keane et al. We find that both the optical and X-ray fluxes are modulated with the same period, which allows us to measure for the first time the orbital period Porb = 1.097 16[6] d. The optical properties are consistent with a main-sequence companion with spectral type G to mid K and, together with the X-ray luminosity (8.8 × 1031 erg s−1 in the 0.5–10 keV band, for a distance of 1.2 kpc), confirm the redback classification of this pulsar. Our results establish the binary nature of PSR J1306–40, which has the longest Porb among all known compact binary MSPs in the Galactic disc. We briefly discuss these findings in the context of irradiation and intrabinary shock emission in compact binary MSPs.
A Mycoses Study Group International Prospective Study of Phaeohyphomycosis: An Analysis of 99 Proven/Probable Cases
Authors: Revankar Sanjay G , Baddley John W , Chen Sharon C -A , Kauffman Carol A , Slavin Monica , Vazquez Jose A , Seas Carlos , Morris Michele I , Nguyen M Hong , Shoham Shmuel , Thompson George R , Alexander Barbara D , Simkins Jacques , Ostrosky-Zeichner Luis , Mullane Kathleen , Alangaden George , Andes David R , Cornely Oliver A , Wahlers Kerstin , Lockhart Shawn R , Pappas Peter G
Published: September 2017

Background

Phaeohyphomycosis is infection caused by dematiaceous, or darkly pigmented, fungi. The spectrum of disease is broad, and optimal therapy remains poorly defined. The Mycoses Study Group established an international case registry of patients with proven/probable phaeohyphomycosis with the goal of improving the recognition and management of these infections.

Methods

Patients from 18 sites in 3 countries were enrolled from 2009–2015. Cases were categorized as local superficial, local deep (pulmonary, sinus, osteoarticular infections), and disseminated infections. End points were clinical response (partial and complete) and all-cause mortality at 30 days and end of follow-up.

Results

Of 99 patients, 32 had local superficial infection, 41 had local deep infection, and 26 had disseminated infection. The most common risk factors were corticosteroids, solid organ transplantation, malignancy, and diabetes. Cultures were positive in 98% of cases. All-cause mortality was 16% at 30 days and 33% at end of follow-up, and 18 of 26 (69%) with dissemination died. Itraconazole was most commonly used for local infections, and voriconazole was used for more severe infections, often in combination with terbinafine or amphotericin B.

Conclusions

Phaeohyphomycosis is an increasingly recognized infection. Culture remains the most frequently used diagnostic method. Triazoles are currently the drugs of choice, often combined with other agents. Further studies are needed to develop optimal therapies for disseminated infections.
Critical appraisal of the unmet needs in the treatment of chronic spontaneous urticaria with omalizumab: an Italian perspective
Authors: Asero Riccardo , Canonica Giorgio W. , Cristaudo Antonio , Fierro Maria T. , Girolomoni Giampiero , Marzano Angelo V. , Nettis Eustachio , Pepe Patrizia , Pigatto Paolo , Rossi Oliviero
Published: September 2017

Purpose of review

The humanized anti-IgE antibody omalizumab has been available for patients with chronic spontaneous urticaria (CSU) in Italy since 2015. This review summarizes the unresolved issues and unmet therapeutic needs associated with omalizumab and discusses practical recommendations for its use in the management of CSU.

Recent findings

Although modern second-generation H1-antihistamines are the standard of care for patients with CSU, adjunctive treatments (including omalizumab) may be required for effective control of symptoms in many patients. Evidence from clinical trials and experience from daily clinical practice suggest that the use of omalizumab in patients with CSU who have inadequate response to H1-antihistamines remains challenging.

Based on current international guidelines, omalizumab labelling information and our experience in clinical practice, we provide treatment recommendations regarding the use of omalizumab in patients with CSU. These include: optimal treatment duration, the use of concomitant antihistamine therapy, the definition and management of disease relapse after treatment, and the management of patients with late or no response to treatment.