bluuebunny/crossref_metadata_2025 huggingface dataset:
Song hybridization events during revolutionary song change provide insights into cultural transmission in humpback whales
Authors: Garland Ellen C. , Rendell Luke , Lamoni Luca , Poole M. Michael , Noad Michael J.
Published: July 2017

Cultural processes occur in a wide variety of animal taxa, from insects to cetaceans. The songs of humpback whales are one of the most striking examples of the transmission of a cultural trait and social learning in any nonhuman animal. To understand how songs are learned, we investigate rare cases of song hybridization, where parts of an existing song are spliced with a new one, likely before an individual totally adopts the new song. Song unit sequences were extracted from over 9,300 phrases recorded during two song revolutions across the South Pacific Ocean, allowing fine-scale analysis of composition and sequencing. In hybrid songs the current and new songs were spliced together in two specific ways: (i) singers placed a single hybrid phrase, in which content from both songs were combined, between the two song types when transitioning from one to the other, and/or (ii) singers spliced complete themes from the revolutionary song into the current song. Sequence analysis indicated that both processes were governed by structural similarity rules. Hybrid phrases or theme substitutions occurred at points in the songs where both songs contained “similar sounds arranged in a similar pattern.” Songs appear to be learned as segments (themes/phrase types), akin to birdsong and human language acquisition, and these can be combined in predictable ways if the underlying structural pattern is similar. These snapshots of song change provide insights into the mechanisms underlying song learning in humpback whales, and comparative perspectives on the evolution of human language and culture.
Language socialization and making sense of place
Authors: Schieffelin Bambi B.
Published: July 2017

From the time we are small, senses of place organize and give meaning to our everyday activities. Little is known, however, about the role language plays in how people come to inhabit or lose a sense of place. Using the theoretical paradigm of language socialization to examine these processes (inclusion and emplacement, and exclusion and displacement), this chapter uses ethnographic and linguistic data from Bosavi (Papua New Guinea) to demonstrate how young children’s everyday verbal activities include place-naming, identification, and representation to index on-going activities and relationships, establishing strong affective connections to place. In contrast, Christian missionization, with its sense of space, changed local meanings of place, and the ways in which Bosavi speakers talked about it and each other.
The politics of place-making and belonging through language choice within center-periphery dynamics in Limburg, The Netherlands
Authors: Thissen Lotte
Published: July 2017

This contribution analyses a case of carnival celebration in Maasniel, Limburg, the Netherlands, a village that was annexed as a neighborhood of the larger city of Roermond in 1959. During the event, the Dutch ritual of Sinterklaas was combined with the carnival celebration, resulting in a staged language conflict between Dutch and dialect. I argue that this language conflict was used by the actors on stage to engage in the politics of place-making and belonging. These politics express who and what practices are perceived as in and out of place during this particular carnival event. I show that the actors of the event, through Bakhtinian carnivalesque manners, centralize the carnival celebration, dialect use, and Maasniel while peripheralizing Sinterklaas celebration practices, the use of Dutch, and the city of Roermond. I argue that the eventual switch from Dutch to dialect may be considered as a way to resist and subvert dominant center-periphery ideas.
Analysis of properties for in situ Al2O3p/A356 composites synthesised from the Al-SiO2 system
Authors: Meng Mingai , Chen Gang , Zhang Zhenya , Zhao Yutao
Published: July 2017

In situ Al2O3p/A356 composites with different particle volume fractions were successfully synthesised from the Al-SiO2 system by a direct-melt reaction. γ-Al2O3 was first produced during the reaction between Al and SiO2, and the phase transformation from γ-Al2O3 to α-Al2O3 then occurred at higher temperatures (1050°C), resulting in a volume contraction. The α-Al2O3p/A356 composite exhibited a reduction in dendrite cell size that was 1.5–2 greater than for the matrix alloy cast using the same conditions. A 10% particle volume fraction yielded optimum mechanical properties, with values for the yield stress, tensile strength, elongation and microhardness of 132 MPa, 268 MPa, 5.1% and 107.2 HV, respectively. These corresponded to increases 50, 31, 19 and 47%, respectively, when compared to the matrix.

This paper is part of a thematic issue on Light Alloys.
Cloud-based interactive analytics for terabytes of genomic variants data
Authors: Pan Cuiping , McInnes Gregory , Deflaux Nicole , Snyder Michael , Bingham Jonathan , Datta Somalee , Tsao Philip S
Published: July 2017

Motivation

Large scale genomic sequencing is now widely used to decipher questions in diverse realms such as biological function, human diseases, evolution, ecosystems, and agriculture. With the quantity and diversity these data harbor, a robust and scalable data handling and analysis solution is desired.

Results

We present interactive analytics using a cloud-based columnar database built on Dremel to perform information compression, comprehensive quality controls, and biological information retrieval in large volumes of genomic data. We demonstrate such Big Data computing paradigms can provide orders of magnitude faster turnaround for common genomic analyses, transforming long-running batch jobs submitted via a Linux shell into questions that can be asked from a web browser in seconds. Using this method, we assessed a study population of 475 deeply sequenced human genomes for genomic call rate, genotype and allele frequency distribution, variant density across the genome, and pharmacogenomic information.

Availability and implementation

Our analysis framework is implemented in Google Cloud Platform and BigQuery. Codes are available at https://github.com/StanfordBioinformatics/mvp_aaa_codelabs.

Supplementary information

Supplementary data are available at Bioinformatics online.
iDNA4mC: identifying DNA N4-methylcytosine sites based on nucleotide chemical properties
Authors: Chen Wei , Yang Hui , Feng Pengmian , Ding Hui , Lin Hao
Published: July 2017

Motivation

DNA N4-methylcytosine (4mC) is an epigenetic modification. The knowledge about the distribution of 4mC is helpful for understanding its biological functions. Although experimental methods have been proposed to detect 4mC sites, they are expensive for performing genome-wide detections. Thus, it is necessary to develop computational methods for predicting 4mC sites.

Results

In this work, we developed iDNA4mC, the first webserver to identify 4mC sites, in which DNA sequences are encoded with both nucleotide chemical properties and nucleotide frequency. The predictive results of the rigorous jackknife test and cross species test demonstrated that the performance of iDNA4mC is quite promising and holds high potential to become a useful tool for identifying 4mC sites.

Availability and implementation

The user-friendly web-server, iDNA4mC, is freely accessible at http://lin.uestc.edu.cn/server/iDNA4mC.
Nutritional Supplementation With Physical Activity Improves Muscle Composition in Mobility-Limited Older Adults, The VIVE2 Study: A Randomized, Double-Blind, Placebo-Controlled Trial
Authors: Englund Davis A , Kirn Dylan R , Koochek Afsaneh , Zhu Hao , Travison Thomas G , Reid Kieran F , von Berens Åsa , Melin Michael , Cederholm Tommy , Gustafsson Thomas , Fielding Roger A
Published: July 2017

Background

Nutritional supplementation and physical activity have been shown to positively influence muscle mass and strength in older adults. The efficacy of long-term nutritional supplementation in combination with physical activity in older adults remains unclear.

Methods

Mobility-limited (short physical performance battery [SPPB] ≤9) and vitamin D insufficient (serum 25(OH) D 9–24 ng/mL) older adults were recruited for this study. All subjects participated in a physical activity program. Subjects were randomized to consume a daily nutritional supplement (150 kcal, 20 g whey protein, 800 IU vitamin D, 119 mL beverage) or placebo (30 kcal, nonnutritive, 119 mL). In a prespecified secondary analysis, we examined total-body composition (dual energy X-ray absorptiometry), thigh composition (computed tomography), and muscle strength, power, and quality before and after the 6-month intervention.

Results

One hundred and forty-nine subjects were randomized into the study [mean (standard deviation, SD) age 78.5 (5.4) years; 46.3% female; mean (SD) short physical performance battery 7.9 (1.2); mean (SD) vitamin D 18.7 (6.4) ng/mL]. After the intervention period both groups demonstrated improvements in muscle strength, body composition, and thigh composition. Nutritional supplementation lead to further losses of intermuscular fat (p = .049) and increased normal muscle density (p = .018).

Conclusions

Six months of physical activity resulted in improvements in body composition, subcutaneous fat, intermuscular fat, and strength measures. The addition of nutritional supplementation resulted in further declines in intermuscular fat and improved muscle density compared to placebo. These results suggest nutritional supplementation provides additional benefits to mobility-limited older adults undergoing exercise training.

ClinicalTrials.gov Identifier: NCT01542892
Dural Closure in Confined Spaces of the Skull Base with Nonpenetrating Titanium Clips
Authors: Glenn Chad A , Baker Cordell M , Burks Joshua D , Conner Andrew K , Smitherman Adam D , Sughrue Michael E
Published: July 2017

BACKGROUND

Dural repair in areas with limited operative maneuverability has long been a challenge in skull base surgery. Without adequate dural closure, postoperative complications, including cerebrospinal fluid (CSF) leak and infection, can occur.

OBJECTIVE

To show a novel method by which nonpenetrating, nonmagnetic titanium microclips can be used to repair dural defects in areas with limited operative access along the skull base.

METHODS

We reviewed 53 consecutive surgical patients in whom a dural repair technique utilizing titanium microclips was performed from 2013 to 2016 at our institution. The repairs primarily involved difficult-to-reach dural defects in which primary suturing was difficult or impractical. A detailed surgical technique is described in 3 selected cases involving the anterior, middle, and posterior fossae, respectively. An additional 5 cases are provided in more limited detail to demonstrate clip artifact on postoperative imaging. Rates of postoperative CSF leak and other complications are reported.

RESULTS

The microclip technique was performed successfully in 53 patients. The most common pathology in this cohort was skull base meningioma (32/53). Additional surgical indications included traumatic dural lacerations (9/53), nonmeningioma tumors (8/53), and other pathologies (4/53). The clip artifact present on postoperative imaging was minor and did not interfere with imaging interpretation. CSF leak occurred postoperatively in 3 (6%) patients. No obvious complications attributable to microclip usage were encountered.

CONCLUSION

In our experience, intracranial dural closure with nonpenetrating, nonmagnetic titanium microclips is a feasible adjunct to traditional methods of dural repair.
Middle Meningeal Artery Embolization as Treatment for Chronic Subdural Hematoma: A Case Series
Authors: Link Thomas W , Boddu Srikanth , Marcus Joshua , Rapoport Benjamin I , Lavi Ehud , Knopman Jared
Published: July 2017

BACKGROUND

Traditional treatment for symptomatic subdural hematoma (SDH) has been surgical evacuation, but recurrence rates are high and patients often harbor complex medical comorbidities. Growth and recurrence is thought to be due to the highly friable nature of the vascularized membrane that forms after initial injury. There have been reported cases of middle meningeal artery (MMA) embolization for treatment of recurrent SDH after surgical evacuation with the goal of eliminating the arterial supply to this vascularized membrane.

OBJECTIVE

To present the first known case series of MMA embolization as upfront treatment for symptomatic chronic SDHs that have failed conservative management in lieu of surgical evacuation.

METHODS

Five patients with symptomatic chronic SDHs underwent MMA embolization using PVA microparticles at our institution. Size of SDH was recorded in maximum diameter and total volume.

RESULTS

Four patients underwent unilateral and 1 underwent bilateral MMA embolization successfully. All cases had significant reduction in total volume of SDH at longest follow-up scan: 81.4 to 13.8 cc (7 wk), 48.5 to 8.7 cc (3 wk), 31.7 and 88 to 0 and 17 cc (14 wk, bilateral), 79.3 to 24.2 cc (8 wk), and 53.5 to 0 cc (6 wk). All patients had symptomatic relief with no complications. Histologic analysis of the chronic SDH membrane in a separate patient that required surgery revealed rich neovascularization with many capillaries and few small arterioles.

CONCLUSION

MMA embolization could present a minimally invasive and low-risk initial treatment alternative to surgery for symptomatic chronic SDH when clinically appropriate.
What the “Nonteaching” Service Can Teach Us
Authors: Repp Allen B. , Bartsch Jason C. , Pasanen Mark E.
Published: July 2017

“Teaching” services usually incorporate a cadre of learners such as resident physicians and medical students as part of the care team, led by a faculty physician. “Nonteaching” services, in contrast, are usually defined by the absence of resident physicians on the care team. The care for patients on a nonteaching service is frequently managed directly by a faculty or nonfaculty physician. Nonteaching services have grown in number and size at academic medical centers (AMCs) in response to regulatory requirements, operational demands, and efforts to improve clinical education. The allocation of patients to teaching and nonteaching services is frequently based on perceived teaching value of hospitalized patients, which can potentially lead to a number of unintended consequences for medical education, professional satisfaction, and patient care. Through a series of four lessons, the authors describe how the structure of nonteaching services can result in curricular gaps, devalue attending physicians, and undermine the educational and clinical missions of AMCs. Anticipating the continued expansion and evolution of nonteaching services, the authors propose seven design principles for nonteaching services to ensure robust education for students and resident physicians, advance quality of care, and enhance attending physician and patient experience.
Modified femorotibial turn-up plasty using an intercalary fibular autograft strut, femoral potting, and plate fixation
Authors: Sojka John H. , Everhart Joshua S. , Skoracki Roman J. , Mayerson Joel L.
Published: July 2017

Tibial turn-up plasty is a reconstructive procedure used to increase above-knee amputation (AKA) residual limb length in limb salvage cases with viable distal tissues. We report using a novel variation of the turn-up plasty procedure in a patient with a previously irradiated femur and chronic treatment-resistant distal femoral osteomyelitis. For patients who may be considering an AKA and have healthy tissue distally, femorotibial turn-up plasty with intercalary fibular autograft can provide increased stump length for improved mechanical advantage. Even in a previously irradiated femur, a very competent and stable femorotibial construct can be formed through the combination of intercalary fibular autograft strut, femoral potting, and locking compression plate with quadcortical screw fixation that spans the length of the fibular strut.
Preparation and Assessment of an Individualized Navigation Template for Lower Cervical Anterior Transpedicular Screw Insertion Using a Three-Dimensional Printing Technique
Authors: Li FengNing , Huang Xuan , Wang Kun , Luo BeiEr , Zhang Fan , Chen Zhi , Li Quan , Zhang YongJin , Qi Ke , Jin ChengChun , Chen WangShenJie , Hou CangLong , Shen HongXing
Published: July 2017

Study Design.

Prospective trial.

Objective.

To establish an individualized navigation template for safe and accurate insertion of lower cervical anterior transpedicular screw (ATPS) based on a three-dimensional (3D) printing technique.

Summary of Background Data.

Conventional screw insertion manually under fluoroscopy easily leading to deviation of ATPS screw channel, cervical instrumentation procedures demand the need for a precise technique for screw placement.

Methods.

Twenty adult cervical spine specimens (10 men and 10 women, with a mean age of 50.29 ± 6.98) were selected for computed tomography pre- and postoperatively. A 3D lower cervical spine model was reconstructed using Mimics software to measure the screw-related parameters and generate a reverse template with optimal screw channel as well as a prototype using 3D printing. Assisted by the navigation template, bilateral ATPS were inserted into the cadavers.

Results.

The mean outer width and height of pedicle were 5.31 ± 1.23 and 6.78 ± 1.10 mm, respectively. The average length, sagittal, and axial angles of the optimal screw channel obtained through the optimal entry point were 36.34 ± 4.39 mm, 40.67° ± 5.10°, and 93.7° ± 7.96°, respectively. The adjustable safe ranges of sagittal and axial angles were 3.89° ± 1.13° and 5.64° ± 0.97°, respectively. The axial and sagittal accuracies of the 200 screws were 99.5% and 97%, respectively. The average deviations of the actual entry point and the preset opening in the X, Y, and Z axes were 0.39 ± 0.43, 0.21 ± 0.41, and 0.29 ± 0.14 mm, respectively (P > 0.05).

Conclusion.

An individualized ATPS navigation template was developed using Mimics software and 3D printing prototyping, based on computed tomography, for highly accurate screw insertion.

Level of Evidence: 4
The potential contribution of dietary factors to breast cancer prevention
Authors: Shapira Niva
Published: July 2017

Breast cancer (BC), the leading cancer in women, is increasing in prevalence worldwide, concurrent with western metabolic epidemics, that is, obesity, metabolic syndrome, and diabetes, and shares major risk factors with these diseases. The corresponding potential for nutritional contributions toward BC prevention is reviewed and related to critical stages in the life cycle and their implications for carcinogenic and pathometabolic trajectories. BC initiation potentially involves diet-related pro-oxidative, inflammatory, and procarcinogenic processes, that interact through combined lipid/fatty acid peroxidation, estrogen metabolism, and related DNA-adduct/depurination/mutation formation. The pathometabolic trajectory is affected by high estrogen, insulin, and growth factor cascades and resultant accelerated proliferation/progression. Anthropometric risk factors – high birth weight, adult tallness, adiposity/BMI, and weight gain – are often reflective of these trends. A sex-based nutritional approach targets women’s specific risk in western obesogenic environments, associated with increasing fatness, estrogen metabolism, n-6 : n-3 polyunsaturated fatty acid ratio, and n-6 polyunsaturated fatty acid conversion to proinflammatory/carcinogenic eicosanoids, and effects of timing of life events, for example, ages at menarche, full-term pregnancy, and menopause. Recent large-scale studies have confirmed the effectiveness of the evidence-based recommendations against BC risk, emphasizing low-energy density diets, highly nutritious plant-based regimes, physical activity, and body/abdominal adiposity management. Better understanding of dietary inter-relationships with BC, as applied to food intake, selection, combination, and processing/preparation, and recommended patterns, for example, Mediterranean, DASH, plant-based, low energy density, and low glycemic load, with high nutrient/phytonutrient density, would increase public motivation and authoritative support for early/timely prevention, optimally merging with other dietary/health goals, for lifelong BC prevention.
Examining the Relationship Between Nursing Informatics Competency and the Quality of Information Processing
Authors: Al-Hawamdih Sajidah , Ahmad Muayyad M.
Published: July 2017

The purpose of this study was to examine nursing informatics competency and the quality of information processing among nurses in Jordan. The study was conducted in a large hospital with 380 registered nurses. The hospital introduced the electronic health record in 2010. The measures used in this study were personal and job characteristics, self-efficacy, Self-Assessment Nursing Informatics Competencies, and Health Information System Monitoring Questionnaire. The convenience sample consisted of 99 nurses who used the electronic health record for at least 3 months. The analysis showed that nine predictors explained 22% of the variance in the quality of information processing, whereas the statistically significant predictors were nursing informatics competency, clinical specialty, and years of nursing experience. There is a need for policies that advocate for every nurse to be educated in nursing informatics and the quality of information processing.
Refinement of Nasal Reconstruction with a V/Y-alar-perforator Flap
Authors: Feinendegen Dominik L. , Langer Martin F. , Roldán J. Camilo
Published: July 2017

Background:

The ala of the nose is vascularized by a dense net of perforators originating from the lateral nasal artery or the angular artery. These vessels reach the ala in a cascade fashion from the alar groove/lateral nasal wall. Based on these vessels, a V/Y flap can be dissected with a wide range of mobility.

Materials and Methods:

Nineteen patients underwent reconstruction of the nose by means of a V/Y-alar-perforator flap alone or in combination with a myocutaneous rotation flap from the lateral nasal wall and/or from the nasal dorsum for reconstruction of defects at the nasal tip, ala of the nose, and/or lateral nasal wall. All patients were followed up 8 months after surgery in average.

Results:

There was no prolonged congestion or any tissue loss. All patients presented postoperatively with excellent aesthetic results, and no nasal distortion was observed.

Conclusion:

The V/Y-alar-perforator flap alone or in combination with a myocutaneous rotation flap proved to be a reliable tool in the armamentarium for reconstruction of nasal tip and alar defects providing good aesthetic results.
Partial Breast Reconstruction with Goldilocks Technique After Excision of Giant Fibroadenoma: A Case Report
Authors: Ter Louw Ryan P. , Bruce Sara B. , Nahabedian Maurice Y.
Published: July 2017

Giant juvenile fibroadenomas are relatively rare, accounting for less than 1% fibroadenomas. Large breast tumors create significant asymmetry and provide unique reconstructive challenges after removal. In this case, we describe a 21-year-old female with delayed presentation of a giant fibroadenoma of the right breast. This represents an unusual presentation of benign breast disease requiring reduction of the skin envelope, extensive glandular resection, lower pole reconstruction, and free nipple grafting to achieve symmetry with the opposite breast. A novel modification of the Goldilocks mastectomy technique is described for partial breast reconstruction. Adaptation of the Goldilocks mastectomy technique provides adequate soft tissue for partial breast reconstruction. Using the lower pole deepithelialization breast skin flap provides autologous vascularized tissue to supplement volume loss after tumor and glandular excision. Benign breast disease can create significant breast deformities. Application and combination of the Goldilocks mastectomy technique allow for partial breast reconstruction without the need for an additional donor site or prosthetic devices.
Lymphaticovenous Anastomosis Releases the Lower Extremity Lymphedema-associated Pain
Authors: Mihara Makoto , Hara Hisako , Zhou Han Peng , Tange Shuichi , Kikuchi Kazuki
Published: July 2017

Background:

We investigate the effectiveness of lymphaticovenous anastomosis (LVA) in releasing lymphedema-associated pain.

Methods:

We performed a retrospective analysis. Subjects of this study included lower extremity lymphedema patients who presented persistent and constant degrees of pain in their lower limbs. LVA was performed under local anesthesia. The preoperative lower extremity pain and postoperative lower extremity pain were surveyed using the visual analog scale on a score from 0 to 10. The circumferences of the limbs were also recorded.

Results:

A total of 8 patients (16 lower limbs) were included. The subjects included 1 man and 7 women, and their average age was 72 years. The average follow-up period was 17 months. The average preoperative and postoperative visual analog scale scores were 5.3 and 1.8, respectively. Moreover, 7 patients who had records of their lower extremity circumference observed an average changing rate of −4.7% in lower extremity lymphedema index after the surgery.

Conclusion:

LVA can release the pain in the affected limbs of lymphedema.
The BREASTrial Stage II: ADM Breast Reconstruction Outcomes from Definitive Reconstruction to 3 Months Postoperative
Authors: Mendenhall Shaun D. , Anderson Layla A. , Ying Jian , Boucher Kenneth M. , Neumayer Leigh A. , Agarwal Jayant P.
Published: July 2017

Background:

The Breast Reconstruction Evaluation of Acellular Dermal Matrix as a Sling Trial is a prospective randomized trial comparing outcomes of tissue expander breast reconstruction using either AlloDerm or DermaMatrix. The trial was divided into 3 outcome stages; this study reports stage II outcomes, which are those from the time of definitive reconstruction to 3 months postoperative.

Methods:

A randomized trial was conducted to compare complication rates between AlloDerm and DermaMatrix groups. The impact of matrix type, age, obesity, radiation therapy, chemotherapy, and reconstruction type on complications was analyzed with regression models.

Results:

Of the 128 patients (199 breasts) who were randomly assigned into the trial, 111 patients (173 breasts) were available for analysis in stage II. There was no difference in overall rates of complications (15.4% vs 18.3%, P = 0.8) or implant loss (2.2% vs 3.7%, P = 0.5) between the AlloDerm and DermaMatrix groups, respectively. Obesity was the only significant predictor of complications on regression analysis (odds ratio, 4.31, P = 0.007). Matrix type, age, radiation therapy, chemotherapy, or reconstruction type had no impact on the incidence/severity of complications.

Conclusions:

Acellular dermal matrix (ADM) will likely continue to have a role in breast reconstructive surgery; however, caution should be taken when using ADM because of relatively high complication rates, especially in obese patients. The particular ADM product should be selected based on individual surgeon preference, experience, and success rates. These data and forthcoming long-term outcomes from the Breast Reconstruction Evaluation of Acellular Dermal Matrix as a Sling Trial will enable surgeons to carefully weigh the risks and benefits of ADM use in breast reconstruction.
Reelevating the Mastectomy Flap: A Safe Technique for Improving Nipple-Areolar Complex Malposition after Nipple-Sparing Mastectomy
Authors: Zhang Shuhao , Blanchet Nadia P.
Published: July 2017

Nipple-areolar complex (NAC) malposition is one of the most common complications following nipple-sparing mastectomy with implant-based reconstruction. To maximize perfusion to the NAC, traditional methods of correcting NAC malposition limit undermining below the NAC. We demonstrate a series of cases in which improvement of NAC malposition was safely performed by reelevating the NAC and mastectomy flap to allow redraping of the soft tissue envelope over the implant and the overlying capsule. Thirty-four patients were identified in a span over 4 years where 44 NACs were repositioned using this method. There was zero incidence of postoperative ischemia or necrosis of the NAC or mastectomy flaps. There was noticeable improvement in the NAC position on the breast mound. Reelevation of the mastectomy skin flap to correct malposition of the NAC after nipple-sparing mastectomy is a safe and effective option, avoids additional scars, and can be performed more than once to further improve positioning of the NAC.
Arterial and Venous Doppler in Evaluation of the “At-Risk” Fetus
Authors: TURAN SIFA , TURAN OZHAN M.
Published: July 2017

Our practice utilizes Doppler ultrasound as one of the most objective and effective methods to assess at-risk pregnancies. This review will discuss the application of arterial and venous Doppler techniques in assessing and managing various diseases and conditions for high-risk fetuses.
Fertility and Endometriosis
Authors: EVANS M. BLAKE , DECHERNEY ALAN H.
Published: July 2017

Approximately 30% to 50% of women that have the diagnosis of endometriosis also struggle with infertility. Twenty five percent to 50% of women diagnosed with infertility also have endometriosis, but the endometriosis may not be severe enough to be the primary etiology of infertility. White women have been reported to be more likely than African American women to have endometriosis. In addition, risk factors for endometriosis include below average body mass index, smoking, and alcohol use. Below is a discussion regarding the various ways in which endometriosis decreases fecundity and also discusses potential outcomes of fertility treatments regarding endometriosis.
Prenatal Diagnosis and Evaluation of Abnormal Placentation
Authors: FOX KARIN A. , LEE WESLEY
Published: July 2017

Abnormalities in placental location or adherence can have important consequences on pregnancy outcome for both mother and fetus. Accurate antenatal detection is crucial for delivery timing and planning to help reduce perinatal risks for adverse events. We review the relevant literature and present a practical approach for the prenatal detection of abnormal placentation.
Cervical Evaluation in Pregnancy: Proper Measurement, Evaluation, and Management
Authors: WAX JOSEPH R. , CARTIN ANGELINA , PINETTE MICHAEL G.
Published: July 2017

Preterm birth is the leading cause of perinatal morbidity and mortality in developed nations. The heterogeneous causes of spontaneous preterm birth make prediction and prevention difficult. The primary importance of transvaginal cervical sonography and cervicovaginal fetal fibronectin lies in their high negative predictive values in assessing risk for preterm birth. Cervical length may be useful in identifying women who are candidates for cervical cerclage or progesterone therapy for preterm birth prevention. Together, cervical length and fibronectin can be used in the triaging of women symptomatic for preterm labor.
Advances in Fetal Cardiac Imaging
Authors: SINKOVSKAYA ELENA
Published: July 2017

This review presents a detailed discussion on recent trends in fetal cardiac imaging. Ultrasound technique which are most useful for clinical practice today and will likely change the approach to cardiac evaluation in the future are presented.
Comparison of 3 Symptom Classification Methods to Standardize the History Component of the HEART Score
Authors: Marchick Michael R. , Setteducato Michael L. , Revenis Jesse J. , Robinson Matthew A. , Weeks Emily C. , Payton Thomas F. , Winchester David E. , Allen Brandon R.
Published: July 2017

Objectives:

The History, Electrocardiography, Age, Risk factors, Troponin (HEART) score enables rapid risk stratification of emergency department patients presenting with chest pain. However, the subjectivity in scoring introduced by the history component has been criticized by some clinicians. We examined the association of 3 objective scoring models with the results of noninvasive cardiac testing.

Methods:

Medical records for all patients evaluated in the chest pain center of an academic medical center during a 1-year period were reviewed retrospectively. Each patient’s history component score was calculated using 3 models developed by the authors. Differences in the distribution of HEART scores for each model, as well as their degree of agreement with one another, as well as the results of cardiac testing were analyzed.

Results:

Seven hundred forty nine patients were studied, 58 of which had an abnormal stress test or computed tomography coronary angiography. The mean HEART scores for models 1, 2, and 3 were 2.97 (SD 1.17), 2.57 (SD 1.25), and 3.30 (SD 1.35), respectively, and were significantly different (P < 0.001). However, for each model, the likelihood of an abnormal cardiovascular test did not correlate with higher scores on the symptom component of the HEART score (P = 0.09, 0.41, and 0.86, respectively).

Conclusions:

While the objective scoring models produced different distributions of HEART scores, no model performed well with regards to identifying patients with abnormal advanced cardiac studies in this relatively low-risk cohort. Further studies in a broader cohort of patients, as well as comparison with the performance of subjective history scoring, is warranted before adoption of any of these objective models.
Quality Improvement in Management of Acute Coronary Syndrome: Continuing Medical Education and Peer Coaching Improve Antiplatelet Medication Adherence and Reduce Hospital Readmissions
Authors: Larkin Amy , LaCouture Michael , Geissel Kathleen , Barr Peri , Bates Eric R. , Cannon Christopher P. , Bhatt Deepak L.
Published: July 2017

Background:

Reducing hospital readmissions and improving patient adherence to antiplatelet medications after an acute coronary syndrome (ACS) event are important goals for improving patient health and decreasing healthcare costs. Nearly half of patients will have a secondary event within 1 year of the initial ACS event. Quality improvement (QI) initiatives that include continuing medical education and peer coaching may improve physician practice patterns and, therefore, patient outcomes.

Methods:

This study evaluated the impact of a QI initiative on antiplatelet (P2Y12 inhibitor) medication adherence (measured via pharmacy fill rates postdischarge) and hospital readmissions.

Results:

Notable physician performance and patient-level changes included significant increases in antiplatelet medication counseling at hospital discharge (30%–57%; P < 0.0001), in P2Y12 inhibitor prescribing at hospital discharge (76%–84%; P = 0.02), and in patient fill rates for branded P2Y12 inhibitors (72%–100%; P = 0.0001). There were numerical trends toward lower rates of ACS-related rehospitalizations at 60 days postdischarge (from 11% to 7%; P = 0.15) and of all-cause rehospitalizations at 60 days (from 20% to 14%; P = 0.10).

Conclusion:

Important in the rapidly evolving landscape of quality healthcare, QI involving continuing medical education and peer coaching demonstrably impacted physician performance and patient outcomes after an ACS event.
Thoracoscopic Implantation of An Array Electrode in the Pericardium Transverse Sinus to Reduce Defibrillation Threshold
Authors: Curnis Antonio , Muneretto Claudio , Bisleri Gianluigi , Cerini Manuel , Inama Lorenza , Salghetti Francesca , De Vito Raffaella , Giroletti Laura , Rosati Fabrizio , Giacopelli Daniele , Vassanelli Francesca , Bontempi Luca
Published: July 2017

Among the implantable cardioverter defibrillator recipients, there is still a subgroup of patients in whom the defibrillation threshold is too high and the maximal shock output of the implantable cardioverter defibrillator can fail to terminate a ventricular arrhythmia. We report a new thoracoscopic minimally invasive approach to place a standard array electrode in the transverse pericardial sinus of a patient implanted with a cardiac resynchronization and defibrillation therapy device with persistent high defibrillation threshold. This approach was developed to achieve very low shock impedance with a consequent increase in the current flow and reduction of defibrillation threshold.
Left Atrial Appendage Resection during Minimally Invasive Aortic Valve Surgery via Right Minithoracotomy
Authors: Kondo Nobuo , Totsugawa Toshinori , Hiraoka Arudo , Tamura Kentaro , Yoshitaka Hidenori , Sakaguchi Taichi
Published: July 2017

Here, we report concomitant resection of the left atrial appendage through the transverse sinus during minimally invasive aortic valve replacement via right anterolateral thoracotomy. The left atrial appendage was exposed by raising the collapsed ascending aorta and was safely resected using a surgical stapling device. This procedure is a feasible option in elderly patients, for whom a percutaneous procedure would be inappropriate, and could be useful for preventing thromboembolic and hemorrhagic complications.
Open: Precannulated Fenestrated Endovascular Aneurysm Repair using Guidewire Fixator
Authors: Bosaeus Linus , Mani Kevin , Wanhainen Anders , Liungman Krister
Published: July 2017

Objective

By using a guidewire fixator, the distal guidewire position can be secured in an artery. This new principle enables a method for fenestrated endovascular aortic repair where the connection between the aortic branches and the stent graft fenestrations is made before inserting and deploying the stent graft.

Methods

This is conducted using a fenestrated stent graft with preloaded catheters, through which the prepositioned and distally secured guidewires from the branches are inserted.

Results

This report covers the method when implementing a single fenestration stent graft in pig.

Conclusions

Successful tests with single and dual fenestrated grafts have been conducted in pigs.
Trends in Otitis Media and Myringotomy With Tube Placement Among American Indian and Alaska Native Children and the US General Population of Children After Introduction of the 13-valent Pneumococcal Conjugate Vaccine
Authors: Singleton Rosalyn , Seeman Sara , Grinnell Margaret , Bulkow Lisa , Kokesh John , Emmett Susan , Holve Stephen , McCollum Jeffrey , Hennessy Thomas
Published: July 2017

Background:

American Indian/Alaska Native (AI/AN) children have experienced higher otitis media (OM) outpatient visit rates than other US children. To understand recent trends, we evaluated AI/AN OM rates before and after 13-valent pneumococcal conjugate vaccine introduction.

Methods:

We analyzed outpatient visits listing OM as a diagnosis among AI/AN children <5 years of age from the Indian Health Service National Patient Information Reporting System for 2010–2013. OM outpatient visits for the general US child population <5 years of age were analyzed using the National Ambulatory Medical Care and National Hospital Ambulatory Care Surveys for 2010–2011.

Results:

The 2010–2011 OM-associated outpatient visit rate for AI/AN children (63.5 per 100/year) was similar to 2010–2011 rate for same-age children in the general US population (62.8) and decreased from the 2003 to 2005 AI/AN rate (91.4). Further decline in AI/AN OM visit rates was seen for 2010–2011 to 2012–2013 (P < 0.0001). The AI/AN infant OM visit rate (130.5) was 1.6-fold higher than the US infant population. For 2010–2011, the highest AI/AN OM visit rate for <5 year olds was from Alaska (135.0).

Conclusions:

AI/AN <5-year-old OM visits declined by one third from 2003–2005 to 2010–2011 to a rate similar to the US general population <5 years. However, the AI/AN infant OM rate remained higher than the US infant population. The highest AI/AN <5-year-old OM rate occurred in Alaska.
The Influence of Heavier Football Helmet Faceguards on Head Impact Location and Severity
Authors: Schmidt Julianne D. , Phan Tracy T. , Courson Ron W. , Reifsteck Fred , Merritt Eric D. , Brown Cathleen N.
Published: July 2017

Objective:

To determine whether players with heavier faceguards have increased odds of sustaining top of the head impacts and head impacts of higher severity.

Design:

Cohort study.

Setting:

On-field.

Participants:

Thirty-five division I collegiate football players.

Interventions:

Faceguard mass was measured. Head impact location and severity (linear acceleration [gravity], rotational acceleration [radian per square second], and Head Impact Technology severity profile [unitless]) were captured for 19 379 total head impacts at practices using the Head Impact Telemetry System.

Main Outcome Measures:

Players' faceguards were categorized as either heavier (>480 g) or lighter (≤480 g) using a median split. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed for sustaining top of the head impacts between faceguard groups using a random intercepts generalized logit model. We compared head impact severity between groups using random intercepts general linear models (α = 0.05). Player position was included in all models.

Results:

Overall, the 4 head impact locations were equally distributed across faceguard groups (F
(3,26) = 2.16, P = 0.117). Football players with heavier faceguards sustained a higher proportion impacts to the top of the head (24.7% vs 17.5%) and had slightly increased odds of sustaining top (OR, 1.72; 95% CI, 1.01-2.94) head impacts rather than front of the head impacts.

Conclusions:

Football players wearing heavier faceguards might be slightly more prone to sustaining a higher proportion of top of the head impacts, suggesting that greater faceguard mass may make players more likely to lower their head before collision. Individuals involved with equipment selection should consider the potential influence of faceguard design on head impact biomechanics when recommending the use of a heavier faceguard.
Near Point of Convergence and Gait Deficits in Adolescents After Sport-Related Concussion
Authors: Howell David R. , O'Brien Michael J. , Raghuram Aparna , Shah Ankoor S. , Meehan William P.
Published: July 2017

Objective:

To prospectively examine gait characteristics of participants acutely after concussion with and without receded near point of convergence (NPC), compared with healthy controls.

Design:

Cross-sectional study.

Setting:

Sports-medicine clinic.

Participants:

Patients examined after concussion (n = 33; mean ± SD = 7.2 ± 3.1 days) and a group of uninjured athletes (n = 31) completed a Postconcussion Symptom Scale, underwent NPC testing, and single/dual-task gait assessments.

Independent Variables:

Near point of convergence was defined as the patient-reported diplopia distance when a fixation target moved toward the nose. Receded NPC was defined as a distance >5 cm from the tip of the nose.

Main Outcome Measures:

Spatiotemporal gait characteristics in single-task and dual-task conditions were evaluated with analysis of variance; correlations were calculated between NPC and gait measures.

Results:

Eighteen of 33 (55%) patients with concussion presented with receded NPC. Those with receded NPC exhibited slower gait speed (single-task = 1.06 ± 0.14 m/s vs 1.19 ± 0.15 m/s; dual-task = 0.80 ± 0.13 m/s vs 0.94 ± 0.13 m/s; P = 0.003) and shorter stride lengths (single-task = 1.11 ± 0.10 m vs 1.24 ± 0.11 m; dual-task = 0.97 ± 0.11 m vs 1.09 ± 0.11 m; P = 0.001) than healthy controls. Near point of convergence was moderately correlated with dual-task average walking speed for the normal NPC group (ρ = −0.56; P = 0.05). Postconcussion Symptom Scale scores did not significantly differ between groups (27 ± 18 vs 28 ± 16).

Conclusions:

After concussion, adolescents with receded NPC exhibited significant gait-related deficits compared with healthy controls, whereas those with normal NPC did not. Vergence and gross motor system dysfunction may be associated after concussion. Gait and vergence measures may contribute useful information to postconcussion evaluations.
Short Sleep and Adolescents' Performance on a Concussion Assessment Battery: An Experimental Sleep Manipulation Study
Authors: Beebe Dean W. , Powers Scott W. , Slattery Eric W. , Gubanich Paul J.
Published: July 2017

Objective:

Correlational studies have linked short sleep to adolescents' report of postconcussion symptoms and cognitive performance during concussion assessments. This study tested whether those are cause–effect relationships.

Design:

Three-week randomly counterbalanced, within-subjects, crossover experiment.

Setting:

Adolescents slept at home with weekly visits to an outpatient clinic for sleep monitor uploads and outcome assessments.

Participants:

Twenty-four healthy 14- to 17.9-year-olds.

Conditions:

After an initial sleep-stabilization period, adolescents experienced 5-night spans of short sleep (SS; 6.5 hours/night in bed) versus Healthy Sleep Opportunity (HS; 9.5 hours/night in bed).

Main Outcome Measures:

Cognitive indexes and the postconcussion symptom scale (PCSS) from the Immediate PostConcussion Assessment and Cognitive Testing.

Results:

Adolescents reported significantly worse symptoms on the PCSS after SS than HS, even after excluding items manifestly related to sleep. Verbal memory was also worse after SS than HS, though the effect was small. The manipulation did not significantly affect other cognitive indexes.

Conclusions:

A realistic “dose” of short sleep, similar to what many adolescents experience regularly on school nights, can cause or contribute to symptom reports during concussion assessments. Consistent with previous sleep research, one-on-one cognitive tests seem to be less sensitive than measures of emotional and behavioral functioning to the effects of short sleep.
Comparison of Tissue Yield Using Frictional Fabric Brush Versus Sharp Curettage For Endocervical Curettage
Authors: Diedrich Justin T. , Rathore Sumra , Bentz Joel S.
Published: July 2017

Objective

The aim of the study was to evaluate and compare the diagnostic yield of conventional endocervical curettage (ECC) with fabric-based ECC in a consistent physician group.

Materials and Methods

This is a retrospective case-control study of patients who underwent ECC both before and after introduction of a fabric-based ECC device. Histologic examination of curettings was categorized as satisfactory, limited, or inadequate. The Kruskall-Wallis test was used to compare proportions of gross descriptions and final diagnoses between groups.

Results

Between January 2010 and July 2011, 9234 ECCs were performed using conventional ECC technique. From September 2011 to October 2013, 774 ECCs were performed with the fabric-based ECC. Using the conventional ECC technique, 7809 (84.6%) of specimens were satisfactory, 1037 (11.2%) were limited, and 388 (4.2%) were inadequate and repeat biopsy was recommended. With fabric ECC, 705 (91.1%) of specimens were satisfactory, 64 (8.3%) were limited, and 5 (0.6%) were inadequate, and repeat biopsy was recommended. There were significantly fewer inadequate specimens with the fabric-based ECC (4.2% vs 0.6%, p < .001).

Conclusions

Fabric-based ECC may significantly decrease inadequate and limited ECC specimens.