bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of Magnetic Topology During the Growth Phase of the Substorm Inducing the Onset of the Near‐Earth Neutral Line
Authors: Tanaka T. , Ebihara Y. , Watanabe M. , Den M. , Fujita S. , Kikuchi T. , Hashimoto K.K. , Kataoka R.
Published: June 2019

The transition of magnetic topology is analyzed during the substorm. During the growth phase in the polar ionosphere, magnetic fields consist of three categories: closed magnetic field, open magnetic field leading to the northward interplanetary magnetic field (IMF), and open field leading to the southward IMF. While the open magnetic field region leading to the southward IMF expands consistently during the growth phase, the ionospheric onset starts inside the closed field line region. There should be triple points where three kinds of magnetic field coexist in the ionosphere. Connected to the triple points, complex magnetic topologies appear in the magnetosphere. There occur definitive changes in the global magnetic topology such as retreat of cusp nulls generated under the northward IMF, generation of plasma sheet magnetic fields with reverse curvature, generation of bifurcation areas on the magnetopause, formation of new dayside nulls, development of null lines on the flank, and generation of bifurcation areas (group of nulls) on the magnetopause. During the late growth phase, divergence Vx flow is excited in the central plasma sheet associated with the appearance of reverse curvature. The plasma sheet reconnection starts 5 min before the ionospheric onset from a localized area at X = −17.5 Re due to the reduction of the normal component Bz caused by divergence Vx flow. It occurs in the residual magnetic structure formed under the northward IMF as a three‐dimensional reconnection with a guide field By. The resulting two‐turn coil of magnetic field forms a plasmoid, which is ejected downtail.
What Do the New 2018 HIWIND Thermospheric Wind Observations Tell Us About High‐Latitude Ion‐Neutral Coupling During Daytime?
Authors: Wu Qian , Knipp Delores , Liu Jing , Wang Wenbin , Häggström Ingemar , Jee Geonhwa , Kwak Young‐Sil , Erickson Philip J.
Published: June 2019

Daytime thermospheric winds observed by the balloon‐borne instrument HIWIND (High‐altitude Interferometer WIND experiment) during two flights in June 2011 and 2018 from Kiruna (68°N, 20°E), along with simultaneous European Incoherent SCATter radar ion drift data, are analyzed. National Center for Atmospheric Research TIEGCM (Thermosphere Ionosphere Electrodynamics General Circulation Model) simulations for both flights are compared with observations. The observed thermospheric winds from the two flights have many similarities. HIWIND‐observed thermospheric winds tend to be equatorward during the morning hours before noon and close to zero in the afternoon. In contrast, TIEGCM predicts poleward winds before noon and near zero in the afternoon. Southward interplanetary magnetic field Bz, occurring as the balloon passed through morning, was associated with greater equatorward meridional winds. The TIEGCM‐simulated zonal winds have large differences with observations under more active conditions. The second HIWIND flight confirms some important results from the first flight and further shows thermospheric wind variations under different interplanetary magnetic field conditions. HIWIND observations in general provide invaluable data for model validation and highlight deficiencies in current high‐latitude simulations.
One-step nanotopography construction by polyaniline polymerization for a superhydrophobic nanofibrous membrane towards direct contact membrane distillation
Authors: Zhong Lingling , Zhu Zhigao , Han Yu , Wang Qiao , Liu Dongmei , Cui Fuyi , Li Bin , Wang Wei
Published: June 2019

In situ polymerization of aniline is used to prepare superhydrophobic PVDF nanofibrous membranes for direct contact membrane distillation with high water flux and long wetting times.
Salt-induced silk gel-derived N and trace Fe co-doped 3D porous carbon as an oxygen reduction catalyst in microbial fuel cells
Authors: Liu Jianting , Wei Liling , Cao Chun , Zhang Fengtao , Lang Fengzheng , Wang Huiqiang , Yang Haijun , Shen Jianquan
Published: June 2019

Salt-induced silk-gel-based N and trace Fe co-doped 3D porous carbon as an cost-effective ORR catalyst in MFCs.
Synthesis of chitosan-mimicking cationic glycopolymers by Cu(0)-LRP for efficient capture and killing of bacteria
Authors: Miao Ziyue , Li Die , Zheng Zhaoquan , Zhang Qiang
Published: June 2019

A schematic representation of the preparation of cationic magnetic glyconanoparticles by Cu(0)-LRP to efficiently capture, kill and separate E. coli from water.
Review on flexible job shop scheduling
Authors: Xie Jin , Gao Liang , Peng Kunkun , Li Xinyu , Li Haoran
Published: June 2019

Flexible job shop scheduling problem (FJSP) is an NP‐hard combinatorial optimisation problem, which has significant applications in the real world. Due to its complexity and significance, lots of attentions have been paid to tackle this problem. In this study, the existing solution methods for the FJSP in recent literature are classified into exact algorithms, heuristics and meta‐heuristics, which are reviewed comprehensively. Moreover, the real‐world applications of the FJSP are also introduced. Finally, the development trends of the manufacturing industry are analysed, and the future research opportunities of the FJSP are summarised in detail.
Cryo-EM structure of OSCA1.2 from
Oryza sativa
elucidates the mechanical basis of potential membrane hyperosmolality gating
Authors: Maity Koustav , Heumann John M. , McGrath Aaron P. , Kopcho Noah J. , Hsu Po-Kai , Lee Chang-Wook , Mapes James H. , Garza Denisse , Krishnan Srinivasan , Morgan Garry P. , Hendargo Kevin J. , Klose Thomas , Rees Steven D. , Medrano-Soto Arturo , Saier Milton H. , Piñeros Miguel , Komives Elizabeth A. , Schroeder Julian I. , Chang Geoffrey , Stowell Michael H. B.
Published: June 2019

Sensing and responding to environmental water deficiency and osmotic stresses are essential for the growth, development, and survival of plants. Recently, an osmolality-sensing ion channel called OSCA1 was discovered that functions in sensing hyperosmolality in
Arabidopsis
. Here, we report the cryo-electron microscopy (cryo-EM) structure and function of an OSCA1 homolog from rice (
Oryza sativa
; OsOSCA1.2), leading to a model of how it could mediate hyperosmolality sensing and transport pathway gating. The structure reveals a dimer; the molecular architecture of each subunit consists of 11 transmembrane (TM) helices and a cytosolic soluble domain that has homology to RNA recognition proteins. The TM domain is structurally related to the TMEM16 family of calcium-dependent ion channels and lipid scramblases. The cytosolic soluble domain possesses a distinct structural feature in the form of extended intracellular helical arms that are parallel to the plasma membrane. These helical arms are well positioned to potentially sense lateral tension on the inner leaflet of the lipid bilayer caused by changes in turgor pressure. Computational dynamic analysis suggests how this domain couples to the TM portion of the molecule to open a transport pathway. Hydrogen/deuterium exchange mass spectrometry (HDXMS) experimentally confirms the conformational dynamics of these coupled domains. These studies provide a framework to understand the structural basis of proposed hyperosmolality sensing in a staple crop plant, extend our knowledge of the anoctamin superfamily important for plants and fungi, and provide a structural mechanism for potentially translating membrane stress to transport regulation.
Program Support for Selection Procedures for Environmentally Oriented Investment Projects
Authors: Bardakhanova T B , Eremko Z S
Published: June 2019

The aim of the work is to develop program support for selection procedures for environmentally oriented investment projects, including the calculation of traditional criteria for the effectiveness of the project, additional environmental criteria for the effectiveness of projects, application of methods for prioritizing projects and their selection with the use of modern information technologies. The article reveals the essence and features of environmentally oriented investment. A system of criteria for assessing the effectiveness of environmentally oriented investment projects has been developed. The conceptual bases of creating an information system for calculating the financial, budgetary, economic, social and environmental indicators of investment projects and their effectiveness, as well as assessing their priority, are proposed for consideration. Calculations of the priority of investment projects were carried out on the basis of the information system developed by the authors using multicriteria analysis methods. As a result, each of the criteria for the effectiveness of the investment project is given a specific quantitative value, and each investment project is a quantitative assessment of the priority of the project, which allows using the results of calculations to select projects and make managerial decisions on their implementation. The proposed information system can be a tool for adopting an effective environmentally oriented economic solution. The conducted experimental calculations showed the adequacy of the developed information system to the existing subject area. The Federal Service for Intellectual Property, Patents and Trademarks of the Russian Federation issued a certificate on the official registration of the computer program for the developed software product.
Rating Assessment of the Potential of Extractive Industry Resources in the Economic Zones of the Republic of Sakha (Yakutia)
Authors: Nikiforova V V
Published: June 2019

Spatially, the territorial structure of the Republic of Sakha (Yakutia) economy is divided into five economic zones: Central, Western, Southern, Eastern and Arctic zones, on whose territories there are many mineral deposits that are unevenly explored and involved in economic turnover. The article presents a quantitative integrated assessment of the potential of extractive industry resources in the economic zones. The assessment was performed using a point rating system with weighting factors determined by the expert evaluation method based on resource importance and taking into account the importance of each resource type in the region’s economy. It has been revealed that the main factors that influence on the potential of extractive industry resources, along with transport and energy infrastructures, are exploration immaturity of deposits, quality of ores, low content of mineral resources, as well as market conditions. In this regard, to improve the ranking of an economic zone, it is recommended to carry out exploration and appraisal activities in economic zones, which need for a strong government support not only in funding, but also in regulation.
Development of Coal Industry as a Resource and Raw Material Base of the Region
Authors: Zaitsev R G , Afanasev M M , Komissarova M A
Published: June 2019

Sector-specific issues of coal industry and its place in the regional economic system are defined in the context of utility theory since for any region it is important to balance the subjective and objective development priorities while implementing the investment process in the development of particular industries’ production companies. Structural logical concept of the development strategy choice for coal mining enterprises is based on their expected utility or their results value taking into account the interests of all participants in the process and considering the needs to integrate the development priorities of the industry and the region as the resources and raw materials base. Strategy development process for successful operation and effective development of coal mining enterprises is offered to be implemented in accordance with Markov chains theory presented in the article. The methodology described provides more efficient use of the enterprise innovative potential consistent with their industry specifics.
Analysis and Assessment of the State of Pension Provision for People of the Russian Federation and Its Immediate Prospects
Authors: Latypov R T , Reznichenko D V , Ruchkin A V
Published: June 2019

The article reveals the topical issues of citizens’ pension provision for the population of the Russian Federation. Economic instability in the country had an objective effect on the pension system as a whole. Growing over the past years budget deficit of the Pension Fund of the Russian Federation, the imperfection of normative regulation of non-state pension funds largely determine the instability and lack of specific perspectives for the pension market’ development in Russia. It should be recognized that despite the ongoing process of reforming the pension system and its legislative improvement, the reform of the pension system itself more actualizes, but does not solve the existing problems of pension provision for citizens.
Development of the Professional Educational Program by Methods of Artificial Intelligence
Authors: Romanova E V , Klashanov F K
Published: June 2019

The article, in General, refers to the technology of training for the construction industry, and in particular the search for a more effective method of forming a professional educational program of training in the field of Computer science and technology (09.04.01). Over the past eight years, Russia has changed three state educational standards of higher education. The procedure of their implementation in the educational process is very time-consuming and takes place in a short time. In order to avoid gross errors and speed up the process of developing an educational program, it is necessary to use computer technologies, among which the most promising are the methods of intelligent systems. The article discusses the method of solving the problem with the requirements of the educational standard.
The Analysis of Trends and the Assessment of the Worldwide High-Tech Production Development
Authors: Astakhova E V , Reshetnyak E I , Ilchenko V V
Published: June 2019

The purpose of the article is to analyze the trends and assess the level of the development of high-tech production in various countries worldwide, as well as to theorize the directions of scientific and technical development of the country by means of increasing the value of innovative products. The prerequisites for the timeliness of mainstreaming of the development of high-tech production for national economies, including GDP growth and improving the competitiveness of the country in global markets have been analyzed. The main aspects of the fourth technological revolution have been identified. The need for regular monitoring of the indicators reflecting the state and the level of the development of high-tech industries in the countries worldwide has been demonstrated. A correlation and regression model of the dependence of the share of high-tech industries in the GDP structure has been developed for the positioning of individual countries in the global technological space with regard to the key market leaders. The model makes it possible to predict the changes in the contribution of high-tech industries to the GDP of the country by means of varying the indicators of scientific and technical activity. A model of the value creation chain for technology-intensive products with account of the institutional means of ensuring scientific and technical development as well as its strategic management at various levels of management (international, national, and local) has been proposed.
The Methodology of Modernization Processes Management in Innovation Networks
Authors: Salnikova Y , Pakhomova A , Dmitrieva E
Published: June 2019

An approach to managing modernization in the framework of an innovation networks was developed, based on the fact that the formation of priority directions for modernization was proposed to be implemented taking into account the potential for modernization of the enterprise and its subdivisions. An algorithm is developed for analyzing the sufficiency of the potential for modernizing production systems. The rating of the enterprises included in the business group was carried out to determine the most investment-attractive objects among them on the basis of the calculation of the complex index of the modernization potential, taking into account the organizational and managerial and personnel components of the modernization potential.
Model for Assessing the Human Capitalof an Enterprise
Authors: Plotnikov V , Pirogova O , Vertakova Y
Published: June 2019

Economic development in modern conditions has acquired a pronounced humanistic orientation. In this regard, human capital is seen as a key factor in production and social well- being. The analysis of human capital is traditionally carried out at the macro level of the economic system. At the micro level, it is studied to a lesser extent.

The purpose of the study is to form a model for assessing the human capital of an enterprise, consistent with the methods of assessing the value of the enterprise.

The methodical basis of the research is the systematization of the publications of Russian and foreign economists on the problems of human capital, human potential, labor potential with its connection of assessing the value of the enterprise.

The results of the research are the systematization of approaches to assessing the value of enterprise’s human capital, the classification of its types (investment, operational, basic) and working out the model for assessing the human capital of an enterprise as a part of its value.

Practical significance of the results: recommendations were developed to increase the value of the enterprise based on the management of its human capital. This ensures balanced social and economic development at the micro level of the economy.
Innovation Potential of the Modern Russian Civil Servants in Public Administration
Authors: Sergeevna N A , Vladimirovich R A
Published: June 2019

Innovation can be defined as a change in technology—more simply stated, in the way government workers/civil servants/public administrators do their jobs—whether the technology relates to a process, computer hardware or software, or the human side of the government enterprise. Contemporary advances in technology facilitating the rapid spread of information have led to worldwide societal changes and improved productivity. After analyzing civil servants’ professional activities, values, and attitudes, and assessing their capacity for change, public sector organizations must adapt functions and strategies. This is a systemic, behavioral analysis of the innovation potential of Russian public administrators. Empirical data were collected using a survey of Russian civil servants of the Sverdlovsk region, an analysis of their job descriptions, expert interviews, and focus-group interviews. The objective of this analysis is to assess innovation potential of these civil servants and identify factors that facilitate or hinder innovation potential within the Russian government. From these factors, practical strategies for increasing the level of civil servants’ innovation potential are deduced and presented. Results of the analysis expand management theories included in public administration literature and curricula thus leading to improved management training or retraining processes.
The growth of energy efficiency of the Baikal region is the basis for its sustainable development
Authors: Muzychuk S Y , Muzychuk R I
Published: June 2019

The Baikal region has a special status of economic activity, as an object of world heritage. In Lake Baikal there are about 20% of the world’s reserves of fresh fresh water. The urgency of energy efficiency growth is determined by the industry specialization of the economy and the requirements for preserving the Baikal nature. The purpose of the research: to identify the significant factors affecting the energy efficiency of the economy and to propose mechanisms for their implementation. A methodical approach is developed based on methods of economic-mathematical modeling, system analysis, statistical analysis, balance and indicative methods. An information and computing complex has been developed that includes: a system of models and databases for analyzing and forecasting the development of the fuel and energy complex of the eastern regions of Russia; economic-mathematical models of fuel and energy balances; methods for assessing the energy efficiency of the economy; methods of statistical analysis to identify factors that affect energy efficiency. Significant factors of reducing the energy intensity of the gross regional product of the Baikal region have been identified, and multiple regression equations have been developed to predict the energy intensity.
Composition and Structure of Microspheres in Ash and Slag Wastes on the Far East of the Russian Federation (Case of the CHPP-2 plant, Vladivostok)
Authors: Taskin A V , Grebenyuk I V , Elkin O I
Published: June 2019

The results of laboratory studies of the composition and structure of microspheres of ash and slag wastes of Russian Far East energy enterprises (in particular, CHPP-2, Vladivostok) are presented in this scientific work. It has been established that the microspheres are concentrated in particles of technogenic wastes with a size of up to 500 μm, with the prevailing mass of valuable geomaterial (75-80 %) being in narrow granulometric classes from 71 to 100 μm and 100 to 200 μm. Part of the microspheres is represented by unusual techogenic metal alloys (for example, antimony with aluminium), has a density of more than 1g/cm3, and when wet enriched in water precipitates. From a practical point of view, the investigated microspheres cannot be considered a ready commercial product, since they contain a significant amount of carbon concentrate, which is unburned solid fuel particles. In this connection, it is required to develop effective technological solutions for the extraction and purification of microspheres from ash and slag wastes from the thermal power industry of the Far East of the Russian Federation.
Scientific-Practical Approach to Revitalization Urban Environment of an Existing Single-Industry Town
Authors: Savostenko V A
Published: June 2019

The research method is aimed at solving the problems of a particular place of settlement and through this to design a key solution to solve the problems of settlement as a whole. The article gives an example of study and development of tools on the revitalization of the urban environment and related facilities in an existing single-industry town. In accordance with temporary, economic, territorial and other factors, principles of revitalization close to urban acupuncture have been developed. During the course of study, five stages of the town revival were proposed. Each stage involves the increase in the radius of the study and the impact on the urban environment. Programs of the stages could be general, but rather individual. Each stage has its own program and result. The strict adherence to each stage of the program gives a better result. And finally the five-stage approach makes it possible to achieve the prosperous, dynamic and sustainable settlement with the well-being town life.
Daily Cannabis use Adversely Affects Mental Health
Authors: Rosenberg Karen
Published: June 2019

According to this study:

Daily use of cannabis, particularly high-potency cannabis, is associated with an increased risk of psychotic disorder.
Stricter State Gun Laws Improve School Environment and Perceptions of Safety
Authors: Rosenberg Karen
Published: June 2019

According to this study:

Adoption of stronger state gun laws was associated with a lower likelihood of students carrying weapons and being threatened at school, as well as an improved perception of school safety.
What Joanna Would Have Wanted
Authors: Chicca Jennifer
Published: June 2019

To help health care proxies with end-of-life decisions, ask about patients’ former selves.
Introduction of Gerontology Into Undergraduate Nursing Curricula: An Innovative Approach Utilizing a Collaborative Partnership for Clinical Nursing Education
Authors: Hunter Amy
Published: June 2019

The focus of this article is an innovative approach to teaching gerontology by utilizing a collaborative approach to structuring clinical experiences. The goal was to better prepare future nurses for the growing epidemic of baby boomers. Faculty were challenged to rethink clinical education and design a new method to better prepare nursing students to care for older adults.
Analyzing Use of the Graduate Record Examinations® General Test in Doctoral Nursing Education: Start, Stop, Continue, or Modify?
Authors: Chicca Jennifer
Published: June 2019

AIM

The purpose of this study was to analyze uses of the Graduate Record Examinations® (GRE) General Test in doctoral nursing education.

BACKGROUND

Doctoral study is a costly (time, money, resources, effort) investment for both students and institutions alike, and it is imperative students who are likely to succeed are admitted. Admission criteria such as the GRE General Test must be examined for appropriate use and necessity.

METHOD

Literature regarding uses of the GRE General Test in doctoral nursing education was analyzed versus GRE General Test publisher evidence-based uses and guidelines while considering test psychometrics.

RESULTS

Although the GRE General Test is widely used in doctoral nursing program admissions, it appears it is often not used according to evidence-based guidelines or uses. Notably, crucial self-validations are infrequent.

CONCLUSION

Self-validations are essential when determining if doctoral nursing programs should start, stop, continue, or modify their use of the GRE General Test. Admission criteria analyses may help streamline admission processes and remove some unnecessary costs in doctoral education.
Differences in Psychomotor Skills Teaching and Evaluation Practices in Undergraduate Nursing Programs
Authors: Kemery S. R. , Morrell Briyana L. M.
Published: June 2019

AIM

The purpose of this study was to understand the methods faculty use to teach and evaluate psychomotor skill performance in associate and baccalaureate nursing programs, resources available to students to master these skills, and policies and procedures related to summative evaluation of psychomotor skills.

BACKGROUND

Despite the importance of psychomotor skills competency in registered nursing programs, published methods for teaching and evaluating competency vary. The literature does not support a particular strategy for teaching or evaluation.

METHOD

In this primarily quantitative descriptive study, participants completed a 28-item questionnaire developed by the authors based on a review of the literature and personal teaching experience.

RESULTS

All respondents indicated that their institutions conducted summative assessment of psychomotor skills; however, the methods for teaching and evaluation varied widely.

CONCLUSION

Well-designed control studies and consensus guidelines from professional nursing education organizations would assist faculty in implementing consistent, effective, evidence-based strategies.
The Sandbox: Development and Implementation of a Technology-Enhanced Classroom
Authors: Logan Rebecca M. , Johnson Cynthia E. , Worsham Jeremy
Published: June 2019

Based on the call to transform nursing education, many nursing programs have begun to integrate more active learning strategies into the traditional classroom setting. Many educators have found successful integration requires an improved learning space that allows students to interact and work collaboratively. This article discusses a new innovative trend in higher education called the active learning classroom (ALC), how one college developed an ALC, and the impact of the ALC on the use of active learning strategies and student learning outcomes in the nursing education department.
A National Study Across Levels of Nursing Education: Can Nurses and Nursing Students Accurately Estimate Their Knowledge of Evidence-Based Practice?
Authors: Wonder Amy Hagedorn , Spurlock Darrell
Published: June 2019

AIM

This national study sought to: a) describe the evidence-based practice (EBP) knowledge levels of nursing students enrolled in baccalaureate through doctorate of nursing practice programs; b) examine relationships between objective and subjective EBP knowledge measures; c) describe correlations between educational and demographic factors and EBP knowledge; and d) further evaluate validity and reliability evidence for the Evidence-Based Practice Knowledge Assessment in Nursing.

BACKGROUND

Rigorous evaluation of students’ EBP knowledge across nursing program levels is vital to enhancing education and patient care.

METHOD

A cross-sectional, correlational design using large-scale survey procedures was used in this study.

RESULTS

Mean Evidence-Based Practice Knowledge Assessment in Nursing scores (N = 674 respondents from five universities in the United States) increased with greater levels of nursing education degree attainment. A weak, positive correlation was found between objective and subjective EBP knowledge measures (r = .13, p = .001).

CONCLUSION

More research is needed to identify effective approaches to EBP education in nursing programs.
Learning Together: Combining Undergraduate and Graduate Simulated Learning for Practicing Physical Assessment Skills
Authors: Schams Kristin , Snyder Audrey , Zeller Dean , Caywood Krisinda
Published: June 2019

The effectiveness of using undergraduate nursing students (UNS) as standardized patients for advanced practice nurses (APNs) was studied. First-semester UNS, as part of their health assessment course requirements, participated in APN students’ practice and testing sessions as standardized patients for their health assessment course physical exam. Analysis of pre/post experience scores and open-ended questions demonstrated UNS perceived confidence increased in 15 of 21 areas and APN students’ confidence increased in three areas. The collaborative examination process aided students in their learning of the process of the physical examination.
Office-based ocular procedures for the allergist
Authors: Leonardi Andrea , Borghesan Franco , Scalora Tania , Modugno Rocco Luigi , Bonaldo Alex
Published: June 2019

Purpose of review

The aim of this study is to suggest principles for ocular procedures to be performed by allergists in their offices in helping their diagnosis of ocular diseases and suggest better interactions between allergists and ophthalmologists.

Recent findings

Diagnosis of ocular allergy is based on clinical history and signs and symptoms, with the support of in-vivo and in-vitro tests for the identification of the specific allergen. Unfortunately, ocular manifestations are frequently misdiagnosed and not properly managed.

A multidisciplinary allergist–ophthalmologist approach may improve early differential diagnosis and the prognosis of patients with allergic disease and conjunctivitis through shared management and earlier etiological treatment.
Underdosing of Prophylactic Enoxaparin Is Common in Orthopaedic Trauma and Predicts 90-Day Venous Thromboembolism
Authors: Jones Daniel L. , Jones William A. , Fleming Kory I. , Higgins Thomas F. , Rothberg David L. , Zhang Yingying , Pannucci Christopher J.
Published: June 2019

Objectives:

To determine the feasibility and impact of real-time anti-factor Xa (aFXa) level monitoring and enoxaparin dose adjustment in orthopaedic trauma. To examine the adequacy of standard fixed-dose enoxaparin chemoprophylaxis and to examine whether patient-specific factors influence enoxaparin metabolism.

Design:

Prospective cohort.

Setting:

Academic Level-I trauma center.

Patients:

Postoperative adult orthopaedic trauma patients undergoing acute fracture or nonunion surgery of the pelvis, acetabulum, or lower extremity placed on 30 mg of enoxaparin twice daily.

Intervention:

Peak steady-state aFXa levels were drawn with a goal range of 0.2–0.4 IU/mL. Patients with out-of-range levels underwent a 10-mg dose adjustment followed by repeat aFXa draws.

Main Outcome Measures:

Peak and trough aFXa levels, 90-day venous thromboembolism, and bleed events.

Results:

Of 109 enrolled patients, 43% had inadequate initial peak aFXa levels (aFXa < 0.2 IU/mL) with standard dosing. Higher gross weight, acetabular surgery, and operation length predicted low aFXa levels (P < 0.001, 0.006, 0.004, respectively). Dose adjustment increased the proportion of patients with in-range aFXa levels from 53.2% to 87.8% (P < 0.001). Patients with low aFXa levels during hospitalization or at discharge had significantly higher 90-day deep vein thrombosis and pulmonary embolism rates compared to those with adequate aFXa levels (deep vein thrombosis 12% vs. 1.36%; P = 0.023, pulmonary embolism 8% vs. 0%; P = 0.027). There were no major bleed events.

Conclusions:

Patients receiving inadequate enoxaparin chemoprophylaxis were at significantly increased risk of 90-day venous thromboembolism. Standard fixed-dose enoxaparin provided inadequate chemoprophylaxis in 43% of postoperative orthopaedic trauma patients, which significantly improved with dose adjustment. Weight, acetabular surgery, and operation length predicted inadequate enoxaparin prophylaxis.

Level of Evidence:

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Zinc-finger protein A20 protects hair cells from damage made by high-power microwave
Authors: Tang Feng , Chen Xiaoling , Jia Lifeng , Li Hai , Li Jingya , Yuan Wei
Published: June 2019

Inner ear hair cells are important for maintaining hearing. Irreversible damage to hair cells is an important cause of sensorineural deafness. Electromagnetic radiation, especially high-power microwave, is an important threat to human health in modern society and war. However, it is not clear whether high-power microwave has an effect on cochlea hair cells. This study aimed to assess the effects of high-power microwave on cochlear hair cells in guinea pigs, and investigate the potential protection of these cells against high-power microwave-induced damage by recombinant adenovirus A20. Based on experimental results, a 65 W/cm
2
irradiation density applied to guinea pigs in this study to establish a high-power microwave inner ear injury model. In addition, pAdEeay-1/A20 was injected via a round window into experimental guinea pig cochlea, whereas artificial perilymph was injected into the control group. Auditory function was assessed by testing the auditory brainstem response threshold, and damage to cochlear hair cells was investigated by cell counting and scanning electron microscopy observations of the basilar membrane. Inner ear injury was observed 6 hours after 65 W/cm
2
of irradiation and the auditory brainstem response threshold was significantly higher in the irradiation group (
P
< 0.05) compared with other groups. Propidium iodide staining and scanning electron microscopy results indicated that significant morphological changes occurred after radiation, especially to inner hair cells, which exhibited remarkable damage and the presence of several unknown spherical substances. Auditory brainstem response threshold was decreased in the pAdEeay-1/A20 group compared with the artificial perilymph group; moreover, damage to hair cells was milder in the pAdEeay-1/A20 group compared with the control group (
P
< 0.01). Thus, high-power microwave can cause damage to cochlear hair cells, as well as hearing loss with prolonged exposure and/or high dosage. In this regard, 65 W/cm
2
of irradiation for 6 hours is a reliable target dose for observation of damage. The zinc finger protein A20 can protect cochlear hair cells from high-power microwave-induced damage and prevent further hearing loss. This study was approved by the Laboratory Animal Welfare and Ethics Committee of the Third Military Medical University, China on April 18, 2017.
Improving outcomes in patients with prediabetes through a lifestyle modification program
Authors: Daftarian Zahra , Bowen Pamela G.
Published: June 2019

Background and purpose:

Type 2 diabetes and obesity are prevalent throughout the United States, and they occur at even higher rates in some southern states. This project aimed at improving outcomes for overweight/obese patients with prediabetes, thus reducing their risk of progression to type 2 diabetes.

Methods:

Twenty-four adults with a diagnosis of prediabetes and body mass index ≥ 25 completed this 3-month program. The Rapid Eating Assessment for Patients (REAPs) tool was used to assess eating habits and physical activity levels. The Single-Item Literacy Screener was used to screen for limited reading ability. The following preintervention and postintervention data were obtained: weight, A1c, REAP score, and REAP Physical Activity question (REAP-PA).

Intervention:

Monthly group educational sessions were conducted followed by individualized goal setting. The content of the sessions encompassed a lifestyle modification program based on the first five sessions of the Centers for Disease Control and Prevention “Prevent T2”curriculum, incorporating the Southern-style diet, food choices, and activity resources available in the local community.

Results:

Results revealed a significant (p < 0.05) decrease in weight (average 4.0 ± 4.2 kg), REAP score (average 17.6 ± 16.6), and REAP-PA (average 0.6) after intervention. A1c values decreased slightly but were not statistically significant, which may be due to the limited sample size. Those with limited reading ability showed a slightly greater A1c loss than those with adequate literacy.

Conclusions:

A 3-month lifestyle modification program resulted in improvement in weight, eating habits, physical activity level, and A1c in overweight/obese patients at risk for type 2 diabetes.
Medical resource utilization and costs for intraoperative and early postoperative periprosthetic hip fractures following total hip arthroplasty in the medicare population
Authors: Chitnis Abhishek Shirish , Mantel Jack , Vanderkarr Mollie , Putnam Matthew , Ruppenkamp Jill , Holy Chantal Elisabeth , Bridgens Joshua
Published: June 2019

This study assessed the impact of intraoperative and early postoperative periprosthetic hip fractures (PPHFx) after primary total hip arthroplasty (THA) on health care resource utilization and costs in the Medicare population.

This retrospective observational cohort study used health care claims from the United States Centers for Medicare and Medicaid Standard Analytic File (100%) sample. Patients aged 65+ with primary THA between 2010 and 2016 were identified and divided into 3 groups – patients with intraoperative PPHFx, patients with postoperative PPHFx within 90 days of THA, and patients without PPHFx. A multi-level matching technique, using direct and propensity score matching was used. The proportion of patients admitted at least once to skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), and readmission during the 0 to 90 or 0 to 365 day period after THA as well as the total all-cause payments during those periods were compared between patients in PPHFx groups and patients without PPHFx.

After dual matching, a total 4460 patients for intraoperative and 2658 patients for postoperative PPHFx analyses were included. Utilization of any 90-day post-acute services was statistically significantly higher among patients in both PPHFx groups versus those without PPHFx: for intraoperative analysis, SNF (41.7% vs 30.8%), IRF (17.7% vs 10.1%), and readmissions (17.6% vs 11.5%); for postoperative analysis, SNF (64.5% vs 28.7%), IRF (22.6% vs 7.2%), and readmissions (92.8% vs 8.8%) (all P < .0001). The mean 90-day total all-cause payments were significantly higher in both intraoperative ($30,114 vs $21,229) and postoperative ($53,669 vs $ 19,817, P < .0001) PPHFx groups versus those without PPHFx. All trends were similar in the 365-day follow up.

Patients with intraoperative and early postoperative PPHFx had statistically significantly higher resource utilization and payments than patients without PPHFx after primary THA. The differences observed during the 90-day follow up were continued over the 1-year period as well.
Comparison of early postoperative recovery between laryngeal mask airway and endotracheal tube in laparoscopic cholecystectomy
Authors: Kang Se Hee , Park MiHye
Published: June 2019

Background:

Laryngeal mask airway (LMA) insertion provokes fewer stress responses than endotracheal intubation. This study aimed to evaluate the LMA Protector for assessing improvements in intraoperative hemodynamic stability and to reduce postoperative discomfort compared with endotracheal intubation in laparoscopic cholecystectomy.

Methods:

Fifty-six patients who underwent laparoscopic cholecystectomy while under sevoflurane-based general anesthesia were randomly allocated to airway management using LMA (LMA group) or endotracheal tube (ETT group). Heart rate, blood pressure, and peak airway pressure were recorded before and after carboperitoneum. Postoperative pain and analgesic requirements were assessed, in addition to nausea, hoarseness, dysphonia, and sore throat during the first 1 hour postoperatively and until postoperative day 1.

Results:

All patients underwent successful LMA or ETT placement within 2 attempts. There was no difference in highest mean (SD) peak airway pressure during carboperitoneum between the LMA and ETT groups (17.7 [2.8] mm Hg vs 19.1 [3.8] mm Hg, P = .159, respectively). The incidence of high systolic blood pressure and bradycardia was higher in the LMA group. The highest pain scores 1 hour postoperatively and on postoperative day 1 were lower in the LMA group than in the ETT group (3.9 [2.0] vs 5.4 [2.3], P = .017 and 5.6 [1.9] vs 6.7 [1.7], P = .042, respectively); requirements for analgesics were similar in the 2 groups. The incidence of nausea was lower in the LMA group than in the ETT group until postoperative day 1 (4/28 [14%] vs 12/28 [43%], P = .031, respectively).

Conclusion:

The LMA Protector was an effective ventilator device associated with fewer intraoperative hemodynamic stress responses and improved the quality of early recovery after laparoscopic cholecystectomy.
Clinical application of RNA sequencing in sarcoma diagnosis
Authors: Pei Jianming , Zhao Xiaofeng , Patchefsky Arthur S. , Flieder Douglas B. , Talarchek Jacqueline N. , Testa Joseph R. , Wei Shuanzeng
Published: June 2019

Accurate diagnoses of sarcoma are sometimes challenging on conventional histomorphology and immunophenotype. Many specific genetic aberrations including chromosomal translocations have been identified in various sarcomas, which can be detected by fluorescence in situ hybridization and polymerase chain reaction analysis. Next-generation sequencing-based RNA sequencing can screen multiple sarcoma-specific chromosome translocations/fusion genes in 1 test, which is especially useful for sarcoma without obvious differentiation. In this report, we utilized RNA sequencing on formalin-fixed paraffin-embedded (FFPE) specimens to investigate the possibility of diagnosing sarcomas by identifying disease-specific fusion genes. Targeted RNA sequencing was performed on 6 sarcoma cases. The expected genetic alterations (clear cell sarcoma/EWSR1-ATF1, Ewing sarcoma/EWSR1-FLI1, myxoid liposarcoma/DDIT3-FUS) in four cases were detected and confirmed by secondary tests. Interestingly, three SS18 fusion genes (SS18-SSX2B, SS18-SSX2, and SS18-SSX4) were identified in a synovial sarcoma case. A rare fusion gene (EWSR1-PATZ1) was identified in a morphologically challenging case; which enabled us to establish the diagnosis of low grade glioneural tumor. In conclusion, RNA sequencing on FFPE specimen is a reliable method in establishing the diagnosis of sarcoma in daily practice.
Pathological complete response from oral chemotherapy combined with trans-arterial chemotherapy and embolization in an unresectable gastric cancer patient
Authors: Su Zhaoran , Shu Kuanshan , Kang Min , Wang Guihe
Published: June 2019

Rationale:

Gastric cancer is still one of the most common cancer in East Asia. More than 70% gastric cancer patients are diagnosed at an advanced stage in China. Moreover, about 10% cases are unresectable which usually suffer a poor prognosis with a median survival time of 5 to 12 months. In recent years, some clinical studies found that many unresectable gastric cancer cases could get opportunity for surgery after treatment that improve prognosis significantly

Patient concerns:

64-year-old male patient was admitted with upper abdominal pain. Upper gastrointestinal endoscopy showed a large ulcerated tumor located from the cardia to the anterior wall of the upper gastric body. Histopathological examination showed it was moderately differentiated adenocarcinoma. Computed tomography (CT) scan image showed a large bulging mass with internal ulcer at the lesser curvature wall, left gastric artery and coeliac trunk were surrounded by fused lymph nodes.

Diagnoses:

Based on the histopathological examination and imaging findings, patient was diagnosed advanced gastric cancer and hardly to resect radically.

Intervention:

Oral chemotherapy combined with trans-arterial chemotherapy and embolization (TACE) was initiated. Eight weeks after initial therapy, radical laparoscopy-assisted total gastrectomy with D2 lymph node dissection and Roux-en-Y anastomosis were performed successfully.

Outcomes:

Patient was discharged on postoperative day 11 without complications. Histological analysis of the specimen and resected 31 lymph nodes revealed no malignancy. The patient experienced a pathological complete response (pCR).

Lessons:

In this case, oral chemotherapy combined with TACE which was rarely reported in the treatment of unresectable gastric cancer achieves a great therapeutic benefit. Although further clinical studies will be needed to establish, it may be a potent strategy for degrading stage and supplying a new chance for surgery.
Ologen implant versus mitomycin-C for trabeculectomy
Authors: Song De-Sheng , Qian Jing , Chen Zhi-Jun
Published: June 2019

Aim:

To evaluate the efficacy and safety of trabeculectomy (Trab) with mitomycin-C (MMC) versus Trab with implant.

Methods:

Studies published in different languages were retrieved by systematically searching Embase, PubMed, Cochrane library, China Biology Medicine disc, and Google Scholar from 1966 to April 2018, as well as manually examining the references of the original articles. The outcome measures of efficacy covered intraocular pressure, glaucoma medications reductions, and success rate. Safety evaluation was measured by relative ratio of complications.

Results:

A total of 11 studies involving 443 participants were covered in this meta-analysis. The weighted mean difference (WMD) in the percentage of intraocular pressure (IOP) reduction (IOPR%) comparing Ologen group with MMC group was −3.69 (95% CI: −6.70 to −0.68) at 1 month, −2.69 (−5.17 to −0.21) at 3 months, −3.67 (−6.09 to −1.25)at 6 months, −3.24 (−6.08 to −0.41) at 12 months, 1.24 (−9.43 to 11.90) at 24 months, and 1.10 (−10.11 to 12.31) at 60 months, which showed that there was statistically significant difference at 1,3, 6, and12 months after the surgery. A significantly higher incidence of postsurgery hypotony (0.64 (95% Cl: 0.42 to 0.98)) and suture lysis (0.30 (95% CI: 0.10–0.93)) was observed in MMC group. However, there was no significant difference in the reduction in glaucoma medications, success rate, and incidence of other complications.

Trab with 0.2 mg/mL MMC presented higher rates of complete success compared with Trab with 0.4 mg/mL MMC (P = .01).

Conclusion:

Trab with MMC was associated with a higher IOP-lowering efficacy and a higher incidence of postsurgery hypotony and suture lysis in contrast to that of Trab with Ologen.