bluuebunny/crossref_metadata_2025 huggingface dataset:
DIII-D research towards establishing the scientific basis for future fusion reactors
Authors: Petty C.C.
Published: January 2019

DIII-D research is addressing critical challenges in preparation for ITER and the next generation of fusion devices through focusing on plasma physics fundamentals that underpin key fusion goals, understanding the interaction of disparate core and boundary plasma physics, and developing integrated scenarios for achieving high performance fusion regimes. Fundamental investigations into fusion energy science find that anomalous dissipation of runaway electrons (RE) that arise following a disruption is likely due to interactions with RE-driven kinetic instabilities, some of which have been directly observed, opening a new avenue for RE energy dissipation using naturally excited waves. Dimensionless parameter scaling of intrinsic rotation and gyrokinetic simulations give a predicted ITER rotation profile with significant turbulence stabilization. Coherence imaging spectroscopy confirms near sonic flow throughout the divertor towards the target, which may account for the convection-dominated parallel heat flux. Core-boundary integration studies show that the small angle slot divertor achieves detachment at lower density and extends plasma cooling across the divertor target plate, which is essential for controlling heat flux and erosion. The Super H-mode regime has been extended to high plasma current (2.0 MA) and density to achieve very high pedestal pressures (~30 kPa) and stored energy (3.2 MJ) with H
98y2  ≈  1.6–2.4. In scenario work, the ITER baseline Q  =  10 scenario with zero injected torque is found to have a fusion gain metric

independent of current between q
95  =  2.8–3.7, and a lower limit of pedestal rotation for RMP ELM suppression has been found. In the wide pedestal QH-mode regime that exhibits improved performance and no ELMs, the start-up counter torque has been eliminated so that the entire discharge uses  ≈0 injected torque and the operating space is more ITER-relevant. Finally, the high-

(⩽3.8) hybrid scenario has been extended to the high-density levels necessary for radiating divertor operation, achieving ~40% divertor heat flux reduction using either argon or neon with P
tot up to 15 MW.
Neurostimulation Reveals Context-Dependent Arbitration Between Model-Based and Model-Free Reinforcement Learning
Authors: Weissengruber Sebastian , Lee Sang Wan , O’Doherty John P , Ruff Christian C
Published: January 2019

While it is established that humans use model-based (MB) and model-free (MF) reinforcement learning in a complementary fashion, much less is known about how the brain determines which of these systems should control behavior at any given moment. Here we provide causal evidence for a neural mechanism that acts as a context-dependent arbitrator between both systems. We applied excitatory and inhibitory transcranial direct current stimulation over a region of the left ventrolateral prefrontal cortex previously found to encode the reliability of both learning systems. The opposing neural interventions resulted in a bidirectional shift of control between MB and MF learning. Stimulation also affected the sensitivity of the arbitration mechanism itself, as it changed how often subjects switched between the dominant system over time. Both of these effects depended on varying task contexts that either favored MB or MF control, indicating that this arbitration mechanism is not context-invariant but flexibly incorporates information about current environmental demands.
Distinct Structure of Cortical Population Activity on Fast and Infraslow Timescales
Authors: Okun Michael , Steinmetz Nicholas A , Lak Armin , Dervinis Martynas , Harris Kenneth D
Published: January 2019

Cortical activity is organized across multiple spatial and temporal scales. Most research on the dynamics of neuronal spiking is concerned with timescales of 1 ms–1 s, and little is known about spiking dynamics on timescales of tens of seconds and minutes. Here, we used frequency domain analyses to study the structure of individual neurons’ spiking activity and its coupling to local population rate and to arousal level across 0.01–100 Hz frequency range. In mouse medial prefrontal cortex, the spiking dynamics of individual neurons could be quantitatively captured by a combination of interspike interval and firing rate power spectrum distributions. The relative strength of coherence with local population often differed across timescales: a neuron strongly coupled to population rate on fast timescales could be weakly coupled on slow timescales, and vice versa. On slow but not fast timescales, a substantial proportion of neurons showed firing anticorrelated with the population. Infraslow firing rate changes were largely determined by arousal rather than by local factors, which could explain the timescale dependence of individual neurons’ population coupling strength. These observations demonstrate how neurons simultaneously partake in fast local dynamics, and slow brain-wide dynamics, extending our understanding of infraslow cortical activity beyond the mesoscale resolution of fMRI.
Improving Dietary Protein Quality Reduces the Negative Effects of Physical Inactivity on Body Composition and Muscle Function
Authors: Arentson-Lantz Emily J , Galvan Elfego , Ellison Jennifer , Wacher Adam , Paddon-Jones Douglas
Published: January 2019

Background

Brief periods of physical inactivity can compromise muscle health. Increasing dietary protein intake is potentially beneficial but complicated by difficulties reconciling anabolic potential with a realistic food volume and energy intake. We sought to determine whether increasing dietary protein quality could reduce the negative effects of physical inactivity.

Methods

Twenty healthy, older men and women completed 7 days of bed rest followed by 5 days of rehabilitation. Volunteers consumed a mixed macronutrient diet (MIXED: N = 10; 68 ± 2 years; 1,722 ± 29 kcal/day; 0.97 ± 0.01 g protein/kg/day) or an isoenergetic, whey-augmented, higher protein quality diet (WHEY: N = 10; 69 ± 1 years; 1,706 ± 23 kcal/day; 0.90 ± 0.01 g protein/kg/day). Outcomes included body composition, blood glucose, insulin, and a battery of physical function tests.

Results

During bed rest, both groups experienced a 20% reduction in knee extension peak torque (p < .05). The WHEY diet partially protected leg lean mass (−1,035 vs. −680 ± 138 g, MIXED vs. WHEY; p = .08) and contributed to a greater loss of body fat (−90 vs. −233 ± 152 g, MIXED vs. WHEY; p < .05). Following rehabilitation, knee extension peak torque in the WHEY group fully recovered (−10.0 vs. 2.2 ± 4.1 Nm, MIXED vs. WHEY; p = .05). Blood glucose, insulin, aerobic capacity, and Short Physical Performance Battery (SPPB) changes were similar in both dietary conditions (p > .05).

Conclusions

Improving protein quality without increasing total energy intake has the potential to partially counter some of the negative effects of bed rest in older adults.
Bone Dysplasias
Authors: Spranger Jürgen W. , Brill Paula W. , Hall Christine , Nishimura Gen , Superti-Furga Andrea , Unger Sheila
Published: January 2019

This is a unique atlas presenting age-related radiographs on more than 250 rare constitutional skeletal diseases (dysplasias, dysostoses, osteolyses, disorders of bone density, and more) focusing on diagnostically essential radiographic and clinical features. Each chapter is supplemented with prognostic and therapeutic information, a guide to differential diagnoses, and a short list of the most relevant publications. A major advantage is the systematic conformation of chapters, sparing the reader a cumbersome read-through of longer text. Presentation in accordance with the most recent International Nosology and Classification of Genetic Skeletal Disorders.
Acute Ischemic Stroke
Authors: Kenmuir Cynthia L. , Jovin Tudor G.
Published: January 2019

Ischemic stroke accounts for 87% of all strokes and remains a leading cause of death and disability in the United States. Early evaluation and management is critical for good outcomes. The neurocritical care team may be the first responders to in-hospital strokes and will become involved in the management of more complicated issues involved in stroke care. As such, this chapter is split into two sections: the first focuses on acute treatment of acute ischemic strokes (AIS) and the second discusses intensive care unit management of AIS.
Anoxic Brain Injury
Authors: Elmer Jonathan , Rittenberger Jon C.
Published: January 2019

Cardiac arrest is common and deadly. Fortunately, with advances in care, short- and long-term outcomes of those resuscitated after cardiac arrest are steadily improving. Initial management focuses on general critical care support of multisystem organ dysfunction and diagnostic workup to identify the etiology of cardiac arrest. Thereafter, provision of a comprehensive bundle of care including active temperature management, coronary revascularization, delayed multimodal neurological prognostication, and best practice neurocritical care can result in a substantial proportion of patients experiencing favorable recovery despite patterns of injury once thought to be incompatible with survival.
Neuroimaging and Neurointerventional Procedures
Authors: Kenmuir Cynthia L. , Jadhav Ashutosh P.
Published: January 2019

Neuroimaging is a powerful accessory to the clinical exam in evaluating patients presenting with acute neurological injury. Judicious use of various techniques facilitates both diagnosis and prognosis. Interventional neurology serves to both clarify areas of diagnostic uncertainty in the case of vascular disease as well as provide therapeutic access for endovascular treatment. Together diagnostic neuroimaging and interventional neurology are commonly used tools in the diagnosis and management of critically ill patients. This chapter is divided in two parts addressing: (a) the imaging indications and findings associated with various disease states and (b) procedural considerations in patients undergoing catheter neuroangiography.
Neuropharmacotherapy
Authors: Brophy Gretchen M. , Human Theresa
Published: January 2019

In the neurologically injured patient, it is extremely important to optimize and individualize pharmacotherapeutic strategies to improve patient outcomes. Therefore, understanding the pharmacology, pharmacokinetics, and pharmacodynamics of medications used in neurocritical care patients, as well as the impact of the acute illness and comorbid states on these characteristics, is essential. This chapter provides practical information on medications and treatment strategies commonly used in patients with neurological injuries, including recommendations to optimize therapeutic strategies and avoid unwanted adverse effects and drug interactions. Specific medications and treatment strategies discussed include hyperosmolar therapy with mannitol and hypertonic saline for management of intracranial pressure, anticonvulsant treatments for status epilepticus and refractory status epilepticus, reversal strategies for oral anticoagulant agents, , shivering control agents for use during therapeutic temperature management and induced hypothermia, and vasoactive therapies to maintain hemodynamic control. The pharmacology, pharmacokinetic and pharmacodynamic characteristics, and clinical pearls of these commonly used treatments in neurocritical care patients will also be highlighted.
Neurocritical Care in Pregnancy
Authors: Shafer Krystle , Baldisseri Marie R.
Published: January 2019

Pregnancy results in physiologic changes that bring added stress to the body. Changes in cardiovascular hemodynamics, respiratory physiology, coagulation profile, hormonal concentrations, and endothelial function can result in the perfect storm for cerebrovascular dysfunction. Cerebrovascular disorders of pregnancy can be grossly simplified to disorders that arise from thrombosis, hemorrhage, and/or hypertension. Care of these patients become more complex when considering the effects of therapy on the fetus. The age of the fetus comes into play as well as pharmacologic agents that cross the placenta and may potentially harm the fetus. Ultimately, the priority for the clinician is to provide life-saving care to the patient even if it is at the expense of the fetus. In rare cases where despite best medical management practices the patient develops brain death or is vegetative, the decision to continue life support to allow further development of the fetus becomes an ethically complex situation.
Low mutation burden and frequent loss of CDKN2A/B and SMARCA2, but not PRC2, define premalignant neurofibromatosis type 1–associated atypical neurofibromas
Authors: Pemov Alexander , Hansen Nancy F , Sindiri Sivasish , Patidar Rajesh , Higham Christine S , Dombi Eva , Miettinen Markku M , Fetsch Patricia , Brems Hilde , Chandrasekharappa Settara C , Jones Kristine , Zhu Bin , Wei Jun S ,   National Intramural Sequencing Center (NISC) Comparative Sequencing Program,   National Cancer Institute (NCI) Division of Cancer Epidemiology and Genetics (DCEG) Cancer Genomics Research Laboratory, Mullikin James C , Wallace Margaret R , Khan Javed , Legius Eric , Widemann Brigitte C , Stewart Douglas R
Published: January 2019

Background

Neurofibromatosis type 1 (NF1) is a tumor-predisposition disorder caused by germline mutations in NF1. NF1 patients have an 8–16% lifetime risk of developing a malignant peripheral nerve sheath tumor (MPNST), a highly aggressive soft-tissue sarcoma, often arising from preexisting benign plexiform neurofibromas (PNs) and atypical neurofibromas (ANFs). ANFs are distinct from both PN and MPNST, representing an intermediate step in malignant transformation.

Methods

In the first comprehensive genomic analysis of ANF originating from multiple patients, we performed tumor/normal whole-exome sequencing (WES) of 16 ANFs. In addition, we conducted WES of 3 MPNSTs, copy-number meta-analysis of 26 ANFs and 28 MPNSTs, and whole transcriptome sequencing analysis of 5 ANFs and 5 MPNSTs.

Results

We identified a low number of mutations (median 1, range 0–5) in the exomes of ANFs (only NF1 somatic mutations were recurrent), and frequent deletions of CDKN2A/B (69%) and SMARCA2 (42%). We determined that polycomb repressor complex 2 (PRC2) genes EED and SUZ12 were frequently mutated, deleted, or downregulated in MPNSTs but not in ANFs. Our pilot gene expression study revealed upregulated NRAS, MDM2, CCND1/2/3, and CDK4/6 in ANFs and MPNSTs, and overexpression of EZH2 in MPNSTs only.

Conclusions

The PN-ANF transition is primarily driven by the deletion of CDKN2A/B. Further progression from ANF to MPNST likely involves broad chromosomal rearrangements and frequent inactivation of the PRC2 genes, loss of the DNA repair genes, and copy-number increase of signal transduction and cell-cycle and pluripotency self-renewal genes.
Free Primary Education, Timing of Fertility, and Total Fertility
Authors: Zenebe Gebre Tihtina
Published: January 2019

This study employs a difference-in-differences estimation strategy to study the causal impacts of free primary education (FPE) on women’s schooling and fertility-related outcomes using the 1990s FPE reform of Malawi. The results show that full exposure to FPE at the mean value of the reform’s potential impact led to an 18.5 percentage points increase in the probability of ever enrolling in school and 1.2 years of additional schooling. Furthermore, the reduced form estimates suggest that full exposure to FPE increased age at first marriage and at first childbirth by almost 0.79 and 0.98 years respectively. The study also finds statistically significant reductions at all ages between age 14 and 24 in the total number of children to which women give birth. By age 24, for example, full exposure to FPE at the mean value of the reform’s potential impact led to 0.28 fewer children. In addition, there is evidence showing that exposure to FPE led to increased spacing between the first two births (about six additional months) if the first child is female. The study explores several channels through which FPE may affect fertility-related outcomes. Postponement of marriage and first childbirth, increased contraceptive use, and changes in mate characteristics all play a role.
Dicarboxylate Transporters ofAzospirillum brasilenseSp7 Play an Important Role in the Colonization of Finger Millet (Eleusine coracana) Roots
Authors: Singh Vijay Shankar , Tripathi Prajna , Pandey Parul , Singh Durgesh Narain , Dubey Basant Kumar , Singh Chhaya , Singh Surendra Pratap , Pandey Rachana , Tripathi Anil Kumar
Published: January 2019

Azospirillum brasilense is a plant growth–promoting bacterium that colonizes the roots of a large number of plants, including C3 and C4 grasses. Malate has been used as a preferred source of carbon for the enrichment and isolation Azospirillum spp., but the genes involved in their transport and utilization are not yet characterized. In this study, we investigated the role of the two types of dicarboxylate transporters (DctP and DctA) of A. brasilense in their ability to colonize and promote growth of the roots of a C4 grass. We found that DctP protein was distinctly upregulated in A. brasilense grown with malate as sole carbon source. Inactivation of dctP in A. brasilense led to a drastic reduction in its ability to grow on dicarboxylates and form cell aggregates. Inactivation of dctA, however, showed a marginal reduction in growth and flocculation. The growth and nitrogen fixation of a dctP and dctA double mutant of A. brasilense were severely compromised. We have shown here that DctPQM and DctA transporters play a major and a minor role in the transport of C4-dicarboxylates in A. brasilense, respectively. Studies on inoculation of the seedlings of a C4 grass, Eleusine corcana, with A. brasilense and its dicarboxylate transport mutants revealed that dicarboxylate transporters are required by A. brasilense for an efficient colonization of plant roots and their growth.
Pilot Trial of a Combined Cognitive Processing Therapy and Smoking Cessation Treatment
Authors: Dedert Eric A. , Resick Patricia A. , Dennis Paul A. , Wilson Sarah M. , Moore Scott D. , Beckham Jean C.
Published: January 2019

Objective/Background:

Posttraumatic stress disorder (PTSD) and smoking are often comorbid. Combining PTSD and smoking cessation treatments could increase access to each treatment and could provide improved rates of smoking cessation through reductions in PTSD and depressive symptoms.

Participants:

Participants were veterans with current PTSD who smoked cigarettes and were willing to initiate treatment for both problems.

Method:

We conducted a randomized pilot trial (n = 40) to explore feasibility and estimate effect sizes of a treatment combining trauma-focused Cognitive Processing Therapy (CPT) with smoking cessation counseling and pharmacotherapy, relative to the same smoking cessation treatment without CPT.

Results:

Rates of bioverified 7-day point prevalence smoking abstinence at the end of treatment or at 6-month follow-up were similar across treatments. Relative to the comparison, the combined CPT and smoking cessation treatment were associated with moderate-to-large effect sizes at end of treatment for reductions in PTSD symptoms, Cohen's d = 0.718, 95% confidence interval (CI) = 0.078–1.358, that decreased by the 6-month follow-up, Cohen's d = 0.306, 95% CI = −0.334 to 0.946; and large reductions in depressive symptoms that were maintained to the 6-month follow-up, Cohen's d = 1.007, 95% CI = 0.367–1.647.

Conclusions:

This pilot trial did not detect a difference in smoking cessation when combining CPT to smoking cessation treatment, relative to smoking cessation treatment without CPT. However, results suggest that combining CPT and smoking cessation treatment was associated with both reductions of psychiatric symptoms along with smoking abstinence rates similar to previous smoking cessation trials in veterans with PTSD.
Supplemental Superior Buttress Plating for the Treatment of Posterosuperior Wall Acetabulum Fractures
Authors: Askam Brad , Sims Stephen
Published: January 2019

Posterosuperior wall acetabulum fractures are a unique and uncommon fracture pattern. Traditional plate fixation may not provide adequate fixation of these fracture fragments. This article presents a surgical technique and the results of a case series using a supplemental 1/3 tubular superior buttress plate to improve fracture reduction and better neutralize shear forces in the treatment of superior posterior wall fractures. Additionally, we compared failure rates of those posterior superior wall acetabular fractures treated with supplemental superior buttress plates to those treated with standard plate fixation and no supplemental superior buttress plates.
Improved Intraoperative Fluoroscopy for Pelvic and Acetabular Surgery
Authors: Routt Milton Lee (Chip) , Gary Joshua L. , Kellam James F. , Burgess Andrew R.
Published: January 2019

Over the past 3 decades, the evolution of pelvic and acetabular surgery has been supported by the advances in intraoperative pelvic fluoroscopic imaging technology. The new Ziehm RFD 3D C-arm unit provides routine fluoroscopic pelvic imaging but also offers rapid and high-quality real-time axial, sagittal, and coronal intraoperative imaging. This technology allows the surgeon to accurately assess fracture reduction, loose body removal, and implant locations while the patient is still under anesthesia. In this way, any necessary corrections can be performed before the patient leaves the operating room. Essentially, this technology should eliminate the need for revision surgeries. In this report, we present our initial experience using this new device.
Does Routine Postoperative Computerized Tomography After Acetabular Fracture Fixation Affect Management?
Authors: Elnahal Walid A. , Ward Anthony J. , Acharya Mehool R. , Chesser Timothy J. S.
Published: January 2019

Introduction and Aims:

The use of routine postoperative computerized tomography (CT) scan after acetabular fracture reconstruction remains controversial. CT scan may provide more accurate detail regarding metalwork position, retained intra-articular fragments, and quality of reduction but does expose the patient to additional radiation dosage and incurs increased cost. The aim of this study was to evaluate a protocol of routine postoperative CT scan for all acetabular fractures after surgical fixation and assess the effect this has on patient management.

Patients and Methods:

The perioperative fluoroscopic images and postoperative plain radiographs of 122 patients who underwent surgical stabilization of a displaced acetabular fracture were reviewed and categorized into 3 groups: (1) safe, when there was no suspicion of metalwork malposition or intra-articular fragments; (2) inconclusive, when it was not possible to exclude malposition; or (3) definite malposition or intra-articular penetration of implants. The findings were compared with postoperative CT scans. The quality of reduction of the acetabular fracture was graded on plain radiographs using the Matta criteria and compared with the CT scan using a standardized technique.

Results:

Fractures that were categorized as safe on plain radiographs were confirmed to have no metalwork malposition on CT scan in 94% of the cases, with the other 6% having insignificant findings that did not require revision surgery. When plain radiographs were inconclusive (n = 17), 4 patients had metalwork malposition documented on CT scan and 2 of these required revision surgery. There was an increased risk of implant malposition with use of spring plates for posterior wall stabilization. There was significant variation between the quality of reduction when assessed with plain radiographs as compared with CT scans (P < 0.001). In 42% of the patients who were thought to have anatomic reduction on plain radiographic assessment, the reduction was either imperfect or poor based on CT assessment.

Conclusions:

CT scans were more accurate than plain radiographs in detecting metalwork malposition and in assessing quality of reduction of the acetabular fracture. The use of postoperative CT scans may be restricted to a group of fractures that have inconclusive or definite malpositioning of implants on perioperative or postoperative radiographs, especially with use of spring pates or to those patients in whom quality of reduction needs more accurate assessment for quality assurance or prognostic reasons.

Level of Evidence:

Level IV; Diagnostic -Investigating a diagnostic test.
Anterior Intrapelvic Approaches: Fracture Patterns You May Want to Reconsider
Authors: Morellato John , Hogue Matthew , O'Toole Robert V. , Sciadini Marcus F. , Nascone Jason
Published: January 2019

The anterior intrapelvic approach with a lateral window is gaining popularity for the surgical treatment of anterior fracture patterns of the acetabulum. Certain fracture patterns and characteristics present challenges when using anterior approaches. This article aims to describe some of the fracture patterns that may be particularly difficult to address using the anterior intrapelvic approach with or without the lateral window.
Efficacy, Pharmacokinetics, and Immunogenicity is Not Affected by Switching From Infliximab Originator to a Biosimilar in Pediatric Patients With Inflammatory Bowel Disease
Authors: van Hoeve Karen , Dreesen Erwin , Hoffman Ilse , Van Assche Gert , Ferrante Marc , Gils Ann , Vermeire Séverine
Published: January 2019

Background:

Rising evidence demonstrates that there are no differences in efficacy and safety between infliximab (IFX) originator and IFX biosimilar CT-P13 in the treatment of inflammatory bowel diseases (IBDs). However, most data are derived from adult patients, and data on pharmacokinetics are limited. The authors evaluated long-term IFX trough levels, immunogenicity, and remission rates in children with IBD who switched from IFX originator to biosimilar CT-P13.

Methods:

In this single-center study, all children with Crohn disease and ulcerative colitis receiving maintenance IFX therapy were switched from originator to biosimilar CT-P13. Demographics, disease activity indices, and IFX drug levels were collected from 6 months before (baseline) till 6 months after switching to CT-P13. All data are presented as median (interquartile range).

Results:

A total of 42 children (26 Crohn disease and 16 ulcerative colitis), with a median duration on IFX originator of 13.5 (6.8–35.5) months before switching to CT-P13, were included. No significant changes in IFX trough levels occurred after switching. The median baseline IFX trough level was 5.7 mcg/mL (3.8–9.3) versus 6.5 mcg/mL (3.9–8.6) at month 6 after switching (P = 0.900). Antibodies to IFX appeared in one patient after switching. The proportion of patients in clinical and/or biological remission did not significantly change after switching (all P > 0.05). No significant changes were observed in C-reactive protein, erythrocyte sedimentation rate, albumin, weight, and body mass index after the switch. Safety profile was also comparable.

Conclusions:

Pediatric patients with IBD on IFX originator can be successfully switched during maintenance to biosimilar CT-P13 without affecting efficacy, pharmacokinetics, immunogenicity, or safety.
Measuring Unbound Versus Total Piperacillin Concentrations in Plasma of Critically Ill Patients: Methodological Issues and Relevance
Authors: Colman Sofie , Stove Veronique , De Waele Jan J. , Verstraete Alain G.
Published: January 2019

Background:

Piperacillin is considered a moderately protein-bound antibiotic (20%–40%), with albumin being an important binding protein. Although infrequently used in practice, different methods to measure the fraction unbound (fu) are available, but uncertainty remains as to what the most appropriate method is. The main goal of this study was to estimate the impact of the methodology used to measure unbound piperacillin in plasma on the fu of piperacillin; we compared ultrafiltration (UF) at 4°C and 37°C with the reference method, equilibrium dialysis. In addition, we analyzed the impact of other proteins on the fu.

Methods:

Anonymized left-over Li-heparin plasma samples (n = 41) from 30 critically ill patients who were treated with piperacillin were used for the analyses.

Results:

We found that the piperacillin fu, determined by UF, is on average 8% higher at 37°C (91%) than at 4°C (83%). There were no systematic or proportional differences between UF at 4°C and equilibrium dialysis at 4°C. This emphasizes the importance of the temperature during UF, which should therefore be clearly stated in publications that report on the methodology of UF. No significant impact of the albumin-, IgA-, total protein-, or α1-acid glycoprotein concentration on the fu was found. The fu found in this study was higher than the generally assumed fu value of 60%–80%. A possible explanation lies in the studied population or in the temperature used. Based on our results, routine monitoring of unbound piperacillin in intensive care unit patients is not recommended.

Conclusions:

Based on the prediction model, we can state that in intensive care patients the fu of piperacillin is 91% (SD 7%), determined with UF at 37°C.
Lung and Heart Injury in a Nonhuman Primate Model of Partial-body Irradiation with Minimal Bone Marrow Sparing: Histopathological Evidence of Lung and Heart Injury
Authors: Parker George A. , Li Na , Takayama Kyle , Farese Ann M. , MacVittie Thomas J.
Published: January 2019

Male rhesus macaques were subjected to partial-body irradiation at 10, 11, or 12 Gy with 5% bone marrow protection. Animals were euthanized when dictated by prospectively determined clinical parameters or at approximately 180 d following irradiation. Histological sections of lung and heart were stained with hematoxylin and eosin as well as a battery of histochemical and immunohistochemical stains. Histopathological alterations in the lung were centered on fibrosis, inflammation, and reactive/proliferative changes in pneumocytes. These changes were noted in animals necropsied after approximately 85–100 d postirradiation and extending through the observation period. Interstitial and pleural fibrosis demonstrated by Masson’s trichrome staining were associated with increased alpha smooth muscle actin and collagen 1 immunohistochemical staining. Areas of interstitial fibrosis had reduced microvascular density with CD31 immunohistochemical staining. Accumulations of CD163- and CD206-positive alveolar macrophages were present in areas of interstitial fibrosis. Unidentified cells termed “myxoid” cells in alveolar walls had histochemical and immunohistochemical staining characteristics of epithelial-, endothelial-, or pericyte-mesenchymal transition states that were developing myofibroblast features. Distinctive focal or multifocal alveolar-bronchiolar hyperplasia had microscopic features of preneoplastic proliferation. Delayed radiation-associated changes in the heart consisted primarily of myocardial fibrosis, with rare histological evidence of myofiber degeneration.
Physical Therapist Determination of Discharge Disposition in the Acute Care Setting
Authors: Shoemaker Michael J. , Gutowski Amanda , Mallgren Megan , Oliver Laura , Van Dam Ashley , McLeod Jessica , Mohney Emily
Published: January 2019

Purpose:

The purpose of this retrospective chart review study was to determine whether physical therapists (PTs) were accurate in determining home discharge (DC) disposition as measured by all cause- and mobility-related readmissions and to examine the extent to which predictors of readmission are associated with PT DC disposition decision making.

Methods:

A retrospective medical record review was completed for 322 patients with at least 1 PT visit who were discharged to home from a large tertiary care teaching hospital. Demographic and clinical data were collected. Multivariate binary logistic regression was used to determine predictors of readmission and PT DC recommendations for location, social support, and post–acute PT services.

Results:

Only 2 of 287 (0.70%) patients recommended for home DC by PT were readmitted and 4 of the 287 (1.39%) returned to the emergency department for mobility-related problems. Having 24-hour social support available upon DC was the only significant predictor of all 3 PT DC recommendations; otherwise, no extensive overlap of predictors was found among the regression models.

Conclusions:

The results of the present study affirm the accuracy of PT determination of safe DC to home, and although no extensive overlap of the predictors of readmission and PT decision making was found, the relationships among the various predictors are hypothesis-generating as to the way in which PT decision making might help reduce non–mobility-related readmissions.
Challenges and obstacles in the transition process through the eyes of the gastroenterologist
Authors: Hald Mette , Carlsen Katrine , Nordgaard-Lassen Inge , Wewer Vibeke
Published: January 2019

Background

Adult and pediatric care have different views and ways of handling the patients and the parents, which may result in insufficient coordination and communication of transfer. The young patient, the parents, the pediatric, and the adult provider constitute four central actors in transition and transfer, and they have different roles, approaches, and needs. Our aim was to clarify the challenges and background for each actor.

Materials and methods

Statements from semistructured interviews of adult gastroenterologists and nurses were analyzed and interpreted by social scientific principles. The interviews were conducted individually, and each interview was completed within 30 min. The interviews were taped, transcribed, and sent to the interviewees for approval.

Results

The analysis of the statements included a description of the motives, perspectives, and approaches of the interviewees as well as an exploration and interpretation of the underlying meaning, patterns, and models. The main points of the article are illustrated through excerpts from the interviews and concluded in the recommendations.

Conclusion

(I) Pediatricians and adult gastroenterologist need to rethink their view on patients aged 15–20 years and understand that they are different from other patients and do have different demands. (II) Transfer should be considered a three-part process: (a) transition at the pediatric department, (b) a coordinated transfer, and (c) a consolidation phase after transfer. (III) Adolescent patients need proper education and empowerment during transition. (IV) Parents need to be timely prepared including an adjustment and redefinition of their roles.
Effectiveness of 8-week sofosbuvir/ledipasvir in the adolescent chronic hepatitis C-infected patients
Authors: El-Khayat Hesham , Kamal Enas M. , Yakoot Mostafa , Gawad Manal A. , Kamal Naglaa , El Shabrawi Mortada , Sameh Yehia , Haseeb Alaa , Fouad Yasser , Attia Dina
Published: January 2019

Background

The sustained virological response (SVR) rate for the 12-week sofosbuvir (SOF)/ledipasvir (LVD) treatment of adolescent genotype-4 patients is high. The aim of this study is to evaluate 8 versus 12-week treatment efficacy and safety in adolescent genotype-4 patients.

Patients and methods

In total, 157 chronic hepatitis C-infected adolescent patients (mean age 14±2 years, 62% males) were included in this study. All patients received a morning dose of SOF (400 mg)/LVD (90 mg) as a single tablet for 8 and 12 weeks. Laboratory and biochemical monitoring were performed at weeks 4 and 8, end of treatment (8/12) and 12 weeks after the end of treatment (SVR12).

Results

In total, SVR12 was 98% [95% confidence interval (CI): 96–100] for all treated patients. For patients treated for 12 weeks, SVR12 was 97.6% (95% CI: 96–101) (82/84 patients), and 98.6% (95% CI: 93–101) (72/73) patients for those treated for 8 weeks. For both regimens, no serious adverse effects, treatment discontinuation or cases of death were detected. The main adverse effects for the 8-week patient group were fatigue (2.8%), headache (1.4%), nausea (1.4%) and epigastric tenderness (1.4%). For the 12-week-treated group, adverse events were epigastric tenderness (1.2%), nausea (1.2%), diarrhoea (2.4%) and rash (2.4%). Three patients were lost to follow-up: two were in the 12-week treatment group and one was in the 8-week group. All of them reached end of treatment but were lost before SVR12. No relapsers were observed in either group.

Conclusion

Eight weeks of treatment of SOF/LVD combination is equally effective and safe as 12 weeks in adolescent genotype-4 patients.
A Retrospective Analysis of Antithrombin III Replacement Therapy for the Treatment of Hepatic Sinusoidal Obstruction Syndrome in Children Following Hematopoietic Stem Cell Transplantation
Authors: Kim Miriam , Rao Seema , Eickhoff Jens C. , DeSantes Kenneth B. , Capitini Christian M.
Published: January 2019

Hepatic sinusoidal obstruction syndrome (SOS) remains a serious complication of hematopoietic stem cell transplantation (HSCT). In this single institution retrospective case series, 18 children developed SOS after HSCT. Patients were treated with antithrombin III (ATIII), defibrotide, or ATIII followed by defibrotide. Twelve of 13 patients who were treated with ATIII therapy alone had complete resolution of SOS, including 4 of 5 children with severe SOS. In this limited cohort, ATIII was safe and successfully prevented progression of hepatic SOS following HSCT in the majority of children at our center.
Fostering Cross-Sector Partnerships
Authors: Holland Diane E. , Vanderboom Catherine E. , Harder Tanya M.
Published: January 2019

Purpose/Objectives:

The purpose of this study was to describe lessons learned during the development and implementation of a community care team (CCT) and the applicability of this model in movement toward cross-sector team-based care coordination.

Primary Practice Setting:

Primary care.

Findings/Conclusions:

Cross-sector CCTs composed of primary care and community service providers are a care coordination approach that attends to the individual's social determinants of health, enhances the individual's capacity to manage treatment and self-care demands of multiple chronic health conditions, improves the care experience, and impacts well-being. A collaborative CCT decreased the use of acute care services and the costs of care.

Implications for Case Management Practice:

As reported in this study, use of interprofessional collaborative health care teams in planning care and services for individuals is a standard of practice for case management. Cross-sector partnerships provide the opportunity to maximize the contributions of health care and community service providers that address both chronic health conditions and social determinants of health, minimize fragmentation and costs of care, and promote collaborative care coordination. Community care teams offer sophisticated care coordination not otherwise available to medically complex high-need individuals who require assistance in navigating the medical and financial systems that exist in health care today.
Molecular Testing for EGFR Mutations and ALK Rearrangements in the Cytological Specimens From the Patients With Non–Small Cell Lung Cancer
Authors: Wang Xiaoyan , Chen Shaoxiong , Emerson Robert E. , Wu Howard H. , Cramer Harvey M. , Curless Kendra , Chang Hsim Yee , Zhang Shaobo , Randolph Melissa L. , Cheng Liang
Published: January 2019

Objective:

The aim of this study was to investigate epidermal growth factor receptor (EGFR) gene mutations and anaplastic lymphoma kinase (ALK) gene rearrangements using cytological specimens from the patients with a diagnosis of primary or metastatic lung non–small cell carcinoma.

Materials and Methods:

A total 307 cases were submitted for EGFR mutational analysis and 265 cases for ALK analysis. The cytological specimen sources included lung, lymph node, liver, bone, adrenal gland, mesentery mass, and body fluids/bronchial brushing. EGFR mutations in the exons 18 to 21 were analyzed with Qiagen EGFR Pyro Kits. Fluorescence in situ hybridization (FISH) studies for ALK rearrangement inv(2)(p21; p23) were performed on the paraffin-embedded cell block sections utilizing dual-color Vysis LSI ALK Break Apart Probe Kit.

Results:

Among 307 fine needle aspirate cases for EGFR analysis, 302 cases (269 from cell blocks, 33 from direct smears) had sufficient material for EGFR test. Five cases failed due to inadequate cellularity. Twenty six of 302 (8.6%) cases were positive for EGFR mutations. A total of 265 cases submitted for ALK analysis included 240 cases of fine needle aspirate, 25 cases of pleural fluid/pericardial fluid/bronchial washings. Eight cases failed because of low cellularity, whereas 257 of 265 cases had sufficient material for ALK FISH study. Nine of 257 cases (3.5%) revealed ALK rearrangement by FISH.

Conclusions:

The current study demonstrates that cytological specimens can yield sufficient material for EGFR mutations and ALK rearrangement test. Our study reveals that 8.6% of EGFR mutation rate and 3.5% of ALK rearrangement rate in the cytology specimens from the patients with primary or metastatic lung non–small cell carcinoma.
Cranial Anchored Mandible Distraction Osteogenesis
Authors: Dong Elaine , Dempsey Robert F. , Wirthlin John O. , Buchanan Edward P.
Published: January 2019

Multiple or large distance mandibular distraction osteogenesis (MDO) in the older child is often complicated by iatrogenic temporomandibular joint (TMJ) pathology. The transmission of significant force to the TMJ in these particular patients is due to the greater distance of distraction required and the relative inelasticity of the soft tissue envelope. The authors present a clinical report of a successful asymmetrically vectored large distance MDO in a 13-year-old female with bilateral craniofacial microsomia with Goldenhar syndrome. During distraction, the TMJ joints were effectively unloaded from the forces of distraction using external bilateral cranial anchored devices (Cranio-Mandibular Fixator; KLS Martin, Jacksonville, FL). Angle's occlusion, facial angle, and evidence of TMJ pathology were assessed.
Systematic Review of Behavioral Therapy to Improve Swallowing Functions of Patients With Parkinson's Disease
Authors: Park Myung Sook , Choi Jin Yi , Song Young-Jin , Choi Heejung , Park Eun-Jun , Ji Eun Sun
Published: January 2019

Decreased swallowing function is a common and main cause of malnutrition and aspiration pneumonia in patients with Parkinson's disease. The aims of this systematic review were to summarize and qualitatively analyze the studies that have been published on behavioral therapies for improving swallowing functions in patients with Parkinson's disease. Studies published from January 2000 to December 2015 were identified via electronic database searches using Ovid-MEDLINE, Ovid-EMBASE, the Cochrane Library, and 8 Korean databases. Two reviewers independently evaluated the studies using inclusion criteria. Nine studies were included, of which 6 evaluated rehabilitation technique studies and 3 evaluated compensatory strategies. The 9 studies were evaluated qualitatively using a methodology checklist of the Scottish Intercollegiate Guideline Network, according to which all of the studies had acceptable quality. The available data on the effects of rehabilitation techniques and compensatory strategies remain insufficient. Further randomized controlled studies should be done to investigate the effect of behavioral therapy on improving swallowing functions in patients with Parkinson's disease.
Acute Posterior Multifocal Placoid Pigment Epitheliopathy Complicated by Fatal Cerebral Vasculitis
Authors: Maamari Robi N. , Stunkel Leanne , Kung Nathan H. , Ferguson Cole J. , Tanabe Jody , Schmidt Robert E. , Dahiya Sonika , Dhand Amar , Van Stavern Gregory P. , Rajagopal Rithwick , Harocopos George J.
Published: January 2019

A 21-year-old man experienced unilateral vision loss associated with multiple atrophic chorioretinal lesions. He was treated for a presumptive diagnosis of acute retinal necrosis, but his vision did not improve with antiviral therapy. Over the course of several weeks, his symptoms progressed to involve both eyes. The fellow eye showed characteristic yellow-white placoid lesions, prompting treatment with oral corticosteroids for acute posterior multifocal placoid pigment epitheliopathy (APMPPE). Despite high-dose therapy with prednisone 80 mg daily, the patient developed the acute onset of mental status changes within the next several days. Neuroimaging revealed multifocal large-vessel strokes associated with cerebral edema; these infarcts led to herniation and death. Postmortem histopathologic examination confirmed granulomatous inflammation in both ocular and cerebral vasculatures. Together with findings from multimodal imaging obtained throughout this patient's clinical course, our findings support the notion that granulomatous choroiditis is the mechanism of the ocular lesions seen in APMPPE. This granulomatous inflammation can also affect cerebral vessels, leading to strokes.
The CAUTI Prevention Tool Kit
Authors: Lawrence Kathleen G. , Bliss Donna Z. , Dailey Maureen , Trevellini Chenel , Pontieri-Lewis Vicky
Published: January 2019

In order to address the need for a tool to support hospital-based nurses in catheter-associated urinary tract infection (CAUTI) prevention, the American Nurses Association (ANA) was asked to convene a Technical Expert Panel of stakeholders in CAUTI prevention. The Technical Expert Panel was chaired by the ANA's Senior Policy Fellow, a certified wound, ostomy and continence (WOC) nurse. The panel comprised 23 representatives, including nurses from specialty practice organizations, nursing affiliated with the ANA, infection control specialists, patient safety authorities, award-winning hospitals using the National Database of Nursing Quality Indicators, and content experts. The Wound, Ostomy and Continence Nurses Society appointed 2 representatives to this panel, a key nurse researcher with expertise in this area of care and a former Society President. The CAUTI Prevention Tool Kit, combined with supplemental guidance documents developed, supports WOC nurses and Society members in achieving quality clinical outcomes for their patients.
The ecological roots of human susceptibility to social influence: a pre-registered study investigating the impact of early-life adversity
Authors: Jacquet Pierre O. , Safra Lou , Wyart Valentin , Baumard Nicolas , Chevallier Coralie
Published: January 2019

There is considerable variability in the degree to which individuals rely on their peers to make decisions. Although theoretical models predict that environmental risks shift the cost–benefit trade-off associated with social information use, this idea has received little empirical support. Here we aim to test the effect of childhood environmental adversity on humans' susceptibility to follow others’ opinion in the context of a standard face evaluation task. Results collected in a pilot study involving 121 adult participants tested online showed that susceptibility to social influence and childhood environmental adversity are positively associated. Computational analyses further confirmed that this effect is not explained by the fact that participants exposed to early adversity produce noisier decisions overall but that they are indeed more likely to follow the group's opinion. To test the robustness of these findings, a pre-registered direct replication using an optimal sample size was run. The results obtained from 262 participants in the pre-registered study did not reveal a significant association between childhood adversity and task performance but the meta-analysis ran on both the pilot and the pre-registered study replicated the initial finding. This work provides experimental evidence for an association between individuals' past ecology and their susceptibility to social influence.