bluuebunny/crossref_metadata_2025 huggingface dataset:
GaAsP/InGaP HBTs grown epitaxially on Si substrates: Effect of dislocation density on DC current gain
Authors: Heidelberger Christopher , Fitzgerald Eugene A.
Published: November 2017

Heterojunction bipolar transistors (HBTs) with GaAs0.825P0.175 bases and collectors and In0.40Ga0.60P emitters were integrated monolithically onto Si substrates. The HBT structures were grown epitaxially on Si via metalorganic chemical vapor deposition, using SiGe compositionally graded buffers to accommodate the lattice mismatch while maintaining threading dislocation density at an acceptable level (∼3 × 106 cm−2). GaAs0.825P0.175 is used as an active material instead of GaAs because of its higher bandgap (increased breakdown voltage) and closer lattice constant to Si. Misfit dislocation density in the active device layers, measured by electron-beam-induced current, was reduced by making iterative changes to the epitaxial structure. This optimized process culminated in a GaAs0.825P0.175/In0.40Ga0.60P HBT grown on Si with a DC current gain of 156. By considering the various GaAsP/InGaP HBTs grown on Si substrates alongside several control devices grown on GaAs substrates, a wide range of threading dislocation densities and misfit dislocation densities in the active layers could be correlated with HBT current gain. The effect of threading dislocations on current gain was moderated by the reduction in minority carrier lifetime in the base region, in agreement with existing models for GaAs light-emitting diodes and photovoltaic cells. Current gain was shown to be extremely sensitive to misfit dislocations in the active layers of the HBT—much more sensitive than to threading dislocations. We develop a model for this relationship where increased base current is mediated by Fermi level pinning near misfit dislocations.
Transient behavior between multi-cell flow states in ferrofluidic Taylor-Couette flow
Authors: Altmeyer Sebastian , Do Younghae , Ryu Soorok
Published: November 2017

We investigate transient behaviors induced by magnetic fields on the dynamics of the flow of a ferrofluid in the gap between two concentric, independently rotating cylinders. Without applying any magnetic fields, we uncover emergence of flow states constituted by a combination of a localized spiral state in the top and bottom of the annulus and different multi-cell flow states with toroidally closed vortices in the interior of the bulk. However, when a magnetic field is presented, we observe the transient behaviors between multi-cell states passing through two critical thresholds in a strength of an axial (transverse) magnetic field. Before the first critical threshold of a magnetic field strength, multi-stable states with different number of cells could be observed. After the first critical threshold, we find the transient behavior between the three- and two-cell flow states. For more strength of magnetic field or after the second critical threshold, we discover that multi-cell states are disappeared and a localized spiral state remains to be stimulated. The studied transient behavior could be understood by the investigation of various quantities including a modal kinetic energy, a mode amplitude of the radial velocity, wavenumber, angular momentum, and torque. In addition, the emergence of new flow states and the transient behavior between their states in ferrofluidic flows indicate that richer and potentially controllable dynamics through magnetic fields could be possible in ferrofluic flow.
Observations of diffusion-limited aggregation-like patterns by atmospheric plasma jet
Authors: Chiu Ching-Yang , Chu Hong-Yu
Published: November 2017

We report on the observations of diffusion-limited aggregation-like patterns during the thin film removal process by an atmospheric plasma jet. The fractal patterns are found to have various structures like dense branching and tree-like patterns. The determination of surface morphology reveals that the footprints of discharge bursts are not as random as expected. We propose a diffusion-limited aggregation model with a few extra requirements by analogy with the experimental results, and thereby present the beauty of nature. We show that the model simulates not only the shapes of the patterns similar to the experimental observations, but also the growing sequences of fluctuating, oscillatory, and zigzag traces.
Determination of stress components in 4H-SiC power devices via Raman spectroscopy
Authors: Sugie Ryuichi , Uchida Tomoyuki
Published: November 2017

The stress dependencies of the phonon modes in a 4H silicon carbide (SiC) crystal were investigated. The deformation potentials of the A1(TO), E2, and E1(TO) modes were determined on the basis of uniaxial stress tests. The A1(TO) mode was sensitive to stress along the c axis, whereas the E1(TO) and E2 modes exhibited larger dependencies on the stress perpendicular to the c axis than the A1(TO) mode as expected from their atomic displacements. The coefficient of the frequency shift in the E2 mode for an isotropic biaxial stress in the c plane was determined to be −323 MPa/cm−1. We applied cross-sectional Raman measurements to SiC metal-oxide-semiconductor field-effect transistors. The horizontal and vertical stress components, σ11 and σ33, were derived from the frequency shifts of the E2 and A1(TO) modes using the deformation-potential constants. A compressive horizontal stress was observed near the interface between the SiC chip and the metals. The observed compressive stress increased as the temperature decreased. The main cause for the compressive horizontal stress at low temperature is considered to be the difference in the coefficients of thermal expansion of the SiC chip and the metals. The results suggest that the temperature of the fabrication process is one of the key factors for achieving a reduction in the thermal stress in the SiC power devices.
Direct observation of magnetic domain evolution in the vicinity of Verwey transition in Fe3O4 thin films
Authors: Liu X. H. , Liu W. , Dai Z. M. , Li S. K. , Wang T. T. , Cui W. B. , Li D. , Komarek A. C. , Chang C. F. , Zhang Z. D.
Published: November 2017

We report a direct observation of magnetic domain evolution near the Verwey transition (TV) in Fe3O4 films. We found the stripe domains in the Fe3O4/Mg2TiO4 film while the irregular domains in the Fe3O4/MgO film and the similar characters of magnetic domains in the vicinity of TV for both samples: the bigger domain size and the higher contrast of the phase signal below TV and the more disordered domain images at TV. Remarkably, the magnetic behaviors can be well understood and the domain-wall energy and the demagnetizing energy can be calculated from the magnetic domains near TV in the Fe3O4/Mg2TiO4 film. Our work presents a demonstration of the low-temperature magnetic domains and gives a new perspective to understand the Verwey transition in Fe3O4 thin films.
Plasma fluid modeling of microwave streamers: Approximations and accuracy
Authors: Arcese Emanuele , Rogier François , Boeuf Jean-Pierre
Published: November 2017

Fluid models of microwave streamers at 110 GHz in atmospheric pressure air predict the formation of filamentary plasma patterns that show a good qualitative agreement with experiments. In order to perform more quantitative comparisons with experiments, in this paper, we study the consequences of different types of approximations that are generally used in the fluid models. We consider here the streamer dynamics before gas heating effects become important, i.e., the first few tens of ns after breakdown at atmospheric pressure. The influence on the results of the local effective field approximation vs. the local mean energy approximation is analyzed in detail. Other approximations that are related to the choice and method of calculation of electron transport parameters are also discussed. It is shown that the local effective field approximation is rather good for a large range of conditions of high frequency breakdown at atmospheric pressure in air while the results may be very sensitive to the choice of transport coefficients.
Observation of impact of eddy current on laser targets in a strong fast rising magnetic field
Authors: Ivanov V. V. , Swanson K. J. , Sarkisov G. S. , Maximov A. V. , Wiewior P. P. , Astanovitskiy A. L. , Nalajala V. , Chalyy O. , Dmitriev O. , Wong N. L.
Published: November 2017

Pulsed power generators are capable of producing strong magnetic fields. Foil laser targets for high intensity interactions with matter were characterized in a strong magnetic field produced by different types of loads. Longitudinal magnetic fields generated by coil loads were measured by Faraday rotation of the polarization plane of laser beams in a small glass sample at two wavelengths. Magnetic fields of 0.8–1.5 MG were measured in different coil loads at 1 MA current. For the first time, the impact of eddy current generated by the fast rising magnetic field with dB/dt = 109 T/s was observed in Al laser targets using shadowgraphy and interferometry. Material of the Al 10 μm foil target expanded from both sides at 0.1–0.2 mm. This effect was not observed in dielectric targets. The impact of eddy current on targets is important for designing experiments for laser plasma interactions in strong magnetic fields.
Symmetries of the gas dynamics equations using the differential form method
Authors: Ramsey Scott D. , Baty Roy S.
Published: November 2017

A brief review of the theory of exterior differential systems and isovector symmetry analysis methods is presented in the context of the one-dimensional inviscid compressible flow equations. These equations are formulated as an exterior differential system with equation of state (EOS) closure provided in terms of an adiabatic bulk modulus. The scaling symmetry generators—and corresponding EOS constraints—otherwise appearing in the existing literature are recovered through the application and invariance under Lie derivative dragging operations.
Three-dimensional blood vessel and velocity imaging visualizes occlusions
Authors: Tracy Samantha
Published: November 2017

Multipoint laser Doppler velocimetry provides three-dimensional in vivo observation of blood flow velocity and blood vessel position.
Identification of vulnerability within a child and family health service
Authors: Kimla Katarina , Nathanson Dania , Woolfenden Susan , Zwi Karen
Published: November 2017

Objective
The aims of the present study were to describe the prevalence of vulnerability in a cohort of newborns, identify the factors that increase the risk of vulnerability and examine whether those who are most vulnerable are receiving home visits.

Methods
A prospective cross-sectional study was performed using data collected from questionnaires completed by child and family health nurses and obstetric discharge summaries for each mother–baby dyad. Descriptive frequencies and percentages are used to describe the proportions of children who were vulnerable, offered services and had risk factors for vulnerability. Categorical data were compared using Pearson’s Chi-squared analysis.

Results
In all, 1517 newborns were included in the present study. Of these, 40.5% were identified as vulnerable and 13.9% had two or more risk factors for vulnerability (95% confidence interval (CI) 12–16%). The most common risk factors were biological. Across all newborns, 33.7% were visited at home, and 74.6% of vulnerable newborns were offered a home visit. Children identified as vulnerable were more likely to have a home visit than those who were not (z for 95% CI=1.96; P<0.1).

Conclusions
Although the high reported prevalence of identified risk needs to be confirmed in further studies, identifying vulnerability allowed the offer of home visiting to be directed towards those most likely to benefit.

What is known about the topic?
Of the Australian child population, 10–20% are vulnerable to adverse health, developmental and wellbeing outcomes. Vulnerable infants are at a greater risk of becoming vulnerable children, adolescents and adults over the life course. Biological and psychosocial risk factors for vulnerability are well described. Families with the greatest need are often the least likely to access or receive support, and have lower utilisation of preventative health services despite evidence that support in the first few years of life can significantly improve long-term outcomes.

What does this paper add?
This paper provides a detailed description of vulnerabilities in a cohort of newborns and demonstrates that it is possible to assign risk of vulnerability within existing child and family health services using tools that identify biological and psychosocial risk factors. Identification of vulnerability risk allows prioritisation of services to those with the greatest need.

What are the implications for practitioners?
It is possible to identify vulnerability risk within child and family health services. This allows those families at risk of future adverse health, developmental and wellbeing outcomes to be prioritised to receive health services and supports.
ΔNp63-mediated regulation of hyaluronic acid metabolism and signaling supports HNSCC tumorigenesis
Authors: Compagnone Mirco , Gatti Veronica , Presutti Dario , Ruberti Giovina , Fierro Claudia , Markert Elke Katrin , Vousden Karen H. , Zhou Huiqing , Mauriello Alessandro , Anemone Lucia , Bongiorno-Borbone Lucilla , Melino Gerry , Peschiaroli Angelo
Published: November 2017

Significance

The p63 isoform ΔNp63, a master regulator of epithelial biology, is overexpressed/amplified in the majority of head and neck squamous cell carcinoma (HNSCC), the sixth most common cancer worldwide. Here, we provide a demonstration of a molecular and functional link between the activity of ΔNp63 and hyaluronic acid (HA), a major component of the extracellular matrix. We unveiled a ΔNp63-dependent transcriptional program involving genes regulating the metabolism (HAS3 and HYAL proteins) and the signaling (CD44) of HA. By directly controlling the expression of these HA-related genes, ΔNp63 contributes to the activation of proproliferative and prosurvival pathway in HNSCC. Accordingly, the p63/HA pathway is a negative prognostic factor of HNSCC patient survival.
Measurement of residual stresses in dissimilar friction stir-welded aluminium and copper plates using the contour method
Authors: Zhang Chengcong , Shirzadi Amir A.
Published: November 2017

The longitudinal residual stresses in the friction stir-welded plates of 5A06 aluminium and pure copper were determined using the contour method. The results revealed the presence of high tensile and compressive residual stresses on the aluminium and copper sides, respectively. The residual stresses were detected on the weld zone as well as the thermo-mechanically affected zone (TMAZ) of the aluminium plate. In contrast, the compressive residual stresses in the copper plate had a much narrower width along the weld line. Peak tensile stresses up to 240 MPa were found in the TMAZ of the aluminium plate.
Extreme learning machines for reverse engineering of gene regulatory networks from expression time series
Authors: Rubiolo M , Milone D H , Stegmayer G
Published: November 2017

Motivation

The reconstruction of gene regulatory networks (GRNs) from genes profiles has a growing interest in bioinformatics for understanding the complex regulatory mechanisms in cellular systems. GRNs explicitly represent the cause–effect of regulation among a group of genes and its reconstruction is today a challenging computational problem. Several methods were proposed, but most of them require different input sources to provide an acceptable prediction. Thus, it is a great challenge to reconstruct a GRN only from temporal gene expression data.

Results

Extreme Learning Machine (ELM) is a new supervised neural model that has gained interest in the last years because of its higher learning rate and better performance than existing supervised models in terms of predictive power. This work proposes a novel approach for GRNs reconstruction in which ELMs are used for modeling the relationships between gene expression time series. Artificial datasets generated with the well-known benchmark tool used in DREAM competitions were used. Real datasets were used for validation of this novel proposal with well-known GRNs underlying the time series. The impact of increasing the size of GRNs was analyzed in detail for the compared methods. The results obtained confirm the superiority of the ELM approach against very recent state-of-the-art methods in the same experimental conditions.

Availability and implementation

The web demo can be found at http://sinc.unl.edu.ar/web-demo/elm-grnnminer/. The source code is available at https://sourceforge.net/projects/sourcesinc/files/elm-grnnminer.

Supplementary information

Supplementary data are available at Bioinformatics online.
Focus on Effector-Triggered Susceptibility
Authors: Ma Wenbo , Wang Yuanchao , McDowell John
Published: November 2017

Effector biology exhibits diversity at every level. Effector proteins play key roles in the molecular interplay between plants and plant-associated organisms, and effector biology remains one of the most active areas in the research field of molecular plant-microbe interactions. Using effectors as probes, much has been learned about pathogen virulence and host immunity, which has broad implications in developing disease-resistant crops that are essential for global food security. Thus, the MPMI Editorial Board is publishing this Focus Issue to showcase recent progress in this area.

Additional content is available on the Focus on Effector-Triggered Susceptibility.

A Phytophthora palmivora Extracellular Cystatin-Like Protease Inhibitor Targets Papain to Contribute to Virulence on Papaya

Conserved RxLR Effectors From Oomycetes Hyaloperonospora arabidopsidis and Phytophthora sojae Suppress PAMP- and Effector-Triggered Immunity in Diverse Plants

Molecular Basis of Citrus sunki Susceptibility and Poncirus trifoliata Resistance Upon Phytophthora parasitica Attack

daTALbase: A Database for Genomic and Transcriptomic Data Related to TAL Effectors

Phytophthora parasitica Effector PpRxLR2 Suppresses Nicotiana benthamiana Immunity

The Agrobacterium F-Box Protein Effector VirF Destabilizes the Arabidopsis GLABROUS1 Enhancer/Binding Protein-Like Transcription Factor VFP4, a Transcriptional Activator of Defense Response Genes

Accessories Make the Outfit: Accessory Chromosomes and Other Dispensable DNA Regions in Plant-Pathogenic Fungi
Measuring Nurse Educators’ Willingness to Adopt Inclusive Teaching Strategies
Authors: Levey Janet A.
Published: November 2017

AIM

The purpose of the study was to examine the characteristics and relationships of nurse educators’ teaching practices, knowledge, support, and willingness to adopt inclusive teaching strategies (WillAdITS).

BACKGROUND

Adopting more inclusive teaching strategies based on universal design for instruction is an innovative way for educators to reach today's diverse student body. However, the pedagogy has not diffused into nursing education.

METHOD

Descriptive statistics and hierarchical multiple regression were used for analyzing data from 311 nurse educators in prelicensure and RN to BSN programs.

FINDINGS

The model explained 44.8 percent of the variance in WillAdITS. The best indicators for this pedagogy were knowledge of universal design for instruction, social system support for inclusive teaching strategies, multiple instructional formats, and years of teaching.

CONCLUSION

Knowing factors influencing the adoption of inclusive teaching strategies can inform schools of nursing of areas needing further development in the preparation of novice to experienced educators to teach diverse learners.
Useful Intraoperative Technique for Percutaneous Stabilization of Bilateral Posterior Pelvic Ring Injuries
Authors: Eastman Jonathan G. , Kuehn Reilly J. , Chip Routt Milton L.
Published: November 2017

Treating patients with bilateral posterior pelvic ring injuries can be challenging. Placement of transiliac-transsacral style screws in available S1 or S2 osseous fixation pathways is becoming an increasingly common fixation method for these unstable injuries. We propose a percutaneous technique that sequences reduction and stabilization of 1 hemipelvis with at least 1 transiliac-transsacral screw and then uses the existing transiliac-transsacral screw and accompanying guide wires to assist in temporary stabilization and definitive fixation of the second hemipelvis.
Determinants of Length of Stay After Operative Treatment for Femur Fractures
Authors: Aizpuru Matthew , Staley Christopher , Reisman William , Gottschalk Michael B. , Schenker Mara L.
Published: November 2017

Objectives:

To investigate the determinants of length of stay (LOS) for patients surgically treated for femur fractures.

Design:

Retrospective medical record review.

Setting:

Urban Level I Trauma Center.

Participants:

Three hundred twenty-one patients operatively treated for femur fractures between July 12, 2015 and July 12, 2016.

Intervention:

Intramedullary nailing, open reduction internal fixation, arthroplasty, or other (percutaneous screw or multiple hardware/technique) definitive fixation of femur fracture.

Main Outcome Measurements:

Hospital LOS.

Results:

Median LOS was 6.43 days (range 1–76 days). Patients were divided into 2 groups: LOS ≥6 days (n = 171) and LOS <6 days (n = 150). Univariate analysis revealed several preoperative, perioperative, and postoperative factors associated with extended LOS. Multivariate analysis demonstrated frailty [odds ratio (OR), 20.58], medical complications (OR, 20.09), an upper extremity injury (OR, 9.97), an ipsilateral lower extremity injury (OR, 6.34), time to definitive fixation (OR, 2.12), time to first physical therapy visit (OR, 1.77), and Injury Severity Score (OR, 1.14) were independent predictors of LOS.

Conclusions:

By understanding the determinants of LOS for patients with femur fracture, high-risk patients can be identified and interventions can be enacted. Earlier fixation and aggressive management of medical complications may decrease patients' LOS. Patients who meet frailty criteria under the Modified Frailty Index are at a twenty-fold increased risk of staying longer than 6 days after having a femur fracture. By identifying these patients on admission, strategies can be devised to reduce their LOS and economic burden.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Identifying Factors Predictive of Atlantoaxial Fusion Failure in Pediatric Patients
Authors: Brockmeyer Douglas L. , Sivakumar Walavan , Mazur Marcus D. , Sayama Christina M. , Goldstein Hannah E. , Lew Sean M. , Hankinson Todd C. , Anderson Richard C.E. , Jea Andrew , Aldana Philipp R. , Proctor Mark , Hedequist Daniel , Riva-Cambrin Jay K.
Published: November 2017

Study Design.

Multicenter retrospective cohort study with multivariate analysis.

Objective.

To determine factors predictive of posterior atlantoaxial fusion failure in pediatric patients.

Summary of Background Data.

Fusion rates for pediatric posterior atlantoaxial arthrodesis have been reported to be high in single-center studies; however, factors predictive of surgical non-union have not been identified by a multicenter study.

Methods.

Clinical and surgical details for all patients who underwent posterior atlantoaxial fusion at seven pediatric spine centers from 1995 to 2014 were retrospectively recorded. The primary outcome was surgical failure, defined as either instrumentation failure or fusion failure seen on either plain x-ray or computed tomography scan. Multiple logistic regression analysis was undertaken to identify clinical and technical factors predictive of surgical failure.

Results.

One hundred thirty-one patients met the inclusion criteria and were included in the analysis. Successful fusion was seen in 117 (89%) of the patients. Of the 14 (11%) patients with failed fusion, the cause was instrumentation failure in 3 patients (2%) and graft failure in 11 (8%). Multivariate analysis identified Down syndrome as the single factor predictive of fusion failure (odds ratio 14.6, 95% confidence interval [3.7–64.0]).

Conclusion.

This retrospective analysis of a multicenter cohort demonstrates that although posterior pediatric atlantoaxial fusion success rates are generally high, Down syndrome is a risk factor that significantly predicts the possibility of surgical failure.

Level of Evidence: 3
Safety of IncobotulinumtoxinA in the Treatment of Facial Lines: Results From a Pooled Analysis of Randomized, Prospective, Controlled Clinical Studies
Authors: Coleman William P. , Sattler Gerhard , Weissenberger Petra , Hast Michael A. , Hanschmann Angelika
Published: November 2017

BACKGROUND

The safety and efficacy of incobotulinumtoxinA in aesthetics has been established in multiple studies. Although individual studies have been reported, a combined assessment of incobotulinumtoxinA safety across studies is not available.

OBJECTIVE

To assess the frequency of adverse events (AEs) across prospective incobotulinumtoxinA studies in aesthetics.

MATERIALS AND METHODS

Safety data were assessed from 9 placebo-controlled or active-controlled single-dose studies on glabellar frown lines (GFL), crow's feet (CF), and upper facial lines (UFL). Analyses by treatment cycle included 4 repeat-dose studies on GFL and UFL.

RESULTS

One thousand three hundred seventy-seven subjects received incobotulinumtoxinA (GFL, n = 1,189; CF, n = 83; UFL, n = 105) in single-dose studies (placebo-controlled studies: incobotulinumtoxinA, n = 866; placebo, n = 395). Over 1,000 subjects received incobotulinumtoxinA in repeat-dose studies (GFL, n = 880; UFL, n = 290). In placebo-controlled single-dose studies, incidences of treatment-related AEs ranged from 5.4% (GFL) to 22.9% (UFL). The most frequent treatment-related AE in single-dose studies was headache (GFL, 4.8%; UFL, 11.4%). In repeat-dose studies, incidence of AEs was highest during cycle 1 (GFL, 8.9%; UFL, 17.2%) and decreased across treatment cycles. No serious treatment-related AEs were observed.

CONCLUSION

Results confirm the favorable safety and tolerability of incobotulinumtoxinA. The frequency of treatment-related AEs was low and may decrease with subsequent treatments.
Forehead Line Treatment With OnabotulinumtoxinA in Subjects With Forehead and Glabellar Facial Rhytids: A Phase 3 Study
Authors: Fagien Steven , Cohen Joel L. , Coleman William , Monheit Gary , Carruthers Jean , Street James , Larsen Kristin E. , Yushmanova Irina , Lei Xiaofang , Lee Elisabeth , Vitarella Domenico , Mao Cheri
Published: November 2017

BACKGROUND

Effacement of horizontal forehead lines (FHL) with onabotulinumtoxinA has not been investigated in prospective Phase 3 studies.

OBJECTIVE

To evaluate safety and efficacy of onabotulinumtoxinA treatment of FHL together with glabellar lines (GL).

MATERIALS AND METHODS

A 12-month, Phase 3 study randomized subjects with moderate-to-severe FHL and GL to onabotulinumtoxinA 40 U or placebo, distributed between the frontalis (20 U) and glabellar complex (20 U). After Day 180, subjects could receive up to 2 additional open-label onabotulinumtoxinA treatments. Efficacy was assessed using the Facial Wrinkle Scale (FWS) and Facial Line Outcomes questionnaire.

RESULTS

The intent-to-treat (ITT) population included 391 subjects, and the modified ITT (mITT) population (subjects with psychological impact) included 254 subjects. After 30 days, onabotulinumtoxinA significantly improved the investigator- and subject-assessed appearance of FHL severity by at least 2 FWS grades in 61.4% of ITT subjects versus 0% of placebo subjects (p < .0001). In the mITT population, 94.8% of onabotulinumtoxinA subjects and 1.7% of placebo subjects achieved investigator- and subject-assessed FWS ratings of none/mild (p = .0003). Patient-reported outcomes were consistent with FWS ratings. OnabotulinumtoxinA was well tolerated.

CONCLUSION

OnabotulinumtoxinA 40 U distributed between the frontalis and glabellar complex was safe and effective for treatment of moderate-to-severe FHL.
Perinatal Tuberculosis: Is It a Forgotten Disease?
Authors: Ferreras-Antolín Laura , Caro-Aguilera Pilar , Pérez-Ruíz Estela , Moreno-Pérez David , Pérez-Frías Francisco Javier
Published: November 2017

Perinatal tuberculosis is an uncommon condition but with a high mortality and a challenging diagnosis. We present 4 cases of perinatal tuberculosis managed between 1991 and 2014 in a Spanish Tertiary Hospital. The infection should be considered in patients with progressive respiratory symptoms and with a poor response to conventional antibiotic therapy, especially in those with positive epidemiologic risk. Bronchoscopy can be a useful tool for diagnosis.
Relationship between concomitant benzodiazepine-opioid use and adverse outcomes among US veterans
Authors: Gressler Laura E. , Martin Bradley C. , Hudson Teresa J. , Painter Jacob T.
Published: November 2017

Benzodiazepines and opioids are commonly used among veterans suffering from mental health disorders and pain conditions. The objective of this study is to determine whether concomitant benzodiazepine-opioid use increases the incidence of adverse outcomes above the baseline risk of nonacute opioid-only use. The dataset contained all veterans who filled at least 1 opioid prescription during the years 2008 to 2012. Nonacute opioid use was defined as having opioid prescriptions greater than or equal to 20 days within a 60-day period. Concomitant use was defined as having opioid and benzodiazepine prescriptions that overlapped for at least 7 days. Nonacute opioid-only users were matched to concomitant opioid-benzodiazepine users based on propensity scores. A 365-day observation period was used to identify adverse outcomes. The primary outcome examines the existence of one or more of the following outcomes: opioid-related accidents and overdoses, alcohol- and nonopioid drug-related accidents and overdoses, self-inflicted injuries, violence-related injuries, wounds/injuries overall, and death. A logistic propensity score adjusted regression controlling for propensity toward concomitant use was used to determine the association of concomitant use with adverse outcomes. The final matched sample consisted of 396,141 nonacute opioid-only using veterans and 48,971 concomitant benzodiazepine-opioid users. Receiving opioids and benzodiazepines concomitantly increased the risk of experiencing an adverse outcome with an odds ratio of 1.359 (95% confidence interval: 1.320-1.400; P < 0.0001). Among veterans receiving opioids, concomitant benzodiazepine use is associated with an increased risk of adverse outcomes when compared to the baseline risk of opioid-only using veterans.
Role of Preemptive Gabapentin on Postoperative Analgesia After Infraumbilical Surgeries Under Subarachnoid Block—A Randomized, Placebo-Controlled, Double-Blind Study
Authors: Tomar Gaurav S. , Singh Farhat , Cherian Grace
Published: November 2017

Background:

Preemptive use of gabapentin might accelerate recovery by reducing acute post-inguinal herniorrhaphy pain and opioid requirement being an analgesic.

Study Question:

Assessing efficacy of three different doses of oral gabapentin premedication for postoperative pain management after inguinal herniorrhaphy under spinal anesthesia.

Study Design:

This prospective, randomized, placebo controlled study was performed on 120 male patients (ASA I/II) undergoing inguinal herniorrhaphy under subarachnoid block. Patients were divided into 4 groups of 30 patients each to receive placebo (group A) or gabapentin 400 mg (B) or 800 mg (C) or 1200 mg (D), administered orally 2 hours before surgery. Assessment of postoperative pain was made on the basis of the visual analog score (VAS), where 0 cm “no pain” and 10 cm “worst pain imaginable.” Patients received IV fentanyl 0.5 μg/kg bolus when VAS >3.

Measures and Outcomes:

VAS score at regular intervals, the first analgesic requirement and total opioid consumption within 24 hours after surgery along with side/adverse effect (s) of study drug in perioperative period.

Results:

The VAS of the study groups B, C, D were significantly lower than placebo group (A) at 0, 1, 2, 4, 8, 12, 16, 20, and 24-hour intervals after surgery (P < 0.05). The first analgesic need and total opioid consumption within 24 hours after surgery of study groups were significantly lower than placebo group (P < 0.005) while within study groups difference was not significant. Dizziness and somnolence were seen maximally in group D patients (P = 0.01). However, pruritus, nausea and vomiting though maximally reported among group (A) patients but statistically non-significant.

Conclusion:

Preemptive gabapentin is opioid sparing to control postoperative pain with anxiolysis and sedation. We found the optimal dose to be 400 mg for gabapentin. However, increasing dose from 400 to 1200 mg does not increase its efficacy as analgesic but with higher adverse effects.
Communicating Health and Nutrition Information After the Death of Expertise
Authors: Rowe Sylvia B. , Alexander Nick
Published: November 2017

This article reframes an issue first visited a decade ago in a Nutrition Today article about the decline in influence of the “gatekeepers” of scientific information. In the current “post-truth” era, characterized by an underskeptical view of “facts,” some observers have expressed fears that public trust in scientific and other expertise is on the decline or, worse, has evaporated altogether. With the ascendancy of Web-based analysis of everything from climate science to nutrition and food safety, these observers fear that actual scientists working in food and health no longer have influence in public discussions. The issue impacts not only scientific issues, but literally everything from pop culture, including music, books, movies, and the like, to highly technical fields such as health insurance and finance: all are subject to this “expertise devaluation” phenomenon. This article explores the arguments and reviews the communication landscape, offering insights into a new disciplined framework for how society, and specifically nutritionists, might extricate themselves from the current minimal trust environment.
Development of a Diagnostic Programmed Cell Death 1-Ligand 1 Immunohistochemistry Assay for Nivolumab Therapy in Melanoma
Authors: Phillips Therese , Millett Molly M. , Zhang Xiaoling , Jansson Malinka , Cleveland Rachel , Simmons Pauline , Cherryholmes Gregory , Carnahan Josette , William Josette , Spaulding Betsy , Satnick Ilana R. , Inzunza H. David , Taylor Clive , Cogswell John , Novotny James , Oroudjev Emin , Winther Henrik
Published: November 2017

Nivolumab is a monoclonal antibody that blocks the interaction between programmed cell death 1 (PD1) and programmed cell death 1-ligand 1 (PD-L1), resulting in enhanced antitumor activity by the immune system. Nivolumab is currently approved by the US Food and Drug Administration (FDA) for melanoma, non-small cell lung cancer (NSCLC), renal cell carcinoma, classical Hodgkin lymphoma, squamous cell carcinoma of the head and neck, and urothelial carcinoma. PD-L1 IHC 28-8 pharmDx is FDA-approved as a complementary diagnostic for immunohistochemical (IHC) detection of PD-L1 in non-squamous NSCLC and melanoma. We report validation of PD-L1 IHC 28-8 pharmDx for PD-L1 detection on formalin-fixed, paraffin-embedded human melanoma specimens using Autostainer Link 48. A prevalence assessment of 104 melanoma specimens indicated that PD-L1 was detected across the full expression level range (0% to 100% of tumor cells). Assay robustness and precision studies were conducted at Agilent Technologies, with additional reproducibility studies performed at 3 external laboratories. Precision studies evaluated at ≥1% and ≥5% expression levels revealed a range of average negative agreement from 89.5%, 95% CI (83.2, 93.6) to 100%, 95% CI (97.3, 100), and average positive agreement from 85.5%, 95% CI (77.6, 90.9) to 100%, 95% CI (97.9, 100). For external reproducibility, precise results were obtained. These results demonstrate PD-L1 IHC 28-8 pharmDx is a precise, robust, and reproducible assay for determining PD-L1 expression in melanoma. This is the first PD-L1 IHC test to receive FDA approval as a complementary diagnostic in melanoma patients whereby positive PD-L1 expression is correlated with the magnitude of nivolumab treatment effect.
Early Reduction of Pediatric Traumatic Posterior Hip Dislocation Is Much More Important Than the Treatment Procedure
Authors: Yuksel Serdar , Albay Cem
Published: November 2017

Traumatic hip dislocations are very rare in the pediatric population, and they are real emergent cases that can occur with minimal trauma. If they are not diagnosed immediately and reduction is not performed as soon as possible, they may cause problems such as avascular necrosis and degenerative arthritis. Performing reduction within the first 6 hours is of vital importance.

We aim to present the functional outcomes and radiographic results of 2 pediatric traumatic hip dislocation cases with 36 months of follow-up who were treated with abduction orthosis after the reduction. We want to emphasize the importance of reduction time in the outcome of posterior traumatic hip dislocations followed with abduction orthesis even if there is a trend and suggestion to treat these patients with spica cast with the review of the recent literature.
Association of Insurance With Use of Emergency Medical Services Among Children
Authors: Dayal Parul , Ruttan Timothy K. , Kissee Jamie L. , Sigal Ilana S. , Marcin James P.
Published: November 2017

Objective

The use of emergency medical services (EMS) can be lifesaving for critically ill children and should be defined by the child's clinical need. Our objective was to determine whether nonclinical demographic factors and insurance status are associated with EMS use among children presenting to the emergency department (ED).

Methods

In this cross-sectional study using the National Hospital Ambulatory Medical Care Survey, we included children presenting to EDs from 2009 to 2014. We evaluated the association between EMS use and patients' insurance status using multivariable logistic regressions, adjusting for demographic, socioeconomic, and clinical factors such as illness severity as measured by a modified and recalibrated version of the Revised Pediatric Emergency Assessment Tool (mRePEAT) and the presence of comorbidities or chronic conditions. A propensity score analysis was performed to validate our findings.

Results

Of the estimated 191,299,454 children presenting to EDs, 11,178,576 (5.8%) arrived by EMS and 171,145,895 (89.5%) arrived by other means. Children arriving by EMS were more ill [mRePEAT score, 1.13; 95% confidence interval (CI), 1.12–1.14 vs mRePEAT score, 1.01; 95% CI: 1.01–1.02] and more likely to have a comorbidity or chronic condition (OR: 3.17, 95% CI: 2.80–3.59). In the adjusted analyses, the odds of EMS use were higher for uninsured children and lower for children with public insurance compared with children with private insurance [OR (95% CI): uninsured, 1.41 (1.12–1.78); public, 0.77 (0.65–0.90)]. The propensity score analysis showed similar results.

Conclusions

In contrast to adult patients, children with public insurance are less likely to use EMS than children with private insurance, even after adjustment for illness severity and other confounders.
Development of a Comprehensive and Interactive Tool to Inform State Violence and Injury Prevention Plans
Authors: Wilson Lauren , Deokar Angela J. , Zaesim Araya , Thomas Karen , Kresnow-Sedacca Marcie-jo
Published: November 2017

Context:

The Center of Disease Control and Prevention's Core State Violence and Injury Prevention Program (Core SVIPP) provides an opportunity for states to engage with their partners to implement, evaluate, and disseminate strategies that lead to the reduction and prevention of injury and violence. Core SVIPP requires awardees to develop or update their state injury and violence plans. Currently, literature informing state planning efforts is limited, especially regarding materials related to injury and violence. Presumably, plans that are higher quality result in having a greater impact on preventing injury and violence, and literature to improve quality would benefit prevention programming.

Objective:

(1) To create a comprehensive injury-specific index to aid in the development and revision of state injury and violence prevention plans, and (2) to assess the reliability and utility of this index.

Design:

Through an iterative development process, a workgroup of subject matter experts created the Violence and Injury Prevention: Comprehensive Index Tool (VIP:CIT). The tool was pilot tested on 3 state injury and violence prevention plans and assessed for initial usability. Following revisions to the tool (ie, a rubric was developed to further delineate consistent criteria for rating; items were added and clarified), the same state plans were reassessed to test interrater reliability and tool utility.

Results:

For the second assessment, reliability of the VIP:CIT improved, indicating that the rubric was a useful addition. Qualitative feedback from states suggested that the tool significantly helped guide plan development and communicate about planning processes.

Conclusion:

The final VIP:CIT is a tool that can help increase plan quality, decrease the research-to-practice gap, and increase connectivity to emerging public health paradigms. The tool provides an example of tailoring guidance materials to reflect academic literature, and it can be easily adapted to other topic areas to promote quality of strategic plans for numerous outcomes.
Trend and Demographic Characteristics of Maxillofacial Fractures in Level I Trauma Center
Authors: Emodi Omri , Wolff Amir , Srouji Hanna , Bahouth Hany , Noy Dani , Abu El Naaj Imad , Rachmiel Adi
Published: November 2017

Aim:

The aim of this study was to analyze the pattern and treatment of craniomaxillofacial injuries in the northern part of Israel, within a Jewish majority and large Arab minority population.

Patients and Methods:

A 5-year retrospective study evaluated patients treated for craniomaxillofacial fractures. Fracture cause, type, site, and patient demographics were evaluated.

Results:

Patient age ranged from 1 to 94 years with an average age of 36.7 years; 52% of the victims were Jews and 48% Arabs. There was male predilection in both sectors (78.3% vs 21.7%). The main site of injury was the zygomatic bone (33.5%) followed by nasal bone, orbital, mandible, frontal sinus, and maxillary fractures. The main etiology of injuries was falls (45.4%) with significantly more falls reported by females (52.1% vs 43.2% in males). Motor vehicle accidents caused injuries more frequent in males. Arabs experienced CMF fractures at a younger age compared to Jews (27.8 and 44.8 average age, respectively). In the elderly, the trend reversed where Jews were more prone to craniomaxillofacial fractures.

Conclusions:

Compared to their weight in the population, the Arab sector experiences more craniomaxillofacial injuries. The Jewish elderly population tends to reside in nursing homes where they are more susceptible to accidental falls, whereas young Arab males are more exposed to motor vehicle accidents and interpersonal violence. Falls were the main cause of injuries particularly in women. This may reflect the women's fear of reporting domestic violence. We believe that increased government investments in infrastructures and education will lower the incidence of craniomaxillofacial trauma and balance the gap between both sectors and sexes.
Bibliometric Analysis of Journals in the Field of Endoscopic Endonasal Surgery for Pituitary Adenomas
Authors: Li Lei , Ma Xiaoye , Pandey Sajan , Fan Aoyuan , Deng Xianyu , Cui Daming
Published: November 2017

Endoscopic endonasal surgery for pituitary adenomas is being performed more frequently worldwide in the recent years. This first bibliometric analysis was conducted aiming to have a microscopic view of research activities about endoscopic endonasal surgery for pituitary adenomas. The original articles about endoscopic endonasal surgery for pituitary adenomas were extracted from the Web of Science (WoS) and analyzed concerning their distributions. We also explored the potential correlations between publications of different countries and their gross domestic product (GDP) via Pearson correlation test. The total number of original articles retrieved from WoS was 307 from 1997 to 2017. The number of original articles published in the last decade has increased by 530.95% compared with that published in the former decade. The United States has published 124 articles (40.391%), followed by Italy with 40 (13.029%) and Japan with 27 articles (8.795%). The journal that published the highest number of original articles was Journal of Neurosurgery with 31 (10.098%), followed by Neurosurgery (n = 23, 7.492%), World Neurosurgery (n = 23, 7.492%), and Neurosurgical Focus (n = 15, 4.886%). There was a strong correlation between publication numbers and GDP of different countries (r
2 = 0.889, P < 0.001). There is a skyrocket trend of endoscopic endonasal surgery for pituitary adenomas during the last 2 decades, and countries with high GDP tend to make more contributions to this field.
Modified Backward Avulsion Used in the Treatment of Third-Branch Primary Trigeminal Neuralgia
Authors: Liang Chao , Wang Xiao-Yu , Li Jun , Zhang Min , Liu Hong-Fei
Published: November 2017

Objective:

A clinical retrospective study was performed to observe the clinical effect of a modified surgical treatment for third-branch primary trigeminal neuralgia.

Method:

Thirty patients who had suffered from neuralgia for several years underwent modified backward avulsion of the inferior alveolar nerve and were followed for 3 to 5 years. In this technique, the inferior alveolar nerve was cut off through the mandibular wisdom tooth extraction socket or the corresponding alveolar ridge window and was avulsed from the mental foramen. Simultaneously, the neural foramen was packed with autogenous bone fragments to prevent recurrence.

Results:

After a 3- to 5-years follow-up, 19 patients were cured, 8 patients reported a partial effect of treatment, and 3 patients exhibited recurrence. The efficacy rate was 90%. Postoperatively, the patients had different degrees of numbness in the area innervated by the third branch of the trigeminal nerve but did not have any other complications.

Conclusions:

This study proved that modified backward avulsion is a simple, effective, and safe method that can be applied in the clinical setting to treat third-branch primary trigeminal neuralgia.
Re-classification of Clavibacter michiganensis subspecies on the basis of whole-genome and multi-locus sequence analyses
Authors: Li Xiang , Tambong James , Yuan Kat (Xiaoli) , Chen Wen , Xu Huimin , Lévesque C. André , De Boer Solke H.
Published: November 2017

Although the genus

Clavibacter

was originally proposed to accommodate all phytopathogenic coryneform bacteria containing B2γ diaminobutyrate in the peptidoglycan, reclassification of all but one species into other genera has resulted in the current monospecific status of the genus. The single species in the genus,

Clavibacter michiganensis

, has multiple subspecies, which are all highly host-specific plant pathogens. Whole genome analysis based on average nucleotide identity and digital DNA–DNA hybridization as well as multi-locus sequence analysis (MLSA) of seven housekeeping genes support raising each of the

C. michiganensis

subspecies to species status. On the basis of whole genome and MLSA data, we propose the establishment of two new species and three new combinations: Clavibacter capsici sp. nov., comb. nov. and Clavibacter tessellarius sp. nov., comb. nov., and Clavibacter insidiosus comb. nov., Clavibacter nebraskensis comb. nov. and Clavibacter sepedonicus comb. nov.