bluuebunny/crossref_metadata_2025 huggingface dataset:
Aryl-alkyl-lysines: small molecular membrane-active antiplasmodial agents
Authors: Ghosh Chandradhish , Chaubey Shweta , Tatu Utpal , Haldar Jayanta
Published: December 2016

Water-soluble membrane-active compounds, that are active againstPlasmodiumsp. bothin vitroandin vivoare reported.
A new and efficient enantioselective synthesis of both enantiomers of the calcium channel blocker bepridil
Authors: Mujahid Mohammad , Subramanian Jambu , Nalla Viswanadh , Sasikumar Murugesan , Kunte Sunita Sharad , Muthukrishnan Murugan
Published: December 2016

We report a simple enantioselective synthesis of bepridil enantiomers employing hydrolytic kinetic resolution and the Mitsunobu reaction as key steps.
Towards a global greener process: from solvent-less synthesis of molybdenum(vi) ONO Schiff base complexes to catalyzed olefin epoxidation under organic-solvent-free conditions
Authors: Cindrić Marina , Pavlović Gordana , Katava Robert , Agustin Dominique
Published: December 2016

Schiff base ligands and corresponding molybdenum(vi) complexes, prepared using classical and/or mechanochemical methods, were active as epoxidation pre(catalysts).
In(OTf)3 assisted synthesis of β-carboline C-3 tethered imidazo[1,2-a]azine derivatives
Authors: Devi Nisha , Singh Dharmender , Kaur Gurpreet , Mor Satbir , Putta V. P. R. Kishore , Polina Saibabu , Malakar Chandi C. , Singh Virender
Published: December 2016

Synthesis of β-carboline based natural products and synthetic derivatives is one of the frontier areas of research owing to their medicinal properties.
Comment on “Non-pitch coal-based activated coke introduced CeOx and/or MnOx for low temperature selective catalytic reduction of NOx by NH3” by Fu et al., RSC Adv., 2016, 6, 8539–8548
Authors: Paparazzo Ernesto
Published: December 2016

I comment on the XPS analysis of these catalysts as a function of MnOx–CeOx content. I argue that it is the total number of oxide sites that enhances the catalysts’ de-nitrification power, and not the MnOx–CeOx interaction, as the authors hold.
Electrospray biodegradable microcapsules loaded with curcumin for drug delivery systems with high bioactivity
Authors: Mai Zhuoxian , Chen Jiali , He Ting , Hu Yang , Dong Xianming , Zhang Hongwu , Huang Wenhua , Ko Frank , Zhou Wuyi
Published: December 2016

Biodegradable microcapsules as novel drug delivery systems were successfully fabricated by one-step processing using an electrospray technique.
Intensive Language Action Therapy in Chronic Aphasia: A Randomized Clinical Trial Examining Guidance by Constraint
Authors: Kurland Jacquie , Stanek, Edward J. , Stokes Polly , Li Minming , Andrianopoulos Mary
Published: December 2016

Purpose

Intensive language action therapy (ILAT) can be effective in overcoming learned nonuse in chronic aphasia. It is suggested that all three guiding principles (constraint, communication embedding, massed practice) are essential to ILAT's success. We examined whether one of these, guidance by constraint, is critical.

Method

Twenty-four participants with aphasia (PWAs) were assigned to ILAT or a modified version of promoting aphasic communicative effectiveness (PACE) in a randomized block, single-blind, parallel-group treatment study. Blocking was by severity (mild/moderate, moderate to severe, severe). Both groups received intensive treatment in the context of therapeutic language action games. Whereas the ILAT group was guided toward spoken responses, the PACE group could choose any response modality.

Results

All participants, whether assigned to ILAT or PACE groups, improved on the primary outcome measure, picture naming. There was a Severity × Treatment interaction, with the largest effects estimated for PWAs with mild/moderate and moderate to severe aphasia. Regardless of severity, the ILAT group outperformed the PACE group on untrained pictures, suggesting some benefit of ILAT to generalization. However, this difference was not statistically significant.

Conclusion

Although the groups differed in subtle ways, including better generalization to untrained pictures for ILAT, the study was inconclusive on the influence of guidance by constraint.
Antenna selection for NR‐STAR‐MQAM spatial modulation
Authors: Pillay Reggie , Xu Hongjun , Pillay Narushan
Published: December 2016

A new multiple‐ring star‐M‐ary quadrature amplitude modulation‐aided spatial modulation (NR‐STAR‐MQAM‐SM) scheme is proposed. The aim is to minimise the average bit error probability (ABEP) of the system. Then in the interest of further minimising the ABEP, the authors formulate a low‐complexity algorithm to achieve the optimum radii of NR‐STAR‐MQAM‐SM. This algorithm is based on a specific multiple‐input multiple‐output configuration and the pairwise error probability function. To validate the results of the proposed scheme, a closed‐form union‐bound theoretical ABEP expression is derived. Finally, to improve the error performance of NR‐STAR‐MQAM‐SM, the authors propose a low‐complexity Euclidean distance‐based antenna selection (EDAS) algorithm for NR‐STAR‐MQAM‐SM (EDAS‐NR‐STAR‐MQAM‐SM). Since all amplitude/phase modulation schemes are considered to have rotational symmetry and symmetric constellation points have the same EDAS solution, the authors achieve EDAS‐NR‐STAR‐MQAM‐SM by searching only one constellation point per symmetric constellation set. The EDAS‐NR‐STAR‐MQAM‐SM solution exhibits a significant reduction in the computational complexity compared with the conventional EDAS solution.
Erratum: The gendered construction of reparations: an exploration of women’s exclusion from the Niger Delta reintegration processes
Authors: Folami Olakunle Michael
Published: December 2016

Correction to: Palgrave Communications (2016) 2 Article number: 16083 doi: 10.1057/palcomms.2016.83; Published 6 December 2016; Updated 20 December 2016 “Niger Delta” was previously not capitalised in the title as it should have been. This has been corrected. The article has been corrected online.
Linear stability of ideal MHD configurations. II. Results for stationary equilibrium configurations
Authors: Demaerel T. , Keppens R.
Published: December 2016

In this paper, we continue exploring the consequences of the general equation of motion (EOM) governing all Lagrangian perturbations ξ about a time-dependent, ideal magnetohydrodynamic (MHD) configuration, which includes self-gravity, external gravity, pressure gradients, compressibility, inertial effects, and anisotropic Lorentz force. We here address the specific case of MHD stability for 3D stationary equilibria, where the perturbed EOM features a symmetric operator F and an antisymmetric Doppler-Coriolis operator v·∇. For this case, we state and prove the general properties for the solutions ξ of the governing dynamical system. For axisymmetric perturbations about axisymmetric equilibria with purely toroidal, or purely poloidal magnetic fields, specific stability theorems can be formulated. We derive a useful integral expression for the quadratic quantity given by the inner product ⟨ξ,F[ξ]⟩. For deriving stability statements on MHD states where self-gravity is involved as well, we provide an upper bound on the perturbed self-gravitational energy associated with the displacement ξ. The resulting expression elucidates the role of potentially stabilizing versus destabilizing contributions and shows the role of gravity, entropy gradients, velocity shear, currents, Lorentz forces, inertia, and pressure gradients in offering many routes to unstable behavior in flowing gases and plasmas. These have historically mostly been studied for static v=0 configurations, looking at stability of exactly force-balanced states, or by assuming stationarity similar to our approach here (i.e., ∂t≡0 for the state we perturb), but typically in combination with some reduced dimensionality on the configuration of interest (translational or axisymmetry). We show that in these limits, we find and generalize expressions well-known from, e.g., the study of ideal MHD stability of tokamak plasmas or from Schwarzschild's criteria controlling convection in hydrodynamic, (external) gravitating systems. When applied to stationary, axisymmetric configurations in motion, we can use our upper bound to derive a sufficient stability criterion for perturbations of arbitrary azimuthal mode number m used in ξ(r)=η(r,z) exp(imφ).
Zonal-flow dynamics from a phase-space perspective
Authors: Ruiz D. E. , Parker J. B. , Shi E. L. , Dodin I. Y.
Published: December 2016

The wave kinetic equation (WKE) describing drift-wave (DW) turbulence is widely used in the studies of zonal flows (ZFs) emerging from DW turbulence. However, this formulation neglects the exchange of enstrophy between DWs and ZFs and also ignores effects beyond the geometrical-optics limit. We derive a modified theory that takes both of these effects into account, while still treating DW quanta (“driftons”) as particles in phase space. The drifton dynamics is described by an equation of the Wigner–Moyal type, which is commonly known in the phase-space formulation of quantum mechanics. In the geometrical-optics limit, this formulation features additional terms missing in the traditional WKE that ensure exact conservation of the total enstrophy of the system, in addition to the total energy, which is the only conserved invariant in previous theories based on the WKE. Numerical simulations are presented to illustrate the importance of these additional terms. The proposed formulation can be considered as a phase-space representation of the second-order cumulant expansion, or CE2.
Effect of oxygen vacancies on the electronic and optical properties of tungsten oxide from first principles calculations
Authors: Mehmood Faisal , Pachter Ruth , Murphy Neil R. , Johnson Walter E. , Ramana Chintalapalle V.
Published: December 2016

In this work, we investigated theoretically the role of oxygen vacancies on the electronic and optical properties of cubic, γ-monoclinic, and tetragonal phases of tungsten oxide (WO3) thin films. Following the examination of structural properties and stability of the bulk tungsten oxide polymorphs, we analyzed band structures and optical properties, applying density functional theory (DFT) and GW (Green's (G) function approximation with screened Coulomb interaction (W)) methods. Careful benchmarking of calculated band gaps demonstrated the importance of using a range-separated functional, where results for the pristine room temperature γ-monoclinic structure indicated agreement with experiment. Further, modulation of the band gap for WO3 structures with oxygen vacancies was quantified. Dielectric functions for cubic WO3, calculated at both the single-particle, essentially time-dependent DFT, as well as many-body GW-Bethe-Salpeter equation levels, indicated agreement with experimental data for pristine WO3. Interestingly, we found that introducing oxygen vacancies caused appearance of lower energy absorptions. A smaller refractive index was indicated in the defective WO3 structures. These predictions could lead to further experiments aimed at tuning the optical properties of WO3 by introducing oxygen vacancies, particularly for the lower energy spectral region.
Phonon-plasmon interaction in magnetized inhomogeneous semiconductor quantum plasmas
Authors: Ghosh S. , Muley Apurva
Published: December 2016

The phonon-plasmon interaction in a magnetized inhomogeneous semiconductor quantum plasma is reported using a quantum hydrodynamic model. A quantum modified dispersion relation is employed, which leads to an evolution expression for the gain coefficient of the acoustic wave. In the present study, quantum effects and inhomogeneity are taken into account through non-dimensional quantum parameter-H and scale length of density variation parameter-L, respectively. The effects of these parameters, as well as propagation distance z, angular frequency ω, and orientation of magnetic field θ, on gain characteristics of the acoustic wave are investigated. These investigations are made for linearly and quadratically varying density structures in the presence and the absence of the magnetic field. The results infer that the magnetic field and linearly or quadratically varying density structures would play a decisive role in deciding the gain characteristics of the acoustic wave in the inhomogeneous semiconductor quantum plasma.
Record-level quantum efficiency from a high polarization strained GaAs/GaAsP superlattice photocathode with distributed Bragg reflector
Authors: Liu Wei , Chen Yiqiao , Lu Wentao , Moy Aaron , Poelker Matthew , Stutzman Marcy , Zhang Shukui
Published: December 2016

Photocathodes that provide high electron-spin polarization (ESP) and high quantum efficiency (QE) can significantly enhance the physics capabilities of electron accelerators. We report record-level QE from a high-polarization strained GaAs/GaAsP superlattice photocathode fabricated with a Distributed Bragg Reflector (DBR). The DBR photocathode technique enhances the absorption of incident laser light thereby enhancing QE, but as literature suggests, it is very challenging to optimize all of the parameters associated with the fabrication of complicated photocathode structures composed of many distinct layers. Past reports of DBR photocathodes describe high polarization but typically QE of only ∼1%, which is comparable to QE of high polarization photocathodes grown without a DBR structure. This work describes a strained GaAs/GaAsP superlattice DBR photocathode exhibiting a high polarization of 84% and significantly enhanced QE of 6.4%.
Surface chemical-bonds analysis of silicon particles from diamond-wire cutting of crystalline silicon
Authors: Benayad Anass , Hajjaji Hamza , Coustier Fabrice , Benmansour Malek , Chabli Amal
Published: December 2016

The recycling of the Si powder resulting from the kerf loss during silicon ingot cutting into wafers for photovoltaic application shows both significant and achievable economic and environmental benefits. A combined x-ray photoelectron spectroscopy (XPS), attenuated total reflection (ATR)-Fourier transform infrared (FTIR) and micro-Raman spectral analyses were applied to kerf-loss Si powders reclaimed from the diamond wire cutting using different cutting fluids. These spectroscopies performed in suitable configurations for the analysis of particles, yield detailed insights on the surface chemical properties of the powders demonstrating the key role of the cutting fluid nature. A combined XPS core peak, plasmon loss, and valence band study allow assessing a qualitative and quantitative chemical, structural change of the kerf-loss Si powders. The relative contribution of the LO and TO stretching modes to the Si-O-Si absorption band in the ATR-FTIR spectra provide a consistent estimation of the effective oxidation level of the Si powders. The change in the cutting media from deionized water to city water, induces a different silicon oxide layer thickness at the surface of the final kerf-loss Si, depending on the powder reactivity to the media. The surfactant addition induces an enhanced carbon contamination in the form of grafted carbonated species on the surface of the particles. The thickness of the modified surface, depending on the cutting media, was estimated based on a simple model derived from the combined XPS core level and plasmon peak intensities. The effective nature of these carbonated species, sensitive to the water quality, was evidenced based on coupled XPS core peak and valence band study. The present work paves the way to a controlled process to reclaim the kerf-loss Si powder without heavy chemical etching steps.
Polarization-mediated Debye-screening of surface potential fluctuations in dual-channel AlN/GaN high electron mobility transistors
Authors: Deen David A. , Miller Ross A. , Osinsky Andrei V. , Downey Brian P. , Storm David F. , Meyer David J. , Scott Katzer D. , Nepal Neeraj
Published: December 2016

A dual-channel AlN/GaN/AlN/GaN high electron mobility transistor (HEMT) architecture is proposed, simulated, and demonstrated that suppresses gate lag due to surface-originated trapped charge. Dual two-dimensional electron gas (2DEG) channels are utilized such that the top 2DEG serves as an equipotential that screens potential fluctuations resulting from surface trapped charge. The bottom channel serves as the transistor's modulated channel. Two device modeling approaches have been performed as a means to guide the device design and to elucidate the relationship between the design and performance metrics. The modeling efforts include a self-consistent Poisson-Schrodinger solution for electrostatic simulation as well as hydrodynamic three-dimensional device modeling for three-dimensional electrostatics, steady-state, and transient simulations. Experimental results validated the HEMT design whereby homo-epitaxial growth on free-standing GaN substrates and fabrication of the same-wafer dual-channel and recessed-gate AlN/GaN HEMTs have been demonstrated. Notable pulsed-gate performance has been achieved by the fabricated HEMTs through a gate lag ratio of 0.86 with minimal drain current collapse while maintaining high levels of dc and rf performance.
The role of intramolecular nonbonded interaction and angle sampling in single-step free energy perturbation
Authors: Chiang Ying-Chih , Pang Yui Tik , Wang Yi
Published: December 2016

Single-step free energy perturbation (sFEP) has often been proposed as an efficient tool for a quick free energy scan due to its straightforward protocol and the ability to recycle an existing molecular dynamics trajectory for free energy calculations. Although sFEP is expected to fail when the sampling of a system is inefficient, it is often expected to hold for an alchemical transformation between ligands with a moderate difference in their sizes, e.g., transforming a benzene into an ethylbenzene. Yet, exceptions were observed in calculations for anisole and methylaniline, which have similar physical sizes as ethylbenzene. In this study, we show that such exceptions arise from the sampling inefficiency on an unexpected rigid degree of freedom, namely, the bond angle θ. The distributions of θ differ dramatically between two end states of a sFEP calculation, i.e., the conformation of the ligand changes significantly during the alchemical transformation process. Our investigation also reveals the interrelation between the ligand conformation and the intramolecular nonbonded interactions. This knowledge suggests a best combination of the ghost ligand potential and the dual topology setting, which improves the accuracy in a single reference sFEP calculation by bringing down its error from around 5kBT to kBT.
Generalized entropy theory of glass-formation in fully flexible polymer melts
Authors: Xu Wen-Sheng , Douglas Jack F. , Freed Karl F.
Published: December 2016

The generalized entropy theory (GET) offers many insights into how molecular parameters influence polymer glass-formation. Given the fact that chain rigidity often plays a critical role in understanding the glass-formation of polymer materials, the GET was originally developed based on models of semiflexible chains. Consequently, all previous calculations within the GET considered polymers with some degree of chain rigidity. Motivated by unexpected results from computer simulations of fully flexible polymer melts concerning the dependence of thermodynamic and dynamic properties on the cohesive interaction strength (ϵ), the present paper employs the GET to explore the influence of ϵ on glass-formation in models of polymer melts with a vanishing bending rigidity, i.e., fully flexible polymer melts. In accord with simulations, the GET for fully flexible polymer melts predicts that basic dimensionless thermodynamic properties (such as the reduced thermal expansion coefficient and isothermal compressibility) are universal functions of the temperature scaled by ϵ in the regime of low pressures. Similar scaling behavior is also found for the configurational entropy density in the GET for fully flexible polymer melts. Moreover, we find that the characteristic temperatures of glass-formation increase linearly with ϵ and that the fragility is independent of ϵ in fully flexible polymer melts, predictions that are again consistent with simulations of glass-forming polymer melts composed of fully flexible chains. Beyond an explanation of these general trends observed in simulations, the GET for fully flexible polymer melts predicts the presence of a positive residual configurational entropy at low temperatures, indicating a return to Arrhenius relaxation in the low temperature glassy state.
Note: Nanosecond LED-based source for optical modeling of scintillators illuminated by partially coherent X-ray radiation
Authors: Siano M. , Paroli B. , Chiadroni E. , Ferrario M. , Potenza M. A. C.
Published: December 2016

We developed a broad-spectrum light source specifically designed to reproduce the temporal behavior of the optical pulses emitted by scintillators for X-ray detection. Nanosecond-to-millisecond pulses are generated through a fast circuit driving Light Emitting Diodes (LEDs) and are endowed with the peculiar time features of the most employed scintillators by means of a dedicated pulse shaping stage. We implement the light source for the optical modeling of the single-shot X-ray coherence measurements with near-field speckles generated by the scattering from colloidal suspensions (heterodyne near field speckle method). Moreover, we derive a rigorous scaling law that quantitatively relates visible and X-ray signal-to-noise ratios.
Mere experience of low subjective socioeconomic status stimulates appetite and food intake
Authors: Cheon Bobby K. , Hong Ying-Yi
Published: December 2016

Significance

Lower socioeconomic status (SES) has been linked to increased risk of obesity. This relationship is generally assumed to be a product of low financial resources or greater stress associated with low SES that promotes unhealthy diets and lifestyles. We demonstrate here that the mere subjective experience of being lower in SES relative to others is alone sufficient to causally elicit behaviors that may risk obesity (e.g., preference, selection, and intake of greater calories), independent of actual economic deprivation or stress from being subordinated. Among social species, the physiological/psychological systems regulating hunger may have been adapted to be sensitive to perceived deprivation of critical social, material, and symbolic resources that underlie social class in addition to caloric deprivation.
Structural and mutational analysis of the nonribosomal peptide synthetase heterocyclization domain provides insight into catalysis
Authors: Bloudoff Kristjan , Fage Christopher D. , Marahiel Mohamed A. , Schmeing T. Martin
Published: December 2016

Significance

Nonribosomal peptide synthetases produce peptides with wide varieties of therapeutic and biological activities. Monomer substrates are typically linked by a condensation domain. However, in many modules, a heterocyclization (Cy) domain takes its place and performs both condensation and cyclodehydration of a cysteine, serine, or threonine to form a five-membered ring in the peptide backbone. Although studied for decades, the mechanisms of condensation and cyclodehydration by Cy domains were previously unknown. The crystal structure of a Cy domain, and accompanying mutagenic and bioinformatics analyses, uncover the importance of an aspartate and a threonine for the cyclodehydration reaction. This study provides insight into the catalysis of condensation by the Cy domain and enables the proposal of a reaction mechanism for cyclodehydration.
Gfi1-Foxo1 axis controls the fidelity of effector gene expression and developmental maturation of thymocytes
Authors: Shi Lewis Zhichang , Saravia Jordy , Zeng Hu , Kalupahana Nishan S. , Guy Clifford S. , Neale Geoffrey , Chi Hongbo
Published: December 2016

Significance

A fundamental question in immunology is the mechanism of thymocyte development, but how differentiating CD4
+
CD8
+
double-positive thymocytes progress into CD4
+
or CD8
+
single-positive cells remains poorly defined. We have now determined that the transcription repressor Growth factor independent 1 (Gfi1) plays a central role in controlling double-positive cell fate and thymocyte maturation. Deletion of Gfi1 in double-positive thymocytes induces premature induction of single-positive–specific effector genes and transcription factors Foxo1 and Klf2 and accelerated transition into single-positive cells. These defects are largely rectified upon partial loss of Foxo1 functions, indicating the critical contribution of aberrant Foxo1 induction to disrupted thymocyte maturation. Our study establishes a molecular mechanism that actively maintains double-positive cell identity and shapes the proper generation of mature T cells.
Impact of Abuse on Adjustment and Chronic Pain Disability
Authors: Mehta Swati , Rice Danielle , Chan Alan , Shapiro Allan P. , Sequeira Keith , Teasell Robert W.
Published: December 2016

Introduction/Aim:

Sexual abuse, state and trait psychosocial factors, pain intensity, and pain-related disability have been shown to be correlated among individuals with chronic pain. However, the interacting relationships among these factors are poorly understood. The current study aims to test model which examines the effect of abuse, state and trait psychosocial factors, and pain intensity on pain-related disability among individuals with chronic pain.

Methods:

In total, 229 participants diagnosed with chronic pain were recruited from a specialist chronic pain hospital in London, Ontario. Participants completed self-report measures related to sexual abuse history, pain intensity, personality (anxiety sensitivity, experiential avoidance, perfectionism), and adjustment (depression, anxiety, disability, maladaptive worrying). A path analysis was used to test the relationship among these variables.

Results:

The model provided a close fit to the data (χ2
21=17.02; P=0.71; root-mean-square error of approximation=0.00; normal fit index=0.97; comparative fit index=1.0). The model demonstrates the direct and indirect effects of childhood sexual abuse on state and trait psychosocial factors among individuals with chronic pain. Pain anxiety, maladaptive worrying, and pain intensity were the main determinants of pain-related disability.

Discussion/Conclusions:

The current model has important implications in understanding the interplay of factors involved in adjustment of individuals with chronic pain. Sexual abuse did not have a direct effect on pain-related disability. However, indirect effects through other psychosocial factors were demonstrated.
Duloxetine as an Analgesic Reduces Opioid Consumption After Spine Surgery
Authors: Bedin Antonio , Caldart Bedin Rafael A. , Vieira Joaquim E. , Ashmawi Hazem A.
Published: December 2016

Objectives:

Multimodal analgesia is widely advocated for the control of perioperative pain in an effort to reduce the use of opioid. Duloxetine is a selective inhibitor of serotonin and norepinephrine reuptake with efficacy for chronic pain conditions. The primary objective of this study was to evaluate the efficacy of two 60 mg oral doses of duloxetine in terms of fentanyl consumption during the postoperative period in patients undergoing elective spine surgery.

Materials and Methods:

This study was prospective, double-blind, randomized, and placebo controlled. Patients received either 60 mg duloxetine or an identical placebo 1 hour before surgery and again the following morning. The study participants were allocated into 2 groups: Group C (control) participants received the placebo and Group D (duloxetine) participants received 60 mg duloxetine. The total consumption of fentanyl 48 hours after surgery was measured. Secondary end points were pain scores and the presence or absence of adverse effects, such as headache, nausea, vomiting, itching, dizziness, and drowsiness.

Results:

Demographic characteristics did not differ between groups. There was a significant difference in fentanyl consumption in the first 24 hours between Groups C and D (mean difference, 223.11±39.32 µg; P<0.001). Fentanyl consumption also differed between Groups C and D after 48 hours (mean difference, 179.35±32.55 µg; P<0.000). The pain scores over 48 hours did not significantly differ between groups. The incidence of side-effects was similar in both groups.

Discussion:

Duloxetine was effective as an adjunct for postoperative analgesia and reduced opioid consumption.
On the Etiology of Listening Difficulties in Noise Despite Clinically Normal Audiograms
Authors: Pienkowski Martin
Published: December 2016

Many people with difficulties following conversations in noisy settings have “clinically normal” audiograms, that is, tone thresholds better than 20 dB HL from 0.1 to 8 kHz. This review summarizes the possible causes of such difficulties, and examines established as well as promising new psychoacoustic and electrophysiologic approaches to differentiate between them. Deficits at the level of the auditory periphery are possible even if thresholds remain around 0 dB HL, and become probable when they reach 10 to 20 dB HL. Extending the audiogram beyond 8 kHz can identify early signs of noise-induced trauma to the vulnerable basal turn of the cochlea, and might point to “hidden” losses at lower frequencies that could compromise speech reception in noise. Listening difficulties can also be a consequence of impaired central auditory processing, resulting from lesions affecting the auditory brainstem or cortex, or from abnormal patterns of sound input during developmental sensitive periods and even in adulthood. Such auditory processing disorders should be distinguished from (cognitive) linguistic deficits, and from problems with attention or working memory that may not be specific to the auditory modality. Improved diagnosis of the causes of listening difficulties in noise should lead to better treatment outcomes, by optimizing auditory training procedures to the specific deficits of individual patients, for example.
Correlates of interorganizational relationship strategies among critical access hospitals
Authors: Hearld Larry R. , Carroll Nathaniel W. , Hearld Kristine R. , Opoku-Agyeman William
Published: December 2016

Background:

Interorganizational relationships (IORs) between hospitals and other health care providers have many potential benefits for critical access hospitals (CAHs) that operate in resource-constrained environments. Given the potential benefits of IORs, especially for CAHs, it is important to identify the conditions that support or hinder IOR development. However, most research examining IORs isolates individual types of relationships while ignoring the practical reality that many hospitals participate in a portfolio of relationships simultaneously.

Purpose:

The aim of the study was to examine the IOR strategies of CAHs as a function of market and organizational characteristics.

Methodology:

The sample consisted of CAHs operating in the United States between the years 2002 and 2012. For each year, hospitals were assigned to one of four mutually exclusive IOR categories: (a) no IOR, (b) vertical IOR only, (c) horizontal IOR only, and (d) both vertical and horizontal IOR. Organizational characteristics were categorized as structural, operational, and financial. Environmental characteristics were categorized as sociodemographic, physical, and health delivery system-related. A multinomial logistic regression model was used to assess the relationship between IOR strategies and organizational and environmental characteristics, with results reported as average marginal effects.

Results:

Approximately 41% of the CAHs were pursuing a combined vertical and horizontal IOR strategy, 20% were pursuing a vertical IOR-only strategy, 18% were pursuing a horizontal IOR-only strategy, and 21% were not engaged in an IOR strategy. Among the organizational characteristics, the type of IOR strategy used by a hospital varied as a function of ownership, total margin, days cash on hand, number of community orientation activities, and census. In contrast, among the environmental characteristics, only the number of community health centers in the community was associated with the type of IOR strategy pursued.

Conclusion:

CAHs’ construction of IOR portfolios may be more dependent on organizational attributes than by environmental conditions.
Clinical assessment of the impact of pelvic pain on women
Authors: Chalmers K. Jane , Catley Mark J. , Evans Susan F. , Moseley G. Lorimer
Published: December 2016

We aimed to develop a questionnaire that assesses the impact of pelvic pain on women, regardless of diagnosis, that has high utility, sound psychometric performance, easy scoring, and high reliability. Two studies, with 3 separate cohorts, were undertaken. Both studies were completed online. Studies included women with self-reported pelvic pain. Women were eligible to participate regardless of whether their pelvic pain was undiagnosed, self-diagnosed, or diagnosed by a clinician. Study 1 used a 3-round “patient-as-expert” Delphi technique. These rounds defined the 10 aspects of life with the self-reported greatest impact on the lives of women with pelvic pain, which formed the questionnaire. Study 2 used Rasch analysis to assess the psychometric properties of the resultant 10-item questionnaire. To assess its reliability, a subgroup completed the questionnaire 3 times over a 3-week period. In study 1, 443 women with pelvic pain participated. The resultant 10-item questionnaire consisted of 8 Likert questions and 2 supplemental, nonscored questions. In study 2, 1203 women with pelvic pain completed the questionnaire. Rasch analysis showed that the questionnaire targeted the pelvic pain population well, had appropriate Likert categories, constituted a unidimensional scale, and showed internal consistency. Twenty-seven women with pelvic pain completed the reliability trial. Test–retest reliability was high (intraclass correlation coefficient 0.91, P < 0.001). The resultant Pelvic Pain Impact Questionnaire assesses the life impact of pelvic pain. It uses patient-generated language, is easily administered and scored, has very strong psychometric properties, and it is suitable for research and clinical settings across primary, secondary, and tertiary care.
Bifunctional peptide-based opioid agonist/nociceptin antagonist ligand for dual treatment of nociceptive and neuropathic pain
Authors: Lagard Camille , Chevillard Lucie , Guillemyn Karel , Risède Patricia , Laplanche Jean-Louis , Spetea Mariana , Ballet Steven , Mégarbane Bruno
Published: December 2016

Drugs able to treat both nociceptive and neuropathic pain effectively without major side effects are lacking. We developed a bifunctional peptide-based hybrid (KGNOP1) that structurally combines a mu-opioid receptor agonist (KGOP1) with antinociceptive activity and a weak nociceptin receptor antagonist (KGNOP3) with anti-neuropathic pain activity. We investigated KGNOP1-related behavioral effects after intravenous administration in rats by assessing thermal nociception, cold hyperalgesia in a model of neuropathic pain induced by chronic constriction injury of the sciatic nerve, and plethysmography parameters including inspiratory time (TI) and minute ventilation (VM) in comparison to the well-known opioid analgesics, tramadol and morphine. Time-course and dose-dependent effects were investigated for all behavioral parameters to determine the effective doses 50% (ED50). Pain-related effects on cold hyperalgesia were markedly increased by KGNOP1 as compared to KGNOP3 and tramadol (ED50: 0.0004, 0.32, and 12.1 μmol/kg, respectively), whereas effects on thermal nociception were significantly higher with KGNOP1 as compared to morphine (ED50: 0.41 and 14.7 μmol/kg, respectively). KGNOP1 and KGOP1 produced a larger increase in TI and deleterious decrease in VM in comparison to morphine and tramadol (ED50(TI): 0.63, 0.52, 12.2, and 50.9 μmol/kg; ED50(VM): 0.57, 0.66, 10.6, and 50.0 μmol/kg, respectively). Interestingly, the calculated ratios of anti-neuropathic pain/antinociceptive to respiratory effects revealed that KGNOP1 was safer than tramadol (ED50 ratio: 5.44 × 10−3 vs 0.24) and morphine (ED50 ratio: 0.72 vs 1.39). We conclude that KGNOP1 is able to treat both experimental neuropathic and nociceptive pain, more efficiently and safely than tramadol and morphine, respectively, and thus should be a candidate for future clinical developments.
Use of smartphones to prospectively evaluate predictors and outcomes of caregiver responses to pain in youth with chronic disease
Authors: Connelly Mark , Bromberg Maggie H. , Anthony Kelly K. , Gil Karen M. , Schanberg Laura E.
Published: December 2016

This study examined outcomes and predictors of different types of responses to child pain used by caregivers of youth with chronic disease. Sixty-six children and adolescents (age 7-18 years) with juvenile idiopathic arthritis answered questions about pain, pain interference in activities, and mood on a smartphone 3 times per day for one month, while a caregiver contemporaneously answered questions about their own mood and use of protecting, monitoring, minimizing, or distracting responses to their child's pain. Multilevel models were used to evaluate (1) how a child's pain and pain interference changes after a caregiver uses different types of pain responses; (2) the extent to which caregiver responses to pain vary across days; and (3) whether variability in caregiver responses to pain is predicted by changes in child pain characteristics, child mood, and/or caregiver mood. Results showed that children's pain intensity and pain interference increased after moments when caregivers used more protective responses, whereas children's pain interference decreased after times when caregivers responded with minimizing responses. Caregiver pain responses varied considerably across days, with caregivers responding with more protecting and monitoring responses and fewer minimizing responses at moments when their child reported high levels of pain unpleasantness and pain interference. Caregivers also were found to respond with fewer protective responses at moments when they themselves were in a more positive mood. Implications for clinical recommendations and future studies are discussed.
Diagnostic Yield and Complications of EBUS-TBNA Performed Under Bronchoscopist-directed Conscious Sedation
Authors: Dhooria Sahajal , Sehgal Inderpaul S. , Gupta Nalini , Aggarwal Ashutosh N. , Behera Digambar , Agarwal Ritesh
Published: December 2016

Background:

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can be performed under either conscious sedation or general anesthesia. Herein, we describe the diagnostic yield and complications of EBUS-TBNA performed under bronchoscopist-directed conscious sedation.

Methods:

This is a retrospective analysis of data collected in the bronchoscopy suite of this center on EBUS-TBNA or endoscopic ultrasound with a bronchoscope-guided fine needle aspiration (EUS-B-FNA) procedures performed between July 2011 and January 2016. All procedures were performed under bronchoscopist-directed conscious sedation with midazolam and pentazocine. The diagnostic yield, sample adequacy rate, complications, and doses of sedative agents are presented.

Results:

Of the total 1005 EBUS-TBNA/EUS-B-FNA procedures performed during the study period, 1004 were performed under conscious sedation in spontaneously breathing subjects [mean (SD) age, 45.9 (15.8) years; 378 (37.6%) women]. The mean (SD) doses of midazolam and pentazocine used were 2.53 (1.8) mg and 30.9 (6.9) mg, respectively. The diagnostic yield of the procedure (972 subjects) was 61.2%. Complications related to EBUS were observed in 60 (5.9%) subjects. Majority of them were minor and self-limiting; major complications occurred in 11 (1.1%) subjects and included respiratory failure requiring assisted ventilation (n=6), arrhythmia (n=3), and hypotension (n=2). Escalation of the level of care was needed in only 8 (0.8%) subjects.

Conclusion:

EBUS-TBNA/EUS-B-FNA performed under bronchoscopist-guided conscious sedation was found to be safe and is associated with a reasonable diagnostic yield.
Vulvodynia: What We Know and Where We Should Be Going
Authors: Havemann Logan M. , Cool David R. , Gagneux Pascal , Markey Michael P. , Yaklic Jerome L. , Maxwell Rose A. , Iyer Ashvin , Lindheim Steven R.
Published: December 2016

Objective

The aim of the study was to review the current nomenclature and literature examining microbiome cytokine, genomic, proteomic, and glycomic molecular biomarkers in identifying markers related to the understanding of the pathophysiology and diagnosis of vulvodynia (VVD).

Materials and Methods

Computerized searches of MEDLINE and PubMed were conducted focused on terminology, classification, and “omics” variations of VVD. Specific MESH terms used were VVD, vestibulodynia, metagenomics, vaginal fungi, cytokines, gene, protein, inflammation, glycomic, proteomic, secretomic, and genomic from 2001 to 2016. Using combined VVD and vestibulodynia MESH terms, 7 references were identified related to vaginal fungi, 15 to cytokines, 18 to gene, 43 to protein, 38 to inflammation, and 2 to genomic. References from identified publications were manually searched and cross-referenced to identify additional relevant articles. A narrative synthesis of the articles was conducted; however, meta-analysis was not conducted because of substantial heterogeneity in the studies and limited numbers of control-matched studies.

Results

Varying definitions of VVD complicate a meta-analysis, and standard definitions will better allow for comparisons of studies and enhance the applicability of evidence to patient populations. Although data are still limited, genomic and molecular diagnostic testings continue to be investigated as potential tools for the diagnosis of VVD.

Conclusions

Standardized nomenclature will allow for comparability of studies and progress in research related to the pathophysiology of VVD and to facilitate clinical decision making and treatment choices. Although the current understanding of the pathogenesis of VVD is limited, there are new opportunities to explore potential diagnostic markers differences in women with VVD, which may lead to targeted therapy.
Venoarterial Extracorporeal Life Support for Neonatal Respiratory Failure: Indications and Impact on Mortality
Authors: Bamat Nicolas A. , Tharakan Sasha J. , Connelly James T. , Hedrick Holly L. , Lorch Scott A. , Rintoul Natalie E. , Williams Susan B. , Dysart Kevin C.
Published: December 2016

Venoarterial (VA) extracorporeal life support (ECLS) for neonatal respiratory failure is associated with increased mortality compared with venovenous (VV) ECLS. It is unclear whether this is a causal relationship or reflects differences in baseline disease severity between infants managed with these two strategies. Our objective was to identify clinical variables associated with the preferential selection of VA over VV ECLS, as these may confound the association between VA ECLS and increased mortality. We identified documented indications for preferential VA selection through chart review. We then assessed how the presence of common indications impacted mortality. Thirty-nine cases met eligibility. Severity of hypotension/degree of inotropic support and ventricular dysfunction on echocardiogram before cannulation were the most common specific indications for preferential VA ECLS. Mortality was 12.5% when neither high inotropic support nor ventricular dysfunction was present. Mortality rose to 20% with high inotropic support and 25% with ventricular dysfunction present alone and to 50% when both were present. We conclude that severe hypotension and ventricular dysfunction before ECLS cannulation are common indications for VA ECLS that likely influence survival. Research assessing the impact of ECLS cannulation mode on survival should adjust for baseline differences between groups for these important variables.
Medical Management of Pump-Related Thrombosis in Patients with Continuous-Flow Left Ventricular Assist Devices: A Systematic Review and Meta-Analysis
Authors: Dang Geetanjali , Epperla Narendranath , Muppidi Vijayadershan , Sahr Natasha , Pan Amy , Simpson Pippa , Baumann Kreuziger Lisa
Published: December 2016

Pump thrombosis is a dreaded complication of left ventricular assist devices (LVADs). We completed a systematic review to evaluate the efficacy and complications associated with medical management of LVAD thrombosis. Databases were searched using the terms “vad*” or “ventricular assist device” or “heart assist device” and “thrombus” or “thrombosis” or “thromboembolism.” Of 2,383 manuscripts, 49 articles met the inclusion criteria. The risk of partial or no resolution of LVAD thrombosis did not significantly differ between thrombolytic and nonthrombolytic regimens (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.20–1.16). When response to therapy was evaluated based on pump type, there were no significant differences in how patients with a HeartMate II or HeartWare ventricular assist device responded to thrombolytic or nonthrombolytic treatment. Pooled risk of major bleeding in the thrombolytic group was 29% (95% CI, 0.17–0.44) and 12% (95% CI, 0.01–0.57) in the nonthrombolytic group. Odds of death did not differ between thrombolytic and nonthrombolytic regimens (OR, 1.28; 95% CI, 0.42–3.89). Although thrombolytic and nonthrombolytic treatment similarly resolved LVAD thrombosis, major hemorrhage may be increased with the use of thrombolysis. Randomized clinical trials comparing thrombolytic and nonthrombolytic treatment of LVAD thrombosis are needed to establish the most effective and safe option for patients who are not surgical candidates.
Retrospective validation of the pulmonary embolism rule-out criteria rule in ‘PE unlikely’ patients with suspected pulmonary embolism
Authors: Crane Steven , Jaconelli Tom , Eragat Mazin
Published: December 2016

Introduction

Patients presenting to emergency departments (EDs) with suspected pulmonary embolism (PE) can be risk stratified and those who are deemed to be at low risk for PE usually undergo D-dimer testing. A negative D-dimer in this low-risk group rules out PE with a high degree of certainty because of its high sensitivity. The D-dimer is, however, a poorly specific test and positive results often lead to unnecessary radiological imaging (notably computed tomography pulmonary angiography). The Pulmonary Embolism Rule-Out Criteria (PERC) rule has been suggested as an alternative to D-dimer testing in these patients. This study looked at whether the PERC rule could safely replace the use of D-dimer in patients suspected of PE, but deemed ‘PE unlikely’ by the dichotomized Wells score in a UK ED setting.

Patients and methods

This was a retrospective review of 986 patients with suspected PE who had a blood sample for D-dimer level taken. In patients deemed ‘PE unlikely’ (using the dichotomized Wells score), the diagnostic performance of the PERC rule was compared with a standard D-dimer level in the detection of PE at index presentation and up to 3 months afterwards.

Results

Of the 986 patients, 940 patients were deemed ‘PE unlikely’ using the dichotomized Wells score. Three patients with confirmed PE would have been missed by the PERC rule compared with only one missed by the D-dimer test. In these patients, the sensitivity of the PERC rule for detecting PE was 91.4% [95% confidence interval (CI): 76.9–98.2%], with a negative likelihood ratio of 0.25 (95% CI: 0.08–0.73). However, the negative predictive value of the PERC rule was 99.1% (95% CI: 97.3–99.8%). In comparison, the sensitivity for the standard D-dimer test was 97.1% (95% CI: 85.1–99.9%), with a negative likelihood ratio of 0.04 (95% CI: 0.01–0.27). The negative predictive value for the standard D-dimer test was 99.8% (95% CI: 99.2–100%).

Conclusion

The PERC rule has a high negative predictive value for excluding PE in patients presenting with suspected PE to the ED. However, the PERC rule may still miss around 8% of confirmed PE in patients who are deemed ‘PE unlikely’ by a dichotomized Wells score. Caution is advised in using the PERC rule as a substitute for the standard D-dimer test in all these patients.