bluuebunny/crossref_metadata_2025 huggingface dataset:
Plasma-chemical synthesis, structure and photoluminescence properties of hybrid graphene nanoflake–BNCO nanowall systems
Authors: Wang B. B. , Zheng K. , Gao D. , Levchenko I. , Ostrikov K. , Keidar M. , Zou S. S.
Published: September 2016

We describe a simple, efficient plasma-chemical technique for the synthesis of hybrid structures formed by vertically oriented BNCO nanowalls and vertically oriented graphene nanoflakes (BNCONW/GNFs), as well as their structure and photoluminescence properties.
Picture Exchange Communication System and Pals: A Peer-Mediated Augmentative and Alternative Communication Intervention for Minimally Verbal Preschoolers With Autism
Authors: Thiemann-Bourque Kathy , Brady Nancy , McGuff Sara , Stump Keenan , Naylor Amy
Published: September 2016

Purpose

This study was conducted to investigate the effectiveness of a social intervention that integrates peer-mediated approaches and the Picture Exchange Communication System (PECS).

Method

Effects were evaluated using a series of A-B designs replicated across 4 children with severe autism and limited verbal skills. Seven peers without disabilities were trained to use PECS and facilitative social skills. Measures of changes included rates of communication behaviors, modes, functions, and engagement.

Results

Outcomes revealed an intervention effect for 1 child with autism, and this effect was replicated across 3 other children. All children improved in peer-directed communication, with greater increases for 2 children during snack time. For each child with autism, the primary communication behavior was to initiate with picture symbols to request; the peer's primary communication was to respond. Two children increased communicative functions to comment and to share, and all 4 children showed improved social engagement. All peers increased their communication with the children with autism.

Conclusions

These findings add to the limited research on the benefits of teaching typically developing peers to be responsive listeners to preschoolers with autism by learning to use PECS. These results invite further investigation of teaching peers other augmentative and alternative communication approaches and how to increase children's communication with peers for different purposes.

Supplemental Material

https://doi.org/10.23641/asha.14963928
Telling Tales: Personal Event Narratives and Life Stories
Authors: Westby Carol , Culatta Barbara
Published: September 2016

Purpose

Speech-language pathologists know much more about children's development of fictional narratives than they do about children's development of personal narratives and the role these personal narratives play in academic success, social–emotional development, and self-regulation. The purpose of this tutorial is to provide clinicians with strategies for assessing and developing children's and adolescents' personal narratives.

Method

This tutorial reviews the literature on (a) the development of autobiographical event narratives and life stories, (b) factors that contribute to development of these genres, (c) the importance of these genres for the development of sense of self-identity and self-regulation, (d) deficits in personal narrative genres, and (e) strategies for eliciting and assessing event narratives and life stories.

Implications

To promote development of personal event narratives and life stories, speech-language pathologists can help clients retrieve information about interesting events, provide experiences worthy of narrating, and draw upon published narratives to serve as model texts. Clinicians can also address four interrelated processes in intervention: reminiscing, reflecting, making coherent connections, and signaling the plot structure. Furthermore, they can activate metacognitive awareness of how evaluations of experiences, coherence, and plot structure are signaled in well-formed personal event narratives and life stories.
Production and dynamics of positrons in ultrahigh intensity laser-foil interactions
Authors: Kostyukov I. Yu. , Nerush E. N.
Published: September 2016

The electron-positron pair production accompanying interaction of a circularly polarized laser pulse with a foil is studied for laser intensities higher than 1024 W cm−2. The laser energy penetrates into the foil due to the effect of the relativistic hole-boring. It is demonstrated that the electron-positron plasma is produced as a result of quantum-electrodynamical cascading in the field of the incident and reflected laser light in front of the foil. The incident and reflected laser light make up the circularly polarized standing wave in the reference frame of the hole-boring front and the pair density peaks near the nodes and anti-nodes of the wave. A model based on the particle dynamics with radiation reaction effect near the magnetic nodes is developed. The model predictions are verified by three dimensional particle-in-cell Monte Carlo simulations.
Light-induced phenomena in one-component gas: The transport phenomena
Authors: Chermyaninov I. V. , Chernyak V. G.
Published: September 2016

The article presents the theory of transport processes in a one-component gas located in the capillary under the action of resonant laser radiation and the temperature and pressure gradients. The expressions for the kinetic coefficients determining heat and mass transport in the gas are obtained on the basis of the modified Boltzmann equations for the excited and unexcited particles. The Onsager reciprocal relations for cross kinetic coefficients are proven for all Knudsen numbers and for any law interaction of gas particles with each other and boundary surface. Light-induced phenomena associated with the possible non-equilibrium stationary states of system are analyzed.
Role of Ge and Si substrates in higher-k tetragonal phase formation and interfacial properties in cyclical atomic layer deposition-anneal Hf1−xZrxO2/Al2O3 thin film stacks
Authors: Dey Sonal , Tapily Kandabara , Consiglio Steven , Clark Robert D. , Wajda Cory S. , Leusink Gert J. , Woll Arthur R. , Diebold Alain C.
Published: September 2016

Using a five-step atomic layer deposition (ALD)-anneal (DADA) process, with 20 ALD cycles of metalorganic precursors followed by 40 s of rapid thermal annealing at 1073 K, we have developed highly crystalline Hf1−xZrxO2 (0 ≤ x ≤ 1) thin films (<7 nm) on ∼1 nm ALD Al2O3 passivated Ge and Si substrates for applications in higher-k dielectric metal oxide semiconductor field effect transistors below 10 nm technology node. By applying synchrotron grazing incidence x-ray d-spacing maps, x-ray photoelectron spectroscopy (XPS), and angle-resolved XPS, we have identified a monoclinic to tetragonal phase transition with increasing ZrO2 content, elucidated the role of the Ge vs Si substrates in complete tetragonal phase formation (CTPF), and determined the interfacial characteristics of these technologically relevant films. The ZrO2 concentration required for CTPF is lower on Ge than on Si substrates (x ∼ 0.5 vs. x ∼ 0.86), which we attribute as arising from the growth of an ultra-thin layer of metal germanates between the Hf1−xZrxO2 and Al2O3/Ge, possibly during the first deposition and annealing cycle. Due to Ge-induced tetragonal phase stabilization, the interfacial metal germanates could act as a template for the subsequent preferential growth of the tetragonal Hf1−xZrxO2 phase following bottom-up crystallization during the DADA ALD process. We surmise that the interfacial metal germanate layer also function as a diffusion barrier limiting excessive Ge uptake into the dielectric film. An ALD Al2O3 passivation layer of thickness ≥1.5 nm is required to minimize Ge diffusion for developing highly conformal and textured HfO2 based higher-k dielectrics on Ge substrates using the DADA ALD process.
Note: A manifold ranking based saliency detection method for camera
Authors: Zhang Libo , Sun Yihan , Luo Tiejian , Rahman Mohammad Muntasir
Published: September 2016

Research focused on salient object region in natural scenes has attracted a lot in computer vision and has widely been used in many applications like object detection and segmentation. However, an accurate focusing on the salient region, while taking photographs of the real-world scenery, is still a challenging task. In order to deal with the problem, this paper presents a novel approach based on human visual system, which works better with the usage of both background prior and compactness prior. In the proposed method, we eliminate the unsuitable boundary with a fixed threshold to optimize the image boundary selection which can provide more precise estimations. Then, the object detection, which is optimized with compactness prior, is obtained by ranking with background queries. Salient objects are generally grouped together into connected areas that have compact spatial distributions. The experimental results on three public datasets demonstrate that the precision and robustness of the proposed algorithm have been improved obviously.
Topological states of nanoscale Bi2Se3 interfaced with AlN
Authors: Freitas Walter A. , Fazzio A. , Schmidt Tome M.
Published: September 2016

Extensive effort has been devoted recently to develop nanoscale films of three-dimensional (3D) topological insulators, but preserving the topological state character. Usually, the surface topological states of ultra thin 3D systems are drastically affected or even suppressed due to quantum tunnelling, interactions with the substrate, as well the enlargement of the band gap due to confinement effects. Here we show that an ultra thin system composed by 2 and 3 quintuple layers of Bi2Se3 adsorbed on AlN surface present pairs of topological states with opposite spin-momentum locking. The preservation of the topological spin texture is a result of a unique combination presented in the system: a strong bond between Bi2Se3 and AlN substrate, and the enhancement of spin-orbit couplings due to a large interface potential gradient.
Exploiting bistable pinning of a ferromagnetic vortex for nitrogen-vacancy spin control
Authors: Badea R. , Wolf M. S. , Berezovsky J.
Published: September 2016

The strong, localized magnetic field produced by the core of a ferromagnetic vortex provides a platform for addressing and controlling individual nitrogen-vacancy (NV) center spins in diamond. Translation of a vortex state in a thin ferromagnetic disk or wire can be understood as motion through an effective pinning potential, arising from the defects in the material. Coupling an NV spin to a vortex state in a proximal ferromagnet imprints the pinning landscape onto the spin transitions. Quantitative characterization of the pinning potential is necessary to control the spin-vortex system. First, we map the effective pinning potential by raster scanning the vortex core through a permalloy disk and measuring the hysteretic vortex displacement vs. magnetic field using differential magneto-optical microscopy. Second, we demonstrate that the interaction between the vortex and a nearby NV spin can be characterized using the pinning map and the path taken by the vortex core through the landscape. Finally, we identify locations of bistability in the pinning landscape, and use them to manipulate the nitrogen vacancy spin in a controlled bimodal fashion by switching the spin on and off resonance with a driving field on a ∼ 10 ns timescale at room temperature.
SARM1-specific motifs in the TIR domain enable NAD
+
loss and regulate injury-induced SARM1 activation
Authors: Summers Daniel W. , Gibson Daniel A. , DiAntonio Aaron , Milbrandt Jeffrey
Published: September 2016

Significance

Axon degeneration is an important pathological event in multiple neurodegenerative disorders. Axon injury stimulates the prodestructive factor SARM1, leading to the precipitous loss in the metabolite NAD
+
. Remarkably, enforcing dimerization of the Toll/interleukin receptor (TIR) domain from SARM1 is sufficient to promote NAD
+
loss and axon degeneration. In this study, we uncover fundamental elements within the SARM1 TIR domain responsible for this activity, including a unique motif that is highly specific to SARM1. In addition, we discover a role for the SARM1 TIR domain in injury-induced activation of the SARM1 protein, suggesting that this domain contributes to SARM1 regulation in addition to the execution of axon degeneration. These studies identify potential avenues for therapeutic intervention in SARM1-dependent axon destruction pathways.
Deletion of the mu opioid receptor gene in mice reshapes the reward–aversion connectome
Authors: Mechling Anna E. , Arefin Tanzil , Lee Hsu-Lei , Bienert Thomas , Reisert Marco , Ben Hamida Sami , Darcq Emmanuel , Ehrlich Aliza , Gaveriaux-Ruff Claire , Parent Maxime J. , Rosa-Neto Pedro , Hennig Jürgen , von Elverfeldt Dominik , Kieffer Brigitte Lina , Harsan Laura-Adela
Published: September 2016

Significance

Mice manipulated by targeted deletion of a specific brain gene show diverse pathological phenotypes, apparent, for example, in behavioral experiments. To explain observed findings, connectome genetics attempts to uncover how brain functional connectivity is affected by genetics. However the causal impact of a single gene on whole-brain networks is still unclear. Here the sole targeted deletion of the mu opioid receptor gene (
Oprm
1), the main target for morphine, induced widespread remodeling of brain functional connectome in mice. The strongest perturbations occurred within the so-called reward/aversion-circuitry, predominantly influencing the negative affect centers. We present a hypothesis-free analysis of combined structural and functional connectivity data obtained via MRI of the living mouse brain, and identify a specific
Oprm
1 gene-to-network signature.
The nature and implications of uniformity in the hierarchical organization of nanomaterials
Authors: O’Brien Matthew N. , Jones Matthew R. , Mirkin Chad A.
Published: September 2016

In this Perspective, we present a framework that defines how to understand and control material structure across length scales with inorganic nanoparticles. Three length scales, frequently discussed separately, are unified under the topic of hierarchical organization: atoms arranged into crystalline nanoparticles, ligands arranged on nanoparticle surfaces, and nanoparticles arranged into crystalline superlattices. Through this lens, we outline one potential pathway toward perfect colloidal matter that emphasizes the concept of uniformity. Uniformity is of both practical and functional importance, necessary to increase structural sophistication and realize the promise of nanostructured materials. Thus, we define the nature of nonuniformity at each length scale as a means to guide ongoing research efforts and highlight potential problems in the field.
Morphology and function of Neandertal and modern human ear ossicles
Authors: Stoessel Alexander , David Romain , Gunz Philipp , Schmidt Tobias , Spoor Fred , Hublin Jean-Jacques
Published: September 2016

Significance

Middle ear ossicles are critical for audition and rarely preserved in fossils. Based on microcomputed tomography images, our comparative 3D shape analysis of Neandertal ossicles shows striking shape differences between Neandertals and anatomically modern humans (AMHs). However, these morphological differences do not affect the functional properties of the ossicles, potentially indicating consistent aspects of vocal communication in Neandertals and AMHs. Instead, a strong relationship between ossicle morphology and tympanic cavity architecture is found.
Temporally flexible feedback signal to foveal cortex for peripheral object recognition
Authors: Fan Xiaoxu , Wang Lan , Shao Hanyu , Kersten Daniel , He Sheng
Published: September 2016

Significance

When subjects were asked to discriminate objects in the periphery, foveal visual noise presented at precise time windows following the peripheral object onset disrupted their performance. Further, this effect of foveal noise depends on task demand and stimulus features and primarily occurs for object tasks that involve spatial details. The time window, during which the noise is effective, can be shifted based on the amount of preprocessing of the peripheral objects, revealing the operation of temporally flexible feedback processing in the foveal cortex for peripheral object recognition.
Little evidence for enhanced phenotypic evolution in early teleosts relative to their living fossil sister group
Authors: Clarke John T. , Lloyd Graeme T. , Friedman Matt
Published: September 2016

Significance

The success of teleost fishes, which represent roughly half of all vertebrate species, has attracted attention since Darwin. Numerous scenarios invoke elevated diversification in teleosts facilitated by supposed key innovations, yet claims of teleost exceptionalism are profoundly biased by the evolutionary “snapshot” of living fishes. Analysis of 160 million y (Permian–Early Cretaceous) of evolution in neopterygian fishes reveals that anatomical diversification in Mesozoic teleosts as a whole differed little from their “living fossil” holostean sister group. There is some evidence for evolutionary heterogeneity within teleosts, with early evolving lineages showing the greatest capacity for evolutionary innovation in body shape among Mesozoic neopterygians, whereas members of the modern teleost radiation show higher rates of shape evolution.
Exogenous remodeling of lung resident macrophages protects against infectious consequences of bone marrow-suppressive chemotherapy
Authors: Kamei Akinobu , Gao Geli , Neale Geoffrey , Loh Lip Nam , Vogel Peter , Thomas Paul G. , Tuomanen Elaine I. , Murray Peter J.
Published: September 2016

Significance

Infectious complications can be lethal in patients with cancer when chemotherapy depletes white blood cells (WBCs) needed to clear microbes. Prevention of infection by vaccination also requires WBCs, and thus has not been effective in saving patients with low WBC counts during chemotherapy. Using a mouse model, we discovered a kind of lung WBC that survives chemotherapy. This cell is found in the lung and can engulf and remove bacteria when activated by a vaccine. This vaccination strategy results in excellent survival in a mouse model of lethal bacterial pneumonia in the setting of chemotherapy. These findings suggest that a protective, chemotherapy-stable lung WBC could be exogenously induced to protect patients with cancer who are at high risk of life-threatening infections.
Asymmetric cryo-EM structure of the canonical
Allolevivirus
Qβ reveals a single maturation protein and the genomic ssRNA in situ
Authors: Gorzelnik Karl V. , Cui Zhicheng , Reed Catrina A. , Jakana Joanita , Young Ry , Zhang Junjie
Published: September 2016

Significance

Single-stranded (ss) RNA viruses have ribonucleic acid as their genetic material and infect animals, plants, and bacteria. Here we used cryo-electron microscopy to reveal the genomic RNA (gRNA) of the ssRNA virus Qβ. The asymmetric gRNA adopts a single dominant structure in all virions and binds the capsid of Qβ at each coat protein. At the same time, we determined the structure of the maturation protein, A
2
, which functions both as the virion’s “tail” and its lysis protein. We see the gRNA is more ordered when interacting with A
2
. These results provide structural insights into gRNA packaging and host infection in ssRNA viruses.
Grad-seq guides the discovery of ProQ as a major small RNA-binding protein
Authors: Smirnov Alexandre , Förstner Konrad U. , Holmqvist Erik , Otto Andreas , Günster Regina , Becher Dörte , Reinhardt Richard , Vogel Jörg
Published: September 2016

Significance

Understanding the functions of cellular transcripts based on their sequence is challenging, in particular for noncoding RNAs, which tend to lack easily recognizable motifs. A more functionally relevant criterion is the association of RNAs with cognate RNA-binding proteins. Here, we describe the gradient profiling by sequencing (Grad-seq) approach to draft global RNA landscapes through partitioning all cellular transcripts into diverse coding and noncoding groups based on their shared RNA–protein interactions. Grad-seq has enabled us to define a large class of structured small RNAs that commonly associate with the conserved RNA-binding protein ProQ and appears to constitute a new branch of posttranscriptional control in bacteria. The generic nature of the Grad-seq approach will help to rapidly describe functional RNA landscapes in numerous understudied microbes.
Diaper Dermatitis
Authors: Esser Media
Published: September 2016

Diaper dermatitis is a major issue among hospitalized infants, leading to increased medical costs, pain, risk for infection, and distress among patients and caregivers. An evidence-based algorithm for prevention and treatment of diaper dermatitis was developed and introduced in a level IV neonatal intensive care unit (NICU). Two cases are discussed as examples of severe diaper dermatitis. The first case demonstrates the final case of severe diaper dermatitis since the introduction of the algorithm. The second case demonstrates a less severe, but equally frustrating, case of diaper dermatitis that occurred after the practice of using the algorithm was established. The need for consistency in the prevention and treatment of diaper dermatitis is paramount to providing quality care. There are a number of points within the bedside care regimen where breakdown in consistency occurs. The adherence to consistent and evidence-based treatment regimens has the potential to decrease the incidence and severity of diaper dermatitis in high-risk hospitalized infants. Initiation of an evidence-based algorithm to assist in the prevention and treatment of diaper dermatitis can be supported by data of the number of cases of diaper dermatitis collected before and after implementing the algorithm. The information can further assist in continued education and pursuance of investigation of other major skin injuries in NICU patients. The importance surrounding infant skin care and building awareness surrounding all of the facets of skin care in this vulnerable population demonstrate the benefits to quality outcomes and care.
Bathing and Beyond
Authors: Lund Carolyn
Published: September 2016

Background:

Bathing the newborn infant is controversial, ranging from how and when to give the newborn their first bath, whether to bathe newborns at all in the initial days of life, and how to approach bathing the hospitalized premature and full-term infant in the neonatal intensive care unit (NICU).

Purpose:

To review relevant literature about bathing newborn infants, as well as examine the controversies about bathing NICU patients including the use of daily chlorhexidine gluconate (CHG) baths.

Findings:

Despite studies showing that temperature can be maintained when the first bath was at 1 hour after delivery, there are benefits from delaying the bath including improved breastfeeding. Tub or immersion bathing improves temperature, and is less stressful. It is not necessary to bathe infants every day, and premature infants can be bathed as little as every 4 days without an increase in skin colonization. No differences have been reported in skin parameters such as pH, transepidermal water loss, and stratum corneum hydration whether the first and subsequent baths are given using water alone or water and a mild baby cleanser. Concerns about systemic absorption suggests caution about widespread practice of daily CHG bathing in the NICU until it is known whether CHG crosses the blood–brain barrier, particularly in premature infants.

Implications for Practice and Research:

Research regarding bathing practices for NICU patients should be evidence-based whenever possible, such as the benefits of immersion bathing. More evidence about the risks and benefits of daily CHG bathing is needed before this practice is widely disseminated.
Older Adults of Underrepresented Populations and Their End-of-Life Preferences
Authors: Rahemi Zahra , Williams Christine Lisa
Published: September 2016

This integrative review was conducted to examine the evidence for understanding diversity in end-of-life preferences among older adults of underrepresented groups. Findings from 21 studies were critically examined, grouped, and compared across studies, populations, and settings. Five major themes emerged: advance directives, hospice and palliative care, communication, knowledge and information, and home and family. Despite multidisciplinary attention, content and methodological limitations narrowed understanding of what matters most to these groups when making decisions at end of life. Rigorous longitudinal studies with more ethnically diverse samples are needed to detect modifiable factors related to disparities at the end of life.
Nerve growth factor blockade for the management of osteoarthritis pain: what can we learn from clinical trials and preclinical models?
Authors: Miller Rachel E. , Block Joel A. , Malfait Anne-Marie
Published: September 2016

Purpose of review

Anti-nerve growth factor (NGF) antibodies hold tremendous potential for the management of osteoarthritis pain, but clinical trials have revealed serious adverse effects that are incompletely understood. This review discusses clinical trial results along with preclinical studies that have assessed NGF blockade in experimental osteoarthritis, in order to provide insight for future studies.

Recent findings

Systematic reviews have revealed that anti-NGF therapy, including tanezumab, is efficacious in improving pain and function, but serious adverse events, including rapidly progressive osteoarthritis and osteonecrosis, resulted in a moratorium on trials that was only recently lifted. Within the past year, preclinical testing has revealed effects of NGF blockade on both pain behaviors and joint structure in experimental models of osteoarthritis. Similar to clinical trial results, these studies in laboratory animals demonstrated analgesic efficacy of NGF blockade. Interestingly, several animal studies have suggested detrimental effects on joint integrity as a result of treatment, particularly when treatment is started early in the disease, when joint damage is mild to moderate.

NGF blockade continues to represent a promising new approach for the treatment of osteoarthritis pain, but the actual benefits and risks remain to be fully elucidated. Preclinical models may suggest patient populations that could be best served while limiting side-effects, but future work should further investigate the mechanisms of benefits and unwanted side-effects.
Facial Laxity Rating Scale Validation Study
Authors: Leal Silva Hector G.
Published: September 2016

BACKGROUND

Age, weight change, clinical or surgical procedures, and distinctive characteristics, combine to be perceived as degrees of flaccidity. There is an absence of a validated scale to accurately assess the firmness-laxity spectrum of the face and neck with accepted classification and terminology.

OBJECTIVE

To create a simplified assessment tool to measure the degree of laxity in the face and neck: the Facial Laxity Rating (FLR) scale.

METHODS

The FLR scale evaluates 4 distinctive signs (eyelid folds, nasojugal folds, jowls, and neck profile) in 4 regions: upper face, middle face, lower face, and neck. This study incorporated a focused training component for 7 independent physician blinded photograph scorers. A total of 188 ratings were assessed.

RESULTS

Combined weighted kappa inter-rater agreement was 0.77 (95% CI, 0.76–0.78) for 188 ratings. Mean inter-rater agreement for laxity class was 0.78 (95% CI, 0.77–0.80). Agreement scoring relative to the truth standard was 92.53% (90.31–94.21), averaged for 7 investigators.

CONCLUSION

This study effectively presents the validation of the FLR scale for both inter-rater and agreement relative to the truth standard, demonstrating that the FLR scale may be used as a reliable instrument for quantitative assessment of chronological or treatment related laxity of the face and neck.
Association Between Phase 3 Cardiac Rehabilitation and Clinical Events
Authors: Brawner Clinton A. , Girdano Daniel , Ehrman Jonathan K. , Keteyian Steven J.
Published: September 2016

PURPOSE:

There is an inverse relationship between phase 2 cardiac rehabilitation (CR) visits and all-cause mortality. Phase 3 CR is a maintenance exercise program for which clinical outcomes are uncertain. This retrospective study describes the association between phase 3 CR participation and clinical events among patients with ischemic heart disease after completion of phase 2 CR.

METHODS:

Patients who completed 12 visits of phase 2 CR as provided by their health insurance were categorized on the basis of their frequency of participation (ie, none, irregular, and regular) in phase 3 CR during the 8 weeks after phase 2 CR. Cox regression analysis was used to evaluate the association between phase 3 CR participation and risk for a composite outcome that included all-cause mortality, nonfatal myocardial infarction, or heart failure hospitalization.

RESULTS:

Among 2039 patients (32% women; age = 59 ± 10 years) who completed phase 2 CR, 101 were regular and 129 were irregular participants of phase 3 CR. Over a median followup of 5.6 years, 556 (27%) patients experienced the outcome. Neither irregular nor regular participation in phase 3 CR was significantly associated with risk for the outcome in unadjusted (P = .671 and P = .396, respectively) or adjusted (P = .737 and P = .890, respectively) analyses.

CONCLUSIONS:

We did not observe an incremental clinical benefit from weekly participation in Phase 3 CR after completion of phase 2 CR among patients with ischemic heart disease. Additional research addressing the dose-response relationship between phase 2 and 3 CR and clinical outcomes is needed.
Gynecologists' Knowledge, Attitudes, and Intentions Toward Human Papillomavirus Vaccination in Serbia
Authors: Stamenkovic Zeljka , Matejic Bojana , Djikanovic Bosiljka , Zaric Marija
Published: September 2016

Objectives

The aims of this study were to estimate the level of knowledge, attitudes, and intentions about human papillomavirus (HPV) infection and HPV vaccine among gynecologists and to explore predictors of gynecologists' intention to recommend the HPV vaccine.

Method

This research was conducted between April and June 2014 among all gynecologists working at women’s health departments in all primary health centers in Belgrade, the capital of Serbia, using a specially designed questionnaire.

Results

The response rate was 88.2%. The knowledge of gynecologists was estimated as average. The most frequently reported obstacles to HPV vaccination was the financial concern (59.8%). More than two thirds of the gynecologists were willing to recommend the vaccine (68.4%). The factors associated with the gynecologists’ intention to recommend the vaccine included their positive attitudes toward boys’ vaccination (odds ratio [OR], 8.96; 95% confidence interval [CI], 2.85–28.16), negative attitudes toward frequent changes the recommendations (OR, 0.31; 95% CI, 0.10–0.93), and beliefs that the vaccine application would decrease condom usage (OR, 0.31; 95% CI, 0.06–0.68).

Conclusions

The findings provide an important insight into the current point of view of the gynecologists, which confirms that the better the knowledge of HPV and vaccine, the higher the likelihood of recommending it.
Elective oocyte cryopreservation for deferred childbearing
Authors: Goldman Kara N. , Grifo Jamie A.
Published: September 2016

Purpose of review

Elective oocyte cryopreservation for deferred childbearing has gained popularity worldwide, commensurate with increased knowledge regarding age-related fertility decline. The purpose of this review is to summarize recent data regarding trends in delayed childbearing, review recent findings surrounding age-related fertility decline, acknowledge significant gaps in knowledge among patients and providers regarding fertility decline and review outcomes following elective oocyte cryopreservation.

Recent findings

Despite an inevitable decline in fertility and increase in miscarriage with increasing female age, there is a growing worldwide trend to delay childbearing. Patients and providers alike demonstrate large gaps in knowledge surrounding age-related fertility decline. Oocyte cryopreservation is clinically approved for medically indicated fertility preservation, but a growing number of women are using oocyte cryopreservation to defer childbearing and maintain reproductive autonomy. Mounting data support the efficacy and safety of oocyte cryopreservation when used to electively defer childbearing, with recent studies demonstrating rates of euploidy, implantation and live birth rates equivalent to in-vitro fertilization (IVF) with fresh oocytes.

Oocyte cryopreservation provides women with an option to defer childbearing and maintain reproductive autonomy, with IVF success rates on par with fresh IVF. However, it is critical that patients understand the limitations of oocyte cryopreservation. Greater education regarding age-related fertility decline should be geared toward patients and providers to prevent unintended childlessness.
A comparison of sedation with midazolam–ketamine versus propofol–fentanyl during endoscopy in children: a randomized trial
Authors: Akbulut Ulas E. , Saylan Sedat , Sengu Bilal , Akcali Gulgun E. , Erturk Engin , Cakir Murat
Published: September 2016

Purpose

We aimed to compare the efficacy and safety of midazolam plus ketamine versus fentanyl plus propofol combination administered to children undergoing upper gastrointestinal endoscopy (UGE) and to determine the most appropriate sedation protocol.

Materials and methods

This prospective, randomized, single-blind study included patients between the ages of 4 and 17 years who underwent UGE for diagnostic purposes. Patients were divided randomly into groups A (midazolam–ketamine combination, n=119) and B (fentanyl plus propofol combination, n=119). The effectiveness of the sedation and complications during the procedure and recovery period were recorded.

Results

The processes started without an additional dose of the drug for 118 patients (99.1%) in group A and for 101 patients (84.8%) in group B (P=0.001). The average dose of ketamine administered to the patients in group A was 1.03±0.15 mg/kg and the average dose of propofol administered to the patients in group B was 1.46±0.55 mg/kg. None of the patients stopped the endoscopic procedure in group A, but one patient (0.8%) had to discontinue the endoscopic procedure in group B. 27 patients in group A (22.7%) and 41 patients (34.5%) in group B developed complications during the procedure (P=0.044). The rate of complications during the recovery of group A (110 patients, 92.4%) was significantly higher than that in group B (48 patients, 40.3%) (P=0.001).

Conclusion

In children, UGE procedures can be quite comfortable when using the midazolam–ketamine combination. However, adverse effects related to ketamine were observed during recovery.
Multiplex Competition, Collaboration, and Funding Networks Among Health and Social Organizations
Authors: Fujimoto Kayo , Wang Peng , Kuhns Lisa M. , Ross Michael W. , Williams Mark L. , Garofalo Robert , Klovdahl Alden S. , Laumann Edward O. , Schneider John A.
Published: September 2016

Background:

Young men who have sex with men (YMSM) have the highest rates of human immunodeficiency virus (HIV) infection in the United States. Decades into the HIV epidemic, the relationships that YMSM-serving health and social organizations have with one another has not been studied in depth.

Objectives:

The aim of this study was to examine the competition, collaboration, and funding source structures of multiplex organization networks and the mechanisms that promote fruitful relationships among these organizations.

Research Design:

The study data collection method was a survey of health and social organizations from 2013–2014 in 2 cities, Chicago, IL and Houston, TX.

Subjects:

Study participants were representatives from 138 health and social organizations.

Measures:

Responses to survey questions were used to reconstruct competition, collaboration, and combined competition-collaboration networks.

Results:

While taking into consideration the collaborative relationships among organizations, we provide statistical evidence that organizations of similar type, similar social media use patterns, comparable patterns of funding, and similar network contexts tended to compete with one another. This competition was less likely to be accompanied by any sort of collaboration if the organizations shared common funding sources.

Conclusions:

Competition that excludes potential collaboration may be detrimental to mobilizing the collective efforts that serve local YMSM communities. System-level interventions may provide promising approaches to scaling-up HIV prevention and treatment efforts so as to encourage organizations to form partnerships with otherwise competing providers.
New oral agents for treating dyslipidemia
Authors: Gryn Steven E. , Hegele Robert A.
Published: September 2016

Purpose of review

We provide an overview of orally administered lipid-lowering therapies under development.

Recent findings

Recent data support statins for intermediate risk primary prevention, and ezetimibe for high-risk secondary prevention. Novel agents in development include bempedoic acid and gemcabene, and work continues on one remaining cholesteryl ester transfer protein inhibitor, anacetrapib, to determine whether this class can reduce cardiovascular risk. Selective peroxisome proliferator-activated receptor modulators such as K-877 are under study to determine whether they have an advantage over older fibrates. Diacylglycerol transferase inhibitors such as pradigastat appear to have potent triglyceride-lowering effects, even for patients with familial chylomicronemia syndrome. Finally, novel ω-3 preparations are available with significant triglyceride lowering, although their role in therapy remains unclear.

Statins will remain the backbone of lipid-lowering therapy, although several novel oral agents are promising. The common theme across drugs in development is the demonstration of good lipid-lowering effect, although lacking cardiovascular outcomes data, which will likely be necessary before any of them, can be recommended or approved for widespread use.
Important considerations in adolescent health maintenance: long-acting reversible contraception, human papillomavirus vaccination, and heavy menstrual bleeding
Authors: Brodie Nicola , Silberholz Elizabeth A. , Spector Nancy D. , Pattishall Amy E.
Published: September 2016

Purpose of review

The present article addresses recent research related to three key facets of adolescent preventive care and health maintenance: long-acting reversible contraception, human papillomavirus vaccination, and heavy menstrual bleeding.

Recent findings

Recent studies suggest that long-acting reversible contraception use results in significantly lower rates of unintended pregnancies, and is well tolerated by nulliparous adolescent females. Additionally, a strong recommendation from a pediatric primary care provider is extremely effective in ensuring human papillomavirus vaccination prior to sexual debut. Finally, heavy menstrual bleeding is often under-recognized in adolescents, and evaluation and treatment of these patients are variable.

Based on the recent literature findings, the pediatric primary care provider should be encouraged to, first, recommend long-acting reversible contraception for prevention of unintended pregnancy in adolescent patients; second, strongly endorse vaccination to protect against human papillomavirus in all patients prior to sexual debut; and, third, screen adolescent females for signs and symptoms of heavy menstrual bleeding.
Starry Sky Pattern in Hematopoietic Neoplasms: A Review of Pathophysiology and Differential Diagnosis
Authors: Dy-Ledesma Janelyn L. , Khoury Joseph D. , Agbay Rose Lou Marie C. , Garcia Mar , Miranda Roberto N. , Medeiros L. Jeffrey
Published: September 2016

The starry sky pattern is a distinctive histologic feature wherein a rapidly proliferating hematolymphoid neoplasm contains scattered histiocytes with abundant pale cytoplasm in a background of monomorphic neoplastic cells. The cytoplasm of these histiocytes typically contains cellular remnants, also known as tingible bodies, incorporated through active phagocytosis. Although common and widely recognized, relatively little is known about the pathophysiological underpinnings of the starry sky pattern. Its resemblance to a similar pattern seen in the germinal centers of secondary follicles suggests a possible starting point for understanding the molecular basis of the starry sky pattern and potential routes for its exploitation for therapeutic purposes. In this review, we discuss the historical, pathophysiological, and clinical implications of the starry sky pattern.
Can Anal Sphincter Defects Be Identified by Palpation?
Authors: Shek Ka Lai , Atan Ixora Kamisan , Dietz Hans Peter
Published: September 2016

Objectives

The aim of this study was to correlate clinical findings of anal sphincter defects and function with a sonographic diagnosis of significant sphincter defects.

Methods

This is an observational cross-sectional study on women seen 6 to 10 weeks after primary repair of obstetric anal sphincter injuries (OASIs). All patients underwent a standardized interview including the St Mark incontinence score, a digital rectal examination, and 3-/4-dimensional transperineal ultrasound imaging.

Results

Two hundred forty-five patients were seen after primary repair of OASIs. Mean age was 29 (17–43) years. They were assessed at a median of 58 (15–278) days postpartum. One hundred fifty-seven (64%) delivered normal vaginally, 72 (29%) delivered by vacuum, and 16 (7%) delivered by forceps. A comparison of external anal sphincter (EAS) and internal anal sphincter ultrasound volume data and palpation was possible in 220 and 212 cases, respectively. Sphincter defects at rest and on contraction were both detected clinically in 17 patients. Significant abnormalities of the EAS were diagnosed on tomographic ultrasound imaging in 99 cases (45%), and significant abnormalities of the internal anal sphincter were diagnosed in 113 cases (53%). Agreement between digital and sonographic findings of sphincter defect was poor (k = 0.03–0.08). Women with significant EAS defects on ultrasound were found to have a lower resistance to digital insertion (P = 0.018) and maximum anal squeeze (P = 0.009) on a 6-point scale. The difference was however small.

Conclusions

Digital rectal examination does not seem to be sufficiently sensitive to diagnose residual sphincter defects after primary repair of OASIs. Imaging is required for the evaluation of sphincter anatomy after repair.
The confused oncologic patient: a rational clinical approach
Authors: Nolan Craig , DeAngelis Lisa M.
Published: September 2016

Purpose of review

The purpose of this review is to provide a practical clinical approach to confusion in the patient with cancer. Confusion in the cancer population has a broader differential diagnosis than in the general medical population. The clinician must consider the usual differential diagnoses as well as causes unique to the cancer patient including direct complications from the cancer and indirect complications related to cancer treatment.

Recent findings

In the recent age of precision medicine, the oncologist now utilizes the genomic profile of both the patient and the tumor to provide advanced biologic therapies including targeted anticancer drugs, antiangiogenic agents, and immunotherapy. Such advances carry with them an emerging pattern of neurotoxicity which, although less well described in the literature, is now an important consideration to the clinical approach to confusion in cancer patients.

Confusion is the most common neurologic complication in cancer and is associated with significant morbidity, mortality, and prolonged hospital stays resulting in increased healthcare costs. Early recognition and treatment of delirium is essential to improve clinical outcomes.
Trigger phosphodiesterases as a novel class of c-di-GMP effector proteins
Authors: Hengge Regine
Published: September 2016

The bacterial second messenger c-di-GMP controls bacterial biofilm formation, motility, cell cycle progression, development and virulence. It is synthesized by diguanylate cyclases (with GGDEF domains), degraded by specific phosphodiesterases (PDEs, with EAL of HD-GYP domains) and sensed by a wide variety of c-di-GMP-binding effectors that control diverse targets. c-di-GMP-binding effectors can be riboswitches as well as proteins with highly diverse structures and functions. The latter include ‘degenerate’ GGDEF/EAL domain proteins that are enzymatically inactive but still able to bind c-di-GMP. Surprisingly, two enzymatically active ‘trigger PDEs’, the
Escherichia coli
proteins PdeR and PdeL, have recently been added to this list of c-di-GMP-sensing effectors. Mechanistically, trigger PDEs are multifunctional. They directly and specifically interact with a macromolecular target (e.g. with a transcription factor or directly with a promoter region), whose activity they control by their binding and degradation of c-di-GMP—their PDE activity thus represents the c-di-GMP sensor or effector function. In this process, c-di-GMP serves as a regulatory ligand, but in contrast to classical allosteric control, this ligand is also degraded. The resulting kinetics and circuitry of control are ideally suited for trigger PDEs to serve as key components in regulatory switches.

This article is part of the themed issue ‘The new bacteriology’.
Control without controllers: Towards a distributed neuroscience of executive control
Authors: Eisenreich Benjamin R. , Akaishi Rei , Hayden Benjamin Y.
Published: September 2016

Executive control refers to the regulation of cognition and behavior by mental processes and is a hallmark of higher cognition. Most approaches to understanding its mechanisms begin with the assumption that our brains have anatomically segregated and functionally specialized control modules. The modular approach is intuitive: control is conceptually distinct from basic mental processing, so an organization that reifies that distinction makes sense. An alternative approach sees executive control as self-organizing principles of a distributed organization. In distributed systems, control and controlled processes are co-localized within large numbers of dispersed computational agents. Control then is often an emergent consequence of simple rules governing the interaction between agents. Because these systems are unfamiliar and unintuitive, here we review several well-understood examples of distributed control systems, group living insects and social animals, and emphasize their parallels with neural systems. We then re-examine the cognitive neuroscience literature on executive control for evidence that its neural control systems may be distributed.