bluuebunny/crossref_metadata_2025 huggingface dataset:
Optical reset modulation in the SiO2/Cu conductive-bridge resistive memory stack
Authors: Kawashima T. , Zhou Y. , Yew K. S. , Ang D. S.
Published: September 2017

We show that the negative photoconductivity property of the nanoscale filamentary breakdown path in the SiO2 electrolyte of the SiO2/Cu conductive bridge resistive random access memory (CBRAM) stack is affected by the number of positive-voltage sweeps applied to the Cu electrode (with respect to a non-metal counter electrode). The path's photo-response to white light, of a given intensity, is suppressed with an increasing number of applied positive-voltage sweeps. When this occurs, the path may only be disrupted by the light of a higher intensity. It is further shown that the loss of the path's photosensitivity to the light of a given intensity can be recovered using a negative-voltage sweep (which eliminates the path), followed by the reformation of the path by a positive-voltage sweep. The above behavior is, however, not seen in the SiO2/Si stack (which involves a non-metal Si electrode), suggesting that the photo-response modulation effect is related to the Cu electrode. The demonstrated reversible electrical modulation of the path's photo-response may afford greater flexibility in the electro-optical control of the CBRAM device.
Enhancement of coherent phonon amplitude in phase-change materials by near-infrared laser irradiation
Authors: Suzuki Takara , Saito Yuta , Fons Paul , Kolobov Alexander V. , Tominaga Junji , Hase Muneaki
Published: September 2017

We have examined the effect of pump-probe photon energy on the amplitude of coherent optical phonons in a prototypical phase change material using a femtosecond time-resolved transmission technique. The photon energy was varied between 0.8 and 1.0 eV (corresponding to the wavelengths of 1550 and 1200 nm), a range over which there is significant optical contrast between the crystalline and amorphous phases of Ge2Sb2Te5 (GST225). It was found that in crystalline GST225, the coherent phonon amplitude monotonically increases as the photon energy increases, indicating that the phonon amplitude is enhanced by interband optical absorption, which is associated with the imaginary part of the dielectric function. In amorphous GST225, in contrast, the coherent phonon amplitude does not depend on the photon energy, remaining almost constant over the tuning range. A possible contribution from the polarizability associated with the resonant bonding nature of GST225 is discussed.
Superballistic characteristics in transient phonon ballistic-diffusive transport
Authors: Tang Dao-Sheng , Cao Bing-Yang
Published: September 2017

While diffusive, superdiffusive, and ballistic phonon transports have been widely investigated, the superballistic phenomenon, where the time index of the energy mean square displacement with respect to time is greater than 2, has been neither predicted nor observed. In this work, we report on the superballistic characteristics obtained from simulations of transient phonon ballistic-diffusive transport both during and after the input of a heat pulse into a nanoscale film. The superballistic behaviors are well described by a previously proposed model for electron wave packet spreading employing a point source and further explained by the superposition effect of heat pulses. The relative superposition time, a dimensionless parameter, is defined to describe the degree of the heat pulse superposition. The analysis of superballistic characteristics in this work is expected to guide experiments for detecting the phonon superballistic transport. Also, it provides a potential phenomenological description for the superballistic phenomena in more complex systems.
Two paths using micro-resonators lead to improved FMR spatial resolution
Authors: Dowd Deborah
Published: September 2017

International research group increases FMR spatial resolution for micro-resonators.
Nanofibre Sepiolite Catalyzed Green and Rapid Synthesis of 2-Amino-4H-chromene Derivatives
Authors: Mohammadinezhad Arezou , Akhlaghinia Batool
Published: September 2017

Nanofibre sepiolite catalyzed the rapid, clean, and highly efficient synthesis of 2-amino-4H-chromene derivatives by a one-pot, three-component condensation of a series of aldehydes, various enolizable C–H bonds (such as dimedone, α-naphthol, resorcinol, and 4-hydroxy-2H-chromen-2-one), and malononitrile in a mixture of water/ethanol. The present method offers several advantages such as high to excellent yields, short reaction times, mild reaction conditions, simple procedure, use of inexpensive, non-toxic, and naturally available catalyst, easy isolation of the products, and no need for column chromatography. The catalyst could be easily separated from the reaction mixture and can be reused for many consecutive trials without a significant decline in its reactivity.
Alternate furrow irrigation affects yield and water-use efficiency of maize under deficit irrigation
Authors: Golzardi Farid , Baghdadi Amirsaleh , Afshar Reza Keshavarz
Published: September 2017

Shortage of fresh water and drought stress are important factors limiting crop productivity in semi-arid and arid regions. Irrigation management needs to be optimised to improve irrigation water-use efficiency (IWUE), and thus, agricultural sustainability in these climates. A field experiment was conducted at two semi-arid locations in Iran to evaluate the impact of irrigation regime (applied after crop evapotranspiration of 70 mm (I70), 100 mm (I100) or 130 mm (I130)) and irrigation method (applied to every furrow (EFI) or variable alternate furrow (AFI)) on yield and IWUE of maize (Zea mays L.). Yield response to irrigation rate was quadratic. Kernel yield was 8476 kg ha–1 under I70, and this reduced by 12.3% under I100 and 27.7% under I130. Yield reduction due to water stress was attributed to decline in both kernel number and kernel weight. Implementation of AFI resulted in a significant saving in irrigation water. At I70, 31% less water was used with AFI than with EFI. Irrigation water saving was even greater under I100 and I130 when AFI was implemented. Regardless of irrigation regime, IWUE under AFI was always greater than under EFI (1.32 vs 1.03 kg m–3 for grain and 3.30 vs 2.47 kg m–3 for biomass production). In addition, plants were shorter with a longer root system under AFI, and the role of carbohydrate remobilisation in kernel filling was greater under AFI consistently among irrigation regimes. The results indicated good potential of AFI for development of water-saving strategies for maize production in semi-arid climates.
Diverse p53/DNA binding modes expand the repertoire of p53 response elements
Authors: Vyas Pratik , Beno Itai , Xi Zhiqun , Stein Yan , Golovenko Dmitrij , Kessler Naama , Rotter Varda , Shakked Zippora , Haran Tali E.
Published: September 2017

Significance

The tumor suppressor protein p53 acts as a transcription factor by binding as a tetramer to response elements made of two DNA half-sites separated by a variable spacer, leading to diverse cellular outcomes. Fifty percent of all p53 response elements contain spacers, but their significance is unclear at present. Here, we show that p53 binds to response elements containing long spacers in two different modes: fully specific and hemispecific. In the latter, only one p53 dimer is specifically bound to a DNA half-site, whereas the other dimer is bound to the spacer DNA. Nonetheless, the two modes have comparable binding affinity and specificity. Our findings expand and diversify the p53 regulatory network.
Well below 2 °C: Mitigation strategies for avoiding dangerous to catastrophic climate changes
Authors: Xu Yangyang , Ramanathan Veerabhadran
Published: September 2017

The historic Paris Agreement calls for limiting global temperature rise to “well below 2 °C.” Because of uncertainties in emission scenarios, climate, and carbon cycle feedback, we interpret the Paris Agreement in terms of three climate risk categories and bring in considerations of low-probability (5%) high-impact (LPHI) warming in addition to the central (∼50% probability) value. The current risk category of dangerous warming is extended to more categories, which are defined by us here as follows: >1.5 °C as dangerous; >3 °C as catastrophic; and >5 °C as unknown, implying beyond catastrophic, including existential threats. With unchecked emissions, the central warming can reach the dangerous level within three decades, with the LPHI warming becoming catastrophic by 2050. We outline a three-lever strategy to limit the central warming below the dangerous level and the LPHI below the catastrophic level, both in the near term (<2050) and in the long term (2100): the carbon neutral (CN) lever to achieve zero net emissions of CO
2
, the super pollutant (SP) lever to mitigate short-lived climate pollutants, and the carbon extraction and sequestration (CES) lever to thin the atmospheric CO
2
blanket. Pulling on both CN and SP levers and bending the emissions curve by 2020 can keep the central warming below dangerous levels. To limit the LPHI warming below dangerous levels, the CES lever must be pulled as well to extract as much as 1 trillion tons of CO
2
before 2100 to both limit the preindustrial to 2100 cumulative net CO
2
emissions to 2.2 trillion tons and bend the warming curve to a cooling trend.
Social Enterprise
Authors: Fernando Rukshan
Published: September 2017

Social enterprise is a management practice that integrates principles of private enterprise with social sector goals and objectives. Social enterprise is a relatively new type of social work macro practice and includes a variety of sustainable economic activities designed to yield social impact for individuals, families, and communities. Despite the increased popularity of social enterprise scholarship, social work is visibly absent from it. Social enterprise is a field that promises to harness the energy and enthusiasm of commercial entrepreneurship combined with macro practice to address many long-standing social issues. Despite being a popular practice phenomenon, empirical research on social enterprise is still quite nascent, indeed: only a few empirical articles on the subject have thus far appeared in academic journals, and even fewer in social work journals. This article provides an overview of social enterprise, and the potential for synergy between social enterprise, the social work profession, and education.
SNP genotyping and parameter estimation in polyploids using low-coverage sequencing data
Authors: Blischak Paul D , Kubatko Laura S , Wolfe Andrea D
Published: September 2017

Motivation

Genotyping and parameter estimation using high throughput sequencing data are everyday tasks for population geneticists, but methods developed for diploids are typically not applicable to polyploid taxa. This is due to their duplicated chromosomes, as well as the complex patterns of allelic exchange that often accompany whole genome duplication (WGD) events. For WGDs within a single lineage (autopolyploids), inbreeding can result from mixed mating and/or double reduction. For WGDs that involve hybridization (allopolyploids), alleles are typically inherited through independently segregating subgenomes.

Results

We present two new models for estimating genotypes and population genetic parameters from genotype likelihoods for auto- and allopolyploids. We then use simulations to compare these models to existing approaches at varying depths of sequencing coverage and ploidy levels. These simulations show that our models typically have lower levels of estimation error for genotype and parameter estimates, especially when sequencing coverage is low. Finally, we also apply these models to two empirical datasets from the literature. Overall, we show that the use of genotype likelihoods to model non-standard inheritance patterns is a promising approach for conducting population genomic inferences in polyploids.

Availability and implementation

A C ++ program, EBG, is provided to perform inference using the models we describe. It is available under the GNU GPLv3 on GitHub: https://github.com/pblischak/polyploid-genotyping.

Supplementary information

Supplementary data are available at Bioinformatics online.
Mobi 2.0: an improved method to define intrinsic disorder, mobility and linear binding regions in protein structures
Authors: Piovesan Damiano , Tosatto Silvio C E
Published: September 2017

Motivation

The structures contained in the Protein Data Bank (PDB) database are of paramount importance to define our knowledge of folded proteins. While providing mainly circumstantial evidence, PDB data is also increasingly used to define the lack of unique structure, represented by mobile regions and even intrinsic disorder (ID). However, alternative definitions are used by different authors and potentially limit the generality of the analyses being carried out.

Results

Here we present Mobi 2.0, a completely re-written version of the Mobi software for the determination of mobile and potentially disordered regions from PDB structures. Mobi 2.0 provides robust definitions of mobility based on four main sources of information: (i) missing residues, (ii) residues with high temperature factors, (iii) mobility between different models of the same structure and (iv) binding to another protein or nucleotide chain. Mobi 2.0 is well suited to aggregate information across different PDB structures for the same UniProt protein sequence, providing consensus annotations. The software is expected to standardize the treatment of mobility, allowing an easier comparison across different studies related to ID.

Availability

Mobi 2.0 provides the structure-based annotation for the MobiDB database. The software is available from URL http://protein.bio.unipd.it/mobi2/.
Monoidal Categories Enriched in Braided Monoidal Categories
Authors: Morrison Scott , Penneys David
Published: September 2017

We introduce the notion of a monoidal category enriched in a braided monoidal category $\mathcal{V}$. We set up the basic theory, and prove a classification result in terms of braided oplax monoidal functors to the Drinfeld centre of some monoidal category $\mathcal{T}$.

Even the basic theory is interesting; it shares many characteristics with the theory of monoidal categories enriched in a symmetric monoidal category, but lacks some features. Of particular note, there is no cartesian product of braided-enriched categories, and the natural transformations do not form a 2-category, but rather satisfy a braided interchange relation.

Strikingly, our classification is slightly more general than what one might have anticipated in terms of strong monoidal functors $\mathcal{V}\to Z(\mathcal{T})$. We would like to understand this further; in a future article, we show that the functor is strong if and only if the enriched category is ‘complete’ in a certain sense. Nevertheless it remains to understand what non-complete enriched categories may look like.

One should think of our construction as a generalization of de-equivariantization, which takes a strong monoidal functor ${\mathsf {Rep}}(G) \to Z(\mathcal{T})$ for some finite group $G$ and a monoidal category $\mathcal{T}$, and produces a new monoidal category $\mathcal{T} _{{/\hspace{-2px}/}G}$. In our setting, given any braided oplax monoidal functor $\mathcal{V} \to Z(\mathcal{T})$, for any braided $\mathcal{V}$, we produce $\mathcal{T} _{{/\hspace{-2px}/}\mathcal{V}}$: this is not usually an ‘honest’ monoidal category, but is instead $\mathcal{V}$-enriched. If $\mathcal{V}$ has a braided lax monoidal functor to ${\mathsf {Vec}}$, we can use this to reduce the enrichment to ${\mathsf {Vec}}$, and this recovers de-equivariantization as a special case. This is the published version of arXiv:1701.00567.
Exploring completeness in clinical data research networks with DQe-c
Authors: Estiri Hossein , Stephens Kari A , Klann Jeffrey G , Murphy Shawn N
Published: September 2017

Objective

To provide an open source, interoperable, and scalable data quality assessment tool for evaluation and visualization of completeness and conformance in electronic health record (EHR) data repositories.

Materials and Methods

This article describes the tool’s design and architecture and gives an overview of its outputs using a sample dataset of 200 000 randomly selected patient records with an encounter since January 1, 2010, extracted from the Research Patient Data Registry (RPDR) at Partners HealthCare. All the code and instructions to run the tool and interpret its results are provided in the Supplementary Appendix.

Results

DQe-c produces a web-based report that summarizes data completeness and conformance in a given EHR data repository through descriptive graphics and tables. Results from running the tool on the sample RPDR data are organized into 4 sections: load and test details, completeness test, data model conformance test, and test of missingness in key clinical indicators.

Discussion

Open science, interoperability across major clinical informatics platforms, and scalability to large databases are key design considerations for DQe-c. Iterative implementation of the tool across different institutions directed us to improve the scalability and interoperability of the tool and find ways to facilitate local setup.

Conclusion

EHR data quality assessment has been hampered by implementation of ad hoc processes. The architecture and implementation of DQe-c offer valuable insights for developing reproducible and scalable data science tools to assess, manage, and process data in clinical data repositories.
Origins of carbon-enhanced metal-poor stars
Authors: Sharma Mahavir , Theuns Tom , Frenk Carlos S. , Cooke Ryan J.
Published: September 2017

We investigate the nature of carbon-enhanced metal-poor (CEMP) stars in Milky Way (MW) analogues selected from the eagle cosmological hydrodynamical simulation. The stellar evolution model in eagle includes the physics of enrichment by asymptotic giant branch (AGB) stars, winds from massive stars, and Type Ia and Type II supernovae (SNe). In the simulation, star formation in young MW progenitors is bursty due to efficient stellar feedback, which enables poor metal mixing leading to the formation of CEMP stars with extreme abundance patterns. Two classes of CEMP stars emerge: those mostly enriched by low-metallicity Type II SNe with low Fe yields that drive galactic outflows, and those mostly enriched by AGB stars when a gas-poor galaxy accretes pristine gas. The first class resembles CEMP-no stars with high [C/Fe] and low [C/O], the second class resembles CEMP-s stars overabundant in s-process elements and high values of [C/O]. These two enrichment channels explain several trends seen in data: (i) the increase in the scatter and median of [C/O] at low and decreasing [O/H], (ii) the trend of stars with very low [Fe/H] or [C/H] to be of type CEMP-no and (iii) the reduction in the scatter of [α/Fe] with atomic number in metal-poor stars. In this interpretation, CEMP-no stars were enriched by the stars that enabled galaxies to reionize the Universe.
Dispositional Mindful Attention in Relation to Negative Affect, Tobacco Withdrawal, and Expired Carbon Monoxide On and After Quit Day
Authors: Paulus Daniel J. , Langdon Kirsten J. , Wetter David W. , Zvolensky Michael J.
Published: September 2017

Background:

Mindfulness (or “Mindful Attention”) has been described as the presence or absence of attention to, and awareness of, what is occurring in the present moment. Among smokers, greater mindfulness is associated with greater effect stability and reduced cue-induced craving. While studies have shown that mindfulness is associated with other smoking-related factors such as reduced withdrawal symptoms using cross-sectional data, relatively little is known about the associations between baseline mindful attention and future abstinence-related effect/withdrawal. The current study sought to examine whether levels of mindful attention before cessation predicts negative affect, withdrawal, and level of expired carbon monoxide (CO) on quit day, and also 3 and 7 days after quitting, during a self-quit attempt.

Methods:

Data from 58 adults (mean age = 34.9; 65.5% male) participating in a self-quit study were available for analysis. Self-report measures of mindful attention, negative affect, and withdrawal symptoms were collected. Biochemical measurement of expired CO was also collected. Dependent variables were assessed on quit day, and also 3 and 7 days after quitting. Covariates included age, race, sex, self-reported level of cigarette dependence, and smoking status through 7 days. Multivariate regression was used to evaluate the association of baseline mindful attention in relation to the studied outcomes.

Results:

Greater mindful attention predicted lower negative affect and reduced withdrawal at all 3 time-points. Mindful attention did not predict levels of expired CO.

Conclusions:

The findings suggest that mindful attention before or during smoking-cessation treatment may help to reduce negative affect and withdrawal, which serve as barriers to cessation for many smokers.
Predictors of Adherence to Psychological Treatment for Insomnia and Pain
Authors: Koffel Erin , Vitiello Michael V. , McCurry Susan M. , Rybarczyk Bruce , Von Korff Michael
Published: September 2017

Objectives:

Poor adherence to psychological treatment for insomnia is common and limits treatment gains. Very little is known about predictors of adherence among patients with chronic pain, although adherence is theorized to be more critical and more challenging for these patients. This secondary data analysis examines predictors of drop-out and therapy nonattendance in an osteoarthritis population receiving psychological treatment for insomnia and pain.

Methods:

Data were analyzed from the “Lifestyles” trial, a randomized controlled trial of a 6-week group cognitive behavioral pain coping skills intervention (CBT-P), group cognitive-behavioral therapy for pain and insomnia (CBT-PI), and an education only attention control group (EOC). The current analysis focuses on 122 participants randomized to CBT-PI from 6 primary care clinics. Measures of treatment acceptability, demographics, and symptoms were collected at baseline. Factor analysis was used to clarify the boundaries of these domains, and hierarchical regression was used to examine the incremental predictive power of these patient characteristics on therapy attendance.

Results:

Ratings of treatment acceptability were distinct from demographic and medical variables and baseline symptoms. Treatment acceptability was significantly related to session attendance and drop-out (rs ranging from 0.24 to 0.32) and was also one of the strongest predictors of session attendance (β=0.20; P<0.05).

Discussion:

Perceptions of treatment acceptability early in treatment represent a potentially modifiable target to enhance adherence to psychological treatment for insomnia and pain among patients with chronic pain. This work represents an important step towards understanding how to best maximize sleep treatments for this patient population.
Systematic Changes in the National Surgical Quality Improvement Program Database Over the Years Can Affect Comorbidity Indices Such as the Modified Frailty Index and Modified Charlson Comorbidity Index for Lumbar Fusion Studies
Authors: Shultz Blake N. , Ottesen Taylor D. , Ondeck Nathaniel T. , Bovonratwet Patawut , McLynn Ryan P. , Cui Jonathan J. , Grauer Jonathan N.
Published: September 2017

Study Design.

Retrospective cohort study of prospectively collected data.

Objective.

The aim of this study was to investigate the influence of changes in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database over the years on the calculation of the modified Frailty Index (mFI) and the modified Charlson Comorbidity Index (mCCI) for posterior lumbar fusion studies.

Summary of Background Data.

Multiple studies have utilized the mFI and/or mCCI and showed them to be predictors of adverse postoperative outcomes. However, changes in the NSQIP database have resulted in definition changes and/or missing data for many of the variables included in these indices. No studies have assessed the influence of different methods of treating missing values when calculating these indices on such studies.

Methods.

Elective posterior lumbar fusions were identified in NSQIP from 2005 to 2014. The mFI was calculated for each patient using three methods: treating conditions for which data was missing as not present, dropping patients with missing values, and normalizing by dividing the raw score by the number of variables collected. The mCCI was calculated by the first two of these methods. Mean American Society of Anesthesiologists (ASA) scores used for comparison.

Results.

In total, 19,755 patients were identified. Mean ASA score increased between 2005 and 2014 from 2.27 to 2.50 (+10.1%). For each of the methods of data handling noted above, mean mFI over the years studied increased by 33.3%, could not be calculated, and increased by 183.3%, respectively. Mean mCCI increased by 31.2% and could not be calculated respectively.

Conclusion.

Systematic changes in the NSQIP database have resulted in missing data for many of the variables included in the mFI and the mCCI and may affect studies utilizing these indices. These changes can be understood in the context of ASA trends, and raise questions regarding the use of these indices with data available in later NSQIP years.

Level of Evidence: 3
Update on second trimester medical abortion
Authors: Lerma Klaira , Shaw Kate A.
Published: September 2017

Purpose of review

To review recent literature on second trimester abortion with medical methods.

Recent findings

Across studies published in the recent past, it is apparent that women prefer shorter procedures and procedure times. Several randomized controlled trials have confirmed adding mifepristone to the second trimester medication abortion regimen results in shorter abortion intervals from first misoprostol administration to complete fetal expulsion. A study of simultaneous administration of mifepristone and misoprostol yielded shorter mean ‘total’ abortion times, presenting several logistical advantages. Recent studies on the continuous dosing of misoprostol have produced critical evidence to support continued dosing until expulsion. These studies had a more practical design compared with previous protocols that capped the number of misoprostol doses.

Second trimester surgical abortion is well tolerated and increasingly expeditious. Further research is needed to refine second trimester medical abortion methods, specific to the mifepristone, misoprostol dosing interval. A 12-hour mifepristone to misoprostol interval may be the optimal interval balancing patient preferences and logistical considerations. Pragmatic dosing, including continuous dosing of misoprostol, could yield results that better inform clinical guidelines and reduce burden on patient, provider, and health facility.
Abortion in the media
Authors: Conti Jennifer A. , Cahill Erica
Published: September 2017

Purpose of review

To review updates in how abortion care is depicted and analysed though various media outlets: news, television, film, and social media.

Recent findings

A surge in recent media-related abortion research has recognized several notable and emerging themes: abortion in the news media is often inappropriately sourced and politically motivated; abortion portrayal in US film and television is frequently misrepresented; and social media has a new and significant role in abortion advocacy.

The portrayal of abortion onscreen, in the news, and online through social media has a significant impact on cultural, personal, and political beliefs in the United States. This is an emerging field of research with wide spread potential impact across several arenas: medicine, policy, public health.
The Dosimetric Demise of 97MNB
Authors: Snyder Sandra F. , Eckerman Keith F.
Published: September 2017

Radionuclide differences between ICRP Publication 38 and its succeeding work, ICPR Publication 107, are reviewed. The specific example of the isomer 97mNb is discussed, examining how dose reporting for this nuclide can be an issue.
Signal transducer and activator of transcription gain-of-function primary immunodeficiency/immunodysregulation disorders
Authors: Consonni Filippo , Dotta Laura , Todaro Francesca , Vairo Donatella , Badolato Raffaele
Published: September 2017

Purpose of review

To describe primary immunodeficiencies caused by gain-of-function (GOF) mutations of signal transducer and activator of transcription (STAT) genes, a group of genetically determined disorders characterized by susceptibility to infections and, in many cases, autoimmune manifestations.

Recent findings

GOF mutations affecting STAT1 result in increased STAT tyrosine phosphorylation and secondarily increased response to STAT1-signaling cytokines, such as interferons. In contrast, STAT3 hyperactivity is not usually related to hyperphosphorylation but rather to increased STAT3-mediated transcriptional activity. In both cases, heterozygous STAT1 and STAT3 GOF mutations trigger a distinct set of genes in target cells that lead to abnormal functioning of antimicrobial response and/or autoimmunity and result in autosomal dominant diseases.

Clinical manifestations of patients with STAT1 GOF are characterized by mucocutaneous candidiasis and recurrent lower tract respiratory infections. In addition, many patients have thyroiditis, type 1 diabetes mellitus, autoimmune cytopenias, cancer or aneurysms. Patients with germline STAT3 GOF mutations have an increased frequency of early-onset multiorgan autoimmunity (i.e. autoimmune enteropathy, type 1 diabetes mellitus, autoimmune interstitial lung disease and autoimmune cytopenias), lymphoproliferation, short stature and, less frequently, severe recurrent infections. Treatment options range from antimicrobial therapy, intravenous or subcutaneous immunoglobulin and immunosuppressive drugs. Some patients with STAT1 GOF disorder have undergone hematopoietic stem cell transplantation, although these have been difficult because of the underlying proinflammatory milieu from the mutation.
Novel Histologic Finding: Adipose Tissue Is Prevalent Within Penile Tunica Albuginea and Corpora Cavernosa
Authors: Rodriguez Ingrid M. , Cuevas Martin , Silvero Arturo , Cañete-Portillo Sofía , Sanchez Diego F. , Barreto Jose , Cubilla Antonio L.
Published: September 2017

Adipose tissue, along with arteries, veins, and peripheral nerves, is a normal constituent of mesenchymal tissues encasing the corpora cavernosa at the level of the penile shaft, variously designated as penile fascia or Bucks fascia. To our knowledge, the presence of fat has not been previously reported within the corpora cavernosa. One or 2 transversal histologic sections at the level of the surgical margin at the shaft of 63 consecutive partial penectomy specimens for squamous cell carcinoma were evaluated. From outer to inner tissues, 3 anatomic levels were identified: (1) outer fascia composed of a loose fibrovascular mesenchyme containing some nerve branches. Adipose tissue was present in the majority of the cases. (2) The tunica albuginea, a thick and dense fibroelastic band of tissue separating the outer fascia from the erectile tissues of the corpora cavernosa. Adipose tissue within the albuginea was present in 21 specimens (19%). (3) Erectile tissues of corpora cavernosa. Besides the typical erectile tissues, adipose tissue was present in 33 cases (52%). The fatty tissue was focal or multifocal and scant and peripherally located at the junction of the tunica albuginea with the corpora. In some cases, it was associated with small amounts of fibrous tissue, small vessels, and nerves. We are reporting the presence of adipose tissue in the tunica albuginea and the corpora cavernosa. It is possible that adipose tissue, along with small nutritional vessels and nerves perforates from the fascia, in which fat is usually present, through the tunica albuginea to reach the corpora. In a previous examination of the local routes of cancer spread, we found this pathway to be one of the mechanisms of cancer invading the penile corpora from the penile fascia.
The Impact of Telemedicine on Pediatric Critical Care Triage*
Authors: Harvey Jillian B. , Yeager Brooke E. , Cramer Christina , Wheeler David , McSwain S. David
Published: September 2017

Objective:

To examine the relationship between pediatric critical care telemedicine consultation to rural emergency departments and triage decisions. We compare the triage location and provider rating of the accuracy of remote assessment for a cohort of patients who receive critical care telemedicine consultations and a similar group of patients receiving telephone consultations.

Design:

Retrospective evaluation of consultations occurring between April 2012 and March 2016.

Setting:

Pediatric critical care telemedicine and telephone consultations in 52 rural healthcare settings in South Carolina.

Patients:

Pediatric patients receiving critical care telemedicine or telephone consultations.

Intervention:

Telemedicine consultations.

Measurements and Main Results:

Data were collected from the consulting provider for 484 total consultations by telephone or telemedicine. We examined the providers’ self-reported assessments about the consultation, decision-making, and triage outcomes. We estimate a logit model to predict triage location as a function of telemedicine consult age and sex. For telemedicine patients, the odds of triage to a non-ICU level of care are 2.55 times larger than the odds for patients receiving telephone consultations (p = 0.0005). Providers rated the accuracy of their assessments higher when consultations were provided via telemedicine. When patients were transferred to a non-ICU location following a telemedicine consultation, providers indicated that the use of telemedicine influenced the triage decision in 95.7% of cases (p < 0.001). For patients transferred to a non-ICU location, an increase in transfers to a higher level of care within 24 hours was not observed.

Conclusion:

Pediatric critical care telemedicine consultation to community hospitals is feasible and results in a reduction in PICU admissions. This study demonstrates an improvement in provider-reported accuracy of patient assessment via telemedicine compared with telephone, which may produce a higher comfort level with transporting patients to a lower level of care. Pediatric critical care telemedicine consultations represent a promising means of improving care and reducing costs for critically ill children in rural areas.
Potential Acceptability of a Pediatric Ventilator Management Computer Protocol*
Authors: Sward Katherine A. , Newth Christopher J. L. , Khemani Robinder G. , Page Kent , Meert Kathleen L. , Carcillo Joseph A. , Shanley Thomas P. , Moler Frank W. , Pollack Murray M. , Dalton Heidi J. , Wessel David L. , Berger John T. , Berg Robert A. , Harrison Rick E. , Doctor Allan , Dean J. Michael , Holobkov Richard , Jenkins Tammara L. , Nicholson Carol E.
Published: September 2017

Objectives:

To examine issues regarding the granularity (size/scale) and potential acceptability of recommendations in a ventilator management protocol for children with pediatric acute respiratory distress syndrome.

Design:

Survey/questionnaire.

Setting:

The eight PICUs in the Collaborative Pediatric Critical Care Research Network.

Participants:

One hundred twenty-two physicians (attendings and fellows).

Interventions:

None.

Measurements and Main Results:

We used an online questionnaire to examine attitudes and assessed recommendations with 50 clinical scenarios. Overall 80% of scenario recommendations were accepted. Acceptance did not vary by provider characteristics but did vary by ventilator mode (high-frequency oscillatory ventilation 83%, pressure-regulated volume control 82%, pressure control 75%; p = 0.002) and variable adjusted (ranging from 88% for peak inspiratory pressure and 86% for Fio
2 changes to 69% for positive end-expiratory pressure changes). Acceptance did not vary based on child size/age. There was a preference for smaller positive end-expiratory pressure changes but no clear granularity preference for other variables.

Conclusions:

Although overall acceptance rate for scenarios was good, there was little consensus regarding the size/scale of ventilator setting changes for children with pediatric acute respiratory distress syndrome. An acceptable protocol could support robust evaluation of ventilator management strategies. Further studies are needed to determine if adherence to an explicit protocol leads to better outcomes.
Objectively Measured Physical Activity and Falls in Well-Functioning Older Adults
Authors: Nastasi Anthony J. , Ahuja Alka , Zipunnikov Vadim , Simonsick Eleanor M. , Ferrucci Luigi , Schrack Jennifer A.
Published: September 2017

Objective

Previous work demonstrates the consequences of falling in older adults and the potential of physical activity (PA) to reduce falls, but few studies have used accelerometer-measured PA to compare overall and time-of-day activity patterns of nonfallers, fallers, or subgroups of fallers.

Methods

In 840 participants (mean age, 66.7; s = 13.2; range, 26–97) of the Baltimore Longitudinal Study of Aging between 2007 and 2014, PA was measured objectively with Actiheart accelerometers and falling status (faller/nonfaller) was assessed during an in-person interview. Differences in daily PA and PA by time-of-day were assessed using multiple linear regression. Differences in PA (multiple linear regression), and functional status (χ2) were further examined in subgroups of “risky” or “normal” fallers.

Results

Overall, fallers and nonfallers exhibited similar daily (β = 22.6, P = 0.48) and time-specific PA; however, those who fell doing risky activities were more active overall (β = 243.8, P = 0.002), during the morning (β = 77.3, P = 0.004), afternoon (β = 78.4, P = 0.001), and late afternoon/evening (β = 56.3, P = 0.006) than those who fell doing normal activities. Risky fallers were significantly higher functioning than normal fallers.

Conclusions

Persons who fell while engaging in normal activities exhibited lower PA overall and throughout most of the day, and were of lower functional status than persons who fell while engaging in risky or unusual activities, suggesting that engagement in risky or unusual PA is associated with higher functional ability and lower falls risk in older persons.
Checklist for the preparation and review of pain clinical trial publications: a pain-specific supplement to CONSORT
Authors: Gewandter Jennifer S. , Eisenach James C. , Gross Robert A. , Jensen Mark P. , Keefe Francis J. , Lee David A. , Turk Dennis C.
Published: September 2017

Introduction:

Randomized clinical trials (RCTs) are considered the gold standard when assessing the efficacy of interventions because randomization of treatment assignment minimizes bias in treatment effect estimates. However, if RCTs are not performed with methodological rigor, many opportunities for bias in treatment effect estimates remain. Clear and transparent reporting of RCTs is essential to allow the reader to consider the opportunities for bias when critically evaluating the results. To promote such transparent reporting, the Consolidated Standards of Reporting Trials (CONSORT) group has published a series of recommendations starting in 1996. However, a decade after the publication of the first CONSORT guidelines, systematic reviews of clinical trials in the pain field identified a number of common deficiencies in reporting (eg, failure to identify primary outcome measures and analyses, indicate clearly the numbers of participants who completed the trial and were included in the analyses, or report harms adequately).

Objectives:

To provide a reporting checklist specific to pain clinical trials that can be used in conjunction with the CONSORT guidelines to optimize RCT reporting.

Methods:

Qualitative review of a diverse set of published recommendations and systematic reviews that addressed the reporting of clinical trials, including those related to all therapeutic indications (eg, CONSORT) and those specific to pain clinical trials.

Results:

A checklist designed to supplement the content covered in the CONSORT checklist with added details relating to challenges specific to pain trials or found to be poorly reported in recent pain trials was developed.

Conclusion:

Authors and reviewers of analgesic RCTs should consult the CONSORT guidelines and this checklist to ensure that the issues most pertinent to pain RCTs are reported with transparency.
Patient-Reported Outcomes following Breast Conservation Therapy and Barriers to Referral for Partial Breast Reconstruction
Authors: Vrouwe Sebastian Q. , Somogyi Ron B. , Snell Laura , McMillan Catherine , Vesprini Danny , Lipa Joan E.
Published: September 2017

Background:

The purpose of this study was to evaluate the self-reported aesthetic outcome of breast conservation therapy in a generalized sample of patients, and to describe potential barriers to referral for partial breast reconstruction.

Methods:

Consecutive breast conservation therapy patients completing radiotherapy over a 1-year period at a regional cancer center were identified. Eligible patients were contacted by means of mail/e-mail and invited to participate. Participants completed the BREAST-Q breast conservation therapy module along with a questionnaire examining feelings about breast reconstruction. Multiple regression analysis was performed using the satisfaction with breasts scale as the dependent variable.

Results:

Surveys were completed by 185 of 592 eligible participants (response rate, 31.3 percent; mean age, 61 years) an average of 38 months after lumpectomy. The mean score for the BREAST-Q satisfaction with breasts scale was 59 of 100. Younger age (p = 0.038), lumpectomy reexcision (p = 0.018), and lumpectomy at a nonacademic center (p = 0.026) were significantly associated with lower satisfaction. Bra size, months from lumpectomy, and tumor quadrant/size were not significantly associated with satisfaction (p > 0.05). The most common statements regarding reconstruction were “I don’t feel the need for it” (60.0 percent), “I don’t like the thought of having breast implants” (22.7 percent), and “I don’t want any more surgeon/doctor visits” (22.2 percent). Before lumpectomy, only 1.6 percent had a consultation for reconstruction, and only 22.7 percent were aware of this option. If offered, 33.1 percent of patients would have attended this consultation.

Conclusion:

There is an unmet demand for partial breast reconstruction, with an opportunity to advocate and increase awareness on behalf of patients undergoing breast conservation therapy.
The Smile Index: Part 1. A Large-Scale Study of Phenotypic Norms for Preoperative and Postoperative Unilateral Cleft Lip
Authors: Yao Caroline A. , Imahiyerobo Thomas , Swanson Jordan , Auslander Allyn , De Cardenas Diego , Figueiredo Jane C. , McCullough Meghan , Costa Melinda , Vanderburg Richard , Magee William P.
Published: September 2017

Background:

Unilateral cleft lip has a spectrum of disease morphology, but severity classifications are difficult given the absence of accessible, objective assessment tools or reference data. The authors characterize the spectrum of cleft morphology before and after surgical repair for a large, multi-ethnic population using easily identifiable facial landmarks collected through a novel smart phone–based application.

Methods:

Anthropometric measurements and standardized photographs were prospectively collected in Morocco, Bolivia, Vietnam, and Madagascar during medical missions in 2015 using an application designed specifically for the study. After data collection, two experienced cleft surgeons and two laypersons subjectively ranked photographs based on the degree of deformity/aesthetics.

Results:

One hundred forty-seven patients were analyzed. Mean preoperative cleft width ratio was 0.4 ± 0.12. Nasolabial symmetry improved significantly from preoperatively to postoperatively for the following measurements: columellar angle (65 ± 17 degrees to 87 ± 8 degrees), nostril width ratio (1.7 ± 0.68 to 1.0 ± 0.22), philtral height ratio (0.8 ± 0.14 to 1.0 ± 0.14), and lip length ratio (0.9 ± 0.26 to 1.0 ± 0.11) (p < 0.001). Surgeon and layperson rankings showed high inter-rater reliability (r = 0.64, p < 0.001). Preoperatively, multivariate regression showed that cleft width ratio, nostril width ratio, and philtral height ratio were predictive of rank (p < 0.01). Postoperatively, philtral height ratio was most predictive of rank (p = 0.0097). Most cleft characteristics were not significantly different between countries.

Conclusions:

The authors present simpler, more straightforward measures to quantify preoperative and postoperative morphology/aesthetics and introduce a novel technology to streamline and standardize measurements to make data collection more accessible.
Unenhanced Dual-Energy Computed Tomography
Authors: Mohammed Mohammed F. , Marais Olivia , Min Adam , Ferguson David , Jalal Sabeena , Khosa Faisal , O'Keeffe Michael , O'Connell Tim , Schmiedeskamp Heiko , Krauss Bernhard , Rohr Axel , Nicolaou Savvas
Published: September 2017

Purpose

The aim of this study was to determine whether dual-energy computed tomography (DECT) imaging is superior to conventional noncontrast computed tomography (CT) imaging for the detection of acute ischemic stroke.

Materials and Methods

This was a retrospective, single-center study of 40 patients who presented to the emergency department (ED) of a major, acute care, teaching center with signs and symptoms of acute stroke. Only those patients who presented to the ED within 4 hours of symptom onset were included in this study. All 40 patients received a noncontrast DECT of the head at the time of presentation. Each patient also received standard noncontrast CT of the head 24 hours after their initial presentation to the ED. “Brain edema” images were then reconstructed using 3-material decomposition with parameters adjusted to suppress gray/white matter contrast while preserving edema and increasing its conspicuity. The initial unenhanced, mixed images, brain edema, and 24-hour follow-up true noncontrast (TNC) images were reviewed and assigned Alberta Stroke Program Early CT scores. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.

Results

Of the 40 patients, 28 (70%) were diagnosed with an acute infarction. Brain edema reconstructions were better able to predict end infarction volume, with Alberta Stroke Program Early CT scores similar to the 24-hour follow-up TNC CT (7.75 vs 7.7; P > 0.05), whereas the mixed images routinely underestimated the extent of infarction (8.975 vs 7.7; P < 0.001). Initial TNC images had a sensitivity, specificity, PPV, and NPV of 80% (95% confidence interval [CI], 51.9%–95.7%), 72.7% (95% CI, 39%–94%), 80% (95% CI, 51.9%–95.7%), and 72.73% (95% CI, 51.91%–95.67%), respectively. The DECT brain edema images provided a sensitivity, specificity, PPV, and NPV of 93.33% (95% CI, 68.05%–99.83%), 100% (95% CI, 71.51%–100%), 100% (95% CI, 76.84%–100%), and 91.67% (95% CI, 61.52%–99.79%), respectively. There was very good interrater reliability across all 3 imaging techniques.

Conclusion

Brain edema reconstructions are able to more accurately detect edema and end-infarct volume as compared with initial TNC images. This provides a better assessment of the degree and extent of infarction and may serve to better guide therapy in the future.