bluuebunny/crossref_metadata_2025 huggingface dataset:
A Monoclonal Antibody-Based Enzyme-Linked Immunosorbent Assay for Determination of Homoharringtonine
Authors: Pongkitwitoon Benyakan , Sakamoto Seiichi , Nagamitsu Rika , Putalun Waraporn , Tanaka Hiroyuki , Morimoto Satoshi
Published: February 2018

Homoharringtonine (HHT), also known as omacetaxine, is a natural compound found in the genus Cephalotaxus and is a promising pharmaceutical drug used for the treatment of chronic or accelerated phase chronic myeloid leukemia. As a tool for the quantitative determination of HHT, a specific monoclonal antibody against HHT (MAb 6A1) was generated by conjugates prepared via sodium periodate-mediated oxidation. The developed indirect competitive enzyme-linked immunosorbent assay (icELISA) using MAb 6A1 was found to be highly specific and sensitive with a limit of detection for HHT of 48.8 ng/mL. Validation assays to evaluate precision and accuracy of the method were conducted by the use of intra- and inter-assay analysis, recovery test, and comparison analysis between the amounts of HHT determined by ELISA and high-performance liquid chromatography. These results revealed that the established icELISA using MAb 6A1 is specific, sensitive, and reliable enough to be applied to the qualitative analysis for HHT. Furthermore, the results of this study support the usefulness of sodium periodate as a reagent for the conjugation between Cephalotaxus alkaloids and proteins for producing specific antibodies.
Erbliche Sehnerverkrankungen
Authors: Rüther Klaus
Published: February 2018

Trotz der Seltenheit haben die erblichen Sehnerverkrankungen den Vorteil, dass sie oftmals durch die Anamnese erkannt werden können und die Diagnosesicherung heute sicher durch eine molekulargenetische Untersuchung geleistet werden kann. Als isolierte erbliche Sehnerverkrankungen sind im augenheilkundlichen Alltag die Leberʼsche hereditäre Optikusneuropathie (LHON) und die autosomal-dominante Optikusatrophie (ADOA) relevant.
Nicht organische Sehstörungen
Authors: Steffen Heimo
Published: February 2018

Nicht organische Sehstörungen sind in der augenärztlichen Praxis eine häufige Herausforderung. Im Kindesalter ist die häufigste Störung eine beidseits unklare Visusreduktion, im Erwachsenenalter eher eine einseitige Sehstörung. Dieser Beitrag soll den Augenarzt für Patienten mit nicht organischer Sehstörung sensibilisieren und einen Überblick über diagnostische Strategien bei Patienten mit dieser vermuteten Diagnose geben.
Endoscopic Endonasal Transplanum Transtuberculum Approach for the Resection of a Large Suprasellar Craniopharyngioma
Authors: Mangussi-Gomes João , Vellutini Eduardo , Truong Huy , Pahl Felix , Stamm Aldo
Published: February 2018

Objectives To demonstrate an endoscopic endonasal transplanum transtuberculum approach for the resection of a large suprasellar craniopharyngioma.

Design Single-case-based operative video.

Setting Tertiary center with dedicated skull base team.

Participants A 72-year-old male patient diagnosed with a suprasellar craniopharyngioma.

Main Outcomes Measured Surgical resection of the tumor and preservation of the normal surrounding neurovascular structures.

Results A 72-year-old male patient presented with a 1-year history of progressive bitemporal visual loss. He also referred symptoms suggestive of hypogonadism. Neurological examination was unremarkable and endocrine workup demonstrated mildly elevated prolactin levels. Magnetic resonance images demonstrated a large solid-cystic suprasellar lesion, consistent with the diagnosis of craniopharyngioma. The lesion was retrochiasmatic, compressed the optic chiasm, and extended into the interpeduncular cistern (Fig. 1). Because of that, the patient underwent an endoscopic endonasal transplanum transtuberculum approach.1
2
3 The nasal stage consisted of a transnasal transseptal approach, with complete preservation of the patient's left nasal cavity.4 The cystic component of the tumor was decompressed and its solid part was resected. It was possible to preserve the surrounding normal neurovascular structures (Fig. 2). Skull base reconstruction was performed with a dural substitute, a fascia lata graft, and a right nasoseptal flap (Video 1). The patient did well after surgery and referred complete visual improvement. However, he also presented pan-hypopituitarism on long-term follow-up.

Conclusions The endoscopic endonasal route is a good alternative for the resection of suprasellar lesions. It permits tumor resection and preservation of the surrounding neurovascular structures while avoiding external incisions and brain retraction.

The link to the video can be found at: https://youtu.be/zmgxQe8w-JQ.
Der asymptomatische Patient mit schwerer Aortenstenose oder Mitralinsuffizienz: wann operieren?
Authors: Kaleschke Gerrit
Published: February 2018

Während symptomatische Herzklappenfehler nicht nur zur Symptomverbesserung, sondern meistens auch aus prognostischen Gründen eine Behandlungsindikation haben, ist die Situation bei noch asymptomatischen Klappenfehlern weniger eindeutig und zum Teil auch umstritten. Die Empfehlungen basieren vor allem auf Prädiktoren für ein schlechteres Outcome im Spontanverlauf oder nach Operation, wie beispielsweise eine progrediente, unter Umständen irreversible Schädigung von Ventrikelmyokard oder Pulmonalgefäßbett. Auch schwere Vitien können oft lange Zeit asymptomatisch bleiben. Ein Abwarten unter Beobachtung („watchful waiting“) kann dann eine sichere Vorgangsweise sein, wenn regelmäßige Kontrollen, die das rechtzeitige Erkennen von prognostisch ungünstigen Zeichen und in der Folge die zeitgerechte Intervention erlauben, gewährleistet sind. Für die Therapieentscheidung sind dabei das individuelle Eingriffsrisiko selbst, die Möglichkeit einer klappenerhaltenden Operation und die langfristigen potenziellen Komplikationen durch Klappenprothesen wie Endokarditis oder Thrombembolie bzw. Blutungsrisiken unter Antikoagulation zu berücksichtigen. Die aktuellen Leitlinien der ESC/EACTS geben praktische Hinweise und beziehen multimodale diagnostische Strategien in die Empfehlungen ein.
Suppression of Na interstitials in Na-F codoped ZnO
Authors: Huo Wenxing , Mei Zengxia , Tang Aihua , Liang Huili , Du Xiaolong
Published: February 2018

Controlling the formation of interstitial Na (Nai) self-compensating defects has been a long-term physics problem for effective Na doping in ZnO. Herein, we present an experimental approach to the suppression of Nai defects in ZnO via Na and F codoping under an oxygen-rich condition during the molecular beam epitaxy growth process. It is found that the incorporation of such large numbers of Na and F dopants (∼1020 cm−3) does not cause an obvious influence on the lattice parameters. Hall-effect measurements demonstrate that F doping efficiently raises the Fermi level (EF) of ZnO films, which is expected to make the formation energy of Nai and NaZn increase and decrease, respectively. Most of the Na atoms occupy the substitutional Zn sites, and the formation of Nai is suppressed consequently. Secondary ion mass spectrometry measurements reveal that F and Na atoms are tightly bonded together due to their strong Coulomb interaction. The enhanced deep level emission (DLE) in ZnO:Na-F is ascribed to the considerable amount of isolated Zn vacancy (VZn) defects induced by the elevated EF and the formation of neutral FO+−NaZn−0 complexes. On the other hand, formation of FO+−VZn2−− complexes in ZnO:F exhausts most of the isolated Zn vacancies, leading to the disappearance of the DLE band.
Cylindrical fast magnetosonic solitary waves in quantum degenerate electron-positron-ion plasma
Authors: Abdikian A.
Published: February 2018

The nonlinear properties of fast magnetosonic solitary waves in a quantum degenerate electron-positron (e-p) plasma in the presence of stationary ions for neutralizing the plasma background of bounded cylindrical geometry were studied. By employing the standard reductive perturbation technique and the quantum hydrodynamic model for the e-p fluid, the cylindrical Kadomtsev-Petviashvili (CKP) equation was derived for small, but finite, amplitude waves and was given the solitary wave solution for the parameters relevant to dense astrophysical objects such as white dwarf stars. By a suitable coordinate transformation, the CKP equation can be solved analytically. An analytical solution for magnetosonic solitons and periodic waves is presented. The numerical results reveal that the Bohm potential has a main effect on the periodic and solitary wave structures. By increasing the values of the plasma parameters, the amplitude of the solitary wave will be increased. The present study may be helpful in the understanding of nonlinear electromagnetic soliton waves propagating in both laboratory and astrophysical plasmas, and can help in providing good agreement between theoretical results and laboratory plasma experiments.
Density functional theory of electron transfer beyond the Born-Oppenheimer approximation: Case study of LiF
Authors: Li Chen , Requist Ryan , Gross E. K. U.
Published: February 2018

We perform model calculations for a stretched LiF molecule, demonstrating that nonadiabatic charge transfer effects can be accurately and seamlessly described within a density functional framework. In alkali halides like LiF, there is an abrupt change in the ground state electronic distribution due to an electron transfer at a critical bond length R = Rc, where an avoided crossing of the lowest adiabatic potential energy surfaces calls the validity of the Born-Oppenheimer approximation into doubt. Modeling the R-dependent electronic structure of LiF within a two-site Hubbard model, we find that nonadiabatic electron-nuclear coupling produces a sizable elongation of the critical Rc by 0.5 bohr. This effect is very accurately captured by a simple and rigorously derived correction, with an M−1 prefactor, to the exchange-correlation potential in density functional theory, M = reduced nuclear mass. Since this nonadiabatic term depends on gradients of the nuclear wave function and conditional electronic density, ∇Rχ(R) and ∇Rn(r, R), it couples the Kohn-Sham equations at neighboring R points. Motivated by an observed localization of nonadiabatic effects in nuclear configuration space, we propose a local conditional density approximation—an approximation that reduces the search for nonadiabatic density functionals to the search for a single function y(n).
The 1-ethyl-3-methylimidazolium bis(trifluoro-methylsulfonyl)-imide ionic liquid nanodroplets on solid surfaces and in electric field: A molecular dynamics simulation study
Authors: Dong Dengpan , Vatamanu Jenel P. , Wei Xiaoyu , Bedrov Dmitry
Published: February 2018

Atomistic molecular dynamics simulations were conducted to study the wetting states of 1-ethyl-3-methylimidazolium bis(trifluoro-methylsulfonyl)-imide ionic liquid (IL) nanodroplets on surfaces with different strengths of van der Waals (VDW) interactions and in the presence of an electric field. By adjusting the depth of Lennard-Jones potential, the van der Waals interaction between the solid surface and ionic liquid was systematically varied. The shape of the droplets was analyzed to extract the corresponding contact angle utilized to characterize wetting states of the nanodroplets. The explored range of surface-IL interactions allowed contact angles ranging from complete IL spreading on the surface to poor wettability. The effect of the external electrical field was explored by adding point charges to the surface atoms. Systems with two charge densities (±0.002 e/atom and ±0.004 e/atom) that correspond to 1.36 V/nm and 2.72 V/nm electric fields were investigated. Asymmetrical wetting states were observed for both cases. At 1.36 V/nm electric field, contributions of IL-surface VDW interactions and Coulombic interactions to the wetting state were competitive. At 2.72 V/nm field, electrostatic interactions dominate the interaction between the nanodroplet and surface, leading to enhanced wettability on all surfaces.
Enhancement of the thermoelectric efficiency in a T-shaped quantum dot system in the linear and nonlinear regimes
Authors: Gómez-Silva G. , Orellana P. A. , Anda E. V.
Published: February 2018

In the present work, we investigate the thermoelectric properties of a T-shaped double quantum dot system coupled to two metallic leads incorporating the intra-dot Coulomb interaction. We explore the role of the interference effects and Coulomb blockade on the thermoelectric efficiency of the system in the linear and nonlinear regimes. We studied as well the effect of a Van-Hove singularity of the leads density of states (DOS) at the neighborhood of the Fermi energy, a situation that can be obtained using a carbon nanotube, a graphene nano-ribbon or other contacts with one-dimensional properties. The system is studied above the Kondo temperature. The Coulomb blockade of the electronic charges is studied using the Hubbard III approximation, which properly describes the transport properties of this regime. In the linear response, our results show an enhancement of the thermopower and the figure of merit of the system. For a nonlinear situation, we calculate the thermoelectric efficiency and power output, concluding that the T-shaped double quantum dot is an efficient thermoelectric device. Moreover, we demonstrate the great importance of the DOS Van-Hove singularity at the neighborhood of the Fermi energy to obtain a very significant increase in the thermoelectric efficiency of the system.
Nanoscale current uniformity and injection efficiency of nanowire light emitting diodes
Authors: May Brelon J. , Selcu Camelia M. , Sarwar A. T. M. G. , Myers Roberto C.
Published: February 2018

As an alternative to light emitting diodes (LEDs) based on thin films, nanowire based LEDs are the focus of recent development efforts in solid state lighting as they offer distinct photonic advantages and enable direct integration on a variety of different substrates. However, for practical nanowire LEDs to be realized, uniform electrical injection must be achieved through large numbers of nanowire LEDs. Here, we investigate the effect of the integration of a III-Nitride polarization engineered tunnel junction (TJ) in nanowire LEDs on Si on both the overall injection efficiency and nanoscale current uniformity. By using conductive atomic force microscopy (cAFM) and current-voltage (IV) analysis, we explore the link between the nanoscale nonuniformities and the ensemble devices which consist of many diodes wired in parallel. Nanometer resolved current maps reveal that the integration of a TJ on n-Si increases the amount of current a single nanowire can pass at a given applied bias by up to an order of magnitude, with the top 10% of wires passing more than ×3.5 the current of nanowires without a TJ. This manifests at the macroscopic level as a reduction in threshold voltage by more than 3 V and an increase in differential conductance as a direct consequence of the integration of the TJ. These results show the utility of cAFM to quantitatively probe the electrical inhomogeneities in as-grown nanowire ensembles without introducing uncertainty due to additional device processing steps, opening the door to more rapid development of nanowire ensemble based photonics.
Intervalley scattering in terahertz quantum cascade lasers with GaSb and InGaSb wells
Authors: Yasuda Hiroaki
Published: February 2018

We theoretically study the performance of terahertz quantum cascade lasers (THz-QCLs) with GaSb wells and InxGa1−xSb wells. The results of rate-equation calculations reveal that the intervalley scattering of electrons from the Γ valley to the L valley in GaSb degrades the performance of the GaSb-based THz-QCLs at high temperatures. We propose the use of InxGa1−xSb (x ≥ 0.25) quantum wells to reduce the intervalley scattering. Our calculations using the nonequilibrium Green’s function method including alloy disorder scattering show that the THz-QCLs with InGaSb wells have higher gain than the GaAs-based THz-QCLs at high temperatures.
Building and expanding interprofessional teaching teams
Authors: Darlow Ben , McKinlay Eileen , Gallagher Peter , Beckingsale Louise , Coleman Karen , Perry Meredith , Pullon Sue
Published: February 2018

ABSTRACT INTRODUCTION Interprofessional education (IPE) aims to prepare learners to work in collaborative health-care teams. The University of Otago, Wellington has piloted, developed and expanded an IPE programme since 2011. An interprofessional teaching team has developed alongside this programme. AIMS This study aimed to understand the development of a university-based interprofessional teaching team over a 4-year period and generate insights to aid the development of such teams elsewhere. METHODS Two semi-structured audio-recorded educator focus groups were conducted at key times in the development of the IPE programme in 2011 and 2014. The programme focused on long-term condition management and involved students from dietetics, medicine, physiotherapy and radiation therapy. Focus group transcripts were independently analysed by two researchers using Thematic Analysis to identify broad themes. Initial themes were compared, discussed and combined to form a thematic framework. The thematic framework was verified by the education team and subsequently updated and reorganised. RESULTS Three key themes emerged: (i) development as an interprofessional educator; (ii) developing a team; and (iii) risk and reward. Teaching in an interprofessional environment was initially daunting but confidence increased with experience. Team teaching highlighted educators’ disciplinary roles and skill sets and exposed educators to different teaching approaches. Educators perceived they modelled team development processes to students through their own development as a team. Interprofessional teaching was challenging to organise but participation was rewarding. Programme expansion increased the risks and complexity, but also acted as a stimulus for development and energised the teaching team. DISCUSSION Interprofessional teaching is initially challenging but ultimately enriching. Interprofessional teaching skills take time to develop and perspectives of role change over time. Educator team development is aided by commitment, understanding, enthusiasm, leadership and trust.
Strong control of Southern Ocean cloud reflectivity by ice-nucleating particles
Authors: Vergara-Temprado Jesús , Miltenberger Annette K. , Furtado Kalli , Grosvenor Daniel P. , Shipway Ben J. , Hill Adrian A. , Wilkinson Jonathan M. , Field Paul R. , Murray Benjamin J. , Carslaw Ken S.
Published: February 2018

Significance

Simulated clouds over the Southern Ocean reflect too little solar radiation compared with observations, which results in errors in simulated surface temperatures and in many other important features of the climate system. Our results show that the radiative properties of the most biased types of clouds in cyclonic systems are highly sensitive to the concentration of ice-nucleating particles. The uniquely low concentrations of ice-nucleating particles in this remote marine environment strongly inhibit precipitation and allow much brighter clouds to be sustained.
Scalable, cGMP‐compatible purification of extracellular vesicles carrying bioactive human heterodimeric IL‐15/lactadherin complexes
Authors: Watson Dionysios C. , Yung Bryant C. , Bergamaschi Cristina , Chowdhury Bhabadeb , Bear Jenifer , Stellas Dimitris , Morales‐Kastresana Aizea , Jones Jennifer C. , Felber Barbara K. , Chen Xiaoyuan , Pavlakis George N.
Published: February 2018

The development of extracellular vesicles (EV) for therapeutic applications is contingent upon the establishment of reproducible, scalable, and high‐throughput methods for the production and purification of clinical grade EV. Methods including ultracentrifugation (U/C), ultrafiltration, immunoprecipitation, and size‐exclusion chromatography (SEC) have been employed to isolate EV, each facing limitations such as efficiency, particle purity, lengthy processing time, and/or sample volume. We developed a cGMP‐compatible method for the scalable production, concentration, and isolation of EV through a strategy involving bioreactor culture, tangential flow filtration (TFF), and preparative SEC. We applied this purification method for the isolation of engineered EV carrying multiple complexes of a novel human immunostimulatory cytokine‐fusion protein, heterodimeric IL‐15 (hetIL‐15)/lactadherin. HEK293 cells stably expressing the fusion cytokine were cultured in a hollow‐fibre bioreactor. Conditioned medium was collected and EV were isolated comparing three procedures: U/C, SEC, or TFF + SEC. SEC demonstrated comparable particle recovery, size distribution, and hetIL‐15 density as U/C purification. Relative to U/C, SEC preparations achieved a 100‐fold reduction in ferritin concentration, a major protein‐complex contaminant. Comparative proteomics suggested that SEC additionally decreased the abundance of cytoplasmic proteins not associated with EV. Combination of TFF and SEC allowed for bulk processing of large starting volumes, and resulted in bioactive EV, without significant loss in particle yield or changes in size, morphology, and hetIL‐15/lactadherin density. Taken together, the combination of bioreactor culture with TFF + SEC comprises a scalable, efficient method for the production of highly purified, bioactive EV carrying hetIL‐15/lactadherin, which may be useful in targeted cancer immunotherapy approaches.
On algebraic multiplicity of (anti)periodic eigenvalues of Hill’s equations
Authors: Chen Zhijie , Lin Chang-Shou
Published: February 2018

We construct two explicit examples of Hill’s equations with complex-valued potentials such that the algebraic multiplicity of some (anti)periodic eigenvalue

E
E

equals

1
+
2

p

i

1+2p_{i}

with

p

i

≥
1

p_{i}\geq 1

, where

p

i

p_{i}

denotes the immovable part of

E
E

as a Dirichlet eigenvalue. These examples confirm a phenomena about Hill’s equations in (Gesztesy and Weikard, Acta Math. 176 (1996), 73–107).
Exploitation
Authors: Ferguson Benjamin
Published: February 2018

The concept of exploitation is often invoked in situations where relatively impoverished people are treated unfairly in economic and social contexts. While the claim that exploitation involves taking unfair advantage is broadly accepted, there is little consensus about what fairness requires and whether unfairness is seriously wrong in the context of exchanges. One family of accounts claims that exploitation involves the maldistribution of resources, either because exploitative transactions result in distributions that violate substantive norms of fairness, or because procedural flaws in the way exploitative transactions come about entail that their outcomes are unfair.

A second, domination-based approach to exploitation claims that the moral flaw embodied by exploitative relations is the exploiter’s disrespectful use of his power over the exploitee. While exploiters’ domination of others may lead to maldistributions, defenders of the domination-based approach argue that distributive unfairness is neither necessary nor sufficient for exploitative relations.

These approaches both face two kinds of challenges. The first concerns the scope. Neither appears to provide necessary and sufficient conditions that are adequate to capture all and only cases commonly described as exploitation. The second concerns the normative status. Exploitation is typically assumed to be morally impermissible, yet neither approach seems to satisfactorily explain how exploitations that nevertheless generate significant welfare gains for both parties can be wrong.
Policy and Organizational Termination
Authors: Adam Christian , Bauer Michael W.
Published: February 2018

In the perspective of a rational policy cycle, termination is the logical end of unsuccessful policy choices. As the deliberate conclusion or cessation of specific government functions, programs, policies, or organizations the termination concept consists of the ending of public policies, as well as public institutions. Its potential as a tool of enlightenment as well as its pitfalls in a world dominated by politics are presented by analyzing five decades of scholarly efforts in the area of policy and organizational termination.
How Gender Intersects With Political Violence and Terrorism
Authors: Ortbals Candice , Poloni-Staudinger Lori
Published: February 2018

Gender influences political violence, which includes, for example, terrorism, genocide, and war. Gender uncovers how women, men, and nonbinary persons act according to feminine, masculine, or fluid expectations of men and women. A gendered interpretation of political violence recognizes that politics and states project masculine power and privilege, with the result that men occupy the dominant social position in politics and women and marginalized men are subordinate. As such, men (associated with masculinity) are typically understood as perpetrators of political violence with power and agency and women (associated with femininity) are seen as passive and as victims of violence. For example, women killed by drone attacks in the U.S. War on Terrorism are seen as the innocent, who, along with children, are collateral damage. Many historical and current examples, however, demonstrate that women have agency, namely that they are active in social groups and state institutions responding to and initiating political violence. Women are victims of political violence in many instances, yet some are also political and social actors who fight for change.

Gendercide, which can occur alongside genocide, targets a specific gender, with the result that men, women, or those who identify with a non-heteronormative sexuality are subject to discriminatory killing. Rape in wartime situations is also gendered; often it is an expression of men’s power over women and over men who are feminized and marginalized. Because war is typically seen as a masculine domain, wartime violence is not associated with women, who are viewed as life givers and not life takers. Similarly, few expect women to be terrorists, and when they are, women’s motivations often are assumed to be different from those of men. Whereas some scholars argue that women pursue terrorism for personal (and feminine) reasons, for example to redeem themselves from the reputation of rape or for the loss of a male loved one, other scholars maintain that women act on account of political or religious motivations. Although many cases of women’s involvement in war and terrorism can be documented throughout history, wartime leadership and prominent social positions following political violence have been reserved for men. Leaders with feminine traits seem undesirable during and after political violence, because military leadership and negotiations to end military conflict are associated with men and masculinity. Nevertheless, women’s groups and individual women respond to situations of violence by protesting against violence, testifying at tribunals and truth commissions, and constructing the political memory of violence.
Craniotomy and Survival for Primary Central Nervous System Lymphoma
Authors: Rae Ali I , Mehta Amol , Cloney Michael , Kinslow Connor J , Wang Tony J C , Bhagat Govind , Canoll Peter D , Zanazzi George J , Sisti Michael B , Sheth Sameer A , Connolly E Sander , McKhann Guy M , Bruce Jeffrey N , Iwamoto Fabio M , Sonabend Adam M
Published: February 2018

BACKGROUND

Cytoreductive surgery is considered controversial for primary central nervous system lymphoma (PCNSL).

OBJECTIVE

To investigate survival following craniotomy or biopsy for PCNSL

METHODS

The National Cancer Database-Participant User File (NCDB, n = 8936), Surveillance, Epidemiology, and End Results Program (SEER, n = 4636), and an institutional series (IS, n = 132) were used. We retrospectively investigated the relationship between craniotomy, prognostic factors, and survival for PCNSL using case–control design.

RESULTS

 In NCDB, craniotomy was associated with increased median survival over biopsy (19.5 vs 11.0 mo), independent of subsequent radiation and chemotherapy (hazard ratio [HR] 0.80, P < .001). We found a similar trend with survival for craniotomy vs biopsy in the IS (HR 0.68, P = .15). In SEER, gross total resection was associated with increased median survival over biopsy (29 vs 10 mo, HR 0.68, P < .001). The survival benefit associated with craniotomy was greater within recursive partitioning analysis (RPA) class 1 group in NCDB (95.1 vs 29.1 mo, HR 0.66, P < .001), but was smaller for RPA 2-3 (14.9 vs 10.0 mo, HR 0.86, P < .001). A surgical risk category (RC) considering lesion location and number, age, and frailty was developed. Craniotomy was associated with increased survival vs biopsy for patients with low RC (133.4 vs 41.0 mo, HR 0.33, P = .01), but not high RC in the IS.

CONCLUSION

Craniotomy is associated with increased survival over biopsy for PCNSL in 3 retrospective datasets. Prospective studies are necessary to adequately evaluate this relationship. Such studies should evaluate patients most likely to benefit from cytoreductive surgery, ie, those with favorable RPA and RC.
FOREST Unbiased Galactic plane Imaging survey with the Nobeyama 45 m telescope (FUGIN). III. Possible evidence for formation of NGC 6618 cluster in M 17 by cloud–cloud collision
Authors: Nishimura Atsushi , Minamidani Tetsuhiro , Umemoto Tomofumi , Fujita Shinji , Matsuo Mitsuhiro , Hattori Yusuke , Kohno Mikito , Yamagishi Mitsuyoshi , Tsuda Yuya , Kuriki Mika , Kuno Nario , Torii Kazufumi , Tsutsumi Daichi , Okawa Kazuki , Sano Hidetoshi , Tachihara Kengo , Ohama Akio , Fukui Yasuo
Published: February 2018

We present 12CO (J = 1–0), 13CO (J = 1–0), and C18O (J = 1–0) images of the M 17 giant molecular clouds obtained as part of the FUGIN (FOREST Ultra-wide Galactic Plane Survey In Nobeyama) project. The observations cover the entire area of the M 17 SW and M 17 N clouds at the highest angular resolution (∼19″) to date, which corresponds to ∼0.18 pc at the distance of 2.0 kpc. We find that the region consists of four different velocity components: a very low velocity (VLV) clump, a low velocity component (LVC), a main velocity component (MVC), and a high velocity component (HVC). The LVC and the HVC have cavities. Ultraviolet photons radiated from NGC 6618 cluster penetrate into the N cloud up to ∼5 pc through the cavities and interact with molecular gas. This interaction is correlated with the distribution of young stellar objects in the N cloud. The LVC and the HVC are distributed complementarily after the HVC is displaced by 0.8 pc toward the east-southeast direction, suggesting that collision of the LVC and the HVC created the cavities in both clouds. The collision velocity and timescale are estimated to be 9.9 km s−1 and 1.1 × 105 yr, respectively. The high collision velocity can provide a mass accretion rate of up to 10$^{-3}{\,\,}M_{\odot }\:$yr−1, and the high column density (4 × 1023 cm−2) might result in massive cluster formation. The scenario of cloud–cloud collision likely explains well the stellar population and the formation history of the NGC 6618 cluster proposed by Hoffmeister et al. (2008, ApJ, 686, 310).
Paradigm Shift in Geriatric Low Back Pain Management: Integrating Influences, Experiences, and Consequences
Authors: Simon Corey B , Hicks Gregory E
Published: February 2018

Geriatric low back pain (LBP) can have a profound impact on physical activity and can cause a decline in physical function, which is a major health risk for older adults. Within the last decade, physical therapist management of LBP has shifted from an emphasis on pathoanatomical mechanisms, such as spine degeneration, to addressing psychological distress factors. Although this approach is promising, the complexity of LBP in older adults (including biological, psychological, cognitive, and social influences), which may differ from that in younger adults, must be considered. Further, outcome assessment should represent not only the LBP experience (eg, pain intensity, pain with movement) but also LBP consequences, such as physical activity decline and physical function decline. This perspective discusses influences on geriatric LBP, experiences, and consequences with the goal of facilitating standardized and comprehensive physical therapist management.
Effectiveness and Downstream Healthcare Utilization for Patients That Received Early Physical Therapy Versus Usual Care for Low Back Pain
Authors: Rhon Daniel I. , Miller Robert B. , Fritz Julie M.
Published: February 2018

Study Design.

Randomized controlled trial.

Objective.

The aim of this study was to compare early physical therapy versus usual care in patients with low back pain.

Summary of Background Data.

Early physical therapy (PT) has been associated with reduced downstream healthcare utilization in retrospective studies, but not investigated prospectively in the military health system.

Methods.

Military service members seeking care from a general practitioner were recruited. Patients attended a 20-minute self-management class with focus on psychosocial resilience and then randomized to usual care only (UC) versus immediately starting a 3-week physical therapy program (PT). Primary outcome was the Oswestry Disability Index at 1 year. Secondary outcomes included Oswestry scores at 4- and 12-week follow-up, numeric pain rating scale, global rating of change, and healthcare utilization at 1 year. Analysis of covariance was used to compare differences between groups, significance set at 0.05. Trial Registration: clinicaltrials.gov: NCT01556581

Results.

A total of 119 patients (mean age 27.2 years; mean BMI 27.8 kg/m2; 15.1% female) enrolled (61 randomized to UC; 58 to PT). No between-group differences found on the Oswestry after 1 year. A between-group difference in Oswestry was present at 4 weeks (mean difference = 4.4; 95% CI: 0.41–10.1; P = 0.042) favoring PT. Total 1-year mean healthcare costs did not differ significantly between groups (UC $5037; 95 CI $4171–$6082 and PT $5299; 95 CI $4367–$6431). The portion of total mean healthcare costs related to low back pain was lower for UC ($1096; 95% CI $855–$1405) compared to PT ($2016, 95% CI $1570–$2590).

Conclusion.

There was no difference between usual care and early PT after 1 year. PT provided greater improvement in disability after 4 weeks. As both groups improved, the impact of the education may have been underestimated. Patients in the PT group utilized greater back-pain-related healthcare resources, but overall healthcare costs did not differ compared to UC.

Level of Evidence: 2
Quality of Sleep Among Intensive Care Unit Patients
Authors: Bani Younis Mohammad , Hayajneh Ferial A.
Published: February 2018

Investigating sleep disturbances among intensive care unit (ICU) patients and its serious consequences is considered a crucial issue for nurses. The need of sleep increases during hospitalization time to preserve energy for the healing process. Previous studies have demonstrated that sleep disturbance is one of the most common complaints of patients in the ICUs, with a prevalence of more than 50%. Although the total sleep time might be normal, the patients' sleep is fragmented and light in the intensive care settings. The main purpose of this review is to generate a clear view of what is known about sleep disturbances among ICU patients as well as to identify the gap in knowledge regarding this issue. This was done by describing, summarizing, clarifying, and evaluating well-selected previous studies about this topic. In addition, this concise review has focused on the prevalence of sleep disturbances in the ICU, factors contributing to poor quality of sleep among ICU patients, and the physiological effects of poor sleep on the patients' prognosis.
Analysis of Two Orthokeratology Lens Designs and Comparison of Their Optical Effects on the Cornea
Authors: Marcotte-Collard Rémy , Simard Patrick , Michaud Langis
Published: February 2018

Purpose:

This study aims to analyze two commercial orthokeratology lens designs and compare their optical effects at the corneal level.

Methods:

This is a retrospective study on subjects seeking an orthokeratology fitting for myopia management at the Université de Montréal clinic between January 2013 and August 2015. Group A included the first 64 subjects fitted with a 4-curve lens design (Paragon CRT; Paragon) who met the inclusion criteria, whereas group B included the same number of subjects fitted with a 5-curve lens design (Dreamlens; Polymer Technology, Rochester, NY). Topographic tangential maps were collected at baseline and 3 months after fitting. The differential map was generated for each patient and analyzed, which involved determining the radius of the central distance zone (CDZ) and the power and width of the high convex zone (HCZ). Results were compared between the two groups, taking baseline refraction into account. Finally, a correlation was estimated between topographic data and corneal parameters (flat and steep K, the corneal eccentricity of each principal meridian).

Results:

The CDZ for group A is significantly larger than the one generated for group B both horizontally (t(126)=12.12, P<0.01) and vertically (t(126)=15.690, P<0.01). However, there was no significant difference regarding the HCZ power generated. The only correlations found were a strong positive association between CDZ radius and HCZ power generated by lens A nasally (r=0.450; P=0.000) and temporally (r=0.558; P=0.000), and a weaker association between the baseline refractive error, along with the nasal (r=0.237; P=0.033) and temporal (r=0.288; P=0.028) HCZ power for lens B.

Conclusion:

The four- and five-curve orthokeratology lens designs generate significantly different optical modifications on the cornea. This can affect reports on orthokeratology efficacy for myopia management as well as the lens selection when used for myopia correction.
Terrien Marginal Degeneration Complicated by a Corneoscleral Cyst
Authors: Lee Tian Loon , Lee Hwei Yee , Tan Johnson Choon Hwai
Published: February 2018

Purpose:

To describe a case of inflammatory Terrien's marginal degeneration (TMD) in a young Chinese girl complicated by a corneoscleral cyst who ultimately underwent surgical treatment with cyst excision, corneal patch graft and amniotic membrane graft.

Methods:

Case report.

Results:

A 12-year-old Chinese female presented initially with redness and discharge from her right eye with bilateral superior corneal thinning. The patient was diagnosed with TMD. She subsequently developed a corneoscleral cyst 2 years later which doubled in size within 1 year. The patient underwent a cyst excision with lamellar corneal patch graft and amniotic membrane grafting. Histopathological examination of the cyst wall showed a lining of squamous epithelium, consistent with a corneoscleral cyst.

Conclusions:

This is an interesting case highlighting the rare complication of corneoscleral cyst in a young patient with inflammatory TMD. Excision of the cyst with a corneal patch graft and amniotic membrane grafting without any chemical cautery is effective in preventing recurrence.
Monitoring of Antiplatelet Therapy in Children on Ventricular Assist Device Support: Comparison of Multiplate and Thromboelastography Platelet Mapping
Authors: Ferguson Lee P. , Duong Phuoc , Pearce Kim F. , Murphy Paul , Biss Tina T.
Published: February 2018

The optimal method for monitoring antiplatelet therapy in children supported with ventricular assist devices (VADs) is unknown. We conducted a retrospective study to compare Thromboelastography Platelet Mapping (TEG/PM) with multiple electrode platelet aggregometry (MEA) on a Multiplate analyzer (Roche Diagnostics, Mannheim, Germany). We analyzed data from 66 paired blood samples from 9 patients <16 years of age on VAD where platelet function was simultaneously measured with TEG/PM and MEA. Antiplatelet dose–response relationships and intraindividual variability during steady state therapy were determined. Agreement in determination of therapeutic antiplatelet therapy was poor (arachidonic acid, κ 0.23; adenosine diphosphate [ADP], κ 0.13). Rate of aspirin and clopidogrel resistance was much higher when determined using TEG/PM than MEA. In patients receiving ≥5 mg/kg/day aspirin, 72% of TEG/PM measurements showed subtherapeutic response compared with 11% of MEA measurements. There was evidence of a dose–response relationship with clopidogrel and MEA ADP-induced aggregation (R
2 = 0.56; p < 0.0001); however, there was no association between dose and TEG/PM% ADP inhibition (p = 0.15). Intraindividual variability in platelet reactivity was far greater when measured by TEG/PM during steady state therapy. Multiple electrode platelet aggregometry appears to be more reliable than TEG/PM for monitoring antiplatelet therapy in children supported with VAD.
A Randomized Controlled Study to Evaluate the Effectiveness of 2 Treatment Methods in Reducing Incidence of Short Peripheral Catheter-Related Phlebitis
Authors: Gunasegaran Nanthakumahrie , See Min Ting Alicia , Leong Siew Teing , Yuan Long Xia , Ang Shin Yuh
Published: February 2018

Short peripheral catheter (SPC)-related phlebitis can lead to bloodstream infections and affect patients' quality of life. A randomized trial was carried out to evaluate the effectiveness of 2 treatment methods in reducing the incidence of SPC-related phlebitis. The 2 treatment methods differed in terms of the cleansing solution used before insertion and dressing material used after removal. The results demonstrated that the type of cleansing solution and postremoval dressing material did not make a difference in the incidence of phlebitis. Strict adherence to aseptic techniques and prompt removal of the SPC remained the cornerstone in the prevention of phlebitis.
Changes in Siblings Over Time After the Death of a Brother or Sister From Cancer
Authors: Akard Terrah Foster , Skeens Micah A. , Fortney Christine A. , Dietrich Mary S. , Gilmer Mary Jo , Vannatta Kathryn , Barrera Maru , Davies Betty , Wray Sarah , Gerhardt Cynthia A.
Published: February 2018

Background

Limited research has examined the impact of a child’s death from cancer on siblings. Even less is known about how these siblings change over time.

Objective

This study compared changes in siblings 1 (T1) and 2 (T2) years after the death of a brother or sister from cancer based on bereaved parent and sibling interviews.

Methods

Participants across 3 institutions represented 27 families and included bereaved mothers (n = 21), fathers (n = 15), and siblings (n = 26) ranging from 8 to 17 years old. Participants completed semistructured interviews. Content analysis identified emerging themes and included frequency counts of participant responses. McNemar tests examined differences in the frequency of responses between T1 and T2 data.

Results

Participants reported similar types of changes in bereaved siblings at both time points, including changes in sibling relationships, life perspectives, their personal lives, and school performance. A new theme of “openness” emerged at T2. Frequencies of responses differed according to mother, father, or sibling informant. Overall, participants less frequently reported changes at T2 versus T1. Compared with findings in the first year, participants reported greater sibling maturity at follow-up.

Conclusion

Overall changes in bereaved siblings continued over 2 years with less frequency over time, with the exception of increases in maturity and openness.

Implications for Practice

Providers can educate parents regarding the impact of death of a brother or sister over time. Nurses can foster open communication in surviving grieving siblings and parents as potential protective factors in families going through their grief.
Spiritual Perspective, Mindfulness, and Spiritual Care Practice of Hospice and Palliative Nurses
Authors: Ricci-Allegra Patricia
Published: February 2018

Spiritual care is a key tenet of palliative care. A nurse's spiritual perspective has been recognized as an influencing factor in spiritual care, and results from several studies have shown an increase in spiritual perspective as a result of participation in programs designed to develop mindfulness as well as developing skills necessary for spiritual care. A descriptive correlational design was used with a convenience sample of nurses from the Hospice and Palliative Nurses Association. Data were collected online using the Spiritual Perspective Scale, Mindful Attention Awareness Scale, and the Nurse Spiritual Care Therapeutics Scale. Spiritual perspective was positively correlated with age (ρ = 0.2, P = .046), years of registered nurse experience (ρ = 0.208, P = .039) and higher in those with a religious affiliation (U = 392.5, P < .001, r = 0.54). A positive correlation was found between mindfulness and spiritual care (r = 0.212, P = .05), with mindfulness explaining 4.5% of the variance in spiritual care. No significant relationships were found between spiritual perspective and mindfulness or spiritual care. Identifying mindfulness as a factor that may influence spiritual care has implications for education, research, and practice.
Caring in Palliative Care
Authors: Parola Vitor , Coelho Adriana , Sandgren Anna , Fernandes Olga , Apóstolo João
Published: February 2018

Providing palliative care involves serious challenges for nurses, such as end-of-life decisions, contact with people’s suffering and dying, and increased risk of burnout. However, studies have revealed that the burnout level of health professionals working in palliative care is lower than that of health professionals working in other settings. This study aimed to describe the lived experiences of nurses caring in a palliative care unit. A phenomenological descriptive study was undertaken. Nine nurses were recruited from a palliative care unit in Portugal. Data were collected using individual interviews and analyzed following the method of Giorgi. Five themes reflect the essence of the lived experience: (1) experience centered on the relationship with the other (ie, the patient and the family), (2) experience centered on the relationship with one’s own self, (3) exhausting experience, (4) rewarding experience, and (5) the team as a pillar. These findings can be valuable for understanding the challenges and strategies experienced by nurses caring in palliative care and for designing interventions that focus on reducing the risk of burnout among nurses—not only those working in palliative care but also those working in other contexts who experience regular contact with suffering and death.
Association Between the Apolipoprotein E Gene Polymorphism and Atherosclerotic Middle Cerebral Artery Stenosis
Authors: Zhang Zhengsheng , Chen Xiang-yan , Baum Larry , Ng Ho Keung , Mok Vincent , Wong Ka Sing
Published: February 2018

Objectives:

Stenosis of the intracranial large arteries, especially the middle cerebral artery (MCA), is common in the Chinese population. We conducted a case-control study to investigate clinical and apolipoprotein E (ApoE) gene polymorphism of MCA atherosclerosis in the Chinese population.

Materials and Methods:

Polymerase chain reaction–based protocols were used to identify the genotypes of polymorphisms in ApoE genes. Clinical parameters and the genotypes of polymorphisms in the ApoE genes were compared in patients with and without MCA stenosis. The ApoE exon ε4 genotypes with risk factors were compared in the patients with and without MCA stenosis.

Results:

In total, 337 ischemic stroke patients were recruited, 156 cases with and 181 without MCA stenosis. Univariate analysis showed that the levels of systolic blood pressure and pulse pressure were higher in the MCA-stenosis group. There were no significant differences in the genotype and allele frequencies of the ApoE polymorphism observed between patients with and without MCA stenosis. However, there was a trend that the MCA-stenosis group tended to have more of genotype ε4/ε4 (3.8% vs. 0.6%, P=0.052) than the non–MCA-stenosis group. There was no effect of ApoE genotype and genotype-by-environment interactions on ischemic stroke susceptibility.

Conclusions:

This present study indicated that the hypertension (ie, systolic blood pressure and pulse pressure) and the ApoEε4/ε4 genotype may be associated with the occurrence of MCA stenosis in the ischemic stroke Chinese patients.