bluuebunny/crossref_metadata_2025 huggingface dataset:
Landau damping of dust acoustic solitary waves in nonthermal plasmas
Authors: Ghai Yashika , Saini N. S. , Eliasson B.
Published: January 2018

Dust acoustic (DA) solitary and shock structures have been investigated under the influence of Landau damping in a dusty plasma containing two temperature nonthermal ions. Motivated by the observations of Geotail spacecraft that reported two-temperature ion population in the Earth's magnetosphere, we have investigated the effect of resonant wave-particle interactions on DA nonlinear structures. The Korteweg-de Vries (KdV) equation with an additional Landau damping term is derived and its analytical solution is presented. The solution has the form of a soliton whose amplitude decreases with time. Further, we have illustrated the influence of Landau damping and nonthermality of the ions on DA shock structures by a numerical solution of the Landau damping modified KdV equation. The study of the time evolution of shock waves suggests that an initial shock-like pulse forms an oscillatory shock at later times due to the balance of nonlinearity, dispersion, and dissipation due to Landau damping. The findings of the present investigation may be useful in understanding the properties of nonlinear structures in the presence of Landau damping in dusty plasmas containing two temperature ions obeying nonthermal distribution such as in the Earth's magnetotail.
Fabrication of fine metal structures based on laser drawing method using interference pattern from co-propagating optical vortices
Authors: Sakamoto Moritsugu , Hizatsuki Takuya , Noda Kohei , Sasaki Tomoyuki , Kawatsuki Nobuhiro , Goto Kohei , Ono Hiroshi
Published: January 2018

We propose and demonstrate a photolithography method for fine metal structure fabrication based on laser drawing that uses the interference pattern generated by co-propagating optical vortices. A tiny dark core region of the optical vortex allows us to overcome the diffraction limit for Gaussian beams. This means that the proposed method can be used to fabricate finer structures than those produced by the conventional laser drawing method while using a Gaussian beam, even under low numerical aperture conditions. The feasibility of the proposed method was demonstrated experimentally using a system that included an axially symmetrical polarization element that can generate the co-propagating optical vortices using a common path optical system. Our method has potential to fabricate few tens of nanometer scale metal line structures by increasing numerical aperture conditions and should be applicable to the development of nanometer scale electronic and optical devices and structures, such as integrated circuits and metamaterials, without using electron beam lithography.
An in-situ photocrosslinking microfluidic technique to generate non-spherical, cytocompatible, degradable, monodisperse alginate microgels for chondrocyte encapsulation
Authors: Wang Shuo , Bruning Andrew , Jeon Oju , Long Fei , Alsberg Eben , Choi Chang Kyoung
Published: January 2018

Alginate microgels are widely generated by ionic crosslinking methods, but this method has limitations in controlling the microgel degradation and generating non-spherical microgels. By employing oxidized methacrylated alginate (OMA) that is degradable and photocrosslinkable, we have successfully photocrosslinked monodisperse OMA microgels and demonstrated the feasibility to generate discoid alginate microgels. However, several technical issues obstructed our opto-microfluidic method from being a useful technique. Here, we further characterized and optimized this method. Monodisperse discoid OMA microgels with good shape consistency were, for the first time, generated. The curability of OMA microgels was characterized as the macromer concentration varied from 2% to 10%, and the minimum required photoinitiator (VA-086) concentrations were determined. The effects of crosslinking density and the presence of ions in the storage solution on swelling of OMA hydrogels were identified to give insights into accurate controlling of the microgel size. A much quicker degradation rate (within three weeks) compared to ionically crosslinked alginate hydrogels was indirectly identified by quantifying the elastic modulus using atomic force microscopy. The viability of encapsulated chondrocytes in OMA microgels formed by this method was higher than those from other existing methods, demonstrating its favorable cytocompatibility. It was found that the oxygen tension played a critical role in both the curability of microgels and the cytocompatibility of this technique. We also summarize common practical issues and provide related solutions and/or operational suggestions. By this method, OMA microgels are expected to be valuable alternatives to traditional ionically crosslinked alginate microgels in drug delivery, tissue engineering, and single cell analysis areas due to their multiple favorable properties.
A Lagrangian model for laser-induced fluorescence and its application to measurements of plasma ion temperature and electrostatic waves
Authors: Chu F. , Skiff F.
Published: January 2018

Extensive information can be obtained on wave-particle interactions and wave fields by a direct measurement of perturbed ion distribution functions using laser-induced fluorescence (LIF). For practical purposes, LIF is frequently performed on metastable states that are produced from neutral gas particles and ions in other electronic states. If the laser intensity is increased to obtain a better LIF signal, then optical pumping can produce systematic effects depending on the collision rates which control metastable population and lifetime. We numerically simulate the ion velocity distribution measurement and wave-detection process using a Lagrangian model for the LIF signal for the case where metastables are produced directly from neutrals. This case requires more strict precautions and is important for discharges with energetic primary electrons and a high density of neutrals. Some of the results also apply to metastables produced from pre-existing ions. The simulations show that optical pumping broadening affects the ion velocity distribution function f0(v) and its first-order perturbation f1(v,t) when the laser intensity is increased above a certain level. The results also suggest that ion temperature measurements are only accurate when the metastable ions can live longer than the ion-ion collision mean free time. For the purposes of wave detection, the wave period has to be significantly shorter than the lifetime of metastable ions for a direct interpretation. It is more generally true that metastable ions may be viewed as test-particles. As long as an appropriate model is available, LIF can be extended to a range of environments.
Phononic frequency comb demonstrated by nonlinear trimodal coupling
Authors: Majors J. H.
Published: January 2018

A driven micromachined device exhibits three-mode four-wave mixing and points to realizable multimode phononic frequency combs.
Advances in vibrational spectroscopy provide new ways for characterizing semiconductor impurities
Authors: Liebendorfer Adam
Published: January 2018

Improvements in computing push the boundaries of vibrational spectroscopy, allowing for observation of new electronic properties of semiconductors with light-mass element impurities.
Morality, loyalty and eloquence
Authors: Livnat Zohar , Kohn Ayelet
Published: January 2018

The new dialogic, conversational nature of television broadcast news (Hamo, 2009) poses a challenge to traditional commentators, who are forced to move from an authoritative monologue to a confrontational dialogue that requires additional flexibility and conversational skills. The paper focuses on an Israeli case study which presents a confrontational dialogue in which one of the discussants is an experienced military correspondent and commentator. We demonstrate the various resources he uses in order to cope with a complex discursive challenge by using multimodal tools, both verbal and visual (Kress 2010; Kress and Van Leeuwen 2001; Jewitt and Oyama 2001).

Besides interrupting his interlocutor’s eloquent discourse in any possible way, demonstrating his well-known direct and involved television persona, the military correspondent employs institutional discursive resources such as using authoritative voice and taking the role of the mediator. Concession structures (Anscombre 1985) reflect his inner moral conflict toward the issue (Livnat 2012).
The actin-MRTF-SRF transcriptional circuit controls tubulin acetylation via α-TAT1 gene expression
Authors: Fernández-Barrera Jaime , Bernabé-Rubio Miguel , Casares-Arias Javier , Rangel Laura , Fernández-Martín Laura , Correas Isabel , Alonso Miguel A.
Published: January 2018

The role of formins in microtubules is not well understood. In this study, we have investigated the mechanism by which INF2, a formin mutated in degenerative renal and neurological hereditary disorders, controls microtubule acetylation. We found that silencing of INF2 in epithelial RPE-1 cells produced a dramatic drop in tubulin acetylation, increased the G-actin/F-actin ratio, and impaired myocardin-related transcription factor (MRTF)/serum response factor (SRF)–dependent transcription, which is known to be repressed by increased levels of G-actin. The effect on tubulin acetylation was caused by the almost complete absence of α-tubulin acetyltransferase 1 (α-TAT1) messenger RNA (mRNA). Activation of the MRTF-SRF transcriptional complex restored α-TAT1 mRNA levels and tubulin acetylation. Several functional MRTF-SRF–responsive elements were consistently identified in the α-TAT1 gene. The effect of INF2 silencing on microtubule acetylation was also observed in epithelial ECV304 cells, but not in Jurkat T cells. Therefore, the actin-MRTF-SRF circuit controls α-TAT1 transcription. INF2 regulates the circuit, and hence microtubule acetylation, in cell types where it has a prominent role in actin polymerization.
On 5-manifolds admitting rank two distributions of Cartan type
Authors: Dave Shantanu , Haller Stefan
Published: January 2018

We consider the question whether an orientable

5
5

-manifold can be equipped with a rank two distribution of Cartan type and what

2
2

-plane bundles can be realized. We obtain a complete answer for open manifolds. In the closed case, we settle the topological part of this problem and present partial results concerning its geometric aspects and new examples.
Anisotropic emission of neutrino and gravitational-wave signals from rapidly rotating core-collapse supernovae
Authors: Takiwaki Tomoya , Kotake Kei
Published: January 2018

We present analysis on neutrino and GW signals based on three-dimensional (3D) core-collapse supernova simulations of a rapidly rotating 27 M⊙ star. We find a new neutrino signature that is produced by a lighthouse effect where the spinning of strong neutrino emission regions around the rotational axis leads to quasi-periodic modulation in the neutrino signal. Depending on the observer's viewing angle, the time modulation will be clearly detectable in IceCube and the future Hyper-Kamiokande. The GW emission is also anisotropic where the GW signal is emitted, as previously identified, most strongly towards the equator at rotating core-collapse and bounce, and the non-axisymmetric instabilities in the postbounce phase lead to stronger GW emission towards the spin axis. We show that these GW signals can be a target of LIGO-class detectors for a Galactic event. The origin of the postbounce GW emission naturally explains why the peak GW frequency is about twice of the neutrino modulation frequency. We point out that the simultaneous detection of the rotation-induced neutrino and GW signatures could provide a smoking-gun signature of a rapidly rotating proto-neutron star at the birth.
Evaluation of Two Decades of Cryphonectria parasitica Hypovirus Introduction in an American Chestnut Stand in Wisconsin
Authors: Double Mark L. , Jarosz Andrew M. , Fulbright Dennis W. , Davelos Baines Anita , MacDonald William L.
Published: January 2018

Hypovirus-infected Cryphonectria parasitica strains were introduced in a large stand of American chestnut (>4,000 individuals) in western Wisconsin (USA) to evaluate whether hypoviruses can serve as biological control agents. They were deployed by treating cankers from 1992 to 1997 and again from 2004 to 2014. After 17 years of hypovirus introductions within an area of the stand with the longest history of disease, isolation of hypovirus-infected strains increased from 55% in 1994 to 86% in 2014 from cankers that were treated. During the same period, isolation from cankers that arose on trees with treated cankers increased from 29 to 72% and from 15 to 84% for cankers on nearby trees that received no treatment. Tree survivorship over the 23-year study period for trees with treated cankers was 51% compared with 31% for trees that were not treated. Introduction of hypovirus has resulted in the regrowth of the crowns of many large-diameter trees. Putative recovery of American chestnut in this stand provides evidence that prolonged hypovirus treatment can act as a biological control when limited numbers of vegetative compatibility types of C. parasitica exist.
Population Genetics of Verticillium dahliae in Iran Based on Microsatellite and Single Nucleotide Polymorphism Markers
Authors: Rafiei Vahideh , Banihashemi Ziaeddin , Bautista-Jalon Laura S. , del Mar Jiménez-Gasco Maria , Turgeon B. Gillian , Milgroom Michael G.
Published: January 2018

Verticillium dahliae is a plant pathogenic fungus that reproduces asexually and its population structure is highly clonal. In the present study, 78 V. dahliae isolates from Iran were genotyped for mating type, single nucleotide polymorphisms (SNPs), and microsatellites to assign them to clonal lineages and to determine population genetic structure in Iran. The mating type of all isolates was MAT1-2. Based on neighbor-joining analysis and minimum spanning networks constructed from SNPs and microsatellite genotypes, respectively, all but four isolates were assigned to lineage 2B824; four isolates were assigned to lineage 4B. The inferred coalescent genealogy of isolates in lineage 2B824 showed a clear divergence into two clades that corresponded to geographic origin and host. Haplotypes of cotton and pistachio isolates sampled from central Iran were in one clade, and those of isolates from Prunus spp. sampled from northwestern Iran were in the other. The strong divergence in haplotypes between the two clades suggests that there were at least two separate introductions of lineage 2B824 to different parts of Iran. Given the history of cotton and pistachio cultivation and Verticillium wilt in Iran, these results are consistent with the hypothesis that cotton was historically a likely source inoculum causing Verticillium wilt in pistachio.
Current concepts in hand and upper extremity amputations
Authors: Thayer Mary Kate , Bellevue Kate D. , Friedrich Jeffrey B.
Published: January 2018

Treatment of a hand or upper extremity amputation requires attention to anatomy, patient factors, cosmetic appearance, and potential functional outcomes of various treatment methods. This article provides a timely review of the most recent advances in the management and understanding of digit, hand, wrist and forearm level amputations with special attention to advances in the field in the past 2 yr.
Pedicle screw placement assisted by 3D imaging (O-arm system with StealthStation® software) versus free-hand technique for multilevel posterior thoracolumbar fusion
Authors: Noshchenko Andriy , Cain Christopher M.J. , Zaghloul Khaled , Lindley Emily M. , Kleck Christopher , Burger Evalina L. , Patel Vikas V.
Published: January 2018

Background:

Comparison of pedicle screw placement accuracy and risk of perioperative complications using O-arm/Stealth Navigation system (Medtronic, Memphis, TN) compared with the free-hand technique for multilevel posterior instrumented thoracolumbar fusion is an actual problem.

Methods:

A retrospective, single-institution case series study was performed. Patients who underwent multilevel instrumented thoracolumbar fusion between 2011 and 2012 were included; age: >20 yr; gender: male and female. Patients with pedicle screw placement assisted by the O-arm navigation were assigned to the navigated group, while patients operated using a free-hand technique to the nonnavigated group. Breaches were defined by CT images and classified by screw extension beyond the cortex: mild (<2 mm), moderate (2-4 mm), and severe (>4 mm). Risk was defined by odds ratio (OR), and P-value by the χ2-test. Bayesian analysis was applied to take into consideration previous findings.

Results:

Placement of 597 pedicle screws (401 navigated and 196 nonnavigated) was defined in 70 patients: 41 (12 male) navigated and 29 (10 male) nonnavigated. The mean age was 62 yr (SD, 9.3). Risk of breaches was less in the navigated group, OR=0.36, P=0.002; in particular, the risk of mild breaches, OR=0.33 (P=0.003), and the risk of moderate and severe breaches, OR=0.48 (P=0.25); more significantly at thoracic levels, OR=0.04 (P=0.005); and specifically, medial and lateral breaches (P<0.03). The total risk of perioperative complications was less in the navigated group, OR=0.68 (P=0.3). The obtained results well complement previously published data.

Conclusions:

Pedicle screw placement using the O-arm is more accurate than a standard free-hand technique, specifically at the thoracic spine.
Biplanar Posterior Pelvic Fixator for Unstable Sacral Fractures: A New Fixation Technique
Authors: Abo-Elsoud Mohamed , Eldeeb Said , Gobba Mohamed , Sadek Fouad Zamel
Published: January 2018

Fixation of comminuted vertically unstable sacral fractures continues to be a surgical dilemma. Although triangular osteosynthesis is a good construct and resists vertical translation, complications still occur. Herein, we introduce a new biplanar fixation technique, using segmental spinal instrumentation as an alternative to triangular osteosynthesis. This technique is remarkably valuable in cases with sacral morphology and/or complex fracture patterns that preclude safe percutaneous iliosacral screw insertion.
Historical Analysis of Bibliometric Trends in the Journal of Pediatric Orthopaedics With a Particular Focus on Sex
Authors: Fischer James P. , Wininger Austin E. , Scofield David C. , Tucker Aamir , Kacena-Merrell Ethan J. , Whipple Elizabeth C. , Kacena Melissa A. , Loder Randall T.
Published: January 2018

Background:

Orthopaedics is the clinical discipline with the lowest percentage of female residents and faculty. Pediatric orthopaedics has a higher percentage of women than other orthopaedic subspecialties. It was the purpose of this study to examine bibliometric trends in the Journal of Pediatric Orthopaedics (JPO) with a specific focus on sex.

Methods:

A bibliometeric analysis for the years 2015, 2005, 1995, 1985, 1981 was performed. The names of first and corresponding authors; corresponding author position; country of origin; number of institutions, countries, authors, printed pages, and references was tabulated. Author sex was identified for the first and corresponding authors using the “Baby Name Guesser” (www.gpeters.com/names/baby-names.php). A P<0.05 was considered significant.

Results:

There were 746 publications; 68.7% were from North America. The average number of authors, corresponding author position, collaborating institutions, countries, and number of references increased, whereas the number of printed pages decreased. Asia had the greatest number of authors (4.4), with Australia/New Zealand the fewest (3.4). Sex was determined for 98.3% of the first authors and 98.5% of the corresponding authors. There was a significant increase in the number of female first authors over time (5.9% to 25.6%, P<10−6), especially in Europe and North America. There were significant increase in the number of female corresponding authors over time (5.8% to 17.6%, P=0.000009). There was a significant trend to have a greater percentage of both female first and corresponding authors over time (P=0.0005) with a reverse trend for both male first and corresponding authors (P<10−6).

Conclusions:

In this study, we noted that the number of female first and corresponding authors in Journal of Pediatric Orthopaedics has been steadily increasing. This should result in more female pediatric orthopaedic surgeons in academic faculty positions.
Obesity’s Influence on Operative Management of Pediatric Supracondylar Humerus Fractures
Authors: Li Neill Y. , Bruce William J. , Joyce Cara , Decker Norman M. , Cappello Teresa
Published: January 2018

Background:

As childhood obesity remains an ongoing issue for the United States there has been an increasing number of studies detailing its effect on fracture complexity, management, and outcomes. This study utilizes a national database to examine whether obese children with supracondylar humerus fractures are more likely to require open reduction and internal fixation than nonobese children.

Methods:

The Healthcare Cost and Utilization Project Kid’s Inpatient Database of 2003, 2006, 2009, 2012 were queried for pediatric supracondylar humerus fractures [International Classification of Disease (ICD-9), 812.41] between 2 and 12 years. Patients were separated into those undergoing closed reduction percutaneous pinning (CRPP), open reduction internal fixation (ORIF), or both. Obesity was determined by comorbidity and ICD-9 coding (ICD-9, 278.00, 278.01). Univariable and multivariable logistic regression models were utilized with P<0.05 considered significant.

Results:

Between 2003 and 2012, 31,905 patients between the ages of 2 and 12 years sustained supracondylar humerus fractures. In total, 105 patients (0.3%) were obese. A majority of patients, 27,658 (86.7%), underwent CRPP. Odds for ORIF increased in association with age, obesity, white race, and private insurance. Significant association was found between age and obesity (P<0.05) in those undergoing ORIF. Obese children between 2 and 7 years of age had no difference in ORIF or CRPP compared with normal-weight children. Those between 8 and 12 years who were obese were significantly more likely to undergo ORIF (OR, 4.29; 95% confidence interval, 1.78-10.36).

Conclusions:

Supracondylar humerus fractures sustained in obese children between 8 and 12 years are over 4 times more likely to require ORIF compared with normal-weight children of the same age. Providers should identify and counsel older obese children and their families regarding the potential for increased difficulty in fracture management that may require open surgical intervention.

Level of Evidence:

Level IV—case series.
Computer-assisted Patient-specific Prototype Template for Thoracolumbar Cortical Bone Trajectory Screw Placement: A Cadaveric Study
Authors: Kim Sang Bum , Rhee John M. , Lee Gi Soo , Lee Hee Young , Kim Taehyung , Won Yougun
Published: January 2018

The cortical bone trajectory (CBT) screw technique yields effective mechanical and clinical results, improving the holding screw strength with a less invasive exposure. Accurate and safe screw placement is crucial. A patient-specific drill template with a preplanned trajectory was considered a promising solution; however, it is critical to assess the efficacy and safety of this technique. This study aims to evaluate the accuracy of patient-specific computed tomography (CT)-based rapid prototype drill guide templates for the CBT technique. CT scanning was performed in 7 cadaveric thoracolumbar spines, and a 3-dimensional reconstruction model was generated. By using computer software, we constructed drill templates that fit onto the posterior surface of thoracolumbar vertebrae with drill guides to match the CBT. In total, 80 guide templates from T11 to L5 were created from the computer models by using rapid prototyping. The drill templates were used to guide the drilling of CBT screws without any fluoroscopic control, and CT images were obtained after fixation. The entry point and direction of the planned and inserted screws were measured and compared. In total, 80 screws were inserted from T11 to L5. No misplacement or bony perforation was observed on postoperative CT scan. The patient-specific prototype template system showed the advantage of safe and accurate cortical screw placement in the thoracolumbar spine. This method showed its ability to customize the patient-specific trajectory of the spine, based on the unique morphology of the spine. The potential use of drill templates to place CBT screws is promising.
CD19 Chimeric Antigen Receptor T Cells From Patients With Chronic Lymphocytic Leukemia Display an Elevated IFN-γ Production Profile
Authors: Magalhaes Isabelle , Kalland Ingrid , Kochenderfer James N. , Österborg Anders , Uhlin Michael , Mattsson Jonas
Published: January 2018

CD19 chimeric antigen receptor (CAR) T cell immunotherapy has demonstrated dramatic results for the treatment of B cell malignancies such as chronic lymphocytic leukemia (CLL). As T cell defects are common in patients with CLL, we compared the T cells from these patients with healthy donors (HDs), and subsequently the CD19 CAR T cells produced from patients and HDs. Despite initial differences when comparing the phenotype of circulating T cells in patients with CLL and HDs, the CD19 CAR T cells manufactured from patients’ or HDs’ cells showed a similar phenotype (effector memory or terminally differentiated), both were specifically activated by and killed CD19+ target cells, and secreted cytokines (ie, IL-2, TNF, and IFN-γ). The frequency of CD19 CAR T cells producing IFN-γ was significantly higher in cells produced from patients as compared with those produced from HDs. Furthermore, our data showed that the polyfunctional profile of CD19 CAR+ T cells was differently modulated by CD19+ K562 cells and autologous B cells. The increased IFN-γ production by CD19 CAR T cells produced from patients with CLL after in vitro stimulation, may if this is also the case in vivo, contribute to a higher risk of a cytokine release syndrome in patients. The different impact by CD19+ target cells on the polyfunctional profile of CD19 CAR T cells in vitro underlines the importance of the choice of CD19+ target cells when assessing CD19 CAR T cells functions.
Choline acetyltransferase and TrkA expression, as well as the improvement in cognition produced by E2 and P4 in ovariectomized rats, are blocked by ICI 182 780 and RU486
Authors: Espinosa-Raya Judith , Cruz-Raya Ulises , López-Martínez Margarita , Picazo Ofir
Published: January 2018

Treatment with 17-β estradiol and progesterone improves the performance of ovariectomized rats in an autoshaping learning task, representing cognitive improvement. To test whether this is attributable to genomic mechanisms, the antiestrogen ICI 182 780 or antiprogesterone RU486 was injected into ovariectomized animals primed previously with estrogen or progesterone, respectively. Compared with the vehicle control, each hormone administered alone produced an elevated expression of choline acetyltransferase and TrkA, along with an improvement in performance on the behavioral test. E2+ICI reverted the increase in these two proteins. However, RU alone elicited higher ChAT expression. With this exception, there was a clear linear regression between the number of conditioned responses and the level of ChAT and TrkA in the basal forebrain. The results suggest that TrkA may be more important than ChAT for regulating autoshaping learning tasks, and that genomic mechanisms in the basal forebrain could possibly underlie hormonal improvement of cognition.
Nonprimary Maternal Cytomegalovirus Infection After Viral Shedding in Infants
Authors: Boucoiran Isabelle , Mayer Bryan T. , Krantz Elizabeth M. , Marchant Arnaud , Pati Sunil , Boppana Suresh , Wald Anna , Corey Larry , Casper Corey , Schiffer Joshua T. , Gantt Soren
Published: January 2018

Background:

Most infants with congenital Cytomegalovirus (CMV) infection are born to seropositive women as a result of maternal CMV nonprimary infection (reinfection or reactivation). Although infected children are known to transmit CMV to their seronegative mothers, the frequency and magnitude of nonprimary maternal CMV infection after exposure to viral shedding by children in their household have not been characterized.

Methods:

A cohort of Ugandan newborns and their mothers were tested weekly for CMV by quantitative polymerase chain reaction of oral swabs. Infant primary infection and maternal nonprimary infection were defined by the onset of persistent high-level oral CMV shedding. Strain-specific antibody testing was used to assess maternal reinfection. Cox regression models with time-dependent covariates were used to evaluate risk factors for nonprimary maternal infection.

Results:

Nonprimary CMV infection occurred in 15 of 30 mothers, all after primary infection of their infants by a median of 6 weeks (range: 1–10) in contrast to none of the mothers of uninfected infants. The median duration of maternal oral shedding lasted 18 weeks (range: 4–42) reaching a median maximum viral load of 4.69 log copies/mL (range: 3.22–5.64). Previous-week infant CMV oral quantities strongly predicted maternal nonprimary infection (hazard ratio: 2.32 per log10 DNA copies/swab increase; 95% confidence interval: 1.63–3.31). Maternal nonprimary infections were not associated with changes in strain-specific antibody responses.

Conclusions:

Nonprimary CMV infection was common in mothers after primary infection in their infants, consistent with infant-to-mother transmission. Because infants frequently acquire CMV from their mothers, for example, through breast milk, this suggests the possibility of “ping-pong” infections. Additional research is needed to characterize the antigenic and genotypic strains transmitted among children and their mothers.
Significance of Early Postoperative Eyelid Position on Late Postoperative Result in Mueller’s Muscle Conjunctival Resection and External Levator Advancement Surgery
Authors: Danesh Jennifer , Ugradar Shoaib , Goldberg Robert , Joshi Naresh , Rootman Daniel B.
Published: January 2018

Purpose:

The purpose of this study was to determine whether advancement of the levator aponeurosis in external levator resection surgery or Mueller’s muscle and conjunctiva in Mueller’s muscle conjunctival resection (MMCR) surgery has a differential effect on variation in eyelid position during the postoperative period.

Methods:

In this retrospective observational cohort study, 2 groups of patients were defined. The first underwent MMCR surgery without tarsectomy by surgeon 1. The second underwent external levator resection without dissection posterior to the levator aponeurosis by surgeon 2. Marginal reflex distance (MRD1) was calculated based on digital photographs at baseline, 1 week postoperatively and at 3-month follow up. The primary outcome measure was change in MRD1 over time. The secondary outcome was defined as the proportion of patients with minimal early postoperative change (change of MRD1 less than 0.5 mm at 1 week postoperatively). Repeated measures analysis of variance, t test, and chi-square analyses were performed.

Results:

Of the 114 eyes in the sample, there were 68 in the MMCR group and 46 in the external levator resection group. A significant interaction between group and time was noted (p < 0.05), indicating change in MRD1 over time was different between the groups. Bonferroni corrected multiple comparisons yielded significant differences between each time point for MMCR surgery (p < 0.01). No difference in MRD1 was noted for the external levator resection group from the early to late postoperative visit. Comparing each time point across groups revealed significantly lower MRD1 for the MMCR group at the early postoperative visit (p < 0.01). Preoperative and late postoperative MRD1 did not significantly differ between the groups. Regarding the secondary outcome, patients undergoing MMCR surgery were 3.7× as likely to demonstrate <0.5 mm of change in MRD1 at week 1 (p < 0.05). When considering the 39.7% (n = 27) MMCR patients in this category, 59.3% (n = 16) went on to show an MRD1 increase >1 mm from the early postoperative to the late postoperative time points.

Conclusions:

Both external levator resection and MMCR can effectively elevate the eyelid in cases of primary involutional ptosis, and have similar late postoperative results. The authors found that MMCR cases undergo greater change between the early and late postoperative period, suggesting the process of eyelid elevation after MMCR may be dynamic, involving postoperative physiologic modification.
Anomalous Sphenoid Diploe Vein: Case Report Highlighting the Value of Careful CT Evaluation Prior to Decompression Surgery
Authors: Rafaelof Michael , Mustak Hamzah , Rootman Daniel B.
Published: January 2018

Lateral bony decompression may offer several biomechanical advantages and has become a commonly used surgical approach. Preoperative imaging plays a key role in surgical planning by providing information about the locoregional anatomy. The marrow space of the greater wing of the sphenoid is a focal point of the decompression surgery based on the volume that it occupies. Several vessels pass through the sphenoid bone, but most are small caliber vessels. The authors describe a case of an uncommon anatomical variant of the cranial diploic venous system in which the anterior transverse diploic vessel traverses the marrow space of the sphenoid. The vessel was identified on preoperative CT evaluation. Despite anticipation of potential bleeding, lateral decompression was abandoned due to difficulties in maintaining hemostasis which compromised the view for safe surgical progress.
Meeting Management Standards and Improvement in Clinical Outcomes Among Patients With Hip Fractures
Authors: Trinh Lieu Thi Thuy , Achat Helen , Loh Sze Ming , Pascoe Robert , Asarreh Hassan , Stubbs Joanne
Published: January 2018

Objectives:

To determine the association between management standards and clinical outcomes among patients with hip fracture (HF).

Methods:

Data from a prospective cohort study were linked with hospital administration data.

Results:

In 2014 and 2015, 493 patients had surgery for HF. The proportion of patients meeting care standards ranged from 69% for surgery within 48 hours to 96% for being seen by a geriatrician. Thirty-nine per cent of patients received all the standards. The mean waiting time for surgery was 44 hours (median, 34 hours; interquartile range [IQR], 22–58 hours). The mean length of stay for patients who were alive at discharge was 17 days (median, 13 days; IQR, 6–24 days). Fifty-six patients were readmitted within 28 days of discharge (12%), and 40 patients died within 28 days of admission (8.1%). Patients who received all standards were less likely to be readmitted or die. Surgery within 48 hours and being seen by a physiotherapist were associated with a lower mortality rate.

Conclusions:

The management standards, collectively and in particular, assessment by a physiotherapist and surgery within 48 hours were significantly associated with better clinical outcomes.
Overall Emergency Department Rating: Identifying the Factors That Matter Most to Patient Experience
Authors: Aaronson Emily L. , Mort Elizabeth , Sonis Jonathan D. , Chang Yuchiao , White Benjamin A.
Published: January 2018

Background:

Patient experience is becoming an area of interest in Emergency Medicine as more is understood about its impact on outcomes and the expectation that it will soon be tied to reimbursement. No study has investigated the predictors of emergency department (ED) patient satisfaction in over a decade. As the care environment, access to information, and consumer interests change, determinants of satisfaction have likely evolved. Our objective was to examine the factors that were most predictive of ED satisfaction.

Methods:

A retrospective cohort study at an urban, university-affiliated ED. The relationship between overall satisfaction and patients' responses to individual questions was assessed using a chi-square test and a multivariable logistic regression model.

Results:

During the study period, 7,872 patients participated in a telephone interview. Logistic regression found 13 questions predictive of high overall ED rating and 9 questions predictive of low overall ED rating. Six questions appeared in both analyses, related to timeliness, cleanliness, the physician's ability to listen carefully, teamwork, and the perception of being helped by the care.

Conclusions:

There are strong predictors of overall ED satisfaction related to communication, wait time, environment, and perception that care was helpful. Further efforts should focus on identifying interventions in each of these domains.
Improving Thermoregulation for Trauma Patients in the Emergency Department: An Evidence-Based Practice Project
Authors: Saqe-Rockoff Ada , Schubert Finn D. , Ciardiello Amanda , Douglas Elizabeth
Published: January 2018

Extensive evidence exists on the association between hypothermia and increased morbidity and mortality in trauma patients. Gaps in practice related to temperature assessment have been identified in literature, along with limited personnel knowledge regarding management of patients with accidental hypothermia. An interdisciplinary team identified gaps in practice in our institution regarding temperature assessment and documentation of rewarming and initiated an evidence-based practice project to change practice at our institution. The goals were to decrease time to temperature assessment, increase core temperature assessment, and increase implementation of appropriate rewarming methods. This project used the Iowa Model of Evidence-Based Practice to provide a framework for execution and evaluation. We conducted a literature review to address all aspects of hypothermia, including incidence, associated and contributing factors, prevention, recognition, and treatment. This evidence-based knowledge was then applied to clinical practice through staff education and training, equipment availability, and environmental adjustments. More patients with hypothermia and hyperthermia were identified in 2017, as compared with 2016. There was a significant increase in core temperature assessment from 4% in 2016 to 23% in 2017 (p < .001). Blanket use in normothermic patients increased in 2017 (p = .002). This project is an example of how nurses can utilize an evidence-based practice model to translate research into clinical practice. Best practice interventions regarding temperature assessment and rewarming measures for trauma patients can be successfully implemented with negligible cost. Further research should be dedicated to examine barriers to implementation and adherence to evidence-based practice interventions.
Effect of Telenursing on Outcomes of Provided Care by Caregivers of Patients With Head Trauma After Discharge
Authors: Shahrokhi Akram , Azimian Jalil , Amouzegar Atousa , Oveisi Sonia
Published: January 2018

Telenursing is a suitable tool for increasing health-related awareness of the caregivers for a better home care. But its efficacy may be affected by several factors. Considering the important complications of head trauma injury and high rate of readmission, we aimed to assess the effect of telenursing on care provided by the family members of patients with head trauma.

This randomized controlled trial investigated 72 patients with head trauma, who were randomly allocated to intervention and control groups (36 patients in each group). The caregivers in both groups were provided with 1-hr face-to-face training session on patients' home care and educational booklets. The patients in the intervention group were followed up every week through phone calls by the telenurse for 12 weeks, who recorded the patient's status, as well. Caregivers in the intervention group could call the telenurse any time they desired. The health status of the control group was followed once by a phone call after 12 weeks. Data on patients' readmission and pressure ulcer (based on Norton's scale) rate and time were compared between the groups and analyzed using SPSS software, version 19. Thirty-three patients with a mean ± SD age of 31.12 ± 10.83 years were studied in the control group and 35 patients with a mean ± SD age of 34.11 ± 12.34 years in the intervention group (p = .098). None of the patients in the intervention group were readmitted, whereas 2 patients in the control group were readmitted s(p = .139). Risk of pressure ulcer did not differ between the groups (p = .583). Telenursing had no significant effect in readmission and decubitus prevention for patients with head trauma. Considering the chronic nature of the illness, a longer follow-up period is deemed necessary for an accurate conclusion.
Pain Assessment in Mechanically Ventilated, Noncommunicative Severe Trauma Patients
Authors: López-López Candelas , Pérez-Pérez Teresa , Beneit-Montesinos Juan Vicente , García-Klepzig José Luis , Martinez-Ureta Mercedes Virginia , Murillo-Pérez María del Ara , Torrente-Vela Silvia Ana , García-Iglesias Mónica
Published: January 2018

The aim of this study was to measure pain levels in noncommunicative patients with severe trauma who required tracheal suctioning and mobilization and to determine the utility of the Behavioral Indicators of Pain Scale (ESCID) in these cases. The pain scores for the procedures were recorded on Days 1, 3, and 6 of the patients' stay in the intensive care unit. These assessments were performed at 3 moments: before, during, and after the application of the procedures. Because of the longitudinal character of the study, data were fitted into a multivariate model using the Generalized Estimating Equations method. The sample of 124 patients comprised 77.4% males and 22.6% females with an average age of 45.93 (SD = 16.43) years. A significant increase (p < .01) in the ESCID score was observed during the application of the procedures that produced similar pain levels. Kappa coefficient value obtained for interobserver agreement of ESCID scale scores during the application of care procedures at the intervals being evaluated was greater than 0.84, which should be interpreted as almost perfect. The ESCID scores increased during 2 care procedures that are frequently carried out in intensive care units and indicated that they produced similar pain levels.
Posttraumatic Stress Syndrome: What Is It?
Authors: Sparks Stephen W.
Published: January 2018

Readily defined as symptoms consistent with posttraumatic stress disorder (PTSD), but that occur earlier than 30 days after experiencing the traumatic event, posttraumatic stress syndrome (PTSS) is now acknowledged to be a serious health issue. Even so, PTSS often goes unrecognized until an official diagnosis of PTSD is made. Screening tools such as the PTSS-14 have proven reliable in identifying people with PTSS who are at risk of developing PTSD. Through early recognition, providers may be able to intervene, thus alleviating or reducing the effects of a traumatic experience.
Trauma and Intensive Care Nursing Knowledge and Attitude of Foley Catheter Insertion and Maintenance
Authors: Shaver Brenda , Eyerly-Webb Stephanie A. , Gibney Zoe , Silverman Linda , Pineda Candace , Solomon Rachele J.
Published: January 2018

In the acute care setting, the majority of urinary tract infections are associated with indwelling urinary catheters. Despite guidelines for proper use, catheter-associated urinary tract infections (CAUTIs) continue to occur in critically ill/injured patients. There is a paucity of data on the translation between CAUTI prevention education and behavioral change. This project evaluated nurse's clinical knowledge and attitude toward Foley catheter insertion and maintenance to determine the benefits of addressing gaps in knowledge and inconsistencies in attitude through education.

A prospective cohort study was conducted with registered nurses from the emergency room, trauma/surgical, and medical intensive care units. Participant's clinical knowledge and attitude toward Foley catheter usage and CAUTIs were evaluated using a 20-question survey tool before and after a CAUTI education program.

Forty-eight nurses completed the presurvey, educational training, and postsurvey. The mean postsurvey score was significantly higher (86.9 ± 8.3%) than the presurvey score (76.0 ± 12.3%) for the knowledge section of the survey. There was no marked difference in participant attitude following the educational training, with mean presurvey and postsurvey scores of 91.3 ± 7.0% and 89.8 ± 5.3%, respectively. After the course, participants were more confident in their clinical knowledge; however, perception regarding CAUTI prevention did not improve. A series of unannounced rounding observations before and after the intervention showed an improvement in proper Foley catheter maintenance.

Catheter-associated urinary tract infection prevention education was an effective countermeasure to address gaps in clinical knowledge, but modifying attitudes was difficult to achieve. In the short term, the training appeared to improve proper maintenance in clinical practice.
Hyperoxia and Hypocapnia During Pediatric Extracorporeal Membrane Oxygenation: Associations With Complications, Mortality, and Functional Status Among Survivors*
Authors: Cashen Katherine , Reeder Ron , Dalton Heidi J. , Berg Robert A. , Shanley Thomas P. , Newth Christopher J. L. , Pollack Murray M. , Wessel David , Carcillo Joseph , Harrison Rick , Dean J. Michael , Tamburro Robert , Meert Kathleen L.
Published: January 2018

Objectives:

To determine the frequency of hyperoxia and hypocapnia during pediatric extracorporeal membrane oxygenation and their relationships to complications, mortality, and functional status among survivors.

Design:

Secondary analysis of data collected prospectively by the Collaborative Pediatric Critical Care Research Network.

Setting:

Eight Collaborative Pediatric Critical Care Research Network–affiliated hospitals.

Patients:

Age less than 19 years and treated with extracorporeal membrane oxygenation.

Interventions:

Hyperoxia was defined as highest Pao
2 greater than 200 Torr (27 kPa) and hypocapnia as lowest Paco
2 less than 30 Torr (3.9 kPa) during the first 48 hours of extracorporeal membrane oxygenation. Functional status at hospital discharge was evaluated among survivors using the Functional Status Scale.

Measurements and Main Results:

Of 484 patients, 420 (86.7%) had venoarterial extracorporeal membrane oxygenation and 64 (13.2%) venovenous; 69 (14.2%) had extracorporeal membrane oxygenation initiated during cardiopulmonary resuscitation. Hyperoxia occurred in 331 (68.4%) and hypocapnia in 98 (20.2%). Hyperoxic patients had higher mortality than patients without hyperoxia (167 [50.5%] vs 48 [31.4%]; p < 0.001), but no difference in functional status among survivors. Hypocapnic patients were more likely to have a neurologic event (49 [50.0%] vs 143 (37.0%]; p = 0.021) or hepatic dysfunction (49 [50.0%] vs 121 [31.3%]; p < 0.001) than patients without hypocapnia, but no difference in mortality or functional status among survivors. On multivariable analysis, factors independently associated with increased mortality included highest Pao
2 and highest blood lactate concentration in the first 48 hours of extracorporeal membrane oxygenation, congenital diaphragmatic hernia, and being a preterm neonate. Factors independently associated with lower mortality included meconium aspiration syndrome.

Conclusions:

Hyperoxia is common during pediatric extracorporeal membrane oxygenation and associated with mortality. Hypocapnia appears to occur less often and although associated with complications, an association with mortality was not observed.