bluuebunny/crossref_metadata_2025 huggingface dataset:
Identifying Asthma Exacerbation-Related Emergency Department Visit Using Electronic Medical Record and Claims Data
Authors: Sundaresan Agnes , Schneider Gargi , Reynolds Joy , Kirchner H.
Published: July 2018

Background Asthma exacerbation leading to emergency department (ED) visit is prevalent, an indicator of poor control of asthma, and is a potentially preventable clinical outcome.

Objective We propose to utilize multiple data elements available in electronic medical records (EMRs) and claims database to create separate algorithms with high validity for clinical and research purposes to identify asthma exacerbation-related ED visit among the general population.

Methods We performed a retrospective study with inclusion criteria of patients aged 4 to 40 years, a visit to Geisinger ED from January 1, 2006, to October 28, 2013, with asthma on their problem list. Different electronic data elements including chief complaints, vitals, season, smoking, medication use, and discharge diagnoses were obtained to create the algorithm. A stratified random sample was generated to select the charts for review. Chart review was performed to classify patients with asthma-related ED visit, that is, the gold standard. Two reviewers performed the chart review and validation was done on a small subset.

Results There were 966 eligible ED visits in the EMR sample and 731 in the claims sample. Agreement between reviewers was 95.45% and kappa statistic was 0.91. Mean age of the EMR sample was 22 years, and mostly white (93%). Multiple models conventionally used in studies were evaluated and the final model chosen included principal diagnosis, bronchodilator, and steroid use for both algorithms, chief complaints for EMR, and secondary diagnosis for claims. Area under the curve was 0.93 (95% confidence interval: 0.91–0.94) and 0.94 (0.93–0.96), respectively, for EMR and claims data, with positive predictive value of > 94%. The algorithms are visually presented using nomograms.

Conclusion We were able to develop two separate algorithms for EMR and claims to identify asthma exacerbation-related ED visit with excellent diagnostic ability and varying discrimination threshold for clinical and research purposes.
Postoperative Management of Lower Extremity Free Tissue Transfer: A Systematic Review
Authors: Soteropulos Carol , Chen Jenny , Poore Samuel , Garland Catharine
Published: July 2018

Background Free tissue transfer for lower extremity reconstruction is a safe and reliable option for a wide range of challenging wounds; however, no consensus exists regarding postoperative management.

Methods A systematic review of postoperative management of lower extremity free tissue transfer was conducted using Medline, Cochrane Database, and Web of Science. Multicenter surveys, randomized controlled trials, cohort studies, and case series were reviewed.

Results Fifteen articles investigating current protocols, flap physiology, and aggressive dangle protocols were reviewed. The following evidence-based conclusions were made: (1) Free tissue transfer to the lower extremity is unique due to altered hemodynamics and dependency during orthostasis. Free flap circulation is dependent on locally mediated responses and deprived of compensatory muscular and neurovascular mechanisms that prevent venous congestion in the normal extremity. (2) Compressive wrapping reduces venous congestion and edema and may induce ischemic conditioning, which can increase blood flow. (3) Dangle protocols vary widely in timing of initiation, frequency, and monitoring. Small volume studies examining aggressive mobilization protocols initiating early dependency have led to earlier ambulation and discharge, with no change in flap survival as compared with conservative protocols. (4) Weight bearing may begin after the completion of dangle protocol if no orthopedic injury is present. Conclusions Early initiation of a dangle protocol does not appear to negatively impact flap survival based on this systematic review. Compressive wrapping may be a useful adjunct. Many surgeons agree that clinical monitoring is sufficient; there is no consensus on the utility of adjunct monitoring techniques. Weight bearing may begin after completion of dangle protocol with close flap monitoring, if not prevented by orthopedic restrictions. By providing additional outflow vasculature to reduce venous congestion, flow-through anastomoses may eliminate the need for a dangle protocol. Further research, including large randomized controlled trials is still needed to establish high-level evidence-based conclusions.
Evaluating Venous Drainage in Reverse Flow Pedicles: Available Evidence and Mechanisms
Authors: Karinja Sarah , Riesel Johanna , Iorio Matthew
Published: July 2018

Background The anatomy and physiology of venous drainage in the reversed flow vascular pedicle is controversial and there have been few well-designed, controlled studies to effectively evaluate the physiology. We evaluated the available evidence for venous drainage to synthesize the conclusions of these studies, and to identify areas in need of further research.

Methods Electronic databases were searched for articles published from January 1, 1950 to November 1, 2017. A total of 316 citations were screened for inclusion. Fifty articles met inclusion criteria and underwent review, yielding 12 articles for final data analysis. Three principal study types were found: human cadaveric (7), animal (3), human clinical (1), and mixed (1).

Results We identified two main theories regarding the mechanism of venous drainage in reverse flow flaps. The “avalvular bypass” theory is based on the findings of intact valves of the venae comitantes, and venous outflow through the crossover pattern of the communicating branches and bypass pattern of the collateral branches. Alternatively, the “valvular incompetence” theory implies that pedicle dissection, proximal ligation, and insetting of the flap cause physiologic changes, such as increased venous pressure, denervation, and simultaneous proximal and distal filling, which together result in valvular insufficiency.

Conclusion The mechanism by which retrograde venous outflow occurs in reverse flow flaps remains controversial. Nonetheless, a few well-designed studies have contributed to the understanding of venous anatomy and outflow. Most likely, the true mechanism is based on venous outflow that occurs via the “avalvular bypass” route initially and the “valvular incompetence” route later.
Prognosis of Resected Non-small Cell Lung Cancer with Ipsilateral Pulmonary Metastasis
Authors: Ucvet Ahmet , Yazgan Serkan , Gursoy Soner , Samancilar Ozgur
Published: July 2018

Background Ipsilateral pulmonary metastasis (PM) in the same lobe (T3Satell) or different lobe (T4Ipsi Nod) constitutes a small proportion of patients with non-small cell lung cancer (NSCLC). In our study, we aimed to determine prognostic factors and to evaluate long-term survival outcomes in the patients who underwent complete resection due to NSCLC.

Methods Data of 1,502 surgically treated patients with NSCLC from January 2007 to December 2016 were retrospectively reviewed. Fifty (3.3%) patients diagnosed with PM were the basis of the study. Demographic and histopathological characteristics, surgical procedures, and prognostic factors for survival were analyzed, categorizing patients according to the presence of PM in the same lobe or different lobe.

Results Among the 50 patients, 23 (46%) had PM in the same lobe as the primary tumor and 27 (54%) had PM in different ipsilateral lobes. The mean size of nodules was 11.5 mm. While T3Satell was detected mostly in squamous cell carcinoma (SCC) (65.2%), T4Ipsi Nod was more common in adenocarcinoma (AC) (70.4%), and the difference was statistically significant (p = 0.022). Survival was significantly better in the SCC-T3Satell group than the AC-T3Satell group (64 and 58.3%, respectively; p = 0.043). Although the overall 5-year survival was better in the T3Satell group, the difference between survival outcomes of both groups was not statistically significant (61.2 and 37.2%, respectively; p = 0.27). In the T3Satell group, nodule size was found to be a negative prognostic factor in survival (p = 0.042), whereas the number of nodules was found to be a negative prognostic factor in the T4Ipsi Nod group (p = 0.046). In multivariate analysis, advanced age was a poor prognostic factor for PM (p = 0.03).

Conclusion There was no significant difference in survival between T3Satell and T4Ipsi Nod patients. Among surgically treated patients due to NSCLC, poor prognostic factors were advanced age for the patients with PM, nodule size and AC for T3Satell patients, and the number of nodules for T4Ipsi Nod patients.
Pfannenstiel versus Vertical Skin Incision for Cesarean Delivery in Women with Class III Obesity: A Randomized Trial
Authors: Blackwell Sean , Hester Ashley , Olson Gayle , Saade George , Faro Jonathan , Pedroza Claudia , Sibai Baha , Marrs Caroline
Published: July 2018

Objective To compare Pfannenstiel versus vertical skin incision for the prevention of cesarean wound complications in morbidly obese women.

Study Design Women with body mass index ≥ 40 kg/m2 undergoing cesarean delivery (CD) were randomly allocated to Pfannenstiel or vertical skin incision. The primary outcome was a wound complication within 6 weeks. Due to a low consent rate, we limited enrollment to a defined time period for feasibility. We conducted a traditional frequentist analysis with log-binomial regression to obtain relative risks (RRs), and a Bayesian analysis to estimate the probability of treatment benefit. A priori, we decided that a ≥60% probability of treatment benefit for either incision type would be convincing evidence to pursue a larger trial.

Results A total of 648 women were approached, 228 were consented, and 91 were randomized. The primary outcome rate was 19% in the Pfannenstiel group and 21% in the vertical group (RR: 1.18; 95% confidence interval: 0.49–2.85). Bayesian analysis revealed a 59% probability that Pfannenstiel had a lower primary outcome rate.

Conclusion In the first published randomized trial to compare skin incision types for obese women undergoing CD, we were unable to demonstrate differences in clinical outcomes. Our trial suggests that a larger study would have a low probability for different findings.

Trial Registration NCT 01897376 (www.clinicaltrials.gov).
The restricted nonlinear large eddy simulation approach to reduced-order wind farm modeling
Authors: Bretheim Joel U. , Meneveau Charles , Gayme Dennice F.
Published: July 2018

A new approach to the reduced-order modeling of wind farms based on the recently formulated restricted nonlinear large eddy simulation (RNL-LES) framework is introduced. The approach has been shown to accurately reproduce mean flow distributions and turbulence statistics in wall-bounded flows at a fraction of the cost of traditional LES, making it a potentially attractive reduced-order model for studying wind farm behavior over a range of conditions. An appropriately altered version of the actuator disk turbine model is used to evaluate the ability of the RNL-LES framework to simulate very large wind farms in the fully developed regime through comparisons with the standard LES of wind farms under a variety of conditions. Then, the low computational cost of the RNL-LES approach is exploited to conduct a parametric study of several vertically staggered wind farm configurations.
Effect of temperature on dielectric response in X-band of silicon nitride ceramics prepared by gelcasting
Authors: Shao Shiyu , Luo Heng , Deng Lianwen , He Jun , Huang Shengxiang
Published: July 2018

Due to the drastic aerodynamic heating effect in supersonic aircrafts, the operational performance of wave-transmitting dielectric ceramics functionalized radomes strongly depends on the temperature and oxidation. In this paper, the evolution of microwave dielectric responses in Si3N4 ceramics via gelcasting over a wide temperature range (25°C∼800°C) is investigated experimentally and theoretically. Specifically, the relative increment rate of real permittivity over evaluated temperature range is 4.46% at 8.2GHz and 8.67% at 12.4GHz, while the imaginary permittivity remains less than 0.06. Taking temperature-dependent polarized bound charge and damping coefficient into consideration, a revised dielectric relaxation model with Lorentz correction for Si3N4 ceramics has been established, which agrees well with evolution of experimental results. Furthermore, the best fitting results indicate that the activation energy of electrons Ea (15.46 ∼17.49 KJ/mol) is less than that of lattice Eb (33.29∼40.40 KJ/mol), which could be ascribed to the binding force between the electrons and nucleus is lower than covalent bonding force of lattice. Besides, excellent restorable feature of permittivity after heat-treatment lays a solid foundation for radome materials serviced in high temperature circumstances.
Experimental evidence for interlayer decoupling distance of twisted bilayer graphene
Authors: Jeon Jun Woo , Kim Hyeonbeom , Kim Hyuntae , Choi Soobong , Kim Byung Hoon
Published: July 2018

Twisted bilayer graphene (tBLG) is two stacked single graphene sheets rotated at a specific angle. The twist angle plays an important role in the physical properties of the tBLG. In this study, we analyzed the interaction distance between two graphene layers in tBLG using Raman spectroscopy and atomic force microscopy. To confirm the interaction of the upper and bottom graphenes in the tBLG, we prepared two tBLGs with twist angles of 5° and 24°. The interlayer distance was controlled by depositing a gold bar between the two graphene layers. We found that the decoupling interlayer distance of the tBLG was different depending on the twist angle (0.74 nm for 5° and 1.66 nm for 24°). This indicates that the interaction between two graphene layers is strongly coupled with small twist angle, as expected.
Phytoplankton-based water quality metrics: feasibility of their use in a Neotropical shallow lake
Authors: Frau Diego , Mayora Gisela , Devercelli Melina
Published: July 2018

Urban lakes constitute important recreational areas, but often they are eutrophicated. In this study we discuss the utility of 12 ecological quality metrics to test whether they: (1) can be applied to Neotropical lakes; (2) are sensitive to environmental variations throughout the year; and (3) are affected by heterogeneous spatial distribution of phytoplankton. Phytoplankton and environmental variables (including nutrients) were sampled monthly in an urban lake (four littoral and one limnetic station) throughout 1 year (n=60 samples). Twelve ecological quality metrics were tested using total phosphorus as a proxy of eutrophication through general lineal models. The best adjusted metrics were then transformed to an ecological quality ratio (EQR) to allow comparisons. The Phytoplankton Assemblage Index (Q-index) and the Cyanobacteria Bloom Index (CBI) were the most accurate. Differences in water quality estimation occurred across the year, with an overestimation of water quality in the absence of cyanobacteria blooms. There were no differences due to effects of the spatial distribution of phytoplankton. The Q-index was related to temperature and soluble reactive phosphorus, whereas the CBI was related to conductivity. We conclude that the Q-index is the most accurate metric for monitoring purposes, responding well to variations in phosphorus.
Clinic predictors of better syphilis testing in Aboriginal primary healthcare: a promising opportunity for primary healthcare service managers
Authors: Nattabi Barbara , Girgis Seham , Matthews Veronica , Bailie Ross , Ward Jeanette E.
Published: July 2018

Integration of public health and primary healthcare (PHC) is a hallmark of comprehensive PHC to reduce inequitable rates of preventable diseases in communities at risk. In the context of a syphilis outbreak among Indigenous people in Northern Australia, the association between PHC clinic factors and syphilis testing performance (STP) was examined to produce empirical insights for service managers. Data from the Audit and Best Practice for Chronic Disease National Program (2012–14) were analysed to examine associations between clinic factors and STP (proportion of clients ≥15 years who were tested for or offered a test for syphilis in the prior 24 months). Univariate analyses were conducted for 77 clinics and a subset of 67 remote clinics. Multivariate linear regression models were used to determine independent predictors of STP. Syphilis testing performance across PHC clinics ranged from 0 to 93.8% (median 46.5%). In univariate analysis, Delivery system design, which refers to clinic infrastructure, staffing profile and allocation of roles and responsibilities, was significantly associated with higher STP in all clinics (P=0.004) and in the subset of remote clinics (P=0.008). Syphilis testing performance was higher in the Northern Territory compared to other states, in remote clinics and clinics serving smaller populations. In multivariate analysis, Delivery system design and jurisdiction remained associated with STP. To better realise the potential of comprehensive PHC, service managers should focus on PHC delivery system design to enhance the current syphilis outbreak response.
Future population and human capital in heterogeneous India
Authors: KC Samir , Wurzer Marcus , Speringer Markus , Lutz Wolfgang
Published: July 2018

Significance

India will soon be the world’s most populous country, but in terms of human capital and, consequently, Gross Domestic Product per capita, it has been trailing behind China. While some economists believe that India’s younger population will be an advantage over China’s aging one, here we show that much will depend on future investments in education and health and thus human capital. In terms of methodology, this paper addresses the question of what sources of observable population heterogeneity should be explicitly incorporated in population projections. It suggests that the dominant model of considering only the age and sex structures at the national level should be complemented by multidimensional models depending on the importance of heterogeneity and substantive user interest in the additional dimensions.
Rheotaxis-based separation of sperm with progressive motility using a microfluidic corral system
Authors: Zaferani Meisam , Cheong Soon Hon , Abbaspourrad Alireza
Published: July 2018

Significance

The separation of motile sperm from semen samples is required for medical infertility treatments and clinical studies. Conventional methods are time- and labor-intensive and could be potentially hazardous to morphology and paternal content of the sperm. Using a microfluidic corral system and the ability of viable sperm to swim against flow, we were able to passively isolate motile sperm from the semen sample inside a corral. This device can separate sperm with velocities higher than a cutoff, which is tunable with the injection rate. The unprecedented efficiency of our device in comparison to previous studies and its benign passive nature make it favorable for sperm separation.
Inhibition of GCN2 sensitizes ASNS-low cancer cells to asparaginase by disrupting the amino acid response
Authors: Nakamura Akito , Nambu Tadahiro , Ebara Shunsuke , Hasegawa Yuka , Toyoshima Kosei , Tsuchiya Yasuko , Tomita Daisuke , Fujimoto Jun , Kurasawa Osamu , Takahara Chisato , Ando Ayumi , Nishigaki Ryuichi , Satomi Yoshinori , Hata Akito , Hara Takahito
Published: July 2018

Significance

l-asparaginase (ASNase) is a critical component of treatment protocols for acute lymphoblastic leukemia (ALL). Although the cure rates have dramatically improved, the prognosis for patients with recurrent ALL remains poor. General control nonderepressible 2 (GCN2) plays a major role in cellular response to amino acid limitation. As inhibitors targeting GCN2 have been lacking, the potential of GCN2 inhibitors as cancer therapeutic agents remains unclear. Here we report potent GCN2 inhibitors that exhibit synergistic antiproliferative effects with ASNase in asparagine synthetase-low cancer. Our findings enhance the molecular understanding of the disrupted amino acid response caused by GCN2 inhibition under limited asparagine availability. Combined treatment with GCN2 inhibitors and ASNase shows promise for achieving improved outcomes in ALL and other types of cancer.
Bottom-up single-molecule strategy for understanding subunit function of tetrameric β-galactosidase
Authors: Li Xiang , Jiang Yu , Chong Shaorong , Walt David R.
Published: July 2018

Significance

β-Galactosidase (β-gal) is one of the most commonly used enzymes in molecular biology. There is widespread interest in understanding the details of how the different monomeric units in the tetrameric structure of β-gal influence the kinetics and affect the enzyme activity. In this work, we present a bottom-up strategy to synthesize β-gal containing varying numbers of active monomers in vitro and profile the single-enzyme activity for each specific configuration. We were able to identify four distinct configurations of the engineered β-gal by measuring the activities of individual β-gal molecules. Based on the resulting correlation between enzyme activity and configuration, we studied rare occurrences of mistranslation using a microwell array platform and determined an accurate in vitro mistranslation frequency.
Nitro-fatty acids are formed in response to virus infection and are potent inhibitors of STING palmitoylation and signaling
Authors: Hansen Anne Louise , Buchan Gregory J. , Rühl Michael , Mukai Kojiro , Salvatore Sonia R. , Ogawa Emari , Andersen Sidsel D. , Iversen Marie B. , Thielke Anne L. , Gunderstofte Camilla , Motwani Mona , Møller Charlotte T. , Jakobsen Andreas S. , Fitzgerald Katherine A. , Roos Jessica , Lin Rongtuan , Maier Thorsten J. , Goldbach-Mansky Raphaela , Miner Cathrine A. , Qian Wei , Miner Jonathan J. , Rigby Rachel E. , Rehwinkel Jan , Jakobsen Martin R. , Arai Hiroyuki , Taguchi Tomohiko , Schopfer Francisco J. , Olagnier David , Holm Christian K.
Published: July 2018

Significance

Several chronic inflammatory conditions have recently been shown to depend on abnormally high activity of the signaling protein stimulator of IFN genes (STING). These conditions include examples from systemic lupus erythematosus, Aicardi–Goutiéres syndrome, and STING-associated vasculopathy with onset in infancy. The involvement of STING in these diseases points to an unmet demand to identify inhibitors of STING signaling, which could form the basis of anti-STING therapeutics. With this report, we identify distinct endogenously formed lipid species as potent inhibitors of STING signaling—and propose that these lipids could have pharmaceutical potential for treatment of STING-dependent inflammatory diseases.
The Rwandan agrarian and land sector modernisation: confronting macro performance with lived experiences on the ground
Authors: Ansoms An , Cioffo Giuseppe , Dawson Neil , Desiere Sam , Huggins Chris , Leegwater Margot , Murison Jude , Nyenyezi Bisoka Aymar , Treidl Johanna , Van Damme Julie
Published: July 2018

Rwanda has embarked on an ambitious policy package to modernise and professionalise the agrarian and land sector. Its reform fits into a broader call – supported by major international donors – to implement a Green Revolution in Sub-Saharan Africa. After 10 years of implementation, there is increased production output and value-addition in commercialised commodity chains. These are promising results. However, poverty reduction, particularly in more recent years, seems limited. Moreover, micro-level evidence from the field calls into question the long-term sustainability of the agricultural and land sector reform. In this article, a group of researchers, having engaged in in-depth qualitative research in a variety of settings and over an extended period, bring together their main research results and combine their key findings to challenge the dominant discourse on Rwanda as a model for development.
Myoepithelial cells are a dynamic barrier to epithelial dissemination
Authors: Sirka Orit Katarina , Shamir Eliah R. , Ewald Andrew J.
Published: July 2018

The mammary epithelium is composed of an inner luminal and surrounding myoepithelial cell layer. The presence of cancer cells beyond the myoepithelium defines invasive breast cancer, yet the role of the myoepithelium during invasion remains unclear. We developed a 3D organotypic culture assay to model this process through lineage-specific expression of the prometastatic transcription factor Twist1. We sought to distinguish the functional role of the myoepithelium in regulating invasion and local dissemination. Myoepithelial-specific Twist1 expression induced cell-autonomous myoepithelial cell escape. Remarkably, luminal-specific Twist1 expression was rarely sufficient for escape. Time-lapse microscopy revealed that myoepithelial cells collectively restrain and reinternalize invading Twist1+ luminal cells. Barrier function correlated with myoepithelial abundance and required the expression of α-smooth muscle actin and P-cadherin. We next demonstrated that myoepithelial cells can restrain and recapture invasive cancer cells. Our data establish the concept of the myoepithelium as a dynamic barrier to luminal dissemination and implicate both smooth muscle contractility and intercellular adhesion in barrier function.
Bilateral comparison of 1.018 V and 10 V standards between the KEBS (Kenya) and the BIPM, January to March 2018, (part of the ongoing BIPM key comparison BIPM.EM-K11.a and b)
Authors: Solve S , Chayramy R , Aguko Gibson O , Stock M
Published: July 2018

As part of the ongoing BIPM key comparison BIPM.EM-K11.a and b, a comparison of the 1.018 V and 10 V voltage reference standards of the BIPM and the Kenya Bureau of Standards, was carried out from January to February 2017. Two BIPM Zener diode-based travelling standards (Fluke 732B), BIPM_A (Z8) and BIPM_B (ZB), were hand carried to KEBS and back to BIPM by M. Gibosn Aguko. Since the total duration of the travels from one institute to the other was not exceeding the capabilities of the self-powering of the Zeners (36 hours), the transfer standards did not need any additional battery connected in parallel to the internal battery. At KEBS, the reference standard for DC voltage is a 732B Zener standard traceable to a primary voltage by means of a calibration service requested once a year from a National Measurement Institute (UME, Turkey) operating a Josephson Voltage Standard (JVS) two times per year. The output EMF (Electromotive Force) of each travelling standard was measured against the Zener voltage standard by means of an accurate multimeter.

At the BIPM, the travelling standards were calibrated, before and after the measurements at KEBS, with the Josephson Voltage Standard. Results of all measurements were corrected for the dependence of the output voltages of the Zener standards on internal temperature and atmospheric pressure.Since KEBS did not record the temperature of the internal voltage reference during its measurement session, no correction for the Zener temperature dependence was applied. However, as a consequence the related uncertainty was adjusted.

The final result of the comparison is presented as the difference between the values assigned to DC voltage standards by KEBS, at the level of 1.018 V and 10 V, at KEBS, U
KEBS, and those assigned by the BIPM, at the BIPM, U
BIPM, at the reference dates of the 2 February 2018.

U
KEBS - U
BIPM = + 0.11 µV; u
c = 0.34 µV, at 1.018 V

U
KEBS - U
BIPM = + 0.25 µV; u
c = 1.55 µV, at 10 V

where u
c is the combined standard uncertainty associated with the measured difference, including the uncertainty of the representation of the volt at the BIPM and at KEBS, based on KJ-90, and the uncertainty related to the comparison. KEBS' uncertainties appear to be over estimated and would require revision.

KEY WORDS FOR SEARCH

Josephson voltage standard; Zener diode; KEBS; BIPM; comparison; Kenya; electricity and magnetism; CIPM MRA

Main text

To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.

The final report has been peer-reviewed and approved for publication by the CCEM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).
Eigen-frequency analysis of spherical shell laminated composite plates with and without central cutouts using finite elements
Authors: Behera Ranjan K. , Garg Kushagra , Patro Sudhansu S. , Sharma Nitin
Published: July 2018

This article presents the free vibration responses of spherical shell laminated composite panels (SSLCP) without and with central cutouts (square, circular and rectangular) using finite elements. The SSLCP midplane kinematics has been modeled using ABAQUS commercial finite element tool in the framework of first order shear deformation theory. Firstly, the validity of the present model is established by comparing the present natural frequencies values with the available benchmark results. Subsequently, the influence of both varying and constant aspect ratio for different central cutouts on the natural frequencies of SSLCP are investigated by solving appropriate numerical examples and findings are discussed in detail. The results are given in the form of tables and figures.
The half-bridge component Kar1 promotes centrosome separation and duplication during budding yeast meiosis
Authors: Agarwal Meenakshi , Jin Hui , McClain Melainia , Fan Jinbo , Koch Bailey A. , Jaspersen Sue L. , Yu Hong-Guo
Published: July 2018

The budding yeast centrosome, often called the spindle pole body (SPB), nucleates microtubules for chromosome segregation during cell division. An appendage, called the half bridge, attaches to one side of the SPB and regulates SPB duplication and separation. Like DNA, the SPB is duplicated only once per cell cycle. During meiosis, however, after one round of DNA replication, two rounds of SPB duplication and separation are coupled with homologue segregation in meiosis I and sister-chromatid segregation in meiosis II. How SPB duplication and separation are regulated during meiosis remains to be elucidated, and whether regulation in meiosis differs from that in mitosis is unclear. Here we show that overproduction of the half-bridge component Kar1 leads to premature SPB separation during meiosis. Furthermore, excessive Kar1 induces SPB overduplication to form supernumerary SPBs, leading to chromosome missegregation and erroneous ascospore formation. Kar1-­mediated SPB duplication bypasses the requirement of dephosphorylation of Sfi1, another half-bridge component previously identified as a licensing factor. Our results therefore reveal an unexpected role of Kar1 in licensing meiotic SPB duplication and suggest a unique mechanism of SPB regulation during budding yeast meiosis.
Intracellular mechanism by which arsenite activates the yeast stress MAPK Hog1
Authors: Lee Jongmin , Levin David E.
Published: July 2018

Stress-activated MAPKs (SAPKs) respond to a wide variety of stressors. In most cases, the pathways through which specific stress signals are transmitted to the SAPKs are not known. In this study, we delineate the intracellular signaling pathway by which the trivalent toxic metalloid arsenite [As(III)] activates the yeast SAPK Hog1. We demonstrate that, to activate Hog1, As(III) must enter the cell through the glycerol channel Fps1 and must be metabolized to methyl arsenite [MAs(III)] by the dimeric methyltransferase Mtq2:Trm112. We found that Mtq2:Trm1 displays SAM-dependent methyltransferase activity toward both As(III) and MAs(III). Additionally, we present genetic and biochemical evidence that MAs(III), but not As(III), is a potent inhibitor of the protein tyrosine phosphatases (Ptp2 and Ptp3) that normally maintain Hog1 in an inactive state. Inhibition of Ptp2 and Ptp3 by MAs(III) results in elevated Hog1 phosphorylation without activation of the protein kinases that act upstream of the SAPK and raises the possibility that other Hog1-activating stressors act intracellularly at different points along the canonical Hog1 activation pathway. Finally, we show that arsenate [As(V)], a pentavalent form of arsenic, also activates Hog1, but through a pathway that is distinct from that of As(III) and involves activation of the Hog1 MEK Pbs2.
Toward mapping the human body at a cellular resolution
Authors: Roy Ananda L. , Conroy Richard S.
Published: July 2018

The adult human body is composed of nearly 37 trillion cells, each with potentially unique molecular characteristics. This Perspective describes some of the challenges and opportunities faced in mapping the molecular characteristics of these cells in specific regions of the body and highlights areas for international collaboration toward the broader goal of comprehensively mapping the human body with cellular resolution.
Harms and objections
Authors: McDermott Michael
Published: July 2018

Intuition says that choosing to create a miserable person is wrong, but choosing not to create a happy one is not; this is ‘the Asymmetry’. There is a complete theory which agrees – the ‘Harm Minimization’ theory. A well-known objection is that this theory rejects Parfit’s principle of ‘No Difference’. But No Difference has less intuitive support than the Asymmetry, and there seems to be no complete theory which agrees with both. There is, however, a more serious problem for Harm Minimization: it says it is wrong to create happy people if we could have made some of them happier at the expense of others. The purpose of this note is to describe a complete theory which agrees with the Asymmetry and avoids this unacceptable consequence; like Harm Minimization, it rejects No Difference.
Acute Kidney Injury in a Patient on Tenofovir Alafenamide Fumarate After Initiation of Treatment for Hepatitis C Virus Infection
Authors: Serota David P , Franch Harold A , Cartwright Emily J
Published: July 2018

HIV treatment with tenofovir alafenamide fumarate (TAF) has decreased renal toxicity compared with tenofovir disoproxil fumarate in clinical trials. We report the case of a patient with HIV/HCV coinfection who was started on a TAF-based HIV regimen and developed acute kidney injury that worsened with the addition of sofosbuvir-ledipasvir.
Nuances of Endovascular Treatment of Transverse/Sigmoid Sinus Stenosis With Stenting Venoplasty in a Patient With Pseudotumor Cerebri: 2-Dimensional Operative Video
Authors: Rangel-Castilla Leonardo , Siddiqui Adnan H
Published: July 2018

We present a case of a patient with pseudotumor cerebri (PC) and transverse/sigmoid junction sinus (TSJS) stenosis treated with stenting venoplasty. A 54-yr-old man with a history of hypertension, hyperlipidemia, and chronic obstructive pulmonary disease presented with subacute onset of progressive headaches, blurred vision, and papilledema. He was clinically diagnosed with PC. Left TSJS stenosis was suspected on magnetic resonance venography and confirmed with digital subtraction angiography and venography. During angiography, venous pressures were measured along the intracranial venous system revealing a significant drop compared with pressures obtained from the superior sagittal and sigmoid sinuses. For 7 d prior to venous sinus stenting, he was prescribed antiplatelet therapy with aspirin (350 mg/d) and clopidogrel (75 mg/d). Patient consent was obtained prior to performing the procedure; institutional board approval is not required for the report of a single case. Under conscious sedation and systemic heparinization, the patient underwent endovascular stenting of the left TSJS with an open-cell carotid stent (Precise 7 × 40 mm; Cordis, Milpitas, California). Successful left TSJS reconstruction transpired with no procedure-related complications. The patient was discharged home 1 d postprocedure. After 2 mo of dual antiplatelet therapy, clopidogrel was discontinued. At the 1-yr follow-up, he had resolution of papilledema and notably less intense headaches. Venous sinus stenting is an effective endovascular treatment for symptomatic patients with PC and sinus stenosis. Venous pressure measurement is imperative for patient selection. Adequate venous access with a 6-French guide catheter into the sigmoid sinus and an intermediate catheter into the transverse sinus is crucial to navigate a stent through the acute angles of the TSJS and jugular vein.
Microsurgery for Upper Basilar Tip Aneurysm With Intraoperative Rupture: 3-Dimensional Operative Video
Authors: Granados Oliver Soto , da Costa Marcos Devanir Silva , Costa Bruno Lourenço , González-Echeverría Kléber , Paganelli Samantha Lorena , Caramanti Ricardo Lourenço , Palmiero Helbert , Chaddad-Neto Feres
Published: July 2018

In the last years, a shift from the microsurgical treatment to an endovascular therapy in patients with basilar apex aneurysm has been settled, part of this phenomenon is related to the significant tendency of vital perforators to be involved in the aneurysm dissection and clipping, which can implicate unfavorable outcomes. Nevertheless, microsurgical treatment remains the treatment that can provide the superior rates of stable and durable aneurysm occlusion, which is most important to young patients.

In this video, we present the case of a 45-yr-old female patient who complained of a sudden and severe headache and presented with progressive lethargy during the following 3 d.

At admission, computed tomography did not show abnormal findings. However, cerebrospinal fluid analysis showed erythrocytes and corroborated the clinical suspicion of spontaneous subarachnoid hemorrhage. The patient signed the Institutional Consent Form, which allows the use of his/her images and videos for any type of medical publications in conferences and/or scientific articles.

Angiography and magnetic resonance imaging revealed a saccular basilar apex aneurysm. It showed a wide neck as well as a lobulated dome with upward and slightly left projection. The aneurysm did not involve angiographically visible thalamoperforator arteries, which allowed the microsurgical treatment by the fronto-orbitozygomatic approach. However, during the interpeduncular cistern dissection, an intraoperative rupture of the aneurysm occurred. This video exemplifies the steps required to manage an intraoperative rupture of a basilar apex aneurysm.
A socialization paradox: trade union policy cooperation in the case of the enforcement directive of the posting of workers directive
Authors: Seeliger Martin , Wagner Ines
Published: July 2018

The formulation of common political positions from the trade union movement at the European Union (EU) level mainly takes place at the European Trade Union Confederation (ETUC). In the case of the Enforcement Directive of the Posting of Workers Directive, a central cleavage line runs between neither countries nor political parties, but between different vertical levels of the system of European labor relations—the sectoral and interprofessional levels. Here, due to both horizontal and vertical differences, trade unions were unable to effectively formulate and pursue joint positions. On these grounds, we aspire to provide a theoretical argument on political dynamics in the EU’s multilevel system. While the ETUC representatives internalize supranational norms through their embeddedness in the EU’s institutional landscape, this socialization process does not advance—but rather prevents—integration by disrupting trade union power at the supranational level.
Health-Related Quality of Life Instruments for Children With Cochlear Implants: Development of Child and Parent-Proxy Measures
Authors: Hoffman Michael F. , Cejas Ivette , Quittner Alexandra L.
Published: July 2018

Objectives:

Severe to profound hearing loss is associated with worse health-related quality of life (HRQoL), reflecting the wide-ranging effects of deafness on spoken language, cognition, and social/behavioral development. However, there are currently no cochlear implant (CI)–specific HRQoL measures that were developed using the Food and Drug Administration Guidance on patient-reported outcomes. This study developed the first HRQoL instruments (CI-QoL) for children with CIs, ages 6 to 12, and a parent-proxy measure for this age group.

Design:

Two phases of instrument development were conducted. Phase 1 consisted of a literature review yielding a conceptual framework and discussion guides to elicit information from stakeholder focus groups at CI clinics in Miami and Philadelphia (n = 30; e.g., physicians, speech pathologists). During phase 2, open-ended interviews were conducted with 21 parent–child dyads (M child age = 9.1 years) recruited from these two clinics. Interviews were transcribed, followed by content analysis in NVivo to identify the most frequent and difficult themes. Items were then derived from these themes to form the initial draft instruments. A multimodal approach was used to create the child-report version (i.e., pictorial representations, audio recording of items, written text above the drawings) to maximize comprehension and ease of responding. Both measures were developed to be administered electronically on a tablet device. In phase 3, a new set of parent–child dyads (n = 20; child age M = 9.2 years) completed a cognitive testing protocol to ensure clarity, ease of use, and comprehensiveness. Cognitive testing led to revisions and finalization of the instruments.

Results:

The final self-report measure contained 33 items across eight domains: Noisy Environments, Academic Functioning, Child Acceptance, Oral Communication, Social Functioning, Fatigue, Emotional Functioning, and Device Management. The final parent-proxy measure included 42 items on nine scales: the same eight scales that appear on the child version, with the addition of Behavior Problems. Correlations between child and parent reports on each scale ranged from r = 0.08 to 0.48.

Conclusions:

CI-specific HRQoL instruments have now been developed for school-age children with CIs, with an accompanying parent-proxy version. After a psychometric validation, these CI-specific measures will enable us to track long-term outcomes, evaluate the efficacy of interventions to improve CI use (e.g., single versus bilateral implantation, AV therapy, maternal sensitivity training), and provide a profile of the “whole child’s” functioning to facilitate care.
Recent Increase in the Rate of Spinal Infections May be Related to Growing Substance-use Disorder in the State of Washington
Authors: Blecher Ronen , Yilmaz Emre , Ishak Basem , Drazin Doniel , Oskouian Rod J. , Chapman Jens R.
Published: July 2018

Study Design.

Epidemiological study.

Objective.

The aim of this study was to evaluate trends in the incidence of spinal infections (SI) and the possible role of substance use disorder (SUD) as a key associated factor.

Summary of Background Data.

SI pose major diagnostic and therapeutic challenge in developed countries, resulting in substantial morbidity and mortality. With an estimated incidence of up to 1:20,000, recent clinical experiences suggest that this rate may be rising.

Methods.

To evaluate a possible change in trend in the proportion of SI, we searched the Washington state Comprehensive Hospital Abstract Reporting System (CHARS) data during a period of 15 years. We retrieved ICD-9 and 10 codes, searching for all conditions that are regarded as SI (discitis, osteomyelitis, and intraspinal abscess), as well as major known SI-related risk factors.

Results.

We found that the proportion of SI among discharged patients had increased by around 40% during the past 6 years, starting at 2012 and increasing steadily thereafter. Analysis of SI-related risk factors within the group of SI revealed that proportion of SUD and malnutrition had undergone the most substantial change, with the former increasing >3-fold during the same period.

Conclusion.

Growing rates of drug abuse, drug dependence, and malnutrition throughout the State of Washington may trigger a substantial increase in the incidence of spinal infections in discharged patients. These findings may provide important insights in planning prevention strategies on a broader level.

Level of Evidence: 4
Association Between Body Weight Variation and Survival and Other Adverse Events in Critically Ill Patients With Shock: A Multicenter Cohort Study of the OUTCOMEREA Network
Authors: Gros Antoine , Dupuis Claire , Ruckly Stéphane , Lautrette Alexandre , Garrouste-Orgeas Maité , Gainnier Marc , Forel Jean-Marie , Marcotte Guillaume , Azoulay Elie , Cohen Yves , Schwebel Carole , Argaud Laurent , de Montmollin Etienne , Siami Shidasp , Goldgran-Toledano Dany , Darmon Michael , Timsit Jean-Francois
Published: July 2018

Objectives:

This study in critically ill patients with shock assessed the prognostic value of body weight variations occurring each day from day 3 to day 7 on the 30-day outcome in terms of mortality, occurrence of ventilator-associated pneumonia and of bedsore, and occurrence of length of stay.

Design:

Retrospective analysis of data. Multivariate subdistribution survival models were used at each day, from day 3 to day 7. The impact of body weight variations on length of stay was estimated through a multivariate negative binomial regression model.

Setting:

Prospective multicenter cohort study.

Patients:

Critically ill patients admitted in ICU with shock and requiring mechanical ventilation within 48 hours.

Intervention:

None.

Measurements and Main Results:

Two-thousand three-hundred seventy-four patients were included. Their median body weight variations increased from 0.4 kg (interquartile range, 0–4.8 kg) on day 3 to 3 kg (interquartile range, –0.4 to 8.2 kg) on day 7. Categories of body weight variations were defined depending on body weight variations interquartiles: weight loss, no weight gain, moderate and severe weight gain. A severe weight gain tended to be associated with death at days 5 and 6 (day 5: subdistribution hazard ratio, 1.27; 95% CI, 0.99–1.63; p = 0.06 and day 6: subdistribution hazard ratio, 1.43; 95% CI, 1.08–1.89; p = 0.01), a weight loss tended to be associated with bedsore, and a severe gain between at days 5 and 6 was associated with ventilator-associated pneumonia. Any body weight variations were associated with an increased length of stay.

Conclusions:

In survivors at day 3, body weight variations during the first days of ICU stay might be a clinically relevant tool to prevent weight gain but also for prognostication of 30-day mortality, occurrence of ventilator-associated pneumonia, and occurrence of prolonged ICU stay.
Overview of Children and Disasters
Authors: Bothe Denise A. , Olness Karen N. , Reyes Charina
Published: July 2018

Currently, throughout the world, there are nearly 40 million children displaced by natural or man-made disasters. The special needs of children in disasters are often unrecognized, yet children comprise half of disaster victims. The purpose of this review is to provide information on (1) demographics related to children and disasters, both domestic and international; (2) risks for children who experience disasters; (3) programs that help children in disasters; and (4) training programs on the special needs of children in disasters. Children who are displaced by disasters are at risk of acute and long-term medical problems. Disaster experiences can also lead to acute and long-term psychological problems. Ultimately, these have worldwide negative implications for human society, including education, health care, security, and economic and political aspects of daily life. There is a compelling need for more services to help the children who have experienced disasters and for education to train more relief workers about the special needs of children in disasters.