bluuebunny/crossref_metadata_2025 huggingface dataset:
Physics‐based compact model for the EMCON p–i–n diode using MATLAB and Simulink
Authors: Xue Peng , Fu Guicui , Zhang Dong
Published: June 2016

In this study, a physics‐based model for emitter controlled (EMCON) p–i–n diode is proposed. The model is based on the one‐dimensional Fourier‐based solution of ambipolar diffusion equation (ADE) implemented in MATLAB and Simulink. The ADE is solved for all injection levels based on the design concepts of EMCON diode. The deep field stop layer utilised in the EMCON diode is also considered in the solution. Moreover, the depletion behaviour in the N‐base during reverse recovery is redescribed. To be self‐contained, a parameter extraction method is proposed to extract all the parameters of the model. In the end, the static and reverse recovery experiments for a commercial EMCON diode are used to validate the proposed model. The simulation results are compared with experiment waveforms and good agreement is obtained.
Multi‐loop control of stand‐alone inverters with minimum number of sensors
Authors: Razi Reza , Monfared Mohammad
Published: June 2016

This study deals with the design of a load sensorless multi‐loop control system for the stand‐alone inverter. In the proposed strategy, only the inverter current is measured, which is practically required for both control and protection purposes, then the load voltage and current are both estimated using the linear Kalman filter algorithm, and the gradient descent adaptive control method, respectively. The estimated quantities are used as feedback signals of an inner‐outer double‐loop controller, which uses a proportional‐resonant outer‐controller to regulate the output voltage with minimum steady‐state error and a simple proportional inner‐controller to provide active damping and improve the transient performance. The controller parameters are designed in the frequency domain based on the required bandwidth and stability margin. Furthermore, the controllability and observability, as well as the stability of overall digital control system, including the dynamics of estimators, are analytically investigated. Simulation and experimental results, with a 600 VA prototype, confirm the theoretical achievements and illustrate the excellent performance of the proposed estimation and control scheme.
Calculation of critical inductance in n‐input buck dc–dc converter
Authors: Babaei Ebrahim , Varesi Kazem , Vosoughi Naser
Published: June 2016

This study investigates a multiple input buck dc–dc converter. Different operational modes of the converter for two‐, three‐ and four‐input sources are studied then, for each item the relation of critical inductance between continuous conduction mode and discontinuous conduction mode is calculated. Finally, a generalised relationship is proposed for calculation of critical inductance of n‐input topology, which is true for any number of input sources. Experimental and simulation results in power systems computer‐aided design/EMTDC are presented to validate the theoretical concepts and proposed generalised relation of converter critical inductance.
Consistent DOA estimation of heavily noisy gunshot signals using a microphone array
Authors: Borzino Ângelo Marcio Cardoso Ribeiro , Apolinário José Antonio , de Campos Marcello Luiz Rodrigues
Published: June 2016

Direction of arrival (DOA) estimation of a gunshot is an important issue in shooter localisation. As the distance between the firing position and the sensor array increases, the signal‐to‐noise ratio decreases, which degrades the accuracy of the DOA estimation. Strong noise may lead to false peaks in cross‐correlation functions, which may result in spurious time difference of arrival (TDOA) estimates and hence spurious DOA estimates. The proposed gunshot DOA estimation algorithm [exhaustive search‐searching consistent fundamental loop (ES‐SCFL)] reduces this problem by combining the methods of standard estimation, ES, and SCFL. The ES‐SCFL method looks for the best set of microphone pairs and the correct peaks of their cross‐correlation functions, and uses the time lags of these peaks as the TDOA estimates for DOA estimation. The performance of the proposed algorithm is evaluated using real gunshot data recorded from a field experiment.
GaN high electron mobility transistors: a review from parasitic elements extraction's perspective
Authors: Jarndal Anwar , Kouki Ammar
Published: June 2016

In this study, three different parameter extraction approaches for GaN high electron mobility transistors are presented and evaluated. The first approach depends on only cold pinch‐off measurements, the second approach based on cold pinch‐off and forward measurements and the last one uses de‐embedding open structure in addition to unbiased cold measurements at V DS = 0 V and V GS = 0 V. The extracted values using the first two methods have a very good agreement with the extracted values using the last mentioned procedure. This study results verify the applicability of using either pinch‐off measurements or cold unbiased measurements with open structure to extract the device parasitic elements. This accordingly will reduce the cost of using extra de‐embedding structures or high‐current stress forward measurements.
Orbital Adherence Syndrome following the Use of Titanium Precontoured Orbital Mesh for the Reconstruction of Posttraumatic Orbital Floor Defects
Authors: Lee Geraldine Hwee Ping , Ho Samuel Yew Ming
Published: June 2016

Orbital blowout fractures are a common occurrence following orbital trauma. Depending on the size of the defect and the contents that have herniated or incarcerated, possible sequelae include enophthalmos, diplopia, dystopia, and entrapment. Surgical intervention aims to prevent or alleviate this through the use of a bone graft or an alloplastic implant to reconstitute the continuity of the orbit. However, in doing so, the implant itself may result in the unexpected adherence of the periorbita, resulting in orbital adherence syndrome. We present two cases of orbital adherence syndrome following the use of titanium mesh for orbital floor reconstruction. In both cases, we also delineate the management of this syndrome. Our first patient reported good recovery after surgical intervention to relieve the tethering to the titanium mesh and subsequent placement of a smooth interface implant. The other patient was managed nonsurgically with resolution of symptoms. We highlight possible signs that might suggest the need for early surgical intervention. Orbital adherence syndrome is a poorly described and understood phenomenon and appears to occur after the use of large-pored titanium mesh for orbital reconstruction. Prevention is possible through careful patient selection and the placement of a smooth interface medium in the initial surgery.
Personalgewinnung und -entwicklung in viszeralchirurgischen Kliniken von Großkrankenhäusern – derzeitiger Stand und Möglichkeiten der Optimierung aus Industrie und Dienstleistungsgewerbe
Authors: Homayounfar K. , König S. , Rabe C. , Beck-Broichsitter B. , Lützen U. , Ghadimi M. , Schmidt C.
Published: June 2016

Hintergrund Verdrängungswettbewerb, Kostendruck, Generation Y, Ärztemangel und Feminisierung beeinflussen das Personalmanagement in der Viszeralchirurgie. Die Einschätzung der Istsituation durch die Abteilungsleiter (AL) sowie die Übertragbarkeit von Strategien aus Industrie und Dienstleistungsgewerbe (ID) wurden bisher nicht untersucht.

Material und Methoden Mittels eines standardisierten Fragebogens mit 43 Items wurden AL an Universitätskliniken und Krankenhäusern mit ≥ 800 Planbetten befragt (n = 100). Geschlossene Fragen wurden anhand einer 5-stufigen Likert-Skala gestaltet. Zehn Personalverantwortliche (PV) aus ID wurden zur Teilnahme an einem 45-minütigen Telefoninterview eingeladen.

Ergebnisse An der Befragung nahmen 37 AL teil, davon 15 Lehrstuhlinhaber. Initiativbewerbung (100%) sowie Stellenanzeigen (78%) und Ansprache von PJ-Studenten (78%) waren die häufigsten Wege der Personalgewinnung. Einen standardisierten Vorbereitungsbogen für Vorstellungsgespräche nutzten nur 17% der AL. Fachkompetenz (MW 2,2 ± 0,9), Sozialkompetenz (MW 1,9 ± 0,6) und gute Deutschkenntnisse (MW 1,8 ± 0,8) wurden als bedeutsame Voraussetzungen für eine Einstellung genannt. Referenzen und Zeugnissen (MW 3,2 ± 0,9) wurde wenig Bedeutung beigemessen. Die Mitarbeiterförderung wurde für sehr wichtig gehalten (MW 1,1 ± 0,2), ein fester Zeitrahmen für die Weiterbildung jedoch nur bedingt zugesichert (MW 3,0 ± 1,5). Transparente Anforderungsprofile für einen Aufstieg (MW 2,5 ± 1,1) und unterschiedliche Karrieremodelle (MW 2,7 ± 1,2) waren wenig vorhanden. Am Telefoninterview nahmen 6 PV teil. Die Mitarbeiterabwerbung (75%), Internet-Plattformen (75%), Werbung auf Messen (75%) sowie Anwerbung von Auszubildenden (50%), Stellenanzeigen (50%) und Social Media (50%) waren häufig genannte Wege der Personalgewinnung. Fach- und Führungskarrieren sind oft voneinander getrennte Karrierepfade, wobei Sozialkompetenz entscheidend für die Besetzung von Führungspositionen ist.

Schlussfolgerung In der Viszeralchirurgie sind Initiativbewerbung, Stellenanzeige und PJ-Studenten die Hauptwege zur Personalgewinnung. Diversifizierte Fach- und Führungskarrieren sind bisher nicht etabliert. In ID erfolgreiche Maßnahmen wie aktives Scouting sowie Social Media sollten ebenso evaluiert werden wie diversifizierte Karrieremodelle.
Performance of cattle reared on rangelands supplemented with farm-formulated diets during the dry season in Zimbabwe
Authors: Gusha J. , Chiuta T. , Katsande S. , Zvinorova P. I. , Kagande S. M.
Published: June 2016

Feed quality in rangelands reaches an all-time low during the dry season thus affecting animal performance. The use of farm-formulated supplements is an alternative which can be adopted to minimise the effects of nutritional stress. However, the effects of supplementing nursing cows, twice a week with farm-formulated diets; on cow maintenance, calf weaning weight and conception rate is little known. Thirty indigenous Mashona cows were allocated to five treatments of a commercial supplement known as beef survival meal, urea-treated maize stover, Leucaena leucocephala meal, mixed forage meal and without supplements. The study was repeated with a new set of nursing cows each year for 3 years. Nutrient composition of treatment diets varied with Leucaena leucocephala having more crude protein than the other diets. Forage-supplemented groups had higher (P < 0.05) rate of weight increase and weaning weights with Leucaena leucocephala and beef survival meal having better results among the groups. Nursing cows that were in protein-supplemented groups had significantly higher (P < 0.05) conception rate than the group of nursing cows, which were not offered the protein supplements. We concluded that, with farm-formulated supplements given twice per week, nursing cows can maintain better body condition, wean heavier calves and successful conceive every year thus improving animal productivity.
Guardian dogs protect sheep by guarding sheep, not by establishing territories and excluding predators
Authors: Allen Lee R. , Stewart-Moore Ninian , Byrne Damian , Allen Benjamin L.
Published: June 2016

Guardian animals have been a common non-lethal method for reducing predator impacts on livestock for centuries in Europe. But elsewhere, livestock producers sometimes doubt whether such methods work or are compatible with modern livestock husbandry practices in extensive grazing systems. In this study we evaluate the hypothesis that guardian dogs primarily ‘work’ by establishing and defending territories from which canid predators are excluded. Eight maremmas and six free-ranging wild dogs of different sexes were fitted with GPS collars and monitored for 7 months on a large sheep property in north Queensland, Australia. Wild dog incursions into the territories of adjacent wild dogs and maremmas were recorded. Wild dog territories never overlapped and their home ranges infrequently overlapped. In contrast, 713 hourly locations from 120 wild dog incursions into maremma territories were recorded, mostly from three wild dogs. These three wild dogs spent a mean of 2.5–5.9 h inside maremma territories during incursions. At this location, maremmas worked by guarding sheep and prohibiting fine-scale interaction between wild dogs and sheep, not by establishing a territory respected by wild dogs. We conclude that shepherding behaviour and boisterous vocalisations of guardian dogs combined with the flocking behaviour of sheep circumvents attacks on sheep but does not prevent nor discourage wild dogs from foraging in close proximity. Certain husbandry practices and the behaviour of sheep at parturition may incur greater predation risk.
Comparable cross-taxa risk perception by means of chemical cues in marine and freshwater crustaceans
Authors: Brooker Rohan M. , Dixson Danielle L.
Published: June 2016

Rapid identification of predation risk and modification of subsequent behaviour is essential for prey survival. In low-visibility aquatic environments, chemical cues emitted by hetero- and conspecific organisms may be an important information source if they identify risk or alternatively, indicate safety or resource availability. This study tested whether ecologically similar shrimp from disparate habitats have a comparable ability to identify predators from a range of taxa based on chemical cues. Shrimp from both temperate marine (Palaemon affinis) and tropical freshwater habitats (Caridina typus) exhibited similar behavioural responses, avoiding chemical cues from predatory heterospecifics, showing no response to non-predatory heterospecific cues, and preferring conspecific cues. These chemical cues also affected habitat selection, with structurally complex microhabitats favoured in the presence of predator cues but avoided in the presence of conspecific cues. The ability to differentiate predators from non-predators irrespective of taxa suggests identification might be due to the predator’s diet. An ability to alter behaviour based on vision-independent perception of ambient risk is likely to reduce capture risk while allowing individuals to maximise time spent on essential processes such as foraging.
Multiple sulfur-isotope signatures in Archean sulfates and their implications for the chemistry and dynamics of the early atmosphere
Authors: Muller Élodie , Philippot Pascal , Rollion-Bard Claire , Cartigny Pierre
Published: June 2016

Significance

In an anoxic world, sulfate is rare or absent and therefore unlikely to be preserved in the geological record. It is puzzling, therefore, that several sulfate deposits were formed during the Archean. In situ S-isotopic fingerprinting of Archean barite (BaSO
4
) revealed that three main sources of photochemical sulfur were involved in their formation. A strongly negative Δ
33
S possibly generated at the point of volcanic emission, a slightly positive Δ
33
S overlapping modern stratosphere-piercing volcanic sulfate aerosols, and a
36
S-anomalous sulfate source matching carbonyl sulfide photolytic products now preserved as background atmospheric sulfate aerosols. It is suggested that Archean barite deposits represent an exceptional period of volcanic sulfate aerosol production and preservation rather than an unexpectedly active biological sulfur cycle.
E3 ubiquitin ligase RFWD2 controls lung branching through protein-level regulation of ETV transcription factors
Authors: Zhang Yan , Yokoyama Shigetoshi , Herriges John C. , Zhang Zhen , Young Randee E. , Verheyden Jamie M. , Sun Xin
Published: June 2016

Significance

An average human lung is composed of 14 million airway tips, conducting air to 300 million gas-exchange units. An organ of such complex architecture is nevertheless constructed with robust precision, the result of a largely stereotypical branching sequence. Although regulation at the transcript level is known to be critical, how control at the protein level may play a role remains poorly understood. The function of the ubiquitin proteasome system in the lung has primarily been studied in pathological settings in the adult. Here, we show that inactivation of Ring finger and WD domain 2 (RFWD2) led to a profound lung branching defect through misregulation of ETV transcription factors. These findings predict a protein-level regulatory network essential for the construction of a functional lung.
Voltage-dependent motion of the catalytic region of voltage-sensing phosphatase monitored by a fluorescent amino acid
Authors: Sakata Souhei , Jinno Yuka , Kawanabe Akira , Okamura Yasushi
Published: June 2016

Significance

Voltage-sensing phosphatase (VSP) dephosphorylates phosphoinositides in a voltage-dependent manner. The molecular mechanisms by which the voltage-sensor domain of VSP activates the catalytic activity of the cytoplasmic region still remain unknown. Using a method of incorporation of a fluorescent unnatural amino acid, 3-(6-acetylnaphthalen-2-ylamino)-2-aminopropanoic acid (Anap), in the catalytic region, we revealed that some loops in the catalytic region move on membrane depolarization and that the catalytic region is located beneath the plasma membrane irrespective of the membrane potential. Furthermore, fluorescence change of Anap in the C2 domain showed multiple voltage-dependent activated states and protein conformation, which is sensitive to substrate availability in the active center. These findings provide novel insights into the mechanisms of voltage-dependent catalytic activity of VSP.
Structures of the orthosomycin antibiotics avilamycin and evernimicin in complex with the bacterial 70S ribosome
Authors: Arenz Stefan , Juette Manuel F. , Graf Michael , Nguyen Fabian , Huter Paul , Polikanov Yury S. , Blanchard Scott C. , Wilson Daniel N.
Published: June 2016

Significance

The ribosome is the protein-synthesizing machine of the cell and is a major target for antibiotics. The increase in multidrug-resistant bacteria has limited the utility of our current arsenal of clinically used antibiotics, highlighting the need for further development of compounds that have distinct binding sites and do not display cross-resistance. Using cryo-electron microscopy, we have visualized the binding site of the orthosomycins evernimicin and avilamycin on the bacterial 70S ribosome. The binding site and mode of interaction of evernimicin and avilamycin are distinct from other ribosome-targeting antibiotics. Together with single-molecule studies, our structures reveal how the orthosomycin antibiotics inhibit protein synthesis by preventing accommodation of the aminoacyl-tRNA at the A site of the ribosome.
YY1 plays an essential role at all stages of B-cell differentiation
Authors: Kleiman Eden , Jia Haiqun , Loguercio Salvatore , Su Andrew I. , Feeney Ann J.
Published: June 2016

Significance

Ying Yang 1 (YY1) is a ubiquitously expressed transcription factor that has been demonstrated to be essential for pro–B-cell development as well as lymphoma. It has recently been proposed that YY1 regulates the germinal center B-cell transcriptional program. We confirm this hypothesis and additionally show that YY1 is equally essential for all stages of B-cell differentiation. Through ChIP-sequencing analysis of YY1 binding, and analysis of differentially expressed genes from RNA-sequencing, our data show that, in addition to the regulation of several B-cell–specific genes, YY1 regulates many genes and pathways important in basic cellular functions, such as mitochondrial bioenergetics, transcription, ribosomal function, and cellular proliferation, thus explaining the requirement for YY1 at all stages of B-cell differentiation.
Early life stages contribute strongly to local adaptation in
Arabidopsis thaliana
Authors: Postma Froukje M. , Ågren Jon
Published: June 2016

Significance

Organisms are often adapted to local environmental conditions. Yet, the contribution of genetic differences expressed during early life stages to the magnitude and genetic basis of local adaptation are poorly known. We planted seeds of recombinant inbred lines derived from a cross between populations of the model plant
Arabidopsis thaliana
in Italy and Sweden at the parental sites, and mapped quantitative trait loci (QTL) for fitness and its components. Natural selection strongly favored the local genotype during seedling establishment, and QTL for establishment contributed to local adaptation and genetic fitness tradeoffs. The results demonstrate that adaptive differentiation during early life stages can be strong and should be considered for a full understanding of the ecology and genetics of local adaptation.
Immobilization of the N-terminal helix stabilizes prefusion paramyxovirus fusion proteins
Authors: Song Albert S. , Poor Taylor A. , Abriata Luciano A. , Jardetzky Theodore S. , Dal Peraro Matteo , Lamb Robert A.
Published: June 2016

Significance

Paramyxovirus fusion proteins (F), critical for viral entry and infection, initially fold into a metastable prefusion state and, upon triggering, refold irreversibly to a stable postfusion state to physically mediate membrane fusion. The large-scale conformational changes that occur in the F-refolding pathway are understood, but a detailed structural understanding of F-protein metastability remains elusive. Here, stabilizing and destabilizing mutations of the parainfluenza virus 5 fusion protein were examined to reveal that the immobilization of the N-terminal helix stabilizes paramyxovirus prefusion F proteins. The N-terminal helix, the interaction of which with domain II appears to be a critical early step in the F-protein refolding pathway, presents a novel alternative target for structure-based antiviral therapeutics.
Crystallising contention: social movements, protests and riots in African Studies
Authors: Philipps Joschka
Published: June 2016

This article critically reviews the recent debate on social movements and protests in African Studies. It problematises prevailing conceptualisations, addresses the methodological difficulties of data gathering and scrutinises theoretical references in contemporary scholarship. As an alternative to established approaches and based on fieldwork in Conakry and Kampala, the author suggests capturing the dynamic nature of protest movements through the concept of crystallisation. Inspired by philosopher Gilbert Simondon, the crystallisation concept grasps protests as processes emerging from everyday urban politics and reflexively considers the researcher as part of the phenomena he or she describes.
CD4 cell count at initiation of ART, long-term likelihood of achieving CD4 >750 cells/mm3 and mortality risk
Authors: Palella F. J. , Armon C. , Chmiel J. S. , Brooks J. T. , Hart R. , Lichtenstein K. , Novak R. M. , Yangco B. , Wood K. , Durham M. , Buchacz K.
Published: June 2016

Objectives

We sought to evaluate associations between CD4 at ART initiation (AI), achieving CD4 >750 cells/mm3 (CD4 >750), long-term immunological recovery and survival.

Methods

This was a prospective observational cohort study. We analysed data from ART-naive patients seen in 1996–2012 and followed ≥3 years after AI. We used Kaplan–Meier (KM) methods and log-rank tests to compare time to achieving CD4 >750 by CD4 at AI (CD4-AI); and Cox regression models and generalized estimating equations to identify factors associated with achieving CD4 >750 and mortality risk.

Results

Of 1327 patients, followed for a median of 7.9 years, >85% received ART for ≥75% of follow-up time; 64 died. KM estimates evaluating likelihood of CD4 >750 during 5 years of follow-up, stratified by CD4-AI <50, 50–199, 200–349, 350–499 and 500–750, were 20%, 25%, 56%, 80% and 87%, respectively (log-rank P < 0.001). In adjusted models, CD4-AI ≥200 (versus CD4-AI <200) was associated with achievement of CD4 >750 [adjusted HR (aHR) = 4.77]. Blacks were less likely than whites to achieve CD4 >750 (33% versus 49%, aHR = 0.77). Mortality rates decreased with increasing CD4-AI (P = 0.004 across CD4 strata for AIDS causes and P = 0.009 for non-AIDS death causes). Among decedents with CD4-AI ≥50, 56% of deaths were due to non-AIDS causes.

Conclusions

Higher CD4-AI resulted in greater long-term CD4 gains, likelihood of achieving CD4 >750, longer survival and decreased mortality regardless of cause. Over 80% of persons with CD4-AI ≥350 achieved CD4 >750 by 4 years while 75% of persons with CD4-AI <200 did not. These data confirm the hazards of delayed AI and support early AI.
Genistein sensitizes sarcoma cells in vitro and in vivo by enhancing apoptosis and by inhibiting DSB repair pathways
Authors: Liu X.X. , Sun C. , Jin X.D. , Li P. , Zheng X.G. , Zhao T. , Li Q.
Published: June 2016

The aim of this work was to investigate the radiosensitization effects of genistein on mice sarcoma cells and the corresponding biological mechanisms in vitro and in vivo . Using the non-toxic dosage of 10 μM genistein, the sensitizer enhancement ratios after exposure to X-rays at 50% cell survival (IC 50 ) was 1.45 for S180 cells. For mice cotreated with genistein and X-rays, the excised tumor tissues had reduced blood vessels and decreased size and volume compared with the control and irradiation-only groups. Moreover, a significant increase in apoptosis was accompanied by upregulation of Bax and downregulation of Bcl-2 in the mitochondria, and lots of cytochrome c being transferred to the cytoplasm. Furthermore, X-rays combined with genistein inhibited the activity of DNA-PKcs, so DNA-injured sites were dominated by Ku70/80, leading to incompleteness of homologous recombination (HR) and non-homologous end-joining (NHEJ) repairs and the eventual occurrence of cell apoptosis. Our study, for the first time, demonstrated that genistein sensitized sarcoma cells to X-rays and that this radiosensitizing effect depended on induction of the mitochondrial apoptosis pathway and inhibition of the double-strand break (DSB) repair pathways.
Evaluation of the relative biological effectiveness of spot-scanning proton irradiation in vitro
Authors: Maeda Kenichiro , Yasui Hironobu , Matsuura Taeko , Yamamori Tohru , Suzuki Motofumi , Nagane Masaki , Nam Jin-Min , Inanami Osamu , Shirato Hiroki
Published: June 2016

Variations in relative biological effectiveness (RBE) from a fixed value of 1.1 are critical in proton beam therapy. To date, studies estimating RBE at multiple positions relative to the spread-out Bragg peak (SOBP) have been predominantly performed using passive scattering methods, and limited data are available for spot-scanning beams. Thus, to investigate the RBE of spot-scanning beams, Chinese hamster fibroblast V79 cells were irradiated using the beam line at the Hokkaido University Hospital Proton Therapy Center. Cells were placed at six different depths, including the entrance of the proton beam and the proximal and distal part of the SOBP. Surviving cell fractions were analyzed using colony formation assay, and cell survival curves were obtained by the curve fitted using a linear–quadratic model. RBE 10 and RBE 37 were 1.15 and 1.21 at the center of the SOBP, respectively. In contrast, the distal region showed higher RBE values (1.50 for RBE 10 and 1.85 for RBE 37 ). These results are in line with those of previous studies conducted using passive scattering proton beams. Taken together, these data strongly suggest that variations in RBE should be considered during treatment planning for spot-scanning beams as well as for passive scattering proton beams.
The Neurologic Examination
Authors: Gelb Douglas J.
Published: June 2016

A careful history can elicit most of the information necessary to localize a patient’s lesion, especially if you follow up open-ended questions with questions that focus on specific nervous system pathways. No matter how accurate and detailed the history, however, you will need to perform a neurologic examination. This is the most reliable way to identify certain abnormalities, such as subtle weakness, eye movement abnormalities, sensory deficits, and asymmetric reflexes. This examination will include patient consent and rely on patient observations. Key areas of a neurologic examination include mental status examination, cranial nerve examination, motor examination, reflex examination, sensory examination
Incontinence
Authors: Gelb Douglas J.
Published: June 2016

Incontinence is a particularly distressing symptom for patients and their families, and this would be reason enough to evaluate it promptly. In addi- tion, although incontinence is not an emergency in and of itself, it some- times indicates the presence of an underlying neurologic condition that must be addressed urgently. Neurologic conditions more often produce urinary incontinence than fecal incontinence, and when both occur, urinary incontinence generally appears first.
Pediatric Neurology
Authors: Gelb Douglas J.
Published: June 2016

Developmental plasticity is the main feature distinguishing pediatric neurology from adult neurology. The diagnostic principles presented in the first three chapters of this book still apply, but many of the nervous system functions typically assessed in adults are not fully operational until months or years after birth. Obvious examples are walking, talking, and control of bladder and bowel function. Thus, a child’s developmental stage determines how the exami- nation is interpreted and how it is performed.
Geriatric Neurology
Authors: Gelb Douglas J.
Published: June 2016

Three principles distinguish the neurologic assessment of older patients. First, and most important, people accumulate more diseases the longer they live. Second, some diseases occur primarily in the elderly. Third, even in the absence of any apparent disease, some components of the aging nervous system gradually deteriorate. As a consequence, older patients often have numerous symptoms referable to more than one organ system. The standard approach of trying to localize all symptoms to a single lesion is untenable in many cases. Instead, the question is whether the patient has a degenerative disease affecting sites distributed diffusely throughout the nervous system or a combination of unrelated diseases. The neurologic examination provides useful information for answering this question, but accurate interpretation of the examination requires knowledge of the changes that occur during normal aging.
Practice Cases
Authors: Gelb Douglas J.
Published: June 2016

This is a self-assessment section with question and answer based cases from throughout the book.
Monilinia Species Associated with Brown Rot of Cultivated Apple and Pear Fruit in China
Authors: Zhu Xiao-Qiong , Niu Cheng-Wang , Chen Xiao-Yu , Guo Li-Yun
Published: June 2016

Monilinia isolates were collected from major apple and pear production regions in China from 2004 to 2011 and identified based on their morphological characteristics and three highly conserved loci. The 247 isolates belonged to three species: Monilinia fructicola, Monilia yunnanensis, and Monilia polystroma. M. yunnanensis was the most prevalent (77%), followed by M. polystroma (20%) and Monilinia fructicola (3%). Monilia yunnanensis is primarily distributed in the south, north, and west of China; M. polystroma is limited to the north and east; and Monilinia fructicola was detected only from a few samples from the north and east. Phylogenetic analysis based on internal transcribed spacer, β-tubulin, and laccase (lcc2) genes suggested that Monilia yunnanensis, M. polystroma, and Monilinia fructigena are closely related, and Monilia yunnanensis is more distantly related. We also found that these three species do not show consistent differences in morphological characteristics, including colony morphology, colony expansion rate, conidial characteristics, and the amount of stroma produced in culture. Thus, these three species are more like phylogenetic species in the process of speciation. In addition, a set of species-specific primers based on single-nucleotide polymorphisms and deletions in the lcc2 gene region were designed and a conventional polymerase chain reaction method successfully developed for differentiating Monilinia fructicola, Monilia yunnanensis, M. polystroma, and Monilinia laxa from the other species.
Mentoring Early-Career Faculty Researchers Is Important—But First “Train the Trainer”
Authors: Sood Akshay , Tigges Beth , Helitzer Deborah
Published: June 2016

It has long been known that mentoring is critical to the success of junior faculty researchers. The controlled intervention study by Libby et al published in this issue of Academic Medicine demonstrates that institutional investment in a mentored research career development program for early-career faculty investigators provided significant long-term gains in grant productivity. Academic institutions hoping to replicate this program’s success by launching similar mentoring programs for their junior faculty investigators will, however, find that the Achilles’ heel lies in the scarcity of skilled research mentors and the relative lack of attention to and recognition of the importance of a supportive institutional climate for mentoring. It is essential, therefore, to begin by developing programs to “train the trainer” as well as programs and policies to support mentors. As a recent trial at 16 Clinical and Translational Science Award institutions demonstrated, competency-based, structured research mentor training can improve mentors’ skills.

In this Commentary, the authors offer a comprehensive two-pronged framework for mentor development with elements that address both individual mentoring competencies and the institutional climate for mentoring. The framework depicts the gaps, activities, and outcomes that a mentor development program can address. Activities directed at changing the institutional climate related to mentor development should complement training activities for individual mentors. The authors propose that employing this framework’s approach to mentor development will lead to the desired impact: to increase the competence, productivity, and retention of a diverse clinical and translational research workforce.
Variability in Women Faculty’s Preferences Regarding Mentor Similarity: A Multi-Institution Study in Academic Medicine
Authors: Carapinha René , Ortiz-Walters Rowena , McCracken Caitlin M. , Hill Emorcia V. , Reede Joan Y.
Published: June 2016

Purpose

To investigate which mentor-similarity characteristics women faculty in academic medicine rate most important and to determine whether this importance differs among women faculty on the basis of current and prior mentoring, demographic and personal factors, and career factors.

Method

Cross-sectional survey data from 3,100 women faculty at 13 purposively sampled U.S. medical schools were collected in 2012. The preferences of participants regarding the importance of mentor similarity in terms of race/ethnicity, gender, personal and career interests, and department and institution were studied. Analysis entailed chi-square tests and multivariable ordered logistic models.

Results

Overall, respondents ranked having a mentor in the same department and institution as most important. Same department and institution were less important for those without a current mentor and for senior faculty, and were more important for Asian faculty. Same career and personal interests were less important for older faculty and more important for those with a doctorate only. Same gender was more important for black faculty, faculty at the rank of instructor, and those without current mentoring. Overall, same race/ethnicity was rated least important; however, it was more important for racial–ethnic minorities, U.S.-born faculty, and those who had never had a mentor.

Conclusions

Mentor preferences, as indicated by level of importance assigned to types of mentor similarity, varied among women faculty. To advance effective mentoring, characterized by good mentor–mentee fit, the authors provide recommendations on matching strategies to be used in academic medicine when considering the diverse mentor preferences of women faculty.
Opening a New Level II Trauma Center Near an Established Level I Trauma Center: Is This Good for Trauma Care?
Authors: Martin Cody L. , Aldridge Petra J. , Harris Anthony M. , Perkins Christopher H.
Published: June 2016

Objectives:

To describe how the initiation and later removal of a provisional level II trauma center (PL2TC) status at a community hospital affected the volume and severity of injured patients seen at an established academic level 1 trauma center (AL1TC).

Methods:

Census data including counts of injury ICD-9 codes and patients seen in the emergency department (ED) and trauma center at an AL1TC were collected monthly from January 2010 to October 2014. An interrupted time series analysis was used to model the monthly census data with 2 time interruptions to describe the change in patient volume at the interruptions. The interruptions were (1) the initiation of the PL2TC status at a nearby community hospital and (2) the subsequent removal of the PL2TC status.

Results:

The number of diagnoses, encounters, and patients seen at the AL1TC ED decreased while the PL2TC was operating. After the removal of the PL2TC status, there was a 19.4% increase in the ED patient volume per month at the AL1TC. The number of orthopaedic trauma patients seen through the ED at the AL1TC dropped 11.1% per month when the PL2TC began functioning as a trauma center. However, the volume of orthopaedic patients at the AL1TC did not recuperate after the PL2TC lost level 2 status.

Conclusions:

A significant decrease in patient volume was seen at the AL1TC with the initiation of the PL2TC in close proximity. Orthopaedic patient volume did not recuperate after the removal of the PL2TC status.
TTF-1 and PAX5 Are Frequently Expressed in Combined Merkel Cell Carcinoma
Authors: Czapiewski Piotr , Majewska Hanna , Kutzner Heinz , Kazakov Dmitry , Renkielska Alicja , Biernat Wojciech
Published: June 2016

Thyroid transcription factor-1 (TTF-1) is a marker of tumors of pulmonary and thyroid origin, and its expression practically excludes diagnosis of Merkel cell carcinoma (MCC). However, TTF-1 expression in combined MCC was recently reported. PAX5 is a marker of B-cell origin that is also expressed in most classical MCC cases; however, its expression was not described in combined MCC. The authors decided to evaluate the expression of both these markers in a group of 5 combined MCCs (2 with invasive squamous cell carcinoma, 2 with squamous cell carcinoma in situ, and 1 with basal cell carcinoma). Expression of TTF-1 was found in 4 of 5 cases; in 3 cases, the marker was shown in the MCC component (weakly in 2 cases and strongly in 1 case), whereas the non-MCC component presented TTF-1 expression in 2 cases. A weak-to-moderate immunoreactivity for PAX5 was identified in all cases of the MCC component but in none of the non-MCC component. The results show that the expression of TTF-1 is a frequent finding in combined MCC and can be present in the neuroendocrine component, which differs from the conventional MCC. In contrast, PAX5 expression pattern is similar to that of the classical MCC.
Photodynamic Therapy: A Clinical Consensus Guide
Authors: Ozog David M. , Rkein Ali M. , Fabi Sabrina G. , Gold Michael H. , Goldman Mitchel P. , Lowe Nicholas J. , Martin George M. , Munavalli Girish S.
Published: June 2016

BACKGROUND

The American Society of Dermatologic Surgery (ASDS) periodically develops consensus documents for its members concerning various aspects of dermatologic surgery. Advances in photodynamic therapy (PDT) have been many and PDT use has been established in a variety of skin conditions.

OBJECTIVE

The ASDS board of directors proposed a committee of experts in the field to develop consensus documents on different treatments. An expert panel reviewed the literature on PDT and discussed the findings. The consensus was reached with evidence-based recommendations on different clinical applications for PDT.

PATIENTS AND METHODS

This consensus document includes discussions regarding PDT, including different photosensitizers and various light source activators, historical perspective, mechanism of action, various therapeutic indications and expected outcomes, pre- and post-care, and management of adverse outcomes.

RESULTS

Photodynamic therapy is highly effective for pre-cancerous lesions, superficial nonmelanoma skin cancers, inflammatory acne vulgaris and other conditions. New protocols including laser mediated PDT significantly improve results for several indications.

CONCLUSION

The ASDS consensus document on PDT will be helpful for educating members on safe and effective PDT for a variety of indications.
Estrogen and DPP4 inhibitor, but not metformin, exert cardioprotection via attenuating cardiac mitochondrial dysfunction in obese insulin-resistant and estrogen-deprived female rats
Authors: Sivasinprasasn Sivaporn , Sa-nguanmoo Piangkwan , Pongkan Wanpitak , Pratchayasakul Wasana , Chattipakorn Siriporn C. , Chattipakorn Nipon
Published: June 2016

Objective:

Cardiac function was markedly compromised in obese insulin-resistant and estrogen-deprived rats. Metformin and dipeptidyl peptidase-4 inhibitor (vildagliptin) were reported to improve cardiac function in insulin-resistant rats. Their effects on the heart under estrogen-deprived conditions are, however, unknown. Therefore, the effects of metformin, vildagliptin, and estrogen on the cardiac function in estrogen-deprived insulin-resistant female rats were investigated.

Methods:

Bilateral ovariectomized female rats (n = 48) were divided to be fed with either a normal diet (ND) or a high-fat diet (HFD) for 12 weeks. Then, both ND- and HFD-fed groups were subdivided to receive a vehicle, estrogen (50 μg/kg), metformin (30 mg/kg), or vildagliptin (3 mg/kg) for 4 weeks (n = 6/group). Heart rate variability, echocardiography, metabolic and biochemical parameters, cardiac function, and mitochondrial function were determined. Sham-operated female rats (n = 6) were used as a control.

Results:

Both ND- and HFD-fed ovariectomized rats developed insulin resistance, depressed heart rate variability, and decreased cardiac contractility. Although treatment with metformin, vildagliptin, and estrogen improved metabolic status and cardiac function, only estrogen and vildagliptin improved diastolic blood pressure and left ventricular ±dP/dt, and also reduced mitochondrial impairment, apoptosis, and oxidative stress in HD-fed ovariectomized rats.

Conclusions:

Treatment with estrogen and vildagliptin provided more beneficial effects in the inhibition of oxidative stress, apoptosis, and cardiac mitochondrial dysfunction, and preserved cardiac contractile performance in estrogen-deprived insulin-resistant female rats.
Varied Definitions of Nasolabial Angle: Searching for Consensus Among Rhinoplasty Surgeons and an Algorithm for Selecting the Ideal Method
Authors: Harris Ryan , Nagarkar Purushottam , Amirlak Bardia
Published: June 2016

Background:

The nasolabial angle (NLA) is an important aesthetic metric for nasal assessment and correction. Although the literature offers many definitions, none has garnered universal acceptance.

Methods:

To gauge the consensus level among practitioners, surveys were administered to a convenience sample of rhinoplasty surgeons soliciting practice characteristics, self-assessment of rhinoplasty experience and expertise, and preferred NLA definition. Choices of NLA definition included the angle between: (A) columella and line intersecting subnasale and labrale superius; (B) columella and line tangent to philtrum; (C) nostril long axis and Frankfort perpendicular; and (D) nostril long axis and vertical facial plane.

Results:

Of the 82 total respondents, mean age was 50 years (range, 30–80years), and mean professional experience was 17 years (range, 0–67 years). Nineteen described themselves as novice rhinoplasty surgeons, 27 as intermediates, and 36 as experts. Mean number of lifetime rhinoplasties performed was 966 (range, 0–10,000). Twenty respondents (24%) agreed with definition A, 27 (33%) with B, 16 (20%) with C, and 13 (16%) with D. Six chose “other,” offering their own explanations of NLA. Self-identified novices were more likely to prefer definition D than were experts (P = 0.009).

Conclusions:

No majority consensus was reached regarding the definition of NLA. Each method has its benefits and drawbacks, and establishing a single one may be unnecessary and even counterproductive in some cases. Having options available means that surgeons can tailor to each encounter, as long as they adopt a systematic methodology. We submit an algorithm to facilitate this effort.
Iron Status at Age 6 Months in Colombian Infants Exclusively Breast‐fed for 4 to 5 Versus 6 Months
Authors: Olaya Gilma A. , Lawson Margaret , Fewtrell Mary
Published: June 2016

Objectives:

The optimal age for introducing complementary feeding to breast‐fed infants may differ depending on the setting. Prolonged exclusive breast‐feeding (EBF) protects against infection but may increase the risk of iron deficiency (ID)/anaemia (IDA) in vulnerable infants. The aim of the present study was to compare haemoglobin (Hb), serum ferritin (SF), anaemia (Hb < 11 g/L), ID (SF < 12 μg/L) and IDA (Hb < 10.5 g/dL + Hct < 33% + ID) using observational analyses in 6‐month old infants from Bogota, Colombia who were EBF for 4 to 5 versus 6 months or older, and examine predictors.

Methods:

Infant feeding was recorded, anthropometry performed, and blood obtained for Hb and SF at 6 months in healthy term infants (birth weight > 2500 g), all EBF for ≥4 months.

Results:

One hundred eight infants (54% boys) were recruited; 46% EBF for 4 to 5 months, 54% EBF at 6 months. Prevalence of anaemia, ID, and IDA was 20%, 10%, and 5%, with no significant difference between EBF4–5 and EBF6 groups. In multivariate models, anaemia/ID were predicted by greater weight gain from 0 to 6 months, and anaemia also by caesarean delivery; Hb was lower in infants with higher intake of cows’ milk; SF was lower in boys and those with greater weight gain. EBF4–5 versus EBF6 was not a significant predictor of any outcome.

Conclusions:

Anaemia and ID were common at 6 months but were not affected by EBF for 4 to 5 versus 6 months, suggesting 6 months EBF is safe in this population. Further research is, however, required to examine effects on later iron status. The findings highlight the need to emphasise avoidance of cow's milk before 12 months.
A Clinical and Molecular Genetic Study in 11 Chinese Children With Peutz‐Jeghers Syndrome
Authors: Zheng Bixia , Wang Chunli , Jia Zhanjun , Liu Zhifeng , Li Mei , Jin Yu , Pan Jian
Published: June 2016

Objectives:

Peutz‐Jeghers syndrome (PJS) is caused by the germline mutations in serine/threonine kinase 11 (STK11) gene. The aim of the present study was to investigate the spectrum of STK11 gene mutations using multiplex ligation–dependent probe amplification (MLPA) assay in combination with direct sequencing in Chinese children with PJS.

Methods:

Nine children who met the clinical criteria for PJS and 2 presumed patients with PJS were enrolled in the present study. Patients’ clinical information on polyp characteristics, polyp‐related complications, family histories, and so on were reviewed and analyzed. After obtaining informed consent, we performed a mutation analysis of STK11 gene in 11 Chinese patients using MLPA assay and direct sequencing.

Results:

By means of MLPA method, we detected exonic deletions in 5 patients. In details, 1 patient had the complete deletion of all 10 exons, 3 patients showed deletions of promoter region and exon 1, and 1 patient had exon deletions from 1 to 9. By direct sequencing of the coding region of STK11 gene, we identified point mutations in 4 patients at c.548T>G/p.Leu183Arg, c.580G>T/p.Asp194Tyr, c.152_153insGG/Asp53GlyfsX12, and c.631delC/Arg211GlyfsX76, respectively, and 3 of them are novel mutations. We failed to find any mutation in left 2 patients who met the clinical criteria of PJS.

Conclusions:

MLPA plus direct sequencing revealed large genomic deletions of STK11 gene in Chinese children with PJS and increased the detecting rate of STK11 gene mutations in Chinese patients with PJS. MLPA combined with direct sequencing could serve as a better strategy for the genetic diagnosis of PJS in Chinese population.