bluuebunny/crossref_metadata_2025 huggingface dataset:
ÖVKT-Tagung 2016: Grenzen überschreiten
Authors: Thalmayr Maria
Published: November 2016

„Mit Technik allein werden wir die Probleme unserer Zukunft nicht lösen“, räumte ÖVKT-Präsident Martin Krammer auf der Jahrestagung der Österreichischen Krankenhaustechniker ein. Krankenhaustechniker seien dennoch gefordert, immer wieder vermeintliche Grenzen zu überschreiten, um – mit angemessenen Mitteln – zu einem bestmöglichen Gesundheitswesen beizutragen.
Bagatellkrankheiten in der Rettungsstelle: Holt die Vertragsärzte in die Notaufnahme!
Authors: Ekkernkamp Axel
Published: November 2016

Eines der Themen, das die Diskussion der Krankenhausrepräsentanten gegenüber Politik und Kostenträgern in diesem Jahr prägt, ist die Überforderung der Krankenhäuser durch Notfallpatienten, die eigentlich im Vertragsarztbereich versorgt werden könnten. Dass Patienten mit einer Erkältung sogar während der Öffnungszeiten von Vertragsarztpraxen Ambulanzen der Krankenhäuser oder gar der Universitätskliniken aufsuchen, ist sicherlich misslich. Wirklich wichtig – leider nicht im Mittelpunkt der Betrachtung – ist dabei die Frage, wie der Notfall zu definieren ist. In einem demokratischen Staatswesen orientiert sich der Notfall nicht an einer staatlich vorgegebenen Liste. Der Patient empfindet ein akutes Ereignis als derartig problematisch, dass er innerhalb kürzester Zeit eine Institution aufsuchen möchte, in die er Vertrauen setzt.
Electronic structure of bilayer graphene physisorbed on metal substrates
Authors: Khan Emroz , Rahman Tahmid Sami , Subrina Samia
Published: November 2016

Graphene-metal interfaces have recently become popular for graphene growth and for making contacts in numerous thermal and photo-electronic devices. A number of studies have already been made to investigate the interfacial properties when single layer graphene is grown on metal substrates. In this study, we consider the physisorption of bilayer graphene on metals and find a significant bandgap opening which is otherwise absent in the single layer case. This gap arises from the asymmetry in the bilayer due to the charge transfer process at the interface. This charge transfer also causes doping in the bilayer graphene and a corresponding shift in the Fermi level. In this work, we present a thorough investigation into the induced bandgap and Fermi level shift when bilayer graphene is adsorbed on Cu, Al, Ag, Pt, and Au(111) surfaces first by reporting their values from Density Functional Theory (DFT) studies with Local Density Approximation functional used for exchange-correlation energy. Next, to obtain an enhanced picture of the surface physics at play (which is usually obscured by the complexities of DFT), we provide an analytical model to relate the induced bandgap and Fermi level shift to the metal work function and interface separation distance. The values predicted from the model shows a high degree of correlation with the values obtained from the DFT simulation. The results are expected to greatly facilitate the understanding of bilayer graphene adsorption on metals, which in turn may aid the study of graphene electronic devices.
A compact five-port waveguide structure and its application as a three-way power divider
Authors: Guo Letian , Li Jiawei , Ba Tao , Huang Wenhua , Shao Hao
Published: November 2016

A compact five-port waveguide structure consisting of three rectangular ports, one coaxial port, and one circular waveguide port is proposed. The three rectangular waveguides are uniformly distributed in space at angles of 120°, and the coaxial and circular waveguides are located at the top and bottom, respectively, of the rectangular waveguides. The ideal scattering matrix is derived from the symmetry properties of the structure. If the circular and coaxial ports are matched, then the entire five-port waveguide structure is automatically matched. Two connected inserted coaxial probes, a frustum, and a coaxial transition are used to match the five-port waveguide structure with a relatively wide bandwidth. The theoretical and experimental results are generally consistent with each other. With the circular port connected to the load, the five-port waveguide structure becomes a reciprocal TEM mode-to-three-way TE10 mode power divider. Measurements indicate that from 8 to 9.6 GHz, the return losses at the three rectangular ports and the coaxial port are greater than 20 dB and 17 dB, respectively. The isolation among the three rectangular ports is higher than 20 dB. The amplitude and phase imbalances in the division of power are less than 0.1 dB and 2°, respectively. The volume of the five-port waveguide structure is as small as 1.5 λ × 1.5λ × λ.
On effects of viscosity and magnetic fields on the largest growth rate of linear Rayleigh–Taylor instability
Authors: Jiang Fei
Published: November 2016

In this article, we investigate the effect of viscosity on the largest growth rate in the linear Rayleigh–Taylor (RT) instability of a three-dimensional nonhomogeneous incompressible viscous flow in a bounded domain. By adapting a modified variational approach and careful analysis, we show that the largest growth rate in linear RT instability tends to zero as the viscosity coefficient goes to infinity. Moreover, the largest growth rate increasingly converges to one of the corresponding inviscid fluids as the viscosity coefficient goes to zero. Applying these analysis techniques to the corresponding viscous magnetohydrodynamic fluids, we can also show that the largest growth rate in linear magnetic RT instability tends to zero as the strength of horizontal (or vertical) magnetic field increasingly goes to a critical value.
Recurrence relations of the multi-indexed orthogonal polynomials. IV. Closure relations and creation/annihilation operators
Authors: Odake Satoru
Published: November 2016

We consider the exactly solvable quantum mechanical systems whose eigenfunctions are described by the multi-indexed orthogonal polynomials of Laguerre, Jacobi, Wilson, and Askey-Wilson types. Corresponding to the recurrence relations with constant coefficients for the M-indexed orthogonal polynomials, it is expected that the systems satisfy the generalized closure relations. In fact we can verify this statement for small M examples. The generalized closure relation gives the exact Heisenberg operator solution of a certain operator, from which the creation and annihilation operators of the system are obtained.
Photogenerated carriers enhancement in Cu-doped ZnSe/ZnS/L-cys self-assembled core-shell quantum dots
Authors: Cui J. Y. , Li K. Y. , Ren L. , Zhao J. , Shen T. D.
Published: November 2016

The photoelectron characteristics and nano-doping mechanism of Cu-doped ZnSe/ZnS/L-cys self-assembled core-shell quantum dots (QDs) are studied by surface photovoltaic (SPV) and photoacoustic (PA) techniques, XRD, HRTEM, FT-IR, UV-VIS adsorption, and Laser Raman spectra. The results suggest that the doped copper element prefers to locate at the Zn atom-vacancy of the (111) face of the QDs in the Cu2+ ion form. The defect-state levels are referred to the shallow accepter levels, leading to an obvious quantum confinement effect and a weakened n-type surface photovoltaic characteristic in the Cu-doped QDs. The quantum confinement effect strongly depends on the depth of the quantum well that is buried in the space charge region located in the graded-band-gap and at the side of the core-ZnSe. These electron structures are responsible for the increased lifetime and diffusion length of photogenerated free charge carriers, which significantly enhance the intensity of SPV response, enlarge the range of SPV response, and weaken the PA signals that are closely related to non-radiation deexcitation processes.
Breaking network connectivity leads to ultralow thermal conductivities in fully dense amorphous solids
Authors: Braun Jeffrey L. , King Sean W. , Giri Ashutosh , Gaskins John T. , Sato Masanori , Fujiseki Takemasa , Fujiwara Hiroyuki , Hopkins Patrick E.
Published: November 2016

We demonstrate a method to reduce the thermal conductivity of fully dense (above the rigidity percolation threshold) amorphous thin films below the minimum limit by systematically changing the coordination number through hydrogenation. Studying a-SiO:H, a-SiC:H, and a-Si:H thin films, we measure the thermal properties using time-domain thermoreflectance to show that thermal conductivity can be reduced below the amorphous limit by a factor of up to two. By experimentally investigating the thermophysical parameters that determine thermal conductivity, we show that sound speed, atomic density, and heat capacity cannot explain the measured reduction in thermal conductivity, revealing that the coordination number can significantly alter the scattering length scale of heat carriers. Reformulating the minimum limit to consider the propensity for energy to transfer through the non-hydrogen network of atoms, we observe greatly improved agreement with experimental data.
An alternative method of constructing axisymmetric toroidal equilibria with nonparallel flow
Authors: Kuiroukidis Ap , Throumoulopoulos G. N.
Published: November 2016

An alternative method based on an inverse aspect ratio (ϵ) expansion which reduces the axisymmetric equilibrium problem to a set of ODEs containing terms of arbitrary order in ϵ is employed to solve a generalized Grad-Shafranov equation with incompressible sheared flow nonparallel to the magnetic field. The method is applied to construct equilibria with either circular magnetic surfaces and reversed magnetic shear or D-shaped magnetic surfaces and normal magnetic shear. From the former equilibrium, it turns out that the electric field results in an increase of the reversed magnetic shear, thus indicating potential synergetic effects of the sheared flow and the magnetic shear in the formation of an internal transport barrier in consistent with experimental evidence.
Computational discovery and characterization of polymorphic two-dimensional IV–V materials
Authors: Ashton Michael , Sinnott Susan B. , Hennig Richard G.
Published: November 2016

First-principles calculations predict the stability and properties of two-dimensional (2D) group IV–V MX compounds (M = Si, Ge, Sn, Pb; X = P, As, Sb, Bi) in two distinct crystallographic configurations: a low symmetry Cm layer inspired by the layered bulk structures of SiP, SiAs, GeP, and GeAs, and a high symmetry P6¯m2 structure previously predicted for 2D SiP. The calculations predict that the Cm structure is more stable for X = As, Sb, and Bi, and the P6¯m2 structure for X = P. The electronic properties of the two structures are quite different. Specifically, the Cm band gaps are systematically larger by about 15% for most compounds, and the band offsets indicate that all of these compounds in the Cm crystal structure will form type II heterojunctions in contact with their P6¯m2 polymorphs. Pourbaix diagrams predict that a few of the 2D IV–V compounds are stable when exposed to water.
Critical role of W deposition condition on spin-orbit torque induced magnetization switching in nanoscale W/CoFeB/MgO
Authors: Zhang C. , Fukami S. , Watanabe K. , Ohkawara A. , DuttaGupta S. , Sato H. , Matsukura F. , Ohno H.
Published: November 2016

We study the spin-orbit torque induced magnetization switching in W/CoFeB/MgO heterostructures with W deposited under different sputtering conditions. We show that the crystal structure and resistivity of W depend on the employed sputtering conditions. Switching current of nanoscale devices is smaller while effective anisotropy field is larger for the devices with more resistive W channel deposited at lower sputtering power and higher Ar gas pressure. The effective spin Hall angle evaluated from the switching probability varies by a factor of 2–3 depending on the W resistivity controlled by the sputtering conditions.
Thermodynamic estimation the compressibility of ferropericlase under high pressure
Authors: Zhang Baohua , Xu Junshan
Published: November 2016

The elastic properties of (Mg1-xFex)O ferropericlase are essential to analyze seismic data and to constrain its chemical composition in the lower mantle. In this study, we suggest a simple thermodynamic model that enables the estimation of the bulk moduli of (Mg1−xFex)O ferropericlase as a function of component x in terms of the elastic data of the end members. Our calculated bulk moduli compare favorably with reported experimental data when uncertainties are considered.
Rapid changes in root HvPIP2;2 aquaporins abundance and ABA concentration are required to enhance root hydraulic conductivity and maintain leaf water potential in response to increased evaporative demand
Authors: Veselov Dmitry S. , Sharipova Guzel V. , Veselov Stanislav Yu. , Dodd Ian C. , Ivanov Igor , Kudoyarova Guzel R.
Published: November 2016

To address the involvement of abscisic acid (ABA) in regulating transpiration and root hydraulic conductivity (LpRoot) and their relative importance for maintaining leaf hydration, the ABA-deficient barley mutant Az34 and its parental wild-type (WT) genotype (cv. Steptoe) were grown in hydroponics and exposed to changes in atmospheric vapour pressure deficit (VPD) imposed by air warming. WT plants were capable of maintaining leaf water potential (ψL) that was likely due to increased LpRoot enabling higher water flow from the roots, which increased in response to air warming. The increased LpRoot and immunostaining for HvPIP2;2 aquaporins (AQPs) correlated with increased root ABA content of WT plants when exposed to increased air temperature. The failure of Az34 to maintain ψL during air warming may be due to lower LpRoot than WT plants, and an inability to respond to changes in air temperature. The correlation between root ABA content and LpRoot was further supported by increased root hydraulic conductivity in both genotypes when treated with exogenous ABA (10−5 M). Thus the ability of the root system to rapidly regulate ABA levels (and thence aquaporin abundance and hydraulic conductivity) seems important to maintain leaf hydration.
Sex and the shifting biodiversity dynamics of marine animals in deep time
Authors: Bush Andrew M. , Hunt Gene , Bambach Richard K.
Published: November 2016

Significance

Fertilization mechanisms explain broad patterns in the taxonomic distribution of diversity in marine animals, as argued previously for land plants. We argue that fertilization via copulation (or some other significant interaction among adults) permits additional mechanisms of reproductive isolation and smaller population sizes relative to fertilization via the broadcasting of sperm into the water, thus enhancing diversification potential. Maximum-likelihood modeling of paleontological data indicates that the diversity of sperm broadcasters has been limited by diversity-dependent factors for the last 450 million years. In contrast, animals that copulate, etc., were also limited until the Cretaceous and then radiated dramatically, coincident with apparent major changes in marine productivity. Fertilization may have acted synergistically with ecological specialization in promoting diversification, particularly in predators.
ESA-UbiSite: accurate prediction of human ubiquitination sites by identifying a set of effective negatives
Authors: Wang Jyun-Rong , Huang Wen-Lin , Tsai Ming-Ju , Hsu Kai-Ti , Huang Hui-Ling , Ho Shinn-Ying
Published: November 2016

Motivation

Numerous ubiquitination sites remain undiscovered because of the limitations of mass spectrometry-based methods. Existing prediction methods use randomly selected non-validated sites as non-ubiquitination sites to train ubiquitination site prediction models.

Results

We propose an evolutionary screening algorithm (ESA) to select effective negatives among non-validated sites and an ESA-based prediction method, ESA-UbiSite, to identify human ubiquitination sites. The ESA selects non-validated sites least likely to be ubiquitination sites as training negatives. Moreover, the ESA and ESA-UbiSite use a set of well-selected physicochemical properties together with a support vector machine for accurate prediction. Experimental results show that ESA-UbiSite with effective negatives achieved 0.92 test accuracy and a Matthews’s correlation coefficient of 0.48, better than existing prediction methods. The ESA increased ESA-UbiSite’s test accuracy from 0.75 to 0.92 and can improve other post-translational modification site prediction methods.

Availability and Implementation

An ESA-UbiSite-based web server has been established at http://iclab.life.nctu.edu.tw/iclab_webtools/ESAUbiSite/.

Supplementary information

Supplementary data are available at Bioinformatics online.
Agent-based re-engineering of ErbB signaling: a modeling pipeline for integrative systems biology
Authors: Das Arya A , Ajayakumar Darsana T , Jacob Elizabeth
Published: November 2016

Motivation

Experiments in systems biology are generally supported by a computational model which quantitatively estimates the parameters of the system by finding the best fit to the experiment. Mathematical models have proved to be successful in reverse engineering the system. The data generated is interpreted to understand the dynamics of the underlying phenomena. The question we have sought to answer is that – is it possible to use an agent-based approach to re-engineer a biological process, making use of the available knowledge from experimental and modelling efforts? Can the bottom-up approach benefit from the top-down exercise so as to create an integrated modelling formalism for systems biology? We propose a modelling pipeline that learns from the data given by reverse engineering, and uses it for re-engineering the system, to carry out in-silico experiments.

Results

A mathematical model that quantitatively predicts co-expression of EGFR-HER2 receptors in activation and trafficking has been taken for this study. The pipeline architecture takes cues from the population model that gives the rates of biochemical reactions, to formulate knowledge-based rules for the particle model. Agent-based simulations using these rules, support the existing facts on EGFR-HER2 dynamics. We conclude that, re-engineering models, built using the results of reverse engineering, opens up the possibility of harnessing the power pack of data which now lies scattered in literature. Virtual experiments could then become more realistic when empowered with the findings of empirical cell biology and modelling studies.

Availability and Implementation

Implemented on the Agent Modelling Framework developed in-house. C ++ code templates available in Supplementary material.

Supplementary information

Supplementary data are available at Bioinformatics online.
Invasive Systemic Infection After Hospital Treatment for Diabetic Foot Ulcer: Risk of Occurrence and Effect on Survival
Authors: Chen Shey-Ying , Giurini John M , Karchmer Adolf W
Published: November 2016

Background

Diabetic foot ulcers (DFUs) threaten limbs and prompt hospitalization. After hospitalization, remote-site invasive systemic infection related to DFU (DFU-ISI) may occur. The characteristics of DFU-ISIs and their effect on mortality risk have not been defined.

Methods

We conducted a retrospective cohort study of 819 diabetic patients hospitalized for treatment of 1212 unique DFUs during a 9-year period. We defined the index ulcer as that present at the first (index) DFU admission to our hospital. We defined DFU-ISI as a nonfoot infection that occurred after the index hospitalization and was caused by a microorganism concomitantly or previously cultured from the index ulcer. We determined the frequency, risk factors, and mortality risk associated with DFU-ISIs.

Results

After 1212 index DFU hospitalizations, 141 patients had 172 DFU-ISIs. Of the initial 141 DFU-ISIs, 64% were bacteremia, 13% deep abscesses, 10% pneumonia, 7% endocarditis, and 6% skeletal infections. Methicillin-resistant Staphylococcus aureus (MRSA) caused 57% of the ISIs. Patients with initial DFU cultures yielding MRSA and protracted open ulcers had a high 24-month cumulative probability of DFU-ISI (31%) and all-cause mortality rate (13%). Analysis with Cox regression modeling showed that complicated ulcer healing (hazard ratio, 3.812; 95% confidence interval, 2.434–5.971) and initial DFU culture yielding MRSA (2.030; 1.452–2.838) predicted DFU-ISIs and that DFU-ISIs were associated with increased mortality risk (1.987; 1.106–3.568).

Conclusions

DFU-ISIs are important late complications of DFUs. Prevention of DFU-ISIs should be studied prospectively. Meanwhile, clinicians should aggressively incorporate treatment to accelerate ulcer healing and address MRSA into the care of diabetic patients with foot ulcers.
Microangiopathic Hemolytic Anemia Due to Malignancy in Pregnancy
Authors: Happe Sarah K. , Zofkie Amanda C. , Nelson David B.
Published: November 2016

BACKGROUND:

Microangiopathic disorders during pregnancy remain a diagnostic challenge because these conditions often imitate more common obstetric diseases.

CASE:

A 31-year-old multigravid woman delivered at term with a postpartum course complicated by laboratory indices consistent with hemolysis, elevated liver enzymes, and low platelet count syndrome. After clinical recovery, she was readmitted 2 weeks after delivery with presumptive pyelonephritis. Persistent hemolysis and worsening thrombocytopenia suggested a diagnosis of thrombotic microangiopathy, which did not respond to plasma exchange. Directed bone biopsy revealed metastatic signet ring cell adenocarcinoma.

CONCLUSION:

Microangiopathic hemolytic anemia is rarely the initial clinical manifestation of malignancy. Given the similar features of several common obstetric complications, additional diagnostic measures may be necessary to refine the diagnosis in cases unresponsive to standard obstetric management.
Hip Dislocation and Dystocia in Early Medieval Times
Authors: Malgosa Assumpció , Carrascal Susana , Piga Giampaolo , Isidro Albert
Published: November 2016

BACKGROUND:

In ancient times, maternal mortality would occur frequently, particularly during labor. Evidence of dystocia resulting in the death of a pregnant woman is very infrequent in paleopathologic literature, with only a few cases being demonstrated.

CASE:

In the early medieval site of Casserres, the skeleton of a young woman with a fetus in the pelvic region was found. Some abnormal findings of the maternal skeleton were evaluated, including a sacral anomaly, femoral head wound, the rare position of the lower left limb with the femoral head dislodged anteriorly and cephalad from the socket, and a fibular fracture.

CONCLUSION:

Examining the anomalies all together, a case of anterior hip dislocation related to a McRoberts-like maneuver performed during labor is a plausible explanation of the findings.
Social Contributors to Glycemic Control in Gestational Diabetes Mellitus
Authors: Colicchia Laura C. , Parviainen Kristiina , Chang Judy C.
Published: November 2016

OBJECTIVE:

To evaluate the association of social factors with glycemic control in women with gestational diabetes mellitus (GDM).

METHODS:

A survey instrument assessing social support, access to healthy food, cooking and meal preparation, chaotic lifestyle, employer support, and physical and emotional responses to food was developed and administered to women with GDM at maternal–fetal medicine office visits. Validated scales were used to measure social support and life chaos (defined as organization, instability, and the ability to plan and prepare for the future). Glycemic control and pregnancy outcome were ascertained by chart review. Multivariable logistic regression was used to quantify the association of these factors with the primary outcome of satisfactory glycemic control, defined as greater than 70% of blood sugars within goal.

RESULTS:

We approached 145 women, of whom 111 agreed to participate (76.5%). Seventy-seven percent of patients (86/111) achieved satisfactory glycemic control. Chaotic lifestyle (Confusion, Hubbub and Order Scale score 12.5±2.9 for those with good control, 16.3±3.9 for poor control; odds ratio [OR] 0.71, 95% confidence interval [CI] 0.59–0.85) and receipt of food stamps (11/86 [12.9%] for good control and 10/25 [40%] for poor control; OR 0.22, 95% CI 0.08–0.62) were associated with decreased likelihood of achieving glycemic control. Being married (67/86 [77.9%] for good control and 12/25 [48.0%] for poor control; OR 3.82, 95% CI 1.49–9.74) and regular exercise (49/86 [57.0%] for good control and 5/25 [20.0%] for poor control; OR 5.03, 95% CI 1.72–14.72) increased the likelihood of achieving glycemic control. Transportation time to food stores, home cooking, and social support were not associated with glycemic control or pregnancy outcomes.

CONCLUSION:

Social factors are associated with glycemic control in GDM and may be modifiable to improve glucose control.
What Is New in Medical–Legal Issues in Obstetrics and Gynecology?
Authors: Shwayder James M.
Published: November 2016

This month we focus on current research in medical–legal issues in obstetrics and gynecology. Dr. Shwayder discusses four recent publications, which are concluded with a “bottom line” that is the take-home message. The complete reference for each can be found in Box 1 on this page, along with direct links to the abstracts.
Extensor Tendon Injury Associated With Dorsal Entry Flexible Nailing of Radial Shaft Fractures in Children: A Report of 5 New Cases and Review of the Literature
Authors: Murphy Hamadi A. , Jain Viral V. , Parikh Shital N. , Wall Eric J. , Cornwall Roger , Mehlman Charles T.
Published: November 2016

Background:

Extensor pollicis longus (EPL) tendon injury following the dorsal approach to elastic stable intramedullary nailing (ESIN) of the radius has been reported in a growing number of cases in the literature. This study includes 5 new cases from our institution as well as a comprehensive review of previously reported cases from the literature.

Methods:

We conducted a retrospective chart review of all patients undergoing ESIN between January 1, 2004 and December 31, 2013 at our institution. Those patients with an EPL injury or rupture were identified and clinical data collected included operative technique, diagnosis, treatment, and outcomes data. In addition, we performed a systematic review of the literature using Pubmed MEDLINE database, the Chochrane database, Scopus, Web of Science, and Embase. A total of 28 cases of EPL injury following ESIN of the radius were identified in the literature and the relevant data were extracted from those studies.

Results:

All 33 pediatric cases of EPL tendon injury occurred after entry to the radial canal was obtained by the dorsal approach to ESIN. EPL injury was diagnosed an average of 10 weeks following the index procedure. Extensor indicis pollicis to EPL transfer was performed in 13 patients, tendon release/lysis of adhesions in 5, EPL repair in 2, EPL graft reconstruction from palmaris longus tendon in 1, 3 patients refused further intervention, and treatment was unreported in 7 cases. By 12-month follow-up, all operatively treated patients had a good functional outcome with near anatomic extension at the thumb interphalangeal joint, no pain, and no further complication.

Conclusions:

EPL tendon injury was found to be a complication unique to the dorsal entry approach for ESIN of the radius. The lateral approach appears to offer a safer alternative with regard to the EPL tendon. We suggest that physicians consider the risk of EPL tendon injury when planning for ESIN of the radius, and make an effort to avoid direct injury when using a dorsal approach.

Level of Evidence:

Level III—therapeutic.
Reliability of Casting Indices Among Members of an Orthopaedic Surgery Residency
Authors: Williams Nathan D. , Rush Jeremy K. , Schmitz Matthew R. , Johnson Anthony E.
Published: November 2016

Background:

Multiple casting indices have been described to evaluate the adequacy of cast placement in pediatric distal forearm fractures. The aim of this study was to determine the intrarater and interrater reliability of the measurements of 5 common casting indices among members of an orthopaedic surgery residency program. The cast index, 3-point index, gap index, padding index, and Canterbury index were evaluated.

Methods:

This was a single-center prospective cohort reliability study that included 12 members of an orthopaedic surgery residency. Participants were placed into 1 of 4 groups by level of training: physician assistants, junior residents, senior residents, and attending orthopaedic surgeons. Twelve radiographs of casted pediatric distal forearm fractures were measured by each participant on 2 separate occasions. Statistical analysis using the intraclass correlation coefficient was used to determine the intrarater and interrater reliability.

Results:

The cast index was the only casting index to meet our criteria for good intrarater and interrater reliability.

Conclusion:

Continued use of the cast index as a tool to assess pediatric distal forearm cast application is supported by this study.

Level of Evidence:

Level 2.
No association of reproductive risk factors with breast cancer tumor grade
Authors: Somasegar Sahana , Li Li , Thompson Cheryl L.
Published: November 2016

Histological tumor grade is a well-established marker of breast tumor aggressiveness and prognosis. A number of reproductive factors, including parity and age at first birth, have been shown to be related to breast cancer risk, but few studies have examined the association of these variables with breast cancer aggressiveness. In this study, 813 newly diagnosed breast cancer patients were surveyed for demographic and lifestyle characteristics. Tumor grade and other clinical variables were abstracted from medical records. Multivariate logistic regressions were performed with each reproductive factor as the independent variable of interest. Regressions were also stratified on menopausal status, hormone therapy use, and tumor receptor status. None of the reproductive factors examined including age of first period, number of pregnancies, number of births, and hormone usage was statistically significantly associated with tumor grade. Although more studies are needed to determine whether other factors unexplored in this study are related to tumor aggressiveness, our study indicates that these factors do not predict the aggressiveness of breast cancers.
Autism Spectrum Disorder and Avoidant/Restrictive Food Intake Disorder
Authors: Lucarelli Jennifer , Pappas Demetra , Welchons Leah , Augustyn Marilyn
Published: November 2016

CASE: Kendra is a 4-year-old girl with autism spectrum disorder (ASD) who presents for follow-up of feeding problems to her pediatric clinician. She is an only child in a family where both parents are scientists. Feeding concerns date to infancy, when she was diagnosed with Gastroesophageal Reflux Disease (GERD) associated with persistent bottle refusal and the acceptance of few pureed foods. At 13 months, milk and peanut allergies were diagnosed. Following a feeding clinic evaluation at 24 months, she was prescribed a soy milk supplement and an H2 blocker. There was no concern for oral-motor dysfunction. She was also referred to early intervention for feeding therapy. However, her parents terminated participation after 6 months because she became anxious and had tantrum prior to treatment groups.

She was seen in another feeding program at 3 years; zinc, folate, thyroid, and a celiac panel were normal, and an endoscopy was negative for eosinophilic esophagitis. She began individual feeding therapy, where concerns for rigidity, difficulty transitioning, and limited peer interactions led to a neuropsychological evaluation. Kendra was diagnosed with an ASD and avoidant/restrictive food intake disorder (ARFID). Her cognitive skills were average, and expressive and receptive language skills were low average.

Her diet consisted of French fries, Ritz crackers, pretzels, and 32 ounces of soy formula daily. She had stopped accepting Cheerios and saltines 2 months prior. She controlled other aspects of feeding, insisting on a specific parking spot at a fast food restaurant and drinking from a particular sippy cup. Her parents accepted these demands with concern about her caloric intake, which they tracked daily.

Following diagnosis with ARFID, she resumed feeding therapy using a systematic desensitization approach with rewards. At the first session, she kissed and licked 2 new foods without gagging. Her mother appeared receptive to recommendations that included continuing the “food game” at home, replacing 1 ounce of soy formula by offering water each day, limiting between-meal grazing, and refusing specific feeding demands.

Currently, her parents plan to discontinue feeding therapy with concerns that the treatment was “too harsh.” Her father produces logs of her caloric and micronutrient intake as evidence that she did not replace missed formula with other foods and reports that she subsequently became more difficult to manage behaviorally. Her father now demands to see randomized controlled trials of feeding therapy approaches. Her weight is stable, but she has now limited her pretzel intake to a specific brand. How would you approach her continued care?
Pattern of Colon Cancer Lymph Node Metastases in Patients Undergoing Central Mesocolic Lymph Node Excision: A Systematic Review
Authors: Bertelsen Claus A. , Kirkegaard-Klitbo Anders , Nielsen Mingyuan , Leotta Salvatore M. G. , Daisuke Fukumori , Gögenur Ismail
Published: November 2016

BACKGROUND:

Extended mesocolic lymph node dissection in colon cancer surgery seems to improve oncological outcome. A possible reason might be related to metastases in the central mesocolic lymph nodes.

OBJECTIVE:

The purpose of this study was to describe the pattern of mesocolic lymph node metastases, particularly in central lymph nodes, and the risk of skip, aberrant, and gastrocolic ligament metastases as the argument for performing extended lymph node dissection.

DATA SOURCES:

EMBASE and PubMed were searched using the terms colon or colorectal with sentinel node, lymph node mapping, or skip node; lymph node resection colon; and complete or total and mesocolic excision.

STUDY SELECTION:

Studies describing the risk of metastases in central, skip, aberrant, and gastrocolic ligament lymph node metastases from colon adenocarcinomas in 10 or more patients were included. No languages were excluded.

MAIN OUTCOME MEASURES:

The risk of metastases in the central mesocolic lymph nodes was measured.

RESULTS:

A total of 2052 articles were screened, of which 277 underwent full-text review. The 47 studies fulfilling the inclusion criteria were very heterogeneous, and meta-analyses were not considered appropriate. The risk of central mesocolic lymph node metastases for right-sided cancers varies between 1% and 22%. In sigmoid cancer, the risk is reported in ≤12% of the patients and is associated with advanced T stage.

LIMITATIONS:

The retrospective design and heterogeneity, in terms of definitions of lymph node location, tumor sites, stage, morphology, pathology assessment, and inclusion criteria (selection bias), of the included studies were limitations. Also, anatomic definitions were not uniform.

CONCLUSIONS:

The present literature cannot give a theoretical explanation of a better oncological outcome after extended lymph node dissection. Consensus for a standardization of anatomical definitions and surgical and pathological assessments is warranted for future mapping studies.
Inadvertent Splenectomy During Resection for Colorectal Cancer Does Not Increase Long-term Mortality in a Propensity Score Model: A Nationwide Cohort Study
Authors: Lolle Ida , Pommergaard Hans-Christian , Schefte David F. , Bulut Orhan , Krarup Peter-Martin , Rosenstock Steffen J.
Published: November 2016

BACKGROUND:

Previous studies suggest that long-term mortality is increased in patients who undergo splenectomy during surgery for colorectal cancer. The reason for this association remains unclear.

OBJECTIVE:

The purpose of this study was to investigate the association between inadvertent splenectomy attributed to iatrogenic lesion to the spleen during colorectal cancer resections and long-term mortality in a national cohort of unselected patients.

DESIGN:

This was a retrospective, nationwide cohort study.

SETTINGS:

Data were collected from the database of the Danish Colorectal Cancer Group and merged with data from the National Patient Registry and the National Pathology Databank.

PATIENTS:

Danish patients with colorectal cancer undergoing curatively intended resection between 2001 and 2011 were included in the study.

MAIN OUTCOME MEASURES:

The primary outcome was long-term mortality for patients surviving 30 days after surgery. Secondary outcomes were 30-day mortality and risk factors for inadvertent splenectomy. Multivariable and propensity-score matched Cox regression analyses were used to adjust for potential confounding.

RESULTS:

In total, 23,727 patients were included, of which 277 (1.2%) underwent inadvertent splenectomy. There was no association between inadvertent splenectomy and long-term mortality (adjusted HR = 1.15 (95% CI, 0.95–1.40); p = 0.16) in the propensity score-matched model, whereas 30-day mortality was significantly increased (adjusted HR = 2.31 (95% CI, 1.71–3.11); p < 0.001). Inadvertent splenectomy was most often seen during left hemicolectomy (left hemicolectomy vs right hemicolectomy: OR = 24.76 (95% CI, 15.30–40.06); p < 0.001).

LIMITATIONS:

This study was limited by its retrospective study design and lack of detailed information on postoperative complications.

CONCLUSIONS:

Inadvertent splenectomy during resection for colorectal cancer does not seem to increase long-term mortality. The previously reported reduced overall survival after inadvertent splenectomy may be explained by excess mortality in the immediate postoperative period.
Hypoactive sexual desire dysfunction in community-dwelling older women
Authors: Zeleke Berihun M. , Bell Robin J. , Billah Baki , Davis Susan R.
Published: November 2016

Objective:

To determine the prevalence of hypoactive sexual desire dysfunction (HSDD) and its associated factors in women aged 65 to 79 years.

Methods:

A questionnaire-based, cross-sectional study was conducted amongst community-dwelling older women. Participants were recruited between April and August 2014 from a national database based on electoral rolls. Sexual function and sexual distress were assessed by the Female Sexual Function Index and the Female Sexual Distress Scale-Revised, respectively. HSDD was defined as the presence of both low sexual desire and sexually related personal distress.

Results:

The mean ± SD age of the 1,548 women was 71 ± 3.4 years and 52.6% were partnered. Among the participants, 88.0% (95% confidence interval [CI], 86.3%-89.6%) had low sexual desire, 15.5% (95% CI, 13.8%-17.4%) had sexually related personal distress, and 13.6% (95% CI, 11.9%-15.4%) had HSDD. The HSDD was more common among partnered than among unpartnered women (23.7% vs 5.9%; P < 0.001). Being partnered (adjusted odds ratio [AOR] = 4.21; 95% CI, 2.50-7.07), having vaginal dryness during intercourse (AOR = 2.37; 95% CI, 1.58-3.55), having symptomatic pelvic floor dysfunction (AOR = 1.92; 95% CI, 1.29-2.92), and having moderate-to-severe depressive symptoms (AOR = 4.15; 95% CI, 2.16-7.96) were independently associated with having HSDD. In a subanalysis, HSDD was more common among sexually active than sexually inactive women (31.5% vs 17.3%; P < 0.001). Furthermore, 32% (95% CI, 27.7%-38.3%) of partnered sexually active women had HSDD, as did 22% (95% CI, 11.5%-37.8%) of unpartnered sexually active women.

Conclusions:

HSDD is common and associated with potentially modifiable risk factors in older women. It should not be assumed that unpartnered older women are sexually inactive or are not distressed by low sexual desire.
Transient Ischemic Attack and Cognitive Impairment: A Review
Authors: Ganzer Christine A. , Barnes Andrea , Uphold Constance , Jacobs Alan R.
Published: November 2016

Transient ischemic attack (TIA) is a neurologic deficit resulting from focal ischemia in the brain, spinal cord, or retina. Historically, the definition included symptom resolution within 24 hours. However, recent studies investigating cognition after TIA suggest that deficits in executive function persist at 7 days post-TIA, although few studies have examined these effects long term. Recent advances in neuroimaging techniques provide emerging evidence of permanent microvascular tissue damage in the brain, suggesting that the effects of TIA may persist beyond resolution of focal symptoms. A further challenge is that there is debate concerning the clinical definition of TIA and the use of diagnostic neuroimaging studies and standardization of neuropsychological tests used to evaluate cognitive deficits in this population. Subtle changes in memory, attention, and problem-solving abilities may negatively influence an individual’s ability to adopt positive health behaviors. Despite advances in the field, more research is needed; hence, the purpose of this article is to provide an overview of clinical factors for clinicians and researchers to consider when investigating cognitive deficits among post-TIA populations. Definitions of TIA are reviewed, and the importance of neuropsychological evaluation and neuroimaging correlates of TIA in establishing a positive diagnosis will be discussed. Nurses especially in advanced practice roles are uniquely positioned to assess and implement treatments in at-risk groups and therefore should be knowledgeable about these possible cognitive effects.
Predictors of Persistent or Recurrent Disease After Loop Electrosurgical Excision Procedure
Authors: Cejtin Helen E. , Zimmerman Lindsay , Mathews Melissa , Patel Ashlesha
Published: November 2016

Objective

Follow-up recommendations after an excisional procedure vary depending on whether or not there is a positive ectocervical or endocervical margin or endocervical curettage (ECC). The purpose of this study was to evaluate the importance of these findings in predicting recurrent/persistent (r/p) disease in a sample of human immunodeficiency virus (HIV)-seropositive and -negative patients.

Materials and Methods

Loop electrosurgical excision procedures with a concurrent ECC performed at the Cook County ambulatory clinic between September 29, 2008, and April 15, 2014 were included in this study. Chart review was performed to collect demographic data, pathology results, and all subsequent cytology or histology. We examined the association of these factors with r/p disease using χ2 and Fisher exact tests as well as log-binomial regression.

Results

There were 242 women included for analysis. Of these, 9 LEEP specimens showed invasive cancer or adenocarcinoma in situ, and 15.7% were HIV positive. Mean follow-up was 16.4 months. On bivariate analysis, HIV serostatus, LEEP histology, ectocervical margin, endocervical margin, and ECC were all associated with r/p disease. On multivariate regression, only HIV serostatus and ECC were associated with r/p disease. Among women with either a positive endocervical or ectocervical margin or ECC, the prevalence of r/p disease is 29% if they are HIV negative, and 75% if they are positive.

Conclusions

In our study, ECC seems more predictive of r/p disease than margin status. Most HIV-positive women with positive margins or ECC have r/p disease, whereas most HIV-negative women do not. One should consider HIV serostatus when deciding whether or not to perform repeat excision.
Early Changes of Irradiated Parotid Glands Evaluated by T1rho-Weighted Imaging: A Pilot Study
Authors: Zhou Nan , Chu Chen , Dou Xin , Li Ming , Liu Song , Guo Tingting , Zhu Lijing , Liu Baorui , Chen Weibo , He Jian , Yan Jing , Zhou Zhengyang , Yang Xiaofeng
Published: November 2016

Objective

The aim of the study was to confirm the feasibility of T1rho-weighted imaging to evaluate the dynamic changes of parotid glands in patients with nasopharyngeal carcinoma (NPC) undergoing intensity-modulated radiation therapy.

Methods

Twenty-six NPC patients (19 men; 7 women; mean [SD] age, 48.9 [13.4] years) underwent the following 3 serial T1rho-weighted imaging: within 2 weeks before radiotherapy (RT, pre-RT), 5 weeks after the beginning of RT (mid-RT), and 4 weeks after RT (post-RT). Parotid volumes, T1rho values, mean radiation doses, and xerostomia degrees were recorded. Change rates of parotid T1rho values were correlated with parotid atrophy rates, mean radiation doses, and xerostomia degrees.

Results

During RT, parotid volume decreased (atrophy rate, 32.7 [8.1%] at mid-RT and 27.9 [10.0%] at post-RT compared with pre-RT; both P < 0.001) and parotid T1rho values increased (change rate, 25.0 [15.8%] at mid-RT and 30.1 [18.0%] at post-RT compared with pre-RT, both P < 0.001) significantly. The change rate of parotid T1rho value correlated with the atrophy rate significantly at post-RT (r = 0.301, P = 0.047). Intraobserver and interobserver reproducibility of parotid T1rho measurements were excellent (intraclass correlation coefficient, 0.974 and 0.956, respectively).

Conclusions

Dynamic changes of radiation-induced parotid damage in NPC patients who underwent intensity-modulated radiation therapy could be noninvasively evaluated by T1rho-weighted imaging.
“Fat Brook” in the Popliteal Fossa: Cadaveric and Clinical Investigation With Magnetic Resonance Imaging
Authors: Song Yoonah , Lee Seunghun , Paik Doo-Jin , Bae Jiyoon
Published: November 2016

Objective

This study aimed to describe the “fat brook” (FB) in the popliteal fossa of a cadaver and to evaluate its clinical significance.

Methods

Ten fresh cadaveric knees underwent magnetic resonance imaging and histologic analyses. In addition, magnetic resonance imaging images from 321 patients (108 men, 213 women; mean age, 49.8 years; age range, 5–92 years) were retrospectively reviewed. Two radiologists independently determined the presence/absence of the FB and internal derangement of the knee.

Results

The FB was present in all cadaveric specimens without synovial lining or joint communication. In the clinical study, the prevalence of FB was 97.8% (314/321). The FB was associated with effusion (P = 0.001) and tear of the medial meniscus (P = 0.022). There was no significant association between prevalence of FB and age or other structures. Determining FB and internal derangement of the knee had excellent interobserver agreement (concordance correlation coefficient = 0.966, 0.834–1.000).

Conclusions

The FB might be a part of the superficial layer of superficial fascia and not be mistaken for a fat fracture or Morel-Lavallée lesion.
Predicting and Early Monitoring Treatment Efficiency of Cervical Cancer Under Concurrent Chemoradiotherapy by Intravoxel Incoherent Motion Magnetic Resonance Imaging
Authors: Zhu Li , Zhu Lijing , Wang Huanhuan , Yan Jing , Liu Baorui , Chen Weibo , He Jian , Zhou Zhengyang , Yang Xiaofeng
Published: November 2016

Objective

The aim of this study was to explore the potential of intravoxel incoherent motion magnetic resonance (MR) imaging in predicting and measuring responses to concurrent chemoradiotherapy (CCRT) in advanced cervical cancers.

Methods

Thirty-seven patients with advanced cervical cancers scheduled for CCRT underwent MR examinations including intravoxel incoherent motion sequence with 9 b values (0–800 s/mm2) before CCRT, 2 and 4 weeks after the initiation of CCRT, and immediately after CCRT. Apparent diffusion coefficient, f, D, and D* values were obtained during the course. The maximum diameter of the tumor was measured to determine the treatment efficiency.

Results

At the end of CCRT, 25 patients were classified as complete response and 12 as partial response. The pretreatment f of cervical cancer showed its efficiency in predicting partial response and complete response with an area under receiver operating characteristic curve of 0.768. During CCRT, the apparent diffusion coefficient, D, and D* values kept on rising, whereas f increased first and then decreased after 4 weeks of CCRT.

Conclusions

Intravoxel incoherent motion MR imaging held great potential in both predicting and early monitoring treatment efficiency of advanced cervical cancer under CCRT.