bluuebunny/crossref_metadata_2025 huggingface dataset:
Feminist Political Thought
Authors: Dietz Mary G. , Cane Lucy
Published: October 2017

Feminist political thought is a capacious term that for these purposes includes works pertaining not only to the fields of “political theory” (in political science) and “political philosophy” (in philosophy) but also to writings generally designated under the rubric of “feminist theory” or “feminist studies” that address politics and political systems, structures, and relations by problematizing gender, sex, sexual difference, and sexuality. If it is not remotely possible to argue that all political thought is “feminist,” it is surely the case that almost all feminist thought is in some palpable sense “political,” insofar as it emerges in academia from out of historical and contemporary movements for women’s liberation and through critiques of gender inequality and patriarchal relations of power and domination. Yet at the same time the term “feminist” is impossible to define with any specificity, given the differences and divisions that constitute it as a multifaceted academic field propelled by epistemological and political contestations over agency, subjectivity, identity, and power that trouble the very coherence of the terms “woman” and “women” themselves. Consequently, this bibliography takes a heterogeneous outlook on its subject matter rather than one that solely focuses “feminist” within the field of political theory, much less in terms of a particular methodology. Three additional notes: First, readers expecting the perhaps familiar designation of various ideological “isms” sometimes associated with the categorization of feminist political thought (e.g., “liberal”; “radical”; “socialist”; “anarchist”; “lesbian”; “eco”; “postmodern”; “posthuman”) will more often find instead categories that specify problems and instigate debates that often cross ideological rubrics and positions. Second, the organization of categories does not follow the standard designation of “first, second, and third waves,” opting instead for as many disruptions and displacements of those textbook conventions as possible. Finally, it is important to acknowledge that feminist political thought is enmeshed with other contemporary disciplinary knowledges and fields of inquiry (e.g., queer theory; new materialisms; masculinities; posthumanist orientations; critical race studies; queer of color critique; global ecologies; neoliberalism; postcolonial and transnational studies) in ways that require some attention to these intersections as well.
A Verticillium dahliae Extracellular Cutinase Modulates Plant Immune Responses
Authors: Gui Yue-Jing , Zhang Wen-Qi , Zhang Dan-Dan , Zhou Lei , Short Dylan P. G. , Wang Jie , Ma Xue-Feng , Li Ting-Gang , Kong Zhi-Qiang , Wang Bao-Li , Wang Dan , Li Nan-Yang , Subbarao Krishna V. , Chen Jie-Yin , Dai Xiao-Feng
Published: October 2017

Cutinases have been implicated as important enzymes during the process of fungal infection of aerial plant organs. The function of cutinases in the disease cycle of fungal pathogens that invade plants through the roots has been less studied. Here, functional analysis of 13 cutinase (carbohydrate esterase family 5 domain–containing) genes (VdCUTs) in the highly virulent vascular wilt pathogen Verticillium dahliae Vd991 was performed. Significant sequence divergence in cutinase family members was observed in the genome of V. dahliae Vd991. Functional analyses demonstrated that only VdCUT11, as purified protein, induced cell death and triggered defense responses in Nicotiana benthamiana, cotton, and tomato plants. Virus-induced gene silencing showed that VdCUT11 induces plant defense responses in Nicotiana benthamania in a BAK1 and SOBIR-dependent manner. Furthermore, coinfiltration assays revealed that the carbohydrate-binding module family 1 protein (VdCBM1) suppressed VdCUT11-induced cell death and other defense responses in N. benthamiana. Targeted deletion of VdCUT11 in V. dahliae significantly compromised virulence on cotton plants. The cutinase VdCUT11 is an important secreted enzyme and virulence factor that elicits plant defense responses in the absence of VdCBM1.
Why is buprenorphine coformulated with naloxone?
Authors: Urnoski Eric
Published: October 2017

Combination buprenorphine-naloxone is a cornerstone of outpatient treatment for substance use disorder, and is more widely accessible in primary care. Because oral buprenorphine has been diverted and abused for its euphoric properties, a combination formulation was developed and will trigger withdrawal symptoms if injected IV.
How and Why Preclerkship Students Set Learning Goals and Assess Their Achievement: A Qualitative Exploration
Authors: Kindler Pawel M. , Bates Joanna , Hui Eric , Eva Kevin W.
Published: October 2017

Purpose

Health professionals are expected to routinely assess their weaknesses, set learning goals, and monitor their achievement. Unfortunately, it is well known that these professionals often struggle with effectively integrating external data and self-perceptions. To know how best to intervene, it is critical that the health professionals community understand the cues students and practitioners use to assess their abilities. Here the authors aimed to gain insights into how and why medical students set learning goals, monitor their progress, and demonstrate their learning.

Method

In 2012, the authors conducted semistructured interviews with Year 2 students (n = 20), applying an inductive approach to data analysis by iteratively developing, refining, and testing coding structures.

Results

Themes were constructed through discussion and consensus: (1) Students were diverse in how they set learning goals, (2) they used a range of approaches to monitor their progress, and (3) they struggled to balance studying for exams with preparation for clinical training. Tensions observed highlight assumptions embedded in medical curricula that can be problematic.

Conclusions

Educators often treat medical students as a cohesive whole, thereby creating a mismatch between assessments that are intended to be formative and information students use to monitor their progress. Despite limited exposure to clinical contexts, goal generation and monitoring often stem from a desire to prepare for clinical practice. In grappling with these tensions, it is important to be mindful that students are individualistic in how they balance their commitment to prepare for clinical work and the need to concentrate on exams.
Formative Assessment in an Integrated Curriculum: Identifying At-Risk Students for Poor Performance on USMLE Step 1 Using NBME Custom Exam Questions
Authors: Brenner Judith M. , Bird Jeffrey B. , Willey Joanne M.
Published: October 2017

Purpose

The Hofstra Northwell School of Medicine (HNSOM) uses an essay-based assessment system. Recognizing the emphasis graduate medical education places on the United States Medical Licensing Examination (USMLE) Step exams, the authors developed a method to predict students at risk for lower performance on USMLE Step 1.

Method

Beginning with the inaugural class (2015), HNSOM administered National Board of Medical Examiners (NBME) Customized Assessment Service (CAS) examinations as formative assessment at the end of each integrated course in the first two years of medical school. Using preadmission data, the first two courses in the educational program, and NBME score deviation from the national test takers’ mean, a statistical model was built to predict students who scored below the Step 1 national mean.

Results

A regression equation using the highest Medical College Admission Test (MCAT) score and NBME score deviation predicted student Step 1 scores. The MCAT alone accounted for 21% of the variance. Adding the NBME score deviation from the first and second courses increased the variance to 40% and 50%, respectively. Adding NBME exams from later courses increased the variance to 52% and 64% by the end of years one and two, respectively. Cross-validation demonstrated the model successfully predicted 63% of at-risk students by the end of the fifth month of medical school.

Conclusions

The model identified students at risk for lower performance on Step 1 using the NBME CAS. This model is applicable to schools reforming their curriculum delivery and assessment programs toward an integrated model.
How Effective Leaders Harness the Future
Authors: Souba Wiley , Souba Matthew
Published: October 2017

Human beings are fundamentally future oriented. Most of our decisions and undertakings are for the sake of a future to which we are committed or obligated. This future orientation is essential to effective leadership in health care, especially during this time of significant reform, when people are at risk of becoming cynical and disengaged. Conventional thinking holds that our effectiveness as leaders is primarily a function of what we have learned in the past—our knowledge, expertise, and experience. In contrast, the emerging model contends that our effectiveness is also a function of how the future (outcome) of our leadership challenges “shows up” for us. If, despite daunting circumstances, we can “see” an aspired future ahead, we are more likely to commit and engage. Our story of the future becomes the “narrative frame” through which we see and tackle leadership challenges today. Because organizations are fundamentally networks of conversations, an organization’s ability to create new language practices is tantamount to its ability to evolve. What makes the future compelling is the embodiment of our deepest convictions and ideals in our image of the future. Because health care reform has challenged the medical profession along the entire spectrum of its traditional values and roles, working toward a unifying vision of the future has been difficult. To enroll others in creating a better future, effective leaders must underscore the purpose and importance of their work and motivate them with inspiring stories.
Five Dimensions of Research Ethics: A Stakeholder Framework for Creating a Climate of Research Integrity
Authors: DuBois James M. , Antes Alison L.
Published: October 2017

The authors explore five dimensions of research ethics: (1) normative ethics, which includes meta-ethical questions; (2) compliance with regulations, statutes, and institutional policies; (3) the rigor and reproducibility of science; (4) social value; and (5) workplace relationships. Each of the five dimensions is important not only because it addresses an aspect of good research done in a good manner but also because it addresses the concerns of key stakeholders in the research enterprise. The five-dimension framework can guide institutions as they answer three questions central to any research ethics program: (1) Who should champion research ethics? (2) What should interventions look like? and (3) Who should participate in the interventions? The framework is valuable because the answers to these three questions are radically different depending on the dimension under consideration. An expanded vision of research ethics does not entail that institutions should require additional online training or approvals from institutional review boards. However, without acknowledging all five dimensions, programs risk missing an important aspect of research ethics or ignoring the interests of important stakeholders.
An Innovative Shared Decision-Making Curriculum for Internal Medicine Residents: Findings From the University of Pittsburgh Medical Center
Authors: Rusiecki Jennifer , Schell Jane , Rothenberger Scott , Merriam Sarah , McNeil Melissa , Spagnoletti Carla
Published: October 2017

Purpose

Shared decision making (SDM) is a core competency in health policy and guidelines. Most U.S. internal medicine residencies lack an SDM education curriculum. A standardized patient (SP)-based curriculum teaching key concepts and skills of SDM was developed.

Method

This curriculum consisted of an innovative seven-step SDM model and a skills-focused SP case, integrated into the ambulatory rotation for senior medicine residents at the University of Pittsburgh Medical Center in 2015. Evaluation consisted of pre/postcurriculum surveys assessing residents’ knowledge of and attitudes toward SDM. Skills development was assessed via pre/postcurricular audio recordings of clinical decision making.

Results

Thirty-six residents completed the curriculum (survey participation rate 88%). There was significant improvement in residents’ knowledge (median score pre 75%, post 100%, P < .01); confidence (median composite score pre 2.87, post 3.0, P < .01, where 1 = not confident/important, 4 = very confident/important); and importance of SDM (median composite score pre 3.14, post 3.5, P < .01). Forty-four clinical recordings (31 pre, 13 post) were assessed using the Observing Patient Involvement in Decision-Making scale. Improvement in use of SDM skills was seen among all residents (mean increase 1.84 points, P = .27). When data were stratified post hoc by U.S. versus international medical graduates, there was significant improvement in total score (mean increase of 5.15 points, P = .01) among U.S. graduates only.

Conclusions

SDM is teachable, and this skill-based curricular intervention resulted in improvement in senior medicine residents’ knowledge of, attitudes toward, and demonstration of SDM skills.
Reconstruction of Traumatic, Open Supracondylar Femoral Fractures by Autologous Fibular Strut Grafting and Cortico-Cancellous Bone Grafting—A Single-Centre, Observational Study
Authors: Iyengar Raju , Cherukuri Nagesh , Patnala Chandrasekar
Published: October 2017

Objectives:

To study the safety and efficacy of staged reconstruction of distal femoral (supracondylar) bone loss using autologous fibular strut, cortico-cancellous bone grafting.

Design:

Single-centre, observational study, with review of literature.

Setting:

Urban Level I Trauma Center.

Patients/Participants:

Eighteen consecutive patients (mean age: 35 ± 8.5 years, all males) with open supracondylar fracture and intercondylar extension (OTA/AO type C3), operated between January 2010 and February 2014 with severe bone loss in 11 patients and moderate loss in 7.

Intervention:

Single free fibular strut was used in 12 femurs and dual fibula in 5 femurs with autologous cortico-cancellous bone grafting in all.

Main Outcome Measures:

Clinical union, radiological union, and knee function using the Sanders' score.

Results:

Mean follow-up was 45.5 ± 17 months. The mean radiological union time was 18 ± 2.6 weeks. Functional assessment after union revealed one patient with excellent knee function, 9 with good, 8 with fair, function according to Sanders' scoring. The mean knee range was 49 degrees (range 5–110 degrees) in which 9 patients achieved a knee range >80 degrees. Mean limb shortening was 2 cm (range 0–7 cm). No limb shortening was observed in 5 patients. Patients were pain free and had no significant graft or donor site morbidity.

Conclusions:

Staged fibular strut grafting, cortico-cancellous bone grafting for traumatic open supracondylar femoral fractures with significant bone loss is a promising technique with a good safety profile and long-term efficacy.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Multiple primary melanoma: a single centre retrospective review
Authors: Menzies Stephanie , Barry Rupert , Ormond Patrick
Published: October 2017

Prognosis has been shown to be worse for patients with multiple primary melanomas than those with a single melanoma. One recent retrospective study showed that older, white men were at higher risk of multiple primary melanomas. In our institution 2057 melanomas were diagnosed between January 1994 and March 2016. We identified 99 (4.8%) patients who had multiple primary melanomas. The average number of melanomas was 2.5 (range: 2–10). The site for first and second melanomas was similar in 30%. We found that subsequent melanomas were more likely to be in situ and thinner in terms of Breslow thickness and Clarks level. The commonest subtypes were superficial spreading and lentigo maligna. The commonest sites involved were the lower limbs. We found no significant difference in age between our total melanoma group and the multiple primary melanoma group (64 and 66 years, respectively). The average time of diagnosis between the first and second melanomas was 33.7 months. Additionally, 70% of second melanomas were diagnosed within 2 years of first diagnosis, highlighting the importance of ongoing skin surveillance in patients with a recent diagnosis of melanoma.
Circulating epithelial tumor cells as a prognostic tool for malignant melanoma
Authors: Pachmann Katharina , Willecke-Hochmuth Regina , Schneider Katrin , Kaatz Martin
Published: October 2017

Although immune therapies with checkpoint inhibitors have gained increasing attention in advanced and metastatic melanoma, interferon-α remains a standard therapy for nonmetastatic malignant melanoma with risk factors. Interferons can successfully prevent relapse; however, the response rate is still not as high as would be desired. Prognostic tools to predict the response are required, which could lead to more individualized treatment regimens. In numerous studies over the past decade, circulating epithelial tumor cells (CETCs) have been shown to be a promising biomarker for estimating the risk of metastatic relapse, and we sought to determine whether they can also be used for this purpose in malignant melanoma. To establish a prognostic tool for patients with melanoma, we quantified CETCs over the course of interferon treatment in 49 patients. Patients were categorized into two groups according to the behavior of their circulating tumor cells during the interferon treatment: those with increasing and those with decreasing numbers of circulating tumor cells. Patients with increasing numbers of circulating tumor cells had a significantly higher risk of relapse. Kaplan–Meier survival analysis showed a significant difference between patients with increasing CETC numbers (mean survival time: 2.6 years) and patients with decreasing or stable CETC numbers (mean survival time: 12.6 years) (P=0.001). Quantification of CETCs could prove to be a prognostic marker for patients with melanoma receiving interferon immunotherapy. Further studies should determine whether these results are applicable to other immunotherapies, for example, immune checkpoint inhibition.
Partitioning an Artificial Anterior Chamber With a Latex Diaphragm to Simulate Anterior and Posterior Segment Pressure Dynamics: The “DMEK Practice Stage,” Where Surgeons Can Rehearse the “DMEK Dance”
Authors: Sáles Christopher S. , Straiko Michael D. , Fernandez Ana Alzaga , Odell Kelly , Dye Philip K. , Tran Khoa D.
Published: October 2017

Purpose:

To present a novel apparatus for simulating the anterior and posterior segment pressure dynamics involved in executing Descemet membrane endothelial keratoplasty (DMEK) surgery when using a chamber-shallowing technique.

Methods:

An artificial anterior chamber (AAC), 18-mm trephine, latex glove, two 3-mL syringes, and one donor cornea comprising an intact corneoscleral cap from which a DMEK tissue was peeled and punched are required for the model. After making the corneal incisions with the corneoscleral cap mounted on the AAC in the usual fashion, the corneoscleral cap is remounted onto the dried AAC over an 18-mm latex diaphragm. The space between the latex diaphragm and the cornea is filled with saline to pressurize the anterior chamber, and the posterior segment is pressurized with air from a syringe. The resulting apparatus comprises a posterior segment and anterior chamber that exert pressure on each other by way of a distensible latex diaphragm.

Results:

A novice and experienced DMEK surgeon and 2 eye bank technicians were able to assemble the apparatus and perform the routine steps of a DMEK procedure, including maneuvers that require shallowing the anterior chamber and lowering its pressure. Only one cornea was required per apparatus.

Conclusions:

We present a novel in vitro model of the human eye that more closely mimics the anterior and posterior segment pressure dynamics of in vivo DMEK surgery than average human and animal cadaveric globes. The model is easy to assemble, inexpensive, and applicable to a range of teaching environments.
Topical Tacrolimus 0.03% for Maintenance Therapy in Steroid-Dependent, Recurrent Phlyctenular Keratoconjunctivitis
Authors: Yoon Chang Ho , Kim Mee Kum , Oh Joo Youn
Published: October 2017

Purpose:

To evaluate the efficacy of topical tacrolimus 0.03% as steroid-free maintenance therapy in young patients with severe, recurrent phlyctenular keratoconjunctivitis (PKC).

Methods:

The medical records of 6 eyes of 5 patients (4 children and 1 young adult) with recurrent, steroid-dependent PKC were reviewed. The patients were treated with combined application of topical steroids and tacrolimus 0.03% in the active phase and maintained on topical tacrolimus alone after remission.

Results:

The clinical signs, symptoms, and visual acuities resolved in all patients after 25.2 ± 16.9 days of combined treatment with steroids and tacrolimus. After disease remission, the patients were maintained on topical tacrolimus 0.03% once daily alone for 8.4 ± 4.7 months, and no recurrence occurred during 10.6 ± 1.9 months of follow-up. Tacrolimus was successfully discontinued in 2 patients without further recurrence. There were no ocular side effects related to the use of topical tacrolimus.

Conclusions:

Topical tacrolimus 0.03% was effective in maintaining long-term remission in patients with recurrent, steroid-dependent PKC.
Predictors of Successful Yield of Transbronchial Lung Biopsy in Patients With Sarcoidosis
Authors: Sehgal Inderpaul S. , Bal Amanjit , Dhooria Sahajal , Gupta Nalini , Ram Babu , Aggarwal Ashutosh N. , Behera Digambar , Agarwal Ritesh
Published: October 2017

Background:

Transbronchial lung biopsy (TBLB) is an important bronchoscopic procedure used in the diagnosis of sarcoidosis. Only a few studies have evaluated determinants associated with successful diagnostic yield of TBLB. Herein, we evaluate the factors predicting successful yield of TBLB in subjects with sarcoidosis.

Methods:

Consecutive subjects with a clinical suspicion of sarcoidosis who underwent TBLB were enrolled. We evaluated the association between symptoms, spirometric lung function, radiologic stage of sarcoidosis, number of specimens, presence of floating biopsies, number of alveoli, and successful diagnostic yield (presence of granuloma) on TBLB.

Results:

Of the 223 subjects, sarcoidosis was diagnosed in 209 [mean (SD) age, 43.9 (12.6) y; 50.7% men] individuals. A total of 1021 TBLB specimens were obtained. Granulomas were demonstrated in 123 (58.9%) subjects on TBLB. On a multivariate analysis, there was no association between successful diagnostic yield and the presence of dyspnea, spirometric lung function, radiologic stage of sarcoidosis, presence of floating biopsies, presence of at least 50 alveoli, or crush artifacts during histopathologic examination. Complications were encountered in 25 (11.9%) subjects. There were no deaths.

Conclusions:

TBLB is a reasonably safe procedure with a good diagnostic yield. The present study did not identify any predictors associated with successful diagnostic yield of TBLB in sarcoidosis.
Lung Ultrasound After Transbronchial Biopsy for Pneumothorax Screening in Post–Lung Transplant Patients
Authors: Bensted Karen , McKenzie Jane , Havryk Adrian , Plit Marshall , Ben-Menachem Erez
Published: October 2017

Background:

Lung ultrasound has been suggested as an alternative to routine chest radiography (CXR) to screen for pneumothorax after transbronchial lung biopsy. In post–lung transplant patients, who may have altered anatomy and pleural adhesions, the validity of lung ultrasound to screen for postbiopsy pneumothoraces has not been investigated.

Methods:

Lung ultrasound using an ultraportable handheld device was performed in a standardized manner 2-hour after biopsy in post–lung transplant patients. Ultrasound assessment was then compared with CXR performed immediately after lung ultrasound.

Results:

In total, 165 patients were enrolled in the study. Eight pneumothoraces were diagnosed by image intensifier or CXR before lung ultrasound. There were 8 pneumothoraces diagnosed on CXR 2-hour postbiopsy. Lung ultrasound had a sensitivity of 75% and specificity of 93%. Positive predictive value was 35% and negative predictive value was 99%. The mean number of biopsies taken in patients with and without a pneuomothorax on CXR was 10.6 (±3.1) and 10.9 (±2.1), respectively (P=0.79). The overall pneumothorax rate was 9.7%.

Conclusions:

Lung ultrasound is a valid tool in excluding penumothoraces after lung biopsy. Ultrasound scans with features of a pneumothorax or patients with symptoms should still undergo CXR. The high false positive rate may be due to small pneumothoraces being seen or the presence of pleural adhesions and altered lung anatomy in post–lung transplant patients.
Endobronchial Ultrasound Transbronchial Needle Aspiration for the Diagnosis of Lymphoma
Authors: Gandotra Sheetal , Dotson Travis , Lamar Zanetta , Bellinger Christina
Published: October 2017

Background:

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) presents a minimally invasive way to evaluate abnormal mediastinal and hilar adenopathy. Although EBUS has been established as an effective modality to diagnose lung cancer, its sensitivity for the diagnosis of lymphoma has been demonstrated to be lower. Because of these lower yields uncertainty persists about the ability of EBUS-TBNA to reliably diagnose lymphoma and questions remain regarding the utility of EBUS-TBNA as a first-line biopsy modality for patients suspected of having lymphoma.

Methods:

We conducted a review of our database (n=806 EBUS-TBNAs) for patients undergoing EBUS-TBNA for mediastinal and/or hilar lymphadenopathy over an 8-year span to identify patients diagnosed with lymphoma.

Results:

Twenty patients (2.3%) who underwent EBUS-TBNA were ultimately diagnosed with lymphoma. In total, 17 of the 20 patients with lymphoma obtained a diagnosis using EBUS-TBNA. The overall sensitivity of EBUS-TBNA for lymphoma was 85%. The sensitivity for de novo diagnosis was 78% (7/9), and sensitivity for recurrence was 91% (10/11). All patients who achieved a diagnosis by EBUS-TBNA could be adequately subtyped, allowing treatment recommendations.

Conclusion:

Although the sensitivity of EBUS-TBNA for the diagnosis of lymphoma did not reach values of published data for non–small cell lung cancer, EBUS-TBNA can be considered as a first-line diagnostic tool for patients with mediastinal and/or hilar lymphadenopathy suspected to be lymphoma. Because of the inherent limitations in small volume needle biopsies it is essential that negative samples obtained in the setting of high clinical suspicion warrant further evaluation.
How Was Your Otology Training? A Survey of Recent Otolaryngology Residents
Authors: Montague Phillip , Bennett Donald , Kellermeyer Brian
Published: October 2017

Objective:

To survey graduating residents or recent graduates of otolaryngology residency programs to evaluate their Otology/Neurotology (ON) experience in residency and discern if they had received adequate training in time to decide whether to pursue a fellowship in Otology or Neurotology.

Study Design:

Internet-based survey.

Methods:

A survey was distributed to all US otolaryngology residency programs to distribute to 5th year residents and recent graduates in last 4 years. The survey assessed satisfaction in ON experience, presence of ON fellows, adequacy of experience to decide on ON fellowship, post-graduate year (PGY) year at which residents observed, performed, and proficiently performed five procedures (tympanoplasty, mastoidectomy, ossiculoplasty, stapedectomy, and cochlear implant), and plan for performing these surgeries in practice.

Results:

89/106 (84%) of respondents felt they had adequate training in Otology in time to decide whether or not to pursue a fellowship and were found to observe and perform surgeries significantly earlier in training by PGY including: mastoidectomy (observed PGY 1.9 versus PGY 2.3, performed PGY 2.9 versus PGY 3.5), ossiculoplasty (observed 2.1 versus 3.0, performed 3.6 versus 4.3), stapedectomy (observed 2.3 versus 3.0, performed 3.9 versus 4.5), and cochlear implant (observed 2.1 versus 2.8, performed 3.4 versus 4.1) all p < 0.05. There were 19/106 (17.9%) respondents who came from programs with fellowships and 78.9% thought fellows were beneficial to their ON experience.

Conclusions:

Early exposure to ON surgeries may aid in residents’ decision to pursue a fellowship in ON. The presence of fellows appears to facilitate residents’ ON experience.
Transarterial chemoembolization for hepatocellular carcinoma: development and external validation of the Munich-TACE score
Authors: op den Winkel Mark , Nagel Dorothea , op den Winkel Philip , Trojan Jörg , Paprottka Philipp M. , Steib Christian J. , Schmidt Laura , Göller Markus , Stieber Petra , Göhring Peter , Herbst Andreas , Rentsch Markus , De Toni Enrico N. , Göke Burkhard , Gerbes Alexander L. , Kolligs Frank T.
Published: October 2017

Background

Allocation of patients with hepatocellular carcinoma (HCC) to the adequate therapy is determined by both tumor burden and liver function. The Barcelona Clinic Liver Cancer (BCLC) staging system and therapeutic algorithm recommends transarterial chemoembolization (TACE) based on the best evidence available to patients with intermediate-stage HCC (BCLC-B). However, many centers also treat subgroups of patients outside these recommendations and with more advanced disease by TACE. The purpose of this study was to identify prognostic factors in a TACE cohort, including BCLC-B patients, as well as patients treated outside of BCLC-B, to test the prognostic capabilities of published staging systems and to optimize prognostication for TACE patients.

Patients and methods

A cohort of 186 first-line TACE patients was analyzed. Independent prognostic factors were identified and used to construct the Munich-TACE score (M-TACE). M-TACE was tested against established staging systems (including BCLC and two recently published TACE-specific scores) and a ranking using concordance index and Akaike Information Criterion was performed. Finally, an external validation in an independent TACE cohort (n=71) was conducted.

Results

Bilirubin, Quick/international normalized ratio, C-reactive protein, creatinine, α-feto protein, and tumor extension were identified as independent prognostic factors and used to construct M-TACE. M-TACE identifies three distinct subgroups (P<0.0001) with median survival times of 35.2, 16.9, and 8.6 months, respectively. Compared with established staging systems, M-TACE showed the best prognostic capabilities in both cohorts of patients (cohort 1: c-index, 0.71; Akaike Information Criterion: 1276; cohort 2: c-index, 0.754).

Conclusion

We identified independent risk factors for patients treated with TACE. The newly constructed M-TACE score is superior to established staging systems and might prove helpful to identify patients who are most suitable for TACE.
Consumer-Centric Care
Authors: Boston-Fleischhauer Carol
Published: October 2017

With the industry in flux as federal healthcare reform legislation debates continue, leaders are preparing for what the post–Affordable Care Act world might look like. Predictions include patients assuming more responsibility for healthcare costs and therefore behaving like consumers, including choosing providers based on perceived value. What actions should chief nurse executives take to ensure the nursing enterprise responds to rising consumerism in healthcare?
Analysis of GNA13 Protein in Follicular Lymphoma and its Association With Poor Prognosis
Authors: Shimono Joji , Miyoshi Hiroaki , Yoshida Noriaki , Kato Takeharu , Sato Kensaku , Sugio Takeshi , Miyawaki Kohta , Kurita Daisuke , Sasaki Yuya , Kawamoto Keisuke , Imaizumi Yoshitaka , Kato Koji , Nagafuji Koji , Akashi Koichi , Seto Masao , Teshima Takanori , Ohshima Koichi
Published: October 2017

GNA13 is a G protein involved in modulating tumor proliferative capacity, infiltration, metastasis, and migration. Genomic alteration of GNA13 was frequently observed in follicular lymphoma (FL). In this study, we examined 167 cases of FL by immunostaining of GNA13 using tissue microarray to evaluate the clinical significance. There were 26 GNA13-positive cases (15.6%) and 141 GNA13-negative cases (84.4%). GNA13-positive cases had a higher incidence of early progression of disease for which disease progression was recognized within 2 years compared with GNA13-negative cases (P=0.03). There were no significant differences in other clinicopathologic factors including histological grade, BCL2-IGH translocation, immunohistochemical phenotype, and Follicular Lymphoma International Prognostic Index. In addition, overall survival and progression-free survival were poorer in GNA13-positive cases than in GNA13-negative cases (P=0.009 and 0.005, respectively). In multivariate analysis, GNA13 positivity was found to be a poor prognostic factor for overall survival and progression-free survival. Thus, GNA13 protein expression was an independent prognostic factor and may affect disease progression in FL.
Evaluation of the Cardiac Morphologic Alterations Secondary to Autoimmune Thyroid Disorder Using Cardiac Magnetic Resonance Imaging
Authors: Zandieh Shahin , Schuck Linus , Mirzaei Siroos , Haller Joerg , Hergan Klaus , Bernt Reinhard
Published: October 2017

Purpose:

Thyroid functional disease is associated with clinically significant cardiovascular changes. The aim of this study was to assess changes in the cardiac magnetic resonance imaging of patients with autoimmune thyroid disorders (AITs).

Materials and Methods:

Forty patients with AIT (12 men, 28 women; age range, 20 to 82 y; mean age, 59 y) were identified and included in our study. In addition, 20 controls (12 men, 8 women; age range, 21 to 76 y; mean age, 50 y) without AIT or cardiac disorders were included.

Results:

In patients with AIT, the mean value calculated for the end diastolic volume was 161.2 mL, the mean end systolic volume value was 95.3 mL, and the mean left ventricular ejection fraction value was 45.2%. In comparing AIT patients with the control group, we found a significant difference in the end systolic volume, ejection fraction, stroke index, cardiac output, cardiac index, and left ventricular diameter (P<0.05).

Conclusions:

We conclude that our data show that there is a correlation between thyroid function and cardiac function, as evaluated with cardiac magnetic resonance imaging. This can be useful in the diagnosis of cardiovascular changes associated with AIT.
Users Guide to Pitfalls and Lessons Learned About HBOC-201 During Clinical Trials, Expanded Access, and Clinical Use in 1,701 Patients
Authors: Mackenzie Colin F. , Dubé Gregory P. , Pitman Arkaidy , Zafirelis Melissa
Published: October 2017

Lessons learned during 1,701 clinical uses of HBOC-201, a polymerized bovine hemoglobin-based oxygen carrier (HBOC), were identified to provide management lessons and training material for future clinical trials and use. HBOC-201 contains 13 g/dL hemoglobin (Hb), is iso-oncotic, stable at 2°C to 30°C with shelf-life of 3 years, requires no cross-matching with half-life of 19 h, and plasma volume distribution. Adverse effects include increased blood pressure, oliguria, gastrointestinal (GI) symptoms, yellow skin and scleral discoloration, decreased pulse oximetry measurements, and transient increases in methemoglobin, hepatic, and pancreatic enzymes. There was no cardiotoxicity. Elevations in blood pressure were transient and were managed with vasodilators. Oliguria was of limited duration. GI symptoms were treated with smooth muscle relaxants. Yellow skin and sclera were self-limiting, caused by Hb metabolism. The most important clinical management errors were lack of understanding of volume expansion effects and the half-life properties of HBOC-201, and failure to repeat infusions. Early use of HBOC-201 for Expanded Access when Hb less than 5 g/dL optimized survival and minimized advanced resource utilization. For phase 3 trials, there was transfusion avoidance of 96% for 24 h, 70% for 1 week, with no difference in serious adverse events or mortality whether patients received at most 10 bags HBOC-201 or at most 3 units blood. More nonserious events occurred with HBOC-201. Age, history of cardiac disease, and Hb deficit, but not randomization to HBOC-201, were significantly predictive of cardiac ischemic events. Administration of HBOC-201 in1,701 humans showed it was well tolerated in a wide range of doses and clinical settings. HBOC-201 should be considered when blood is not available or an option.
Managing high blood pressure during acute ischemic stroke and intracerebral hemorrhage
Authors: Appiah Karen O. , Minhas Jatinder S. , Robinson Thompson G.
Published: October 2017

Purpose of review

Blood pressure (BP) elevations above premorbid levels are observed in at least 60% of acute ischemic and hemorrhagic stroke patients, within the first 24 h of symptom onset. A number of potential causes have been hypothesized, and high BP may be associated with poor stroke outcome. This review discusses management strategies of high BP in acute stroke, in the context of current guidelines.

Recent findings

Excessive BP elevation can impact acute stroke therapeutic strategies, particularly in modifying intervention safety and efficacy. Currently, guidance on BP management in acute ischemic stroke and intracerebral hemorrhage (ICH) exists in a limited number of specific clinical presentations, including spontaneous ICH and continuing versus stopping preexisting antihypertensive therapy. However, ongoing clinical trials will further investigate the safety and efficacy of urgent BP-lowering therapy for other indications.

There are clear national and international guidelines on BP lowering for specific indications, as well as ongoing clinical trials aiming to address common clinical scenarios in which the evidence-base is lacking and uncertain. This is specifically in important stroke subgroups previously excluded from trials, patients requiring mechanical thrombectomy and nonvitamin K antagonist-associated ICH reversal.
Do extra-group fertilizations increase the potential for sexual selection in male mammals?
Authors: Isvaran Kavita , Sankaran Sumithra
Published: October 2017

Fertilizations by males outside the social breeding group (extra-group paternity, EGP) are widespread in birds and mammals. EGP is generally proposed to increase male reproductive skew and thereby increase the potential for sexual selection, but the generality of this relationship is unclear. We extracted data from 27 mammals in seven orders and used phylogenetic comparative methods to investigate the influence of EGP and social mating system on measures of inequality in male fertilization success, which are indices of the potential for sexual selection. We find that EGP and social mating system can predict the potential for sexual selection in mammalian populations, but only when considered jointly and not individually. EGP appears to increase the potential for sexual selection but only when the degree of social polygyny is relatively low. When social polygyny is high, EGP appears to result in a more uniform distribution of reproduction and a decrease in the potential for sexual selection. A possible explanation to be investigated is that the phenotype of extra-group fathers differs systematically across social mating systems. Our findings have implications for the use of EGP and social mating system as indices of sexual selection in comparative analyses of trait evolution under sexual selection.
Quality characteristics of fresh-cut Dioscorea bulbifera treated under various blanching conditions prior to vacuum-packaging during storage
Authors: Seong Bong Jae , Kim Sun Ick , Jee Moo Geun , Kim Soo Dong , Kwon A Reum , Kim Hyun Ho , Lee Ka Soon
Published: October 2017

This study was carried out to investigate shelf-life and quality of fresh-cut Dungkunma (Dioscorea bulbifera) in order to elevate utilization of Dungkunma a fresh food. Before vacuum-packaging (in polyethylene/polypropylene film (100μm, 15×20 cm, 75±2 cmHg) and storaging at 2℃, Dungkunma was peeled out and cut to dice type (2.0±0.5 cm3), and then washed and blanched using hot water (at 90±2℃ with 2% NaCl solution for 30 sec). Blanched Dungkunma was pre-dried at room temperature, 40℃ and 50℃ for removing surface water. Each peeled dice Dungkunma was packed 50 g in polyethylene/polypropylene film (100 μm, 15×20 cm) with vacuum treatment (75±2 cmHg) and stored at 2℃ for 90 days. Hardness and adhesiveness of Dungkunma blanched by 2% NaCl and pre-dried at 50℃ (SB50) were the highest, but changes were the least during storage. Lightness and yellowness of stored Dungkunma in all treatments decreased slightly while redness increased during storage. Changes of color of SB50 was the least. Total concentration of aerobic bacteria in SB50 was 1.88±0.18 log CFU/g during 90 days and E. coli was detected in all treatments during whole storage periods. Dioscin and allantoin contents of SB50 were virtually unchanged during the storage. Consequently, the results of this study suggest that vacuum packaged Dungkunma after blanching using 2% NaCl solution could be effective to prolong the quality of fresh-cut Dungkunma.
Soju brewing characteristics of yeast strains N4 and N9 isolated from Korean traditional Nuruk
Authors: Choi Han-Seok , Kang Ji-Eun , Jeong Seok-Tae , Kim Chan-Woo , Baek Seong-Yeol , Yeo Soo-Hwan
Published: October 2017

Soju is a Korean traditional distilled alcoholic beverage produced from mashes various crops and Nuruk which is cultured with wild microorganisms. This study was conducted to investigate rice-Soju brewing characteristics of yeasts isolated from Korean traditional Nuruk. The general components of rice (Hanarumbyeo) raw materials were 14.7 g of water, 6.8 g of crude protein, 0.9 g of crude lipid, 0.4 g of crude ash, and 76.5 g of carbohydrate in 100 g. Saccharifying and proteolytic activities in Hanarumbyeo ipguk (solid-state culture of Aspergillus luchuensis) were also determined. The alcohol content of the fermented wash from isolates was 15.37-16.58% (v/v), which is 16.7-36.0% higher than that of industrial yeasts (12.33-13.19%). Reducing sugar contents were 2.04-3.92 and 7.92-8.78 g/100 mL in the isolates and industrial yeasts, respectively. The isolated yeasts showed 25.2-52.7% higher yield of distillates (41% alcohol) compared to industrial yeasts. Forty-one components were detected in the rice distillated Soju (25% alcohol) and principal component analysis revealed differences between the isolated and industrial yeasts with respect to the contents of i-BuOH, isobutanal diethyl acetal, ethyl caprate, and tetradecanoic acid.
Non-invasive imaging reveals conditions that impact distribution and persistence of cells after in vivo administration
Authors: Scarfe Lauren , Taylor Arthur , Sharkey Jack , Harwood Rachel , Barrow Michael , Comenge Joan , Beeken Lydia , Astley Cai , Santeramo Ilaria , Hutchinson Claire , Ressel Lorenzo , Smythe Jon , Austin Eric , Levy Raphael , Rosseinsky Matthew J. , Adams Dave J. , Poptani Harish , Park B. Kevin , Murray Patricia , Wilm Bettina
Published: October 2017

Background

Cell-based regenerative medicine therapies are now frequently tested in clinical trials. In many conditions, cell therapies are administered systemically, but there is little understanding of their fate, and adverse events are often under-reported. Currently, it is only possible to assess safety and fate of cell therapies in preclinical studies, specifically by monitoring animals longitudinally using multimodal imaging approaches. Here, using a suite of in vivo imaging modalities to explore the fate of a range of human and murine cells, we investigate how route of administration, cell type and host immune status affect the fate of administered cells.

Methods

We applied a unique imaging toolkit combining bioluminescence, optoacoustic and magnetic resonance imaging modalities to assess the safety of different human and murine cell types by following their biodistribution and persistence in mice following administration into the venous or arterial system. Results: Longitudinal imaging analyses (i) suggested that the intra-arterial route may be more hazardous than intravenous administration for certain cell types; (ii) revealed that the potential of a mouse mesenchymal stem/stromal cell (MSC) line to form tumours, depended on administration route and mouse strain; and (iii) indicated that clinically tested human umbilical cord (hUC)-derived MSCs can transiently and unexpectedly proliferate when administered intravenously to mice.

Conclusions

In order to perform an adequate safety assessment of potential cell-based therapies, a thorough understanding of cell biodistribution and fate post administration is required. The non-invasive imaging toolbox used here can expose not only the general organ distribution of these therapies, but also a detailed view of their presence within different organs and, importantly, tumourigenic potential. Our observation that the hUC-MSCs but not the human bone marrow (hBM)-derived MSCs persisted for a period in some animals, suggests that therapies with these cells should proceed with caution.
Dynamics of pollen tube growth and embryo sac development in Pozna Plava plum cultivar related to fruit set
Authors: Đorđević Milena , Cerović Radosav , Radičević Sanja , Nikolić Dragan , Milošević Nebojša , Glišić Ivana , Marić Slađana , Lukić Milan
Published: October 2017

A newly released, late ripening plum cultivar Pozna Plava sets fruit poorly, although it produces high quality fruit. This study aimed to evaluate which factors in the reproductive process could be related to the lack of fruit set. In two consecutive years, establishment of a suitable polleniser and the stage of ovule development at anthesis as well as initial and final fruit set have been studied. In addition to this, the impact made by temperature fluctuations on the interaction between male gametophytes and female sporophytes was also analysed. Growth of the pollen tubes in the style and penetration into the nucellus as well as fruit set were more effective in cross-pollination than in open and self-pollination. A relative delay in ovule development was observed, and most ovules had an embryo sac with eight nuclei. Considering the results of the quantitiative parameter study of pollen tube growth in the ovary as well as the results of the stage of ovule development, a conclusion can be made that this cultivar is characterised by an extremely short effective period of pollination.
QTLseqr: An R package for bulk segregant analysis with next-generation sequencing
Authors: Mansfeld Ben N. , Grumet Rebecca
Published: October 2017

1

Next Generation Sequencing Bulk Segregant Analysis (NGS-BSA) is efficient in detecting quantitative trait loci (QTL). Despite the popularity of NGS-BSA and the R statistical platform, no R packages are currently available for NGS-BSA. We present QTLseqr, an R package for NGS-BSA that identifies QTL using two statistical approaches: QTL-seq and G’. These approaches use a simulation method and a tricube smoothed G statistic, respectively, to identify and assess statistical significance of QTL. QTLseqr, can import and filter SNP data, calculate SNP distributions, relative allele frequencies, G’ values, and log10(p-values), enabling identification and plotting of QTL. The source code is available at https://github.com/bmansfeld/QTLseqr.

Core ideas

An R package that performs Next Generation Sequencing Bulk Segregant Analysis was developed

Two methods for analysis are provided: QTL-seq and G’

The QTLseqr package is quick and produces publication quality figures and tables