bluuebunny/crossref_metadata_2025 huggingface dataset:
Optically modulated electric synapses realized with memristors based on ZnO nanorods
Authors: Zhou Wen , Yang Rui , He Hui-Kai , Huang He-Ming , Xiong Jue , Guo Xin
Published: August 2018

Artificial synapses based on compact nanodevices are indispensable building blocks for implementing artificial neural networks in hardware. In this work, we demonstrate optically modulated artificial synapses realized with ZnO nanorods. These artificial synapses advance preceding memristive synapses with regard to the ability of response to not only electric but also optical modulation. The high surface state densities of the ZnO nanorods endow the present device with high photoresponse, resulting in the optical shielding effect, while the subsequent deshielding can be realized by applying electric pulses. The optical shielding and electrical deshielding functions provide abilities to process massive data for artificial neural networks. Moreover, with the aid of the optical modulation, methods are opened up for future optically tuned synaptic devices for secured communications.
Expression characterisation of cyclophilin BrROC1 during light treatment and abiotic stresses response in Brassica rapa subsp. rapa ‘Tsuda’
Authors: Yan Haifang , Zhou Bo , He Wei , Nie Yuzhe , Li Yuhua
Published: August 2018

ROC1 is a prototypic peptidyl prolyl cis/trans isomerase (PPIase) of the plant cytosol belonging to the large subfamily of cyclophilins that are associated with diverse functions through foldase, scaffolding, chaperoning or other unknown activities. Although many functions of plant cyclophilins have been reported, the molecular basis of stress-responsive expression of plant cyclophilins is still largely unknown. To characterise the roles of BrROC1 during light treatment and their responses in various abiotic stresses, we identified BrROC1 genes and characterised their expression patterns in Brassica rapa subsp. rapa ‘Tsuda’. Our results showed that BrROC1 genes are multi-family genes. Transcript level analysis showed BrROC1-2 expressed higher than BrROC1-1 in 0 to 6-day-old seedlings under natural light. Moreover, BrROC1-2 genes were also induced to highly express in the cotyledon, upper hypocotyls and lower hypocotyls of seedlings under UV-A and blue-light treatment. In addition, the transcript level of BrROC1-1 was higher in pigment tissues than that in unpigment tissues (cotyledon and lower hypocotyl) under UV-A and blue-light treatment. Furthermore, when the unpigment epidermis (shaded light) of 2-month-old ‘Tsuda’ turnip roots was exposed to UV-A light, transcript levels of the BrROC1-1 and BrROC1-2 were significantly increased with time prolongation. These two BrROC1 genes might be involved in UV-A-induced anthocyanin synthesis in the root epidermis of ‘Tsuda’ turnip, which accumulates high levels of anthocyanin. These two BrROC1 genes were also induced to be regulated by abiotic stresses such as high or low temperature, dehydration, osmotic and salt stresses. Then, the results indicate that BrROC1 genes are involved in light induction response and may play important roles in adaptation of plants to various environmental stresses.
Breastfeeding questions to medicines call centres from the Australian public and health professionals
Authors: Stephens Amelia , Brodribb Wendy , McGuire Treasure , Deckx Laura
Published: August 2018

There is considerable uncertainty regarding medication use during breastfeeding. This study compared lactation-related questions about medicines from consumers and health professionals to identify knowledge gaps. A retrospective, mixed-methods study of lactation-related call data extracted from two Australian medicines call centre databases: National Prescribing Service (NPS) Medicines Line (ML) for the general public and Therapeutic Advice and Information Service (TAIS) for health professionals, was conducted. Of the 5662 lactation-related calls by consumers to ML, most were from women enquiring about themselves (95%). The 2219 lactation-related calls from health professionals to TAIS were largely from GPs (46%), community pharmacists (35%) and nurses (12%). Consumers commonly enquired about medicines freely accessible or over-the-counter, including non-steroidal anti-inflammatory products (9.3%), paracetamol (6.9%), ibuprofen (4.8%) and codeine (4.2%). Health professionals’ questions involved prescription medicines such as antidepressants (16.9%), with queries on sertraline (3.7%), levonorgestrel (2.7%) and domperidone (2.4%) most common. Question themes were similar for both cohorts, focusing mainly around medication safety, risk minimisation and milk supply. Understanding the compelling and common themes driving medicines help-seeking related to breastfeeding is key to addressing information gaps and improving overall medication use during breastfeeding.
Comparative analysis of testis transcriptomes associated with male infertility in triploid cyprinid fish
Authors: Li Wuhui , Tan Hui , Liu Junmei , Hu Jie , Cui Jialin , Wang Shi , Liu Qingfeng , Hu Fangzhou , Ren Li , Tao Min , Zhao Rurong , Yang Conghui , Qin Qinbo , Liu Shaojun
Published: August 2018

Spermatogenesis involves a series of cellular transformations and thousands of regulated genes. Previously, we showed that the triploid fish (3nBY) cannot produce mature spermatozoa. In the present study, evaluation of the testis microstructure revealed that germ cells of 3nBY could develop into round spermatids, but then degenerated, resulting in male infertility. In this study we comparatively analysed the testis transcriptomes from 3nBY and its diploid parent YB and identified a series of differentially expressed genes (DEGs) that were enriched in the Wnt signalling pathway and the apoptotic and ubiquitin-mediated proteolysis processes in 3nBY. Gene ontology functional analyses revealed that some DEGs in 3nBY were directly associated with the process of gamete generation, development and sperm flagellum assembly. In addition, the expression of a number of genes related to meiosis (Inhibitor Of DNA Binding 2 (ID2), Ovo Like Transcriptional Repressor 1 (OVOL1)), mitochondria (ATP1b (ATPase Na+/K+ Transporting Subunit Beta 1), ATP2a (ATPase, Ca++ Transporting, Cardiac Muscle, Slow Twitch 2), ATP5a (ATP Synthase F1 Subunit Alpha), Mitochondrially Encoded Cytochrome C Oxidase I (COX1), NADH Dehydrogenase Subunit 4 (ND4)) and chromatin structure (Histone 1 (H1), Histone 2a (H2A), Histone 2b (H2B), Histone 3 (H3), Histone 4 (H4)) was lower in the testes of 3nBY, whereas the expression of genes encoding ubiquitin (Ubiquitin Conjugating Enzymes (UBEs), Ring Finger Proteins (RNFs)) and apoptosis (CASPs (Caspase 3, Caspase 7,Caspase 8), BCLs (B-Cell Lymphoma 3, B-Cell CLL/Lymphoma 2, B Cell CLL/Lymphoma 10)) proteins involved in spermatid degeneration was higher. These data suggest that the disrupted expression of genes associated with spermatogenesis and the increased expression of mitochondrial ubiquitin, which initiates cell apoptosis, may result in spermatid degeneration in male 3nBY. This study provides information regarding the potential molecular regulatory mechanisms underlying male infertility in polyploid fish.
FromEl Gran MeaulnestoMeaulnes el Grande
Authors: Schnell Bettina , Rodríguez Nadia
Published: August 2018

The present contribution aims at a comparative study of the Spanish retranslations of the French classicLe Grand Meaulnes. With the objective of identifying macro and micro-structural variations among the various retranslations, a parallel corpus is compiled, the source-text and the various translations are aligned and imported into a translation memory which allows for a targeted analysis of specific linguistic elements. The results obtained from the corpus analysis show that, despite their differences the retranslations display a relative homogeneity, in so far as they are largely source-text oriented and foreignizing. Relative homogeneity notwithstanding, differences can be observed between twentieth century-translations and those carried out in the twenty-first-century. The translators of the latter take a specific approach to translating the novel, either as a literary critic or by taking a critical stance towards a more assimilative approach adopted in an earlier translation.
Plasma sprayed α-Al2O3 main phase coating using γ-Al2O3 powders
Authors: Niu Bolong , Qiang Li , Zhang Junyan , Zhang Fan , Hu Yong , Chen Wei , Liang Aimin
Published: August 2018

Although α-Al2O3 is commonly used as crude materials for preparing Al2O3 coating by plasma spraying, the obtained coatings are mainly made up of γ-Al2O3 crystalline phase with relatively poor mechanical performance. In this research, we employed an unconventional way, i.e. adopting low-cost γ-Al2O3 powders as crude material via the optimisation of plasma spraying process to prepare a novel aluminium oxide coating containing α-Al2O3 crystals with excellent mechanical properties as main phase, and the microstructure, microhardness and tribological properties of the coating were characterised and analysed. The results indicated that the aluminium oxide coating possesses favourable toughness, strength and wear resistance (e.g. HV602.4 and wear loss ∼2.5 μm), consequently having a great potential for exploration and application.
Beyond muscle: the effects of creatine supplementation on brain creatine, cognitive processing, and traumatic brain injury
Authors: Dolan Eimear , Gualano Bruno , Rawson Eric S.
Published: August 2018

The ergogenic and therapeutic effects of increasing muscle creatine by supplementation are well‐recognized. It appears that similar benefits to brain function and cognitive processing may also be achieved with creatine supplementation, however research in this area is more limited, and important knowledge gaps remain. The purpose of this review is to provide a comprehensive overview of the current state of knowledge about the influence of creatine supplementation on brain function in healthy individuals. It appears that brain creatine is responsive to supplementation, however higher, or more prolonged dosing strategies than those typically used to increase muscle creatine, may be required to elicit an increase in brain creatine. The optimal dosing strategy to induce this response, is currently unknown, and there is an urgent need for studies investigating this. When considering the influence of supplementation strategies on cognitive processes, it appears that creatine is most likely to exert an influence in situations whereby cognitive processes are stressed, e.g. during sleep deprivation, experimental hypoxia, or during the performance of more complex, and thus more cognitively demanding tasks. Evidence exists indicating that increased brain creatine may be effective at reducing the severity of, or enhancing recovery from mild traumatic brain injury, however, only limited data in humans are available to verify this hypothesis, thus representing an exciting area for further research.
Arch‐support foot‐orthoses normalize dynamic in‐shoe foot pressure distribution in medial tibial stress syndrome
Authors: Naderi Aynollah , Degens Hans , Sakinepoor Ainollah
Published: August 2018

Excessive foot pronation during gait is a risk factor in medial tibial stress syndrome (MTSS). Arch‐support foot‐orthoses are commonly used to manage overpronation, but it is unknown whether it is effective to manage MTSS. The present study investigated the effects of bilateral foot orthoses during running on dynamic foot‐pressure distribution patterns in recreational runners with MTSS. Fifty novice (started within the last 4 months) runners diagnosed with MTSS (20.7 ± 2.2 years; 71.1 ± 8.6 kg; 1.78 ± 0.07 m; mean ± SD) and 50 anthropometrically‐matched healthy novice runners (21.9 ± 2.4 years; 71.4 ± 8.8 kg; 1.73 ± 0.07 m) participated in this study. The dynamic foot‐pressure distribution during running with and without bilateral arch‐support foot‐orthoses was measured using pedobarography. MTSS novice runners have more medially directed pressures during the touchdown phase of the forefoot flat (p = 0.009) and heel off (p = 0.009), and a lateral pressure distribution during forefoot push‐off phase (p = 0.007) during running than healthy runners. When using the arch‐support foot‐orthoses the foot‐pressure distribution during all phases was not significantly different from that seen in participants without MTSS. These findings indicate that during running the medial shift of foot pressures during the loading response phase and the lateral shift during the propulsion phase of foot roll‐over in MTSS are effectively corrected by using arch‐support foot‐orthoses. The use of such arch‐support orthoses may thus be an effective tool to normalize foot‐pressure distribution patterns during running, indicating the potential to treat and prevent MTSS in recreational runners.
Introducing the urban wind island effect
Authors: Droste A M , Steeneveld G J , Holtslag A A M
Published: August 2018

Wind is a key component of the urban climate due to its relevance for ventilation
of air pollution and urban heat, wind nuisance, as well as for urban wind energy
engineering. These winds are governed by the dynamics of the atmosphere closest
to the surface, the atmospheric boundary layer (ABL). Making use of a conceptual
bulk model of the ABL, we find that for certain atmospheric conditions the
boundary-layer mean wind speed in a city can surprisingly be higher than its
rural counterpart, despite the higher roughness of cities. This urban wind
island effect (UWI) prevails in the afternoon, and appears to be caused by a
combination of differences in ABL growth, surface roughness and the ageostrophic
wind, between city and countryside. Enhanced turbulence in the urban area
deepens the ABL, and effectively mixes momentum into the ABL from aloft.
Furthermore, the oscillation of the wind around the geostrophic equilibrium,
caused by the rotation of the Earth, can create episodes where the urban
boundary-layer mean wind speed is higher than the rural wind. By altering the
surface properties within the bulk model, the sensitivity of the UWI to urban
morphology is studied for the 10 urban local climate zones (LCZs). These LCZs
classify neighbourhoods in terms of building height, vegetation cover etc, and
represent urban morphology regardless of culture or location. The ideal
circumstances for the UWI to occur are a deeper initial urban boundary-layer
than in the countryside, low-rise buildings (up to 12 m) and a moderate
geostrophic wind (∼5 m s−1). The UWI phenomenon challenges
the commonly held perception that urban wind is usually reduced due to drag
processes. Understanding the UWI can become vital to accurately model urban air
pollution, quantify urban wind energy potential or create accurate background
conditions for urban computational fluid dynamics models.
Generating function for the Bannai-Ito polynomials
Authors: Bergeron Geoffroy , Vinet Luc , Tsujimoto Satoshi
Published: August 2018

A generating function for the Bannai-Ito polynomials is derived using the fact that these polynomials are known to be essentially the Racah or

6
j

6j

coefficients of the

o
s
p

(
1

|

2
)

\mathfrak {osp}(1|2)

Lie superalgebra. The derivation is carried in a realization of the recoupling problem in terms of three Dunkl oscillators.
Myosin-dependent actin stabilization as revealed by single-molecule imaging of actin turnover
Authors: Yamashiro Sawako , Tanaka Soichiro , McMillen Laura M. , Taniguchi Daisuke , Vavylonis Dimitrios , Watanabe Naoki
Published: August 2018

How mechanical stress applied to the actin network modifies actin turnover has attracted considerable attention. Actomyosin exerts the major force on the actin network, which has been implicated in actin stability regulation. However, direct monitoring of immediate changes in F-actin stability on alteration of actomyosin contraction has not been achieved. Here we reexamine myosin regulation of actin stability by using single-molecule speckle analysis of actin. To avoid possible errors attributable to actin-binding probes, we employed DyLight-labeled actin that distributes identical to F-actin in lamellipodia. We performed time-resolved analysis of the effect of blebbistatin on actin turnover. Blebbistatin enhanced actin disassembly in lamellipodia of fish keratocytes and lamellar of Xenopus XTC cells at an early stage of the inhibition, indicating that actomyosin contraction stabilizes cellular F-actin. In addition, our data show a previously unrecognized relationship between the actin network-driving force and the actin turnover rates in lamellipodia. These findings point to the power of direct viewing of molecular behavior in elucidating force regulation of actin filament turnover.
Population structure of Miscanthus sacchariflorus reveals two major polyploidization events, tetraploid-mediated unidirectional introgression from diploid M. sinensis, and diversity centred around the Yellow Sea
Authors: Clark Lindsay V , Jin Xiaoli , Petersen Karen Koefoed , Anzoua Kossanou G , Bagmet Larissa , Chebukin Pavel , Deuter Martin , Dzyubenko Elena , Dzyubenko Nicolay , Heo Kweon , Johnson Douglas A , Jørgensen Uffe , Kjeldsen Jens Bonderup , Nagano Hironori , Peng Junhua , Sabitov Andrey , Yamada Toshihiko , Yoo Ji Hye , Yu Chang Yeon , Long Stephen P , Sacks Erik J
Published: August 2018

Background and Aims

Miscanthus, a C4 perennial grass native to East Asia, is a promising biomass crop. Miscanthus sacchariflorus has a broad geographic range, is used to produce paper in China and is one of the parents (along with Miscanthus sinensis) of the important biomass species Miscanthus × giganteus. The largest study of M. sacchariflorus population genetics to date is reported here.

Methods

Collections included 764 individuals across East Asia. Samples were genotyped with 34 605 single nucleotide polymorphisms (SNPs) derived from restriction site-associated DNA sequencing (RAD-seq) and ten plastid microsatellites, and were subjected to ploidy analysis by flow cytometry.

Key Results

Six major genetic groups within M. sacchariflorus were identified using SNP data: three diploid groups, comprising Yangtze (M. sacchariflorus ssp. lutarioriparius), N China and Korea/NE China/Russia; and three tetraploid groups, comprising N China/Korea/Russia, S Japan and N Japan. Miscanthus sacchariflorus ssp. lutarioriparius was derived from the N China group, with a substantial bottleneck. Japanese and mainland tetraploids originated from independent polyploidization events. Hybrids between diploid M. sacchariflorus and M. sinensis were identified in Korea, but without introgression into either parent species. In contrast, tetraploid M. sacchariflorus in southern Japan and Korea exhibited substantial hybridization and introgression with local diploid M. sinensis.

Conclusions

Genetic data indicated that the land now under the Yellow Sea was a centre of diversity for M. sacchariflorus during the last glacial maximum, followed by a series of migrations as the climate became warmer and wetter. Overall, M. sacchariflorus has greater genetic diversity than M. sinensis, suggesting that breeding and selection within M. sacchariflorus will be important for the development of improved M. × giganteus. Ornamental M. sacchariflorus genotypes in Europe and North America represent a very narrow portion of the species’ genetic diversity, and thus do not well represent the species as a whole.
Developing a Computerized Brief Cognitive Screening Battery for Botswana: A Feasibility Study
Authors: Plattner Ilse Elisabeth , Mbakile-Mahlanza Lingani , Marobela Shathani , Kgolo Tumelo Juliet Faith , Monyane-Pheko Makhetha Motheo Bakang , Patel Viral , Feinstein Anthony
Published: August 2018

Objective

To determine the feasibility of using a brief computerized battery for assessing cognition in citizens of Botswana.

Method

A group of 134 healthy subjects were administered a brief computerized battery of tests (Stroop, Symbol Digit Modalities Test (c-SDMT), and 2 and 4 second versions of the Paced Visual Serial Addition Test (PVSAT)). Half the subjects were tested in English and the other half in Setswana.

Results

All subjects completed the 20 min battery. Participants administered the tests in English had more years of education (p < .001) and were more likely to be male (p = .024) than those administered the tests in Setswana. There were no significant cognitive differences between the English and Setswana groups. Predictors of cognition were education (c-SDMT, PVSAT 4 and 2 second versions), age (Stroop, c-SDMT), and sex (c-SDMT), with females performing better than males on the latter. Language was not associated with performance on any of the cognitive tests and there were no significant interactions between language and any of the demographic predictors of cognition.

Conclusions

The results demonstrate that our brief computerized approach is feasible with similar findings obtained for both language groups. Two further phases to the development of the Botswana version of the brief computerized battery can now proceed. The first is to obtain normative data from a larger sample representative of Botswana society in general. The second will be to validate the cognitive measures in a sample of people with acquired brain injury using the normative data to determine thresholds for impairment.
Using Normalization Process Theory to Evaluate the Implementation of Montessori-based Volunteer Visits Within a Canadian Long-term Care Home
Authors: Hunter Paulette V , Thorpe Lilian , Hounjet Celine , Hadjistavropoulos Thomas
Published: August 2018

Background and Objectives

Montessori-based interventions (MBIs) have potential to improve the life quality of long-term care residents with dementia. In this study, we aimed to understand the processes by which staff integrated a volunteer-led MBI into practice within a special dementia care unit, and to explore staff members ’ perceptions of associated strengths and limitations.

Research Design and Methods

This study relied on a qualitative descriptive design. Following a 3-month period of volunteer involvement, we conducted 21 interviews with staff members to document perceptions of the new program and subjected interview transcripts to qualitative content analysis, guided by normalization process theory.

Results

During the implementation of the volunteer-led MBI, staff members developed a shared understanding of the intervention, a sense of commitment, practical ways to support the intervention, and opinions about the value of the residents. Overall, we found that the volunteer-led MBI was quickly and successfully integrated into practice and was perceived to support both residents and staff members in meaningful ways. Nevertheless, some limitations were also identified.

Discussion and Implications

Volunteer-delivered MBIs are a useful adjunct to practice within a special dementia care unit. This article raises attention to some strengths and limitations associated with this approach.
A Modified Lateral Orbitotomy Approach to the Superior Orbital Fissure: A Video Case Report and Review of Anatomy
Authors: Alzhrani Gmaan A , Gozal Yair M , Sherrod Brandon A , Couldwell William T
Published: August 2018

BACKGROUND

The lateral orbitotomy approach (LOA) is often used for accessing the orbital contents and middle skull base; however, most prior descriptions of the LOA involve complete drilling of the lateral orbital wall. This practice requires retraction of the orbital contents and produces postoperative diplopia that the patient experiences for a limited time.

OBJECTIVE

To describe a modified LOA with partial sparing of the lateral orbital wall for accessing lesions of the superior orbital fissure (SOF).

METHODS

One patient with a progressively enlarging SOF lesion and visual loss underwent a modified LOA for resection. The orbital rim lateral to the SOF was removed as a bone flap, and the greater wing of the sphenoid inferior to the SOF was drilled to expose the lesion. The lateral orbital wall was thinned but was not completely removed. The orbital rim was resecured with miniplates and screws.

RESULTS

Gross total resection of the SOF mass was achieved without unnecessary exposure or retraction of the orbital contents. Histopathologic analysis of the resected mass was consistent with a cavernous hemangioma. The patient had a good cosmetic outcome without complication.

CONCLUSION

Modified LOA with partial sparing of the lateral orbital wall is a feasible approach for lesions of the SOF.
Evaluation of the Risk of Development of Fluopicolide Resistance in Phytophthora erythroseptica
Authors: Zhang Xuemei , Jiang He , Hao Jianjun
Published: August 2018

Fluopicolide has shown effective pink rot (Phytophthora erythroseptica) control in potato disease management. To efficiently utilize this chemical, the risk of fluopicolide resistance in P. erythroseptica needs to be assessed. In this study, 34 isolates of P. erythroseptica were obtained from symptomatic potato tubers with pink rot in Maine. The sensitivity of these wild-type isolates to fluopicolide was assessed by culturing them on agar medium amended with fluopicolide at various concentrations. The 50% effective concentration (EC50) of fluopicolide for the inhibition of mycelial growth was determined and used to establish a baseline sensitivity of these P. erythroseptica isolates to fluopicolide. The wild-type isolates were sensitive to fluopicolide, with EC50 values ranging from 0.08 to 0.35 μg/ml. By exposing P. erythroseptica zoospores to agar medium containing 100 μg/ml fluopicolide, 6 out of the 34 wild-type isolates produced fluopicolide-resistant mutants. The mutants were transferred to fungicide-free V8 medium consecutively for 10 times, and the 10th transfer of mutants was examined for resistance stability and biological fitness. In general, the mutants had similar or slower growth rates compared with their wild-type parents, and the virulence of some mutants was significantly reduced. The results indicated a low to moderate risk of P. erythroseptica developing resistance to fluopicolide, and suggested a trade-off between fluopicolide resistance and biological fitness in P. erythroseptica.
Recommendations for evaluating and managing idiopathic pulmonary fibrosis
Authors: Provencher Daniel M. , Jauregui Andrew R.
Published: August 2018

Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease characterized by progressive and irreversible fibrosis of lung parenchyma that reduces lung function. This rare, incurable disease often is mistaken for an inflammatory condition. IPF typically manifests in older men and is associated with a history of smoking. Disease progression is rapid, with a 5-year survival rate of 20%. Treatment options include lung transplantation and medical therapies to reduce the steady decline in lung function. This article reviews the epidemiology, pathophysiology, presentation, diagnosis, and management of IPF.
Development of a Foundations of Simulation Teaching Course for Nurse Educators
Authors: Gore Teresa , Singh Oma Baliram
Published: August 2018

Academic leaders in a college of nursing were faced with an increasing need to integrate high quality simulations into their undergraduate curriculum; however, there was a general lack of expertise in the subject area among faculty. The leaders supported the development of an online course that focused on improving foundational simulation knowledge. The course, developed through collaboration between a faculty simulation expert and an instructional designer, was specifically designed to focus on key simulation objectives to improve the simulation skill set of faculty. Posttest scores revealed an increase in simulation knowledge.
A Randomized Controlled Trial of a Video-Enhanced Advanced Airway Curriculum for Pediatric Residents
Authors: Miller Kelsey A. , Monuteaux Michael C. , Aftab Saima , Lynn Alex , Hillier Debra , Nagler Joshua
Published: August 2018

Purpose

Pediatric advanced airway management is a low-frequency but critical procedure, making it challenging for trainees to learn. This study examined the impact of a curriculum integrating prerecorded videos of patient endotracheal intubations on performance related to simulated pediatric intubation.

Method

The authors conducted a randomized controlled educational trial for pediatric residents between January 2015 and June 2016 at Boston Children’s Hospital. Investigators collecting data were blinded to the intervention. The control group received a standard didactic curriculum including still images, followed by simulation on airway trainers. The intervention group received a video-enhanced didactic curriculum including deidentified intubation clips recorded using a videolaryngoscope, followed by simulation. The study assessed intubation skills on simulated infant and pediatric airway scenarios of varying difficulty immediately after instruction and at three months.

Results

Forty-nine trainees completed the curriculum: 23 received the video-enhanced curriculum and 26 received the standard curriculum. Median time to successful intubation was 18.5 and 22 seconds in the video-enhanced and standard groups, respectively. Controlling for mannequin age and difficulty, residents receiving the video-enhanced curriculum successfully intubated faster (hazard ratio [95% confidence interval]: 1.65 [1.25, 2.19]). Video-enhanced curriculum participants also demonstrated decreased odds of requiring multiple attempts and of esophageal intubation. At three-month follow-up, residents who received the video-enhanced curriculum remained faster at intubation (hazard ratio [95% confidence interval]: 1.93 [1.23, 3.02]).

Conclusions

Integrating videos of patient intubations into an airway management curriculum improved participating pediatric residents’ intubation performance on airway trainers with sustained improvement at three months.
Mentorship Is Not Enough: Exploring Sponsorship and Its Role in Career Advancement in Academic Medicine
Authors: Ayyala Manasa S. , Skarupski Kimberly , Bodurtha Joann N. , González-Fernández Marlís , Ishii Lisa E. , Fivush Barbara , Levine Rachel B.
Published: August 2018

Purpose

To explore how sponsorship functions as a professional relationship in academic medicine.

Method

The authors conducted semistructured interviews with Johns Hopkins University School of Medicine faculty in 2016: department chairs (sponsors) and faculty participants of an executive leadership development program (protégés). Using editing analysis style, the authors coded interview transcripts for thematic content; a coding framework and themes were derived using an iterative process.

Results

Five themes were identified from 23 faculty interviews (12 sponsors, 11 protégés): (1) Mentorship is different: Sponsorship is episodic and focused on specific opportunities; (2) Effective sponsors are career-established and well-connected talent scouts; (3) Effective protégés rise to the task and remain loyal; (4) Trust, respect, and weighing risks are key to successful sponsorship relationships; (5) Sponsorship is critical to career advancement. Sponsorship is distinct from mentorship, though mentors can be sponsors if highly placed and well connected. Effective sponsors have access to networks and provide unequivocal support when promoting protégés. Effective protégés demonstrate potential and make the most of career-advancing opportunities. Successful sponsorship relationships are based on trust, respect, mutual benefits, and understanding potential risks. Sponsorship is critical to advance to high-level leadership roles. Women are perceived as being less likely to seek sponsorship but as needing the extra support sponsorship provides to be successful.

Conclusions

Sponsorship, in addition to mentorship, is critical for successful career advancement. Understanding sponsorship as a distinct professional relationship may help faculty and academic leaders make more informed decisions about using sponsorship as a deliberate career-advancement strategy.
Weekly Teriparatide Administration and Preoperative Anterior Slippage of the Cranial Vertebra Next to Fusion Segment < 2 mm Promote Osseous Union After Posterior Lumbar Interbody Fusion
Authors: Ushirozako Hiroki , Hasegawa Tomohiko , Ebata Shigeto , Oba Hiroki , Ohba Tetsuro , Mukaiyama Keijiro , Isogai Yukihiro , Okada Eisaku , Ojima Toshiyuki , Takahashi Jun , Haro Hirotaka , Matsuyama Yukihiro
Published: August 2018

Study Design.

A multicenter case-control study.

Objective.

The aim of this study was to investigate the independent predictors of osseous union after posterior lumbar interbody fusion (PLIF).

Summary of Background Data.

PLIF is usually performed to treat lumbar degenerative diseases in elderly patients. Some patients exhibit intervertebral pseudoarthrosis.

Methods.

We analyzed 66 elderly patients with osteoporosis who underwent PLIF from 2011 to 2014 (all women, mean age 71 years, follow-up period ≥6 months). Patients were randomly allocated to receive either treatment with weekly teriparatide, starting at 1 week postoperatively, or no teriparatide. Preoperative lumbar spine radiographs were obtained, and the amount of anterior slippage was measured. Osseous union was assessed by computed tomography at 6 months postoperatively.

Results.

Thirty-three patients (50%) showed complete osseous union, while 33 did not. Teriparatide was administered in 20 (61%) patients of the union group and in 9 (27%) patients of the nonunion group (P < 0.01). The preoperative anterior slippage of the cranial vertebra next to fusion segment < 2 mm was observed in 16 (49%) and 4 (12%) patients in the union and nonunion groups, respectively (P < 0.01). Multivariate regression analysis showed that teriparatide administration (odds ratio, 4.75; 95% confidence interval: 1.51–14.90; P < 0.01) and preoperative anterior slippage of the cranial vertebra next to fusion segment < 2 mm (odds ratio, 5.90; 95% confidence interval: 1.53–22.70; P < 0.01) were independently associated with osseous union within 6 months after PLIF. At 6 months postoperatively, the mean femoral neck bone mineral density significantly increased by 1.1% in the union group and decreased by 1.3% in the nonunion group (P < 0.05).

Conclusion.

Weekly teriparatide administration and preoperative anterior slippage of the cranial vertebra next to fusion segment < 2 mm were independent predictors of osseous union within 6 months after PLIF. Our findings suggest that biological and mechanical factors may influence the improvement of spinal fusion.

Level of Evidence: 4
Cervical Alignment of Anterior Cervical Hyperostosis Causing Dysphagia
Authors: Kawamura Ichiro , Tominaga Hiroyuki , Tanabe Fumito , Yamamoto Takuya , Taniguchi Noboru
Published: August 2018

Study Design.

Retrospective case control study.

Objective.

To investigate whether cervical alignment is related to dysphagia in patients with cervical diffuse idiopathic skeletal hyperostosis (DISH).

Summary of Background Data.

DISH involves a wide range of ligamentous ossifications, which can cause dysphagia. However, even patients with a high degree of ossification can have only mild dysphagia. Dysphagia results from esophageal compression due to ossification; however, the exact cause of dysphagia is unknown.

Methods.

We reviewed five patients with advanced dysphagia due to anterior cervical hyperostosis who underwent resection (S group), and five patients with mild symptoms who were only monitored (NS group). The patients were evaluated using the Eating Assessment Tool-10 (EAT-10) and plain kinetic radiographs of the cervical spine. The O–C2 angle, M–C angle, C2–7 angle, and C2–6a angle were measured in the flexion, neutral, and extension positions. We compared these parameters in the S group versus the NS group, and compared the pre- and postoperative values in the S group.

Results.

The EAT-10 score indicated a high degree of dysphagia in the S group preoperatively (25 [22–27]) compared with the NS group (1 [1–6]). In the S group, the EAT-10 score significantly decreased postoperatively to 1 (0–1), and improvement of dysphagia was observed. There was a significant difference between the S and NS groups in the ΔC2–7 and ΔC2–6a, and between pre- and postoperative values in the S group. There were no significant changes in O–C2 angle and M–C angle, which are parameters of the superior cervical vertebrae.

Conclusion.

The present results suggest that the restriction of flexion due to cervical spine ankylosis may be one of the reasons for dysphagia in patients with DISH.

Level of Evidence: 4
PROMIS Physical Function Score Strongly Correlates With Legacy Outcome Measures in Minimally Invasive Lumbar Microdiscectomy
Authors: Khechen Benjamin , Haws Brittany E. , Patel Dil V. , Bawa Mundeep S. , Elboghdady Islam M. , Lamoutte Eric H. , Karmarkar Sailee S. , Singh Kern
Published: August 2018

Study Design.

Retrospective cohort.

Objective.

This study aims to determine the validity of the patient-reported outcomes measurement information system (PROMIS) physical function (PF) in minimally invasive lumbar discectomy (MIS LD) patients.

Summary of Background Data.

PROMIS was designed to allow for assessment of clinical outcomes in fewer questions than previous outcome measures with the goal of reducing noncompliance associated with longer, time-consuming surveys. However, there exists a paucity of evidence regarding the efficacy of the PROMIS PF domain in patients undergoing MIS LD.

Methods.

A surgical database of patients undergoing 1–3 level MIS LD was retrospectively reviewed. Postoperative changes in PROMIS PF scores were analyzed at 6-weeks, 12-weeks, and 6-months using paired Student t tests. PROMIS scores were compared to Oswestry disability index (ODI), visual analog scale (VAS) back, and VAS leg scores. Correlations were tested using Pearson correlation coefficient.

Results.

Forty-one MIS LD patients were identified, reporting an average preoperative PROMIS PF score of 35.36 ± 7. Patients demonstrated significant improvement in ODI, VAS back, and VAS leg scores. Additionally, strong associations with PROMIS scores were observed for preoperative and postoperative ODI (r range: 0.5735–0.8543) and postoperative VAS back (r range: 0.5332–0.6522) and VAS leg pain (r range: 0.5257–0.6412).

Conclusion.

Patients undergoing MIS LD demonstrated significant improvements in PROMIS PF, ODI, VAS back, and VAS leg pain postoperatively. Additionally, improvements in PROMIS physical function scores at each postoperative time point were determined to be significantly correlated with ODI, VAS back, and VAS leg pain. The results of the current study demonstrate PROMIS PF has strong utility as a postoperative outcome assessment tool.

Level of Evidence: 4
Early Right Ventricular Systolic Dysfunction and Pulmonary Hypertension Are Associated With Worse Outcomes in Pediatric Acute Respiratory Distress Syndrome
Authors: Himebauch Adam S. , Yehya Nadir , Wang Yan , Conlon Thomas , Kilbaugh Todd J. , McGowan Francis X. , Mercer-Rosa Laura
Published: August 2018

Objectives:

The prevalence and importance of early right ventricular dysfunction and pulmonary hypertension in pediatric acute respiratory distress syndrome are unknown. We aimed to describe the prevalence of right ventricular dysfunction and pulmonary hypertension within 24 hours of pediatric acute respiratory distress syndrome diagnosis and their associations with outcomes.

Design:

Retrospective, single-center cohort study.

Setting:

Tertiary care, university-affiliated PICU.

Patients:

Children who had echocardiograms performed within 24 hours of pediatric acute respiratory distress syndrome diagnosis.

Interventions:

None.

Measurements and Main Results:

Between July 1, 2012, and June 30, 2016, 103 children met inclusion criteria. Echocardiograms were analyzed using established indices of right ventricular and left ventricular systolic function and for evidence of pulmonary hypertension. Echocardiographic abnormalities were common: 26% had low right ventricular fractional area change, 65% had low tricuspid annular plane systolic excursion, 30% had low left ventricular fractional shortening, and 21% had evidence of pulmonary hypertension. Abnormal right ventricular global longitudinal strain and abnormal right ventricular free wall strain were present in 35% and 40% of patients, respectively. No echocardiographic variables differed between or across pediatric acute respiratory distress syndrome severity. In multivariable analyses, right ventricular global longitudinal strain was independently associated with PICU mortality (odds ratio, 3.57 [1.33–9.60]; p = 0.01), whereas right ventricular global longitudinal strain, right ventricular free wall strain, and the presence of pulmonary hypertension were independently associated with lower probability of extubation (subdistribution hazard ratio, 0.46 [0.26–0.83], p = 0.01; subdistribution hazard ratio, 0.58 [0.35–0.98], p = 0.04; and subdistribution hazard ratio, 0.49 [0.26–0.92], p = 0.03, respectively).

Conclusions:

Early ventricular dysfunction and pulmonary hypertension were detectable, prevalent, and independent of lung injury severity in children with pediatric acute respiratory distress syndrome. Right ventricular dysfunction was associated with PICU mortality, whereas right ventricular dysfunction and pulmonary hypertension were associated with lower probability of extubation.
Nutrition and the Plastic Surgeon: Possible Interventions and Practice Considerations
Authors: Roy Mélissa , Perry Julie A. , Cross Karen M.
Published: August 2018

The objective of this article is to convey the importance of nutrition in plastic surgery, to offer possible outpatient nutritional interventions within the surgical care setting, and to guide the plastic surgeon in integrating nutrition as a key practice enhancement strategy for the care of wound patients and beyond. The impact of nutritional status on surgical outcomes is well recognized. Malnutrition is very frequent among the hospitalized patient population and up to 1 in 4 plastic surgery outpatient is at risk for malnutrition. Micro- and macronutrients are both essential for optimal wound healing and although specific patient populations within the field of plastic surgery are more at risk of malnutrition, universal screening, and actions should be implemented. Outpatient interventions to promote adequate nutritional intake and address barriers to the access of fruits and vegetables have included both exposure and incentive interventions. In the clinical setting, universal screening using validated and rapid tools such as the Canadian Nutritional Screening Tool are encouraged. Such screening should be complemented by appropriate blood work, body mass index measurements, and prompt referral to a dietician when appropriate. The notion of prehabilitation has also emerged with impetus in surgery and encompasses the nutritional optimization of patients by promoting the enhancement of functional capacity preoperatively.
Local Cooling as a Step of Treatment for Tissue Ischemia Caused by Hyaluronic Acid Injection-induced Embolism—A Report of 9 Cases
Authors: Zhang Chen , Ge Chunying , Du Chunxiao , Li Jieqi
Published: August 2018

Hyaluronic acid injection is 1 of the most popular procedures in facial rejuvenation and augmentation. It is widely popular in the cosmetic surgery due to several advantages, which include rapid effect, minimal injury, and a short postoperative recovery period. With continuous increase in hyaluronic acid injections, many cases of hyaluronic acid injection-induced embolism have been reported. At present, methods for early treatment of hyaluronic acid injection–induced embolism include local injection of hyaluronidase, topical application of nitroglycerin ointment, massage, hot compression, and intravenous injections of antibiotics and hormones. Although early warm massage may facilitate hyaluronic acid degradation by hyaluronidase, local application of heat will also increase metabolic rate in the tissue, thereby reducing the ischemic tolerance of the tissue. Therefore, in this study, warm massage was limited to the first 30 minutes after hyaluronidase injection and was followed by local cooling using a gauze pad soaked with antibiotic saline solution. Excellent therapeutic effects were achieved with this approach. The methods of treatment for tissue ischemia caused by hyaluronic acid injection–induced embolism and clinical cases are introduced in the article.
Prevalence of Burnout among Plastic Surgeons and Residents in Plastic Surgery: A Systematic Literature Review and Meta-analysis
Authors: Ribeiro Rafael V. E. , Martuscelli Osíris J. D. , Vieira Antônio C. , Vieira Christian F.
Published: August 2018

Background:

Few studies have demonstrated the prevalence of burnout in the specialty of plastic surgery. Therefore, the objective of this systematic literature review and meta-analysis was to analyze the prevalence of burnout among plastic surgeons and residents in plastic surgery.

Methods:

The PRISMA statement for systematic reviews was followed, and the most relevant studies, published originally in any language until January 2018, were analyzed. The searches were conducted by 3 researchers in the following databases: the US National Library of Medicine (PubMed), Cochrane Central Register of Controlled Trials, Web of Science, and Scientific Electronic Library Online.

Results:

The final sample consisted of 6 publications, including 2,670 plastic surgeons and 90 residents in plastic surgery. There was a prevalence of male subjects, with mean ages of 47.2 years for plastic surgeons and 28.4 years for residents. The prevalence rates of burnout were 32.32% among plastic surgeons and 36.66% among residents in plastic surgery, and high emotional exhaustion, depersonalization, and low personal accomplishment scores were considerably higher among residents in plastic surgery (37.78%, 35.56%, and 42.22%, respectively) than among plastic surgeons (25.84%, 19.15%, and 7.50%, respectively).

Conclusion:

Given the high prevalence and fact that burnout syndrome correlates with the impairment of the professional and personal life of surgeons and residents in plastic surgery, and reduces quality in the care of patients, it is necessary to perform an early assessment and to regulate this phenomenon, with a focus on identifying, diagnosing, and providing appropriate treatment.
Burn in an Irradiated Prepectoral Breast Reconstruction: A Cautionary Tale
Authors: Nigro Lauren C. , Feldman Michael J. , Blanchet Nadia P.
Published: August 2018

Burns to breast reconstructions, both autologous and implant-based, are well described in the plastic surgery literature. The mechanism has often been contact; however, burns secondary to sun exposure have also been reported. With the increasing number of prepectoral breast reconstructions, including irradiated prepectoral reconstructions, we would like to highlight the increased susceptibility of these reconstructions to thermal and ultraviolet injury. We present the case of a patient who underwent prepectoral implant-based breast reconstruction years after irradiation, who subsequently developed full-thickness injury to her mastectomy flap after minor sun exposure. After weeks of daily wound care and hyperbaric oxygen treatments, the patient eventually reepithelialized over her exposed acellular dermal matrix tissue layer, allowing for implant salvage. Postmastectomy flaps overlying implants in the prepectoral plane are delicate; major burns can develop from minor thermal injury, even months after surgery. Irradiated prepectoral reconstruction patients should be educated about the susceptibility of their breast flaps to even minor burn injury and should maintain vigilance beyond the immediate postoperative period. It remains to be seen whether prepectoral reconstruction in an irradiated breast can be a viable, long-term option.