bluuebunny/crossref_metadata_2025 huggingface dataset:
Herzinsuffizienz und Diabetes
Authors: Baldia Philipp , Schütt Katharina
Published: July 2017

Patienten mit Diabetes mellitus haben ein deutlich erhöhtes Risiko für die Entwicklung einer Herzinsuffizienz. Liegen beide Erkrankungen gemeinsam vor, geht dies mit einer sehr schlechten Prognose einher. Daten neuer Studien legen nahe, dass eine frühe Diagnose von entscheidender Bedeutung für eine spezifische Therapie der Herzinsuffizienz bei Patienten mit Diabetes sein könnte. Aus diesem Grund ist das Verständnis der zugrunde liegenden Pathophysiologie und der diagnostischen Möglichkeiten insbesondere der Herzinsuffizienz mit erhaltender linksventrikulärer Funktion von entscheidender Bedeutung. Die vorliegende Arbeit gibt einen Überblick über Inzidenz und Prävalenz, Prognose, zugrunde liegende Pathomechanismen sowie die diagnostischen Möglichkeiten bei Herzinsuffizienz.
Herzinsuffizienz und Diabetes
Authors: Rau Matthias , Lehrke Michael
Published: July 2017

Epidemiologische und klinische Daten weisen auf eine hohe Prävalenz und Inzidenz einer Herzinsuffizienz bei Patienten mit Diabetes mellitus hin, was mit einer schlechten Prognose assoziiert ist.

Die vorliegende Übersicht fasst die therapeutischen Strategien zur Behandlung einer Herzinsuffizienz bei Patienten mit Diabetes zusammen. Des Weiteren wird die Behandlung des Diabetes bei Patienten mit Herzinsuffizienz unter Berücksichtigung der aktuellen klinischen Studien diskutiert.
Patientenautonomie und -informiertheit in der Psychoonkologie: Computerbasiertes Belastungs-screening zur interaktiven Behandlungsplanung (ePOS-react)
Authors: Schäffeler Norbert , Sedelmaier Jana , Möhrer Hannah , Ziser Katrin , Ringwald Johanna , Wickert Martin , Brucker Sara , Junne Florian , Zipfel Stephan , Teufel Martin
Published: July 2017

Die Identifizierung belasteter onkologischer Patienten mithilfe von Screening-Instrumenten stellt in der Praxis eine große Herausforderung dar. Bislang fehlen evidenzbasierte Empfehlungen, welches Instrument am geeignetsten ist, sowie zur Implementierung eines Screenings. Die Nutzung computerbasierter Instrumente eröffnet neben automatisierter Auswertung und Information psychoonkologischer sowie medizinischer Behandler die Möglichkeit eines reaktiven Fragebogens. Welche Faktoren die Behandlungsentscheidung in der Psychoonkologie unterstützen können ist bislang wenig untersucht.Methode Frauen mit Brustkrebs und gynäkologischen Tumoren, die sich zur stationären operativen Behandlung in der Universitäts-Frauenklinik befanden, wurden konsekutiv in die Studie eingeschlossen (n=103). Bei Aufnahme erfolgte ein computerbasiertes Screening zur Belastungsmessung (ePOS-react). Hierbei wird abschließend auf dem Computer basierend auf der im Screening ermittelten Belastung eine Behandlungsempfehlung gegeben: i) psychoonkologische Beratung/Behandlung, ii) psychoonkologischer Kurzkontakt/Informationsgespräch, iii) kein Angebot. Die Patienten konnten sich für eine der 3 Optionen entscheiden (Behandlungswunsch). Am ersten postoperativen Tag wurde ferner ein klinisches Interview (Psychoonkologischen Basisdiagnostik, PO-Bado) zur Fremdbeurteilung des Behandlungsbedarfs durchgeführt.Ergebnisse 68,9% folgten der Behandlungsempfehlung, 22,3% wünschten ein „intensiveres“ (z. B. Beratung anstelle von empfohlenem Kurzkontakt) und 8,7% ein weniger „intensives“ als das empfohlene Angebot. Die Übereinstimmung zwischen Fremdbeurteilung und screeningbasierter Behandlungsempfehlung liegt bei 72,8%. Die Übereinstimmung zwischen Fremdbeurteilung und Behandlungswunsch der Patientinnen liegt bei 58,3%. Letztere ist niedriger, da sich 29,1% einen psychoonkologischen Kurzkontakt wünschten, für welche aus Sicht der Fremdeinschätzung keine akute Behandlungsindikation bestand.Diskussion Die direkte Rückmeldung des Screening-Ergebnisses in Form einer Behandlungsempfehlung während des computerbasierten Screenings und anschließende Abfrage eines Behandlungswunsches der Patientinnen führt zu einem Anstieg von Kurzkontakten zur persönlichen Informationsvermittlung. Dies erhöht zwar nicht die Genauigkeit hinsichtlich der Fremdbeurteilung, führt jedoch zu einer höheren Transparenz im Zugang zu psychoonkologischer Behandlung und kann damit Patientenautonomie und Adhärenz stärken.
Verbesserung des metabolischen Stoffwechsels bei Patienten mit Typ-2-Diabetes
Authors: Birkenfeld Andreas
Published: July 2017

Der Typ-2-Diabetes ist nicht nur eine Erkrankung des Blutzuckers, sondern die Summe der Effekte mehrerer fehlregulierter Stoffwechselwege. Im Zusammenspiel dieser ausgelenkten Stoffwechselwege kommt es zu makrovaskulären Komplikationen, wie Herzinfarkt, Schlaganfall und peripherer arterieller Verschlusskrankheit. Eine erfolgreiche Therapie des Diabetes muss daher alle fehlregulierten Komponenten betreffen. Neue antidiabetische Medikationen, wie GLP-1-Rezeptoragonisten und SGLT-2-Inhibitoren, haben neben ihrer blutzuckersenkenden Wirkung auch positive pleiotrope Effekte, die wiederum dazu beitragen, das kardiovaskuläre Risiko der behandelten Patienten zu reduzieren.
Der Tanz mit dem Krebs
Authors: Warchold Heike
Published: July 2017

Tanztherapie ist eine körperorientierte Form der Psychotherapie, die in psychiatrischen, psychosomatischen und onkologischen Kliniken Anwendung findet. In der Psychoonkologie ist sie ein wichtiger Baustein, um Betroffenen in Gruppen- oder Einzeltherapie die Verarbeitung belastender Gefühle zu erleichtern. Rhythmus, Musik und Bewegung helfen den Patienten dabei, ihr Körper- und Selbstwertgefühl wiederzufinden und seelische Blockaden zu überwinden.
Abrupt dependence of ultrafast extrinsic photoconductivity on Er fraction in GaAs:Er
Authors: Brown E. R. , Mingardi A. , Zhang W.-D. , Feldman A. D. , Harvey T. E. , Mirin R. P.
Published: July 2017

We present a study of room-temperature, ultrafast photoconductivity associated with a strong, sub-bandgap, resonant absorption around λ = 1550 nm in three MBE-grown GaAs epitaxial layers heavily doped with Er at concentrations of ≈2.9 × 1018 (control sample), 4.4 × 1020, and 8.8 × 1020 cm−3, respectively. Transmission-electron microscopy reveals lack of nanoparticles in the control sample, but abundant in the other two samples in the 1.0-to-3.0-nm-diameter range, which is consistent with the previously known results. We measure very high photoelectron (Hall) mobility (2.57 × 103 cm2/V-s) and terahertz power (46 μW average) in the 4.4 × 1020 sample, but then, an abrupt decay in these properties as well as the dark resistivity is seen as the Er doping is increased just 2 times. The Er doping has little effect on the picosecond-scale, 1550-nm photocarrier lifetime.
Excited state absorption spectra of dissolved and aggregated distyrylbenzene: A TD-DFT state and vibronic analysis
Authors: Oliveira Eliezer Fernando , Shi Junqing , Lavarda Francisco Carlos , Lüer Larry , Milián-Medina Begoña , Gierschner Johannes
Published: July 2017

A time-dependent density functional theory study is performed to reveal the excited state absorption (ESA) features of distyrylbenzene (DSB), a prototype π-conjugated organic oligomer. Starting with a didactic insight to ESA based on simple molecular orbital and configuration considerations, the performance of various density functional theory functionals is tested to reveal the full vibronic ESA features of DSB at short and long probe delay times.
Floquet analysis of spatially periodic thermocapillary convection in a low-Prandtl-number liquid bridge
Authors: Motegi K. , Fujimura K. , Ueno I.
Published: July 2017

Secondary instability of thermocapillary convection was investigated for a half-zone liquid bridge with low Prandtl number fluids. The liquid bridge was suspended between two cylindrical flat disks, which were maintained at different temperatures. The thermocapillary-driven flow formed an axisymmetric steady toroidal vortex. If the temperature difference between the two disks exceeded a certain threshold, the axisymmetric flow transitioned to an azimuthal periodic steady flow. The objective in the analysis of secondary instability is to examine the stability limit of this steady flow. Employing Floquet analysis, we obtained the neutral stability curves as a function of the aspect ratio (radius/height) of the liquid bridge and identified the critical modes. The critical modes of the Floquet analysis are referred to as critical Floquet modes and are classified by Floquet parameter β, which characterizes a set of azimuthal wave numbers of the Floquet mode. The Newton–Krylov method and Arnoldi method are implemented to solve the large-scale nonlinear equations and generalized eigenvalue problems, respectively. Two critical Floquet modes were observed having different Floquet parameters, β = 0 and β = 1, which appear preferential in the liquid bridge for high and low aspect ratios, respectively. The mode with β = 1 was steady for low aspect ratios and was able to change to an oscillatory mode with a frequency of oscillation that rapidly increased with increasing aspect ratio. We visualized the temperature and azimuthal velocity distributions of the critical Floquet modes and its Fourier components. We concluded that the mode with β = 1 leads to a pulsating oscillation, denoted as “P-type,” whereas that with β = 0 leads to a twisting oscillation, denoted as “T-type.” Both types of oscillations were reported in previous studies. The present neutral stability curves are for the most part in good agreement with critical Reynolds numbers previously obtained in numerical simulations.
Growth of InGaZnO nanowires via a Mo/Au catalyst from amorphous thin film
Authors: Felizco Jenichi Clairvaux , Uenuma Mutsunori , Senaha Daiki , Ishikawa Yasuaki , Uraoka Yukiharu
Published: July 2017

InGaZnO nanowires were grown from amorphous InGaZnO thin films using Mo/Au-catalyzed Vapor-Liquid-Solid (VLS) growth process. The Mo/Au/amorphous InGaZnO stacked sample was annealed at 700 °C in N2 atmosphere. The growth of InGaZnO nanowires was confirmed on the edge of the Mo thin film closest to the Mo/Au overlap. The Au or Mo-covered areas, on the other hand, were not found to be sites of nanowire growth. Nanowires have Mo contained Au nanoparticles at the tip, which suggests the VLS growth mechanism. TEM results also verified that the nanowires are single crystalline, and that their growth direction is along the c-axis.
Cluster expansion of the solvation free energy difference: Systematic improvements in the solvation of single ions
Authors: Pliego Josefredo R.
Published: July 2017

The cluster expansion method has been used in the imperfect gas theory for several decades. This paper proposes a cluster expansion of the solvation free energy difference. This difference, which results from a change in the solute-solvent potential energy, can be written as the logarithm of a finite series. Similar to the Mayer function, the terms in the series are related to configurational integrals, which makes the integrand relevant only for configurations of the solvent molecules close to the solute. In addition, the terms involve interaction of solute with one, two, and so on solvent molecules. The approach could be used for hybrid quantum mechanical and molecular mechanics methods or mixed cluster-continuum approximation. A simple form of the theory was applied for prediction of pKa in methanol; the results indicated that three explicit methanol molecules and the dielectric continuum lead to a root of mean squared error (RMSE) of only 1.3 pKa units, whereas the pure continuum solvation model based on density method leads to a RMSE of 6.6 pKa units.
Behavior of a supercooled chalcogenide liquid in the non-Newtonian regime under steady vs. oscillatory shear
Authors: Sen S. , Zhu W. , Aitken B. G.
Published: July 2017

The steady and oscillatory shear rate dependence of viscosity of a supercooled chalcogenide liquid of composition As10Se90 is measured at Newtonian viscosities ranging between 103 and 107 Pa s using capillary and parallel plate rheometry. The liquid displays strong violation of the Cox-Merz rule in the non-Newtonian regime where the viscosity under steady shear is nearly an order of magnitude lower than that under oscillatory shear. This behavior is argued to be related to the emergence of unusually large (6-8 nm) cooperatively rearranging regions with long relaxation times in the liquid that result from significant structural rearrangements under steady shear.
Identifying and overcoming the interface originating c-axis instability in highly Sc enhanced AlN for piezoelectric micro-electromechanical systems
Authors: Fichtner Simon , Wolff Niklas , Krishnamurthy Gnanavel , Petraru Adrian , Bohse Sascha , Lofink Fabian , Chemnitz Steffen , Kohlstedt Hermann , Kienle Lorenz , Wagner Bernhard
Published: July 2017

Enhancing the piezoelectric activity of AlN by partially substituting Al with Sc to form Al1–xScxN is a promising approach to improve the performance of piezoelectric micro-electromechanical systems. Here, we present evidence of an instability in the morphology of Al1–xScxN, which originates at, or close to, the substrate/Al1–xScxN interface and becomes more pronounced as the Sc content is increased. Based on Transmission electron microscopy, piezoresponse force microscopy, X-ray diffraction, and SEM analysis, it is identified to be the incipient formation of (100) oriented grains. Approaches to successfully reestablish exclusive c-axis orientation up to x = 0.43 are revealed, with electrode pre-treatment and cathode-substrate distance found to exert significant influence. This allows us to present first measurements of the transversal thin film piezoelectric coefficient e31,f and dielectric loss tangent tan δ beyond x = 0.3.
Terahertz polarization mode conversion in compound metasurface
Authors: Xu Shi-Tong , Fan Fei , Chen Meng , Ji Yun-Yun , Chang Sheng-Jiang
Published: July 2017

A compound metasurface for terahertz (THz) wave polarization mode conversion has been experimentally investigated, which is integrated with an H-shaped metallic metamaterial and 45° arranged subwavelength dielectric grating on the two surfaces of a Si substrate. The polarization mode conversion from a TM to a TE resonance mode is achieved at 1.3 THz for forward transmission and 0.63 THz for backward transmission. Based on this property, a unidirectional transmission is obtained with the highest extinction of 23 dB at 0.63 THz. Moreover, due to the multiple reflections and subwavelength integration, a localized resonance mechanism in this metasurface greatly enhances the polarization conversion rate, reduces the insertion loss, and expands the operating bandwidth from 0.3 to 1.6 THz, not merely at the π phase matching point, which are quite different with the properties of the discrete metallic metamaterial and dielectric grating. This work provides an efficient way towards practical applications in THz broadband polarization conversion, polarization resonance mode manipulation, and unidirectional transmission.
Observation of anisotropy in thermoelectric properties of individual single-crystalline bismuth nanowires
Authors: Kim Jeongmin , Roh Jong Wook , Moon Hongjae , Lee Wooyoung
Published: July 2017

The anisotropy in the thermoelectric-transport properties of single-crystalline Bi nanowires was systematically investigated. Bi nanowires were grown along the crystal orientations of the [-102] and [100] directions using the on-film formation of nanowires method. The electrical conductivity and Seebeck coefficient of Bi nanowires with different diameters were measured with respect to temperature in both directions. The temperature dependence in electrical conductivity exhibited a significant diameter dependence, and significant anisotropy was observed in the Seebeck coefficient. Anisotropy was also observed in the thermoelectric power factor. The thermoelectric figure of merit was estimated using our previously reported thermal-conductivity data, which indicate that [100]-oriented Bi nanowires are more suitable for thermoelectric applications than [-102] nanowires. This is the first report of the anisotropy investigating all the thermoelectric-transport properties of single-crystalline Bi nanowires.
Strong yellow emission of high-conductivity bulk ZnO single crystals irradiated with high-power gyrotron beam
Authors: Kato Kosaku , Qiu Hongsong , Khutoryan Eduard M. , Tatematsu Yoshinori , Tani Masahiko , Idehara Toshitaka , Yamaguchi Yuusuke , Fukunari Masafumi , Maeda Yuto , Takayama Kyoya , Minami Yuki , Empizo Melvin John F. , Kurihara Takayuki , Yamanoi Kohei , Shimizu Toshihiko , Takano Keisuke , Sarukura Nobuhiko , Fukuda Tsuguo , Yoshimura Masashi , Nakajima Makoto
Published: July 2017

We report the strong yellow emission of bulk ZnO single crystals irradiated with the high-power gyrotron beam. Hydrothermally grown bulk crystals with high conductivity are irradiated at room temperature with up to 60-W output of a sub-terahertz gyrotron wave source. During gyrotron irradiation, the high-conductivity crystals exhibit intense emissions with a peak of around 2 eV (600 nm) and a longer-wavelength tail. The sample temperatures were also elevated from room temperature to above 1000 K by irradiation. However, when heated up to 1250 K using a heater without irradiation, the ZnO crystals do not exhibit similar visible emissions. We then use the generalized Planck's radiation in non-equilibrium states as an explanation of our experimental observations. The emission peak intensity can be enhanced by the gyrotron-induced non-equilibrium states, and the emission peak position can be related to the Urbach energy. With high intensities in the visible wavelengths, the emissions of the irradiated crystals can be readily observed with our bare eyes or with inexpensive digital cameras. As the spatial distribution of the yellow emission reflects the gyrotron beam pattern, the bulk ZnO single crystals can then be utilized for the quick diagnosis of gyrotron beam patterns and positions.
Cryptic oxygen cycling in anoxic marine zones
Authors: Garcia-Robledo Emilio , Padilla Cory C. , Aldunate Montserrat , Stewart Frank J. , Ulloa Osvaldo , Paulmier Aurélien , Gregori Gerald , Revsbech Niels Peter
Published: July 2017

Significance

Anoxic marine zones (AMZs) create expansive habitats for microbes whose anaerobic metabolisms help drive global nutrient cycles, for example, by removing nitrogen from the oceans by producing N
2
gas. AMZ cycles may also be shaped by oxygen intrusion from outside the AMZ, creating opportunities for aerobic microbial metabolisms. Here we show that aerobic processes in AMZs are linked to oxygen production within the anoxic zone. Oxygen is produced during daytime in a layer of photosynthetic cyanobacteria near the top of the AMZ and then rapidly consumed by aerobic processes without accumulating. Oxygen turnover and carbon fixation rates are comparable to those of microbial N
2
production, suggesting an important role for internal oxygen cycling in AMZ transformations of matter and energy.
Molecular mechanism of environmental
d
-xylose perception by a XylFII-LytS complex in bacteria
Authors: Li Jianxu , Wang Chengyuan , Yang Gaohua , Sun Zhe , Guo Hui , Shao Kai , Gu Yang , Jiang Weihong , Zhang Peng
Published: July 2017

Significance

d
-xylose is the most abundant pentose in nature and is considered an attractive carbon source for bio-based fuel/chemical production through fermentation. The first step of
d
-xylose utilization, cross-membrane sensing, is mediated by the membrane complex LytS-XylFII in solventogenic clostridia, the mechanism of which remains unclear. We found that the perception of the environmental
d
-xylose by the LytS-XylFII complex is initiated through the
d
-xylose–specific binding to XylFII. Binding of
d
-xylose to XylFII induces the inactive LytS-XylFII heterodimer to form an active heterotetramer and transmits the signal to activate the downstream target genes responsible for
d
-xylose uptake and metabolism. The molecular mechanism revealed here will benefit the metabolic engineering to improve the
d
-xylose utilization efficiency.
Intracellular zinc activates KCNQ channels by reducing their dependence on phosphatidylinositol 4,5-bisphosphate
Authors: Gao Haixia , Boillat Aurélien , Huang Dongyang , Liang Ce , Peers Chris , Gamper Nikita
Published: July 2017

Significance

M-type (Kv7, KCNQ) potassium channels are powerful regulators of neuronal and muscular excitability and are validated drug targets for the treatment of excitability disorders. The plasma membrane phosphoinositide phosphatidylinositol 4,5-bisphosphate (PIP
2
) is required to maintain M channel activity. We report that intracellular free zinc directly and reversibly augments the activity of recombinant and native M channels by reducing or virtually abolishing the channel requirement for PIP
2
, thereby permitting a PIP
2
-gated ion channel to operate independently of this important signaling molecule. Given the growing recognition of zinc as an intracellular second messenger, this phenomenon might represent a hitherto unknown pathway of M channel modulation and provide a fresh strategy for design of M channel-targeting drugs.
Sequential eviction of crowded nucleoprotein complexes by the exonuclease RecBCD molecular motor
Authors: Terakawa Tsuyoshi , Redding Sy , Silverstein Timothy D. , Greene Eric C.
Published: July 2017

Significance

Chromosomes are crowded places, and any nucleic acid motor proteins that act on DNA must function within these crowded environments. How crowded environments affect motor protein behaviors remains largely unexplored. Here, we use single-molecule fluorescence microscopy to visualize the ATP-dependent motor protein RecBCD as it travels along crowded DNA molecules bearing long tandem arrays of DNA binding proteins. Our findings show that RecBCD can push through highly crowded protein arrays while evicting the proteins from DNA. This behavior on crowded DNA is distinct from a previously described mechanism by which RecBCD disrupts single isolated nucleoprotein complexes. These findings may provide insights into how other types of motor proteins travel along crowded nucleic acids.
Bacterial infection imaging with [
18
F]fluoropropyl-trimethoprim
Authors: Sellmyer Mark A. , Lee Iljung , Hou Catherine , Weng Chi-Chang , Li Shihong , Lieberman Brian P. , Zeng Chenbo , Mankoff David A. , Mach Robert H.
Published: July 2017

Significance

The ability to distinguish bacterial infection from other pathologies in humans can be challenging. An imaging agent with great sensitivity and spatial resolution that would allow noninvasive identification of sites of bacterial infection could increase our understanding of the natural history of bacterial infection in patients and potentially be used to support clinical decision making. Here, we report the first synthesis of a fluorine-18–labeled derivative of the antibiotic trimethoprim for positron emission tomography imaging and show that it can identify bacterial infection in rodents. Importantly, this radiotracer does not accumulate at sites of sterile inflammation or cancer, pathologies that often have overlapping imaging features with bacterial infection.
Metabolic profiles of exercise in patients with McArdle disease or mitochondrial myopathy
Authors: Delaney Nigel F. , Sharma Rohit , Tadvalkar Laura , Clish Clary B. , Haller Ronald G. , Mootha Vamsi K.
Published: July 2017

Significance

Metabolic myopathies resulting from defects in skeletal muscle energy metabolism represent a spectrum of disorders that are typically mild at rest and unmasked with exercise. Although the genetic basis for many metabolic myopathies is known, their management remains challenging in part because we have an incomplete understanding of the biochemical pathogenesis. Here we applied plasma metabolic profiling to capture a holistic picture of metabolism at rest and with exercise in two metabolic myopathies that restrict oxidative metabolism: McArdle disease, characterized by defective glycogen fuel mobilization, and mitochondrial disease, characterized by a defective respiratory chain. Our work provides insights into how biochemistry is remodeled in these two disorders, revealing candidate biomarkers that may prove to have clinical utility.
Activation and synchronization of the oscillatory morphodynamics in multicellular monolayer
Authors: Lin Shao-Zhen , Li Bo , Lan Ganhui , Feng Xi-Qiao
Published: July 2017

Significance

Oscillatory morphodynamics of collective cells is of fundamental importance for concerting cellular events and tissue-level developments in many living systems. We demonstrate that the collective cell oscillations in an epithelium-like monolayer are attributed to a chemomechanical Hopf bifurcation tailored by external forces and boundary physics and geometry. Our findings not only offer mechanistic insights into the synchronization and activation of supracellular oscillations inDrosophilaembryogenesis but also help uncover collective events in other scenarios, including wound healing and cancer invasion.
A competition-based analysis of French anticausatives
Authors: Legendre Géraldine , Smolensky Paul
Published: July 2017

Some long-standing questions surrounding anticausatives in languages like French include whether the morphological marking (presence/absence ofse) correlates with interpretational differences and/or different syntax. We examine the three anticausatives classes (optionalse, obligatoryse, nose) in three aspectual contexts and formulate a generalization whereby a default morphological form (reflexive-/non-reflexive-marked) can be identified for each context, plus an interpretive anti-blocking effect: if the lexicon does not provide the default form then the other form (regardless of morphology) preserves the aspectual interpretation of its transitive source. French anticausativeseis tied to lexical aspect (rather than syntax), but the distribution is complex and non-transparent. We argue that the grammar allows bidirectional competition among forms and interpretations and the formalize analysis in Bidirectional OT (Superoptimality).
Core Addiction Medicine Competencies for Doctors: An International Consultation on Training
Authors: Ayu Astri Parawita , el-Guebaly Nady , Schellekens Arnt , De Jong Cor , Welle-Strand Gabrielle , Small William , Wood Evan , Cullen Walter , Klimas Jan
Published: July 2017

Background

Despite the high prevalence of substance use disorders, associated comorbidities, and the evidence base upon which to base clinical practice, most health systems have not invested in standardized training of health care providers in addiction medicine. As a result, people with substance use disorders often receive inadequate care, at the cost of quality of life and enormous direct health care costs and indirect societal costs. Therefore, this study was undertaken to assess the views of international scholars, representing different countries, on the core set of addiction medicine competencies that need to be covered in medical education.

Methods

A total of 13 members of the International Society of 20 Addiction Medicine (ISAM), from 12 different countries (37% response rate), were interviewed over Skype, e-mail survey, or in person at the annual conference. Content analysis was used to analyze interview transcripts, using constant comparison methodology.

Results

We identified recommendations related to the core set of the addiction medicine competencies at 3 educational levels: (i) undergraduate, (ii) postgraduate, and (iii) continued medical education (CME). The participants described broad ideas, such as knowledge/skills/attitudes towards addiction to be obtained at undergraduate level, or knowledge of addiction treatment to be acquired at graduate level, as well as specific recommendations, including the need to tailor curriculum to national settings and different specialties.

Conclusions

Although it is unclear whether a global curriculum is needed, a consensus on a core set of principles for progression of knowledge, attitudes, and skills in addiction medicine to be developed at each educational level amongst medical graduates would likely have substantial value.
Against Organizational Functions
Authors: Garson Justin
Published: July 2017

Over the last 20 years, several philosophers have developed a new approach to biological functions, the organizational (or systems-theoretic) approach. This is not a single theory but a family of theories based on the idea that a trait token can acquire a function by virtue of the way it contributes to a complex, organized system and thereby to its own continued persistence as a token. I argue that the organizational approach faces a serious liberality objection. I examine three different ways organizational theorists have tried to avoid that objection and show how they fail.
Contingency and Individuality: A Plurality of Evolutionary Individuality Types
Authors: McConwell Alison K.
Published: July 2017

Recently, philosophers have sought to determine the nature of individuals relevant to evolution by natural selection or evolutionary individuals. The Evolutionary Contingency Thesis is a claim about evolution that emphasizes the role of contingency or dependency relations and chance-based factors in how evolution unfolds. In this article, I argue that if we take evolutionary contingency seriously, then we should be pluralists about the types of individuals in selection.
On Mushroom Individuality
Authors: Molter Dan
Published: July 2017

Genidentity coupled with material continuity is proposed as a minimum conception of biological individuality, and then theoretical individuation is employed to identify multiple kinds of biological individuals in a single example from mycology, a patch of chanterelle mushrooms. Of the many candidate materially continuous genidenticals found in a mushroom patch, only those with functional roles in biological theory are notable as biological individuals. Evolutionary and physiological theories pick out multiple kinds of functional individuals in mushrooms, so a pluralistic account of mushroom individuality is warranted.
Organ Vouchers and Barter Markets: Saving Lives, Reducing Suffering, and Trading in Human Organs
Authors: Cherry Mark J
Published: July 2017

The essays in this issue of The Journal of Medicine and Philosophy explore an innovative voucher program for encouraging kidney donation. Discussions cluster around a number of central moral and political/theoretical themes: (1) What are the direct and indirect health care costs and benefits of such a voucher system in human organs? (2) Do vouchers lead to more effective and efficient organ procurement and allocation or contribute to greater inequalities and inefficiencies in the transplantation system? (3) Do vouchers contribute to the inappropriate commodification of human body parts? (4) Is there a significant moral difference between such a voucher system and a market in human organs for transplantation? This paper argues that while kidney vouchers constitute a step in the right direction, fuller utilization of market-based incentives, including, but not limited to, barter exchanges (e.g., organ exchanges, organ chains, and organ vouchers), would save more lives and further reduce human suffering.
A Defence of the Resemblance Meaning of ‘What it’s like’
Authors: Gaskin Richard
Published: July 2017

It is often held to be definitive of consciousness that there is something it is like to be in a conscious state. A consensus has arisen that ‘is like’ in relevant ‘what it is like’ locutions does not mean ‘resembles’. This paper argues that the consensus is mistaken. It is argued that a recently proposed ‘affective’ analysis of these locutions fails, but that a purported rival of the resemblance analysis, the property account, is in fact compatible with it. Some of the implications of this argument are briefly explored: it is suggested that the meaning of ‘what it’s like’ does not, in itself, have any special bearing on consciousness, and that the implications for the so-called ‘hard problem’ of consciousness are deflationary.
Vaccine Rejection and Hesitancy: A Review and Call to Action
Authors: Smith Tara C
Published: July 2017

Vaccine refusal has been a recurring story in the media for well over a decade. Although there is scant evidence that refusal is genuinely increasing in the population, multiple studies have demonstrated concerning patterns of decline of confidence in vaccines, the medical professionals who administer vaccines, and the scientists who study and develop vaccines. As specialists in microbiology, immunology, and infectious diseases, scientists are content experts but often lack the direct contact with individuals considering vaccination for themselves or their children that healthcare professionals have daily. This review examines the arguments and players in the US antivaccination scene, and it discusses ways that experts in infectious diseases can become more active in promoting vaccination to friends, family, and the public at large.
Pasta Production: Complexity in Defining Processing Conditions for Reference Trials and Quality Assessment Methods
Authors: Murray Jessica C. , Kiszonas Alecia M. , Morris Craig F.
Published: July 2017

Pasta is a simple food made from water and durum wheat (Triticum turgidum subsp. durum) semolina. As pasta increased in popularity, studies endeavored to analyze the attributes that contribute to high‐quality pasta. Despite being a simple food, the laboratory‐scale analysis of pasta quality is a complex process. Spaghetti is the most commonly studied form of pasta because its long, uniform shape lends itself well to analysis. Pasta production at a laboratory scale is not standardized, leading to large amounts of variation owing to differing equipment and protocols. Pasta production protocols vary in their target moisture content, mixing profile, extrusion die material, and spaghetti diameter. Once pasta is extruded, the equipment and protocols used to dry the pasta at the laboratory scale are far from consistent. Measurement of pasta quality parameters is also lacking in updated standardized methods, making it difficult to compare pasta quality data among laboratories. AACC International is actively working to develop an improved method for laboratory‐scale pasta production and analysis via the Pasta Products Analysis Committee. This review summarizes the equipment, protocols, and methods utilized in pasta quality studies.
Not just feeling blue
Authors: Davis Charlotte , Lockhart Lisa
Published: July 2017

Nurses may encounter patients experiencing depression in acute care hospitals, long-term-care facilities, and outpatient areas, not only on behavioral health units.
The Relationship Between Structural and Functional Brain Changes and Altered Emotion and Cognition in Chronic Low Back Pain Brain Changes
Authors: Ng Sin Ki , Urquhart Donna M. , Fitzgerald Paul B. , Cicuttini Flavia M. , Hussain Sultana M. , Fitzgibbon Bernadette M.
Published: July 2017

Objectives:

Chronic low back pain (CLBP) is a major health issue, yet its underlying mechanisms remain unknown. Studies have demonstrated the importance of emotion and cognition in chronic pain; however, the relevant brain physiology in magnetic resonance imaging (MRI) studies are unclear in CLBP populations. Therefore, this review aimed to identify MRI brain changes and examine their potential relationship with emotional and cognitive processes in CLBP.

Methods:

A systematic search was conducted in 5 databases. Studies that recruited adult, CLBP populations, and used brain MRI protocols were included.

Results:

In total, 55 studies met the inclusion criteria. Of the structural MRI studies, 10 of 15 studies found decreased gray matter and 7 of 8 studies found white matter changes in CLBP groups compared with controls. Fourteen resting-state functional MRI studies all reported differences between CLBP and control groups in the default mode network. Interestingly, only 3 of 10 functional MRI studies observed significant differences during noxious stimulation between CLBP and control groups, whereas 13 of 16 studies observed significant brain activation differences in CLBP groups during various external tasks. Finally, there were 3 studies that observed a degree of recovery in functional connectivity following intervention.

Discussion:

The brain changes in CLBP groups were mainly observed in areas and networks important in emotion and cognition, rather than those typically associated with nociception. This supports the understanding that emotional and cognitive processes may be the core contributor to the CLBP experience; however, future studies need to explore these processes further.
Is the Organization of the Primary Motor Cortex in Low Back Pain Related to Pain, Movement, and/or Sensation?
Authors: Elgueta-Cancino Edith , Schabrun Siobhan , Hodges Paul
Published: July 2017

Aim/Background:

Primary motor cortex (M1) organization differs between individuals with and without chronic low back pain (CLBP), in parallel with motor and sensory impairments. This study investigated whether movement behaviour and tactile/pain sensation are related to M1 organisation in CLBP.

Methods:

Transcranial magnetic stimulation (TMS) was used to map the M1 representation of the erector spinae and multifidus muscles in 20 participants with and without CLBP. Cortical organisation was quantified by: map volume; center of gravity (CoG); number of peaks; and primary and secondary peak location. Movement behaviour was assessed as the ability to dissociate lumbar from thorax motion and sensory function as two-point discrimination, pressure pain thresholds, and pain intensity (visual analogue scale).

Results:

People with CLBP showed more anterior location of the CoG than controls. Map peaks were more numerous in CLBP participants who performed the movement task good than those with poor performance. In CLBP, smaller map volume correlated with greater pain during the movement task. Movement behaviour was not linearly correlated with M1 features.

Conclusions:

This study confirms that M1 maps differ between people with and without CLBP, but these changes are variable within the CLBP group and are not related to motor and sensory features in a simple manner.
Pediatric supracondylar humerus fractures: is surgeon experience a surrogate for the need of open reduction?
Authors: Silva Mauricio , Kazantsev Maria , Aceves Martin Bianka , Delfosse Erin M.
Published: July 2017

Although there are many factors that are likely to influence the need for open reduction and percutaneous pinning (ORPF) in the treatment of pediatric supracondylar humerus fractures (SCHFs), the role of surgeon’s experience (as represented by the total number of surgically treated SCHFs) on the need for ORPF has seldom been investigated. We reviewed the data on all completely displaced, pediatric SCHFs that were treated surgically by a single, fellowship-trained, pediatric orthopedic surgeon over the first 10 years of the surgeon’s clinical practice. The incidence of ORPF was calculated as the percentage of open reductions among surgically treated, completely displaced, consecutive SCHFs at any given time during the 10-year period. From September 2005 to August 2015, a total of 212 completely displaced SCHFs were treated surgically at our institution by a single surgeon. When analyzing the incidence of ORPFs among surgically treated, completely displaced SCHFs at any given time, a bimodal curve was found: there was an increasing slope over the first 30 surgically treated SCHFs, with a progressive decreasing slope afterward. The incidence of ORPF within the first 10, 20, and 30 surgically treated, completely displaced SCHFs was 10.0, 30.0, and 26.7%, respectively, decreasing to 16.0, 9.0, 6.7, and 5.0% within the first 50, 100, 150, and 200 surgeries, respectively. The incidence of ORPF was almost 17-fold higher within the first 30 surgically treated, completely displaced SCHFs (17%), when compared with the following 182 (1.1%) cases (P<0.00001). Although it is likely that many factors influence the need for ORPF in the treatment of completely displaced SCHFs, surgeon’s experience appears to play a significant role. Strategies aimed to accelerate the learning curve in the treatment of pediatric SCHFs should be undertaken.
Patient-Perceived Facilitators of and Barriers to Electronic Portal Use
Authors: Powell Kimberly R.
Published: July 2017

This systematic review describes characteristics of portal users and their perceptions of this emerging technology. Recent empirical evidence (2010-2016) was reviewed to answer three questions: (1) What are the characteristics of electronic patient portal users? (2) What are patient-perceived facilitators of electronic patient portal use? (3) What are patient-perceived barriers to electronic patient portal use? Characteristics of portal users are described according to three broad categories: demographic characteristics, patterns of use, and complexity and duration of disease. Three themes were found related to patient-perceived facilitators of use: provider encouragement, access/control over health information, and enhanced communication; two themes were found related to patient-perceived barriers to use: lack of awareness/training and privacy and security concerns. Understanding a patient’s perception of technology is paramount in optimizing use. These insights will allow for development of better products and clinical processes that facilitate broad goals of improved use of information technology. Policy and practice implications are discussed, as well as suggestions for future research.
Concordance of Motion Sensor and Clinician-Rated Fall Risk Scores in Older Adults
Authors: Elledge Julie
Published: July 2017

As the older adult population in the United States continues to grow, developing reliable, valid, and practical methods for identifying fall risk is a high priority. Falls are prevalent in older adults and contribute significantly to morbidity and mortality rates and rising health costs. Identifying at-risk older adults and intervening in a timely manner can reduce falls. Conventional fall risk assessment tools require a health professional trained in the use of each tool for administration and interpretation. Motion sensor technology, which uses three-dimensional cameras to measure patient movements, is promising for assessing older adults' fall risk because it could eliminate or reduce the need for provider oversight. The purpose of this study was to assess the concordance of fall risk scores as measured by a motion sensor device, the OmniVR Virtual Rehabilitation System, with clinician-rated fall risk scores in older adult outpatients undergoing physical rehabilitation. Three standardized fall risk assessments were administered by the OmniVR and by a clinician. Validity of the OmniVR was assessed by measuring the concordance between the two assessment methods. Stability of the OmniVR fall risk ratings was assessed by measuring test-retest reliability. The OmniVR scores showed high concordance with the clinician-rated scores and high stability over time, demonstrating comparability with provider measurements.
Impact of socioeconomic status and district of residence on cutaneous malignant melanoma prognosis: a survival study on incident cases between 1991 and 2011 in the province of Ferrara, northern Italy
Authors: Borghi Alessandro , Corazza Monica , Virgili Annarosa , Lambertini Anna G. , Caranci Nicola , Pacelli Barbara , Carcoforo Paolo , Ferretti Stefano
Published: July 2017

The aim of this study was to analyse the impact of socioeconomic status (SES) on the prognosis of patients with invasive malignant melanoma (MM) incident from 1991 to 2011 in the province of Ferrara, northern Italy. A total of 750 patients provided by the Area Vasta Emilia Centrale Cancer Registry were included in this retrospective cohort study. Prognosis was analysed in terms of overall survival and specific survival. The study determinants were the patients’ SES and district of residence. The confounding effect of sex, age, period and TNM stage at diagnosis was evaluated. In the study population, neither overall survival nor specific survival showed significant differences among different layers of SES and districts of residence. The risk for death from MM was lower for the female sex [hazard risk (HR)=0.68, 95% confidence interval (CI): 0.50–0.94] and for diagnoses made in the most recent period (2005–2011: HR=0.56, 95% CI: 0.36–0.89 with respect to 1991–1997). A worse prognosis was observed in patients older than 70 years at the time of diagnosis (HR=2.33, 95% CI: 1.39–3.91 with respect to the <40-year age group) and in patients with more than pT1 tumours (up to 20 times for pT4 tumours). SES and district of residence did not constitute prognostic factors for MM patients residing in the province of Ferrara. Homogeneity in MM staging, treatment and follow-up strategies due to the relatively small extent of the study area and the presence of a single university hospital of reference, as well as less marked social and economic differences among the study patients in comparison with other previously analysed populations, may account for this finding.
Neurocognitive and Symptom Trajectories of ADHD from Childhood to Early Adolescence
Authors: Murray Andrea L. , Robinson Thomas , Tripp Gail
Published: July 2017

Objective:

This longitudinal study investigated changes in neurocognitive functioning from childhood to early adolescence in a sample of children diagnosed with DSM-IV attention-deficit hyperactivity disorder (ADHD). It also compared the neurocognitive trajectories of children who continued to meet the diagnostic criteria for ADHD at follow-up and those in partial remission.

Methods:

Children diagnosed with ADHD (N = 55) were tested at baseline (M = 7.7 years, SD = 1.5) and 4 years later (M = 11.7 years, SD = 1.5) on measures of intellectual, academic, and executive functioning. Group and individual analyses were used to examine neurocognitive functioning over this period.

Results:

Intellectual function was stable over the 4-year interval. Reliable change analyses highlighted variability in academic performance. Approximately half the sample showed a reliable decline in at least 1 academic subject with almost a third showing reliable improvement. Executive functions generally followed a stable or improving course, with significant improvements on measures of information processing, attentional control, cognitive flexibility, and goal setting. There was some evidence of better neurocognitive performance in those with partial symptom remission at follow-up.

Conclusion:

Study findings emphasize the importance of monitoring academic performance in children with ADHD, including examination of change at the individual level. Declines in academic performance were observed, despite stable intellectual and improving executive function. Early cognitive functioning did not predict symptom remission; however, reduced symptoms at follow-up were associated with better executive function.