bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparison of Chain Saws, Brushcutters, and Machetes in Thinning a Young Conifer Plantation in the Sierra Nevada
Authors: Jamnick Mark S.
Published: August 2019

Chain saws, power brushcutters, and machetes were used in thinning an 8-year-old, 14.5 ac mixed conifer plantation in the Sierra Nevada. A comparison of production rates indicated no significant difference between chainsaws and machetes, with brushcutter production rates significantly lower than the other two tools. Differences in production rates were not attributable to tree size or number of trees per acre. Inefficiency of brushcutters was attributable to greater maintenance and downtime as compared to the other two tools. Further comparisons of these tools could be useful in determining the least expensive method of conducting precommercial thinnings in young mixed conifer plantations. West. J. Appl. For. 4(2):60-62, April 1989.
Impact of Shrub Sprout Competition on Douglas-fir Seedling Development
Authors: Tesch Steven D. , Hobbs Stephen D.
Published: August 2019

In 1983, 1-0 container-grown Douglas-fir (Pseudotsuga menziesii) seedlings were planted on a site subject to summer drought under three levels of sprout competition from greenleaf manzanita (Arctostaphylos patula) and canyon live oak (Quercus chrysolepis). Seedlings were planted with 0.25-m-tall dead sprouts, mature shrubs slashed just before planting, or 1-m tall sprouts, which represent an increasing order of competition. After 3 years, Douglas-fir survival did not differ significantly among levels of competition. However, percentage cover of competing shrubs was negatively correlated with conifer root and shoot biomass. Under the least competition, root biomass increased 25 times and shoot biomass 103 times over dry weight at planting, but dry weights in other treatments increased <5 times. Douglas-fir seedling growth did not increase significantly following shrub removal when vigorous sprouting occurred during the first year. After 3 years, however, competitor cover in the minimum-competition plots was less than 15%, and conifer biomass had increased exponentially. West. J. Appl. For. 4(3):89-92, July 1989.
A Comparison of Diameter-and Volume-Based Stocking Guides for Red Alder
Authors: Hibbs David E. , Carlton Gary C.
Published: August 2019

Stocking guides based on Reineke's stand density index concept (diameter vs stem density) and on the self-thinning rule (volume vs stem density) are currently in use in the western United States. A self-thinning rule-based guide has been developed for red alder (Alnus rubra). In this paper, we develop a Reineke-type guide for red alder and compare the growth of thinned and self-thinning stands in both systems. Stand density appears to be defined differently in the two systems, leading to differences in density management prescriptions. West. J. Appl. For. 4(4):113-115, October 1989.
Growth Response to Fertilization in Young Douglas-Fir Stands
Authors: Heath Linda S. , Chappell H. N.
Published: August 2019

Response surface methodology was used to estimate six-year volume growth response to 1 application of 200 lb nitrogen per acre in unthinned and thinned Douglas-fir (Pseudotsuga menziesii) stands of breast height age (bha) 25 years or less. Regional mean fertilizer response was 16% in unthinned stands and 20% in thinned stands. Site index had an increasingly inverse effect on response as basal area increased in both unthinned and thinned stands. Response varied little over site index in regions of low basal area, decreased moderately as site index increased in the intermediate region, and decreased rapidly in the high basal area region. West. J. Appl. For. 4(4):116-119, October 1989.
Separable Costs of Provisions for Nontimber Resources in Forest Service Timber Sales
Authors: Schuster Ervin G. , Niccolucci Michael J.
Published: August 2019

The authors investigated the separable costs of provisions to mitigate damage to or enhance nontimber resources in timber sales for national forests in the Northern and Intermountain Regions. Data were obtained from 224 timber sales made between 1983 and 1985. A "timber-only" design was developed for each sale, was compared to the actual design, and the loss in estimated stumpage receipts was used to reflect the cost due to nontimber considerations. This loss averaged about $20 per mbf (1985 dollars), much of which could be traced to reduced harvest volumes. Most modifications and associated costs were intended to mitigate adverse impacts and resulted from required, policy-based choices. West. J. Appl. For. 4(4):119-124, October 1989.
Relationship of Pacific Madrone Sprout Growth to Productivity of Douglas-Fir Seedlings and Understory Vegetation
Authors: Hughes Thomas F. , Tappeiner John C. , Newton Michael
Published: August 2019

We studied the development of Pacific madrone (Arbutus menziesii) sprout clumps of various initial densities and their effect on Douglas-fir (Pseudotsuga menziesii) seedling growth and understory vegetation. Five years after density treatments, average leaf area index (LAI) of 9-year-oldmadrone sprouts ranged from 3.6-1.0 m²/m² and total aboveground biomass from 25,630-8,390 kg/ha on the high- and low-density plots, respectively. Diameter of 9-year-old Douglas-fir was inversely related to madrone LAI and ranged from about 27 mm on the high-density plots to 54 mmin the absence of madrone. Analyses of diameter growth trends also indicated that, in the absence of madrone, Douglas-fir grew significantly (P = 0.001 to 0.023) faster than in other treatments. An index of shrub, forb, and grass density was inversely related to madrone LAI, suggesting thatunderstory species are quickly excluded from young madrone stands during secondary succession. We provide equations relating the 5-year growth of 9-year-old Douglas-fir to measures of madrone density and seedling size made when the plantation was 5 years old. West. J. Appl. For. 5(1):20-24.
Bark Thickness and Bark Volume in Southwestern Oregon Douglas-Fir
Authors: Maguire Douglas A. , Hann David W.
Published: August 2019

A segmented polynomial taper equation for southwestern Oregon Douglas-fir (Pseudotsuga menziesii) predicts double bark thickness (dbt) at any point above breast height. Below breast height predictions assume conformity to a neiloid frustrum. The equations facilitate estimation of inside bark diameter (dib) given outside bark (dob) measurements. Bark volume and bark biomass can also be estimated when supplemented with existing dib taper equations developed for southwestern Oregon. West J. Appl. For. 5(1):5-8.
Twenty-Eight Years of Thinning at Several Intensities in a High-Site Douglas-Fir Stand in Western Washington
Authors: O'Hara Kevin L.
Published: August 2019

A 28-year thinning study in a dense, natural, high-site coastal Douglas-fir (Pseudotsuga menziesii) stand compared three thinning treatments and an unthinned control. Gross, net, and total recoverable periodic cubic volume increments from the control treatment were not significantly different from the highest yielding thinned treatment. An increasing reserve basal area thinning treatment was the least severe thinning treatment and produced the highest gross, net, and total recoverable periodic increments of the thinning treatments. Commercial thinnings of dense or fully stocked plantations of Douglas-fir may produce similar results: vigorous stands with rapid growth potential. West. J. Appl. For. 5(2):37-40, April 1990.
Viability of Bigleaf Maple Seeds After Storage
Authors: Zasada John C. , Tappeiner II John C. , Max Timothy A.
Published: August 2019

Bigleaf maple is a common hardwood in western Oregon and Washington. Stored seeds from this species are generally believed to lose viability within a few weeks. In this study, two experiments were conducted with seeds collected in 1986 and 1987 in the Oregon Coast Range west of Corvallis, OR. Seeds collected in 1986 had a field moisture content (percentage of dry weight) of 49% and in 1987, 16%. The viability of the seed with the lowest moisture content declined from 75 to 60% during 1 year of storage at 1°C; the seed with the highest moisture content declined from about 90 to less than 10% viability. Storing the seeds at -10°C did not increase viability. Stratification of seeds for more than 60 days did not appear to increase germination. West. J. Appl. For. 5(2):52-55, April 1990.
Public Policies, Private Resources, and the Future of the Douglas-Fir Region Forest Economy
Authors: Adams Darius M. , Haynes Richard W.
Published: August 2019

Projections of the Douglas-fir region forest economy indicate: (1) industrial harvest will decline over the next 20 years, in the range of 8 to 14% relative to current levels depending on the extent of reductions in public cut, but will rise in subsequent decades to near current levels; (2) nonindustrial lands can maintain present or higher levels with little reduction in timber inventory; (3) any private offset to a public harvest reduction will be modest and short-lived, and as a result large changes in public harvest will have significant impacts on the region's economy; (4) management intensification on private lands would have little impact on harvest potential in the next 3 decades; (5) minimum real stumpage price growth over the next 2 decades would be roughly 2.5% per year assuming no change in public harvest. West. J. Appl. For. 5(3):64-69, July 1990.
Bole Implantation of Systemic Insecticides Does Not Protect Trees From Spruce Beetle Attack
Authors: Shea Patrick J. , Holsten Edward H. , Hard John
Published: August 2019

Two experiments were conducted on the Kenai Peninsula, Alaska, to evaluate the effectiveness of acephate, dimethoate, and carbofuran delivered by Medicap implants in previously unattacked spruce trees [natural hybrids of Sitka (Picea sitchensis) and white spruce (P. glauca)] to prevent tree mortality (preventive treatment); and in successfully attacked spruce trees to kill brood of spruce beetle, Dendroctonus rufipennis, and thereby prevent tree mortality (remedial treatment). Tree mortality ranged from 60% to 93% in the treated trees and were judged as inadequate in preventing tree mortality. There was no evidence of egg, larval, pupae, or adult beetle mortality. Residue analysis of foliages removed from the crown of sample trees ranged from ca. 5 ppm 28-days postspray to ca 23 ppm 128 days postspray showing that acephate moved vertically into the tree crown. Neither carbofuran nor dimethoate were recovered from foliage samples. West. J. Appl. For. 6(1):4-7.
Production Equations for Grapple Yarding in Coastal British Columbia
Authors: Howard Andrew F.
Published: August 2019

An elemental time study was designed and used in a comprehensive investigation of grapple yarding productivity in coastal British Columbia. Data were collected using hand-held computers and processed through a series of editing and auditing programs prior to analysis. A comprehensive statistical analysis was applied to the data including fitting regression equations, stratification and hypothesis testing. The findings include a library of production equations suitable for estimating productive and total cycle times for a wide range of machines and operating conditions. West. J. Appl. For. 6(1):7-10.
Propagation of Western Larch by Stem Cuttings
Authors: Edson John L. , Wenny David L. , Fins Lauren
Published: August 2019

Seed shortages have hampered the artificial regeneration of western larch (Larix occidentalis) in parts of the interior Pacific Northwest. Mass vegetative propagation of this valuable timber species could provide a more reliable supply of reforestation material and enhance genetic gain in early larch selections. Earlier attempts to root stem cuttings of western larch achieved relatively low rates of success. In this study, indolebutyric acid (IBA) treatments resulted in rooting of more than 70% of the late-summer semi-hardwood cuttings from 1.5-year-old seedlings compared to less than 20% rooting with the spring-harvested softwood cuttings. Rooting exceeded 80% when stem caliper was greater than 2.0 mm. IBA best enhanced rooting rate and quality when applied at 16,000 ppm. High rooting rates suggest that mass propagation of western larch is feasible, but growth and form of the rooted cuttings require additional assessment. West. J. Appl. For. 6(2):47-49.
Nitrogen Fertilizer Response of Rocky Mountain Douglas-Fir by Geographic Area Across the Inland Northwest1
Authors: Moore James A. , Mika Peter G. , Vander Ploeg James L.
Published: August 2019

Response to nitrogen fertilization treatments in Rocky Mountain Douglas-fir (Pseudotsuga menziesii var. glauca) differed significantly among geographic regions within the inland northwest. Gross basal area and volume growth on fertilized plots were significantly greater than growth on controls for all geographic regions, but only in northern Idaho and central Washington was gross response significantly greater on 400 lb/ac N plots than on 200 lb N plots. Net basal area and volume growth on treated plots in Montana, central Idaho, and northeast Oregon were not significantly greater than the controls for either nitrogen treatment. Analysis of 2-year periodic basal area increment indicated that, while response did decline through time, treated plots continued to produce more gross growth than control plots 6 years after treatment. Similar operational nitrogen treatments applied to the Douglas-fir population sampled in this study should produce gross responses exceeding 10% after 6 years three out of four times. West. J. Appl. For. 6(4):94-98.
Chemical and Manual Control of Thimbleberry (Rubus parviflorus) in Northwestern British Columbia: A Rate and Timing Trial1
Authors: LePage P. , Pollack J. C. , Coates K. D.
Published: August 2019

The effects of different site preparation treatments and their timing on thimbleberry (Rubus parviflorus) percent cover were examined using a factorial experiment. Methods of thimbleberry control tested were: an untreated control, manual cutting, 1.4 kg active ingredient (a.i.)/ha glyphosate, and 2.1 kg a.i./ha glyphosate. Four treatment dates covering the growing season of thimbleberry in the study area were examined. In all 3 post-treatment years there was a strong interaction between method and timing of control. Thimbleberry percent cover in the manual cutting treatments was not significantly different from the untreated control in any of the years. Chemical treatments were less effective early in the growing season than those later on. Early midseason chemical applications were most effective at the higher rate. Late midseason and late season treatments provided uniformly excellent control at both the low and high rates of application. West. J. Appl. For. 6(4):99-102.
Estimating Dominant Height and Site Index of Even-Aged Interior Douglas-Fir in British Columbia
Authors: Thrower James S. , Goudie James W.
Published: August 2019

Height-age and site-index curves were developed from stem analysis of 262 Douglas-fir trees (Pseudotsuga menziesii var. glauca) from 68 plots in the Interior Douglas-fir, Interior Cedar-Hemlock, and Sub-boreal Spruce Biogeoclimatic zones in the interior of British Columbia. Plots ranged in site index from about 8 to 30 m and in age from about 60 to 350 years; however, the analyses were limited to data up to 100 years of age. A conditioned logistic function was selected for predicting height, and a linear model was selected for predicting site index. The curves are similar to those developed in comparable studies in the Inland Empire, but differ substantially from curves developed in British Columbia from temporary sample plots. This study supports previous observations that the pattern of height growth for a given site index varies among ecologically different areas. West. J. Appl. For. 7(1):20-25.
Green Foliage Losses from Ponderosa Pines Induced by Abert Squirrels and Snowstorms: A Comparison
Authors: Allred W. Sylvester , Gaud William S.
Published: August 2019

Abert squirrels (Sciurus aberti) are obligate herbivores on ponderosa pine (Pinus ponderosa). The inner bark of pine shoots is considered one of the predominant food resources obtained by foraging squirrels. As squirrels forage for this resource they induce green needle losses from chosen feed trees. Amounts of induced green needle losses appear to vary according to the availability of alternative foods and squirrel population densities. Weather also induces green needle losses to ponderosa pines. Results of this study indicate that, at least in some years, heavy snowstorms can induce greater amounts of green needle losses than squirrels. Squirrel herbivory was not indicated as a factor in any tree mortality. However, losses due to snowstorms are more severe since they may cause the actual depletion of trees in the forest because of the tree mortality they inflict. West. J. Appl. For. 8(1):16-18.
Employment- and Wage-Consumption Ratios for Montana's Forest Products Manufacturers
Authors: Keegan III Charles E. , Wichman Daniel P. , Evans Gerald E. , Fight Roger D.
Published: August 2019

This article presents information on employment and payroll generated per unit volume of timber or wood fiber processed by the various manufacturing sectors of Montana's forest products industry for 1987-1989. Average employment ranged from a high of 117 workers per million cubic feet (mmcf) of wood fiber processed at house log plants, to a low of 12 workers per mmcf at stud mills. Employment-consumption ratios for cedar products plants and producers of utility poles and posts and small poles were 48, 47, and 34 workers per mmcf respectively. At sawmills, employment-consumption ratios ranged from 23 workers per mmcf for board mills to 12 workers per mmcf for stud mills. Plywood plants are slightly more labor intensive than board mills, employing 26 workers per mmcf of wood fiber processed. The processing of mill residue from sawmills and plywood plants by such users as the pulp and paper industry adds substantially to the employment per unit volume of timber processed. Because different components of the industry often use timber of different sizes, species, and quality, changes in the kind of timber available can have considerable influence on the structure of the industry and related employment. West. J. Appl. For. 8(2):54-57.
Susceptibility of Western Conifers to Laminated Root Rot (Phellinus weirii) in Oregon and British Columbia Field Tests
Authors: Nelson E. E. , Sturrock Rona N.
Published: August 2019

Several species of conifers were outplanted around infected stumps in Oregon and British Columbia to measure their susceptibility to laminated root rot caused by Phellinus weirii. Grand fir (Abies grandis) experienced nearly 30% mortality caused by P. weirii. Douglas-fir (Pseudotsuga menziesii) mortality exceeded 20%. Noble fir (A. procera), Sitka spruce (Picea sitchensis), giant sequoia (Sequoiadendron giganteum), western hemlock (Tsuga heterophylla), and ponderosa pine (Pinus ponderosa) mortality averaged less than 10%. Western white pine (P. monticola) and lodgepole pine (P. contorta) mortality was less than 1%. Phellinus weirii did not cause mortality of western redcedar (Thuja plicata) or redwood (Sequoia sempervirens). Apparent susceptibility, based on mortality over 17-20 growing seasons, was similar to that recorded in past field observations. West. J. Appl. For. 8(2):67-70.
A Whole-Stand Growth and Yield Model for Interior Douglas-Fir
Authors: Zhang Lianjun , Moore James A. , Newberry James D.
Published: August 2019

A whole-stand model, Simulation Of Stands (SOS), was developed for even-aged Douglas-fir (Pseudotsuga menziesii var. glauca) stands in the inland Northwest. The model consists of three new components: (1) volume prediction model, (2) basal area prediction model, and (3) survival model. Existing height growth models were used to estimate stand top height growth. The behavior and performance of SOS were evaluated by simulating stand development over time under alternative conditions and comparing the results with growth and yield concepts suggested in the literature. The predicted stand attributes from SOS were also compared with predictions from the Stand Prognosis Model and Stand Projection System (SPS). SOS behavior was similar to Prognosis for lower site indices, but more like SPS for higher site indices. The three models differed mainly with respect to stand top height growth and tree survival. West. J. Appl. For. 8(4):120-125.
Long-Term Response of Planted Ponderosa Pine to Thinning in Oregon's Blue Mountains
Authors: Cochran P. H. , Barrett James W.
Published: August 2019

A spacing study in ponderosa pine (Pinus ponderosa) was established in 1959 by thinning plots in a 33-yr-old plantation near John Day, Oregon. The influence of 4 spacings (17.2, 12.5, 10.1, and 8.7 ft) on stand and tree growth for a 31-yr period was examined. Study plots were remeasured five times after establishment. Periodic annual increments (PAI) of gross basal area, gross volume, and average height differed with period but not with spacing (P ≤ 0.10). The PAIs of mean diameter differed with period and decreased with increasing density. Annual height growth and annual gross and net growth of basal area and volume did not differ with spacing. Annual diameter growth was much greater for trees at the widest spacing. Annual volume growth of the largest 90 trees/ac was greatest at the widest spacing. Thirty-one years after thinning, the largest 90 trees/ac on the widest spacing had 73% of the volume of all the trees on the narrowest spacing. Mortality due to mountain pine beetle (Dendroctonus ponderosae) increased markedly when values for stand density index exceeded 200. Wide spacings increased average tree volumes, increased mean diameters, and reduced the probability of mortality without sacrificing gross cubic volume growth potential. West. J. Appl. For. 8(4):126-132.
Mortality and Growth of Urea-Fertilized Douglas-Fir on a Phellinus weirii-Infested Site in Oregon
Authors: Nelson E. E. , McWilliams M. G. , Thies W. G.
Published: August 2019

Twelve plots were established in 1972 in an 11-yr-old Douglas-fir (Pseudotsuga menziesii) plantation infected with Phellinus weirii, the cause of laminated root rot. All plots were thinned and either interplanted with red alder (Alnus rubra) or fertilized at 5-10 yr intervals with urea to determine the effect of nitrogen on tree growth and mortality caused by P. weirii, or left untreated. Interplanted alder, however, failed to survive. Mortality was assessed at intervals of 2 to 3 yr. Plots were inventoried (100% cruise) in 1978 and 1990. Growth over 12 yr appeared better on fertilized than nonfertilized plots, but the difference was not significant (alpha = 0.05 ). Mortality caused by the preferential feeding of bears on the inner bark of fertilized trees reduced the overall gain. Mortality caused by laminated root rot did not differ significantly (alpha = 0.05) among treatments. Three months after the initial application of urea at 448 kg N/ha, soil sampled to a depth of 30 cm was higher in ammonium and nitrate forms of nitrogen on fertilized than nonfertilized plots, but increases were not significant (alpha = 0.05). Numbers of bacteria were directly correlated with soil ammonium content (P = 0.1092). Numbers of aerobic actinomycetes were inversely correlated with soil nitrate content (P = 0.0398).West. J. Appl. For. 9(2): 00-00.
Branch Diameter of Western Hemlock: Effects of Precommercial Thinning and Implications for Log Grades
Authors: DeBell Jeffrey D. , Tappeiner II John C. , Krahmer Robert L.
Published: August 2019

Branch diameter was measured in 29- and 38-yr-old western hemlock (Tsuga heterophylla) that had been precommercially thinned to spacings of 4.0 to 21.8 ft at about the time of initial crown closure (age 11 and 12 yr). Branch diameter increased with spacing, but did not exceed 2 in. even at the widest spacings. At the 40- to 60-yr rotations now planned by most industrial and private forest owners, western hemlock can be thinned to any of the spacings evaluated in this study without concern that increased knot size will lower log grades according to current standards. At these rotation lengths, it is probably more valuable to manipulate tree spacing so as to optimize tree size and stand volume production, rather than to minimize knot size. West. J. Appl. For. 9(3):88-90.
The cephalic lateral-line system of Characiformes (Teleostei: Ostariophysi): anatomy and phylogenetic implications
Authors: Pastana Murilo N L , Bockmann Flávio A , Datovo Aléssio
Published: August 2019

The lateral-line system has been traditionally recognized as an important source of phylogenetic information for different groups of fishes. Although extensively studied in Siluriformes and Cypriniformes, the lateral-line system of Characiformes remained underexplored. In the present study, the anatomy of the cephalic lateral-line canals of characiforms is described in detail and a unifying terminology that considers the ontogeny and homologies of the components of this system is offered. Aspects of the arrangement of lateral-line canals, as well as the number, location and size of canal tubules and pores, resulted in the identification of novel putative synapomorphies for Characiformes and several of its subgroups. The study also revised synapomorphies previously proposed for different characiform families and provided comments on their observed distribution across the order based on extensive taxon sampling. Information from the ontogenetic studies of the cephalic lateral-line canal system and a proposal for the proper use of these data to detect truncations in the development of the lateral-line canals across the order is also offered.
Aurix Gel Is an Effective Intervention for Chronic Diabetic Foot Ulcers: A Pragmatic Randomized Controlled Trial
Authors: Gude Warren , Hagan Daniel , Abood Ferial , Clausen Peter
Published: August 2019

BACKGROUND

Autologous platelet-rich plasma products can significantly vary with respect to platelet concentration, the presence of additional cellularity, and the use of additives. Therefore, the utility of each formulation for treating chronic wounds needs to be established.

OBJECTIVE

To establish the efficacy of up to 12 weeks of treatment with Aurix hematogel for healing diabetic foot ulcers against usual and customary care including any wound modality in 129 patients using a Medicare Coverage with Evidence Development paradigm.

METHODS

This pragmatic randomized controlled trial was conducted in 28 real-world outpatient wound care sites using an inclusive design that included participants with various health risks, comorbidities (eg, peripheral arterial disease, smoking), and any wound severity (Wagner 1–4).

RESULTS

Kaplan-Meier analysis showed a significant (log-rank P = .0476) time-to-heal advantage, with 48.5% of wounds healing with Aurix hematogel compared with 30.2% with usual and customary care. A higher percentage of healing was observed for Aurix across all wound severities (Wagner grade 1–4). Subgroup analysis revealed a significant healing advantage for Aurix when treating wounds accompanied by peripheral arterial disease and a demonstrated advantage for smokers.

CONCLUSIONS

This first Coverage with Evidence Development study in wound care demonstrates the effectiveness of Aurix for treating diabetic foot ulcers in Medicare beneficiaries.
Synthesizing and Reporting Milestones-Based Learner Analytics: Validity Evidence From a Longitudinal Cohort of Internal Medicine Residents
Authors: Park Yoon Soo , Zar Fred , Tekian Ara
Published: August 2019

Purpose

Coordinating and operationalizing assessment systems that effectively streamline and measure fine-grained progression of residents at various stages of graduate medical training can be challenging. This article describes development, administration, and psychometric analyses of a learner analytics system to resolve challenges in implementation of milestones by introducing the Scoring Grid Model, operationalized in an internal medicine (IM) residency program.

Method

A 3-year longitudinal cohort of 34 residents at the University of Illinois at Chicago College of Medicine began using this learner analytics system, from entry (July 2013) to graduation (June 2016). Scores from 23 assessments used throughout the 3-year training were synthesized using the Scoring Grid Model learner analytics system, to generate scores corresponding to the 22 reportable IM subcompetencies. A consensus model was used to develop and pilot test the model using feedback from IM faculty members and residents. Scores from the scoring grid were used to inform promotion decisions and reporting of milestone levels. Descriptive statistics and mixed-effects regression were used to examine data trends and gather validity evidence.

Results

Initial validity evidence for content, internal structure, and relations to other variables that systematically integrate assessment scores aligned with the reportable milestones framework are presented, including composite score reliability of scores generated from the learner analytics system. The scoring grid provided fine-grained learner profiles and showed predictive utility in identifying low-performing residents.

Conclusions

The Scoring Grid Model and associated learner analytics data platform may provide a practical, reasonable solution for generating fine-grained, milestones-based profiles supporting resident progress.
Vocal Turn-Taking Between Mothers and Their Children With Cochlear Implants
Authors: Kondaurova Maria V. , Smith Nicholas A. , Zheng Qi , Reed Jessa , Fagan Mary K.
Published: August 2019

Objectives:

The primary objective of the study was to examine the occurrence and temporal structure of vocal turn-taking during spontaneous interactions between mothers and their children with cochlear implants (CI) over the first year after cochlear implantation as compared with interactions between mothers and children with normal hearing (NH).

Design:

Mothers’ unstructured play sessions with children with CI (n = 12) were recorded at 2 time points, 3 months (mean age 18.3 months) and 9 months (mean age 27.5 months) post-CI. A separate control group of mothers with age-matched hearing children (n = 12) was recorded at the same 2 time points. Five types of events were coded: mother and child vocalizations, vocalizations including speech overlap, and between- and within-speaker pauses. We analyzed the proportion of child and mother vocalizations involved in turn-taking, the temporal structure of turn-taking, and the temporal reciprocity of turn-taking using proportions of simultaneous speech and the duration of between- and within-speaker pauses.

Results:

The CI group produced a significantly smaller proportion of vocalizations in turn-taking than the NH group at the first session; however, CI children’s proportion of vocalizations in turn-taking increased over time. There was a significantly larger proportion of simultaneous speech in the CI compared with the NH group at the first session. The CI group produced longer between-speaker pauses as compared with those in the NH group at the first session with mothers decreasing the duration of between-speaker pauses over time. NH infants and mothers in both groups produced longer within- than between-speaker pauses but CI infants demonstrated the opposite pattern. In addition, the duration of mothers’ between-speaker pauses (CI and NH) was predicted by the duration of the infants’ between-speaker pauses.

Conclusions:

Vocal turn-taking and timing in both members of the dyad, the mother and infant, were sensitive to the experiential effects of child hearing loss and remediation with CI. Child hearing status affected dyad-specific coordination in the timing of responses between mothers and their children.
Biomarkers in systemic sclerosis
Authors: Skaug Brian , Assassi Shervin
Published: August 2019

Purpose of review

To discuss recent advances in identification of biomarkers in systemic sclerosis for disease severity, prognosis, and treatment response.

Recent findings

Recent reports describe novel circulating markers of disease severity, autoantibody associations with specific manifestations including cancer, and skin gene expression-based predictors of modified Rodnan skin score progression and treatment response. Moreover, there is converging evidence that C-reactive protein and pneumoproteins such as Krebs von den Lungen-6 and chemokine ligand 18 could serve as prognostic biomarkers in systemic sclerosis-associated interstitial lung disease.

Several novel biomarkers show promise in improving the assessment of systemic sclerosis (SSc) disease severity, prognosis, and treatment response. Their potential utility in prospective selection of patients for clinical trials and in individual patient management require additional research.
Oncologic Accuracy of Image-guided Percutaneous Core-Needle Biopsy of Peripheral Nerve Sheath Tumors at a High-volume Sarcoma Center
Authors: Graham Danielle S. , Russell Tara A. , Eckardt Mark A. , Motamedi Kambiz , Seeger Leanne L. , Singh Arun S. , Bernthal Nicholas M. , Kalbasi Anusha , Dry Sarah M. , Nelson Scott D. , Elashoff David , Levine Benjamin D. , Eilber Fritz C.
Published: August 2019

Objectives:

Peripheral nerve sheath tumors (PNSTs) are clinically heterogenous, comprising benign (BPNST) and malignant (MPNST) variants. BPNSTs can be managed with nerve-sparing excision or observation. MPNSTs require radical resection and multidisciplinary oncologic management (1, 15). Image-guided core-needle biopsy (IGCNBx) is the well-established standard to obtain preoperative tissue diagnosis of soft tissue tumors. However, there has been resistance to performing IGCNBx of PNSTs because of the presumed risk of nerve injury and unknown accuracy in determining malignancy. We sought to define the accuracy and safety of IGCNBx in PNSTs.

Materials and Methods:

All patients that underwent both IGCNBx and surgical resection of a PNST at our institution between 2002 and 2016 were analyzed. The accuracy of IGCNBx in determining malignancy was calculated, including subgroup analyses by histologic subtype and neurofibromatosis 1 status. Complication data were collected and analyzed.

Results:

Among the 78 PNSTs with IGCNBx and postresection surgical pathology, 76% (n=59) had BPNST and 24% (n=19) had MPNST on postresection surgical pathology. IGCNBx accurately determined malignancy in 94% of cases. IGCNBx demonstrating schwannoma or MPNST were 100% accurate in determining malignancy. IGCNBx demonstrating neurofibroma or indeterminate results were 33% and 57% malignant on postresection surgical pathology, respectively. There were no long-term complications, including sensory or motor deficits, from IGCNBx.

Conclusions:

Percutaneous IGCNBx demonstrates 94% accuracy in differentiating benign from malignant PNSTs. IGCNBx demonstrating neurofibroma or indeterminate pathology should be interpreted with caution because of risk of malignant reclassification on surgical pathology. Our results reaffirm the safety of IGCNBx, as no patients experienced long-term complications.
Early Corneal Wound Healing Response After Small Incision Lenticule Extraction
Authors: Sun Yuan , Zhang Ting , Liu Manli , Zhou Yugui , Weng Shengbei , Yang Xiaonan , Liu Quan
Published: August 2019

Purpose:

To evaluate the corneal wound healing response after small incision lenticule extraction surgery.

Methods:

Small incision lenticule extraction was performed in both eyes of 12 New Zealand White rabbits. The refractive spherical correction was set at −6.00 D. Two animals were analyzed at each time point (1 hour, 4 hours, 1 day, 3 days, 7 days, and 28 days). The corneas were evaluated using slit-lamp and in vivo confocal microscopy. After euthanatization, the corneal tissues were subjected to light microscopy, transferase 2′-Deoxyuridine 5′-Triphosphate (dUTP) nick end labeling assay, and immunofluorescence microscopy (CD11b, fibronectin, tenascin, alpha-smooth muscle actin [α-SMA]).

Results:

The corneas did not show any opacity at any time point except at the side-cut incision. By contrast, there was obvious scar tissue at the side-cut incision. Scattered, hyperreflective spots were seen by confocal microscopy from 1 hour postoperatively. Transferase dUTP nick end labeling-positive keratocytes were abundant near the femtosecond laser incision area at 1 hour and reached a peak at 4 hours postoperatively and then decreased. Inflammatory cells migrated from the incision into the central cornea, and this process began 1 hour after surgery and peaked at 7 days. Extracellular matrix components were deposited at the beginning of day 1 postoperatively, and the distribution pattern differed between the central cornea and the incision site. α-SMA–positive myofibroblasts were only detected at the side-cut incision.

Conclusions:

The scar tissue response in the peripheral cornea is related to the epithelium debridement. Inflammatory cells begin to be recruited by 1 hour after surgery. Therefore, it is necessary to implement antiinflammation interventions at a very early stage.
Does Preoperative or Postoperative Graft Thickness Influence Postoperative Visual Acuity in Descemet Stripping Automated Endothelial Keratoplasty for Advanced Pseudophakic Bullous Keratopathy?
Authors: Perone Jean-Marc , Rolland Le Moal Pauline , Sot Maxime , Bloch Florian , Maleki Alireza , Goetz Christophe , Lhuillier Louis , Zaidi Mohamed
Published: August 2019

Purpose:

To describe the evolution of best spectacle-corrected visual acuity (BSCVA) after Descemet stripping automated endothelial keratoplasty (DSAEK) for very advanced pseudophakic bullous keratopathy (PBK) and to determine whether the thickness of corneal grafts in DSAEK surgery for advanced PBK correlates with BSCVA 6 months postoperatively.

Methods:

In a prospective, single-center, observational study, 141 eyes treated with DSAEK surgery were studied, from patients requiring posterior lamellar transplantation for advanced PBK. Graft thickness was measured during the surgery and in vivo 6 months later. The primary end point was BSCVA in LogMAR at 6 months.

Results:

BSCVA 6 months after surgery was slightly correlated with 6 months graft thickness (r = 0.24, P = 0.01), but not with preoperative graft thickness (r = 0.01, P = 0.93). After adjusting for preoperative BSCVA, a better 6 months BSCVA was best associated with thinner grafts at 6 months (P < 0.01), but not with preoperative graft thickness (P = 0.80).

Conclusions:

BSCVA after DSAEK was significantly related to graft thickness measured 6 months after surgery, suggesting that better BSCVA after DSAEK is related to a decrease in graft thickness after surgery and not to the use of a thinner graft during surgery. This decrease may be because of the good health of the endothelium, but this result may be biased because of the intrastromal scars inherent in severe PBK. This study shows that DSAEK is a good option for advanced PBK but has low visual acuity potential recovery because of stromal scarring. Therefore, a penetrating keratoplasty may be indicated to obtain maximal recovery of visual acuity or for monocular patients.
Nutrition Support of Children With Chronic Liver Diseases
Authors: Mouzaki Marialena , Bronsky Jiri , Gupte Girish , Hojsak Iva , Jahnel Jorg , Pai Nikhil , Quiros‐Tejeira Ruben E. , Wieman Renee , Sundaram Shikha
Published: August 2019

Chronic liver disease places patients at increased risk of malnutrition that can be challenging to identify clinically and treat. Nutrition support is a key aspect of the management of these patients as it has an impact on their quality of life, morbidity, and mortality. There are significant gaps in the literature regarding the optimal nutrition support for patients with different types of liver diseases and the impact of these interventions on long‐term outcomes. This Position Paper summarizes the available literature on the nutritional aspects of the care of patients with chronic liver diseases. Specifically, the challenges associated with the nutritional assessment of these subjects are discussed, and recently investigated approaches to determining the patients’ nutritional status are reviewed. Furthermore, the pathophysiology of the malnutrition seen in the context of chronic liver disease is summarized and monitoring, as well as treatment, recommendations are provided. Lastly, suggestions for future research studies are described.
Learning Curve Analyses for Achieving Satisfactory Procedural Completion Rates in Paediatric Oesophagogastroduodenoscopy
Authors: Barraclough Harriet , Siau Keith , Ward Stephen T. , Dunckley Paul , Hawkes Neil , Thomson Mike , Narula Priya
Published: August 2019

Background:

The learning curve in paediatric oesophagogastroduodenoscopy (OGD) is unknown. Using ≥95% D2 (second part of the duodenum) intubation rates as a marker of technical competency, we conducted learning curve analyses to identify when trainees achieve competency in paediatric OGD. Factors associated with competency were also evaluated.

Methods:

This nationwide study analysed data from paediatric OGD procedures prospectively entered into the UK endoscopy training e‐portfolio between 2014 and 2018. Moving average and learning curve cumulative summation analyses were performed to determine procedural numbers required to achieve ≥95% D2 intubation rates. Factors associated with D2 intubation were assessed using a multivariable binary logistic regression approach.

Results:

A total of 8929 procedures performed by 61 trainees were identified. These 61 trainees had recorded a mean of 124.6 procedures (range 22–571, interquartile range 165). By moving average analysis, 95% D2 intubation was achieved after 79 procedures. By learning curve cumulative summation analysis, 81.6% of trainees were competent after 100 procedures. Multivariable factors associated with unassisted procedural completion included: lifetime procedure count (P < 0.001), higher trainee seniority (P < 0.001), patient age (P = 0.002), outpatient status (P < 0.001), and attendance at a national Basic Skills OGD course (P = 0.011).

Conclusions:

This study demonstrates that, on average, 79 procedures in paediatric OGD are required to attain the competency outcome of ≥95% D2 intubation rates. By 100 procedures, 81.6% of our sample had achieved ≥95% D2 intubation. The minimum procedural count of 100 set by the UK and international training programmes can be used alongside existing objective assessment measures to safeguard competency within a training cohort.
Health‐related Quality of Life in Newly Diagnosed Pediatric Patients With Celiac Disease
Authors: Shull Mary H. , Ediger Tracy R. , Hill Ivor D. , Schroedl Rose L.
Published: August 2019

Objectives:

Celiac disease (CD) is a common chronic condition with potential adverse physical and psychosocial implications for affected children. The study purpose was to characterize health‐related quality of life (HRQOL) in a large sample of pediatric patients with newly diagnosed CD using the PedsQL 4.0 Generic Core Scales, and compare it to that of healthy children and children with nonceliac gastrointestinal (GI) conditions using historic data.

Methods:

The PedsQL was administered to 159 children with newly diagnosed CD and their parents at either the time of diagnostic esophagogastroduodenoscopy or before their initial dietitian appointment for gluten‐free diet teaching. Mean parent‐report and self‐report PedsQL summary and subscale scores were calculated, then compared to published means from a sample of healthy children and a sample of children with nonceliac GI symptoms using 1‐sample t tests.

Results:

Compared to the healthy children, those with newly diagnosed CD had lower Total Scores, Physical Health, Psychosocial Health, Emotional Functioning, and School Functioning on parent report (P < 0.008) with similar findings on self‐report. Within the CD sample, clinically significant scores were found in 55.9% for School Functioning, 62.7% for Physical Health, 54.4% for Emotional Functioning, 43.7% for Social Functioning, and 49% for Total Score.

Conclusions:

Children and adolescents with newly diagnosed CD had lower HRQOL than healthy children and similar HRQOL to that of patients with nonceliac GI conditions. Patients with deficits in domains such as school or emotional functioning may benefit from early interventions including a Section 504 plan or meeting with a psychologist or social worker.
Symptom Burden and Quality of Life Over Time in Pediatric Eosinophilic Esophagitis
Authors: Klinnert Mary D. , Atkins Dan , Pan Zhaoxing , Franciosi James P. , Aceves Seema S. , Spergel Jonathan M. , Furuta Glenn T.
Published: August 2019

Objective:

The aim of the study was to evaluate whether children with eosinophilic esophagitis (EoE) demonstrated an association between health‐related quality of life (HRQoL) improvements and symptom reduction during 12 months of treatment; to examine age‐related EoE discrete symptom presentation; and to describe residual symptom and HRQoL burden.

Methods:

Children ages 2 to 18 years with EoE were assessed at the onset of treatment and 12 months later at 4 tertiary care centers. Continuous measures of symptoms and symptom severity were based on 8 discrete EoE symptoms. HRQoL was measured with the Pediatric Quality of Life (PedsQL) parent‐proxy (PR) report, child self‐report (CR), and Family Impact Module. Mixed‐effects modeling was used to test changes over time for symptom burden and child and family HRQoL.

Results:

One hundred nine children were followed (ages 2–18 years, mean age 7.6 [4.6] years, 77% boys, 87% white). Baseline symptom number mean was 3.5 (standard deviation = 2.3, range 0–8) and symptom severity mean was 5.5 (standard deviation = 4.3, range 0–24). EoE symptom number and symptom severity decreased significantly over the 12 months (P = 0.013, P < 0.001, respectively). PedsQL PR Total, Physical, Psychosocial, and Family Impact scores all improved significantly (P = 0.001, 0.012, 0.012, 0.015, respectively) but PedsQL child self‐report scores did not. Symptom reduction correlated with PR PedsQL improvement (P = 0.01). Few discrete symptoms completely remitted, but lowered severity ratings indicated clinically significant improvement.

Conclusions:

Year‐long treatment in multidisciplinary tertiary centers reduced most symptoms and improved parent‐reported HRQoL in children with EoE. The frequency of residual symptoms and persistently lower HRQoL, however, underscore the chronic nature of pediatric EoE.