bluuebunny/crossref_metadata_2025 huggingface dataset:
Using a pruned, nondirect product basis in conjunction with the multi-configuration time-dependent Hartree (MCTDH) method
Authors: Wodraszka Robert , Carrington Tucker
Published: July 2016

In this paper, we propose a pruned, nondirect product multi-configuration time dependent Hartree (MCTDH) method for solving the Schrödinger equation. MCTDH uses optimized 1D basis functions, called single particle functions, but the size of the standard direct product MCTDH basis scales exponentially with D, the number of coordinates. We compare the pruned approach to standard MCTDH calculations for basis sizes small enough that the latter are possible and demonstrate that pruning the basis reduces the CPU cost of computing vibrational energy levels of acetonitrile (D = 12) by more than two orders of magnitude. Using the pruned method, it is possible to do calculations with larger bases, for which the cost of standard MCTDH calculations is prohibitive. Pruning the basis complicates the evaluation of matrix-vector products. In this paper, they are done term by term for a sum-of-products Hamiltonian. When no attempt is made to exploit the fact that matrices representing some of the factors of a term are identity matrices, one needs only to carefully constrain indices. In this paper, we develop new ideas that make it possible to further reduce the CPU time by exploiting identity matrices.
Two structural relaxations in protein hydration water and their dynamic crossovers
Authors: Camisasca G. , De Marzio M. , Corradini D. , Gallo P.
Published: July 2016

We study the translational single particle dynamics of hydration water of lysozyme upon cooling by means of molecular dynamics simulations. We find that water close to the protein exhibits two distinct relaxations. By characterizing their behavior upon cooling, we are able to assign the first relaxation to the structural α-relaxation also present in bulk water and in other glass-forming liquids. The second, slower, relaxation can be ascribed to a dynamic coupling of hydration water motions to the fluctuations of the protein structure. Both relaxation times exhibit crossovers in the behavior upon cooling. For the α-process, we find upon cooling a crossover from a fragile behavior to a strong behavior at a temperature which is about five degrees higher than that of bulk water. The long-relaxation time appears strictly connected to the protein motion as it shows upon cooling a temperature crossover from a strong behavior with a lower activation energy to a strong behavior with a higher activation energy. The crossover temperature coincides with the temperature of the protein dynamical transition. These findings can help experimentalists to disentangle the different information coming from total correlators and to better characterize hydration water relaxations in different biomolecules.
The rectangular array of magnetic probes on J-TEXT tokamak
Authors: Chen Zhipeng , Li Fuming , Zhuang Ge , Jian Xiang , Zhu Lizhi
Published: July 2016

The rectangular array of magnetic probes system was newly designed and installed in the torus on J-TEXT tokamak to measure the local magnetic fields outside the last closed flux surface at a single toroidal angle. In the implementation, the experimental results agree well with the theoretical results based on the Spool model and three-dimensional numerical finite element model when the vertical field was applied. Furthermore, the measurements were successfully used as the input of EFIT code to conduct the plasma equilibrium reconstruction. The calculated Faraday rotation angle using the EFIT output is in agreement with the measured one from the three-wave polarimeter-interferometer system.
Nonlinear wavenumber shift of large amplitude Langmuir waves
Authors: Li Dehui , Wang Shaojie
Published: July 2016

Nonlinear particle-in-cell simulation is carried out to investigate the nonlinear behavior of the Langmuir wave launched with a fixed frequency in a uniform plasma. It is found that in the strong driving case, the launched wave propagates in a phase velocity larger than that predicted by the linear theory; there appears a nonlinear down-shift of wavenumber. The phase velocity of the nonlinear wave and the down-shift of the wavenumber are demonstrated to be determined by the velocity of nonlinearly accelerated resonant electrons.
Elastic properties of AlAs-like and InSb-like strained interfaces in [InAs/AlSb] heterostructures
Authors: Claveau Y. , Vallet M. , Tang H. , Combe N. , Ponchet A.
Published: July 2016

Elastic properties of [InAs/AlSb] heterostructures coherently grown on a (001) InAs substrate are investigated by the density functional theory and compared to the prediction of the linear elasticity theory. The stress-strain curves of the four involved binaries (InAs, AlAs, AlSb, and InSb) are first studied: a significant deviation to the linear elasticity theory is observed for strain above 2.5% (in absolute value). Nevertheless, the relationship between the out-of-plane and in-plane strains is in a good agreement with the prediction of the linear elasticity theory. In the heterostructures, highly strained perfect AlAs-like and InSb-like interfaces are examined. The interfacial strains calculated using the density functional theory are in a surprisingly good agreement with the prediction of the linear elasticity theory. The reduction of the layer thickness to the thinnest possible InAs or AlSb layers while keeping perfect interfaces does not change these conclusions.
Analytical energy-barrier-dependent Voc model for amorphous silicon solar cells
Authors: Castro-Carranza A. , Nolasco J. C. , Reininghaus N. , Geißendörfer S. , Vehse M. , Parisi J. , Gutowski J. , Voss T.
Published: July 2016

We show that the open circuit voltage (Voc) in hydrogenated amorphous silicon (a-Si:H) solar cells can be described by an analytical energy-barrier-dependent equation, considering thermionic emission as the physical mechanism determining the recombination current. For this purpose, the current-voltage characteristics of two device structures, i.e., a-Si:H(n)/a-Si:H(i)/a-Si:H(p)/AZO p-i-n solar cells with different p-doping concentrations and a-Si:H(n)/a-Si:H(i)/AZO Schottky structures with different intrinsic layer thicknesses, were analyzed in dark and under illumination, respectively. The calculated barrier in the p-i-n devices is consistent with the difference between the work function of the p-layer and the conduction band edge of the i-layer at the interface in thermal equilibrium.
Electronic structure and magnetic anisotropy of L1-FePt thin film studied by hard x-ray photoemission spectroscopy and first-principles calculations
Authors: Ueda S. , Mizuguchi M. , Miura Y. , Kang J. G. , Shirai M. , Takanashi K.
Published: July 2016

We have studied the electronic structure of the L10 ordered FePt thin film by hard x-ray photoemission spectroscopy (HAXPES), cluster model, and first-principles calculations to investigate the relationship between the electronic structure and perpendicular magneto-crystalline anisotropy (MCA). The Fe 2p core-level HAXPES spectrum of the ordered film revealed the strong electron correlation in the Fe 3d states and the hybridization between the Fe 3d and Pt 5d states. By comparing the experimental valence band structure with the theoretical density of states, the strong electron correlation in the Fe 3d states modifies the valence band electronic structure of the L10 ordered FePt thin film through the Fe 3d-Pt 5d hybridization. These results strongly suggest that the strong electron correlation effect in the Fe 3d states and the Fe 3d-Pt 5d hybridization as well as the spin-orbit interaction in the Pt 5d states play important roles in the perpendicular MCA for L10-FePt.
Parameter estimation of photovoltaic panels and a model-based maximum power point tracking algorithm
Authors: Azizi Kianoosh , Ghaffari Ali
Published: July 2016

This paper presents a model-based algorithm for fast tracking of maximum power point of a photovoltaic panel. Parameters of an equivalent circuit have been estimated based on experimental data and characteristic data provided by manufacturer. Since photoelectric current is highly temperature-dependent, the effect of temperature is considered in the model. The proposed method is based on the maximum power point locus of the solar panel. So the tracking speed is much faster than a model-free method. In the suggested technique, the voltage of maximum power point can be determined using output voltage and current of solar panel and the voltage of a point on the maximum power point locus with the same current, in three steps. The main novelty of the proposed model-based method is that there is no need to measure solar radiation. Experiment results are presented and prove the feasibility of the proposed maximum power point tracking method.
Suppression of power system voltage and frequency fluctuations by decentralized controllable loads
Authors: Palmer Michael D. , Uehara Takahiro , Shigenobu Ryuto , Matayoshi Hidehito , Senjyu Tomonobu , Datta Manoj
Published: July 2016

A recent trend of the power system is the ever increasing number of distributed generators (DGs) utilizing renewable energy sources, which have output powers that fluctuate due to unpredictable weather and ambient conditions. This causes fluctuations in system frequency and bus voltages, resulting in poor quality power, higher prices for electricity, and increased chances of reverse power flow and voltage collapse. In order to allow higher levels of DG penetration, methods of reducing the effects of fluctuations must be implemented. This paper proposes a method to mitigate these fluctuations using controllable loads such as heat pump water heaters (HPs) and battery storage systems. The HPs are controlled using a decentralized bang-bang (on/off) control based on the cumulative distribution of water temperature of HPs in the local area and the local frequency. Battery systems are controlled using a smart frequency and voltage droop characteristics based control. The decentralized bang-bang control mitigates local frequency fluctuations by increasing active power consumption to lower frequency as well as decreasing active power consumption to increase the frequency. The smart droop characteristics based control applies a commonly used droop characteristics control to voltage and frequency; however, the control system monitors the state of charge (SOC) of the battery system and takes appropriate actions to prevent the SOC from reaching a critical level. The results of simulations show that fluctuations in frequency and bus voltage are mitigated by the application of the proposed control methodologies without adversely affecting the comfort level of consumers.
Fish larvae and recruitment patterns in floodplain lagoons of the Australian Wet Tropics
Authors: Godfrey Paul C. , Arthington Angela H. , Pearson Richard G. , Karim Fazlul , Wallace Jim
Published: July 2016

Floodplain lagoons in the Queensland Wet Tropics bioregion, Australia, are important and threatened habitats for fish. As part of studies to assess their ecological condition and functions, we examined patterns of occurrence of fish larvae, juveniles and adults in 10 permanent lagoons on the Tully–Murray floodplain. Lagoons contained early life-history stages of 15 of the 21 native species present, including 11 species that complete their life cycle in fresh waters and 4 that require access to saline habitats for larval development. Lagoon connectivity to the rivers, distance from the coast and flood dynamics influenced temporal variation in fish abundance, population size structures and recruitment patterns. This study and the literature show that wet, post-wet and dry-season habitats are utilised by small opportunists (e.g. Melanotaenia splendida), an equilibrium species (Glossamia aprion) and larger periodic strategists (neosilurid catfishes). Maintenance of natural seasonal patterns of flow and connectivity, and active protection of permanent floodplain lagoons from riparian and land-use disturbance, will be essential if their roles in fish recruitment are to be sustained.
AIM2 inflammasome is activated by pharmacological disruption of nuclear envelope integrity
Authors: Di Micco Antonia , Frera Gianluca , Lugrin Jérôme , Jamilloux Yvan , Hsu Erh-Ting , Tardivel Aubry , De Gassart Aude , Zaffalon Léa , Bujisic Bojan , Siegert Stefanie , Quadroni Manfredo , Broz Petr , Henry Thomas , Hrycyna Christine A. , Martinon Fabio
Published: July 2016

Significance

Inflammasomes are cellular sensors of harmful situations such as the presence of microbes or alterations in cellular homeostasis. Upon activation, inflammasomes trigger the proteolytic maturation and release of inflammatory cytokines to initiate immune and repair responses. The assembly of inflammasome relies on a diverse repertoire of sensor proteins that can detect specific stimuli. For example, the AIM2 inflammasome is activated by the presence of microbial DNA within the cytosol. In this paper, alterations of the nuclear envelope integrity are found to cause the exposure of nuclear DNA in the cytosol to promote the activation of the AIM2 inflammasome. Nuclear envelope stress can therefore directly engage innate immune sensors to elicit inflammation.
Chemical shift imprint of intersubunit communication in a symmetric homodimer
Authors: Falk Bradley T. , Sapienza Paul J. , Lee Andrew L.
Published: July 2016

Significance

Regulatory signals between protein subunits depend on communication between sequential binding events. How such long-range communication, or allostery, operates at the subdomain level has been elusive, especially for homooligomeric proteins. To address this problem, homodimers of thymidylate synthase were generated for optimized study of individual protomers of the singly bound dimer. Mixed15N-labeled dimers were created with a single functional active site, allowing site-specific, protomer-specific chemical shifts to report on step-wise binding effects. Long-range intersubunit communication was observed although this communication was apparent only in the second ligand-binding step, in which changes were in the first ligand-bound region. Visualization of up to four peaks for each residue amide provides a unique way to assess the allosteric mechanism.
Gambogic acid identifies an isoform-specific druggable pocket in the middle domain of Hsp90β
Authors: Yim Kendrick H. , Prince Thomas L. , Qu Shiwei , Bai Fang , Jennings Patricia A. , Onuchic José N. , Theodorakis Emmanuel A. , Neckers Leonard
Published: July 2016

Significance

The molecular chaperone heat-shock protein 90 (Hsp90) is a key member of the cellular proteostasis network, and as such helps to protect cells against proteotoxic stress. Cancer cells have up-regulated members of this network, including Hsp90, to promote their survival and growth. Several Hsp90 inhibitors have undergone clinical trials, but these drugs, which bind to a shared nucleotide pocket in the N-terminal domain, do not differentiate between the four Hsp90 family members [Hsp90α, Hsp90β, GRP94 (glucose-regulated protein 94 kDa), and TRAP1 (tumor necrosis receptor-associated protein 1)]. In this report, we identify a pharmacophore contained within the natural product gambogic acid that binds uniquely to a site in Hsp90β, thus identifying this compound as a prototype of a new class of isoform-specific Hsp90 inhibitors.
Joan Tower, Silver Ladders (1986)
Authors: Bernard Jonathan W.
Published: July 2016

Although at first glance Joan Tower’s orchestral work Silver Ladders (1986) might seem to follow a well-established twentieth-century tradition of “octatonicism,” closer analytical examination reveals compositional uses of the octatonic collection that are quite original. A typology is developed that makes distinctions between employment of the octatonic in just one of its transpositions and the projection of two or even all three transpositions at once, and that identifies mechanisms by which one transposition can be gradually transformed into another or into non-octatonic collections such as the total chromatic. This typology is applied to analysis of passages of varying length, permitting provisional conclusions to be reached concerning form. The final section of the essay offers some musings on the significance of these analytical findings in light of Tower’s comments on her attitudes toward composition in general and on her working methods in particular.
A Reduced Duty Hours Model for Senior Internal Medicine Residents: A Qualitative Analysis of Residents’ Experiences and Perceptions
Authors: Mathew Rebecca , Gundy Serena , Ulic Diana , Haider Shariq , Wasi Parveen
Published: July 2016

Purpose

To assess senior internal medicine residents’ experience of the implementation of a reduced duty hours model with night float, the transition from the prior 26-hour call system, and the new model’s effects on resident quality of life and perceived patient safety in the emergency department and clinical teaching unit at McMaster University.

Method

Qualitative data were collected during May 2013–July 2014, through resident focus groups held prior to implementation of a reduced duty hours model and 10 to 12 months postimplementation. Data analysis was guided by a constructivist grounded theory based in a relativist paradigm. Transcripts were coded; codes were collapsed into themes.

Results

Thematic analysis revealed five themes. Residents described reduced fatigue in the early morning, counterbalanced with worsened long-term fatigue on night float blocks; anticipation of negative impacts of the loss of distributed on-call experience and on-call shift volume; an urgency to sleep postcall in anticipation of consecutive night float shifts accompanied by conflicting role demands to stay postcall for care continuity; increased handover frequency accompanied by inaccurate/incomplete communication of patients’ issues; and improvement in the senior resident experience on the clinical teaching unit, with increased ownership over patient care and improved relationships with junior housestaff.

Conclusions

A reduced duty hours model with night float has potential to improve residents’ perceived fatigue on call and care continuity on the clinical teaching unit. This must be weighed against increased handover frequency and loss of the postcall day, which may negatively affect patient care and resident quality of life.
Co-occurring Disordered Gambling Among Treatment-Seekers at a Community Outpatient Addiction Clinic
Authors: Elman Igor , Borodovsky Jacob , Howard Margaret , Scoglio Arielle , Steinkamp Jackson , Sobieszczyk Amy , Mysels David , Albanese Mark
Published: July 2016

Background:

Parallel to the ongoing expansion of legalized gambling activities is a growing concern about rising occurrence of uncontrollable gambling. People with preexisting gambling and/or chemical addictions may be particularly vulnerable, but the extent of such co-occurring conditions and their demographic and clinical characteristics have not been sufficiently elucidated. To that end, the present study attempted to both, quantify the presence and to characterize co-occurring pathological or problem gambling (ie, respectively, at least 1- or at least 5 pathological gambling criteria from theDiagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) among treatment-seeking patients at a community outpatient addiction program.

Methods:

The patients were assessed with the South Oaks Gambling Screen and their charts were reviewed for the extraction of demographic and clinical information according to a predetermined template. Data from 183 subjects withstood quality control procedures and were included.

Results:

The prevalence rates of co-occurring problem- (18.6%) and pathological (10.9%) gambling were strikingly higher than those found in the general population (2% and 0.5%, respectively). No increase in the clinical severity indices was observed across the gambling groups.

Conclusions:

Our data replicate those of prior studies reporting heightened prevalence of problematic gambling in patients with substance use disorders and extend the prior findings by including a subject population of treatment-seekers. In the era of the gambling industry growth, these results call for creation and/or adjustment of clinical addiction services to meet emerging preventive and therapeutic needs.
Intraoperative Care Transitions Are Not Associated with Postoperative Adverse Outcomes
Authors: Terekhov Maxim A. , Ehrenfeld Jesse M. , Dutton Richard P. , Guillamondegui Oscar D. , Martin Barbara J. , Wanderer Jonathan P.
Published: July 2016

Background

Whether anesthesia care transitions and provision of short breaks affect patient outcomes remains unclear.

Methods

The authors determined the number of anesthesia handovers and breaks during each case for adults admitted between 2005 and 2014, along with age, sex, race, American Society of Anesthesiologists physical status, start time and duration of surgery, and diagnosis and procedure codes. The authors defined a collapsed composite of in-hospital mortality and major morbidities based on primary and secondary diagnoses. The relationship between the total number of anesthesia handovers during a case and the collapsed composite outcome was assessed with a multivariable logistic regression. The relationship between the total number of anesthesia handovers during a case and the components of the composite outcome was assessed using multivariate generalized estimating equation methods. Additionally, the authors analyzed major complications and/or death within 30 days of surgery based on the American College of Surgeons National Surgical Quality Improvement Program–defined events.

Results

A total of 140,754 anesthetics were identified for the primary analysis. The number of anesthesia handovers was not found to be associated (P = 0.19) with increased odds of postoperative mortality and serious complications, as measured by the collapsed composite, with odds ratio for a one unit increase in handovers of 0.957; 95% CI, 0.895 to 1.022, when controlled for potential confounding variables. A total of 8,404 anesthetics were identified for the NSQIP analysis (collapsed composite odds ratio, 0.868; 95% CI, 0.718 to 1.049 for handovers).

Conclusions

In the analysis of intraoperative handovers, anesthesia care transitions were not associated with an increased risk of postoperative adverse outcomes.
Complications in Tibial Pilon Fractures: Avoiding Errors in Judgment
Authors: Watson John T.
Published: July 2016

Pilon fracture surgery is fraught with many potential complications. Careful preoperative evaluation is required. Techniques for preoperative soft tissue management include compression dressings, stable ankle spanning external fixation, and compression foot pumps. Errors in judgment regarding the timing of surgery and over aggressive surgical exposure can lead to soft tissue complications. Postoperative wound management techniques include negative-pressure wound therapy to reduce incisional edema. Wound complications can be handled with a number of newer local pedicled rotational flaps, as well as biomaterials. These include acellular biomembranes to facilitate formation of a well-developed subcuticular tissue layer to serve as a substrate for local skin grafting. Mechanical instability occurs when the surgeon fails to neutralize deforming forces. This is accomplished by correct plate application, as well as treating areas of bone loss, that can all lead to late deformation, mechanical failure, and nonunion. This review covers crucial decision-making points regarding soft tissue and fixation strategies in an attempt to help avoid the frequency and severity of these complications.

Levels of Evidence: Diagnostic Level I, II, III, IV, and V. See Instructions for Authors for a complete description of levels of evidence.
Successful Treatment of Chronic Venous Ulcers With a 1,320-nm Endovenous Laser Combined With Other Minimally Invasive Venous Procedures
Authors: Wysong Ashley , Taylor Brent R. , Graves Michael , Mishra Vineet , Gilbertson Ryan , Greenway Hubert T. , Housman Leland
Published: July 2016

BACKGROUND

Venous ulcers are very common with few curative treatment options.

OBJECTIVE

To report the closure rate and clinical characteristics of active venous ulcers in a vein clinic using endovenous laser ablation (EVLA) with a 1,320-nm laser.

METHODS AND MATERIALS

A prospective database was kept consisting of patients with an active venous ulcer at the time of consultation in a single-practitioner academic vein clinic from March 2007 to May 2014. A database was maintained and charts were reviewed with attention to the length of time the patient reported having the ulcer, procedures performed, and time to ulcer healing.

RESULTS

Thirty-one patients were identified at consultation with venous ulceration. One patient's ulcer was healed with conservative medical management before receiving treatment. The remaining 30 patients were treated with a combination of EVLA of the great and/or short saphenous veins, foam sclerotherapy of insufficient varicose and reticular veins, and phlebectomy as appropriate. Two patients were lost to follow up after partial treatment. Ulcer healing occurred in more than 93% (27/29) of patients with a median healing time of 55 days from the time of first treatment. The median follow-up time after treatment was 448 days.

CONCLUSION

Endovenous laser ablation with a 1,320-nm laser in combination with foam sclerotherapy and phlebectomy as appropriate is effective treatment of chronic venous ulcers and should be considered as a treatment option for patients with C6 venous insufficiency. To the authors' knowledge, this is the largest, prospective series of chronic venous ulcers treated with EVLA. Further randomized controlled studies are needed to confirm these findings.
Penile Squamous Cell Carcinoma: Penis-Preserving Treatment With Mohs Micrographic Surgery
Authors: Machan Mac , Brodland David , Zitelli John
Published: July 2016

BACKGROUND

There have been few published case series of penile squamous cell carcinoma (SCC) removed with Mohs micrographic surgery (MMS). Of these case series, the published cure rates are between 68% and 74%.

OBJECTIVE

To report 30 years of experience removing penile SCCs with MMS.

METHODS and Materials

Retrospective record review of 42 patients with 44 penile SCCs.

RESULTS

There was one recurrence of the 19 primary SCCs in situ, resulting in a cure rate of 94.7%. There were no recurrences among the 10 primary invasive SCC. Of the 6 recurrent invasive SCCs, 2 recurred, resulting in an initial cure rate of 66.7%. These 2 recurrences were re-treated with MMS with no evidence of recurrence at 5 years. There were 4 patients with SCC in situ of the glans with extension down the urethra. While all 4 patients required urethral dilation postoperatively secondary to urethral stricture, none of these tumors recurred and normal function was restored in each case.

CONCLUSION

In conclusion, MMS may be preferred for patients with penile carcinoma by providing a high cure rate and tissue conservative alternative to partial or total penectomy and does not need to be limited to low-grade, small, superficial tumors.
MiR-30s Family Inhibit the Proliferation and Apoptosis in Human Coronary Artery Endothelial Cells Through Targeting the 3′UTR Region of ITGA4 and PLCG1
Authors: Ma Feng , Li Tao , Zhang Huan , Wu GuanJi
Published: July 2016

Atherosclerosis (As) is a common disease, which is serious hazard to human health. As the main pathological basis of ischemic cardiac and cerebral vascular disease, including coronary heart disease, cerebrovascular disease, and thromboembolic disease, it is a chronic inflammatory lesion of the arterial vessel wall. So far the pathogenesis of As has not been fully understood. Therefore, it is still lack of effective clinical prevention and treatment of drugs. More and more evidence indicate that miRNA plays an important role in the pathophysiology of many diseases, especially the occurrence and development of cardiovascular diseases. MiRNAs are widely detected in human coronary artery endothelial cells, which might participate in diverse biological functions through targeting different As associated genes. The aim of this study was to investigate the molecular mechanisms underlying miR-30s roles in As. Our study found the high expression of miR-30b and miR-30e in As clinical samples, identified the regulatory relationship of miR-30b and miR-30e to ITGA4 and PLCG1, respectively, and initially explored the effects of miR-30b and miR-30e on cell cycle and apoptosis through targeting ITGA4 and PLCG1. These data may provide a theoretical basis for clarifying the mechanism of miR-30s in As.
Does the uterus need to be removed to correct uterovaginal prolapse?
Authors: Gutman Robert E.
Published: July 2016

Purpose of review

Owing to growing interest in uterine preservation, this evidence-based review compares hysteropexy with hysterectomy during surgery for uterovaginal prolapse.

Recent findings

LeFort colpocleisis is preferred over vaginal hysterectomy and total colpocleisis. The majority of studies show no differences in outcomes comparing sacrospinous hysteropexy with vaginal hysterectomy native tissue prolapse repair except for a single randomized controlled trial showing increased apical recurrences with advanced prolapse. Results comparing uterosacral hysteropexy and sacral hysteropexy with hysterectomy native tissue repairs are inconclusive. Potentially better outcomes are reported when laparoscopic hysterectomy (total or supracervical) is performed with sacral colpopexy compared with laparoscopic sacral hysteropexy, but mesh and morcellation risks should be considered. Data comparing vaginal mesh hysteropexy with currently available products with hysterectomy prolapse repairs are lacking but a high-quality study is underway.

High satisfaction and low reoperation rates can be accomplished using a variety of hysteropexy techniques. The advantages and disadvantages of uterine conservation must be considered when planning uterovaginal prolapse surgery. The type of hysteropexy and possible graft configuration may impact reoperation rates for recurrent prolapse. Vaginal mesh risks must be considered and laparoscopic mesh risks must be balanced with potential difficulty of future hysterectomy if needed.
Reduced risk of breast cancer mortality in women using postmenopausal hormone therapy: a Finnish nationwide comparative study
Authors: Mikkola Tomi S. , Savolainen-Peltonen Hanna , Tuomikoski Pauliina , Hoti Fabian , Vattulainen Pia , Gissler Mika , Ylikorkala Olavi
Published: July 2016

Objective:

Data are controversial on the impact of postmenopausal hormone therapy (HT) on breast cancer mortality. We analyzed nationwide Finnish data on breast cancer mortality risk in women using HT consisting of estradiol-only therapy (ET) or estrogen-progestogen therapy (EPT).

Methods:

In total, 489,105 women using HT in 1994 to 2009, traced from the nationwide reimbursement register, were followed from the HT initiation (3.3 million cumulative exposure years) to breast cancer death (n = 1,578 women). The observed deaths were compared with those in the age-standardized background population.

Results:

The breast cancer mortality risk was reduced in all HT users with exposure for at most 5 years (standardized mortality ratio 0.56; CI 0.52-0.60), more than 5 to 10 years (0.46; 0.41-0.51), or more than 10 years (0.62; 0.56-0.68). A significantly larger risk reduction was detected in the 50 to 59 years age group (0.33; 0.29-0.37) compared with 60 to 69 (0.64; 0.59-0.70) or 70 to 79 (0.78; 0.69-0.87) years age groups. The death risk reductions in ET users tended to be larger in all age groups compared with EPT users, with a significant difference only in the 70 to 79 years age group (0.66; 0.57-0.76 vs 0.88; 0.77-1.00). The age at HT initiation, regardless whether ET or EPT, showed no association with breast cancer mortality.

Conclusions:

In the Finnish unselected population, breast cancer is fatal in 1 of 10 patients. Our data imply that this risk is prevalent in 1 of 20 patients with history of HT use. This is an important message for women considering or already using HT.
Leading on the edge
Authors: Mercer Danielle , Haddon Arlene , Loughlin Catherine
Published: July 2016

Background:

Health care organizations are considered complex systems that represent both formal leadership as well as more informal and shared leadership models. Implementing these models is essential for optimizing care and patient outcomes. The paramedic profession specifically, although considered informally, leads out of hospital patient care.

Purpose:

To date, few empirical studies investigate shared leadership in health care settings. In paramedicine specifically, studies of leadership are scarce, despite paramedics' essential role in leading on the front lines of care. Using an exemplar of paramedics, we examine what it means to informally lead on the front lines of patient care with the emphasis on paramedics responding out of hospital.

Methodology:

We employed a qualitative, semistructured interview methodology with 29 paramedics from a group of companies in central/eastern Canada to explore the conditions and practices surrounding shared leadership.

Findings:

Paramedics argue that, despite their job title, they classify themselves as informal leaders who share the leadership role. More specifically, the paramedics discuss the precursors, practices, and structural conditions surrounding shared leadership within the realm of emergency medical services. They note that they often face out-of-hospital care without a formal manager, requiring them to collectively lead. The leader will shift in times of urgency, and this is contingent on their skills and competence. Furthermore, managers routinely called upon paramedics to lead in their absence.

Practice Implications:

It is shown here that, although informally enacted, paramedics view leadership as a necessary competency for clinical practice. We argue that leadership development of paramedics must begin during their formal education and training as part of the core curriculum. As well, direct managers can promote an environment of shared leadership and encourage paramedics to practice leadership with quality of patient service in mind.
A Novel Survey Tool to Quantify the Degree and Duration of STEMI Regionalization Across California
Authors: Rokos Ivan C. , Sporer Karl , Savino Paul B. , Mercer Mary P. , Shontz Selinda S. , Sabbagh Sarah , Hsia Renee Y.
Published: July 2016

Introduction:

California has been a global leader in regionalization efforts for time-critical medical conditions. A total of 33 local emergency medical service agencies (LEMSAs) exist, providing an organized EMS framework across the state for almost 40 years. We sought to develop a survey tool to quantify the degree and duration of ST-elevation myocardial infarction (STEMI) regionalization over the last decade in California.

Methods:

The project started with the development of an 8-question survey tool via a multi-disciplinary expert consensus process. Next, the survey tool was distributed at the annual meeting of administrators and medical directors of California LEMSAs to get responses valid through December, 2014. The first scoring approach was the Total Regionalization Score (TRS) and used answers from all 8 questions. The second approach was called the Core Score, and it focused on only 4 survey questions by assuming that the designation of STEMI Receiving Centers must have occurred at the beginning of any LEMSA’s regionalization effort. Scores were ranked and grouped into tertiles.

Results:

All 33 LEMSAs in California participated in this survey. The TRS ranged from 15 to 162. The Core Score range was much narrower, from 2 to 30. In comparing TRS and Core Score rankings, the top-tertiles were quite similar. More rank variation occurred between mid- and low-tertiles.

Conclusion:

This study evaluated the degree and duration of STEMI network regionalization from 2004 to 2014 in California, and ranked 33 LEMSAs into tertiles based upon their TRS and their Core Score. Successful application of the 8-item survey and ranking strategies across California suggests that this approach can be used to assess regionalization in other states or countries around the world.
Diplopia and Symblepharon Following Mueller’s Muscle Conjunctival Resection in Patients on Long-Term Multiple Antiglaucoma Medications
Authors: Lee Wendy W. , Portaliou Dimitra , Sayed Mohamed S. , Kankariya Shrutika
Published: July 2016

To report the occurrence of diplopia and symblepharon following conjunctival Muellerectomy for ptosis repair in 3 patients under chronic antiglaucoma treatment. In this retrospective observational case series, 3 patients were identified who were being treated chronically with multiple antiglaucoma agents and concurrently underwent Mueller’s muscle conjunctival resection (MMCR) for the management of ptosis. These patients developed conjunctival scarring and symblepharon extending from the operative site to the bulbar conjunctiva postoperatively. All 3 patients reported diplopia after surgery. Two of the patients were treated with prismatic correction and one underwent surgical correction. All patients were closely monitored postoperatively and 1 out of the 3 required symblepharon lysis and mucous membrane graft for ocular surface reconstruction with a consequent improvement in symptoms. Long-term use of topical antiglaucoma medications may alter the integrity of the conjunctiva, rendering conjunctival procedures more prone to postoperative scarring. In patients treated with multiple antiglaucoma medications who are in need of ptosis repair surgery, consideration should be given to an external approach to avoid the potential for postoperative symblepharon and diplopia.
Severe Elevation of Liver Tests in Choledocholithiasis
Authors: Bangaru Saroja , Thiele Dwain , Sreenarasimhaiah Jayaprakash , Agrawal Deepak
Published: July 2016

Background and Aims:

Choledocholithiasis is not commonly associated with dramatic elevations in aminotransferase or total serum bilirubin. Ours is the largest case series thus far studying the prevalence of dramatic elevations in liver tests associated with choledocholithiasis.

Materials and Methods:

We performed a retrospective chart review of all patients with choledocholithiasis diagnosed on endoscopic retrograde pancreatocholangiogram at a tertiary referral hospital over 7 years. We identified 740 patients with available liver tests and determined the prevalence of aspartate aminotransferase (AST)/alanine aminotransferase (ALT) >1000 IU/L and of total serum bilirubin >10 mg/dL. We compared clinical characteristics of these 2 nonoverlapping groups.

Results:

Of 740 patients, AST and/or ALT values >1000 IU/L were present in 45 (6.1%) patients. On average AST and ALT decreased 79% and 56%, respectively, at discharge 1 to 8 days later. Total serum bilirubin levels >10 mg/dL were present in 35 (4.7%) patients and decreased by an average of 64% at discharge 1 to 8 days later. When compared with the group with total serum bilirubin >10 mg/dL, the group with elevated aminotransferases had significantly more females (93% vs. 43%, P<0.001), had smaller common bile duct diameter (8.5 vs. 10.6 mm, P=0.04), and were more likely to have had a prior cholecystectomy (40% vs. 14%, P=0.01). These 80 patients had higher utilization of health resources: half had additional laboratory studies and one fourth had additional imaging studies performed.

Conclusions:

In patients with high AST and/or ALT and serum total bilirubin levels with known choledocholithiasis, elaborate work up to look for another etiology is not required. As long as the values decrease significantly, they do not need to be followed until they normalize in the same hospitalization.
Randomized placebo-controlled study of baclofen in the treatment of muscle cramps in patients with liver cirrhosis
Authors: Elfert Asem A. , Abo Ali Lobna , Soliman Samah , Zakaria Sherin , Shehab El-Din Ibrahim , Elkhalawany Walaa , Abd-Elsalam Sherief
Published: July 2016

Background and aims

Muscle cramps adversely influence the quality of life of patients with liver cirrhosis. Indeed, to date, a well-established therapy for this complication is still lacking. This is the first randomized placebo-controlled trial of baclofen in the treatment of muscle cramps in patients with liver cirrhosis.

Patients and methods

A total of 100 patients with liver cirrhosis and muscle cramps signed an informed consent to participate in this study. They were recruited from the Department of Tropical Medicine-Tanta University Hospital. They were randomized to receive either baclofen or placebo for 3 months. Patients were followed monthly and 1 month after withdrawal. At each visit, the clinicoepidemiological data were recorded, the muscle cramp questionnaire was filled, and any drug-related side effects were reported.

Results

In the baclofen group, the frequency of muscle cramps decreased significantly after 1 and 3 months of treatment (P<0.005), with a significant relapse after withdrawal (P<0.001). Patients receiving baclofen showed a significant decrease in the severity and duration of muscle cramps (P<0.001). After 3 months of baclofen therapy at a dose of 30 mg/day, muscle cramps disappeared completely in 72%, reduced in 20%, and led to no change in 8% of patients. No significant changes in the frequency, severity, and duration of muscle cramps were noted in the placebo group. There were few but nonsignificant side effects in the baclofen group compared with the placebo group.

Conclusion

Baclofen was well tolerated, safe, and effective in the treatment of muscle cramps in patients with liver cirrhosis.
The Association Between Plasma Ferritin Level and Simple Febrile Seizures in Children
Authors: Köksal Ali O. , Özdemir Osman , Büyükkaragöz Bahar , Karaömerlioglu Merve , Bulus Ayse D.
Published: July 2016

Introduction:

We conducted this study to determine the role of iron deficiency (ID) as a risk factor for simple febrile seizure (SFS) in 6- to 60-month-old children.

Materials and Methods:

In this case-control study 100 children aged 6 to 60 months with febrile seizure (FS) (study group) and 100 febrile children without seizures (control group) admitted to Pediatric Departments of Kecioren Training and Research Hospital in between June 2014 and March 2015 were evaluated. Complete blood count, serum iron, plasma ferritin, and total iron binding capacity analyses were performed in children with FS and were compared with controls.

Results:

Ferritin level was significantly lower in the study group than controls (P<0.05). Compared with the onset of the study (first day), ferritin levels of the study group significantly decreased at the 10th day (P<0.05). At the onset, we were not able to determine ID in 18% of children because of fever.

Conclusions:

There was a relationship between low plasma ferritin level and SFS. Low plasma ferritin level may be a risk factor for the development of SFS. For preventing the FS attacks, treatment of present ID and oral supplementary iron therapy should be initiated for children with SFS who have a low plasma ferritin.
Primary Orbital Histiocytic Sarcoma in a Child Successfully Treated With Multiagent Chemotherapy
Authors: Mittal Nupur , Aakalu Vinay , Mehendele Sangeeta , Setabutr Pete , Michals Edward , Schmidt Mary L.
Published: July 2016

Histiocytic sarcoma (HS), a malignant proliferation of mature tissue histiocytes presenting with single or multifocal extranodal tumors, is rarely seen in children. Primary orbital HS has never been reported in a child. Disseminated disease to the bone marrow typically has an aggressive course and poor prognosis. There is no consensus currently on the optimal therapeutic approach for HS. We present the case of a 2-year-old girl with orbital HS with likely bone marrow involvement treated successfully with multiagent chemotherapy, now in complete remission and disease free 3.5 years from end of therapy.
Hepatoblastoma and Abernethy Malformation Type I: Case Report
Authors: Correa Catalina , Luengas Juan P. , Howard Scott C. , Veintemilla Galo
Published: July 2016

A 2-year-old boy presented with pneumonia and an abdominal mass was noted incidentally. A right lobe hepatic mass classified as PRETEXT III and congenital absence of the portal vein with drainage of the superior mesenteric vein to the inferior vena cava (Abernethy malformation type I) were confirmed by computed tomography and angiography. After a clinical diagnosis of hepatoblastoma had been made, he was treated with 4 cycles of doxorubicin and cisplatin and hepatic arterial chemoembolization with doxorubicin, after which the tumor was classified as POSTEXT III. He underwent a right extended hepatic lobectomy with resection of the caudate lobe but died on postoperative day 4 due to hepatic failure. The Abernethy malformation type I is associated with the development of hepatic tumors, and the abnormal blood flow might predispose to hepatic failure after liver resection. Extensive study of the hepatic vasculature is warranted in patients with suspected malformations. Liver transplant could be considered in patients with congenital portosystemic shunt and malignant liver tumors.
Delayed Measurement of Eosin-5′-Maleimide Binding May Affect the Test Results of Highly Hemolyzed Samples In Vivo and In Vitro—A Case Study
Authors: Ciepiela Olga , Adamowicz-Salach Anna , Zdziechowicz Izabela , Kotuła Iwona
Published: July 2016

Diagnosis of hereditary spherocytosis (HS) is based on clinical evaluation and eosin-5′-maleimide (EMA) test. A decrease in EMA fluorescence compared with healthy individuals is typical for HS and serves as a basis for HS diagnosis. Sensitivity and specificity of the test is high and false-positive results rarely occur. Studies have shown that anticoagulated blood sample when stored at 4°C for 7 days do not affect the test results. This case study is about an autoimmune hemolytic anemia patient who showed a primary positive result for EMA test (decrease in EMA fluorescence—47% compared with 100% for samples of healthy individual), when the test was performed in the sample stored for 48 hours after venipuncture and before staining. An irrelevant decrease (92.5% compared with 100% for samples of healthy individual) was found when freshly collected sample was analyzed. On the basis of the results obtained, it is recommended that EMA staining should be performed on the same day of blood collection for patients with significant hemolysis.
The Gut Microbiome and Its Role in Obesity
Authors: Davis Cindy D.
Published: July 2016

The human body is host to a vast number of microbes, including bacterial, fungal, and protozoal microorganisms, which together constitute our microbiota. Evidence is emerging that the intestinal microbiome is intrinsically linked with overall health, including obesity risk. Obesity and obesity-related metabolic disorders are characterized by specific alterations in the composition and function of the human gut microbiome. Mechanistic studies have indicated that the gastrointestinal microbiota can influence both sides of the energy balance equation, namely, as a factor influencing energy utilization from the diet and as a factor that influences host genes that regulate energy expenditure and storage. Moreover, its composition is not fixed and can be influenced by several dietary components. This fact raises the attractive possibility that manipulating the gut microbiota could facilitate weight loss or prevent obesity in humans. Emerging as possible strategies for obesity prevention and/or treatment are targeting the microbiota to restore or modulate its composition through the consumption of live bacteria (probiotics), nondigestible or limited digestible food constituents such as oligosaccharides (prebiotics), or both (synbiotics) or even fecal transplants.