bluuebunny/crossref_metadata_2025 huggingface dataset:
The R2C2 Model in Residency Education: How Does It Foster Coaching and Promote Feedback Use?
Authors: Sargeant Joan , Lockyer Jocelyn M. , Mann Karen , Armson Heather , Warren Andrew , Zetkulic Marygrace , Soklaridis Sophie , Könings Karen D. , Ross Kathryn , Silver Ivan , Holmboe Eric , Shearer Cindy , Boudreau Michelle
Published: January 2018

Purpose

The authors previously developed and tested a reflective model for facilitating performance feedback for practice improvement, the R2C2 model. It consists of four phases: relationship building, exploring reactions, exploring content, and coaching. This research studied the use and effectiveness of the model across different residency programs and the factors that influenced its effectiveness and use.

Method

From July 2014–October 2016, case study methodology was used to study R2C2 model use and the influence of context on use within and across five cases. Five residency programs (family medicine, psychiatry, internal medicine, surgery, and anesthesia) from three countries (Canada, the United States, and the Netherlands) were recruited. Data collection included audiotaped site assessment interviews, feedback sessions, and debriefing interviews with residents and supervisors, and completed learning change plans (LCPs). Content, thematic, template, and cross-case analysis were conducted.

Results

An average of nine resident–supervisor dyads per site were recruited. The R2C2 feedback model, used with an LCP, was reported to be effective in engaging residents in a reflective, goal-oriented discussion about performance data, supporting coaching, and enabling collaborative development of a change plan. Use varied across cases, influenced by six general factors: supervisor characteristics, resident characteristics, qualities of the resident–supervisor relationship, assessment approaches, program culture and context, and supports provided by the authors.

Conclusions

The R2C2 model was reported to be effective in fostering a productive, reflective feedback conversation focused on resident development and in facilitating collaborative development of a change plan. Factors contributing to successful use were identified.
How Academic Health Systems Can Achieve Population Health in Vulnerable Populations Through Value-Based Care: The Critical Importance of Establishing Trusted Agency
Authors: Wesson Donald E. , Kitzman Heather E.
Published: January 2018

Improving population health may require health systems to proactively engage patient populations as partners in the implementation of healthy behaviors as a shared value using strategies that incentivize healthy outcomes for the population as a whole. The current reactive health care model, which focuses on restoring the health of individuals after it has been lost, will not achieve the goal of improved population health. To achieve this goal, health systems must proactively engage in partnerships with the populations they serve. Health systems will need the help of community entities and individuals who have the trust of the population being served and are willing to act on behalf of the health system if they are to achieve this effective working partnership. The need for these trusted agents is particularly pertinent for vulnerable and historically underserved segments of the population. In this Invited Commentary, the authors discuss ways by which health systems might identify, engage, and leverage trusted agents to improve the health of the population through value-based care.
Utility of a High-Resolution Superficial Diagnostic Ultrasound System for Assessing Skin Thickness: A Cross-Sectional Study
Authors: Iyengar Sanjana , Makin Inder R. , Sadhwani Divya , Moon Esther , Yanes Arianna F. , Geisler Amelia , Silapunt Sirunya , Servaes Sabah , Weil Alexandra , Poon Emily , Alam Murad
Published: January 2018

BACKGROUND

Compared with other imaging modalities, ultrasound is relatively deeply penetrating and can be used to evaluate deep dermal and subcutaneous structures.

OBJECTIVE

Image skin thickness of the face and neck using high-frequency diagnostic ultrasound devices.

MATERIALS AND METHODS

Skin overlying 20 different predesignated face and neck anatomic sites in 32 individuals was imaged using 2 commercially available high-frequency diagnostic ultrasound devices, a dedicated imaging device and a diagnostic device bundled with a therapeutic device. At each site, the subcutaneous and combined epidermal and dermal layer thicknesses were assessed by blinded expert raters.

RESULTS

Similar skin thickness measurements were obtained. Notably, subcutaneous fat depth was measured to be 0.2 cm at the forehead; 0.5 cm at the mental eminence; and 0.6 cm at the submental, supraglenoid, and temporal regions. The combined epidermal and dermal thickness was approximately 0.1 cm at the zygomatic process, suborbital area, inferior malar region, gonion, supraglenoid area, and nasolabial-buccal, and nasolabial fold regions.

CONCLUSION

This is the first study using high-resolution superficial diagnostic ultrasound to map skin thickness of the face and neck at standard anatomic locations. Ultrasound is an inexpensive, noninvasive, and convenient means to monitor dermatologic conditions and guide their treatment.
Treatment of Previously Treated Facial Capillary Malformations: Results of Single-Center Retrospective Objective 3-Dimensional Analysis of the Efficacy of Large Spot 532 nm Lasers
Authors: Kwiek Bartłomiej , Ambroziak Marcin , Osipowicz Katarzyna , Kowalewski Cezary , Rożalski Michał
Published: January 2018

BACKGROUND

Current treatment of facial capillary malformations (CM) has limited efficacy.

OBJECTIVE

To assess the efficacy of large spot 532 nm lasers for the treatment of previously treated facial CM with the use of 3-dimensional (3D) image analysis.

PATIENTS AND METHODS

Forty-three white patients aged 6 to 59 were included in this study. Patients had 3D photography performed before and after treatment with a 532 nm Nd:YAG laser with large spot and contact cooling. Objective analysis of percentage improvement based on 3D digital assessment of combined color and area improvement (global clearance effect [GCE]) were performed.

RESULTS

The median maximal improvement achieved during the treatment (GCEmax) was 59.1%. The mean number of laser procedures required to achieve this improvement was 6.2 (range 1–16). Improvement of minimum 25% (GCE25) was achieved by 88.4% of patients, a minimum of 50% (GCE50) by 61.1%, a minimum of 75% (GCE75) by 25.6%, and a minimum of 90% (GCE90) by 4.6%. Patients previously treated with pulsed dye lasers had a significantly less response than those treated with other modalities (GCEmax 37.3% vs 61.8%, respectively).

CONCLUSION

A large spot 532 nm laser is effective in previously treated patients with facial CM.
Elemental Composition at Silicone Hydrogel Contact Lens Surfaces
Authors: Rex Jessica , Knowles Timothy , Zhao Xueying , Lemp Jessie , Maissa Cecile , Perry Scott S.
Published: January 2018

Objectives:

The outermost surface composition of 11 silicone hydrogel (SiHy) lenses was measured using X-ray photoelectron spectroscopy (XPS) to understand differences in wettability and potential interactions within an ocular environment. The SiHy lenses tested included balafilcon A, lotrafilcon A, lotrafilcon B, senofilcon A, comfilcon A, and somofilcon A reusable 2-week or monthly replacement lenses and delefilcon A, samfilcon A, narafilcon A, stenfilcon A, and somofilcon A daily disposable lenses.

Methods:

All lenses were soaked for 24 hr in phosphate-buffered saline to remove all packaging solution and dried under vacuum overnight before analysis. X-ray photoelectron spectroscopy measurements were performed at 2 take-off angles, 55° and 75°, to evaluate changes in elemental composition as a function of depth from the surface.

Results:

Detailed analysis of the XPS data revealed distinct differences in the chemical makeup of the different lens types. For all lenses, carbon, oxygen, and nitrogen were observed in varying quantities. In addition, fluorine was detected at the outermost surface region of comfilcon A (3.4%) and lotrafilcon A and B (<0.5%). The silicon content of the near-surface region analyzed varied among lens types, ranging from a low of 1.6% (lotrafilcon B) to a high of 16.5% (comfilcon A). In most instances, silicon enrichment at the outermost surface was observed, resulting from differences in lens formulation and design.

Conclusions:

Lenses differed most in their surface silicon concentration, with lotrafilcon B and delefilcon A exhibiting the lowest silicon contents and comfilcon A lens exhibiting the highest. Silicon has hydrophobic properties, which, when found at the surface, may influence the wettability of the contact lenses and their interaction with the tear film and ocular tissues. Higher surface silicon contents have been previously correlated with adverse effects, such as enhanced lipid uptake, thus underscoring the importance of monitoring their presence.
Atopy in Patients With Ocular Cicatricial Pemphigoid
Authors: Ebrahimiadib Nazanin , Hernandez Mikhail , Modjtahedi Bobeck S. , Roohipoor C. Ramak , Foster C. Stephen
Published: January 2018

Purpose:

To evaluate the presence of atopy in patients with ocular cicatricial pemphigoid (OCP).

Method:

Patient encounters between August 2005 and November 2016 at the Massachusetts Eye Research and Surgery Institute (MERSI) were searched to identify those with biopsy-proven OCP who had concurrent evidence of atopy.

Results:

There were 230 patients with biopsy-proven OCP. Thirty-three of them were found to have clinical symptoms of atopy (asthma, hay fever, and eczema) and of these, 23 had evidence of atopy in their conjunctival biopsy specimens. All patients were administered immunomodulatory therapy for treatment of their OCP with 20 patients requiring additional antiallergy treatment to control residual atopic ocular symptoms. Among patients who used antiallergy medications, 80% showed improvement in residual symptoms. Rituximab and/or intravenous immunoglobulin is a preferred OCP medication for patients with OCP with some evidence of atopy.

Conclusions:

Clinicians should consider the coexistence of atopy in patients with OCP, especially in those with persistent symptoms after initiation of immunomodulatory therapy.
Extensive Necrotic Skin Lesions Due to Post-varicella Protein S Deficiency
Authors: De Geyer Aymeric , Robert Guillaume , Marleix Sylvette , Fraisse Bernard , Lucas Grégory , Tattevin Pierre , Violas Philippe
Published: January 2018

Postvaricella protein S deficiency is a rare and severe disease. We report a case of extensive necrotic skin lesions of acute onset 7 days after varicella in a 4-year-old girl. Protein S antigen and activity were <10%, and antiprotein S antibodies were detected. She was treated with anticoagulation, plasmapheresis and fresh frozen plasma. She survived but required leg amputation.
Angiomatosis of the Orbit: Clinical, Imaging, and Histologic Findings
Authors: Vahdani Kaveh , Kim Yoon-Duck , Suh Yeon-Lim , Kim Jeong Hee
Published: January 2018

Angiomatosis is a complex vascular malformation that denotes a clinically extensive hemangioma, which either involves multiple tissue planes or extensively infiltrates 1 type of tissue. It is a rare condition characterized by diffuse proliferation of blood vessels admixed with fat and fibrotic tissue. Typically, this process involves the limbs in multiple tissue planes, including dermis, subcutis, muscle, and bone. In this report, the authors present the first case of angiomatosis infiltrating the orbit, controlled effectively with a combination of systemic steroids, radiation, and beta-blocker therapy. The characteristic imaging and histologic features and management options are discussed.
Association of Involutional Lower Eyelid Entropion with Reduced Upper Eyelid Position Relative to the Corneal Light Reflex: Quantification of Facial Asymmetry
Authors: Phelps Paul O. , Wladis Edward J. , Meyer Dale R.
Published: January 2018

Purpose:

To investigate the association between upper eyelid position relative to the corneal light reflex (MRD1) and to delineate an association between eyelid height and involutional lower eyelid entropion.

Methods:

Retrospective study of patients presenting for entropion repair to an academic ophthalmic plastic surgery service. A total of 111 patients were included in the study; 95 had unilateral involutional lower eyelid entropion, and 16 had bilateral lower eyelid entropion. Patients with a history of previous eyelid surgery, trauma, upper eyelid entropion, or cicatricial changes were excluded from the study.

Results:

Of the 95 patients with unilateral involutional lower eyelid entropion, 45 (47.4%) had a lesser MRD1 on the side ipsilateral to the involutional lower eyelid entropion. In this unilateral group, the mean MRD1 (± standard deviation) on the ipsilateral to the involutional lower eyelid entropion was 2.9 (±1.2) mm, while the mean MRD1 on the contralateral side was 3.3 (±1.0) mm. This difference was 0.4 mm and was statistically significant (p < 0.0001). Most patients with unilateral involutional entropion demonstrated a right-sided involutional lower eyelid entropion (56 of 95; 58.9%), although this finding was not statistically significant (p = 0.083). The frequency of true blepharoptosis (MRD1 ≤ 2.0 mm) was 24 of 95 (25.3%) in the unilateral involutional entropion group and was even higher in the bilateral involutional lower eyelid entropion group, with 7 of 16 (43.8%) patients exhibiting bilateral blepharoptosis.

Conclusions:

Patients presenting with involutional lower eyelid entropion tend to have a relatively reduced MRD1 on the ipsilateral (affected) side. When both lower eyelids are affected by involutional entropion, the reduced MRD1 tends to be more pronounced.
A Clinical Amalgam
Authors: Lacy Mark , Fuller Audra , Radhi Saba , Warraich Irfan
Published: January 2018

Infectious disease specialists are frequently called to investigate fever of unknown origin, the etiology attributed to noninfectious causes more than half the time. This reports a fever of unknown origin case of intravascular large B-cell lymphoma and secondary hemophagocytic lymphohistoiocytosis despite a negative lymph node pathology result and a myriad of investigations.
Foot Osteomyelitis in Patients Without Diabetes
Authors: Mitbander Urvashi , Musher Daniel , Mindru Cezarina , Barshes Neal R.
Published: January 2018

Background

Virtually all studies describing osteomyelitis of the foot have confined themselves to patients with diabetes mellitus. Although much less common, infection of bones in the feet does occur in patients without diabetes. We characterized episodes of foot osteomyelitis occurring in patients without diabetes to help guide clinical management.

Methods

Patients treated for probable or definite osteomyelitis at the Michael E. DeBakey Veterans Affairs Medical Center from January 2011 to March 2015 were included in this study. We reviewed patient and infection characteristics, treatments, and outcomes. Nonparametric analyses were used for comparisons.

Results

A total of 184 episodes of foot osteomyelitis met inclusion criteria: 20 in patients without diabetes and 164 in patients with diabetes. Patients without diabetes were older, thinner, had better renal function, and a stronger history of cigarette smoking (P < 0.05 for all comparisons). There were no significant differences in the proportion of patients presenting with various local or systemic signs of infection. Most episodes were polymicrobial (61% overall) and occurred in the toes (85% overall), and the metatarsals were less commonly affected in patients without diabetes (10% vs 38%, P = 0.01). The proportion of episodes with various isolates identified did not differ significantly. The rate of treatment failure was similar in both groups, but 1-year mortality was greater among nondiabetics (P = 0.002).

Conclusions

Patients without diabetes who develop foot osteomyelitis are older and have a much poorer short-term survival, but the presentation and microbiology of foot osteomyelitis occurring in patients without diabetes are largely similar to that occurring in patients with diabetes.
Incidence, Etiology, and Clinicopathologic Features of Endobronchial Benign Lesions
Authors: Marchioni Alessandro , Casalini Eleonora , Andreani Alessandro , Cappiello Gaia , Castaniere Ivana , Fantini Riccardo , Cecilia Mengoli Maria , Tonelli Roberto , Clini Enrico M. , Rossi Giulio
Published: January 2018

Background:

Airways can be affected by non-neoplastic lesions leading to critical stenosis of the lumen. Incidence, etiology, and clinical significance of endobronchial benign lesions are not systematically characterized.

This study aimed to assess the epidemiology of nonmalignant processes involving the bronchial tree on clinical, pathologic, endoscopic, and radiologic grounds.

Methods:

We retrospectively analyzed bronchoscopy procedures over 10 years at the Bronchoscopy Unit of Modena University Hospital. All the endoscopically growing benign lesions with histologic confirmation were considered. For each lesion, we evaluated demographics, clinical features and outcome, the endoscopic aspect and radiologic characteristics by means of computed tomography as assessed by 2 experienced radiologists blinded with regard to the diagnosis.

Results:

Over the study period, we analyzed 10,431 bronchoscopies and identified 2075 cases of tracheobronchial alterations. Among these, 11.2% had a benign etiology with an average annual incidence of 23 new cases/year and a general incidence of 2.2%. Anthrachosis was the most prevalent bronchial lesion. In total, 22% of benign lesions presented airway stenosis >50% and required bronchoscopic treatment. Bronchial stenosis was most frequently observed in tuberculosis (P=0.031) and aspergillosis (P=0.020) when compared with sarcoidosis. Immunosuppressive status was significantly associated with endobronchial aspergillosis (P=0.0001) and the 1-year survival from diagnosis resulted significantly lower irrespectively to the immune system condition.

Conclusions:

A consistent proportion of endobronchial benign lesions are reported. One fifth of these are associated with critical stenosis of the airway lumen, requiring rigid bronchoscopy. Among these, aspergillosis is characterized by the poorest prognosis, regardless of host immunity status.
Comparison of Diagnostic Potential of Narrow Band Imaging Bronchoscopy Over White Light Bronchoscopy in Lung Cancer
Authors: Advani Manish , Purohit Gopal , Vyas Sunil , Kumari Jyoti
Published: January 2018

Background:

Worldwide, lung cancer is the largest contributor to new cancer diagnoses and to death from cancer. Narrow band imaging (NBI) is a novel bronchoscopic technique which enables detailed examination of submucosal microcapillary grid and showed great potential in early detection of malignant lesions of the bronchial mucosa. The aim of this study was to compare diagnostic potential of NBI bronchoscopy over white light (WL) bronchoscopy in lung cancer.

Methods:

We enrolled 187 patients having clinical and radiologic findings highly suspicious of lung cancer. Patients were further divided into 2 groups: NBI group (n=102), and control WL group (n=85). Bronchoscopy examination was performed with respective visualization modes and all pathologic lesions were biopsied and histologically confirmed.

Results:

On NBI bronchoscopy, malignancy was suspected in 69 patients, of whom 62 had malignancy, and 33 patients were suspected of inflammation, of whom 32 had inflammation and only 1 patient had malignancy. Under WL bronchoscopy, 54 patients were suspected of malignancy, of whom 36 had malignancy, and 31 patients were suspected of inflammation, of whom 23 had inflammatory disease and 8 had malignancy. NBI bronchoscopy had sensitivity 98.1%, specificity 82.05%, positive predictive value 89.86% and negative predictive value 96.97% in comparison to standard WL bronchoscopy which had sensitivity 81.82%, specificity 56.10%, positive predictive value 66.67% and negative predictive value 74.19%.

Conclusion:

NBI bronchoscopy demonstrated better results in comparison to WL bronchoscopy. The presence of pathologic vascularization of the tumor helps to better identify the malignant process. Inflammatory changes in the mucosa can be easily differentiated from malignant changes by the appearance of vessels.
Trends in Intraoperative Testing During Cochlear Implantation
Authors: Page Joshua Cody , Cox Matthew D. , Hollowoa Blake , Bonilla-Velez Juliana , Trinidade Aaron , Dornhoffer John L.
Published: January 2018

Objective:

No consensus guidelines exist regarding intraoperative testing during cochlear implantation and wide variation in practice habits exists. The objective of this observational study was to survey otologists/neurotologists to understand practice habits and overall opinion of usefulness of intraoperative testing.

Study Design:

Cross-sectional survey.

Setting:

A web-based survey was sent to 194 practicing Otologists/Neurotologists.

Main Outcome Measures:

Questions included practice setting and experience, habits with respect to electrodes used, intraoperative testing modalities used, overall opinion of intraoperative testing, and practice habits in various scenarios.

Results:

Thirty-nine of 194 (20%) completed the survey. For routine patients, ECAPs and EIs were most commonly used together (38%) while 33% do not perform testing at all. Eighty-nine percent note that testing “rarely” or “never” changes management. Fifty-one percent marked the most important reason for testing is the reassurance provided to the family and/or the surgeon.

Conclusion:

Intraoperative testing habits and opinions regarding testing during cochlear implantation vary widely among otologic surgeons. The majority of surgeons use testing but many think there is minimal benefit and that surgical decision-making is rarely impacted. The importance of testing may change as electrodes continue to evolve.
Multicenter US Clinical Trial With an Electric-Acoustic Stimulation (EAS) System in Adults: Final Outcomes
Authors: Pillsbury Harold C. , Dillon Margaret T. , Buchman Craig A. , Staecker Hinrich , Prentiss Sandra M. , Ruckenstein Michael J. , Bigelow Douglas C. , Telischi Fred F. , Martinez Diane M. , Runge Christina L. , Friedland David R. , Blevins Nikolas H. , Larky Jannine B. , Alexiades George , Kaylie David M. , Roland Peter S. , Miyamoto Richard T. , Backous Douglas D. , Warren Frank M. , El-Kashlan Hussam K. , Slager Heidi K. , Reyes Carisa , Racey Allison I. , Adunka Oliver F.
Published: January 2018

Objective:

To demonstrate the safety and effectiveness of the MED-EL Electric-Acoustic Stimulation (EAS) System, for adults with residual low-frequency hearing and severe-to-profound hearing loss in the mid to high frequencies.

Study Design:

Prospective, repeated measures.

Setting:

Multicenter, hospital.

Patients:

Seventy-three subjects implanted with PULSAR or SONATA cochlear implants with FLEX24 electrode arrays.

Intervention:

Subjects were fit postoperatively with an audio processor, combining electric stimulation and acoustic amplification.

Main Outcome Measures:

Unaided thresholds were measured preoperatively and at 3, 6, and 12 months postactivation. Speech perception was assessed at these intervals using City University of New York sentences in noise and consonant–nucleus–consonant words in quiet. Subjective benefit was assessed at these intervals via the Abbreviated Profile of Hearing Aid Benefit and Hearing Device Satisfaction Scale questionnaires.

Results:

Sixty-seven of 73 subjects (92%) completed outcome measures for all study intervals. Of those 67 subjects, 79% experienced less than a 30 dB HL low-frequency pure-tone average (250–1000 Hz) shift, and 97% were able to use the acoustic unit at 12 months postactivation. In the EAS condition, 94% of subjects performed similarly to or better than their preoperative performance on City University of New York sentences in noise at 12 months postactivation, with 85% demonstrating improvement. Ninety-seven percent of subjects performed similarly or better on consonant–nucleus–consonant words in quiet, with 84% demonstrating improvement.

Conclusion:

The MED-EL EAS System is a safe and effective treatment option for adults with normal hearing to moderate sensorineural hearing loss in the low frequencies and severe-to-profound sensorineural hearing loss in the high frequencies who do not benefit from traditional amplification.
Benefit of Preoperative Temporal Bone CT for Atraumatic Cochlear Implantation
Authors: Karkas Alexandre , Champfleur Nicolas Menjot de , Uziel Alain , Mondain Michel , Puel Jean-Luc , Venail Frédéric
Published: January 2018

Hypothesis:

Evaluate the benefit of preoperative surgical planning using computed tomography (CT) for atraumatic cochlear implantation.

Background:

The surgical technique has a direct impact on hearing and structure preservation. Much interest has been given to depth of electrode insertion. We focused on electrode diameter depending on exposure of round window membrane (RWM) as calculated on preoperative CT.

Methods:

Measurements were calculated radiologically and anatomically on 10 temporal bones. Results were compared with CT scans of a control population. Thereafter, preoperative CT scan measurements were applied to seven additional temporal bones that underwent cochlear implantation with the insertion of two electrodes of different diameters (14 implantations) to validate radiological analysis.

Results:

RWM size was 1.5 ± 0.2 mm on CT and 1.2 ± 0.2 mm during dissection; posterosuperior bony overhang of round window niche was 1.1 ± 0.1 mm on CT and 1.3 ± 0.2 mm during dissection. There was no statistically significant difference between radiological and anatomical measurements and between radiological measurements of cadaveric temporal bones and control population (p > 0.05 for both). Also, preoperative surgical planning was reliable in the seven temporal bones implanted with two electrode types (accuracy 93%, sensitivity 85.7%, specificity 100%) yielding no damage to intracochlear structures.

Conclusion:

Difficulties to access RWM could be predicted on preoperative CT of temporal bones and control population, which correlated well with anatomical dissections and surgical findings during cochlear implantation. According to CT planning, electrode insertion through RWM was feasible in most patients, with or without drilling posterosuperior bony overhang of round window niche. Promontory cochleostomy could be recommended when electrode apical diameter exceeded maximal RWM exposure. There was no case of intracochlear trauma on microdissections.
Long-term Administration of Salicylate-induced Changes in BDNF Expression and CREB Phosphorylation in the Auditory Cortex of Rats
Authors: Yi Bin , Wu Cong , Shi Runjie , Han Kun , Sheng Haibin , Li Bei , Mei Ling , Wang Xueling , Huang Zhiwu , Wu Hao
Published: January 2018

Hypothesis:

We investigated whether salicylate induces tinnitus through alteration of the expression levels of brain-derived neurotrophic factor (BDNF), proBDNF, tyrosine kinase receptor B (TrkB), cAMP-responsive element-binding protein (CREB), and phosphorylated CREB (p-CREB) in the auditory cortex (AC).

Background:

Salicylate medication is frequently used for long-term treatment in clinical settings, but it may cause reversible tinnitus. Salicylate-induced tinnitus is associated with changes related to central auditory neuroplasticity. Our previous studies revealed enhanced neural activity and ultrastructural synaptic changes in the central auditory system after long-term salicylate administration. However, the underlying mechanisms remained unclear.

Methods:

Salicylate-induced tinnitus-like behavior in rats was confirmed using gap prepulse inhibition of acoustic startle and prepulse inhibition testing, followed by comparison of the expression levels of BDNF, proBDNF, TrkB, CREB, and p-CREB. Synaptic ultrastructure was observed under a transmission electron microscope.

Results:

BDNF and p-CREB were upregulated along with ultrastructural changes at the synapses in the AC of rats treated chronically with salicylate (p < 0.05, compared with control group). These changes returned to normal after 14 days of recovery (p > 0.05).

Conclusion:

Long-term administration of salicylate increased BDNF expression and CREB activation, upregulated synaptic efficacy, and changed synaptic ultrastructure in the AC. There may be a relationship between these factors and the mechanism of tinnitus.
Near-infrared spectroscopy to predict organ failure and outcome in sepsis: the Assessing Risk in Sepsis using a Tissue Oxygen Saturation (ARISTOS) study
Authors: Macdonald Stephen P.J. , Kinnear Frances B. , Arendts Glenn , Ho Kwok M. , Fatovich Daniel M.
Published: January 2018

Objectives

Sepsis is acute organ dysfunction in the setting of infection. An accurate diagnosis is important to guide treatment and disposition. Tissue oxygen saturation (StO2) can be estimated noninvasively by near-infrared spectroscopy (NIRS), and may be an indicator of microcirculatory dysfunction in early sepsis. We aimed to determine the utility of StO2 for sepsis recognition and outcome prediction among patients presenting to the emergency department (ED) with infection.

Patients and methods

A multicentre, prospective, observational cohort study recruited patients who were being admitted to hospital with infection. StO2 was measured in the ED using a handheld NIRS device, Inspectra 300. Outcomes were sepsis, defined as an increase in sequential organ failure assessment score of at least 2 points within 72 h, and composite in-hospital mortality/ICU admission at least 3 days.

Results

A cohort of 323 participants, median age 64 (interquartile range: 47–77) years, was recruited at three Australian hospitals. 143 (44%) fulfilled the criteria for sepsis and 22 (7%) died within 30 days. The mean ± SD StO2 was 74 ± 8% in sepsis and 78 ± 7% in nonsepsis (P < 0.0001). StO2 correlated with the peak sequential organ failure assessment score (Spearman’s ρ −0.27, P  <  0.0001). Area under the receiver operating characteristic curve was 0.66 (95% confidence interval: 0.60–0.72) for sepsis and 0.66 (0.58–0.75) for the composite outcome. StO2 less than 75% had an odds ratio of 2.67 (1.45–4.94; P = 0.002), for the composite outcome compared with StO2 at least 75%.

Conclusion

NIRS-derived StO2 correlates with organ failure and is associated with outcome in sepsis. However, its ability to differentiate sepsis among ED patients with infection is limited. NIRS cannot be recommended for this purpose.
Obesity and chronic kidney disease
Authors: Nehus Edward
Published: January 2018

Purpose of review

To review recent advances in the epidemiology, pathophysiology, clinical features, and treatment of obesity-related kidney disease.

Recent findings

Studies have confirmed that obesity is associated with increased risk of developing chronic kidney disease (CKD). This risk extends to those who are metabolically healthy, indicating that obesity per se contributes to CKD independent of the metabolic syndrome. Recent developments in the pathophysiology of obesity-related kidney disease indicate that chronic inflammation and abnormal lipid metabolism contribute to kidney cell injury. Children with severe obesity have increased prevalence of early kidney abnormalities, including albuminuria, decreased kidney function, and elevated biomarkers of early kidney injury. For these patients, bariatric surgery has emerged as a treatment option to consider. Longitudinal studies in children and adults have demonstrated that in patients with obesity-related kidney disease, kidney function and albuminuria improve following bariatric surgery.

The injurious renal effects of obesity are present in childhood, although the natural history and clinical spectrum of obesity-related kidney disease in children are not known. In obese children with early kidney disease, identification of kidney injury, implementation of preventive strategies, and prompt treatment are essential to improving clinical outcomes.
Neonatal abstinence syndrome: an update
Authors: Sanlorenzo Lauren A. , Stark Ann R. , Patrick Stephen W.
Published: January 2018

Purpose of review

The current review provides an update focused on the evolving epidemiology of neonatal abstinence syndrome (NAS), factors influencing disease expression, advances in clinical assessment of withdrawal, novel approaches to NAS treatment, and the emerging role of quality improvement in assessment and management of NAS.

Recent findings

The rise in the incidence of NAS disproportionately occurred in rural and suburban areas. Polysubstance exposure and genetic polymorphisms have been shown to modify NAS expression and severity. New bedside assessments using a limited number of factors to identify infants with NAS result in fewer infants receiving pharmacotherapy. In addition, buprenorphine may be a promising therapeutic alternative to morphine to treat NAS. Lastly, local, state, and national quality improvement initiatives have emerged as an effective mechanism to advance the care of infants with NAS.

NAS remains a critical public health issue associated with significant medical, economic, and personal burdens. Emerging data on associated risk factors, assessment of and treatment for NAS provide clinicians and hospitals with new knowledge and an urgency to promote standardization of care for infants with NAS.
Why Don't Hospitals Prioritize Substance Abuse in Their Community Benefit Programming?
Authors: Franz Berkeley , Skinner Daniel , Kelleher Kelly
Published: January 2018

The goal of this study was to understand whether Appalachian Ohio hospitals prioritized substance abuse in their IRS-mandated community health needs assessments (CHNAs) and if not, what factors were important in this decision. Analysis of CHNA reports from all 28 hospitals in the region supplemented interview data from in-depth phone interviews, with 17 participants tasked with overseeing CHNAs at 21 hospitals. The CHNA reports show that hospitals in this region prioritize substance abuse and mental health less often than access to care and obesity. Interviews suggest 4 reasons: lack of resources, risk aversion, concern about hospital expertise, and stigma related to substance abuse. Hospitals are playing a larger role in public health as a result of CHNA requirements but resist taking on challenging problems such as substance abuse. The report concludes by summarizing concrete steps to ensure that community benefit efforts address pressing health problems. The implications of this study are manifest in concrete recommendations for encouraging hospitals to address pressing health problems in their community benefit efforts.
Editorial (Spring) Board? Gender Composition in High-impact General Surgery Journals Over 20 Years
Authors: Harris Chelsea A. , Banerjee Tanima , Cramer Monica , Manz Shannon , Ward Sarah T. , Dimick Justin , Telem Dana A.
Published: January 2018

Objective:

To quantify gender composition of 10 high-impact general surgery journals, delineate how board composition has changed over time, and evaluate qualification metrics by gender.

Background:

Underrepresentation of women on editorial boards may contribute to the gender-based achievement gap in surgery.

Methods:

We performed a cross-sectional analysis of the editorial board gender composition among 10 high-impact general surgery journals in 1997, 2007, and 2017. Univariate and multivariate regression analyses were used to assess differences in editors’ H-indices, academic rank, and number of advanced degrees. Differences in editor turnover and multiple board positions were evaluated for each time interval.

Results:

Over 20 years, the proportion of women on editorial boards increased from 5% to 19%. After controlling for time since board certification, no differences between men and women's number of advanced degrees, H-indices, or academic rank remained significant. Women and men were equally likely to hold multiple board positions (1997 P = 0.74; 2007 P = 0.42; 2017 P = 0.69), but men's editorial board tenure was longer across each time interval (1997–2007 P = 0.003; 2007–2017 P < 0.001; 1997–2017 P = 0.01).

Conclusions:

Women surgeons have a small but growing presence on surgical editorial boards, and gender-based qualification differences are likely attributable to practice length. Men's longer tenure on editorial boards may drive some of the observed disparity by limiting new appointment opportunities. Strategies such as imposing term limits or instituting merit-based performance reviews may help editorial boards capture the field's changing demographics.
Adipocytokines in Steatotic Liver Surgery/Transplantation
Authors: Jiménez-Castro Mónica B. , Casillas-Ramírez Araní , Negrete-Sánchez Elsa , Avalos-de León Cindy G. , Gracia-Sancho Jordi , Peralta Carmen
Published: January 2018

Because of the shortage of liver grafts available for transplantation, the restrictions on graft quality have been relaxed, and marginal grafts, such as steatotic livers, are now accepted. However, this policy change has not solved the problem, because steatotic liver grafts tolerate ischemia-reperfusion (I/R) injury poorly. Adipocytokines differentially modulate steatosis, inflammation, and fibrosis and are broadly present in hepatic resections and transplants. The potential use of adipocytokines as biomarkers of the severity of steatosis and liver damage to aid the identification of high-risk steatotic liver donors and to evaluate hepatic injury in the postoperative period are discussed. The hope of finding new therapeutic strategies aimed specifically at protecting steatotic livers undergoing surgery is a strong impetus for identifying the mechanisms responsible for hepatic failure after major surgical intervention. Hence, the most recently described roles of adipocytokines in steatotic livers subject to I/R injury are discussed, the conflicting results in the literature are summarized, and reasons are offered as to why strategic pharmacologic control of adipocytokines has yet to yield clinical benefits. After this, the next steps needed to transfer basic knowledge about adipocytokines into clinical practice to protect marginal livers subject to I/R injury are presented. Recent strategies based on adipocytokine regulation, which have shown efficacy in various pathologies, and hold promise for hepatic resection and transplantation are also outlined.
Non-destructive geographical traceability of sea cucumber (
Apostichopus japonicus
) using near infrared spectroscopy combined with chemometric methods
Authors: Guo Xiuhan , Cai Rui , Wang Shisheng , Tang Bo , Li Yueqing , Zhao Weijie
Published: January 2018

Sea cucumber is the major tonic seafood worldwide, and geographical origin traceability is an important part of its quality and safety control. In this work, a non-destructive method for origin traceability of sea cucumber (
Apostichopus japonicus
) from northern China Sea and East China Sea using near infrared spectroscopy (NIRS) and multivariate analysis methods was proposed. Total fat contents of 189 fresh sea cucumber samples were determined and partial least-squares (PLS) regression was used to establish the quantitative NIRS model. The ordered predictor selection algorithm was performed to select feasible wavelength regions for the construction of PLS and identification models. The identification model was developed by principal component analysis combined with Mahalanobis distance and scaling to the first range algorithms. In the test set of the optimum PLS models, the root mean square error of prediction was 0.45, and correlation coefficient was 0.90. The correct classification rates of 100% were obtained in both identification calibration model and test model. The overall results indicated that NIRS method combined with chemometric analysis was a suitable tool for origin traceability and identification of fresh sea cucumber samples from nine origins in China.
Development of bioabsorbable polylactide membrane with controllable hydrophilicity for adjustment of cell behaviours
Authors: Yang Yang , Qiu Xiaofeng , Sun Yi , Wang Yifeng , Wang Jine , Li Yulin , Liu Changsheng
Published: January 2018

Cell functions can be mediated through their interactions with the microenvironments, which highly depend on the surface state of the substrate. However, how to finely adjust the surface of biomaterials is still very challenging. In this study, poly(
d,l
-lactide) (PDLLA) with high molecular weight was synthesized via ring opening polymerization, which was hot-pressed into PDLLA membrane. In order to modify the hydrophobicity of the membrane (a limiting factor for its biomedical application), an amphiphilic monomethoxyl poly(ethylene glycol)-b-poly(
d,l
-lactide) (PEG-PDLLA) was selected to improve its surface hydrophilicity through a simple self-assembly approach. It was found that the contact angles of the modified membrane can be well controlled by variation of PEG-PDLLA concentrations.
In vitro
cell biological study indicates that optimized cell adhesion can be achieved on the modified membrane with a contact angle of around 50° via its self-assembly with an ethanol/water solution of PEG-PDLA (35 mg ml
−1
). The surface modification of the membrane also changed its biodegradation property in the process of its incubation period up to 240 days. The surface modification method may afford an effective way for adjustment of the surface (interface) of membrane (scaffolds) of different biomaterials, beyond polylactide.
Prediction of cholesterol ratios within a Korean population
Authors: Lee Jin Sol , Cheong Hyun Sub , Shin Hyoung Doo
Published: January 2018

Cholesterol ratios (total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-c) and triglyceride (TG)/HDL-c) have been suggested as better indicators to predict various clinical features such as insulin resistance and heart disease. Therefore, we aimed to build a single nucleotide polymorphism (SNP) set to predict constitutional lipid metabolism. The genotype data of 7795 samples were obtained from the Korea Association Resource. Among the total of 7795 samples, 7016 subjects were used to perform 10-fold cross-validation. We selected the SNPs that showed significance constantly throughout all 10 cross-validation sets; another 779 samples were used as the final validation set. After performing the 10-fold cross-validation, the six SNPs (
rs4420638
(
APOC1
),
rs12421652
(
BUD13
)
, rs17411126
(
LPL
)
, rs6589566
(
ZPR1
)
, rs16940212
(
LOC101928635
) and
rs10852765
(
ABCA8
)) were finally selected for predicting cholesterol ratios. The weighted genetic risk scores (wGRS) were calculated based on the regression slopes of the six selected SNPs. Our results showed upward trends of wGRS for both the TC/HDL-c and TG/HDL-c ratios within the 10-fold cross-validation. Similarly, the wGRS of the six SNPs also showed upward trends in analyses using the SNP selection set and final validation set. The selected six SNPs can be used to explain both the TC/HDL-c and TG/HDL-c ratios. Our results may be useful for the prospective predictions of cholesterol-related diseases.
Diversity of management strategies in Mesoamerican turkeys: archaeological, isotopic and genetic evidence
Authors: Manin Aurelie , Corona-M Eduardo , Alexander Michelle , Craig Abigail , Thornton Erin Kennedy , Yang Dongya Y. , Richards Michael , Speller Camilla F.
Published: January 2018

The turkey (Meleagris gallopavo) represents one of the few domestic animals of the New World. While current research points to distinct domestication centres in the Southwest USA and Mesoamerica, several questions regarding the number of progenitor populations, and the timing and intensity of turkey husbandry remain unanswered. This study applied ancient mitochondrial DNA and stable isotope (δ13C,δ15N) analysis to 55 archaeological turkey remains from Mexico to investigate pre-contact turkey exploitation in Mesoamerica. Three different (sub)species of turkeys were identified in the archaeological record (M. g. mexicana,M. g. gallopavoandM. ocellata), indicating the exploitation of diverse local populations, as well as the trade of captively reared birds into the Maya area. No evidence of shared maternal haplotypes was observed between Mesoamerica and the Southwest USA, in contrast with archaeological evidence for trade of other domestic products. Isotopic analysis indicates a range of feeding behaviours in ancient Mesoamerican turkeys, including wild foraging, human provisioning and mixed feeding ecologies. This variability in turkey diet decreases through time, with archaeological, genetic and isotopic evidence all pointing to the intensification of domestic turkey management and husbandry, culminating in the Postclassic period.
Energyscapes and prey fields shape a North Atlantic seabird wintering hotspot under climate change
Authors: Amélineau F. , Fort J. , Mathewson P. D. , Speirs D. C. , Courbin N. , Perret S. , Porter W. P. , Wilson R. J. , Grémillet D.
Published: January 2018

There is an urgent need for a better understanding of animal migratory ecology under the influence of climate change. Most current analyses require long-term monitoring of populations on the move, and shorter-term approaches are needed. Here, we analysed the ecological drivers of seabird migration within the framework of the energyscape concept, which we defined as the variations in the energy requirements of an organism across geographical space as a function of environmental conditions. We compared the winter location of seabirds with their modelled energy requirements and prey fields throughout the North Atlantic. Across six winters, we tracked the migration of 94 little auks (Alle alle), a key sentinel Arctic species, between their East Greenland breeding site and wintering areas off Newfoundland. Winter energyscapes were modelled with Niche Mapper™, a mechanistic tool which takes into account local climate and bird ecophysiology. Subsequently, we used a resource selection function to explain seabird distributions through modelled energyscapes and winter surface distribution of one of their main prey,Calanus finmarchicus. Finally, future energyscapes were calculated according to IPCC climate change scenarios. We found that little auks targeted areas with high prey densities and moderately elevated energyscapes. Predicted energyscapes for 2050 and 2095 showed a decrease in winter energy requirements under the high emission scenario, which may be beneficial if prey availability is maintained. Overall, our study demonstrates the great potential of the energyscape concept for the study of animal spatial ecology, in particular in the context of global change.
On the approximate solutions of fragmentation equations
Authors: Saha Jitraj , Kumar Jitendra , Heinrich Stefan
Published: January 2018

A numerical model based on the finite volume scheme is proposed to approximate the binary breakage problems. Initially, it is considered that the particle fragments are characterized by a single property, i.e. particle’s volume. We then investigate the extension of the proposed model for solving breakage problems considering two properties of particles. The efficiency to estimate the different moments with good accuracy and simple extension for multi-variable problems are the key features of the proposed method. Moreover, the mathematical convergence analysis is performed for one-dimensional problems. All mathematical findings and numerical results are validated over several test problems. For numerical validation, we propose the extension of Bourgade & Filbet (2008
Math. Comput.
77
, 851–882. (
doi:10.1090/S0025-5718-07-02054-6
)) model for solving two-dimensional pure breakage problems. In this aspect, numerical treatment of the two-dimensional binary breakage models using finite volume methods can be treated to be the first instance in the literature.