bluuebunny/crossref_metadata_2025 huggingface dataset:
Towards Emotion Classification Using Appraisal Modeling
Authors: de Vries Gert-Jan , Lemmens Paul , Brokken Dirk , Pauws Steffen , Biehl Michael
Published: September 2015

The authors studied whether a two-step approach based on appraisal modeling could help in improving performance of emotion classification from sensor data that is typically executed in a one-stage approach in which sensor data is directly classified into a (discrete) emotion label. The proposed intermediate step is inspired by appraisal models in which emotions are characterized using appraisal dimensions, and subdivides the task in a person-dependent and person-independent stage. In this paper, the authors assessed feasibility of this second stage: the classification of emotion from appraisal data. They applied a variety of machine learning techniques and used visualization techniques to gain further insight into the classification task. Appraisal theory assumes the second step to be independent of the individual. Results obtained are promising, but do indicate that not all emotions can be equally well classified, perhaps indicating that the second stage is not as person-independent as proposed in the literature.
Data Modeling
Authors: Chan Hock Chuan , Tan Chuan-Hoo , Teo Hock-Hai
Published: September 2015

Research on ontology and conceptual data modeling builds on the premise that the world could be represented in terms of concepts (also known as “things”), their properties and their (things') relationships. A persistent effort in the representation is how to distinguish things from their properties, as well as how to denote relationships that relate two things together. Following the tradition of deriving guidelines from ontology studies, this paper proposes a need to make a clear distinction between relationships among things and relationships among things' properties. The central thrust of this paper is in proposing an ontologically guided principle: For the same relationship, working with the relationship among things will lead to better user performance than working with the relationship among things' properties. This principle, called Relationship without Pointers principle, is robustly validated by re-analyzing a set of experiment data on user data modeling performance with three database models. This principle may be applicable to other contexts that study relationships.
SEDRIS Transmittal Storing and Retrieval System using Relational Databases
Authors: Kim Yongkwon , Yang Heejung , Chung Chin-Wan
Published: September 2015

Modeling and simulation (M&S) are widely used for design, analysis, and optimization of complex systems and natural phenomena in various areas such as the defense industry and the weather system. In many cases, the environment is a key part of complex systems and natural phenomena. It includes physical aspects of the real world which provide the context for a specific simulation. Recently, several simulation systems are integrated to work together when they have needs for exchanging information. Interoperability of heterogeneous simulations depends heavily on sharing complex environmental data in a consistent and complete manner. SEDRIS (Synthetic Environmental Data Representation and Interchange Specification) is an ISO standard for representation and interchange of environmental data and widely adopted in M&S area. As the size of the simulation increases, the size of the environmental data which should be exchanged between simulations increases. Therefore, an efficient management of the environmental data is very important. In this paper, the authors propose storing and retrieval methods of SEDRIS transmittals using a relational database system in order to be able to retrieve data efficiently in the environmental data server cooperating with many heterogeneous distributed simulations. By analyzing the structure and the content of SEDRIS transmittals, relational database schemas are designed. To reduce query processing time of SEDRIS transmittals, direct storing and retrieval methods which do not require the type conversion of SEDRIS transmittals are proposed. Experimental analyses are conducted to show the efficiency of the proposed approach. The results confirm that the proposed approach greatly reduces the storing time and retrieval time compared to comparison approaches.
Acute Viral Respiratory Infection Rapidly Induces a CD8+ T Cell Exhaustion–like Phenotype
Authors: Erickson John J. , Lu Pengcheng , Wen Sherry , Hastings Andrew K. , Gilchuk Pavlo , Joyce Sebastian , Shyr Yu , Williams John V.
Published: September 2015

Acute viral infections typically generate functional effector CD8+ T cells (TCD8) that aid in pathogen clearance. However, during acute viral lower respiratory infection, lung TCD8 are functionally impaired and do not optimally control viral replication. T cells also become unresponsive to Ag during chronic infections and cancer via signaling by inhibitory receptors such as programmed cell death-1 (PD-1). PD-1 also contributes to TCD8 impairment during viral lower respiratory infection, but how it regulates TCD8 impairment and the connection between this state and T cell exhaustion during chronic infections are unknown. In this study, we show that PD-1 operates in a cell-intrinsic manner to impair lung TCD8. In light of this, we compared global gene expression profiles of impaired epitope-specific lung TCD8 to functional spleen TCD8 in the same human metapneumovirus–infected mice. These two populations differentially regulate hundreds of genes, including the upregulation of numerous inhibitory receptors by lung TCD8. We then compared the gene expression of TCD8 during human metapneumovirus infection to those in acute or chronic lymphocytic choriomeningitis virus infection. We find that the immunophenotype of lung TCD8 more closely resembles T cell exhaustion late into chronic infection than do functional effector T cells arising early in acute infection. Finally, we demonstrate that trafficking to the infected lung alone is insufficient for TCD8 impairment or inhibitory receptor upregulation, but that viral Ag–induced TCR signaling is also required. Our results indicate that viral Ag in infected lungs rapidly induces an exhaustion-like state in lung TCD8 characterized by progressive functional impairment and upregulation of numerous inhibitory receptors.
The Ubiquitin-like Modifier FAT10 Is Selectively Expressed in Medullary Thymic Epithelial Cells and Modifies T Cell Selection
Authors: Buerger Stefanie , Herrmann Valerie L. , Mundt Sarah , Trautwein Nico , Groettrup Marcus , Basler Michael
Published: September 2015

HLA-F adjacent transcript 10 (FAT10) is a cytokine-inducible ubiquitin-like modifier that is highly expressed in the thymus and directly targets FAT10-conjugated proteins for degradation by the proteasome. High expression of FAT10 in the mouse thymus could be assigned to strongly autoimmune regulator–expressing, mature medullary thymic epithelial cells, which play a pivotal role in negative selection of T cells. Also in the human thymus, FAT10 is localized in the medulla but not the cortex. TCR Vβ-segment screening revealed a changed T cell repertoire in FAT10-deficient mice. Analysis of five MHC class I– and II–restricted TCR-transgenic mice demonstrated an altered thymic negative selection in FAT10-deficient mice. Furthermore, the repertoire of peptides eluted from MHC class I molecules was influenced by FAT10 expression. Hence, we identified FAT10 as a novel modifier of thymic Ag presentation and epitope-dependent elimination of self-reactive T cells, which may explain why the fat10 gene could recently be linked to enhanced susceptibility to virus-triggered autoimmune diabetes.
Yet another atypical presentation of anti-GQ1b antibody syndrome
Authors: Alroughani Raed , Thussu Anil , Guindi Raouf T.
Published: September 2015

Variants of Guillain-Barre syndrome such as Bickerstaff encephalitis and Miller-Fisher syndrome have been reported. We report a 15-year-old boy who presented, after a prodromal illness, with 3-day progressive limb weakness, diplopia, and acute urinary retention. Clinically, he had horizontal gaze-evoked and upbeat nystagmus, bilateral extensor plantars in addition to quadriparesis and areflexia. Magnetic resonance imaging of the brain and spine was unremarkable and cerebral spinal fluid analysis showed lymphocytic pleocytosis. Nerve conduction study revealed symmetrical axonal neuropathy. Anti-GQ1b antibody was positive. A combination of IV methylprednisone followed by IVIg was instituted which led to remarkable clinical recovery. This case underpins the importance of recognizing atypical presentations of acute autonomic dysfunction and central nervous system features such as nystagmus, which may be associated with anti-GQ1b antibody syndrome. Features mimicking myelitis and brainstem encephalitis may pose diagnostic and therapeutic dilemma among the treating physicians.
Relapsing remitting multiple sclerosis in an Iranian patient with neurofibromatosis type I
Authors: Mohebi Nafiseh , Moghaddasi Mehdi , Zaribafian Maryam
Published: September 2015

Neurofibromatosis type 1 (NF-1) is a common hereditary neuro-cutaneous disease, with known gene mutations, that mainly involves the skin and nervous system. Multiple sclerosis (MS) is an acquired inflammatory disease in which the myelin of nerve cells in the brain and spinal cord is damaged. These two disease do not share any apparent pathological similarities. We herein present a 32-year-old woman with definite NF-1, who has recently been diagnosed with MS, which to the best of our knowledge is a rare co-occurrence. Though there are often neurologic sign and symptoms in patients with NF-1, they should not always be considered as the natural history of the disease, and other overlapped pathologies should be kept in mind, in order to not miss or postpone the efficient treatment.
Integrated statistical modelling of spatial landslide probability
Authors: Mergili M. , Chu H.-J.
Published: September 2015

Abstract. Statistical methods are commonly employed to estimate spatial probabilities of landslide release at the catchment or regional scale. Travel distances and impact areas are often computed by means of conceptual mass point models. The present work introduces a fully automated procedure extending and combining both concepts to compute an integrated spatial landslide probability: (i) the landslide inventory is subset into release and deposition zones. (ii) We employ a simple statistical approach to estimate the pixel-based landslide release probability. (iii) We use the cumulative probability density function of the angle of reach of the observed landslide pixels to assign an impact probability to each pixel. (iv) We introduce the zonal probability i.e. the spatial probability that at least one landslide pixel occurs within a zone of defined size. We quantify this relationship by a set of empirical curves. (v) The integrated spatial landslide probability is defined as the maximum of the release probability and the product of the impact probability and the zonal release probability relevant for each pixel. We demonstrate the approach with a 637 km2 study area in southern Taiwan, using an inventory of 1399 landslides triggered by the typhoon Morakot in 2009. We observe that (i) the average integrated spatial landslide probability over the entire study area corresponds reasonably well to the fraction of the observed landside area; (ii) the model performs moderately well in predicting the observed spatial landslide distribution; (iii) the size of the release zone (or any other zone of spatial aggregation) influences the integrated spatial landslide probability to a much higher degree than the pixel-based release probability; (iv) removing the largest landslides from the analysis leads to an enhanced model performance.
An Analysis of Iranian Electronic Cities Case Study: Uremia City (Challenges and Opportunities)
Authors: Alizadeh Asl Jabbar , Zarrabi Asghar , Taghvaei Masoud , Mohamadi Jamal
Published: September 2015

Electronic cities result from the implication of information and communication technology (ICT) in the contemporary era. Significant ICT development and internet network expansion as well as the need of urban management to new ideas in managing cities lead us toward a new strategy called "electronic cities". The current study aims at investigating the strategic planning of Iranian electronic cities, case study of the metropolitan uremia, Iran. Research method is documentary and survey. Research Statistical population consists of all experts located in Uremia, selected through Morgan Table. To collect data, Likert spectrum is employed. Findings indicate that the most important challenges in the way of establishing an electronic city include the lack of strategic document for urban development, high number of decision-making centers and administrative extra parallel works among them, the inclination of the urban managers toward traditional methods, low-speed, high-cost internet connection, the lack of infrastructures for ICT, the lack of digital literacy among citizens and so on. According to the findings, some strategies have been recommended, which they need the serious care of urban managers and planners in the metropolitan Uremia. 
Hybrid Lumbar Fusion: A clinical and radiological review at 2 years
Authors: Dyson P. , Abuhadra K. , Warren M.
Published: September 2015

We report on our first 20 patients treated with hybrid lower lumbar stabilization, in which one or more segments were treated with caged interbody fusion by PLIF technique and one or more adjacent segments were stabilized using GRAF instrumentation.

The indications for interbody fusion included spondylolysis; previous failed disc surgery, and primary discopathy with positive discography and/or active modic signal on MRI.

The indication for flexible stabilization of adjacent segments was for disc degeneration on MRI scanning with or without evidence of posterior annular tear.

This was a prospective study with clinical evaluation using VAS pain scales and Oswestry disability score. All patients were reviewed by an independent consultant radiologist to assess integrity of the implant after two years and underwent CT scanning to assess progression of the caged fusion. There were no instances of failed fusion in this group and no cases of implant failure.
Epidemiology of Breast Cancer in Qatar 1999-2000
Authors: Bujassoum S. M.
Published: September 2015

This is retrospective study of breast cancer in Qatar during period 1999-2002, using cancer registry data. A total 214patients were diagnosed with breast cancer; with incidence of5/10,000 ofpopulation per year; accounting for l3.3%of new cancer cases and 29.9%of all female cancer. Male breast cancer is rare accounting for 3.2% of total number. Qatari patients were 23%and non-Qatari patients were 36.2%. The disease more common in ages between 46-55years old accounting for 64%of total breast cancer; patients usually presented beyond or equal to stage II and with distant metastasis in 7% of cases, patients commonly present with invasive ductal carcinoma and histological grade 2and 3, it has been noticed that were decrease in incidence of stage III and IV and increase in stage I and II which reflect improvement in patient awareness of this problem.
Hypothermia in Infants: The Important Factors
Authors: Al Hammadi T. , Sinha T. , Ahmed O. K. , Hamouda S. B.
Published: September 2015

A prospective consecutive observational study over a period of six months was conducted in the pediatric surgical theatre of Hamad General Hospital, Qatar; on infants aged one day to one year who required general anesthesia with or without regional anesthesia. It was found that neonates (aged 1-29 days) had difficulty in maintaining a stable body temperature despite various methods of promoting warmth. Infants (aged 1-12 months) undergoing major surgery were more exposed to hypothermia than those in minor surgery. Causes of hypothermia were multifactorial
Study of Patients with Heat Stroke Admitted to the Intensive Care Unit of Hamad General Hospital, Doha, Qatar During Summer 2004
Authors: Khan F. Y. , Kamha A. , El Hiday A.
Published: September 2015

Summer shade temperatures in the State of Qatar are commonly above 40 °C making heat stroke a big problem in unacclimatized outside immigrant workers. Seven males were admitted with heatstroke to the ICU, Hamad General Hospital between 4th July and 24th August 2004. Presenting signs varied but included coma, abnormal behavior; aggression, mental confusion, fits, hypovolemic shock and respiratory failure, metabolic acidosis, hypokalemia, hyponatremia, elevated serum enzymes and sinus tachycardia. All developed renal insufficiency but none died and there appeared to be no residual brain or organ damage. This has been taken as a measure of the effectiveness of the treatment and management in the ICU. It is emphasized that heat stroke is a medical emergency that can result in major organ failure and death and that early recognition and correct treatment are crucial
Tension Free Vaginal Tape (TVT) Procedure for Female Stress Incontinence: Qatar Experience
Authors: Farid I. , Aboud I. , Al Blushi M. A. , Al Mansoori Z. S.
Published: September 2015

A retrospective study was conducted on the records of 44 women who had received tension-free vaginal tape as a primary or secondary procedure for the treatment of stress urinary incontinence. Intra-operative complications were uncommon, operative time and hospital stays were short and late postoperative complications were few. 36(81.8%) women became dry, six cases (13.6%) are satisfied and two patients (4.5%) are still complaining of stress incontinence. The tension free vaginal tape procedure appeared to be an effective, minimally invasive method for treating female stress urinary incontinence
An Unusual Common Bile Duct Foreign Body
Authors: Khairat M. , Allam H. I. , Sholiek N. , Kassem H.
Published: September 2015

A 35-year-old man developed obstructive jaundice ten months after laparoscopic cholecystectomy. Endoscopic retrograde cholangiography extracted a foreign body from the common bile duct. Histopathological examination revealed that the extracted foreign body was the remnant of vicryl endoloop with calcification around. Since laparoscopic surgery has become a very common procedure, endoclips and endoloops are used more frequently. It is emphasized that careful surveillance and strict follow-up are necessary to avoid similar complications.
Hemolytic Uraemic Syndrome Associated with Pregnancy
Authors: Sheikh N. M. , Kettern M. A. , Ahmed A. H. A.
Published: September 2015

Hemolytic uraemic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) are described as acute syndromes with multisystem abnormalities and pentad of thrombocytopenia, microangiopathic hemolysis, neurological symptoms, renal impairment and fever. Both diseases were believed to form a continuum of the same disease, but recently it was found, that they were having a different pathophysiology, as TTP patients have a deficiency in von wilbrand factor (vWF) cleavage protease. When renal involvement is severe with little or no neurological manifestation, this microangiopathy is termed as haemolytic-uraemic syndrome. If the hemolytic uraemic syndrome is not associated with diarrhoea, it is called Dnegative or atypical HUS. This subdivision is of etiological and prognostic importance. TTP-HUS is associated with high maternal and fetal morbidity and mortality. Treatment of these syndromes differs from syndrome of hemolysis with elevated liver enzymes (HE LLP syndrome) and acute fatty liver of pregnancy hence accurate diagnosis is important for optimal therapy. Plasma transfusion and plasmapheresis have revolutionized management of TTP and HUS by increasing survival 80% to 90%. Here we are reporting a case of D-negative hemolytic uraemic syndrome associated with pregnancy causing intrauterine fetal death. Diagnosis made on clinical and hematological findings, successfully treated by plasmapheresis with residual maternal renal impairment. We are presenting this case, as it is rare disorder associated with high mortality and morbidity, to increase awareness about disease, its diagnosis and management.
“From Qatar to the World” Abstracts Presented at International Conferences /or Published in Medical Journals
Authors: Gehani A. A. , Hammoudeh Mohammed
Published: September 2015

Objective: The management of antenatally diagnosed ureteropelvic junction obstruction (PUJO) is controversial. Here, we present our experience over a period of 13 years and discuss our management protocol.

Materials and Methods: We received the files of 234 patients with antenatally diagnosed congenital hydronephrosis due to PUJO. Management was tailored to each patient, based on a combination of diethylenetetraminepentacetic acid renogram outcome, pelvic diameter, as well as the patient's symptoms.
Sustain Distribution System Integrity with Pipeline Installation, Replacement, or Rehabilitation
Authors: Martin Barb , Ries Tom
Published: September 2015

Pipeline installation, rehabilitation, and replacement practices can affect a distribution system's physical integrity and a water utility's ability to maintain optimized performance. Applying appropriate pipeline assessment and planning practices will help utilities maintain performance and condition of this significant system asset.
Stop Age Discrimination in Pipe Replacement Strategies
Authors: Moore Randy , Wagner Travis B.
Published: September 2015

The very nature of buried pipeline assets presents a challenge to accurately access their condition, making it even harder to optimize water distribution systems by employing effective asset management strategies. To optimize pipeline renewal strategies based on actual conditions, new pipeline condition assessment techniques and technologies offer pipe‐specific evaluations that can end the water industry's reliance on desktop studies using age, or break frequency, as the primary criteria for pipeline renewal planning.
Lighted Valve Key Illuminates Valve Nuts
Authors: McIntyre Larry
Published: September 2015

The Light Up Key is fitted with lights along its shaft to illuminate the bottom of valve vaults and valve boxes.
Reward modulates the effect of visual cortical microstimulation on perceptual decisions
Authors: Cicmil Nela , Cumming Bruce G , Parker Andrew J , Krug Kristine
Published: September 2015

Effective perceptual decisions rely upon combining sensory information with knowledge of the rewards available for different choices. However, it is not known where reward signals interact with the multiple stages of the perceptual decision-making pathway and by what mechanisms this may occur. We combined electrical microstimulation of functionally specific groups of neurons in visual area V5/MT with performance-contingent reward manipulation, while monkeys performed a visual discrimination task. Microstimulation was less effective in shifting perceptual choices towards the stimulus preferences of the stimulated neurons when available reward was larger. Psychophysical control experiments showed this result was not explained by a selective change in response strategy on microstimulated trials. A bounded accumulation decision model, applied to analyse behavioural performance, revealed that the interaction of expected reward with microstimulation can be explained if expected reward modulates a sensory representation stage of perceptual decision-making, in addition to the better-known effects at the integration stage.
Molecular architecture of the yeast Mediator complex
Authors: Robinson Philip J , Trnka Michael J , Pellarin Riccardo , Greenberg Charles H , Bushnell David A , Davis Ralph , Burlingame Alma L , Sali Andrej , Kornberg Roger D
Published: September 2015

The 21-subunit Mediator complex transduces regulatory information from enhancers to promoters, and performs an essential role in the initiation of transcription in all eukaryotes. Structural information on two-thirds of the complex has been limited to coarse subunit mapping onto 2-D images from electron micrographs. We have performed chemical cross-linking and mass spectrometry, and combined the results with information from X-ray crystallography, homology modeling, and cryo-electron microscopy by an integrative modeling approach to determine a 3-D model of the entire Mediator complex. The approach is validated by the use of X-ray crystal structures as internal controls and by consistency with previous results from electron microscopy and yeast two-hybrid screens. The model shows the locations and orientations of all Mediator subunits, as well as subunit interfaces and some secondary structural elements. Segments of 20–40 amino acid residues are placed with an average precision of 20 Å. The model reveals roles of individual subunits in the organization of the complex.
A genetic link between discriminative fear coding by the lateral amygdala, dopamine, and fear generalization
Authors: Jones Graham L , Soden Marta E , Knakal Cerise R , Lee Heather , Chung Amanda S , Merriam Elliott B , Zweifel Larry S
Published: September 2015

The lateral amygdala (LA) acquires differential coding of predictive and non-predictive fear stimuli that is critical for proper fear memory assignment. The neurotransmitter dopamine is an important modulator of LA activity and facilitates fear memory formation, but whether dopamine neurons aid in the establishment of discriminative fear coding by the LA is unknown. NMDA-type glutamate receptors in dopamine neurons are critical for the prevention of generalized fear following an aversive experience, suggesting a potential link between a cell autonomous function of NMDAR in dopamine neurons and fear coding by the LA. Here, we utilized mice with a selective genetic inactivation functional NMDARs in dopamine neurons (DAT-NR1 KO mice) combined with behavior, in vivo electrophysiology, and ex vivo electrophysiology in LA neurons to demonstrate that plasticity underlying differential fear coding in the LA is regulated by NMDAR signaling in dopamine neurons and alterations in this plasticity is associated non-discriminative cued-fear responses.
Differential interaction forces govern bacterial sorting in early biofilms
Authors: Oldewurtel Enno R , Kouzel Nadzeya , Dewenter Lena , Henseler Katja , Maier Berenike
Published: September 2015

Bacterial biofilms can generate micro-heterogeneity in terms of surface structures. However, little is known about the associated changes in the physics of cell–cell interaction and its impact on the architecture of biofilms. In this study, we used the type IV pilus of Neisseria gonorrhoeae to test whether variation of surface structures induces cell-sorting. We show that the rupture forces between pili are fine-tuned by post-translational modification. Bacterial sorting was dependent on pilus post-translational modification and pilus density. Active force generation was necessary for defined morphologies of mixed microcolonies. The observed morphotypes were in remarkable agreement with the differential strength of adhesion hypothesis proposing that a tug-of-war among surface structures of different cells governs cell sorting. We conclude that in early biofilms the density and rupture force of bacterial surface structures can trigger cell sorting based on similar physical principles as in developing embryos.
Performance comparison of box-cox transformation and weighted variance methods with weibull distribution
Authors: Sennaroglu Bahar , Senvar Ozlem
Published: September 2015

A standard process capability index is calculated based on the assumption that the quality characteristic of the process follows the normal distribution. But there are many cases in which the quality characteristic comes from a non-normal distribution. This paper studies Box-Cox transformation method and Weighted Variance method to calculate process capability indices for Weibull distributed quality characteristic and compares performances of these methods. Weibull distribution is extensively used as a lifetime distribution model because of its flexible shape. The data sets used in performance comparison are randomly generated from Weibull distribution for two different shape and scale parameters through a simulation study. The results indicate that Box-Cox transformation method produces better estimates for process capability than Weighted Variance method.
Acute effects of anterior thigh foam rolling on hip angle, knee angle, and rectus femoris length in the modified Thomas test
Authors: Vigotsky Andrew D. , Lehman Gregory J. , Contreras Bret , Beardsley Chris , Chung Bryan , Feser Erin H.
Published: September 2015

Background.Foam rolling has been shown to acutely increase range of motion (ROM) during knee flexion and hip flexion with the experimenter applying an external force, yet no study to date has measured hip extensibility as a result of foam rolling with controlled knee flexion and hip extension moments. The purpose of this study was to investigate the acute effects of foam rolling on hip extension, knee flexion, and rectus femoris length during the modified Thomas test.

Methods.Twenty-three healthy participants (male = 7; female = 16; age = 22 ± 3.3 years; height = 170 ± 9.18 cm; mass = 67.7 ± 14.9 kg) performed two, one-minute bouts of foam rolling applied to the anterior thigh. Hip extension and knee flexion were measured via motion capture before and after the foam rolling intervention, from which rectus femoris length was calculated.

Results.Although the increase in hip extension (change = +1.86° (+0.11, +3.61); z(22) = 2.08;p= 0.0372; Pearson’sr= 0.43 (0.02, 0.72)) was not due to chance alone, it cannot be said that the observed changes in knee flexion (change = −1.39° (−5.53, +2.75); t(22) = −0.70;p= 0.4933; Cohen’sd= − 0.15 (−0.58, 0.29)) or rectus femoris length (change = −0.005 (−0.013, +0.003); t(22) = −1.30;p= 0.2070; Cohen’sd= − 0.27 (−0.70, 0.16)) were not due to chance alone.

Conclusions.Although a small change in hip extension was observed, no changes in knee flexion or rectus femoris length were observed. From these data, it appears unlikely that foam rolling applied to the anterior thigh will improve passive hip extension and knee flexion ROM, especially if performed in combination with a dynamic stretching protocol.
Evaluating Didactic Methods for Training Medical Students in the Use of Bedside Ultrasound for Clinical Practice at a Faculty of Medicine in Romania
Authors: Florescu Cosmin C. , Mullen Jeffrey A. , Nguyen Vivian My , Sanders Brooke E. , Vu Priscilla Quynh-Phuon
Published: September 2015

Objectives

Medical students' time is limited, so efficiency in medical education is valued. This research project aimed to determine the most effective means to teach bedside ultrasound to medical students in a 1‐week training course. We hypothesized that the best method would include a combination of podcasts and hands‐on teaching; therefore, there would be a statistically significant difference among the various methods of teaching.

Methods

Medical students were randomly assigned to 3 groups. All groups attended a 50‐minute hands‐on bedside ultrasound training session. Students in the first group attended a 50‐minute live lecture before the hands‐on session, whereas students in the second group watched a podcast that covered the same material as the live lecture. Students in the third group served as the control and only attended the hands‐on sessions. Five topics were covered during the course: (1) introduction to ultrasound, (2) pulmonary ultrasound, (3) cardiac ultrasound, (4) hepatobiliary ultrasound, and (5) focused assessment with sonography for trauma. Students completed a 20‐question pre‐ and post‐training quiz that covered basic ultrasound principles. Students also conducted a focused assessment with sonography for trauma examination for the practical portion of their evaluation.

Results

Students' pre‐ to post‐training quiz scores increased from 33.6% to 72.6% correct in the lecture group (n = 21; P < .0001), from 40.7% to 75.5% correct in the podcast group (n = 20; P< .0001), and from 37.8% to 70.0% correct in the control group (n = 23; P< .0001). Data analysis of written and practical examination scores showed no significant differences among the groups [F(2,61) = 0.885; P = .418; F(2,60) = 1.739; P = .184, respectively].

Conclusions

These results suggest that all 3 methods are equally effective in teaching novice medical students basic ultrasound knowledge and skills.
Bleeding Rate for Ultrasound‐Guided Paracentesis in Thrombocytopenic Patients
Authors: Kurup A. Nicholas , Lekah Alexander , Reardon Scott T. , Schmit Grant D. , McDonald Jennifer S. , Carter Rickey E. , Kamath Patrick S. , Callstrom Matthew R. , Atwell Thomas D.
Published: September 2015

Objectives

The purpose of this study was to determine the rate of major bleeding complications for ultrasound‐guided paracentesis performed in thrombocytopenic patients.

Methods

We retrospectively reviewed the electronic medical records of patients with platelet counts of less than 50,000/μL who had ultrasound‐guided paracenteses performed in the Department of Radiology without correcting preprocedural platelet transfusions between 2005 and 2011. Medical records were evaluated for evidence of major bleeding complications (grade 3 or higher as defined by the National Institutes of Health's Common Terminology Criteria for Adverse Events, version 4.03) and their clinical sequelae. Platelet count and bleeding complications were evaluated for an association, and a sensitivity analysis was performed to determine whether analysis of a control group of patients without thrombocytopenia would yield added confidence in this assessment.

Results

Among 304 procedures in 205 thrombocytopenic patients (69% male; mean age ± SD, 56.6 ± 11.9 years), the mean platelet count was 38,400 ± 9300/μL (range, 9000–49,000/μL). Three major bleeding complications requiring red blood cell transfusion were observed in patients with platelet counts of 41,000 to 46,000/μL, for a complication rate of 0.99% (95% confidence interval, 0.3%–2.9%). No patient required an additional procedure or died because of the bleeding complication. There was no association of platelet count with bleeding complications. The sensitivity analysis showed that further evaluation of patients with normal platelet counts would not add to the conclusion.

Conclusions

The risk of major bleeding after ultrasound‐guided paracentesis in thrombocytopenic patients is very low. In most patients, routine assessment of the preprocedural serum platelet concentration is not necessary, and correction of such an abnormal laboratory value is not indicated.
Sonographic Parameters for Prediction of Miscarriage
Authors: Wie Jeong Ha , Choe Suyearn , Kim Sa Jin , Shin Jong Chul , Kwon Ji Young , Park In Yang
Published: September 2015

Objectives

To evaluate the value of volume measurement using 3‐dimensional sonography for prediction of miscarriage.

Methods

We prospectively enrolled 188 singleton pregnant women at 5 to 9 weeks' gestation. The 3‐dimensional sonographic gestational sac volume and yolk sac volume were measured together with the fetal heart rate, gestational sac diameter, and yolk sac diameter. For each sonographic parameter, nomograms were created; z scores were calculated for each measurement, and the values were compared between miscarriage and ongoing pregnancy groups. Sonographic parameters for prediction of miscarriage were evaluated by multivariate analysis, and the screening performance was assessed by a receiver operating characteristic curve.

Results

Among the 188 pregnancies, 30 (16.0%) had miscarriage. Multivariate analysis showed that fetal heart rate below the 5th percentile (odds ratio, 6.43), gestational sac diameter below the 5th percentile (odds ratio, 4.87), gestational sac volume below the 5th percentile (odds ratio, 5.25), and yolk sac diameter below the 2.5th or above the 97.5th percentile (odds ratio, 15.86) were significant predictors of miscarriage (P= .018;P= .018;P= .033; andP< .001, respectively). At a false‐positive rate of 30%, the detection rate for miscarriage in screening by a combination of fetal heart rate, gestational sac diameter, gestational sac volume, and yolk sac diameter was 77.8%.

Conclusions

A small‐for‐gestational‐age gestational sac volume is a significant sonographic predictor of miscarriage, as are fetal bradycardia, a small gestational sac diameter, and a small or large yolk sac diameter.
Prepubertal Testicular Teratomas and Epidermoid Cysts
Authors: Chang Min-Yung , Shin Hyun Joo , Kim Hyun Gi , Kim Myung-Joon , Lee Mi-Jung
Published: September 2015

Objectives

To evaluate clinical and sonographic features of testicular teratomas and epidermoid cysts in children and to assess differential points of immature teratomas from benign counterparts.

Methods

We retrospectively reviewed testicular teratomas and epidermoid cysts in children. Age at surgery, α‐fetoprotein (AFP) level, and sonographic findings, including components (mainly cystic, mainly solid, or mixed), presence of calcification, and size, were reviewed.

Results

Nineteen cases were included, with 10 mature teratomas, 3 immature teratomas, and 6 epidermoid cysts. On sonography, most of the teratomas (n = 9) had mixed components, with 2 mainly cystic and 2 mainly solid lesions. The 2 mainly cystic teratomas underwent follow‐up sonography and showed component changes to mainly solid. Compared to epidermoid cysts, teratomas were larger (P = .029) with less cystic components (P = .046). All 3 immature teratomas showed mixed components with calcification. In differentiating immature from benign teratomas, immature teratomas were larger (P= .047) in younger children (P= .008) with higher AFP levels (P= .023). The optimal cutoff values for diagnosing immature teratomas were 8 months of age, 23 ng/mL in AFP level, and 2.5 cm in size, with 100% sensitivity and 89.5% accuracy rates. However, sonographic features, including tumor components and presence of calcification, were not helpful for differentiating immature teratomas.

Conclusions

Testicular masses in children younger than 8 months with AFP levels higher than 23 ng/mL and size larger than 2.5 cm need to be considered for orchiectomy rather than testis‐sparing tumorectomy because of the increased frequency of immature teratomas versus mature teratomas or epidermoid cysts.
A Model Using Texture Features to Differentiate the Nature of Thyroid Nodules on Sonography
Authors: Song Gesheng , Xue Fuzhong , Zhang Chengqi
Published: September 2015

Objectives

To evaluate the use of texture‐based gray‐level co‐occurrence matrix (GLCM) features extracted from thyroid sonograms in building prediction models to determine the nature of thyroid nodules.

Methods

A GLCM was used to extract the texture features of 155 sonograms of thyroid nodules (76 benign and 79 malignant). The GLCM features included energy, contrast, correlation, sum of squares, inverse difference moment, sum average, sum variance, sum entropy, entropy, difference variance, difference entropy, information measures of correlation, and maximal correlation coefficient. The texture features extracted by the GLCM were used to build 6 different statistical models, including support vector machine, random tree, random forest, boost, logistic, and artificial neural network models. The models' performances were evaluated by 10‐fold cross‐validation combining a receiver operating characteristic curve, indices of accuracy, true‐positive rate, false‐positive rate, sensitivity, specificity, precision, recall, F‐measure, and area under the receiver operating characteristic curve. External validation was used to examine the stability of the model that showed the best performance.

Results

The logistic model showed the best performance, according to 10‐fold cross‐validation, among the 6 models, with the highest area under the curve (0.84), accuracy (78.5%), true‐positive rate (0.785), sensitivity (0.789), specificity (0.785), precision (0.789), recall (0.785), and F‐measure (0.784), as well as the lowest false‐positive rate (0.215). The external validation results showed that the logistic model was stable.

Conclusions

Gray‐level co‐occurrence matrix texture features extracted from sonograms of thyroid nodules coupled with a logistic model are useful for differentiating between benign and malignant thyroid nodules.
Using Ultrasound to Enhance Medical Students' Femoral Vascular Physical Examination Skills
Authors: Ahn Justin S. , French Andrew J. , Thiessen Molly E. W. , Browne Vaughn , Deutchman Mark , Guiton Gretchen , Madigosky Wendy , Kendall John L.
Published: September 2015

Objectives

To determine whether the addition of ultrasound to traditional physical examination instruction improves junior medical students' abilities to locate the femoral pulse.

Methods

Initially, 150 second‐year medical students were taught the femoral pulse examination using traditional bedside teaching on standardized patients and online didactic videos. Students were then randomized into 2 groups: group 1 received ultrasound training first and then completed the standardized examination; and group 2 performed the standardized examination first and then received ultrasound training. On the standardized patients, the femoral artery was marked with invisible ink before the sessions using ultrasound. Compared to these markers, students were then evaluated on the accuracy of femoral artery pulse palpation and the estimated location of the femoral vein. All students completed a self‐assessment survey after the ultrasound sessions.

Results

Ultrasound training improved the students' ability to palpate the femoral pulse (P= .02). However, ultrasound did not facilitate correct estimation of the femoral vein's anatomic location (P = .09). Confidence levels in localizing the femoral artery and vein were equal between groups at baseline, and both increased after the ultrasound sessions.

Conclusions

The addition of ultrasound teaching to traditional physical examination instruction enhanced medical student competency and confidence with the femoral vascular examination. However, understanding of anatomy may require emphasis on precourse didactic material, but further study is required.
Standardization of Sonographic Lung‐to‐Head Ratio Measurements in Isolated Congenital Diaphragmatic Hernia
Authors: Britto Ingrid Schwach Werneck , Sananes Nicolas , Olutoye Oluyinka O. , Cass Darrell L. , Sangi-Haghpeykar Haleh , Lee Timothy C. , Cassady Christopher I. , Mehollin-Ray Amy , Welty Stephen , Fernandes Caraciolo , Belfort Michael A. , Lee Wesley , Ruano Rodrigo
Published: September 2015

Objectives

The purpose of this study was to evaluate the impact of standardization of the lung‐to‐head ratio measurements in isolated congenital diaphragmatic hernia on prediction of neonatal outcomes and reproducibility.

Methods

We conducted a retrospective cohort study of 77 cases of isolated congenital diaphragmatic hernia managed in a single center between 2004 and 2012. We compared lung‐to‐head ratio measurements that were performed prospectively in our institution without standardization to standardized measurements performed according to a defined protocol.

Results

The standardized lung‐to‐head ratio measurements were statistically more accurate than the nonstandardized measurements for predicting neonatal mortality (area under the receiver operating characteristic curve, 0.85 versus 0.732; P = .003). After standardization, there were no statistical differences in accuracy between measurements regardless of whether we considered observed‐to‐expected values (P > .05). Standardization of the lung‐to‐head ratio did not improve prediction of the need for extracorporeal membrane oxygenation (P> .05). Both intraoperator and interoperator reproducibility were good for the standardized lung‐to‐head ratio (intraclass correlation coefficient, 0.98 [95% confidence interval, 0.97–0.99]; bias, 0.02 [limits of agreement, −0.11 to +0.15], respectively).

Conclusions

Standardization of lung‐to‐head ratio measurements improves prediction of neonatal outcomes. Further studies are needed to confirm these results and to assess the utility of standardization of other prognostic parameters.
A review of suicidality in nonpsychotropic medications
Authors: Koch Jessa , Ward Sarah , Martin Bobbie , Thomas Christopher
Published: September 2015

Introduction

The term suicidality describes the multitude of behaviors related to suicide: suicidal ideation, self-injurious behavior, suicide attempt, and completed suicide. Risk factors associated with increased suicidality in individuals include specific demographics, medical and psychologic conditions, socioeconomic status, family history, and major life events. In addition to baseline risk factors, there have been reports of numerous medications associated with increased suicidality in patients. Most of these medications are antiepileptics and antidepressants. Because of the contradictory risk posed by the exact medications prescribed to treat depression and psychologic conditions, the nonpsychotropic medications with reports of suicidality are often overshadowed.

Methods

Medications with FDA-issued warnings were reviewed for inclusion. Further medications were identified through PubMed literature review.

Results

Eight medications with various indications were identified and evidence is assessed regarding risk of suicidality.

Discussion

This review evaluates the current literature for nonpsychotropic medications that have been implicated in treatment-emergent suicidality.
Dissolved organic carbon pools and export from the coastal ocean
Authors: Barrón Cristina , Duarte Carlos M.
Published: September 2015

The distribution of dissolved organic carbon (DOC) concentration across coastal waters was characterized based on the compilation of 3510 individual estimates of DOC in coastal waters worldwide. We estimated the DOC concentration in the coastal waters that directly exchange with open ocean waters in two different ways, as the DOC concentration at the edge of the shelf break and as the DOC concentration in coastal waters with salinity close to the average salinity in the open ocean. Using these estimates of DOC concentration in the coastal waters that directly exchange with open ocean waters, the mean DOC concentration in the open ocean and the estimated volume of water annually exchanged between coastal and open ocean, we estimated a median ± SE (and average ± SE) global DOC export from coastal to open ocean waters ranging from 4.4 ± 1.0 Pg C yr−1 to 27.0 ± 1.8 Pg C yr−1 (7.0 ± 5.8 Pg C yr−1 to 29.0 ± 8.0 Pg C yr−1) depending on the global hydrological exchange. These values correspond to a median and mean median (and average) range between 14.7 ± 3.3 to 90.0 ± 6.0 (23.3 ± 19.3 to 96.7 ± 26.7) Gg C yr−1 per km of shelf break, which is consistent with the range between 1.4 to 66.1 Gg C yr−1 per km of shelf break of available regional estimates of DOC export. The estimated global DOC export from coastal to open ocean waters is also consistent with independent estimates of the net metabolic balance of the coastal ocean. The DOC export from the coastal to the open ocean is likely to be a sizeable flux and is likely to be an important term in the carbon budget of the open ocean, potentially providing an important subsidy to support heterotrophic activity in the open ocean.