bluuebunny/crossref_metadata_2025 huggingface dataset:
What is a large-scale dynamo?
Authors: Nigro G. , Pongkitiwanichakul P. , Cattaneo F. , Tobias S. M.
Published: September 2016

We consider kinematic dynamo action in a sheared helical flow at moderate to high values of the magnetic Reynolds number (Rm). We find exponentially growing solutions which, for large enough shear, take the form of a coherent part embedded in incoherent fluctuations. We argue that at large Rm large-scale dynamo action should be identified by the presence of structures coherent in time, rather than those at large spatial scales. We further argue that although the growth rate is determined by small-scale processes, the period of the coherent structures is set by mean-field considerations.
CO Multi-line Imaging of Nearby Galaxies (COMING). I. Physical properties of molecular gas in the barred spiral galaxy NGC 2903
Authors: Muraoka Kazuyuki , Sorai Kazuo , Kuno Nario , Nakai Naomasa , Nakanishi Hiroyuki , Takeda Miho , Yanagitani Kazuki , Kaneko Hiroyuki , Miyamoto Yusuke , Kishida Nozomi , Hatakeyama Takuya , Umei Michiko , Tanaka Takahiro , Tomiyasu Yuto , Saita Chey , Ueno Saeko , Matsumoto Naoko , Salak Dragan , Morokuma-Matsui Kana
Published: September 2016

We present simultaneous mappings of J = 1–0 emission of 12CO, 13CO, and C18O molecules toward the whole disk (8′ × 5′ or 20.8 kpc × 13.0 kpc) of the nearby barred spiral galaxy NGC 2903 with the Nobeyama Radio Observatory 45 m telescope at an effective angular resolution of 20″ (or 870 pc). We detected 12CO(J = 1–0) emission over the disk of NGC 2903. In addition, significant 13CO(J = 1–0) emission was found at the center and bar-ends, whereas we could not detect any significant C18O(J = 1–0) emission. In order to improve the signal-to-noise ratio of CO emission and to obtain accurate line ratios of 12CO(J = 2–1)/12CO(J = 1–0) (R2−1/1−0) and 13CO(J = 1–0)/12CO(J = 1–0) (R13/12), we performed the stacking analysis for our 12CO(J = 1–0), 13CO(J = 1–0), and archival 12CO(J = 2–1) spectra with velocity axis alignment in nine representative regions of NGC 2903. We successfully obtained the stacked spectra of the three CO lines, and could measure averaged R2−1/1−0 and R13/12 with high significance for all the regions. We found that both R2−1/1−0 and R13/12 differ according to the regions, which reflects the difference in the physical properties of molecular gas, i.e., density ($n_{\rm H_2}$) and kinetic temperature (TK). We determined $n_{\rm H_2}$ and TK using R2−1/1−0 and R13/12 based on the large velocity gradient approximation. The derived $n_{\rm H_2}$ ranges from ∼1000 cm−3 (in the bar, bar-ends, and spiral arms) to 3700 cm−3 (at the center) and the derived TK ranges from 10 K (in the bar and spiral arms) to 30 K (at the center). We examined the dependence of star formation efficiencies (SFEs) on $n_{\rm H_2}$ and TK, and found a positive correlation between SFE and $n_{\rm H_2}$ with correlation coefficient for the least-squares power-law fit R2 of 0.50. This suggests that molecular gas density governs the spatial variations in SFEs.
Utility of a Cesarean Delivery Surgical Skills Simulation Session for Family Medicine Residents Pursuing Surgical Obstetrics Training
Authors: Kremer Timothy
Published: September 2016

BACKGROUND:

Family medicine residents pursuing surgical obstetrics training face the challenge of limited opportunities for intraoperative experience during their formal training. The utility of both low and high fidelity surgical simulation models have been demonstrated to increase technical skill development. Obstetrical emergencies have been taught to family medicine utilizing simulation, but have not included cesarean delivery.

METHODS:

Family medicine residents enrolled in the surgical obstetrics tract underwent a cesarean delivery surgical simulation session. Surgical performance evaluations were obtained from live surgeries performed immediately before and after the simulation session utilizing a previously validated global rating score. De-identified surgical evaluations were used for statistical analysis. Unpaired T test was performed to assess for statistical difference in pre-session and post session scores.

RESULTS:

Seven residents participated in the simulation session. Fourteen surgical evaluations were completed before the session; 9 evaluations were completed after the session. Global rating scores increased from 21.5 (±0.66) to 28.2 (±0.84), reaching statistical significance (P=.008). All subcomponent scores increased, with tissue respect, time and motion, instrument handling, flow, assistance usage, and procedural knowledge reaching statistical significance.

DISCUSSION:

A single simulation session utilizing a low fidelity model did show statistical improvement in global surgical skill ratings and its subcomponents.
Simulation to Improve Trainee Knowledge and Comfort About Twin Vaginal Birth
Authors: Easter Sarah Rae , Gardner Roxane , Barrett Jon , Robinson Julian N. , Carusi Daniela
Published: September 2016

OBJECTIVE:

To describe a simulation-based curriculum on twin vaginal delivery and evaluate its effects on trainee knowledge and comfort about twin vaginal birth.

METHODS:

Trainees participated in a three-part simulation consisting of a patient counseling session, a twin delivery scenario, and a breech extraction skills station. Consenting trainees completed a 21-item presimulation survey and a 22-item postsimulation survey assessing knowledge, experience, attitudes, and comfort surrounding twin vaginal birth. Presimulation and postsimulation results were compared using univariate analysis. Our primary outcomes were change in knowledge and comfort before and after the simulation.

RESULTS:

Twenty-four obstetrics and gynecology residents consented to participation with 18 postsimulation surveys available for comparison (75%). Trainees estimated their participation in 445 twin deliveries (median 19, range 0–52) with only 20.4% of these as vaginal births. Participants reported a need for more didactic or simulated training on this topic (64% and 88%, respectively). Knowledge about twin delivery improved after the simulation (33.3% compared with 58.3% questions correct, P<.01). Before training, 33.3% of participants reported they would strongly counsel a patient to attempt vaginal birth instead of elective cesarean delivery for twins compared with 50% after training (P=.52). Personal comfort with performing a breech extraction of a nonvertex second twin improved from 5.5% to 66.7% after the simulation (P<.01).

CONCLUSION:

Resident exposure to twin vaginal birth is infrequent and variable with a demonstrable need for more training. Our contemporary obstetric climate is prioritizing vaginal birth despite less frequent operative obstetric interventions. We describe a reproducible twin delivery simulation associated with a favorable effect on resident knowledge and comfort levels.
Narrative Medicine Workshops for Obstetrics and Gynecology Residents and Association With Burnout Measures
Authors: Winkel Abigail Ford , Feldman Nathalie , Moss Haley , Jakalow Holli , Simon Julia , Blank Stephanie
Published: September 2016

OBJECTIVE:

To determine whether a workshop Narrative Medicine curriculum can improve burnout among obstetrics and gynecology residents.

METHODS:

A Narrative Medicine curriculum was conducted at three obstetrics and gynecology training programs. An explanatory research design examined correlation between Narrative Medicine attendance and changes in survey responses. Residents completed a pretest and 1-year posttest survey that included validated measures of burnout and empathy. A within-participants design used baseline pretest scores as an internal control and measured changes in individual scores. The primary outcome of the study was change in burnout rates. Mann–Whitney U and Kruskal–Wallis tests were used to analyze the data.

RESULTS:

A total of 66 residents at three institutions participated in the Narrative Medicine curriculum. Of those, 54 (81%) enrolled in the study by completing any part of the surveys, and 43 (80%) of those enrolled had complete data for analysis. Burnout was high on all Maslach Burnout Inventory subscales and increased over 1 year. Participants with high Narrative Medicine attendance had decreased burnout on the Emotional Exhaustion subscale (−4.1 [±8.1]) points compared with an increase of 0.5 (±6.0) for low-attendance participants (U=134, P=.02, d=0.65). Lower self-care ratings were associated with improved Personal Accomplishment (+0.5 [±5.0]) compared with +2.0 (±2.7), U=84, P=.01]. Other characteristics did not significantly correlate with burnout or empathy.

CONCLUSION:

Burnout was high and worsened over time among obstetrics and gynecology residents in these three programs. Higher attendance at Narrative Medicine workshops was associated with improved Emotional Exhaustion.
Comfort With Skills and Knowledge After Immediate Postpartum Intrauterine Device Training
Authors: Goldthwaite Lisa M. , Sheeder Jeanelle , Teal Stephanie B. , Tocce Kristina M.
Published: September 2016

OBJECTIVE:

To estimate whether a standardized immediate postpartum intrauterine device (IUD) simulation results in sustained improvement in perceived comfort with procedural skills.

METHODS:

From November 2013 to April 2015, obstetric health care providers at two teaching hospitals participated in a 30-minute immediate postpartum IUD simulation workshop and program evaluation. We assessed knowledge of indications, insertion technique, safety, and comfort with knowledge and skills preintervention immediately after and 6 months posttraining.

RESULTS:

Training participants (N=84) included 39 residents and 45 attendings (25 certified nurse–midwives and 20 obstetrician–gynecologists). Fifty-seven participants (68%) completed the 6-month assessments. Many participants had placed immediate postpartum IUDs before the training (54% of residents compared with 64% of attendings, P=.32); 60% were comfortable with their knowledge and 52% with their insertion skills defined by self-assessment of 7 or greater on a 10-point scale. On the pretest, 77% answered 80% or greater of the knowledge-based questions correctly; this proportion rose to 95% and 97% on the immediate and 6-month assessments, respectively, and were similar between residents and attendings. Immediately posttraining, 94% of participants rated their comfort with knowledge at 7 or greater out of 10; this fell to 86% by 6 months. Likewise, 87% and 74% scored their comfort with skills at 7 or greater out of 10 immediately and at 6 months, respectively. By 6 months, 81% reported placing one or more immediate postpartum IUDs(92% of residents and 71% of attendings, P=.05).

CONCLUSION:

Residents and attendings demonstrate sustained improvement in knowledge and comfort with immediate postpartum IUDs 6 months after a standardized simulation workshop.
What Is New in Trauma-Related Amputations
Authors: Tintle Scott M. , LeBrun Christopher , Ficke James R. , Potter Benjamin K.
Published: September 2016

Traumatic and trauma-related amputations represent unfortunate sequelae of severe injury, but should not be viewed as a treatment failure and may represent the best reconstructive option for some patients. Lessons from recent military conflicts have guided the evolution of modern surgical techniques and rehabilitation management of this challenging patient population, and treatment at a specialty center may improve patient outcomes. Despite appropriate management, however, surgical complications remain common and revision surgery is often necessary. Bridge synostosis procedures remain controversial, and clinical equipoise remains regarding their functional benefits. Based on European experience over the last 3 decades, osseointegration has evolved into a viable clinical alternative for patients unable to achieve acceptable function using conventional sockets, and several devices are being developed or tested in the United States. Targeted muscle reinnervation and advanced pattern recognition may dramatically improve the functional potential of many upper extremity amputees, and the procedure may also relieve neuroma-related pain. Furthermore, exciting new research may eventually facilitate haptic feedback and restore useful sensation for amputees. Natural disasters and global terrorism events, in addition to conventional trauma resulting in limb loss, make a working knowledge of current amputation surgical techniques essential to the practicing orthopaedic trauma surgeon.
Prognostication in Developmental Dysplasia of the Hip Using the Ossific Nucleus Center Edge Angle
Authors: Firth Gregory B. , Robertson Anthony J.F. , Ramguthy Yammesh , Ramachandran Manoj , Schepers Anton
Published: September 2016

Background:

The aim of this paper was to determine the prognostic potential of the ossific nucleus center edge angle (ONCEA) in patients below 5 years of age treated for developmental dysplasia of the hip (DDH) to predict final outcome and the need for a secondary procedure.

Methods:

The interobserver and intraobserver reliability was calculated using the intraclass correlation coefficient for measurement of the ONCEA. The ONCEA was divided a priori into 3 groups: group A≥10 degrees, group B −9 to 9 degrees, and group C ≤−10 degrees. Final outcome was measured using the McKay score and Severin classification. The presence of osteonecrosis was recorded at final follow-up.

Results:

One hundred one patients with 133 dislocated hips underwent closed or open reduction for DDH. Mean age at presentation was 19 months with a mean age at final follow-up of 12.4 years. A significant difference was shown in a comparison of the 3 ONCEA groups using the McKay score, Severin classification, and need for a secondary procedure. Eighty seven of the 101 patients underwent ONCEA reliability measurements. The ONCEA was shown to have a mean intrarater reliability of 0.89, and a mean interrater reliability of 0.77.

Conclusions:

The ONCEA is a reliable measurement in predicting medium-term outcome of the hip post reduction in children under the age of 5 years with DDH and might be useful as a predictor for a secondary procedure before the age of 5 years.

Level of Evidence:

Level III—prognostic case control study.

Clinical Relevance:

This case control study shows the importance of measuring the ONCEA within 6 months of removing the final cast after reduction of a dislocated hip and its implications for further management and outcome.
Comparison of Three Reconstructive Techniques in the Surgical Management of Patients With Four-Level Cervical Spondylotic Myelopathy
Authors: Li Zhonghai , Wang Huadong , Tang Jiaguang , Ren Dongfeng , Li Li , Hou Shuxun , Zhang Hailong , Hou Tiesheng
Published: September 2016

Study Design.

Retrospective clinical series.

Objective.

To compare perioperative parameters, clinical outcomes, radiographic parameters, and complication rates of three reconstructive techniques after the anterior decompression of four-level cervical spondylotic myelopathy (CSM).

Summary of Background Data.

At present, the decision to treat multilevel CSM, especially four-level CSM, remains controversial. No one compares multilevel anterior cervical discectomy and fusion (mACDF), segmental anterior cervical corpectomy and fusion (sACCF) to multilevel anterior cervical discectomy and fusion with cage alone (mACDF-CA) in four-level constructs.

Methods.

Between July 2006 and February 2014, 97 consecutive patients with four-level CSM were enrolled in this study and divided into sACCF (n = 39) group, mACDF (n = 31) group, and mACDF-CA (n = 27) group. The study compared perioperative parameters, complication rates, clinical and radiologic parameters of three reconstructive techniques after the anterior decompression of four-level CSM.

Results.

The mACDF-CA group had the least bleeding and cost of index surgery compared with the sACCF group having the most bleeding and cost. Although significant pain relief and functional activity improvement have been achieved in the three groups at the final follow-up, there was no significant difference in the Japanese Orthopedic Association, SF-36 and NDI scores among the three groups (P >0.05). The mACDF group maintained the best cervical lordosis at the final follow-up, compared with the sACCF group maintained the worst cervical lordosis. Solid fusion was achieved in 87.1% of subjects in sACCF group, 90.3% in mACDF, and in 88.9% in mACDF-CA. The mACDF-CA group had a higher rate of subsidence and lower rate of dysphagia than other two groups.

Conclusion.

mACDF-CA can be considered an effective and safe alternative procedure in the treatment of the four-level CSM.

Level of Evidence: 4
Development and Validation of a Photonumeric Scale for Evaluation of Facial Fine Lines
Authors: Carruthers Jean , Donofrio Lisa , Hardas Bhushan , Murphy Diane K. , Jones Derek , Carruthers Alastair , Sykes Jonathan M. , Creutz Lela , Marx Ann , Dill Sara
Published: September 2016

BACKGROUND

A validated scale is needed for objective and reproducible comparisons of facial fine lines before and after treatment in practice and clinical studies.

OBJECTIVE

To describe the development and validation of the 5-point photonumeric Allergan Fine Lines Scale.

METHODS

The Allergan Fine Lines Scale was developed to include an assessment guide, verbal descriptors, morphed images, and real subject images for each scale grade. The clinical significance of a 1-point score difference was evaluated in a review of multiple image pairs representing varying differences in severity. Interrater and intrarater reliability was evaluated in a live subject validation study (N = 289) completed during 2 sessions occurring 3 weeks apart.

RESULTS

A score difference of ≥1 point was shown to reflect a clinically significant difference (mean [95% CI] absolute score difference, 1.06 [0.92–1.21] for clinically different image pairs and 0.50 [0.38–0.61] for not clinically different pairs). Intrarater agreement between the 2 live subject validation sessions was almost perfect (weighted kappa = 0.85). Interrater agreement was substantial during the second rating session (0.76, primary end point).

CONCLUSION

The Allergan Fine Lines Scale is a validated and reliable scale for physician rating of severity of superficial fine lines.
Development and Validation of a Photonumeric Scale for Evaluation of Static Horizontal Forehead Lines
Authors: Carruthers Alastair , Donofrio Lisa , Hardas Bhushan , Murphy Diane K. , Carruthers Jean , Sykes Jonathan M. , Jones Derek , Creutz Lela , Marx Ann , Dill Sara
Published: September 2016

BACKGROUND

A validated scale is needed for objective and reproducible comparisons of static forehead lines before and after treatment in practice and clinical studies.

OBJECTIVE

To describe the development and validation of the 5-point photonumeric Allergan Forehead Lines Scale.

METHODS

The Allergan Forehead Lines Scale was developed to include an assessment guide, verbal descriptors, morphed images, and real subject images for each scale grade. The clinical significance of a 1-point score difference was evaluated in a review of multiple image pairs representing varying differences in severity. Interrater and intrarater reliability was evaluated in a live-subject validation study (N = 295) completed during 2 sessions occurring 3 weeks apart.

RESULTS

A difference of ≥1 point on the scale was shown to reflect a clinically significant difference (mean [95% confidence interval] absolute score difference, 1.06 [0.91–1.21] for clinically different image pairs and 0.38 [0.26–0.51] for not clinically different pairs). Intrarater agreement between the 2 live-subject validation sessions was almost perfect (mean weighted kappa = 0.87). Interrater agreement was almost perfect during the second rating session (0.86, primary end point).

CONCLUSION

The Allergan Forehead Lines Scale is a validated and reliable scale for physician rating of static horizontal forehead lines.
Development and Validation of a Photonumeric Scale for Evaluation of Infraorbital Hollows
Authors: Donofrio Lisa , Carruthers Jean , Hardas Bhushan , Murphy Diane K. , Jones Derek , Sykes Jonathan M. , Carruthers Alastair , Creutz Lela , Marx Ann , Dill Sara
Published: September 2016

BACKGROUND

A validated scale is needed for objective and reproducible comparisons of infraorbital hollows (i.e., tear troughs) before and after treatment in practice and clinical studies.

OBJECTIVE

To describe the development and validation of the 5-point photonumeric Allergan Infraorbital Hollows Scale.

METHODS

The scale was developed to include an assessment guide, verbal descriptors, morphed images, and real subject images for each grade. The clinical significance of a 1-point score difference was evaluated in a review of image pairs representing varying differences in severity. Interrater and intrarater reliability was evaluated in a live-subject validation study (N = 297) completed during 2 sessions occurring 3 weeks apart.

RESULTS

A score difference of ≥1 point was shown to reflect a clinically significant difference (mean [95% confidence interval] absolute score difference, 0.90 [0.79–1.02] for clinically different image pairs and 0.33 [0.19–0.46] for not clinically different pairs). Intrarater agreement between the 2 validation sessions was substantial (mean weighted kappa = 0.79). Interrater agreement was substantial during the second rating session (0.70, primary end point).

CONCLUSION

The Allergan Infraorbital Hollows Scale is a validated and reliable scale for physician rating severity of hollowing in the infraorbital area.
Incidence and Clinical Features of Rare Cutaneous Malignancies in Olmsted County, Minnesota, 2000 to 2010
Authors: Tolkachjov Stanislav N. , Schmitt Adam R. , Muzic John G. , Weaver Amy L. , Baum Christian L.
Published: September 2016

BACKGROUND

The incidence of rare cutaneous malignancies is unknown. Current estimates of rare cutaneous malignancy incidences are based on broad epidemiologic data or single institution experiences, not population-based data.

OBJECTIVE

To determine the incidence of several rare nonmelanoma skin cancers.

MATERIALS AND METHODS

The authors conducted a retrospective chart review of a population-based cohort between the years 2000 and 2010. Residents of Olmsted County, Minnesota, who were diagnosed with a biopsy-proven nonmelanoma skin cancer—excluding basal cell carcinoma and squamous cell carcinoma—were included in this study. The primary outcome was tumor incidence. Additionally, the authors extracted patient demographics, tumor characteristics, treatment modalities, and outcomes.

RESULTS

The age-adjusted and sex-adjusted incidences per 100,000 persons of multiple rare cutaneous malignancies were: atypical fibroxanthoma (1.8), sebaceous carcinoma (0.8), dermatofibrosarcoma protuberans (0.4), microcystic adnexal carcinoma (0.7), eccrine carcinoma (0.4), eccrine porocarcinoma (0.2), and leiomyosarcoma (0.2).

CONCLUSION

The authors report population-based incidences and clinical characteristics for these rare cutaneous malignancies. The immune status and smoking status of patients and the treatment and outcomes of these tumors are reported. Additional studies in a broader population are needed to further define the epidemiology and outcomes of these malignancies.
The Effect of Chronic Activation of the Novel Endocannabinoid Receptor GPR18 on Myocardial Function and Blood Pressure in Conscious Rats
Authors: Matouk Asmaa I. , Taye Ashraf , El-Moselhy Mohamed A. , Heeba Gehan H. , Abdel-Rahman Abdel A.
Published: September 2016

Although acute activation of the novel endocannabinoid receptor GPR18 causes hypotension, there are no reports on GPR18 expression in the heart or its chronic modulation of cardiovascular function. In this study, after demonstrating GPR18 expression in the heart, we show that chronic (2 weeks) GPR18 activation with its agonist abnormal cannabidiol (abn-cbd; 100 µg·kg−1·d−1; i.p) produced hypotension, suppressed the cardiac sympathetic dominance, and improved left ventricular (LV) function (increased the contractility index dp/dtmax and reduced LV end-diastolic pressure, LVEDP) in conscious rats. Ex vivo studies revealed increased: (1) cardiac and plasma adiponectin (ADN) levels; (2) vascular (aortic) endothelial nitric oxide synthase (eNOS) expression, (3) vascular and serum nitric oxide (NO) levels; (4) myocardial and plasma cyclic guanosine monophosphate (cGMP) levels; (5) phosphorylation of myocardial protein kinase B (Akt) and extracellular signal regulated kinase 1/2 (ERK1/2) along with reduced myocardial reactive oxygen species (ROS) in abn-cbd treated rats. These biochemical responses contributed to the hemodynamic responses and were GPR18-mediated because concurrent treatment with the competitive GPR18 antagonist (O-1918) abrogated the abn-cbd-evoked hemodynamic and biochemical responses. The current findings present new evidence for a salutary cardiovascular role for GPR18, mediated, at least partly, via elevation in the levels of adiponectin.
UNILATERAL BEST DISEASE: A CASE REPORT
Authors: Kaden Talia R. , Tan Anna C. S. , Feiner Leonard , Freund K. Bailey
Published: September 2016

Purpose:

To describe the multimodal imaging findings observed unilaterally in a patient with Best disease due to a p.G15D mutation in the BEST1 gene.

Methods:

The clinical history of a 62-year-old female patient with unilateral Best disease was reviewed. Retinal findings were documented by clinical examination and multimodal imaging.

Results:

Posterior segment examination of the patient's right eye demonstrated retinal pigment epithelium hypopigmentation and clumping in the central macula beneath a chronic shallow serous retinal detachment (SRD), confirmed by optical coherence tomography. Fluorescein angiography showed central staining with no evidence of focal leakage or choroidal neovascularization, and correlated with the hypoautofluorescence seen on fundus autofluorescence. There was no evidence of choroidal hyperpermeability on indocyanine green angiography, nor was there any neovascularization detected on optical coherence tomography–angiography. The left eye appeared normal with all imaging modalities.

Conclusion:

Best disease is an autosomal dominant disease that is generally bilateral. We present a case of a unilateral Best disease with serous retinal detachment in a patient with a p.G15D mutation in BEST1. Best disease should be considered in the differential diagnosis of serous retinal detachment and may masquerade as central serous chorioretinopathy.
Heat Generation in Axial and Centrifugal Flow Left Ventricular Assist Devices
Authors: Yost Gardner , Joseph Christine Rachel , Royston Thomas , Tatooles Antone , Bhat Geetha
Published: September 2016

Despite increasing use of left ventricular assist devices (LVADs) as a surgical treatment for advanced heart failure in an era of improved outcomes with LVAD support, the mechanical interactions between these pumps and the cardiovascular system are not completely understood. We utilized an in vitro mock circulatory loop to analyze the heat production incurred by operation of an axial flow and centrifugal flow LVAD. A HeartMate II and a HeartWare HVAD were connected to an abbreviated flow loop and were implanted in a viscoelastic gel. Temperature was measured at the surface of each LVAD. Device speed and fluid viscosity were altered and, in the HeartMate II, as artificial thrombi were attached to the inflow stator, impeller, and outflow stator. The surface temperatures of both LVADs increased in all trials and reached a plateau within 80 minutes of flow initiation. Rate of heat generation and maximum system temperature were greater when speed was increased, when viscosity was increased, and when artificial thrombi were attached to the HeartMate II impeller. Normal operation of these two widely utilized LVADs results in appreciable heat generation in vitro. Increased pump loading resulted in more rapid heat generation, which was particularly severe when a large thrombus was attached to the impeller of the HeartMate II. While heat accumulation in vivo is likely minimized by greater dissipation in the blood and soft tissues, focal temperature gains with the pump housing of these two devices during long-term operation may have negative hematological consequences.
Validation of Macular Choroidal Thickness Measurements from Automated SD-OCT Image Segmentation
Authors: Twa Michael D. , Schulle Krystal L. , Chiu Stephanie J. , Farsiu Sina , Berntsen David A.
Published: September 2016

Purpose

Spectral domain optical coherence tomography (SD-OCT) imaging permits in vivo visualization of the choroid with micron-level resolution over wide areas and is of interest for studies of ocular growth and myopia control. We evaluated the speed, repeatability, and accuracy of a new image segmentation method to quantify choroid thickness compared to manual segmentation.

Methods

Two macular volumetric scans (25 × 30°) were taken from 30 eyes of 30 young adult subjects in two sessions, 1 hour apart. A single rater manually delineated choroid thickness as the distance between Bruch’s membrane and sclera across three B-scans (foveal, inferior, and superior-most scan locations). Manual segmentation was compared to an automated method based on graph theory, dynamic programming, and wavelet-based texture analysis. Segmentation performance comparisons included processing speed, choroid thickness measurements across the foveal horizontal midline, and measurement repeatability (95% limits of agreement (LoA)).

Results

Subjects were healthy young adults (n = 30; 24 ± 2 years; mean ± SD; 63% female) with spherical equivalent refractive error of −3.46 ± 2.69D (range: +2.62 to −8.50D). Manual segmentation took 200 times longer than automated segmentation (780 vs. 4 seconds). Mean choroid thickness at the foveal center was 263 ± 24 μm (manual) and 259 ± 23 μm (automated), and this difference was not significant (p = 0.10). Regional segmentation errors across the foveal horizontal midline (±15°) were ≤9 μm (median) except for nasal-most regions closest to the nasal peripapillary margin—15 degrees (19 μm) and 12 degrees (16 μm) from the foveal center. Repeatability of choroidal thickness measurements had similar repeatability between segmentation methods (manual LoA: ±15 μm; automated LoA: ±14 μm).

Conclusions

Automated segmentation of SD-OCT data by graph theory and dynamic programming is a fast, accurate, and reliable method to delineate the choroid. This approach will facilitate longitudinal studies evaluating changes in choroid thickness in response to novel optical corrections and in ocular disease.
Descemet’s Membrane Detachment with Schisis Induced by Phacoemulsification
Authors: Xie Wenjia , Xu Yesheng , Yao Yu-Feng
Published: September 2016

Purpose

To describe a case of Descemet’s membrane detachment and schisis (Descemet’s membrane separated into multiple layers) with confirmation by high-definition anterior segment optical coherence tomography (AS-OCT) after phacoemulsification and intraocular lens implantation.

Case Report

A 72-year-old woman presented with persistent corneal edema after phacoemulsification. She was diagnosed with herpes simplex keratitis and had been unsuccessfully treated for 60 days in her local hospital. Slit-lamp examination revealed moderate conjunctival injection, disciform-like stromal edema, and diffuse superficial punctate epithelial erosions. Descemet’s membrane schisis and detachment with an interlayer tear were verified by high-definition AS-OCT. After 2 weeks of medication with topical 0.1% fluorometholone eye drops four times daily together with 3% ofloxacin eye ointment twice daily, Descemet’s membrane was reattached with complete resolution of conjunctival injection, corneal edema, and epithelial erosions.

Conclusions

This is a report of Descemet’s membrane schisis in vivo that is documented and confirmed by high-definition AS-OCT. Descemet’s membrane detachment and schisis caused by phacoemulsification can be misdiagnosed as herpetic keratitis due to stromal edema and epithelial erosion. Topical steroid and lubrication may help reattach Descemet’s membrane to its original position.
Evaluation and Management of Acute-Onset Hemiparesis in an Adolescent With Leukemia
Authors: Subrahmanian Krishnan N. , Shim Young H. , Shah Mona D. , Tran Brandon H. , Stevens Alexandra M. , Cruz Andrea T.
Published: September 2016

Emergency departments (EDs) are alert to the possibility of stroke and the need for early interventions to improve long-term clinical outcomes. However, new-onset hemiparesis in pediatric patients with leukemia may be due to a number of different etiologies, including most common side effects from chemotherapeutic agents. We present a case of a 15-year-old boy with pre-B acute lymphoblastic leukemia on chemotherapy, having recently received a high-dose methotrexate infusion in addition to intrathecal methotrexate therapy, who presented to our ED with acute right-sided hemiparesis. He was initially suspected as having a possible ischemic stroke. Magnetic resonance imaging (diffusion-weighted and fluid-attenuated inversion recovery sequence) demonstrated focal areas of diffusion restriction, an early sign of delayed-onset methotrexate neurotoxicity. Our patient received appropriate supportive care and leucovorin rescue with gradual clinical recovery, after a prolonged hospitalization and acute care rehabilitation over the course of several months. Our case illustrates the need for ED providers to consider methotrexate neurotoxicity in pediatric oncology patients presenting with acute neurologic changes.
Profile of Interfacility Emergency Department Transfers
Authors: Li Joyce , Pryor Stephanie , Choi Ben , Rees Chris A. , Senthil Mamata V. , Tsarouhas Nicholas , Myers Sage R. , Monuteaux Michael C. , Bachur Richard G.
Published: September 2016

Objectives

The aim of this study was to determine the reasons for pediatric emergency department (ED) transfers and the professional characteristics of transferring providers.

Methods

We performed a multicenter, cross-sectional survey of ED medical providers transferring patients younger than 18 years to 1 of 4 tertiary care children's hospitals. Referring providers completed surveys detailing the primary reasons for transfer and their medical training.

Results

The survey data were collected for 25 months, during which 641 medical providers completed 890 surveys, with an overall response rate of 25%. Most pediatric patients were seen by physicians (89.4%) with predominantly general emergency medicine training (64.2%). The median age of patients seen was 5.6 years. The 3 most common diagnoses were closed extremity fracture (12.2%), appendicitis (11.6%), and pneumonia (3.7%). The 3 most common reasons for transfer were need for medical/surgical subspecialist consultation (62.6%), admission to the inpatient unit (17.1%), and admission to the intensive care unit (6.5%). When asked about the need for supportive pediatric services, referring providers ranked pediatric subspecialty and pediatric inpatient unit availability as the highest.

Conclusions

Most pediatric interfacility ED transfers are referred by general emergency medicine physicians who often transfer for inpatient admission or subspecialty consultation. Understanding the needs of the community-based ED providers is an important step to forming more collaborative efforts for regionalized pediatric emergency care.
Unilateral Lung Whiteout in Children
Authors: Iwama Itaru , Kohama Moriyasu
Published: September 2016

Unilateral lung whiteout is not a common pediatric chest radiograph finding, but when it is encountered, timely and accurate interpretations of the radiograph are required because life-threatening respiratory failure can be associated. Lung whiteout may result from several conditions, and the differential diagnosis has a broad range. We describe 4 pediatric patients with different etiologies of unilateral lung whiteout: a large pleural effusion, mainstem bronchial plugging with a large cast, a mediastinal tumor, and consolidation. The ultimate causal diagnosis may not be initially obvious, but valuable clues can usually be found in the conventional chest radiograph to assist with appropriate early management. Chest ultrasound provides additional information, and we recommend it as the second examination for such patients.
Virtual Sensorimotor Training for Balance: Pilot Study Results for Children With Fetal Alcohol Spectrum Disorders
Authors: Jirikowic Tracy , Westcott McCoy Sarah , Price Robert , Ciol Marcia A. , Hsu Lin-Ya , Kartin Deborah
Published: September 2016

Purpose:

To examine the effects of Sensorimotor Training to Affect Balance, Engagement, and Learning (STABEL), a virtual reality system to train sensory adaptation for balance control, for children with fetal alcohol spectrum disorders (FASDs).

Methods:

Twenty-three children with FASDs received STABEL training in a university laboratory, or home, or were controls. The Movement Assessment Battery for Children–2nd edition (MABC-2) and Pediatric Clinical Test of Sensory Interaction for Balance–2 (P-CTSIB-2) were analyzed by group (lab, home, and control), session (pre-STABEL, 1 week post-STABEL, and 1 month post-STABEL), and group-by-session interaction.

Results:

Significant effects were group and session for MABC-2 Balance and interaction for MABC-2 Total Motor and P-CTSIB-2.

Conclusion:

Preliminary results support improved sensory adaptation, balance, and motor performance post-STABEL, which warrant further study with a larger, randomized sample.
Factors Related to the Changes in Quality of Life for Patients With Depression After an Acute Course of Electroconvulsive Therapy
Authors: Huang Chun-Jen , Huang Yu-Hui , Lin Ching-Hua
Published: September 2016

Objective

The aim of this study was to examine the effect of electroconvulsive therapy (ECT) on quality of life (QOL), depressive symptoms, and functioning for patients with depression, and to explore the variables related to QOL changes.

Methods

Ninety-five inpatients with depression receiving at least 6 ECT sessions and completed all measures were included. Quality of life, symptom severity, and functioning were assessed using Short Form 36 (SF-36), the 17-item Hamilton Rating Scale for Depression (HAMD-17), and the Modified Work and Social Adjustment Scale (MWSAS), before and after ECT. The SF-36 includes 8 subscales, physical component summary (PCS), and mental component summary (MCS). Adverse effects after ECT, including headache, muscle pain, and nausea/vomiting, were also recorded.

Results

All 8 SF-36 subscales, PCS, MCS, HAMD-17, and MWSAS improved significantly after treatment. Using multiple linear regression analysis, MWSAS changes predicted PCS changes significantly after adjusting for baseline PCS. Similarly, using multiple linear regression analysis, MWSAS changes were significant variables associated with MCS changes after adjusting for ECT frequency, HAMD-17 changes, and baseline MCS. The ECT improved QOL, depressive symptoms, and functioning.

Conclusions

Whether strategies to enhance functioning during an acute course of ECT could improve QOL is needed to be examined in a further study.
Knock-In of a 25-Kilobase Pair BAC-Derived Donor Molecule by Traditional and CRISPR/Cas9-Stimulated Homologous Recombination
Authors: Leidy-Davis Tiffany , Cheng Kai , Goodwin Leslie O. , Morgan Judith L. , Juan Wen Chun , Roca Xavier , Ong Sin-Tiong , Bergstrom David E.
Published: September 2016

Here, we describe an expansion of the DNA size limitations associated with CRISPR knock-in technology, more specifically, the physical extent to which mouse genomic DNA can be replaced with donor (in this case, human) DNA at an orthologous locus. Driving our efforts was the desire to create a whole animal model that would replace 17 kbp of the mouseBcl2l11gene with the corresponding 25-kbp segment of humanBCL2L11, including a conditionally removable segment (2.9-kbp) of intron 2, a cryptic human exon immediately 3′ of this, and a native human exon some 20 kbp downstream. Using two methods, we first carried out the replacement by employing a combination of bacterial artificial chromosome recombineering, classic ES cell targeting, dual selection, and recombinase-driven cassette removal (traditional approach). Using a unique second method, we employed the same vector (devoid of its selectable marker cassettes), microinjecting it along with CRISPR RNA guides andCas9into mouse zygotes (CRISPR approach). In both instances we were able to achieve humanization ofBcl2l11to the extent designed, remove all selection cassettes, and demonstrate the functionality of the conditionally removable,loxP-flanked, 2.9-kbp intronic segment.

AUTHOR SUMMARY

Clustered regularly interspaced short palindromic repeat (CRISPR) technology can be used to place DNA sequences (designed in the laboratory) into the genomes of living organisms. Here, we describe a new method, whereby we have replaced an exceptionally large segment of the mouseBcl2l11gene with the corresponding segment of humanBCL2L11gene. The method represents an expansion of the DNA size limitations typically associated with the introduction of DNA sequences through traditional CRISPR methods.
Using RNA-seq for genomic scaffold placement, correcting assemblies, and genetic map creation in a commonBrassica rapamapping population
Authors: Cody Markelz RJ , Covington Michael F , Brock Marcus T , Devisetty Upendra K , Kliebenstein Daniel J , Weinig Cynthia , Maloof Julin N
Published: September 2016

Brassica rapais a model species for agronomic, ecological, evolutionary and translational studies. Here we describe high-density SNP discovery and genetic map construction for aBrassica raparecombinant inbred line (RIL) population derived from field collected RNA-seq data. This high-density genotype data enables the detection and correction of putative genome mis-assemblies and accurate assignment of scaffold sequences to their likely genomic locations. These assembly improvements represent 7.1-8.0% of the annotatedBrassica rapagenome. We demonstrate how using this new resource leads to a significant improvement for QTL analysis over the current low-density genetic map. Improvements are achieved by the increased mapping resolution and by having known genomic coordinates to anchor the markers for candidate gene discovery. These new molecular resources and improvements in the genome annotation will benefit theBrassicaceaegenomics community and may help guide other communities in finetuning genome annotations.
SiLiCO: A Simulator of Long Read Sequencing in PacBio and Oxford Nanopore
Authors: Baker Ethan Alexander García , Goodwin Sara , McCombie W. Richard , Mendivil Ramos Olivia
Published: September 2016

Long read sequencing platforms, which include the widely used Pacific Biosciences (PacBio) platform and the emerging Oxford Nanopore platform, aim to produce sequence fragments in excess of 15-20 kilobases, and have proved advantageous in the identification of structural variants and easing genome assembly. However, long read sequencing remains relatively expensive and error prone, and failed sequencing runs represent a significant problem for genomics core facilities. To quantitatively assess the underlying mechanics of sequencing failure, it is essential to have highly reproducible and controllable reference data sets to which sequencing results can be compared. Here, we present SiLiCO, the firstin silicosimulation tool to generate standardized sequencing results from both of the leading long read sequencing platforms.

Availability

SiLiCO is an open source package written in Python. It is freely available athttps://www.github.com/ethanagbaker/SiLiCOunder the GNU GPL 3.0 license.

Contact

Supplementary information

Supplementary data are available atBioinformaticsonline.
The Identification of a 1916 Irish Rebel: New Approach for Estimating Relatedness From Low Coverage Homozygous Genomes
Authors: Fernandes Daniel , Sirak Kendra , Novak Mario , Finarelli John , Byrne John , Connolly Edward , Carlsson Jeanette EL , Ferretti Edmondo , Pinhasi Ron , Carlsson Jens
Published: September 2016

Thomas Kent was an Irish rebel who was executed by British forces in the aftermath of the Easter Rising armed insurrection of 1916 and buried in a shallow grave on Cork prison's grounds. In 2015, ninety-nine years after his death, a state funeral was offered to his living family to honor his role in the struggle for Irish independence. However, inaccuracies in record keeping did not allow the bodily remains that supposedly belonged to Kent to be identified with absolute certainty. Using a novel approach based on homozygous single nucleotide polymorphisms, we identified these remains to be those of Kent by comparing his genetic data to that of two known living relatives. As the DNA degradation found on Kent's DNA, characteristic of ancient DNA, rendered traditional methods of relatedness estimation unusable, we forced all loci homozygous, in a process we refer to as “forced homozygote approach”. The results were confirmed using simulated data for different relatedness classes. We argue that this method provides a necessary alternative for relatedness estimations, not only in forensic analysis, but also in ancient DNA studies, where reduced amounts of genetic information can limit the application of traditional methods.
Harnessing Big Data for Systems Pharmacology
Authors: Xie Lei , Draizen Eli J. , Bourne Philip E.
Published: September 2016

Systems pharmacology aims to holistically understand genetic, molecular, cellular, organismal, and environmental mechanisms of drug actions through developing mechanistic or predictive models. Data-driven modeling plays a central role in systems pharmacology, and has already enabled biologists to generate novel hypotheses. However, more is needed. The drug response is associated with genetic/epigenetic variants and environmental factors, is coupled with molecular conformational dynamics, is affected by possible off-targets, is modulated by the complex interplay of biological networks, and is dependent on pharmacokinetics. Thus, in order to gain a comprehensive understanding of drug actions, systems pharmacology requires integration of models across data modalities, methodologies, organismal hierarchies, and species. This imposes a great challenge on model management, integration, and translation. Here, we discuss several upcoming issues in systems pharmacology and potential solutions to them using big data technology. It will allow systems pharmacology modeling to be findable, accessible, interoperable, reusable, reliable, interpretable, and actionable.
X-ray multi-beam resonant diffraction analysis of crystal symmetry for layered perovskite YBaCuFeO5
Authors: Liu Wen-Chung , Zheng Yu-Zhan , Chih Yu-Chieh , Lai Yen-Chung , Tsai Yi-Wei , Zheng Yan-Zong , Du Chao-Hung , Chou Fang-Cheng , Soo Yun-Liang , Chang Shih-Lin
Published: September 2016

The open question of crystal symmetry for YBaCuFeO5, still under debate, is resolved by using diffraction anomalous fine structure and resonant multi-beam X-ray diffraction at the Fe and Cu K edges. The different asymmetric intensity distributions observed at 7, 7.1305 and 8.9945 keV give direct evidence that the space group of YBaCuFeO5 should be P4/mmm with the distance between Cu and apical O atoms longer than that between Fe and O atoms. This approach provides a direct way to resolve detailed structural symmetry which is indeterminate in conventional Bragg diffraction.
(E)-N,N′-(1,2-Dicyanoethene-1,2-diyl)dipicolinamide
Authors: Posel Maciej , Stoeckli-Evans Helen
Published: September 2016

The whole molecule of the title dicyanoethene derivative, C16H10N6O2, is generated by inversion symmetry. The conformation about the central C=C bond, which is situated about the inversion center, isE. There are short intramolecular N—H...N contacts present and the molecule is slightly twisted, with the plane of the amide C(=O)N group being inclined to the pyridine ring by 10.6 (4)°, and by 20.2 (4)° to the plane of the dicyanoethene unit (N[triple-bond]C—C=C—C[triple-bond]N). In the crystal, molecules are linked by C—H...O and C—H...N hydrogen bonds, forming sheets parallel to (1-21), enclosingR22(10),R22(22) andR44(22) ring motifs.