bluuebunny/crossref_metadata_2025 huggingface dataset:
Behaviors of Ce, Pr, and Nd in liquid cesium by ab initio molecular dynamics simulations
Authors: Li Xiang , Zhang Jinsuo , Unal Cetin , Mariani Robert D.
Published: October 2018

The fuel cladding chemical interaction (FCCI) phenomenon is potentially the main factor restricting the application of metallic fuels in liquid sodium cooled fast reactors. The understanding of the lanthanide (Ln) transport behaviors in liquid Cs filled pores in U-Zr fuel is essential for understanding FCCIs. By using ab initio molecular dynamics, fundamental properties of the metallic system Cs-Ln, such as density of states and coordination number, have been studied. Then, the Ln diffusivities in liquid cesium and the solution viscosity were calculated. For validating the model, the viscosity of the pure liquid Cs which has been well measured is also calculated at three temperatures, which indicates the present model has a high accuracy in calculation of viscosity and self-diffusivity of Cs in liquid Cs.
Effects of annealing with CO and CO2 molecules on oxygen vacancy defect density in amorphous SiO2 formed by thermal oxidation of SiC
Authors: Chokawa Kenta , Araidai Masaaki , Shiraishi Kenji
Published: October 2018

SiO2 formed by the thermal oxidation of SiC has numerous defects, and the stoichiometry of the SiO2 near the SiC/SiO2 interface differs from that of SiO2 near the Si/SiO2 interface. We assume that, during the oxidation of SiC, CO and CO2 molecules are released, and that these molecules interact with the SiO2 and form defects. Considering the Gibbs free energy of these molecules, we found that CO molecules reduce part of the amorphous SiO2 at high temperatures, resulting in the formation of oxygen vacancy defects concomitant with the formation of CO2 molecules. In particular, when the partial pressure of the CO molecules is higher than that of the CO2 molecules, the number of oxygen vacancy defects increases. This means that post-oxidation annealing with CO molecules induces defects and degrades the breakdown field of SiO2. On the other hand, when the partial pressure of the CO2 molecules is larger than that of the CO molecules, reduction by the CO molecules does not occur, and the CO2 molecules can oxidize oxygen vacancy defects in SiO2. This means that post-oxidation annealing with CO2 molecules enables recovery of the oxygen vacancy defects and improves the breakdown field and flatband shift of SiO2 gate dielectrics. Accordingly, it is possible to reduce the formation of oxygen vacancies in amorphous SiO2 by performing post-oxidation annealing in a CO2 gas ambient.
An analog magnon adder for all-magnonic neurons
Authors: Brächer T. , Pirro P.
Published: October 2018

Spin-waves are excellent data carriers with a perspective use in neuronal networks: Their lifetime gives the spin-wave system an intrinsic memory, they feature strong nonlinearity, and they can be guided and steered through extended magnonic networks. In this work, we present a magnon adder that integrates over incoming spin-wave pulses in an analog fashion. Such an adder is a linear prequel to a magnonic neuron, which would integrate over the incoming pulses until a certain nonlinearity is reached. In this work, the adder is realized by a resonator in combination with a parametric amplifier which is just compensating the resonator losses.
Invited Article: Digital refocusing in quantitative phase imaging for flowing red blood cells
Authors: Park Han Sang , Ceballos Silvia , Eldridge Will J. , Wax Adam
Published: October 2018

Quantitative phase imaging (QPI) offers high optical path length sensitivity, probing nanoscale features of live cells, but it is typically limited to imaging just few static cells at a time. To enable utility as a biomedical diagnostic modality, higher throughput is needed. To meet this need, methods for imaging cells in flow using QPI are in development. An important need for this application is to enable accurate quantitative analysis. However, this can be complicated when cells shift focal planes during flow. QPI permits digital refocusing since the complex optical field is measured. Here we analyze QPI images of moving red blood cells with an emphasis on choosing a quantitative criterion for digitally refocusing cell images. Of particular interest is the influence of optical absorption which can skew refocusing algorithms. Examples of refocusing of holographic images of flowing red blood cells using different approaches are presented and analyzed.
Overcoming the trade-off between exciton dissociation and charge recombination in organic photovoltaic cells
Authors: Zhang Tao , Holmes Russell J.
Published: October 2018

The electron donor-acceptor (D-A) interface is an essential component for realizing efficient exciton dissociation and charge generation in organic photovoltaic cells (OPVs). It can also however enable rapid charge recombination due to the close spatial proximity of electrons and holes. To frustrate recombination losses, attempts have been made to separate charge carriers by introducing an insulating blocking interlayer at the D-A interface. It is challenging to realize increased efficiency using this approach as the relative similarity of interlayer optical and transport energy gaps may also frustrate exciton harvesting and charge generation. To overcome this trade-off, the interlayer must block charge carriers while continuing to permit exciton migration to the dissociating interface. In this work, we demonstrate this configuration in archetypical copper phthalocyanine (CuPc)-C60 planar OPVs containing a rubrene interlayer to frustrate charge recombination. Critically, the similarity in triplet exciton energy levels between rubrene and CuPc allows the interlayer to be permeable to excitons. Devices containing an interlayer show a reduction in the charge transfer state binding energy and non-geminate recombination rate with increasing interlayer thickness. For thin interlayers, geminate recombination is also suppressed. Thus, devices containing an exciton permeable interlayer show a simultaneous increase in open-circuit voltage, short-circuit current, and power efficiency.
Modification of plasma flows in edge and SOL regions by influence of neutral gas
Authors: Bisai N. , Banerjee Santanu , Sangwan Deepak
Published: October 2018

Plasma flows and their profiles in edge and scrape-off layer (SOL) regions of a tokamak plasma are important as these can modify the interchange plasma turbulence. These flows have been investigated in the presence of neutral gas numerically using the two-dimensional model equations. A reduction of poloidal flows, radial particle, and energy fluxes has been observed in the edge and SOL regions by the presence of the neutral gas. The reduction of radial flux is due to the reduction in the radial velocity of the plasma blob. We have investigated Reynolds stress in the presence of the gas. It is found that in the presence of ion-neutral collisions, the magnitude of the stress decreases. The gas also reduces the diamagnetic drift frequency in the edge and SOL regions.
Moderation of flame acceleration in obstructed cylindrical pipes due to gas compression
Authors: Akkerman V’yacheslav , Valiev Damir
Published: October 2018

The role of gas compression in the process of extremely fast flame acceleration in obstructed cylindrical tubes is studied analytically and validated by computational simulations. This acceleration is associated with a powerful jet-flow produced by delayed burning in spaces between the obstacles. The acceleration mechanism is Reynolds-independent and conceptually laminar, with turbulence playing only a supplementary role. In this work, the incompressible formulation is extended to account for small but finite initial flame Mach number up to the first-order terms. As a result, it is shown that flame-generated compression mitigates the acceleration process noticeably. Being qualitatively the same as in two-dimensional channels, quantitatively, the effect is much stronger in cylindrical pipes, which reduces the validity domain of the incompressible cylindrical-axisymmetric formulation as compared to the incompressible two-dimensional theory. The latter is also tested when the theory is validated by the computational simulations.
Total electron scattering cross sections from thiophene for the (1-300 eV) impact energy range
Authors: Lozano A. I. , Loupas A. , Blanco F. , Gorfinkiel J. D. , García G.
Published: October 2018

Experimental electron scattering cross sections for thiophene in the impact energy range from 1 to 300 eV have been measured with a magnetically confined electron transmission-beam apparatus. Random uncertainty limits have been estimated to be less than 5%, and systematic errors derived from acceptance angle limitations have also been identified and evaluated. Experimental values are compared with our previous low energy (1-15 eV) R-matrix and intermediate/high energy (15-300 eV) IAM-SCAR+I calculations finding reasonable agreement, within the combined uncertainty limits. Some of the low energy shape and core-excited resonances predicted by previous calculations are experimentally confirmed in this study.
Self-channeling of a powerful microwave beam in a preliminarily formed plasma
Authors: Cao Y. , Leopold J. G. , Bliokh Y. P. , Krasik Ya. E.
Published: October 2018

The self-channeling of a high power (≤500 MW) sub-nanosecond microwave beam in the plasma formed by a neutral gas (>103 Pa) ionization was demonstrated by Shafir et al. [Phys. Rev. Lett. 120, 135003 (2018)]. In the present research, this effect is observed and studied in detail in a plasma, preliminarily formed by an rf discharge, in a low (<150 Pa) pressure gas. The results of analytical modeling and numerical particle-in-cell simulations show that ionization-induced channeling can be realized at a significantly lower power of the microwave beam and gas pressure if the preliminarily formed plasma is radially non-uniform with minimal on axis density.
Measurement of toroidal variation in conducted heat loads in locked mode induced disruptions on DIII-D
Authors: Hollmann E. M. , Commaux N. , Eidietis N. W. , Lasnier C. J. , Moyer R. A. , Paz-Soldan C. , Shiraki D. , Watkins J. G.
Published: October 2018

Locked mode disruptions with a controlled toroidal phase are produced in the DIII-D tokamak by locking to large non-axisymmetric applied magnetic perturbations with different toroidal phases. The disruption conducted heat loads are found to reach almost completely the divertor region, possibly due to not only strong inner leg detachment but also plasma motion and limiting on the outer divertor leg shelf. The outer leg conducted heat loads are found to have a significant toroidal variation of order ±30%, with a dominant n = 1 structure. The heat load phase is shifted from the initial locked mode phase in a way that is approximately consistent with heat loss into the scrape-off layer being enhanced at the mode island O-point outer midplane crossing. These measurements suggest that pre-existing locked modes can affect the conducted heat load structure during the thermal quench by affecting the thermal quench MHD phase. This is consistent with previous MHD simulations which indicated that pre-disruption locked mode structures can persist and survive to some degree through the large thermal quench MHD. This work complements previous work [Shiraki et al., Nucl. Fusion 55, 073029 (2015)] which showed that n = 1 structures in mitigated disruptions can create toroidal variations in the disruption radiated power.
Baseline characteristics of gay and bisexual men in a HIV pre-exposure prophylaxis demonstration project with equity quotas in Auckland, New Zealand
Authors: Saxton Peter J. W. , Azariah Sunita , Franklin Richard A. , Forster Rose F. , Werder Suzanne F. , Jenkins Renee , Myers Jason M. , Rich Joseph G. , Te Wake Whatitiri P. , Fisher Mark D.
Published: October 2018

Background
In New Zealand, pre-exposure prophylaxis (PrEP) should target gay and bisexual men (GBM), and equity is an important principle. Baseline characteristics of GBM offered PrEP in a demonstration project with an enrolment quota of 50% non-Europeans are described. Methods: An open-label, single-arm treatment evaluation study design (‘NZPrEP’) was used. The settings were four publicly funded sexual health clinics in Auckland in 2017. The study population was 150 GBM recruited from clinics, community sources and social media. Participants self-completed an online questionnaire about PrEP awareness, attitudes and sexual risk behaviour in the last 3 months. Baseline characteristics are described and examined to determine whether these were associated with PrEP initiation status (self-referral vs doctor/nurse recommendation). Results: In total, 150 GBM of whom half (52%) were non-European, including 21.3% Maori, 19.3% Asian and 8.7% Pacific, were enrolled into the study. Two-thirds (65.3%) self-referred for PrEP and one-third (34.7%) were recommended PrEP by the doctor/nurse. Participants reported a high number of male condomless receptive anal intercourse partners (MenAICLR) (median 3, range 0–50), with 10% reporting 10 or more MenAICLR and 45.3% reporting group sex. In the previous year, 65.3% had a sexually transmissible infection (STI); 18% had rectal chlamydia or gonorrhoea at enrolment. Almost half (47.7%) had recently used drugs with sex, including 8.1% who used methamphetamine. Participants recommended PrEP had lower education, lived less centrally and had a higher STI prevalence than PrEP self-referrers, but their risk behaviour was similar. Conclusions: Early PrEP adopters in New Zealand have high HIV risk. Demonstration projects should consider equity mechanisms so that minorities can participate meaningfully.
Education can reduce health differences related to genetic risk of obesity
Authors: Barcellos Silvia H. , Carvalho Leandro S. , Turley Patrick
Published: October 2018

This work investigates whether genetic makeup moderates the effects of education on health. Low statistical power and endogenous measures of environment have been obstacles to the credible estimation of such gene-by-environment interactions. We overcome these obstacles by combining a natural experiment that generated variation in secondary education with polygenic scores for a quarter-million individuals. The additional schooling affected body size, lung function, and blood pressure in middle age. The improvements in body size and lung function were larger for individuals with high genetic predisposition to obesity. As a result, education reduced the gap in unhealthy body size between those in the top and bottom terciles of genetic risk of obesity from 20 to 6 percentage points.
Structural characterization of the D290V mutation site in hnRNPA2 low-complexity–domain polymers
Authors: Murray Dylan T. , Zhou Xiaoming , Kato Masato , Xiang Siheng , Tycko Robert , McKnight Steven L.
Published: October 2018

Significance

Genetic studies have shown that mutations of conserved Asp residues in three analogous heterogeneous ribonucleoproteins are causative of three neurological diseases. All three Asp residues map to domains of low complexity (LC) or intrinsic disorder. These domains form labile self-associated polymers as normal functional states, and the mutations abnormally enhance the stability of the polymers via heretofore unknown mechanisms. The present study gives evidence that the charged Asp residues are closely aligned in the polymer core and removal of electrostatic repulsion enhances polymer stability. These results may provide insight into other neurodegenerative diseases also caused by mutations in LC domains.
Enhanced dynamic nuclear polarization via swept microwave frequency combs
Authors: Ajoy A. , Nazaryan R. , Liu K. , Lv X. , Safvati B. , Wang G. , Druga E. , Reimer J. A. , Suter D. , Ramanathan C. , Meriles C. A. , Pines A.
Published: October 2018

Significance

Dynamic nuclear polarization (DNP) can lead to rapidly accelerated NMR spectroscopy and MRI imaging via significant magnetic resonance signal gains. We develop a technique of microwave frequency comb DNP that is especially suited to broad-spectrum electron radicals widely used for DNP in a variety of contexts. The frequency comb allows one to overcome the bottleneck set by slow electron sweeps, increasing the effective number of polarization transfer events and resulting in a multiplicative gain in DNP signal enhancement. We demonstrate the technique by increasing the DNP enhancement from 30 to 100 measured with respect to the thermal signal at 7T in powdered diamond with optically polarizable defect centers and discuss its applications more widely for a variety of DNP radicals.
The new struggles of precarious workers in South Africa: nascent organisational responses of community health workers
Authors: Hlatshwayo Mondli
Published: October 2018

Based on in-depth interviews largely with women working as community health workers (CHWs) and documents, the article shines the spotlight on CHWs, who remain a blind spot in the literature on South African labour studies. Abandoned by mainstream unions and often ignored by labour scholars, the article reveals that CHW workers are crafting their own nascent organisational responses as women and as precarious workers to their conditions. New organisational responses led by women who carry most of the social and economic burden are beginning to contest their conditions of precariousness by using tools such as strikes.
The rise of oligarchy in Ethiopia: the case of wealth creation since 1991
Authors: Gebregziabher Tefera Negash , Hout Wil
Published: October 2018

This article focuses on the political economy of Ethiopia since the ruling party EPRDF came to power in 1991 and argues that the country has seen the rise of oligarchy during this period. The party claims that its development strategy has reduced poverty, but it is evident that the country’s inequality has been growing in the past decade. The briefing identifies the mechanisms of oligarchisation, most notably privatisation, land expropriation, phoney shareholding and corruption. The conclusion is that Ethiopia’s growing inequality is related to the process of oligarchy formation.
Creating Multiple Seasons Spatial Model (Maps) to Improve and Habilitate the Marshes Area in Southern Iraq
Authors: Meki Jassim Ameera , Ahamad Mohd Sanusi S.
Published: October 2018

Climate factors are one of the main criterion in the study of any area especially for sustainable development goals. The year in Iraq has four seasons. The important climate factors for the marshes area in Southern Iraq are the temperature, the rainfall, the wind speed and the humidity. This research explained the composition (creating) of 24 climate maps representing the dynamic climate factors for the four seasons experienced by the marshes area in Southern Iraq that is located in three governorates, i.e. Missan, Thi-Qar and Basra. The methodology applies the spatial Interpolation Method using the GIS - IDRISI software. The climate maps of a particular area can be used for multi - purpose study either for development or for preparing a project such as ecotourism. Their capability in dynamic mapping and analysis are one of the most useful applications of GIS for sustainable environmental planning and management. The GIS spatial analytical technique applied in this study can reduce time and cost by 20 - 30 % compared to traditional methods. The created dynamic climate maps for each required climate factor are in high resolution (36m x 32m) pixel. In addition, this method of obtaining climate factors values is the ideal and one of few methods in difficult areas where there are mountains, forests…etc. or in dangerous areas which have such as predators, remnants of war…etc.
Impact of Hepatitis B Virus Coinfection on Human T-Lymphotropic Virus Type 1 Clonality in an Indigenous Population of Central Australia
Authors: Turpin Jocelyn , Yurick David , Khoury Georges , Pham Hai , Locarnini Stephen , Melamed Anat , Witkover Aviva , Wilson Kim , Purcell Damian , Bangham Charles R M , Einsiedel Lloyd
Published: October 2018

Human T-cell lymphotropic virus type 1 (HTLV-1) and hepatitis B virus coinfection is frequent in certain Indigenous Australian populations, but its outcome remains unknown. We report a higher degree of HTLV-1 clonal expansion than in those with HTLV-1 alone.
Trunk Disease Fungi Associated withSyzygium cuminiin Iran
Authors: Panahandeh Saleh , Mohammadi Hamid , Gramaje David
Published: October 2018

Syzygium cumini trees with dieback symptoms and cankers were observed in two provinces in Iran. Isolations were made from diseased branches and cankers and from asymptomatic S. cumini wood samples. Several trunk disease pathogens were identified based on morphological characteristics and by molecular methods, including Cadophora luteo-olivacea, Diplodia sapinea, D. seriata, Neoscytalidium hyalinum, Phaeoacremonium fraxinopennsylvanicum, P. krajdenii, P. parasiticum, P. viticola, and Pleurostoma richardsiae, which were isolated from S. cumini for the first time in the world. Pathogenicity tests conducted with all species confirmed their status as possible S. cumini pathogens. N. hyalinum was the most aggressive species and caused the longest lesions on inoculated shoots. The endophytic character of some fungal species isolated from asymptomatic wood of S. cumini is further discussed. Our results indicated that S. cumini is a new woody host to many known fungal trunk pathogens.
The Importance of Selecting Appropriate Rotation and Tank-Mix Partners for Novel SDHIs to Enhance Botrytis Fruit Rot Control in Strawberry
Authors: Amiri Achour , Zuniga Adrian I. , Cordova Leandro G. , Peres Natalia A.
Published: October 2018

Botrytis fruit rot (BFR), caused by the necrotrophic fungus Botrytis cinerea, is the most important disease of strawberry and is mainly controlled by applications of fungicides from multiple chemical groups. To develop more effective and sustainable BFR management programs, field trials were conducted to evaluate the efficacy of fluopyram and penthiopyrad, two newly registered succinate dehydrogenase inhibitors (SDHIs), rotated or tank mixed with the multisites thiram and captan or the single-sites fludioxonil and fenhexamid. The treatments were applied at two different strawberry fields during the 2013–14 and 2014–15 seasons. Overall, tank mixtures of fluopyram and penthiopyrad increased yield and reduced BFR better than rotations with the same fungicides. The multisite thiram tank mixed with fluopyram reduced BFR incidence by 63 to 86% versus 56 to 84% when the two fungicides were rotated. Thiram tank mixed with penthiopyrad reduced BFR incidence by 55 to 72% versus 42 to 66% when rotated. Captan rotated or tank mixed with fluopyram had a positive effect on yield and BFR incidence, whereas the combination of captan with penthiopyrad had negative impacts. Similarly, the single-site fenhexamid had significant positive impacts when rotated or tank mixed with fluopyram but resulted in poor BFR control when combined with penthiopyrad. The rotation of fludioxonil with both SDHIs had a significant positive effect, although its combination with fluopyram was more effective. The multirotation consisting of both SDHIs and different multi- and single-site fungicides did not provide a greater efficacy than the dual rotation or tank-mixture programs. Our findings suggest more scrutiny is needed when recommending tank-mixture or rotation partners for new fungicides to ensure compatibility and enhanced BFR management. Future recommendations should emphasize the importance of such selections at an early stage for delaying fungicide resistance development and extending the lifespan of at-risk fungicides.
Genome-Wide Association Studies for Spot Blotch (Cochliobolus sativus) Resistance in Bread Wheat Using Genotyping-by-Sequencing
Authors: Jamil Muhammad , Ali Aamir , Gul Alvina , Ghafoor Abdul , Ibrahim Amir M. H. , Mujeeb-Kazi Abdul
Published: October 2018

Spot blotch is a severe biotic menace of wheat caused by Cochliobolus sativus (syn. Bipolaris sorokiniana). Spot blotch is liable to major yield losses in warm humid regions. A genome-wide association study using genotyping-by-sequencing (GBS) markers was conducted to identify genomic regions associated with spot blotch resistance in a diversity panel of 159 spring wheat genotypes. In total, 87,096 GBS markers covering the whole genome, with an average polymorphism information content value of 0.276, were applied. Linkage disequilibrium (LD) analysis indicated that the LD decay extent was approximately 100 Mbp. The panel was evaluated for disease severity (DS) and area under disease progress curve (AUDPC) for 2 years. In total, 24 marker-trait associations (MTA) were identified for DS and AUDPC of spot blotch, with 11 on chromosome 5B, 3 on 3A, 2 on 6B, and 1 each on 1A, 2A, 1D, 2D, 4B, 5A, 7A, and 7B. A marker on chromosome 7B significantly explained 14% of the phenotypic variation of spot blotch severity as well as 11% of AUDPC. Five markers—three on chromosome 5B, one on 3A, and one on 7B—were associated with both DS and AUDPC with R2 ranging from 8 to 12%. Significant MTA can be utilized to develop wheat germplasm with resistance to spot blotch.
Xylella fastidiosasubsp.paucaandfastidiosaColonizeArabidopsisSystemically and Induce Anthocyanin Accumulation in Infected Leaves
Authors: Pereira W. E. L. , Ferreira C. B. , Caserta R. , Melotto M. , de Souza A. A.
Published: October 2018

The bacterium Xylella fastidiosa is a multihost pathogen that affects perennial crops such as grapevine, sweet orange, and olive tree worldwide. It is inherently difficult to study these pathosystems owing to the long-term growth habit of the host plant. Thus, the availability of model plants becomes essential to accelerate discoveries with economic impact. In this study, we uncovered evidence that the model plant Arabidopsis thaliana can be colonized by two different X. fastidiosa subspecies, pauca and fastidiosa. We observed that these bacteria are able to move away from the inoculation point as high bacterial populations were found in distant tissues. In addition, confocal laser scanning microscopy analysis of bacterial movement inside the petiole revealed the ability of the bacterium to move against the net xylem flow during the time course of colonization forming biofilm. These findings provide evidence for the capacity of X. fastidiosa to colonize Arabidopsis. Furthermore, leaves inoculated with X. fastidiosa showed a significant accumulation of anthocyanin. We propose that the X. fastidiosa subsp. pauca or fastidiosa colonization pattern and anthocyanin accumulation in the Arabidopsis ecotype Col-0 can be used as marker phenotypes to facilitate further studies aimed at improving genetic components involved in X. fastidiosa−host interaction.
Genome-Wide Association Studies Identified Resistance Loci to Orange Rust and Yellow Leaf Virus Diseases in Sugarcane (Saccharum spp.)
Authors: Yang Xiping , Sood Sushma , Luo Ziliang , Todd James , Wang Jianping
Published: October 2018

Sugarcane (Saccharum spp.) supplies globally ∼80% of table sugar and 60% of bioethanol. Sugarcane orange rust and Sugarcane yellow leaf virus (SCYLV) are major sugarcane diseases, causing up to 50 and 40% yield losses, respectively. Sugarcane cultivars resistant to these diseases are needed to sustain sugarcane production in several regions. Dissecting DNA sequence variants controlling disease resistance provides a valuable tool for fulfilling a breeding strategy to develop resistant cultivars. In this study, we evaluated disease reactions to orange rust and SCYLV of a sugarcane diversity panel in repeated trials. We conducted a genome-wide association study between high-density markers and disease resistance reactions. We identified 91 putative DNA markers and 82 candidate genes significantly associated with resistance to one of the two diseases. These provide an important genetic resource for finding genes and molecular markers for disease resistance. Our results emphasized the importance of utilizing a wide germplasm collection for breeding resistant sugarcane cultivars.
Upper-Limb Morbidity in Patients Undergoing a Rehabilitation Program After Breast Cancer Surgery: A 10-Year Follow-up Study
Authors: de Carlos-Iriarte Esperanza , Mosquera-González Margarita , Alonso-García Marcos , Andrés-Prado María José , Machota-Blas Elizabeth , Hernández-García José Manuel , Rodríguez-Caravaca Gil
Published: October 2018

Objective:

To identify long-term predictive factors for upper-limb morbidity in patients who completed an early rehabilitation program after breast cancer surgery.

Material and Methods:

Prospective cohort study. The study population comprised 659 female patients who were consecutively enrolled in a rehabilitation program shortly after breast cancer surgery between April 1999 and June 2010. The rehabilitation program comprised clinical evaluation, written information on hygiene measures, aerobic exercise, and physical therapy. Variables assessed for affected and contralateral limb included circumferential measurement for lymphedema, passive range of motion in the shoulder, pain intensity using a visual analog scale, and sensory loss by the pin-prick method and tactile sensitivity. Predictive variables covered age, body mass index, regular physical activity, previous shoulder pathology, type of breast surgery, side of surgery, postsurgical complications, sentinel lymph node biopsy/axillary lymph node dissection, tumor size and histology, chemotherapy, radiotherapy, and hormonal treatment. A multivariate logistic regression analysis was performed to control for confounding factors.

Results:

The mean follow-up period was 72 months. A total of 306 patients (64.4%) showed upper-limb symptoms at some point during the follow-up period. Sensory loss and pain were the most relevant impairments. Predictive factors for shoulder and arm morbidity were obesity (odds ratio [OR] = 2.45; 95% confidence interval [CI], 1.18-5.08), previous shoulder pathology (OR = 6.05; 95% CI, 2.89-12.63), postsurgical complications (OR = 2.16; 95% CI, 1.05-4.43), and regional lymph node radiotherapy (OR = 3.42; 95% CI, 2.07-5.63).

Conclusions:

Previous shoulder pathology, postsurgical events, obesity, and site of radiotherapy were significant risk factors for developing shoulder and arm morbidity.
Educating for Indigenous Health Equity: An International Consensus Statement
Authors: Jones Rhys , Crowshoe Lynden , Reid Papaarangi , Calam Betty , Curtis Elana , Green Michael , Huria Tania , Jacklin Kristen , Kamaka Martina , Lacey Cameron , Milroy Jill , Paul David , Pitama Suzanne , Walker Leah , Webb Gillian , Ewen Shaun
Published: October 2018

The determinants of health inequities between Indigenous and non-Indigenous populations include factors amenable to medical education’s influence—for example, the competence of the medical workforce to provide effective and equitable care to Indigenous populations. Medical education institutions have an important role to play in eliminating these inequities. However, there is evidence that medical education is not adequately fulfilling this role and, in fact, may be complicit in perpetuating inequities.

This article seeks to examine the factors underpinning medical education’s role in Indigenous health inequity, to inform interventions to address these factors. The authors developed a consensus statement that synthesizes evidence from research, evaluation, and the collective experience of an international research collaboration including experts in Indigenous medical education. The statement describes foundational processes that limit Indigenous health development in medical education and articulates key principles that can be applied at multiple levels to advance Indigenous health equity.

The authors recognize colonization, racism, and privilege as fundamental determinants of Indigenous health that are also deeply embedded in Western medical education. To contribute effectively to Indigenous health development, medical education institutions must engage in decolonization processes and address racism and privilege at curricular and institutional levels. Indigenous health curricula must be formalized and comprehensive, and must be consistently reinforced in all educational environments. Institutions’ responsibilities extend to advocacy for health system and broader societal reform to reduce and eliminate health inequities. These activities must be adequately resourced and underpinned by investment in infrastructure and Indigenous leadership.
Affirmative Action and Holistic Review in Medical School Admissions: Where We Have Been and Where We Are Going
Authors: Thomas Billy R. , Dockter Nancy
Published: October 2018

Current challenges to affirmative action policies are cause for concern for medical schools that employ holistic admissions processes, which consider an applicant’s race, ethnicity, gender, status as a first-generation college student, educational and socioeconomic status, geographical location, past experiences with minority and underserved populations, social capital, and immigration status. Students from minority and underserved communities bring with them experiences and perspectives that may enhance the care they provide to underserved patients, improving patient outcomes. Student body diversity is also associated with increases in students’ academic performance, retention, community engagement, cooperation, and openness to different ideas and perspectives, and institutions that foster diversity tend to be nurturing places where all students and faculty can thrive.

The use of race as a factor in admissions has been upheld in three Supreme Court decisions. Yet, the Supreme Court likely will rule again on this issue. In the meantime, medical schools must maintain or increase support for science, technology, engineering, and math academic enrichment programs at all levels, stay informed about their institutional climate, and support a holistic admissions process that considers race and socioeconomic status. Doing so will help disadvantaged students overcome the intergenerational barriers created by race, ethnicity, and poverty and help grow a culturally competent health care workforce, which is essential to improving individual and population health and narrowing racial and ethnic health disparities.
The Incidence of Posterior Malleolar Involvement in Distal Spiral Tibia Fractures: Is it Higher than We Think?
Authors: Sobol Garret L. , Shaath M. Kareem , Reilly Mark C. , Adams Mark R. , Sirkin Michael S.
Published: October 2018

Objectives:

To investigate the incidence of concomitant posterior malleolar fractures (PMFs) in operative, distal-third, spiral tibia fractures.

Design:

Prospective protocol with retrospective review of data.

Setting:

Single, Level 1 trauma center.

Patients/Participants:

One hundred ninety-three consecutive, skeletally mature patients with operatively treated fractures of the distal-third, tibial shaft and metaphysis. Pilon fractures were excluded.

Intervention:

Computed tomography (CT) scans were obtained in all distal-third, spiral fractures of the tibia to determine fracture morphology and presence of a PMF.

Main Outcome Measurements:

The incidence of concurrent PMFs in operative spiral fractures of the distal tibia.

Results:

Twenty-six distal-third, spiral fractures were identified with an ipsilateral PMF diagnosed in 92.3% of cases (24 cases). PMFs were over 25 times more likely to occur in distal-third, spiral fractures when compared with other distal-third fracture patterns (relative risk = 25.7, 95% confidence interval, 11.6–56.8). PMFs were treated with supplemental fixation in 23/24 (95.8%) cases.

Conclusions:

There is a high incidence of concomitant, ipsilateral fractures of the posterior malleolus in patients presenting with operative distal-third, spiral fractures of the tibia. A preoperative ankle computed tomography should be strongly considered in all cases with this specific fracture morphology.

Level of Evidence:

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Does the Coexistence of Multiple Segmental Rib Fractures in Polytrauma Patients Presenting With “Major” Vertebral Fracture Affect Care and Acute Outcomes?
Authors: Alvi Mohammed Ali , Kapurch Joseph R. , Ivanov David V. , Kerezoudis Panagiotis , Bydon Mohamad , Freedman Brett A.
Published: October 2018

Objective:

To determine whether operating on “major” vertebral fractures leads to premature abortion of surgery and/or other acute cardiopulmonary complications.

Design:

Retrospective review.

Clinical Setting:

Level 1 trauma center.

Patients/Participants and Intervention:

We retrospectively queried our institutional Trauma Rregistry for all cases presenting with concomitant rib fractures and surgically managed vertebral fractures.

Main Outcome Measurements:

The main outcomes included the surgical outcome (aborted vs. successfully performed), total and Intensive Care Unit length of stay (LOS), adverse discharge, mortality, and functional outcomes.

Results:

We found 57 cases with concomitant segmental rib fractures and surgically managed vertebral fractures. Seven patients (12%) received a rib fixation, of which 1 received before vertebral fixation and 6 after. Importantly, 4 vertebral fixation cases (7.02%) had to be aborted intraoperatively because of the inability to tolerate prone positioning for surgery. For case–control analysis, we performed propensity score matching to obtain matched controls, that is, cases of vertebral fixation but no rib fractures. On matched case–control analysis, patients with concomitant segmental rib fractures and vertebral fractures were found to have higher Intensive Care Unit LOS [median = 3 days (Inter-Quartile Range = 0–9) versus. 8.4 days, P = 0.003], whereas total LOS, frequency of complete, incomplete or functional spinal cord injury, discharge to rehab, and discharge to nursing home were found to be similar between the 2 groups.

Conclusion:

Our findings demonstrate that segmental rib fractures with concomitant vertebral fractures undergoing surgical treatment represent a subset of patients that may be at increased risk of intraoperative cardio-pulmonary complications and rib fixation before prone spine surgery for cases in which the neurological status is stable is reasonable.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Significance of Lateral Process Fractures Associated With Talar Neck and Body Fractures
Authors: Romeo Nicholas M. , Hirschfeld Adam G. , Githens Michael , Benirschke Stephen K. , Firoozabadi Reza
Published: October 2018

Objectives:

To determine whether fracture of the lateral process (LP) elevates the risk of development of radiographic subtalar arthrosis in patients with talar body and neck fractures.

Design:

Retrospective review.

Setting:

Level 1 academic trauma center.

Patients/Participants:

Eighty-two patients with 43 talar neck and 43 talar body fractures treated over a 5-year period.

Intervention:

Preoperative and postoperative radiographs were evaluated for fracture of the LP of the talus and subsequent development of radiographic subtalar arthritis.

Main Outcome Measurements:

Radiographic evidence of subtalar arthritis.

Results:

Seventy-six percent of talar neck fractures with involvement of the LP went on to develop radiographic evidence of subtalar arthrosis compared with 36% of talar neck fractures without LP involvement (P = 0.035). Thirty of the fractures involving the LP had a separate LP fragment. Fifteen of the 30 fractures with a separate LP fragment that underwent reduction and fixation developed radiographic evidence of subtalar arthrosis, whereas all 13 fractures with an independent LP fragment that did not have fixation of the LP went on to develop radiographic evidence of subtalar arthritis (P = 0.001). Comminution of the inferior talar articular surface was found to significantly increase the risk of radiographic subtalar arthritis in both talar body and talar neck fractures (P = 0.0003). An anatomic reduction of both talar neck and body fractures was found to be associated with a lower incidence of radiographic subtalar arthritis (P = 0.00001).

Conclusion:

Comminution of the inferior articular surface of the talus elevates the risk of subtalar arthritis in patients with both talar neck and body fractures. Fracture of the LP is a marker for injury to the talar inferior articular surface and increases the risk for the radiographic finding of subtalar arthritis in patients with talar neck fractures.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Outcome Analysis of Surgical Stabilization of Rib Fractures in Trauma Patients
Authors: Fokin Alexander A. , Wycech Joanna , Weisz Russell , Puente Ivan
Published: October 2018

Objectives:

To compare outcomes in patients with rib fractures (RFX) who underwent surgical stabilization of rib fractures (SSRF) to those treated nonoperatively.

Design:

Retrospective cohort study.

Setting:

Two Level 1 Trauma Centers.

Patients:

One hundred seventy-four patients with multiple RFX divided into 2 groups: patients with surgically stabilized RFX (n = 87) were compared with nonoperatively managed patients in the matched control group (MCG) (n = 87).

Intervention:

SSRF.

Outcome Measurements:

Age, sex, injury severity score, RFX, mortality, hospital length of stay (HLOS) and intensive care unit length of stay (ICULOS), duration of mechanical ventilation (DMV), co-injuries, and time to surgery. Patients were further stratified by presence or absence of flail chest and pulmonary contusion (PC).

Results:

Flail chest, displaced RFX, and PC were present significantly more often in SSRF patients compared with the MCG. Mortality was lower in SSRF group. HLOS and ICULOS were longer in SSRF group compared with the corresponding MCG patients regardless of timing to surgery (P < 0.01 for all). SSRF patients with flail chest had comparable HLOS, ICULOS, and DMV to MCG patients with flail chest (P > 0.3 for all). SSRF patients without flail chest had significantly longer HLOS and ICULOS than MCG patients without flail chest (P < 0.001 for both). Presence of PC did not affect lengths of stay.

Conclusions:

SSRF patients had reduced mortality compared with nonoperatively managed patients. HLOS, ICULOS, and DMV were longer in SSRF patients than in MCG. When flail chest was present, lengths of stay were comparable. PC did not seem to affect the surgical outcome.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Decreased Lean Psoas Cross-Sectional Area Is Associated With Increased 1-Year All-Cause Mortality in Male Elderly Orthopaedic Trauma Patients
Authors: Touban Basel M. , Pavlesen Sonja , Smoak Jason B. , Sayegh Michael J. , Wang Jiefei , Zhao Jiwei , Anders Mark J.
Published: October 2018

Objectives:

To investigate the association between lean psoas cross-sectional area (CSA) and 1-year all-cause mortality in elderly patients sustaining pelvic and long bone fractures.

Design:

Retrospective cohort.

Setting:

Level I trauma center.

Patients:

Elderly trauma patients admitted from 2007 to 2014.

Methods:

We reviewed demographic and clinical data, injury mechanism, fracture OTA/AO classification, and mortality. Axial computed tomography images were used to measure lean psoas CSA at the L3-L4 disk space. Cox proportional hazard regression analysis was used to estimate 1-year mortality association with psoas CSA in crude and adjusted for age, body mass index, Injury Severity Score, medical comorbidities, and discharge destination in total population and stratified by sex.

Main Outcome Measurement:

One-year all-cause mortality defined as death within 12 months from date of hospitalization.

Results:

Five hundred fifty-eight patients (54% female, 46% male) were analyzed. The pelvis was most commonly fractured (37.81%). A statistically significant association was observed between decreased lean psoas CSA and 1-year mortality in total population {hazard ratio [HR] = 0.93 [95% confidence interval (CI) = 0.90–0.96], P < 0.0001}. Stratification by gender revealed a statistically significant mortality HR in male patients [HR = 0.89 (95% CI = 0.84–0.96), P = 0.002]. We did not find a statistically significant mortality HR in female patients [HR = 0.95 (95% CI = 0.89–1.01), P = 0.103].

Conclusions:

In this cohort of elderly orthopaedic trauma patients, decreased lean psoas CSA was associated with increased 1-year all-cause mortality in total population and males. Further investigation of the association of sarcopenia with mortality in the elderly is warranted.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Nail Plate Combination Technique for Native and Periprosthetic Distal Femur Fractures
Authors: Liporace Frank A. , Yoon Richard S.
Published: October 2018

In the elderly, low-energy distal femur fractures (native or periprosthetic) can be devastating injuries, carrying high rates of morbidity and mortality, comparable with the hip fracture population. Poor, osteoporotic bone quality facilitates fracture in a vulnerable anatomical region, and as a result, operative fixation can be challenging. With goals of early mobilization to reduce subsequent complication risk, using the nail plate combination technique can offer stable, balanced fixation allowing for immediate weight bearing and early mobilization. We outline the rationale, technical steps, and early clinical outcomes after nail plate combination in the treatment of osteoporotic distal femur (native or periprosthetic) fractures.
Knee Pain and Functional Scores After Intramedullary Nailing of Tibial Shaft Fractures Using a Suprapatellar Approach
Authors: Serbest Sancar , Tiftikçi Uğur , Çoban Mehmet , Çirpar Meriç , Dağlar Bülent
Published: October 2018

Objectives:

To evaluate the effects of intramedullar nailing of the tibia using a suprapatellar (SP) approach with respect to pain and function of the knee.

Design:

Prospective clinical investigation.

Setting:

Academic level I trauma center.

Patients/Participants:

Twenty-one patients with tibial shaft fractures (Orthopaedic Trauma Association 42A-B-C) with a minimum of 12-month follow-up.

Intervention:

Locked intramedullary nailing using a SP approach.

Main Outcome Measurements:

Radiographic evaluation for nail position proximally, tibial shaft alignment and union, anterior knee pain using the visual analog scale, and knee function evaluation using the Lysholm and SF-36 scores. Examination of intra-articular damage was performed using intraoperative patellofemoral arthroscopy before and after nail insertion.

Results:

The mean age of the patients was 35.4 ± 12.4 years (range, 18–63 years), and the mean follow-up period was 15.62 ± 3.2 months (range, 12–21 months). The visual analog scale score for anterior knee pain was a mean of 1.0 ± 1.3 (range, 0–4). The SF-36 physical score was mean 45.1 ± 9, and the SF-36 mental score was a mean of 51.7 ± 9.9. The knee joint range of movement was measured as 133.1 ± 87 degrees on the affected extremity side and 134.05 ± 8.4 degrees on the unaffected side. The mean Lysholm knee score was 95.76 ± 4. No intra-articular pathology was seen on arthroscopy after nail insertion.

Conclusions:

The SP approach for intramedullar nailing for tibial shaft fractures was not associated with either anterior knee pain or functional limitations of the knee in our series.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.