bluuebunny/crossref_metadata_2025 huggingface dataset:
Fine- and hyperfine-structure effects in molecular photoionization. I. General theory and direct photoionization
Authors: Germann Matthias , Willitsch Stefan
Published: July 2016

We develop a model for predicting fine- and hyperfine intensities in the direct photoionization of molecules based on the separability of electron and nuclear spin states from vibrational-electronic states. Using spherical tensor algebra, we derive highly symmetrized forms of the squared photoionization dipole matrix elements from which we derive the salient selection and propensity rules for fine- and hyperfine resolved photoionizing transitions. Our theoretical results are validated by the analysis of the fine-structure resolved photoelectron spectrum of O2 reported by Palm and Merkt [Phys. Rev. Lett. 81, 1385 (1998)] and are used for predicting hyperfine populations of molecular ions produced by photoionization.
Photonic states mixing beyond the plasmon hybridization model
Authors: Suryadharma Radius N. S. , Iskandar Alexander A. , Tjia May-On
Published: July 2016

A study is performed on a photonic-state mixing-pattern in an insulator-metal-insulator cylindrical silver nanoshell and its rich variations induced by changes in the geometry and dielectric media of the system, representing the combined influences of plasmon coupling strength and cavity effects. This study is performed in terms of the photonic local density of states (LDOS) calculated using the Green tensor method, in order to elucidate those combined effects. The energy profiles of LDOS inside the dielectric core are shown to exhibit consistently growing number of redshifted photonic states due to an enhanced plasmon coupling induced state mixing arising from decreased shell thickness, increased cavity size effect, and larger symmetry breaking effect induced by increased permittivity difference between the core and the background media. Further, an increase in cavity size leads to increased additional peaks that spread out toward the lower energy regime. A systematic analysis of those variations for a silver nanoshell with a fixed inner radius in vacuum background reveals a certain pattern of those growing number of redshifted states with an analytic expression for the corresponding energy downshifts, signifying a photonic state mixing scheme beyond the commonly adopted plasmon hybridization scheme. Finally, a remarkable correlation is demonstrated between the LDOS energy profiles outside the shell and the corresponding scattering efficiencies.
Electron-hole pair effects in methane dissociative chemisorption on Ni(111)
Authors: Luo Xuan , Jiang Bin , Juaristi J. Iñaki , Alducin Maite , Guo Hua
Published: July 2016

The dissociative chemisorption of methane on metal surfaces has attracted much attention in recent years as a prototype of gas-surface reactions in understanding the mode specific and bond selective chemistry. In this work, we systematically investigate the influence of electron-hole pair excitations on the dissociative chemisorption of CH4/CH3D/CHD3 on Ni(111). The energy dissipation induced by surface electron-hole pair excitations is modeled as a friction force introduced in the generalized Langevin equation, in which the independent atomic friction coefficients are determined within the local-density friction approximation. Quasi-classical trajectory calculations for CH4/CH3D/CHD3 have been carried out on a recently developed twelve-dimensional potential energy surface. Comparing the dissociation probabilities obtained with and without friction, our results clearly indicate that the electron-hole pair effects are generally small, both on absolute reactivity of each vibrational state and on the mode specificity and bond selectivity. Given similar observations in both water and methane dissociation processes, we conclude that electron-hole pair excitations would not play an important role as long as the reaction is direct and the interaction time between the molecule and metal electrons is relatively short.
Using ordinal partition transition networks to analyze ECG data
Authors: Kulp Christopher W. , Chobot Jeremy M. , Freitas Helena R. , Sprechini Gene D.
Published: July 2016

Electrocardiogram (ECG) data from patients with a variety of heart conditions are studied using ordinal pattern partition networks. The ordinal pattern partition networks are formed from the ECG time series by symbolizing the data into ordinal patterns. The ordinal patterns form the nodes of the network and edges are defined through the time ordering of the ordinal patterns in the symbolized time series. A network measure, called the mean degree, is computed from each time series-generated network. In addition, the entropy and number of non-occurring ordinal patterns (NFP) is computed for each series. The distribution of mean degrees, entropies, and NFPs for each heart condition studied is compared. A statistically significant difference between healthy patients and several groups of unhealthy patients with varying heart conditions is found for the distributions of the mean degrees, unlike for any of the distributions of the entropies or NFPs.
Erratum to: New perspectives on the mineral nutrition of livestock grazing cereal and canola crops
Authors: Dove H. , Masters D. G. , Thompson A. N.
Published: July 2016

The grazing of cereal and canola crops during winter is an increasing component of grazing systems in southern Australia. The capacity of such crops to meet the requirements of young livestock and reproducing animals for sodium (Na), magnesium (Mg), calcium (Ca) and potassium (K) is reviewed. The growth responses of young stock to Na and/or Mg supplements when grazing wheat are discussed. These responses differ from ‘literature expectation' in that they are rapid in onset and involve no clinical signs. We demonstrate that more insight about the variability in supplement response, both between and between crops species, is obtained when mineral contents are viewed from the perspective of their frequency distributions, rather than their mean values. The pivotal importance of high K concentration, low Na and the resultant K:Na ratio of forage is stressed, as is the interaction of these minerals in relation to Mg absorption. We also present frequency distributions for a range of mineral indices that ‘capture' mineral interactions, including the ‘tetany index', forage K: (Na+Mg) ratio and dietary cation–anion difference. It is concluded that the last two indices warrant a much closer investigation. Possible effects of forage aluminium and organic acid contents are briefly discussed; these also deserve closer examination. As research in this area continues, it would be prudent to provide Na and/or Mg supplements for livestock grazing wheat and possibly oats and barley, and calcium supplements for livestock grazing oats or for reproducing animals grazing all three cereals.
Importance of the natural flow regime to an amphidromous shrimp: a case study
Authors: Novak Peter A. , Garcia Erica A. , Pusey Bradley J. , Douglas Michael M.
Published: July 2016

Amphidromous shrimp inhabiting large river systems are thought to migrate downstream to hatch larvae close to the estuary or sea. Recent work on Macrobrachium spinipes in northern Australia challenged this hypothesis, with the discovery of abundant females in reproductive condition over 400km upstream. We investigated the early life history of M. spinipes by using a combination of field sampling, laboratory experiments and modelling. We determined the spatial and temporal production of larvae, larval salinity requirements, and, finally, the potential for transport of larvae to the estuary during the wet season. Larvae occurred in high abundances across a 400-km river reach. However, successful larval development was contingent on access, by drift, to saltwater within 7 days. This interval is longer than that found for the majority of amphidromous shrimp species and we propose that larvae in the study river are able to successfully moult through the early stages in freshwater. Large, wet-season discharge events were critical for transporting larvae from all sampled sites to the estuary. The present study confirmed the amphidromous life history of M. spinipes, highlighted the importance of natural flows for maintaining existing populations and provided evidence of a novel type of amphidromous life-history strategy.
Effect of roost choice on winter torpor patterns of a free-ranging insectivorous bat
Authors: Stawski Clare , Currie Shannon E.
Published: July 2016

Gould’s wattled bat (Chalinolobus gouldii) is one of only three native Australian mammals with an Australia-wide distribution. However, currently no data are available on the thermal physiology of free-ranging C. gouldii. Therefore, we aimed to quantify the effect of roost choice on daily skin temperature fluctuations during winter in C. gouldii living in an agricultural landscape in a temperate region. Ambient conditions consisted of long periods below 0°C and snow. Some individuals roosted high in dead branches whereas one individual roosted in a large cavity located low in a live tree. Torpor was employed on every day of the study period by all bats, with bouts lasting for over five days. The skin temperature of individuals in the dead branches tracked ambient temperature, with skin temperatures below 3°C on 67% of bat-days (lowest recorded –0.2°C). In contrast, the individual in the tree cavity maintained a larger skin-ambient temperature differential, likely influenced by the internal cavity temperature. Our study presents the lowest skin temperature recorded for a free-ranging Australian microbat and reveals that roost choice affects the thermal physiology of C. gouldii, ensuring survival during periods of cold weather and limited food supply.
Impact of a homing intein on recombination frequency and organismal fitness
Authors: Naor Adit , Altman-Price Neta , Soucy Shannon M. , Green Anna G. , Mitiagin Yulia , Turgeman-Grott Israela , Davidovich Noam , Gogarten Johann Peter , Gophna Uri
Published: July 2016

Significance

Parasitic interactions can result in changes to the host’s behavior in a way that promotes the distribution or life cycle of the parasite. Inteins are molecular parasites found in all three domains of life. Here we look at the influence of an intein in the DNA polymerase on a population of halophilic archaea in simulations, in experiments, and in the wild. This intein has a fitness cost that is higher than expected for a self-splicing genetic element. In these populations, where mating is independent of host replication, the intein increases the recombination rate between cells with and without inteins. This modification may contribute to the long-term persistence of these genetic parasites, despite the fitness burden they impart on their host.
Stacked charge stripes in the quasi-2D trilayer nickelate La
4
Ni
3
O
8
Authors: Zhang Junjie , Chen Yu-Sheng , Phelan D. , Zheng Hong , Norman M. R. , Mitchell J. F.
Published: July 2016

Significance

Competition between localized and itinerant electrons in highly correlated materials can lead to myriad insulating ground states, including spatially inhomogeneous but ordered charge superlattices. In layered transition metal oxides, such charge order can take the form of stripes, which typically arrange themselves in staggered formations to reduce Coulomb repulsion. Having achieved single-crystal growth of the layered nickelate La
4
Ni
3
O
8
, we show that its heretofore incompletely understood phase transition is associated with charge stripe ordering. We find that the stripes are stacked directly on top of one another within nickel oxide trilayers but staggered between successive trilayers. A unique, paradoxical ground state results, in which the electrostatic building principle is respected at long range but violated at short range.
An instrument for the study of wishes, defenses and their state in patients’ narratives / Un instrumento para el estudio de los deseos, las defensas y su estado en los relatos de los pacientes
Authors: Maldavsky David
Published: July 2016

Our aim is to expose the DLA-N (an integrant of the David Liberman Algorithm), useful for the study of wishes and defenses (and their states) in narratives, and to illustrate its implementation. The instruments are: (1) a grid; (2) instructions to infer defenses and their state; (3) the frequency distribution of wishes in patients’ narratives. As illustrations, three research studies, with objectives, samples and different strategies are exposed. The first one shows the utility of the DLA-N in the determination of, in a case: (a) when and in connection with what or who the patient’s defenses have failed; (b) changes in some of the defenses. In the second research study we apply the DLA-N to a sample of 15 episodes of violence aiming to infer: (a) what were the triggering factors; and (b) the anticipation of the emergence of one of those episodes. In the third research study we apply the DLA-N to three sessions of the same case aiming to discuss the utility of the frequency distribution in evaluating the clinical change.
Effects of ultrasonic peening treatment on hydrogen sulphide corrosion behaviour
Authors: Feng Y. , Hu S. , Wang D. , Liu J. , Zhang C.
Published: July 2016

After being subjected to ultrasonic peening treatment (UPT), the resistance of X65 pipeline steel to hydrogen sulphide corrosion was investigated through electrochemical, immersion and slow-strain-rate testing. In addition, the UPT-induced compressive residual stresses layer and related changes in the steel near-surface microstructure and hardness were examined by scanning electron microscopy, optical microscopy and X-ray diffraction. The obtained results revealed that UPT was able to significantly improve the corrosion potential of X65 pipeline steel and reduce its hydrogen sulphide corrosion rate, while the formation of the compressive stress layer increased the steel's tensile strength and inhibited hydrogen blistering.
A novel rare earth-salt bath nitriding of TC21-DT titanium alloy
Authors: Zhu Y. S. , Lu W. Z. , Zuo D. W. , Cao D. W.
Published: July 2016

A novel rare earth (RE)-salt bath nitriding of TC21-DT titanium alloy was primarily developed by adding certain amount of RE cerium oxide (CeO2) in KNO3 and NaNO3 salt bath, heated to temperatures in the range 590–650°C for periods up to 5 h in an ambient furnace atmosphere. The results showed that Ti phases and titanium nitride phase were formed on the surface of RE added samples; while no titanium nitride phases formed on the surface of conventional one, without RE addition. Furthermore, the surface hardness of nitrided samples, incorporated with RE addition, was about two times higher than that of conventional one (340HV0.01). The main improvement mechanism was analysed as well.
Multiplicative structures and the twisted Baum-Connes assembly map
Authors: Bárcenas Noé , Carrillo Rouse Paulo , Velásquez Mario
Published: July 2016

Using a combination of Atiyah-Segal ideas on one side and of Connes and Baum-Connes ideas on the other, we prove that the twisted geometric K-homology groups of a Lie groupoid have an external multiplicative structure extending hence the external product structures for proper cases considered by Adem-Ruan in 2003 or by Tu, Xu and Laurent-Gengoux in 2004. These twisted geometric K-homology groups are the left-hand sides of the twisted geometric Baum-Connes assembly maps recently constructed by Carrillo Rouse and Wang (2016), and hence one can transfer the multiplicative structure via the Baum-Connes map to the twisted K-theory groups whenever these assembly maps are isomorphisms.
Norma Beecroft, Improvvisazioni Concertanti No. 1 (1961)
Authors: Neidhöfer Christoph
Published: July 2016

This essay studies the concept of written-out improvisation in the one-movement flute concerto Improvvisazioni Concertanti No. 1 (1961) by the Canadian composer Norma Beecroft (b. 1934) through an analysis of the work’s serial structure and form. Beecroft’s compositional techniques are examined in the context of the European avant-garde around 1960, particularly with respect to the teachings of Bruno Maderna, whose courses she attended in Darmstadt and Dartington while living in Rome from 1959 to 1961. Based on information from her sketches, notes, and interviews, the essay shows how Beecroft responded to Maderna’s interval classification system and demonstrates how the work’s serial structure and discourse between soloist and orchestra inspire a multitude of hermeneutic perspectives.
Sofia Gubaidulina, String Quartet No. 2 (1987)
Authors: Lochhead Judy
Published: July 2016

Sofia Gubaidulina’s Second String Quartet “musically thinks” difference, enacting in musical sound how difference arises through repetition. This analytical essay demonstrates how processes of timbre, dynamics, articulations, register, and pitch shape the Quartet’s overall formal design in which differing plays an integral role. The essay takes account of music differing through the three parts of the single-movement Quartet: Part 1, Reaching Out and Tethering; Part 2, Reaching Up and Renewing; and Part 3, Affirmation. The analysis also demonstrates how Gubaidulina’s musical thinking of difference resonates with the philosophical thinking of Gilles Deleuze, especially in his 1968 Difference and Repetition, and how such thinking of difference has a distinctive significance for the composer who is female.
Chen Yi, Symphony No. 2 (1993)
Authors: Rao Nancy Yunhwa
Published: July 2016

Musical gestures play an important role in the process of spiritual transformation in Chen Yi’s Symphony No. 2 (1998), which was written in commemoration of her father’s recent passing. Chen Yi uses unique luogu dianzi (percussion patterns used in Beijing opera), characteristic melodic elements, and large-scale rhythmic design to convey an intense process of grieving and transcendence. Linking Chen Yi’s unique adaptation of traditional rhythmic patterns to musical gestures, the chapter considers how traditional music signifiers of the Chinese operatic stage have been shifted into another kind of musical space and genre, while gaining significantly more weight and dignity. The symphony reflects not only her crossing of borderlines between cultures and nations, but also the bringing together of these simultaneous dimensions to create a powerful work and to pay homage to her father.
Kaija Saariaho, “The claw of the magnolia … ,” From the Grammar of Dreams (1988)
Authors: Roeder John
Published: July 2016

Kaija Saariaho’s From the Grammar of Dreams, for two solo female singers, elegantly articulates the poetic structure of Sylvia Plath’s poem “Paralytic” by variations of rhythmic density and register; changes of pitch, intervals, and rhythmic behavior; and an arch-shaped tessitura. Its most striking feature, though, is its “polyvocality,” in which the voices simultaneously sing the same words to very different rhythms and pitches. This essay examines the multiple senses of musical time and space created by the shifting metrical and tonal relationships between the voices. As they imitate, synchronize, and diverge, two distinct concurrent points of reference—two equally present tonalities, and the coexistence of multiple meters—emerge that artfully portray the poem’s symbolic superposition of life and death.
Libby Larsen, Chanting to Paradise (1997)
Authors: Ravenscroft Brenda
Published: July 2016

Emily Dickinson’s sensitive use of phonetic patterns and interest in intensely personal perspectives make her poetry ideal for Libby Larsen’s intimately nuanced vocal settings in the cycle Chanting to Paradise (1997). By making subtle structural changes to Dickinson’s poems, Larsen underscores her understanding of the text, which she then clarifies musically through her symbolic use of constrained pitch-class, intervallic, rhythmic, and gestural materials. The opposition inherent in both poems examined in this analytical study is mirrored musically in quite different ways: “Bind me” weaves together elegantly contrasting elements in Larsen’s characteristic linear compositional language, while in “In this short Life” pitch and rhythmic patterns, cross-pulses, and tonal shifts enact the text. In conclusion, the essay examines mirroring in terms of relations between composer and poet, feminist concerns of power and escape, and the role of the female composer in contemporary society.
Dull Disasters?
Authors: Clarke Daniel J. , Dercon Stefan
Published: July 2016

Economic losses from disasters are now reaching an average of US$250–$300 billion a year. In the last 20 years, more than 530,000 people died as a direct result of extreme weather events; millions more were seriously injured. Most of the deaths and serious injuries were in developing countries. Meanwhile, highly infectious diseases will continue to emerge or re-emerge, and natural hazards will not disappear. But these extreme events do not need to turn into large-scale disasters. Better and faster responses are possible. The authors contend that even though there is much generosity in the world to support the responses to and recovery from natural disasters, the current funding model, based on mobilizing financial resources after disasters take place, is flawed and makes responses late, fragmented, unreliable, and poorly targeted, while providing poor incentives for preparedness or risk reduction. The way forward centres around reforming the funding model for disasters, moving towards plans with simple rules for early action and that are locked in before disasters through credible funding strategies—all while resisting the allure of post-disaster discretionary funding and the threat it poses for those seeking to ensure that disasters have a less severe impact.
Finance as the Glue
Authors: Clarke Daniel J. , Dercon Stefan
Published: July 2016

Financial and budgetary instruments are the glue that holds credible plans together and makes them strong enough to withstand the whirlwind of highly charged post-disaster politics. When designing and implementing disaster risk financing strategies, details matter. It is important to pay for financial advice and build in-house expertise. Discipline, cost, accuracy, and speed all matter when structuring a disaster risk financing strategy. Speed matters but not all resources are needed at once. The triggers in the financial strategy should match the triggers in the plan. Traditional reinsurance can be particularly useful for locking in plans for reconstruction, and indexed reinsurance can play the same role for financing indexed early actions. Financial instruments can enable multiple parties to contribute to the same plan. Subsidized financial instruments can be used to encourage others to contribute towards the cost of well-defined plans.
Adherence to Antiretroviral Therapy During and After Pregnancy: Cohort Study on Women Receiving Care in Malawi's Option B+ Program
Authors: Haas Andreas D. , Msukwa Malango T. , Egger Matthias , Tenthani Lyson , Tweya Hannock , Jahn Andreas , Gadabu Oliver J. , Tal Kali , Salazar-Vizcaya Luisa , Estill Janne , Spoerri Adrian , Phiri Nozgechi , Chimbwandira Frank , van Oosterhout Joep J. , Keiser Olivia
Published: July 2016

Background.  Adherence to antiretroviral therapy (ART) is crucial to preventing mother-to-child transmission of human immunodeficiency virus (HIV) and ensuring the long-term effectiveness of ART, yet data are sparse from African routine care programs on maternal adherence to triple ART.

Methods.  We analyzed data from women who started ART at 13 large health facilities in Malawi between September 2011 and October 2013. We defined adherence as the percentage of days “covered” by pharmacy claims. Adherence of ≥90% was deemed adequate. We calculated inverse probability of censoring weights to adjust adherence estimates for informative censoring. We used descriptive statistics, survival analysis, and pooled logistic regression to compare adherence between pregnant and breastfeeding women eligible for ART under Option B+, and nonpregnant and nonbreastfeeding women who started ART with low CD4 cell counts or World Health Organization clinical stage 3/4 disease.

Results.  Adherence was adequate for 73% of the women during pregnancy, for 66% in the first 3 months post partum, and for about 75% during months 4–21 post partum. About 70% of women who started ART during pregnancy and breastfeeding adhered adequately during the first 2 years of ART, but only about 30% of them had maintained adequate adherence at every visit. Risk factors for inadequate adherence included starting ART with an Option B+ indication, at a younger age, or at a district hospital or health center.

Conclusions.  One-third of women retained in the Option B+ program adhered inadequately during pregnancy and breastfeeding, especially soon after delivery. Effective interventions to improve adherence among women in this program should be implemented.
Spatial reference points for groundfish
Authors: Reuchlin-Hugenholtz Emilie , Shackell Nancy L. , Hutchings Jeffrey A. ,   Handling editor: Valerio Bartolino
Published: July 2016

According to density-dependent habitat selection theory, areas of high density can be indicative of high population productivity and have positive individual fitness consequences. Here, we explore six groundfish populations on the Scotian Shelf, Canada, where a decline in areas of high density beyond a certain threshold is associated with disproportionately large declines in Spawning Stock Biomass (SSB). This is evidenced by empirical, concave, positive relationships between high-density areas (HDAs) and SSB. We introduce a methodology to estimate the threshold below which SSB declines increasingly faster per unit of HDA decline. The spatial threshold among these six stocks was remarkably consistent; when stocks lose 70–80% of HDAs, disproportionately large SSB declines are likely to occur. We propose that spatial thresholds could serve as spatial reference points to complement existing SSB limit reference points (LRPs). For some stocks we identify spatial thresholds which correspond to SSB levels that exceed those associated with the designated SSB LRP, suggesting that a review of these SSB LRPs warrants merit. For other stocks, spatial reference points can be used in concert with SSB reference points, strengthening efforts to incorporate a precautionary approach to fisheries management. Our results warrant further research into the general application of HDA as spatial limit and target reference points for fisheries management in addition to other population status indicators within a broad recovery framework.
Chronic exposure of adult, postnatal and in utero rat models to low-dose 137Cesium: impact on circulating biomarkers
Authors: Manens Line , Grison Stéphane , Bertho Jean-Marc , Lestaevel Philippe , Guéguen Yann , Benderitter Marc , Aigueperse Jocelyne , Souidi Maâmar
Published: July 2016

The presence of 137Cesium (137Cs) in the environment after nuclear accidents at Chernobyl and more recently Fukushima Daiichi raises many health issues for the surrounding populations chronically exposed through the food chain. To mimic different exposure situations, we set up a male rat model of exposure by chronic ingestion of a 137Cs concentration likely to be ingested daily by residents of contaminated areas (6500 Bq.l−1) and tested contaminations lasting 9 months for adult, neonatal and fetal rats. We tested plasma and serum biochemistry to identify disturbances in general indicators (lipids, proteins, carbohydrates and electrolytes) and in biomarkers of thyroid, heart, brain, bone, kidney, liver and testis functions. Analysis of the general indicators showed increased levels of cholesterol (+26%), HDL cholesterol (+31%), phospholipids B (+15%) and phosphorus (+100%) in the postnatal group only. Thyroid, heart, brain, bone and kidney functions showed no blood changes in any model. The liver function evaluation showed changes in total bilirubin (+67%) and alkaline phosphatase (–11%) levels, but only for the rats exposed to 137Cs intake in adulthood. Large changes in 17β-estradiol (–69%) and corticosterone (+36%) levels affected steroidogenesis, but only in the adult model. This study showed that response profiles differed according to age at exposure: lipid metabolism was most radiosensitive in the postnatal model, and steroid hormone metabolism was most radiosensitive in rats exposed in adulthood. There was no evidence of deleterious effects suggesting a potential impact on fertility or procreation.
Reimann's “Habitual Hyperthermia” Responding to Hormone Therapy
Authors: Yang Otto O. , Currier Judith S.
Published: July 2016

A 25-year-old woman presented with fever of unknown origin, exhibiting malaise and low-grade fevers in evenings. These fevers exhibited a pattern of starting mid-menstrual cycle with resolution around the onset of menses, matching a pattern of “habitual hyperthermia” reported by H. Reimann in the 1930s. Extensive workup was unremarkable, and the fevers improved on oral synthetic estrogen and progesterone therapy.
Social Network, Surgeon, and Media Influence on the Decision to Undergo Contralateral Prophylactic Mastectomy
Authors: Venetis Maria K. , MacGeorge Erina L. , Baptiste Dadrie F. , Mouton Ashton , Friley Lorin B. , Pastor Rebekah , Hatten Kristen , Lagoo Janaka , Bowling Monet W. , Clare Susan E.
Published: July 2016

Objectives:

The rate of contralateral prophylactic mastectomy (CPM) has risen sharply in the past decade. The current study was designed to examine social network, surgeon, and media influence on patients’ CPM decision-making, examining not only who influenced the decision, and to what extent, but also the type of influence exerted.

Methods:

Patients (N=113) who underwent CPM at 4 Indiana University–affiliated hospitals between 2008 and 2012 completed structured telephone interviews in 2013. Questions addressed the involvement and influence of the social network (family, friends, and nonsurgeon health professionals), surgeon, and media on the CPM decision.

Results:

Spouses, children, family, friends, and health professionals were reported as exerting a meaningful degree of influence on patients’ decisions, largely in ways that were positive or neutral toward CPM. Most surgeons were regarded as providing options rather than encouraging or discouraging CPM. Media influence was present, but limited.

Conclusions:

Patients who choose CPM do so with influence and support from members of their social networks. Reversing the increasing choice of CPM will require educating these influential others, which can be accomplished by encouraging patients to include them in clinical consultations, and by providing patients with educational materials that can be shared with their social networks. Surgeons need to be perceived as having an opinion, specifically that CPM should be reserved for those patients for whom it is medically indicated.
Rac1 as a Potential Pharmacodynamic Biomarker for Thiopurine Therapy in Inflammatory Bowel Disease
Authors: Seinen Margien L. , van Nieuw Amerongen Geerten P. , de Boer Nanne K. H. , Mulder Chris J. J. , van Bezu Jan , van Bodegraven Adriaan A.
Published: July 2016

Background:

Azathioprine and mercaptopurine (MP) are effective in treating patients with inflammatory bowel disease (IBD). Immunosuppressive effects of thiopurines involve T-cell apoptosis after inhibition of GTPase Ras-related C3 botulinum toxin substrate 1 (Rac1). This study aimed to assess whether expression and activity of Rac1 or phosphorylated ezrin-radixin-moesin (pERM) in patients with IBD could provide a useful biomarker for the pharmacodynamic thiopurine effect and might be related to clinical effectiveness.

Methods:

This was a 2-stage study: stage 1 concerned a cross-sectional cohort of patients with IBD clinically in remission and treated with (n = 10) or without stable weight-based thiopurine therapy (n = 11) and healthy controls (n = 6); stage 2 concerned a prospective study regarding IBD patients with clinically active disease who initiated MP therapy (n = 11) compared with healthy controls (n = 11). Expression and activity of Rac1 and ERM and pERM were determined.

Results:

The median Rac1 expression was statistically significantly reduced by thiopurine maintenance therapy {0.54 [interquartile range (IQR) 0.47–0.88] versus 0.80 arbitrary units [IQR 0.64–1.46]} compared with patients without immunosuppressive therapy (P = 0.042), but not Rac1 activity and pERM. In responders to MP therapy (n = 6), both median active Rac1 [93 (IQR 81–151) to 76 ng Rac1/mg protein (IQR 62–98)] and Rac1 expression [16.2 (8.8–29.4) to 1.5 arbitrary units (0.9–5.3)] decreased (P = 0.028). In nonresponders (n = 3), Rac1 expression and activity increased.

Conclusions:

IBD patients treated with thiopurines had a lower expression of Rac1 compared with those not treated with thiopurine. Effective MP therapy led to decreasing concentrations of Rac1-GTP and Rac1 expression. Therefore, Rac1-GTP and expression of Rac1, but not phosphorylation of ERM, form potentially pharmacodynamic markers of therapeutic thiopurine effectiveness in patients with IBD.
Low AMH levels as a marker of reduced ovarian reserve in young women affected by Down's syndrome
Authors: Romualdi Daniela , Proto Caterina , De Cicco Simona , Immediata Valentina , Barone Concetta , Romano Corrado , Lanzone Antonio
Published: July 2016

Objective:

Women with Down's syndrome (DS) experience menopause earlier than healthy women and are twice as likely to undergo premature ovarian insufficiency. Menopause accelerates cognitive decline and is associated with a twofold increased mortality risk in DS women. Nonetheless, no previous studies investigated the ovarian reserve in this population. The aim of the present study was to evaluate the circulating antimullerian hormone (AMH) levels in DS women with regular menstrual cycles, in comparison with those observed in an age-matched group of healthy women.

Methods:

Fourteen women with DS and 20 normo-ovulatory volunteers were enrolled in this study. A general physical examination was performed. Hormonal assays, including AMH, fasting insulin levels, and homeostatic model assessment-insulin resistance, were investigated in all participants.

Results:

AMH levels were significantly lower in DS women compared with controls (1.34 ± 1.11 vs 3.01 ± 1.65 ng/mL, P < 0.01). Prolactin concentrations were in the normal range, although higher in DS women compared with controls (P < 0.01). After dividing the participants according to age, AMH was significantly lower in the DS group compared with controls, both below and above 30 years of age (1.77 vs 3.73 ng/mL, P < 0.01; 0.28 vs 2.20 ng/mL, P < 0.01, respectively). AMH was inversely correlated with age in both groups, and directly correlated with testosterone and dehydroepiandrosterone sulfate only in DS women. In the same participants, AMH showed a tendency toward a direct correlation with insulin levels (P = 0.055).

Conclusions:

AMH levels were significantly lower in DS women compared with age-matched controls. A subanalysis of data in DS participants under 30 years of age suggested an early follicular depletion related to trisomy 21.
Reproductive history and risk of type 2 diabetes mellitus in postmenopausal women: findings from the Women's Health Initiative
Authors: LeBlanc Erin S. , Kapphahn Kristopher , Hedlin Haley , Desai Manisha , Parikh Nisha I. , Liu Simin , Parker Donna R. , Anderson Matthew , Aroda Vanita , Sullivan Shannon , Woods Nancy F. , Waring Molly E. , Lewis Cora E. , Stefanick Marcia
Published: July 2016

Objective:

The aim of the study was to understand the association between women's reproductive history and their risk of developing type 2 diabetes. We hypothesized that characteristics signifying lower cumulative endogenous estrogen exposure would be associated with increased risk.

Methods:

Prospective cohort analysis of 124,379 postmenopausal women aged 50 to 79 years from the Women's Health Initiative (WHI). We determined age of menarche and final menstrual period, and history of irregular menses from questionnaires at baseline, and calculated reproductive length from age of menarche and final menstrual period. Presence of new onset type 2 diabetes was from self-report. Using multivariable Cox proportional hazards models, we assessed associations between reproductive variables and incidence of type 2 diabetes.

Results:

In age-adjusted models, women with the shortest (<30 y) reproductive periods had a 37% (95% CI, 30-45) greater risk of developing type 2 diabetes than women with medium-length reproductive periods (36-40 y). Women with the longest (45+ y) reproductive periods had a 23% (95% CI, 12-37) higher risk than women with medium-length periods. These associations were attenuated after full adjustment (HR 1.07 [1.01, 1.14] for shortest and HR 1.09 [0.99, 1.22] for longest, compared with medium duration). Those with a final menstrual period before age 45 and after age 55 had an increased risk of diabetes (HR 1.04; 95% CI, 0.99-1.09 and HR 1.08; 95% CI, 1.01-1.14, respectively) compared to those with age of final menstrual period between 46 and 55 years. Timing of menarche and cycle regularity was not associated with risk after full adjustment.

Conclusions:

Reproductive history may be associated with type 2 diabetes risk. Women with shorter and longer reproductive periods may benefit from lifestyle counseling to prevent type 2 diabetes.
The Importance of an Evidence-based Workup for Recurrent Pregnancy Loss
Authors: GIBBINS KAREN J. , PORTER T. FLINT
Published: July 2016

Choosing an evidence-based workup and treatment for recurrent pregnancy loss is imperative to provide best patient care and create a culture that permits rigorous research into potential (not yet evidence-based) tests and therapeutics. As health sciences technologies become more sophisticated, more precise, and less expensive, new tools may be developed that allow better evaluation and treatment of couples with recurrent pregnancy loss. The goal must remain optimizing value and adhering to evidence-based care.
Longitudinal analysis of high-technology medical services and hospital financial performance
Authors: Zengul Ferhat D. , Weech-Maldonado Robert , Ozaydin Bunyamin , Patrician Patricia A. , O'Connor Stephen J.
Published: July 2016

Background:

U.S. hospitals have been investing in high-technology medical services as a strategy to improve financial performance. Despite the interest in high-tech medical services, there is not much information available about the impact of high-tech services on financial performance.

Purpose:

The aim of this study was to examine the impact of high-tech medical services on financial performance of U.S. hospitals by using the resource-based view of the firm as a conceptual framework.

Methodology/Approach:

Fixed-effects regressions with 2 years lagged independent variables using a longitudinal panel sample of 3,268 hospitals (2005–2010). It was hypothesized that hospitals with rare or large numbers (breadth) of high-tech medical services will experience better financial performance.

Findings:

Fixed effects regression results supported the link between a larger breadth of high-tech services and total margin, but only among not-for-profit hospitals. Both breadth and rareness of high-tech services were associated with high total margin among not-for-profit hospitals. Neither breadth nor rareness of high-tech services was associated with operating margin. Although breadth and rareness of high-tech services resulted in lower expenses per inpatient day among not-for-profit hospitals, these lower costs were offset by lower revenues per inpatient day.

Practice Implications:

Enhancing the breadth of high-tech services may be a legitimate organizational strategy to improve financial performance, especially among not-for-profit hospitals. Hospitals may experience increased productivity and efficiency, and therefore lower inpatient operating costs, as a result of newer technologies. However, the negative impact on operating revenue should caution hospital administrators about revenue reducing features of these technologies, which may be related to the payer mix that these technologies may attract. Therefore, managers should consider both the cost and revenue implications of these technologies.
Idarucizumab (Praxbind) Formulary Review
Authors: Buchheit Jessica , Reddy Prabashni , Connors Jean M.
Published: July 2016

Idarucizumab (Praxbind), a humanized monoclonal antibody fragment was granted accelerated approval from the Food and Drug Administration in October 2015 as the first agent to reverse the effects of a novel oral anticoagulant. The drug is indicated for dabigatran reversal in patients requiring emergency surgery/urgent procedures or with life-threatening or uncontrolled bleeding. In a randomized study with healthy volunteers, compared with placebo, idarucizumab reduced the clotting times for all tests assays (assessed pre-, end of-, and 24 hours after infusion), while the results for the placebo group remained unchanged. Another randomized clinical trial assessed the safety and efficacy of idarucizumab in patients with either overt bleeding or undergoing emergency surgery where hemostasis was required. This study is ongoing, but preliminary results showed reversal efficacy demonstrated a reasonable safety profile from the time of the infusion to 90 days after. The wholesale acquisition cost of two 2.5 g vials of idarucizumab is currently $3482.50. To treat 10 or 20 patients per year with a single 5 g dose is estimated to cost $34,825 and $69,650, respectively. In the clinical trial described above, approximately 20% of patients required a second dose, which would further increase the cost of use. In this formulary review for a health system’s pharmacy and therapeutics committee, idarucizumab clinical trials and medication package insert were summarized and, after consulting with clinical experts from our institutions, practical recommendations for use were generated to ensure appropriate and safe use of this agent.
Process Improvements to Reduce Cardiac Troponin Turnaround Time in the Emergency Department
Authors: Ison Tracy , Morris Linda , Wilkerson Gloria , Schmidt Carla , Winchester David E.
Published: July 2016

Background:

An efficient testing process is a key to a timely diagnosis of acute myocardial infarction in the emergency department (ED). This includes a rapid evaluation cardiac biomarkers.

Methods:

We conducted a quality and process improvement project to reduce troponin-T turnaround time (TAT) in the central laboratory at our facility. An interdisciplinary team, including front-line staff members, reviewed each step of troponin-T processing in both the ED and the central laboratory. A series of improvements were implemented during 2013, including changes to specimen labeling, elimination of duplicate test ordering, and efficiencies within the laboratory. Data from January 2013 to December 2014 on 31,496 patients with troponin tests were included in the analysis.

Results:

Over the 2-year period of the projects, median troponin-T TAT decreased from 74 minutes to consistently less than 60 minutes.

Conclusions:

With an interdisciplinary team of health care professionals, we successfully reduced troponin-T TAT for possible acute coronary syndrome patients in our ED by 19%, consistently achieving laboratory results in less than 60 minutes.
Multicenter Study of a Novel Topical Interleukin-1 Receptor Inhibitor, Isunakinra, in Subjects With Moderate to Severe Dry Eye Disease
Authors: Goldstein Michael H. , Martel Joseph R. , Sall Kenneth , Goldberg Damien F. , Abrams Marc , Rubin Jay , Sheppard John , Tauber Joseph , Korenfeld Michael , Agahigian Jennifer , Durham Todd A. , Furfine Eric
Published: July 2016

Objectives:

Isunakinra, formerly known as EBI-005, is a novel interleukin (IL)-1 receptor inhibitor developed for topical treatment of patients with dry eye disease (DED). This phase 1b/2a multicenter, double-masked, randomized, vehicle controlled environmental trial assessed the safety and biological activity of isunakinra in patients with moderate to severe DED.

METHODS:

Subjects (N=74) were randomized to vehicle (placebo) or isunakinra (5 or 20 mg/mL) 3×/daily for 6 weeks. Evaluations included safety, tolerability, biological activity for signs (corneal fluorescein staining [CFS]), symptoms (pain or sore eyes and total Ocular Surface Disease Index [OSDI]), and reduction in rescue artificial tear use.

Results:

Topical administration of isunakinra (5 and 20 mg/mL) was safe and well tolerated and resulted in clinically relevant improvements in symptoms (OSDI score, painful/sore eye component of OSDI) and signs (total CFS) compared with baseline with no dose response. OSDI scores improved from baseline by 38% (18.9 points) at 6 weeks and CFS scores improved by 33% (3 points) in the isunakinra groups. These changes were not statistically significant compared with the vehicle. Use of artificial rescue tears was significantly reduced in the isunakinra treatment groups (mean=9 vials) compared with vehicle (mean=31 vials). The differences between isunakinra and vehicle treatments were more pronounced in subjects with OSDI scores less than 50 at baseline.

Conclusions:

Isunakinra was safe, well tolerated and showed clinically meaningful improvements in signs and symptoms of DED. These results encouraged the design of an adequately powered study to characterize the safety and efficacy of isunakinra in ocular surface diseases.
Interexaminer Reliability of Meibography: Upper or Lower Eyelid?
Authors: Dogan Aysun Sanal , Kosker Mustafa , Arslan Nese , Gurdal Canan
Published: July 2016

Objectives:

To investigate the interexaminer reliability of meibography evaluation and the impact of eyelid selection for the procedure.

Methods:

Meibography images of 30 subjects' right eye, including both lids, were evaluated by three clinicians. Meibomian gland (MG) dropout was noted with respect to both percentage and grading (0–4). The examiners' (E1, E2, and E3) consistency was assessed by the intraclass correlation coefficient for MG loss percent and weighted kappa for grading. Correlations between the meibography findings and the fluorescein tear break-up time (FBUT), ocular surface disease index (OSDI) questionnaire, and noninvasive tear break-up time (NIBUT) data were also analyzed.

Results:

The patients' mean age was 49.2±13.4 years, and the male/female ratio distribution was 15/15. Mean FBUT was 9.6±3.1 sec. OSDI and NIBUT were not correlated with meibography findings. FBUT measurements were correlated with the MG loss assessments of all examiners for the upper lid (Spearman correlation test, E1: r=−0.617, P<0.001; E2: r=–0.428, P<0.018; E3: r=−0.429, P=0.018) but not for the lower lid. Weighted kappa statistics based on MG dropout grading revealed moderate-to-good agreement for the upper lid (E1–E2: κ=0.516, P<0.001; E1−E3: κ=0.621, P<0.001; E2−E3: κ=0.650, P<0.001) and fair-to-moderate agreement for the lower lid (E1–E2: κ=0.212; E1–E3: κ=0.272; E2–E3: κ=0.530).

Conclusions:

Meibography is an objective tool for the detection of MG loss. Because of the correlation with FBUT and better interexaminer agreement on dropout by grading, the upper lid might be the preferred lid to make an evaluation.
Neonatal Orbital Abscess Secondary to Pseudomonas Aeruginosa Conjunctivitis
Authors: Yazici Bulent , Orucov Nesimi , Ibrahimzade Gunay
Published: July 2016

Pseudomonas aeruginosa conjunctivitis, although rare in healthy infants, may cause serious ocular and systemic complications. A 30-day-old, otherwise healthy male infant was referred with the diagnosis of right orbital abscess. The patient had been diagnosed as having Pseudomonas conjunctivitis 9 days previously at the referring center. Despite antibiotic treatment, his ocular findings had worsened and marked proptosis had developed. Other examination findings were ptosis, restriction of eye movements, periorbital erythema, and chemosis. Radiologic studies showed a large, homogenous mass with a thick capsule in the lateral retrobulbar orbit. The abscess was drained through a lateral orbitotomy. A culture of the abscess yielded P. aeruginosa. After surgery, the ocular findings improved rapidly without any complication. No other focus of infection or immune system abnormality was found. The patient did not experience any other significant disease during a follow up of 23 months.