bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Cerebral Blood Flow and Vessel Conditions on Speech Recognition in Patients With Postlingual Adult Cochlear Implant: Predictable Factors for the Efficacy of Cochlear Implant
Authors: Ishino Takashi , Ragaee Mahmoud Ali , Maruhashi Tatsuya , Kajikawa Masato , Higashi Yukihito , Sonoyama Toru , Takeno Sachio , Hirakawa Katsuhiro
Published: November 2017

Objectives:

Cochlear implantation (CI) has been the most successful procedure for restoring hearing in a patient with severe and profound hearing loss. However, possibly owing to the variable brain functions of each patient, its performance and the associated patient satisfaction are widely variable. The authors hypothesize that peripheral and cerebral circulation can be assessed by noninvasive and globally available methods, yielding superior presurgical predictive factors of the performance of CI in adult patients with postlingual hearing loss who are scheduled to undergo CI.

Design:

Twenty-two adult patients with cochlear implants for postlingual hearing loss were evaluated using Doppler sonography measurement of the cervical arteries (reflecting cerebral blood flow), flow-mediated dilation (FMD; reflecting the condition of cerebral arteries), and their pre-/post-CI best score on a monosyllabic discrimination test (pre-/post-CI best monosyllabic discrimination [BMD] score). Correlations between post-CI BMD score and the other factors were examined using univariate analysis and stepwise multiple linear regression analysis. The prediction factors were calculated by examining the receiver-operating characteristic curve between post-CI BMD score and the significantly positively correlated factors.

Results:

Age and duration of deafness had a moderately negative correlation. The mean velocity of the internal carotid arteries and FMD had a moderate-to-strong positive correlation with the post-CI BMD score in univariate analysis. Stepwise multiple linear regression analysis revealed that only FMD was significantly positively correlated with post-CI BMD score. Analysis of the receiver-operating characteristic curve showed that a FMD cutoff score of 1.8 significantly predicted post-CI BMD score.

Conclusions:

These data suggest that FMD is a convenient, noninvasive, and widely available tool for predicting the efficacy of cochlear implants. An FMD cutoff score of 1.8 could be a good index for determining whether patients will hear well with cochlear implants. It could also be used to predict whether cochlear implants will provide good speech recognition benefits to candidates, even if their speech discrimination is poor. This FMD index could become a useful predictive tool for candidates with poor speech discrimination to determine the efficacy of CI before surgery.
Effects of Combined Magnetic Fields Treatment and Nano-Hydroxyapatite Coating on Porous Biphasic Calcium Phosphate Bone Graft in Rabbit Spinal Fusion Model
Authors: Zhuo Xianglong , Li Chentian , Li Bing , Li Zhaoyang , Lv Hongbin , Huang Jianjun , Xu Daqi , Hu Jianzhong
Published: November 2017

Study Design.

An animal experimental study was designed to investigate the efficacy of combined magnetic fields (CMF) treatment and nano-hydroxyapatite (HA) coating in the biphasic calcium phosphate (BCP) graft in posterolateral lumbar fusion.

Objective.

To evaluate the effects of CMF treatment and nano-HA/BCP and their combination effect in posterolateral lumbar fusion.

Summary of Background Data.

Enhancement of artificial bone graft bioeffects could improve spinal fusion outcomes. The bone graft integration is vital in spinal fusion, nano-HA coating, and CMF treatment were reported as effective methods to improve bone graft integration.

Methods.

A bilateral transverse process fusion model was performed on 32 rabbits. The CMF treatment was performed for 30 minutes per day postoperation. The fusion rate, new bone formation, artificial bone graft-autologous bone fusion interface in x-ray and scanning electron microscopy, biomechanics property of fusion rate, histological fusion condition, artificial bone residual rate, and immunohistochemistry assessment of bone morphogenetic protein 2 (BMP-2) and Transforming growth factor beta 1 (TGF-β1) expression were observed at 9th week after surgery.

Results.

CMF treatment and nano-HA coating increased the fusion rate, adjusted optical density index, intensity of binding of artificial and autologous bone, bone growth rate, and bending stiffness. CMF treatment also significantly increased BMP-2 and TGF-β1 expression in fusion region while nano-HA coating significantly decreased artificial bone residual rate.

Conclusion.

Our findings suggest that porous nano-HA/BCP graft could significantly improve spine fusion outcome with excellent bioactivity, biocompatibility and degradability and CMF treatment could significantly improve spine fusion outcome by improving bioactivity and biocompatibility of artificial bone graft in rabbit. Combination of CMF treatment with nano-HA/BCP graft could significantly increase posterolateral lumbar fusion rate in rabbit, which would be a potential strategy for spine fusion preclinical study.

Level of Evidence: N/A
Increased Risk of Acute Cholecystitis in Patients With Spinal Cord Injury
Authors: Hsu Cherng-Lan , Wang Mei-Ting , Ho Yu-Chun , Pan Shin-Liang
Published: November 2017

Study Design.

Retrospective cohort study.

Objective.

To evaluate the risk of acute cholecystitis (AC) in patients with spinal cord injury (SCI) based on a nationwide sample.

Summary of Background Data.

Prior research evaluating the risk of AC in patients with SCI is limited. Moreover, since most previous studies on the association between AC and SCI used case-series designs, little is known about the relative risk of SCI patients developing AC from a longitudinal follow-up, compared with individuals without SCI.

Methods.

We used the data from Taiwan's National Health Insurance Research Database. The SCI group consisted of 11,523 patients with SCI aged between 20 and 90 years. Propensity score matching procedure was employed to minimize potential confounding effects arising from the imbalance in the baseline characteristics. A total of 23,046 propensity score-matched patients without SCI were enrolled in the non-SCI group. We compared the incidence of AC between these two groups, and assessed the impact of SCI on the risk of developing AC.

Results.

In the SCI and non-SCI groups, the respective incidence rates of AC were 36.9 (95% confidence interval [CI], 30.0–44.8) and 25.2 (95% CI, 21.2–29.8) per 10,000 person-years. As compared with the non-SCI group, the hazard ratio for the SCI group of AC was 1.71 (95% CI, 1.22–2.41, P = 0.0018); and the cumulative incidence of AC of the SCI group was higher than that of the non-SCI group (P = 0.0036).

Conclusion.

This population-based cohort study showed that there was an increased risk of AC in patients with SCI.

Level of Evidence: 3
Serious Adverse Events Significantly Reduce Patient-Reported Outcomes at 2-Year Follow-up
Authors: Pugely Andrew J. , Kelly Michael P. , Baldus Christine R. , Gao Yubo , Zebala Lukas , Shaffrey Christopher , Glassman Steven , Boachie-Adjei Oheneba , Parent Stefan , Lewis Stephen , Koski Tyler , Edwards Charles , Schwab Frank , Bridwell Keith H.
Published: November 2017

Study Design.

This is an analysis of a prospective 2-year study on nonoperative patients enrolled in the Adult Symptomatic Lumbar Scoliosis (ASLS) National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) trial.

Objective.

The purpose was to evaluate the impact of serious adverse events (SAEs) on patient-reported outcomes (PROs) in nonoperative management of ASLS as measured by Scoliosis Research Society-22 (SRS-22), Oswestry Disability Index (ODI), and Short Form-12 (SF-12) at 2-year follow-up.

Summary of Background Data.

Little is known about PROs in the nonoperative management of ASLS or the prevalence and impact of SAEs on PROs.

Methods.

The ASLS trial dataset was analyzed to identify adult lumbar scoliosis patients electively choosing or randomly assigned to nonoperative treatment with minimum 2-year follow-up. Patient data were collected prospectively from 2010 to 2015 as part of NIAMS R01-AR055176–01A2 “A Multi-Centered Prospective Study of Quality of Life in Adult Scoliosis.” SAEs were defined as life-threatening medical events, new significant or permanent disability, new or prolonged hospitalization, or death.

Results.

One hundred five nonoperative patients were studied to 2-year follow-up. Twenty-seven patients (25.7%) had 42 SAEs; 15 (14.3%) had a SAE during the first year. The SAE group had higher body mass index (29.4 vs. 25.2; P = 0.008) and reported worse SRS-22 Function scores than the non-SAE group at baseline (3.3 vs. 3.6; P = 0.024). At 2-year follow-up, SAE patients experienced less improvement (change) in SRS-22 Self-Image (−0.07 vs. 0.26; P = 0.018) and Mental Health domains (−0.19 vs. 0.25; P = 0.002) than non-SAE patients and had lower SRS-22 Function, Self-Image, Subscore, and SF-12 Mental and Physical component scores (MCS/PCS). Fewer SAE patients reached minimal clinically important difference (MCID) threshold in SRS-22 Mental Health (14.8% vs. 43.6%; P = 0.01).

Conclusion.

A high percentage (25.7%) of ASLS patients managed nonoperatively experienced SAEs. Those patients who sustained a SAE had less improvement in reported outcomes.

Level of Evidence: 2
Increased Lumbar Lordosis and Smaller Vertebral Cross-Sectional Area Are Associated With Spondylolysis
Authors: Wren Tishya A. L. , Ponrartana Skorn , Aggabao Patricia C. , Poorghasamians Ervin , Skaggs David L. , Gilsanz Vicente
Published: November 2017

Study Design.

A cross-sectional comparison of vertebral morphology and lumbar lordosis (LL) in adolescents with and without spondylolysis.

Objective.

To test the hypothesis that in addition to LL, vertebral cross-sectional area (CSA) is also associated with spondylolysis.

Summary of Background Data.

Recent data indicate that the CSA of the vertebral body is a determinant of LL, which has been shown to be associated with spondylolysis.

Methods.

Using magnetic resonance imaging, we compared the degree of LL from L1 to L5 and the CSA of the lumbar vertebrae in 35 adolescents (16 females and 19 males) with spondylolysis and 86 healthy controls (36 females and 50 males) of similar sex, age, height, and weight.

Results.

There were no significant differences in age, height, weight, or vertebral height between subjects with and without spondylolysis, regardless of sex. In contrast, LL angle in spondylolysis patients was 57% and 51% greater in girls and boys with spondylolysis; 44.1 ± 10.4° versus 28.1 ± 9.8° and 34.8 ± 5.9° versus 23.0 ± 6.0° for girls and boys, respectively (both P's < 0.0001). Additionally, values for vertebral CSA were on average, 8% and 10% smaller in females and males with spondylolysis; 7.6 ± 0.8 cm2
versus 8.3 ± 1.1 cm2 and 8.4 ± 1.6 versus 9.3 ± 1.6 for girls and boys, respectively (both P's ≤ 0.039). Multiple linear and logistic regression analyses indicated that the CSA of the vertebral body was negatively associated with LL angle and an independent predictor of the presence of spondylolysis. This was true regardless of whether girls and boys were analyzed together or independently, and whether LL angle was measured from L1 to L5 or S1.

Conclusion.

We provide evidence that patients with spondylolysis have increased LL and smaller vertebral CSA.

Level of Evidence: 4
Simultaneous Inhibition of Tumor Necrosis Factor Receptor 1 and Matrix Metalloproteinase 8 Completely Protects Against Acute Inflammation and Sepsis
Authors: Steeland Sophie , Van Ryckeghem Sara , Vandewalle Jolien , Ballegeer Marlies , Van Wonterghem Elien , Eggermont Melanie , Decruyenaere Johan , De Bus Liesbet , Libert Claude , Vandenbroucke Roosmarijn E.
Published: November 2017

Objectives:

Sepsis causes very high mortality and morbidity rates and remains one of the biggest medical challenges. This study investigates whether plasma levels of both matrix metalloproteinase 8 and tumor necrosis factor receptor 1 are associated with sepsis severity and also investigates the therapeutic applicability of simultaneous inhibition of the two molecules in sepsis.

Design:

Observational human pilot study—prospective controlled animal study.

Setting:

University hospital and research laboratory.

Subjects:

Sepsis patients and C57BL/6 mice deficient for matrix metalloproteinase 8 and/or tumor necrosis factor receptor 1.

Intervention:

Plasma and whole blood RNA were collected from 13 sepsis patients for 7 consecutive days and within 24 hours of admission to ICU. Matrix metalloproteinase 8 and tumor necrosis factor receptor 1 plasma and expression levels were determined in these patients. Mice deficient for both matrix metalloproteinase 8 and tumor necrosis factor receptor 1 were generated and subjected to endotoxemia and cecal ligation and puncture. Additionally, a bispecific Nanobody that simultaneously blocks matrix metalloproteinase 8 and tumor necrosis factor receptor 1 was created.

Measurements and Main Results:

Plasma levels of matrix metalloproteinase 8 and tumor necrosis factor receptor 1 were positively correlated with the Sequential Organ Failure Assessment score (r, 0.51 and 0.58) and interleukin 6 levels (r, 0.59 and 0.52) in 13 sepsis patients. Combined elimination of tumor necrosis factor receptor 1 and matrix metalloproteinase 8 in double knockout mice resulted in superior survival in endotoxemia and CLP compared with single knockouts and wild-type mice. Cotreatment with our bispecific Nanobody in CLP resulted in improved survival rates (28% vs 19%) compared with untreated mice.

Conclusions:

Inhibition of matrix metalloproteinase 8 and tumor necrosis factor receptor 1 might have therapeutic potential to treat sepsis and proof-of-principle was provided as therapeutics that inhibit both tumor necrosis factor receptor 1 and matrix metalloproteinase 8 are effective in CLP.
Sleep Sufficiency in Pediatric and Adolescent Tourette's Disorder: National Survey of Children's Health
Authors: Ricketts Emily J. , Rozenman Michelle , Choy Caitlin , Goldberg Hannah B. , Kim Jessica S. , Colwell Christopher S. , McCracken James T. , Piacentini John
Published: November 2017

Objective:

The present study compared sleep sufficiency in youth with current Tourette's disorder (TD), history of TD and matched case controls, and examined predictors of sufficient sleep using a large US population–based survey.

Method:

Participants were 673 caregivers of youth aged 6 to 17 years (298 with current TD, 122 with a history of TD with no endorsement of current diagnosis, and 254 matched case controls) from the 2007 and 2011–2012 versions of the National Survey of Children's Health. History and current TD status, current comorbidity (attention deficit/hyperactivity disorder, anxiety, and depression) and psychiatric medication status were assessed by yes/no items. Current TD severity was dichotomized into mild or moderate/severe symptoms. Sleep was assessed by parent-reported number of sufficient nights their child slept in the past week.

Results:

Univariate analysis of variance yielded significant group differences in nights of sufficient sleep (F[2,369.70] = 71.53, p < .001), with controls having 1.5 more nights per week relative to both TD groups (p < .001). With respect to predictors of sufficient sleep, the analysis of covariance yielded a significant age × sex × TD severity interaction (F[1,15.84] = 4.28, p = .04) such that older adolescent males with mild TD had significantly fewer nights of sufficient sleep than children (p = .004) and early adolescents (p = .002; F[2,54.93] = 7.45, p = .001). Early adolescent females with moderate/severe TD had fewer nights of sufficient sleep relative to males (p = .008). Comorbidity type and psychiatric medication status did not significantly predict sleep.

Conclusion:

Findings suggest that insufficient sleep in youth with TD persists independently of comorbidity or psychiatric medication status. Findings highlight the importance of clinical sleep monitoring in this population.
Evaluation of the Effect of Moist Chamber Spectacles in Patients With Dry Eye Exposed to Adverse Environment Conditions
Authors: Ogawa Mamoru , Dogru Murat , Toriyama Naoki , Yamaguchi Takefumi , Shimazaki Jun , Tsubota Kazuo
Published: November 2017

Purpose:

To evaluate the effect of moist chamber spectacle wear on the ocular surface and tear functions in a controlled wind exposure environment.

Methods:

Twenty-eight eyes of 14 probable dry eye subjects (4 men, 10 women; mean age: 34.5 years) underwent constant wind exposure for 10 min without spectacle, with conventional spectacle wear, and with moist chamber spectacle wear. Dryness Visual Analog Scale (VAS) scores, tear evaporation, blink rate, tear film breakup testing, and fluorescein staining were performed before and after wind exposure.

Results:

The mean dryness VAS score after wind exposure was significantly higher when no spectacles were worn or when conventional spectacles with no moist chambers were worn compared with after exposure scores when moist chamber spectacles were worn (P=0.02). The mean of tear evaporation rate from the ocular surface and blink rate increased significantly with wind exposure when no spectacles were worn or when conventional spectacles with no moist chambers were worn (P=0.04). There were no significant changes before and after wind exposure when the moist chamber spectacles were worn (P=0.1).

Conclusion:

Moist chamber spectacles appear to have favorable effects on dry eye symptomatology, tear stability, and blink rates in adverse environment conditions such as wind exposure.
Cross-Sectional and Longitudinal Investigation of the Power Vector in Astigmatism: The Yamagata Study (Funagata)
Authors: Namba Hiroyuki , Kawasaki Ryo , Sugano Akira , Nishi Katsuhiro , Murakami Takanori , Nishitsuka Koichi , Kato Takeo , Kayama Takamasa , Yamashita Hidetoshi
Published: November 2017

Purpose:

To investigate how age and other factors affect astigmatism in Japanese adults over a period of 5 years.

Methods:

We included 512 Japanese participants who had undergone systemic and ophthalmological examinations both in 2005–2007 and in 2010–2012 in Funagata town, Yamagata, Japan. Astigmatism was evaluated using power vector analyses, where J0 represents the power of orthogonal astigmatism. Positive values of J0 indicate with-the-rule astigmatism, whereas negative values indicate against-the-rule (ATR).

Results:

In this cross-sectional investigation, J0 represented the power of orthogonal astigmatism, and multivariate regression revealed that both J0 and corneal J0 (cJ0) declined with increasing age (both P < 0.001). In a longitudinal investigation spanning 5 years, the mean amounts of change (Δ) in J0 and ΔcJ0 were −0.045 ± 0.308 and −0.072 ± 0.278, respectively. This confirmed an ATR shift with increasing age in most individuals. The age-divided distribution of the magnitude of differences indicated that older age was associated with a larger astigmatic change over a 5-year period in both the cornea and the entire eye. Using multivariate logistic regression, we observed that older age at baseline was a risk factor for low ΔJ0, indicating a large shift toward ATR astigmatism.

Conclusions:

We confirmed that a refractive and keratometric shift toward ATR astigmatism occurs with aging. Older age at baseline was also associated with a larger magnitude of astigmatic changes over the subsequent 5 years.
Improving Quality of Care in Federally Qualified Health Centers Through Ambulatory Care Accreditation
Authors: Nair Suma , Chen Jie
Published: November 2017

HRSA supported health centers have a long history of participating in ambulatory care accreditation; however, there is a dearth of information on the relationship between accreditation and quality of care. We conducted a cross-sectional study of 1,202 health centers, using multivariate regression to estimate the association between accreditation and 14 clinical quality measures, controlling for patient and organizational characteristics. We also predicted national estimates of accreditation-related improvement in quality. Adjusted analyses show that accredited health centers achieved higher performance on adult weight screening and follow-up (coef = 0.037, p < .05), tobacco cessation intervention (coef = 0.042, p < .05), and use of lipid-lowering therapy (coef = 0.028, p < .05). Study results show that universal accreditation could result in additional 552,087 adult patients receiving weight screening and follow-up, 157,434 receiving tobacco cessation intervention and 25,289 receiving lipid-lowering therapy. This is the first national study to examine the impact of accreditation on health center quality of care. Findings suggest that HRSA support for accreditation has the potential to improve quality of care and as a result, reduce health disparities in underserved communities across the United States. Further research is necessary to identify specific elements of accreditation that have the greatest impact on quality of care.
Pediatric Nonalcoholic Fatty Liver Disease
Authors: Nobili Valerio , Socha Piotr
Published: November 2017

Nonalcoholic fatty liver disease (NAFLD), an increasingly prevalent paediatric disorder, is diagnosed and managed not only by both pediatric gastroenterologists/hepatologists but also frequently by the general pediatrician. This article updates recent advances in diagnostic and therapeutic approach, which may be applied to everyday practice. Diagnosis of NAFLD takes into account the risk factor profile and is a diagnosis of exclusion. Techniques such as transient elastography and specific biomarkers aimed at improving diagnosis and monitoring of NAFLD need further validation in the pediatric population. Defining the risk to develop cirrhosis seems to be of primary importance already in childhood and a combination of genetic, clinical, and environmental factors can help in monitoring and making decisions on therapy. Weight reduction therapy should be the aim of treatment approach, but the compliance is poor and pharmacological treatment would be helpful; docosahexaenoic acid, some probiotics, and vitamin E are to be considered, but evidence is not sufficient to recommend widespread use.
Cognitive Apprenticeship During Preceptorship
Authors: Key Betty A. , Wright Vivian H.
Published: November 2017

This study investigated whether implementation of an instructional strategy during hospital orientation preceptorship of newly graduated nurses would impact their confidence and ease of transition. Findings revealed an increase in confidence of newly graduated nurses after implementation of cognitive apprenticeship principles. The findings suggest that it can be beneficial to teaching cognitive apprenticeship principles to preceptors for use during preceptorship.
Evaluating Continuing Nursing Education
Authors: Wellings Cynthea A. , Gendek Marilyn A. , Gallagher Silvia E.
Published: November 2017

Evaluating the effectiveness of continuing nursing education does not always include behavioral change and patient health outcomes. A qualitative analysis of open-ended evaluation questions from continuing nursing education activities was conducted. The aim was to evaluate learners' intentions to change their practice resulting from their learning and their perceived barriers to implementing practice changes. Results revealed the multiple, interconnected challenges involved in translating new learning into practice.
Torticollis and Fever in a Young Boy
Authors: Rafferty Jason R. , Janopaul-Naylor Elizabeth , Riese Jeffrey
Published: November 2017

Cat-scratch disease–associated vertebral osteomyelitis and epidural involvement are rare and may manifest with nonspecific chronic symptoms in children, such as fever or torticollis. We present only the fourth case in the literature describing epidural involvement in an immunocompetent boy presenting with fever, torticollis, and indiscriminate left upper back tenderness. Bartonella henselae serologies are important to consider because such atypical complications often are responsive to conservative management with antibiotics.
Feasibility of Early, Motor-Assisted Cycle Ergometry in Critically Ill Neurological Patients With Upper Limb Weakness and Variable Cognitive Status
Authors: Deluzio Sandra , Vora Isha , Kumble Sowmya , Zink Elizabeth K. , Stevens Robert D. , Bahouth Mona N.
Published: November 2017

Upper limb paresis, common in many neurological conditions, is a major contributor of long-term disability and decreased quality of life. Evidence shows that repetitive, bilateral arm movement improves upper limb coordination after neurological injury. However, it is difficult to integrate upper limb interventions into very early rehabilitation of critically ill neurological patients because of patient arousal and medical acuity. This report describes the safety and feasibility of bilateral upper limb cycling in critically ill neurological patients with bilateral or unilateral paresis. Patients were included in this pilot observational series if they used upper limb cycle ergometry with occupational therapy while in the neurocritical care unit between May and August 2016. Patient demographics, neurological function, and hemodynamic status were recorded precycling and postcycling. Cycling parameters including duration and active and/or passive cycling were collected. No significant changes in hemodynamic or respiratory status were noted postintervention. No adverse effects or safety events were noted. In this series, upper limb cycle ergometry was a safe and feasible intervention for early rehabilitation in critically ill patients in the neurocritical care unit. Future studies will prospectively measure the impact of early upper limb cycle ergometry on neurological recovery and functional outcome in this population.
Orbital Floor Fractures
Authors: Ramponi Denise R. , Astorino Terri , Bessetti-Barrett Colleen R.
Published: November 2017

The orbital bones are thin and exposed, making the orbital walls vulnerable to fractures. The floor of the orbit is the weakest portion of this 4-sided pyramid structure. Blunt force trauma is the primary mechanism of injury in young men between the ages of 18 and 30 years. Computerized tomography is the primary imaging technique to diagnose orbital fractures. Conservative versus surgical management is determined by maxillofacial and ophthalmology specialists.
Changing the Emergency Department's Practice of Rapid Sequence Intubation to Reduce the Incidence of Hypoxia
Authors: Gooch Michael D. , Roberts Eric
Published: November 2017

Rapid sequence intubation (RSI) is an advanced procedure performed by nurse practitioners in the emergency department (ED). Hypoxia is one of the most common complications associated with RSI, which may lead to serious sequela, including death. Hypoxia may result from medications that are given to facilitate the procedure or the underlying disease process. Without preventive measures, oxygen levels may fall rapidly when patients are no longer actively breathing. The incidence of RSI-induced hypoxia may be mitigated with proper education, preoxygenation, positioning, and the utilization of passive (apneic) oxygenation. The purpose of this project was to determine whether RSI practice could be changed through education and implementation of an evidence-based protocol in the ED of a hospital in south central United States. Baseline practice was determined by chart audits and compared with practice after educational sessions and protocol implementation. Change occurred as evidenced by an increase in the utilization of all 3 hypoxia prevention interventions included in the protocol. Staff education and utilization of a protocol changed the care provided, which can influence patient outcomes and decrease the incidence of RSI-induced hypoxia.
Reducing Unnecessary Head Computed Tomography in Mild Traumatic Brain Injury
Authors: Webster Nathaniel John , Moore Nathan , Stewart Felicia
Published: November 2017

There is growing concern about the frequency of computed tomographic (CT) scans performed for evaluation of adults with suspected mild traumatic brain injury. The Canadian CT Head Rule and the New Orleans Criteria are the most studied head CT decision tools that aid providers in determining which patients do not require a CT scan. This article examines recent research to determine which of these tools has proven to be the most effective at safely reducing the use of head CT scans. The reviewed studies concluded that both the Canadian CT Head Rule and the New Orleans Criteria had similar sensitivities, but the Canadian CT Head Rule showed superior specificity in predicting the presence of a clinically significant brain injury. The authors of this article recommend that the Canadian CT Head Rule be used in the evaluation of minor head injury to reduce unnecessary CT scans.
Sugammadex for Neuromuscular Blockade Reversal
Authors: Papathanas Michelle R. , Killian Alley
Published: November 2017

Postoperative residual neuromuscular blockade is associated with an increased risk of respiratory insufficiency, aspiration, and potential pulmonary complications. The standard of care for reversal of residual block centers on anticholinesterases such as neostigmine. However, these medications provide inconsistent or inadequate effect while being associated with potentially severe adverse effects. Sugammadex, a modified γ-cyclodextrine compound, is a recently approved agent for the reversal of blockade with aminosterodial neuromuscular blockers. Randomized controlled trials, in addition to a meta-analysis and a systematic review, have published results indicating faster and more consistent reversal of blockade while leading to fewer adverse events.
Genetics of vestibular syndromes
Authors: Roman-Naranjo Pablo , Gallego-Martinez Alvaro , Lopez Escamez Jose A.
Published: November 2017

Purpose of review

The increased availability of next generation sequencing has enabled a rapid progress in the discovery of genetic variants associated with vestibular disorders. We have summarized molecular genetics finding in vestibular syndromes during the last 18 months.

Recent findings

Genetic studies continue to shed light on the genetic background of vestibular disorders. Novel genes affecting brain development and otolith biogenesis have been associated with motion sickness. Exome sequencing has made possible to identify three rare single nucleotide variants in PRKCB, DPT and SEMA3D linked with familial Meniere disease. Moreover, superior canal dehiscence syndrome might be related with variants in CDH3 gene, by increasing risk of its development. On the other hand, the association between vestibular schwannoma and enlarged vestibular aqueduct with variants in NF2 and SLC26A4, respectively, seems increasingly clear. Finally, the use of mouse models is allowing further progress in the development gene therapy for hearing and vestibular monogenic disorders.

Most of episodic or progressive syndromes show familial clustering. A detailed phenotyping with a complete familial history of vestibular symptoms is required to conduct a genetic study. Progress in these studies will allow us to understand diseases mechanisms and improve their current medical treatments.
Metabolic depression and the evolution of hypoxia tolerance in threespine stickleback,Gasterosteus aculeatus
Authors: Regan Matthew D. , Gill Ivan S. , Richards Jeffrey G.
Published: November 2017

Anthropogenic increases in global temperature and agricultural runoff are increasing the prevalence of aquatic hypoxia throughout the world. We investigated the potential for a relatively rapid evolution of hypoxia tolerance using two isolated (for less than 11 000 years) populations of threespine stickleback: one from a lake that experiences long-term hypoxia (Alta Lake, British Columbia) and one from a lake that does not (Trout Lake, British Columbia). Loss-of-equilibrium (LOE) experiments revealed that the Alta Lake stickleback were significantly more tolerant of hypoxia than the Trout Lake stickleback, and calorimetry experiments revealed that the enhanced tolerance of Alta Lake stickleback may be associated with their ability to depress metabolic rate (as indicated by metabolic heat production) by 33% in hypoxia. The two populations showed little variation in their capacities for O2extraction and anaerobic metabolism. These results reveal that intraspecific variation in hypoxia tolerance can develop over relatively short geological timescales, as can metabolic rate depression, a complex biochemical response that may be favoured in long-term hypoxic environments.
The role of visual cues in mother–pup reunions in a colonially breeding mammal
Authors: Wierucka Kaja , Pitcher Benjamin J. , Harcourt Robert , Charrier Isabelle
Published: November 2017

Parental care is an important factor influencing offspring survival and adult reproductive success in many vertebrates. Parent–offspring recognition ensures care is only directed to filial young, avoiding the costs of misallocated resource transfer. It is essential in colonial mammal species, such as otariids (fur seals and sea lions), in which repeated mother–offspring separations increase the risk of misdirecting maternal effort. Identification of otariid pups by mothers is known to be multi-modal, yet the role of visual cues in this process remains uncertain. We used three-dimensional visual models to investigate the importance of visual cues in maternal recognition of pups in Australian sea lions (
Neophoca cinerea
). We showed that the colour pattern of pup pelage in the absence of any other sensory cues served to attract the attention of females and prompt investigation. Furthermore, females were capable of accurately distinguishing between models imitating the age-class of their own pup and those resembling older or younger age-classes. Our results suggest that visual cues facilitate age-class discrimination of pups by females and so are likely to play an important role in mother–pup reunions and recognition in otariid species.
Kleptopredation: a mechanism to facilitate planktivory in a benthic mollusc
Authors: Willis Trevor J. , Berglöf Kimberly T. L. , McGill Rona A. R. , Musco Luigi , Piraino Stefano , Rumsey Claire M. , Fernández Tomás Vega , Badalamenti Fabio
Published: November 2017

Predation occurs when an organism completely or partially consumes its prey. Partial consumption is typical of herbivores but is also common in some marine microbenthic carnivores that feed on colonial organisms. Associations between nudibranch molluscs and colonial hydroids have long been assumed to be simple predator–prey relationships. Here we show that while the aeolid nudibranch
Cratena peregrina
does prey directly on the hydranths of
Eudendrium racemosum
, it is stimulated to feed when hydranths have captured and are handling prey, thus ingesting recently captured plankton along with the hydroid polyp such that plankton form at least half of the nudibranch diet. The nudibranch is thus largely planktivorous, facilitated by use of the hydroid for prey capture. At the scale of the colony this combines predation with kleptoparasitism, a type of competition that involves the theft of already-procured items to form a feeding mode that does not fit into existing classifications, which we term kleptopredation. This strategy of subsidized predation helps explain how obligate-feeding nudibranchs obtain sufficient energy for reproduction from an ephemeral food source.
Leaf anatomy of a late Palaeozoic cycad
Authors: Feng Zhuo , Lv Yong , Guo Yun , Wei Hai-Bo , Kerp Hans
Published: November 2017

Today, cycads are a small group of gymnospermous plants with a limited distribution in the (sub)tropics, but they were major constituents of Mesozoic floras. Fossil leaves sporadically found in latest Carboniferous and Permian floras have putatively been ascribed to cycads. However, their true affinity remains unclear due to the lack of anatomical evidence. Virtually all modern cycads have pinnate leaves, but this type of leaf morphology is by no means unique for cycads. Pinnate leaves of
Plagiozamites oblongifolius
Halle 1927 with well-preserved cuticles showing the epidermal anatomy are here described from the upper Permian Xuanwei Formation of Yunnan Province, Southwest China. The cuticles show a clear differentiation into costal and intercostal zones; stomata are confined to the intercostal zones on both the upper and lower leaf surfaces. The external morphology and the epidermal anatomy of these fossil leaves are closely comparable with those of extant cycads, particularly members of the family Zamiaceae.
Exploring the role of competition induced by non-vaccine serotypes for herd protection following pneumococcal vaccination
Authors: Masala G. L. , Lipsitch M. , Bottomley C. , Flasche S.
Published: November 2017

The competitive pressure from non-vaccine serotypes may have helped pneumococcal conjugate vaccines (PCVs) to limit vaccine-type (VT) serotype prevalence. We aimed to investigate if, consequently, the indirect protection of vaccines targeting most pneumococcal serotypes could fall short of the profound effects of current formulations. We compared three previously described pneumococcal models harmonized to simulate 20 serotypes with a combined pre-vaccination prevalence in children younger than 5-years-old of 40%. We simulated vaccines of increasing valency by adding serotypes in order of their competitiveness and explored their ability to reduce VT carriage by 95% within 10 years after introduction. All models predicted that additional valency will reduce indirect vaccine effects and hence the overall vaccine impact on carriage both in children and adults. Consequently, the minimal effective coverage (efficacy against carriage×vaccine coverage) needed to eliminate VT carriage increased with increasing valency. One model predicted this effect to be modest, while the other two predicted that high-valency vaccines may struggle to eliminate VT pneumococci unless vaccine efficacy against carriage can be substantially improved. Similar results were obtained when settings of higher transmission intensity and different PCV formulations were explored. Failure to eliminate carriage as a result of increased valency could lead to overall decreased impact of vaccination if the disease burden caused by the added serotypes is low. Hence, a comparison of vaccine formulations of varying valency, and pan-valent formulations in particular, should consider the invasiveness of targeted serotypes, as well as efficacy against carriage.
Scale invariance in natural and artificial collective systems: a review
Authors: Khaluf Yara , Ferrante Eliseo , Simoens Pieter , Huepe Cristián
Published: November 2017

Self-organized collective coordinated behaviour is an impressive phenomenon, observed in a variety of natural and artificial systems, in which coherent global structures or dynamics emerge from local interactions between individual parts. If the degree of collective integration of a system does not depend on size, its level of robustness and adaptivity is typically increased and we refer to it as scale-invariant. In this review, we first identify three main types of self-organized scale-invariant systems: scale-invariant spatial structures, scale-invariant topologies and scale-invariant dynamics. We then provide examples of scale invariance from different domains in science, describe their origins and main features and discuss potential challenges and approaches for designing and engineering artificial systems with scale-invariant properties.
Desert mammal populations are limited by introduced predators rather than future climate change
Authors: Greenville Aaron C. , Wardle Glenda M. , Dickman Chris R.
Published: November 2017

Climate change is predicted to place up to one in six species at risk of extinction in coming decades, but extinction probability is likely to be influenced further by biotic interactions such as predation. We use structural equation modelling to integrate results from remote camera trapping and long-term (17–22 years) regional-scale (8000 km2) datasets on vegetation and small vertebrates (greater than 38 880 captures) to explore how biotic processes and two key abiotic drivers influence the structure of a diverse assemblage of desert biota in central Australia. We use our models to predict how changes in rainfall and wildfire are likely to influence the cover and productivity of the dominant vegetation and the impacts of predators on their primary rodent prey over a 100-year timeframe. Our results show that, while vegetation cover may decline due to climate change, the strongest negative effect on prey populations in this desert system is top-down suppression from introduced predators.
Errors in mutagenesis and the benefit of cell-to-cell signalling in the evolution of stress-induced mutagenesis
Authors: Dellus-Gur Eynat , Ram Yoav , Hadany Lilach
Published: November 2017

Stress-induced mutagenesis is a widely observed phenomenon. Theoretical models have shown that stress-induced mutagenesis can be favoured by natural selection due to the beneficial mutations it generates. These models, however, assumed an error-free regulation of mutation rate in response to stress. Here, we explore the effects of errors in the regulation of mutagenesis on the evolution of stress-induced mutagenesis, and consider the role of cell-to-cell signalling. Using theoretical models, we show (i) that stress-induced mutagenesis can be disadvantageous if errors are common; and (ii) that cell-to-cell signalling can allow stress-induced mutagenesis to be favoured by selection even when error rates are high. We conclude that cell-to-cell signalling can facilitate the evolution of stress-induced mutagenesis in microbes through second-order selection.
Lattice-geometry effects in garnet solid electrolytes: a lattice-gas Monte Carlo simulation study
Authors: Morgan Benjamin J.
Published: November 2017

Ionic transport in solid electrolytes can often be approximated as ions performing a sequence of hops between distinct lattice sites. If these hops are uncorrelated, quantitative relationships can be derived that connect microscopic hopping rates to macroscopic transport coefficients; i.e. tracer diffusion coefficients and ionic conductivities. In real materials, hops are uncorrelated only in the dilute limit. At non-dilute concentrations, the relationships between hopping frequency, diffusion coefficient and ionic conductivity deviate from the random walk case, with this deviation quantified by single-particle and collective correlation factors,
f
and
f
I
, respectively. These factors vary between materials, and depend on the concentration of mobile particles, the nature of the interactions, and the host lattice geometry. Here, we study these correlation effects for the garnet lattice using lattice-gas Monte Carlo simulations. We find that, for non-interacting particles (volume exclusion only), single-particle correlation effects are more significant than for any previously studied three-dimensional lattice. This is attributed to the presence of two-coordinate lattice sites, which causes correlation effects intermediate between typical three-dimensional and one-dimensional lattices. Including nearest-neighbour repulsion and on-site energies produces more complex single-particle correlations and introduces collective correlations. We predict particularly strong correlation effects at
x
Li
=3 (from site energies) and
x
Li
=6 (from nearest-neighbour repulsion), where
x
Li
=9 corresponds to a fully occupied lithium sublattice. Both effects are consequences of ordering of the mobile particles. Using these simulation data, we consider tuning the mobile-ion stoichiometry to maximize the ionic conductivity, and show that the ‘optimal’ composition is highly sensitive to the precise nature and strength of the microscopic interactions. Finally, we discuss the practical implications of these results in the context of lithium garnets and other solid electrolytes.
Competing opinion diffusion on social networks
Authors: Hu Haibo
Published: November 2017

Opinion competition is a common phenomenon in real life, such as with opinions on controversial issues or political candidates; however, modelling this competition remains largely unexplored. To bridge this gap, we propose a model of competing opinion diffusion on social networks taking into account degree-dependent fitness or persuasiveness. We study the combined influence of social networks, individual fitnesses and attributes, as well as mass media on people’s opinions, and find that both social networks and mass media act as amplifiers in opinion diffusion, the amplifying effect of which can be quantitatively characterized. We analytically obtain the probability that each opinion will ultimately pervade the whole society when there are no committed people in networks, and the final proportion of each opinion at the steady state when there are committed people in networks. The results of numerical simulations show good agreement with those obtained through an analytical approach. This study provides insight into the collective influence of individual attributes, local social networks and global media on opinion diffusion, and contributes to a comprehensive understanding of competing diffusion behaviours in the real world.
Tweeting birds: online mentions predict future citations in ornithology
Authors: Finch Tom , O'Hanlon Nina , Dudley Steve P.
Published: November 2017

The rapid growth of online tools to communicate scientific research raises the important question of whether online attention is associated with citations in the scholarly literature. The Altmetric Attention Score (AAS) quantifies the attention received by a scientific publication on various online platforms including news, blogs and social media. It has been advanced as a rapid way of gauging the impact of a piece of research, both in terms of potential future scholarly citations and wider online engagement. Here, we explore variation in the AAS of 2677 research articles published in 10 ornithological journals between 2012 and 2016. On average, AAS increased sevenfold in just five years, primarily due to increased activity on Twitter which contributed 75% of the total score. For a subset of 878 articles published in 2014, including an additional 323 ornithology articles from non-specialist journals, an increase in AAS from 1 to 20 resulted in a predicted 112% increase in citation count from 2.6 to 5.5 citations per article. This effect interacted with journal impact factor, with weaker effects of AAS in higher impact factor journals. Our results suggest that altmetrics (or the online activity they measure), as well as complementing traditional measures of scholarly impact in ornithology such as citations, may also anticipate or even drive them.
Predators indirectly induce stronger prey through a trophic cascade
Authors: Spyksma Arie J. P. , Shears Nick T. , Taylor Richard B.
Published: November 2017

Many prey species induce defences in direct response to predation cues. However, prey defences could also be enhanced by predators indirectly via mechanisms that increase resource availability to prey, e.g. trophic cascades. We evaluated the relative impacts of these direct and indirect effects on the mechanical strength of the New Zealand sea urchinEvechinus chloroticus. We measured crush-resistance of sea urchin tests (skeletons) in (i) two marine reserves, where predators of sea urchins are relatively common and have initiated a trophic cascade resulting in abundant food for surviving urchins in the form of kelp, and (ii) two adjacent fished areas where predators and kelps are rare. Sea urchins inhabiting protected rocky reefs with abundant predators and food had more crush-resistant tests than individuals on nearby fished reefs where predators and food were relatively rare. A six-month long mesocosm experiment showed that while both food supply and predator cues increased crush-resistance, the positive effect of food supply on crush-resistance was greater. Our results demonstrate a novel mechanism whereby a putative morphological defence in a prey species is indirectly strengthened by predators via cascading predator effects on resource availability. This potentially represents an important mechanism that promotes prey persistence in the presence of predators.