bluuebunny/crossref_metadata_2025 huggingface dataset:
Gravity drives the evolution of infrared dark hubs: JVLA observations of SDC13
Authors: Williams G. M. , Peretto N. , Avison A. , Duarte-Cabral A. , Fuller G. A.
Published: January 2018

Context. Converging networks of interstellar filaments, that is hubs, have been recently linked to the formation of stellar clusters and massive stars. Understanding the relationship between the evolution of these systems and the formation of cores and stars inside them is at the heart of current star formation research.

Aims. The goal is to study the kinematic and density structure of the SDC13 prototypical hub at high angular resolution to determine what drives its evolution and fragmentation.

Methods. We have mapped SDC13, a ~1000 M⊙ infrared dark hub, in NH3(1,1) and NH3(2,2) emission lines, with both the Jansky Very Large Array and Green Bank Telescope. The high angular resolution achieved in the combined dataset allowed us to probe scales down to 0.07 pc. After fitting the ammonia lines, we computed the integrated intensities, centroid velocities and line widths, along with gas temperatures and H2 column densities.

Results. The mass-per-unit-lengths of all four hub filaments are thermally super-critical, consistent with the presence of tens of gravitationally bound cores identified along them. These cores exhibit a regular separation of ~0.37 ± 0.16 pc suggesting gravitational instabilities running along these super-critical filaments are responsible for their fragmentation. The observed local increase of the dense gas velocity dispersion towards starless cores is believed to be a consequence of such fragmentation process. Using energy conservation arguments, we estimate that the gravitational to kinetic energy conversion efficiency in the SDC13 cores is ~35%. We see velocity gradient peaks towards ~63% of cores as expected during the early stages of filament fragmentation. Another clear observational signature is the presence of the most massive cores at the filaments’ junction, where the velocity dispersion is largest. We interpret this as the result of the hub morphology generating the largest acceleration gradients near the hub centre.

Conclusions. We propose a scenario for the evolution of the SDC13 hub in which filaments first form as post-shock structures in a supersonic turbulent flow. As a result of the turbulent energy dissipation in the shock, the dense gas within the filaments is initially mostly sub-sonic. Then gravity takes over and starts shaping the evolution of the hub, both fragmenting filaments and pulling the gas towards the centre of the gravitational well. By doing so, gravitational energy is converted into kinetic energy in both local (cores) and global (hub centre) potential well minima. Furthermore, the generation of larger gravitational acceleration gradients at the filament junctions promotes the formation of more massive cores.
The near-infrared outflow and cavity of the proto-brown dwarf candidate ISO-Oph 200
Authors: Whelan E. T. , Riaz B. , Rouzé B.
Published: January 2018

In this Letter a near-infrared integral field study of a proto-brown dwarf candidate is presented. A ~0.′′5 blue-shifted outflow is detected in both H2 and [Fe II] lines at Vsys = (–35 ± 2) km s−1 and Vsys = (–51 ± 5) km s−1 respectively. In addition, slower (~±10 km s−1) H2 emission is detected out to <5.′′4, in the direction of both the blue and red-shifted outflow lobes but along a different position angle to the more compact faster emission. It is argued that the more compact emission is a jet and the extended H2 emission is tracing a cavity. The source extinction is estimated at Av = 18 ± 1 mag and the outflow extinction at Av = 9 ± 0.4 mag. The H2 outflow temperature is calculated to be 1422 ± 255 K and the electron density of the [Fe II] outflow is measured at ~10 000 cm−3. Furthermore, the mass outflow rate is estimated at Ṁout [H2]  = 3.8 × 10−10 M⊙ yr−1 and Ṁout[Fe II] = 1 × 10−8 M⊙ yr−1. Ṁout[Fe II] takes a Fe depletion of ~88% into account. The depletion is investigated using the ratio of the [Fe II] 1.257 μm and [P II] 1.188 μm lines. Using the Paβ and Brγ lines and a range in stellar mass and radius Ṁacc is calculated to be (3–10) × 10−8 M⊙ yr−1. Comparing these rates puts the jet efficiency in line with predictions of magneto-centrifugal models of jet launching in low mass protostars. This is a further case of a brown dwarf outflow exhibiting analogous properties to protostellar jets.
Genetics of Refractory Rickets: Identification of Novel PHEX Mutations in Indian Patients and a Literature Update
Authors: Marik Binata , Bagga Arvind , Sinha Aditi , Hari Pankaj , Sharma Arundhati
Published: January 2018

Refractory rickets is a genetic disorder that cannot be treated by vitamin D supplementation and adequate dietary calcium and phosphorus. Hereditary hypophosphatemic rickets is one of the major forms of refractory rickets in Indian children and caused due to mutations in the PHEX, FGF23, DMP1, ENPP1, and SLC34A3 genes. This is the first study in India on a large number of patients reporting on mutational screening of the PHEX gene. Direct sequencing in 37 patients with refractory rickets revealed eight mutations in 13 patients of which 1 was nonsense, 2 were deletions, 1 was a deletion–insertion, and 4 were missense mutations. Of these mutations, four (c.566_567 delAG, c.651_654delACAT, c.1337delinsAATAA, and c.2048T > A) were novel mutations. This article discusses the mutations in Indian patients, collates information on the genetic causes of refractory rickets, and emphasizes the significance of genetic testing for precise diagnosis, timely treatment, and management of the condition, especially in developing countries.
An Ecology of the Russian Avant-Garde Picturebook
Authors: Weld Sara Pankenier
Published: January 2018

An Ecology of the Russian Avant-Garde Picturebook takes a new approach to interpreting 1920s and 1930s picturebooks by prominent Russian writers, artists, and intellectuals by examining them within the ecological environment that, first, made them possible and, then, led to their demise. It argues that naturalistic models of the complex interactions of dynamic systems offer effective tools for understanding the fraught interrelations of art and censorship in the early Soviet period. Through illustrative case studies, it mounts a close analysis of word and image and their synergistic interplay in avant-garde picturebooks, while also recontextualizing them within the ecology of their original environment where extraordinary countervailing forces played out a drama of which these books survive as telling artifacts. Ultimately, it argues that the Russian avant-garde picturebook offers a uniquely illustrative example of literary ecology that sheds light on issues of creativity and censorship, politics and art, more broadly as well.
Usage-inspired L2 instruction
Authors: Tyler Andrea E. , Ortega Lourdes
Published: January 2018

A new ethos for second language (L2) instruction is offered in this volume, one that gathers key instructed second language acquisition (SLA) scholars around usage-based perspectives grounded in over twenty years of exciting discoveries in psychology, psycholinguistics, cognitive science, linguistic theory, and other related fields. All authors contribute theoretical and empirical answers to two general questions: What might a usage-inspired language pedagogy look like? And does it work? In this chapter, we first outline five tenets of usage-based approaches that we consider foundational for the design of usage-inspired L2 instruction. We then present the chapters in the volume, highlighting their respective contributions.
L2 developmental education and systemic theoretical instruction
Authors: Lantolf James P. , Tsai Mei-Hsing
Published: January 2018

One of the difficult problems for language learners to master in English is verb+noun collocations, particularly with regard to verbs such as make and do. Using the educational framework informed by sociocultural psychology referred to as systemic theoretical instruction (STI), this chapter describes one aspect of a larger classroom study carried out in a Taiwanese college which addressed particularly problematic verb+noun collocations. This chapter deals with two of the five verbs addressed in the study: make and do. Instruction consisted of two major components: one focused on the meanings of the relevant collocations as derived from cognitive linguistic research; the other, involved students verbally and visually explaining their understandings of the meanings of the verb+noun collocations as a way of internalizing the appropriate meanings, as called for in STI. Student development is traced through their verbalizations and schematic drawings of the meanings of the verb+noun collocations.
Foreign language instruction from a dynamic usage-based (DUB) perspective
Authors: Rousse-Malpat Audrey , Verspoor Marjolijn H.
Published: January 2018

In this chapter we combine ideas of usage based linguistics and dynamic systems theory to argue that language is a dynamic usage based system and L2 learning is a dynamic process. Two teaching approaches based on Dynamic Usage-based (DUB) principles with mainly implicit attention to form – a movie approach and the Accelerative Integrated Method – were compared with two more traditional teaching approaches. The results show that if effectiveness is operationalized as gain in general proficiency, both in spoken and written production, and if the intervention is at least one semester long, the DUB approaches are more effective than their traditional semi-communicative counterparts. We also argue that effects of such methods should not be measured in one-off interventions because implicit learning may take longer than explicit learning.
On the relationship between interaction and language learning
Authors: Davies Catherine Evans
Published: January 2018

Interactional Sociolinguistics (IS) offers a multifaceted perspective on how language is contextually interpreted, as well as a rich methodology for discovering the speaker’s choices when creating situated discourse. For those concerned with second language learning and the current usage-based turn, IS can provide important insights into language use and learning. This chapter gives a brief overview of the fundamentals of IS, followed by a set of examples concerning how an IS orientation has been implemented in practice, starting with classroom-based learning and moving into increasingly authentic contexts while at the same time increasing the agentivity of the learner. The key idea is that an approach rooted in interactional sociolinguistics highlights the development of skills in the learner to become an active agent and even an ethnographer of his/her/their own communication.
Student perception and different performance in a combined usage-based and sociocultural theory approach to learning Japanese polysemous particles
Authors: Masuda Kyoko , Labarca Angela
Published: January 2018

Recent second language studies have explored the implementation of a usage-based approach in the classroom (Csábi, 2004; Lam, 2009; Masuda, 2013; Tyler, Mueller, & Ho, 2010; Tyler, 2012; White, 2012). Adding to this research, Masuda and Labarca (2015, 2018) have investigated the effects of usage-based instruction supported by schematic aids and conceptual explanations of usages when teaching Japanese polysemous particles to English-speaking college students (N = 28). Following sociocultural theory (SCT) tenets, it is equally necessary to explore the interaction between peers, given the role that working together plays in concept development (Lantolf, 2010). In this chapter, we examine student perception of such innovative teaching and pair-work from a SCT perspective along with student different performance by comparing usage-based instruction to traditional instruction. When perceptions were collected through a questionnaire, one-to-one interviews, and recorded pair exchanges or languaging, evidence was found for the value of visualization of the concept driven by schematic diagrams and guided conceptual tasks that had differential effects on student progress and longer retention.
The impact of prior knowledge on second language grammar practice
Authors: Alonso-Aparicio Irene
Published: January 2018

Both the skill building paradigm of language learning known as skills acquisition theory (DeKeyser, 2007) and the family of usage-based theories (N. Ellis, 2015; Tyler, 2012) hold that second language (L2) practice, broadly defined as repeated language usage, is pivotal to the learning of constructions. Intuition would thus suggest that L2 grammar pedagogy must rely on practice activities in the classroom. However, the praxis of practice is less clear. One variable that might moderate the effectiveness of practice is prior knowledge (PK), as it is reasonable to expect that the more learners can rely on PK that is relevant to a new target form, the less intensive or prolonged practice might need to be (Llopis-García, 2010). This chapter investigated the impact of prior knowledge (PK) of a given construction on practice of a new, related construction. It did so by comparing a group of students who, prior to the experiment, could already conjugate the present subjunctive and were familiar with the mood selection in some limited constructional contexts to another group of students who did not have any previous knowledge related to the mood selection in Spanish, and both to a control group. The goal was to ascertain whether PK modulates the benefits that can be obtained from activities that supported extensive practice of Spanish L2 mood selection over 6 weeks totaling 9 hours. Following a pretest/posttest design, results showed that, contrary to expectations, the group with no PK outperformed the group with PK. Results are discussed within the dynamic systems theory paradigm (Verspoor, de Bot, & Lowie, 2011). It is argued that mastery of Spanish L2 mood selection may be subject to processes of cognitive restructuring leading to a variable pathway as evidenced by a U-shaped learning curve.
The role of ‘roles’ in task-design
Authors: Kraut Joshua
Published: January 2018

An important strand of research in the field of Task-Based Language Teaching (TBLT) has aimed to better understand the variables of task-design which render different tasks more or less effective in facilitating L2 acquisition (e.g., Pica, Kanagy, & Falodun, 1993). The current study aimed to investigate an as-yet little-studied dimension of tasks, the phenomenon of framing. Framing derives from Goffman’s (1974) notion of activity frames, the idea that any stretch of human activity is organized by certain rules and principles to which people “fit their actions” including, crucially, their language. Framing thus represents a basic element of what speakers perceive as the context of a given interaction (Gumperz & Cook-Gumperz, 2012). Framing therefore varies as the social purpose of interaction varies, which in turn should have an impact on the quality of interactions a given task yields. The study reveals that, while the particular manipulation in framing of learner’s talk featured had little effect on negotiation for meaning as traditionally measured (cf. Long, 1980), it had a marked impact on (1) the amount and quality of assistance learners provided each other in conversation, measured in co-constructions, other-corrections and continuers (Foster & Ohta, 2005), and (2) the type of questions produced, with one of the two experimental groups asking substantially more content questions, maintaining a highly argumentative dialogue. The construct of framing is thus seen as a potentially exploitable feature of task design, and one that is promising in moving TBLT closer to usage-inspired thinking about L2 instruction.
Compounds and productivity in advanced L2 German writing
Authors: Zeldes Amir
Published: January 2018

The frequent formation of complex, hierarchically structured compounds is a striking property of German grammar to non-natives, to the point that German has been referred to as ‘compounding happy’ (Schlücker, 2012). This chapter asks how compounding works in second language (L2) German grammar, by exploring data from the error-annotated Falko corpus of native and advanced non-native German writing. Beyond differences in overall frequency and productivity of L2 compounding, I use a constructional approach based on compound paraphrases and partially filled prototypes to analyze differences between first language (L1) and L2 usage, as well as to identify frequent error types. Although errors are overall not very frequent (about 11% in total), the data show significant differences in compounding frequency based on learner native language, and some possible phonetic explanations are offered for morphological errors at the boundary between compound heads and modifiers. The results also reveal that productivity as evidenced by rare items in L2 output is a key factor in the native-like acquisition of compounding, and that proficiency as assessed by a C-Test correlates better with more complex productivity measures than with raw vocabulary size. Semantic errors are overall very rare but in many cases attributable to transfer effects, even from constructions that are not compounds in the underlying L1, or indeed from languages low in compounds. This suggests that both abstract and partially lexicalized compounding constructions are learned, and errors can affect either of these at the lexical level.
Examining multifaceted sources of input
Authors: Gurzynski-Weiss Laura , Geeslin Kimberly L. , Daidone Danielle , Linford Bret , Long Avizia Y. , Michalski Ian , Solon Megan
Published: January 2018

Input is a central, driving component in nearly all theories of second language acquisition, but little is known about the relationship between the instructor-provided input to which classroom second language learners are exposed and attested patterns of acquisition. Our study investigates this relationship through an examination of instructors’ Spanish subject expression in oral and written classroom input, as well as their subject expression during three sociolinguistic tasks. Our analysis of five native-speaking instructors’ subject expression, a variable structure, revealed several common patterns across input modes, such as the distribution of the three most common subject forms, as well as subtle differences in the factors constraining use across input modes and tasks. Findings are discussed in relationship to what is known about the acquisition of Spanish subject forms by second language learners, and implications and areas for future research are outlined.
Usage-inspired L2 instruction
Authors: Tyler Andrea E. , Ortega Lourdes
Published: January 2018

The work gathered in this collection suggests that usage-inspired second language (L2) instruction is beginning to take hold in instructed second language acquisition (SLA) and has a bright future as a researched pedagogy in support of adult L2 learning and multilingualism. In this closing chapter, we offer our personal reflections on the study of usage-inspired L2 instruction as a new research domain within instructed SLA. We also propose four broad criteria by which one might be able to judge the degree to which a particular instructional proposal is usage-inspired, related to meaningfulness, contextualization, prior knowledge, and learning goals and mechanisms.
Validating the Revised Scale for Caregiving Self-Efficacy: A Cross-National Review
Authors: Steffen Ann M , Gallagher-Thompson Dolores , Arenella Katherine M , Au Alma , Cheng Sheung-Tak , Crespo María , Cristancho-Lacroix Victoria , López Javier , Losada-Baltar Andrés , Márquez-González María , Nogales-González Celia , Romero-Moreno Rosa
Published: January 2018

Background and Objectives

This article reviews an instrument used in cross-national research with dementia family caregivers—the Revised Scale for Caregiving Self-Efficacy (RSCSE). Although the RSCSE has been translated into multiple languages, few studies have examined scale performance across samples. We examine congruence of psychometric, reliability, and validity data to inform research and practice.

Methods

We conducted citation searches using Scopus, Google Scholar, Web of Science, and PsycINFO. Identified dementia caregiving studies cited the original RSCSE article and described results of English and/or non-English translations of the scale.

Results

Peer-reviewed published studies (N = 58) of dementia family caregivers included data for Arabic, Chinese, English, French, Italian, and Spanish translations of the RSCSE; the majority (72%) reported use of non-English translations. Studies utilizing confirmatory factor analytic approaches reported findings consistent with the original development study. Internal consistency, convergent/discriminant validity, and criterion validity indices were congruent across diverse cross-national caregiving samples assessed with different translations. Data supported the RSCSE’s sensitivity to change following specific psychosocial caregiving interventions.

Discussion

The reliability and validity of different translations of the RSCSE support continued use with cross-national samples of dementia family caregivers. Limitations of the scale point to the need for further self-efficacy measurement development within caregiving domains. Consistent with Bandura’s discussion of social cognitive theory in cultural contexts, personal agency for caregiving challenges remains generalizable to cross-national populations. This review discusses the implications for cross-cultural research and practice.
Social movement involvement and healthy diet and activity behaviors among US adults
Authors: Emley Elizabeth A , Musher-Eizenman Dara R
Published: January 2018

Unhealthy lifestyle behaviors, namely poor diet and inadequate physical activity, significantly contribute to poor health and obesity risk, which in turn impact chronic illness outcomes. A possible approach to improving these health behaviors and subsequent outcomes is to capitalize on the theorized link between social movement involvement and overlapping health behaviors. Social movement involvement may be a viable stealth intervention for health, utilizing intrinsic motivators to improve health without an explicit focus on changing health behavior. Thus, the current study explored the links between social movement involvement and diet and physical activity. Two samples from a college population (N = 196) and the general population (N = 195) participated in an online survey, which included measures of social movement involvement, social movement-related health behaviors and dietary intake and physical activity. After controlling for known covariates, social movement-related health behaviors mediated the relationship between level of social movement involvement and fruit and vegetable consumption, whole grain intake and average daily physical activity in both samples. These findings suggest that health behaviors associated with social movement involvement may be an important mechanism in promoting health among social movement members and that the model holds across adult populations. This research adds to existing literature on stealth interventions as a viable means of improving important behavioral health components linked with obesity and chronic disease and supports social movement involvement as a potential form of stealth intervention.
Immune Relevant Models for Ocular Inflammatory Diseases
Authors: Gilger Brian C
Published: January 2018

Ocular inflammatory diseases, such as dry eye and uveitis, are common, painful, difficult to treat, and may result in vision loss or blindness. Ocular side effects from the use of antiinflammatory drugs (such as corticosteroids or nonsteroidal antiinflammatories) to treat ocular inflammation have prompted development of more specific and safer medications to treat inflammatory and immune-mediated diseases of the eye. To assess the efficacy and safety of these new therapeutics, appropriate immune-relevant animal models of ocular inflammation are needed. Both induced and naturally-occurring models have been described, but the most valuable for translating treatments to the human eye are the animal models of spontaneous, immunologic ocular disease, such as those with dry eye or uveitis. The purpose of this review is to describe common immune-relevant models of dry eye and uveitis with an overview of the immuno-pathogenesis of each disease and reported evaluation of models from small to large animals. We will also review a selected group of naturally-occurring large animal models, equine uveitis and canine dry eye, that have promise to translate into a better understanding and treatment of clinical immune-relevant ocular disease in man.
Roles of IL-22 in allergic airway inflammation in mice and humans
Authors: Hirose Koichi , Ito Takashi , Nakajima Hiroshi
Published: January 2018

Asthma is a chronic inflammatory disease of the airways that is characterized by eosinophilic inflammation, mucus hypersecretion and airway remodeling that leads to airway obstruction. Although these pathognomonic features of asthma are primarily mediated by allergen-specific T helper type 2 cells (Th2 cells) and their cytokines, recent studies have revealed critical roles of lung epithelial cells in the pathogenesis of asthma. Lung epithelial cells not only form physical barriers by covering the surfaces of the airways but also sense inhaled allergens and initiate communication between the environment and the immune system. The causative involvement of lung epithelium in the pathogenesis of asthma suggests that some molecules that modulate epithelial function have a regulatory role in asthma. IL-22, an IL-10-family cytokine produced by IL-17A-producing T helper cells (Th17 cells), γδ T cells and group 3 innate lymphoid cells (ILC3s), primarily targets epithelial cells and promotes their proliferation. In addition, IL-22 has been shown to induce epithelial production of various molecules that regulate local immune responses. These findings indicate that IL-22 plays crucial roles in the pathogenesis of asthma by regulating epithelial function. Here, we review the current understanding of the molecular and cellular mechanisms underlying IL-22-mediated regulation of airway inflammation in asthma.
Interaction patterns of trauma providers are associated with length of stay
Authors: Chen You , Patel Mayur B , McNaughton Candace D , Malin Bradley A
Published: January 2018

Background

Trauma-related hospitalizations drive a high percentage of health care expenditure and inpatient resource consumption, which is directly related to length of stay (LOS). Robust and reliable interactions among health care employees can reduce LOS. However, there is little known about whether certain patterns of interactions exist and how they relate to LOS and its variability. The objective of this study is to learn interaction patterns and quantify the relationship to LOS within a mature trauma system and long-standing electronic medical record (EMR).

Methods

We adapted a spectral co-clustering methodology to infer the interaction patterns of health care employees based on the EMR of 5588 hospitalized adult trauma survivors. The relationship between interaction patterns and LOS was assessed via a negative binomial regression model. We further assessed the influence of potential confounders by age, number of health care encounters to date, number of access action types care providers committed to patient EMRs, month of admission, phenome-wide association study codes, procedure codes, and insurance status.

Results

Three types of interaction patterns were discovered. The first pattern exhibited the most collaboration between employees and was associated with the shortest LOS. Compared to this pattern, LOS for the second and third patterns was 0.61 days (P = 0.014) and 0.43 days (P = 0.037) longer, respectively. Although the 3 interaction patterns dealt with different numbers of patients in each admission month, our results suggest that care was provided for similar patients.

Discussion

The results of this study indicate there is an association between LOS and the extent to which health care employees interact in the care of an injured patient. The findings further suggest that there is merit in ascertaining the content of these interactions and the factors that induce these differences in interaction patterns within a trauma system.
Long-Acting Lipoglycopeptides for Gram-Positive Bacteremia at the End of Life to Facilitate Hospice Care: A Report of 3 Cases
Authors: Datta Rupak , McManus Dayna , Topal Jeffrey , Juthani-Mehta Manisha
Published: January 2018

Administering and monitoring intravenous antimicrobials may cause discomfort in patients at the end of life and delay transition to hospice. We describe 3 patients with terminal cancer with methicillin-resistant Staphylococcus aureus, Streptococcus gallolyticus, and Granulicatella adiacens bacteremia who were managed with the long-acting lipoglycopeptide oritavancin to facilitate discharge to hospice.
Multimorbidity in South Asian adults: prevalence, risk factors and mortality
Authors: Singh Kalpana , Patel Shivani A , Biswas Suddhendu , Shivashankar Roopa , Kondal Dimple , Ajay Vamadevan S , Anjana Ranjit Mohan , Fatmi Zafar , Ali Mohammed K , Kadir M Masood , Mohan Viswanathan , Tandon Nikhil , Narayan K M Venkat , Prabhakaran Dorairaj
Published: January 2018

Background

We report the prevalence, risk factors and mortality associated with multimorbidity in urban South Asian adults.

Methods

Hypertension, diabetes, heart disease, stroke and chronic kidney disease were measured at baseline in a sample of 16 287 adults ages ≥20 years in Delhi, Chennai and Karachi in 2010–11 followed for an average of 38 months. Multimorbidity was defined as having ≥2 chronic conditions at baseline. We identified correlates of multimorbidity at baseline using multinomial logistic models, and we assessed the prospective association between multimorbidity and mortality using Cox proportional hazards models.

Results

The adjusted prevalence of multimorbidity was 9.4%; multimorbidity was highest in adults who were aged ≥60 years (37%), consumed alcohol (12.3%), body mass index ≥25 m/kg2 (14.1%), high waist circumference (17.1%) and had family history of a chronic condition (12.4%). Compared with adults with no chronic conditions, the fully adjusted relative hazard of death was twice as high in adults with two morbidities (hazard ratio [HR] = 2.3; 95% confidence interval [CI]: 1.6, 3.3) and thrice as high in adults with ≥3 morbidities (HR = 3.1; 95% CI: 1.9, 5.1).

Conclusion

Multimorbidity affects nearly 1 in 10 urban South Asians, and each additional morbidity carries a progressively higher risk of death. Identifying locally appropriate strategies for prevention and coordinated management of multimorbidity will benefit population health in the region.
SBM recommends policy support to reduce smoking disparities for sexual and gender minorities
Authors: Matthews Phoenix Alicia , Blok Amanda C , Lee Joseph G L , Hitsman Brian , Sanchez-Johnsen Lisa , Watson Karriem , Breen Elizabeth , Ruiz Raymond , Scout  , Simon Melissa A , Fitzgibbon Marian , Hein Laura C , Winn Robert
Published: January 2018

The Society of Behavioral Medicine supports the inclusion of gender and sexual minorities in all local, state, and national tobacco prevention and control activities. These activities include surveillance of tobacco use and cessation activities, targeted outreach and awareness campaigns, increasing access to culturally appropriate tobacco use dependence treatments, and restricting disproportionate marketing to lesbian, gay, bisexual, and transgender communities by the tobacco industry, especially for mentholated tobacco products.
Clinically Relevant Outcome Measures Following Limb Osseointegration; Systematic Review of the Literature
Authors: Al Muderis Munjed M. , Lu William Y. , Li Jiao Jiao , Kaufman Kenton , Orendurff Michael , Highsmith M. Jason , Lunseth Paul A. , Kahle Jason T.
Published: January 2018

Objectives:

The current standard of care for an amputee is a socket-based prostheses. An osseointegrated implant (OI) is an alternative for prosthetic attachment. Osseointegration addresses reported problems related to wearing a socket interface, such as skin issues, discomfort, diminished function, quality of life, prosthetic use, and abandonment. The purpose of this report is to systematically review current literature regarding OI to identify and categorize the reported clinically relevant outcome measures, rate the quality of available evidence, and synthesize the findings.

Data sources:

A multidisciplinary team used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methods. Search methodology was based on identifying clinically relevant articles. Three databases were searched: PubMed, CINAHL, and Web of Science.

Study Selection:

Clinical studies with aggregated data reporting at least 1 clinically relevant outcome measure were included.

Data Extraction:

The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criterion was used for critical appraisal and recommendations.

Conclusions:

This review identified 21 clinically relevant observational studies. Outcome measures were categorized into the following 9 categories: vibratory stimulation, complications, biomechanics, economics, patient-reported outcome measures, electromyography, x-ray, physical functional performance, and energy consumption. This systematic review consisted of Level III and IV observational studies. Homogeneous outcome measures with strong psychometric properties across prospective studies do not exist to date. Higher-level, prospective, randomized, long-term, clinically relevant trials are needed to prove efficacy of OI compared with socket prosthetic attachment. Osseointegration was at least equivalent to sockets in most studies. In some cases, it was superior. Osseointegration represents a promising alternative to socket prosthetic attachments for extremity amputees.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Outcomes of Presumed Aseptic Long-Bone Nonunions With Positive Intraoperative Cultures Through a Single-Stage Surgical Protocol
Authors: Arsoy Diren , Donders Johanna C. E. , Kleeblad Laura J. , Miller Andy O. , Henry Michael W. , Wellman Davis S. , Helfet David L.
Published: January 2018

Objective:

To evaluate the outcomes of a single-stage surgical protocol to treat a presumed aseptic long-bone nonunion with positive intraoperative cultures obtained at the time of surgery.

Design:

Retrospective comparative series.

Setting:

Orthopaedic specialty hospital.

Patients and Methods:

We retrospectively identified 77 patients with long-bone nonunions thought to be aseptic preoperatively, which grew bacteria from cultures obtained at the time of index nonunion surgery.

Intervention:

Fifty (65%) patients underwent open debridement of the nonunion site followed by surgical stabilization through plates and screws. Twenty-seven (35%) patients underwent exchange nailing with canal reamings used for cultures.

Main Outcome Measurement:

Rate of radiographic union, time to clinical and radiographic union, nonunion rate after index nonunion surgery, and final union rate after revision procedures.

Results:

Osseous union after the index nonunion surgery was achieved in 84% of the patients (65 of 77). Time to clinical union was 6.3 months (range, 1–24 months), and time to radiographic union was 7.4 months (range, 2–24 months). Eighteen percent (14 of 77 patients) did not heal after the index nonunion surgery and required additional surgeries. The final union rate after revision surgery was 99% (76 of 77 patients).

Conclusions:

Eighty-four percent of presumed aseptic nonunions of long-bone fractures with positive intraoperative cultures fully healed after a single-stage surgical protocol and long-term antibiotic when appropriate. When patients are diagnosed with a subclinical infected nonunion, they should be counseled about the higher likelihood of reoperation, but in most cases can expect excellent union rates after 1 additional surgery.

Level of Evidence:

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Generic Preoperative Planning for Proximal Femoral Osteotomy in the Treatment of Nonunion of the Femoral Neck
Authors: Mayo Keith , Kuldjanov Djoldas
Published: January 2018

Despite improvements in surgical technique and overall patient care, failed treatment of fractures of the femoral neck persists. For the physiologically young patient, joint preservation is the preferred method of treatment. Unfortunately, the best treatment option, proximal femoral osteotomy, is fast becoming a lost art. Preoperative planning is critical in this regard. The described preoperative planning work flow is a reliable method for obtaining the desired deformity correction for a variety of proximal femoral malunions and nonunion. Revisiting the classic Pauwels osteotomy for femoral neck nonunion is an appropriate vehicle to supply the first link in resurrecting this treatment modality by providing a standardized preoperative planning protocol.
Double Oblique Osteotomy: A Technique for Correction of Posttraumatic Deformities of the Distal Femur
Authors: Miranda Michael A. , DeAngelis Joseph P. , Canizares George H. , Mast Jeffery W.
Published: January 2018

Objective:

To evaluate the outcomes of a double oblique osteotomy for the management of distal femoral malunions and a combination malunion/nonunion.

Design:

Case series.

Setting:

Level 1/2 hospital.

Patients/Participants:

Ten patients with a mean age of 50 years (range 30–69 years) with posttraumatic deformities of the distal femur.

Intervention:

A 2-level, length-sparing osteotomy was performed in accordance with a detailed preoperative plan for correction of the mechanical axis in a distal femoral deformity.

Main Outcome Measurements:

Radiographic alignment and physical examination.

Results:

Average length of follow-up was 26 months. The average coronal plane correction was 12 degrees (range 4–20 degrees) for a residual coronal plane deformity average of 0 degrees. The residual flexion deformity was less than 10 degrees in all cases. All rotational deformities were corrected to within 5 degrees of neutral. The average limb length correction was 1.6 cm (range 0.4–2.6 cm). Eight patients recovered without complication. One patient received bone grafting to achieve union, and a prominent angled blade plate was removed in another. An isolated saphenous nerve sensory deficit resolved spontaneously.

Conclusions:

The double oblique osteotomy is a reliable technique for the correction of multiplane deformities of the distal femur.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Routine Postoperative Computed Tomography Scans After Pelvic Fracture Fixation: A Necessity or a Luxury?
Authors: Elnahal Walid A. , Vetharajan Niraj , Mohamed Bashir , Acharya Mehool , Chesser Timothy J. S. , Ward Anthony J.
Published: January 2018

Introduction:

There is no consensus regarding the postoperative radiology imaging protocol after pelvic fracture surgery. Some institutes routinely scan all patients after their surgery, others do not. The aim of this study was to assess the value of routine use of computed tomography (CT) scans after pelvic fracture surgery and to determine the sensitivity of conventional plain radiographs and intraoperative fluoroscopy in detecting metalwork malposition.

Patients and Methods:

The radiographs and clinical notes of patients undergoing pelvic fracture surgery in the period between January 2010 and December 2015 were reviewed. Patients were categorized into 2 main groups: group A—patients whose fixation entailed the use of a sacroiliac (SI) screws and group B—patients whose fixation did not require an SI screw. Furthermore, the patients were classified according to the position of metalwork in their postoperative plain radiographs and perioperative fluoroscopy into 3 groups: (1) Safe: When there was no suspicion of metalwork malposition. (2) Suspicious: When there was some suspicion of malposition but radiographs were inconclusive. (3) Definite: When plain imaging showed a definite malposition.

Results:

One hundred ninety-eight patients were included in this study (161 in group A and 37 in group B). In group A, 148 (92%) were classified as safe, 10 were suspicious (6%), and 3 (2%) showed definite malposition. Of the fractures that were believed to be safe on plain radiographs, 78% were confirmed to be safe on CT scans, whereas 22% showed malpositioned metalwork, and 7 patients (4%) required a revision surgery. Plain radiographs showed a sensitivity of 27% in detecting metalwork malposition and a specificity of 99%. Increasing the number of screws significantly increased the risk of malposition and reoperation (P = 0.006 and 0.002 respectively). The plain images of group B were all classified as safe. The CT scans detected 2 cases with long metalwork protruding into the soft tissues, none of which required a revision surgery.

Conclusion:

Perioperative fluoroscopy and plain postoperative radiographs have a low sensitivity in detecting the metalwork malposition after pelvic fracture surgery. We recommend the use of routine postoperative CT scans in patients whose fixation entails the use of SI screws. In this series, routine scanning of patients who did not have SI screws added no significant clinical value.

Level of Evidence:

Level IV Diagnostic. See Instructions for Authors for a complete description of levels of evidence.
Soft Tissue Structures Differ in Patients With Prearthritic Hip Disease
Authors: Le Bouthillier Anne , Rakhra Kawan S. , Belzile Etienne L. , Foster Ryan C. B. , Beaulé Paul E.
Published: January 2018

Background:

Clinically, understanding how the soft tissue envelope adapts to various forms of hip dysfunction could enhance both surgical and nonsurgical management. Very few studies have looked at soft tissue structures as preoperative discriminators between varying underlying etiologies of hip conditions.

Purpose:

To demonstrate that the magnetic resonance arthrography assessment of soft tissue structures of the hip will preoperatively differ in patients with different underlying hip joint diseases.

Methods:

Fifty-seven patients who underwent preoperative magnetic resonance arthrography and corrective hip surgery were retrospectively identified yielding 3 groups: 17 with developmental dysplasia of the hip (DDH) (11 F, 6 M; mean age 35.1 years, range 19.6–53.6); 20 with isolated labral tears (LTs) (17 F, 3 M; mean age 38.4 years, range 15.2–62.1), and 20 with cam-type femoroacetabular impingement (FAI) (11 F, 9 M; mean age 38.8 years, range 18.9–51.2). Measurements of the hip labral length, capsule thickness, and psoas, rectus femoris, and gluteal muscle dimensions were performed, with normalization of the values for statistical analysis.

Results:

The superior labral length was significantly greater in the DDH group [normalized value (NV): 0.30] compared with the FAI group (NV: 0.25, P < 0.05). In addition, the superior (12 o'clock) capsular thickness (NV: 0.24) was significantly greater compared with the LT group (NV: 0.15, P < 0.05) and the FAI group (NV: 0.16, P < 0.05). The DDH group also had a significantly greater anterior (3 o'clock) capsular thickness (NV: 0.18) compared with the LT group (NV: 0.13, P < 0.05). The transverse dimension of the rectus femoris was larger in the DDH group (NV: 1.39) compared with the FAI group (NV: 1.14, P < 0.05).

Conclusion:

An enlarged rectus femoris and thicker hip capsule as well as an enlarged labrum are characteristic findings in hip dysplasia.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Intraosseous Plating for the Management of Cortical Defects
Authors: Bergin Patrick F. , Weber Timothy G. , Gerow Daniel E. , Spitler Clay A. , Graves Matthew L. , Russell George V.
Published: January 2018

The management of fractures with segmental bone loss or abundant comminution on the far cortex is often complicated by deformity or frank hardware failure. Using plate constructs that rely on off-axis loading may not be sufficient to support the limb until healing occurs. There are a number of techniques to mitigate this problem, notably the use of intramedullary nails and bicolumnar plating of the fracture. These techniques are not always possible and do come with the biologic cost of additional surgery. In this article, the authors present a technique along with 2 case examples of using plates in an intraosseous location that was described by Dr Mast in his classic orthopaedic text. By placing these plates in the intramedullary space and then interdigitating fixation from the standard cortical plate, a rigid “I-beam” of fixation can be created to mitigate the eccentric loading placed on extraosseous plates. This technique is especially useful in situations in which intramedullary nails are precluded (comminuted intraarticular and some periprosthetic fractures).
Chlamydia Prevalence Trends Among Women and Men Entering the National Job Training Program From 1990 Through 2012
Authors: Learner Emily R. , Torrone Elizabeth A. , Fine Jason P. , Pence Brian W. , Powers Kimberly A. , Miller William C.
Published: January 2018

Background

Evaluating chlamydia prevalence trends from sentinel surveillance is important for understanding population disease burden over time. However, prevalence trend estimates from surveillance data may be misleading if they do not account for changes in risk profiles of individuals who are screened (case mix) and changing performance of the screening tests used.

Methods

We analyzed chlamydia screening data from a sentinel surveillance population of 389,555 young women (1990–2012) and 303,699 young men (2003–2012) entering the US National Job Training Program. This period follows the introduction of national chlamydia screening programs designed to prevent transmission and reduce population disease burden. After ruling out bias due to case mix, we used an expectation-maximization–based maximum likelihood approach to account for measurement error from changing screening tests, and generated minimally biased long-term chlamydia prevalence trend estimates among youth and young adults in this sentinel surveillance population.

Results

Adjusted chlamydia prevalence among women was high throughout the study period, but fell from 20% in 1990 to 12% in 2003, and remained between 12% and 14% through 2012. Adjusted prevalence among men was steady throughout the study period at approximately 7%. For both women and men, adjusted prevalence was highest among Black and American Indian youth and young adults, and in the Southern and Midwestern regions of the United States throughout the study period.

Conclusions

Our minimally biased trend estimates provide support for an initial decrease in chlamydia prevalence among women soon after the introduction of national chlamydia screening programs. Constant chlamydia prevalence in more recent years suggests that screening may not be sufficient to further reduce chlamydia prevalence among high-risk youth and young adults.