bluuebunny/crossref_metadata_2025 huggingface dataset:
Colposcopy Simulation: A Necessary Tool in an Era of Decreased Referrals
Authors: Cronin Beth , Hampton Star , Kenton Kimberly
Published: September 2017

OBJECTIVE:

To develop a comprehensive curriculum and simulation for educating trainees on screening, evaluation and treatment of cervical dysplasia.

METHODS:

A needs assessment demonstrated that our residents' colposcopy numbers are low compared to American Society for Colposcopy and Cervical Pathology mentoring program expectations (mean of 22.6 per resident compared to 25 recommended). Existing colposcopy didactic content was updated and image review slides improved. An existing colposcopy simulation model was streamlined and enhanced with pathology specimen cervices to better simulate the colposcopic exam. Each resident completes the simulation at the start of their 6-week colposcopy rotation, allowing for hands-on training with the colposcope, proper techniques for biopsy acquisition and simulated patient conversations prior to having these experiences with patients.

EVALUATION:

Eight residents have completed the revised curriculum during the 2016–2017 academic year. I plan to continue to assess experiences and knowledge using a questionnaire tool before and after simulation and postrotation knowledge assessment. In the future, I would like to do a multi-institution assessment given the small numbers of trainees rotating at any given time in our residency program.

DISSEMINATION:

Submission of curriculum simulation construction tutorial to MedEdPORTAL for publication.

REFLECTIVE CRITIQUE:

I have learned the importance of a needs assessment, and how to improve existing materials to make them more useful for all participants. I plan to continue to update and improve didactic content at staggered intervals to ensure materials stay up to date. I hope to collaborate with others to help implement the simulation curriculum nationally.
Creation of a Virtual Community Resource to Optimize Resident Self-Guided Learning
Authors: Dancz Christina , Ciotti Mary , Muderspach Laila , Ciotti Mary , Hueppchen Nancy
Published: September 2017

OBJECTIVE:

To develop a tool to create an online clearinghouse for resident self-guided learning.

METHODS:

We identified a need for a repository of educational resources. Surveys and group discussion identified: 1) desirable characteristics for an “ideal” resource, 2) four priority topics for testing, and 3) learning goals/objectives. The online tool was designed using Blackboard, which launched June 1, 2016, for testing.

EVALUATION:

Residents were surveyed about existing tools. Three existing websites were used, two purely educational and one patient care. Only the site for patient care was accessed by the majority of the residents (75.8%) at least once. Of 36 residents, at 5 months, 15 (41.7%) never logged into Blackboard. Of the 21 residents that logged in at least once, the average length of time reviewing information was 0.99±1.3 hours. Baseline knowledge was assessed using quizzes on bleeding. The average score on the quiz was 65.7±16.4%, N=17. Self-assessment of efficiency and ability to find resources was obtained.

DISSEMINATION:

Preliminary results of the resource tool, resident uptake and 6-month survey data will be ready to present at the CREOG APGO annual meeting in 2017, 12-month data will be presented at the CREOG APGO annual meeting in 2018. Our goal is to publish an open-domain version on MedEdPortal.

REFLECTIVE CRITIQUE:

Overall, website development was able to satisfy most of the factors deemed important by the residents. Approximately 40% of the residents have never logged into the website at 5 months. Future efforts will be directed toward incentivizing utilization.
Surgical Skills Feedback and myTIPreport
Authors: Connolly AnnaMarie , Blanchard Anita , Goepfert Alice , Donnellan Nicole , Buys Elizabeth , Uribe Richard , Kenton Kimberly
Published: September 2017

OBJECTIVE:

To initiate construct validity testing of myTIPreport for procedural skill assessment in a prospective multicenter evaluation study.

METHODS:

Teachers and learners from a convenience-based site selection of obstetrics and gynecology (OBGYN) and female pelvic medicine and reconstructive surgery (FPMRS) training programs performed procedural assessments in myTIPreport. The specifically defined 5-point Dreyfus rating scale describing ability levels from novice to expert was used. Defined as the degree to which a test or measure assesses what it was designed to measure, construct validity of myTIPreport was tested by comparing the medians of procedure-specific overall assessments, by both teachers and learners themselves, of senior learners with junior learners. To minimize type I error, comparisons were performed only when a threshold of 10 or greater feedback encounters per learner group was met. Correlation of teacher assessments and learner self-assessments was examined for myTIPreport.

RESULTS:

From November 2014 to May 2016, 12 OBGYN and 7 FPMRS training programs participated. There were 440 learners and 443 teachers. Feedback was recorded on 5,093 surgical procedures; 4,567 for OBGYN residents and 526 for FPMRS fellows. Each OBGYN procedure had two categories of teacher and learner assessments comparing postgraduate year (PGY)-4 with PGY-1 learner performance. This yielded 48 possible assessment comparisons for the included 24 OBGYN procedures. In all, 28 of these 48 (58%) met the threshold number of observations per learner group. In 28 of these 28 (100%) comparison categories, PGY-4s rated significantly higher than PGY-1s. Similarly, in 16 of 18 (89%) comparison categories meeting inclusion criteria, FPMRS PGY-7s rated significantly higher than FPMRS PGY-5s. Strong correlation was noted of teacher assessments and learner self-assessments in myTIPreport with a Spearman correlation coefficient of 0.89 (P<.001).

CONCLUSION:

As noted for the majority of compared teacher assessments and learner self-assessments, myTIPreport appeared to detect differences between senior and junior learners. These data support the emerging construct validity of myTIPreport for procedural skills assessment.
Percutaneous Application of a Medial Plate for Dual Plate Stabilization of Supracondylar Femur Fractures
Authors: Swentik Andrew , Tucker Michael , Jones Thomas
Published: September 2017

Supracondylar femur fractures with segmental defects can be difficult fractures to treat. When associated with open wounds, these injuries can be associated with numerous complications including nonunion, malunion, infection, and arthrofibrosis. In this article, we review our algorithm for treating these fractures and highlight critical aspects of the process which differs from previous techniques described. We feel that this technique has specific benefits that mitigate infection risk and minimize additional soft-tissue insult without compromising stability. Our results demonstrate good postoperative knee range of motion, a high union rate, with low complication rates.
Epidemiology of Anterior Tibial Spine Fractures in Young Patients: A Retrospective Cohort Study of 122 Cases
Authors: Axibal Derek P. , Mitchell Justin J. , Mayo Meredith H. , Chahla Jorge , Dean Chase S. , Palmer Claire E. , Campbell Kristen , Vidal Armando F. , Rhodes Jason T.
Published: September 2017

Background:

Historically, bicycle accidents were described as the most common mechanism for pediatric anterior tibial spine fractures (ATSFs). There is a paucity of current literature examining the demographic factors associated with these injuries. The purpose of this cohort study was to characterize the epidemiology of ATSFs presenting to a single tertiary referral pediatric hospital.

Methods:

A consecutive cohort of 122 pediatric patients with ATSFs between 1996 and 2014 were reviewed. Radiographic variables, classification of fractures (Meyers and McKeever type), age, sex, height, weight, body mass index, and mechanism of injury were retrieved. Categories of mechanism of injury included organized sports (football, soccer, basketball, lacrosse, wrestling, and gymnastics), bicycling, outdoor sports (skiing, skateboarding, and sledding), fall, motor vehicle collision/pedestrian versus motor vehicle, and trampoline.

Results:

Organized sports-related injuries represented the most common cause of ATSFs (36%). Other common mechanisms of injury included bicycle accidents (25%), outdoor sports (18%), and falls (11%). There was a higher proportion of males (69%) compared with females (31%). Males (mean age, 11.6 y) were significantly older than females (mean age, 9.8 y) (P=0.004). Younger patients (aged 11.5 y and below) were more likely to have displaced fractures (type III), whereas type I and type II were more common in patients above 11.5 years (P=0.02). Patients with fracture type I were significantly taller than patients with fracture type III. No other variables were found to differ significantly according to fracture severity, including sex, weight, and body mass index.

Conclusions:

To our knowledge, our study represents both the largest (n=122) and most up-to-date epidemiological ATSF study in pediatric patients. A higher rate of ATSF occurs due to organized sports rather than bicycling or motor vehicle collision. This 18-year data collection represents a change in the paradigm, and is likely multifactorial, including increased participation in youth sports and early sport specialization.

Level of Evidence:

Level IV—retrospective, cohort study.
A Novel Funnel-Shaped Flap for Reconstruction Surgery after Total Laryngopharyngectomy with Total Glossectomy
Authors: Kurosawa Koreyuki , Asada Yukinori , Matsumoto Ko , Imai Takayuki , Matsuura Kazuto , Goto Takahiro
Published: September 2017

Reconstruction following total laryngopharyngectomy with total glossectomy (TLPTG) is challenging. To reconstruct this extended range of mucosal defect, it is necessary to overcome the remarkable discrepancy of apertures of oral and esophageal sides. We report a case of reconstruction surgery for total laryngopharyngectomy with total glossectomy with a funnel-shaped rectus abdominis musclocutaneous flap. The patient recovered without major complications and could keep a relatively good swallowing function. We believe this simple method should contribute to cases with complicated ablation.
Severe Corneal Disorders Developed After Brimonidine Tartrate Ophthalmic Solution Use
Authors: Maruyama Yuko , Ikeda Yoko , Yokoi Norihiko , Mori Kazuhiko , Kato Hiroaki , Ueno Morio , Kinoshita Shigeru , Sotozono Chie
Published: September 2017

Purpose:

The primary side effects associated with 0.1% brimonidine tartrate (BT) ophthalmic solution with sodium chlorite are allergic conjunctivitis, blepharitis, and conjunctival hyperemia. However, cornea-related side effects are rare. In this study, we report 2 similar cases in which corneal neovascularization, corneal infiltration, and corneal opacity developed after BT eye-drop use.

Methods:

Retrospective report of 2 cases of corneal infiltration after BT eye-drop use.

Results:

Case 1 involved a 78-year-old woman with follicular conjunctivitis, corneal neovascularization, and infiltration in her left eye after unilateral instillation of BT eye drops in that eye. Case 2 involved a 75-year-old woman with bilateral corneal neovascularization and infiltration after instillation of BT eye drops. In both cases, the corneal complications were deemed to be side effects of BT, so those eye drops were replaced with 0.1% fluorometholone eye drops. After replacement, blepharitis and corneal neovascularization successfully resolved; however, a layer of opacity remained across the transparent layer of the cornea in both cases.

Conclusions:

We encountered 2 cases of corneal and conjunctival complications that developed as side effects after BT eye-drop use, thus indicating that strict attention should be paid to the possibility of side effects after initiation of antiglaucoma eye-drop use.
Arthroscopic Versus Open Treatment for Acute Septic Arthritis of the Knee in Children
Authors: Johns Brenton , Loewenthal Mark , Ho Eric , Dewar David
Published: September 2017

Background:

Acute septic arthritis of the knee in children may be treated by arthroscopic or open methods; however, pediatric data comparing these methods is limited regarding both short- and long-term outcomes. This study aimed to compare outcomes after arthroscopic versus open surgery for acute pediatric septic knee arthritis.

Methods:

Pediatric patients with acute knee septic arthritis treated at our institution from 1996 to 2016 were retrospectively assessed. The clinical presentations, operations, microorganisms, laboratory results, knee radiologic findings and antibiotics administered were compared. Patients’ long-term outcomes were assessed at mean 6.9 (range 1.1–20.3) years.

Results:

Twenty-four patients met the inclusion criteria. Eleven patients received arthroscopic irrigation and 13 had open irrigation. Five patients in the open group (38.5%) required a second irrigation compared with none in the arthroscopic group [95% confidence interval (CI): 12%–65%; P = 0.041]. Time to range the knee occurred earlier in the arthroscopic group (5.0 days; arthroscopic vs. 10.6 days; open, difference 5.6 days: 95% CI: 0.84–10.3, P = 0.023), as well as weight-bearing (2.7 days; arthroscopic vs. 10.3 days; open, difference 7.6 days: 95% CI: 2.3–12.9, P = 0.008). Eighty-three percent of patients attended follow-up. No infections recurred. No significant differences were found in Knee injury and Osteoarthritis Outcome Scores for children, Lysholm scores, range-of-motion, leg length, gait and radiologic findings.

Conclusions:

For acute pediatric septic knee arthritis, arthroscopic irrigation is associated with less repeat surgical irrigations and allows earlier knee ranging and weight-bearing compared with open irrigation. At long-term follow-up, no significant difference was found between groups.
A Cluster of Cases of Babesia microti Among Neonates Traced to a Single Unit of Donor Blood
Authors: Glanternik Julia R. , Baine Ian L. , Rychalsky Michelle R. , Tormey Christopher A. , Shapiro Eugene D. , Baltimore Robert S.
Published: September 2017

Three premature infants in 1 neonatal intensive care unit developed transfusion-transmitted babesiosis. Two of the infants developed high-grade parasitemia. All 3 affected infants were treated and cured with azithromycin and atovaquone. No infant required exchange transfusion. Clinicians should be cognizant that babesiosis may be acquired via blood transfusion.
A Randomized Controlled Study of Single-Dose Antibiotic Prophylaxis for Clean Surgeries
Authors: Yalagachin Gurushantappa Halappa , Raman Prashant , Huchchannavar Suresh
Published: September 2017

Objectives

The aims of this study were to establish the use of single-dose prophylactic intravenous antibiotics in the prevention of postoperative wound infection following clean surgeries in a government setup in India and to assess the efficacy of single-dose prophylactic ceftriaxone in preventing surgical site infection following clean surgeries by a prospective randomized trial.

Methods

A prospective study was done on patients in the Department of General Surgery in Karnataka Institute of Medical Sciences, Hubli, Karnataka, India, from January 2011 to December 2014. A total of 822 patients were divided into 2 groups. The first group (A), consisting of 406 patients, received a single-dose antibiotic prophylaxis, and the second group (B), consisting of 416 patients, received 3 days or more of postoperative doses of antibiotic therapy. Only clean procedures are included, and results were compared.

Results

In the first group (A), the rate of infection was 4 of 406. In the second group (B), the rate of infection was 6 of 416. Overall wound infection rate was 0.95%; wound infection rate after administration of single-dose preoperative antibiotic was 0.96%, and in the routine postoperative group, it was 0.94% (P= 0.9).

Conclusions

This study concludes that single-dose preoperative antibiotic alone is as effective as the use of empiric antibiotics given for 3 days or more in clean surgeries. It will facilitate in decreasing superinfections among and resistance to bacterial strains, health care costs, and morbidity secondary to antibiotic administration (eg, drug toxicity, antibiotic-related diarrhea) in a developing country such as India.
Uterine Mesenchymal Tumors: Hereditary Aspects
Authors: Joehlin-Price Amy S. , Garg Karuna
Published: September 2017

The topic of hereditary gynecologic malignancies readily evokes associations between Lynch syndrome and endometrial adenocarcinoma, or between BRCA mutations and tubo-ovarian serous carcinoma, but other familial associations are less well-known. Two hereditary syndromes are known to be related to uterine mesenchymal tumors: hereditary leiomyomatosis and renal cell carcinoma syndrome and the tuberous sclerosis complex. In the following review, we describe the current literature on these syndromes, summarizing their clinical, morphologic, immunophenotypic, and genetic data. It is possible that the surgical pathologic diagnosis is the first indication of a familial syndrome, thus emphasizing the importance of a pathologist’s familiarity with these potentially suggestive lesions.
Expression of TFH Markers and Detection of RHOA p.G17V and IDH2 p.R172K/S Mutations in Cutaneous Localizations of Angioimmunoblastic T-Cell Lymphomas
Authors: Leclaire Alirkilicarslan Ariane , Dupuy Aurélie , Pujals Anaïs , Parrens Marie , Vergier Béatrice , Robson Alistair , Delfau-Larue Marie-Hélène , Ingen-Housz-Oro Saskia , Chosidow Olivier , Haioun Corinne , Beylot-Barry Marie , Merlio Jean-Philippe , Copie-Bergman Christiane , Gaulard Philippe , Ortonne Nicolas
Published: September 2017

Skin biopsies of 41 angioimmunoblastic T-cell lymphoma patients were retrospectively analyzed for the expression of follicular helper T-cell (TFH) markers, Epstein-Barr virus (EBV), and the presence of RHOA (p.G17V) and IDH2 (p.R172K/S) mutations using allele-specific polymerase chain reaction. We categorized cases into 4 distinctive patterns: (1) low-density lymphocytic perivascular infiltrates (n=11), (2) dense perivascular infiltrates with atypical cells and occasional inflammatory cells (n=13), (3) diffuse infiltrates reminiscent of angioimmunoblastic T-cell lymphoma (n=4), or (4) other aspects (n=13). Two EBV+ and 2 plasmacytoid lymphoproliferative disorders were seen. We observed variable expression of TFH markers (CD10 [50%], BCLB6 [84%], PD1 [94%], CXCL13 [84%], and ICOS [97.5%]), and EBV+ B-blasts (26%). A TFH phenotype was identified in 82% and 73%, respectively, of cases with the most challenging patterns 1 and 2. TFH markers and EBV can thus help for diagnosis and are detected in samples with low-density infiltrates. We found RHOA G17V and IDH2 R172K/S mutations in the skin in 14/18 (78%) and 3/16 (19%) cases, respectively. The RHOA G17V mutation was identified in a proportion of biopsies with patterns 1 and 2, which represent a diagnostic challenge. The RHOA G17V mutation was detected both in the skin and lymph node (LN) biopsies in 7/9 (64%) cases, and in only the skin or the LN of 1 sample each. The frequency of RHOA G17V mutation was similar to that reported in LNs. It may represent a sensitive diagnostic marker in the skin, helpful in cases with low-density infiltrates.
Critical Care Resource Utilization and Outcomes of Children With Moderate Traumatic Brain Injury
Authors: Chandee Theerada , Lyons Vivian H. , Vavilala Monica S. , Krishnamoorthy Vijay , Chaikittisilpa Nophanan , Watanitanon Arraya , Lele Abhijit V.
Published: September 2017

Objectives:

To characterize admission patterns, critical care resource utilization, and outcomes in moderate pediatric traumatic brain injury.

Design:

Retrospective cohort study.

Setting:

National Trauma Data Bank.

Patients:

Children under 18 years old with a diagnosis of moderate traumatic brain injury (admission Glasgow Coma Scale score of 9–13) in the National Trauma Data Bank between 2007 and 2014.

Measurement and Main Results:

We examined clinical characteristics, critical care resource utilization, and discharge outcomes. Poor outcomes were defined as discharge to hospice, skilled nursing facility, long-term acute care, or death. We examined 20,010 patient records. Patients were 9 years old (interquartile range, 2–15 yr), male (64%) with isolated traumatic brain injury (81%), Glasgow Coma Scale score of 12, head Abbreviated Injury Scale score of 3, and Injury Severity Score of 10. Majority (34%) were admitted to nontrauma hospitals. Critical care utilization was 58.7% including 11.5% mechanical ventilation and 3.2% intracranial pressure monitoring. Compared to patients with Glasgow Coma Scale score of 13, admission Glasgow Coma Scale score of 9 was associated with greater critical care resource utilization, such as ICU admission (72% vs 50%), intracranial pressure monitoring (7% vs 1.8%), mechanical ventilation (21% vs 6%), and intracranial surgery (10% vs 5%). Most patients (70%) were discharged to home, but up to one third had poor outcomes. Older age group had a higher risk of poor outcomes (10–14 yr; adjusted relative risk, 1.32; 95% CI, 1.13–1.54; 15–17 yr; adjusted relative risk, 2.39; 95% CI, 2.12–2.70). Poor outcomes occurred with lower Glasgow Coma Scale (Glasgow Coma Scale score of 9 vs Glasgow Coma Scale score of 13: adjusted relative risk, 2.89; 95% CI, 2.47–3.38), higher Injury Severity Score (Injury Severity Score of ≥ 16 vs Injury Severity Score of < 9: adjusted relative risk, 8.10; 95% CI 6.27–10.45), and polytrauma (adjusted relative risk, 1.40; 95% CI, 1.22–1.61).

Conclusions:

Critical care resources are used in more than half of all moderate pediatric traumatic brain injury, and many receive care at nontrauma hospitals. Up to one third of moderate pediatric traumatic brain injury have poor outcomes, risk factors for which include age greater than 10 years, lower admission Glasgow Coma Scale, higher Injury Severity Score, and polytrauma. There is urgent need to optimize triage, care, and outcomes in this vulnerable population.
Quality and Safety in Health Care, Part XXXIII
Authors: Harolds Jay A.
Published: September 2017

The transcatheter mitral valve procedure with the MitraClip device has been clinically available in much of Europe since 2008. In 2013, the Food and Drug Administration permitted MitraClip procedures to be done commercially for those patients with primary severe mitral regurgitation who were not surgical candidates. The COAPT trial is designed to see if the MitraClip procedure should be approved in the United States for those with secondary mitral regurgitation, although it has been used for that purpose in much of Europe for years.
Laparoscopic Adrenalectomy in Elderly Patients
Authors: Weinandt Marthe , Gaujoux Sébastien , Khayat Antoine , Bertherat Jérôme , Baillard Christophe , Dousset Bertrand
Published: September 2017

With increase life expectancy, surgical indications in elderly become more frequent. The aim of this study was to analyze indications and outcome of laparoscopic adrenalectomy in patients over 75. Between 1994 and 2014, 641 patients underwent laparoscopic adrenalectomy. Preoperatively, all patients had a standardized preoperative work-up. Patients over 75 were compared with a control group of younger patients. The median age was 52 years (41 to 61) and 3.6% of patients (n=23) were over 75. Patients over 75 were more frequently operated for malignant lesion (21.7% vs. 4.7%; P=0.005). There was no postoperative mortality. Conversion rate was 3.4% (n=22), with no significant difference between the groups. The overall morbidity and severe morbidity rates were, respectively, 16.9% and 3.3%, with no significant difference between the groups. In experienced team and for selected patients, laparoscopic adrenalectomy after 75 years is safe, without increased postoperative morbidity, as compared with younger population.
The Uncinate Process First Approach in Laparoscopic Pancreaticoduodenectomy: A Single-institution Experience
Authors: Zhang Yue , Sun Dong-Lin , Chen Xue-Min
Published: September 2017

Background:

Limited studies regarding the uncinate process first in laparoscopic pancreaticoduodenectomy (LPD) have been reported. The objective of this study was to evaluate the feasibility, safety, and efficacy of LPD using the uncinate process first approach.

Methods:

This is a retrospective study of selected patients who underwent LPD using the uncinate process first approach at our center between between June 2015 and January 2017. Clinical characteristics and intraoperative and postoperative data were retrospectively analyzed.

Results:

LPD was performed successfully in 45 patients. The median operative time was 410±68 minutes and the median loss of blood was 258±50 mL. Intraoperative frozen section histologic analyses revealed that margin-negative resections were negative in all cases. The median first flatus time was 2±1 day, and median diet start time was 3±1.5 day. The median postoperative hospital stay was 13±4 day. There were no deaths within 30 days following LPD. The mean number of lymph nodes removed was 20±5. The overall morbidity rate was 20%.

Conclusion:

LPD with the uncinate process first approach well combines the benefits of laparoscopy with low risk of postoperative complications and high rate of curative resection.
Dynamical modulation of theta-gamma coupling during REM sleep
Authors: Bandarabadi Mojtaba , Boyce Richard , Herrera Carolina Gutierrez , Bassetti Claudio , Williams Sylvain , Schindler Kaspar , Adamantidis Antoine
Published: September 2017

Theta phase modulates gamma amplitude during spatial navigation and rapid eye movement sleep (REMs). Although the REMs theta rhythm has been linked to spatial memory consolidation, the underlying mechanism remains unclear. We investigate dynamics of theta-gamma interactions across multiple frequency and temporal scales in simultaneous recordings from hippocampal CA3, CA1, subiculum, and parietal cortex. We show that theta phase significantly modulates three distinct gamma bands during REMs, dynamically. Interestingly, we further show that theta-gamma coupling swings between different hippocampal and cortical structures during REMs and tends to increase over a single REMs episode. Comparing to active wake, theta-gamma coupling during REMs is significantly increased for subicular and cortical, but not for CA3 and CA1, recordings. Finally, optogenetic silencing of septohippocampal GABAergic projections significantly impedes both theta-gamma coupling and theta phase coherence, two neural mechanisms of working and long-term memory, respectively. Thus, we show that theta-gamma coupling and theta phase coherence are highly modulated during single REMs episode and propose that theta-gamma coupling provides a predominant mechanism for information processing within each brain region, while the orchestrated nature of coupling activity establishes a specific phase-space coding of information during sleep.
Aging Of Antiviral CD8+Memory T Cells Fosters Increased Survival, Metabolic Adaptations And Lymphoid Tissue Homing
Authors: Davenport Bennett , Eberlein Jens , van der Heide Verena , Jhun Kevin , Nguyen Tom T. , Victorino Francisco , Trotta Andrew , Chipuk Jerry , Yi Zhengzi , Zhang Weijia , Clambey Eric T. , Scott Donald K. , Homann Dirk
Published: September 2017

Aging of established antiviral T cell memory fosters a series of progressive adaptations that paradoxically improve rather than compromise protective CD8+T cell immunity. We now provide evidence that this gradual evolution, the pace of which is contingent on the precise context of the primary response, also impinges on the molecular mechanisms that regulate CD8+memory T cell (CD8+TM) homeostasis. Over time, CD8+TMbecome more resistant to apoptosis and acquire enhanced cytokine responsiveness without adjusting their homeostatic proliferation rates; concurrent metabolic adaptations promote increased CD8+TMquiescence and fitness but also impart the re-acquisition of a partial effector-like metabolic profile; and a gradual redistribution of aging CD8+TMfrom blood and nonlymphoid tissues to lymphatic organs results in CD8+TMaccumulations in bone marrow, splenic white pulp and particularly lymph nodes. Altogether, these data demonstrate how temporal alterations of fundamental homeostatic determinants converge to render aged CD8+TMpoised for greater recall responses.

ABBREVIATIONS

AT

adoptive transfer

ATGL

adipose triglyceride lipase

BMP

blood and marginated pool

FA, FAO, FAS, FASN

fatty acid, fatty acid oxidation, fatty acid synthesis, fatty acid synthase

FSC, SSC

forward scatter, side scatter

GMFI

geometric mean of fluorescence intensity

GP, NP

glycoprotein, nucleoprotein

GSEA

gene set enrichment analysis

GSH

glutathione

Io, IIo

primary, secondary

KEGG

Kyoto Encyclopedia of Genes and Genomes

LAL

lysosomal acid lipase (LIPA)

LCMV

lymphocytic choriomeningitis virus

NES

normalized enrichment score

NLTs

nonlymphoid tissues

O, Y

old, young

OxPhos

oxidative phosphorylation

p14 cells

TCRtg CD8+T cells specific for the LCMV-GP33-41determinant

RP, WP

red pulp, white pulp (spleen)

T cell subsets

TE

effector T cells

TCM

central memory T cells (CD62Lhi)

TEM

effector memory T cells (CD62Llo)

TEMRA

terminally differentiated CD45RA+effector memory T cells (human)

TM

memory T cells

TMP

memory-phenotype T cells (CD44hi)

TN

naïve T cells (CD44lo)

TRM

resident memory T cells (CD69/CD103-enriched)

TCRtg

T cell receptor transgenic

TSLP

Thymic stromal lymphopoietin
Working Memory Load Modulates Neuronal Coupling
Authors: Pinotsis Dimitris A. , Buschman Timothy J. , Miller Earl K.
Published: September 2017

There is a severe limitation in the number of items that can be held in working memory. However, the neurophysiological limits remain unknown. We asked whether the capacity limit might be explained by differences in neuronal coupling. We developed a theoretical model based on Predictive Coding and used it to analyze Cross Spectral Density data from the prefrontal cortex (PFC), frontal eye fields (FEF) and lateral intraparietal area (LIP). Monkeys performed a change detection task (Buschman et al., 2011). The number of objects that had to be remembered (memory load) was varied (1-3 objects in the same visual hemifield). Changes in memory load changed the connectivity in the PFC-FEF-LIP network. Feedback (top-down) coupling broke down when the number of objects exceeded cognitive capacity. Thus, impaired behavioral performance coincided with a break-down of Prediction signals. This provides new insights into the neuronal underpinnings of cognitive capacity and how coupling in a distributed working memory network is affected by memory load.
Revealing ETC-1922159 affected unknown 3rd order WNT10B-X-X combinations, in silico
Authors: Gong Mengsha , Kim Kibeom , Frick Christopher , Abrams Micheal , Sinha Shriprakash , Basinger Ty , Goentoro Lea , Gardinaru Viviana , Arnold Frances , Murray Richard , Mayo Stephan , Rosenbaum Thomas
Published: September 2017

WNT10B belongs to the family of WNT proteins that are implicated in a range of phenomena that are affected by the Wnt signaling pathway. Recent studies have shown that WNT10B plays a role in colorectal cancer. WNTs have been found to directly affect the stemness of the tumor cells via regulation of ASCL2. Switching off the ASCL2 literally blocks the stemness process of the tumor cells and vice versa. Furthermore, recent findings suggest BVES to be highly suppressed in malignancies and in vitro deletions of BVES show higher Wnt signaling activity to induce stemness. WNT10B was found to be highly expressed in such cases. Often, in biology, we are faced with the problem of exploring relevant unknown biological hypotheses in the form of myriads of combination of factors that might be affecting the pathway under certain conditions. For example, WNT10B-ASCL2 is one such 2nd order combination whose relation needs to be tested under the influence of recently developed porcupine-WNT inhibitor ETC-1922159. The inhibitor is known to suppress PORCN (porcupine) and thus inhibit a range of oncogenes known to be directly or indirectly affected by the Wnts. In a recent unpublished work in bioRxiv, we had the opportunity to rank these unknown biological hypotheses for down regulated genes at 2nd order level after the drug was administered. The in silico observations showed that the combination of WNT10B-ASCL2 was assigned a relatively lower rank, thus validating the pipeline's efficacy with the confirmed wet lab experiment that indicate that both WNT10B and ASCL2 were down regulated after treatment in cancer cells. Here, we take one step further by in silico analysis of the 3rd order combinations of WNT10B-X-X (X can be known or unknown factor), from a range of 100 randomly picked down regulated genes after ETC-1922159 treatment. The pipeline uses the density based HSIC (Hilbert Schmidt Information Criterion) sensitivity index with an rbf (radial basis function) kernel, which is known to be highly effective in sensitivity analysis. Various unknown/unexplored/untested 3rd order biological hypotheses emerge some of which are confirmed in wet lab, while others need to be tested. The potential of such ranking is indispensable in the current era of search in a vast combinatorial forest.
Stimulus familiarity and expectation jointly modulate neural activity in the visual ventral stream
Authors: Manahova Mariya E. , Mostert Pim , Kok Peter , Schoffelen Jan-Mathijs , de Lange Floris P.
Published: September 2017

Prior knowledge about the visual world can change how a visual stimulus is processed. Two forms of prior knowledge are often distinguished: stimulus familiarity (i.e., whether a stimulus has been seen before) and stimulus expectation (i.e., whether a stimulus is expected to occur, based on the context). Neurophysiological studies in monkeys have shown suppression of spiking activity both for expected and for familiar items in object-selective inferotemporal cortex (IT). It is an open question, however, if and how these types of knowledge interact in their modulatory effects on the sensory response. In order to address this issue and to examine whether previous findings generalize to non-invasively measured neural activity in humans of both sexes, we separately manipulated stimulus familiarity and expectation, while non-invasively recording human brain activity using magnetoencephalography (MEG). We observed independent suppression of neural activity by familiarity and expectation, specifically in the lateral occipital complex (LOC), the putative human homologue of monkey IT. Familiarity also led to sharpened response dynamics, which was predominantly observed in early visual cortex. Together, these results show that distinct types of sensory knowledge jointly determine the amount of neural resources dedicated to object processing in the visual ventral stream.
Cold-hearted bats: Cardiac function and metabolism of small bats during torpor at subzero temperatures
Authors: Currie Shannon E. , Stawski Clare , Geiser Fritz
Published: September 2017

Despite their small size and large relative surface area, many hibernating bats have the ability to thermoregulate and defend their body temperature (Tb) often below 10°C by an increase in metabolic rate. Above a critical temperature (Tcrit) animals usually thermoconform. We investigated the physiological responses above and below Tcritfor a small tree dwelling bat (Chalinolobus gouldii, ∼14g) that is often exposed to subzero temperatures during winter. Through simultaneous measurement of heart rate (HR) and oxygen consumption () we show that the relationship between oxygen transport and cardiac function is substantially altered in thermoregulating torpid bats down to −2°C, compared with thermoconforming torpid bats at mild ambient temperatures (Ta5-20°C). Tcritfor this species was Ta0.7 ± 0.4°C, with a corresponding Tbof 1.8 ± 1.2°C. Below this Tcritanimals began to thermoregulate, indicated by a considerable but disproportionate increase in both HR and. The maximum increase in HR was only 4-fold greater than the average thermoconforming minimum, compared to a 46-fold increase in. The differential response of HR andto low Tawas represented by a 15-fold increase in oxygen delivery per heart beat (cardiac oxygen pulse). During torpor at low Ta, thermoregulating bats maintain a relatively slow HR and compensate for increased metabolic demands by significantly increasing stroke volume and tissue oxygen extraction. Our study provides valuable new information on the relationship between metabolism and HR in an unstudied physiological state and further advances our knowledge of the thermogenic capacity of small bats.
Employers’ perception of women workers in Oman and the challenges they face
Authors: Belwal Rakesh , Belwal Shweta
Published: September 2017

Purpose

The participation and productivity of women in Oman’s labor force are very low and heavily skewed toward the government sector. There are few women in the private sector and the reasons for this are not well-known. The challenges that women workers face specifically in the Arab World are worth understanding from a participation and policy perspective. The purpose of this paper is to explore employers’ perceptions of women workers and the major challenges they face in Oman in the context of government efforts to develop the female workforce in this Middle East region.

Design/methodology/approach

Data collected by interviewing the top executives (employers) from 28 organizations in two major cities in Oman were analyzed qualitatively, grouped into emerging themes, triangulated, and discussed.

Findings

The results indicated that employers, in general, are impressed by women workers in Oman. However, they identify a number of challenges women face. This study synthesized and grouped employers’ perceptions of these challenges in the following categories: women’s natural and physiological composition, their attitude at work, post-marital challenges, socio-cultural barriers, nature and place of work, organizational preparedness and governance, biases or prejudices of employers, and work-life balance (WLB) issues facing them.

Practical implications

This study suggests that since female participation in the government sector in Oman is substantial, women can also be attracted to work in the private sector if policies are formulated to safeguard their interests.

Originality/value

There is an absolute dearth of studies about female participation in the Omani workforce; this study is one of the pioneering efforts. Whereas the extant literature on WLB issues represents mostly the western perspective, this study highlights the major WLB issues in Oman and fills some important gaps between the West and the Middle East by focusing on women, WLB, and policies triangle.
Innovative tools and techniques to overcome HR challenges globally
Authors: Rao M.S.
Published: September 2017

Purpose

The purpose of this research paper is to address the current challenges in HR and offer innovative tools and techniques to craft a modern HR philosophy.

Design/methodology/approach

It illustrates with examples of global companies, including Google, LinkedIn, Twitter, FedEx Corporation, Mayo Clinic, Rolls-Royce, Shell, Ford, Boston Consulting Group, Nissan, and Cadbury, that are noted for innovative HR practices.

Findings

It concludes that global organizations and senior leaders must address the current HR challenges and adopt innovative tools and techniques to stay relevant and competent in the present global dynamic business environment to achieve organizational excellence and effectiveness.

Practical implications

The tools and techniques adopted to achieve a modern HR philosophy can be applied in any industry and in any size of organization.

Social implications

The social implications of this research suggest that HR leaders can achieve organizational excellence and effectiveness by adopting these innovative tools and techniques.

Originality/value

It advises placing more emphasis on leadership than on leaders because leaders are mortal, whereas leadership is immortal. It explains the role of HR leaders and CEOs in crafting a modern HR philosophy.
Accrual and real-based earnings management by UK acquirers
Authors: Kassamany Talie , Ibrahim Salma , Archbold Stuart
Published: September 2017

Purpose

This study aims to investigate the occurrence of pre-merger earnings management for a sample of 197 stock- and cash-financed UK acquirers between 1990 and 2009. It also examines the earnings management behaviour around the change in the Corporate Governance Code in 2003 based on the Higgs recommendations.

Design/methodology/approach

Mean and median accrual- and real-based manipulation are examined in the period before the announcement of a merger and acquisition. These are compared across stock and cash acquirers as well as before and after the implementation of the Higgs recommendations. Logistic regressions are also run to examine accrual- and real-based manipulation across stock and cash acquirers after controlling for variables that may affect the acquisition type.

Findings

The study found some evidence of upward pre-merger accrual-based earnings management by stock-financed acquirers, which is in line with the findings of Botsari and Meeks (2008). Furthermore, no significant changes were found in the post-Higgs period, which indicates that the recommendations put forth by Higgs may not have been successful in mitigating earnings management. The evidence also shows that cash bidders engage in pre-merger real earnings manipulation through lower discretionary expenses, possibly to enhance cash availability for the bid.

Practical implications

The findings in this study confirm earnings management exists around mergers and acquisitions and provide some evidence that the recommendations set out in the Higgs Report do not appear to have mitigated earnings management activities. This is of interest to regulators as well as investors and academicians.

Originality/value

This provides the first analysis in the UK examining the use of real-based earnings management activities by UK acquirers. It also extends prior research around corporate governance changes that occurred in the UK.
Student experiences of taught part-time study on a postgraduate dementia studies programme: findings from an electronic questionnaire survey
Authors: Burrow Simon , Bradshaw Tim , Mairs Hilary , Pusey Helen , Keady John
Published: September 2017

Purpose

The purpose of this paper is to describe the findings from an electronic questionnaire survey which set out to explore experiences of graduates of a part-time Master’s programme in dementia care at The University of Manchester.

Design/methodology/approach

An electronic questionnaire survey was sent to 57 graduates who had studied on the programme since it began in 2003. Thematic analysis was applied to qualitative data from responses to six open-ended questions.

Findings

In total, 31 completed questionnaires were received. Four key themes were identified from the qualitative data: juggling competing demands; experiencing personal growth and achievement; locating sources of support; and supporting changes to practice.

Research limitations/implications

Limitations included the small sample size and the survey not covering the experiences of students who had failed to complete the first year of study.

Originality/value

The study demonstrates the perceived value of dementia education at more advanced levels for people working in professional roles in dementia care, this included professional and personal development and supporting changes to practice. The study additionally adds to a limited evidence base relating to how mature, health and social care students experience part-time study in higher education and has implications for future research aimed at informing the development of appropriate course design and employer support.
Service users’ experiences of participation in clinical psychology training
Authors: Campbell Meadhbh , Wilson Charlotte
Published: September 2017

Purpose

The purpose of this paper is to explore mental health service users’ experiences of involvement in a clinical psychology course.

Design/methodology/approach

Five participants were recruited from a service user and carer group aligned to a university professional clinical psychology course. Data were collected using semi-structured interviews and data were analysed using an interpretative phenomenological analysis (IPA).

Findings

Four superordinate themes, group processes, advocating, transforming and power, were drawn from the data, with ten subthemes emerging capturing experiences on the personal, professional and group levels.

Research limitations/implications

The study is not generalisable and has a small number of participants. However, many of the themes have resonance with existing literature.

Practical implications

Service user initiatives need to consider the personal and contextual issues that service users may have experienced prior to their involvement. The needs of service user initiatives may change over time. Such initiatives must evolve in conjunction with the personal and political journeys of participants.

Originality/value

Few studies have explored the experiences of mental health service users in clinical psychology training using a robust methodology. The current study suggests that eliciting these experiences highlights factors that facilitate involvement as well as the barriers.
Consumer perspectives on personal recovery and borderline personality disorder
Authors: Donald Fiona , Duff Cameron , Broadbear Jillian , Rao Sathya , Lawrence Katherine
Published: September 2017

Purpose

Borderline personality disorder (BPD) is a complex condition characterized by a number of psychosocial difficulties that typically involve considerable suffering for individuals with the condition. Recovery from BPD may involve specific processes such as work on how the self is perceived by the individual with BPD and his or her relationships which differ from those common to recovery from other mental health conditions. The details of the processes that may best promote changes within the self and relationships are yet to be established. The paper aims to discuss these issues.

Design/methodology/approach

In total, 17 consumers from a specialist BPD service were interviewed to identify factors they have experienced that contribute to recovery from BPD. Thematic analysis within a grounded theory framework was used to understand key themes within the interview data. The emphasis was on specific conditions of change rather than the more global goals for recovery suggested by recent models.

Findings

Key themes identified included five conditions of change: support from others; accepting the need for change; working on trauma without blaming oneself; curiosity about oneself; and reflecting on one’s behavior. To apply these conditions of change more broadly, clinicians working in the BPD field need to support processes that promote BPD-specific recovery identified by consumers rather than focusing exclusively on the more general recovery principles previously identified within the literature.

Originality/value

The specific factors identified by consumers as supporting recovery in BPD are significant because they involve specific skills or attitudes rather than aspirations or goals. These specific skills may be constructively supported in clinical practice.