bluuebunny/crossref_metadata_2025 huggingface dataset:
Low magnetic field cooling of lepton plasmas via cyclotron-cavity resonance
Authors: Hunter E. D. , Evetts N. , Fajans J. , Hardy W. N. , Landsberger H. , Mcpeters R. , Wurtele J. S.
Published: December 2017

Pure electron or pure positron plasmas held in magnetic fields B radiate energy because of the cyclotron motion of the plasma particles; nominally, the plasmas should cool to the often cryogenic temperatures of the trap in which they are confined. However, the cyclotron cooling rate for leptons is (1/4 s)(B/1 T)2, and significant cooling is not normally observed unless B≳1 T. Cooling to the trap temperatures of ∼10 K is particularly difficult to attain. Here, we show that dramatically higher cooling rates (×100) and lower temperatures (÷1000) can be obtained if the plasmas are held in electromagnetic cavities rather than in effectively free space conditions. We find that plasmas with up to 107 particles can be cooled in fields close to 0.15 T, much lower than 1 T commonly thought to be necessary to obtain plasma cooling. Appropriate cavities can be constructed with only minor modifications to the standard Penning-Malmberg trap structures.
Analytical torque calculation and experimental verification of synchronous permanent magnet couplings with Halbach arrays
Authors: Seo Sung-Won , Kim Young-Hyun , Lee Jung-Ho , Choi Jang-Young
Published: December 2017

This paper presents analytical torque calculation and experimental verification of synchronous permanent magnet couplings (SPMCs) with Halbach arrays. A Halbach array is composed of various numbers of segments per pole; we calculate and compare the magnetic torques for 2, 3, and 4 segments. Firstly, based on the magnetic vector potential, and using a 2D polar coordinate system, we obtain analytical solutions for the magnetic field. Next, through a series of processes, we perform magnetic torque calculations using the derived solutions and a Maxwell stress tensor. Finally, the analytical results are verified by comparison with the results of 2D and 3D finite element analysis and the results of an experiment.
Enhanced room-temperature spin Seebeck effect in a YIG/C60/Pt layered heterostructure
Authors: Das R. , Kalappattil V. , Geng R. , Luong H. , Pham M. , Nguyen T. , Liu Tao , Wu Mingzhong , Phan M. H. , Srikanth H.
Published: December 2017

We report on large enhancement of the longitudinal spin Seebeck effect (LSSE) in the Y3Fe5O12 (YIG)/Pt system at room temperature due to the addition of a thin layer of organic semiconductor (C60) in between the YIG and the Pt. LSSE measurements show that the LSSE voltage increases significantly, from the initial value of 150 nV for the YIG/Pt structure to 240 nV for the YIG/C60(5nm)/Pt structure. Radio-frequency transverse susceptibility experiments reveal a significant decrease in the surface perpendicular magnetic anisotropy (PMA) of the YIG film when C60 is deposited on it. These results suggest that the LSSE enhancement may be attributed to increased spin mixing conductance, the decreased PMA, and the large spin diffusion length of C60.
Temperature-feedback direct laser reshaping of silicon nanostructures
Authors: Aouassa M. , Mitsai E. , Syubaev S. , Pavlov D. , Zhizhchenko A. , Jadli I. , Hassayoun L. , Zograf G. , Makarov S. , Kuchmizhak A.
Published: December 2017

Direct laser reshaping of nanostructures is a cost-effective and fast approach to create or tune various designs for nanophotonics. However, the narrow range of required laser parameters along with the lack of in-situ temperature control during the nanostructure reshaping process limits its reproducibility and performance. Here, we present an approach for direct laser nanostructure reshaping with simultaneous temperature control. We employ thermally sensitive Raman spectroscopy during local laser melting of silicon pillar arrays prepared by self-assembly microsphere lithography. Our approach allows establishing the reshaping threshold of an individual nanostructure, resulting in clean laser processing without overheating of the surrounding area.
Geometrically enhanced closed-loop multi-turn sensor devices that enable reliable magnetic domain wall motion
Authors: Borie B. , Wahrhusen J. , Grimm H. , Kläui M.
Published: December 2017

We experimentally realize a sophisticated structure geometry for reliable magnetic domain wall-based multi-turn-counting sensor devices, which we term closed-loop devices that can sense millions of turns. The concept relies on the reliable propagation of domain walls through a cross-shaped intersection of magnetic conduits, allowing for the intertwining of loops of the sensor device. As a key step to reach the necessary reliability of the operation, we develop a combination of tilted wires called the syphon structure at the entrances of the cross. We measure the control and reliability of the domain wall propagation individually for cross-shaped intersections, the syphon geometries, and finally combinations of the two for various field configurations (strengths and angles). The various measured syphon geometries yield a dependence of the domain wall propagation on the shape that we explain by the effectively acting transverse and longitudinal external applied magnetic fields. The combination of both elements yields a behaviour that cannot be explained by a simple superposition of the individual different maximum field operation values. We identify as an additional process the nucleation of domain walls in the cross, which then allows us to fully gauge the operational parameters. Finally, we demonstrate that by tuning the central dimensions of the cross and choosing the optimum angle for the syphon structure, reliable sensor operation is achieved, which paves the way for disruptive multi-turn sensor devices.
Molecular dynamics simulations of concentration-dependent defect production in Fe-Cr and Fe-Cu alloys
Authors: Zhang Yaxuan , Schwen Daniel , Bai Xian-Ming
Published: December 2017

Molecular dynamics simulations are conducted to study the effects of alloying elements on the primary damage behaviors in three Fe-based ferritic alloy systems: (1) a Fe-Cr system in which the heat of mixing changes its sign with the Cr concentration; (2) a Fe-Cu system that has a positive heat of mixing; and (3) an ideal but artificial Fe-Cr system that has a zero heat of mixing, which is used as a reference system to investigate solute interstitial formation based on probability. It is found that in these alloys, the solute type and concentration do not have a significant effect on the total number of surviving Frenkel pairs. However, the fraction of solute interstitials has distinct behaviors. In Fe-Cr, the Cr interstitial fraction is much higher than the Cr solute concentration and the Cr interstitial production efficiency decreases with the increasing Cr concentration. By contrast, in Fe-Cu, Cu interstitials are barely produced. In the ideal alloy, the solute interstitial fraction is close to the solute concentration. The defect formation energies in both dilute and concentrated alloys, interstitial binding energies, liquid diffusivities of Fe and solute atoms, and heat of mixing have been calculated for both Fe-Cr and Fe-Cu alloys. Among them, we find that the relative thermodynamic stability between Fe self-interstitials and solute interstitials plays the most important role in the solute interstitial production behaviors. The decrease of Cr interstitial production efficiency with increasing Cr concentration can be explained by the probability distribution functions of solute interstitial formation energy in concentrated alloys.
High-quality multilayer graphene on an insulator formed by diffusion controlled Ni-induced layer exchange
Authors: Murata H. , Saitoh N. , Yoshizawa N. , Suemasu T. , Toko K.
Published: December 2017

The Ni-induced layer-exchange growth of amorphous carbon is a unique method used to fabricate uniform multilayer graphene (MLG) directly on an insulator. To improve the crystal quality of MLG, we prepare AlOx or SiO2 interlayers between amorphous C and Ni layers, which control the extent of diffusion of C atoms into the Ni layer. The growth morphology and Raman spectra observed from MLG formed by layer exchange strongly depend on the material type and thickness of the interlayers; a 1-nm-thick AlOx interlayer is found to be ideal for use in experiments. Transmission electron microscopy and electron energy-loss spectra reveal that the crystal quality of the resulting MLG is much higher than that of a sample without an interlayer. The grain size reaches a few μm, leading to an electrical conductivity of 1290 S/cm. The grain size and the electrical conductivity are the highest among MLG synthesized using a solid-phase reaction including metal-induced crystallization. The direct synthesis of uniform, high-quality MLG on arbitrary substrates will pave the way for advanced electronic devices integrated with carbon materials.
Complex band structure and electronic transmission eigenchannels
Authors: Jensen Anders , Strange Mikkel , Smidstrup Søren , Stokbro Kurt , Solomon Gemma C. , Reuter Matthew G.
Published: December 2017

It is natural to characterize materials in transport junctions by their conductance length dependence, β. Theoretical estimations of β are made employing two primary theories: complex band structure and density functional theory (DFT) Landauer transport. It has previously been shown that the β value derived from total Landauer transmission can be related to the β value from the smallest |ki| complex band; however, it is an open question whether there is a deeper relationship between the two. Here we probe the details of the relationship between transmission and complex band structure, in this case individual eigenchannel transmissions and different complex bands. We present calculations of decay constants for the two most conductive states as determined by complex band structure and standard DFT Landauer transport calculations for one semi-conductor and two molecular junctions. The molecular junctions show that both the length dependence of the total transmission and the individual transmission eigenvalues can be, almost always, found through the complex band structure. The complex band structure of the semi-conducting material, however, does not predict the length dependence of the total transmission but only of the individual channels, at some k-points, due to multiple channels contributing to transmission. We also observe instances of vertical bands, some of which are the smallest |ki| complex bands, that do not contribute to transport. By understanding the deeper relationship between complex bands and individual transmission eigenchannels, we can make a general statement about when the previously accepted wisdom linking transmission and complex band structure will fail, namely, when multiple channels contribute significantly to the transmission.
A rough wall is like no wall at all for colloidal glass
Authors: Patrick Chris
Published: December 2017

Rough walls erase the effect of a container in the behavior of colloidal glasses.
A close look at fast ion microturbulence in tokamaks builds predictive capability for fusion
Authors: Majors J. H.
Published: December 2017

Though typically not the focus of study for predicting fast ion confinement behavior, microturbulence proves to offer key insights for predictive capabilities in conventional and spherical tokamaks.
Characterization of SPP inhibitors suppressing propagation of HCV and protozoa
Authors: Hirano Junki , Okamoto Toru , Sugiyama Yukari , Suzuki Tatsuya , Kusakabe Shinji , Tokunaga Makoto , Fukuhara Takasuke , Sasai Miwa , Tougan Takahiro , Matsunaga Yasue , Yamashita Kazuo , Sakai Yusuke , Yamamoto Masahiro , Horii Toshihiro , Standley Daron M. , Moriishi Kohji , Moriya Kyoji , Koike Kazuhiko , Matsuura Yoshiharu
Published: December 2017

Significance

Signal peptide peptidase (SPP) is an essential host factor for propagation of hepatitis C virus (HCV). Here, we show that dibenzoazepine-type γ-secretase inhibitors suppressed the maturation of all genotypes of HCV core proteins through a specific interaction with Val223 in SPP, and no drug-resistant virus emerged after several passages of HCV in the presence of the SPP inhibitors. In addition, SPP encoded byPlasmodium falciparumwas functionally similar to human SPP, and treatment with the SPP inhibitors suppressed the propagation of protozoa, includingP. falciparumandToxoplasma gondii. Structural analysis in silico revealed that Phe258 of SPP participates in binding to the inhibitors. Compounds possessing a high affinity to Val223/Phe258 in SPP might be novel therapeutics for chronic hepatitis C and protozoiasis.
Instrument constituencies and public policy-making: an introduction
Authors: Béland Daniel , Howlett Michael , Mukherjee Ishani
Published: December 2017

For many years, policy-making has been envisioned as a process in which subsets of policy actors engage in specific types of interactions involved in the definition of policy problems, the articulation of solutions and their matching or enactment. This activity involves the definition of policy goals (both broad and specific), the creation or identification of the means and mechanisms that need to be implemented to realize these goals, and the set of bureaucratic, partisan, electoral and other political struggles involved in their acceptance and transformation into action. While past research on policy subsystems has often assumed or implied that these tasks could be undertaken by any actor, more recent research argues that distinct sets of actors are involved in these three tasks: epistemic communities that are engaged in discussions about policy dilemmas and problems; instrument constituencies that define and promote policy instruments and alternatives; and advocacy coalitions which compete to have their choice of policy alternative and problem frames adopted. Two of these three sets of actors are quite well known and, indeed, have their own literature about what it takes to be a member of an epistemic community or advocacy coalition, although interactions between the two are rarely discussed. The third subset, the instrument constituency, is much less known but has from the outset been considered in relation to these other policy actors. The articles in this special issue focus on better understanding the nature of actor interactions undertaken by instrument constituencies and how these relate to the other kinds of actors involved in policy-making.
Test–retest reliability of the irrational performance beliefs inventory
Authors: Turner M. J. , Slater M. J. , Dixon J. , Miller A.
Published: December 2017

The irrational performance beliefs inventory (iPBI) was developed to measure irrational beliefs within performance domains such as sport, academia, business, and the military. Past research indicates that the iPBI has good construct, concurrent, and predictive validity, but the test–retest reliability of the iPBI has not yet been examined. Therefore, in the present study the iPBI was administered to university sport and exercise students (n = 160) and academy soccer athletes (n = 75) at three‐time points. Time point two occurred 7 days after time point one, and time point three occurred 21 days after time point two. In addition, social desirability was also measured. Repeated‐measures MANCOVAs, intra‐class coefficients, and Pearson's (r) correlations demonstrate that the iPBI has good test–retest reliability, with iPBI scores remaining stable across the three‐time points. Pearson's correlation coefficients revealed no relationships between the iPBI and social desirability, indicating that the iPBI is not highly susceptible to response bias. The results are discussed with reference to the continued usage and development of the iPBI, and future research recommendations relating to the investigation of irrational performance beliefs are proposed.
Rho GTPase signaling complexes in cell migration and invasion
Authors: Lawson Campbell D. , Ridley Anne J.
Published: December 2017

Cell migration is dependent on the dynamic formation and disassembly of actin filament–based structures, including lamellipodia, filopodia, invadopodia, and membrane blebs, as well as on cell–cell and cell–extracellular matrix adhesions. These processes all involve Rho family small guanosine triphosphatases (GTPases), which are regulated by the opposing actions of guanine nucleotide exchange factors (GEFs) and GTPase-activating proteins (GAPs). Rho GTPase activity needs to be precisely tuned at distinct cellular locations to enable cells to move in response to different environments and stimuli. In this review, we focus on the ability of RhoGEFs and RhoGAPs to form complexes with diverse binding partners, and describe how this influences their ability to control localized GTPase activity in the context of migration and invasion.
Uncorking AMPA receptors
Authors: Sedwick Caitlin
Published: December 2017

New JGP study explains how auxiliary proteins relieve polyamine block of AMPARs.
Microstructure and filtration performance of konjac glucomannan-based aerogels strengthened by wheat straw
Authors: Wang Yixin , Chen Xi , Kuang Ying , Xiao Man , Su Yuehong , Jiang Fatang
Published: December 2017

This study presents the preparation and measurement of a novel environmentally friendly konjac glucomannan (KGM)-based composite aerogels enhanced with wheat straw (WS) via a sol–gel and freeze-drying progress. With the addition of WS, the porosity of aerogels could be increased from 50 to 88.13%, the filtration resistance of aerogels could be reduced from 500 to 205 Pa, and the filtration efficiency could be improved to 90.38%. The addition of WS also enhances the mechanical properties of composite aerogels with compression modulus of 2000.66 Pa, compressive strength of 501.56 Pa and elasticity of 0.603. The results demonstrate the high potential of KGM-based composite aerogels enhanced with WS for applications in air filtering.
Case Study of an Epidemiological Approach Dissecting Historical Soybean Sclerotinia Stem Rot Observations and Identifying Environmental Predictors of Epidemics and Yield Loss
Authors: Fall Mamadou L. , Boyse John F. , Wang Dechun , Willbur Jaime F. , Smith Damon L. , Chilvers Martin I.
Published: December 2017

Sclerotinia sclerotiorum is a significant threat to soybean production worldwide. In this study, an epidemiological approach was used to examine 11 years of historical data from a soybean management performance trial in order to advance our understanding of Sclerotinia stem rot (SSR) development and to identify environmental predictors of SSR epidemics and associated yield losses. Recursive partitioning analysis suggested that average air temperature and total precipitation in July were the most significant variables associated with disease severity. High levels of SSR disease severity index were observed when the average temperature in July was below 19.5°C and total precipitation in July was moderate, between 20 and 108.5 mm. A biphasic sigmoidal curve accurately described the relationship between SSR disease severity index (DSI) and yield, with a DSI threshold of 22, below which minimal yield loss was observed. A 10% increase in the DSI, from 22.0 to 24.2, led to an 11% decrease in yield, from 3,308.14 to 2,951.29 kg/ha. Also, a yield threshold (3,353 kg/ha) that was higher than the annual U.S. average soybean yield (3,039.7 kg/ha) was suggested as an expected yield under low or no SSR pressure in the U.S. Midwest. These thresholds can allow soybean stakeholders to assess the value of disease control and establish an SSR baseline for cost-effective management to protect yields. Because S. sclerotiorum has more than 400 plant host species, and because having quantitative information concerning crop losses is crucial for decision making, this study shows the usefulness of historical data on SSR and, hence, can serve as a model in other SSR pathosystems (canola, dry bean, potato, pea, and so on).
Surgical Treatment of Chronic Elbow Dislocation Allowing for Early Range of Motion: Operative Technique and Clinical Results
Authors: Anderson Duane R. , Haller Justin M. , Anderson Lucas A. , Hailu Samuel , Chala Abebe , O'Driscoll Shawn W.
Published: December 2017

Objectives:

To describe the surgical treatment and patient outcomes of chronic elbow dislocations.

Design:

Retrospective review.

Setting:

Two tertiary referral centers.

Patients/Participants:

All patients with surgically treated chronic elbow dislocation with no associated articular fracture from January 2009 to January 2015.

Intervention:

Review of patient demographics, injury chronicity, surgical technique, and patient outcomes.

Main Outcome Measurement:

Clinical outcomes included elbow range of motion and complications. Radiographic outcomes included the presence of heterotopic ossification. Patient-reported outcomes included the Mayo Elbow Performance Index (MEPI) and the Summary Outcome Determination (SOD).

Results:

Thirty-two patients with mean follow-up of 22 months (range, 13–41 months) were included. The mean dislocation duration was 6 months (range, 1–34 months). The mean preoperative range of motion was 8 degrees (range, 0–30 degrees). There were no infections or recurrent dislocations. One patient developed transient ulnar nerve palsy postoperatively. There were no cases of new or progressive heterotopic ossification. The mean postoperative extension was 31 degrees (range, 0–75 degrees), and the mean postoperative flexion was 132 degrees (range, 95–150 degrees); the mean final arc of motion was 101 degrees (range, 50–140 degrees). The mean postoperative MEPI was 93 (range, 70–100), and the mean SOD score was 9 (range, 6–10). Using the MEPI, 97% (31/32 patients) had good or excellent outcome. There was no difference in flexion/extension arc or MEPI scores between groups of elbows older and younger than 17 years or dislocations less or more than 3 months.

Conclusion:

This is the largest case series of surgically treated patients with chronic elbow dislocation. Using our surgical technique, 97% of patients had good or excellent outcome with a low complication rate. Open reduction of chronic elbow dislocation can be accomplished while permitting early motion with minimal recurrent dislocation risk.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Granulomatous Tumoral Melanosis Associated With Pembrolizumab Therapy: A Mimicker of Disease Progression in Metastatic Melanoma
Authors: Woodbeck Randi , Metelitsa Andrei I. , Naert Karen A.
Published: December 2017

Immune checkpoint inhibitor therapy has revolutionized the treatment of advanced melanoma, with these agents significantly improving survival for patients with metastatic disease. With the increasing use of these agents, the number of adverse reactions secondary to their use has also increased. Sarcoidosis and sarcoid-like reactions are one such immune checkpoint inhibitor–related adverse event. We report a case of sarcoid-like granulomatous tumoral melanosis in a patient on the programmed cell death-1 (PD-1) receptor inhibitor pembrolizumab for metastatic melanoma. This is, to our knowledge, the first reported case of a sarcoidal form of tumoral melanosis in a patient on anti-PD-1 therapy. We postulate that this reflects tumor regression in response to pembrolizumab-induced immune activation, with concomitant therapy–triggered induction of a sarcoid-like reaction. These findings and the literature review presented herein should alert clinicians and pathologists to the possibility of regressed lesions with sarcoid-like features presenting as mimickers of disease progression in patients undergoing immunotherapy for advanced melanoma.
Additive and subadditive antiallodynic interactions between μ-opioid agonists and N-methyl d-aspartate antagonists in male rhesus monkeys
Authors: Cornelissen Jeremy C. , Steele Floyd F. , Rice Kenner C. , Nicholson Katherine L. , Banks Matthew L.
Published: December 2017

μ-Opioid agonists are clinically effective analgesics, but also produce undesirable effects such as sedation and abuse potential that limit their clinical utility. Glutamatergic systems also modulate nociception and N-methyl d-aspartate (NMDA) receptor antagonists have been proposed as one useful adjunct to enhance the therapeutic effects and/or attenuate the undesirable effects of μ-opioid agonists. Whether NMDA antagonists enhance the antiallodynic effects of μ-agonists in preclinical models of thermal hypersensitivity (i.e. capsaicin-induced thermal allodynia) are unknown. The present study determined the behavioral effects of racemic ketamine, (+)-MK-801, (−)-nalbuphine, and (−)-oxycodone alone and in fixed proportion mixtures in assays of capsaicin-induced thermal allodynia and schedule-controlled responding in rhesus monkeys. Ketamine, nalbuphine, and oxycodone produced dose-dependent antiallodynia. MK-801 was inactive up to doses that produced undesirable effects. Ketamine, but not MK-801, enhanced the potency of μ-agonists to decrease rates of operant responding. Ketamine and nalbuphine interactions were additive in both procedures. Ketamine and oxycodone interactions were additive or subadditive depending on the mixture. Furthermore, oxycodone and MK-801 interactions were subadditive on antiallodynia and additive on rate suppression. These results do not support the broad clinical utility of NMDA receptor antagonists as adjuncts to μ-opioid agonists for thermal allodynic pain states.
INTERNAL LIMITING MEMBRANE PEELING VERSUS INVERTED FLAP TECHNIQUE FOR TREATMENT OF FULL-THICKNESS MACULAR HOLES
Authors: Rizzo Stanislao , Tartaro Ruggero , Barca Francesco , Caporossi Tomaso , Bacherini Daniela , Giansanti Fabrizio
Published: December 2017

Background:

The inverted flap (IF) technique has recently been introduced in macular hole (MH) surgery. The IF technique has shown an increase of the success rate in the case of large MHs and in MHs associated with high myopia. This study reports the anatomical and functional results in a large series of patients affected by MH treated using pars plana vitrectomy and gas tamponade combined with internal limiting membrane (ILM) peeling or IF.

Methods:

This is a retrospective, consecutive, nonrandomized comparative study of patients affected by idiopathic or myopic MH treated using small-gauge pars plana vitrectomy (25- or 23-gauge) between January 2011 and May 2016. The patients were divided into two groups according to the ILM removal technique (complete removal vs. IF). A subgroup analysis was performed according to the MH diameter (MH < 400 µm and MH ≥ 400 µm), axial length (AL < 26 mm and AL ≥ 26 mm), and the presence of chorioretinal atrophy in the macular area (present or absent).

Results:

We included 620 eyes of 570 patients affected by an MH, 300 patients underwent pars plana vitrectomy and ILM peeling and 320 patients underwent pars plana vitrectomy and IF. Overall, 84.94% of the patients had complete anatomical success characterized by MH closure after the operation. In particular, among the patients who underwent only ILM peeling the closure rate was 78.75%; among the patients who underwent the IF technique, it was 91.93% (P = 0.001); and among the patients affected by full-thickness MH ≥400 µm, success was achieved in 95.6% of the cases in the IF group and in 78.6% in the ILM peeling group (P = 0.001); among the patients with an axial length ≥26 mm, success was achieved in 88.4% of the cases in the IF group and in 38.9% in the ILM peeling group (P = 0.001). Average preoperative best-corrected visual acuity was 0.77 (SD = 0.32) logarithm of the minimum angle of resolution (20/118 Snellen) in the peeling group and 0.74 (SD = 0.33) logarithm of the minimum angle of resolution (20/110 Snellen) in the IF group (P = 0.31). Mean postoperative best-corrected visual acuity was 0.52 (SD = 0.42) logarithm of the minimum angle of resolution (20/66 Snellen) in the peeling group and 0.43 (SD = 0.31) logarithm of the minimum angle of resolution (20/53 Snellen) in the IF group (P = 0.003).

Conclusion:

Vitrectomy associated with the inverted ILM flap technique seems to be effective surgery for idiopathic and myopic large MHs, improving both functional and anatomical outcomes.
Trabeculectomy Outcomes After Glaucoma Drainage Device Surgery
Authors: Alizadeh Reza , Akil Handan , Tan James , Law Simon K. , Caprioli Joseph
Published: December 2017

Purpose:

To evaluate outcomes of trabeculectomy with adjunctive mitomycin C in patients with uncontrolled intraocular pressure (IOP) after glaucoma drainage device implantation.

Materials and Methods:

Consecutive patients who had undergone a trabeculectomy after GDD were reviewed. The primary outcome was surgical success with stratified IOP targets based on the following criteria: (A) IOP<18 mm Hg and IOP reduction of 20%; (B) IOP<15 mm Hg and IOP reduction of 25%; (C) IOP<12 mm Hg and IOP reduction of 30%. Secondary outcomes were number of glaucoma medications, complications, and need for additional glaucoma surgery.

Results:

Twenty eyes (19 patients) were included for analysis. Median follow-up and age were 3.7 years (range, 1.1 to 10.2 y) and 64.2 years (range, 25.2 to 85.6 y), respectively. Mean IOP (±SD) has dropped from 19.3±4.2 mm Hg preoperatively to 9.8±2.2 mm Hg at 1 year, 8.8±3.2 mm Hg at 3 years and 8.4±1.5 mm Hg at 5 years (P<0.001 for all). Hypotony maculopathy was the only serious complication (2/19 patients; 10%) that needed surgical revision. The cumulative success rate (±SD) for criterion A and B were 73.2% (±10.0%) and 68.2% (±9.5%), respectively, between the first and fifth year of follow-up, for criterion C it was 49.1% (±10.8%) at the first year and 32.7% (±12%) between the second and fifth year of follow-up.

Conclusions:

Trabeculectomy is a viable surgical option to treat IOP that is uncontrolled after GDD implantation.
The Axillary Intra-Aortic Balloon Pump as a Bridge to Recovery Allows Early Ambulation in Long-Term Use
Authors: Nwaejike Nnamdi , Son Andre Y. , Patel Chetan B. , Schroder Jacob N. , Milano Carmelo A. , Daneshmand Mani A.
Published: December 2017

We evaluated the feasibility, tolerability, and efficacy of a strategy for transaxillary artery intra-aortic balloon pump placement for extended mechanical circulatory support of patients with post-cardiotomy shock as a bridge to recovery. Patients requiring prolonged intra-aortic balloon pump support for postcardiotomy heart failure were identified. Intra-aortic balloon pump was tunneled through a 6-mm Dacron graft anastomosed to the right axillary artery. The intra-aortic balloon pump catheter is advanced under fluoroscopic guidance into the descending thoracic aorta. Three patients were transferred from outside facilities, requiring prolonged intra-aortic balloon pump support for postcardiotomy heart failure. Patients included a 54-year-old woman with occluded grafts and left ventricular thrombus after coronary artery bypass grafting, ejection fraction (EF) of 23.4% on dobutamine infusion, intra-aortic balloon pump support for 39 days, max daily ambulated distance of 1250 feet, and discharged home on day 51 on milrinone infusion; a 63-year-old man with kinked left internal mammary artery to left anterior descending artery graft (surgically repaired), multiple failed extubations requiring tracheostomy, EF of 15% on epinephrine and milrinone, intra-aortic balloon pump support for 43 days, max daily ambulated distance of 400 feet, and discharged home on day 54; and a 66-year-old man after redo coronary artery bypass grafting + carotid endarterectomy, with failure to wean off cardiopulmonary bypass requiring veno-arterial extracorporeal membrane oxygenator, EF of 20% on epinephrine and norepinephrine, intra-aortic balloon pump support for 41 days, max daily ambulated distance of 2800 feet, and discharged home on day 91. There were no infection, thromboembolic, cerebrovascular, bleeding, or intra-aortic balloon pump malpositioning/migration complications. We found that transaxillary artery intra-aortic balloon pump is well tolerated by patients and allows early ambulation and aggressive physical therapy in patients needing extended support. Duration of intra-aortic balloon pump support was up to 43 days with no complications.
Utilization of iPad Technology to Decrease Pediatric Preoperative Anxiety
Authors: Caldwell Rosaline Michelle , Ray Robyn
Published: December 2017

Purpose

The purpose of this project was to determine if iPad technology could decrease preoperative anxiety in school-age children. Each year, more than five million children in the United States have surgical procedures. Preoperative anxiety can delay induction of anesthesia, provoke the release of stress hormones, and hinder postoperative recovery. To decrease preoperative anxiety, a 17-page colorful iPad prep book was developed. The iPad prep book included pictures and words describing the outpatient day surgery process.

Procedure

A preexperimental one-group pretest/posttest design was utilized to focus on decreasing preoperative anxiety in 30 school-age children with the use of an iPad prep book before surgery on the day of surgery. Implementation of the project included administration of the Children's Anxiety Meter-State scale to patients to assess their level of anxiety. The iPad prep book was read to each participant by the researcher or child life specialist. To evaluate effectiveness of the iPad prep book, anxiety was reevaluated within 30 minutes of reading and discussing the iPad prep book.

Results

Data analysis utilized a one-sample t test to determine if changes in anxiety were statistically significant between preintervention and postintervention values. Children's (N = 30) anxiety scores were significantly decreased with iPad technology, t = −8.39, p < .05.

Conclusion

The use of iPad technology did positively improve preoperative anxiety in pediatric surgical patients.
The difference in endoscopic yield in patients with either iron-deficiency anemia or anemia with normal ferritin
Authors: Kwakman Judith A. , van Oostveen Catharina J. , van Stralen Karlijn J. , Cleeren Eva , Neerincx Maarten , van der Hulst René W.M.
Published: December 2017

Objective

Current guidelines recommend a gastroduodenoscopy (GDS) and colonoscopy in patients with iron-deficiency anemia (IDA). However, in daily practice, patients with nonferriprive anemia are also referred for endoscopy. The aim of this study is to compare the diagnostic yield of colonoscopy and GDS in patients with IDA and non-IDA.

Patients and methods

A retrospective single-center cohort study was carried out from January 2013 till February 2016 that included 917 patients with anemia. We compared the endoscopic yield in patients with IDA versus patients with anemia otherwise. Multivariate regression analyses were carried out to identify predictive factors for the diagnostic yield of GDS and colonoscopy.

Results

The yield of both GDS (25%) and colonoscopy (30%) was comparable in IDA and non-IDA patients. However, in patients without known gastrointestinal medical history and without concomitant indications for endoscopy (N=373), the diagnostic yield of GDS was three times higher in IDA patients compared with non-IDA patients (P<0.01). The diagnostic yield for colonoscopy was not significantly different between the two groups. Age and sex were recurrent predictive variables in the outcome of both GDS and colonoscopies.

Conclusion

We recommend IDA as well as non-IDA as indications for GDS and colonoscopy. Only in patients without gastrointestinal history or localizing complaints a significant difference in the diagnostic yield is found between IDA and non-IDA patients. In this group, upper endoscopy can be omitted in non-IDA patients as they were three times less likely to have a bleeding source found on GDS compared with IDA patients.
The Effects of Known Cardioprotective Drugs on Proinflammatory Cytokine Secretion From Human Coronary Artery Endothelial Cells
Authors: Haas Michael J. , Jurado-Flores Marilu , Hammoud Ramadan , Feng Victoria , Gonzales Krista , Onstead-Haas Luisa , Mooradian Arshag D.
Published: December 2017

Background:

Endothelial cell dysfunction in diabetes is involved in the pathogenesis and progression of premature atherosclerosis. High-dextrose has been shown to induce both oxidative stress and endoplasmic reticulum stress in cultured human coronary artery endothelial cells (HCAEC).

Study Question:

To determine whether or not several classes of cardioprotective drugs inhibit proinflammatory cytokine expression by HCAEC.

Measures and Outcomes:

To determine the effects of high dextrose on expression of proinflammatory cytokines by HCAEC, cells were treated with either 5.5 mM or 27.5 mM dextrose for 24 hours and interleukin-1β (IL-1β), interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor α were measured by enzyme immunoassay in the presence or absence of known cardioprotective drugs, including select β-blockers, statins, and renin-angiotensin system inhibitors.

Results:

IL-1β levels increased significantly in cells treated with high dextrose; however, IL-6 and IL-8 levels did not change. Treatment of cells with carvedilol, atenolol, and propranolol decreased levels of all 3 cytokines in cells exposed to either 5.5 or 27.5 mM dextrose. Similar effects on IL-1β, IL-6, and IL-8 levels were observed when cells were treated with simvastatin, pravastatin, and the renin-angiotensin system inhibitors spironolactone, captopril, lisinopril, candesartan, and losartan. No Il-2 or tumor necrosis factor α expression was observed in any of the experiments indicating that HCAEC do not express these cytokines.

Conclusions:

We conclude that each of the classes of drugs tested possess pleiotropic anti-inflammatory activities and are effective in both low- and high-dextrose–treated cells.
Evaluating the Clinical Judgment of Prelicensure Nursing Students in the Clinical Setting
Authors: Manetti Wendy
Published: December 2017

Assessing clinical judgment for safe nursing practice is a challenge. In this study, the Lasater Clinical Judgment Rubric (LCJR) was used to evaluate clinical judgment of junior and senior nursing students in the clinical setting. Juniors demonstrated an accomplished level on the total scale and all 4 subscales, whereas seniors had exemplary clinical judgment on the total scale and 3 of 4 subscales. The study provides evidence in support of the use of the LCJR to assess students’ clinical judgment in the clinical practice setting.
A Backward Walking Training Program to Improve Balance and Mobility in Acute Stroke: A Pilot Randomized Controlled Trial
Authors: Rose Dorian K. , DeMark Lou , Fox Emily J. , Clark David J. , Wludyka Peter
Published: December 2017

Background and Purpose:

Strategies to address gait and balance deficits early poststroke are minimal. The postural and motor control requirements of Backward Walking Training (BWT) may provide benefits to improve balance and walking speed in this population. This pilot study (1) determined the feasibility of administering BWT during inpatient rehabilitation and (2) compared the effectiveness of BWT to Standing Balance Training (SBT) on walking speed, balance, and balance-related efficacy in acute stroke.

Methods:

Eighteen individuals 1-week poststroke were randomized to eight, 30-minute sessions of BWT or SBT in addition to scheduled therapy. Five-Meter Walk Test, 3-Meter Backward Walk Test, Activities-Specific Balance Confidence Scale, Berg Balance Scale, Sensory Organization Test, and Function Independence Measure—Mobility were assessed pre- and postintervention and at 3 months poststroke.

Results:

Forward gait speed change (BWT: 0.75 m/s; SBT: 0.41 m/s), assessed by the 5-Meter Walk Test, and backward gait speed change (BWT: 0.53 m/s; SBT: 0.23 m/s), assessed by the 3-Meter Backward Walk Test, preintervention to 1-month retention were greater for BWT than for SBT (P < 0.05). Group difference effect size from preintervention to 1-month retention was large for Activities-Specific Balance Confidence Scale, moderate for Berg Balance Scale and Function Independence Measure—Mobility, and small for Sensory Organization Test.

Discussion and Conclusions:

Individuals 1-week poststroke tolerated 30 min/d of additional therapy. At 1-month postintervention, BWT resulted in greater improvements in both forward and backward walking speed than SBT. Backward walking training is a feasible important addition to acute stroke rehabilitation. Future areas of inquiry should examine BWT as a preventative modality for future fall incidence.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A193).
Outcome Measure Scores Predict Discharge Destination in Patients With Acute and Subacute Stroke: A Systematic Review and Series of Meta-analyses
Authors: Thorpe Emily R. , Garrett Katie B. , Smith Ashley M. , Reneker Jennifer C. , Phillips Robert S.
Published: December 2017

Background and Purpose:

To identify the association between outcome measure score and discharge destination in adults following acute or subacute stroke in the United States.

Methods:

A systematic literature search was performed in 3 databases using the PRISMA guidelines. Cohort studies were selected that included patients with acute or subacute stroke, which explored the relationship between scores on outcome measures and discharge destination. Four meta-analyses were performed.

Results:

Nine articles met the inclusion criteria for systematic review and 5 for the series of meta-analyses. For every 1-point increase on the Functional Independence Measure (FIM), a patient is approximately 1.08 times more likely to be discharged home than to institutionalized care (odds ratio [OR] = 1.079; 95% confidence interval [CI], 1.056- 1.102). Patients with stroke who performed above-average (FIM ≥80; NIH Stroke Scale [NIHSS] score ≤5; etc) are 12 times (OR = 12.08; 95% CI, 3.550-41.07) more likely to discharge home. Patients who perform poorly (FIM ≤39; NIHSS score ≥14), experience discharge to institutionalized care 3.4 times (OR = 3.385; 95% CI, 2.591-4.422) more likely than home, with skilled nursing facility admission more likely than inpatient rehabilitation facility. Patients who perform average (FIM = 40-79; NIHSS score = 6-13) are 1.9 times (OR = 1.879; 95% CI, 1.227-2.877) more likely to be discharged to institutionalized care.

Discussion and Conclusion:

Outcome measure scores are strong predictors of discharge destination among patients with stroke and provide an objective means of early discharge planning. Discharge decisions should be made with consideration for patient-specific biopsychosocial factors that may supersede isolated results of the outcome measures, and further research needs to assess the success of the location that a patient is referred at discharge.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A194).
Pulmonary Tumor Thrombotic Microangiopathy
Authors: Hutchinson Josh Curtis , Fulcher James W. , Hanna Jeff , Ward Michael E.
Published: December 2017

Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare rapidly progressive fatal disease that is difficult to diagnosis antemortem. Activation of the coagulation cascade and fibrocellular intimal thickening caused by embolism of tumor cells into pulmonary vasculature leads to extensive pulmonary hypertension and eventually death. We describe a case of PTTM with association of a presumed lung adenocarcinoma primary. Although rare in nature, PTTM should be a considered diagnosis with chronic dyspnea of unknown origin, severe pulmonary hypertension coupled with right-side heart failure, in the absence of pulmonary embolism.
Randomized Clinical Trial of Lidocaine Analgesia for Transurethral Bladder Catheterization Delivered via Blunt Tipped Applicator in Young Children
Authors: Uspal Neil G. , Strelitz Bonnie , Gritton Jesse , Follmer Kristin , Bradford Miranda C. , Colton Taryn L. , Merguerian Paul A. , Klein Eileen J.
Published: December 2017

Objective

Transurethral bladder catheterization (TUBC) is a painful, frequently performed procedure for collecting sterile urine. We sought to determine if administration of intraurethral lidocaine before TUBC using a blunt tipped syringe decreases procedural pain in young children in the pediatric emergency department.

Methods

Randomized clinical trial of children 0 to 36 months old requiring TUBC for collection of urine in a pediatric emergency department was performed. Patients received intraurethral 2% lidocaine jelly or usual care (no analgesia). Randomization was stratified by sex. Intraurethral lidocaine jelly was administered via Uro-Jet, 5 minutes before TUBC. Baseline child state, lidocaine application, TUBC, and child state 1 minute post-TUBC were videotaped. Neither providers nor parents were blinded to study arm. Videos were scored by a trained, independent, blinded reviewer using the Faces, Legs, Arms, Cry, and Consolability (FLACC) and Modified Behavioral Pain Score scales. Pain scores were compared using the Wilcoxon rank sum test. Our primary outcome was difference in FLACC scores between groups.

Results

Eighty children were enrolled in the study, and 73 had analyzable data. No differences were detected in pain by mean FLACC score between intervention (8; 95% confidence interval, 7–9) and control (9; 95% confidence interval, 8–10) groups. There were no differences between groups in mean FLACC score when stratified by age or sex or in mean Modified Behavioral Pain Score.

Conclusions

Intraurethral lidocaine for TUBC for urine collection using a blunt tipped applicator did not improve procedural pain scores. Pain scores were high across groups. Further study should be performed to improve analgesia for this highly painful procedure.
Improving Pediatric Preparedness in Critical Access Hospital Emergency Departments
Authors: Katznelson Jessica H. , Wang Jiangxia , Stevens Martha W. , Mills William A.
Published: December 2017

Objectives

Critical access hospitals (CAH) see few pediatric patients. Many of these hospitals do not have access to physicians with pediatric training. We sought to evaluate the impact of an in situ pediatric simulation program in the CAH emergency department setting on care team performance during resuscitation scenarios.

Methods

Five CAHs conducted 6 high-fidelity pediatric simulations over a 12-month period. Team performance was evaluated using a validated 35-item checklist representing commonly expected resuscitation team interventions. Checklists were scored by assigning zero point for “yes” and 1 point for “no”. A lower final score meant more items on the list had been completed. The Kruskal-Wallis rank test was used to assess for differences in average scores among institutions. A linear mixed effects model with a random institution intercept was used to examine trends in average scores over time. P < 0.05 was considered significant.

Results

The Kruskal-Wallis rank test showed no difference in average scores among institutions. (P = 0.90). Checklist scores showed a significant downward trend over time, with a scenario-to-scenario decrease of 0.022 (P < 0.01). One hundred percent of providers surveyed in the last month stated they would benefit from ongoing scenarios.

Conclusions

Regularly scheduled pediatric simulations in the CAH emergency department setting improved team performance over time on expected resuscitation tasks. The program was accepted by providers. Implementation of simulation-based training programs can help address concerns regarding pediatric preparedness in the CAH setting. A future project will look at the impact of the program on patient care and safety.