bluuebunny/crossref_metadata_2025 huggingface dataset:
Bi3.25La0.75Ti3O12 thin film capacitors for energy storage applications
Authors: Yang B. B. , Guo M. Y. , Song D. P. , Tang X. W. , Wei R. H. , Hu L. , Yang J. , Song W. H. , Dai J. M. , Lou X. J. , Zhu X. B. , Sun Y. P.
Published: November 2017

Environmentally benign Bi3.25La0.75Ti3O12 (BLTO) thin film capacitors were prepared by a cost effective chemical solution deposition method for high energy density storage device applications. Low annealing temperature annealed BLTO thin films showed very slim hysteresis loops with high maximum and small remnant polarization values. Increasing the applied electric field to 2040 kV/cm, the optimized BLTO thin films show a high recoverable energy density of 44.7 J/cm3 and an energy efficiency of 78.4% at room temperature. Additionally, the BLTO thin film capacitors exhibited excellent fatigue endurance after 4 × 108 cycles and a good thermal stability up to 140 °C, proving their strong potential for high energy density storage and conversion applications.
Threshold collision-induced dissociation and theoretical study of protonated azobenzene
Authors: Rezaee Mohammadreza , McNary Christopher P. , Armentrout P. B.
Published: October 2017

Protonated azobenzene (AB), H+(C6H5N2C6H5), has been studied using threshold collision-induced dissociation in a guided ion beam tandem mass spectrometer. Product channels observed are C6H5N2+ + C6H6 and C6H5+ + N2 + C6H6. The experimental kinetic energy-dependent cross sections were analyzed using a statistical model that accounts for internal and kinetic energy distributions of the reactants, multiple collisions, and kinetic shifts. From this analysis, the activation energy barrier height of 2.02 ± 0.11 eV for benzene loss is measured. To identify the transition states (TSs) and intermediates (IMs) for these dissociations, relaxed potential energy surface (PES) scans were performed at the B3LYP/aug-cc-pVTZ level of theory. The PES indicates that there is a substantial activation energy along the dissociation reaction coordinate that is the rate-limiting step for benzene loss and at some levels of theory, for subsequent N2 loss as well. Relative energies of the reactant, TSs, IMs, and products were calculated at B3LYP, wB97XD, M06, PBEPBE, and MP2(full) levels of theory using both 6-311++G(2d,2p) and aug-cc-pVTZ basis sets. Comparison of the experimental results with theoretical values from various computational methods indicates how well these theoretical methods can predict thermochemical properties. In addition to these density functional theory and MP2 methods, several high accuracy multi-level calculations such as CBS-QB3, G3, G3MP2, G3B3MP2, G4, and G4MP2 were performed to determine the thermochemical properties of AB including the proton affinity and gas-phase basicity, and to compare the performance of different theoretical methods.
Global existence and local well-posedness of the single-cycle pulse equation
Authors: Li Min , Yin Zhaoyang
Published: October 2017

In this paper, we mainly study the Cauchy problem of the integrable single-cycle pulse equation in the periodic domain. We first establish the local well-posedness of the equation in Hs(S),s≥2, by using an orthogonal projection of the equation onto mean zero functions and the Kato method. Then, we derive a relationship between the single-cycle pulse equation and the sine-Gordon equation rigorously and reveal some useful conservation laws of the sine-Gordon equation. Next, we deduce a new conservative quantity of the single-cycle pulse equation and get the upper bound of the H2-norm control of the solution. By a precise blow-up criterion, we finally get a global existence result for the equation.
Coupled electron-ion Monte Carlo simulation of hydrogen molecular crystals
Authors: Rillo Giovanni , Morales Miguel A. , Ceperley David M. , Pierleoni Carlo
Published: October 2017

We performed simulations for solid molecular hydrogen at high pressures (250 GPa ≤ P ≤ 500 GPa) along two isotherms at T = 200 K (phase III) and at T = 414 K (phase IV). At T = 200 K, we considered likely candidates for phase III, the C2c and Cmca12 structures, while at T = 414 K in phase IV, we studied the Pc48 structure. We employed both Coupled Electron-Ion Monte Carlo (CEIMC) and Path Integral Molecular Dynamics (PIMD). The latter is based on Density Functional Theory (DFT) with the van der Waals approximation (vdW-DF). The comparison between the two methods allows us to address the question of the accuracy of the exchange-correlation approximation of DFT for thermal and quantum protons without recurring to perturbation theories. In general, we find that atomic and molecular fluctuations in PIMD are larger than in CEIMC which suggests that the potential energy surface from vdW-DF is less structured than the one from quantum Monte Carlo. We find qualitatively different behaviors for systems prepared in the C2c structure for increasing pressure. Within PIMD, the C2c structure is dynamically partially stable for P ≤ 250 GPa only: it retains the symmetry of the molecular centers but not the molecular orientation; at intermediate pressures, it develops layered structures like Pbcn or Ibam and transforms to the metallic Cmca-4 structure at P ≥ 450 GPa. Instead, within CEIMC, the C2c structure is found to be dynamically stable at least up to 450 GPa; at increasing pressure, the molecular bond length increases and the nuclear correlation decreases. For the other two structures, the two methods are in qualitative agreement although quantitative differences remain. We discuss various structural properties and the electrical conductivity. We find that these structures become conducting around 350 GPa but the metallic Drude-like behavior is reached only at around 500 GPa, consistent with recent experimental claims.
Global kinetic simulations of neoclassical toroidal viscosity in low-collisional perturbed tokamak plasmas
Authors: Matsuoka Seikichi , Idomura Yasuhiro , Satake Shinsuke
Published: October 2017

The neoclassical toroidal viscosity (NTV) caused by a non-axisymmetric magnetic field perturbation is numerically studied using two global kinetic simulations with different numerical approaches. Both simulations reproduce similar collisionality (νb*) dependencies over wide νb* ranges. It is demonstrated that resonant structures in the velocity space predicted by the conventional superbanana-plateau theory exist in the small banana width limit, while the resonances diminish when the banana width becomes large. It is also found that fine scale structures are generated in the velocity space as νb* decreases in the large banana width simulations, leading to the νb*-dependency of the NTV. From the analyses of the particle orbit, it is found that the finite k∥ mode structure along the bounce motion appears owing to the finite orbit width, and it suffers from bounce phase mixing, suggesting the generation of the fine scale structures by the similar mechanism as the parallel phase mixing of passing particles.
Effects and mechanisms of an allied health research position in a Queensland regional and rural health service: a descriptive case study
Authors: Wenke Rachel J. , Tynan Anna , Scott Annette , Mickan Sharon
Published: October 2017

The aim of the present case study is to illustrate the outcomes of a dedicated allied health (AH) research position within a large Queensland regional and rural health service. The secondary aim of the case study is to describe the enabling and hindering mechanisms to the success of the role. Semistructured interviews were conducted with the Executive Director of Allied Health and the current AH research fellow incumbent within the health service. A focus group was also undertaken with six stakeholders (e.g. clinicians, team leaders) who had engaged with the research position. Outcomes of the AH research fellow included clinical and service improvements, enhanced research culture and staff up-skilling, development of research infrastructure and the formation of strategic research collaborations. Despite being a sole position in a geographically expansive health service with constrained resources, key enabling mechanisms to the success of the role were identified, including strong advocacy and regular communication with the Executive. In conclusion, the case study highlights the potential value of an AH research position in building research capacity within a large non-metropolitan health service. Factors to facilitate ongoing success could include additional research and administrative funding, as well as increased use of technology and team-based research.

What is known about the topic?
Dedicated research positions embedded within health care settings are a well cited strategy to increase research capacity building of allied health professionals (AHPs). However the majority of these positions are within metropolitan health settings and unique challenges exist for these roles in regional and rural areas. Few studies have described the impact of dedicated AH research positions within regional health centres or the factors which facilitate or hinder their role.

What does this paper add?
Dedicated research positions within a non-metropolitan Australian health service may have a positive impact on AH clinical services, research culture, staff upskilling, research infrastructure and research collaborations. Key enabling mechanisms to support the role may include advocacy from higher level management, strong networks and communication channels. Additional research and administrative funding, the use of technology and team based research may enhance sustainability of such roles.

What are the implications for practitioners?
AH research positions have potential value in building research capacity within a large non-metropolitan health service. Health managers and researchers should be aware of the unique challenges to these roles and consider mechanisms that may best enhance and sustain outcomes of the positions including: the development of infrastructure (i.e. technology, website of resources), networks, and communication strategies (i.e. regular meetings with leadership and promotion internally).
The LmSAP gene isolated from the halotolerant Lobularia maritima improves salt and ionic tolerance in transgenic tobacco lines
Authors: Ben Saad Rania , Farhat-Khemekhem Ameny , Ben Halima Nihed , Ben Hamed Karim , Brini Faical , Saibi Walid
Published: October 2017

The A20/AN1 zinc-finger domain-containing proteins of the stress-associated proteins (SAPs) family are fast emerging as potential candidates for biotechnological approaches to improve abiotic stress tolerance in plants. We identified LmSAP, one of the SAPs genes in Lobularia maritima (L.) Desv., a halophyte brassicaceae, through its transcript accumulation in response to salinity and ionic stresses. Sequence homology analysis revealed that LmSAP contains two conserved zinc-finger domains A20 and AN1. Phylogeny analyses showed that LmSAP exhibited high amino acid sequence identity to other plant SAPs. Heterologous expression of LmSAP in yeast increased cell tolerance to salt and osmotic stress. In addition, the overexpression of LmSAP conferred high salt and ionic tolerance to transgenic tobacco plants. Transgenic tobacco seedlings showed higher survival rates and antioxidant activities under salt and ionic stresses. Enhanced antioxidant activities paralleled lower malondialdehyde and superoxide anion O2− levels in the LmSAP transgenic seedlings. Overall, our results suggest that overexpression of LmSAP enhanced salt tolerance by maintaining ionic balance and limiting oxidative and osmotic stresses.
Early T cell receptor signals globally modulate ligand:receptor affinities during antigen discrimination
Authors: Pielak Rafal M. , O’Donoghue Geoff P. , Lin Jenny J. , Alfieri Katherine N. , Fay Nicole C. , Low-Nam Shalini T. , Groves Jay T.
Published: October 2017

Significance

Antigen discrimination by T cells is based on subtle differences in binding of the T cell receptor (TCR) for its peptide major histocompatibility complex (pMHC) ligand. While such binding characteristics are readily mapped with great precision in reconstituted biochemical systems, it is less clear how these interactions are affected in the live cell environment. Here we utilize single-molecule imaging to individually resolve all of the pMHC:TCR binding events in live T cells. The quantitative measurements reveal an active feedback mechanism that globally modulates the probability of pMHC:TCR binding throughout the cell–cell interface, without affecting the unbinding rate. The result is to increase the efficiency with which TCRs scan for antigen pMHC after the first few molecular encounters have occurred.
Strong texturing of lithium metal in batteries
Authors: Shi Feifei , Pei Allen , Vailionis Arturas , Xie Jin , Liu Bofei , Zhao Jie , Gong Yongji , Cui Yi
Published: October 2017

Significance

This work represents a first attempt to study the crystallographic texture of Li metal in batteries. X-ray diffraction pole-figure analysis demonstrates that the texture of Li deposition is primarily dependent on the type of additive or cross-over molecule from the cathode side. We find that reversibility of Li, which is phenomenologically influenced by morphology, is fundamentally driven by the texture (crystallographic orientation). Additives in electrolytes and the cross-over molecules from the cathode play crucial roles on the crystallographic texture because they hinder the cathodic process and selectively adsorb/react on different crystal planes. Additives with favorable adsorption and reusability will generate controllable texture, resulting in more uniform morphology and better cycling reversibility.
Cooperative cortical network for categorical processing of Chinese lexical tone
Authors: Si Xiaopeng , Zhou Wenjing , Hong Bo
Published: October 2017

Significance

The variation of pitch in speech not only creates the intonation for affective communication but also signals different meaning of a word in tonal languages, like Chinese. Due to its subtle and brisk pitch contour distinction between tone categories, the underlying neural processing mechanism is largely unknown. Using direct recordings of the human brain, we found categorical neural responses to lexical tones over a distributed cooperative network that included not only the auditory areas in the temporal cortex but also motor areas in the frontal cortex. Strong causal links from the temporal cortex to the motor cortex were discovered, which provides new evidence of top-down influence and sensory–motor interaction during speech perception.
Direct observation of impact propagation and absorption in dense colloidal monolayers
Authors: Buttinoni Ivo , Cha Jinwoong , Lin Wei-Hsun , Job Stéphane , Daraio Chiara , Isa Lucio
Published: October 2017

Significance

Single-particle characterization of the impact response has unveiled design principles to focus and control stress propagation in macroscopic granular crystalline arrays. We demonstrate that similar principles apply to aqueous monolayers of microparticles excited by localized mechanical pulses. By inducing extreme local deformation rates and tracking the motion of each particle with velocities that reach up to few meters per second, we reveal that a regime of elastic collisions, typically forbidden due to overdamping, becomes accessible. This provides insights on the stress propagation and energy absorption of dense suspensions upon fast deformation rates.
Probing the cooperativity of
Thermoplasma acidophilum
proteasome core particle gating by NMR spectroscopy
Authors: Huang Rui , Pérez Felipe , Kay Lewis E.
Published: October 2017

Significance

In the cell, protein degradation occurs, to a large extent, by a barrel-like structure called the proteasome. Degradation is highly regulated, ensuring that only proteins targeted for elimination are removed. This is accomplished through gates that close the proteasome entrance pores, localized to the top and bottom of the structure, as well as through the binding of regulator molecules. Here, we study the properties of the individual gates using solution NMR spectroscopy and a labeling procedure in which a series of molecules are prepared with subunits that have different types of gates. Our results show that gates are formed via residues that have a very high intrinsic propensity to enter the lumen of the proteasome, with each gate behaving independently.
Genomic features shaping the landscape of meiotic double-strand-break hotspots in maize
Authors: He Yan , Wang Minghui , Dukowic-Schulze Stefanie , Zhou Adele , Tiang Choon-Lin , Shilo Shay , Sidhu Gaganpreet K. , Eichten Steven , Bradbury Peter , Springer Nathan M. , Buckler Edward S. , Levy Avraham A. , Sun Qi , Pillardy Jaroslaw , Kianian Penny M. A. , Kianian Shahryar F. , Chen Changbin , Pawlowski Wojciech P.
Published: October 2017

Significance

Meiotic recombination is a process in plants, animals, and fungi during which chromosomes exchange their parts. It generates new genetic variation in the progeny and is one of the reasons why progeny are both similar to and different from their parents. Recombination is initiated by formation of breaks in chromosomal DNA. We generated a high-resolution map of sites where these breaks are formed in the genome of maize. Surprisingly, we found that DNA breaks are abundant in all genome regions, including sites where recombination was thought to be limited, such as repetitive DNA. The map will allow understanding of how recombination patterns shape the genome and aid development of more efficient breeding methods.
A vimentin binding small molecule leads to mitotic disruption in mesenchymal cancers
Authors: Bollong Michael J. , Pietilä Mika , Pearson Aaron D. , Sarkar Tapasree Roy , Ahmad Insha , Soundararajan Rama , Lyssiotis Costas A. , Mani Sendurai A. , Schultz Peter G. , Lairson Luke L.
Published: October 2017

Significance

Cancer cells derived from mesenchymal tissues or induced to adopt a mesenchymal state have been demonstrated to be largely resistant to standard chemotherapies, necessitating the identification of new effective treatment strategies. From a high throughput screen, we have discovered FiVe1, a compound capable of irreversibly inhibiting the growth of mesenchymally transformed cancer cells by binding to and interfering with the organization and phosphorylation of vimentin (VIM) during mitosis. In contrast to the many naturally and synthetically derived compounds targeting microtubules, we report that chemically targeting an intermediate filament protein, VIM, promotes mitotic catastrophe. As VIM expression is restricted to mesenchymal cells, these results provide a mechanistic basis toward developing genotype-selective chemotherapeutics for the treatment of mesenchymal cancers.
Mast cells acquire MHCII from dendritic cells during skin inflammation
Authors: Dudeck Jan , Medyukhina Anna , Fröbel Julia , Svensson Carl-Magnus , Kotrba Johanna , Gerlach Michael , Gradtke Ann-Christine , Schröder Bernd , Speier Stephan , Figge Marc Thilo , Dudeck Anne
Published: October 2017

Mast cells (MCs) and dendritic cells (DCs) are essential innate sentinels populating host-environment interfaces. Using longitudinal intravital multiphoton microscopy of DCGFP/MCRFP reporter mice, we herein provide in vivo evidence that migratory DCs execute targeted cell-to-cell interactions with stationary MCs before leaving the inflamed skin to draining lymph nodes. During initial stages of skin inflammation, DCs dynamically scan MCs, whereas at a later stage, long-lasting interactions predominate. These innate-to-innate synapse-like contacts ultimately culminate in DC-to-MC molecule transfers including major histocompatibility complex class II (MHCII) proteins enabling subsequent ex vivo priming of allogeneic T cells with a specific cytokine signature. The extent of MHCII transfer to MCs correlates with their T cell priming efficiency. Importantly, preventing the cross talk by preceding DC depletion decreases MC antigen presenting capacity and T cell–driven inflammation. Consequently, we identify an innate intercellular communication arming resident MCs with key DC functions that might contribute to the acute defense potential during critical periods of migration-based DC absence.
Electromechanical wave imaging and electromechanical wave velocity estimation in a large animal model of myocardial infarction
Authors: Costet Alexandre , Melki Lea , Sayseng Vincent , Hamid Nadira , Nakanishi Koki , Wan Elaine , Hahn Rebecca , Homma Shunichi , Konofagou Elisa
Published: October 2017

Echocardiography is often used in the clinic for detection and characterization of myocardial infarction. Electromechanical wave imaging (EWI) is a non-invasive ultrasound-based imaging technique based on time-domain incremental motion and strain estimation that can evaluate changes in contractility in the heart. In this study, electromechanical activation is assessed in infarcted heart to determine whether EWI is capable of detecting and monitoring infarct formation. Additionally, methods for estimating electromechanical wave (EW) velocity are presented, and changes in the EW propagation velocity after infarct formation are studied.

Five (n  =  5) adult mongrels were used in this study. Successful infarct formation was achieved in three animals by ligation of the left anterior descending (LAD) coronary artery. Dogs were survived for a few days after LAD ligation and monitored daily with EWI. At the end of the survival period, dogs were sacrificed and TTC (tetrazolium chloride) staining confirmed the formation and location of the infarct. In all three dogs, as soon as day 1 EWI was capable of detecting late-activated and non-activated regions, which grew over the next few days. On final day images, the extent of these regions corresponded to the location of infarct as confirmed by staining. EW velocities in border zones of infarct were significantly lower post-infarct formation when compared to baseline, whereas velocities in healthy tissues were not.

These results indicate that EWI and EW velocity might help with the detection of infarcts and their border zones, which may be useful for characterizing arrhythmogenic substrate.
A microtubule bestiary: structural diversity in tubulin polymers
Authors: Chaaban Sami , Brouhard Gary J.
Published: October 2017

Microtubules are long, slender polymers of αβ-tubulin found in all eukaryotic cells. Tubulins associate longitudinally to form protofilaments, and adjacent protofilaments associate laterally to form the microtubule. In the textbook view, microtubules are 1) composed of 13 protofilaments, 2) arranged in a radial array by the centrosome, and 3) built into the 9+2 axoneme. Although these canonical structures predominate in eukaryotes, microtubules with divergent protofilament numbers and higher-order microtubule assemblies have been discovered throughout the last century. Here we survey these noncanonical structures, from the 4-protofilament microtubules of Prosthecobacter to the 40-protofilament accessory microtubules of mantidfly sperm. We review the variety of protofilament numbers observed in different species, in different cells within the same species, and in different stages within the same cell. We describe the determinants of protofilament number, namely nucleation factors, tubulin isoforms, and posttranslational modifications. Finally, we speculate on the functional significance of these diverse polymers. Equipped with novel tubulin-purification tools, the field is now prepared to tackle the long-standing question of the evolutionary basis of microtubule structure.
Differential ability of proinflammatory and anti-inflammatory macrophages to perform macropinocytosis
Authors: Redka Dar’ya S. , Gütschow Michael , Grinstein Sergio , Canton Johnathan
Published: November 2017

Macropinocytosis mediates the uptake of antigens and of nutrients that dictate the regulation of cell growth by mechanistic target of rapamycin complex 1 (mTORC1). Because these functions differ in proinflammatory and anti-inflammatory macrophages, we compared the macropinocytic ability of two extreme polarization states. We found that anti-inflammatory macrophages perform vigorous macropinocytosis constitutively, while proinflammatory cells are virtually inactive. The total cellular content of Rho-family GTPases was higher in anti-inflammatory cells, but this disparity failed to account for the differential macropinocytic activity. Instead, reduced activity of Rac/RhoG was responsible for the deficient macropinocytosis of proinflammatory macrophages, as suggested by the stimulatory effects of heterologously expressed guanine nucleotide-exchange factors or of constitutively active (but not wild-type) forms of these GTPases. Similarly, differences in the activation state of phosphatidylinositol 3-kinase (PtdIns3K) correlated with the macropinocytic activity of pro- and anti-inflammatory macrophages. Differences in PtdIns3K and Rho-GTPase activity were attributable to the activity of calcium-sensing receptors (CaSRs), which appear to be functional only in anti-inflammatory cells. However, agonists of PtdIns3K, including cytokines, chemokines, and LPS, induced macropinocytosis in proinflammatory cells. Our findings revealed a striking difference in the macropinocytic ability of pro- and anti-inflammatory macrophages that correlates with their antigen-presenting and metabolic activity.
Chaperonin studies: faith, luck, and a little help from our friends
Authors: Horwich Arthur L.
Published: October 2017

Basic cellular research is a trail. One follows one’s nose toward what might be new understanding. When that leads to a need to employ unfamiliar or novel technology, it’s both exciting and very worthwhile to form collaborations. Our early studies of chaperonins support such a philosophy, as detailed in the two stories that follow, written in deep appreciation of recognition by the E.B. Wilson Medal of the American Society for Cell Biology.
Unfolding the chaperone story
Authors: Hartl F. Ulrich
Published: October 2017

Protein folding in the cell was originally assumed to be a spontaneous process, based on Anfinsen’s discovery that purified proteins can fold on their own after removal from denaturant. Consequently cell biologists showed little interest in the protein folding process. This changed only in the mid and late 1980s, when the chaperone story began to unfold. As a result, we now know that in vivo, protein folding requires assistance by a complex machinery of molecular chaperones. To ensure efficient folding, members of different chaperone classes receive the nascent protein chain emerging from the ribosome and guide it along an ordered pathway toward the native state. I was fortunate to contribute to these developments early on. In this short essay, I will describe some of the critical steps leading to the current concept of protein folding as a highly organized cellular process.
Germline competency of human embryonic stem cells depends on eomesodermin
Authors: Chen Di , Liu Wanlu , Lukianchikov Anastasia , Hancock Grace V , Zimmerman Jill , Lowe Matthew G , Kim Rachel , Galic Zoran , Irie Naoko , Surani M Azim , Jacobsen Steven E , Clark Amander T
Published: October 2017

In humans, germline competency and the specification of primordial germ cells (PGCs) are thought to occur in a restricted developmental window during early embryogenesis. Despite the importance of specifying the appropriate number of PGCs for human reproduction, the molecular mechanisms governing PGC formation remain largely unexplored. Here, we compared PGC-like cell (PGCLC) differentiation from 18 independently derived human embryonic stem cell (hESC) lines, and discovered that the expression of primitive streak genes were positively associated with hESC germline competency. Furthermore, we show that chemical inhibition of TGFβ and WNT signaling, which are required for primitive streak formation and CRISPR/Cas9 deletion of Eomesodermin (EOMES), significantly impacts PGCLC differentiation from hESCs. Taken together, our results suggest that human PGC formation involves signaling and transcriptional programs associated with somatic germ layer induction and expression of EOMES.
Immunogenicity of Different Routine Poliovirus Vaccination Schedules: A Randomized, Controlled Trial in Karachi, Pakistan
Authors: Saleem Ali F , Mach Ondrej , Yousafzai Mohammad T , Khan Asia , Weldon William C , Steven Oberste M , Zaidi Syed S , Alam Muhammad M , Quadri Farheen , Sutter Roland W , Zaidi Anita K M
Published: November 2017

Background

We assessed immunity against polioviruses induced with a new Pakistani poliovirus immunization schedule and compared it to alternative poliovirus immunization schedules.

Methods

Newborns were randomized to undergo vaccination based on 1 of 5 vaccination schedules, with doses administered at birth and at 6, 10, and 14 weeks of age. Arm A received inactivated poliovirus vaccine (IPV) at all time points. Arm B received bivalent oral poliovirus vaccine (bOPV) at all time points. Arms C and D received bOPV at the first 3 time points and bOPV plus IPV at the final time point (the current schedule). Arm E received trivalent OPV (tOPV) at all time points. At 22 weeks of age, all children received 1 challenge dose of tOPV, and children in arm D received 1 additional IPV dose. Sera were analyzed for the presence of poliovirus neutralizing antibodies at birth and 14 and 22 weeks of age.

Results

Seroconversion for poliovirus type 1 (PV1) at 22 weeks of age was observed in 80% of individuals in arm A, 97% in arm B, 94% in arm C, 96% in arm D, and 94% in arm E; for PV2, seroconversion frequencies were 84%, 19%, 53%, 49%, and 93%, respectively; and for PV3, seroconversion frequencies were 93%, 94%, 98%, 94%, and 85%, respectively.

Conclusions

The current immunization schedule in Pakistan induced high seroconversion rates for PV1 and PV3; however, it induced PV2 seroconversion in only half of study subjects. There is a growing cohort of young children in Pakistan who are unprotected against PV2; and this creates an increasing risk of a large-scale outbreak of poliomyelitis caused by circulating vaccine-derived PV2.
Increased Volume of Lumbar Surgeries for Herniated Intervertebral Disc Disease and Cost-Effectiveness Analysis
Authors: Kim Chi Heon , Chung Chun Kee , Kim Myo Jeong , Choi Yunhee , Kim Min-Jung , Hahn Seokyung , Shin Sukyoun , Jong Jong-myung , Lee Jun Ho
Published: November 2017

Study Design.

Retrospective cohort study of a nationwide database.

Objective.

The primary objective was to summarize the use of surgical methods for lumbar herniated intervertebral disc disease (HIVD) at two different time periods under the national health insurance system. The secondary objective was to perform a cost-effectiveness analysis by utilizing incremental cost-effectiveness ratio (ICER).

Summary of Background Data.

The selection of surgical method for HIVD may or may not be consistent with cost effectiveness under national health insurance system, but this issue has rarely been analyzed.

Methods.

The data of all patients who underwent surgeries for HIVD in 2003 (n = 17,997) and 2008 (n = 38,264) were retrieved. The surgical methods included open discectomy (OD), fusion surgery, laminectomy, and percutaneous endoscopic lumbar discectomy (PELD). The hospitals were classified as tertiary-referral hospitals (≥300 beds), medium-sized hospitals (30–300 beds), or clinics (<30 beds). ICER showed the difference in the mean total cost per 1% decrease in the reoperation probability among surgical methods. The total cost included the costs of the index surgery and the reoperation.

Results.

In 2008, the number of surgeries increased by 2.13-fold. The number of hospitals increased by 34.75% (731 in 2003 and 985 in 2008). The proportion of medium-sized hospitals increased from 62.79% to 70.86%, but the proportion of surgeries performed at those hospitals increased from 61.31% to 85.08%. The probability of reoperation was highest after laminectomy (10.77%), followed by OD (10.50%), PELD (9.20%), and fusion surgery (7.56%). The ICERs indicated that PELD was a cost-effective surgical method. The proportion of OD increased from 71.21% to 84.12%, but that of PELD decreased from 16.68% to 4.57%.

Conclusion.

The choice of surgical method might not always be consistent with cost-effectiveness strategies, and a high proportion of medium-sized hospitals may be responsible for this change.

Level of Evidence: 4
Acute Respiratory Distress Syndrome Cases Volume and ICU Mortality in Medical Patients
Authors: Dres Martin , Austin Peter C. , Pham Tài , Aegerter Philippe , Guidet Bertrand , Demoule Alexandre , Vieillard-Baron Antoine , Brochard Laurent , Geri Guillaume
Published: November 2017

Objectives:

To determine whether ICUs caring for higher volumes of acute respiratory distress syndrome patients would be associated with lower ICU mortality.

Design:

A 9-year multicenter retrospective cohort study of prospectively collected data.

Setting:

French medical ICUs.

Patients:

From 2004 to 2012, acute respiratory distress syndrome cases were identified from a coding system through a regional database (Collège des Utilisateurs de Données en Réanimation).

Interventions:

None.

Measurements and Main Results:

Volume was calculated as the cumulative annual mean number of acute respiratory distress syndrome cases. Severity (Simplified Acute Physiology Score 2) and ICU mortality between categories (low, medium, and high) of acute respiratory distress syndrome cases volume were analyzed. Multivariable analysis using mixed effects models was performed to adjust for severity of illness and confounding factors. Over the study period, 8,383 acute respiratory distress syndrome patients among 31 ICUs met the study inclusion criteria. Overall, Simplified Acute Physiology Score 2 (median [interquartile]) was 58 (43−74), whereas ICU mortality was 53.7%. Severity as assessed by Simplified Acute Physiology Score 2 (median [interquartile]) was significantly higher in high-volume ICUs (> 65 acute respiratory distress syndrome per year) as compared to low (≤ 29 acute respiratory distress syndrome per year) and medium-volume ICUs (> 29−65 acute respiratory distress syndrome per year): 61 (46−77) versus 55 (41−72) and 55.0 (40−72), respectively (p < 0.01). ICU mortality was similar across the acute respiratory distress syndrome volume categories (53.6%, 54.1%, and 53.3% in low-, medium-, and high-volume categories ICUs, respectively). After adjustment for confounders, acute respiratory distress syndrome case volume was independently associated with ICU mortality (odds ratio for log-transformed volume: 0.77 [95% CI, 0.62–0.96]; p = 0.02).

Conclusions:

ICUs caring for higher volumes of acute respiratory distress syndrome cases were associated with lower ICU mortality.
Using Robotics to Quantify Impairments in Sensorimotor Ability, Visuospatial Attention, Working Memory, and Executive Function After Traumatic Brain Injury
Authors: Logan Lindsey M. , Semrau Jennifer A. , Debert Chantel T. , Kenzie Jeffrey M. , Scott Stephen H. , Dukelow Sean P.
Published: October 2017

Objective:

To investigate the use of a robotic assessment tool to quantify sensorimotor, visuospatial attention, and executive function impairments in individuals with traumatic brain injury (TBI).

Setting:

Foothills Hospital (Calgary, Canada).

Participants:

Twenty-three subjects with first-time TBI in the subacute to chronic phase participated in this study. Normative data were collected from 275 to 494 neurologically intact control subjects for each robotic task.

Design:

A prospective observational case series. Subjects with TBI completed brief clinical cognitive and motor assessments followed by robotic assessments of upper limb reaching, position sense, bimanual motor ability, attention, and visuospatial skills. Scores of subjects with TBI were compared with normative data.

Main Measures:

Robotic task performance was computed for each subject on each task, as well as performance on specific task parameters. Clinical assessments included the Montreal Cognitive Assessment, Fugl-Meyer upper extremity assessment, and Purdue Peg Board.

Results:

Subjects with TBI demonstrated a variety of deficits on robotic tasks. The proportion of TBI subjects who were significantly different from controls ranged from 36% (dominant arm reaching) to 60% (bimanual object hitting task).

Conclusion:

Robotic measures allowed us to quantify a range of impairments specific to each subject, and offer an objective tool with which to examine these abilities after TBI.
Lifetime History of Traumatic Brain Injury and Current Disability Among Ohio Adults
Authors: Yi Honggang , Corrigan John D. , Singichetti Bhavna , Bogner Jennifer A. , Manchester Kara , Guo Jinhong , Yang Jingzhen
Published: October 2017

Objective:

To examine the associations between lifetime history of traumatic brain injury (TBI) with loss of consciousness (LOC) and several types of current disability among adult, noninstitutionalized residents of Ohio.

Participants:

2014 Ohio Behavioral Risk Factors Surveillance System participants (n = 6998).

Design:

Statewide population-based survey.

Main Measures:

Lifetime history of TBI with LOC (number and severity of injury, age of first injury), and number and type of disability (vision, cognition, mobility, self-care, and/or independent living).

Results:

Of the 6998 participants, 1325 reported lifetime history of TBI with LOC, and 1959 reported currently having one or more disabilities. When weighted, these represented 21.7% and 23.7% of Ohio's noninstitutionalized adult population, respectively. Adults with a history of TBI with LOC showed greater odds of any disability compared with adults with no history (odds ratio = 2.49; 95% confidence interval = 1.97-3.15). The likelihood of having any and each type of disability increased as the number of TBIs or the severity of worst TBI increased, regardless of sustaining first TBI before or after the age of 15 years.

Conclusions:

Lifetime history of TBI with LOC is significantly associated with disability among Ohio adults. Further research on the natural course of the relation and preventive strategies is warranted.
Acute Illness Protocol for Maple Syrup Urine Disease
Authors: Rodan Lance H. , Aldubayan Saud H. , Berry Gerard T. , Levy Harvey L.
Published: November 2017

Inborn errors of metabolism (IEMs) are genetic disorders that disrupt enzyme activity, cellular transport, or energy production. They are individually rare but collectively have an incidence of 1:1000. Most patients with IEMs are followed up by a physician with expertise in biochemical genetics (metabolism), but may present outside this setting. Because IEMs can present acutely with life-threatening crises that require specific interventions, it is critical for the emergency medicine physician, pediatrician, internist, and critical care physician as well as the biochemical geneticist to have information on the initial assessment and management of patients with these disorders. Appropriate early care can be lifesaving. This protocol is not designed to replace the expert consultation of a biochemical geneticist, but rather to improve early care and increase the level of comfort of the acute care physician with initial management of maple syrup urine disease until specialty consultation is obtained.
Patient-Reported Pain Outcomes for Children Attending an Emergency Department With Limb Injury
Authors: Clapp Adrianna D.M. , Thull-Freedman Jennifer , Mitra Tatum , Lethebe Brendan Cord , Williamson Tyler , Stang Antonia Schirmer
Published: October 2017

Objectives

The aim of this study was to describe patient-reported pain outcomes at various stages of an emergency department (ED) visit for pediatric limb injury.

Methods

This prospective cohort consisted of 905 patients aged 4 to 17 years with acute limb injury and a minimum initial pain score of 4/10. Patients reported pain scores and treatments offered and received at each stage of their ED visit. Multiple logistic regression was used to identify predictors for severe pain on initial assessment and moderate or severe pain at ED discharge.

Results

The initial median pain score was 6/10 (interquartile range, 4–6) and decreased at discharge to 4/10 (interquartile range, 2–6). Stages of the ED visit where the highest proportion of patients reported severe pain (score, ≥8 of 10) were fracture reduction (26.0% [19/73]; 95% confidence interval [CI], 17.1%–37.5%), intravenous insertion (24.4% [11/45]; 95% CI, 13.8%–39.6%), and x-ray (23.7% [158/668]; 95% CI, 20.6%–27.0%). Predictors of severe pain at initial assessment included younger age (odds ratio [OR], 0.92; 95% CI, 0.87–0.97), female sex (OR, 0.58; 95% CI, 0.40–0.84), and presence of fracture (OR, 1.58; 95% CI, 1.07–2.33) whereas, at discharge, older age (OR, 1.14; 95% CI, 1.06–1.23) predicted moderate/severe pain (score, ≥4 of 10).

Conclusions

These results on the location and predictors of severe pain during an ED visit for limb injury can be used to target interventions to improve pain management and patient outcomes.
Hyperglycemic Hyperosmolar State During Induction Chemotherapy for Acute Lymphoblastic Leukemia
Authors: Chan Randall Yimbong , Shah Ankit V.K. , Lewis Keith E. , Johnson Jeffrey L. , Sequeira Paola , Ho Cynthia H.
Published: November 2017

We present the case of a 16-year-old boy who presented with fatigue, polyuria, and polydipsia while on chemotherapy for his relapsed acute lymphoblastic leukemia (ALL). Blood gas examination confirmed the diagnosis of hyperosmolar hyperglycemic state. The etiology for his hyperglycemia was most likely a result of oral glucocorticoid therapy combined with asparaginase therapy—both are a cornerstone of induction chemotherapy for ALL. The patient was aggressively rehydrated with saline, and medications were administered to correct his hyperkalemia. He was then slowly brought to euglycemia with a continuous infusion of insulin. Although hyperosmolar hyperglycemic state is rare during the treatment of ALL, frontline providers should be aware of this diagnosis because of the significant risk of hypovolemic shock and death if correction of hyperglycemia occurs prior to complete fluid resuscitation.
Coronal Plane Magnetic Resonance Imaging Measurement of Hippocampal Formation Volume of Healthy Chinese Adults
Authors: Zhong Hua , Yang Ming , Cheng Kai Liang , Fu Qiang , Tian Yong , Li Youqiong
Published: October 2017

The aim of this study was to provide hippocampal formation volume data for the clinic and diagnoses of the related diseases for healthy Chinese adult. Three-dimensional fast-spoiled gradient echo magnetic resonance imaging sequence scanning was used in 68 cases of healthy adult brain to gain the image between lateral border of bilateral fourth ventricle and vitreous body. The image then was divided into 10 equal parts in the sagittal plane. We draw the outline and then obtain the area and volume of the hippocampal formation in each part, and the data were analyzed using SPSS 17.0 software. Results of the research showed that the volume of the hippocampal in healthy Chinese adult left side is ∼2319.87 to 2602.47 mm3, right side is ∼2443.96 to 2755.89 mm3; male left side is ∼2135.00 to 2494.29 mm3, right side is −2350.21 to 2745.61 mm3; female left side is ∼2328.13 to 2748.41 mm3, right side is ∼2398.41 to 2909.48 mm3. The volume of hippocampal absence correlated with age (P > 0.05), youth group. The volume of hippocampal has significant sexual difference (t = 2.500, P < 0.05). The volumes of the left and right sides have significant difference (t = 2.571, P < 0.05). For the female group (middle-age and youth), the volumes of right side hippocampal have significant difference (P < 0.05).
Efficacy of Surgical Treatment on the Recurrent Stroke Prevention for Adult Patients With Hemorrhagic Moyamoya Disease
Authors: Wang Guoqing , Zhang Xiaoyang , Feng Mengzhao , Liu Xianzhi , Guo Fuyou
Published: October 2017

Objective:

It remains controversial about the optimal treatment of adult hemorrhagic moyamoya disease (MMD). In this study, the authors performed a meta-analysis to determine whether surgical treatment of adult hemorrhagic MMD is superior to conservative treatment.

Methods:

A systematic search of the PubMed, EMBASE, and Cochrane Central databases was performed for articles published until May 2017. Randomized-controlled trials and cohort studies about the efficacy of surgical treatment and conservative treatment in patients with hemorrhagic MMD at 16 years of age or older were selected. Recurrent stroke incidence including hemorrhagic and ischemic events at the end of the follow-up period was calculated between the 2 groups with a 95% confidence interval (CI).

Results:

A total of 3 articles (including 146 patients) were included in the meta-analysis. There were significant differences between the 2 groups when the authors compared the overall recurrent stroke rate at the end of the follow-up period. Surgical treatment significantly reduced the risk of stroke (risk ratio, 0.43; 95% CI, 0.24–0.76; P = 0.004).

Conclusions:

The current meta-analysis suggests that surgical treatment is better for conservative treatment in adult hemorrhagic MMD with recurrent stroke rate. Future studies are required to confirm this conclusion.
Maxillary Osteomyelitis Caused by Kocuria Species in a Patient Who Is on Long-Term Uncontrolled Use of Methylprednisolone
Authors: Kilinç Adnan , Tepecik Tahsin , Baş Mehmet Zahit , Sancar Bahadir
Published: October 2017

Uncontrolled use of medicines bring with it serious health problems. Long-term and uncontrolled use of steroids, without the supervision of a healthcare professional, may cause unexpected infections due to immunosuppression. The authors present a patient with maxillary osteomyelitis caused by Kocuria species in a 41-year-old male who has been receiving methylprednisolone without control for 1.5 years.
Barriers to Research Recruitment of Women Experiencing a Pregnancy Loss in the Emergency Department
Authors: Punches Brittany E. , Johnson Kimberly D. , Acquavita Shauna P. , Felblinger Dianne M. , Gillespie Gordon L.
Published: November 2017

Women often come to the emergency department (ED) with signs and symptoms suggesting an early pregnancy loss; yet, little is known about their experience and how it relates to future outcomes. To improve patient outcomes and experiences of women seeking care for a pregnancy loss, research is required. However, recruitment of participants experiencing an event such as a pregnancy loss is challenging. The purpose of this article is to discuss the application of an electronic medical record (EMR)-based participant screening tool recruiting women seeking care for a pregnancy loss in the ED. This study implemented an EMR-based prompt to assist participant screening completed by ED nurses: (a) The prompts were based on criteria built into triggers that activated a recruitment screening form to print upon discharge; (b) nurses completed the form with patients, asking for willingness to be contacted at home; and (c) participants were subsequently contacted and enrolled in the study. Our research screening program was implemented continuously in 2 EDs: a large, urban, academic medical center and a community academic hospital. Data were analyzed through descriptive statistics of reports built within the EMR. These reports signaled when the screening tool flagged participants and subsequently tied the corresponding information to the completed forms. The recruitment tool fired 1,169 times, with 61% (n = 714) screened. Fifty percent (n = 37) of women experiencing an early pregnancy loss were willing to be contacted at home for research recruitment. Of those approached after discharge (n = 24), 33% (n = 8) enrolled in the study. Of note, at one site, 14% (81/577) of potential participants with early pregnancy loss symptoms left before seeing a provider, with 26% (150/577) of these encounters were repeat visits. Staff education, nurse reluctance to approach potential participants, and patients who left without being seen led to barriers in participant screening.