bluuebunny/crossref_metadata_2025 huggingface dataset:
Penile tourniquet injury due to a coil of hair
Authors: Chaware Suresh M , Gajbhiye Raj , Singh A K
Published: January 2020

Penile strangulation caused by a coil of hair is frequently an unrecognized clinical entity with several potential complications, such as necrosis of glans penis, urethrocutaneous fistulae and partial or complete amputation of the glans. We report on a 7 year old boy with a tourniquet injury to the penis secondary to strands of hair being tied around the glans at the level of the corona.
Reducing Interruptive Alert Burden Using Quality Improvement Methodology
Authors: Chaparro Juan D. , Hussain Cory , Lee Jennifer A. , Hehmeyer Jessica , Nguyen Manjusri , Hoffman Jeffrey
Published: January 2020

Background Increased adoption of electronic health records (EHR) with integrated clinical decision support (CDS) systems has reduced some sources of error but has led to unintended consequences including alert fatigue. The “pop-up” or interruptive alert is often employed as it requires providers to acknowledge receipt of an alert by taking an action despite the potential negative effects of workflow interruption. We noted a persistent upward trend of interruptive alerts at our institution and increasing requests for new interruptive alerts.

Objectives Using Institute for Healthcare Improvement (IHI) quality improvement (QI) methodology, the primary objective was to reduce the total volume of interruptive alerts received by providers.

Methods We created an interactive dashboard for baseline alert data and to monitor frequency and outcomes of alerts as well as to prioritize interventions. A key driver diagram was developed with a specific aim to decrease the number of interruptive alerts from a baseline of 7,250 to 4,700 per week (35%) over 6 months. Interventions focused on the following key drivers: appropriate alert display within workflow, clear alert content, alert governance and standardization, user feedback regarding overrides, and respect for user knowledge.

Results A total of 25 unique alerts accounted for 90% of the total interruptive alert volume. By focusing on these 25 alerts, we reduced interruptive alerts from 7,250 to 4,400 per week.

Conclusion Systematic and structured improvements to interruptive alerts can lead to overall reduced interruptive alert burden. Using QI methods to prioritize our interventions allowed us to maximize our impact. Further evaluation should be done on the effects of reduced interruptive alerts on patient care outcomes, usability heuristics on cognitive burden, and direct feedback mechanisms on alert utility.
Crossbreeding with a tropically adapted Bos taurus breed (Senepol) to improve meat quality and production from Brahman herds in Northern Australia. 1. Steer performance
Authors: Schatz T. , Thomas S. , Reed S. , Hearnden M.
Published: January 2020

The performance of four year groups of Brahman and F1 Senepol × Brahman steers was compared grazing buffel pasture at the Douglas-Daly Research Farm, Douglas-Daly, NT, Australia. F1 Senepol × Brahman steers were on average 32 kg heavier at turnoff at ~18 months of age (P < 0.001) as a result of higher average weaning weights (+19 kg, P < 0.001) and higher growth during the post-weaning year (+12 kg, P < 0.001). These results, combined with previous studies that found that F1 Senepol × Brahman steers had more tender meat and performed better than Brahman in an Indonesian feedlot, indicate that crossbreeding with a tropically adapted Bos taurus breed, such as Senepol, could be an effective way for north Australian cattle producers with Brahman herds to produce cattle that perform well under northern conditions, and are suited to both the live export and domestic markets.
Ecosystem management applications of resource objective wildfires in forests of the Grand Canyon National Park, USA
Authors: Stoddard Michael T. , Fulé Peter Z. , Huffman David W. , Sánchez Meador Andrew J. , Roccaforte John Paul
Published: January 2020

Forest managers of the western United States are increasingly interested in utilising naturally ignited wildfires to achieve management objectives. Wildfires can accomplish a range of objectives, from maintenance of intact ecological conditions, to ecosystem restoration, to playing vital natural disturbance roles; however, few studies have carefully evaluated long-term effectiveness and outcomes of wildfire applications across multiple forest types. We remeasured monitoring plots more than 10 years after ‘resource objective’ (RO) fires were allowed to burn in three main south-western forest types. Results showed minimal effects and effective maintenance of open conditions in an intact pine-oak site. Higher-severity fire and delayed mortality of larger and older trees contributed to reductions in basal area and canopy cover at the mixed-conifer and spruce-fir sites. Species dominance shifted towards ponderosa pine in both the mixed-conifer and spruce-fir sites. Although fires resulted in 46–68% mortality of smaller trees initially, substantial ingrowth brought tree density to near pre-fire levels in all forest types after 12 years. Overall, the 2003 RO fires were broadly successful at maintaining or creating open and heterogeneous conditions and resulted in fire- and drought-tolerant species composition. These conditions are likely to be resilient to changing climate, at least in the short term. Substantial mortality of large trees and continuing loss of basal area, however, are a concern, given further climate warming.
What are speakers doing when they pretend to be uncertain?
Authors: Zhou Yan
Published: January 2020

This paper investigates conversational actions accomplished by a knowing speaker who takes a non-committal epistemic stance using epistemic adverbs expressing uncertainty in Mandarin conversations. This study finds that adverbs of uncertainty such askeneng,yexu,anddagai, are used predominantly by knowing speakers, rather than unknowing speakers in Mandarin conversations. Moreover, most of these epistemically incongruent cases occur in sequence-initiating actions. Three most common practices are announcements involved in a request project, announcements of self-related positive news, and advice-giving actions. Adverbs of uncertainty are less frequently used by knowing speakers to take a non-committal stance in the sequence-responsive actions. A common practice observed is responses to information-seeking questions that have negative valence. Adverbs of uncertainty are adopted by knowing speakers to minimize disaffiliation caused by these dispreferred actions such as requests, self-praising of accomplishments, advice-giving, and informing with negative valence.
Habitat assessment for ecosystem services in South Africa
Authors: Ntshane  , Gambiza
Published: January 2020

Biodiversity is the foundation of life-support systems on earth and underpins the delivery of ecosystem services (ES) important for human well-being. The loss of biodiversity worldwide, however, remains one of the most daunting challenges. Among the major causes of biodiversity loss
is habitat loss due to transformation of land to agricultural, mining and urban areas. We applied the Integrated Valuation of Ecosystem Services and Trade-offs (InVEST) biodiversity modelling tool to assess the condition of habitats to support the delivery of ES in a biosphere reserve (BR)
in South Africa. Results indicated that 72% of the surveyed habitats were of high quality to provide the necessary services. However, some of the habitats were found to be affected by threats as follows: low (0–20%) to moderate (20–32%) habitat loss was recorded in habitats adjacent
to mining and plantation areas, and high (32–56%) to severe (56–95%) habitat loss was recorded in habitats in close proximity to urban and cultivated areas. At least 56% of the vegetation types found in the study area were threatened by transformation to agriculture, mining and
urban areas. We strongly recommend that existing biodiversity policies and legislation should be enforced to avoid habitat loss and degradation.
Enhancement of fiber-matrix interface of recycled cotton fibers reinforced epoxy composite for improved mechanical properties
Authors: Baccouch Wafa , Ghith Adel , Yalcin-Enis Ipek , Sezgin Hande , Miled Wafa , Legrand Xavier , Faten Fayala
Published: January 2020

The aim of this study is to enhance the fiber-matrix interface of cotton waste reinforced composite panels by a specific chemical treatment. For this purpose, cotton fibers are treated in sodium hydroxide (NaOH) solution with three different concentrations (0.5 M, 1 M, and 1.5 M) and three different soaking times combinations (1 h, 3 h, and 5 h). Mechanical evaluation of treated and untreated reinforcements and composite panels are characterized using tensile test whereas the chemistries of fiber reinforcements are investigated using Fourier-transform infrared spectroscopy analysis and the fiber-matrix interactions are morphologically examined using scanning electron microscopy. Results indicate a remarkable enhancement in mechanical properties of composites via improving the interfacial adhesion and compatibility between fiber and matrix with a significant increase of Young modulus up to 270% for reinforcements and to 70% for composite materials compared to untreated materials.
Microstructure-based modeling of IMC layer thickness effect on tensile behavior of Cu/Al clad strip
Authors: Sun Tao , Song Hong-wu , Hua Fu-an , Li Jian-ping
Published: January 2020

A microstructure-based model is proposed for quantitative estimation of tensile mechanical property of Cu/Al clad strips. In the proposed model, the fracture criterion for matrix Cu and Al, interface intermetallic compounds (IMCs) and interface between matrix and IMCs are established and incorporated. The effect of IMCs thickness and strip thickness on tensile behavior of Cu/Al strip was studied quantitatively using the proposed model. And a new dimensionless parameter w/t is also proposed to be a control index for tensile mechanical property of Cu/Al clad strips. And a critical value of w/t which is defined to be 0.025 in this study is found to be important in controlling mechanical property of Cu/Al strip with a thickness less than 0.5 mm. The potential application of the proposed model and parameter is also discussed for annealing process optimization and mechanical property control of 0.12 mm thick Cu/Al clad strips.
Study of TiO2, SnO2 and nanocomposites TiO2:SnO2 thin films prepared by sol-gel method: Successful elaboration of variable–refractive index systems
Authors: Medjaldi F , Bouabellou A , Bouachiba Y , Taabouche A , Bouatia K , Serrar H
Published: January 2020

In this research TiO2, SnO2 and TiO2:SnO2 nanocomposite thin films were fabricated by the sol–gel dip coating technique. The mixture was prepared by varying the molar ratio of SnO2 to TiO2, i.e. TiO2:SnO2 (9:1), TiO2:SnO2 (8:2) and TiO2:SnO2 (6:4)). The obtained samples were characterized by means of the Raman microscopy, Scanning Electron Microscopy (SEM), UV–Vis spectrophotometry and m-lines spectroscopy (Prism coupler). Raman analysis shows that pure TiO2 and SnO2 thin films are characterized by the vibrational modes of anatase and rutile cassiterite, respectively. Furthermore, the Raman spectra of the TiO2:SnO2 nanocomposites show the presence of a mixture of anatase and rutile TiO2 phases. The SEM images reveal that the morphology is clearly modified with SnO2 content. The ripples in the transmittance spectra decreased with increasing SnO2 content. Also, the evolution of the optical band gap seems to be consistent with the Raman analysis. A great attention has been paid to the refractive index measurements by the prism coupler technique. In this way, variable–refractive index systems have been successfully obtained using TiO2:SnO2 nanocomposite thin films.
Sustained released Metformin microparticles for better management of type II diabetes mellitus: in-vitro studies
Authors: Raza Hina , Javeria Sadaf , Rashid Zermina
Published: January 2020

This work investigates Ethyl cellulose (EC) and polyethylene glycol (PEG) microparticles for prolonged delivery of Metformin HCl.The microparticles were synthesised by emulsion solvent evaporation technique; characterized for encapsulation efficiency, particle size, flow properties, surface morphology, FTIR, PXRD and drug release pattern; and investigated for the effect of formulation parameters like EC:PEG ratio, drug to polymers ratio and stirring speed on various properties of the microparticles. The drug entrapment efficiency, percent yield, particle size and drug release behaviour were found to be influenced by various formulation parameters.SEM images and size analysis confirmed formation of spherical shaped microparticles, with slightly rough surface and good flowability. FTIR revealed absence of any drug-polymer interaction and PXRD confirmed the molecular dispersion of drug with in microparticles. All the formulations showed sustained drug release pattern at pH 6.8, up to 91.34% ±1.68 metformin was released in 12 h with fickian diffusion mechanism. The designed microparticles could possibly be advantageous in terms of prolonged release, to achieve reduced dose frequency and improved patient compliance.
Direct writing of PVDF piezoelectric film based on near electric field added by [Emim]BF4
Authors: Liao Linchen , Chen Caifeng , Qian Jilong , Zhang Youming , Zhang Ruifang , Zhu Jiaguang
Published: January 2020

PVDF/IL piezoelectric film based on [Emim]BF4-added was prepared by near electric field direct writing. The β-phase content and its electric property of the film were analyzed. The results showed that the content of β crystal phase of PVDF film was improved by the synergistic effect of IL ([Emim]BF4) and near electric field. When the amount of [Emim]BF4 added was 1.5 wt%, the relative β-phase content of PVDF film reached 85.09%, and the crystallinity is 47.84%. Increase in [Emim]BF4 content resulted in a significant increase in the relative dielectric constant of the film, from 6 to 285, but also accompanied by a sharp increase in dielectric loss. The d33 value of the film can be as high as −10 pC/N, and the output voltage from the cantilever beam vibration feedback indicates that the voltage strength of the [Emim]BF4-added film is greatly improved compared with the pure PVDF film.
Impact and indenting damage of CVD-produced ZnS and ZnSe ceramics
Authors: Chmel Alexandre , Dunaev Anatolij , Sinani Alfred , Shcherbakov Igor’
Published: January 2020

Time series of acoustic emission pulses were excited in ductile ZnS and ZnSe ceramics either by a falling weight or by indenting the Vickers pyramid. Energy distributions in emitted acoustical emission pulses were found to be random (Poisson-like) in the events of short (0.3–0.5 ms) impact forcing. In the case of the gradual (∼1 s) indenting, the energy distributions followed a power law typical for the self-similar structures appearing through long-range interactions between nucleating microcracks (scaling). In ductile materials, the rate of straining governs the dislocation motion. Provided enough loading time, such as in indenting experiments, the sliding dislocations form bunches, which serve as weak points for the crack nucleation. Given a tend to self-organizing in the ensemble of dislocations, the energy release in impeded cracking process (i. e. indenting) exhibits statistically ordered behavior.
Electromagnetic wave absorption performance of Ni doped Cu-ferrite nanocrystals
Authors: Saleem Adil , Zhang Yujun , Gong Hongyu , Majeed Muhammad K , Lin Xiao , Hussain M Muzammal , Ashfaq M Zeeshan
Published: January 2020

NixCu1−xFe2O4 nanocrystals were prepared by co-precipitation technique to study the electromagnetic (EM) wave absorption properties. The XRD and SEM results confirm the formation of single-phase cubic spinel structure and reveal that the crystallite size decreases with the addition of Ni content. The vibrating sample magnetometer results showed that the as-prepared material was soft magnetic and have potential applications in magnetic storage technology and field sensors. The dielectric parameters and EM wave absorption characteristics of NixCu1−xFe2O4 nanocrystals were studied in the frequency range of 1-18GHz using a vector network analyzer. The permittivity, impedance matching, and EM wave absorption of the materials are significantly improved with the increase in Ni content. The lowest value of reflection loss (RL) is observed −22.8 dB at 16.09 GHz (RL ≤ −10dB, absorption >90%), showing an optimal EM wave absorption performance, which might generate from the synergistic effect between relative permittivity and permeability.
Characterization of a bacterial cellulose-silica nanocomposite prepared from agricultural waste products
Authors: Soemphol Wichai , Charee Panadda , Audtarat Sasiporn , Sompech Supachai , Hongsachart Piyorot , Dasri Thananchai
Published: January 2020

Bacterial cellulose (BC) has attracted considerable scientific interest and can be modified, making it more widely useful in composites with guest nanoparticles. In this study, silica nanoparticles obtained from rice husks were used to prepare BC-silica composite aerogels (CAs) via a sol-gel method. Various amount of silica nanoparticles (3, 6, 9 and 12% w/v) dissolved in 2.5 M NaOH were used as a precursor for inclusion into BC. Subsequently, it was employed to form a SiO2 gel skeleton in a BC matrix by adding 2 M H2SO4, as a catalyst. Increasing levels of silica nanoparticles led progressively lower transmittance values of BC-silica CAs. SEM images revealed a surface morphology of spheroid particles with little agglomeration. The XRD diffraction peaks were gradually covered by a broad peak of silica as increasing silica content. Similarly, FTIR spectroscopy results also indicate the presence of silica in proportion to its content. Furthermore, addition of silica nanoparticles improved the thermal properties using TGA analysis, shifting the decomposition temperature of BC up to 550 °C and retaining of BC weight at least 60% with the BC sample with 3% of silica. This unique characteristic implies that silica had a stabilizing effect on polymeric cellulose. These results demonstrate an economical and environmentally friendly preparation of BC-silica CAs that can benefit material applications.
Effect of grid resolution and spatial representation of NH3 emissions from fertilizer application on predictions of NH3 and PM2.5 concentrations in the United States Corn Belt
Authors: Balasubramanian Srinidhi , McFarland Donald Michael , Koloutsou-Vakakis Sotiria , Fu Kan , Menon Rohit , Lehmann Christopher , Rood Mark J
Published: January 2020

Ammonia (NH3) emissions from fertilizer application is a highly uncertain input to chemical transport models (CTMs). Reducing such uncertainty is important for improving predictions of ambient NH3 and PM2.5 concentrations, for regulatory and policy purposes and for exploring linkages of air pollution to human health and ecosystem services. Here, we implement a spatially and temporally resolved inventory of NH3 emissions from fertilizers, based on high-resolution crop maps, crop nitrogen demand and a process model, as input to the Comprehensive Air Quality Model with Extensions (CAMx). We also examine sensitivity to grid resolution, by developing inputs at 12 km × 12 km and 4 km × 4 km, for the Corn Belt region in the Midwest United States, where NH3 emissions from chemical fertilizer application contributes to approximately 50% of anthropogenic emissions. Resulting predictions of ambient NH3 and PM2.5 concentrations were compared to predictions developed using the baseline 2011 National Emissions Inventory, and evaluated for closure with ground observations for May 2011. While CAMx consistently underpredicted NH3 concentrations for all scenarios, the new emissions inventory reduced bias in ambient NH3 concentration by 33% at 4 km × 4 km, and modestly improved predictions of PM2.5, at 12 km × 12 km (correlation coefficients r = 0.57 for PM2.5, 0.88 for PM-NH4, 0.71 for PM-SO4, 0.52 for PM-NO3). Our findings indicate that in spite of controlling for total magnitude of emissions and for meteorology, representation of NH3 emissions and choice of grid resolution within CAMx impacts the total magnitude and spatial patterns of predicted ambient NH3 and PM2.5 concentrations. This further underlines the need for improvements in NH3 emission inventories. For future research, our results also point to the need for better understanding of the effect of model spatial resolution with regard to both meteorology and chemistry in CTMs, as grid size becomes finer.
An unusual presentation of sporadic Creutzfeldt-Jakob disease
Authors: Podger Hannah , Ipe Anil
Published: January 2020

Sporadic Creutzfeld-Jakob disease (CJD) is a rare neurodegenerative disorder. It is uniformly fatal. Clinical signs include myoclonus, visual disturbances, cerebellar ataxia, akinetic mutism and pyramidal/extrapyramidal signs in addition to a rapidly progressive dementia. Premortem diagnosis is challenging due to the rarity of the condition and the subsequent low index of suspicion held for it. On literature review, isolated language impairment as the first neurological symptom occurs in only about 1% of patients with sporadic CJD (El Tawil et al. (2017, Acta Neurol Scand, 135: 316–23)). We present this patient’s case, marked for the unusual presentation and the rapidity of decline, to emphasise the need for awareness of CJD as an important differential diagnosis on stroke units. In our case, magnetic resonance imaging findings drove the suspicion of sporadic CJD as the diagnosis. This seems to correlate with other case reports recognising CJD presenting with progressive aphasic disorders (Terrin et al. (2017, Neurol Sci, 38: 1535–7); Mandell et al. (1989, Neurology, 39: 55–8); Martory et al. (2012, Eur Neurol, 67: 360–2)).
Sharing the ‘weight’ of obesity management in primary care: integration of registered dietitian nutritionists to provide intensive behavioural therapy for obesity for Medicare patients
Authors: Jacobs Molly , Harris Jordan , Craven Kay , Sastre Lauren
Published: January 2020

Background

Clinical provision of intensive behavioral therapy for obesity (IBTO) has been a reimbursable treatment for obesity since 2012. However, gaps remain in the literature regarding its impact on patient outcomes.

Objectives

The primary objective of this study was to examine the integration of registered dietitian nutritionist provided IBTO into a primary care setting and evaluate clinic outcomes for Medicare Part B beneficiaries. A secondary objective was to examine intensity of IBTO (quantity of IBTO visits) versus clinical outcomes and influence of socioeconomic factors.

Methods

A case–control retrospective chart review was conducted at a rural, Academic Family Medicine Clinic in Eastern North Carolina for patients seen between 1 January 2016 and 1 January 2019. In order to be included in the treatment group, patients had to be female, white or black race, have Medicare insurance and a body mass index ≥ 30 kg/m2.

Results

Mixed model analysis showed statistically significant improvements in clinical outcomes from IBTO treatment. Weight decreased by nearly 3 pounds, while body mass index was half a point lower. A1C was 0.1 units lower for IBTO patients, and they took prescription medication and average of 6 days less than the control group. Minorities and older respondents experienced smaller, all else constant, and annual fixed effects suggest that differentials widen over time.

Conclusions

Registered dietitian nutritionist (RDN) provision of IBTO has demonstrated benefit in improving clinical outcomes including weight, A1C, and reduced medication duration (use) as demonstrated by the IBTO treatment group versus control. IBTO intensity was not predictive of success, and its impact was reduced with older and African American patients. IBTO is beneficial and can be delivered within the primary care setting by a RDN.
Person–Environment Resources for Aging Well: Environmental Docility and Life Space as Conceptual Pillars for Future Contextual Gerontology
Authors: Wahl Hans-Werner , Gerstorf Denis
Published: January 2020

A variety of different disciplines in the study of aging have long acknowledged that individual functioning and development are profoundly shaped by the contexts people live in. The Gerontologist has played a central role in publishing and fostering theoretical and empirical work geared toward better understanding many of the questions that revolve around the how and the why. To illustrate, we consider in a first step the environmental docility hypothesis and the life space construct as two landmark concepts published in The Gerontologist and review how these—in conjunction with the later introduced proactivity perspective—have shaped for decades and continue to shape the larger field of (contextual) gerontology. In a second step, we discuss how these two entirely separate conceptualizations could be integrated in a late pas-de-deux. In doing so, we also make use of Wahl & Gerstorf's conceptual framework for studying COntext Dynamics in Aging (CODA) to discuss how these classic concepts can promote future gerontological research.
Prospective Evaluation of Universal BRCA Testing for Women With Triple-Negative Breast Cancer
Authors: Emborgo Trisha S , Saporito Donika , Muse Kimberly I , Barrera Angelica M Gutierrez , Litton Jennifer K , Lu Karen H , Arun Banu K
Published: January 2020

Background

Limited published literature exists on women with triple-negative breast cancer (TNBC) diagnosed over the age of 60 years with breast cancer gene (BRCA) pathogenic variants. Our study determined whether the rate of BRCA pathogenic variants in a prospective cohort of TNBC patients outside the definition of current clinical genetic testing (GT) guidelines warrants a change in recommendations.

Methods

A prospective study of 395 women with TNBC underwent genetic counseling and 380 (96.2%) underwent clinical BRCA GT regardless of age of diagnosis beginning January 2014 to October 2015 at The University of Texas MD Anderson Cancer Center, Houston. TNBC patients older than 60 years who did not meet clinical GT guidelines had comprehensive sequencing and large rearrangement GT as part of the research protocol.

Results

Fifty-one of 380 (13.4%) women with TNBC who underwent clinical BRCA GT were BRCA positive. Of the 86 patients diagnosed at age over 60 years and underwent GT, only two (2.3%) were positive for BRCA. These two patients would have met clinical testing criteria due to family or ancestral history.

Conclusions

Our study does not support universal BRCA testing for TNBC patients diagnosed older than 60 years as their only risk factor for a BRCA pathogenic variant. Both of the positive BRCA patients older than 60 years identified would have met current National Comprehensive Cancer Network criteria for testing. Therefore, our study demonstrates that the National Comprehensive Cancer Network guidelines provide sufficient criteria for identifying BRCA pathogenic variants in women with TNBC at 60 years or younger.
Dynamic games for secure and resilient control system design
Authors: Huang Yunhan , Chen Juntao , Huang Linan , Zhu Quanyan
Published: January 2020

Modern control systems are featured by their hierarchical structure composed of cyber, physical and human layers. The intricate dependencies among multiple layers and units of modern control systems require an integrated framework to address cross-layer design issues related to security and resilience challenges. To this end, game theory provides a bottom-up modeling paradigm to capture the strategic interactions among multiple components of the complex system and enables a holistic view to understand and design cyber-physical-human control systems. In this review, we first provide a multi-layer perspective toward increasingly complex and integrated control systems and then introduce several variants of dynamic games for modeling different layers of control systems. We present game-theoretic methods for understanding the fundamental tradeoffs of robustness, security and resilience and developing a cross-layer approach to enhance the system performance in various adversarial environments. This review also includes three quintessential research problems that represent three research directions where dynamic game approaches can bridge between multiple research areas and make significant contributions to the design of modern control systems. The paper is concluded with a discussion on emerging areas of research that crosscut dynamic games and control systems.
A current understanding of multiple sclerosis
Authors: Shull Catherine , Hoyle Brittany , Iannotta Caylin , Fletcher Eden , Curan Megan , Cipollone Victoria
Published: January 2020

Multiple sclerosis (MS) is an autoimmune inflammatory disorder that affects more than 900,000 Americans. Patient presentations vary widely; therefore, symptom recognition and an understanding of diagnostic criteria are critical in providing timely patient referrals. This article describes recognition and diagnosis of MS using the updated 2017 criteria, and offers an overview of epidemiology, prognosis, and treatment strategies.
Immediate Internal Fixation of Open Ankle Fractures
Authors: Franklin JONATHAN L. , Johnson KENNETH D. , Hansen SIGVARD T.
Published: January 2020

We reviewed thirty-eight cases of open ankle fractures that had been treated with a standard protocol: alignment and splinting of the fracture at the scene of injury if possible, antibiotics administered in the emergency room and continued for forty-eight hours, admission of the patient to the operating room as quickly as possible, copious irrigation and thorough debridement of the wound, immediate rigid anatomical internal fixation, and delayed primary closure at five days. All of the fractures united, but three patients required subsequent ankle fusion because of cartilage damage noted at the initial operation. Of the thirty-five ankles with complete follow-up, the functional result was excellent in twenty-six and fair or poor in nine.
Proteomics-Enriched Prediction Model for Poor Neurologic Outcome in Cardiac Arrest Survivors*
Authors: Distelmaier Klaus , Muqaku Besnik , Wurm Raphael , Arfsten Henrike , Seidel Stefan , Kovacs Gabor G. , Mayer Rupert L. , Szekeres Thomas , Wallisch Christine , Hubner Pia , Goliasch Georg , Heinze Georg , Heinz Gottfried , Sterz Fritz , Gerner Christopher , Adlbrecht Christopher
Published: January 2020

Objectives:

Neurologic outcome prediction in out-of-hospital cardiac arrest survivors is highly limited due to the lack of consistent predictors of clinically relevant brain damage. The present study aimed to identify novel biomarkers of neurologic recovery to improve early prediction of neurologic outcome.

Design:

Prospective, single-center study,

Setting:

University-affiliated tertiary care center.

Patients:

We prospectively enrolled 96 out-of-hospital cardiac arrest survivors into our study.

Interventions:

None.

Measurements and Main Results:

Neurologic outcome was assessed by the Cerebral Performance Categories score. To identify plasma biomarkers for poor neurologic outcome (Cerebral Performance Categories score ≥ 3), we performed a three-step proteomics strategy of preselection by shotgun analyses, crosschecking in brain tissue samples, and verification by targeted proteomic analyses using a multistep statistical modeling approach. Sixty-three patients (66%) had a poor neurologic outcome. Out of a total of 299 proteins, we identified α-enolase, 14-3-3 protein ζ/δ, cofilin-1, and heat shock cognate 71 kDa protein as novel biomarkers for poor neurologic outcome. The implementation of these biomarkers into a clinical multimarker model, consisting of previously identified covariates associated to outcome, resulted in a significant improvement of neurologic outcome prediction (C-index, 0.70; explained variation, 11.9%;pfor added value, 0.019).

Conclusions:

This study identified four novel biomarkers for the prediction of poor neurologic outcome in out-of-hospital cardiac arrest survivors. The implementation of α-enolase, 14-3-3 protein ζ/δ, cofilin-1, and heat shock cognate 71 kDa protein into a multimarker predictive model along with previously identified risk factors significantly improved neurologic outcome prediction. Each of the proteomically identified biomarkers did not only outperform current risk stratification models but may also reflect important pathophysiologic pathways undergoing during cerebral ischemia.
Cytomegalovirus-Induced Hemophagocytic Lymphohistiocytosis
Authors: Jain Hanish , Tambe Ajay , Gada Kunal , Yadava Sanjay , Eranki Ambika
Published: January 2020

Hemophagocytic lymphohistiocytosis (HLH) is a rare immunopathological syndrome, which can be fatal if not diagnosed early. It is characterized by excessive immune activation and can be observed in all age groups depending on the causes of HLH. Here, we describe a case of cytomegalovirus-induced HLH in an immunocompromised host which was diagnosed in the setting of high clinical suspicion and insufficient diagnostic information.
An Update on Epidemiology and Management Trends of Vestibular Schwannomas
Authors: Pandrangi Vivek C. , Han Albert Y. , Alonso Jose E. , Peng Kevin A. , St. John Maie A.
Published: January 2020

Objective:

To determine the current epidemiology and management trends for patients with vestibular schwannomas (VS).

Study Design:

Retrospective cohort study.

Setting:

The Surveillance, Epidemiology, and End Results (SEER) tumor registry.

Patients:

The SEER database was queried to identify patients diagnosed with VS from 1973 to 2015. Demographics, patient and tumor characteristics, and treatment methods were analyzed.

Results:

A total of 14,507 patients with VS were identified. The mean age at diagnosis was 55 ± 14.9 years. Age-adjusted incidence from 2006 to 2015 was 1.4 per 100,000 per year and remained relatively stable. Incidence across age varied with sex, as younger women and older men had increased incidences comparatively. A higher percentage of patients underwent surgery alone (43%), followed by observation (32%), radiation alone (23%), and combined radiation and surgery (2%). Age 65 and older was associated with observation (odds ratio [OR] 1.417;p = 0.029) whereas age 20 to 39 and 40 to 49 were associated with surgery (OR 2.013 and 1.935;p < 0.001). Older age was associated with radiation. Larger tumor size was associated with surgery and combined treatment. African American patients and American Indian or Alaskan Native patients were more likely to undergo observation than surgery.

Conclusions:

The overall incidence of VS is 1.4 per 100,000 per year and has remained relatively stable. There is a trend toward more conservative management with observation, which may be secondary to earlier diagnosis given widespread use of magnetic resonance imaging. Further studies are necessary to investigate differences in disease patterns and disparities in management.
Incidence of Congenital Stapes Footplate Fixation Since 1970: A Population-based Study
Authors: Totten Douglas J. , Marinelli John P. , Carlson Matthew L.
Published: January 2020

Objective:

Several reports have suggested that the incidence of otosclerosis is declining. However, due to the limitations of epidemiologic databases within the United States, little is known about the incidence of congenital stapes footplate fixation (CSFF), much less epidemiological trends over the past 50 years. The current study was conceived to characterize the epidemiology of CSFF over the past five decades using the unique resources of the Rochester Epidemiology Project (REP).

Study Design:

Population-based study.

Patients:

The medical records of every resident of Olmsted County, Minnesota who was diagnosed with CSFF was reviewed from January 1, 1970 to December 12, 2017 using the REP. The population of Olmsted County on January 1, 2017 was 159,689 persons.

Main Outcome Measure:

Incidence of CSFF.

Results:

Sixteen cases of CSFF were identified at a median age at diagnosis of 8 years (IQR, 6–17), eight of whom confirmed by exploratory tympanotomy. Three of the 16 (19%) cases were bilateral, and the median pure-tone average (500, 1k, 2k, 3k Hz) at time of diagnosis was 37 dB (IQR, 31–48). Two (13%) cases were identified in patients bearing a syndromic condition and one (6%) case demonstrated a malformed external ear on physical examination. The incidence rate of surgically confirmed cases among residents of Olmsted County was 0.31 per 100,000 person-years from 1970 to 1979 and 0.28 from 2000 to 2009. No incident cases among residents of Olmsted County were identified since 2010.

Conclusions:

CSFF constitutes a rare disease. Unlike epidemiological trends in otosclerosis, the incidence of surgically confirmed cases of CSFF remained stable over the past 50 years.
Change in Eustachian Tube Function With Balloon Dilation in Adults With Ventilation Tubes
Authors: Alper Cuneyt M. , Teixeira Miriam S. , Rath Tanya J. , Hall-Burton Denise , Swarts J. Douglas
Published: January 2020

Objective:

Assess the changes in Eustachian tube (ET) function (ETF) with balloon dilation of Eustachian tube (BDET).

Study Design:

Prospective cohort for repeated testing measures.

Setting:

Clinical research center.

Patients:

Eleven adults with at least one patent ventilation tube (VT) inserted for chronic ET dysfunction (ETD) and history of otitis media with effusion.

Interventions:

Subjects with evidence of moderate to severe ETD on the side with a VT underwent unilateral BDET.

Main Outcome Measures:

Changes in ETF parameters after BDET measured by Forced Response Test (FRT), Inflation Deflation Test (IDT), and Pressure Chamber test.

Results:

With the FRT at 11 ml/min, opening pressure (OP) decreased from 458 ± 160 to 308 ± 173 daPa and closing pressure (CP) from 115 ± 83 to 72 ± 81 daPa at the 3-month post-BDET visit. The IDT and Pressure Chamber test showed that the percentage of middle ear (ME) pressure gradient equilibrated with swallows improved from 28 ± 34 to 53 ± 5% for positive and from 20 ± 28 to 38 ± 43% for negative ME pressure. Images from the pre- and post-BDET functional CT scans did not show apparent changes in the anatomy. Comparisons of ETF test parameters pre- and post-BDET suggested that the ET was easier to open and stayed open longer after the procedure. However, during the limited duration of follow-up most subjects continued to have ETD, some requiring VT re-insertion after the study period.

Conclusions:

Adults with severe ETD may benefit from BDET, however ETD may not be completely resolved and patients may continue to need VTs.
Multidetector Computed Tomography Findings of Adhesive Internal Hernias
Authors: Zhang Fengyan , Qiao Ying , Zhang Hui
Published: January 2020

Objective

To identify multidetector computed tomography (MDCT) findings of surgically confirmed adhesive internal hernias (IHs).

Methods

Two gastrointestinal radiologists performed blinded, independent, and retrospective reviews of MDCT findings from a consecutive cohort of 35 adhesive IH and 41 adhesive small-bowel obstruction cases that had undergone surgery within 48 hours after MDCT. Univariate statistical analyses were performed to assess CT signs of adhesive IHs and CT findings of intestinal necrosis in patients presenting with adhesive IHs.

Results

Dislocated cluster of the intestine (P = 0.005), 2 transitional zones (P = 0.002), and presence of fat in the center sign (P = 0.001) were key CT outcomes that were significantly associated with adhesive IHs. Additionally, intramural hemorrhage was found the MDCT feature indicative of intestinal necrosis (P = 0.028).

Conclusions

This study illustrates specific MDCT findings of IHs, and these observations may help guide early clinical management of the condition.
Improved Visualization and Identification of the Right Adrenal Vein in 70-kVp Contrast-Enhanced Computed Tomography
Authors: Maruyama Koji , Sofue Keitaro , Horinouchi Hiroki , Okada Takuya , Ueshima Eisuke , Gentsu Tomoyuki , Sasaki Koji , Yamaguchi Masato , Sugimoto Koji , Murakami Takamichi
Published: January 2020

Objective

The aim of this study was to assess the utility of 70-kilovoltage-peak (kVp) contrast-enhanced computed tomography (CECT) for visualization and identification of the right adrenal vein (RAV) in comparison with that of conventional 120-kVp CECT.

Methods

This retrospective study included patients who underwent adrenal venous sampling with concurrent biphasic 120-kVp (120-kVp group, n = 43) or 70-kVp (70-kVp group, n = 47) CECT. Signal-to-noise ratios, contrast-to-noise ratios, longitudinal lengths, conspicuity scores, RAV detection rates, and size-specific dose estimates were compared between the 2 groups.

Results

In comparison with the 120-kVp group, the 70-kVp group had significantly higher signal-to-noise and contrast-to-noise ratios (P < 0.001–P = 0.033), greater longitudinal lengths (P < 0.001–P = 0.002), superior conspicuity scores for the RAV (P < 0.001), higher RAV detection rates (P = 0.015–P = 0.033), and lower size-specific dose estimates (P < 0.001).

Conclusions

Seventy-kilovoltage-peak CECT has advantages over conventional 120-kVp CECT and is potentially useful for noninvasive assessment of the precise anatomy of the RAV.
Gastrointestinal Air Motion Artifact Which Can Be Mistaken for Active Gastrointestinal Bleeding in Multidetector Computed Tomography: Phantom and Clinical Study
Authors: Lee Jeong Sub , Kim Seung Hyoung , Kim Jeong Jae , Kim Bong Soo , Choi Guk Myung , Kim Doo Ri
Published: January 2020

Objectives

We investigated the computed tomographic characteristics of gastrointestinal air motion artifact (GIAMA), which can be misinterpreted as active gastrointestinal bleeding.

Methods

We simulated GIAMA using 3 types of air-ball phantoms (air-ball in water, air-ball in oil, air–water-ball in oil) and a bovine intestine in oil phantom. We also performed a retrospective clinical review of precontrast abdominal computed tomography images of 76 patients to investigate the frequency, location, shape, and maximum density of hyperdense GIAMA.

Results

In phantom studies, air motion artifacts appeared as dark and bright streak artifacts at the borders of a moving air-ball and water or oil. In the clinical study, hyperdense GIAMA was visualized in 60 (79.0%) of 76 patients. The small intestine was most commonly affected (46.4%), and the intramural type had the highest frequency (58.0%).

Conclusion

Knowing the radiologic features of GIAMA can assists radiologists in identifying active gastrointestinal bleeding sites accurately.
A practical view of fine-mapping and gene prioritization in the post-genome-wide association era
Authors: Broekema R. V. , Bakker O. B. , Jonkers I. H.
Published: January 2020

Over the past 15 years, genome-wide association studies (GWASs) have enabled the systematic identification of genetic loci associated with traits and diseases. However, due to resolution issues and methodological limitations, the true causal variants and genes associated with traits remain difficult to identify. In this post-GWAS era, many biological and computational fine-mapping approaches now aim to solve these issues. Here, we review fine-mapping and gene prioritization approaches that, when combined, will improve the understanding of the underlying mechanisms of complex traits and diseases. Fine-mapping of genetic variants has become increasingly sophisticated: initially, variants were simply overlapped with functional elements, but now the impact of variants on regulatory activity and direct variant-gene 3D interactions can be identified. Moreover, gene manipulation by CRISPR/Cas9, the identification of expression quantitative trait loci and the use of co-expression networks have all increased our understanding of the genes and pathways affected by GWAS loci. However, despite this progress, limitations including the lack of cell-type- and disease-specific data and the ever-increasing complexity of polygenic models of traits pose serious challenges. Indeed, the combination of fine-mapping and gene prioritization by statistical, functional and population-based strategies will be necessary to truly understand how GWAS loci contribute to complex traits and diseases.
Multimodality and the origin of a novel communication system in face-to-face interaction
Authors: Macuch Silva Vinicius , Holler Judith , Ozyurek Asli , Roberts Seán G.
Published: January 2020

Face-to-face communication is multimodal at its core: it consists of a combination of vocal and visual signalling. However, current evidence suggests that, in the absence of an established communication system, visual signalling, especially in the form of visible gesture, is a more powerful form of communication than vocalization and therefore likely to have played a primary role in the emergence of human language. This argument is based on experimental evidence of how vocal and visual modalities (i.e. gesture) are employed to communicate about familiar concepts when participants cannot use their existing languages. To investigate this further, we introduce an experiment where pairs of participants performed a referential communication task in which they described unfamiliar stimuli in order to reduce reliance on conventional signals. Visual and auditory stimuli were described in three conditions: using visible gestures only, using non-linguistic vocalizations only and given the option to use both (multimodal communication). The results suggest that even in the absence of conventional signals, gesture is a more powerful mode of communication compared with vocalization, but that there are also advantages to multimodality compared to using gesture alone. Participants with an option to produce multimodal signals had comparable accuracy to those using only gesture, but gained an efficiency advantage. The analysis of the interactions between participants showed that interactants developed novel communication systems for unfamiliar stimuli by deploying different modalities flexibly to suit their needs and by taking advantage of multimodality when required.
A novel Movement Amplification environment reveals effects of controlling lateral centre of mass motion on gait stability and metabolic cost
Authors: Wu Mengnan/Mary , Brown Geoffrey L. , Woodward Jane L. , Bruijn Sjoerd M. , Gordon Keith E.
Published: January 2020

During human walking, the centre of mass (COM) laterally oscillates, regularly transitioning its position above the two alternating support limbs. To maintain upright forward-directed walking, lateral COM excursion should remain within the base of support, on average. As necessary, humans can modify COM motion through various methods, including foot placement. How the nervous system controls these oscillations and the costs associated with control are not fully understood. To examine how lateral COM motions are controlled, healthy participants walked in a ‘Movement Amplification’ force field that increased lateral COM momentum in a manner dependent on the participant's own motion (forces were applied to the pelvis proportional to and in the same direction as lateral COM velocity). We hypothesized that metabolic cost to control lateral COM motion would increase with the gain of the field. In the Movement Amplification field, participants were significantly less stable than during baseline walking. Stability significantly decreased as the field gain increased. Participants also modified gait patterns, including increasing step width, which increased the metabolic cost of transport as the field gain increased. These results support previous research suggesting that humans modulate foot placement to control lateral COM motion, incurring a metabolic cost.