bluuebunny/crossref_metadata_2025 huggingface dataset:
Hematoma intradiploico: tratamento cirúrgico e relato de caso
Authors: Amoreira Gepp Ricardo de , Neri Eidmar Augusto , Junior Altamir Monteiro , Kalil Ricardo Karam
Published: January 2018

O hematoma intradiploico é uma lesão rara do crânio. Foi descrita inicialmente em 1934 e até hoje a sua patogênese não é conhecida. Trata-se de uma lesão rara e secundária a um processo reativo benigno após traumas cranianos leves ou coagulopatias. Paciente de 42 anos apresentava quadro progressivo de perda da marcha e alteração visual. Foi identificada massa na região occipital do paciente, de caráter progressivo. Os estudos radiológicos demonstravam lesão de aspecto heterogêneo, erosiva da calota craniana e com expansão intracraniana. Realizou angiografia digital que demonstrou trombose de seio sagital superior. Foi submetido à biópsia seguida de ressecção da lesão associada à cranioplastia. Houve melhora do padrão visual e do desempenho de marcha do paciente, em relação ao pré-operatório. Os autores relatam um caso raro de hematoma intradiploico, analisaram os diagnósticos diferenciais e discutem as opções cirúrgicas dessa rara doença.
Low Aromatase Activity and Estradiol/Sex Hormone Binding Globulin Ratio are Associated with Total Hip Bone Mineral Density and the Presence of Osteoporosis: A Study in Chinese Postmenopausal Women
Authors: Liu Hai-Juan , Yan Jun , Li Yan , Zhou Fang-Yuan , Su Xu-Dong , Fan Hui-jing , Bai Jie , Zhang Guang-Zhen
Published: January 2018

Several groups have reported the important role of estradiol (E2) and testosterone (T) in postmenopausal osteoporosis (PMOP). Because aromatase catalyzes the conversion of T to E2, the purpose of this study was to determine the influence of aromatase activity on the bone mineral density (BMD) in postmenopausal women. A total of 344 postmenopausal women were selected for this study. Serum E2, T, sex hormone-binding globulin (SHBG), calcium (Ca), alkaline phosphatase (ALP), C-terminal telopeptide of type I collagen (CTX), and procollagen type I amino-terminal propeptide (PINP) were examined. The E2/T was positively associated with total hip BMD and PINP (p<0.05). When E2/T was divided into quartiles, participants in lower quartiles of E2/T were likely to have higher PINP and lower BMD (p<0.05). The prevalence of osteoporosis significantly increased as E2/T ratio decreased. The receiver operating characteristic (ROC) curves were constructed for serum E2, free E2 index (FEI), and E2/T, to assess their diagnostic accuracy in PMOP. The overall area under the curve (AUC) were 0.83 (95% CI=0.77–0.88) for E2, 0.87 (95% CI=0.82–0.92) for FEI, and 0.89 (95% CI=0.85–0.94), respectively. In conclusion, the study suggests that in postmenopausal women, aromatase activity could be an important determinant of skeletal health. The women with lower aromatase activity may have greater likelihood of PMOP and the E2/T was expected to be a valuable indicator for the prediction of PMOP and to monitor the process of osteoporosis.
A comparison of endoscopic and non-endoscopic biliary intervention outcomes in patients with prior bariatric surgery
Authors: Kamboj Amrit , Pidlaoan Victorio , Shakhatreh Mohammad , Hinton Alice , Conwell Darwin , Krishna Somashekar
Published: January 2018

Background and study aims Endoscopic biliary intervention (BI) is often difficult to perform in patients with prior bariatric surgery (BRS). We sought to analyze outcomes of patients with prior BRS undergoing endoscopic and non-endoscopic BI.

Patients and methods The Nationwide Inpatient Sample (2007 – 2011) was reviewed to identify all adult inpatients (≥ 18 years) with a history of BRS undergoing BI. The clinical outcomes of interest were in-patient mortality, length of stay (LOS), and total hospital charges.

Results There were 7,343 patients with prior BRS who underwent BIs where a majority were endoscopic (4,482 vs. 2,861, P < 0.01). The mean age was 50±30.8 years and the majority were females (80.5 %). Gallstone-related disease was the most common indication for BI and managed more often with primary endoscopic management (2,146 vs. 1,132, P < 0.01). Inpatient mortality was not significantly different between patients undergoing primary endoscopic versus non-endoscopic BI (0.2 % vs. 0.7 %, P = 0.2). Patients with sepsis were significantly more likely to incur failed primary endoscopic BI (OR 2.74, 95 % CI 1.15, 6.53) and were more likely to be managed with non-endoscopic BI (OR 2.13, 95 % CI 1.3, 3.5). Primary non-endoscopic BI and failed endoscopic BI were both associated with longer LOS (by 1.77 days, P < 0.01 and by 2.17 days, P < 0.01, respectively) and higher hospitals charges (by $11,400, P < 0.01 and by $ 14,200, P < 0.01, respectively).

Conclusion Primary endoscopic management may be a safe and cost-effective approach for patients with prior BRS who need BI. While primary endoscopic biliary intervention is more common, primary non-endoscopic intervention may be used more often for sepsis.
Efficacy and safety of sedation during endoscopic submucosal dissection of gastric cancers using a comparative trial of propofol versus midazolam
Authors: Kikuchi Hitomi , Hikichi Takuto , Watanabe Ko , Nakamura Jun , Takagi Tadayuki , Suzuki Rei , Sugimoto Mitsuru , Waragai Yuichi , Konno Naoki , Asama Hiroyuki , Takasumi Mika , Sato Yuki , Obara Katsutoshi , Ohira Hiromasa
Published: January 2018

Background and study aims Proper sedation is necessary for the safe and satisfactory completion of endoscopic submucosal dissection (ESD) for early gastric cancer. This study was conducted as a comparative trial of efficacy and safety, comparing propofol-based sedation and midazolam-based sedation during ESD of early gastric cancer patients.

Patients and methods This study examined 64 lesions in 58 patients treated using ESD with midazolam plus pentazocine between July 2013 and January 2014 (group M) and 237 lesions in 216 patients treated by ESD using propofol plus pentazocine between February 2014 and December 2015 (group P). The two groups were compared in terms of the frequency of body movement during ESD as the primary outcome and in terms of the procedure time, en bloc resection rate, intraoperative change in cardiorespiratory dynamics, and postoperative awareness as the secondary outcomes. Body movement was defined as movement by a patient that required interruption of the procedure or restraint of the patient’s body trunk, and addition of a sedative agent.

Results The median frequency of body movement during ESD was significantly lower in group P (0 times) than in group M (3 times) (P < 0.001). No significant difference was found for the mean procedure time (117 min in group P; 127 min in group M). Although no significant difference was found in the incidence of hypoxemia, bradycardia, or bradypnea, the incidence of hypotension was significantly higher in group P (31.5 %) than in group M (6.9 %) (P = 0.004). Patients in group P had significantly higher postoperative awareness immediately after ESD and at 1 hour after ESD (P = 0.002 and 0.022, respectively).

Conclusion These results demonstrate the efficacy and safety of propofol-based sedation for gastric ESD.
Development of a high current 60 keV neutral lithium beam injector for beam emission spectroscopy measurements on fusion experiments
Authors: Anda G. , Dunai D. , Lampert M. , Krizsanóczi T. , Németh J. , Bató S. , Nam Y. U. , Hu G. H. , Zoletnik S.
Published: January 2018

A 60 keV neutral lithium beam system was designed and built up for beam emission spectroscopy measurement of edge plasma on the KSTAR and EAST tokamaks. The electron density profile and its fluctuation can be measured using the accelerated lithium beam-based emission spectroscopy system. A thermionic ion source was developed with a SiC heater to emit around 4-5 mA ion current from a 14 mm diameter surface. The ion optic is following the 2 step design used on other devices with small modifications to reach about 2-3 cm beam diameter in the plasma at about 4 m from the ion source. A newly developed recirculating sodium vapour neutralizer neutralizes the accelerated ion beam at around 260-280 °C even during long (<20 s) discharges. A set of new beam diagnostic and manipulation techniques are applied to allow optimization, aiming, cleaning, and beam modulation. The maximum 60 keV beam energy with 4 mA ion current was successfully reached at KSTAR and at EAST. Combined with an efficient observation system, the Li-beam diagnostic enables the measurement of the density profile and fluctuations on the plasma turbulence time scale.
Measurement of pre-bunched beam’s longitudinal form factor based on radiation from a tunable-gap undulator
Authors: Su Xiaolu , Wang Dan , Yan Lixin , Tian Qili , Liang Yifan , Niu Lujia , Du Yingchao , Huang Wenhui , Tang Chuanxiang
Published: January 2018

The form factor, representing the statistical characteristics of a bunch’s longitudinal distribution, is one of the most essential properties of a pre-bunched electron beam and is used for many types of frontier accelerator applications. We demonstrated the measurement of a pre-bunched beam’s longitudinal form factor component based on coherent radiation from a widely tunable-gap undulator. The radiation energy from bunches with different longitudinal properties was measured as a function of undulator gap. The root-mean-square length of a 60 pC ultrashort quasi-Gaussian bunch generated by linac and chicane compression ranged from 75 fs to 240 fs, as obtained by fitting the radiation energy curve. Furthermore, the form factor component of the bunch train based on nonlinear longitudinal space charge oscillation was measured, and a higher-order harmonic component was observed with the proposed method than with the widely used coherent transition radiation method. The proposed method may satisfy the requirements of sub-fs bunch length measurement with proper undulator design.
Large amplitude oscillations in a trapped dissipative electron gas
Authors: Haas Fernando , Soares Luiz Gustavo Ferreira
Published: January 2018

A collisional trapped non-neutral plasma is described by a hydrodynamical model in one-dimensional geometry. For suitable initial conditions and velocity fields, the Lagrangian variables method reduces the pressure dominated problem to a damped autonomous Pinney equation, representing a dissipative nonlinear oscillator with an inverse cubic force. An accurate approximate analytic solution derived from Kuzmak-Luke perturbation theory is applied, allowing the assessment of the fully nonlinear dynamics. On the other hand, in the cold plasma case, the Lagrangian variables approach allows the derivation of exact damped nonlinear oscillations. The conditions for the applicability of the hot, pressure dominated or cold gas assumptions are derived.
Particle-in-cell simulation of the cathodic arc thruster
Authors: Lüskow Karl Felix , Neumann Patrick R. C. , Bandelow Gunnar , Duras Julia , Kahnfeld Daniel , Kemnitz Stefan , Matthias Paul , Matyash Konstantin , Schneider Ralf
Published: January 2018

The cathodic arc thruster is a newly developed electric propulsion system. It provides a stream of ions with very high velocities from a solid conducting cathode. This high ion velocity in combination with a high ionization fraction makes the cathodic arc thruster attractive for spacecraft propulsion. In the past, a record-high specific impulse was measured for such thrusters. The thruster uses a voltage of −220 V at the cathode for several microseconds, producing plasma from the cathode material which then streams out of the thruster producing thrust. In this work, a two-dimensional axial-symmetric particle-in-cell code with Monte-Carlo collisions is used to simulate the plasma of a cathodic arc thruster with a simplified wall model for the initial triggering of the arc. The work concentrates on the plasma transport and aims not at a self-consistent description of the arc, including plasma-wall interaction, e.g., description of the erosion and surface heating. The interaction of the arc beam with the background plasma results in a plasma-beam instability. Due to this instability charge separation can be detected that leads to large electric fields. By this electric field, plasma particles are accelerated and contribute to the thrust.
Lumped element kinetic inductance detectors based on two-gap MgB2 thin films
Authors: Yang C. , Niu R. R. , Guo Z. S. , Cai X. W. , Chu H. M. , Yang K. , Wang Y. , Feng Q. R. , Gan Z. Z.
Published: January 2018

Lumped element kinetic inductance detectors (LEKIDs) are made from a single layer superconducting thin film. Because of their low noise and highly multiplexibility, LEKIDs provide a sensitive technology for the detection of millimeter and submillimeter waves. In this work, a 5-pixel 50-nm-thick MgB2 array is made. The microwave properties of the array are measured under dark conditions. We show that the loaded quality factor Q of the resonant circuit is 30 000 at 7.5 K, which is comparable to that of lower-operating-temperature (usually several hundred mK) LEKIDs made from superconductors such as Al and Nb. Moreover, the temperature dependence of resonance frequency gives the two-gap character of MgB2, Δπ (0) = 2.58 meV and Δσ (0) = 8.26 meV. The gap frequency (f = 2Δ/h) indicates that MgB2 LEKIDs have a promising application on terahertz detection.
Asymptotics of the bound state induced by δ-interaction supported on a weakly deformed plane
Authors: Exner Pavel , Kondej Sylwia , Lotoreichik Vladimir
Published: January 2018

In this paper, we consider the three-dimensional Schrödinger operator with a δ-interaction of strength α > 0 supported on an unbounded surface parametrized by the mapping R2∋x↦(x,βf(x)), where β∈0,∞ and f:R2→R, f ≢ 0, is a C2-smooth, compactly supported function. The surface supporting the interaction can be viewed as a local deformation of the plane. It is known that the essential spectrum of this Schrödinger operator coincides with −14α2,+∞. We prove that for all sufficiently small β > 0, its discrete spectrum is non-empty and consists of a unique simple eigenvalue. Moreover, we obtain an asymptotic expansion of this eigenvalue in the limit β → 0+. In particular, this eigenvalue tends to −14α2 exponentially fast as β → 0+.
The chronotopes of authenticity
Authors: Wang Xuan , Kroon Sjaak
Published: January 2018

This paper examines the ways in which the ethnic minority group the Tujia in Enshi, China, engages with heritage tourism, as a complex project of designing authenticity. Authenticity is taken as part of the chronotopic phenomena of identity making: the complex interplay of multiple, nonrandom timespace frames of discourses and semiotic performances which condition and offer new potentials to the meanings of authenticity. We show ethnographically the chronotopic nature of the local production of “authentic” heritage for tourism in Enshi. This leads to a historical grounding of the Tujia in China’s nation-building and state politics of multiculturalism, which uncovers the anxiety of inauthenticity experienced by the Tujia in Enshi with their own minority status and cultural heritage, as well as their strategic chronotopic incorporation of both “authentic” and “inauthentic” aspects of local identity practices into a new order of authenticity afforded by heritage tourism as a form of new economy. Through such practices, we argue, the Tujia in Enshi chronotopically shift away from the periphery towards a new and reconfigured center of meaning-making, although this reappropriation of authenticity still must be understood within the “cunning of recognition” scheme, i.e. within the constraints of late modernity.
Challenge from the margins
Authors: Ballena Camilo , Unamuno Virginia
Published: January 2018

This paper explores the production of new meanings linked to written practices in the Wichi language in the Impenetrable Chaqueño (Argentina). Through collaborative ethnography examining different collective experiences and points of view, we study changes in writing in connection with changes in the access, distribution and availability of written practices in the Wichi language, and particularly in connection with social processes that position the Wichi people as key agents. Voice and agency are considered in order to explain meaning-making of language practices that are central but at the same time peripheral, and which seem to challenge, from the margins, social relationships between languages and people that hitherto seemed to be immovable.
Optimal water networks in protein cavities with GAsol and 3D-RISM
Authors: Fusani Lucia , Wall Ian , Palmer David , Cortes Alvaro
Published: January 2018

Motivation

Water molecules in protein binding sites play essential roles in biological processes. The popular 3D-RISM prediction method can calculate the solvent density distribution within minutes, but is difficult to convert it into explicit water molecules.

Results

We present GAsol, a tool that is capable of finding the network of water molecules that best fits a particular 3D-RISM density distribution in a fast and accurate manner and that outperforms other available tools by finding the globally optimal solution thanks to its genetic algorithm.

Availability and implementation

https://github.com/accsc/GAsol. BSD 3-clauses license

Supplementary information

Supplementary data are available at Bioinformatics online.
Levinas and the Holocaust
Authors: Eaglestone Robert
Published: January 2018

This chapter argues that Levinas’s thought is a response to the Holocaust. Although the chapter covers Levinas’s prewar and postwar biography in relation to the genocide, the central claim of this chapter is that, while Levinas rarely mentions the Holocaust explicitly, it is ubiquitously implicit in his work. The chapter demonstrates that it is the unspoken reference for the profoundest aims of his philosophy, apparent in the structure of his writing, in the themes to which his work attends (the chapter singles out rhetoric, hatred, war), even in the choices of specific words (for example, “good soup” or “bread”) or metaphors.
Levinas on Nature and Naturalism
Authors: Ellis Fiona
Published: January 2018

Levinas’s work is situated within the context of the recent debate on nature and naturalism in Anglo-American philosophy. This debate is shown to weigh in favor of scientism, and the state of play in Continental philosophy is acknowledged. His conceptions of God, theism, and atheism are examined, and the implications are drawn out for an understanding of the distinction between ethics and nature, and, more generally, the limits of nature and naturalism. It is concluded that Levinas’s position is best understood in expansive naturalistic terms, and that he can help us to see what it could mean for such a position to be genuinely theistic.
Levinas and Husserl
Authors: Bergo Bettina
Published: January 2018

This article explores Levinas’s complex relationship to Husserlian phenomenology as evinced in four periods marking the former’s intellectual development: 1929–1940, with Levinas exploring Husserl’s conception of “intuition”; 1940–1945, the years when Levinas developed a hermeneutic phenomenology of an embodied subject (“hypostasis”); 1961, with his arguments for a phenomenologically unconstitutable alterity; and 1965−1974, with his first elaborate criticism of Husserl’s “absolute subjectivity” as standing-streaming time consciousness (“Intentionality and Sensation”) and his elaboration of a new phenomenology of passive synthesis and the time of allogenic “affectivity.”
Levinas’s Ethics, Politics, and Zionism
Authors: Herzog Annabel
Published: January 2018

This article discusses Levinas’s thoughts about Zionism in his Talmudic Readings and in articles published together with the Readings. It is indeed in this body of work that Levinas attempts to demonstrate the concrete relevance of his utopian ethics through cases that are supposed to represent everyday life. In other words, the Talmudic Readings are meant to display the tangible relationship between utopian principles and mundane reality. The essay explains Levinas’s defense of the modern State of Israel in this context, and it shows that Zionism is addressed in the Readings as an occurrence of the intrigue of ethics and politics. However, it also shows that, in line with his philosophy, Levinas voiced strong criticism of that State—criticism often overlooked or underanalyzed in the scholarship. Finally, the essay examines the main weakness of Levinas’s Zionism, namely, the patent Hegelianism which clashes with a philosophy that claims to refute Hegel.
The Politics of Intergovernmental Organizations in Global Health
Authors: Hanrieder Tine
Published: January 2018

The rules and services of intergovernmental organizations (IGOs) such as the World Health Organization, the World Bank, and even the World Trade Organization affect health outcomes around the globe. Health-related IGOs have grown more numerous and more powerful but also more contested. This chapter explores the role of health-related IGOs in two main sections. The first section discusses the power of IGOs in global health, focusing on their capacity for autonomous action and their authority vis-à-vis states. The second section explores dynamics of change in and between health-related IGOs. The aim of the chapter is to outline productive cross-fertilization between the global health and IGO literatures.
Arguments for Consuming Animal Products
Authors: Fischer Bob
Published: January 2018

What can be said in favor of consuming animal products? This chapter surveys the options, with special focus on attempts to exploit pro-vegan principles for anti-vegan ends. Utilitarian, rights-based, contractualist, and agrarian proposals are explored, as well as some recent arguments that attempt to revive a form of speciesism. Ultimately, the chapter considers how such arguments might inform a broad case for consuming animal products—that is, one that might earn respect from those in a variety of moral camps—and it suggests that there may be good reasons to eat roadkill, bugs, bivalves, in vitro meat, animal products that will be wasted, and the bodies and byproducts of animals that live full, pleasant lives.
Food Insecurity
Authors: Isaacs Tracy
Published: January 2018

Feminists have long considered dieting for weight loss to be a practice of sexist oppression. This chapter argues that dieting has the status of ideology in the Western world—an unquestioned assumption that generates a sense of “food insecurity” and is indeed oppressive. However, thinking more globally, food security and insecurity have a more urgent meaning, as roughly 1 billion people worldwide live in a state of food insecurity, lacking access to “sufficient, safe, nutritious food to maintain a healthy and active life.” Seen in this context and the more politicized concept of food sovereignty, the Western ideology of dieting appears to be one of privilege. The feminist concept of intersectionality can explain how the same ideology can be oppressive while at the same time reflecting privilege.
Shame, Seduction, and Character in Food Messaging
Authors: Kukla Rebecca
Published: January 2018

This chapter explores the rhetorical and ethical structure of our public communications and representations concerning food, eating, health, and obesity. Food messages in our culture are deeply contradictory and tension-ridden, leaving us with no “right” way to eat. Moreover, eating practices are routinely portrayed as having characterological significance, so there is no right kind of person to be, when it comes to food. Food messaging follows a broadly pornographic logic, in which images of shame, sin, disgust, temptation, risk, safety, perversion, pleasure, and recklessness are mixed together in a fundamentally incoherent way. Furthermore, these meanings are socially and materially scaffolded in important ways; one cannot just use willpower to ignore or overcome them but must cope with them as one navigates the world. Thus, people are left in a practically and ethically untenable situation when it comes to eating.
Consumer Choice and Collective Impact
Authors: Nefsky Julia
Published: January 2018

Taken collectively, consumer food choices have a major impact on animal lives, human lives, and the environment. But it is far from clear how to move from facts about the power of collective consumer demand to conclusions about what one ought to do as an individual consumer. In particular, even if a large-scale shift in demand away from a certain product (e.g., factory-farmed meat) would prevent grave harms or injustices, it typically does not seem that it will make a difference whether one refrains from purchasing that product oneself. Most present-day food companies operate at too large a scale for a single purchase to make a difference to production decisions. If that is true, then it is not clear what point there is in refraining. This is “the problem of collective impact.” This chapter explores a range of proposals for how to solve this problem.
The Moral Burdens of Temporary Farmwork
Authors: Tsuruda Sabine
Published: January 2018

This chapter discusses how agricultural guest worker programs fail to treat guest workers as moral equals. Such programs are typically justified on the theory that they enable host countries to cheaply meet labor needs while offering nonresidents access to higher wages than in their home countries. The chapter explains how, to participate in the programs, guest workers must rupture personal and political ties to then come to a new country and either not establish new relations or rupture the new ones when their work authorization expires. The chapter argues that adopting such programs to reduce the amount of farmwork host-country residents must perform treats guest workers’ interests in associational life as less valuable than the like interests of host-country residents. It concludes that even if the programs could ensure decent working conditions, the programs’ unjustified effect on associational life recommends ceasing such programs under their current formulation and, instead, extending a path to citizenship to guest workers.
Overdose Education and Naloxone Distribution Programmes and the Ethics of Task Shifting
Authors: Buchman Daniel Z , Orkin Aaron M , Strike Carol , Upshur Ross E G
Published: January 2018

North America is in the grips of an epidemic of opioid-related poisonings. Overdose education and naloxone distribution (OEND) programmes emerged as an option for structurally vulnerable populations who could not or would not access mainstream emergency medical services in the event of an overdose. These task shifting programmes utilize lay persons to deliver opioid resuscitation in the context of longstanding stigmatization and marginalization from mainstream healthcare services. OEND programmes exist at the intersection of harm reduction and emergency services. One goal of OEND programmes is to help redress the health-related inequities common among people who use drugs, which include minimizing the gap between people who use drugs and the formal healthcare system. However, if this goal is not achieved these inequities may be entrenched. In this article, we consider the ethical promises and perils associated with OEND as task shifting. We argue that public health practitioners must consider the ethical aspects of task shifting programmes that may inadvertently harm already structurally vulnerable populations. We believe that even if OEND programmes reduce opioid-related deaths, we nevertheless question if, by virtue of its existence, OEND programmes might also unintentionally disenfranchise structurally vulnerable populations from comprehensive healthcare services, including mainstream emergency care.
Late Blight Resistance Screening of Major Wild Swedish Solanum Species: S. dulcamara, S. nigrum, and S. physalifolium
Authors: Abreha Kibrom B. , Lankinen Åsa , Masini Laura , Hydbom Sofia , Andreasson Erik
Published: January 2018

To understand the contribution of wild Solanum species to the epidemiology of potato late blight in Sweden, we characterized the resistance of the three putative alternative hosts: S. physalifolium, S. nigrum, and S. dulcamara to Phytophthora infestans, the causal agent of late blight. The pathogen sporulated in all 10 investigated S. physalifolium genotypes, suggesting susceptibility (S phenotype). Field-grown S. physalifolium was naturally infected but could regrow, though highly infected genotypes were smaller at the end of the season. In 75 S. nigrum genotypes, there were no symptoms (R phenotype) or a lesion restricted to the point of inoculation (RN phenotype), indicating resistance. In 164 S. dulcamara genotypes, most resistance variability was found within sibling groups. In addition to the three resistance phenotypes (R, RN, and S), in S. dulcamara a fourth new resistance phenotype (SL) was identified with lesions larger than the point of inoculation but without visible sporulation of the pathogen. Quantitative PCR confirmed P. infestans growth difference in RN, SL, and S phenotypes. Thus, in Sweden S. physalifolium is susceptible and could be a player in epidemiology. A limited role of S. dulcamara leaves in the epidemiology of late blight was suggested, since no major symptoms have been found in the field.
CE: Managing Sepsis and Septic Shock: Current Guidelines and Definitions
Authors: Makic Mary Beth Flynn , Bridges Elizabeth
Published: January 2018

Sepsis is a leading cause of critical illness and hospital mortality. Early recognition and intervention are essential for the survival of patients with this syndrome. In 2002, the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM) launched the Surviving Sepsis Campaign (SSC) to reduce overall patient morbidity and mortality from sepsis and septic shock by driving practice initiatives based on current best evidence. The SSC guidelines have been updated every four years, with the most recent update completed in 2016. The new guidelines have increased the focus on early identification of infection, risks for sepsis and septic shock, rapid antibiotic administration, and aggressive fluid resuscitation to restore tissue perfusion.

In 2014, the SCCM and the ESICM convened a task force of specialists to reexamine the definitions of terms used to identify patients along the sepsis continuum. In 2016, this task force published the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). The new definitions and recommendations included tools, based on an updated understanding of the pathobiology of sepsis, that can be used to predict adverse outcomes in patients with infection.

This article discusses the new SSC treatment guidelines, changes in the sepsis bundle interventions, and the Sepsis-3 definitions and tools, all of which enable nurses to improve patient outcomes through timely collaborative action.
Cybersecurity matters
Authors: Kim Lee
Published: January 2018

How to safeguard patient and other sensitive data
Master protocols in lung cancer: experience from Lung Master Protocol
Authors: Lam Vincent K. , Papadimitrakopoulou Vassiliki
Published: January 2018

Purpose of review

Contemporary advances in the understanding of the molecular and immunologic basis of metastatic lung cancer have firmly changed its treatment paradigm to a personalized, biomarker-driven approach. However, the majority of lung-cancer patients [especially lung squamous cell carcinoma (LUSC)] still do not have effective targeted therapeutic options. Master protocols, such as Lung-MAP, represent an innovative clinical trial approach designed to accelerate evaluation of novel biomarker-driven therapies.

Recent findings

Lung-MAP is an umbrella trial for advanced LUSC and has been active since 2014. Cumulative experience from this overarching, multi-institution master protocol has demonstrated that centralized, real-time biomarker screening is feasible and substudy modularity is essential for protocol adaptability in a rapidly changing treatment landscape. In addition, screening and efficacy results from Lung-MAP affirm that LUSC has several putative drivers but remains difficult to effectively treat with targeted therapy.

Master protocols are a feasible and efficient approach for evaluating biomarker-driven therapies in lung cancer. As we begin to target less common genomic and immunotherapy subtypes, centrally coordinated clinical trial designs such as Lung-MAP are necessary to rapidly deliver effective therapies to patients, whereas also maximizing the quality of research data obtained.
Case of Congenital Self-Healing Reticulohistiocytosis Expanding the Spectrum of Blueberry Muffin Baby
Authors: Cano Bará Sara , Vargas-Navia Natalia , Rueda Plata Ricardo
Published: January 2018

Congenital self-healing reticulohistiocytosis (CSHRH) is a benign, rare variant of histiocytosis. This condition can present phenotypically as blueberry muffin baby. This is the case of a male neonate with skin involvement of papulonodular violaceous lesions, which resolved spontaneously. The diagnosis of CSHRH is confirmed using histopathology and immunohistochemistry.
Severe Intraocular Pressure Elevation After Intracameral Healon 5 Viscoelastic Support for Postoperative Hypotony After XEN Gel Stent Insertion
Authors: Bruynseels Alice , Sii Freda , Masood Imran , Shah Peter
Published: January 2018

Purpose:

The purpose of this article was to describe (i) a novel case of severe intraocular pressure (IOP) elevation due to intracameral Healon 5 for management of early postoperative (post-op) hypotony following XEN Gel Stent insertion and (ii) the management of this complication.

Materials and Methods:

A case report.

Results:

A 52-year-old man, with primary open-angle glaucoma and suboptimal left IOP control on maximally tolerated medical therapy, was managed with XEN Gel Stent insertion at another tertiary eye unit. Post-op, the IOP was 2 mm Hg with a shallow anterior chamber (AC) and choroidal effusions. Intracameral injections of Provisc on post-op days 1 and 3 failed to reverse hypotony. At 1 week post-op, persistent clinically significant hypotony was managed with Healon 5 injection into the AC. Twelve hours later, the patient experienced significant pain and reduced vision and presented to a different tertiary eye unit, where left visual acuity was hand movements, IOP was 70 mm Hg with a deep AC (complete ophthalmic viscosurgical device fill with Healon 5) and a flat drainage bleb with no external drainage. Emergency AC washout of the Healon 5 was performed with resolution of symptoms, visual acuity, and IOP control.

Conclusions:

We caution against the use of intracameral Healon 5 in the management of post-op hypotony following XEN Gel Stent insertion, given the potential risk for extreme IOP elevation and sight loss.
Hematologic Manifestations of Brucellosis in Children
Authors: Justman Naphtali , Fruchtman Yariv , Greenberg David , Ben-Shimol Shalom
Published: January 2018

Background:

Brucellosis is a common zoonosis in the Bedouin population of southern Israel. Limited data exist for the rate and risk factors of hematologic complication of brucellosis in children. We assessed anemia, leukopenia, thrombocytopenia and pancytopenia in childhood brucellosis in southern Israel.

Methods:

Our medical center is the sole hospital in southern Israel. All medical files of brucellosis, 2005–2014, identified through positive blood cultures or International Classification of Diseases 9th revision coding with positive serology, were reviewed retrospectively.

Results:

Overall, 511 brucellosis episodes were identified; 42% (N = 214) with ≥1 cytopenia, including 13% (N = 68) anemia, 28% (N = 144) leukopenia, 14% (N = 74) thrombocytopenia and 2% (N = 9) pancytopenia. Overall, 99.8% of episodes were in Bedouin children and 70% in males. In 79% of episodes, blood culture was positive for Brucella melitensis. Acute infections comprised 84% of all episodes. In univariate analysis, older age (10.49 ± 4.81 vs. 9.25 ± 4.89 years), fever (92% vs. 78%), positive blood culture (84% vs. 75%) and IgM ≥1:640 levels (50% vs. 39%) were associated with cytopenia. In contrast, arthralgia was associated with noncytopenic episodes. In multivariate analyses, older age (odds ratio = 1.063) and fever (odds ratio = 3.127) were associated with cytopenia.

Conclusions:

Brucellosis is commonly presented with cytopenia, especially in bacteremic episodes with fever. However, pancytopenia is uncommon and its finding should alert the physician to look for other possible etiologies.
Continuous Positive Airway Pressure Thresholds for Nasolacrimal Air Regurgitation in a Cadaveric Model
Authors: Blandford Alexander D. , Cherfan Daniel G. , Drake Richard L. , McBride Jennifer M. , Hwang Catherine J. , Perry Julian D. , Cheng Olivia T.
Published: January 2018

Purpose:

To elucidate the mechanisms underlying nasolacrimal air regurgitation (AR) in the setting of continuous positive airway pressure therapy.

Methods:

Twelve nasolacrimal systems of 6 fresh female human cadavers were evaluated individually for AR using continuous positive airway pressure therapy before any nasolacrimal procedure. Cadavers were then randomly assigned to undergo nasolacrimal duct probing or endoscopic dacryocystorhinostomy and then each hemisystem was again evaluated for AR. The pressure where AR was first observed (discovery pressure) or maximum possible pressure in systems without AR was recorded. In systems that demonstrated AR, the pressure was then gradually decreased to the lowest pressure where regurgitation persisted. This pressure was recorded as the secondary threshold pressure.

Results:

None of the 12 unoperated nasolacrimal systems or the 6 systems that underwent nasolacrimal duct probing demonstrated AR through the maximum continuous positive airway pressure therapy (30 cm H2O). After endoscopic dacryocystorhinostomy, all 6 nasolacrimal systems demonstrated AR. The mean discovery pressure was 16.0 cm H2O (range, 14.0–18.0 cm H2O) and mean secondary threshold pressure was 7.25 cm H2O (range, 6.5–8.0 cm H2O).

Conclusions:

Air regurgitation during continuous positive airway pressure therapy in the setting of prior endoscopic dacryocystorhinostomy can be replicated in a cadaver model. The secondary threshold pressures required for AR in this model were similar to AR pressures reported clinically. Prior to dacryocystorhinostomy, patients using continuous positive airway pressure therapy should be counseled on AR, and physicians should consider this phenomenon when evaluating ophthalmic complaints in postoperative patients on positive airway pressure therapy.
Symptomatic Hyperammonemia With Erwinia chrysanthemi–derived Asparaginase in Pediatric Leukemia Patients
Authors: Gossai Nathan , Richards Michael , Boman Lara , Messinger Yoav , Gernbacher Sara , Perkins Joanna , Bostrom Bruce
Published: January 2018

Erwinia chrysanthemi–derived asparaginase is increasingly integral to acute lymphoblastic leukemia therapy. In our series, 16% of patients developed symptomatic hyperammonemia following Erwinia administration with symptoms including refractory nausea, vomiting, profound fatigue, malaise, and coma. This series of patients receiving Erwinia indicates higher than expected incidence of hyperammonemia, correlation between ammonia and asparaginase levels and therapeutic asparaginase activity levels despite dose reduction. The series provides evidence for investigation into which patients require intervention to prevent toxicity, which patients may have ammonia levels used as an asparaginase activity surrogate and which patients may achieve equivalent efficacy with abridged dosing.
A Systematic Review of Risk Factors Associated With Cognitive Impairment After Pediatric Critical Illness*
Authors: Kachmar Alicia G. , Irving Sharon Y. , Connolly Cynthia A. , Curley Martha A. Q.
Published: January 2018

Objectives:

To identify risk factors associated with cognitive impairment as assessed by neuropsychologic tests in neurotypical children after critical illness.

Data Sources:

For this systematic review, we searched the Cochrane Library, Scopus, PubMed, Ovid, Embase, and CINAHL databases from January 1960 to March 2017.

Study Selection:

Included were studies with subjects 3–18 years old at the time of post PICU follow-up evaluation and use of an objective standardized neuropsychologic test with at least one cognitive functioning dimension. Excluded were studies featuring patients with a history of cardiac arrest, traumatic brain injury, or genetic anomalies associated with neurocognitive impairment.

Data Extraction:

Twelve studies met the sampling criteria and were rated using the Newcastle-Ottawa Quality Assessment Scale.

Data Synthesis:

Ten studies reported significantly lower scores in at least one cognitive domain as compared to healthy controls or normed population data; seven of these—four case-control and three prospective cohort studies—reported significant lower scores in more than one cognitive domain. Risk factors associated with post critical illness cognitive impairment included younger age at critical illness and/or older age at follow-up, low socioeconomic status, high oxygen requirements, and use of mechanical ventilation, sedation, and pain medications.

Conclusions:

Identifying risk factors for poor cognitive outcomes post critical illness may help healthcare teams modify patient risk and/or provide follow-up services to improve long-term cognitive outcomes in high-risk children.
SpaRC: Scalable Sequence Clustering using Apache Spark
Authors: Shi Lizhen , Meng Xiandong , Tseng Elizabeth , Mascagni Michael , Wang Zhong
Published: January 2018

Whole genome shotgun based next generation transcriptomics and metagenomics studies often generate 100 to 1000 gigabytes (GB) sequence data derived from tens of thousands of different genes or microbial species. De novo assembling these data requires an ideal solution that both scales with data size and optimizes for individual gene or genomes. Here we developed a Apache Spark-based scalable sequence clustering application, SparkReadClust (SpaRC), that partitions the reads based on their molecule of origin to enable downstream assembly optimization. SpaRC produces high clustering performance on transcriptomics and metagenomics test datasets from both short read and long read sequencing technologies. It achieved a near linear scalability with respect to input data size and number of compute nodes. SpaRC can run on different cloud computing environments without modifications while delivering similar performance. In summary, our results suggest SpaRC provides a scalable solution for clustering billions of reads from the next-generation sequencing experiments, and Apache Spark represents a cost-effective solution with rapid development/deployment cycles for similar large scale sequence data analysis problems. The software is available under the Apache 2.0 license at https://bitbucket.org/LizhenShi/sparc.
The crystal structure of a new ferrocenyl P,N ligand: 1-[(2,2-dimethylhydrazin-1-ylidene)methyl]-1′-(diphenylphosphorothioyl)ferrocene
Authors: Mouas Toma Nardjes , Daran Jean-Claude , Merazig Hocine , Manoury Eric
Published: January 2018

The asymmetric unit of the title compound, [Fe(C8H11N2)(C17H14PS)], contains two independent molecules (A and B) with very similar conformations. Each molecule is built up from a ferrocene unit substituted in the 1 and 1′ positions by a protected sulfur diphenylphosphine and by a dimethylhydrazine, –C(H)=N—N(CH3)2, fragment. The two independent molecules are linked by a C—H...N hydrogen bond. In the crystal, the A–B dimer is linked by a pair of C—H...S hydrogen bonds, forming a centrosymmetric four-molecule arrangement. These units are linked by C—H...π interactions, forming a supramolecular three-dimensional structure.
1-(2-Bromo-4-methylphenyl)-3,3-dimethylthiourea
Authors: El-Hiti Gamal A. , Smith Keith , Hegazy Amany S. , Alshammari Mohammed B. , Kariuki Benson M.
Published: January 2018

The bromomethylphenyl and dimethylthiourea groups of the molecule of the title compound, C10H13BrN2S, are inclined to one another at an interplanar angle of 55.13 (6)°. In the crystal, molecules are stacked along thebaxis and intermolecular N—H...S contacts form chains of molecules along [010].
S-2-Aminophenyl phenylcarbamothioate
Authors: Öztürk Yıldırım Sema , Butcher Ray J.
Published: January 2018

In the title compound, C13H12N2OS, which was obtained from the condensation reaction of 2-aminobenzenethiol with isocyanatobenzene, the benzene rings are inclined to one another by 83.5 (1)° and a short intramolecular C—H...O contact is observed. In the crystal, molecules are linked by N—H...O and N—H...N hydrogen bonds, generating (001) sheets.
The business of integrated care: implementing new models of care in a fee-for-service setting
Authors: Yu Serena , van Gool Kees , Edwards Karen , Kirby Sue , Gardner Karen , Robinson Louise , Linehan Tricia , Harris Mark , Hall Jane
Published: January 2018

Purpose

The Western New South Wales Integrated Care Strategy (ICS) was rolled out from November 2014 across three rural sites. The purpose of this paper is to assess its impact on general practices, and examine the feasibility of implementing an ICS, within a predominantly fee-for-service delivery model.

Design/methodology/approach

Mixed methods were used to analyse the implementation of the ICS, including practice-level patient data on changes in service provision. This includes unit-record data on 130 enroled patients across three rural sites, as well as qualitative data collection from providers.

Findings

There were significant increases in both revenue-generating and non-revenue-generating activities (primarily care coordination activities) associated with implementing the ICS. Each occasion of service involved greater contact time with practice staff other than GPs, as well as greater administration time. There is evidence that ICS activities such as case conferencing and team care planning substitute for traditional GP consultations. Overall, the study found that a significant investment of resources – namely staff time devoted to a range of activities – was required to support the implementation of the ICS. Such an investment was supported both externally and through revenue-generating practice-level activities.

Research limitations/implications

The data collection and evaluation project is ongoing, with analysis based on the first wave of data from three sites.

Practical implications

At the practice level, a substantial commitment of resources is required to invest in, and sustain, a new model of integrated care (IC). This commitment can currently be supported both through higher revenue generation at the practice level, and externally by health system stakeholders, but changes in financial settings could impact on financial viability.

Originality/value

This paper provides evidence on the role of blended payment mechanisms in facilitating the implementation of IC in a rural setting where there are medical workforce constraints.