bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of a Clinical Risk Assessment Tool for 6-Week Postpartum Visit Nonadherence
Authors: Kaur Sangeeta , Bahado-Singh Ray , Qafiti Fred
Published: December 2017

Objective The 6-week postpartum visit (6WPP) is integral in addressing postpartum medical concerns. Failure to attend this routine visit is a measure of suboptimal care. This study aims to identify patients at risk of 6WPP nonadherence by developing a novel point-based risk scoring system.

Methods In this retrospective case–control study (n = 587), a randomly selected subgroup, that is, the “test” group (n = 303), was used to develop the model. The remaining patients were used as an independent “validation” group (n = 284) to assess the model performance.

Results Five factors were found to correlate with 6WPP nonadherence. Positive correlations include: Medicaid health insurance (odds ratio [OR]: 2.40, 95% confidence interval [CI]: 1.38–4.15); prenatal care initiated at ≥ 14 weeks' gestation (OR: 1.82, 95% CI: 1.11–2.96); and maternal age < 24.0 years (OR: 2.02, 95% CI: 1.13–3.61). Factors negatively correlated with nonadherence include: “married” marital status (OR: 0.50, 95% CI: 0.30–0.84) and primiparity (OR: 0.51, 95% CI: 0.30–0.85). The final scoring system demonstrates significant predictive power in both the test and validation groups (respectively, area under the curve = 0.682, p < 0.001 and 0.629, p < 0.001).

Conclusion This risk assessment tool relies on routinely collected data, making its implementation simple. Applying it in the clinical setting allows for early, targeted intervention aimed at minimizing 6WPP nonadherence.
Zylindrische abdominoperineale Rektumexstirpation mit partieller Vulva- und Vaginaresektion sowie perinealer und vaginaler Defektrekonstruktion durch einen vertikalen Rectus-abdominis-Muskel-Haut-Lappen (VRAM-Lappen)
Authors: Krautz Christian , Weber Klaus , Croner Roland , Denz Axel , Maak Matthias , Horch Raymund , Grützmann Robert
Published: December 2017

Einleitung Patienten mit sehr tief sitzenden Rektum- oder Analkarzinomen, bei denen eine abdominoperineale Rektumexstirpation (APE) durchgeführt werden muss, profitieren von einer Erweiterung der Resektion und der damit verbundenen Vermeidung des sog. „Coning“ im Levatorenbereich. Diese von T. Holm entwickelte Technik der zylindrischen APE hat zu einer deutlichen Reduktion der Rate an intraoperativen Tumorperforationen sowie der positiven zirkumferenziellen Resektionsränder und konsekutiv zu einer erniedrigten Lokalrezidivrate geführt. Aufgrund des Auftretens von Wundheilungsstörungen in bis zu 60% aller Fälle hat sich die Verwendung myokutaner Lappenplastiken vor allem nach neoadjuvanter Radiotherapie bewährt. Derartige Lappenplastiken liefern ausreichend Füllsubstanz für Hohlräume, ergänzen vaskularisiertes Gewebe in vorbestrahlten Regionen, erleichtern den Wundverschluss und ermöglichen vaginale und perineale Rekonstruktionen. In diesem Video wird das Prinzip der zylindrischen APE mit Erweiterung durch eine partielle Vulva- und Vaginaresektion sowie nachfolgender Rekonstruktion der vaginalen Hinterwand und des vulvoperianalen Defekts mit einem vertikalen Rectus-abdominis-Muskel-Haut-Lappen (VRAM-Lappen) dargestellt.

Indikation Lokal fortgeschrittenes Analkarzinom mit Infiltration und Fistel zur posterioren Vagina ohne Hinweis auf eine Fernmetastasierung bei Zustand nach neoadjuvanter Radiochemotherapie.

Operation Erweiterte zylindrische abdominoperineale Rektumexstirpation mit partieller Vulva- und Vaginaresektion, Anlage eines endständigen Descendostomas mit parastomaler, intraperitonealer Onlay-Mesh-Augmentation (IPOM), vaginale und perineale Rekonstruktionen mit einem VRAM-Lappen rechts und Inlay-Netzaugmentation des vorderen Rektusscheidenblatts rechts.

Zusammenfassung Die extralevatorische APE ist aus onkologischer Sicht der herkömmlichen Technik überlegen. Die Verwendung myokutaner Lappenplastiken verbessert die postoperative Wundheilung und Lebensqualität.
Medizinische Prüfung zwischen Wunsch und Wirklichkeit – Analyse der Übereinstimmung zwischen dem 2. Abschnitt der ärztlichen Prüfung und dem Nationalen Kompetenzbasierten Lernzielkatalog Chirurgie
Authors: Sterz Jasmina , Rüsseler Miriam , Britz Vanessa , Stefanescu Christina , Hoefer Sebastian , Adili Farzin , Schreckenbach Teresa , Schleicher Iris , Weber Roxane , Hofmann Hans-Stefan , Voß Friedericke , König Sarah , Heinemann Markus , Kadmon Martina
Published: December 2017

Hintergrund Die Chirurgische Arbeitsgemeinschaft Lehre der Deutschen Gesellschaft für Chirurgie (CAL) hat den Nationalen Kompetenzbasierten Lernzielkatalog Chirurgie (NKLC) entwickelt. Der NKLC definiert für jedes der 230 Lernziele eine Kompetenzebene (KE) von „KE 1: Faktenwissen“ bis zu „KE 3: selbstständige Handlung“. Die vorliegende Studie untersucht, inwiefern sich die Prüfungsfragen des 2.Staatsexamens mit den Lernzielen des NKLC decken und welche thematische Gewichtung dabei vom Institut für Medizinische und Pharmazeutische Prüfungsfragen (IMPP) vorgenommen wurde.

Material und Methoden Zunächst wurden ein Leitfaden und ein Auswertungsbogen entwickelt, um die standardisierte Zuordnung und Dokumentation einzelner Prüfungsfragen des 2. Staatexamens zu Lernzielen des NKLC zu ermöglichen. In einer retrospektiven Analyse wurden dann 11 Staatsexamina (Herbst 2009 bis Herbst 2014) von mindestens 3 Reviewern unabhängig voneinander analysiert. Die Chirurgie-Fragen wurden identifiziert und einem Lernziel des NKLC zugeordnet. In die Analyse gingen die Anzahl der chirurgischen Lernziele sowie die Anzahl der chirurgischen Fragen pro Examen, pro Lernziel und pro festgelegte KE ein.

Ergebnisse Es analysierten 13 Reviewer aus 6 chirurgischen Disziplinen. Durchschnittlich wurden 79,1% aller 3480 Fragen aus 11 Examina übereinstimmend als chirurgisch oder nicht chirurgisch gewertet. Pro Examen (aus je max. 320 Fragen) wurden 98,8 ± 22,6 Fragen (Min.: 69, Max.: 150) als chirurgisch eingestuft. Pro Lernziel wurden 2,2 ± 0,3 Fragen (Min.: 1, Max.: 16) gestellt. Pro Examen wurden 23,5 ± 6,3 Fragen (Min.: 11; Max.: 31) zu Lernzielen mit der KE 3 (selbstständige Durchführung), 52,5 ± 16,7 (Min.: 34; Max.: 94) zu Lernzielen mit KE 2 (Anwendungs- und Entscheidungswissen) und 22,8 ± 7,7 Fragen (Min.: 9; Max.: 34) zu Lernzielen mit KE 1 (reines Faktenwissen) pro Examen gestellt. 64 Lernziele (27,8% der insgesamt 230 Lernziele des NKLC) wurden gar nicht geprüft. Das am häufigste geprüfte chirurgische Lernziel stammte mit 70 Fragen aus dem Bereich „Erkrankungen des rheumatischen Formenkreises“.

Schlussfolgerung Die Anzahl der Fragen im 2. Staatsexamen aus dem Fach Chirurgie erscheint ausreichend, jedoch thematisch ungleichmäßig verteilt. Um eine inhaltlich homogenere Repräsentation relevanter chirurgischer Lernziele zu gewährleisten, ist eine bessere Abstimmung der Staatsprüfungen mit den existierenden Lernzielkatalogen durch das IMPP zu wünschen.
Neue Wege zum chirurgischen Nachwuchs – Studierendenforum für Minimal Invasive Chirurgie
Authors: Roch Paul , Friedrich Mirco , Kowalewski Karl-Friedrich , Schmidt Mona , Herrera Javier , Müller Philip , Benner Laura , Romero Philipp , Müller-Stich Beat , Nickel Felix
Published: December 2017

Hintergrund Der Ärztemangel ist besonders in den chirurgischen Fächern spürbar. Dachverbände bemühen sich um die Rekrutierung neuen Nachwuchses. Vielversprechend für frühe Interessenbildung scheinen Studierendenforen im Kontext fachspezifischer Kongresse. Beim Dreiländertreffen für Minimal Invasive Chirurgie (MIC) 2016 in Heidelberg wurde ein beispielhaftes Studierendenforum durchgeführt. Ziel war die Evaluation des Studierendenforums aus Studierendensicht für Empfehlungen zukünftiger Veranstaltungen.

Methoden Von insgesamt 60 teilnehmenden Studierenden nahmen 50% (30/60) an der Evaluation teil. Auf einer 5-Punkte-Likert-Skala wurden einzelne Programmpunkte, die Zunahme spezieller Interessen, der persönliche Benefit und die Wahrscheinlichkeit einer erneuten Teilnahme beurteilt.

Ergebnisse Beim Studierendenforum zeigte sich der Interessenzuwachs für die MIC mit einer positiven Bewertung von 60% (18/30) der Studierenden am stärksten. Der Interessenzuwachs für die Chirurgie im Allgemeinen und für die robotische Chirurgie im Spezifischen war mit 57% (17/30) positiven Bewertungen minimal geringer. Unter den einzelnen Programmpunkten wurde der laparoskopische Hands-on-Workshop mit 90% (27/30) positiven Bewertungen am besten bewertet. Die Studierenden wünschten sich noch mehr Möglichkeiten zum direkten Austausch mit erfahrenem Personal. Von den Studierenden gaben 67% (40/60) an, definitiv oder sehr wahrscheinlich erneut teilzunehmen.

Diskussion Der Erfolg des Studierendenforums bestätigte sich am deutlichen Interessenzuwachs für die MIC und die Chirurgie im Allgemeinen. Hands-on-Workshops erfahren eine sehr gute Resonanz. Der Kontaktaufbau zwischen Studierenden und erfahrenem Personal sollte gezielt gefördert werden. Für die Debatte über eine ausgeglichene Work-Life-Balance ist das zur Reduzierung von Vorurteilen von besonderer Bedeutung. Hinsichtlich des Nachwuchsproblems chirurgischer Fachgebiete stellt das Konzept des Studierendenforums eine wertvolle Maßnahme dar und sollte etabliert und konsequent weiterentwickelt werden.
Implementation of a checklist before colonoscopy: a quality improvement initiative
Authors: Kherad Omar , Restellini Sophie , Ménard Charles , Martel Myriam , Barkun Alan
Published: December 2017

Background and study aims Checklists can prevent errors and have a positive impact on patient morbidity and mortality in different surgical settings, and possibly also in gastrointestinal endoscopy. The aims of this study were to reinforce commitment in safety culture and better communication among team members in endoscopy, and to prove the feasibility of successful checklist adoption before colonoscopy.

Patients and methods The study involved a pre – post quality improvement intervention involving all consecutive patients undergoing a colonoscopy at a single academic endoscopy unit. The first part of the study was a retrospective audit, carried out over a 3-month period (July to September 2016). A checklist developed through a formal validation process was implemented during the intervention period (October to December 2016). Primary outcomes were changes in patient and team satisfaction after the quality improvement intervention, using validated 5-point scale questionnaires. Secondary outcomes included successful procedure completion rates and safety outcomes.

Results During the baseline and comparative intervention period, 1317 and 1141 colonoscopies, respectively, were performed. Overall, checklists were fully completed by nurses and physicians for 791 patients (69.3 %). Mean overall patient satisfaction was high at baseline and did not differ following the quality improvement intervention (4.66 vs. 4.63; P  = 0.5). Perception of team communication and teamwork was improved after checklist implementation. Comparative analyses of per-procedure and safety outcomes did not differ between the pre- and post-checklist implementation.

Conclusion Adoption of an endoscopy checklist before colonoscopy is feasible, and significantly increases perception of team communication and teamwork. Additional studies are needed to assess the generalizability of these results to complex endoscopic procedures and to characterize any improvement in patient safety outcomes.
Ehrenamtliche in der Flüchtlingshilfe – sind gesundheitsfördernde Maßnahmen (durch den ÖGD) notwendig?
Authors: Andrees Valerie , Freyer Beke , Borgmeier Ingrid , Galle Hans-Jürgen , Westenhöfer Joachim
Published: December 2017

Zielsetzung Es sollen gesundheitliche Ressourcen und Belastungen von ehrenamtlich in der Flüchtlingshilfe tätigen Helfern untersucht werden.

Methodik Qualitative Interviews mit 10 ehrenamtlich in der Flüchtlingshilfe tätigen Helferinnen und Helfern sowie mit 11 koordinativ tätigen Fachleuten wurden durchgeführt, transkribiert und mittels qualitativer Inhaltsanalyse ausgewertet.

Ergebnisse Die ehrenamtliche Tätigkeit in der Flüchtlingshilfe wird als starke Ressource erlebt. Die Ehrenamtlichen erfahren viel Dankbarkeit und Bestätigung und erleben das Engagement als bereichernd und selbstwert-stärkend. Andererseits werden aber auch viele Belastungen und Probleme erlebt. Schwierigkeiten in der zeitlichen und emotionalen Abgrenzung werden als wichtige Ursache für die erlebten Belastungen benannt.

Schlussfolgerungen Angebote zur Unterstützung der ehrenamtlich in der Flüchtlingshilfe tätigen Personen sollten optimiert und ausgebaut werden, um die Helfer vor gesundheitlichen Belastungen besser zu schützen. Hierbei könnte der öffentliche Gesundheitsdienst wichtige Aufgaben übernehmen.
Short-term outcomes following endoscopic submucosal dissection of large protruding colorectal neoplasms
Authors: Sakamoto Taku , Saito Yutaka , Nakamura Fumihiko , Abe Seiichiro , Takamaru Hiroyuki , Sekiguchi Masau , Yamada Masayoshi , Nakajima Takeshi , Matsuda Takahisa , Yamagishi Hidetsugu , Kato Hiroyuki
Published: December 2017

Background Although submucosal dissection is useful for treating laterally spreading colorectal tumors, there is little information regarding the endoscopic treatment of large protruding colorectal neoplasms. Here, we aimed to evaluate the clinical outcomes of endoscopic submucosal dissection for protruding colorectal neoplasms ≥ 20 mm in diameter.

Methods In total, 112 consecutive patients undergoing treatment between January 2005 and June 2017 were enrolled retrospectively. The study period was divided into six periods to evaluate any changes in outcomes over time. We reviewed all short-term clinical outcomes, including lesion characteristics, procedure time, and percentages of en bloc resection, curative resection, adverse events, and treatment discontinuation.

Results The percentages of en bloc, en bloc R0, and en bloc curative resections were 88 %, 82 %, and 59 %, respectively. Perforation occurred in 11 patients (10 %), and the endoscopic procedure was discontinued in five patients (4 %) because of technical difficulty. For lesions ≥ 40 mm in diameter, the procedure time showed a statistically significant decreasing trend in the latter half of the study period. However, the rate of cure did not improve along with enhancements to the procedure’s technological aspects.

Conclusions Although endoscopic submucosal dissection for large protruding lesions has advanced in terms of its technical aspects, its ability to cure large protruding neoplasms has not shown gratifying results.
Suspended liquid particle disturbance on laser-induced blast wave and low density distribution
Authors: Ukai Takahiro , Zare-Behtash Hossein , Kontis Konstantinos
Published: December 2017

The impurity effect of suspended liquid particles on the laser-induced gas breakdown was experimentally investigated in quiescent gas. The focus of this study is the investigation of the influence of the impurities on the shock wave structure as well as the low density distribution. A 532 nm Nd:YAG laser beam with an 188 mJ/pulse was focused on the chamber filled with suspended liquid particles 0.9 ± 0.63 μm in diameter. Several shock waves are generated by multiple gas breakdowns along the beam path in the breakdown with particles. Four types of shock wave structures can be observed: (1) the dual blast waves with a similar shock radius, (2) the dual blast waves with a large shock radius at the lower breakdown, (3) the dual blast waves with a large shock radius at the upper breakdown, and (4) the triple blast waves. The independent blast waves interact with each other and enhance the shock strength behind the shock front in the lateral direction. The triple blast waves lead to the strongest shock wave in all cases. The shock wave front that propagates toward the opposite laser focal spot impinges on one another, and thereafter a transmitted shock wave (TSW) appears. The TSW interacts with the low density core called a kernel; the kernel then longitudinally expands quickly due to a Richtmyer-Meshkov-like instability. The laser-particle interaction causes an increase in the kernel volume which is approximately five times as large as that in the gas breakdown without particles. In addition, the laser-particle interaction can improve the laser energy efficiency.
Design and development of compact coaxial to coplanar waveguide directional coupler for HPM measurement
Authors: Cui Xinhong , Wu Xiaolong , Xiong Zhengfeng , Yan Feng , Yan Junkai , Ye Hu , Liu Min , Yang Meng , Yang Wensen , Huangfu Huidong
Published: December 2017

A compact, high-directivity, weak-coupling directional coupler with coaxial–coplanar waveguide structure and diamond-shaped coupling slot was developed at L band for a high-power microwave measurement by both theoretical analysis and experiments. The relation between the dimension of the coupling slot and the characteristic parameters of the coupler was studied by the small-hole coupling theory and the infinitesimal method. According to the analysis results, the directivity could be better than 20 dB while the length of the slot is just less than a single λ because of the use of the diamond coupling slot. For demonstration, a 45-dB L band coaxial–coplanar waveguide directional coupler was designed and verified by test. The experiment results and the theoretical analysis are in good agreement, which indicates that in the range of 1–2 GHz, the coupling was approximately −45 dB and the directivity was better than 17 dB. The power-handling capacity was demonstrated to reach 2 MW with a length (150 mm) of less than λ and a cross section (46 mm × 55 mm) of less than one-twelfth of the BJ-14 waveguide directional coupler.
Transverse magnetic field effect on the transport of relativistic electrons beam in laser irradiating plasmas
Authors: Hou Ya-Juan , Lv Chong , Wan Feng , Yasen Nureli , Bake Muhammad Ali , Sang Hai-Bo , Xie Bai-Song
Published: December 2017

A transverse gauss shape magnetic field with wide width is proposed for collimating the fast relativistic electron beam in laser irradiating plasmas, which is highlighted by the two-dimensional particle-in-cell simulations, in particular, the effects of this magnetic field on the production and transport of fast electron beam. When the axial magnetic field is also present, it is found that the energy density of fast electrons can be enhanced greatly. For example, in the presence of 30 MG axial magnetic field, it is enhanced by 3–4 times when the amplitude of the applied transverse magnetic field lies within the optimal regime 200–300 MG comparable to that without the transverse magnetic field. Meanwhile, the divergence angle of the electron beam can be controlled and even decreased a little due to the better sandwich structure of the overall weakening magnetic field. The study implies that the proposed transverse magnetic field is helpful to obtain the high quality electron beam which is beneficial to the fast ignition in inertial confinement fusion.
Nonequilibrium Green’s function theory for nonadiabatic effects in quantum electron transport
Authors: Kershaw Vincent F. , Kosov Daniel S.
Published: December 2017

We develop nonequilibrium Green’s function-based transport theory, which includes effects of nonadiabatic nuclear motion in the calculation of the electric current in molecular junctions. Our approach is based on the separation of slow and fast time scales in the equations of motion for Green’s functions by means of the Wigner representation. Time derivatives with respect to central time serve as a small parameter in the perturbative expansion enabling the computation of nonadiabatic corrections to molecular Green’s functions. Consequently, we produce a series of analytic expressions for non-adiabatic electronic Green’s functions (up to the second order in the central time derivatives), which depend not solely on the instantaneous molecular geometry but likewise on nuclear velocities and accelerations. An extended formula for electric current is derived which accounts for the non-adiabatic corrections. This theory is concisely illustrated by the calculations on a model molecular junction.
Absolute cross section measurements for the scattering of low- and intermediate-energy electrons from PF3. I. Elastic scattering
Authors: Hishiyama N. , Hoshino M. , Blanco F. , García G. , Tanaka H.
Published: December 2017

We report absolute elastic differential cross sections (DCSs) for electron collisions with phosphorus trifluoride, PF3, molecules (e− + PF3) in the impact energy range of 2.0–200 eV and over a scattering angle range of 10°–150°. Measured angular distributions of scattered electron intensities were normalized by reference to the elastic DCSs of He. Corresponding integral and momentum-transfer cross sections were derived by extrapolating the angular range from 0° to 180° with the help of a modified phase-shift analysis. In addition, due to the large dipole moment of the considered molecule, the dipole-Born correction for the forward scattering angles has also been applied. As a part of this study, independent atom model calculations in combination with screening corrected additivity rule were also performed for elastic and inelastic (electronic excitation plus ionization) scattering using a complex optical potential method. Rotational excitation cross sections have been estimated with a dipole-Born approximation procedure. Vibrational excitations are not considered in this calculation. Theoretical data, at the differential and integral levels, were found to reasonably agree with the present experimental results. Furthermore, we explore the systematics of the elastic DCSs for the four-atomic trifluoride molecules of XF3 (X = B, N, and P) and central P-atom in PF3, showing that, owing to the comparatively small effect of the F-atoms, the present angular distributions of elastic DCSs are essentially dominated by the characteristic of the central P-atom at lower impact energies. Finally, these quantitative results for e− − PF3 collisions were compiled together with the previous data available in the literature in order to obtain a cross section dataset for modeling purposes. To comprehensively describe such a considerable amount of data, we proceed by first discussing, in this paper, the vibrationally elastic scattering processes whereas vibrational and electronic excitation shall be the subject of our following paper devoted to inelastic collisions.
Analysis of synchrotron radiation spectra of runaway electrons in Tokamak
Authors: Xiao M. , Zhou R. J. , Hu L. Q. , Zhang Y. K. ,   EAST Team
Published: December 2017

The full expression of runaway electron radiation in a tokamak is calculated accurately without any additional simplifications in this letter. By comparing the synchrotron radiation spectra of runaway electrons based on the full expression, their asymptotic expressions, and pure circular orbit expressions, it is analyzed how radiation spectra and total radiation power of runaway electrons in Tokamak can be analyzed correctly and efficiently.
Life assessment prognostic modelling for multi-layered coating systems using a multidisciplinary approach
Authors: Latif Jawwad , Khan Zulfiqar Ahmad , Nazir Mian Hammad , Stokes Keith , Plummer Joseph
Published: December 2017

The multidisciplinary approach has been adopted to model the formation and propagation of blistering effect for evaluation of useful coating life in the multi-layered coating–substrate system. A prognostic model of de-bonding driving force has been formulated as a function of material science, solid mechanics and fracture mechanics properties to estimate critical, safe and fail conditions of the coating–substrate system. The blister growth velocity rate is also included in the developed model to estimate the blister propagation as a function of diffusion-induced stress and residual stress. The proposed prognostic modelling for the formation and propagation of blistering effect are combined to form an assessment model for the evaluation of useful coating life of the multi-layered coating–substrate system and validated through experimental observation.
Microstructure and mechanical properties of AZ31-Ce prepared by multipass solid-phase synthesis
Authors: Zhu Yao , Hu Maoliang , Wang Dianjun , Xu Hongyu , Wang Ye , Ji Zesheng
Published: December 2017

The effects of extrusion passes on the microstructure and mechanical properties of the magnesium AZ31-Ce alloy prepared by solid-phase synthesis were studied. The deformation mechanism of Mg-Ce chips was also discussed. The alloy was characterised by optical microscopy, scanning electron microscopy, energy-dispersive X-ray spectrometry and an electronic universal strength tester. The results show that Mg-Ce chips are constantly crushed and deformed, and finally exhibit a fine granulated shape as the number of extrusion passes increases. The mechanical properties of the alloy markedly increase with further extrusion passes. After five passes, the tensile strength and elongation reach 311 MPa and 9.83%, respectively. The solid-phase synthesis method has the potential to prepare wrought magnesium alloys with rare earth alloying additions.
Microstructure and properties of Ti/Al lightweight graded material by direct laser deposition
Authors: Liu Yang , Liu Chao , Liu Wensheng , Ma Yunzhu , Zhang Cheng , Cai Qingshan , Liu Bing
Published: December 2017

A novel Ti/Al lightweight graded material was fabricated successfully using the direct laser deposition process, with the composition continuously changing from 100 vol.-% Ti6Al4V to 100 vol.-% AlSi10Mg. Microstructures and phase transformations were characterised, and the mechanical properties of the Ti/Al lightweight graded material were investigated. It was found that element concentrations followed a nearly linear relationship along the compositional gradient. The maximum hardness reached 619 HV in the ‘II’ zones, and then it decreased gradually to 214 HV at the outermost layer, with the increase in the proportion of AlSi10Mg. The values for the ultimate tensile strength were above 400 MPa, and the fracture surfaces indicated a transition from ductile to brittle fracture along the graded direction.
Large Databases for Pediatric Research on Children with Autism Spectrum Disorder
Authors: Kuhlthau Karen A. , Bailey L. Charles , Baer Briella L. , Coury Daniel L. , Law J. Kiely , Murray Donna S. , Razzaghi Hanieh , Forrest Christopher B. , Lipkin Paul H.
Published: December 2017

Objective:

This article reviews the data available in 3 large databases for use in conducting studies of children with autism spectrum disorder (ASD).

Methods:

The article describes the data structure, data elements, and strengths and weaknesses of the 3 data sets.

Results:

Each of the 3 data sets, the Interactive Autism Network (IAN), the Autism Treatment Network (ATN), and PEDSnet have large cohorts of children with ASD. IAN has strengths in patient-reported measures, ATN in clinical characterization, and PEDSnet in health care encounters and electronic medical record data.

Conclusion:

The data sets described here have potential for further studies that could help improve the care and well-being of children with ASD and their families.
Intraluminal Deposits Found in Glaucoma Tube Shunts Via Anterior Segment Ocular Coherence Tomography
Authors: Alvarado Jorge A. , Srivastava Vinita , Sun Yang
Published: December 2017

Purpose:

To describe and characterize a novel observation of intraluminal deposits of glaucoma tube shunts (TS) using spectral domain (SD) ocular coherence topography (OCT).

Patients and Methods:

Fifteen TS in 11 patients diagnosed with primary open-angle, neovascular, aphakic, and uveitic glaucomas. Both Ahmed (n=11) and Baerveldt (n=4) TS were examined with 5-line raster anterior segment SD-OCT imaging.

Results:

The exposed tubes of 2 patients had highly reflective intraluminal deposits in the corresponding exposed areas. Seven tubes without exposure had a thin rim of highly reflective material. Six tubes were clear of luminal deposits. The most common diagnosis in the study was uveitic glaucoma which occurred in 5 of the 15 eyes (33%). The next most common diagnosis was primary open-angle glaucoma which occurred in 4 of the 15 eyes (25%). There were 2 nonvalved Baerveldt tubes in each group. The mean duration of TS implantation was 15.0 months in the deposit group and 33.7 months in the group without luminal deposits. The majority of patients in each group were using eye drops at presentation (88.9% deposit, 83.3% clear), and the average intraocular pressure was 20.2 mm Hg in the deposit group and 19.0 mm Hg in the clear group.

Conclusions:

Anterior segment OCT imaging may be used to evaluate TS integrity. Intraluminal deposits in TS may occur as a natural response to implanted drainage device, possibly as an inflammatory response.
Gastrointestinal Symptoms in Children and Adolescents With Neurofibromatosis Type 1
Authors: Ejerskov Cecilie , Krogh Klaus , Ostergaard John R. , Joensson Iben , Haagerup Annette
Published: December 2017

Objectives:

Neurofibromatosis type 1 (NF1) is a complex genetic disorder characterized by symptoms of the skin and nervous system. A previous study indicated that constipation is common in children with NF1. The aim of the present study was to investigate the phenotype and prevalence of gastrointestinal (GI) symptoms in a population of 4 to 17‐year‐olds with NF1 compared with their unaffected siblings.

Methods:

GI symptoms were assessed with a web‐based, parent or self‐administered, validated, Rome III diagnostic questionnaire. Participants were recruited from 1 of 2 Danish National Centers of Expertise for NF1. Logistic regression was used to estimate the prevalence of functional dyspepsia, irritable bowel syndrome (IBS), and constipation in each group and the groups were compared using odds ratio (OR).

Results:

We compared 102 NF1 patients (median age 10.3 years) and 46 of their unaffected siblings (median age 10 years). The overall likelihood of having GI symptoms usually attributed to either functional dyspepsia, IBS, or constipation was 30.4% in patients versus 10.9% in siblings, OR 3.58 (95% confidence interval 1.30 to 9.79). The prevalence of constipation was 22.5% in patients and 4.3% in siblings, OR 6.41 (95% confidence interval 1.45 to 28.24). The use of laxatives was 16% (n = 16) in patients and 2% (n = 1) in siblings.

Conclusions:

Overall, GI symptoms attributed to functional dyspepsia, IBS or constipation are more common in 4 to 17‐year‐olds with NF1 when compared with their unaffected siblings. The high prevalence indicates that GI dysfunction in NF1 is not functional but may be part of the underlying NF1 disorder.
Derivation and Internal Validation of a Mortality Prediction Tool for Initial Survivors of Pediatric In-Hospital Cardiac Arrest*
Authors: Holmberg Mathias J. , Moskowitz Ari , Raymond Tia T. , Berg Robert A. , Nadkarni Vinay M. , Topjian Alexis A. , Grossestreuer Anne V. , Donnino Michael W. , Andersen Lars W.
Published: December 2017

Objectives:

To develop a clinical prediction score for predicting mortality in children following return of spontaneous circulation after in-hospital cardiac arrest.

Design:

Observational study using prospectively collected data.

Setting:

This was an analysis using data from the Get With The Guidelines-Resuscitation registry between January 2000 and December 2015.

Patients:

Pediatric patients (< 18 yr old) who achieved return of spontaneous circulation.

Interventions:

None.

Measurements and Main Results:

The primary outcome was in-hospital mortality. Patients were divided into a derivation (3/4) and validation (1/4) cohort. A prediction score was developed using a multivariable logistic regression model with backward selection. Patient and event characteristics for the derivation cohort (n = 3,893) and validation cohort (n = 1,297) were similar. Seventeen variables associated with the outcome remained in the final reduced model after backward elimination. Predictors of in-hospital mortality included age, illness category, pre-event characteristics, arrest location, day of the week, nonshockable pulseless rhythm, duration of chest compressions, and interventions in place at time of arrest. The C-statistic for the final score was 0.77 (95% CI, 0.75–0.78) in the derivation cohort and 0.77 (95% CI, 0.74–0.79) in the validation cohort. The expected versus observed mortality plot indicated good calibration in both the derivation and validation cohorts. The score showed a stepwise increase in mortality with an observed mortality of less than 15% for scores 0–9 and greater than 80% for scores greater than or equal to 25. The model also performed well for neurologic outcome and in sensitivity analyses for events within the past 5 years and for patients with or without a pulse at the onset of chest compressions.

Conclusions:

We developed and internally validated a prediction score for initial survivors of pediatric in-hospital cardiac arrest. This prediction score may be useful for prognostication following cardiac arrest, stratifying patients for research, and guiding quality improvement initiatives.
Latest Advances in Ultrasound Assessment of Salivary Glands in Sjögren Syndrome
Authors: Martire María Victoria , Santiago María Lida , Cazenave Tomas , Gutierrez Marwin
Published: December 2017

Objective

There are different imaging techniques to assess the parotid glands (i.e., sialography, salivary gland scintigraphy) in patients with Sjögren syndrome (SS). However, their use is limited by the invasive character or high cost. Ultrasound (US) is gaining interest by rheumatologists as a complementary diagnostic tool for SS. To date, there is an increasing body of evidence supporting its sensitivity in the assessment of salivary glands in SS. The aim of our study was to analyze the potential role of US as a diagnostic and prognostic tool in SS and to discuss existing evidence to support its application use.

Methods

A systematic search was performed in the electronic database PubMed, using the following search terms: (salivary glands OR parotid glands OR submandibular glands) AND Sjögren's syndrome AND (ultrasonography OR ultrasound OR sonography). Titles, abstracts, and full reports were systematically screened.

Results

The results of the studies analyzed in this review show encouraging results in terms of accuracy, validity, and diagnostic value, which leads us to believe that in the future US could become the reference imaging tool to assess SS. The studies include a small cohort of patients, and there is no standardized approach in terms of US techniques for the assessment of salivary glands.

Conclusions

Ultrasound of major salivary glands is a useful tool for diagnosis, prognostic evaluation, and response to treatment in SS. The use of this imaging technology is still under development, and more multicentric studies are needed to validate this tool.
Genome-wide Discovery of a Novel Gene-expression Signature for the Identification of Lymph Node Metastasis in Esophageal Squamous Cell Carcinoma
Authors: Sonohara Fuminori , Gao Feng , Iwata Naoki , Kanda Mitsuro , Koike Masahiko , Takahashi Naoki , Yamada Yasuhide , Kodera Yasuhiro , Wang Xin , Goel Ajay
Published: December 2017

Objective:

This study aimed to develop a gene-expression signature for identification of lymph node (LN) metastasis in esophageal squamous cell carcinoma (ESCC) patients.

Summary of Background Data:

LN metastasis is recognized as the most important independent risk factor for therapeutic decision-making of ESCC patients.

Methods:

A bioinformatic approach was used to analyze RNA sequencing profiles of ESCC patients, and to develop a gene-expression signature for identifying LN metastasis. The robustness of this panel was assessed in 2 independent patient cohorts (n = 56 and 224).

Results:

We initially prioritized a 16-gene signature out of the total 20,531 mRNAs. The model estimated by these 16 genes discriminated LN status with an area under the curve (AUC) of 0.77 [95% confidence interval (95% CI), 0.68–0.87, 5-fold cross-validation]. Subsequently, a reduced and optimized 5-gene panel was trained in a clinical cohort, which effectively distinguished ESCC patients with LN metastasis (cohort-1: AUC, 0.74; 95% CI, 0.58–0.89; cohort-2, T1-T2: AUC, 0.74; 95% CI, 0.63–0.86), and was significantly superior to preoperative computed tomography (AUC, 0.61; 95% CI, 0.50–0.72). Furthermore, a combination signature comprising of the 5-gene panel together with the lymphatic vessel invasion (LVI) and venous invasion (VI) demonstrated a significantly improved diagnostic performance compared with individual clinical variables, in both cohorts (cohort-1: AUC, 0.87; 95% CI, 0.78–0.96; cohort-2: AUC, 0.76; 95% CI, 0.65–0.88).

Conclusion:

Our novel 5-gene panel is a robust diagnostic tool for LN metastasis, especially in early-T stage ESCC patients, with a promising clinical potential.
Genome-wide discovery of somatic coding and regulatory variants in Diffuse Large B-cell Lymphoma
Authors: Arthur Sarah , Jiang Aixiang , Grande Bruno M. , Alcaide Miguel , Mottok Anja , Ennishi Daisuke , Rushton Christopher , Jessa Selin , Lat Prince Kumar , Pararajalingam Prasath , Meissner Barbara , Boyle Merrill , Chong Lauren , Lai Daniel , Farinha Pedro , Slack Graham W. , Davidson Jordan , Bushell Kevin R. , Shah Sohrab , Sen Dipankar , Jones Steven J.M. , Mungall Andrew J. , Gascoyne Randy D. , Marra Marco A. , Steidl Christian , Connors Joseph M. , Scott David W. , Morin Ryan D.
Published: December 2017

Diffuse large B-cell lymphoma (DLBCL) is an aggressive cancer originating from mature B-cells. Many known driver mutations are over-represented in one of its two molecular subgroups, knowledge of which has aided in the development of therapeutics that target these features. The heterogeneity of DLBCL determined through prior genomic analysis suggests an incomplete understanding of its molecular aetiology, with a limited diversity of genetic events having thus far been attributed to the activated B-cell (ABC) subgroup. Through an integrative genomic analysis we uncovered genes and non-coding loci that are commonly mutated in DLBCL including putative regulatory sequences. We implicate recurrent mutations in the 3’UTR of NFKBIZ as a novel mechanism of oncogene deregulation and found small amplifications associated with over-expression of FC-γ receptor genes. These results inform on mechanisms of NF-κB pathway activation in ABC DLBCL and may reveal a high-risk population of patients that might not benefit from standard therapeutics.
Transcriptome Analysis of Adult C. elegans Cells Reveals Tissue-specific Gene and Isoform Expression
Authors: Kaletsky Rachel , Yao Vicky , Williams April , Runnels Alexi M. , King Sean B. , Tadych Alicja , Zhou Shiyi , Troyanskaya Olga G. , Murphy Coleen T.
Published: December 2017

The biology and behavior of adults differ substantially from those of developing animals, and cell-specific information is critical for deciphering the biology of multicellular animals. Thus, adult tissue-specific transcriptomic data are critical for understanding molecular mechanisms that control their phenotypes. We used adult cell-specific isolation to identify the transcriptomes of C. elegans’ four major tissues (or “tissue-ome”), identifying ubiquitously expressed and tissue-specific “super-enriched” genes. These data newly reveal the hypodermis’ metabolic character, suggest potential worm-human tissue orthologies, and identify tissue-specific changes in the Insulin/IGF-1 signaling pathway. Tissue-specific alternative splicing analysis identified a large set of collagen isoforms and a neuron-specific CREB isoform. Finally, we developed a machine learning-based prediction tool for 70 sub-tissue cell types, which we used to predict cellular expression differences in IIS/FOXO signaling, stage-specific TGF-b activity, and basal vs. memory-induced CREB transcription. Together, these data provide a rich resource for understanding the biology governing multicellular adult animals
A Genetic Pathway Composed of EDT1/HDG11, ERECTA, and E2Fa Loci Regulates Water Use Efficiency by Modulating Stomatal Density
Authors: Guo Xiao-Yu , Wang Yao , Xu Ping , Yu Guo-Hua , Zhang Li-Yong , Xiong Yan , Xiang Cheng-Bin
Published: December 2017

Improvement of crop drought resistance and water use efficiency (WUE) has been a major endeavor in agriculture. ERECTA is the first identified major effector of water use efficiency. However, the underlying molecular mechanism is not well understood. Here, we report a genetic pathway, composed of EDT1/HDG11, ERECTA, and E2Fa loci, which regulates water use efficiency by modulating stomatal density. The HD-START transcription factor EDT1/HDG11 transcriptionally activates ERECTA expression by binding to an HD cis-element in the ERECTA promoter. ERECTA in turn relies on E2Fa to control the expression of cell-cycle related genes and the transition from mitosis to endocycle, which leads to increased nuclear DNA content in leaf cells, and therefore increased cell size and decreased stomatal density. The decreased stomatal density improves plant WUE. Our study demonstrates the EDT1/HDG11-ERECTA-E2Fa genetic pathway that reduces stomatal density by increasing cell size, providing a new avenue to improve WUE of crops.
Female grant applicants are equally successful when peer reviewers assess the science, but not when they assess the scientist
Authors: Witteman Holly O. , Hendricks Michael , Straus Sharon , Tannenbaum Cara
Published: December 2017

Background

Previous research shows that men often receive more research funding than women, but does not provide empirical evidence as to why this occurs. In 2014, the Canadian Institutes of Health Research (CIHR) created a natural experiment by dividing all investigator-initiated funding into two new grant programs: one with and one without an explicit review focus on the caliber of the principal investigator.

Methods

We analyzed application success among 23,918 grant applications from 7,093 unique principal investigators in a 5-year natural experiment across all investigator-initiated CIHR grant programs in 2011-2016. We used Generalized Estimating Equations to account for multiple applications by the same applicant and an interaction term between each principal investigator’s self-reported sex and grant programs to compare success rates between male and female applicants under different review criteria.

Results

The overall grant success rate across all competitions was 15.8%. After adjusting for age and research domain, the predicted probability of funding success in traditional programs was 0.9 percentage points higher for male than for female principal investigators (OR 0.934, 95% CI 0.854-1.022). In the new program focused on the proposed science, the gap was 0.9 percentage points in favour of male principal investigators (OR 0.998, 95% CI 0.794-1.229). In the new program with an explicit review focus on the caliber of the principal investigator, the gap was 4.0 percentage points in favour of male principal investigators (OR 0.705, 95% CI 0.519- 0.960).

Interpretation

This study suggests gender gaps in grant funding are attributable to less favourable assessments of women as principal investigators, not differences in assessments of the quality of science led by women. We propose ways for funders to avoid allowing gender bias to influence research funding.

Funding

This study was unfunded.
Slightly deleterious genomic variants and transcriptome perturbations in Down syndrome embryonic selection
Authors: Popadin Konstantin , Peischl Stephan , Garieri Marco , Sailani M. Reza , Letourneau Audrey , Santoni Federico , Lukowski Samuel W. , Bazykin Georgii A. , Nikolaev Sergey , Meyer Diogo , Excoffier Laurent , Reymond Alexandre , Antonarakis Stylianos E.
Published: December 2017

The majority of aneuploid fetuses are spontaneously miscarried. Nevertheless, some aneuploid individuals survive despite the strong genetic insult. Here, we investigate if the survival probability of aneuploid fetuses is affected by the genome-wide burden of slightly deleterious variants. We analyzed two cohorts of live-born Down syndrome individuals (388 genotyped samples and 16 fibroblast transcriptomes) and observed a deficit of slightly deleterious variants on Chromosome 21 and decreased transcriptome-wide variation in the expression level of highly constrained genes. We interpret these results as signatures of embryonic selection, and propose a genetic handicap model whereby an individual bearing an extremely severe deleterious variant (such as aneuploidy) could escape embryonic lethality if the genome-wide burden of slightly deleterious variants is sufficiently low. This approach can be used to study the composition and effect of the numerous slightly deleterious variants in humans and model organisms.
ASEAN’s flagship universities and regional integration initiatives
Authors: Sirat Morshidi
Published: December 2017

Purpose

The purpose of this paper is to examine the role of Association of Southeast Asian Nations’ (ASEAN) flagship universities in moving the agenda of regional integration forward through academic/research collaboration and cooperation.

Design/methodology/approach

Flagship universities are leading universities in the national higher education systems of countries that make up the ASEAN. This study on the ASEAN’s flagship universities is based on a three-pronged strategy, namely, a literature review, analysis of websites contents, and citation of supporting pieces of evidence from other relevant studies to support arguments. Using the QS top universities in Asia 2016 listing, top 70 public universities in ASEAN were selected for investigation. In instances where public universities in a particular ASEAN country were not listed in the QS listing, a premier public university of that country was then selected for investigation.

Findings

There is a tendency for ASEAN’s flagship universities to look beyond ASEAN, primarily to establish vertical collaboration, which is important to their efforts in creating their image and enhancing their reputation. As a result, academic/research collaboration among flagship universities and collaboration between these universities and other universities in ASEAN is glaringly on the low side. Interestingly, to move the regional integration agenda in ASEAN, other intermediary agencies outside of ASEAN, such as in the European Union, are very active in providing a platform for both flagship and non-flagship universities to collaborate.

Originality/value

While regional collaboration and cooperation within ASEAN and East Asia have been discussed elsewhere, this paper has utilised and expanded Douglass’ (2016) idea of flagship universities to include regional relevance for the purpose of regional integration of ASEAN.
Online traceability for halal product information: perceptions of Muslim consumers in Indonesia
Authors: Sayogo Djoko Sigit
Published: December 2017

Purpose

This paper aims to provide a preliminary understanding of factors that contribute to consumer perceptions of value and usefulness regarding online traceability for product compliance to halal principles.

Design/methodology/approach

In total, 160 usable questionnaires were obtained from a large Muslim University in Indonesia through a survey. The data were tested using a multivariate regression analysis.

Findings

The current study suggests that Muslim consumers in Indonesia perceive the ability to trace a product’s compliance to halal principles as useful and important. The Muslim consumer’s perception of online traceability as useful is influenced by three main factors: the consumer’s disposition to trust, a healthy lifestyle and the reputation of the company, as well as the certification bodies.

Social implications

The findings suggest that information and communication technologies play an instrumental role in facilitating smart food safety policies by fostering positive changes in consumer behavior, specifically in supporting halal and healthy consumption.

Originality/value

Online traceability for halal product is a novel issue that is yet to be examined empirically in the context of Indonesia. This research should be of value to those who have an interest in assessing the importance of online traceability to enhance assessment of product information, particularly in developing countries.