bluuebunny/crossref_metadata_2025 huggingface dataset:
Fuzzy‐PI‐based sensorless frequency and voltage controller for doubly fed induction generator connected to a DC microgrid
Authors: Bayhan Sertac , Demirbas Sevki , Abu‐Rub Haitham
Published: April 2016

This study presents fuzzy‐proportional–integral (PI)‐based sensorless frequency and voltage control strategy for doubly fed induction generator connected to a dc microgrid system. A significant reduction of the costs can be achieved by this topology because only a single dc/ac converter and a diode rectiﬁer are required instead of the traditional back‐to‐back converter topology. To improve the performance of the rotor current controller, a fuzzy PI‐based control algorithm is used. Furthermore, a simple sensorless control technique based on the detection of the stator frequency is employed to detect the rotor position. The sensorless control technique can operate without the knowledge of the machine parameters. The main aim of this study is to keep the stator frequency as well as the dc bus voltage at the desired value under different load and wind speed conditions without using position sensor. Simulation and experimental studies were performed to verify the dynamic and steady‐state performances of the proposed control strategy The results show that the proposed strategy not only has an excellent steady state and dynamic performance, but also it is robust against the variation of system parameters such as wind speed and load.
Long-range forces affecting equilibrium inertial focusing behavior in straight high aspect ratio microfluidic channels
Authors: Reece Amy E. , Oakey John
Published: April 2016

The controlled and directed focusing of particles within flowing fluids is a problem of fundamental and technological significance. Microfluidic inertial focusing provides passive and precise lateral and longitudinal alignment of small particles without the need for external actuation or sheath fluid. The benefits of inertial focusing have quickly enabled the development of miniaturized flow cytometers, size-selective sorting devices, and other high-throughput particle screening tools. Straight channel inertial focusing device design requires knowledge of fluid properties and particle-channel size ratio. Equilibrium behavior of inertially focused particles has been extensively characterized and the constitutive phenomena described by scaling relationships for straight channels of square and rectangular cross section. In concentrated particle suspensions, however, long-range hydrodynamic repulsions give rise to complex particle ordering that, while interesting and potentially useful, can also dramatically diminish the technique’s effectiveness for high-throughput particle handling applications. We have empirically investigated particle focusing behavior within channels of increasing aspect ratio and have identified three scaling regimes that produce varying degrees of geometrical ordering between focused particles. To explore the limits of inertial particle focusing and identify the origins of these long-range interparticle forces, we have explored equilibrium focusing behavior as a function of channel geometry and particle concentration. Experimental results for highly concentrated particle solutions identify equilibrium thresholds for focusing that scale weakly with concentration and strongly with channel geometry. Balancing geometry mediated inertial forces with estimates for interparticle repulsive forces now provide a complete picture of pattern formation among concentrated inertially focused particles and enhance our understanding of the fundamental limits of inertial focusing for technological applications.
Trap state passivation improved hot-carrier instability by zirconium-doping in hafnium oxide in a nanoscale n-metal-oxide semiconductor-field effect transistors with high-k/metal gate
Authors: Liu Hsi-Wen , Chang Ting-Chang , Tsai Jyun-Yu , Chen Ching-En , Liu Kuan-Ju , Lu Ying-Hsin , Lin Chien-Yu , Tseng Tseung-Yuen , Cheng Osbert , Huang Cheng-Tung , Ye Yi-Han
Published: April 2016

This work investigates the effect on hot carrier degradation (HCD) of doping zirconium into the hafnium oxide high-k layer in the nanoscale high-k/metal gate n-channel metal-oxide-semiconductor field-effect-transistors. Previous n-metal-oxide semiconductor-field effect transistor studies demonstrated that zirconium-doped hafnium oxide reduces charge trapping and improves positive bias temperature instability. In this work, a clear reduction in HCD is observed with zirconium-doped hafnium oxide because channel hot electron (CHE) trapping in pre-existing high-k bulk defects is the main degradation mechanism. However, this reduced HCD became ineffective at ultra-low temperature, since CHE traps in the deeper bulk defects at ultra-low temperature, while zirconium-doping only passivates shallow bulk defects.
On the kinetics of dendritic sidebranching: A three dimensional phase field study
Authors: Shang Shan , Guo Zhipeng , Han Zhiqiang
Published: April 2016

The underlying mechanism for dendritic sidebranching was studied using 3-D phase field modeling. Results showed that in 3-D the requirement of applying the random thermal noise to induce dendritic sidebranching (i.e., normally the case for 2-D phase field simulations) was fully relaxed. The stretching of the secondary or higher order arms occurred spontaneously and symmetrically as the growth of the dendrite. With periodic external perturbation and if the stimulating frequency was lower than a critical value, both tip velocity and sidebranching would get completely synchronized with the perturbation. Whereas if the perturbation frequency was higher than the critical value, rather than increasing, the sidebranching frequency would become stable and maintain at the same magnitude as that of the natural sidebranching, i.e., when no external perturbation was applied. It was shown that the underlying mechanism for sidebranching was deterministic rather than stochastic, and anisotropy tendency and curvature effect were shown to be the most important influence factors. Moreover, the difference of the anisotropy tendency would lead to an uneven distribution of curvature on the solid/liquid interface, i.e., formation of concave and convex geometries. The growth of these geometries would subsequently break the initial spherical structure of solid seed and lead to further sidebranching.
Orientational relaxations in solid (1,1,2,2)tetrachloroethane
Authors: Tripathi P. , Mitsari E. , Romanini M. , Serra P. , Tamarit J. Ll. , Zuriaga M. , Macovez R.
Published: April 2016

We employ dielectric spectroscopy and molecular dynamic simulations to investigate the dipolar dynamics in the orientationally disordered solid phase of (1,1,2,2)tetrachloroethane. Three distinct orientational dynamics are observed as separate dielectric loss features, all characterized by a simply activated temperature dependence. The slower process, associated to a glassy transition at 156 ± 1 K, corresponds to a cooperative motion by which each molecule rotates by 180° around the molecular symmetry axis through an intermediate state in which the symmetry axis is oriented roughly orthogonally to the initial and final states. Of the other two dipolar relaxations, the intermediate one is the Johari-Goldstein precursor relaxation of the cooperative dynamics, while the fastest process corresponds to an orientational fluctuation of single molecules into a higher-energy orientation. The Kirkwood correlation factor of the cooperative relaxation is of the order of one tenth, indicating that the molecular dipoles maintain on average a strong antiparallel alignment during their collective motion. These findings show that the combination of dielectric spectroscopy and molecular simulations allows studying in great detail the orientational dynamics in molecular solids.
Observation of turnover of spontaneous polarization in ferroelectric layer of pentacene/poly-(vinylidene-trifluoroethylene) double-layer capacitor under photo illumination by optical second-harmonic generation measurement
Authors: Shi Zhemin , Taguchi Dai , Manaka Takaaki , Iwamoto Mitsumasa
Published: April 2016

The details of turnover process of spontaneous polarization and associated carrier motions in indium-tin oxide/poly-(vinylidene-trifluoroethylene)/pentacene/Au capacitor were analyzed by coupling displacement current measurement (DCM) and electric-field-induced optical second-harmonic generation (EFISHG) measurement. A model was set up from DCM results to depict the relationship between electric field in semiconductor layer and applied external voltage, proving that photo illumination effect on the spontaneous polarization process lied in variation of semiconductor conductivity. The EFISHG measurement directly and selectively probed the electric field distribution in semiconductor layer, modifying the model and revealing detailed carrier behaviors involving photo illumination effect, dipole reversal, and interfacial charging in the device. A further decrease of DCM current in the low voltage region under illumination was found as the result of illumination effect, and the result was argued based on the changing of the total capacitance of the double-layer capacitors.
Electric field induced lattice strain in pseudocubic Bi(Mg1/2Ti1/2)O3-modified BaTiO3-BiFeO3 piezoelectric ceramics
Authors: Fujii Ichiro , Iizuka Ryo , Nakahira Yuki , Sunada Yuya , Ueno Shintaro , Nakashima Kouichi , Magome Eisuke , Moriyoshi Chikako , Kuroiwa Yoshihiro , Wada Satoshi
Published: April 2016

Contributions to the piezoelectric response in pseudocubic 0.3BaTiO3-0.1Bi(Mg1/2Ti1/2)O3-0.6BiFeO3 ceramics were investigated by synchrotron X-ray diffraction under electric fields. All of the lattice strain determined from the 110, 111, and 200 pseudocubic diffraction peaks showed similar lattice strain hysteresis that was comparable to the bulk butterfly-like strain curve. It was suggested that the hysteresis of the lattice strain and the lack of anisotropy were related to the complex domain structure and the phase boundary composition.
Fabrication of flexible ultraviolet photodetectors using an all-spray-coating process
Authors: Han Junebeom , Lee Jonghun , Ju Sanghyun
Published: April 2016

We report on a flexible ultraviolet (UV) photodetector fabricated using an all-spray-coating process. Two spray coating units were utilized to deposit semiconducting tin oxide nanowires as an active channel layer and metallic silver nanowires as an electrode layer. The device was mounted on the back of a human hand, and the UV intensities in sunlight were monitored over time. The fabricated flexible UV photodetector showed highly sensitive, stable, and reproducible detection properties. The main advantage of the proposed fabrication method is the extension of the integration environment by allowing direct application on various substrates, such as clothes and human skin, with varying device size and shape.
Fresnel analysis of Kretschmann geometry with a uniaxial crystal layer on a three-layered film
Authors: Hung Yu-Ju , Yen Yin-Rui , Lin I-Sheng
Published: April 2016

The use of total internal reflection within the prism coupling scheme is a simple approach to the generation of surface plasmon polariton waves on a metal/dielectric interface. Unfortunately, an anisotropic layer on a metallic film complicates the derivation of resonance angle. In this study, we present clear Fresnel analysis of a liquid crystal film on a metal surface. Few current simulation packages enable the analysis of multiple layers with a single anisotropic layer. The proposed formulation process is applicable to multi-layered structures.
Optimization of BaZrO3 concentration as secondary phase in superconducting YBa2Cu3O7 for high current applications
Authors: Malik Bilal A. , Malik Manzoor A. , Asokan K.
Published: April 2016

We report the superconducting state properties of YBa2Cu3O7 (YBCO) on introduction of BaZrO3 (BZO) as a secondary phase. YBCO+xBZO (x= 0, 2, 4, 6, and 10 wt%) composite samples were prepared by solid state reaction method and characterized for structural, morphological and superconducting properties. X-ray diffraction confirms the increased crystallinity and images of scanning electron microscopy measurement show an increase in both grain size and grain connectivity on addition of BZO in YBCO. These effects are well pronounced in an applied magnetic field. Critical current density, JC, as well as the pinning force peaks at 4% of BZO concentration showed significant difference. A three-fold enhancement in JC and a six-fold enhancement in pinning force were observed at this optimum BZO concentration. This has been attributed to the pinning of flux lines in YBCO due to introduction of BZO as a secondary phase. These results show that this composite has potential application in high current applications.
Proteome of equine oviducal fluid: effects of ovulation and pregnancy
Authors: Smits Katrien , Nelis Hilde , Van Steendam Katleen , Govaere Jan , Roels Kim , Ververs Cyrillus , Leemans Bart , Wydooghe Eline , Deforce Dieter , Van Soom Ann
Published: April 2016

The equine oviduct plays a pivotal role in providing the optimal microenvironment for early embryonic development, but little is known about the protein composition of the oviducal fluid in the horse. The aim of the present study was to provide a large-scale identification of proteins in equine oviducal fluid and to determine the effects of ovulation and pregnancy. Four days after ovulation, the oviducts ipsilateral and contralateral to the ovulation side were collected from five pregnant and five non-pregnant mares. Identification and relative quantification of proteins in the oviducal fluid of the four groups was achieved by isobaric tags for relative and absolute quantification (iTRAQ) labelling and HPLC–tandem mass spectrometry. The presence of an embryo in the ipsilateral oviducal fluid of pregnant mares induced upregulation of 11 and downregulation of two proteins compared with the contralateral side, and upregulation of 19 proteins compared with the ipsilateral side of non-pregnant mares. Several of these upregulated proteins are related to early pregnancy in other species. The present study represents the first high-throughput identification of proteins in the oviducal fluid of the mare. The results support the hypothesis that the equine embryo interacts with the oviduct, affecting the maternal secretion pattern of proteins involved in pregnancy-related pathways.
What drives forest fire in Fujian, China? Evidence from logistic regression and Random Forests
Authors: Guo Futao , Wang Guangyu , Su Zhangwen , Liang Huiling , Wang Wenhui , Lin Fangfang , Liu Aiqin
Published: April 2016

We applied logistic regression and Random Forest to evaluate drivers of fire occurrence on a provincial scale. Potential driving factors were divided into two groups according to scale of influence: ‘climate factors’, which operate on a regional scale, and ‘local factors’, which includes infrastructure, vegetation, topographic and socioeconomic data. The groups of factors were analysed separately and then significant factors from both groups were analysed together. Both models identified significant driving factors, which were ranked in terms of relative importance. Results show that climate factors are the main drivers of fire occurrence in the forests of Fujian, China. Particularly, sunshine hours, relative humidity (fire seasonal and daily), precipitation (fire season) and temperature (fire seasonal and daily) were seen to play a crucial role in fire ignition. Of the local factors, elevation, distance to railway and per capita GDP were found to be most significant. Random Forest demonstrated a higher predictive ability than logistic regression across all groups of factors (climate, local, and climate and local combined). Maps of the likelihood of fire occurrence in Fujian illustrate that the high fire-risk zones are distributed across administrative divisions; consequently, fire management strategies should be devised based on fire-risk zones, rather than on separate administrative divisions.
Interactions between Hatch Dates, Growth Rates, and Mortality of Age‐0 Native Rainbow Smelt and Nonnative Alewife in Lake Champlain
Authors: Simonin Paul W. , Parrish Donna L. , Rudstam Lars G. , Pientka Bernard , Sullivan Patrick J.
Published: April 2016

Timing of hatch in fish populations can be critical for first‐year survival and, therefore, year‐class strength and subsequent species interactions. We compared hatch timing, growth rates, and subsequent mortality of age‐0 Rainbow Smelt Osmerus mordax and Alewife Alosa pseudoharengus, two common open‐water fish species of northern North America. In our study site, Lake Champlain, Rainbow Smelt hatched (beginning May 26) almost a month earlier than Alewives (June 20). Abundance in the sampling area was highest in July for age‐0 Rainbow Smelt and August for age‐0 Alewives. Late‐hatching individuals of both species grew faster than those hatching earlier (0.6 mm/d versus 0.4 for Rainbow Smelt; 0.7 mm/d versus 0.6 for Alewives). Mean mortality rate during the first 45 d of life was 3.4%/d for age‐0 Rainbow Smelt and was 5.5%/d for age‐0 Alewives. Alewife mortality rates did not differ with hatch timing but daily mortality rates of Rainbow Smelt were highest for early‐hatching fish. Cannibalism is probably the primary mortality source for age‐0 Rainbow Smelt in this lake. Therefore, hatching earlier may not be advantageous because the overlap of adult and age‐0 Rainbow Smelt is highest earlier in the season. However, Alewives, first documented in Lake Champlain in 2003, may increase the mortality of age‐0 Rainbow Smelt in the summer, which should favor selection for earlier hatching.

Received October 16, 2015; accepted January 12, 2016 Published online April 27, 2016
Couple Beads: An Integrated Method of Natural Family Planning
Authors: Mulcaire-Jones George , Fehring Richard J. , Bradshaw Megan , Brower Karen , Lubega Gonzaga , Lubega Paskazia
Published: April 2016

Various fertility indicators are used by natural family planning methods to identify the fertile and infertile phases of a woman's menstrual cycle: mucus observations, cycle-day probabilities, basal body temperature readings, and hormonal measures of LH and estrogen. Simplified NFP methods generally make use of a single fertility indicator such as cycle-day probabilities (Standard Days Method) or mucus observations (Billings Ovulation Method). The Couple Bead Method integrates the two simplest fertility indicators, cycle-day probabilities and mucus observations, expanding its applicability to all women, regardless of cycle regularity and length. In determining cycle-day probabilities, the Couple Bead Method relies on a new data set from ultrasound-derived determinants of gestational age that more directly define the day of conception and the fertile window. By using a visual-based system of inexpensive colored beads, the Couple Bead Method can be used by couples of all educational and income levels.

Lay Summary: Natural family planning methods provide education in regard to the signs of a woman's body which indicate if she is possibly fertile or not. Two important signs are the day of her menstrual cycle and her observations of bleeding and cervical mucus or dryness. The Couple Bead Method teaches a couple how to observe these signs and chart them with a system of colored beads. The Couple Bead Method can be used by women with regular or irregular cycles. The bead sets are inexpensive and consist of a length of plastic cord, colored “pony beads” and safety pins.
Williamson on Fine on Prior on the reduction of possibilist discourse
Authors: Fine Kit
Published: April 2016

I attempt to meet some criticisms that Williamson makes of my attempt to carry out Prior's project of reducing possibility discourse to actualist discourse.
Experience and information loss in auditory and visual memory
Authors: Gloede Michele E. , Paulauskas Emily E. , Gregg Melissa K.
Published: April 2016

Recent studies show that recognition memory for sounds is inferior to memory for pictures. Four experiments were conducted to examine the nature of auditory and visual memory. Experiments 1–3 were conducted to evaluate the role of experience in auditory and visual memory. Participants received a study phase with pictures/sounds, followed by a recognition memory test. Participants then completed auditory training with each of the sounds, followed by a second memory test. Despite auditory training in Experiments 1 and 2, visual memory was superior to auditory memory. In Experiment 3, we found that it is possible to improve auditory memory, but only after 3 days of specific auditory training and 3 days of visual memory decay. We examined the time course of information loss in auditory and visual memory in Experiment 4 and found a trade-off between visual and auditory recognition memory: Visual memory appears to have a larger capacity, while auditory memory is more enduring. Our results indicate that visual and auditory memory are inherently different memory systems and that differences in visual and auditory recognition memory performance may be due to the different amounts of experience with visual and auditory information, as well as structurally different neural circuitry specialized for information retention.
Delayed Diagnosis, Leprosy Reactions, and Nerve Injury Among Individuals With Hansen's Disease Seen at a United States Clinic
Authors: Leon Kristoffer E. , Jacob Jesse T. , Franco-Paredes Carlos , Kozarsky Phyllis E. , Wu Henry M. , Fairley Jessica K.
Published: April 2016

Background.  Hansen's disease (HD), or leprosy, is uncommon in the United States. We sought to describe the characteristics of patients with HD in a US clinic, including an assessment of delays in diagnosis and HD reactions, which have both been associated with nerve damage.

Methods.  A retrospective chart review was conducted on patients seen at an HD clinic in the southern United States between January 1, 2002 and January 31, 2014. Demographic and clinical characteristics were summarized, including delays in diagnosis, frequency of reactions, and other complications including peripheral neuropathy.

Results.  Thirty patients were seen during the study time period. The majority of patients were male (73%) and had multibacillary disease (70%). Brazil, Mexico, and the United States were the most frequent of the 14 countries of origin. Hansen's disease “reactions”, severe inflammatory complications, were identified among 75% of patients, and nerve damage was present at diagnosis in 36% of patients. The median length of time between symptom onset and diagnosis was long at 12 months (range, 1–96), but no single factor was associated with a delay in diagnosis.

Conclusions.  The diagnosis of HD was frequently delayed among patients referred to our US clinic. The high frequency of reactions and neuropathy at diagnosis suggests that further efforts at timely diagnosis and management of this often unrecognized disease is needed to prevent the long-term sequelae associated with irreversible nerve damage.
Parting the Clouds: Three Professionalism Frameworks in Medical Education
Authors: Irby David M. , Hamstra Stanley J.
Published: April 2016

Current controversies in medical education associated with professionalism, including disagreements about curriculum, pedagogy, and assessment, are rooted in part in the differing frameworks that are used to address professionalism. Three dominant frameworks, which have evolved in the medical education community, are described. The oldest framework is virtue based and focuses on the inner habits of the heart, the development of moral character and reasoning, plus humanistic qualities of caring and compassion: The good physician is a person of character. The second framework is behavior based, which emphasizes milestones, competencies, and measurement of observable behaviors: The good physician is a person who consistently demonstrates competence in performing patient care tasks. The third framework is identity formation, with a focus on identity development and socialization into a community of practice: The good physician integrates into his or her identity a set of values and dispositions consonant with the physician community and aspires to a professional identity reflected in the very best physicians. Although each professionalism framework is useful and valid, the field of medical education is currently engaged in several different discourses resulting in misunderstanding and differing recommendations for strategies to facilitate professionalism. In this article, the assumptions and contributions of each framework are described to provide greater insight into the nature of professionalism. By examining each discourse in detail, underlying commonalities and differences can be highlighted to assist educators in more effectively creating professionalism curricula, pedagogy, and assessment.
Why July Matters
Authors: Petrilli Christopher M. , Del Valle John , Chopra Vineet
Published: April 2016

Each July, new graduates from premedical, medical, and residency programs, along with junior and midcareer faculty, acclimatize to their changing roles. During this month, overall efficiency, quality, and patient safety may suffer, a problem dubbed the “July effect.” The many transitions that occur in teaching hospitals during July are often implicated as the root cause of this problem. The question, then, of how best to improve the team-based clinical care provided in July remains important. In this Commentary, the authors outline a model that combines the team-based care paradigm with effective leadership, followership, and communication-based strategies and propose some actionable steps.

A key first step to enhancing patient safety in July is improving effective leadership through use of a select group of attendings whose teaching style empowers learners within a framework of close supervision. Second, programmatic efforts to pair these leaders with good followers are needed. Senior residents in July should be selected on their ability to mentor, guide, and support interns. Third, a system of free-flowing, bidirectional communication must be nurtured to ensure optimal outcomes. Adapting strategies from the airlines (e.g., interdisciplinary conferences to discuss optimal patient care approaches; checklists for daily activities such as sign-outs; directed feedback and debriefing techniques emphasizing actionable areas for improvement) is promising and worth studying.

Available data suggest that the “July effect” is real. Developing new and exploring existing approaches for allaying this phenomenon are important areas of further investigation.
Caring to Care: Applying Noddings’ Philosophy to Medical Education
Authors: Balmer Dorene F. , Hirsh David A. , Monie Daphne , Weil Henry , Richards Boyd F.
Published: April 2016

The authors argue that Nel Noddings’ philosophy, “an ethic of caring,” may illuminate how students learn to be caring physicians from their experience of being in a caring, reciprocal relationship with teaching faculty. In her philosophy, Noddings acknowledges two important contextual continuities: duration and space, which the authors speculate exist within longitudinal integrated clerkships. In this Perspective, the authors highlight core features of Noddings’ philosophy and explore its applicability to medical education. They apply Noddings’ philosophy to a subset of data from a previously published longitudinal case study to explore its “goodness of fit” with the experience of eight students in the 2012 cohort of the Columbia-Bassett longitudinal integrated clerkship. In line with Noddings’ philosophy, the authors’ supplementary analysis suggests that students (1) recognized caring when they talked about “being known” by teaching faculty who “cared for” and “trusted” them; (2) responded to caring by demonstrating enthusiasm, action, and responsibility toward patients; and (3) acknowledged that duration and space facilitated caring relations with teaching faculty. The authors discuss how Noddings’ philosophy provides a useful conceptual framework to apply to medical education design and to future research on caring-oriented clinical training, such as longitudinal integrated clerkships.
A Hybrid Interview Model for Medical School Interviews: Combining Traditional and Multisampling Formats
Authors: Bibler Zaidi Nikki L. , Santen Sally A. , Purkiss Joel A. , Teener Carol A. , Gay Steven E.
Published: April 2016

Problem

Most medical schools have either retained a traditional admissions interview or fully adopted an innovative, multisampling format (e.g., the multiple mini-interview) despite there being advantages and disadvantages associated with each format.

Approach

The University of Michigan Medical School (UMMS) sought to maximize the strengths associated with both interview formats after recognizing that combining the two approaches had the potential to capture additional, unique information about an applicant. In September 2014, the UMMS implemented a hybrid interview model with six, 6-minute short-form interviews—highly structured scenario-based encounters—and two, 30-minute semistructured long-form interviews. Five core skills were assessed across both interview formats.

Outcomes

Overall, applicants and admissions committee members reported favorable reactions to the hybrid model, supporting continued use of the model. The generalizability coefficients for the six-station short-form and the two-interview long-form formats were estimated to be 0.470 and 0.176, respectively. Different skills were more reliably assessed by different interview formats. Scores from each format seemed to be operating independently as evidenced through moderate to low correlations (r = 0.100–0.403) for the same skills measured across different interview formats; however, after correcting for attenuation, these correlations were much higher.

Next Steps

This hybrid model will be revised and optimized to capture the skills most reliably assessed by each format. Future analysis will examine validity by determining whether short-form and long-form interview scores accurately measure the skills intended to be assessed. Additionally, data collected from both formats will be used to establish baselines for entering students’ competencies.
Variability Over Time of Preoperative Sagittal Alignment Parameters
Authors: Menga Emmanuel N. , Spiegel Matthew A. , Vira Shaleen , Lafage Renaud , Henry Jensen K. , Liabaud Barthelemy , Oren Jonathan H. , Worley Nancy , Schwab Frank J. , Errico Thomas J. , Lafage Virginie , Protopsaltis Themistocles S.
Published: April 2016

Study Design.

Retrospective review.

Objective.

To evaluate preoperative variability in radiographic sagittal parameters in adult spinal deformity (ASD).

Summary of Background Data.

In ASD surgical planning, deformity magnitude is determined from preoperative radiographs. There are no studies evaluating the clinical relevance and timing to repeat radiographs during interval clinic visits and timing to repeat radiograph for preoperative planning.

Methods.

A total of 139 patients with ASD with minimum two preoperative full-body spine x-rays were included. Cervical, thoracic, lumbar, pelvic, and hip/knee sagittal alignment parameters were analyzed using dedicated spine measurement software. Patients were grouped by time intervals between x-rays: A: 8 weeks or lesser, B: 10 to 20 weeks, and C: 21 weeks or more. Changes in sagittal parameters were correlated to age and deformity magnitude (T1 pelvic angle or pelvic tilt [PT] >20°).

Results.

The cohort had mean age 59 years, mean body mass index 27, 30% men, 95 patients with no prior spine surgery, and 44 patients at minimum 9 months since prior spine surgery. There were 25 patients in group A, 38 in B, and 71 in C. All radiographic measures showed good time-based consistency at intervals less than 21 weeks (groups A and B). Group C had significant increases in PT (1.5°) and hip extension (2.1°) (P < 0.05). These changes were greater in group C patients with previous surgery (PT 3.7°; P < 0.006, hip extension 3.2°; P < 0.025). Greater interval changes in parameters were also associated with higher magnitudes of deformity and younger patient ages.

Conclusion.

All sagittal radiographic parameters were statistically consistent at intervals of less than 21 weeks. In patients with more than 21 weeks between interval x-rays, change in PT was greater than the standard error of measurement for patients with prior surgery or severe deformity. Consideration should be made to obtain new x-rays for patients with ASD when the interval between clinical visits exceeds 5 months.

Level of Evidence: 4
Health-Related Quality of Life Improves Similarly in Patients With and Without Type 2 Diabetes After Cardiac Rehabilitation
Authors: Wald Caroline M. , Crecelius Anne R.
Published: April 2016

PURPOSE:

Cardiovascular disease is the leading cause of death in the United States and results in substantial healthcare expenditures. Health-related quality of life (HRQoL) is an important aspect in long-term recovery for patients with cardiovascular disease. As such, improvement in HRQoL is a relevant outcome for determining cardiovascular rehabilitation (CR) program efficacy. Increasingly, diabetic patients are participating in CR and face additional challenges to HRQoL, yet there is a lack of research addressing program efficacy in this population. This study tested the hypothesis that CR would effect a favorable change in HRQoL for both diabetic (D; n = 37) and nondiabetic (N-D; n = 58) patients. Furthermore, we tested the hypothesis that the D group would demonstrate a greater overall change compared with the N-D group.

METHODS:

In this retrospective study, we reviewed the charts of 95 patients who completed a CR program and collected HRQoL measures using the COOP questionnaire, where lower scores indicate higher HRQoL.

RESULTS:

After CR, COOP scores for both the N-D improved (pre: 20.39 ± 0.79 vs post: 16.06 ± 0.75; P < .05) and D (pre: 20.92 ± 0.88 vs post: 15.84 ± 0.80; P < .05). HRQoL was not different between groups at the start of the program (P = .88) or at the end (P = .58), and thus, the improvement in HRQoL was not different between groups (P = .44).

CONCLUSIONS:

These results suggest that D and N-D patients do not differ in their HRQoL at the start or end of CR, and that the 2 groups show similar improvements from attending the program. Larger sample studies are needed to confirm these findings.
The effectiveness of external sensory cues in improving functional performance in individuals with Parkinson’s disease: a systematic review with meta-analysis
Authors: Cassimatis Constantine , Liu Karen P.Y. , Fahey Paul , Bissett Michelle
Published: April 2016

A systematic review with meta-analysis was performed to investigate the effect external sensory cued therapy on activities of daily living (ADL) performance that include walking and daily tasks such as dressing for individuals with Parkinson’s disease (PD). A detailed computer-aided search of the literature was applied to MEDLINE, Cumulative Index to Nursing and Allied Health Literature, EMBASE and PubMed. Studies investigating the effects of external sensory cued therapy on ADL performance for individuals with PD in all stages of disease progression were collected. Relevant articles were critically reviewed and study results were synthesized by two independent researchers. A data-analysis method was used to extract data from selected articles. A meta-analysis was carried out for all randomized-controlled trials. Six studies with 243 individuals with PD were included in this review. All six studies yielded positive findings in favour of external sensory cues. The meta-analysis showed that external sensory cued therapy improved statistically after treatment (P=0.011) and at follow-up (P<0.001) for ADL performance. The results of this review provided evidence of an improvement in ADL performance in general in individuals with PD. It is recommended that clinicians incorporate external sensory into a training programme focused on improving daily task performance.
The Association Between Obesity and Hostility: The Mediating Role of Plasma Lipids
Authors: DIMITRIADIS DIMITRIOS G. , MAMPLEKOU EFTERPI , DIMITRIADIS PANAYIOTIS G. , KOMESSIDOU VASSO , PAPAKONSTANTINOU ALEXANDROS , DIMITRIADIS GEORGE D. , PAPAGEORGIOU CHARALAMBOS
Published: April 2016

Objective:

Recent research indicates an association between obesity and psychopathology status, the nature of which remains unclear. We evaluated the mediating role of biochemical disturbances in this association among a treatment-seeking sample of obese individuals.

Method:

The study enrolled 143 consecutive overweight and obese individuals (mean age 35±9 y) and 143 normal-weight controls (mean age 34±9 y), matched by age and sex. We measured psychopathology features using the Symptom Checklist 90-Revised (SCL-90-R), a standardized self-evaluation rating scale, and biochemical parameters (plasma cholesterol, triglyceride, and fasting glucose levels) of all participants. Nonlinear regression models were used to estimate the associations among obesity, psychopathology, and biochemical factors.

Results:

Obesity was associated positively and significantly (P<0.05) with all of the SCL-90-R subscales, with the exception of anxiety and phobic anxiety, as well as with levels of plasma glucose, cholesterol (P<0.01), and triglycerides (P<0.001). Tests for mediation showed that obesity was significantly associated, for the mediators of plasma cholesterol [parameter estimate=−0.033, P<0.05] and triglycerides (parameter estimate=−0.059, P<0.05), only with hostility (parameter estimate=−0.024, P<0.05 and parameter estimate=−0.041, P<0.05, respectively).

Conclusions:

Our data suggest that biological substrates that are critically related to obesity, such as dyslipidemia, may mediate, at least in part, the association between obesity and hostility.
Atomoxetine-related Takotsubo Cardiomyopathy
Authors: NAGUY AHMED , AL-MUTAIRI HAYA , AL-TAJALI ALI
Published: April 2016

Many psychotropic medications target norepinephrine receptors, which can have serious cardiovascular implications, especially in the context of overdoses, polypharmacy, and high-risk populations. This article presents the case of a patient with adult attention-deficit/hyperactivity disorder who developed takotsubo cardiomyopathy subsequent to pharmacokinetic and pharmacodynamic interactions between atomoxetine, a selective norepinephrine reuptake inhibitor, and fluoxetine. Clinicians should be mindful of the potential for cardiovascular adverse effects when prescribing agents that target noradrenergic receptors.
Molecular Ultrasound Imaging of αvβ3-Integrin Expression in Carotid Arteries of Pigs After Vessel Injury
Authors: Rix Anne , Fokong Stanley , Heringer Sarah , Pjontek Rastislav , Kabelitz Lisa , Theek Benjamin , Brockmann Marc-Alexander , Wiesmann Martin , Kiessling Fabian
Published: April 2016

Objectives

Interventions such as balloon angioplasty can cause vascular injury leading to platelet activation, thrombus formation, and inflammatory response. This induces vascular smooth muscle cell activation and subsequent re-endothelialization with expression of αvβ3-integrin by endothelial cells and vascular smooth muscle cell. Thus, poly-N-butylcyanoacrylate microbubbles (MBs) targeted to αvβ3-integrin were evaluated for monitoring vascular healing after vessel injury in pigs using molecular ultrasound imaging.

Materials and Methods

Approval for animal experiments was obtained. The binding specificity of αvβ3-integrin–targeted MB to human umbilical vein endothelial cells was tested with fluorescence microscopy. In vivo imaging was performed using a clinical ultrasound system and an 8-MHz probe. Six mini pigs were examined after vessel injury in the left carotid artery. The right carotid served as control. Uncoated MB, cDRG-coated MB, and αvβ3-integrin–specific cRGD-coated MB were injected sequentially. Bound MBs were assessed 8 minutes after injection using ultrasound replenishment analysis. Measurements were performed 2 hours, 1 and 5 weeks, and 3 and 6 months after injury. In vivo data were validated by immunohistochemistry.

Results

Significantly stronger binding of cRGD-MB than MB and cDRG-MB to human umbilical vein endothelial cells was found (P < 0.01). As vessel injury leads to upregulation of αvβ3-integrin, cRGD-MBs bound significantly stronger (P < 0.05) in injured carotid arteries than at the counter side 1 week after vessel injury and significant differences could also be observed after 5 weeks. After 3 months, αvβ3-integrin expression decreased to baseline and binding of cRGD-MB was comparable in both vessels. Values remained at baseline also after 6 months.

Conclusions

Ultrasound imaging with RGD-MB is promising for monitoring vascular healing after vessel injury. This may open new perspectives to assess vascular damage after radiological interventions.
Impact of an Evidence-Based Practice Intervention on Knowledge and Clinical Practice Behaviors Among Registered Dietitians
Authors: Vogt E. Annelie M. , Byham-Gray Laura D. , Denmark Robert , Touger-Decker Riva
Published: April 2016

Implementation of evidence-based practice in clinical practice is essential for safety, quality, cost, and reimbursement of dietetics services. This prospective randomized controlled trial aimed to measure changes in knowledge and practice behaviors of evidence-based practice after an educational intervention. The ability to interpret statistical results improved significantly in the intervention group. When motivation to change was controlled for over time, a higher total knowledge score was demonstrated in the intervention group. This finding suggests that motivation to change was an important factor for the adoption of evidence-based practice knowledge into clinical practice among registered dietitians.
Two Days With Diabetes
Authors: Gaba Ann , Wong Sally S. , Ghatak Ronita
Published: April 2016

This study examined the impact of an experiential learning project for dietetics students on attitudes toward diabetes management. A questionnaire was used to compare attitudes before and after the project. This questionnaire was also given to a control class. Pre- and postsurvey results diverged between the 2 groups. To further examine the impact of the experimental team, a content analysis was done on journals submitted by the students for the experiential project. The barriers to following the planned diabetes management regimen that emerged from the content analysis were similar to issues reported in the literature from people with diabetes.
Sandwich
Authors: San Mauro Martín Ismael , Gil de Sola Díaz Jose Ignacio , Garicano Vilar Elena
Published: April 2016

Children, adolescents, and adults have dropped foods from the Mediterranean diet in favor of less healthy products. Seventeen nutritional features of sandwiches were calculated for a 2500 kcal diet (5%-10% for midday and afternoon breaks). Ideal reference values of macronutrients were obtained using the Mediterranean diet energy distribution. Sandwiches covering 5% of the total energy were composed of 17.2-g carbohydrates, 4.7-g protein, and 4-g fat; total fat was divided into 1.4-g saturated fatty acids, 1.4-g monounsaturated fatty acids, and 1.8-2.5 g polyunsaturated fatty acids. The composition of the sandwiches covering 10% of the total energy composition was 34-g carbohydrates, 9-g protein, 8-g fat, 2.8-g saturated fatty acids, 2.78-g polyunsaturated fatty acids, and monounsaturated fatty acids. Both types of sandwiches covered 100% of the ideal nutritional recommendations. Sandwiches that conform to the Mediterranean diet pattern are considered healthy options for a balanced diet.
Should Expanded Weight Loss Counseling Include Sleep Counseling and Simple Clinical Tools for Patient Assessment?
Authors: Nantsupawat Nopakoon , Buscemi Dolores , Nugent Kenneth , Limas Nora
Published: April 2016

Sleep restriction is associated with weight gain and chronic medical disorders. We randomized 40 women with body mass indices between 25 and 49 kg/m2 into 2 counseling groups: dietary advice with exercise and dietary advice with exercise and sleep counseling. We measured blood pressure, gait speed, and the Get Up and Go test. The mean age was 43.0 ± 10.4 years; the mean body mass index was 33.4 ± 4.3 kg/m2. Twenty-seven subjects completed 6 visits. There was no difference between the 2 intervention groups in weight loss. Mean blood pressures were within normal limits. Gait speeds increased and Get Up and Go times decreased in the women who completed 6 months of counseling. These tools provide quick assessments of health and physical performance and provide dietitians with additional outcome measurements.
The Registered Dietitian as the Food Allergy Educator for the 6- to 12-Grade Kitchen Staff
Authors: Edelstein Sari , Frankel Farrell , Miller Katie A.
Published: April 2016

Staff education is necessary to prevent severe allergic reactions and respond to food allergy emergencies in schools. In particular, cafeteria staff and kitchen employees need to learn how to minimize known allergens and to recognize the signs of anaphylaxis, a severe allergic reaction that needs to be treated promptly with epinephrine to prevent a possible fatality. As a food expert, the registered dietitian is the knowledgeable professional to provide this training. Based on this premise, we presented a workshop to kitchen staff in a 6- to 12-grade school, including roundtable talks, small breakout sessions, videos, and hands-on demonstrations. The staff members indicated that they felt better prepared to help students with food allergies.
Diagnostic Contribution of Donor-Specific Antibody Characteristics to Uncover Late Silent Antibody-Mediated Rejection—Results of a Cross-Sectional Screening Study
Authors: Eskandary Farsad , Bond Gregor , Kozakowski Nicolas , Regele Heinz , Marinova Lena , Wahrmann Markus , Kikić Željko , Haslacher Helmuth , Rasoul-Rockenschaub Susanne , Kaltenecker Christopher C. , König Franz , Hidalgo Luis G. , Oberbauer Rainer , Halloran Philip F. , Böhmig Georg A.
Published: April 2016

Background

Circulating donor-specific antibodies (DSA) detected on bead arrays may not inevitably indicate ongoing antibody-mediated rejection (AMR). Here, we investigated whether detection of complement-fixation, in parallel to IgG mean fluorescence intensity (MFI), allows for improved prediction of AMR.

Methods

Our study included 86 DSA+ kidney transplant recipients subjected to protocol biopsy, who were identified upon cross-sectional antibody screening of 741 recipients with stable graft function at 6 months or longer after transplantation. IgG MFI was analyzed after elimination of prozone effect, and complement-fixation was determined using C1q, C4d, or C3d assays.

Results

Among DSA+ study patients, 44 recipients (51%) had AMR, 24 of them showing C4d-positive rejection. Although DSA number or HLA class specificity were not different, patients with AMR or C4d + AMR showed significantly higher IgG, C1q, and C3d DSA MFI than nonrejecting or C4d-negative patients, respectively. Overall, the predictive value of DSA characteristics was moderate, whereby the highest accuracy was computed for peak IgG MFI (AMR, 0.73; C4d + AMR, 0.71). Combined analysis of antibody characteristics in multivariate models did not improve AMR prediction.

Conclusions

We estimate a 50% prevalence of silent AMR in DSA+ long-term recipients and conclude that assessment of IgG MFI may add predictive accuracy, without an independent diagnostic advantage of detecting complement-fixation.