bluuebunny/crossref_metadata_2025 huggingface dataset:
Cognitive processes of high intelligence student with autism spectrum disorder in understanding mathematical problems
Authors: Fauziyah N , Budayasa I K , Juniati D , Lant C L
Published: August 2019

The purpose of this study is to describe the cognition processes of an ASD student with a high intelligence quotient (IQ) in understanding mathematical problems. The processes of cognition being studied are the process of receiving, storing, recalling and processing information. The subject of this research is a high IQ autism spectrum disorder (ASD) student. Data was gathered from task-based interviews. The results of this research indicate that in the process of receiving information, the ASD characteristics of the subject were still very visible, such as reading with a flat expression, interspersed laughing and smiling to themselves, repeating certain words and muttering speaking an unclear sentence. In the process of storing and recalling information, the subject: (1) stored and recalled information in the problem in three visual representation forms: images, verbal language and arithmetic symbols, (2) stored and recalled important information, and (3) recalled information that has been stored in his long-term memory by linking it to the concepts in the problems. In processing information, the subject: (1) mentioned the information and the question in the problems, (3) understood the meaning of the symbol in the problems, (4) understood the adequacy of the information in the problems, and (5) was able to reduce the information in the problems.
A Bayesian approach on multicollinearity problem with an Informative Prior
Authors: Jaya I G N M , Tantular B , Andriyana Y
Published: August 2019

Multicollinearity is a severe problem in multiple regression. High collinearity in some explanatory variables leads to the high standard error estimates. It becomes a problem for the hypothesis test on the slope of regression. The ridge regression is the most popular method used to minimize the standard error estimates. However, the hypothesis testing in regression model has been not solved yet. It does not provide the statistical hypothesis test. Therefore, the alternative method is needed. The method must be able to obtain the parameter estimates with a high level of precision and also facilitates the hypothesis test of regression parameters simultaneously. We proposed the Bayesian method with an informative prior as an alternative solution. The Monte Carlo simulation concludes the Bayesian method outperformed to ridge regression in term of Bias, Mean Square Error and power of the test. Based on the simulation result, the Bayesian method can be used to solve hypothesis testing in regression analysis with multicollinearity problem effectively.
A panel data analysis of tourism and economic development in Southeast Asian countries
Authors: Yunitaningtyas K , Yolanda A M , Indahwati
Published: August 2019

Southeast Asia is a strategic region in tourism because of its natural and cultural richness. Thus, tourism ministers of ASEAN countries agreed to launch a joint ten-year plan to make Southeast Asia as one destination package for international tourists. The aim of this plan is to increase the share of tourism to the regional economy by 15 percent in 2025. This paper estimates the relationship between tourism and economic development in ten Southeast Asian countries of Brunei Darussalam, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, and Vietnam using regression analysis of panel data. It tests the effect of tourism factors such as visitor exports, internal travel and tourism consumption, business tourism spending and capital investment in tourism industry on gross domestic product from 2014 to 2016. The best model obtained is fixed effect model and the tourism aspects that have positive significant impact on gross domestic product improvement in Southeast Asian countries are internal travel and tourism consumption also capital investment in tourism industry. Furthermore, the factors that effect gross domestic product negatively are visitor exports and business tourism spending.
A geometric formula for multiplicities of 𝐾-types of tempered representations
Authors: Hochs Peter , Song Yanli , Yu Shilin
Published: August 2019

Let

G
G

be a connected, linear, real reductive Lie group with compact centre. Let

K
>
G

K>G

be compact. Under a condition on

K
K

, which holds in particular if

K
K

is maximal compact, we give a geometric expression for the multiplicities of the

K
K

-types of any tempered representation (in fact, any standard representation)

π
\pi

of

G
G

. This expression is in the spirit of Kirillov’s orbit method and the quantisation commutes with reduction principle. It is based on the geometric realisation of

π

|

K

\pi |_K

obtained in an earlier paper. This expression was obtained for the discrete series by Paradan, and for tempered representations with regular parameters by Duflo and Vergne. We obtain consequences for the support of the multiplicity function, and a criterion for multiplicity-free restrictions that applies to general admissible representations. As examples, we show that admissible representations of

SU

(
p
,
1
)

\textrm {SU}(p,1)

,

SO

0

(
p
,
1
)

\textrm {SO}_0(p,1)

, and

SO

0

(
2
,
2
)

\textrm {SO}_0(2,2)

restrict multiplicity freely to maximal compact subgroups.
Self-adjoint Jacobi matrices on trees and multiple orthogonal polynomials
Authors: Aptekarev Alexander , Denisov Sergey , Yattselev Maxim
Published: August 2019

We consider a set of measures on the real line and the corresponding system of multiple orthogonal polynomials (MOPs) of the first and second type. Under some very mild assumptions, which are satisfied by Angelesco systems, we define self-adjoint Jacobi matrices on certain rooted trees. We express their Green’s functions and the matrix elements in terms of MOPs. This provides a generalization of the well-known connection between the theory of polynomials orthogonal on the real line and Jacobi matrices on

Z

+

\mathbb {Z}_+

to a higher dimension. We illustrate the importance of this connection by proving ratio asymptotics for MOPs using methods of operator theory.
Assessing the Role of Selection Bias in the Protective Relationship Between Caregiving and Mortality
Authors: Smith Meghan L , Heeren Timothy C , Ranker Lynsie R , Fredman Lisa
Published: August 2019

Caregivers have lower mortality rates than noncaregivers in population-based studies, which contradicts the caregiver-stress model and raises speculation about selection bias influencing these findings. We examined possible selection bias due to 1) sampling decisions and 2) selective participation among women (baseline mean age = 79 years) in the Caregiver-Study of Osteoporotic Fractures (Caregiver-SOF) (1999–2009), an ancillary study to the Study of Osteoporotic Fractures (SOF). Caregiver-SOF includes 1,069 SOF participants (35% caregivers) from 4 US geographical areas (Baltimore, Maryland; Minneapolis, Minnesota; the Monongahela Valley, Pennsylvania; and Portland, Oregon). Participants were identified by screening all SOF participants for caregiver status (1997–1999; n = 4,036; 23% caregivers) and rescreening a subset of caregivers and noncaregivers matched on sociodemographic factors 1–2 years later. Adjusted hazard ratios related caregiving to 10-year mortality in all women initially screened, subsamples representing key points in constructing Caregiver-SOF, and Caregiver-SOF. Caregivers had better functioning than noncaregivers at each screening. The association between caregiving and mortality among women invited to participate in Caregiver-SOF (41% died; adjusted hazard ratio (aHR) = 0.73, 95% confidence interval (CI): 0.61, 0.88) was slightly more protective than that in all initially screened women (37% died; aHR = 0.83, 95% CI: 0.73, 0.95), indicating little evidence of selection bias due to sampling decisions, and was similar to that in Caregiver-SOF (39% died; aHR = 0.71, 95% CI: 0.57, 0.89), indicating no participation bias. These results add to a body of evidence that informal caregiving may impart health benefits.
Personality traits covary with individual differences in inhibitory abilities in 2 species of fish
Authors: Lucon-Xiccato Tyrone , Montalbano Giulia , Bertolucci Cristiano
Published: August 2019

In a number of animal species, individuals differ in their ability to solve cognitive tasks. However, the mechanisms underlying this variability remain unclear. It has been proposed that individual differences in cognition may be related to individual differences in behavior (i.e., personality); a hypothesis that has received mixed support. In this study, we investigated whether personality correlates with the cognitive ability that allows inhibiting behavior in 2 teleost fish species, the zebrafish Danio rerio and the guppy Poecilia reticulata. In both species, individuals that were bolder in a standard personality assay, the open-field test, showed greater inhibitory abilities in the tube task, which required them to inhibit foraging behavior toward live prey sealed into a transparent tube. This finding reveals a relationship between boldness and inhibitory abilities in fish and lends support to the hypothesis of a link between personality and cognition. Moreover, this study suggests that species separated by a relatively large phylogenetic distance may show the same link between personality and cognition, when tested on the same tasks.
Lipid management in rheumatoid arthritis: a position paper of the Working Group on Cardiovascular Pharmacotherapy of the European Society of Cardiology
Authors: Hollan Ivana , Ronda Nicoletta , Dessein Patrick , Agewall Stefan , Karpouzas George , Tamargo Juan , Niessner Alexander , Savarese Gianluigi , Rosano Giuseppe , Kaski Juan Carlos , Wassmann Sven , Meroni Pier Luigi
Published: August 2019

Rheumatoid arthritis (RA) is associated with increased cardiovascular morbidity, partly due to alterations in lipoprotein quantity, quality and cell cholesterol trafficking. Although cardiovascular disease significantly contributes to mortality excess in RA, cardiovascular prevention has been largely insufficient. Because of limited evidence, optimal strategies for lipid management (LM) in RA have not been determined yet, and recommendations are largely based on expert opinions. In this position paper, we describe abnormalities in lipid metabolism and introduce a new algorithm for estimation of cardiovascular risk (CVR) and LM in RA. The algorithm stratifies patients according to RA-related factors impacting CVR (such as RA activity and severity and medication). We propose strategies for monitoring of lipid parameters and treatment of dyslipidaemia in RA (including lifestyle, statins and other lipid-modifying therapies, and disease modifying antirheumatic drugs). These opinion-based recommendations are meant to facilitate LM in RA until more evidence is available.
Modeling the Determinants of Mechanical Advantage During Jumping: Consequences for Spring- and Muscle-Driven Movement
Authors: Olberding Jeffrey P , Deban Stephen M , Rosario Michael V , Azizi Emanuel
Published: August 2019

Systems powered by elastic recoil need a latch to prevent motion while a spring is loaded but allow motion during spring recoil. Some jumping animals that rely on elastic recoil use the increasing mechanical advantage of limb extensor muscles to accomplish latching. We examined the ways in which limb morphology affects latching and the resulting performance of an elastic-recoil mechanism. Additionally, because increasing mechanical advantage is a consequence of limb extension that may be found in many systems, we examined the mechanical consequences for muscle in the absence of elastic elements. By simulating muscle contractions against a simplified model of an extending limb, we found that increasing mechanical advantage can limit the work done by muscle by accelerating muscle shortening during limb extension. The inclusion of a series elastic element dramatically improves mechanical output by allowing for additional muscle work that is stored and released from the spring. This suggests that elastic recoil may be beneficial for more animals than expected when assuming peak isotonic power output from muscle during jumping. The mechanical output of elastic recoil depends on limb morphology; long limbs moving small loads maximize total work, but it is done at a low power, whereas shorter limbs moving larger loads do less work at a higher power. This work-power trade-off of limb morphology is true with or without an elastic element. Systems with relatively short limbs may have performance that is robust to variable conditions such as body mass or muscle activation, while long-limbed systems risk complete failure with relatively minor perturbations. Finally, a changing mechanical advantage latch allows for muscle work to be done simultaneously with spring recoil, changing the predictions for spring mechanical properties. Overall, the design constraints revealed by considering the mechanics of this particular latch will inform our understanding of the evolution of elastic-recoil mechanisms and our attempts to engineer similar systems.
Why do Large Animals Never Actuate Their Jumps with Latch-Mediated Springs? Because They can Jump Higher Without Them
Authors: Sutton Gregory P , Mendoza Elizabeth , Azizi Emanuel , Longo Sarah J , Olberding Jeffrey P , Ilton Mark , Patek Sheila N
Published: August 2019

As animals get smaller, their ability to generate usable work from muscle contraction is decreased by the muscle’s force–velocity properties, thereby reducing their effective jump height. Very small animals use a spring-actuated system, which prevents velocity effects from reducing available energy. Since force–velocity properties reduce the usable work in even larger animals, why don’t larger animals use spring-actuated jumping systems as well? We will show that muscle length–tension properties limit spring-actuated systems to generating a maximum one-third of the possible work that a muscle could produce—greatly restricting the jumping height of spring-actuated jumpers. Thus a spring-actuated jumping animal has a jumping height that is one-third of the maximum possible jump height achievable were 100% of the possible muscle work available. Larger animals, which could theoretically use all of the available muscle energy, have a maximum jumping height that asymptotically approaches a value that is about three times higher than that of spring-actuated jumpers. Furthermore, a size related “crossover point” is evident for these two jumping mechanisms: animals smaller than this point can jump higher with a spring-actuated mechanism, while animals larger than this point can jump higher with a muscle-actuated mechanism. We demonstrate how this limit on energy storage is a consequence of the interaction between length–tension properties of muscles and spring stiffness. We indicate where this crossover point occurs based on modeling and then use jumping data from the literature to validate that larger jumping animals generate greater jump heights with muscle-actuated systems than spring-actuated systems.
MHO_0730 as a Surface-Exposed Calcium-Dependent Nuclease of Mycoplasma hominis Promoting Neutrophil Extracellular Trap Formation and Escape
Authors: Cacciotto Carla , Dessì Daniele , Cubeddu Tiziana , Cocco Anna Rita , Pisano Andrea , Tore Gessica , Fiori Pier Luigi , Rappelli Paola , Pittau Marco , Alberti Alberto
Published: August 2019

Mycoplasma lipoproteins play a relevant role in pathogenicity and directly interact with the host immune system. Among human mycoplasmas, Mycoplasma hominis is described as a commensal bacterium that can be associated with a number of genital and extragenital conditions. Mechanisms of M. hominis pathogenicity are still largely obscure, and only a limited number of proteins have been associated with virulence. The current study focused on investigating the role of MHO_0730 as a virulence factor and demonstrated that MHO_0730 is a surface lipoprotein, potentially expressed in vivo during natural infection, acting both as a nuclease with its amino acidic portion and as a potent inducer of Neutrophil extracellular trapsosis with its N-terminal lipid moiety. Evidence for M. hominis neutrophil extracellular trap escape is also presented. Results highlight the relevance of MHO_0730 in promoting infection and modulation and evasion of innate immunity and provide additional knowledge on M. hominis virulence and survival in the host.
The Study of Human Rights Practice: State of the Art
Authors: Dudai Ron
Published: August 2019

This essay offers a ‘state of the art’ of the study of human rights practice. It begins with delineating human rights practice as an academic perspective, defining its distinct research questions and approaches, and noting in particular the influence of sociological and anthropological standpoints on its development. The essay proceeds by exploring the study of human rights practice as a form of activist-scholarship—bridging the world of academia and practice—and the strengths and risks that such a position entails, and later by characterizing this type of research as a self-critical project, utilizing an insider perspective to identify the weaknesses of the human rights framework but also to avoid abstract gloomy generalizations. The concluding section identifies the themes of pragmatism and radical hope and introduces the contributions to this special issue.
Blood-Brain Barrier Dysfunction in Idiopathic Intracranial Hypertension
Authors: Hasan-Olive Md Mahdi , Hansson Hans-Arne , Enger Rune , Nagelhus Erlend A , Eide Per Kristian
Published: August 2019

Idiopathic intracranial hypertension (IIH) is traditionally considered benign and characterized by symptoms related to increased intracranial pressure, including headache and impaired vision. We have previously demonstrated that brains of IIH patients exhibit patchy astrogliosis, increased perivascular expression of the water channel aquaporin-4 (AQP4) as well as degenerating pericyte processes and capillary basement membranes. Given the established association between pericyte degeneration and blood-brain barrier (BBB) dysfunction, we investigated blood protein leakage by light microscopic immunohistochemistry. We also assessed perivascular AQP4 expression by immunogold transmission electron microscopy. The study included 14 IIH patients and 14 reference (REF) subjects undergoing neurosurgery for epilepsy, aneurysm, or tumor. Evidence of BBB dysfunction, measured as area extravasated fibrinogen/fibrin, was significantly more pronounced in IIH than REF individuals. The extent of extravasated fibrinogen was positively correlated with increasing degree of astrogliosis and vascular AQP4 immunoreactivity, determined by light microscopy. Immunogold transmission electron microscopy revealed no overall changes in AQP4 expression at astrocytic vascular endfeet in IIH (n = 8) compared to REF (n = 11) individuals. Our results provide evidence of BBB leakage in IIH, signifying that IIH is a more serious neurodegenerative disease than previously considered.
Thermally driven wind as the origin of warm absorbers in AGN
Authors: Mizumoto Misaki , Done Chris , Tomaru Ryota , Edwards Isaac
Published: August 2019

Warm absorbers are present in many active galactic nuclei (AGN), seen as mildly ionized gas outflowing with velocities of a few hundred to a few thousand kilometres per second. These slow velocities imply a large launch radius, pointing to the broad-line region and/or torus as the origin of this material. Thermal driving was originally suggested as a plausible mechanism for launching this material but recent work has focused instead on magnetic winds, unifying these slow, mildly ionized winds with the more highly ionized ultrafast outflows. Here we use the recently developed quantitative models for thermal winds in black hole binary systems to predict the column density, velocity, and ionization state from AGN. Thermal winds are sensitive to the spectral energy distribution (SED), so we use realistic models for SEDs which change as a function of mass and mass accretion rate, becoming X-ray weaker (and hence more disc dominated) at higher Eddington ratio. These models allow us to predict the launch radius, velocity, column density, and ionization state of thermal winds as well as the mass-loss rate and energetics. While these match well to some of the observed properties of warm absorbers, the data point to the presence of additional wind material, most likely from dust driving.
DNA polymerase ζ in DNA replication and repair
Authors: Martin Sara K , Wood Richard D
Published: August 2019

Here, we survey the diverse functions of DNA polymerase ζ (pol ζ) in eukaryotes. In mammalian cells, REV3L (3130 residues) is the largest catalytic subunit of the DNA polymerases. The orthologous subunit in yeast is Rev3p. Pol ζ also includes REV7 subunits (encoded by Rev7 in yeast and MAD2L2 in mammalian cells) and two subunits shared with the replicative DNA polymerase, pol δ. Pol ζ is used in response to circumstances that stall DNA replication forks in both yeast and mammalian cells. The best-examined situation is translesion synthesis at sites of covalent DNA lesions such as UV radiation-induced photoproducts. We also highlight recent evidence that uncovers various roles of pol ζ that extend beyond translesion synthesis. For instance, pol ζ is also employed when the replisome operates sub-optimally or at difficult-to-replicate DNA sequences. Pol ζ also participates in repair by microhomology mediated break-induced replication. A rev3 deletion is tolerated in yeast but Rev3l disruption results in embryonic lethality in mice. Inactivation of mammalian Rev3l results in genomic instability and invokes cell death and senescence programs. Targeting of pol ζ function may be a useful strategy in cancer therapy, although chromosomal instability associated with pol ζ deficiency must be considered.
Patient-derived xenografts of central nervous system metastasis reveal expansion of aggressive minor clones
Authors: Tew Ben Yi , Legendre Christophe , Schroeder Mark A , Triche Tim , Gooden Gerald C , Huang Yizhou , Butry Loren , Ma Daniel J , Johnson Kyle , Martinez Rae Anne , Pierobon Mariaelena , Petricoin Emanuel F , O’shaughnessy Joyce , Osborne Cindy , Tapia Coya , Buckley David N , Glen Jennifer , Bernstein Mark , Sarkaria Jann N , Toms Steven A , Salhia Bodour
Published: August 2019

Background

The dearth of relevant tumor models reflecting the heterogeneity of human central nervous system metastasis (CM) has hindered development of novel therapies.

Methods

We established 39 CM patient-derived xenograft (PDX) models representing the histological spectrum, and performed phenotypic and multi-omic characterization of PDXs and their original patient tumors. PDX clonal evolution was also reconstructed using allele-specific copy number and somatic variants.

Results

PDXs retained their metastatic potential, with flank-implanted PDXs forming spontaneous metastases in multiple organs, including brain, and CM subsequent to intracardiac injection. PDXs also retained the histological and molecular profiles of the original patient tumors, including retention of genomic aberrations and signaling pathways. Novel modes of clonal evolution involving rapid expansion by a minor clone were identified in 2 PDXs, including CM13, which was highly aggressive in vivo forming multiple spontaneous metastases, including to brain. These PDXs had little molecular resemblance to the patient donor tumor, including reversion to a copy number neutral genome, no shared nonsynonymous mutations, and no correlation by gene expression.

Conclusions

We generated a diverse and novel repertoire of PDXs that provides a new set of tools to enhance our knowledge of CM biology and improve preclinical testing. Furthermore, our study suggests that minor clone succession may confer tumor aggressiveness and potentiate brain metastasis.
Giant magnetic field from moiré induced Berry phase in homobilayer semiconductors
Authors: Yu Hongyi , Chen Mingxing , Yao Wang
Published: August 2019

When quasiparticles move in condensed matters, the texture of their internal quantum structure as a function of position and momentum can give rise to Berry phases that have profound effects on the material’s properties. Seminal examples include the anomalous Hall and spin Hall effects from the momentum-space Berry phases in homogeneous crystals. Here, we explore a conjugate form of the electron Berry phase arising from the moiré pattern: the texture of atomic configurations in real space. In homobilayer transition metal dichalcogenides, we show that the real-space Berry phase from moiré patterns manifests as a periodic magnetic field with magnitudes of up to hundreds of Tesla. This quantity distinguishes moiré patterns from different origins, which can have an identical potential landscape, but opposite quantized magnetic flux per supercell. For low-energy carriers, the homobilayer moirés realize topological flux lattices for the quantum-spin Hall effect. An interlayer bias can continuously tune the spatial profile of the moiré magnetic field, whereas the flux per supercell is a topological quantity that can only have a quantized jump observable at a moderate bias. We also reveal the important role of the non-Abelian Berry phase in shaping the energy landscape in small moiré patterns. Our work points to new possibilities to access ultra-high magnetic fields that can be tailored to the nanoscale by electrical and mechanical controls.
Ultra-thin metal-organic framework nanoribbons
Authors: Wang Bingqing , Zhao Meiting , Li Liuxiao , Huang Ying , Zhang Xiao , Guo Chong , Zhang Zhicheng , Cheng Hongfei , Liu Wenxian , Shang Jing , Jin Jing , Sun Xiaoming , Liu Junfeng , Zhang Hua
Published: August 2019

Structure engineering of metal-organic frameworks (MOFs) at the nanometer scale is attracting increasing interest due to their unique properties and new functions that normally cannot be achieved in bulk MOF crystals. Here, we report the preparation of ultra-thin MOF nanoribbons (NRBs) by using metal-hydroxide nanostructures as the precursors. Importantly, this general method can be used to synthesize various kinds of ultra-thin MOF NRBs, such as MBDC (M = Co, Ni; BDC = 1,4-benzenedicarboxylate), NiCoBDC, CoTCPP (TCPP = tetrakis(4-carboxyphenyl)porphyrin) and MIL-53(Al) NRBs. As a proof-of-concept application, the as-prepared ultra-thin CoBDC NRBs have been successfully used as a fluorescent sensing platform for DNA detection, which exhibited excellent sensitivity and selectivity. The present strategy might open an avenue to prepare MOF nanomaterials with new structures and unique properties for various promising applications.
EXHALATION OF RADON FROM NATURALLY OCCURRING RADIOACTIVE MATERIALS (NORM) IN NIGERIA
Authors: Sesay Isata Esther , Paul Monday , Ademola Janet Ayobami
Published: August 2019

Radon-222 mass exhalation rate, EM, and surface exhalation rate, EA, have been determined for some building materials and fertilizers in Nigeria by accumulation method using AlphaGUARD radon monitor. The building materials include granite, cement, tile, white marble, brick, concrete and sand. The mean EM of the building materials varied from 0.06 ± 0.03 for white marble to 0.23 ± 0.15 Bq kg−1 h−1 for brick. The mean EA ranged between 1.06 ± 0.56 Bq kg−1 h−1 and 3.15 ± 1.52 Bq m−2 h−1 for white marble and brick, respectively. Most of the EM and EA of the building materials were higher than those of other countries. For the fertilizers, the EM and EA ranged from 0.13 ± 0.01 to 0.42 ± 0.03 Bq kg−1 h−1 and 2.11 ± 0.56 to 4.81 ± 1.24 Bq m−2 h−1 with mean values of 0.25 ± 0.07 Bq kg−1 h−1 and 3.24 ± 0.93 Bq m−2 h−1, respectively. The radon mass and surface exhalation rates of the fertilizers were higher than those of the building materials.
A WALK-IN TYPE CALIBRATION CHAMBER FACILITY FOR 222Rn MEASURING DEVICES AND INTER-COMPARISON EXERCISES
Authors: Trilochana S , Somashekarappa H M , Kumara K Sudeep , Mohan M P , Nayak S Rashmi , D’Souza Renita Shiny , Kamath Srinivas S , Sahoo B K , Gaware J J , Sapra B K , Janik M , Al-Azmi Darwish , Mayya Y S , Karunakara N
Published: August 2019

A walk-in type 222Rn calibration chamber of volume 22.7 m3, which has traceability to international standards, is established at the Centre for Advanced Research in Environmental Radioactivity, Mangalore University, India. It has a human–machine interface communication system, a programmable logic controller and sensor feedback circuit for controlling and data acquisition of relative humidity (RH) and temperature (T). An innovative method for the generation of desired 222Rn concentration (a few hundred Bq m−3 up to about 36 kBq m−3) using soil gas as a source was adopted. Leak rates of 222Rn from the chamber for the mixing fan ON and OFF conditions were determined to be 0.0011 and 0.00018 h−1 respectively. With the exhaust system fully turned on, the maximum clearance rate of the chamber was 0.58 ± 0.07 h−1. Excellent spatial uniformity in 222Rn concentration in the chamber was confirmed (with a mean value of relative standard deviation < 12%) through measurements at 23 locations using CR-39 film-based passive devices. Demonstration of calibration applications was performed using charcoal canister and PicoRad vials as the 222Rn adsorption devices. The study shows that gamma spectrometry is a convenient alternative approach to liquid scintillation analysis of PicoRad vials for 222Rn measurement.
HPV-associated oropharyngeal cancer
Authors: Sheedy Trina , Heaton Chase
Published: August 2019

Exposure of the oral cavity and oropharynx to human papillomavirus (HPV) often results in an asymptomatic, transient oral infection that is cleared by the body's immune system; however, a small percentage of these oral infections can persist in a dormant state. Depending on the HPV genotype, a persistent oral infection may lead to benign or malignant disease. High-risk HPV types 16 and 18, which cause most cervical and anal cancers, also are the cause of the rising rate of oropharyngeal squamous cell carcinoma (SCC) in the United States. This article focuses on the epidemiology, transmission, risk factors, and clinical presentation of HPV-associated oropharyngeal SCC, and provides an update on HPV vaccination in the context of the new head and neck cancer epidemic.
Pregnancy Outcomes After Removal of Osmotic Dilators in Patients Who Presented for Second-Trimester Abortion
Authors: Mark Katrina , Merchant Rashida M. , Hu Kevin
Published: August 2019

(Abstracted from Contraception 2019;99:285–287)

The primary method used in the United States to induce second-trimester abortions is dilation and evacuation (D&E). Typically with D&E, a cervical preparation of osmotic dilators is placed up to 24 hours prior to the procedure to decrease surgical risks and complications.
Do End-of-Rotation Evaluations Adequately Assess Readiness to Operate?
Authors: Ahle Samantha L. , Schuller Mary , Clark Michael J. , Williams Reed G. , Wnuk Gregory , Fryer Jonathan P. , George Brian C.
Published: August 2019

Purpose

Medical educators have developed no standard way to assess the operative performance of surgical residents. Most residency programs use end-of-rotation (EOR) evaluations for this purpose. Recently, some programs have implemented workplace-based “microassessment” tools that faculty use to immediately rate observed operative performance. The authors sought to determine (1) the degree to which EOR evaluations correspond to workplace-based microassessments and (2) which factors most influence EOR evaluations and directly observed workplace-based performance ratings and how the influence of those factors differs for each assessment method.

Method

In 2017, the authors retrospectively analyzed EOR evaluations and immediate postoperative assessment ratings of surgical trainees from a university-based training program from the 2015–2016 academic year. A Bayesian multivariate mixed model was constructed to predict operative performance ratings for each type of assessment.

Results

Ratings of operative performance from EOR evaluations vs workplace-based microassessment ratings had a Pearson correlation of 0.55. Postgraduate year (PGY) of training was the most important predictor of operative performance ratings on EOR evaluations: Model estimates ranged from 0.62 to 1.75 and increased with PGY. For workplace-based assessment, operative autonomy rating was the most important predictor of operative performance (coefficient = 0.74).

Conclusions

EOR evaluations are perhaps most useful in assessing the ability of a resident to become a surgeon compared with other trainees in the same PGY of training. Workplace-based microassessments may be better for assessing a trainee’s ability to perform specific procedures autonomously, thus perhaps providing more insight into a trainee’s true readiness for operative independence.
Building the Bridge to Quality: An Urgent Call to Integrate Quality Improvement and Patient Safety Education With Clinical Care
Authors: Wong Brian M. , Baum Karyn D. , Headrick Linda A. , Holmboe Eric S. , Moss Fiona , Ogrinc Greg , Shojania Kaveh G. , Vaux Emma , Warm Eric J. , Frank Jason R.
Published: August 2019

Current models of quality improvement and patient safety (QIPS) education are not fully integrated with clinical care delivery, representing a major impediment toward achieving widespread QIPS competency among health professions learners and practitioners. The Royal College of Physicians and Surgeons of Canada organized a 2-day consensus conference in Niagara Falls, Ontario, Canada, called Building the Bridge to Quality, in September 2016. Its goal was to convene an international group of educational and health system leaders, educators, frontline clinicians, learners, and patients to engage in a consensus-building process and generate a list of actionable strategies that individuals and organizations can use to better integrate QIPS education with clinical care.

Four strategic directions emerged: prioritize the integration of QIPS education and clinical care, build structures and implement processes to integrate QIPS education and clinical care, build capacity for QIPS education at multiple levels, and align educational and patient outcomes to improve quality and patient safety. Individuals and organizations can refer to the specific tactics associated with the 4 strategic directions to create a road map of targeted actions most relevant to their organizational starting point.

To achieve widespread change, collaborative efforts and alignment of intrinsic and extrinsic motivators are needed on an international scale to shift the culture of educational and clinical environments and build bridges that connect training programs and clinical environments, align educational and health system priorities, and improve both learning and care, with the ultimate goal of achieving improved outcomes and experiences for patients, their families, and communities.
Nerve Injury With Acetabulum Fractures: Incidence and Factors Affecting Recovery
Authors: Simske Natasha M. , Krebs J. Collin , Heimke Isabella M. , Scarcella Nicholas R. , Vallier Heather A.
Published: August 2019

Objectives:

To determine factors associated with nerve injury after acetabulum fracture and to evaluate recovery and outcomes.

Design:

Retrospective cohort study.

Setting:

Level 1 trauma center.

Patients and Participants:

Nine hundred seventy-five skeletally mature patients with acetabulum fracture.

Intervention:

Operative and nonoperative management.

Main Outcome Measurements:

Nerve injuries, categorized as traumatic or iatrogenic, recovery (none, partial, or complete), and patient-reported functional outcomes with the Musculoskeletal Function Assessment (n = 353, 36.2%).

Results:

Thirty-two patients (3.3%) experienced nerve injury with 24 (78%) resulting from trauma and 23 with an associated posterior hip dislocation. Eight injuries (25%) were iatrogenic. Thirty-one (97%) occurred in patients with operative fractures (n = 738). The most common fracture pattern associated with nerve injury was transverse posterior wall (31% of injuries). Obesity was more common in patients with nerve injuries (59% vs. 30% in those without nerve injury (P = 0.001), but was not related to age or sex. Sixty-five percent of sciatic nerve injuries were to the common peroneal division only, while none were isolated to the tibial division. All iatrogenic injuries occurred after the ilioinguinal approach (P < 0.001). Overall, 50% experienced partial nerve recovery and 22% had complete recovery. However, 24% of patients with sciatic or common peroneal injuries had no recovery. Thirty-three percent of tobacco smokers experienced no recovery (vs. 26% of nonsmokers). Average Musculoskeletal Function Assessment scores for patients with nerve injuries was 32, similar to those without (33).

Conclusions:

Posterior acetabulum fracture dislocations are associated with traumatic nerve injury, although 25% of nerve injuries were iatrogenic. Nerve injuries are more common in obese patients. More than one-quarter of patients had no recorded nerve recovery.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Predicted Economic Benefits of a Novel Biomarker for Earlier Sepsis Identification and Treatment: A Counterfactual Analysis
Authors: Paoli Carly J. , Reynolds Mark A. , Coles Courtney , Gitlin Matthew , Crouser Elliott
Published: August 2019

Objectives:

To estimate the potential clinical and health economic value of earlier sepsis identification in the emergency department using a novel diagnostic marker, monocyte distribution width.

Design:

The analysis was conducted in two phases: 1) an analysis of the pivotal registration trial evidence to estimate the potential benefit of monocyte distribution width for early sepsis identification and (2) a cost-consequence analysis to estimate the potential economic and clinical benefits that could have resulted from earlier administration of antibiotics for those patients.

Setting:

Sepsis identified in the emergency department which led to inpatient hospitalizations.

Patients:

Adult sepsis patients admitted through the emergency department.

Interventions:

None. This was a model simulation of clinical and economic outcomes of monocyte distribution width based on results from a noninterventional, multicenter clinical trial.

Measurements and Main Results:

Among the 385 patients with sepsis, a total of 349 were eligible for inclusion. Sixty-seven percent of patients were predicted to benefit from monocyte distribution width results, resulting in an estimated mean reduction in time to antibiotics administration from 3.98 hours using standard of care to 2.07 hours using monocyte distribution width + standard of care. Based on this simulated reduction in time to antibiotics, monocyte distribution width + standard of care could have resulted in a less than or equal to 14.2% reduction (27.9% vs 32.5%) in mortality, a mean reduction of 1.48 days (10.0 vs 11.5 d) in length of stay, and $3,460 ($23,466 vs $26,926) savings per hospitalization. At the hospital level, based on an established national mean of 206 sepsis hospitalizations per hospital per year, earlier identification with monocyte distribution width is predicted to result in a total of $712,783 in annual cost savings per hospital.

Conclusions:

Improved early identification of sepsis using monocyte distribution width along with current standard of care is estimated to improve both clinical and economic outcomes of sepsis patients presenting in the emergency department. Further research is warranted to confirm these model projections.
Rapid Response and Cardiac Arrest Teams: A Descriptive Analysis of 103 American Hospitals
Authors: Mitchell Oscar J. L. , Motschwiller Caroline W. , Horowitz James M. , Friedman Oren A. , Nichol Graham , Evans Laura E. , Mukherjee Vikramjit
Published: August 2019

Objectives:

Despite improvements in the management of in-hospital cardiac arrest over the past decade, in-hospital cardiac arrest continues to be associated with poor prognosis. This has led to the development of rapid response systems, hospital-wide efforts to improve patient outcomes by centering on prompt identification of decompensating patients, expert clinical management, and continuous quality improvement of processes of care. The rapid response system may include cardiac arrest teams, which are centered on identification and treatment of patients with in-hospital cardiac arrest. However, few evidence-based guidelines exist to guide the formation of such teams, and the degree of their variation across the United States has not been well described.

Design:

Descriptive cross-sectional, internet-based survey.

Setting:

Cohort of preidentified clinicians involved in their hospital’s adult rapid response system across the United States.

Subjects:

Clinicians who had been identified by study team members using personal and professional contacts over a 7-month period from June 2018 to December 2018.

Interventions:

An 80-item survey was developed by the investigators. It sought information on the afferent (identification and notification of providers) and efferent (response of providers to patient) limbs of the rapid response system, as well as management of patients post in-hospital cardiac arrest.

Measurements and Main Results:

One-hundred fourteen surveys were distributed. Of these, 109 (96%) were completed. Six were duplicates and were excluded, leaving a total of 103 surveys from 103 hospitals in 30 states. Seventy-six percent of hospitals were academic, 30% were large hospitals (> 750 inpatient beds), and 58% had large ICUs (> 50 ICU beds). We found wide variation in the structure and function in both the afferent and efferent limbs of the rapid response system. The majority of hospitals had a rapid response team and a cardiac arrest team. Most rapid response teams contained a provider, a critical care nurse, and a respiratory therapist. In hospitals with training programs in internal medicine, anesthesia, emergency medicine, or critical care, 45% of rapid response teams and 75% of cardiac arrest teams were led by trainees, with inconsistent attending presence. Targeted temperature management and coronary catheterization were widely used post in-hospital cardiac arrest, but indications varied considerably.

Conclusions:

We have demonstrated substantial variation in the structure and function of rapid response systems as well as in management of patients during and after in-hospital cardiac arrest.
Emergency Department to ICU Time Is Associated With Hospital Mortality: A Registry Analysis of 14,788 Patients From Six University Hospitals in The Netherlands*
Authors: Groenland Carline N. L. , Termorshuizen Fabian , Rietdijk Wim J. R. , van den Brule Judith , Dongelmans Dave A. , de Jonge Evert , de Lange Dylan W. , de Smet Anne Marie G. A. , de Keizer Nicolette F. , Weigel Joachim D. , Jewbali Lucia S. D. , Boersma Eric , den Uil Corstiaan A.
Published: August 2019

Objectives:

Prolonged emergency department to ICU waiting time may delay intensive care treatment, which could negatively affect patient outcomes. The aim of this study was to investigate whether emergency department to ICU time is associated with hospital mortality.

Design, Setting, and Patients:

We conducted a retrospective observational cohort study using data from the Dutch quality registry National Intensive Care Evaluation. Adult patients admitted to the ICU directly from the emergency department in six university hospitals, between 2009 and 2016, were included. Using a logistic regression model, we investigated the crude and adjusted (for disease severity; Acute Physiology and Chronic Health Evaluation IV probability) odds ratios of emergency department to ICU time on mortality. In addition, we assessed whether the Acute Physiology and Chronic Health Evaluation IV probability modified the effect of emergency department to ICU time on mortality. Secondary outcomes were ICU, 30-day, and 90-day mortality.

Interventions:

None.

Measurements and Main Results:

A total of 14,788 patients were included. The median emergency department to ICU time was 2.0 hours (interquartile range, 1.3–3.3 hr). Emergency department to ICU time was correlated to adjusted hospital mortality (p< 0.002), in particular in patients with the highest Acute Physiology and Chronic Health Evaluation IV probability and long emergency department to ICU time quintiles: odds ratio, 1.29; 95% CI, 1.02–1.64 (2.4–3.7 hr) and odds ratio, 1.54; 95% CI, 1.11–2.14 (> 3.7 hr), both compared with the reference category (< 1.2 hr). For 30-day and 90-day mortality, we found similar results. However, emergency department to ICU time was not correlated to adjusted ICU mortality (p= 0.20).

Conclusions:

Prolonged emergency department to ICU time (> 2.4 hr) is associated with increased hospital mortality after ICU admission, mainly driven by patients who had a higher Acute Physiology and Chronic Health Evaluation IV probability. We hereby provide evidence that rapid admission of the most critically ill patients to the ICU might reduce hospital mortality.
One-Year Outcomes Following Tracheostomy for Acute Respiratory Failure*
Authors: Mehta Anuj B. , Walkey Allan J. , Curran-Everett Douglas , Douglas Ivor S.
Published: August 2019

Objectives:

Tracheostomy utilization has dramatically increased recently. Large gaps exist between expected and actual outcomes resulting in significant decisional conflict and regret. We determined 1-year patient outcomes and healthcare utilization following tracheostomy to aid in decision-making and resource allocation.

Design:

Retrospective cohort study.

Setting:

All California hospital discharges from 2012 to 2013 with follow-up through 2014.

Patients:

Nonsurgical patients who received a tracheostomy for acute respiratory failure.

Interventions:

None.

Measurements and Main Results:

Our primary outcome was 30-day, 90-day, and 1-year mortality. We also determined hospitals readmissions rates and healthcare utilization in the first year following tracheostomy. We identified 8,343 tracheostomies during the study period. One-year mortality following tracheostomy was high, 46.5%. Older adults (≥ 65 yr) had significantly higher mortality compared with younger patients (< 65 yr) (54.7% vs 36.5%; p < 0.0001). Median survival for older adults was 175 days (95% CI, 150–202 d) compared with greater than 1 year for younger adults (adjusted hazard ratio, 1.25; 95% CI, 1.14–1.36). Within 1 year of tracheostomy, 60.3% of patients required hospital readmission. Older adults were more likely to be readmitted in the first year after tracheostomy compared with younger adults (66.1% vs 55.2%; adjusted hazard ratio, 1.19; 95% CI, 1.09–1.29). Total short-term acute care hospital costs (index and readmissions) in the first year after tracheostomy were high (mean, $215,369; sd, $160,874).

Conclusions:

Long-term outcomes following tracheostomy are extremely poor with high mortality, morbidity, and healthcare resource utilization especially among older patients. Some subsets of younger patients may have better outcomes compared with the general tracheostomy population. Short-term acute care costs were extremely high in the first year following tracheostomy. If extended to the entire U.S. population, total short-term acute care hospital costs approach $11 billion dollars per year for tracheostomy-related to acute respiratory failure. These findings may aid families and surrogates in the decision-making process.