bluuebunny/crossref_metadata_2025 huggingface dataset:
Hyoid Bone Suspension as a Part of Multilevel Surgery for Obstructive Sleep Apnea Syndrome
Authors: Tantawy Abd , Askar Sherif , Amer Hazem , Awad Ali , El-Anwar Mohammad
Published: October 2017

Introduction Since oropharyngeal surgery alone is often insufficient to treat obstructive sleep apnea (OSA), advances have been developed in hypopharyngeal surgery.

Objective To assess hyoid suspension surgery as part of a multilevel OSA surgery, also including palatal surgery.

Methods The study included patients with OSA symptoms with apnea hypopnea index (AHI) > 15. They were scheduled for hyoid suspension after a nasoendoscopy during Müller maneuver and drug induced sleep endoscopy (DISE). All patients had body mass index (BMI) < 35 kg/m2. Hyoidothyroidopexy combined with tonsillectomy and palatal suspension was performed in all cases.

Results The mean AHI dropped significantly (p < 0.0001) from 68.4 ± 25.3 preoperatively to 25.6 ± 9.52 postoperatively. The mean lowest oxygen (O2) saturation level increased significantly from 66.8 ± 11.3 to 83.2 ± 2.86 (p < 0.0001). In addition, the snoring score significantly decreased (p < 0.0001) from a preoperative mean of 3.4 ± 0.54 to 2 ± 0.7 at 6 months postoperatively. In regard to the Epworth sleepiness scale (ESS), it showed significant improvements (p < 0.0001) as its mean diminished from 13.8 ± 5.4 preoperatively to 5.2 ± 1.6 postoperatively.

Conclusion Hyoidothyroidopexy using absorbable suture seems to produce a good outcome in treating OSA. It could be effectively and safely combined with other palatal procedures in the multilevel surgery for OSA.
Endoscopic Endonasal Reconstructive Methods to the Anterior Skull Base
Authors: Chakravarthi Srikant , Gonen Lior , Monroy-Sosa Alejandro , Khalili Sammy , Kassam Amin
Published: October 2017

The success of expanded endoscopic endonasal approaches (EEAs) to the anterior skull base, sellar, and parasellar regions has been greatly aided by the advancement in reconstructive techniques. In particular, the pedicled vascularized flaps have been developed and effectively cover skull base defects of varying sizes with a significant reduction in postoperative CSF leaks. There are two aims to this review: (1) We will provide our current, simplified reconstruction algorithm. (2) We will describe, in detail, the relevant anatomy, indications/contraindications, and surgical technique, with a particular emphasis on the nasoseptal flap (NSF). The inferior turbinate flap (ITF), middle turbinate flap (MTF), pericranial flap (PCF), and temporoparietal fascial flap (TPFF) will also be described. The NSF should be the primary option for reconstruction of majority of skull base defects following endonasal endoscopic surgery. In general, for the planum, cribriform, and upper two-thirds of the clivus, the NSF is ideal. For the lower-third of the clivus, the NSF may not be adequate and may require additional reconstructive options. Although limited in reach or more technically challenging, these reconstructive flaps should still be considered and kept in the surgical algorithm.
Outcomes of Automated Auditory Evoked Potential Performed in Different Settings and the Factors Associated with Referred Cases
Authors: Silva Daniela , Ribeiro Georgea , Castilho Gustavo , Mantovani Jair
Published: October 2017

Introduction For the population with risk factors for hearing loss, the first option to assess the hearing status is the performance of the automated brainstem auditory evoked potential (BAEP) test because of its efficacy in identifying retrocochlear hearing loss.

Objective To verify the outcomes of automated BAEP performed in different settings as well as the factors associated with the prevalence of hearing impairment.

Methods Cross-sectional study conducted from October of 2014 to May of 2015. The sample consisted of 161 infants with at least one risk factor for hearing loss who underwent automated BAEP during the hospital stay or at the outpatient clinic. After 30 days, the altered cases were referred for BAEP diagnosis.

Results One hundred and thirty-eight infants (86%) had a result of “pass” and 23 (14%) of “failure” in the automated BAEP. There was no statistically significant difference in the rate of “referred” results between examinations performed in different settings. The infants' ages did not influence the number of abnormal cases. All of the 23 infants who presented a “referred” result in the automated BAEP, unilateral or bilateral, were sent for BAEP diagnosis, and out of these, 9 (39%) remained with at least some degree of alteration. The average age of diagnosis was 2.7 months.

Conclusion The results of the automated BAEP were similar when performed during hospitalization or after discharge. Neither the age at the examination nor the gender of the patient influenced the prevalence of hearing loss.
An Analysis of Anatomic Variations of the Sphenoid Sinus and Its Relationship to the Internal Carotid Artery
Authors: Dal Secchi Myrian , Dolci Ricardo , Teixeira Reginaldo , Lazarini Paulo
Published: October 2017

Introduction The sphenoid sinus (SS) has a high variability; its anatomical relations and variations must be well understood prior to the expanded endoscopic surgery (EES) at the skull base via the endonasal transsphenoidal approach. A feared complication is injury to the internal carotid artery (ICA).

Objective To evaluate the anatomic variations of the SS and its relationship to the ICA using computed tomography (CT).

Methods Cross-sectional retrospective study. Analysis of 90 patients' CT scans on axial, coronal and sagittal planes with 1 mm slices, evaluating lateral and posterior extensions of pneumatization of the SS, deviation of the sphenoid septum, presence of septations and their relationship to the parasellar and paraclival segments of the internal carotid artery (psICA and pcICA, respectively).

Results The association between the protrusions of the psICA and the pcICA was statistically significant (p < 0.001), as was the association between the lateral extension of pneumatization of the SS and the protrusion of the psICA (p = 0.014). The presence of the posterior extension of pneumatization of the SS and protrusion of the pcICA occurred in 46% of the cases. Deviation of the sphenoid septum in the direction of the pcICA was present in 14% and dehiscence of the pcICA was seen in 3.6% of the cases.

Conclusion Using the CT scan to recognize the type of extensions of pneumatization of the SS, the deviation of the sphenoid septum, and the presence of septations is beneficial to identify accurately the ICA and to reduce the risk of injury to it.
Feline chronische Gingivo-Stomatitis – Therapiekonzept anhand einer retrospektiven Analyse
von 265 Fällen
Authors: Mihaljevic Susann-Yvonne
Published: October 2017

Die Therapie der felinen chronischen Gingivo-Stomatitis basiert auf einer profunden Zahnbehandlung unter
dentaler Röntgendiagnostik und einer oft langfristigen medikamentösen Therapie, v. a. mit Analgetika und
Immunstimulanzien. Anhand einer Analyse von 265 behandelten Fällen werden Tipps zum Management dieser
Erkrankung vorgeschlagen.
BARF-Rationen bei Hunden – Wie gut beraten Internetforen?
Authors: Loescher Anne-Sophie , Küller Valeria , Vervuert Ingrid
Published: October 2017

Das Füttern von sogenannten BARF-Rationen ist ein aktueller Ernährungstrend bei Hunden. Im Rahmen eines
studentischen Forschungsprojekts sollten die Motivation der Hundehalter BARF-Rationen zu füttern sowie
verschiedene Internetrezepte zu BARF-Rationen auf das Einhalten der adäquaten Energie- und
Nährstoffversorgung überprüft werden.
Teilnahmemotivation von Männern an bewegungsorientierten Präventionsangeboten
Authors: Wollesen Bettina , Lorf Sarah , Bischoff Laura , Menzel Josefine
Published: October 2017

Fragestellung Maßnahmen zur Gesundheitsförderung werden von Männern deutlich seltener in Anspruch genommen als von Frauen. Motivationshürden sowie zielgruppenspezifische Wünsche und Vorstellungen von Männern zur Ausgestaltung von Angeboten wurden bislang kaum erfasst. Das quantitative Survey analysiert Motive und Hürden zur Teilnahme an Präventionsangeboten von Männern. Hierbei wurde die Stichprobe in 2 Untergruppen anhand ihrer potenziellen Bereitschaft zur Aufnahme einer gesundheitsförderlichen Aktivität (motiviert vs. nicht-motiviert) unterteilt und Unterschiede der Motivationstypen hinsichtlich des gegenwärtigen Gesundheitszustands und -verhaltens ermittelt, mit dem Ziel zukünftig bedarfsgerechtere Maßnahmen zu planen.

Methodik N=243 Männer (Motivierte n=147, nicht-Motivierte n=96) nahmen an der standardisierten Online-Befragung teil. Zur quantitativen Datenerhebung wurden der BMZI, KKG, SF-12, TICS und der MGV-39 eingesetzt. Die Überprüfung von Unterschieden zwischen Motivierten und nicht-Motivierten Männern erfolgte über Chi²-Tests sowie einfaktorielle Varianzanalysen (one-way ANOVA) mittels IBM SPSS 22 (Armonk, NY: IBM Corp).

Ergebnisse Motivierte schätzen ihren Gesundheitszustand und insbesondere ihr psychisches Wohlbefinden (psychischer Summenscore SF-12: F=6,3, p=0,013, eta²=0,025) schlechter ein. Beide Gruppen benennen die Bereiche Substanzvermeidung, Ernährung und aktive Lebensgestaltung als wichtige Einflussfaktoren auf die eigene Gesundheit. Nicht-motivierte Männer zeigten eine höhere fatalistische Externalität (KKG: F=7,609, p=0,006, eta²=0,031) als motivierte Männer und empfanden Gesundheitsförderung verstärkt als Bevormundung (Chi-Quadrat: 17,693, p≤0,001, C=0,261).

Schlussfolgerungen Die teilnahmemotivierten Männer dieser Stichproben hatten schlechtere gesundheitliche Voraussetzungen, womit sich möglicherweise über den eigenen Leidensdruck die Teilnahmebereitschaft erklären lässt. Für die nicht-motivierten Männer zeigte sich eine Diskrepanz zwischen dem eigenen Wissen über gesundheitsförderliches Verhalten und dem tatsächlichen Alltagshandeln (z.B. eigene körperliche Aktivität). Um die Zielgruppe zu erreichen, bevor die Teilnahmemotivation aufgrund des individuell verschlechterten Zustands entsteht, sollten Programme mit Anreizsystemen entstehen, die Aspekte zur Motivationsbildung integrieren.
Umsetzung der Nationalen VersorgungsLeitlinie (NVL) zur Therapie des Diabetes mellitus Typ 2 in diabetologischen Schwerpunktpraxen
Authors: Marahrens Lydia , Röck Daniel , Ziemssen Tjalf , Kern Raimar , Ziemssen Focke , Fritsche Andreas
Published: October 2017

Die Nationale VersorgungsLeitlinie (NVL) zur Therapie des Diabetes mellitus Typ 2 sieht eine Therapieintensivierung zur Blutzuckersenkung in 4 Therapiestufen vor. Bisher gibt es kaum Daten, wie die NVL patientenindividuell implementiert wird. Daher wurden in der DiabCheckOCTplus-Studie 810 Patienten in diabetologischen Schwerpunktpraxen anhand der in der Nationalen VersorgungsLeitlinie definierten 4 Therapiestufen untersucht. 81 % der Patienten in Therapiestufe 2 erhielten Metformin, 48 % in Therapiestufe 3 die Pharmaka-Zweifachkombination aus Metformin plus einem DPP-4-Inhibitor und in Therapiestufe 4 wurden 41 % mit einer intensivierten Insulintherapie mit Metformin versorgt. Der Gesamtanteil lag 2014 für Metformin bei 67 %, für DPP-4-Inhibitoren bei 21 % und für Sulfonylharnstoffe bei nur 10 %. Die Diabetesdauer stieg mit den NVL-Stufen deutlich an. Erhielten nach einer Diabetesdauer von 3 Jahren 55 % der Patienten mehr als 1 Antidiabetikum, wurde nach 9 Jahren die Hälfte aller Patienten in Stufe 4 – nach 25 Jahren nahezu alle Patienten – mit komplexen Insulinstrategien behandelt. Die Therapie der diabetischen Sekundärversorgung entsprach damit in einem hohen Maß den nationalen und internationalen Leitlinien. Entsprechende Daten aus der hausärztlichen Versorgung wären von Interesse. Da die Therapiestufe bei den untersuchten Patienten eng mit der Diabetesdauer korreliert, könnte sich der Parameter daher zur Kommunikation des Risikoprofils eignen.
Field guides, bird names, and conservation
Authors: Recher Harry F.
Published: October 2017

This is an essay that began as a book review. The book reviewed is: ‘The Australian Bird Guide’ by Peter Menkhorst, Danny Rogers, Rohan Clarke, Jeff Davies, Peter Marsack and Kim Franklin, and published in 2017 by CSIRO Publishing, Clayton, Victoria, Australia (paperback, AU$49.95, ISBN 9780643097544). I enjoy reviewing books and particularly enjoyed reading and reviewing this one. I enjoyed it because the illustrations of birds are superb and because the decision of the authors to follow a global list of bird names provided me with an opportunity to once again raise questions about the names given to Australian birds. Thus, the review morphed into an essay: in part an account of my experiences over the past 60 years with field guides, names, and nomenclature, in part a book review, and in part a bit about the conservation of Australia’s birds.
Humanized mouse model supports development, function, and tissue residency of human natural killer cells
Authors: Herndler-Brandstetter Dietmar , Shan Liang , Yao Yi , Stecher Carmen , Plajer Valerie , Lietzenmayer Melanie , Strowig Till , de Zoete Marcel R. , Palm Noah W. , Chen Jie , Blish Catherine A. , Frleta Davor , Gurer Cagan , Macdonald Lynn E. , Murphy Andrew J. , Yancopoulos George D. , Montgomery Ruth R. , Flavell Richard A.
Published: October 2017

Significance

Humanized mice represent a promising approach to study the human immune system in health and disease. However, insufficient development and function of human lymphocytes limit the applicability of humanized mice for cancer biology and therapy. We demonstrate that humanSIRPAandIL15knock-in (SRG-15) mice support efficient development of circulating and tissue-resident natural killer (NK) cells, intraepithelial lymphocytes, and innate lymphoid cell subsets. In contrast to previous humanized mouse models, human NK cells in SRG-15 mice mediate efficient antibody-dependent cellular cytotoxicity and thereby enable NK cell-targeted cancer immunotherapy of tumor xenografts. As such, SRG-15 humanized mice may facilitate translational research by enabling the development of novel NK and CD8+T cell-based therapeutic approaches that target human infections and malignancies.
Cryo-EM structure of Mcm2-7 double hexamer on DNA suggests a lagging-strand DNA extrusion model
Authors: Noguchi Yasunori , Yuan Zuanning , Bai Lin , Schneider Sarah , Zhao Gongpu , Stillman Bruce , Speck Christian , Li Huilin
Published: October 2017

Significance

During initiation of DNA replication in eukaryotes, the origin recognition complex, with Cdc6 and Cdt1, assembles an inactive Mcm2-7 double hexamer on the dsDNA. Later, the double hexamer recruits Cdc45 and GINS to form two active and separate DNA helicases. The active Cdc45–Mcm2-7–GINS helicase encircles the leading strand while excluding the lagging strand. One of the fundamental unanswered questions is how each Mcm2-7 hexamer converts from binding dsDNA to binding one of the single strands. The structure of the double hexamer on dsDNA reveals how DNA interacts with key elements inside the central channel, leading us to propose a lagging-strand extrusion mechanism. This work advances our understanding of eukaryotic replication initiation.
Exploitation of an iron transporter for bacterial protein antibiotic import
Authors: White Paul , Joshi Amar , Rassam Patrice , Housden Nicholas G. , Kaminska Renata , Goult Jonathan D. , Redfield Christina , McCaughey Laura C. , Walker Daniel , Mohammed Shabaz , Kleanthous Colin
Published: October 2017

Significance

The outer membrane (OM) excludes antibiotics such as vancomycin that kill gram-positive bacteria, and so is a major contributor to multidrug resistance in gram-negative bacteria. Yet, the OM is readily bypassed by protein bacteriocins, which are toxins released by bacteria to kill their neighbors during competition for resources. Discovered over 60 y ago, it has been a mystery how these proteins cross the OM to deliver their toxic payload. We have discovered how the bacteriocin pyocin S2 (pyoS2), which degrades DNA, enters
Pseudomonas aeruginosa
cells. PyoS2 tricks the iron transporter FpvAI into transporting it across the OM by a process that is remarkably similar to that used by its endogenous ligand, the siderophore ferripyoverdine.
Effect of temperature on the residual stress of a β-PbO2 coating
Authors: Du Bingqian , Chen Zhen , Yu Qiang , Zhu Wei , Yan Wen , Guo Zhongcheng
Published: October 2017

In the study of dimensionally stable anodes, the root causes of poor adhesion must be identified because the lead dioxide coating easily falls off. In this paper, the surface morphologies of a series of lead dioxide coatings prepared at different temperatures were observed by scanning electron microscopy, and the residual stresses of the coatings were determined by an X-ray diffraction method. Moreover, electrochemical impedance spectroscopy was used to measure the corrosion resistance of the samples. The analysis demonstrated that the preparation temperature effectively changed the morphology of the β-PbO2 coating, and the density of grain boundaries and crystal defects in the coating were the main causes of tensile stress, which can accelerate the exfoliation of the coating.
Fractional differentiability for solutions of the inhomogeneous 𝑝-Laplace system
Authors: Miśkiewicz Michał
Published: October 2017

It is shown that if

p
⩾
3

p \geqslant 3

and

u
∈

W

1
,
p

(
Ω
,

R

N

)

u \in W^{1,p}(\Omega ,\mathbb {R}^N)

solves the inhomogeneous

p
p

-Laplace system
\[
<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" alttext="d i v left-parenthesis StartAbsoluteValue nabla u EndAbsoluteValue Superscript p minus 2 Baseline nabla u right-parenthesis equals f comma f element-of upper W Superscript 1 comma p Super Superscript prime Superscript Baseline left-parenthesis normal upper Omega comma double-struck upper R Superscript upper N Baseline right-parenthesis comma">

div
⁡
(

|

∇
u

|

p
−
2

∇
u
)
=
f
,

f
∈

W

1
,

p
′

(
Ω
,

R

N

)
,

\operatorname {div} (|\nabla u|^{p-2} \nabla u) = f, \qquad f \in W^{1,p’}(\Omega ,\mathbb {R}^N),

\]
then locally the gradient

∇
u

\nabla u

lies in the fractional Nikol’skiĭ space

N

θ
,
2

/

θ

\mathcal {N}^{\theta ,2/\theta }

with any

θ
∈
[

2
p

,

2

p
−
1

)

\theta \in [ \tfrac {2}{p}, \tfrac {2}{p-1} )

. To the author’s knowledge, this result is new even in the case of

p
p

-harmonic functions, slightly improving known

N

2

/

p
,
p

\mathcal {N}^{2/p,p}

estimates. The method used here is an extension of the one used by A. Cellina in the case

2
⩽
p
>
3

2 \leqslant p > 3

to show

W

1
,
2

W^{1,2}

regularity.
Reductions modulo primes of systems of polynomial equations and algebraic dynamical systems
Authors: D’Andrea Carlos , Ostafe Alina , Shparlinski Igor , Sombra Martín
Published: October 2017

We give bounds for the number and the size of the primes

p
p

such that a reduction modulo

p
p

of a system of multivariate polynomials over the integers with a finite number

T
T

of complex zeros does not have exactly

T
T

zeros over the algebraic closure of the field with

p
p

elements.

We apply these bounds to study the periodic points and the intersection of orbits of algebraic dynamical systems over finite fields. In particular, we establish some links between these problems and the uniform dynamical Mordell–Lang conjecture.
ViewBS: a powerful toolkit for visualization of high-throughput bisulfite sequencing data
Authors: Huang Xiaosan , Zhang Shaoling , Li Kongqing , Thimmapuram Jyothi , Xie Shaojun
Published: October 2017

Motivation

High throughput bisulfite sequencing (BS-seq) is an important technology to generate single-base DNA methylomes in both plants and animals. In order to accelerate the data analysis of BS-seq data, toolkits for visualization are required.

Results

ViewBS, an open-source toolkit, can extract and visualize the DNA methylome data easily and with flexibility. By using Tabix, ViewBS can visualize BS-seq for large datasets quickly. ViewBS can generate publication-quality figures, such as meta-plots, heat maps and violin-boxplots, which can help users to answer biological questions. We illustrate its application using BS-seq data from Arabidopsis thaliana.

Availability

ViewBS is freely available at: https://github.com/xie186/ViewBS.

Supplementary information

Supplementary data are available at Bioinformatics online.
Dynamic assessment of microbial ecology (DAME): a web app for interactive analysis and visualization of microbial sequencing data
Authors: Piccolo Brian D , Wankhade Umesh D , Chintapalli Sree V , Bhattacharyya Sudeepa , Chunqiao Luo , Shankar Kartik
Published: October 2017

Dynamic assessment of microbial ecology (DAME) is a Shiny-based web application for interactive analysis and visualization of microbial sequencing data. DAME provides researchers not familiar with R programming the ability to access the most current R functions utilized for ecology and gene sequencing data analyses. Currently, DAME supports group comparisons of several ecological estimates of α-diversity and β-diversity, along with differential abundance analysis of individual taxa. Using the Shiny framework, the user has complete control of all aspects of the data analysis, including sample/experimental group selection and filtering, estimate selection, statistical methods and visualization parameters. Furthermore, graphical and tabular outputs are supported by R packages using D3.js and are fully interactive.

Availability and implementation

DAME was implemented in R but can be modified by Hypertext Markup Language (HTML), Cascading Style Sheets (CSS), and JavaScript. It is freely available on the web at https://acnc-shinyapps.shinyapps.io/DAME/. Local installation and source code are available through Github (https://github.com/bdpiccolo/ACNC-DAME). Any system with R can launch DAME locally provided the shiny package is installed.
MutaNET: a tool for automated analysis of genomic mutations in gene regulatory networks
Authors: Hollander Markus , Hamed Mohamed , Helms Volkhard , Neininger Kerstin
Published: October 2017

Mutations in genomic key elements can influence gene expression and function in various ways, and hence greatly contribute to the phenotype. We developed MutaNET to score the impact of individual mutations on gene regulation and function of a given genome. MutaNET performs statistical analyses of mutations in different genomic regions. The tool also incorporates the mutations in a provided gene regulatory network to estimate their global impact. The integration of a next-generation sequencing pipeline enables calling mutations prior to the analyses. As application example, we used MutaNET to analyze the impact of mutations in antibiotic resistance (AR) genes and their potential effect on AR of bacterial strains.

Availability and implementation

MutaNET is freely available at https://sourceforge.net/projects/mutanet/. It is implemented in Python and supported on Mac OS X, Linux and MS Windows. Step-by-step instructions are available at http://service.bioinformatik.uni-saarland.de/mutanet/.

Supplementary information

Supplementary data are available at Bioinformatics online.
An analytical framework for the study of epidemic models on activity driven networks
Authors: Zino Lorenzo , Rizzo Alessandro , Porfiri Maurizio
Published: October 2017

Network theory has greatly contributed to an improved understanding of epidemic processes, offering an empowering framework for the analysis of real-world data, prediction of disease outbreaks, and formulation of containment strategies. However, the current state of knowledge largely relies on time-invariant networks, which are not adequate to capture several key features of a number of infectious diseases. Activity driven networks (ADNs) constitute a promising modelling framework to describe epidemic spreading over time varying networks, but a number of technical and theoretical gaps remain open. Here, we lay the foundations for a novel theory to model general epidemic spreading processes over time-varying, ADNs. Our theory derives a continuous-time model, based on ordinary differential equations (ODEs), which can reproduce the dynamics of any discrete-time epidemic model evolving over an ADN. A rigorous, formal framework is developed, so that a general epidemic process can be systematically mapped, at first, on a Markov jump process, and then, in the thermodynamic limit, on a system of ODEs. The obtained ODEs can be integrated to simulate the system dynamics, instead of using computationally intensive Monte Carlo simulations. An array of mathematical tools for the analysis of the proposed model is offered, together with techniques to approximate and predict the dynamics of the epidemic spreading, from its inception to the endemic equilibrium. The theoretical framework is illustrated step-by-step through the analysis of a susceptible–infected–susceptible process. Once the framework is established, applications to more complex epidemic models are presented, along with numerical results that corroborate the validity of our approach. Our framework is expected to find application in the study of a number of critical phenomena, including behavioural changes due to the infection, unconscious spread of the disease by exposed individuals, or the removal of nodes from the network of contacts.
Anchored Hybrid Enrichment-Based Phylogenomics of Leafhoppers and Treehoppers (Hemiptera: Cicadomorpha: Membracoidea)
Authors: Dietrich Christopher H , Allen Julie M , Lemmon Alan R , Lemmon Emily Moriarty , Takiya Daniela M , Evangelista Olivia , Walden Kimberly K O , Grady Patrick G S , Johnson Kevin P
Published: October 2017

A data set comprising DNA sequences from 388 loci and >99,000 aligned nucleotide positions, generated using anchored hybrid enrichment, was used to estimate relationships among 138 leafhoppers and treehoppers representative of all major lineages of Membracoidea, the most diverse superfamily of hemipteran insects. Phylogenetic analysis of the concatenated nucleotide sequence data set using maximum likelihood produced a tree with most branches receiving high support. A separate coalescent gene tree analysis of the same data generally recovered the same strongly supported clades but was less well resolved overall. Several nodes pertaining to relationships among leafhopper subfamilies currently recognized based on morphological criteria were separated by short internodes and received low support. Although various higher taxa were corroborated with improved branch support, relationships among some major lineages of Membracoidea are only somewhat more resolved than previously published phylogenies based on single gene regions or morphology. In agreement with previous studies, the present results indicate that leafhoppers (Cicadellidae) are paraphyletic with respect to the three recognized families of treehoppers (Aetalionidae, Melizoderidae, and Membracidae). Divergence time estimates indicate that most of the poorly resolved divergence events among major leafhopper lineages occurred during the lower to middle Cretaceous and that most modern leafhopper subfamilies, as well as the lineage comprising the three recognized families of treehoppers, also arose during the Cretaceous.
Identification of diverse target RNAs that are functionally regulated by human Pumilio proteins
Authors: Bohn Jennifer A , Van Etten Jamie L , Schagat Trista L , Bowman Brittany M , McEachin Richard C , Freddolino Lydia , Goldstrohm Aaron C
Published: October 2017

Human Pumilio proteins, PUM1 and PUM2, are sequence specific RNA-binding proteins that regulate protein expression. We used RNA-seq, rigorous statistical testing and an experimentally derived fold change cut-off to identify nearly 1000 target RNAs—including mRNAs and non-coding RNAs—that are functionally regulated by PUMs. Bioinformatic analysis defined a PUM Response Element (PRE) that was significantly enriched in transcripts that increased in abundance and matches the PUM RNA-binding consensus. We created a computational model that incorporates PRE position and frequency within an RNA relative to the magnitude of regulation. The model reveals significant correlation of PUM regulation with PREs in 3′ untranslated regions (UTRs), coding sequences and non-coding RNAs, but not 5′ UTRs. To define direct, high confidence PUM targets, we cross-referenced PUM-regulated RNAs with all PRE-containing RNAs and experimentally defined PUM-bound RNAs. The results define nearly 300 direct targets that include both PUM-repressed and, surprisingly, PUM-activated target RNAs. Annotation enrichment analysis reveal that PUMs regulate genes from multiple signaling pathways and developmental and neurological processes. Moreover, PUM target mRNAs impinge on human disease genes linked to cancer, neurological disorders and cardiovascular disease. These discoveries pave the way for determining how the PUM-dependent regulatory network impacts biological functions and disease states.
Election in the Bible
Authors: Kaminsky Joel S. , Lohr Joel N.
Published: October 2017

Election within the Bible is the notion that God favors some individuals and groups over others, an idea that finds fullest expression in the Hebrew Bible’s affirmation, supported in the New Testament, that Israel is God’s chosen people. Election/chosenness is quite pervasive in the Hebrew Bible as evidenced by the recurring sibling rivalry stories in Genesis in which one sibling is specially favored. God’s granting Israel special status entailed both unmerited privilege as well as an expectation of a proper human response toward God. Genesis 18:19 states, “I have chosen him [Abraham], that he may charge his children and his household after him to keep the way of the Lord by doing righteousness and justice; so that the Lord may bring about for Abraham what he has promised him.” Similarly, Exodus 19:5–6 proclaims: “Now then, if you will obey Me faithfully and keep My covenant, you shall be My treasured possession among all the peoples.” Election is related to Israel’s status as a “holy nation” (e.g., Deut 14:2, “For you are a people holy to the Lord your God; it is you the Lord has chosen out of all the peoples on earth to be his people, his treasured possession”), and is grounded in an act of divine love and faithfulness to the divine promise (Deut 7:6–9). Despite severe castigation of Israel’s failings, the prophetic corpus appears to assume the permanence of Israel’s election even while the prophets proclaim that Israel’s privileged status carried with it heavier responsibility than other nations and stricter standards of judgment (Amos 3:2). Some of the most profound biblical meditations on the implications of chosenness can be found in Isaiah 40–66, a collection of postexilic oracles, sayings that time and again declare God’s enduring love for his beloved people and his intention to restore them once more to a flourishing life in the land of Israel. The belief that the Jews are God’s chosen people is a central theological axiom within post-biblical Jewish tradition. The New Testament, building on Hebrew Bible antecedents, depicts Jesus as the beloved, or specially chosen, son of God. Certain New Testament texts, like the Gospel of John and Revelation, at times appear to equate those chosen by God with those who will obtain ultimate salvation, a notion that becomes amplified within those forms of Protestantism influenced by Luther’s emphasis on being saved by grace (through faith) and especially Calvin’s theology of double predestination. Yet, within much of the biblical tradition the idea of election is neither dualistic nor directly linked with one’s salvation or damnation. One of the most central debates in New Testament studies is the question of the nascent church’s relationship to the historic people of Israel and whether Jewish resistance to the gospels meant they had forfeited their election, a topic discussed in great depth by Paul in Romans 9–11. Ultimately, Paul concludes that God’s election of Israel stands, even for those who have become “enemies of the gospel,” something he calls a “mystery” (Rom 11:25–28).
Theoretical modeling of Comptonized X-ray spectra of super-Eddington accretion flow: Origin of hard excess in ultraluminous X-ray sources
Authors: Kitaki Takaaki , Mineshige Shin , Ohsuga Ken , Kawashima Tomohisa
Published: October 2017

X-ray continuum spectra of super-Eddington accretion flow are studied by means of Monte Carlo radiative transfer simulations based on the radiation hydrodynamic simulation data, in which both thermal- and bulk-Compton scatterings are taken into account. We compare the calculated spectra of accretion flow around black holes with masses of MBH = 10, 102, 103, and 104 M⊙ for a fixed mass injection rate (from the computational boundary at 103 rs) of 103 LEdd/c2 (with rs, LEdd, and c being the Schwarzschild radius, the Eddington luminosity, and the speed of light, respectively). The soft X-ray spectra exhibit mass dependence in accordance with the standard-disk relation; the maximum surface temperature is scaled as $T \propto M_{\,\rm BH}^{\,-1/4}$. The spectra in the hard X-ray band, by contrast with soft X-ray, look to be quite similar among different models, if we normalize the radiation luminosity by MBH. This reflects that the hard component is created by thermal- and bulk-Compton scatterings of soft photons originating from an accretion flow in the overheated and/or funnel regions, the temperatures of which have no dependence on mass. The hard X-ray spectra can be reproduced by a Wien spectrum with the temperature of T ∼ 3 keV accompanied by a hard excess at photon energy above several keV. The excess spectrum can be fitted well with a power law with a photon index of Γ ∼ 3. This feature is in good agreement with that of the recent NuSTAR observations of ULXs (ultra-luminous X-ray sources).
Quantitative and Qualitative Analysis of the Impact of Adoption of a Mobile Application for the Assessment of Professionalism in Medical Trainees
Authors: Cendán Juan C. , Castiglioni Analia , Johnson Teresa R. , Eakins Mike , Verduin Marcia L. , Asmar Abdo , Metcalf David , Hernandez Caridad
Published: October 2017

Purpose

Capturing either lapses or excellence in behaviors related to medical professionalism is difficult. The authors report a mixed-methods analysis of a novel mobile platform for assessing medical professionalism in a training environment.

Method

A mobile Web-based platform to facilitate professionalism assessment in a situated clinical setting (Professional Mobile Monitoring of Behaviors [PROMOBES]) was developed. A professionalism framework consisting of six domains (reliability, adaptability, peer relationships, upholding principles, team relationships, and scholarship) encompassing 25 subelements underpins the reporting structure. This pilot study involved 26 faculty supervising 93 medical trainees at two sites from January 12 to August 8, 2016. Notable professionalism behaviors were linked to the framework domains and elements; narrative details about incidences were captured on mobile devices. Surveys gauged the technological functionality and impact of PROMOBES on faculty assessment of professionalism. Qualitative focus groups were employed to elucidate user experience.

Results

Although users anticipated PROMOBES’s utility would be for reporting lapses in professionalism, 94.7% of reports were for commendation. Comfort assessing professionalism (P = .04) and recognition of the reporting procedures for professionalism-related concerns (P = .01) improved. PROMOBES attained high acceptance ratings. Focus group analysis revealed that the explicit connection to the professionalism framework was powerful; similarly, the near real-time reporting capability, multiple observer inputs, and positive feedback facilitation were strengths.

Conclusions

Making the professionalism framework visible and accessible via a mobile platform significantly strengthens faculty knowledge and behaviors regarding assessment. The strong desire to capture positive behaviors was an unexpected finding.
Personalized Video Feedback and Repeated Task Practice Improve Laparoscopic Knot-Tying Skills: Two Controlled Trials
Authors: Abbott Eduardo F. , Thompson Whitney , Pandian T.K. , Zendejas Benjamin , Farley David R. , Cook David A.
Published: October 2017

Purpose

Compare the effect of personalized feedback (PF) vs. task demonstration (TD), both delivered via video, on laparoscopic knot-tying skills and perceived workload; and evaluate the effect of repeated practice.

Method

General surgery interns and research fellows completed four repetitions of a simulated laparoscopic knot-tying task at one-month intervals. Midway between repetitions, participants received via e-mail either a TD video (demonstration by an expert) or a PF video (video of their own performance with voiceover from a blinded senior surgeon). Each participant received at least one video per format, with sequence randomly assigned. Outcomes included performance scores and NASA Task Load Index (NASA-TLX) scores. To evaluate the effectiveness of repeated practice, scores from these trainees on a separate delayed retention test were compared against historical controls who did not have scheduled repetitions.

Results

Twenty-one trainees completed the randomized study. Mean change in performance scores was significantly greater for those receiving PF (difference = 23.1 of 150 [95% confidence interval (CI): 0, 46.2], P = .05). Perceived workload was also significantly reduced (difference = −3.0 of 20 [95% CI: −5.8, −0.3], P = .04). Compared with historical controls (N = 93), the 21 with scheduled repeated practice had higher scores on the laparoscopic knot-tying assessment two weeks after the final repetition (difference = 1.5 of 10 [95% CI: 0.2, 2.8], P = .02).

Conclusions

Personalized video feedback improves trainees’ procedural performance and perceived workload compared with a task demonstration video. Brief monthly practice sessions support skill acquisition and retention.
Using the Readiness for Clerkship and Residency Surveys to Evaluate the Effectiveness of Four MD Programs: A Cross-Institutional Generalizability Study
Authors: Peterson Linda N. , Rusticus Shayna A. , Eva Kevin W. , Wilson Derek A. , Pittini Richard J. , Schreiber Martin , Pinchin Sheila E. , Moffatt Susan L. , Sargeant Joan M. , Warren Andrew E. , Alexiadis-Brown Peggy
Published: October 2017

Purpose

The importance of confidence for learning and performance makes learners’ perceptions of readiness for the next level of training valuable indicators of curricular success. The “Readiness for Clerkship” (RfC) and “Readiness for Residency” (RfR) surveys have been shown to provide reliable ratings of the relative effectiveness of various aspects of training. This study examines the generalizability of those results.

Method

Surveys were administered at four medical schools approximately four months after the start of clerkship and eight months after the start of residency during 2013–2015. Collected data were anonymized. A total of 647 medical students and 483 residents participated.

Results

Reliabilities of G = 0.8 could be obtained with only 6 to 12 medical students and 8 to 15 residents. Within MD programs, no meaningful differences in item ratings were observed across cohorts. Residents in each school consistently rated themselves higher than clerks on the majority of Medical Expert and Communicator competencies common to both surveys. Similar strengths and weaknesses were identified across programs, but differences were observed on five clerkship items and one residency item.

Conclusions

Across four MD programs, the RfC and RfR surveys provided reliable ratings of the relative effectiveness of aspects of training with small numbers of respondents. The capacity of these surveys to efficiently identify perceived strengths and weaknesses held by cohorts of learners may, thereby, facilitate program improvement.
Health Care Organizations and Policy Leadership: Perspectives on Nonsmoker-Only Hiring Policies
Authors: McDaniel Patricia A. , Malone Ruth E.
Published: October 2017

Purpose

To explore employers’ decisions to base hiring policies on tobacco or nicotine use and community perspectives on such policies, and analyze the implications for organizational identity, community engagement, and health promotion.

Method

From 2013 to 2016, 11 executives from six health care organizations and one non-health-care organization with nonsmoker-only hiring policies were interviewed about why and how their policies were created and implemented, concerns about the policies, and perceptions of employee and public reactions. Focus groups were conducted with community members (n = 51) who lived in or near cities where participating employers were based, exploring participants’ opinions about why an employer would stop hiring smokers and their support (or not) for such a policy.

Results

Most employers excluded from employment those using all forms of nicotine. Several explained their adoption of the policy as a natural extension of a smoke-free campus and as consistent with their identity as health care organizations. They regarded the policy as promoting health. No employer mentioned engaging in a community dialogue before adopting the policy or reported efforts to track the policy’s impact on rejected applicants. Community members understood the cost-saving appeal of such policies, but most opposed them. They made few exceptions for health care organizations.

Conclusions

Policy decisions undertaken by health care organizations have influence beyond their immediate setting and may establish precedents that others follow. Nonsmoker-only hiring policies may fit with a health care organization’s institutional identity but may not be congruent with community values or promote public health.
Simulation-Based Mastery Learning for Thoracentesis Skills Improves Patient Outcomes: A Randomized Trial
Authors: Barsuk Jeffrey H. , Cohen Elaine R. , Williams Mark V. , Scher Jordan , Jones Sasha F. , Feinglass Joe , McGaghie William C. , O’Hara Kelly , Wayne Diane B.
Published: October 2017

Purpose

Physicians-in-training often perform bedside thoracenteses in academic medical centers, and complications are more common among less experienced clinicians. Simulation-based mastery learning (SBML) is one potential solution to this problem. This study evaluated the effects of a randomized trial of thoracentesis SBML on patient complications: iatrogenic pneumothorax (IP), hemothorax, and reexpansion pulmonary edema (REPE).

Method

The authors randomized internal medicine residents to undergo thoracentesis SBML at a tertiary care academic center from December 2012 to May 2016. They subsequently compared thoracentesis complications from procedures performed by SBML-trained residents, traditionally trained residents (no simulation training), and those referred to pulmonary medicine or interventional radiology (IR).

Results

During the study period, 917 thoracenteses were performed on 709 patients. IP occurred in 60 (6.5%) procedures, of which 7 (11.6%) were clinically meaningful. SBML-trained residents performed procedures with a trend toward lower combined clinically meaningful complications (IP, hemothorax, REPE) compared with traditionally trained residents (7.9% vs. 0%; P = .06). SBML-trained residents caused fewer clinically meaningful IPs compared with traditionally trained residents, pulmonary, and IR referrals (P = .02). Hemothorax occurred after 4 (0.4%) thoracenteses, and SBML-trained residents had a trend toward lower hemothorax (0) compared with other groups (P = .07). REPE occurred after 3 (0.3%) procedures, with no differences between groups. SBML-trained residents performed procedures with lower combined clinically meaningful complications compared with other groups (P = .008).

Conclusions

Residents randomized to an SBML intervention performed thoracenteses with low rates of clinically meaningful complications. Rigorous education represents a successful quality improvement strategy.
A review of current management of vasculo-Behcet's
Authors: Merashli Mira , Eid Rozana El , Uthman Imad
Published: October 2017

Purpose of review

To give an overview of recently published articles about the management of vasculo-Behcet's with particular emphasis on anticoagulation.

Recent findings

Biologic agents are emerging as a potential therapeutic option in refractory vasculo-Behcet with a good safety profile. Evidence further shows that following nonpulmonary aneurysm repair, there is a reduced risk of recurrent aneurysmal formation at the operative site in patients treated with immunosuppressants in addition to their surgery, than those undergoing surgical intervention alone.

Behcet disease patients are at risk of developing multiple vascular complications including thrombosis and aneurysms. Treatment should focus on reducing inflammation; and the role of anticoagulation is still debatable.
Combined Conjunctival Limbal Autografts and Living-Related Conjunctival Limbal Allografts for Severe Unilateral Ocular Surface Failure
Authors: Cheung Albert Y. , Sarnicola Enrica , Govil Amit , Holland Edward J.
Published: October 2017

Purpose:

To describe the technique and present 2 cases of a combined conjunctival limbal autograft (CLAU) and living-related conjunctival limbal allograft (lr-CLAL) procedure for treatment of severe unilateral ocular surface failure.

Methods:

Interventional case series of 2 eyes of 2 patients sustaining severe thermal/chemical injuries from firework explosions. They both underwent the combined CLAU/lr-CLAL procedure followed by penetrating keratoplasty. Systemic immunosuppression consisted of oral tacrolimus and mycophenolate mofetil.

Results:

Preoperative vision was counting fingers for both patients, whereas visual acuity at last follow-up ranged between 20/40 and 20/50. Both patients maintained a stable surface at last follow-up without any episodes of rejection. Patients tolerated systemic immunosuppression well without any persistent adverse reactions.

Conclusions:

Certain etiologies of limbal stem cell deficiency also lead to significant conjunctival (and goblet cell) deficiency. Combined CLAU and lr-CLAL procedures maximize the amount of healthy limbal stem cells with conjunctiva while also minimizing the antigenic burden as all transplanted tissue potentially can be a complete (or near-complete), compatible HLA and crossmatch.
Supporting Clinical Nurses Through a Research Fellowship
Authors: Mason Barbara , Lambton Judith , Fernandes Roxanne
Published: October 2017

After reviewing the literature, nurses at the bedside seeking answers to clinical questions may find their inquiries remain unanswered. This article describes the yearlong Research Fellows Program in which candidates, funded for 12 hours per month of research release time, answered formal research questions in a curriculum designed to provide the skills to complete their study. Five have completed their studies; 1 has received a grant to continue. Two are in process of submitting manuscripts to journals.
Circle of Advisors
Authors: Cherry Barbara , Yoder-Wise Patricia S. , Kowalski Karren E.
Published: October 2017

The CGEAN Board established a goal to support MSN administration programs to thrive and meet the need for well-prepared nurses to assume leadership roles. This column addresses how we embarked on this work through creation of a Circle of Advisors composed of national nursing leaders who came together to address specific curricular issues and more importantly to voice support for continuation of MSN administration programs.