bluuebunny/crossref_metadata_2025 huggingface dataset:
Interprofessional Education in the Obstetrics and Gynecology Clerkship: Do We Teach Collaboration?
Authors: Justicia-Linde Faye
Published: September 2016

Local Mentor: Glenna Bett, PhD

APGO Advisors: Jody Steinauer, MD, MAS, and Sonya Erickson, MD

PURPOSE:

To ascertain how obstetrics and gynecology (Ob-Gyn) clerkships incorporate interprofessional education (IPE) into the curriculum and Ob-Gyn clerkship directors' opinions regarding IPE.

BACKGROUND:

The Association of American Medical Colleges (AAMC) identified IPE as a “horizon issue.” Literature review revealed 6 publications regarding IPE focused on the Ob-Gyn clerkship from the United States, Canada and United Kingdom. Most publications on IPE in Ob-Gyn investigated resident and attending perspectives.

METHODS:

The study used an online survey of Ob-Gyn clerkship directors at English-speaking LCME-accredited allopathic medical schools identified through the AAMC's website. Clerkship directors were identified through institutions' websites. The survey contained 16 questions about clerkship structure, if/how IPE activities are conducted, and clerkship director attitudes regarding IPE.

RESULTS:

One hundred fifty-four eligible medical schools were identified; 237 invitations were sent and 84 complete responses received. Seventy-two percent of clerkship directors believed that IPE should be included in the Ob-Gyn clerkship; 25% were unsure, and 4% did not. However, only 54% of Ob-Gyn clerkships incorporated IPE activities, 39% did not, and 7% planned to do so. The most common IPE activities were joint didactic sessions (58%) and interprofessional patient rounds (47%). The main barrier to implementing IPE was difficulty coordinating schedules (78%).

DISCUSSION:

The majority of respondents believed IPE should be included in the Ob-Gyn clerkship and had already done so. This is the first study to address practices and attitudes regarding IPE in the Ob-Gyn clerkship, a strength being its broad reach across LCME-accredited institutions. Potential weaknesses include response biases.
Satisfaction With an Electronic Feedback Tool for the OBGYN Clerkship
Authors: Pearson Mary Jane , Meyer Bruce , Green Victoria , Lai Ki
Published: September 2016

Local Mentor: Bruce Meyer, MD, MBA

APGO Advisor: Alice R. Goepfert, MD

PURPOSE:

To develop an electronic feedback tool and evaluate clerkship student and faculty satisfaction.

BACKGROUND:

Provision of formative feedback during clerkships is mandated by the Liaison Council on Medical Education as important in the development of clinical competence. A common concern in medical student education is the dichotomy wherein faculty believe that feedback has been provided but students do not recognize feedback was given. There is need for a simple tool that documents and collects feedback. No recent literature has cited use of an electronic feedback tool.

METHODS:

An electronic feedback tool, using elements of the AAMC Entrustable Professional Activities, was developed following a needs assessment survey administered to students and ObGyn faculty. This tool, housed on a secure institutional website, was available to both clerkship students and faculty using smartphone, tablet or computer. The project was IRB exempt.

EVALUATION PLAN:

The electronic tool was offered at family planning and ambulatory gynecology clinics to 31 clerkship students and the 11 attending faculty. Thirty student satisfaction surveys and 7 faculty satisfaction surveys were collected. Satisfaction with the electronic tool was assessed using an online survey. Sixty percent of students and 100% faculty were neutral or dissatisfied with the electronic tool. Commonly cited issues were electronic access problems and adequacy of training.

DISSEMINATION:

Information in this survey will be helpful in the further development of electronic tools in the clinical setting.

REFLECTIVE CRITIQUE:

Future development will need to incorporate strategies to enrich faculty training and improve access.
Use of a Perceptual Adaptive Learning Module Results in Improved Accuracy and Fluency of Fetal Heart Rate Categorization by Medical Students
Authors: Wong Melissa
Published: September 2016

Local Mentor: Sally Krasne, PhD

APGO Advisor: Nancy Hueppchen, MD, MSc

PURPOSE:

Our aim is to evaluate whether use of a Perceptual Adaptive Learning Module (PALM) by medical students would result in improved accuracy and “fluency” (accuracy and speed) of Fetal Heart Rate (FHR) categorization versus traditional lecture methods.

BACKGROUND:

No published studies have evaluated the best method of teaching FHR interpretation. The PALM has been shown to improve learning in skills requiring pattern recognition.

METHODS:

This is a non-randomized controlled trial of third-year medical students. All subjects underwent a pretest and received a basic FHR physiology lecture. Subjects were then exposed to the PALM or to additional lecture reviewing details of FHR categorization. All subjects took an immediate posttest and a delayed test 5 weeks later.

RESULTS:

From April to September 2015, 66 subjects participated: 33 were assigned to the experimental (PALM) arm and 33 to the control (traditional lecture) arm. Only the PALM showed a significant improvement in accuracy and fluency from the pretest to posttest (accuracy from 35% to 71%, P<.05; fluency 27–65%, P<.05). Both interventions showed significant improvement in accuracy and fluency on the delayed test reflecting learning throughout the rotation. However, the PALM showed a significantly greater improvement as compared to the lecture group in both the posttest (accuracy 70% PALM versus 47% lecture, P<.05; fluency 61% versus 29%, P<.05) and the delayed test (accuracy 69% PALM versus 57% lecture, P<.05; fluency 58% versus 41%, P<.05).

DISCUSSION:

The PALM resulted in more accurate and fluent categorization of FHR tracings compared to traditional lecture, and the effect persisted on delayed testing.
Faculty Attitudes Towards TVH and Impact of Vaginal Hysterectomy Simulator
Authors: Dayaratna Sandra
Published: September 2016

BACKGROUND:

Resident education is dependent on the expertise of faculty. Many residents are graduating with the minimum acceptable number of TVHs. Increasing the number TVH scheduled by faculty, will have a tremendous impact on resident education.

METHODS:

Attending physicians practicing gynecology at a large University hospital were surveyed regarding experience and current practice with performing TVH. Physicians were asked to identify perceived difficulties or barriers with the procedure. OR logs were reviewed for the number of TVHs performed by provider. Faculty members used a vaginal hysterectomy simulator with guidance by a gynecologic expert. A post intervention survey was distributed. OR logs will be pulled for the year after the intervention.

RESULTS:

Less than 50% of faculty reported being very comfortable with TVH. All participants had performed twenty or fewer TVHs during training. Anterior entry was identified as the most difficult step. Over half reported they would more likely do a TVH if they could double scrub. Results from use of the simulator are to be reported at a later date.

DISCUSSION:

There is ample data that TVH is the safest and most cost effective mode of hysterectomy when feasible. There is also data that volume of cases has an impact on surgical outcomes. At present, all faculty were considered low volume surgeons. This underscores the importance of increasing faculty comfort level with TVH so that residents can be trained adequately. In addition, additional support should be provided for anterior entry as most respondents identified that as the most difficult part of the procedure.
Faculty Development and Surgical Training: Are Audio Podcasts an Effective Tool?
Authors: Smith Katie , Crouse Elisa , Anderson Ted
Published: September 2016

BACKGROUND:

Increased workload and reduction in resident work hours have made didactic teaching and faculty development more difficult to achieve. Needs assessment at the University of Oklahoma revealed a gap in effective faculty development. Audio podcasts are ideal developmental tools as they can be accessed in many settings while engaged in activities such as driving or exercise. Our objective was to create an audio podcast for departmental faculty development. The podcast will address identification of and early interventions for residents who are having difficulty with mastering surgical skills.

METHODS:

A single high fidelity audio podcast was created and distributed to our faculty. A survey was given to faculty before and after the podcast distribution.

RESULTS:

Most of the 24 faculty responding to the initial survey had no structured format for evaluating resident surgical skills. Although 67% had previously listened to a podcast, about half reported that it had been more than 2 months. Eight faculty listened to the podcast and responded to the post listening survey. The majority reported learning new information from listening which some have used and all felt it was an effective way of learning.

DISCUSSION:

Faculty in our department had some baseline knowledge and experience with audio podcasts. All who listened to our podcast felt it was an effective tool for faculty development and education.
Impact of an Abdominal Hysterectomy Simulator on Obstetrics and Gynecology Residents Surgical Confidence
Authors: Stickrath Elaine , Alston Meredith , Mazzoni Sara
Published: September 2016

BACKGROUND:

The number of abdominal hysterectomies (AH) performed by Obstetrics and Gynecology (OB/GYN) residents has decreased dramatically. Thus, there is a need for simulation training to compliment operating room experience. The objective of this study is to evaluate the impact of an AH simulator on resident surgeon confidence.

METHODS:

A low-fidelity AH simulator was constructed from craft store supplies costing less than $40. OB/GYN residents in a single academic program completed the simulation between July and September 2015. The 1-hour simulation experience included a pre-test, a 5 minute presentation, the simulation, and a post-test. On the pre and post-tests, participants rated their confidence with the steps of AH as Not at All, Somewhat or Very confident.

RESULTS:

Eighty-six percent (32/37) of possible residents completed the session with even representation from all levels of training (9 PGY-1, 7 PGY-2, 8 PGY-3 and 8 PGY-4). Knowledge of the steps of the procedure and instrumentation improved for all levels of trainees (P=.001). One hundred percent (16/16) of the PGY-1 and PGY-2 residents rated their confidence as increased afterwards, while only 25% (4/16) of the PGY-3 and PGY-4 residents did so. Ninety-four percent (30/32) rated the session as Very helpful on a scale of Not at All, Somewhat or Very Helpful.

DISCUSSION:

A low-fidelity, low-cost simulator showed an increase in trainee confidence with AH, particularly in the first and second year trainees. Nearly all participants found the exercise helpful, suggesting that it may be beneficial to incorporate into OB/GYN training programs nationwide.
Monitoring Resident Surgical Performance Through Dictated Feedback
Authors: Rhoades-Lazenby Courtney
Published: September 2016

BACKGROUND:

We rely on 3 faculty for most feedback about resident surgical performance. However, more than half the resident surgical experience involves private surgeons from whom we were not receiving case-specific feedback. We needed a system to capture this feedback.

METHODS:

We implemented a phone dictation system distributed to all surgeons participating in resident education in May 2015. We consented 17 gynecologists who were asked to use telephone dictation cards to provide feedback after each case involving a resident. We compared number of dictations with number of resident cases that could have been dictated each month using resident logs of cases scrubbed. We also tracked how many different surgeons provided dictations.

RESULTS:

Not all gynecologists used the dictation system. Despite initial promising results, there was a time dependent trail-off in both number of surgeons using the system and number of dictations received. In total, out of 205 cases performed, we received 50 dictations—24% feedback rate.

DISCUSSION:

It is difficult to get resident surgical performance feedback from private surgeons, even when you provide structure and accessibility. However, a 24% feedback rate is still improved from no surgical case feedback.
Spine Injuries in Child Abuse
Authors: Jauregui Julio J. , Perfetti Dean C. , Cautela Frank S. , Frumberg David B. , Naziri Qais , Paulino Carl B.
Published: September 2016

Background:

Although rare, spinal injuries associated with abuse can have potentially devastating implications in the pediatric population. We analyzed the association of pediatric spine injury in abused children and determined the anatomic level of the spine affected, while also focusing on patient demographics, length of stay, and total hospital charges compared with spine patients without a diagnosis of abuse.

Methods:

A retrospective review of the Kids’ Inpatient Database was conducted from 2000 to 2012 to identify pediatric patients (below 18 y) who sustained vertebral column fractures or spinal cord injuries. Patients with a documented diagnosis of abuse were identified using ICD-9-CM diagnosis codes. Our statistical models consisted of multivariate linear regressions that were adjusted for age, race, and sex.

Results:

There were 22,192 pediatric patients with a diagnosis of spinal cord or vertebral column injury during the study period, 116 (0.5%) of whom also had a documented diagnosis of abuse. The most common type of abuse was physical (75.9%). Compared with nonabused patients, abused patients were more likely to be below 2 years of age (OR=133.4; 95% CI, 89.5-198.8), female (OR=1.67; 95% CI, 1.16-2.41), and nonwhite (black: OR=3.86; 95% CI, 2.31-6.45; Hispanic: OR=2.86; 95% CI, 1.68-4.86; other: OR=2.33; 95% CI, 1.11-4.86). Abused patients also presented with an increased risk of thoracic (OR=2.57; 95% CI, 1.67-3.97) and lumbar (OR=1.67; 95% CI, 1.03-2.72) vertebral column fractures and had a multivariate-adjusted mean length of stay that was 62.2% longer (P<0.001) and mean total charges that were 52.9% higher (P<0.001) compared with nonabused patients. Furthermore, 19.7% of all pediatric spine patients under 2 years of age admitted during the study period belonged to the abused cohort.

Conclusions:

Spine injuries are rare but can be found in the pediatric population. With an additional documented diagnosis of abuse, these injuries affect younger patients in the thoracolumbar region of the spine, and lead to longer lengths of stay and higher hospital costs when compared with nonabused patients. Because of these findings, physicians should maintain a higher level of suspicion of abuse in patients with spine injuries, especially patients under 2 years of age.

Level of Evidence:

Level III evidence—a case-control study.
Effects of Antibiotic Timing on Culture Results and Clinical Outcomes in Pediatric Musculoskeletal Infection
Authors: Benvenuti Michael A. , An Thomas J. , Mignemi Megan E. , Martus Jeffrey E. , Thomsen Isaac P. , Schoenecker Jonathan G.
Published: September 2016

Introduction:

Musculoskeletal infection (MSI) is a common cause of morbidity and hospital resource utilization in the pediatric population. Many physicians prefer to withhold antibiotics until tissue cultures can be taken in an effort to improve culture yields. However, there is little evidence that this practice improves culture results or outcomes in pediatric MSI. Therefore, investigating the effects of antibiotic timing may lead to improved clinical practice guidelines for treating children with MSI.

Methods:

An IRB-approved retrospective review was conducted that identified 113 patients aged 0 to 18 who presented to the pediatric emergency room at a tertiary care children’s hospital with MSI from 2008 to 2013. Demographic data, culture results, severity markers, and intervention timing were obtained from the medical record. Logistic regression and Cox survival analysis were performed to determine the relationship of antibiotic timing with culture sensitivity and time to discharge.

Results:

No difference was seen in culture sensitivity antibiotic administration in either the local (55% culture before antibiotics vs. 89% after antibiotics) or disseminated group (76% before vs. 79% after), which persisted when further accounting for disease severity with C-reactive protein. However, later administration of antibiotics in the local infection group correlated with a decreased likelihood of discharge (3.91 d when cultured before antibiotics vs. 2.93 d when cultured after antibiotics; hazard ratio, 0.53; P<0.05). In patients with disseminated infection, antibiotic administration was not shown to correlate with any difference in time to discharge (hazard ratio, 1.08).

Conclusions:

The authors were surprised to find that tissue culture sensitivities were not decreased by antibiotic administration in either local or disseminated MSI, suggesting that antibiotic administration should not be delayed to obtain tissue cultures. The correlation of earlier antibiotic administration with shorter length of stay in children with local MSI led the authors to conclude that antibiotics should be initiated as quickly as possible. Further study is necessary to confirm these findings and establish clinical practice guidelines.

Level of Evidence:

Level III—retrospective cohort.
Development and Validation of a Photonumeric Scale for Evaluation of Facial Skin Texture
Authors: Donofrio Lisa , Carruthers Alastair , Hardas Bhushan , Murphy Diane K. , Carruthers Jean , Jones Derek , Sykes Jonathan M. , Creutz Lela , Marx Ann , Dill Sara
Published: September 2016

BACKGROUND

A validated scale is needed for objective and reproducible comparisons of facial skin roughness before and after aesthetic treatment in practice and in clinical studies.

OBJECTIVE

To describe the development and validation of the 5-point photonumeric Allergan Skin Roughness Scale.

METHODS

The scale was developed to include an assessment guide, verbal descriptors, morphed images, and real subject images for each grade. The clinical significance of a 1-point score difference was evaluated in a review of image pairs representing varying differences in severity. Interrater and intrarater reliability was evaluated in a live-subject validation study (N = 290) completed during 2 sessions occurring 3 weeks apart.

RESULTS

A score difference of ≥1 point was shown to reflect a clinically meaningful difference (mean [95% confidence interval] absolute score difference 1.09 [0.96–1.23] for clinically different image pairs and 0.53 [0.38–0.67] for not clinically different pairs). Intrarater agreement between the 2 validation sessions was almost perfect (weighted kappa = 0.83). Interrater agreement was almost perfect during the second rating session (0.81, primary end point).

CONCLUSION

The Allergan Skin Roughness Scale is a validated and reliable scale for physician rating of midface skin roughness.
Current Management of the Axilla
Authors: McCARTAN DAMIAN , GEMIGNANI MARY L.
Published: September 2016

Despite advances in estimating prognosis and predicting response to adjuvant systemic therapy, the status of the axillary lymph nodes remains a critical component in initial surgical planning and in determining therapeutic strategies for patients with breast cancer. Buoyed by evidence from multi-institutional randomized clinical trials, the last 2 decades have witnessed remarkable and practice-changing advances in our approach to the axilla. This review concentrates on the current best practice in axillary management for both node-negative and node-positive patients, with particular focus on the evolving management of the axilla in the era of neoadjuvant systemic therapy.
Borderline Personality Disorder and Narcissistic Personality Disorder Diagnoses From the Perspective of the DSM-5 Personality Traits
Authors: Fossati Andrea , Somma Antonella , Borroni Serena , Maffei Cesare , Markon Kristian E. , Krueger Robert F.
Published: September 2016

To evaluate the associations between Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) Alternative Model of Personality Disorder traits and domains and categorically diagnosed narcissistic personality disorder (NPD) and borderline personality disorder (BPD), respectively, 238 inpatient and outpatient participants who were consecutively admitted to the Clinical Psychology and Psychotherapy Unit of San Raffaele Hospital in Milan, Italy, were administered the Personality Inventory for DSM-5 (PID-5) and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Based on SCID-II, the participants were assigned to the following groups: a) NPD (n = 49), b) BPD (n = 32), c) any other PD (n = 91), and d) no PD (n = 63). Emotional lability, separation insecurity, depressivity, impulsivity, risk taking, and hostility were significantly associated with BPD diagnosis. Attention seeking significantly discriminated participants who received an SCID-II categorical NPD diagnosis. Separation insecurity, impulsivity, distractibility, and perceptual dysregulation were the DSM-5 traits that significantly discriminated BPD participants. Domain-level analyses confirmed and extended trait-level findings.
Does Exercise Decrease Pain via Conditioned Pain Modulation in Adolescents?
Authors: Stolzman Stacy , Bement Marie Hoeger
Published: September 2016

Purpose:

Pain relief after exercise, exercise-induced hypoalgesia (EIH), is established across the lifespan. Conditioned pain modulation (CPM: pain inhibits pain) may be a mechanism for EIH.

Methods:

In 55 adolescents, pressure pain thresholds were measured before and after exercise (deltoid, quadriceps, and nail bed) and during CPM at the nail bed and deltoid test stimulus sites. The relationship between EIH and CPM was explored.

Results:

EIH occurred at deltoid and quadriceps; CPM occurred at nail bed and deltoid. CPM and EIH correlated at deltoid; adolescents with greater CPM experienced greater pain relief after exercise. At this site, CPM predicted 5.4% of EIH. Arm lean mass did not add a significant effect. Peak exercise pain did not influence EIH. Adolescents with none, minimal, moderate, or severe peak exercise pain experienced similar EIH.

Conclusions:

A potential relationship exists between CPM and EIH in adolescents. Pediatric physical therapists should consider the CPM response when prescribing exercise as a pain management tool.
Cholecystostomy Treatment in an ICU Population: Complications and Risks
Authors: Friedrich Ann-Kristin U. , Baratta Kevin P. , Lewis Joanne , Karam Adib R. , Hudlin Margaret , Litwin Demetrius E.M. , Cahan Mitchell A.
Published: September 2016

Background:

Percutaneous cholecystostomy tube placement has widely been used as an alternative treatment to cholecystectomy, especially in advanced disease or critically ill patients. Reported postprocedural complication rates have varied significantly over the last decade. The goal of this study is to evaluate the safety of percutaneous cholecystostomy tube treatment in critically ill patients.

Study Design:

We performed a retrospective chart analysis of 96 critically ill patients who underwent cholecystostomy tube placement during an intensive care unit (ICU) stay between 2005 and 2010 in a tertiary care center in central Massachusetts. Complications within 72 hours of cholecystostomy tube placement and any morbidity or mortality relating to presence of cholecystostomy tube were considered.

Results:

A total of 65 male and 31 female patients with a mean age of 67.4 years underwent percutaneous cholecystostomy tube placement during an ICU stay. Sixty-six patients experienced a total of 121 complications, resulting in an overall complication rate of 69%. Fifty-four of these complications resulted from the actual procedure or the presence of the cholecystostomy tube; the other 67 complications occurred within 72 hours of the cholecystostomy procedure. Ten patients died. Tube dislodgment was the most common complication with a total of 34 episodes.

Conclusions:

Cholecystostomy tube placement is associated with frequent complications, the most common of which is tube dislodgment. Severe complications may contribute to serious morbidity and death in an ICU population. Complication rates may be underreported in the medical literature. The potential impact of cholecystostomy tube placement in critically ill patients should not be underestimated.
A Whole-Brain Computational Modeling Approach to Explain the Alterations in Resting-State Functional Connectivity during Progression of Alzheimer’s Disease
Authors: Demirtaş Murat , Falcon Carles , Tucholka Alan , Gispert Juan Domingo , Molinuevo José Luis , Deco Gustavo
Published: September 2016

Understanding the mechanisms behind Alzheimer’s disease (AD) is one of the most challenging problems in neuroscience. Recent efforts provided valuable insights on the genetic, biochemical and neuronal correlates of AD. The advances in structural and functional neuroimaging provided massive evidence for the AD related alterations in brain connectivity. In this study, we investigated the whole-brain resting state functional connectivity (FC) and variability in dynamic functional connectivity (v-FC) of the subjects with preclinical condition (PC), mild cognitive impairment (MCI) and Alzheimer’s disease (AD). The synchronization in the whole-brain was monotonously decreasing during the course of the progression. However, only in the AD group the reduced synchronization produced significant widespread effects in FC. Furthermore, we found elevated variability of FC in PC group, which was reversed in AD group. We proposed a whole-brain computational modeling approach to study the mechanisms behind these alterations. We estimated the effective connectivity (EC) between brain regions in the model to reproduce observed FC of each subject. First, we compared ECs between groups to identify the changes in underlying connectivity structure. We found that the significant EC changes were restricted to temporal lobe. Then, based on healthy control subjects we systematically manipulated the dynamics in the model to investigate its effect on FC. The model showed FC alterations similar to those observed in clinical groups providing a mechanistic explanation to AD progression.
Widespread allelic heterogeneity in complex traits
Authors: Hormozdiari Farhad , Zhu Anthony , Kichaev Gleb , Segrè Ayellet V. , Ju Chelsea J.-T. , Joo Jong Wha J , Won Hyejung , Sankararaman Sriram , Pasaniuc Bogdan , Shifman Sagiv , Eskin Eleazar
Published: September 2016

Recent successes in genome-wide association studies (GWASs) make it possible to address important questions about the genetic architecture of complex traits, such as allele frequency and effect size. One lesser-known aspect of complex traits is the extent of allelic heterogeneity (AH) arising from multiple causal variants at a locus. We developed a computational method to infer the probability of AH and applied it to three GWAS and four expression quantitative trait loci (eQTL) datasets. We identified a total of 4152 loci with strong evidence of AH. The proportion of all loci with identified AH is 4-23% in eQTLs, 35% in GWAS of High-Density Lipoprotein (HDL), and 23% in schizophrenia. For eQTLs, we observed a strong correlation between sample size and the proportion of loci with AH (R2=0.85, P = 2.2e-16), indicating that statistical power prevents identification of AH in other loci. Understanding the extent of AH may guide the development of new methods for fine mapping and association mapping of complex traits.
Morphology of Fe nanolayers with Pt overlayers on low-temperature annealing
Authors: Gong Jing , Paul Neelima , Nagy Béla , Dolgos Miklós , Bottyán László , Müller-Buschbaum Peter , Böni Peter , Zheng Jian-Guo , Paul Amitesh
Published: September 2016

Agglomeration or dewetting is technologically important in the microelectronics industry as it is one of the methods of producing arrays of nanosized metal clusters. This report investigates the grain morphology evolution due to low-temperature annealing (473 K) in Fe layers with Pt overlayers. X-ray diffuse scattering and grazing-incidence small-angle X-ray scattering (GISAXS) have been used to access different correlation lengths and correlate them with grain sizes from transmission electron microscopy. Overall, the GISAXS data indicate that the nanoparticles or nanoclusters in the samples appear as bimodal distributions. It is shown that, for an Fe layer with vertical grain sizes of 5 and 11 nm, irrespective of cluster size, there is no signature of agglomeration between the Fe and Pt layers even with very long annealing times (3000 min). The vertical grain sizes are mediated by the film thickness. Furthermore, an alternating variation with grain sizes of 4 and 7 nm is achieved by Al doping, but without a restriction on the Fe layer thickness. Even in this case, the agglomeration process is seen to remain unaffected by annealing for the same time durations, but only for the larger sized nanoclusters. The smaller ones are seen to grow in size, with increased correlation lengths for the maximum annealing time owing to higher surface energy.
Self-organized in-plane ordering of nanostructures at epitaxial ferroelectric–ferromagnetic interfaces
Authors: Flaschmann Rasmus , Ye Jingfan , Paul Neelima , Bern Francis , Esquinazi Pablo , Müller-Buschbaum Peter , Stahn Jochen , Böni Peter , Zheng Jian-Guo , Aoki Toshihiro , Paul Amitesh
Published: September 2016

The formation of self-assembled structures is of great interest in the field of ferroelectric (FE)–ferromagnetic (FM) oxide interfaces with novel functionalities driven by the combination of strain relaxation and diffusion/segregation processes occurring during epitaxial growth of Mn-based heterostructures. In epitaxial bilayers and multilayers of La0.67Sr0.33MnO3 (LSMO)/BaTiO3 (BTO) on (001) SrTiO3, using the grazing-incidence small-angle X-ray scattering technique, self-assembled in-plane structural ordering with a repeated sequence of the bilayers has been found. This ordering has important magnetic consequences, as the materials show characteristics of a superparamagnetic type of behavior even with an increased number of bilayers. Transmission electron microscopy images reveal strain due to lattice mismatch between BTO and LSMO. This strain is greatly enhanced with the number of BTO and LSMO repetitions in a multilayer as an interdiffused columnar structure is formed. Electron energy loss spectra indicate a variation in oxygen environment from one monolayer to another within one LSMO layer. Reflectivity measurements with polarized neutrons prove that the LSMO layers are grown with sufficient periodicity but have a strongly reduced magnetic moment. This reduction is plausibly associated with interfacial strain and varying oxygen deficiencies within the layers or symmetry breaking effects which can turn the LSMO layer almost antiferromagnetic.
Formation of swift heavy ion tracks on a rutile TiO2 (001) surface
Authors: Karlušić Marko , Bernstorff Sigrid , Siketić Zdravko , Šantić Branko , Bogdanović-Radović Ivančica , Jakšić Milko , Schleberger Marika , Buljan Maja
Published: September 2016

Nanostructuring of surfaces and two-dimensional materials using swift heavy ions offers some unique possibilities owing to the deposition of a large amount of energy localized within a nanoscale volume surrounding the ion trajectory. To fully exploit this feature, the morphology of nanostructures formed after ion impact has to be known in detail. In the present work the response of a rutile TiO2 (001) surface to grazing-incidence swift heavy ion irradiation is investigated. Surface ion tracks with the well known intermittent inner structure were successfully produced using 23 MeV I ions. Samples irradiated with different ion fluences were investigated using atomic force microscopy and grazing-incidence small-angle X-ray scattering. With these two complementary approaches, a detailed description of the swift heavy ion impact sites, i.e. the ion tracks on the surface, can be obtained even for the case of multiple ion track overlap. In addition to the structural investigation of surface ion tracks, the change in stoichiometry of the rutile TiO2 (001) surface during swift heavy ion irradiation was monitored using in situ time-of-flight elastic recoil detection analysis, and a preferential loss of oxygen was found.
Crystal structure and hydrogen bonding in the hydrated cocrystalline salt tryptaminium–3,5-dinitrobenzoate–quinoline–water (3/3/2/2)
Authors: Lynch Daniel E. , Smith Graham , Keene Tony D. , Horton Peter N.
Published: September 2016

The study of ternary systems is interesting because it introduces the concept of molecular preference/competition into the system where one molecule may be displaced because the association between the other two is significantly stronger. Current definitions of a tertiary system indicate that solvent molecules are excluded from the molecule count of the system and some of the latest definitions state that any molecule that is not a solid in the parent form at room temperature should also be excluded from the molecule count. In the structure of the quinoline adduct hydrate of tryptaminium 3,5-dinitrobenzoate, 3C10H13N2+·3C7H3N2O6−·2C9H7N·2H2O, the asymmetric unit comprises multiple cation and anion species which are conformationally similar among each type set. In the crystal, a one-dimensional hydrogen-bonded supramolecular structure is generated through extensive intra- and inter-unit aminium N—H...O and N—H...N, and water O—H...O hydrogen bonds. Within the central-core hydrogen-bonding associations, conjoined cyclicR44(10),R53(10) andR44(12) motifs are generated. The unit is expanded into a one-dimensional column-like polymer extending along [010]. Present also in the crystal packing of the structure are a total of 19 π–π interactions involving both cation, anion and quinoline species [ring-centroid separation range = 3.395 (3)–3.797 (3) Å], as well as a number of weak C—H...O hydrogen-bonding associations. The presence of the two water molecules in the crystal structure is considered to be the principal causative factor in the low symmetry of the asymmetric unit.
Crystal structure, solvothermal synthesis, thermogravimetric studies and DFT calculations of a five-coordinate cobalt(II) compound based on the N,N-bis(2-hydroxyethyl)glycine anion
Authors: Zhou Yanling , Liu Xianrong , Wang Qijun , Wang Lisheng , Song Baoling
Published: September 2016

The reaction of CoCl2·6H2O, N,N-bis(2-hydroxyethyl)glycine and triethylamine (Et3N) in ethanol solution under solvothermal conditions produced crystals of [N,N-bis(2-hydroxyethyl)glycinato]chloridocobalt(II), [Co(C6H12NO4)Cl]. The CoII ion is coordinated in a slightly distorted trigonal–bipyramidal environment which is defined by three O atoms occupying the equatorial plane and the N and Cl atoms in the apical sites. In the crystal, two types of O—H...O hydrogen bonds connect the molecules, forming a two-dimensional network parallel to (001). The molecular structure of the title compound confirms the findings of FTIR, elemental analysis, ESI–MS analysis and TG analysis. By using the density functional theory (DFT) (B3LYP) method with 6-31G(d) basis set, the molecular structure has been calculated and optimized.
Crystal structure of N,N′-bis(pyridin-4-ylmethyl)cyclohexane-1,4-diammonium dichloride dihydrate
Authors: Moon Suk-Hee , Kang Donghyun , Park Ki-Min
Published: September 2016

Treatment of N,N-bis(pyridin-4-ylmethyl)cyclohexane-1,4-diamine with hydrochloric acid in ethanol led to the formation of the title salt, C18H26N4
2+·2Cl−·2H2O, which lies about a crystallographic inversion center at the center of the cyclohexyl ring. The asymmetric unit therefore comprises one half of the N,N-bis(pyridin-4-ylmethyl)cyclohexane-1,4-diammonium dication, a chloride anion, and a solvent water molecule. In the dication, the two trans-(4-pyridine)–CH2–NH2– moieties occupy equatorial sites at the 1- and 4-positions of the central cyclohexyl ring, which is in a chair conformation. The terminal pyridine ring is tilted by 27.98 (5)° with respect to the mean plane of the central cyclohexyl moiety (r.m.s. deviation = 0.2379 Å). In the crystal, dications, anions, and solvent water molecules are connected via N/C/O—H...Cl and N—H...O hydrogen bonds together with C—H...π interactions, forming a three-dimensional network.
Occurrence and molecular characteristics of antimicrobial resistance of Escherichia coli from broilers, pigs and meat products in Thailand and Cambodia provinces
Authors: Trongjit Suthathip , Angkittitrakul Sunpetch , Chuanchuen Rungtip
Published: September 2016

Nine hundred and forty‐one samples were collected in Sa Keao, Thailand (n = 554) and Banteay Meanchey, Cambodia (n = 387) from July 2014 to January 2015. A total of 667 Escherichia coli isolates (381 isolates from Sa Keao and 286 isolates from Banteay Meanchey) were obtained and examined for antimicrobial susceptibility, class 1 integrons, ESBL genes and horizontal transfer of resistance determinants. Prevalence of E. coli in pig and broiler carcass samples from slaughterhouses and fresh markets was 36–85% in Sa Keao and 11–69% in Banteay Meanchey. The majority of these isolates were multidrug resistant (75.3%). Class 1 integrons were common in both Thai (47%) and Cambodian (62%) isolates, of which four resistance gene cassette arrays including aadA1, dfrA1‐aadA1, dfrA12‐aadA2 and aadA2‐linF were identified. Class 1 integrons in two broiler isolates from Sa Keao (dfrA12‐aadA2) and one broiler isolate from Banteay Meanchey (dfrA1‐aadA1) were horizontally transferable. Sixteen isolates were confirmed to be ESBL‐producing strains with ESBL gene blaCTX‐M‐15, broad spectrum β‐lactamase gene blaTEM‐1 and the AmpC gene blaCMY‐2 being detected. The blaTEM‐1 gene was most prevalent and located on a conjugative plasmid.
A fast joint seismic data reconstruction by sparsity‐promoting inversion
Authors: Bai Lanshu , Lu Huiyi , Liu Yike , Khan Majid
Published: September 2016

Seismic field data are often irregularly or coarsely sampled in space due to acquisition limits. However, complete and regular data need to be acquired in most conventional seismic processing and imaging algorithms. We have developed a fast joint curvelet‐domain seismic data reconstruction method by sparsity‐promoting inversion based on compressive sensing. We have made an attempt to seek a sparse representation of incomplete seismic data by curvelet coefficients and solve sparsity‐promoting problems through an iterative thresholding process to reconstruct the missing data. In conventional iterative thresholding algorithms, the updated reconstruction result of each iteration is obtained by adding the gradient to the previous result and thresholding it. The algorithm is stable and accurate but always requires sufficient iterations. The linearised Bregman method can accelerate the convergence by replacing the previous result with that before thresholding, thus promoting the effective coefficients added to the result. The method is faster than conventional one, but it can cause artefacts near the missing traces while reconstructing small‐amplitude coefficients because some coefficients in the unthresholded results wrongly represent the residual of the data. The key process in the joint curvelet‐domain reconstruction method is that we use both the previous results of the conventional method and the linearised Bregman method to stabilise the reconstruction quality and accelerate the recovery for a while. The acceleration rate is controlled through weighting to adjust the contribution of the acceleration term and the stable term. A fierce acceleration could be performed for the recovery of comparatively small gaps, whereas a mild acceleration is more appropriate when the incomplete data has a large gap of high‐amplitude events. Finally, we carry out a fast and stable recovery using the trade‐off algorithm. Synthetic and field data tests verified that the joint curvelet‐domain reconstruction method can effectively and quickly reconstruct seismic data with missing traces.
Dietary rapamycin supplementation reverses age‐related vascular dysfunction and oxidative stress, while modulating nutrient‐sensing, cell cycle, and senescence pathways
Authors: Lesniewski Lisa A. , Seals Douglas R. , Walker Ashley E. , Henson Grant D. , Blimline Mark W. , Trott Daniel W. , Bosshardt Gary C. , LaRocca Thomas J. , Lawson Brooke R. , Zigler Melanie C. , Donato Anthony J.
Published: September 2016

Inhibition of mammalian target of rapamycin, mTOR, extends lifespan and reduces age‐related disease. It is not known what role mTOR plays in the arterial aging phenotype or if mTOR inhibition by dietary rapamycin ameliorates age‐related arterial dysfunction. To explore this, young (3.8 ± 0.6 months) and old (30.3 ± 0.2 months) male B6D2F1 mice were fed a rapamycin supplemented or control diet for 6–8 weeks. Although there were few other notable changes in animal characteristics after rapamycin treatment, we found that glucose tolerance improved in old mice, but was impaired in young mice, after rapamycin supplementation (both P < 0.05). Aging increased mTOR activation in arteries evidenced by elevated S6K phosphorylation (P < 0.01), and this was reversed after rapamycin treatment in old mice (P < 0.05). Aging was also associated with impaired endothelium‐dependent dilation (EDD) in the carotid artery (P < 0.05). Rapamycin improved EDD in old mice (P < 0.05). Superoxide production and NADPH oxidase expression were higher in arteries from old compared to young mice (P < 0.05), and rapamycin normalized these (P < 0.05) to levels not different from young mice. Scavenging superoxide improved carotid artery EDD in untreated (P < 0.05), but not rapamycin‐treated, old mice. While aging increased large artery stiffness evidenced by increased aortic pulse‐wave velocity (PWV) (P < 0.01), rapamycin treatment reduced aortic PWV (P < 0.05) and collagen content (P < 0.05) in old mice. Aortic adenosine monophosphate‐activated protein kinase (AMPK) phosphorylation and expression of the cell cycle‐related proteins PTEN and p27kip were increased with rapamycin treatment in old mice (all P < 0.05). Lastly, aging resulted in augmentation of the arterial senescence marker, p19 (P < 0.05), and this was ameliorated by rapamycin treatment (P < 0.05). These results demonstrate beneficial effects of rapamycin treatment on arterial function in old mice and suggest these improvements are associated with reduced oxidative stress, AMPK activation and increased expression of proteins involved in the control of the cell cycle.
Body‐mass index is associated with fibrosis regression during long‐term nucleoside analogue therapy in chronic hepatitis B
Authors: Seto W.‐K. , Fung J. , Cheung K.‐S. , Mak L.‐Y. , Hui R. W. H. , Liu K. S. H. , Lai C.‐L. , Yuen M.‐F.
Published: September 2016

Background

Factors influencing changes in liver stiffness measurements during long‐term nucleoside analogue therapy for chronic hepatitis B (CHB) have not been thoroughly investigated.

Aim

To identify determinants of on‐treatment fibrosis regression in CHB.

Methods

We performed follow‐up liver stiffness and controlled attenuation parameter measurements on nucleoside analogue‐treated CHB patients with severe liver fibrosis, according to EASL‐ALEH criteria, diagnosed by transient elastography in 2006–2008. Anthropometric measurements and different metabolic parameters were recorded.

Results

Among 257 patients with severe liver fibrosis by initial transient elastography, 123 (47.9%) were recruited for reassessment. Median treatment duration was 87.5 (interquartile range 75.3–102.2) months; 97.5% had undetectable HBV DNA. There was a significant reduction in median liver stiffness from 14.6 to 8.3 kPa (P < 0.001). A total of 29.3% had fibrosis regression, with lower rates of 17.9%, 14.9% and 11.5% noted in patients with body‐mass index (BMI) ≥25 kg/m2, metabolic syndrome and diabetes, respectively. Absence of BMI ≥25 kg/m2, diabetes and metabolic syndrome, when compared with presence of any one of these three factors, was associated with increased fibrosis regression (43.1% vs. 16.9%, P = 0.001). Multivariate analysis found a lower BMI to be the only factor independently associated with fibrosis regression (P = 0.034, odds ratio 0.68, 95% CI 0.48–0.97). No association was noted between controlled attenuation parameter measurements and fibrosis regression (P > 0.05).

Conclusion

An increased BMI hindered fibrosis regression in patients with chronic hepatitis B during nucleoside analogue treatment, suggesting that control of metabolic risk factors, in addition to virologic suppression via antiviral therapy, might be needed to halt the fibrogenic process in chronic hepatitis B.
Feasibility of BAALC gene expression for detection of minimal residual disease and risk stratification in normal karyotype acute myeloid leukaemia
Authors: Weber Simone , Haferlach Torsten , Alpermann Tamara , Perglerová Karolína , Schnittger Susanne , Haferlach Claudia , Kern Wolfgang
Published: September 2016

High BAALC gene expression has been associated with poor prognosis in cytogenetically normal acute myeloid leukaemia (CN‐AML) and has been suggested as a suitable marker for assessing minimal residual disease (MRD). The purpose of this study was to substantiate these findings by the analysis of a large data set of 632 diagnostic and follow‐up samples in 142 intensively treated CN‐AML patients. Paired diagnostic/relapse samples of 35 patients revealed stable high BAALC expression in 89%, irrespective of a high proportion of clonal evolution found in 49% of these cases. High BAALC expression, both directly after induction chemotherapy and within 3–6 months after induction chemotherapy, correlated significantly with shorter event‐free survival and overall survival. Moreover, 8 of 10 patients displaying high BAALC expression levels after completion of induction therapy as well as 5 of 5 patients exhibiting high BAALC expression levels within 3–6 months after induction chemotherapy experienced relapse with a median of 197 and 101 days, respectively, from sampling to relapse. Thus, BAALC expression‐based MRD detection during therapy may be considered a strategy to identify patients at high risk of relapse.
3D echocardiographic imaging of a septal myocardial cleft in hypertrophic cardiomyopathy
Authors: Cagli Kumral , Golbasi Zehra , Turak Osman , Ozeke Ozcan , Ekizler Firdevs Aysenur
Published: September 2016

Myocardial clefts are defined as narrow, deep blood‐filled invaginations within the left ventricular myocardium. They occur in hypertrophic cardiomyopathy patients with different frequency and represent a distinctive morphological expression of hypertrophic cardiomyopathy. Although two‐dimensional transthoracic echocardiography is able to detect myocardial clefts in some cases, cardiovascular magnetic resonance imaging with its high spatial resolution can detect myocardial clefts not visualized with echocardiography. In this report, we represent multimodality imaging of a septal myocardial cleft in a hypertrophic cardiomyopathy patient.