bluuebunny/crossref_metadata_2025 huggingface dataset:
Hygienische Abnahmeprüfungen raumlufttechnischer Anlagen unter Ruhebedingungen nach DIN 1946-4:1999-03 – eine retrospektive Auswertung
Authors: Friedrich Lena , Boeckelmann Irina
Published: January 2018

Hintergrund Die Erhaltung einer arbeitshygienisch und mikrobiologisch einwandfreien Raumluft, insbesondere in Operationssälen, soll durch die Verwendung von raumlufttechnischen Anlagen (RLTA) gewährleistet werden. Diese sollen u. a. die Zahl an Partikeln und Keimen in der Luft unter empfohlenen Grenzwerten halten. Um die regelrechte Funktion sicherzustellen, werden in festgelegten Abständen Kontrolluntersuchungen unter Ruhebedingungen, frühmorgens vor offiziellem OP-Beginn durchgeführt. Ziel dieser Studie ist es, den Effekt von verschiedenen Belüftungsarten auf die Raumluftqualität in einer medizinischen Einrichtung anhand der Untersuchungsergebnisse aufzuzeigen.

Methodik In der Studie wurden Messprotokolle von 34 Operationssälen aus einem Zeitraum von 10 Jahren ausgewertet. 29 Operationssäle wurden mittels turbulenzarmer Verdrängungsströmung belüftet, 5 mittels turbulenter Mischströmung. In allen 34 Operationssälen wurde die Luftreinheit bez. der Höhe an Luftpartikelzahlen und Luftkeimzahlen untersucht. Gemessen wurde an Messpunkten 10 mm unterhalb der Zuluftdecke, im Bereich des OP-Tisches und außerhalb der Zuluftdecke.

Ergebnisse Luftpartikelzahlen an der Zuluftdecke lagen zwischen 0/m³ Luft und 4441/m³ und überschritten den empfohlenen Grenzwert nie. Luftkeimzahlen hingegen lagen bei 0 KBE/m³ bis 200 KBE/m³. In 10,9% der Messungen wurde hier der Grenzwert überschritten. Die Werte in Raummitte waren generell höher als an der Zuluftdecke. Es lagen signifikante Unterschiede (p < 0,001) zwischen den Werten an der Zuluftdecke oder am Bereich des OP-Tisches und Werten außerhalb der Zuluftdecke vor. Der Kontaminationsgrad im Bereich des OP-Tisches war je nach Belüftungsartsystem unterschiedlich (p < 0,001).

Schlussfolgerungen Die Auswertungen verdeutlichen, dass durch die Verwendung von RLT-Anlagen i. d. R. eine partikel- und keimarme Raumluft gewährleistet werden kann. Die Verwendung turbulenzarmer Verdrängungsströmung scheint dabei bessere Ergebnisse zu liefern als die turbulente Mischströmung. Eine ausreichend große Zuluftdecke kann das OP-Gebiet, den Instrumententisch, das operierende Personal und den Patienten vor Kontamination schützen. Von einer Auswirkung der Luftkontamination auf postoperative Wundinfektionen ist jedoch laut aktuellem Kenntnisstand nicht auszugehen. Die Messmethodik sollte hinsichtlich Optimierungsmöglichkeiten überdacht werden.
Das Mikrobiom des Darms: Dysbiose
Authors: van der Giet Markus
Published: January 2018

Das Mikrobiom des Darms wird gelegentlich auch als das „zweite menschliche Genom“ bezeichnet, da es eine hoch relevante Bedeutung in
Gesundheit, aber auch Krankheit hat. Im Darm gibt es eine beeindruckend große Anzahl von Bakterien, die eine enge Beziehung zum Wirt
pflegen. In bestimmten Situationen kann es zu einer Dysbiose kommen, was in der Konsequenz eine Schädigung des Wirtes nach sich ziehen kann.
In den Bakterien werden zahlreiche Substanzen gebildet, die vom gesunden Körper nach der Aufnahme unkompliziert verstoffwechselt bzw.
ausgeschieden werden können. Bei Patienten mit terminaler Nierenfunktionsstörung hingegen kommt es zum einen zu einer Veränderung des
Darmmikrobioms und gleichzeitig zu einer Akkumulation von aus dem Darm aufgenommenen Substanzen, die durch das veränderte Mikrobiom
produziert und nicht mehr eliminiert werden können. Dies führt zu einer Akkumulation von Urämietoxinen, die auch wesentlich zu dem
exzessiven, v. a. kardiovaskulären Mortalitätsrisiko der Patienten beitragen. Eine Strategie zur Hilfe für den betroffenen Patienten mag die
Wiederherstellung des Mikrobioms sein. In der vorliegenden Übersicht werden die Veränderungen des Mikrobioms und deren Auswirkungen
vorgestellt. Auch Ideen für eine Beeinflussung des Mikrobioms werden diskutiert.
Note: Motor-piezoelectricity coupling driven high temperature fatigue device
Authors: Ma Z. C. , Du X. J. , Zhao H. W. , Ma X. X. , Jiang D. Y. , Liu Y. , Ren L. Q.
Published: January 2018

The design and performance evaluation of a novel high temperature fatigue device simultaneously driven by servo motor and piezoelectric actuator is our focus. The device integrates monotonic and cyclic loading functions with a maximum tensile load of 1800 N, driving frequency of 50 Hz, alternating load of 95 N, and maximum service temperature of 1200 °C. Multimodal fatigue tests with arbitrary combinations of static and dynamic loads are achieved. At temperatures that range from RT to 1100 °C, the tensile and tensile-fatigue coupling mechanical behaviors of UM Co50 alloys are investigated to verify the feasibility of the device.
Conductive contact area estimation for carbon nanotube via interconnects using secondary-electron imaging
Authors: Abe Yusuke , Suzuki Makoto , Vyas Anshul , Yang Cary Y.
Published: January 2018

A major challenge for carbon nanotube (CNT) to become a viable replacement of copper and tungsten in the next-generation on-chip via interconnects is the high contact resistance between CNT and metal electrodes. A first step in meeting this challenge is an accurate characterization of via contact resistance. In this paper, the scanning electron microscope (SEM) image contrast at low landing energy is employed to estimate the conductive CNT area inside vias. The total conductive CNT area inside each via is deduced using SEM image with 0.1 keV landing energy and a specified threshold brightness, yielding via resistance versus CNT area behavior, which correlates well with electrical nanoprobing measurements of via resistance. Monte Carlo simulation of secondary electron generation lends further support for our analysis and suggests that the residue covering the CNT does not affect the conduction across the contact for residue thickness below 1 nm. This imaging and analysis technique can add much value to CNT via interconnect contact characterization.
Single-shot selective femtosecond laser ablation of multi-layered Ti/Al and Ni/Ti films: “Cascaded” heat conduction and interfacial thermal effects
Authors: Kudryashov S. I. , Gakovic B. , Danilov P. A. , Petrovic S. M. , Milovanovic D. , Rudenko A. A. , Ionin A. A.
Published: January 2018

Single-shot femtosecond laser ablation of Ti(Al/Ti)5 and (Ni/Ti)5 films on silicon substrates was studied as a function of laser fluence by means of scanning electron microscopy, energy-dispersive x-ray spectroscopy, and optical profilometry. Ablation occurs as gradual threshold-like selective removal of a few top layers at lower fluences and rather continuous removal at higher fluences, exponentially increasing versus ablated depth, with the final complete (through) ablation of the entire films. The observed selective rupture at the different internal interfaces was related to thermomechanically and chemically enhanced (interface-facilitated) explosive boiling, with the corresponding energy deposition provided by “cascaded” heat transfer in the poorly conducting Ti and Ni, and highly conducting Al layers and the interfacial thermal (Kapitza) resistance effect.
Tuning the pure monoclinic phase of WO3 and WO3-Ag nanostructures for non-enzymatic glucose sensing application with theoretical insight from electronic structure simulations
Authors: Ponnusamy Rajeswari , Gangan Abhijeet , Chakraborty Brahmananda , Sekhar Rout Chandra
Published: January 2018

Here, we report the controlled hydrothermal synthesis and tuning of the pure monoclinic phase of WO3 and WO3-Ag nanostructures. Comparative electrochemical nonenzymatic glucose sensing properties of WO3 and WO3-Ag were investigated by cyclic voltammetry and chronoamperometric tests. We observed enhanced glucose sensing performance of WO3-Ag porous spheres as compared to bare WO3 nanoslabs. The sensitivity of the pure WO3 nanoslabs is 11.1 μA μM−1 cm−2 whereas WO3-Ag porous spheres exhibit sensitivity of 23.3 μA μM−1 cm−2. The WO3-Ag porous spheres exhibited a good linear range (5–375 μM) with excellent anti-interference property. Our experimental observations are qualitatively supported by density functional theory simulations through investigation of bonding and charge transfer mechanism of glucose on WO3 and Ag doped WO3. As the binding energy of glucose is more on the Ag doped WO3 (100) surface compared to the bare WO3 (100) surface and the Ag doped WO3 (100) surface becomes more conducting due to enhancement of density of states near the Fermi level, we can infer that Ag doped WO3 exhibits a better charge transfer media compared to bare WO3 resulting in enhanced glucose sensitivity in consistency with our experimental data.
Steel reinforced composite silicone membranes and its integration to microfluidic oxygenators for high performance gas exchange
Authors: Matharoo Harpreet , Dabaghi Mohammadhossein , Rochow Niels , Fusch Gerhard , Saraei Neda , Tauhiduzzaman Mohammed , Veldhuis Stephen , Brash John , Fusch Christoph , Selvaganapathy P. Ravi
Published: January 2018

Respiratory distress syndrome (RDS) is one of the main causes of fatality in newborn infants, particularly in neonates with low birth-weight. Commercial extracorporeal oxygenators have been used for low-birth-weight neonates in neonatal intensive care units. However, these oxygenators require high blood volumes to prime. In the last decade, microfluidics oxygenators using enriched oxygen have been developed for this purpose. Some of these oxygenators use thin polydimethylsiloxane (PDMS) membranes to facilitate gas exchange between the blood flowing in the microchannels and the ambient air outside. However, PDMS is elastic and the thin membranes exhibit significant deformation and delamination under pressure which alters the architecture of the devices causing poor oxygenation or device failure. Therefore, an alternate membrane with high stability, low deformation under pressure, and high gas exchange was desired. In this paper, we present a novel composite membrane consisting of an ultra-thin stainless-steel mesh embedded in PDMS, designed specifically for a microfluidic single oxygenator unit (SOU). In comparison to homogeneous PDMS membranes, this composite membrane demonstrated high stability, low deformation under pressure, and high gas exchange. In addition, a new design for oxygenator with sloping profile and tapered inlet configuration has been introduced to achieve the same gas exchange at lower pressure drops. SOUs were tested by bovine blood to evaluate gas exchange properties. Among all tested SOUs, the flat design SOU with composite membrane has the highest oxygen exchange of 40.32 ml/min m2. The superior performance of the new device with composite membrane was demonstrated by constructing a lung assist device (LAD) with a low priming volume of 10 ml. The LAD was achieved by the oxygen uptake of 0.48–0.90 ml/min and the CO2 release of 1.05–2.27 ml/min at blood flow rates ranging between 8 and 48 ml/min. This LAD was shown to increase the oxygen saturation level by 25% at the low pressure drop of 29 mm Hg. Finally, a piglet was used to test the gas exchange capacity of the LAD in vivo. The animal experiment results were in accordance with in-vitro results, which shows that the LAD is capable of providing sufficient gas exchange at a blood flow rate of ∼24 ml/min.
Passive wavelength tuning and multichannel photonic coupling using monolithically integrated vertical microresonators on ridge waveguides
Authors: Yu Xin , Goddard Lynford L. , Zhu Jinlong , Li Xiuling , Chen Xiaogang
Published: January 2018

The passive tuning of the resonant coupling wavelength in a SiNx vertical microring coupler (VμRC) monolithically integrated on a ridge waveguide by engineering the structural parameters of the VμRCs is experimentally demonstrated and theoretically verified. Multi-channel photonic coupling is achieved by integrating two different VμRCs on a single ridge waveguide. This work represents a critical step to 3D photonic integration using VμRCs.
Interaction of miscible solutions and superhydrophobic surfaces
Authors: He Jian , Li Bian , Wu Hai , Kulasinski Karol , Mao Ming , Jiang Wei , Niu Jinan
Published: January 2018

The complex composition in industrial pollutants includes immiscible liquid and miscible solution that present a great challenge to deal with the effluent. In this research, the interaction between super hydrophobic surface and the miscible solution is studied based on surface tension (ST) and contact angle. A superhydrophobic surface is fabricated by simple anodisation and self-assemble method. Then two different types of miscible solution are adopted to evaluate the property of the superhydrophobic surfaces. The obtained result shows that the wettability is closely related to ST of mixtures, which is controlled by the interface component. When the ST is less than 31.55 mN m−1, the critical pressure reduced from maximum value (6442.8 Pa) to negative number. In turn, the superhydrophobic film loses its repellency and shows affinity to the mixtures. This can provide an important supplement for utilising superhydrophobic materials, especially for the oil–water separation.
Drosophila Big bang regulates the apical cytocortex and wing growth through junctional tension
Authors: Tsoumpekos Giorgos , Nemetschke Linda , Knust Elisabeth
Published: January 2018

Growth of epithelial tissues is regulated by a plethora of components, including signaling and scaffolding proteins, but also by junctional tension, mediated by the actomyosin cytoskeleton. However, how these players are spatially organized and functionally coordinated is not well understood. Here, we identify the Drosophila melanogaster scaffolding protein Big bang as a novel regulator of growth in epithelial cells of the wing disc by ensuring proper junctional tension. Loss of big bang results in the reduction of the regulatory light chain of nonmuscle myosin, Spaghetti squash. This is associated with an increased apical cell surface, decreased junctional tension, and smaller wings. Strikingly, these phenotypic traits of big bang mutant discs can be rescued by expressing constitutively active Spaghetti squash. Big bang colocalizes with Spaghetti squash in the apical cytocortex and is found in the same protein complex. These results suggest that in epithelial cells of developing wings, the scaffolding protein Big bang controls apical cytocortex organization, which is important for regulating cell shape and tissue growth.
A benchmark study of scoring methods for non-coding mutations
Authors: Drubay Damien , Gautheret Daniel , Michiels Stefan
Published: January 2018

Motivation

Detailed knowledge of coding sequences has led to different candidate models for pathogenic variant prioritization. Several deleteriousness scores have been proposed for the non-coding part of the genome, but no large-scale comparison has been realized to date to assess their performance.

Results

We compared the leading scoring tools (CADD, FATHMM-MKL, Funseq2 and GWAVA) and some recent competitors (DANN, SNP and SOM scores) for their ability to discriminate assumed pathogenic variants from assumed benign variants (using the ClinVar, COSMIC and 1000 genomes project databases). Using the ClinVar benchmark, CADD was the best tool for detecting the pathogenic variants that are mainly located in protein coding gene regions. Using the COSMIC benchmark, FATHMM-MKL, GWAVA and SOMliver outperformed the other tools for pathogenic variants that are typically located in lincRNAs, pseudogenes and other parts of the non-coding genome. However, all tools had low precision, which could potentially be improved by future non-coding genome feature discoveries. These results may have been influenced by the presence of potential benign variants in the COSMIC database. The development of a gold standard as consistent as ClinVar for these regions will be necessary to confirm our tool ranking.

Availability and implementation

The Snakemake, C++ and R codes are freely available from https://github.com/Oncostat/BenchmarkNCVTools and supported on Linux.

Supplementary information

Supplementary data are available at Bioinformatics online.
The complex kinematics of rotating star clusters in a tidal field
Authors: Tiongco Maria A , Vesperini Enrico , Varri Anna Lisa
Published: January 2018

We broaden the investigation of the dynamical properties of tidally perturbed, rotating star clusters by relaxing the traditional assumptions of coplanarity, alignment, and synchronicity between the internal and orbital angular velocity vector of their initial conditions. We show that the interplay between the internal evolution of these systems and their interaction with the external tidal field naturally leads to the development of a number of evolutionary features in their three-dimensional velocity space, including a precession and nutation of the global rotation axis and a variation of its orientation with the distance from the cluster centre. In some cases, such a radial variation may manifest itself as a counter-rotation of the outermost regions relative to the inner ones. The projected morphology of these systems is characterized by a non-monotonic ellipticity profile and, depending on the initial inclination of the rotation axis, it may also show a twisting of the projected isodensity contours. These results provide guidance in the identification of non-trivial features which may emerge in upcoming investigations of star cluster kinematics and a dynamical framework to understand some of the complexities already hinted by recent observational studies.
Survivorship care planning in neuro-oncology
Authors: Leeper Heather E , Acquaye Alvina A , Bell Susan , Clarke Jennifer L , Forst Deborah , Laack Nadia N , Link Michael J , Taylor Jennie W , Armstrong Terri S
Published: January 2018

Cancer patient survivorship has become a significant topic within oncology care for both adult and pediatric patients. Starting in 2005, the Institute of Medicine recommended the use of survivorship care plans to assist patients transitioning from active treatment to the posttreatment phase of their cancer care, a critical time for many patients. Since 2014 there has been a mandate within the United States for adult cancer patients treated with curative intent to receive survivorship care plans comprised of a treatment summary and a follow-up plan to facilitate a better understanding among patients of what to expect after treatment. In addition to a general oncology survivorship care plan, specific care plans have been created for breast, lung, prostate, and colon cancers, as well as lymphoma. A survivorship care plan specific to adult neuro-oncology has been developed by a multidisciplinary and interprofessional committee, with approval from the Society for Neuro-Oncology Guidelines Committee. It has been published in compendium with this review of survivorship care planning and available as a fillable PDF on the Society of Neuro-Oncology Guidelines Endorsement web page (https://www.soc-neuro-onc.org/SNO/Resources/Survivorship_Care_Plan.aspx). Implementation of this survivorship care plan provides a unique opportunity to begin addressing the range of survivorship issues our neuro-oncology patients navigate from diagnosis to end of life.
Authoritarianism in the Public
Authors: Suhay Elizabeth , Maurer Brianna
Published: January 2018

The study of the “authoritarian personality” began in Europe with the rise of Hitler as an effort to understand why so many seemingly ordinary Germans (and others) were willing to lend their support to an obviously anti-democratic and racist leader. Research on authoritarianism continues in this vein today, although it is now used throughout the world to explain why many people oppose democratic institutions, support authoritarian leaders, and hold prejudiced attitudes. The study of authoritarianism is as popular as it is controversial, with scholars disagreeing over whether it is a personality characteristic or a set of attitudes, how it develops, whether it occurs only on the political right or on the left as well, and how it is best measured, among other debates. Even so, scholars generally agree on the characteristics associated with authoritarianism: those who exhibit authoritarianism tend to be high group identifiers, submissive to in-group authorities, traditional and conforming, and aggressive toward those who either defy accepted norms or are members of outgroups. As has been evident for decades, authoritarianism is closely associated with all manner of highly consequential social and political attitudes, including anti-Semitism, racism, xenophobia, and homophobia, opposition to civil liberties and rights, support for war, and, of course, support for leaders who govern in an authoritarian manner.
Psychology of Stress and Coping
Authors: Wendorf Angela R. , Brouwer Amanda M.
Published: January 2018

The psychology of stress and coping has been a prominent topic of scientific study and of popular interest over the last century. Applying the study of the mind and behavior to a concept such as stress and coping has led to an evolving definition of stress, more research on its physical, psychological and social effects, and the development of comprehensive ways in which individuals cope with stress. Our understanding of how individuals cope with stress has advanced to include perception of one’s ability to cope, approach to coping, assessment and utilization of coping resources available, and enacting of strategies. We review the psychology of stress and coping as it presents itself in the current evolving research and theoretical development, documenting historical, theoretical, and methodological perspectives on stress and coping. In so doing, we will provide sources and commentary on the definitions of stress, main theories of stress, categories of stressors, consequences of stress, definitions of coping, main theories of coping, coping styles and strategies, assessment of coping, descriptions of coping processes, coping functions and goals, coping resources, and coping and stress management interventions. We would like to acknowledge Samantha Lee for her assistance with this project.
Links Between Genetic Groups, Host Specificity, and Ergot-Alkaloid Profiles within Claviceps purpurea (Fr.) Tul. on Slovenian Grasses
Authors: Likar Matevž , Grandič Marjana , Strajn Breda Jakovac , Kos Katarina , Celar Franci Aco
Published: January 2018

In the present study, the genetic relationships and ergot-alkaloid production of the fungus Claviceps purpurea on grasses were investigated, to determine any associations between grass host specificity, ergot-alkaloid production, and geographic origin. C. purpurea sclerotia were obtained from wild and cultivated grasses along a 300-km climatic gradient, from sub-Mediterranean to continental climates. Twenty-one infected grass samples provided 39 sclerotia for analysis of the ergot alkaloids ergometrine, ergosine, ergotamine, ergocornine, ergocryptine, and ergocristine, and their “-inine” epimers, using liquid chromatography–tandem mass spectrometry. C. purpurea ribosomal DNA underwent molecular classification to determine any grass host or geographic specificity of ergot-alkaloid composition for the different operational taxonomic units. Molecular analysis of sclerotia ribosomal DNA showed three genetic groups, with some associations with specific grass host taxonomic groups. The ergot-alkaloid composition data were in agreement with the data obtained by molecular methods. The most frequent ergot-alkaloid epimers were ergocristine, and ergosine. The total ergot-alkaloid concentrations in sclerotia varied from 59 to 4,200 mg kg–1, which corresponds to 0.059 to 4.2 mg kg–1 in animal feed (assuming ergot alkaloids at 1,000 mg kg–1 sclerotia). Therefore, grasses can be associated with significant levels of ergot alkaloids. In addition, the ergot-alkaloid compositions of C. purpurea sclerotia can be different for infections with different C. purpurea genetic groups, because these show different ergot-alkaloid compositions.
Chemical Management of Invasive Shot Hole Borer and Fusarium Dieback in California Sycamore (Platanus racemosa) in Southern California
Authors: Mayorquin Joey S. , Carrillo Joseph D. , Twizeyimana Mathias , Peacock Beth B. , Sugino Kameron Y. , Na Francis , Wang Danny H. , Kabashima John N. , Eskalen Akif
Published: January 2018

Fusarium dieback (FD) is a new vascular disease of hardwood trees caused by Fusarium spp. and other associated fungal species which are vectored by two recently introduced and highly invasive species of ambrosia beetle (Euwallacea spp. nr. fornicatus). One of these ambrosia beetles is known as the polyphagous shot hole borer (PSHB) and the other as the Kuroshio shot hole borer (KSHB). Together with the fungi that they vector, this pest–disease complex is known as the shot hole borer–Fusarium dieback (SHB-FD) complex. Mitigation of this pest–disease complex currently relies on tree removal; however, this practice is expensive and impractical given the wide host range and rapid advancement of the beetles throughout hardwoods in southern California. This study reports on the assessment of various pesticides for use in the management of SHB-FD. In vitro screening of 13 fungicides revealed that pyraclostrobin, trifloxystrobin, and azoxystrobin generally have lower effective concentration that reduces 50% of mycelial growth (EC50) values across all fungal symbionts of PSHB and KSHB; metconazole was found to have lower EC50values for Fusarium spp. and Paracremonium pembeum. Triadimefon and fluxapyroxad were not capable of inhibiting any fungal symbiont at the concentrations tested. A 1-year field study showed that two insecticides, emamectin benzoate alone and in combination with propiconazole, and bifenthrin, could significantly reduce SHB attacks. Two injected fungicides (tebuconazole and a combination of carbendazim and debacarb) and one spray fungicide (metconazole) could also significantly reduce SHB attacks. Bioassays designed to assess fungicide retention 1 year postapplication revealed that six of the seven fungicides exhibited some level of inhibition in vitro and all thiabendazole-treated trees sampled exhibiting inhibition. This study has identified several pesticides which can be implemented as part of an integrated pest management strategy to reduce SHB infestation in low to moderately infested landscape California sycamore trees and potentially other landscape trees currently affected by SHB-FD.
Internal Podalic Version and Breech Extraction
Authors: Cornette Jérôme M. J. , Erkamp Jan S.
Published: January 2018

BACKGROUND:

Experience with internal podalic version and breech extraction is diminishing, especially in the younger generation of obstetricians. Simulation training is essential to teach and maintain these skills.

INSTRUMENT:

We present a mannequin-based simulation method that enhances realistic sensations during training.

EXPERIENCE:

By positioning the fetal mannequin into a thin plastic bag filled with water, the impression of palpating, grabbing, and pulling the fetal feet through the plastic bag is similar to reaching feet through intact membranes. The unique approach of this realistic simulation model makes the experience fun and memorable, which contributes to the didactic value and success of the model.

CONCLUSION:

The simulation model we present mimics the situation and sensation obstetricians experience while performing internal podalic version and breech extraction.
Preterm Birth and Gestational Length in Four Race–Nativity Groups, Including Somali Americans
Authors: Oliver Emily A. , Klebanoff Mark , Yossef-Salameh Lina , Oza-Frank Reena , Moosavinasab Soheil , Reagan Patricia , Muglia Louis , Buhimschi Catalin S. , Buhimschi Irina A.
Published: January 2018

OBJECTIVE:

To compare preterm birth rates and gestational length in four race–nativity groups including Somali Americans.

METHODS:

Using a retrospective cohort study design of Ohio birth certificates, we analyzed all singleton births between 2000 and 2015 from four groups of women categorized as U.S.-born, non-Hispanic white (USBW), U.S.-born, non-Hispanic black (USBB), African-born black (ABB, primarily of West African birth country), and Somalia-born (SB). An algorithm trained on maternal names was used to confirm Somali ethnicity. Gestational length was analyzed as completed weeks or aggregated by clinically relevant periods. Risk of spontaneous and health care provider–initiated preterm birth was calculated in a competing risk model.

RESULTS:

Births to women in the designated groups accounted for 1,960,693 births (USBW n=1,638,219; USBB n=303,028; ABB n=10,966, and SB n=8,480). Women in the SB group had a lower preterm birth rate (5.9%) compared with women in the USBB (13.0%), ABB (8.4%), and USBW (7.9%) groups (P<.001). Women in the SB group had a higher frequency of postterm pregnancy (5.8% vs less than 1%, P<.001 for all groups). The lower rate of preterm birth in the SB group was unrelated to differences in parity or smoking or whether preterm birth was spontaneous or health care provider–initiated. The lower rate of preterm birth and tendency for prolonged gestation was attenuated in ethnic Somali women born outside Somalia.

CONCLUSION:

We report a positive disparity in preterm birth and a tendency for prolonged gestation for ethnic Somali women in Ohio. Etiologic studies in multiethnic cohorts aimed to uncover the sociobiological determinants of gestational length may lead to practical approaches to reduce prematurity in the general population.
Quality Assurance Practices in Obstetric Care
Authors: Lundsberg Lisbet S. , Lee Henry C. , Dueñas Grace Villarin , Gregory Kimberly D. , Grossetta Nardini Holly K. , Pettker Christian M. , Illuzzi Jessica L. , Xu Xiao
Published: January 2018

OBJECTIVE:

To assess hospital practices in obstetric quality management activities and identify institutional characteristics associated with utilization of evidence-supported practices.

METHODS:

Data for this study came from a statewide survey of obstetric hospitals in California regarding their organization and delivery of perinatal care. We analyzed responses from 185 hospitals that completed quality assurance sections of the survey to assess their practices in a broad spectrum of quality enhancement activities. The association between institutional characteristics and adoption of evidence-supported practices (ie, those supported by prior literature or recommended by professional organizations as beneficial for improving birth outcome or patient safety) was examined using bivariate analysis and appropriate statistical tests.

RESULTS:

Most hospitals regularly audited adherence to written protocols regarding critical areas of care; however, 77.7% and 16.8% reported not having written guidelines on diagnosis of labor arrest and management of abnormal fetal heart rate, respectively. Private nonprofit hospitals were more likely to have a written protocol for management of abnormal fetal heart rate (P=.002). One in 10 hospitals (9.7%) did not regularly review cases with significant morbidity or mortality, and only 69.0% regularly tracked indications for cesarean delivery. Moreover, 26.3%, 14.3%, and 8.7% of the hospitals reported never performing interprofessional simulations for eclampsia, shoulder dystocia, or postpartum hemorrhage, respectively. Teaching status was associated with more frequent simulations in these three areas (P≤.04 for all), while larger volume was associated with more frequent simulations for eclampsia (P=.04).

CONCLUSION:

Hospitals in California engage in a wide range of practices to assure or improve quality of obstetric care, but substantial variation in practice exists among hospitals. There is opportunity for improvement in adoption of evidence-supported practices.
Titanium Elastic Nailing has Superior Value to Plate Fixation of Midshaft Femur Fractures in Children 5 to 11 Years
Authors: Allen Jerad D. , Murr Kevin , Albitar Ferras , Jacobs Cale , Moghadamian Eric S. , Muchow Ryan
Published: January 2018

Background:

American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guidelines for pediatric femoral shaft fractures indicate titanium elastic nails (TENs) for children 5 to 11 years old. Growing evidence suggests these fractures may also be treated with open or submuscular plating. The purpose of this study was to compare estimated blood loss (EBL), operative time, fluoroscopy time, cost, and subjective and objective pain scores between TENs and plating techniques used in 5- to 11-year-old children with midshaft femur fractures based on length stability. We hypothesized that EBL, operative time, and fluoroscopy time would be greater and pain would be lower with plate fixation.

Methods:

We retrospectively identified all pediatric midshaft femur fractures treated with TENs, submuscular plating, or open plating between 2004 and 2014. Demographic, injury, and surgical data were obtained for analysis. Cost data were obtained from Synthes Inc. Outcomes were determined using the TEN outcome scoring system. Variables were compared between the 3 fixation methods using paired t tests or Fisher exact test as appropriate. Cost data were compared with Mann-Whitney nonparametric test.

Results:

There were 65 midshaft femur fractures in 63 patients included. TENs accounted for 77% and plating 23%. There were no statistical differences in injury severity score, length of stay, length unstable fractures, open fractures, fluoroscopy time, or pain. However, there was a significantly greater operative time (P=0.007) and a notably greater EBL (P=0.057) for the plating technique compared with TENs. Patient outcomes were found to be equivalent. Implant cost was not significantly different although increased surgical costs were seen in plating (P=0.0007).

Conclusions:

This study supports the use of TENs or plating for midshaft femur fractures in children 5 to 11 years old, regardless of length stability. The use of plates resulted in higher EBL, longer operative time, increased cost, and equivalent pain compared with TENs. To our knowledge, this study represents the first direct comparison of the common fixation methods specifically for midshaft femur fractures and favors the use of TENs.

Level of Evidence:

Level III.
Do Professional Society Advocacy Campaigns Have an Impact on Pediatric Orthopaedic Injuries?
Authors: Karkenny Alexa J. , Burton Denver A. , Maguire Kathleen J. , Hanstein Regina , Otsuka Norman Y.
Published: January 2018

Purpose:

The American Academy of Orthopaedic Surgeons (AAOS) and the American Academy of Pediatrics (AAP) both advocate for childhood injury prevention by publishing recommendations to orthopaedic surgeons, pediatricians, and the public. Popular topics of advocacy campaigns have included trampolines, all-terrain vehicles (ATVs), and lawnmowers. The purpose of this study was to investigate the temporal relationship between AAOS/AAP advocacy and pediatric orthopaedic injury rates, using these topics as examples. We hypothesized that pediatric orthopaedic injury rates decline in years, following related AAOS/AAP recommendations.

Methods:

A retrospective review of fractures associated with trampolines, lawnmowers, and ATVs among patients aged 2 to 18 years from 1991 to 2014 was performed using the National Electronic Injury Surveillance System (NEISS). Fracture rates and percent changes year-to-year were calculated. A timeline of AAOS and AAP advocacy statements published on the products was created.

Results:

Trampoline-related fractures rose 14% yearly from 1991 to 1999, reached a plateau from 1999 to 2003, corresponding with a 1999 AAP statement. Injury rates dropped 4.3% from 2006 to 2010 after 2005 and 2006 statements, and reached another plateau thereafter, as 2010 and 2012 statements were published. ATV-related fractures rose 14% yearly between 1997 and 2002, then dropped 15% from 2007 to 2010 following yearly AAP or AAOS statements from 2004 to 2007. From 2010 to 2014, the injury rate held constant during which time 2010, 2013, and 2014 statements were published. Lawnmower injury rates did not fall despite statements in 1998 and 2001 and a poster campaign in 2001. A 25% drop from 2007 to 2008 coincided with an AAOS statement in 2008. Fracture rates further dropped 31% from 2009 to 2011 and 21% from 2012 to 2014, amidst 2012 and 2014 statements. For ATV-related and lawnmower-related injuries, more male individuals were affected than female individuals, and for ATVs alone, injury rates increased with age.

Conclusions:

Although AAOS/AAP statements did not universally coincide with dropping fracture rates, statements often were associated with substantial decreases in following years. This is likely because injury prevention messages are dispersed from providers to the public over time and outcomes depend on highly variable patient behaviors.

Level of Evidence:

Level V—systematic review of descriptive data.
INTRAVITREAL AFLIBERCEPT IN THE TREATMENT OF POLYPOIDAL CHOROIDAL VASCULOPATHY ASSOCIATED WITH MORNING GLORY SYNDROME
Authors: Iovino Claudio , Fossarello Maurizio , Peiretti Enrico
Published: January 2018

Purpose:

To describe an unusual case of polypoidal choroidal vasculopathy secondary to morning glory syndrome successfully treated with three aflibercept intravitreal injections.

Methods:

Case report.

Results:

A 68-year-old white man presented with a 2-month history of diminished vision of his left eye. Fundus examination showed a morning glory syndrome disk anomaly with some perimacular subretinal hemorrhages and lipid depositions. Fundus autofluorescence, fluorescein and green indocyanine angiography, spectral domain optical coherence tomography, and optical coherence tomography angiography were performed and confirmed the presence of a juxtapapillary polypoidal choroidal vasculopathy with intraretinal and subretinal fluid. Patient underwent 3 monthly intravitreal injections of aflibercept and at 4-month follow-up visit, multimodal imaging findings did not show any kind of neovascular lesion activity.

Conclusion:

Polypoidal choroidal vasculopathy can occur in morning glory syndrome and it can be successfully treated with anti–vascular endothelial growth factor intravitreal injections of aflibercept.
Pythium Keratitis Leading to Fatal Cavernous Sinus Thrombophlebitis
Authors: Rathi Anubha , Chakrabarti Arunaloke , Agarwal Tushar , Pushker Neelam , Patil Mukesh , Kamble Hemant , Titiyal Jeewan S. , Mohan Rishi , Kashyap Seema , Sharma Sanjay , Sen Seema , Satpathy Gita , Sharma Namrata
Published: January 2018

Purpose:

To report a case of Pythium insidiosum keratitis leading to fatal cavernous sinus thrombophlebitis.

Methods:

Case report.

Results:

A 70-year-old man presented with excruciating pain, redness, and diminution of vision in his left eye for 2 weeks after washing his hair with tap water. A total corneal ulcer with surrounding infiltrates and associated corneal thinning was present. Corneal scraping revealed the presence of Gram-positive cocci. KOH wet mount and in vivo confocal microscopy revealed branching hyphae. Combined antibacterial and antifungal treatment was started, but 4 days later, the ulcer showed signs of worsening with perforation for which a large therapeutic penetrating keratoplasty was done. The host cornea showed branching septate hyphae on Sabarouds Dextrose Agar. Two weeks later, the patient developed left eye proptosis with associated extraocular movement restriction. Magnetic resonance imaging of the head and orbit revealed cavernous sinus thrombophlebitis. Lid sparing partial exenteration was performed. Polymerase chain reaction revealed P. insidiosum. The patient subsequently developed a cerebrovascular attack and died of its complications.

Conclusions:

Ocular pythiosis may lead to cavernous sinus thrombophlebitis and can even be life threatening. Timely diagnosis and early radical surgery are of value. A high index of suspicion must be kept for P. insidiosum in cases with suspected fungal etiology not responding to conventional treatment.
Forward Masking of the Speech-Evoked Auditory Brainstem Response
Authors: Hodge Sarah E. , Menezes Denise C. , Brown Kevin D. , Grose John H.
Published: January 2018

Hypothesis:

The hypothesis tested was that forward masking of the speech-evoked auditory brainstem response (sABR) increases peak latency as an inverse function of masker-signal interval (Δt), and that the overall persistence of forward masking is age dependent.

Background:

Older listeners exhibit deficits in forward masking. If forward-masked sABRs provide an objective measure of the susceptibility of speech sounds to prior stimulation, then this provides a novel approach to examining the age dependence of temporal processing.

Methods:

A /da/ stimulus forward masked by speech-shaped noise (Δt = 4–64 ms) was used to measure sABRs in 10 younger and nine older participants. Forward masking of subsegments of the /da/ stimulus (Δt = 16 ms) and click trains (Δt = 0–64 ms) was also measured.

Results:

Forward-masked sABRs from young participants showed an increase in latency with decreasing Δt for the initial peak. Latency shifts for later peaks were smaller and more uniform. None of the peak latencies returned to baseline by Δt = 64 ms. Forward-masked /da/ subsegments showed peak latency shifts that did not depend simply on peak position, while forward-masked click trains showed latency shifts that were dependent on click position. The sABRs from older adults were less robust but confirmed the viability of the approach.

Conclusion:

Forward masking of the sABR provides an objective measure of the susceptibility of the auditory system to prior stimulation. Failure of recovery functions to return to baseline suggests an interaction between forward masking by the prior masker and temporal effects within the stimulus itself.
Anticoagulant Bridge Comparison in Mechanical Circulatory Support Patients
Authors: Cosgrove Richard H. , Basken Robyn L. , Smith Richard G. , Hsu Chiu-Hsieh , Kazui Toshinobu , Martinez Brandon K. , Burt Richard W. , Crawford Eric S. , Lick Scott D. , Khalpey Zain
Published: January 2018

Maintaining mechanical circulatory support (MCS) device patients in a specified therapeutic range for anticoagulation remains challenging. Subtherapeutic international normalized ratios (INRs) occur frequently while on warfarin therapy. An effective anticoagulant bridge strategy may improve the care of these patients. This retrospective review of MCS patients with subtherapeutic INRs compared an intravenous unfractionated heparin (UFH) strategy with a subcutaneous enoxaparin or fondaparinux strategy. Native thromboelastography (n-TEG) was used to evaluate anticoagulant effect with coagulation index (CI) as the primary outcome measure. Enoxaparin 0.5 mg/kg subcutaneously (SC) every 12 hours or fondaparinux 2.5–5 mg SC daily were compared with an initial UFH rate of 5 units/kg/hr and titrated to stated n-TEG goal range. The anticoagulant groups UFH, enoxaparin, and fondaparinux were found to be statistically similar with regard to frequency in n-TEG goal range, above range (hypercoagulability), or below range (hypocoagulability). Clinical outcomes were similar among groups with three gastrointestinal bleeds in UFH, one in enoxaparin, and one in fondaparinux groups. Device thrombosis occurred in one UFH patient, while UFH and fondaparinux groups had one ischemic cerebrovascular accident event each. These strategies provided comparable n-TEG results and clinical outcomes when compared with intravenous UFH. Low-dose enoxaparin or fondaparinux may provide an alternative anticoagulant bridging option in MCS patients presenting with subtherapeutic INR.
Fractures Related to Tenofovir: A Case/Noncase Study in the European Pharmacovigilance Database
Authors: García Montserrat G. , Larrinaga-Torrontegui Unai , Eduardo Martinez Eduardo , Lertxundi Unax , Palacios-Zabalza Itziar , Aguirre Carmelo
Published: January 2018

Background:

There is no clear consensus on the relationship between tenofovir (TDF) and fracture risk because the studies published so far present contradictory findings.

Study Question:

Our objective was to detect, from the European pharmacovigilance database (EudraVigilance), a signal of fracture risk during TDF exposure in patients infected with HIV.

Methods:

Herein, we analyze all the cases of fractures suspected to be related to TDF recorded in EudraVigilance between 2001 and November 10, 2016. A case/noncase method was used to assess the association between fractures and TDF, calculating proportional reporting ratios (PRRs) and their 95% confidence intervals (CIs) as a measure of disproportionality. According to the Medical Dictionary for Regulatory Activities (MedDRA) terminology, osteoporotic fractures are included in High Level Group Term (HLGT) “Fractures” and traumatic fractures in HLGT “Bone and joint injuries,” so, we selected cases included in both HLGTs. The noncases used as controls were all the remaining adverse drug reaction reports recorded in EudraVigilance during the same period.

Results:

There were 68,113 cases of fractures in the 4,776,472 reports recorded in EudraVigilance during the study period. TDF was involved in 181 cases. The median latency period until the appearance of fracture was 995 days. TDF was present as the only suspect drug in 140 cases. The PRR of TDF and fractures was 1.11 (95% CI, 0.96–1.28). Nevertheless, disproportionality was observed for some types of fractures: osteoporotic fractures (PRR 17.24; 95% CI, 9.90–30.01), bone fissure (PRR 16.60; 95% CI, 6.11–45.10), and pathological fracture (PRR 4.40; 95% CI, 2.77–7.00).

Conclusions:

Our findings do not show a disproportionality for fractures in patients treated with TDF, although disproportionality was found for some types of fractures, mainly osteoporotic fractures.
Enteroviral Encephalitis in a Child With CNS Relapse of Burkitt Leukemia Treated With Rituximab
Authors: Shaheen Najma , Mussai Francis
Published: January 2018

A boy with central nervous system relapse of Burkitt leukemia developed fever and neurologic symptoms and cognitive impairment. He had received multi-drug chemotherapy including rituximab. Enterovirus (EV) was detected in cerebrospinal fluid by polymerase chain reaction, and magnetic resonance imaging findings were consistent with viral infection. The patient was treated with intravenous immunoglobulin and within 1 month cleared his EV. Rituximab can cause a profound B-cell deficiency predisposing patients to infections including EV encephalitis. This is the first report of enteroviral encephalitis in a child undergoing treatment for lymphoma with rituximab and suggests the need to watch for this complication of therapy.