bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlational approach to study interactions between dust Brownian particles in a plasma
Authors: Lisin E. A. , Vaulina O. S. , Petrov O. F.
Published: January 2018

A general approach to the correlational analysis of Brownian motion of strongly coupled particles in open dissipative systems is described. This approach can be applied to the theoretical description of various non-ideal statistically equilibrium systems (including non-Hamiltonian systems), as well as for the analysis of experimental data. In this paper, we consider an application of the correlational approach to the problem of experimental exploring the wake-mediated nonreciprocal interactions in complex plasmas. We derive simple analytic equations, which allows one to calculate the gradients of forces acting on a microparticle due to each of other particles as well as the gradients of external field, knowing only the information on time-averaged correlations of particles displacements and velocities. We show the importance of taking dissipative and random processes into account, without which consideration of a system with a nonreciprocal interparticle interaction as linearly coupled oscillators leads to significant errors in determining the characteristic frequencies in a system. In the examples of numerical simulations, we demonstrate that the proposed original approach could be an effective instrument in exploring the longitudinal wake structure of a microparticle in a plasma. Unlike the previous attempts to study the wake-mediated interactions in complex plasmas, our method does not require any external perturbations and is based on Brownian motion analysis only.
Ab initio molecular dynamics study of the Eley-Rideal reaction of H + Cl–Au(111) → HCl + Au(111): Impact of energy dissipation to surface phonons and electron-hole pairs
Authors: Zhou Linsen , Zhou Xueyao , Alducin Maite , Zhang Liang , Jiang Bin , Guo Hua
Published: January 2018

The reaction between an impinging H atom and a Cl atom adsorbed on Au(111), which is a prototype for the Eley-Rideal mechanism, is investigated using ab initio molecular dynamics at different incidence angles. The reaction yielding gaseous HCl with large internal excitation proceeds via both direct and hot-atom mechanisms. Significant energy exchange with both surface phonons and electron-hole pairs has been observed. However, their impact on the reactivity and final state distributions was found to be limited, thanks to the large exothermicity and small barrier of the reaction.
Nanoparticle formation in a low pressure argon/aniline RF plasma
Authors: Pattyn C. , Kovacevic E. , Hussain S. , Dias A. , Lecas T. , Berndt J.
Published: January 2018

The formation of nanoparticles in low temperature plasmas is of high importance for different fields: from astrophysics to microelectronics. The plasma based synthesis of nanoparticles is a complex multi-scale process that involves a great variety of different species and comprises timescales ranging from milliseconds to several minutes. This contribution focuses on the synthesis of nanoparticles in a low temperature, low pressure capacitively coupled plasma containing mixtures of argon and aniline. Aniline is commonly used for the production of polyaniline, a material that belongs to the family of conductive polymers, which has attracted increasing interest in the last few years due to the large number of potential applications. The nanoparticles which are formed in the plasma volume and levitate there due to the collection of negative charges are investigated in this contribution by means of in-situ FTIR spectroscopy. In addition, the plasma is analyzed by means of plasma (ion) mass spectroscopy. The experiments reveal the possibility to synthesize nanoparticles both in continuous wave and in pulsed discharges. The formation of particles in the plasma volume can be suppressed by pulsing the plasma in a specific frequency range. The in-situ FTIR analysis also reveals the influence of the argon plasma on the characteristics of the nanoparticles.
The fat in a perfect croissant
Authors: Macias Rodriguez Braulio , Marangoni Alejandro G.
Published: January 2018

Delicious, flaky croissants owe their wonderful texture to the complex, multiscale structure of butter or related fats.
Atomic mutagenesis of stop codon nucleotides reveals the chemical prerequisites for release factor-mediated peptide release
Authors: Hoernes Thomas Philipp , Clementi Nina , Juen Michael Andreas , Shi Xinying , Faserl Klaus , Willi Jessica , Gasser Catherina , Kreutz Christoph , Joseph Simpson , Lindner Herbert , Hüttenhofer Alexander , Erlacher Matthias David
Published: January 2018

Significance

Translation termination is a crucial process during protein synthesis. Class I release factors (RFs) are in charge of recognizing stop codons and consequently hydrolyzing the peptidyl-tRNA at the ribosomal P site. High-resolution crystal- and cryo-EM structures of RFs bound to the ribosome revealed a network of potential interactions that is formed between the mRNA and RFs; however, it remained enigmatic which interactions are critical for accurate stop codon recognition and peptide release. By using chemically modified stop codon nucleotides, the importance and the contribution of single hydrogen bonds to stop codon recognition was investigated. This approach revealed a detailed picture of chemical groups defining a stop codon and contributing to the discrimination against sense codons during prokaryotic and eukaryotic translation termination.
Fatigue strength of a vacuum-carburised TRIP-aided martensitic steel
Authors: Sugimoto Koh-ichi , Hojo Tomohiko , Mizuno Yuta
Published: January 2018

Fatigue properties of a transformation-induced plasticity-aided martensitic steel subjected to vacuum carburisation under carbon potentials ranging from 0.70 to 0.80 mass% and subsequent fine-particle peening were investigated for the fabrication of precision transmission gears. The fatigue limits of smooth specimens increased by 34–41% with increasing carbon potential, compared with that of heat-treated and fine-particle peened steel. The notched fatigue limits increased to a lesser degree except in case of carbon potential of 0.70 mass%. The increased smooth fatigue limits were associated with the high Vickers hardness and compressive residual stress via severe plastic deformation and the strain-induced martensitic transformation during fine-particle peening, as well as a 50% reduction of retained austenite fraction during fatigue deformation.
Identification of Polygonum orientale constituents using high-performance liquid chromatography high-resolution tandem mass spectrometry
Authors: Shin Hyeji , Park Yeeun , Jeon Young Ho , Yan Xi-Tao , Lee Ki Yong
Published: January 2018

Our primary focus in this research was to identify and characterize its bioactive compounds for potential therapeutic use. Twenty-seven metabolites of Polygonum orientale were identified using LC-QTOF tandem mass spectrometry. Interestingly, P. orientale extracts included several highly oxygenated flavonoids were isolated from P. orientale by column chromatography. 13C NMR data of highly oxygenated flavonoids (1–7) are reported here for the first time. In addition, nitric oxide, 1,1-diphenyl-2-picrylhydrazyl, and water-soluble tetrazolium salt assays were carried out on the isolated compounds to investigate their anti-inflammatory, anti-oxidant, and neuroprotective activities, respectively. Compounds 1, 2, 3, 5, 7, and 8 significantly attenuated lipopolysaccharide-stimulated NO production in BV2 cells without affecting cell viability. Compounds 9–12 exhibited significant antioxidant activity, while compounds 8, 9, and 12 exhibited protective effects against glutamate-induced neurotoxicity in HT22 cells. Our results indicate that P. orientale is a promising source of natural agents for the potential treatment of inflammation and neurodegenerative diseases.
Novel tyrosinase inhibitors from liquid culture ofNeolentinus lepideus
Authors: Ishihara Atsushi , Ide Yuri , Bito Tomohiro , Ube Naoki , Endo Naoki , Sotome Kozue , Maekawa Nitaro , Ueno Kotomi , Nakagiri Akira
Published: January 2018

Tyrosinase is the key enzyme that controls melanin formation in the human skin. We performed a screening of 96 extracts of mushroom cultures and fruiting bodies for examining their inhibitory activity against mushroom tyrosinase. The ethyl acetate extracts of culture filtrate of Neolentinus lepideus exhibited the strongest inhibitory activity. The active compounds 1 and 2 were purified by repeated chromatographic separations from the extract. On the basis of spectroscopic analyses, 1 and 2 were identified to be 1,3-dihydroisobenzofuran-4,5,7-triol and 5-methoxy-1,3-dihydroisobenzofuran-4,7-diol, respectively. Lineweaver-Burk plot of the enzyme reaction in the presence of 1 indicated that 1 was a potent competitive inhibitor. The respective IC50 values of 1 and 2 were 173 and 263 μg/mL. Compound 1 at 15 μg/mL suppressed melanin accumulation stimulated by α-MSH in the murine melanoma B16 cells, as well as the induced accumulation of both tyrosinase transcript and protein without inhibiting cell proliferation.
Cash transfers for families and children in Argentina, Brazil and Chile: segmented expansion or universal benefits?
Authors: Arza Camila
Published: January 2018

Over the past two decades, most Latin American countries have developed cash transfer programmes for poor and low income families not covered by the social security system. These programmes now benefit about 127 million people throughout Latin America and in some countries they include more children than the family allowances of the social insurance system. How have these innovations changed the structure of child benefits in Latin America? This article discusses this issue by looking at the experiences of Argentina, Brazil, and Chile. In these three countries, a wide-ranging programme of non-contributory cash transfers for low income families now operates alongside a pre-existing scheme of family allowances for formal sector workers. This has contributed to expand coverage of cash benefits for families and children, while at the same time keeping a segmented benefit structure. In contrast, a universal child benefit could overcome this segmentation and guarantee equal rights to all children.
Regular Yogurt Intake and Risk of Cardiovascular Disease Among Hypertensive Adults
Authors: Buendia Justin R , Li Yanping , Hu Frank B , Cabral Howard J , Bradlee M Loring , Quatromoni Paula A , Singer Martha R , Curhan Gary C , Moore Lynn L
Published: January 2018

BACKGROUND

High blood pressure (HBP) is a major cardiovascular disease (CVD) risk factor. Clinical trials including Dietary Approaches to Stop Hypertension (DASH) have demonstrated beneficial effects of dairy consumption on risks of HBP and CVD. Yogurt, a fermented dairy product, may independently be related to CVD risk.

OBJECTIVE

To evaluate the association between yogurt consumption and CVD risk among hypertensive individuals in 2 large cohorts and to determine whether the association differs among those whose eating pattern more closely resembles the DASH diet.

METHODS

Overall, 55,898 female Nurses’ Health Study (NHS) and 18,232 male Health Professionals Follow-Up Study (HPFS) participants with prevalent HBP were included. Cumulative average estimates of yogurt intake from validated food frequency questionnaires were related to verified self-reported CVD outcomes using Cox proportional hazards models. Hazard ratios and 95% confidence intervals (CI) were adjusted for CVD risk factors, medications, and diet covariates.

RESULTS

Yogurt intake was inversely associated with CVD risk (myocardial infarction and stroke) among hypertensive participants (P <0.01 in both cohorts). Among participants consuming ≥2 servings/week of yogurt, NHS women had a 17% (95% CI: 0.74–0.92) lower risk while HPFS men experienced a 21% (95% CI: 0.66–0.96) lower CVD risk compared to those who consumed <1 serving/month. Regular yogurt consumers with higher DASH diet scores had 16% (95% CI: 0.73–0.96) and 30% (95% CI: 0.57–0.85) CVD risk reductions in the 2 cohorts, respectively.

CONCLUSION

Hypertensive men and women who consumed ≥2 servings/week of yogurt, especially in the context of a healthy diet, were at lower risk for developing CVD.
Rapid immunosurveillance by recirculating lymphocytes in the rat intestine: critical role of unsulfated sialyl-Lewis X on high endothelial venules of the Peyer’s patches
Authors: Uchida Tomomi , Ueta Hisashi , Xu Xue-Dong , Hirakawa Jotaro , Tahara Kazunori , Zhou Shu , Sawanobori Yasushi , Simmons Szandor , Kitazawa Yusuke , Kawashima Hiroto , Matsuno Kenjiro
Published: January 2018

Naive lymphocytes systemically recirculate for immunosurveillance inspecting foreign antigens and pathogens in the body. Trafficking behavior such as the migration pathway and transit time within the gastrointestinal tract, however, remains to be elucidated. Rat thoracic duct lymphocytes (TDLs) were transferred to a congeneic host that had undergone mesenteric lymphadenectomy. The migration pathway was investigated using newly developed four-color immunohistochemistry and immunofluorescence. Donor TDLs showed rapid transition in gut tissues from which they emerged in mesenteric lymph around 4 h after intravenous injection. Immunohistochemistry showed that donor TDLs predominantly transmigrated across high endothelial venules (HEVs) at the interfollicular area of the Peyer’s patches (PPs), then exited into the LYVE-1+ efferent lymphatics, that were close to the venules. The rapid recirculation depended largely on the local expression of unsulfated sialyl-Lewis X on these venules where putative dendritic cells (DCs) were associated underneath. Recruited naive T cells briefly made contact with resident DCs before exiting to the lymphatics in the steady state. In some transplant settings, however, the T cells retained contact with DCs and were sensitized and differentiated into activated T cells. In conclusion, we directly demonstrated that lymphocyte recirculation within the gut is a very rapid process. The interfollicular area of PPs functions as a strategically central site for rapid immunosurveillance where HEVs, efferent lymphatics and resident DCs converge. PPs can, however, generate alloreactive T cells, leading to exacerbation of graft-versus-host disease or gut allograft rejection.
Factors Associated With Small Aggressive Non–Small Cell Lung Cancers in the National Lung Screening Trial: A Validation Study
Authors: Warkentin Matthew T , Tammemägi Martin C , Freedman Matthew T , Ragard Lawrence R , Hocking William G , Kvale Paul A , Brenner Darren R , Hu Ping , Riley Thomas L , Commins John , Church Timothy R , Berg Christine D
Published: January 2018

Background

A small proportion of non–small cell lung cancers (NSCLCs) have been observed to spread to distant lymph nodes (N3) or metastasize (M1) or both, while the primary tumor is small (≤3 cm, T1). These small aggressive NSCLCs (SA-NSLSC) are important as they are clinically significant, may identify unique biologic pathways, and warrant aggressive follow-up and treatment. This study identifies factors associated with SA-NSCLC and attempts to validate a previous finding that women with a family history of lung cancer are at particularly elevated risk of SA-NSCLC.

Methods

This study used a case–case design within the National Cancer Institute’s National Lung Screening Trial (NLST) cohort. Case patients and “control” patients were selected based on TNM staging parameters. Case patients (n = 64) had T1 NSCLCs that were N3 or M1 or both, while “control” patients (n = 206) had T2 or T3, N0 to N2, and M0 NSCLCs. Univariate and multivariable logistic regression were used to identify factors associated with SA-NSCLC.

Results

In bootstrap bias–corrected multivariable logistic regression models, small aggressive adenocarcinomas were associated with a positive history of emphysema (odds ratio [OR] = 5.15, 95% confidence interval [CI] = 1.63 to 23.00) and the interaction of female sex and a positive family history of lung cancer (OR = 6.55, 95% CI = 1.06 to 50.80).

Conclusions

Emphysema may play a role in early lung cancer progression. Females with a family history of lung cancer are at increased risk of having small aggressive lung adenocarcinomas. These results validate previous findings and encourage research on the role of female hormones interacting with family history and genetic factors in lung carcinogenesis and progression.
Powdery Mildew Resistant Rootstocks that Impart Tolerance to Grafted Susceptible Watermelon Scion Seedlings
Authors: Kousik Chandrasekar S. , Mandal Mihir , Hassell Richard
Published: January 2018

Powdery mildew (PM) is a major foliar disease causing serious economic losses of cucurbit crops grown in the United States. The pathogen Podosphaera xanthii, which causes PM, is known to infect seedlings, stems, foliage, petioles, and fruit of cucurbit crops. In recent years, grafting watermelon on resistant rootstocks for managing soilborne diseases has been gaining popularity in the U.S.A. However, grafting for managing foliar diseases has not yet received adequate attention. Three greenhouse experiments were conducted during the summer months of 2012, 2013, and 2014 to determine if PM-resistant rootstocks could impart resistance to a susceptible watermelon scion. Susceptible watermelon scion ‘Mickey Lee’ seedlings were grafted onto 25 watermelon (Citrullus lanatus, C. amarus, C. mucosospermus) and four bottle gourd (Lagenaria siceraria) rootstocks. Grafted plants were inoculated with a 2 × 104 conidia ml−1 suspension of P. xanthii conidia and disease severity was rated 14 days after inoculation. Mickey Lee grafted on six PM-resistant watermelon rootstocks had significantly (P ≤ 0.05) lower PM severity on cotyledons, 2nd true leaf, and upper leaves (rating for 3rd to 7th or 8th true leaf) compared with Mickey Lee grafted on susceptible watermelon USVL677-PMS or bottle gourd USVL848-PMS rootstocks. However, some of the resistant watermelon rootstocks did not impart significant resistance to the scion. The resistant bottle gourd rootstocks USVL482-PMR and USVL351-PMR provided significantly greater levels of resistance, compared with many of the resistant watermelon rootstocks. Grafting watermelon on resistant rootstocks may help mitigate the effects of PM on susceptible scion seedlings.
An Integrated Career Coaching and Time-Banking System Promoting Flexibility, Wellness, and Success: A Pilot Program at Stanford University School of Medicine
Authors: Fassiotto Magali , Simard Caroline , Sandborg Christy , Valantine Hannah , Raymond Jennifer
Published: January 2018

Faculty in academic medicine experience multiple demands on their time at work and home, which can become a source of stress and dissatisfaction, compromising success. A taskforce convened to diagnose the state of work–life flexibility at Stanford University School of Medicine uncovered two major sources of conflict: work–life conflict, caused by juggling demands of career and home; and work–work conflict, caused by competing priorities of the research, teaching, and clinical missions combined with service and administrative tasks. Using human-centered design research principles, the 2013–2014 Academic Biomedical Career Customization (ABCC) pilot program incorporated two elements to mitigate work–life and work–work conflict: integrated career–life planning, coaching to create a customized plan to meet both career and life goals; and a time-banking system, recognizing behaviors that promote team success with benefits that mitigate work–life and work–work conflicts. A matched-sample pre–post evaluation survey found the two-part program increased perceptions of a culture of flexibility (P = .020), wellness (P = .013), understanding of professional development opportunities (P = .036), and institutional satisfaction (P = .020) among participants. In addition, analysis of research productivity indicated that over the two-year program, ABCC participants received 1.3 more awards, on average, compared with a matched set of nonparticipants, a funding difference of approximately $1.1 million per person. These results suggest it is possible to mitigate the effects of extreme time pressure on academic medicine faculty, even within existing institutional structures.
The Advocacy Portfolio: A Standardized Tool for Documenting Physician Advocacy
Authors: Nerlinger Abby L. , Shah Anita N. , Beck Andrew F. , Beers Lee S. , Wong Shale L. , Chamberlain Lisa J. , Keller David
Published: January 2018

Recent changes in health care delivery systems and in medical training have primed academia for a paradigm shift, with strengthened support for an expanded definition of scholarship. Physicians who consider advocacy to be relevant to their scholarly endeavors need a standardized format to display activities and measure the value of health outcomes to which their work can be attributed. Similar to the Educator Portfolio, the authors here propose the Advocacy Portfolio (AP) to document a scholarly approach to advocacy.

Despite common challenges faced in the arguments for both education and advocacy to be viewed as scholarship, the authors highlight inherent differences between the two fields. On the basis of prior literature, the authors propose a broad yet comprehensive set of domains to categorize advocacy activities, including advocacy engagement, knowledge dissemination, community outreach, advocacy teaching/mentoring, and advocacy leadership/administration. Documenting quality, quantity, and a scholarly approach to advocacy within each domain is the first of many steps to establish congruence between advocacy and scholarship for physicians using the AP format.

This standardized format can be applied in a variety of settings, from medical training to academic promotion. Such documentation will encourage institutional buy-in by aligning measured outcomes with institutional missions. The AP will also provide physician–advocates with a method to display the impact of advocacy projects on health outcomes for patients and populations. Future challenges to broad application include establishing institutional support and developing consensus regarding criteria by which to evaluate the contributions of advocacy activities to scholarship.
Cortical Pain Response of Newborn Infants to Venepuncture
Authors: Rioualen Stéphane , Durier Virginie , Hervé David , Misery Laurent , Sizun Jacques , Roué Jean-Michel
Published: January 2018

Objective:

Sucrose administration and breastfeeding decrease behavioral expressions of pain in neonates. However, recent studies indicated that there is a persistent cortical response with sucrose. This study compared the efficacy of sucrose administration versus breastfeeding to decrease cortical responses to pain during venepuncture.

Patients and Methods:

A randomized, prospective, controlled trial was conducted in a tertiary level maternity ward. Healthy, 3-day-old term neonates, undergoing venepuncture for neonatal screening, were randomly assigned to receive sucrose solution or be breastfed before venepuncture. Variations in the total hemoglobin concentration [HbT] in the contralateral somatosensory cortex were assessed with near infrared spectroscopy. The Neonatal Facial Coding System (NFCS) was used to assess reactions.

Results:

There were 114 term neonates included, with 102 included for the primary outcome (breastfed group: 48; sucrose group: 54). Similar maximum increases in [HbT] were observed in both groups (mean±SD: sucrose group: 31.2±58.1 μmol/L; breastfed group: 38.9±61.4 μmol/L; P=0.70). Breastfed neonates presented more behavioral expressions that indicated pain compared with sucrose-administered neonates (46.8% vs. 26.8% of NFCS ≥1, P=0.04). The maximum increase in [HbT] was persistent, although newborn infants who did not express behavioral signs of pain had lower concentrations than neonates who did (mean±SD: 21.2±29.1 vs. 60.0±89.8 μmol/L, P<0.01).

Discussion:

There was no difference in the cortical responses to pain during venepuncture in newborn infants who were administered sucrose versus those who were breastfed.
FLUORESCEIN ANGIOGRAPHIC EVALUATION OF PERIPHERAL RETINAL VASCULATURE AFTER PRIMARY INTRAVITREAL RANIBIZUMAB FOR RETINOPATHY OF PREMATURITY
Authors: Harper C. Armitage , Wright Lauren M. , Young Ryan C. , Read Sarah P. , Chang Emmanuel Y.
Published: January 2018

Purpose:

To evaluate angiographic findings in neonates up to 150 weeks postmenstrual age who received intravitreal ranibizumab for primary treatment of Type 1 retinopathy of prematurity.

Methods:

Retrospective evaluation of fluorescein angiogram findings was completed for 30 eyes of 16 neonates who received intravitreal ranibizumab as primary treatment for Type 1 retinopathy of prematurity between April 2013 and January 2015. Outcome measures included maturity to Zone III, vascular blunting, vascular loops, vascular dilatation, capillary dropout, and vascular fluorescein leakage.

Results:

Mean gestational age was 241/7 weeks and mean postmenstrual age at time of intravitreal ranibizumab treatment was 35 weeks. Fluorescein angiograms performed at 44 weeks to 150 weeks postmenstrual age showed only 50% of eyes reached vascularization to Zone III; 40% had persistent vascular leakage; and ≥90% exhibited vascular blunting, vascular dilatation, and/or capillary dropout.

Conclusion:

Although intravitreal ranibizumab is effective in initial cessation of Type 1 retinopathy of prematurity, vascularization to Zone III was only achieved in 50% of eyes in our series and most eyes had fluorescein angiography evidence of vascular anomalies. If future studies are performed comparing treatment with laser photocoagulation to anti–vascular endothelial growth factor, fluorescein angiographic studies should be considered to assess the status of the peripheral retinal vasculature to determine treatment effect.
Incidence of Cystoid Macular Edema After Descemet Membrane Endothelial Keratoplasty
Authors: Kocaba Viridiana , Mouchel Romain , Fleury Jacques , Marty Anne-Sophie , Janin-Manificat Hélène , Maucort-Boulch Delphine , Burillon Carole
Published: January 2018

Purpose:

The incidence of and risk factors for cystoid macular edema (CME) after Descemet membrane endothelial keratoplasty (DMEK) remain uncertain. This study examines the incidence of and risk factors for CME after DMEK.

Methods:

This retrospective, single-center study included patients with no history of CME who had undergone DMEK. Patients were examined weekly for 1 month after surgery and at 3 and 6 months after surgery. Follow-up examinations included visual acuity (VA) assessment, pachymetry, anterior segment optical coherence tomography, biomicroscopy, intraocular pressure measurement, and fundoscopy. Eyes suspected of having CME (reduced VA and/or abnormal fundoscopic findings) underwent macular optical coherence tomography. Potential risk factors for CME examined included age, axial length, anterior chamber rebubbling, not using a topical nonsteroidal antiinflammatory after surgery, and concurrent DMEK and cataract surgery (triple-DMEK).

Results:

Eighty eyes (74 subjects) were included. Eleven eyes (13.8%) developed CME within 6 months after undergoing DMEK. Univariate analyses did not identify any significant CME risk factors. Interestingly, the triple-DMEK procedure did not put subjects at risk for developing CME (P = 0.184). Visual prognosis after medical treatment for CME was excellent, and subjects with and without CME had comparable VA at 6 months [CME: logarithm of the minimum angle of resolution (logMAR) VA = 0.3 (first–third quartile: 0.1–1.0), 20/40; no CME: logMAR VA = 0.3 (0.1–0.5), 20/40; P = 0.391].

Conclusions:

Although CME frequently occurred after DMEK, no CME risk factors were identified. In addition, CME did not significantly affect long-term visual outcomes when it was appropriately treated.
Human pain genetics database: a resource dedicated to human pain genetics research
Authors: Meloto Carolina B. , Benavides Rodrigo , Lichtenwalter Ryan N. , Wen Xia , Tugarinov Nicol , Zorina-Lichtenwalter Katerina , Chabot-Doré Anne-Julie , Piltonen Marjo H. , Cattaneo Stefano , Verma Vivek , Klares Richard , Khoury Samar , Parisien Marc , Diatchenko Luda
Published: January 2018

The Human Pain Genetics Database (HPGDB) is a comprehensive variant-focused inventory of genetic contributors to human pain. After curation, the HPGDB currently includes 294 studies reporting associations between 434 distinct genetic variants and various pain phenotypes. Variants were then submitted to a comprehensive analysis. First, they were validated in an independent high-powered replication cohort by testing the association of each variant with 10 different pain phenotypes (n = 1320-26,973). One hundred fifty-five variants replicated successfully (false discovery rate 20%) in at least one pain phenotype, and the associationPvalues of the HPGDB variants were significantly lower compared with those of random controls. Among the 155 replicated variants, 21 had been included in the HPGDB because of their association with analgesia-related and 13 with nociception-related phenotypes, confirming analgesia and nociception as pathways of vulnerability for pain phenotypes. Furthermore, many genetic variants were associated with multiple pain phenotypes, and the strength of their association correlated between many pairs of phenotypes. These genetic variants explained a considerable amount of the variance between different pairs of pain phenotypes, indicating a shared genetic basis among pain phenotypes. In addition, we found that HPGDB variants show many pleiotropic associations, indicating that genetic pathophysiological mechanisms are also shared among painful and nonpainful conditions. Finally, we demonstrated that the HPGDB data set is significantly enriched for functional variants that modify gene expression, are deleterious, and colocalize with open chromatin regions. As such, the HPGDB provides a validated data set that represents a valuable resource for researchers in the human pain field.
Osteotomies in Patello-Femoral Instabilities
Authors: Dejour David , Le Coultre Bertrand
Published: January 2018

Patellar instability is defined by clinical and radiologic criteria. The surgical treatment is aimed at restoring the congruence of the patellofemoral articulation and correcting extensor mechanism malalignment, to prevent recurrence of dislocation. The standard soft-tissue procedures are lateral release and vastus medialis advancement and medial patello femoral ligament plasty. Bony procedures are frequently performed in addition to soft-tissue surgery, to realign the extensor mechanism by means of tibial tubercle medialization, or to correct the patellar index in patella alta. In a smaller number of patients, the trochlea may be reshaped, by elevating the lateral trochlear facet or by lowering the floor of the sulcus. The morphologic abnormalities encountered are studied and quantified in the light of preoperative investigations (conventional radiographs and computed tomography), and addressed at surgery using the technique or techniques most appropriate for the management of the individual patient’s pattern.
Therapeutic Approaches to Secondary Fracture Prevention in High Risk Populations: Current Recommendations and Advances
Authors: Lim Huei-Wen , Chamblain Melissa , Wong Benny , Raghavan Siddharth
Published: January 2018

Background:

Osteoporotic fragility fracture is a burgeoning health epidemic that is associated with high rates of disability, morbidity, and mortality. Based on NHANES data, approximately 10 million Americans are affected by this disease.

Areas of Uncertainty:

Successful secondary fracture prevention measures are often limited by the under-diagnosis of osteoporosis after fragility fractures because of lack of patient and physician awareness of the disease, lack of follow-up, and medical nonadherence.

Therapeutic Advances:

Current guidelines recommend the use of Bisphosphonate as the first-line therapy for secondary fracture prevention. Compared with placebo, randomized controlled trials have demonstrated a significant reduction in vertebral and nonvertebral fractures using Alendronate, Risedronate, Ibandronate, and Zoledronic acid. All but Ibandronate showed a significant reduction in hip fractures as well (all trials withP< 0.05). Denosumab is an option in patients with impaired renal function or who are unresponsive to other therapies. It significantly decreases the risk of new vertebral fracture [hazard ratio (HR) = 0.32, 95% confidence interval (CI), 0.26–0.41], hip fracture (HR = 0.60, 95% CI, 0.37–0.97) and nonvertebral fracture (HR = 0.80; 95% CI, 0.67–0.95) without an increased in adverse events. Hormonal therapy has been shown to be effective but should be used in the lowest effective dose to minimize the risk of coronary heart disease, stroke, and venous thromboembolism. Selective estrogen replacement modulators, calcitonin, and parathyroid hormone analog are other alternatives described in this article. In addition to current therapies, emerging therapies under investigation such as Abaloparatide, a parathyroid receptor ligand, and Romosozumab, a monoclonal anti-sclerotin antibody both showed a reduction in new morphometric vertebral fractures compared with placebo (0.58% vs. 4.22%, relative risk = 0.14, 95% CI, 0.05–0.39 and 0.5 vs. 1.8%, relative risk = 0.27, 95% CI, 0.16–0.47, respectively). In this article, we summarize advances in current therapeutic agents used for secondary fracture prevention and provide insight into potential therapies that hold promise in the future of osteoporosis.

Conclusion:

Secondary prevention of fragility fractures through care coordination and initiation of various pharmacologic agents is crucial in the elderly population. Careful risk assessment and stratification should be performed before the initiation of pharmacologic treatment to optimize disease management.
Therapeutic Advances in the Management of Orthostatic Hypotension
Authors: Patel Karishma , Kiszko Kinga , Torbati Ali
Published: January 2018

Background:

Orthostatic hypotension (OH) is a common condition in hospitalized geriatric patients. These patients are more susceptible to OH during dehydration and volume depletion.

Areas of Uncertainty:

OH is often times asymptomatic. There is clear evidence that OH is a risk factor for cardiovascular disease, ischemic stroke, and mortality. Although certain treatments have demonstrated some success in improving OH, it is unclear whether these interventions have any effect on clinical outcomes such as falls, syncope, and mortality.

Therapeutic Advances:

Initial approaches to treatment should focus on nonpharmaceutical interventions, such as education about symptom recognition, lifestyle modifications, promotion of early mobilization, and avoidance of unnecessary bed rest orders. Pharmaceutical treatments are only indicated if the patient continues to be symptomatic in spite on nonpharmacologic interventions. The 2 main approaches to treating hypotension with pharmaceuticals include increasing blood volume and peripheral vascular resistance. Fludrocortisone should not be used as an isolated therapy, but a next step after dietary salt and water expansion. The recommended starting dose of fludrocortisone is 0.1 mg daily early in the morning with potential weekly increase up to 0.3 mg per day. If fludrocortisone is unsuccessful, midodrine may be used to increase peripheral vascular resistance. The starting dose of midodrine is 2.5 mg 3 times per day, with a slow titration to a maximum of 10 mg 3 times per day. Given the increased potential for underlying cardiovascular diseases in geriatric patients, midodrine should be used cautiously in acute illness. The use of prostaglandin inhibitors that is nonsteroidal anti-inflammatory drugs to raise blood pressure should be limited because of the increased risk of gastrointestinal bleeding, renal failure, and electrolytes abnormalities in elderly adults. Other agents which may be of benefit include clonidine, yohimbine, pyridostigmine, methylxanthine, dihydroergotamine, Cafergot, octreotide, and droxidopa; however, their use is conditional to certain etiologies behind OH, and the supporting evidence is low.

Conclusions:

Although there is no accepted protocol regarding how to manage hypertension in patients with OH, some studies favor the use of beta blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, over alpha-receptor antagonists and diuretics.
Overview of the Diagnosis, Evaluation, and Novel Treatment Strategies for Ophthalmic Emergencies in the Hospitalized Geriatric Patient
Authors: Palazzolo Laura , Gorski Matthew
Published: January 2018

The review highlights common ophthalmic emergencies seen in the hospitalized geriatric patient. It describes key features of the ophthalmic examination, early identification, and treatment of ophthalmic emergencies, including transient monocular loss of vision with risk of future ischemic complications, central retinal artery occlusion, giant-cell arteritis, retinal detachment, acute angle closure glaucoma, orbital cellulitis, and orbital trauma. Research is ongoing regarding the best techniques to maximize visual outcome for these conditions. The benefits of surgical versus medical management for transient monocular blindness and central retinal artery occlusion are debated. Currently, patients with central retinal artery occlusion have low potential for visual recovery, and to change this potential there is significant ongoing research into novel medical approaches, including the use of thrombolytics, pentoxyphylline to promote vasodilation, and hyperbaric oxygen to enhance oxygenation of damaged retinal tissue. Giant-cell arteritis is another emergency with potential for poor visual outcome, and mainstream management at this time dictates prolonged steroid regimens, which have their own significant side effects. Current therapeutic research is investigating optimal glucocorticoid regimens as well as newer therapeutic advances for alternatives to glucocorticoid therapy, such as tocilizumab and methotrexate. For all the ophthalmic emergencies described, high suspicion should be held for these conditions when patients complain of sudden vision changes or severe eye pain. Urgent intervention and ophthalmology consultation are essential for preventing irreversible visual damage.
Trends in Preventable Inpatient and Emergency Department Utilization in California Between 2012 and 2015
Authors: Cunningham Peter , Sheng Yaou
Published: January 2018

Background:

Expansions of health insurance coverage tend to increase hospital emergency department (ED) utilization and inpatient admissions. However, provisions in the Affordable Care Act that expanded primary care supply were intended in part to offset the potential for increased hospital utilization.

Objectives:

To examine the association between health insurance coverage, primary care supply, and ED and inpatient utilization, and to assess how both factors contributed to trends in utilization in California between 2012 and 2015.

Methods:

Population-based measures of ED and inpatient utilization, insurance coverage, and primary care supply were constructed for California counties for the years 2012 through 2015. Fixed effects regression analysis is used to examine the association between health insurance coverage, primary care supply, and rates of preventable ED and inpatient utilization.

Results:

Higher levels of Medicaid coverage in a county are associated with higher levels of preventable ED and inpatient utilization, although greater numbers of primary care practitioners and Federally Qualified Health Centers reduce this type of utilization.

Conclusions:

Increases in coverage accelerated a long-term increase in ED visits and prevented an even larger decrease in inpatient admissions, but changes in coverage do not fully explain these underlying trends. Increases in primary care supply offset the effects of coverage changes only modestly. Policymakers should not overstate the impact of the Affordable Care Act on increasing ED visits, and should focus on better understanding the underlying factors that are driving the trends.
Childhood Nasopharyngeal Carcinoma: State-of-the-Art, and Questions for the Future
Authors: Dourthe Marie-Emilie , Bolle Stéphanie , Temam Stéphane , Jouin Anais , Claude Line , Reguerre Yves , Defachelles Anne-Sophie , Orbach Daniel , Fresneau Brice
Published: January 2018

In children, nasopharyngeal carcinoma (NPC) is a very rare tumor, mostly Epstein-Barr Virus related and quite always diagnosed at a locally advanced stage. With current protocols associating induction cisplatin-based chemotherapy and concomitant chemoradiotherapy, prognosis is excellent with overall survival higher than 85%. However, long-term toxicities are frequent. Improvement in radiation therapy modalities like intensity-modulated radiation therapy and new strategies with radiation dose adaptation to chemotherapy response have been introduced to reduce acute and long-term toxicities. Actually, 2 main questions remain: is it possible to pursue a therapeutic deescalation in children with low-risk NPC or very good response to induction chemotherapy in order to reduce the risk of late effects? Could an immunologic maintenance treatment improve prognosis of children with high-risk NPC? International collaborative groups and prospective trials including biological studies are necessary to answer these questions to improve childhood NPC treatment and knowledge.
We're the Eyes and the Ears, but We Don't Have a Voice
Authors: Lai Djin , Cloyes Kristin G. , Clayton Margaret F. , Doyon Katherine , Reblin Maija , Beck Anna C. , Ellington Lee
Published: January 2018

Hospice aides are integral to the delivery of home hospice care and play an essential role in the effective communication and collaboration of the hospice interdisciplinary team. Despite their critical role, little is known about hospice aides' perceptions of their role in providing hospice services. This qualitative study explores hospice aides' perspectives of their work; their relationships with patients, families, and interdisciplinary team members; and their contributions to end-of-life care. Two focus groups of hospice aides (N = 13) and 16 hours of observation of in-home caregiving were conducted. Focus group data were inductively and iteratively coded, and three themes were identified: (1) “We're the eyes and ears,” (2) “We're kept out of the loop,” and (3) “We have no voice.” Aides described themselves as frontline providers based on the close relationships they formed with patients and family members yet felt underrecognized by members of the hospice team. Observational field notes were reexamined with themes to confirm convergence of qualitative and observational data. Better understanding of their role could enhance the integration of aides into patient- and family-centered team interactions, leading to both improved patient and family outcomes and retention and support of this critical component of the hospice workforce.
Palliative Nursing Summit
Authors: Mazanec Polly , Lamb Gerri , Haas Sheila , Dahlin Connie , Mooney Alicia , LaFond Deborah
Published: January 2018

The Hospice and Palliative Nurses Association Palliative Nursing Summit (Summit) “Nurses Leading Change and Transforming Care” brought nurses from numerous specialties together to discuss collaboration in advancing primary palliative nursing. Nursing leadership was highlighted, and the future of integrating primary palliative care was emphasized. Three workshop groups held discussions on key collaborative topics of communication/advance care planning, pain and symptom management, and coordination of care/transition management (CCTM). Nursing has historically led the way in CCTM, especially in acute- and long-term-care settings. The philosophy and principles of CCTM are in direct alignment with the values and guidelines for quality palliative care. Goals of CCTM include the achievement of optimal health, equal access to care, and appropriate utilization of health care resources, balanced with the patient’s right to self-determination. This article presents an overview of the patient and family outcomes and nursing actions identified by the group regarding CCTM.
Components of the Advance Care Planning Process in the Nursing Home Setting
Authors: Mayahara Masako , Miller Arlene Michaels , O'Mahony Sean
Published: January 2018

The purposes of this study were to describe the advance care planning process for nursing home residents and identify common concerns regarding advance care planning. We conducted a content analysis of video-conferenced advance care planning meetings in the nursing home. Fourteen nursing home residents and 10 family members were included in the analysis. Themes based on the participants' statements during the meetings were used to generate the Advance Care Planning Process Framework. The Advance Care Planning Process Framework has 3 primary phases: (1) assess resident's status regarding end-of-life care, which includes establishing common language; identifying resident's unrealistic goals and wishes; and identifying inconsistencies between resident's expressed wishes and the preferences documented in medical record; (2) negotiate realistic plan of care, which includes addressing inconsistencies between resident's and family's goals; rephrasing goals and wishes in hypothetical scenarios; and clarifying goals; and (3) create action plan, which includes complete advance directives and revisit/revise in the future as needed. Most of the consultations resulted in action plans to facilitate concordance between resident wishes and medical records. Advance care planning with palliative care specialists provided a valuable opportunity for nursing home residents and families to discuss advance directives and provided valuable clarification of their goals of care.
Prospective Evaluation of Cervicovaginal Self- and Cervical Physician Collection for the Detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium Infections
Authors: Lockhart Alexandre , Psioda Matt , Ting Jie , Campbell Sara , Mugo Nelly , Kwatampora Jessie , Chitwa Michael , Kimani Joshua , Gakure Anne , Smith Jennifer S.
Published: January 2018

Background

This study aimed to examine the agreement between sexually transmitted infection (STI) screening using self-collected specimens and physician-collected specimens, and to investigate the acceptability of self-collection for screening in an 18-month study of female sex workers in a high-risk, low-resource setting.

Methods

A total of 350 female sex workers in Nairobi, Kenya, participated in a prospective study from 2009 to 2011. Women self-collected a cervicovaginal specimen. Next, a physician conducted a pelvic examination to obtain a cervical specimen. Physician- and self-collected specimens were tested for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium (MG) using Aptima nucleic acid amplification assays (Hologic). Specimens were collected at 3-month intervals over 18-month follow-up. κ Statistics measured agreement of positivity between self-collection and physician collection.

Results

Baseline STI prevalence was 2.9% for N. gonorrhoeae, 5.2% for C. trachomatis, 9.2% for T. vaginalis, and 20.1% for MG in self-collected samples, and 2.3%, 3.7%, 7.2%, and 12.9%, respectively, in physician-collected samples. κ Agreement was consistently strong (range, 0.66–1.00) for all STIs over the 18-month study period, except for MG, which had moderate agreement (range, 0.50–0.75). Most participants found self-collection easy (94%) and comfortable (89%) at baseline, with responses becoming modestly more favorable over time.

Conclusions

Self-collected specimen screening results showed strong agreement to clinical-collected specimens, except for MG, which was consistently detected more commonly in self-collected than in physician-collected specimens. Acceptability of the self-collection procedure was high at baseline and increased modestly over time. In high-risk, low-resource settings, STI screening with self-collected specimens provides a reliable and acceptable alternative to screening with physician-collected specimens.