bluuebunny/crossref_metadata_2025 huggingface dataset:
Communication: Theoretical study of HfF+ cation to search for the T,P-odd interactions
Authors: Skripnikov L. V.
Published: July 2017

The combined all-electron and two-step approach is applied to calculate the molecular parameters which are required to interpret the ongoing experiment to search for the effects of manifestation of the T,P-odd fundamental interactions in the HfF+ cation by Loh et al. [Science 342, 1220 (2013)] and Ni et al. [J. Mol. Spectrosc. 300, 12 (2014)]. The effective electric field that is required to interpret the experiment in terms of the electron electric dipole moment is found to be 22.5 GV/cm. In the work of Pospelov and Ritz [Phys. Rev. D 89, 056006 (2014)], it was shown that another source of the T,P-odd interaction, the scalar-pseudoscalar nucleus-electron interaction with the dimensionless strength constant kT,P can dominate over the direct contribution from the electron electric dipole moment within the standard model and some of its extensions. Therefore, for the comprehensive and correct interpretation of the HfF+ experiment, one should also know the molecular parameter WT,P, the value of which is reported here to be 20.1 kHz.
Artifact mitigation of ptychography integrated with on-the-fly scanning probe microscopy
Authors: Huang Xiaojing , Yan Hanfei , Ge Mingyuan , Öztürk Hande , Nazaretski Evgeny , Robinson Ian K. , Chu Yong S.
Published: July 2017

We report our experiences with conducting ptychography simultaneously with the X-ray fluorescence measurement using the on-the-fly mode for efficient multi-modality imaging. We demonstrate that the periodic artifact inherent to the raster scan pattern can be mitigated using a sufficiently fine scan step size to provide an overlap ratio of >70%. This allows us to obtain transmitted phase contrast images with enhanced spatial resolution from ptychography while maintaining the fluorescence imaging with continuous-motion scans on pixelated grids. This capability will greatly improve the competence and throughput of scanning probe X-ray microscopy.
High Catalytic Activity of Peptide Nanofibres Decorated with Ni and Cu Nanoparticles for the Synthesis of 5-Substituted 1H-Tetrazoles and N-Arylation of Amines
Authors: Ghorbani-Choghamarani Arash , Taherinia Zahra
Published: July 2017

A rapid development of a new methodology for decarboxylative N-arylation of carboxylic acids and the preparation of 5-substituted 1H-tetrazoles catalysed by peptide nanofibres decorated with Cu and Ni nanoparticles is presented. Compared with conventional aryl halides, benzoic acids are extremely interesting and environmentally friendly options for the synthesis of secondary aryl amines.
Behavioral self-organization underlies the resilience of a coastal ecosystem
Authors: de Paoli Hélène , van der Heide Tjisse , van den Berg Aniek , Silliman Brian R. , Herman Peter M. J. , van de Koppel Johan
Published: July 2017

Significance

Theoretical models suggest that spatial self-organization enhances the resistance of ecosystems to disturbance. However, experiments investigating this important prediction are lacking. Our paper provides clear experimental evidence that spatial self-organization profoundly increases the ability of ecosystems to persist in the face of disturbance. The mechanisms underlying this positive impact of self-organization are driven by the combination of ecological and behavioral processes. Specifically, large-scale banded patterns in mussel beds created by ecological feedback processes facilitate fast behavioral aggregation of individual mussels into clumps, in turn improving mussel survival. Our study emphasizes the potential of harnessing spatial self-organization to enhance restoration success and persistence of threatened ecosystems.
Acute inflammation regulates neuroregeneration through the NF-κB pathway in olfactory epithelium
Authors: Chen Mengfei , Reed Randall R. , Lane Andrew P.
Published: July 2017

Significance

After injury to the olfactory mucosa, neural progenitor cells residing in the basal layer are capable of completely reconstituting the neuroepithelium. The molecular events underlying this striking regenerative capacity are not fully understood. We present evidence that damage to the mouse olfactory mucosa results in a transient acute inflammatory response. Using genetic manipulations in a model of olfactory epithelial repair we demonstrate a key role of inflammation in driving the reparative activity of basal olfactory progenitor cells, in a process involving TNF-α signaling via TNF receptor 1 and the NF-κB pathway. This study, revealing cross-talk between the immune system and olfactory neural stem cells, provides insight into the endogenous activation of neuroregeneration.
Escherichia coli
cytochrome
c
peroxidase is a respiratory oxidase that enables the use of hydrogen peroxide as a terminal electron acceptor
Authors: Khademian Maryam , Imlay James A.
Published: July 2017

Significance

Hydrogen peroxide has been regarded exclusively as a hazard for bacteria; its sources and concentrations in natural habitats are uncertain. The cytochrome
c
peroxidase of
Escherichia coli
exhibits an expression pattern and flux rate that provides surprising insights into these issues. This periplasmic enzyme is induced only when H
2
O
2
is present and molecular oxygen is absent. Intriguingly, it was ineffective as a defensive enzyme, but through its linkage to the quinone pool it did enable
E. coli
to respire using H
2
O
2
as an anaerobic electron acceptor. We suggest that both chemical and biotic processes generate micromolar H
2
O
2
at oxic/anoxic interfaces and that this scenario is common enough that microbes have evolved strategies to productively exploit the H
2
O
2
.
Bayesian markets to elicit private information
Authors: Baillon Aurélien
Published: July 2017

Significance

People’s private information can be revealed by the way in which they trade specifically designed assets in a new type of market. People trade an asset whose value is the proportion of affirmative answers to a question. Their trading position then reveals their own answer to the question. In Bayesian markets, people can be rewarded for telling the truth even when the truth is not verifiable. Bayesian markets are simpler and more transparent than alternative methods, avoiding the measurements of metabeliefs about others and prior beliefs.
Acetylcholine-producing NK cells attenuate CNS inflammation via modulation of infiltrating monocytes/macrophages
Authors: Jiang Wei , Li Daojing , Han Ranran , Zhang Chao , Jin Wei-Na , Wood Kristofer , Liu Qiang , Shi Fu-Dong , Hao Junwei
Published: July 2017

Significance

Acetylcholine (ACh) produced by neurons performs an array of functions that control cardiac, gastrointestinal, and other biosystems. Here we discovered that lymphocytic natural killer (NK) cells bear machinery that produces ACh. The activity of ACh-producing NK cells up-regulates during the disease flare of multiple sclerosis (MS) and may, therefore, reflect the pathologic state. In the mouse model of MS, experimental autoimmune encephalomyelitis, these ACh-producing NK cells can reduce the intensity of inflammation and autoimmune responses in the brain and spinal cord. Therefore, the nonneural cholinergic system, as reflected by ACh-producing NK cells, appeared to counteract aberrant immune responses and lessen brain damage. This observation offers insight into the therapeutic mechanisms of the Food and Drug Administration-approved drug daclizumab high-yield process for MS.
NontypeableHaemophilus influenzaereleases DNA and DNABII proteins via a T4SS-like complex and ComE of the type IV pilus machinery
Authors: Jurcisek Joseph A. , Brockman Kenneth L. , Novotny Laura A. , Goodman Steven D. , Bakaletz Lauren O.
Published: July 2017

Significance

Extracellular DNA and DNABII proteins are essential structural components of the extracellular polymeric substance, or matrix, of the nontypeableHaemophilus influenzaebiofilm; however, the mechanisms by which these elements are released from the bacterial cell for incorporation into the biofilm matrix are not yet characterized. Here, we propose a mechanism for active DNA release during biofilm formation that involves an inner-membrane complex (TraCG) and the ComE pore through which the type IV pilus is typically expressed. Knowledge of how and when DNA and DNABII proteins are released into the extracellular milieu for integration into the biofilm matrix will further our understanding of biofilm formation and maturation and, in turn, guide development of directed therapies for diseases with a biofilm etiology.
Intranasal oxytocin treatment for social deficits and biomarkers of response in children with autism
Authors: Parker Karen J. , Oztan Ozge , Libove Robin A. , Sumiyoshi Raena D. , Jackson Lisa P. , Karhson Debra S. , Summers Jacqueline E. , Hinman Kyle E. , Motonaga Kara S. , Phillips Jennifer M. , Carson Dean S. , Garner Joseph P. , Hardan Antonio Y.
Published: July 2017

Significance

Autism spectrum disorder (ASD) is characterized by social deficits. Emerging evidence suggests that the neuropeptide oxytocin, which regulates mammalian social functioning, may be a promising treatment for ASD. However, prior oxytocin treatment trials in ASD patients have produced equivocal results, perhaps because of variability in patients’ underlying neuropeptide biology. Here we provide evidence that oxytocin treatment improves social abilities in children with ASD and that individuals with the lowest pretreatment blood oxytocin concentrations benefit the most from oxytocin administration. These findings reveal a personalized component to oxytocin treatment which may have important implications for accurately testing oxytocin’s therapeutic potential, both for ASD and for a broad range of developmental and psychiatric disorders in which patients exhibit social impairments.
Harm to self outweighs benefit to others in moral decision making
Authors: Volz Lukas J. , Welborn B. Locke , Gobel Matthias S. , Gazzaniga Michael S. , Grafton Scott T.
Published: July 2017

Significance

Principles guiding decisions that affect both ourselves and others are of prominent importance for human societies. Previous accounts in economics and psychological science have often described decision making as either categorically egoistic or altruistic. Instead, the present work shows that genuine altruism is embedded in context-specific egoistic bias. Participants were willing to both forgo monetary reward to spare the other from painful electric shocks and also to suffer painful electric shocks to secure monetary reward for the other. However, across all trials and conditions, participants accrued more reward and less harm for the self than for the other person. These results characterize human decision makers as egoistically biased altruists, with important implications for psychology, economics, and public policy.
Effect of pulsed current on the microstructure evolution of Cu–Sn intermetallic compounds
Authors: Li Kewei , Wang Xiaobo
Published: July 2017

The dissolution behaviour between Cu and Sn during spark plasma sintering (SPS) was investigated with emphasis on the intrinsic effect of the applied pulsed current. Metallographic analyses revealed that the phase formation of Cu–Sn intermetallics was significantly influenced by the applied pulsed current as a series of phase evolutions along the sintering temperature occurred: Cu6Sn5 + Sn → Cu6Sn5 + Cu3Sn → Cu3Sn. The evolution of Cu–Sn intermetallic compounds (IMCs) was analysed by considering the accelerated atomic diffusion and the increased flux of Cu into the IMCs with a pulsed current, which can provide new insights into the basic understanding of the SPS process and promote the development of rapid forming process of IMCs joints for applications at higher temperatures.
The redundancy effect in human causal learning: No evidence for changes in selective attention
Authors: Jones Peter M , Zaksaite Tara
Published: July 2017

Several recent papers have reported a difference in associative learning for two kinds of redundant cues, such that a blocked cue (e.g., X in A+ AX+) apparently forms a stronger association with the outcome than an uncorrelated cue (e.g., Y in BY+ CY-). This difference is referred to as the redundancy effect, and is of interest because it is contrary to the predictions of a number of popular learning models. One way of reconciling these models with the redundancy effect is to assume that the amount of attention paid to redundant cues changes as a result of experience, and that these changes in attention influence subsequent learning. Here, we present two experiments designed to evaluate this idea, in which we measured overt attention using an eye tracker while participants completed a learning task that elicited the redundancy effect. In both experiments, gaze duration was longer for uncorrelated cues than for blocked cues, but this difference disappeared when we divided gaze durations by trial durations. In Experiment 2, we failed to observe any difference in gaze duration when blocked and uncorrelated cues were subsequently presented together. While the observed difference in gaze duration for the two types of redundant cue may contribute to differences in learning during initial training, we suggest that the principal causes of the redundancy effect are likely to lie elsewhere.
Blimp-1–dependent and –independent natural antibody production by B-1 and B-1–derived plasma cells
Authors: Savage Hannah P. , Yenson Vanessa M. , Sawhney Sanjam S. , Mousseau Betty J. , Lund Frances E. , Baumgarth Nicole
Published: July 2017

Natural antibodies contribute to tissue homeostasis and protect against infections. They are secreted constitutively without external antigenic stimulation. The differentiation state and regulatory pathways that enable continuous natural antibody production by B-1 cells, the main cellular source in mice, remain incompletely understood. Here we demonstrate that natural IgM-secreting B-1 cells in the spleen and bone marrow are heterogeneous, consisting of (a) terminally differentiated B-1–derived plasma cells expressing the transcriptional regulator of differentiation, Blimp-1, (b) Blimp-1+, and (c) Blimp-1neg phenotypic B-1 cells. Blimp-1neg IgM-secreting B-1 cells are not simply intermediates of cellular differentiation. Instead, they secrete similar amounts of IgM in wild-type and Blimp-1–deficient (PRDM-1ΔEx1A) mice. Blimp-1neg B-1 cells are also a major source of IgG3. Consequently, deletion of Blimp-1 changes neither serum IgG3 levels nor the amount of IgG3 secreted per cell. Thus, the pool of natural antibody-secreting B-1 cells is heterogeneous and contains a distinct subset of cells that do not use Blimp-1 for initiation or maximal antibody secretion.
Therapeutic antibody targeting of Notch3 signaling prevents mural cell loss in CADASIL
Authors: Machuca-Parra Arturo I. , Bigger-Allen Alexander A. , Sanchez Angie V. , Boutabla Anissa , Cardona-Vélez Jonathan , Amarnani Dhanesh , Saint-Geniez Magali , Siebel Christian W. , Kim Leo A. , D’Amore Patricia A. , Arboleda-Velasquez Joseph F.
Published: July 2017

Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a neurological syndrome characterized by small vessel disease (SVD), stroke, and vascular cognitive impairment and dementia caused by mutations in NOTCH3. No therapies are available for this condition. Loss of mural cells, which encompass pericytes and vascular smooth muscle cells, is a hallmark of CADASIL and other SVDs, including diabetic retinopathy, resulting in vascular instability. Here, we showed that Notch3 signaling is both necessary and sufficient to support mural cell coverage in arteries using genetic rescue in Notch3 knockout mice. Furthermore, we show that systemic administration of an agonist Notch3 antibody prevents mural cell loss and modifies plasma proteins associated with Notch3 activity, including endostatin/collagen 18α1 and Notch3 extracellular domain in mice with the C455R mutation, a CADASIL variant associated with Notch3 loss of function. These findings open opportunities for the treatment of CADASIL and other SVDs by modulating Notch3 signaling.
Necrotizing enterocolitis
Authors: Agnoni Alysia , Lazaros Amendola Christine
Published: July 2017

Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in preterm infants and continues to be a major cause of morbidity and mortality. The incidence of NEC as well as mortality from the disease has persisted at unacceptably high levels for decades as current understanding of the cause remains incomplete. Identifying infants at risk and preventing NEC are mainstays of care. This article briefly examines disease presentation and treatment, identifies gaps in current understanding of disease pathology, and highlights new research that may lead to a decrease in the incidence of NEC in the future.
Repair of Displaced Partial Articular Fracture of the Distal Femur: The Hoffa Fracture
Authors: Egol Kenneth A. , Broder Kari , Fisher Nina , Konda Sanjit R.
Published: July 2017

Purpose:

The Hoffa fracture is a rare fracture pattern consisting of a unicondylar posterior fracture of the distal femur. This video demonstrates a case of Hoffa fracture repair using headless screw compression.

Methods:

Hoffa fractures are intra-articular in nature. Given that isolated Hoffa fractures are rare, there is little information available as to the best management of this injury. However, several small studies have demonstrated good-to-excellent functional results after anatomical reduction and rigid fixation of the Hoffa fracture, followed by early mobilization.

Results:

This video presents a case of surgical repair of a Hoffa fracture, and contaminant meniscal repair, in a 25-year-old man. Partially threaded, headless compression screws provide for independent compression of the fracture after placement.

Conclusions:

The Hoffa fracture is a rare injury typically seen after high-energy trauma. The surgical technique for treatment of the Hoffa fracture as seen in this video provides good stabilization and enables for early range of motion.
Suggested Tips and Tricks to Enhance Surgical Video Production
Authors: Fisher Nina , Kaplan Daniel , Egol Kenneth A.
Published: July 2017

Purpose:

Surgical video production is an important skill that can be of valuable use as an educational tool. However, it is important that surgical videos be filmed and edited in a methodological way to maximize its potential. In this video, we describe our preference for producing quality surgical videos.

Methods:

There are many important factors to consider during the filming process, including vantage point of the videographer, lighting, and visualization of instruments. During the editing process, certain techniques can be used to make the video more stimulating and thus more engaging to the viewer.

Results:

This video presents the filming and editing of a single case. In addition, we provide examples of acceptable and poor footage and editing techniques.

Conclusions:

Surgical videos can be a valuable educational tool when properly executed. In this video, we describe techniques to ensure quality production.
Segmental Bone Defect Treated With the Induced Membrane Technique
Authors: Konda Sanjit R. , Gage Mark , Fisher Nina , Egol Kenneth A.
Published: July 2017

Purpose:

Posttraumatic bone defects in the setting of severe open injuries of the lower extremity present a significant challenge for orthopaedic trauma surgeons. The induced membrane technique, also known as the Masquelet technique, has been shown to be generally successful in achieving bony union. This video demonstrates the use of the Masquelet technique for a large (18 cm) femoral defect.

Methods:

The Masquelet technique is a 2-stage process. The first stage involves debridement of all devitalized tissue, using open reduction and internal fixation, and placement of a cement spacer with or without antibiotics. In the second stage, which is performed at least 6 weeks after the first, the spacer is removed and the resulting void is filled with bone graft.

Results:

This surgical case video reviews the relevant patient injury presentation, initial management, and indications for the Masquelet technique. The second stage of the Masquelet technique is featured in this video.

Conclusions:

The Masquelet technique is a generally reliable method for treating large segmental bone defects. In addition, this relatively simple technique is suitable for both infected and noninfected cases.
Plate Osteosynthesis of Patella Fractures—A Video Case Report
Authors: Siljander Matthew , Vara Alexander D. , Koueiter Denise M. , Gandhi Sapan , Quigley Meghan , Wiater Brett , Wiater Patrick
Published: July 2017

Operative management of patella fractures continues to be associated with poor outcomes and high reoperation rates. Traditionally, tension band fixation has been used for more simple fracture patterns; however, fixation remains a challenge particularly for comminuted fractures. More recently, various types of plate fixation have been used and reported in the literature. Earlier mobilization after plate osteosynthesis of patella fractures is possible because of a more robust construct, with the potential for decreased knee stiffness and improved functional outcomes. We present a video case of a 79-year-old man who sustained a displaced patella fracture treated with an anterior mesh plate.
Fixation of a Proximal Humerus Fracture With an Intramedullary Nail
Authors: Sobel Andrew D. , Shah Kalpit N. , Paxton E. Scott
Published: July 2017

Proximal humerus fractures (PHFs) are common injuries seen mostly in elderly patients. Although nonoperative management is acceptable for most patients, surgical fixation is often advocated for younger patients or active, elderly patients with reconstructable fractures. A variety of fixation methods exist: percutaneous pinning, open reduction and internal fixation with locking plates, and intramedullary nailing are viable options. Modern intramedullary nails serve as excellent options for the fixation of many operative PHFs. In this Supplemental Digital Content 1 (see video, http://links.lww.com/JOT/A27), we discuss the care of a 63-year-old active, healthy female with a 2-part PHF. The details of fixation of PHFs using a straight intramedullary nail are included, as well as a relevant literature review and description of our postoperative rehabilitation protocol.
Management of Pediatric Both Bone Forearm Fractures With Titanium Elastic Nails: A Cost Cutting Measure
Authors: Rijal Laxman , Ansari Tahir , Gupta Vikas
Published: July 2017

Pediatric forearm fracture is a common injury. The displaced fractures, and unstable fractures are many a time treated with intramedullary elastic nails. The flexible titanium nails are easy to insert but increases the treatment cost. To minimize cost, we are routinely using single nail with a slight modification in the surgical procedure yet stabilizing both the bones with comparable results.
Eruptive Multifocal Cutaneous Mucinous Cysts
Authors: Sebaratnam Deshan F. , Agar Nita , Cooper Wendy , Jackett Louise
Published: July 2017

Cutaneous cysts lined by mucinous epithelium are rare entities. We report an unusual case of a 60-year-old female patient who presented with a 2-month history of eruptive cystic papules on her right thigh. Histopathologic study showed multiple, multiloculated cysts located in the dermis lined by nonciliated mucinous epithelium. The cyst lining was positive for AE1/AE3, CK7, CK20, and GCDFP15. Patchy positivity was noted on the p53 stain. Attenuated Sox10 positive cells were identified, raising the possibility of sweat duct origin; however, no myoepithelial layer was identified by p63 staining. Mullerian markers, including ER, PR, WT1, and Pax8, were negative. We propose this as a unique case that may represent mucinous metaplasia of a cystic sweat duct lesion. Here, we review the literature of mucinous and other glandular cutaneous cysts.
Caring for the lesbian patient at midlife and beyond
Authors: Rullo Jordan E. , Faubion Stephanie S.
Published: July 2017

Clinicians who have an understanding of lesbian women and their unique stressors, who provide a welcoming and inclusive environment, and who provide cross-cultural care are well positioned to reduce healthcare stigma and improve clinical outcomes. This Practice Pearl addresses these issues, focusing on the lesbian patient at midlife and beyond.
Hospitals’ use of hospitalists: Implications for financial performance
Authors: Epané Josué Patien , Weech-Maldonado Robert , Hearld Larry , Menachemi Nir , Sen Bisakha , O’Connor Stephen , Ramamonjiarivelo Zo
Published: July 2017

Background:

Hospitalists, or physicians specializing in hospital-based practice, have grown significantly since they were first introduced in the United States in the mid-1990s. Prior studies on the impact of hospitalists have focused on costs and length of stay. However, there is dearth of research exploring the relationship between hospitals’ use of hospitalists and organizational performance.

Purpose:

Using a national longitudinal sample of acute care hospitals operating in the United States between 2007 and 2014, this study explores the impact of hospitalists staffing intensity on hospitals’ financial performance.

Methodology:

Data sources for this study included the American Hospital Association Annual Survey, the Area Health Resources File, and the Centers for Medicare & Medicaid Services’ costs reports and Case Mix Index files. Data were analyzed using a panel design with facility and year fixed effects regression.

Results:

Results showed that hospitals that switched from not using hospitalists to using a high hospitalist staffing intensity had both increased patient revenues and higher operating costs per adjusted patient day. However, the higher operating costs from high hospitalist staffing intensity were offset by increased patient revenues, resulting in a marginally significant increase in operating profitability (p < .1).

Practice Implications:

These findings suggest that the rise in the use of hospitalists may be fueled by financial incentives such as increased revenues and profitability in addition to other drivers of adoption.
A New Craniothoracic Mattress for Immobilization of the Cervical Spine in Critical Care Patients
Authors: Holla Micha , Driessen Mitchel , Eggen Thomas G. E. , Daanen Robin A. , Hosman Allard J. F. , Verdonschot Nico , Hannink Gerjon
Published: July 2017

Current immobilization techniques of the cervical spine are associated with complications including pressure ulcers, discomfort, and elevated intracranial pressures with limited access to the thorax and airway. In this study, a newly developed craniothoracic immobilizer (Pharaoh mattress) for critical care patients with cervical injury was tested for its restriction of cervical movement, peak interface pressures, comfort, and radiolucency, and compared with headblocks strapped to a spineboard. Cervical movement was measured by roentgen stereophotogrammetric analysis in 5 fresh frozen cadavers. Peak interface and discomfort pressures were measured in 10 healthy volunteers. Radiographic absorption was calculated by measuring the total emission radiation with and without immobilizer. The Pharaoh mattress caused a mean restriction of 59% (SD: 15) flexion–extension, 77% (SD: 14) lateral bending, and 93% (SD: 3) rotation, compared with the unrestricted situation. No significant differences in restriction of cervical movement were found between headblocks strapped to a spineboard and the Pharaoh mattress. The mean peak pressures on the Pharaoh mattress were significantly lower than on the spineboard. Healthy volunteers gave significantly lower numeric discomfort scores on the Pharaoh mattress than on the spineboard. The Pharaoh mattress absorbed more x-rays than the spineboard. The Pharaoh mattress provides similar restriction of cervical movement compared with headblocks strapped to a spineboard but with lower interface pressures and increased comfort. This new mattress could be useful for immobilization of the cervical spine in critical care patients with mechanically instable spinal fractures.
Emotional Intelligence and the Occurrence of Accidents in Motorcycle Drivers in Kashan, Iran
Authors: Asgarian Fatemeh Sadat , Aghajani Mohammad , Alavi Negin Masoudi
Published: July 2017

There is an inherent risk of death and injury for motorcyclists. Some factors such as personality and psychological characteristics may be contributors of motor vehicle accidents/crashes. This study aimed to determine the relationship between emotional intelligence and its related components and the occurrence of accidents/crashes in motorcycle drivers. In this case–control study, 280 motorcycle drivers with and without a history of motorcycle-related accidents or crashes in Kashan, Iran, were selected for convenience sampling. The tool used was the Bar-On Emotional Intelligence Questionnaire and included 90 items. Logistic regression revealed that components of emotional intelligence identified as happiness, optimism, flexibility, self-actualization, autonomy, and interpersonal relationships were different between motorcycle drivers with and without an accident/crash. Our findings emphasized the important role of developing and enhancing the skills of emotional intelligence as related to the prevention of accidents/crashes.
Impact of Pharmacy Students on a Level II Trauma Center
Authors: Smith Lindsey , Samai Kathryn , Peshek Stephanie , Kimbrell Brian
Published: July 2017

This study aims to quantify the benefits of allowing advanced pharmacy practice experience (APPE) students to make medical interventions while on rotation by analyzing their interventions made and the resulting cost avoidance. This retrospective, observational cohort study was completed using self-reported data of APPE student interventions made at a Level II trauma center, under the supervision of a clinical pharmacist. Interventions were analyzed for their impact on patient care and cost avoidance through a comprehensive literature search and online Quantifi reference. A total of 187 interventions over a 7-month study period resulted in an estimated cost avoidance of $26,175. Advanced pharmacy practice experience students acting as pharmacist extenders resulted in a monthly cost avoidance of $3,739, which corresponds to $44,871 per year. Incorporating student pharmacists as active members of an interprofessional team enhanced patient care by increasing medical interventions, leading to increased cost avoidance by optimizing medication regimens.
Preoperative Nutritional Assessment with the Prognostic Nutrition Index in Patients Undergoing Left Ventricular Assist Device Implantation
Authors: Yost Gardner , Tatooles Antone , Bhat Geetha
Published: July 2017

The prognostic nutritional index (PNI) is a simple metric that uses serum albumin and total lymphocyte count to provide a basic indicator for nutritional status. It has recently garnered attention as a prognosticator of outcomes in many types of cancer. We investigated the utility of the PNI as a marker for poor outcomes following left ventricular assist device (LVAD) implantation. Two hundred eighty-eight consecutive patients implanted with continuous-flow LVADs were included. Prognostic nutritional index was calculated for all patients (PNI = [10 × serum albumin {g/dl}] + [0.005 × total lymphocytes {1,000/μl}]). The population was split into two groups based on median PNI; group 1 with PNI <30 and group 2 with PNI ≥30. Mean age was 60.3 years in group 1 and 59.8 years in group 2. There were no significant differences between groups in terms of age, gender, ethnicity, or comorbidities. The mean PNI for the group as a whole was 30.1 ± 4.6, indicating pervasive malnutrition in this group of advanced heart failure patients. Group 1 had significantly longer postoperative length of stay than did group 2 (27.42 ± 19.31 vs. 21.66 ± 15.0 days; p = 0.008). Patients in group 1 also had higher rates of right ventricular failure (37.8% vs. 25.5%; p = 0.025). A multivariate model indicated that PNI less than 30 was associated with a 12.2% reduction in postoperative survival (Hazard Ratio: 0.888; confidence interval [CI]: 0.795–0.993; p = 0.037). Our results suggest that the PNI may be an indicator for worsened outcomes in patients with advanced heart failure. These patients, who often suffer from chronic malnutrition, may experience worsened outcomes because of associated neurohormonal, muscular, and metabolic derangements.
Circulating Epithelial Cells in Intraductal Papillary Mucinous Neoplasms and Cystic Pancreatic Lesions
Authors: Poruk Katherine E. , Valero Vicente , He Jin , Ahuja Nita , Cameron John L. , Weiss Matthew J. , Lennon Anne Marie , Goggins Michael , Wood Laura D. , Wolfgang Christopher L.
Published: July 2017

Objectives

Circulating epithelial cells (CECs) are identified in the blood of patients with intraductal papillary mucinous neoplasms (IPMNs) despite the absence of malignancy. We assessed the blood of patients undergoing resection for IPMN or other benign pancreatic lesions for CECs.

Methods

Peripheral blood was collected from 26 patients prior to pancreatic resection and filtered by the ISET (Isolation by Size of Epithelial Tumor Cells) method. Circulating epithelial cells were identified with antibodies to cytokeratin and Pdx1 (pancreas and duodenal homeobox protein 1), a pancreas marker.

Results

Nineteen patients underwent resection of an IPMN without associated malignancy. Eleven patients (58%) had cytokeratin-positive CECs. Circulating epithelial cells were significantly more likely to be found in patients with IPMNs with high-grade dysplasia (P = 0.04). In addition, 10 of the 11 patients with cytokeratin-positive CECs also had separate populations of cytokeratin-positive, Pdx1-positive CECs, suggesting a pancreatic source. Dual-staining CECs were more frequently found in patients with high-grade dysplasia (P = 0.04). Patients with IPMNs were significantly more likely to have pan-cytokeratin CECs in the blood compared with those without IPMNs (P = 0.01).

Conclusions

Circulating epithelial cells staining with potential pancreas-specific markers have been found in patients with IPMNs, even without malignancy. Circulating epithelial cells may help to differentiate patients with high-grade IPMN from lower grades of dysplasia and other pancreatic cysts.
The Impact of Risk Factors of Chronic Pancreatitis on Secretin Pancreatic Function Testing
Authors: Kothari Darshan , Ketwaroo Gyanprakash , Freedman Steven D. , Sheth Sunil G.
Published: July 2017

Objectives

The aim of this study was to determine the effect of established risk factors on the outcome of secretin pancreatic function testing (sPFT) in patients undergoing work-up for suspected chronic pancreatitis.

Methods

We completed a retrospective review of patients who underwent sPFT for suspected chronic pancreatitis over 20 years. We compared peak bicarbonate concentrations between groups and completed univariate and multivariate analyses to determine associations between risk factors and positive sPFT results (peak bicarbonate <80 mEq/L).

Results

Forty-three of 162 patients had positive sPFT results. There were significant differences in peak bicarbonate concentrations in patients with and without recurrent acute pancreatitis (RAP) and with local complications from acute pancreatitis (AP) (P ≤ 0.05). The bicarbonate concentration in patients with and without other risk factors such as tobacco use, alcohol use, and family history of pancreatitis was not significantly different. Female sex, a history of AP, and a history of RAP were associated with positive sPFT results on univariate analysis (P ≤ 0.05). On multivariate analysis, sex and RAP remained significant.

Conclusions

Our study demonstrates that female sex, history of AP and RAP, and AP with local complications are associated with positive sPFT results or lower peak bicarbonate concentration. However, other risk factors do not impact the results of sPFT.
Viral-induced Modulation of Multiple Checkpoint Proteins in Cancers
Authors: Nuovo Gerard J. , Folcik Virginia A. , Magro Cynthia
Published: July 2017

Therapy with checkpoint inhibitors represents a major advance in cancer treatment. The purpose of this study was to examine the expression patterns of the checkpoint proteins programmed death ligand 1 (PD L1), PD L2, indoleamine 2,3-dioxygenase 1 (IDO1), and cytotoxic T-lymphocyte antigen 4 (CTLA4) in cancers including those associated with viral infections. Normal, noninflamed tissues rarely express checkpoint proteins with exceptions including the placenta and stomach. Expression of PD L1 was noted in 30%, PD L2 in 18%, IDO1 in 13%, and CTLA4 in 14% of 333 nonviral malignancies including endometrial, ovarian, lung, and breast cancers. The expression of each checkpoint protein was significantly higher among 166 cases of viral-related (mostly human papillomavirus) cancers where expression of PD L1 was noted in 84%, PD L2 in 67%, IDO1 in 61%, and CTLA4 in 37% (each P value <0.001); 97% of the viral-related cancers showed expression of at least 1 checkpoint protein. In addition, over 90% of the CD8+ cells in the viral-associated cancers were quiescent based on low coexpression of Ki-67 as well as pSTAT1. It is concluded that viral infection in cancers is associated with the increased expression of key checkpoint proteins. This indicates that cancers with productive viral infection may be better targets for checkpoint inhibitor therapy.
Outpatient Parenteral Antimicrobial Therapy and Judicious Use of Pediatric Emergency Resources
Authors: Xu Michael , Doan Quynh
Published: July 2017

Background

Pediatric returns to the emergency department (RTED) vary between 3% and 13% of the total ED volume of visits. However, the incidence and contribution of scheduled RTED on pediatric emergency department (PED) utilization is less clear. Antimicrobial stewardship programs on inpatient wards have been shown to improve judicious use of outpatient parenteral antimicrobial therapy (OPAT) in upon discharge. The implementation of such programs in PEDs has yet to be reported. The objectives of this study are to quantify the burden of scheduled RTED for OPAT on PED utilization and to examine how frequently OPAT use are supported by published practice standards for 3 common pediatric infections—cellulitis, pneumonia, and urinary tract infections.

Methods

We conducted a single-center retrospective cohort study of all visits made to the British Columbia Children's Hospital PED from May 1, 2012, to April 30, 2013. We identified scheduled RTEDs and characterized those associated with OPAT use with regard to their measures of PED utilization and clinical features.

Results

Of 3904 RTED visits, 1310 (33.6%) were scheduled, of which 1029 were OPAT related. Among the latter, 749 RTEDs (69%) were for cellulitis, pneumonia, or urinary tract infections. The median length of stay for OPAT-related RTEDs was 2.0 hours. For 75 (24%) of 317 index visits and 213 (28%) of 749 subsequent RTEDs, oral antibiotic therapy would have been an appropriate option and OPAT could have been avoided.

Conclusions

Our findings suggest that OPAT poses a sizable burden on PED utilization, with a proportion of them potentially preventable.
Severe Infant Rash Resistant to Therapy Due to Zinc Deficiency
Authors: Mohammed Javed , Mehrotra Shruti , Schulz Helene , Lim Rodrick
Published: July 2017

Pediatric skin diseases are a common presenting complaint to emergency medicine physicians but often pose a significant diagnostic challenge. Skin eruptions that are unusually severe for the diagnosis in question, lasting beyond the typical time of resolution, or not responding to conventional therapy should raise concern of a misdiagnosis. We present the case of a severe rash not responding to conventional atopic dermatitis therapy that led to a diagnosis of transient neonatal zinc deficiency. Clinicians caring for children should be aware of zinc deficiency and its corresponding clinical presentation, because it is readily treatable and may lead to the avoidance of unnecessary treatments and prevention of serious complications.
Atypical Proliferative (Borderline) Serous Tumor in the Brain: A Case Report
Authors: Xing Deyin , Jenson Erik G. , Zwick Christopher A. , Rodriguez Fausto J. , Kurman Robert J.
Published: July 2017

A 59-year-old woman with a remote history of invasive ductal carcinoma of the breast was found on a follow-up computed tomography scan of her brain to have a 1-cm lesion in the right frontal lobe in 2008. In the ensuing years, before her current admission, multiple imaging studies of the brain revealed that the lesion was stable and it was, therefore, interpreted as a small area of encephalomalacia related to a thrombosed cortical vein, a cavernoma, or treated metastatic breast cancer. In 2013, the patient underwent a bilateral salpingo-oophorectomy for ovarian tumors that were diagnosed as bilateral serous cystadenofibromas. A partial omentectomy showed no evidence of implants. In June 2016, the brain lesion was completely excised and diagnosed as an atypical proliferative (borderline) serous tumor. Immunohistochemical staining demonstrated that the tumor cells were immunoreactive for Pax8, WT-1, ER, and CK-7 and negative for Gata-3, PR, TTF-1, CDX-2, Napsin A, and CK-20, which was consistent with that diagnosis. We present a brief review of possible mechanisms to account for this unusual presentation and speculate that the most likely one is exfoliation of fallopian tube epithelial cells into the peritoneal cavity, which then gain access to lymphatics resulting in cells implanting in the brain and subsequently progressing to an atypical proliferative (borderline) serous tumor.
Methods for Measuring and Staging a Uterine Cervical Adenocarcinoma Showing Intracystic Papillary Growth: A Case Report
Authors: Yoshida Hiroshi , Ikeda Shunichi , Tsukada Takafumi , Watanabe Reiko , Hiraoka Nobuyoshi , Kato Tomoyasu
Published: July 2017

Endocervical adenocarcinomas usually demonstrate infiltrative and/or destructive invasion, and the depth and horizontal extent of the invasion are known to have prognostic utility. Here, we report the unusual case of a patient with endocervical adenocarcinoma showing intracystic papillary growth and discuss our methods for measuring and staging this lesion. A 45-yr-old Japanese woman (gravida, 0; para, 0) underwent a cone biopsy for squamous cell carcinoma in situ and atypical glandular cells. Macroscopically, an intracystic tumor (∼7.5 mm in diameter) was detected in the cervix. Microscopically, we observed both squamous cell carcinoma in situ and adenocarcinoma involving the squamo-columnar junction. Adenocarcinoma cells lining the nabothian cyst showed papillary proliferation and expansile stromal invasion without desmoplastic reaction. We evaluated this macroscopically and found that the visible papillary growth and expansile invasion deviated from the adenocarcinoma in situ; hence, we concluded that this lesion was an International Federation of Gynecology and Obstetrics stage IB1 adenocarcinoma. The patient underwent an abdominal radical hysterectomy, followed by bilateral salpingo-oophorectomy and pelvic lymph node dissection. No residual cervical cancer, other gynecologic malignancies, or lymph node metastases were observed. Further studies using cases with the same growth pattern are needed to determine whether our evaluation method is optimal for this type of lesion.
Epidermodysplasia Verruciformis–like HPV Infection of the Vulva in Immunosuppressed Women
Authors: Pohthipornthawat Natkrita , Feldman Sarah , Granter Scott R. , Laga Alvaro C. , Crum Christopher P. , Herfs Michael
Published: July 2017

The vast majority of vulvar human papilloma virus infections are produced by α human papilloma viruses and consist of exophytic or flat warts and classic or “usual” vulvar intraepithelial neoplasia. This report details 2 examples of epidermodysplasia verruciformis–like lesions of the vulva in women who were immunosuppressed. The most consistent morphologic feature was the presence of abnormal mature keratinocytes with large pale open nuclei with small nucleoli and eosinophilic cytoplasm, situated in the upper epithelial layers. In addition to these features, which are commonly seen in epidermodysplasia verruciformis-associated lesions, 1 case displayed in addition more extensively distributed abnormal nuclei, including involvement of both the upper epithelial strata and the epithelial/stromal interface. Both lesions were associated with β-papilloma virus type 5. The unique aspects of epidermodysplasia verruciformis-like lesions relative to the more common human papilloma virus infections of the vulva are highlighted and these cases illustrate the range of epithelial distribution that might be encountered in lesions involving the vulvar mucosa.
Associations Among Cardiometabolic Abnormalities, Obesity, and Sociobehavioral Factors in a Southern Nevada Adult Population
Authors: Feng Jing , Johnson Michael D. , Iser Joseph P.
Published: July 2017

Context:

Cardiometabolic abnormalities underlie many health risks associated with obesity.

Objective:

We determined the relationship between cardiometabolic abnormalities, sociodemographic characteristics, and modifiable risk factors among adults in Southern Nevada.

Design:

We included 2415 participants older than 20 years from the Behavioral Risk Factor Surveillance System surveys conducted in 2011, 2013, and 2015 in Southern Nevada. Cardiometabolic abnormalities were assessed on the combined basis of blood pressure, cholesterol, and diabetes status. Logistic regression stratified by body mass index status was used to examine cardiometabolic abnormalities in different body mass index classes.

Main Outcome Measure:

Odds ratio estimates for cardiometabolic abnormalities after accounting for sociodemographic and health behavior characteristics.

Results:

Cardiometabolic abnormalities followed a socioeconomic gradient, although adjustment for lifestyle variables attenuated the associative link. Non-Hispanic black (vs white) race did not elevate cardiometabolic abnormalities risk among nonobese adults, yet conferred a multivariable-adjusted odds ratio of 2.18 (95% confidence interval [CI], 1.03-4.61) among obese adults. By comparison, odds of cardiometabolic abnormalities among nonobese adults were 2.42 (95% CI, 0.99-5.92) times higher for Hispanics and 2.83 (95% CI, 1.23-6.55) times higher for other or multiracial minorities. Among obese adults, male gender (odds ratio: 1.84; 95% CI, 1.03-3.27) and former (odds ratio: 2.09; 95% CI, 1.14-3.85) smoker status were associated with cardiometabolic abnormalities independent of other covariates.

Conclusions:

The present data support intervention strategies tailored to reinforce and promote positive health behaviors among disadvantaged groups. There were variable patterns of ethnic group disparities in clustered cardiometabolic abnormalities across body mass index classes. Targeted prevention approaches incorporating an explicit health equity perspective may help mitigate observed differences.