bluuebunny/crossref_metadata_2025 huggingface dataset:
Surface emitting thermally assisted polaritonic light-emitting device
Authors: Chastanet D. , Manceau J.-M. , Laurent T. , Bousseksou A. , Beaudoin G. , Sagnes I. , Colombelli R.
Published: February 2017

We report a mid-infrared surface-emitting electroluminescent device operating in the strong coupling regime between light and matter. The structure is semiconductor based and can operate in absorption or—upon current injection—in emission. The observed minimum Rabi splitting at room-temperature is of the order of 15% of the bare transition. The polaritonic electroluminescence matches the polaritonic branches as measured in absorption and it tunes in frequency with the emission angle, covering a wide spectral range from 900 cm−1 to 1300 cm−1. The emitted light is mostly transverse-magnetic polarized, but its intensity increases with increasing temperature. This finding suggests a thermally assisted emission process. A simple model that takes into account both the contributions reproduces the data fairly well. This grating-based, surface-emitting resonator architecture suits the future study and development of electroluminescent intersubband devices operating in the strong-coupling regime between light and matter.
Real-time, single-shot, carrier-envelope-phase measurement of a multi-terawatt laser
Authors: Adolph D. , Möller M. , Bierbach J. , Schwab M. , Sävert A. , Yeung M. , Sayler A. M. , Zepf M. , Kaluza M. C. , Paulus G. G.
Published: February 2017

We present the single-shot carrier-envelope phase (CEP) determination of a 1 Hz, multi-terawatt (TW) laser system with a setup based on spectral broadening in a hollow-core fiber and a stereographic measurement of the energy-dependent above-threshold ionization plateau. The latter is extremely sensitive to variations in CEP. As compared to the f-2f interferometers, this technique reduces the uncertainties due to the shot-to-shot intensity fluctuations, which are prevalent in the TW laser systems. The experimental results pave the way towards the investigation and control over CEP-sensitive processes at ultra-high intensities.
Disruptive and reactive interface formation of molybdenum trioxide on organometal trihalide perovskite
Authors: Thibau Emmanuel S. , Llanos Adrian , Lu Zheng-Hong
Published: February 2017

X-ray and ultra-violet photoemission spectroscopies (XPS and UPS) are used to elucidate the physical, chemical, and electronic properties of MAPbI3/MoO3 interface. The XPS data suggest migration of iodide species from the MAPbI3 into the MoO3 upon direct contact of these two layers. Chemically, these iodide inclusions cause a significant presence in reduced Mox+ species. Electronically, UPS data show that this reaction induces gap states and reduces the MoO3 workfunction. It is shown that a thin organic interlayer blocks migration of volatile iodide from MAPbI3 into the MoO3. This organic buffer layer results in significantly better chemical stability, reduced gap state density, and higher MoO3 workfunction. These results highlight the importance of organic buffer layers in separating these two materials during device fabrication.
Intra-particle chemical homogeneity determining the exchange coupling in palladium-iron nanoparticles
Authors: Castellanos-Rubio Idoia , Insausti Maite , de Muro Izaskun Gil , Arias-Duque D. Carolina , Hernández-Garrido Juan Carlos , Lezama Luis
Published: February 2017

The interplay between chemical inhomogeneities and magnetic properties in iron alloys is a subtle question that affects several nanoalloys with potential technological and biomedical applications. Herein below, we focus on the FCC palladium rich–iron nanoparticle system, specifically in three samples that reflect the key influence of synthesis conditions. Magnetic measurements as a function of field and temperature have allowed detecting the onset of anomalous relaxation phenomena of the magnetization due to the strong weakening of the exchange coupling in nanoparticles prepared at low temperatures. Such effects are triggered by the lack of a good inter-diffusion of atomic species during core growth and directly affect the magnetic anisotropy. Electron Magnetic Resonance spectroscopy has confirmed that iron clustering leads to a gradual transition from a superparamagnetic state at low temperatures to a nearly paramagnetic behaviour at high temperatures. The measurements of the g-factor and the average magnetic moment per Fe atom do not account for a significant polarization in Pd atoms.
Magnon-photon coupling in antiferromagnets
Authors: Yuan H. Y. , Wang X. R.
Published: February 2017

Magnon-photon coupling in antiferromagnets has many attractive features that do not exist in ferro- or ferrimagnets. We show quantum-mechanically that, in the absence of an external field, one of the two degenerated spin wave bands couples with photons, while the other does not. The photon mode anticrosses with the coupled spin waves when their frequencies are close to each other. Similar to its ferromagnetic counterpart, the magnon-photon coupling strength is proportional to the square root of the number of spins N in antiferromagnets. An external field removes the spin wave degeneracy, and both spin wave bands couple to the photons, resulting in two anticrossings between the magnons and photons. Two transmission peaks were observed near the anticrossing frequency. The maximum damping that allows clear discrimination of the two transmission peaks is proportional to N, and it is well below the damping of antiferromagnetic insulators. Therefore, the strong magnon-photon coupling can be realized in antiferromagnets and the coherent information transfer between the photons and magnons is possible.
Rumen degradability characteristics of five starch-based concentrate supplements used on Australian dairy farms
Authors: McDonnell R. P. , Staines M. vH. , Douglas M. L. , Auldist M. J. , Jacobs J. L. , Wales W. J.
Published: February 2017

This experiment compared the rumen degradability characteristics of five starch-based concentrate supplements used by Western Australia (WA) dairy producers. Six rumen-fistulated, non-lactating, Holstein-Friesian cows were used to measure the in sacco rumen degradability of maize grain, oats, wheat, sodium hydroxide-treated wheat (NaOH wheat) and Maximize® (a commercial pellet commonly used by WA dairy producers). Cows were offered a basal diet of custom-made cubes (60 : 40 lucerne hay : wheat grain) at maintenance feeding level. Rumen disappearance of dry matter (DM), starch and crude protein was determined for each concentrate at 0, 1, 2, 4, 8, 16, 24, 36, 48 and 72 h, and fitted to an exponential model to estimate degradation kinetics. Effective degradability coefficients were then calculated at three rumen solid-outflow rates (0.02, 0.05 and 0.08/h). Degradability of DM at 0.08/h was lowest (P < 0.001) in maize grain (0.64) and oats (0.68) and greatest in wheat (0.83), with that in NaOH wheat (0.80) and Maximize (0.76) being intermediate. Starch degradability at 0.08/h was also lowest (P < 0.001) in maize grain (0.70), intermediate for NaOH wheat (0.83) and Maximize (0.87), and greatest for wheat (0.96) and oats (0.98). Degradability of crude protein was lowest (P = 0.001) in Maximize (0.66) and NaOH wheat (0.69), greatest in oats (0.85), with that in maize grain (0.72) and wheat (0.79) being intermediate. For producers where availability of maize grain for dairy cow rations is limited, such as in WA, these results indicated that NaOH wheat and Maximize may be considered as alternative starch sources to increase post-ruminal digestion of starch, although the magnitude of this increase will still not be as great as for maize grain.
In situ detection of intermediates from the interaction of dissolved sulfide and manganese oxides with a platinum electrode in aqueous systems
Authors: Luo Yao , Shen Yougang , Liu Lihu , Hong Jun , Qiu Guohong , Tan Wenfeng , Liu Fan
Published: February 2017

Environmental contextDissolved sulfide results in soil acidification and subsequent contaminant leaching via oxidation processes, usually involving manganese oxides. In this work, redox processes were monitored in situ by cyclic voltammetry and HS– concentrations were semi-quantitatively determined. The method provides qualitative and semi-quantitative assessment for dissolved sulfide and its oxidation intermediates in aqueous systems. AbstractDissolved sulfide can be oxidised by manganese oxides in supergene environments, while the intermediates including S0, S2O32– and SO32– are easily oxidised by oxygen in air, resulting in some experimental errors in conventional analyses. In this work, the electrochemical behaviours of HS–, S2O32– and SO32– on a platinum electrode were studied by cyclic voltammetry and constant potential electrolysis, and in situ detection of the intermediates was conducted in aqueous systems of HS– and manganese oxides. The results showed that HS– was first oxidised to S0, and then transformed to SO42–. The peak current for the oxidation of HS– to S0 had a positive linear correlation with the used starting HS– concentration. S2O32– and SO32– were directly electrochemically oxidised to SO42–. The oxidation current peak potentials at 0, 0.45 and 0.7V were respectively observed for HS–, S2O32– and SO32– at pH 12.0. Cyclic voltammetry was conducted to monitor the redox processes of HS– and manganese oxides. The oxidation peak current of HS– to S0 decreased, and that of S2O32– to SO42– was observed to increase as the reaction proceeded. The rate of the decrease of the oxidation peak current of HS– indicated that the oxidation activity followed the order of birnessite>todorokite>manganite.
Trimethylamine
N
-oxide stabilizes proteins via a distinct mechanism compared with betaine and glycine
Authors: Liao Yi-Ting , Manson Anthony C. , DeLyser Michael R. , Noid William G. , Cremer Paul S.
Published: February 2017

Significance

Although trimethylamine
N
-oxide (TMAO) is perhaps the quintessential protein-stabilizing osmolyte, its mechanism of action has long remained elusive. Our study indicates that, in contrast to betaine and glycine, TMAO forms direct attractive interactions with polypeptides. This work strengthens and extends Berne’s previous conclusions, because we report results for a model polypeptide rather than a hydrophobic polymer. Our results are particularly striking, because we consider a model polypeptide that is enriched in amide groups that are believed responsible for the depletion of TMAO from unfolded proteins. Our study leads to the surprising conclusion that TMAO stabilizes folded conformations, despite interacting with unfolded conformations. We hypothesize that TMAO acts as a unique surfactant for the heterogeneous surface that emerges on protein folding.
On suprema of autoconvolutions with an application to Sidon sets
Authors: Cloninger Alexander , Steinerberger Stefan
Published: February 2017

Let

f
f

be a nonnegative function supported on

(
−
1

/

4
,
1

/

4
)

(-1/4, 1/4)

. We show that
\[
<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" alttext="sup Underscript x element-of double-struck upper R Endscripts integral Underscript double-struck upper R Endscripts f left-parenthesis t right-parenthesis f left-parenthesis x minus t right-parenthesis d t greater-than-or-equal-to 1.28 left-parenthesis integral Subscript negative 1 slash 4 Superscript 1 slash 4 Baseline f left-parenthesis x right-parenthesis d x right-parenthesis squared comma">

sup

x
∈

R

∫

R

f
(
t
)
f
(
x
−
t
)
d
t

≥
1.28

(

∫

−
1

/

4

1

/

4

f
(
x
)
d
x

)

2

,

\sup _{x \in \mathbb {R}}{\int _{\mathbb {R}}{f(t)f(x-t)dt}} \geq 1.28\left (\int _{-1/4}^{1/4}{f(x)dx} \right )^2,

\]
where 1.28 improves on a series of earlier results. The inequality arises naturally in additive combinatorics in the study of Sidon sets. We derive a relaxation of the problem that reduces to a finite number of cases and yields slightly stronger results. Our approach should be able to prove lower bounds that are arbitrary close to the sharp result. Currently, the bottleneck in our approach is runtime: new ideas might be able to significantly speed up the computation.
On strictly nonzero integer-valued charges
Authors: Kopparty Swastik , Rao K.
Published: February 2017

A charge (finitely additive measure) defined on a Boolean algebra of sets taking values in a group

G
G

is called a strictly nonzero (SNZ) charge if it takes the identity value in

G
G

only for the zero element of the Boolean algebra. A study of such charges was initiated by Rüdiger Göbel and K. P. S. Bhaskara Rao in 2002.

Our main result is a solution to one of the questions posed in that paper: we show that for every cardinal

ℵ
\aleph

, the Boolean algebra of clopen sets of

{
0
,
1

}
ℵ

\{0,1\}^\aleph

has a strictly nonzero integer-valued charge. The key lemma that we prove is that there exists a strictly nonzero integer-valued permutation-invariant charge on the Boolean algebra of clopen sets of

{
0
,
1

}

ℵ
0

\{0,1\}^{\aleph _0}

. Our proof is based on linear-algebraic arguments, as well as certain kinds of polynomial approximations of binomial coefficients.

We also show that there is no integer-valued SNZ charge on

P

(

N

)

{\mathcal {P}}(\mathbb {N})

. Finally, we raise some interesting problems on integer-valued SNZ charges.
A minimal actomyosin-based model predicts the dynamics of filopodia on neuronal dendrites
Authors: Marchenko Olena O. , Das Sulagna , Yu Ji , Novak Igor L. , Rodionov Vladimir I. , Efimova Nadia , Svitkina Tatyana , Wolgemuth Charles W. , Loew Leslie M.
Published: February 2017

Dendritic filopodia are actin-filled dynamic subcellular structures that sprout on neuronal dendrites during neurogenesis. The exploratory motion of the filopodia is crucial for synaptogenesis, but the underlying mechanisms are poorly understood. To study filopodial motility, we collected and analyzed image data on filopodia in cultured rat hippocampal neurons. We hypothesized that mechanical feedback among the actin retrograde flow, myosin activity, and substrate adhesion gives rise to various filopodial behaviors. We formulated a minimal one-dimensional partial differential equation model that reproduced the range of observed motility. To validate our model, we systematically manipulated experimental correlates of parameters in the model: substrate adhesion strength, actin polymerization rate, myosin contractility, and the integrity of the putative microtubule-based barrier at the filopodium base. The model predicts the response of the system to each of these experimental perturbations, supporting the hypothesis that our actomyosin-driven mechanism controls dendritic filopodia dynamics.
Association of Lyn kinase with membrane rafts determines its negative influence on LPS-induced signaling
Authors: Borzęcka-Solarz Kinga , Dembińska Justyna , Hromada-Judycka Aneta , Traczyk Gabriela , Ciesielska Anna , Ziemlińska Ewelina , Świątkowska Anna , Kwiatkowska Katarzyna
Published: February 2017

Lipopolysaccharide (LPS) is the component of Gram-negative bacteria that activates Toll-like receptor 4 (TLR4) to trigger proinflammatory responses. We examined the involvement of Lyn tyrosine kinase in TLR4 signaling of macrophages, distinguishing its catalytic activity and intermolecular interactions. For this, a series of Lyn-GFP constructs bearing point mutations in particular domains of Lyn were overexpressed in RAW264 macrophage-like cells or murine peritoneal macrophages, and their influence on LPS-induced responses was analyzed. Overproduction of wild-type or constitutively active Lyn inhibited production of TNF-α and CCL5/RANTES cytokines and down-regulated the activity of NFκB and IRF3 transcription factors in RAW264 cells. The negative influence of Lyn was nullified by point mutations of Lyn catalytic domain or Src homology 2 (SH2) or SH3 domains or of the cysteine residue that undergoes LPS-induced palmitoylation. Depending on the cell type, overproduction of those mutant forms of Lyn could even up-regulate LPS-induced responses, and this effect was reproduced by silencing of endogenous Lyn expression. Simultaneously, the Lyn mutations blocked its LPS-induced accumulation in the raft fraction of RAW264 cells. These data indicate that palmitoylation, SH2- and SH3-mediated intermolecular interactions, and the catalytic activity of Lyn are required for its accumulation in rafts, thereby determining the negative regulation of TLR4 signaling.
The Industrial Revolution: A Very Short Introduction
Authors: Allen Robert C.
Published: February 2017

The Industrial Revolution was a pivotal point in British history that occurred between the mid-18th and mid-19th centuries, and led to far reaching transformations of society. The Industrial Revolution: A Very Short Introduction analyses the key features of the Industrial Revolution in Britain, and the spread of industrialization to other countries. It considers the factors that combined to enable industrialization at this time, including Britain’s position as a global commercial empire, and discusses the changes in technology and business organization, and their impact on different social classes and groups. It looks at how the changes were reflected in evolving government policies, and what contribution these made to the economic transformation.
Individualized Prediction of Reading Comprehension Ability Using Gray Matter Volume
Authors: Cui Zaixu , Su Mengmeng , Li Liangjie , Shu Hua , Gong Gaolang
Published: February 2017

Reading comprehension is a crucial reading skill for learning and putatively contains 2 key components: reading decoding and linguistic comprehension. Current understanding of the neural mechanism underlying these reading comprehension components is lacking, and whether and how neuroanatomical features can be used to predict these 2 skills remain largely unexplored. In the present study, we analyzed a large sample from the Human Connectome Project (HCP) dataset and successfully built multivariate predictive models for these 2 skills using whole-brain gray matter volume features. The results showed that these models effectively captured individual differences in these 2 skills and were able to significantly predict these components of reading comprehension for unseen individuals. The strict cross-validation using the HCP cohort and another independent cohort of children demonstrated the model generalizability. The identified gray matter regions contributing to the skill prediction consisted of a wide range of regions covering the putative reading, cerebellum, and subcortical systems. Interestingly, there were gender differences in the predictive models, with the female-specific model overestimating the males’ abilities. Moreover, the identified contributing gray matter regions for the female-specific and male-specific models exhibited considerable differences, supporting a gender-dependent neuroanatomical substrate for reading comprehension.
Three-Dimensional Printed Modeling of Diffuse Low-Grade Gliomas and Associated White Matter Tract Anatomy
Authors: Thawani Jayesh P. , Singh Nickpreet , Pisapia Jared M. , Abdullah Kalil G. , Parker Drew , Pukenas Bryan A. , Zager Eric L. , Verma Ragini , Brem Steven
Published: February 2017

BACKGROUND: Diffuse low-grade gliomas (DLGGs) represent several pathological
entities that infiltrate and invade cortical and subcortical structures in the brain.

OBJECTIVE: To describe methods for rapid prototyping of DLGGs and surgically
relevant anatomy.

METHODS: Using high-definition imaging data and rapid prototyping
technologies, we were able to generate 3 patient DLGGs to scale and represent the
associated white matter tracts in 3 dimensions using advanced diffusion tensor imaging
techniques.

RESULTS: This report represents a novel application of 3-dimensional (3-D)
printing in neurosurgery and a means to model individualized tumors in 3-D space with
respect to subcortical white matter tract anatomy. Faculty and resident evaluations of
this technology were favorable at our institution.

CONCLUSION: Developing an understanding of the anatomic relationships
existing within individuals is fundamental to successful neurosurgical therapy.
Imaging-based rapid prototyping may improve on our ability to plan for and treat complex
neuro-oncologic pathology.
Safety of Tetanus, Diphtheria, and Pertussis Vaccination During Pregnancy
Authors: McMillan Mark , Clarke Michelle , Parrella Adriana , Fell Deshayne B. , Amirthalingam Gayatri , Marshall Helen S.
Published: February 2017

OBJECTIVE:

To assess antenatal, birth, and infant outcomes for pregnant women, fetuses, and infants after antenatal vaccination with any antigen present in combination pertussis vaccines.

DATA SOURCES:

PubMed, EMBASE, Literature in the Health Sciences in Latin America and the Caribbean, ClinicalTrials.gov, Cochrane Library, and World Health Organization (inception to May 5, 2016).

METHODS OF STUDY SELECTION:

Studies reporting outcomes for pregnant women, their fetus, or infant after antenatal exposure to either monovalent or combined tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) or inactivated polio vaccines were considered for inclusion.

RESULTS:

A total of 21 studies were included in this review. Point estimates ranged from 0.47 to 1.50 for preterm birth (less than 37 weeks of gestation), 0.65–1.00 for small for gestational age (birth weight less than the 10th percentile), 0.36–0.85 for stillbirth, 0.16–1.00 for neonatal death, 0.76–1.20 for low birth weight (less than 2,500 g), and 0.20–0.91 for congenital anomalies. All lower 95% confidence intervals (CIs) were less than 1.0. Of three retrospective studies assessing chorioamnionitis after vaccination, one showed a small but statistically significant increase. Point estimates for all anomalies after antenatal tetanus toxoid vaccination ranged from 1.20 to 1.60 and had 95% CIs that crossed 1.0. There was substantial clinical and methodologic heterogeneity from mainly retrospective observational studies with an overall high risk of bias. Objective rates of fever were low, 3% or below, and more common systemic events observed included headache, malaise, and myalgia.

CONCLUSION:

Evidence suggests that antenatal combined Tdap administered during the second or third trimester of pregnancy is not associated with clinically significant harms for the fetus or neonate. Medically attended events in pregnant women are similar between vaccinated and unvaccinated groups.
First-Trimester and Second-Trimester Maternal Serum Biomarkers as Predictors of Placental Abruption
Authors: Ananth Cande V. , Wapner Ronald J. , Ananth Srinidhi , D'Alton Mary E. , Vintzileos Anthony M.
Published: February 2017

OBJECTIVE:

We hypothesized that the origins of abruption may extend to the stages of placental implantation; however, there are no reliable markers to predict its development. Based on this hypothesis, we sought to evaluate whether first-trimester and second-trimester serum analytes predict placental abruption.

METHODS:

We performed a secondary analysis of data of 35,307 women (250 abruption cases) enrolled in the First and Second Trimester Evaluation of Risk cohort (1999–2003), a multicenter, prospective cohort study. Percentiles (based on multiples of the median) of first-trimester (pregnancy-associated plasma protein A and total and free β-hCG) and second-trimester (maternal serum alpha-fetoprotein, unconjugated estriol, and inhibin-A) serum analytes were examined in relation to abruption. Associations are based on risk ratio (RR) and 95% confidence interval (CI).

RESULTS:

Women with an abnormally low pregnancy-associated plasma protein A (fifth percentile or less) were at increased risk of abruption compared with those without abruption (9.6% compared with 5.3%; RR 1.9, 95% CI, 1.2–2.8). Maternal serum alpha-fetoprotein 95th percentile or greater was more common among abruption (9.6%) than nonabruption (5.1%) pregnancies (RR 1.9, 95% CI 1.3–3.0). Inhibin-A fifth percentile or less (8.0% compared with 5.1%; RR 1.8, 95% CI 1.1–2.9), and 95th percentile or greater (9.6% compared with 5.0%; RR 2.0, 95% CI 1.3–3.1) were associated with abruption. Women with all three abnormal pregnancy-associated plasma protein A, maternal serum alpha-fetoprotein, and inhibin-A analytes were at 8.8-fold (95% CI 2.3–34.3) risk of abruption. No associations were seen with other analytes.

CONCLUSION:

These data provide support for our hypothesis that the origins of placental abruption may extend to the early stages of pregnancy.
Single Health System Adherence to 2012 Cervical Cancer Screening Guidelines at Extremes of Age and Posthysterectomy
Authors: Teoh Deanna , Isaksson Vogel Rachel , Hultman Gretchen , Monu Minnu , Downs Levi , Geller Melissa A. , Le Chap , Melton-Meaux Genevieve , Kulasingam Shalini
Published: February 2017

OBJECTIVE:

To estimate the proportion of guideline nonadherent Pap tests in women aged younger than 21 years and older than 65 years and posthysterectomy in a single large health system. Secondary objectives were to describe temporal trends and patient and health care provider characteristics associated with screening in these groups.

METHODS:

A retrospective cross-sectional chart review was performed at Fairview Health Services and University of Minnesota Physicians. Reasons for testing and patient and health care provider information were collected. Tests were designated as indicated or nonindicated per the 2012 cervical cancer screening guidelines. Point estimates and descriptive statistics were calculated. Patient and health care provider characteristics were compared between indicated and nonindicated groups using χ2 and Wilcoxon rank-sum tests.

RESULTS:

A total of 3,920 Pap tests were performed between September 9, 2012, and August 31, 2014. A total of 257 (51%; 95% confidence interval [CI] 46.1–54.9%) of tests in the younger than 21 years group, 536 (40%; 95% CI 37.7–43.1%) in the older than 65 years group, and 605 (29%; 95% CI 27.1–31.0%) in the posthysterectomy group were not indicated. White race in the older than 65 years group was the only patient characteristic associated with receipt of a nonindicated Pap test (P=.007). Health care provider characteristics associated with nonindicated Pap tests varied by screening group. Temporal trends showed a decrease in the proportion of nonindicated tests in the younger than 21 years group but an increase in the posthysterectomy group.

CONCLUSION:

For women aged younger than 21 years and older than 65 years and posthysterectomy, 35% of Pap tests performed in our health system were not guideline-adherent. There were no patient or health care provider characteristics associated with guideline nonadherent screening across all groups.
Posterior Fourchette Fissure Resolution After Injection of Autologous Adipose-Derived Regenerative Cells
Authors: Andjelkov Katarina , Maricic Zoran
Published: February 2017

BACKGROUND:

Posterior fourchette fissures can recur and become chronic despite multiple medical and surgical treatments. We report the case of a recurrent posterior fourchette fissure that resolved after subdermal injection with adipose-derived regenerative cells.

CASE:

A 44-year-old primiparous patient experienced severe dyspareunia for 10 years as a result of a recurrent posterior fourchette fissure that began after a vaginal delivery with episiotomy. She was treated unsuccessfully with topical antibiotics, estrogen, and steroids and ultimately with a perineoplasty at the age of 42 years. Adipose-derived regenerative cells were extracted enzymatically from her adipose tissue and injected subdermally and submucosally beneath the fissure and surrounding area. The fissure completely resolved within 3 months after treatment and has not recurred after more than 1 year of follow-up.

CONCLUSION:

Subdermal injection of autologous adipose-derived regenerative cells may be a treatment option for treatment of recurrent fourchette fissures that do not respond to standard medical and surgical therapies.
Longitudinal monitoring of patient limb loading throughout ankle fracture rehabilitation using an insole load monitoring system: a case series
Authors: North Kylee , Kubiak Erik N. , Rothberg David L. , Lajevardi-Khosh Arad , Petelenz Tomasz J. , Hitchcock Robert W. , Stuart Ami R.
Published: February 2017

Background:

The purpose of this prospective, direct observational study was to evaluate limb loading in lower extremity orthopaedic trauma patients using a novel insole sensor, the Ambulatory Tibial Load Analysis System (ATLAS).

Methods:

Three patients from a level I trauma center, one with a trimalleolar ankle fracture, one with a distal, spiral fracture of the tibia and fibula at the same level, and one with a bimalleolar ankle fracture were observed using an insole load monitoring system to record their weight bearing during standard of care rehabilitation. No clinical decisions were made based on the limb loading data. The primary study measures were limb-loading data provided by the ATLAS and patient reported physical function as measured by the PROMIS Physical Function Computer Adapted Test.

Results:

The ATLAS provided 8-12 wk of continuous limb loading data, with raw loading data, duration of insole sensor and CAM walker wear, daily step count, median load per day, and periods of static and dynamic loading for three patients with varying ankle fractures.

Conclusions:

The findings of this case study support the use of the ATLAS sensor in evaluation of limb loading in patients with lower extremity fracture. The data suggest that the current weight bearing prescription may not be sufficient for all patients and that personalized protocols are warranted.
Global Sagittal Imbalance Due to Change in Pelvic Incidence After Traumatic Spinopelvic Dissociation
Authors: Lee Han-Dong , Jeon Chang-Hoon , Won Suk-Hyeong , Chung Nam-Su
Published: February 2017

Objectives:

To examine how spinopelvic morphology changes after traumatic spinopelvic dissociation and whether these changes affect the sagittal balance of the spine.

Design:

Retrospective analysis.

Setting:

Level I trauma center.

Patients:

Thirty-nine consecutive patients who were diagnosed with traumatic spinopelvic dissociation and had a minimum 2-year radiological follow-up were included.

Intervention:

Nineteen patients underwent spinopelvic pedicle screw fixation, 11 patients underwent percutaneous iliosacral screw fixation, and 9 patients were treated conservatively.

Main Outcome Measurements:

The main outcome measurements are as follows: (1) injury morphology (injury type and kyphotic angulation) at the initial and follow-up visits; (2) sagittal vertical axis (SVA) at the 2-year follow-up; (3) spinopelvic parameters [pelvic incidence (PI), sacral slope, pelvic tilt, lumbar lordosis, and thoracic kyphosis] at the 2-year follow-up; and (4) bodily pain and Oswestry Disability Index at the 2-year follow-up.

Results:

There were 21 men and 18 women, with a mean age of 28.3 years (15–62 years). At the 2-year follow-up, the mean SVA was 5.4 ± 4.1 cm and the mean PI was 76.9 ± 24.6 degrees. Factors related to SVA after traumatic spinopelvic dissociation were PI (r = 0.441, P = 0.017), pelvic tilt (r = 0.387, P = 0.038), and injury type of complete displacement (r = 0.372, P = 0.047). The bodily pain and Oswestry Disability Index was significantly poorer in patients with SVA modifier “+” than in patients with SVA modifier “0.”

Conclusions:

Lumbosacral kyphosis after traumatic spinopelvic dissociation increases PI, which can affect the sagittal balance of the spine and clinical outcome. Restoration of lumbosacral orientation is important for preventing sagittal imbalance.

Level of Evidence:

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Comparison of the Conventional Dresden Protocol and Accelerated Protocol With Higher Ultraviolet Intensity in Corneal Collagen Cross-Linking for Keratoconus
Authors: Choi Moonjung , Kim Jiwon , Kim Eung Kweon , Seo Kyoung Yul , Kim Tae-im
Published: February 2017

Purpose:

To compare the accelerated corneal cross-linking (CXL) protocol and the conventional Dresden protocol in patients with keratoconus in terms of visual acuity, keratometric values, and topographic parameters.

Methods:

Twenty-eight eyes of 25 patients with primary keratoconus were divided into 2 groups; 15 eyes in group 1 received CXL under the standard Dresden protocol (3 mW/cm2 for 30 min, dose 5.4 J/cm2) and 13 eyes in group 2 were treated with the accelerated protocol (30 mW/cm2 for 3 min 40 s, dose 6.6 J/cm2). Visual acuity, refractive error, keratometry values obtained by both Pentacam and Auto Kerato-Refractometer, corneal thickness, and topometric indexes were compared 6 months postoperatively.

Results:

The visual acuity improved significantly from 0.17 ± 0.16 to 0.08 ± 0.09 logarithm of the minimum angle of resolution in group 1 (P = 0.009). The cylindrical refractive error improved in both groups (P = 0.05 in group 1 and P = 0.011 in group 2), and the spherical equivalent increased in group 1 (P = 0.021). In group 1, the maximum keratometry value decreased by 0.55 ± 0.89 diopters (P = 0.03), and the mean keratometry value decreased by 0.44 ± 0.63 diopters (P = 0.017), whereas the changes in visual acuity, spherical and spherical equivalent refractive errors, and keratometric values in group 2 were not statistically significant. The corneal thickness at the apex decreased significantly in group 1 (P = 0.001), but the change was not significant in group 2.

Conclusions:

Despite a higher UV dose (6.6 J/cm2), accelerated CXL with higher UV intensity and reduced irradiation time showed a smaller topographic flattening effect than did the conventional Dresden protocol in primary keratoconus with documented progression.
Functional Gastrointestinal Disorders in Children
Authors: Scarpato Elena , Quitadamo Paolo , Roman Enriqueta , Jojkic‐Pavkov Danijela , Kolacek Sanja , Papadopoulou Alexandra , Roma Eleftheria , Shamir Raanan , Lev Michal R.B. , Lutovac Branko , Djurisic Veselinka , Orel Rok , Koleilat Aziz , Mneimneh Sirin , Coppola Vincenzo , Corazziari Enrico , Staiano Annamaria
Published: February 2017

Objectives:

Childhood functional gastrointestinal disorders (FGIDs) are common conditions associated with significant morbidity and high healthcare costs. This multicenter study aimed at assessing the clinical approach to infants (0–6 months) and children/adolescents (4–18 years) with suspected FGIDs by pediatricians from the Mediterranean Area.

Methods:

A survey evaluating the diagnostic approach, including the use of Rome II and III criteria, and the therapeutic management of some of the most prevalent FGIDs, such as irritable bowel syndrome (IBS), functional constipation (FC), and functional regurgitation (FR), was distributed to a sample of pediatricians.

Results:

We collected 278 questionnaires from 9 countries (Croatia, Greece, Israel, Italy, Lebanon, Montenegro, Serbia, Slovenia, and Spain). Rome III criteria are used to diagnose FC by 28.8%. Treatment of FC is based on dietary modifications (97.5%) and osmotic laxatives (93.5%). Rome III criteria are used to diagnose FR by 22.3% of the responders, in contrast to 79.5% who rely on personal experience for diagnosis. Reported treatments mainly consist of reassurance (96.8%) and thickened feedings (77.3%). Nevertheless, 21.2% prescribe proton pump inhibitors or H2‐blockers to infants with FR. Rome III criteria are used to diagnose IBS by only 25.9%. Moreover, 86% of the pediatricians base IBS therapy on the predominant symptom. The most prescribed treatments are analgesics (36.6%) for pain control, dietary advice (41.5%) for diarrhea‐predominant IBS, and dietary advice (47.8%) for constipation‐predominant IBS.

Conclusions:

Our data show that the use of Rome III diagnostic criteria is not sufficiently widespread among pediatricians, and that large variability remains in the management of FGIDs within the different Mediterranean countries surveyed.
Designing Human Immunodeficiency Virus Counselling and Testing Services to Maximize Uptake Among High School Learners in South Africa: What Matters?
Authors: Strauss Michael , George Gavin , Rhodes Bruce
Published: February 2017

Background

Increasing human immunodeficiency virus (HIV) testing in South Africa is vital for the HIV response. Targeting young people is important as they become sexually active and because HIV risk rapidly increases as youth enter their 20s. This study aims to increase the understanding of high school learners' preferences regarding the characteristics of HIV testing service delivery models and to inform policy makers and implementers regarding potential barriers to and facilitators of HIV testing.

Methods

An attitudinal survey was used to examine HIV testing preferences among 248 high school learners in KwaZulu-Natal. Statistical tests were used to identify the most favored characteristics of testing service delivery models and examine key differences in preferences based on demographic characteristics and testing history.

Results

Most learners were found to prefer testing offered at a clinic on a Saturday (43%), using a finger prick test (59%), conducted by a doctor (61%) who also provides individual counselling (60%). Shorter testing times were preferred, as well as a monetary incentive to cover any associated expenses. Time, location, the type of test, and who conducts the test were most important. However, stratified analysis suggests that preferences diverge, particularly around gender, grade, but also sexual history and previous testing experience.

Conclusions

Human immunodeficiency virus testing services can be improved in line with preferences, but there is no single optimal design that caters to the preferences of all learners. It is unlikely that a “one-size-fits-all” approach will be effective to reach HIV testing targets. A range of options may be required to maximize coverage.
Motivating Physicians to Report Adverse Medical Events in China: Stick or Carrot?
Authors: Xue Yajiong , Yang Jing , Zhang Jing , Luo Mengyun , Zhang Zhiruo , Liang Huigang
Published: February 2017

Background

Adverse medical events (AMEs) pose serious threats to patient safety. One of the major challenges of AME reporting is low physician engagement. This study attempted to examine how punishment and reward can improve physicians’ AME reporting in China.

Methods

A survey was conducted in a large hospital with 1693 beds in China. Data were collected from 311 physicians. Ordinal and binary logistic regression was used for data analysis.

Results

This study reveals that both punishment and reward are positively associated with intention to report AMEs. There is a negative interaction effect between punishment and reward. Although collective punishment is positively associated with intention to report AMEs, collective reward is not. Moreover, the physicians who have fear of negative consequences of AMEs and lack knowledge of AME reporting have lower intention to report AMEs. These findings do not differ between male and female physicians.

Conclusions

This survey suggests that punishment and reward have potential to motivate Chinese physicians to report AMEs. However, the implementation strategies of these control mechanisms may not be universally applicable and should be carefully designed on the basis of the specific characteristics of the practice site.
Experimental Texture Analysis in Glioblastoma
Authors: Hainc Nicolin , Stippich Christoph , Stieltjes Bram , Leu Severina , Bink Andrea
Published: February 2017

Objectives

Analysis of a single slice of a tumor to extract biomarkers for texture analysis may result in loss of information. We investigated correlation of fractional volumes to entire tumor volumes and introduced expanded regions of interest (ROIs) outside the visual tumor borders in glioblastoma.

Materials and Methods

Retrospective slice-by-slice volumetric texture analysis on 46 brain magnetic resonance imaging subjects with histologically confirmed glioblastoma was performed. Fractional volumes were analyzed for correlation to total volume. Expanded ROIs were analyzed for significant differences to conservative ROIs.

Results

As fractional tumor volumes increased, correlation with total volume values for mean, SD, mean of positive pixels, skewness, and kurtosis increased. Expanding ROI by 2 mm resulted in significant differences in all textural values.

Conclusions

Fractional volumes may provide an optimal trade-off for texture analysis in the clinical setting. All texture parameters proved significantly different with minimal expansion of the ROI, underlining the susceptibility of texture analysis to generating misrepresentative tumor information.
Validating the Postdischarge Surgical Recovery Scale 13 as a Measure of Perceived Postoperative Recovery After Laparoscopic Sacrocolpopexy
Authors: Carpenter Janet S. , Heit Michael , Chen Chen X. , Stewart Ryan , Hamner Jennifer , Rand Kevin L.
Published: February 2017

Objectives

No postoperative recovery measurement tools have been validated among women undergoing laparoscopic sacrocolpopexy for pelvic organ prolapse, which impedes development and testing of strategies to improve recovery. The purpose of this study was to evaluate the performance of the Postdischarge Surgical Recovery Scale (PSR) as a measure of perceived recovery in laparoscopic sacrocolpopexy patients.

Methods

Women (N = 120) with stage 2 or higher pelvic organ prolapse undergoing laparoscopic sacrocolpopexy completed a 15-minute postoperative survey (days 7, 14, 42, and 90 [each ± 3 days]) which included the 15-item PSR. A confirmatory factor analysis was conducted using data from 14 days postsurgery, when patients would have begun to recover, but there was likely to be substantial variability in recovery across patients. We also assessed validity and explored sensitivity to change over time and minimally important difference values.

Results

Confirmatory factor analysis indicated a good fitting model for a reduced version of the PSR (ie, PSR13). Regressions showed that the PSR13 prospectively predicted single-item recovery scores. The PSR13 recovery significantly improved from days 7 to 42, suggesting the PSR13 is sensitive to change. Descriptive statistics including minimally important differences are reported. The minimally important difference was estimated to be around 5 points.

Conclusions

The PSR13 is a psychometrically sound tool for measuring recovery over time in this population. Its short length makes it an ideal postoperative recovery measure in clinical practice or research.
Direct and Indirect Effects of Personality Traits on Psychological Distress in Women With Pelvic Floor Disorders
Authors: Yaakobi Tal , Handelzalts Jonathan E. , Peled Yoav , Levy Sigal , Wiznitzer Arnon , Krissi Haim
Published: February 2017

Objectives

The diagnosis and treatment of pelvic floor disorders may involve subjective self-report symptom measures that may be related to personality traits. We aimed to construct a model that integrates pelvic floor disorders, personality variables (optimism and neuroticism), psychological distress, and related demographic variables.

Methods

In a cross-sectional study, conducted between August 2014 and June 2015, 155 women following an intake to an urogynecology outpatient clinic of a tertiary health center completed personality questionnaires of optimism and neuroticism (Life Orientation Test–Revised, 10-item Big Five Inventory), pelvic floor symptoms (Pelvic Floor Distress Inventory Short Form), psychological distress (18-item Brief Symptom Inventory), and a demographic questionnaire.

Results

A path analysis mediation model showed that patients who had more pelvic floor symptoms felt more psychological distress and that psychological distress increased as the level of neuroticism increased. As for optimism, the correlation to pelvic floor symptoms was nearly significant. Optimism and neuroticism had indirect effects on psychological distress through pelvic floor symptoms in women with urinary incontinence and pelvic organ prolapse. Neuroticism had a direct effect on psychological distress in these women as well.

Conclusions

Our suggested statistical path analysis model supports the important role of personality traits in pelvic floor disorder self-reports and the effect of these traits on psychological distress. Therefore, the optimal treatment for pelvic floor symptoms should include psychological interventions in addition to traditional medical or surgical therapy in hope of reducing psychology distress associated with urinary incontinence and pelvic organ prolapse.
Single Port Robotic Assisted Sacrocolpopexy: Our Experience With the First 25 Cases
Authors: Matanes Emad , Lauterbach Roy , Mustafa-Mikhail Susana , Amit Amnon , Wiener Zeev , Lowenstein Lior
Published: February 2017

Objectives

In single-port surgery, the surgeon operates almost exclusively through a single entry point, typically the patient's navel, leaving only a single small scar. The aims of this study were to share some tips and tricks of single-port robotic-assisted sacrocolpopexy and to evaluate the learning curve of mastering the skills to operate this procedure.

Methods

This is a retrospective study of the first 25 single-port; robotic-assisted sacrocolpopexy surgeries performed during July to December 2015 at Rambam Health Care Campus by a single surgeon.

Primary points of interest included intraoperative bleeding, length of surgery, length of hospitalization, and surgical complications.

Results

The median age was 59 years (range, 35–74); the median “pelvic organ prolapse quantification” stage was 3 (range, 2–4). The median total operative time was 190 minutes (range, 114–308), and console time was 130 minutes (85–261). Comparisons between the first 15 cases and the following 10 cases demonstrated significant decreases in median total operative and console times: 226 minutes (range, 142–308) versus 156 minutes (range, 114–180), and 170 minutes (range, 85–261) versus 115 minutes (range, 90–270), respectively (P < 0.008). There were no intraoperative adverse events. Postoperative adverse events were also rare, including 1 case of small bowel adhesions that required a second laparoscopic surgery for adhesiolysis. After this incident, we peritonalized the mesh in all 13 successive cases; median time was 8 minutes (range, 5–15 minutes).

Conclusions

Single-port robotic-assisted sacrocolpopexy is a feasible procedure with low complication rates, minimal blood loss and postsurgical pain, fast recovery, short hospitalization, and virtually scar-free results. Outcomes of long-term follow-up should be investigated.