bluuebunny/crossref_metadata_2025 huggingface dataset:
Captive Ancestry Upwardly Biases Estimates of Relative Reproductive Success
Authors: Willoughby Janna R , Christie Mark R
Published: May 2017

Supplementation programs, which release captive-born individuals into the wild, are commonly used to demographically bolster declining populations. In order to evaluate the effectiveness of these programs, the reproductive success of captive-born individuals released into the wild is often compared to the reproductive success of wild-born individuals in the recipient population (relative reproductive success, RRS). However, if there are heritable reductions in fitness associated with captive breeding, gene flow from captive-born individuals into the wild population can reduce the fitness of the wild population. Here, we show that when captive ancestry in the wild population reduces mean population fitness, estimates of RRS are upwardly biased, meaning that the relative fitness of captive-born individuals is over-estimated. Furthermore, the magnitude of this bias increases with the length of time that a supplementation program has been releasing captive-born individuals. This phenomenon has long-term conservation impacts since management decisions regarding the design of a supplementation program and the number of individuals to release can be based, at least in part, on RRS estimates. Therefore, we urge caution in the interpretation of relative fitness measures when the captive ancestry of the wild population cannot be precisely measured.
Global Spinal Alignment in Cervical Kyphotic Deformity: The Importance of Head Position and Thoracolumbar Alignment in the Compensatory Mechanism
Authors: Mizutani Jun , Verma Kushagra , Endo Kenji , Ishii Ken , Abumi Kuniyoshi , Yagi Mitsuru , Hosogane Naobumi , Yang Jeffrey , Tay Bobby , Deviren Vedat , Ames Christopher
Published: May 2017

BACKGROUND

Previous studies have evaluated cervical kyphosis (C-kypho) using cervical curvature or chin-brow vertical angle, but the relationship between C-kypho and global spinal alignment is currently unknown.

OBJECTIVE

To elucidate global spinal alignment and compensatory mechanisms in primary symptomatic C-kypho using full-spine radiography.

METHODS

In this retrospective multicenter study, symptomatic primary C-kypho patients (Cerv group; n = 103) and adult thoracolumbar deformity patients (TL group; n = 119) were compared. We subanalyzed Cerv subgroups according to sagittal vertical axis (SVA) values of C7 (SVAC7 positive or negative [C7P or C7N]). Various Cobb angles (°) and SVAs (mm) were evaluated.

RESULTS

SVAC7 values were –20.2 and 63.6 mm in the Cerv group and TL group, respectively (P < .0001). Various statistically significant compensatory curvatures were observed in the Cerv group, namely larger lumbar lordosis (LL) and thoracic kyphosis. The C7N group had significantly lower SVACOG (center of gravity of the head) and SVAC7 (32.9 and –49.5 mm) values than the C7P group (115.9 and 45.1 mm). Sagittal curvatures were also different in T4-12, T10-L2, LL4-S, and LL. The value of pelvic incidence (PI)-LL was different (C7N vs C7P; –2.2° vs 9.9°; P < .0003). Compensatory sagittal curvatures were associated with potential for shifting of SVAC7 posteriorly to adjust head position. PI-LL affected these compensatory mechanisms.

CONCLUSION

Compensation in symptomatic primary C-kypho was via posterior shifting of SVAC7, small T1 slope, and large LL. However, even in C-kypho patients, lumbar degeneration might affect global spinal alignment. Thus, global spinal alignment with cervical kyphosis is characterized as head balanced or trunk balanced.
Surgical Decompression of High-Grade Spinal Cord Compression from Hormone Refractory Metastatic Prostate Cancer
Authors: Chohan Muhammad Omar , Kahn Sweena , Cederquist Gustav , Reiner Anne S , Schwab Joseph , Laufer Ilya , Bilsky Mark
Published: May 2017

BACKGROUND

Spine and nonspine skeletal metastases occur in more than 80% of patients with prostate cancer.

OBJECTIVE

To examine the characteristics of the patient population undergoing surgery for the treatment of prostate cancer metastatic to the spine.

METHODS

A retrospective chart review was performed on all patients treated at our institution from June 1993 to August 2014 for surgical management of metastatic spine disease from prostate cancer.

RESULTS

During the study period, 139 patients with 157 surgical lesions underwent surgery for metastatic spine disease. Decompression for high-grade epidural spinal cord compression was required for 126 patients with 143 lesions. Preoperatively, 69% had a motor deficit and 21% were nonambulatory, with 32% due to motor weakness. At surgery, 87% of patients had hormone-refractory prostate cancer (HRPC) and 61% failed prior radiation. Median overall survival for HRPC patients was 6.6 mo (95% confidence interval [CI]: 5.6-8.6) while the median overall survival for hormone-sensitive patients was 16.3 mo (95% CI: 4.0-26.6).

CONCLUSION

The majority of patients undergoing surgery for prostate cancer metastases to the spine were refractory to hormone therapy, indicating that patients with hormone-sensitive prostate cancer are unlikely to develop symptomatic spinal cord compression or spinal instability. A significant number of HRPC patients presented with neurological deficits attributable to spinal cord compression. Vigilant monitoring for the development of signs and symptoms of epidural spinal cord compression and spinal instability in hormone-refractory patients is recommended. Surgical decision making may be affected by the much shorter postoperative survival for HRPC patients as compared to patients with hormone-sensitive cancer.
The Pandemic H30 Subclone of Sequence Type 131 (ST131) as the Leading Cause of Multidrug-Resistant Escherichia coli Infections in the United States (2011–2012)
Authors: Johnson James R. , Porter Stephen , Thuras Paul , Castanheira Mariana
Published: May 2017

Background

Extraintestinal Escherichia coli infections are increasingly challenging due to emerging antimicrobial resistance, including resistance to extended-spectrum beta-lactams and fluoroquinolones. Sequence type 131 (ST131) is a leading contributor.

Methods

Three hundred sixty E. coli clinical isolates from across the United States (2011–2012), selected randomly from the SENTRY collection within 3 resistance categories (extended-spectrum cephalosporin [ECS]–reduced susceptibility [RS]; fluoroquinolone-resistant, ESC-susceptible; and fluoroquinolone-susceptible, ESC-susceptible) were typed for phylogroup, sequence type complex (STc), subsets thereof, virulence genotype, O type, and beta-lactamase genes. Molecular results were compared with susceptibility profile, specimen type, age, and sex.

Results

Phylogroup B2 accounted for most isolates, especially fluoroquinolone-resistant isolates (83%). Group B2–derived ST131 and its H30 subclone (divided between H30Rx and H30R1) predominated, especially among ESC-RS and fluoroquinolone-resistant isolates. In contrast, among fluoroquinolone-susceptible isolates, group B2–derived STc73 and STc95 predominated. Within each resistance category, ST131 isolates exhibited more extensive resistance and/or virulence profiles than non-ST131 isolates. ST131-H30 was distributed broadly by geographical region, age, and specimen type and exhibited distinctive beta-lactamase genes. Back-calculations indicated that within the source population ST131 accounted for 26.4% of isolates overall (vs 17% in 2007), including 19.8% ST131-H30, 13.2% ST131-H30R1, and 6.6% each ST131-H30Rx and non-H30 ST131.

Conclusions

ST131-H30, with its ESC resistance-associated H30Rx subset, caused most antimicrobial-resistant E. coli infections across the United States in 2011–2012 and, since 2007, increased in relative prevalence by >50%. Focused attention to this strain could help combat the current E. coli resistance epidemic.
Diagnosis of Upper Quadrant Lymphedema Secondary to Cancer: Clinical Practice Guideline From the Oncology Section of the American Physical Therapy Association
Authors: Levenhagen Kimberly , Davies Claire , Perdomo Marisa , Ryans Kathryn , Gilchrist Laura
Published: May 2017

The Oncology Section of the American Physical Therapy Association (APTA) developed a clinical practice guideline to aid the clinician in diagnosing secondary upper quadrant cancer-related lymphedema. Following a systematic review of published studies and a structured appraisal process, recommendations were written to guide the physical therapist and other health care clinicians in the diagnostic process. Overall clinical practice recommendations were formulated based on the evidence for each diagnostic method and were assigned a grade based on the strength of the evidence for different patient presentations and clinical utility. In an effort to maximize clinical applicability, recommendations were based on the characteristics as to the location and stage of a patient's upper quadrant lymphedema.
Hearing Threshold Shifts Among 11- to 35-Year-Olds With Early Hearing Impairment
Authors: Carter Lyndal , Black Deborah
Published: May 2017

Objectives:

Data obtained from the clinical records of selected 11- to 35-year-olds with preadult onset hearing impairment were analyzed with 2 primary aims: (1) to determine the incidence of hearing threshold level (HTL) shift in this cohort and, (2) to examine the relationship between HTL shift, whole-of-life noise exposure, and other factors.

Design:

Cross-sectional cohort study. Retrospective HTL + survey data for a sample of 237 young Australians receiving hearing (re)habilitation services were obtained. From these data, two subsets, (A) n = 127 and (B) n = 79, were analyzed. Participants with risk factors for progressive hearing loss (other than noise exposure) were excluded from both subsets. Subset (A) additionally excluded cochlear implant recipients, and subset (B) excluded cases with diagnosis of hearing loss after age 5 years. Using subset (A) data, the differences between final (recent) and specified baseline (initial) HTLs at 250, 500, 1000, 2000, and 4000 Hz were calculated and three criteria for HTL shift were applied. Correlations between reported noise exposure and HTL shift were calculated (Mann–WhitneyUtest). Using subset (B) data, relationships between high frequency (HF) HTL shift and exposure, and other personal and extrinsic factors were examined (Cox Regression model). Survival analyses (Kaplan–Meier) were performed to reveal the temporal pattern of HF shift. The magnitude of HF shifts at 5, 10, and 15 years post initial (i.e., specified baseline) audiogram were also calculated.

Results:

For subset (A), HTL shift (≥15 dB any frequency, and/or ≥10 dB*at two adjacent frequencies) was observed in 46.5% of cases examined. HF shift (≥15 dB at 2000 and/or 4000 Hz; one or both ears) was observed in 33.1% of cases. There was no relationship between HTL shift and reported whole-of-life exposure. For subset (B), no relationship was found between HF shift and noise exposure, nor 9 of 10 personal or extrinsic covariates tested. HF shift was significantly associated with HTL ≥ 70 dB at 2000 and/or 4000 Hz at initial audiogram. Survival analysis also illustrated that HF shift was more frequent, and occurred earlier, when HF hearing loss was ≥70 dB at initial audiogram. Median HF shifts at 15 years after initial audiogram were in the magnitude of 5 to 10 dB, and at the 90th percentile were 25 to 30 dB.

Conclusions:

HTL shift was observed in almost 50% of cases without predisposing factors for progressive hearing loss. The magnitude of HF shift increased gradually over time. While no relationship was found between HTL shift and noise exposure, the interpretation of this finding is restrained by the small spread of whole-of-life noise exposures, within a relatively conservative range. Nevertheless, this is the first direct examination of the relationship between HTL shift and noise exposure in young people with preadult hearing impairment.
High-resolution Esophageal Manometry Patterns in Children and Adolescents With Rumination Syndrome
Authors: Righini Grunder Franziska , Aspirot Ann , Faure Christophe
Published: May 2017

Background:

Rumination is defined by effortless regurgitation within seconds or minutes of ingested food. The aim of this study was to determine the high-resolution esophageal manometry (HREM) pattern in children with rumination syndrome.

Methods:

HREM was evaluated in 15 pediatric patients with rumination syndrome according to the Rome criteria and compared with 15 controls. Primary rumination was defined as a clinical rumination episode associated with a rise of gastric pressure above 30 mmHg. Secondary rumination was defined as a clinical rumination episode associated with a rise of gastric pressure above 30 mmHg during a transient lower esophageal sphincter relaxation (TLESR).

Results:

Ninety-two episodes of rumination were demonstrated during HREM study in 12 of the 15 patients (80%; 1–29 episodes per patient; median intragastric pressure 49.6 mmHg). Primary rumination occurred in 3 patients and secondary rumination in 5 patients. One patient had primary and secondary rumination episodes. In 3 patients, classification of rumination episodes was not possible due to repetitive swallowing leading to lower esophageal sphincter relaxation. In the control group, no episodes of rumination occurred. The sensitivity and the specificity of the HREM study (association of a clinical rumination episode with a rise in gastric pressure >30 mmHg) to confirm the diagnosis of rumination were 80% and 100%, respectively.

Conclusions:

HREM allows confirming diagnosis of rumination syndrome and to differentiate between primary and secondary rumination in the presence of objective rumination episodes. Further research is needed to study whether HREM results may influence treatment and outcome of children with rumination syndrome.
A Case Report of Transient Cortical Blindness After Angiography
Authors: Chen Chih Yen , Chen Chi Jen , Tseng Ying Chi
Published: May 2017

Introduction:

Transient cortical blindness (TCB) is a rare complication after angiography and is proposed to be related to contrast extravasation. We present the first case of TCB after angiography that was evaluated using serial arterial spin-labeling magnetic resonance perfusion (ASLMRP) and susceptibility-weighted imaging (SWI).

Case Report:

A 65-year-old woman with dyslipidemia who had been treated for left vertebral artery dissection 3 months previously presented with dizziness and right hemiparesis. Magnetic resonance imaging of the brain revealed suspected dissection of the V4 segment of the left vertebral artery. Cerebral angiography was performed using a total of 46 mL of nonionic contrast material. Approximately 3 hours after the procedure, the patient started complaining of a slight headache and nausea along with bilateral cortical blindness. The 6-hour ASLMRP and SWI of the brain, respectively, revealed hypoperfusion and increased oxygen extraction fraction in the bilateral occipital lobes. The patient gradually regained vision over the next 12 hours, and follow-up ASLMRP and SWI revealed normal perfusion and normal SWI findings, respectively.

Conclusions:

Hypoperfusion on ASLMRP and increased oxygen extraction fraction on SWI results derived for a patient presenting with TCB were demonstrated. Thus, we hypothesize that endothelin-related vasoconstriction is a pathophysiologic mechanism for TCB. To the best of our knowledge, this report is the first to describe ASLMRP and SWI findings in TCB after angiography.
Angioinvasive Aspergillus-associated Stroke in an Immunocompetent Host Following Cardiac Surgery and ECMO
Authors: Kavi Tapan , Madan Nikhil , Majic Tamara , Rosengart Axel , Maya Marcel , Bannykh Serguei , Lahiri Shouri
Published: May 2017

Introduction:

Invasive cerebral aspergillosis is an uncommon cause of stroke among immunocompetent patients and has not been reported in association with cardiac surgery or extracorporeal membrane oxygenation (ECMO). We report the case of an immunocompetent host who developed aspergillus-associated stroke following coronary artery bypass graft (CABG) and ECMO.

Case Report:

A 59-year-old woman developed cardiogenic shock after 3-vessel-CABG requiring intra-aortic balloon pump placement and subsequent veno-arterial ECMO. Noncontrast computed tomography of the brain was suggestive of multiple bihemispheric ischemic infarcts. Postmortem pathologic analysis revealed aspergillus-associated inflammation of blood vessels and ischemic and petechial hemorrhagic strokes in the affected territories.

Discussion and Conclusions:

Ischemic infarcts in the setting of CABG or ECMO are often presumed to be thromboembolic from the heart or device, related to underlying hemodynamic instability, or due to a clinically apparent systemic infection such as endocarditis. This report suggests that invasive cerebral aspergillosis should be considered in seemingly immunocompetent patients following CABG or ECMO. The mechanism is unclear, but may be related to systemic inflammatory dysregulation resulting in increased susceptibility to uncommon pathogens.
Clinical Impact of Rapid Intravenous Rehydration With Dextrose Serum in Children With Acute Gastroenteritis
Authors: Sendarrubias Marta , Carrón Marta , Molina Juan Carlos , Pérez Maria Ángeles , Marañón Rafael , Mora Andrea
Published: May 2017

Objectives

We designed a study to compare rapid intravenous rehydration based on 0.9% normal saline (NS) or on NS + glucose 2.5% serum (SGS 2.5%) in patients with dehydration secondary to acute gastroenteritis. Our hypothesis is that the addition of glucose 2.5% serum (SGS 2.5%) to 0.9% saline solution could reduce the proportion of hospital admissions and return emergency visits in these patients. The secondary objective was to identify differences in the evolution of blood glucose and ketonemia between the groups.

Methods

We designed a prospective randomized open-label clinical trial that was conducted in 2 tertiary hospitals over 9 months. Patients were randomized to receive SGS 2.5% or NS. Baseline clinical, analytical, and disease-related data were collected. Data were analyzed using SPSS.

Results

The frequency of hospitalization in the SGS 2.5% group was 30.3% (n = 23) compared with 34.8% (n = 24) in the NS group, although the difference was not statistically significant (P = 0.59). The frequency of return visits to the emergency department was 17.8% (n = 8) in the NS group and 5.6% (n = 3) in the SGS 2.5% group (P = 0.091). Changes in glucose and ketone levels were more favorable in the SGS 2.5% group.

Conclusions

Our results enabled us to conclude that there were no significant differences in hospital admission or return visits to the emergency department between children with dehydration secondary to acute gastroenteritis.
Congenital Clavicular Pseudoarthosis—How to Differentiate It From the More Common Clavicular Fractures
Authors: Chalfant James Stewart , Sanchez Thomas Ray
Published: May 2017

Congenital pseudoarthrosis of the clavicle is a rare entity that can be confused for a traumatic injury. We present 4 cases of congenital clavicular pseudoarthrosis and discuss its imaging findings that can help differentiate it from the more common clavicular facture. We also reviewed its epidemiology, embryology, and management based on available and most recent literature.
Predictive Variables for Abnormal Comprehensive Metabolic Panel Testing and Potential Cost Savings in Children Receiving Pediatric Emergency Department Care
Authors: Huckaby Matthew David , Freeman Shayla , Thurmond Christopher , Cooper Matthew , Losek Joseph D.
Published: May 2017

Objective

The aim of this study was to determine variables predictive of abnormal comprehensive metabolic panel (CMP) results in pediatric emergency department (PED) patients and the potential cost savings of a basic metabolic panel (BMP) versus a CMP.

Methods

This is a retrospective cross-sectional descriptive study of children (<18 y) at an urban academic PED (annual census, 22,000). Clinical data included 12 clinical variables: right upper quadrant pain, overdose, emesis, liver disorder, malignancy, heart disease, bleeding disorder, jaundice, right upper quadrant tenderness, hepatomegaly, ascites/peripheral edema and shock, and the liver function test (LFT) results not in a BMP (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total bilirubin, total protein, and albumin).

Results

There were 207 children in the study population. The mean age was 8 years. There were 106 boys (51%).

Variables significantly associated with abnormal LFT result were history of liver disease (P = 0.007), history of heart disease (P = 0.040), jaundice (P = 0.045), and hepatomegaly (P = 0.048). The false-negative rate was 16%. However, of the 10 patients for whom this false-negative rate remained true, the LFT values were marginally abnormal, and performance of further investigation of these results was minimal to none. There were 66 patients with no clinical variables and normal CMP results. With a cost difference of $21 between BMP and CMP, this gives a potential savings of $7125 if extrapolated for 1 year in our PED.

Conclusions

Limiting testing to a BMP for patients with none of the 12 clinical variables has the potential annual cost savings of $7125.
Oral Mucosal Envenomation of an Infant by a Puss Caterpillar
Authors: Pappano Dante Allen , Trout Fryxell Rebecca , Warren Molly
Published: May 2017

The term “puss caterpillar” describes the larva of at least two Megalopygidae species common to North America. Accidental contact with the hairs (setae) is intensely painful, and serious systemic effects have been reported. We describe the envenomation of an infant through the face and oral mucosa, resulting in severe discomfort, limited oral intake, and vomiting, but no other untoward effects.
Emergency Management of the Ingested Magnet
Authors: Bauman Brent , McEachron Kendall , Goldman Deborah , Louiselle Amanda , Zheng Eugene , Mills David , Louie Jeffrey , Segura Bradley
Published: May 2017

Introduction

Accidental ingestion of foreign bodies is an increasing problem in the pediatric population. Symptoms are often nonspecific and may lead to a missed diagnosis because the ingestion event often goes unwitnessed.

Case

We present a case of a missed diagnosis of a multiple magnet ingestion event in a pediatric patient leading to operative management. A 2-year-old boy with a 4-week history of nonspecific abdominal pain presented to the emergency department (ED) with vomiting and worsening abdominal pain. He was recently seen in the ED for nonspecific abdominal pain diagnosed as acute otitis media. In this second ED visit, the child was found to be febrile and tachycardic and had signs of peritonitis. Radiographs revealed a foreign body in the right lower quadrant. The child was taken to the operating room where multiple intestinal perforations were identified and repaired. The child had an uneventful postoperative course and was discharged 7 days later.

Discussion

There are increasing awareness and growing concern over complications from pediatric magnet ingestion. Complications from neodymium magnet ingestion may include bowel obstruction, perforation, and fistula formation. The risk of complications is especially high with multiple-magnet ingestion. Pediatric foreign-body magnet ingestion may be a diagnostic challenge because the associated symptoms are nonspecific, and the ingestion is often unwitnessed.

Conclusions

Our case represents the missed diagnosis of 4 magnets ingested separately over time. Emergency department providers may benefit from a clinical algorithm guiding the management of these increasingly prevalent patient presentations to prevent delayed diagnoses and to decrease morbidity.
A Flow-Based Model of the HIV Care Continuum in the United States
Authors: Gonsalves Gregg S. , Paltiel A. David , Cleary Paul D. , Gill Michael J. , Kitahata Mari M. , Rebeiro Peter F. , Silverberg Michael J. , Horberg Michael , Abraham Alison G. , Althoff Keri N. , Moore Richard , Bosch Ronald J. , Tang Tian , Hall H. Irene , Kaplan Edward H.
Published: May 2017

Background:

Understanding the flow of patients through the continuum of HIV care is critical to determine how best to intervene so that the proportion of HIV-infected persons who are on antiretroviral treatment and virally suppressed is as large as possible.

Methods:

Using immunological and virological data from the Centers for Disease Control and Prevention and the North American AIDS Cohort Collaboration on Research and Design from 2009 to 2012, we estimated the distribution of time spent in and dropout probability from each stage in the continuum of HIV care. We used these estimates to develop a queueing model for the expected number of patients found in each stage of the cascade.

Results:

HIV-infected individuals spend an average of about 3.1 months after HIV diagnosis before being linked to care, or dropping out of that stage of the continuum with a probability of 8%. Those who link to care wait an additional 3.7 months on average before getting their second set of laboratory results (indicating engagement in care) or dropping out of care with probability of almost 6%. Those engaged in care spent an average of almost 1 year before achieving viral suppression on antiretroviral therapy or dropping out with average probability 13%. For patients who achieved viral suppression, the average time suppressed on antiretroviral therapy was an average of 4.5 years.

Conclusions:

Interventions should be targeted to more rapidly identifying newly infected individuals, and increasing the fraction of those engaged in care that achieves viral suppression.
How Do Thresholds of Principle and Preference Influence Surgeon Assessments of Learner Performance?
Authors: Apramian Tavis , Cristancho Sayra , Sener Alp , Lingard Lorelei
Published: May 2017

Objective:

The present study asks whether intraoperative principles are shared among faculty in a single residency program and explores how surgeons’ individual thresholds between principles and preferences might influence assessment.

Background:

Surgical education continues to face significant challenges in the implementation of intraoperative assessment. Competency-based medical education assumes the possibility of a shared standard of competence, but intersurgeon variation is prevalent and, at times, valued in surgical education. Such procedural variation may pose problems for assessment.

Methods:

An entire surgical division (n = 11) was recruited to participate in video-guided interviews. Each surgeon assessed intraoperative performance in 8 video clips from a single laparoscopic radical left nephrectomy performed by a senior learner (>PGY5). Interviews were audio recorded, transcribed, and analyzed using the constant comparative method of grounded theory.

Results:

Surgeons’ responses revealed 5 shared generic principles: choosing the right plane, knowing what comes next, recognizing normal and abnormal, making safe progress, and handling tools and tissues appropriately. The surgeons, however, disagreed both on whether a particular performance upheld a principle and on how the performance could improve. This variation subsequently shaped their reported assessment of the learner's performance.

Conclusions:

The findings of the present study provide the first empirical evidence to suggest that surgeons’ attitudes toward their own procedural variations may be an important influence on the subjectivity of intraoperative assessment in surgical education. Assessment based on intraoperative entrustment may harness such subjectivity for the purpose of implementing competency-based surgical education.
Antiemetic Use in the Emergency Department
Authors: Weant Kyle A. , Bailey Abby M. , Baum Regan A. , Justice Stephanie B. , Calhoun Chara D.
Published: May 2017

Nausea and vomiting are 2 of the most common complaints of patients presenting to the emergency department (ED). In addition, antiemetics are the most commonly prescribed medications in the ED behind analgesics. Treating these conditions can be complex, especially as one considers that nausea and/or vomiting could be the primary presenting illness or simply a symptom of a more complex etiology. Although there is a wide variety of pharmacotherapeutic options in the armamentarium to treat these conditions, very few consensus recommendations exist to help guide the use of antiemetic agents in the ED, leading to wide variability in medication use. Contributing to these variations in practice is the extended spectrum of etiologies and potential physiological factors that contribute to the development of nausea or vomiting. A thorough understanding of the pharmacology and administration of these agents can help practitioners devise tailored antiemetic regimens based upon the underlying etiology.
Is Subdissociative Ketamine As Safe and Effective As Morphine for Pain Management in the Emergency Department?
Authors: Howard Patricia Kunz , Gisness Christine M.
Published: May 2017

Review of recent evidence with translation to practice for the advanced practice nurse (APN) role is presented using a case study module for “Intravenous Subdissociative-Dose Ketamine Versus Morphine for Analgesia in the Emergency Department: A Randomized Controlled Trial.” This prospective, randomized controlled inquiry enrolled 90 patients into 2 groups (ketamine vs. morphine) for patients seeking care in an emergency department with acute pain. Data regarding pain scores were collected at baseline, 15, 30, 60, 90, and 120 min. Study subjects reporting persistent pain could receive rescue analgesia with fentanyl. Initial pain scores for the subjects in each of the groups were comparable (ketamine: 8.6; morphine: 8.5). Pain management for the 2 groups revealed similar average doses (ketamine: 21.8 mg; morphine: 7.7 mg). Although subjects in both groups reported reduction in pain scores at 15 and 30 min, no clinical significance was found. Subjects experienced greater pain relief (pain score = 0) in the ketamine group at 15 min (percentage difference 31%; 95% confidence interval [13, 49]), yet this was not sustained at the 30-min interval. There were no serious or life-threatening adverse effects in either group. This study highlights the important role of the APN in providing quality care, communication about pain management, and related follow-up care.
Management of Hand Injuries: Part III
Authors: Hoyt K. Sue , Ramirez Elda G.
Published: May 2017

Assessment of Acute Hand Injuries was discussed in Part I (E. Ramirez & K. S. Hoyt, 2014). Part I reviewed approaches to the assessment of the patient with a hand injury and established a process for basic identification of the hand structures and function. Approaches to history taking and specific evaluations for the hand were discussed, and examples of the assessments were provided. Diagnostic approaches to support physical findings were discussed, and methods of radiological assessment provided assistance to the audience in making appropriate diagnosis in relation to hand injuries. Management of bony hand injuries was discussed in Part II. In Part II, the authors also described the epidemiology, radiographs, and the management of hand lacerations, fingertip injuries, and fractures. In this article, Part III, the management of tendon, ligamentous, neurovascular, and other specific hand injuries, along with the management of selected chronic hand conditions, is discussed.
The impact of reducing car weight on global emissions: the future fleet in Great Britain
Authors: Serrenho André Cabrera , Norman Jonathan B. , Allwood Julian M.
Published: May 2017

Current European policies define targets for future direct emissions of new car sales that foster a fast transition to electric drivetrain technologies. However, these targets do not consider the emissions produced in electricity generation and material production, and therefore fail to incentivise car manufacturers to consider the benefits of vehicle weight reduction. In this paper, we examine the potential benefits of limiting the average weight and altering the material composition of new cars in terms of global greenhouse gas emissions produced during the use phase, electricity generation and material production. We anticipate the emissions savings for the future car fleet in Great Britain until 2050 for various alternative futures, using a dynamic material flow analysis of ferrous metals and aluminium, and considering an evolving demand for car use. The results suggest that fostering vehicle weight reduction could produce greater cumulative emissions savings by 2050 than those obtained by incentivising a fast transition to electric drivetrains, unless there is an extreme decarbonization of the electricity grid. Savings promoted by weight reduction are immediate and do not depend on the pace of decarbonization of the electricity grid. Weight reduction may produce the greatest savings when mild steel in the car body is replaced with high-strength steel.

This article is part of the themed issue ‘Material demand reduction’.
Political economies and environmental futures for the sharing economy
Authors: Frenken Koen
Published: May 2017

The sudden rise of the sharing economy has sparked an intense public debate about its definition, its effects and its future regulation. Here, I attempt to provide analytical guidance by defining the sharing economy as the practice that consumers grant each other temporary access to their under-utilized physical assets. Using this definition, the rise of the sharing economy can be understood as occurring at the intersection of three salient economic trends: peer-to-peer exchange, access over ownership and circular business models. I shortly discuss some of the environmental impacts of online sharing platforms and then articulate three possible futures of the sharing economy: a capitalist future cumulating in monopolistic super-platforms allowing for seamless services, a state-led future that shifts taxation from labour to capital and redistributes the gains of sharing from winners to losers, and a citizen-led future based on cooperatively owned platforms under democratic control. The nature and size of the social and environmental impacts are expected to differ greatly in each of the three scenarios.

This article is part of the themed issue ‘Material demand reduction’.
Why we use more materials
Authors: Gutowski Timothy , Cooper Daniel , Sahni Sahil
Published: May 2017

In this paper, we review the drivers for the high levels of material use in society, investigating both historical and current trends. We present recent national and global data by different material categories and accounting schemes, showing the correlations between materials use and different measures of human well-being. We also present a development narrative to accompany these observed trends, focusing on the strong role materials have played in economic development by industrialization and in the consumer economy. Finally, we speculate on how material efficiency might alter this pattern going forward and whether it is possible to de-couple well-being from material use.

This article is part of the themed issue ‘Material demand reduction’.
Are prices enough? The economics of material demand reduction
Authors: Aidt Toke , Jia Lili , Low Hamish
Published: May 2017

Recent policy proposals to achieve carbon targets have emphasized material demand reduction strategies aimed at achieving material efficiency. We provide a bridge between the way economists and engineers think about efficiency. We use the tools of economics to think about policies directed at material efficiency and to evaluate the role and rationale for such policies. The analysis highlights when prices (or taxes) can be used to induce changes in material use and when taxes may not work. We argue that the role of taxes is limited by concerns about their distributional consequences, by international trade and the lack of international agreement on carbon prices, and by investment failures.

This article is part of the themed issue ‘Material demand reduction’.
Energy demand for materials in an international context
Authors: Worrell Ernst , Carreon Jesus Rosales
Published: May 2017

Materials are everywhere and have determined society. The rapid increase in consumption of materials has led to an increase in the use of energy and release of greenhouse gas (GHG) emissions. Reducing emissions in material-producing industries is a key challenge. If all of industry switched to current best practices, the energy-efficiency improvement potential would be between 20% and 35% for most sectors. While these are considerable potentials, especially for sectors that have historically paid a lot of attention to energy-efficiency improvement, realization of these potentials under current ‘business as usual’ conditions is slow due to a large variety of barriers and limited efforts by industry and governments around the world. Importantly, the potentials are not sufficient to achieve the deep reductions in carbon emissions that will be necessary to stay within the climate boundaries as agreed in the 2015 Paris Conference of Parties. Other opportunities need to be included in the menu of options to mitigate GHG emissions. It is essential to develop integrated policies combining energy efficiency, renewable energy
and
material efficiency and material demand reduction, offering the most economically attractive way to realize deep reductions in carbon emissions.

This article is part of the themed issue ‘Material demand reduction’.
The austere life
Authors: Xenos Nicholas
Published: May 2017

Since the 2008 financial crisis, austerity has been deployed as a public policy geared towards reducing sovereign debt and restoring economic order, on the one hand, and descried as an example of punitive moralizing by political and economic elites, on the other. This article challenges the economic understanding of the concept of austerity. Some recent examples from popular culture are adduced to indicate societal dissatisfaction with the accumulation of material things, examples of what has been called ‘the new minimalism’. Contextualizing this phenomenon within a culture of intensive consumption, it is argued here that there is a history of austerity as an aversion to ostentation and excess in western tradition that runs from the Stoics through to recent pronouncements by Pope Francis and that provides a vantage point from which to question the economistic deployment of the term. When understood in this way, the austere can be seen to carry an important political meaning today and may contribute to the sorts of transformation necessary in order to reduce material demand on a societal scale.

This article is part of the themed issue ‘Material demand reduction’.
Recomposing consumption: defining necessities for sustainable and equitable well-being
Authors: Gough Ian
Published: May 2017

This paper focuses on consumption in the affluent world and the resulting level, composition and distribution of consumption-based emissions. It argues that public policy should foster the recomposition of consumption, while not disadvantaging poorer groups in the population. To combine these two imperatives entails making a distinction between goods and services that are necessary for a basic level of well-being, and those that are surplus to this requirement. The argument proceeds in six stages. First, the paper outlines a theory of universal need, as an alternative conception of well-being to consumer preference satisfaction. Second, it proposes a dual strategy methodology for identifying need satisfiers or necessities in a given social context. Then, it applies this methodology to identify a minimum bundle of necessary consumption items in the UK and speculates how it might be used to identify a maximum bundle for sustainable consumption. The next part looks at corporate barriers and structural obstacles in the path of sustainable consumption. The following part reveals a further problem: mitigation policies can result in perverse distributional outcomes when operating in contexts of great inequality. The final section suggests four ecosocial public policies that would simultaneously advance sustainable and equitable consumption in rich nations.

This article is part of the themed issue ‘Material demand reduction’.
Radical dematerialization and degrowth
Authors: Kallis Giorgos
Published: May 2017

The emission targets agreed in Paris require a radical reduction of material extraction, use and disposal. The core claim of this article is that a radical dematerialization can only be part and parcel of degrowth. Given that capitalist economies are designed to grow, this raises the question of whether, and under what circumstances, the inevitable ‘degrowth’ can become socially sustainable. Three economic policies are discussed in this direction: work-sharing, green taxes and public money.

This article is part of the themed issue ‘Material demand reduction’.
Bactericidal mechanisms and effector targets of TiO
2
and Ag-TiO
2
against Staphylococcus aureus
Authors: Jiang Xuhong , Lv Bin , Wang Yuan , Shen Qianhong , Wang Xinmin
Published: May 2017

Purpose. In our previous study, Ag+-loaded TiO2 and Ag+-loaded SiO2 coatings for tracheal intubation were prepared to prevent ventilator-associated pneumonia (VAP), but the antimicrobial targets and the underlying mechanisms of TiO2 and Ag-TiO2 (Ag+) are still unclear. We attempted to elucidate the antimicrobial activity and potential mechanisms against Staphylococcus aureus.

Methodology. The study tested the TiO2 and Ag+ bacteriostatic activity against S. aureus strains by MIC assays and S. aureus growth curves, lesion in the membranes by surface hydrophobicity tests, conductivity tests and measurements of DNA and RNA contents in S. aureus cultures, and investigated the inhibition of soluble protein and nucleic acid synthesis by measurements of soluble protein content, fluorescent intensity and nucleic acid content of living S. aureus.

Results. The MIC values of TiO2 and Ag+ were 1.6 mg ml−1 and 5.781 µg ml−1. TiO2 and Ag+ could inhibit the growth of S. aureus. After treatment with TiO2 and Ag+, the surface hydrophobicity was significantly reduced, the conductivity of cultures increased, and DNA and RNA content in cultures showed no obvious changes. The expressions of soluble proteins and nucleic acid contents of living S. aureus were reduced after treatment with TiO2 and Ag+.

Conclusion. TiO2 and Ag+ could cause slight lesion in the membrane to affect S. aureus membrane permeability, but not decomposition of membrane. Moreover, TiO2 and Ag+ could lead to reduced expression of soluble protein by inhibiting the synthesis of nucleic acids, thereby further inhibiting the growth of S. aureus.
Increased drug resistance of meticillin-resistant Staphylococcus aureus biofilms formed on a mouse dermal chip model
Authors: Jimi Shiro , Miyazaki Motoyasu , Takata Tohru , Ohjimi Hiroyuki , Akita Sadanori , Hara Shuuji
Published: May 2017

Purpose. Meticillin-resistant Staphylococcus aureus (MRSA) biofilm formation in humans is of serious clinical concern. Previous in vitro studies have been performed with biofilms grown only on inorganic substrates; therefore, we investigated the vancomycin (VCM) resistance of MRSA biofilms grown on skin tissue.

Methodology. We established a novel tissue substrate model, namely MRSA grown on segments of mouse skin tissue (dermal chips, DCs), and compared its resistance capacity against VCM with that of MRSA biofilms grown on plastic chips (PCs).

Results/Key findings. For one MRSA isolate, we found that the VCM MIC was identical (1.56 µg ml−1) for planktonic cultures and for biofilms-formed on PCs (PC-BF), although the minimum bactericidal concentration (MBC) increased to 6.25 µg ml−1 in PC-BF. On the contrary, the MIC and MBC for biofilms formed on DCs (DC-BF) significantly increased (25 and 50 µg ml−1, respectively). Furthermore, the minimum biofilm-eradicating concentration was higher for DC-BF (100 µg ml−1) than for PC-BF (25 µg ml−1). Using six MRSA strains, we found that in PC-BF, the c.f.u. number decreased with increasing VCM concentration, whereas in DC-BF, it greatly increased until the MIC was reached, accompanied by the formation of large colonies, thicker bacterial walls and the presence of many mitotic cells.

Conclusion. Our results indicate that the VCM resistance of MRSA was greater in DC-BF. We conclude that DCs may provide a specific environment for MRSA that enhances bacterial growth under cytotoxic VCM concentrations, and might be useful for the study of skin wound infections and the effects of antimicrobial drugs.
European admixture in Chinchorro DNA
Authors: Smith Robert
Published: May 2017

It is widely held that, except for migrations from Beringia or Siberia, there was no contact between the Old World and the New World prior to the colonization of North America by the Norse in the late 10thcentury AD. Analyses of 23 ancient American DNA samples reveal, however, the presence of European admixture in a sample taken from a Chinchorro mummy of northern Chile dated to 3972–3806 BC. This discovery implies a more complex history of the peopling of the Americas than previously accepted.
Detecting presence of mutational signatures in cancer with confidence
Authors: Huang Xiaoqing , Wojtowicz Damian , Przytycka Teresa M.
Published: May 2017

Cancers arise as the result of somatically acquired changes in the DNA of cancer cells. However, in addition to the mutations that confer a growth advantage, cancer genomes accumulate a large number of somatic mutations resulting from normal DNA damage and repair processes as well as mutations triggered by carcinogenic exposures or cancer related aberrations of DNA mainte-nance machinery. These mutagenic processes often produce characteristic mutational patterns called mutational signatures. Decomposition of cancer’s mutation catalog into mutations consistent with such signatures can provide valuable information about cancer etiology. However, the results from diﬀerent decomposition methods are not always consistent. Hence, one needs to not only be able to decompose a patient’s mutational profile into signatures but also to establish the accuracy of such decomposition. We proposed two complementary ways of measuring confidence and stability of decomposition results and applied them to analyze mutational signatures in breast cancer genomes. We identified very stable and highly unstable signatures, as well as signatures that have been missed altogether. We also provided additional support for the novel signatures. Our results emphasize the importance of assessing the confidence and stability of inferred signature contributions. All tools developed in this paper have been implemented in an R package, calledSignatureEstimation, which is available fromhttps://www.ncbi.nlm.nih.gov/CBBresearch/Przytycka/index.cgi#signatureestimation.