bluuebunny/crossref_metadata_2025 huggingface dataset:
Colorectal endoscopic submucosal dissection: predictors and neoplasm-related gradients of difficulty
Authors: Iacopini Federico , Saito Yutaka , Bella Antonino , Gotoda Takuji , Rigato Patrizia , Elisei Walter , Montagnese Fabrizio , Iacopini Giampaolo , Costamagna Guido
Published: September 2017

Background and study aim The role of colorectal endoscopic submucosal dissection (ESD) is standardized in Japan and East Asia, but technical difficulties hinder its diffusion. The aim was to identify predictors of difficulty for each neoplasm type.

Methods A competent operator performed all procedures. ESD difficulty was defined as: en bloc with a slow speed (< 0.07 cm2/min; 30 × 30 mm neoplasm in > 90 min), conversion to endoscopic mucosal resection, or resection abandonment. Pre- and intraoperative difficulty variables were defined according to standard criteria, and evaluated separately for the rectum and colon. Difficulty predictors and gradients were evaluated by the multivariate logistic regression model.

Results A total of 140 ESDs were included: 110 in the colon and 30 in the rectum. Neoplasms were laterally spreading tumors – granular type (LST-G) in 85 cases (61 %); the median longer axis was 30 mm (range 15 – 180 mm); a scar was present in 15 cases (11 %). ESD en bloc resection and difficulty rates were 85 % (n = 94) and 35 % (n = 39) in the colon, and 73 % (n = 22) and 50 % (n = 15) in the rectum (P = 0.17 and 0.28, respectively). The scar was the only preoperative predictor of difficulty in the rectum (odds ratio [OR] 12.3, 95 % confidence interval [CI] 1.27 – 118.36), whereas predictors in the colon were: scar (OR 12.7, 95 %CI 1.15 – 139.24), LST – nongranular type (NG) (OR 10.5, 95 %CI 1.20 – 55.14), and sessile polyp morphology (OR 3.1, 95 %CI 1.18 – 10.39). Size > 7 – ≤ 12 cm2 (OR 0.20, 95 %CI 0.06 – 0.74) and operator experience > 120 procedures (OR 0.19, 95 %CI 0.04 – 0.81) were predictors for a easy procedure. No intraoperative predictors of difficulty were identified in the rectum, whereas predictors in the colon were: severe submucosal fibrosis (OR 21.9, 95 %CI 2.11 – 225.64), ineffective submucosal exposure by gravity countertraction (OR 12.3, 95 %CI 2.43 – 62.08), and perpendicular submucosal dissection approach (OR 5.2, 95 %CI 1.07 – 25.03). When experience was /= 90, preoperative gradient of colonic ESD difficulty was the highest for LST-NGs (scar positive and negative up to 47 % and 20 %, respectively), intermediate for sessile polyps with scar (up to 23 %), and the lowest for LST-Gs (< 8 %). Different difficulty gradients between neoplasm types persisted with increasing experience: LST-NG rate up to 14 % after 120 procedures.

Conclusions Colonic and rectal ESD difficulty has qualitative differences. Preoperative predictors should be considered to identify the difficulty gradient of each neoplasm type and the appropriate setting for ESD.
Development and validation of an algorithm to complete colonoscopy using standard endoscopes in patients with prior incomplete colonoscopy
Authors: Rogers Melinda , Gawron Andrew , Grande David , Keswani Rajesh
Published: September 2017

Background and study aims Incomplete colonoscopy may occur as a result of colon angulation (adhesions or diverticulosis), endoscope looping, or both. Specialty endoscopes/devices have been shown to successfully complete prior incomplete colonoscopies, but may not be widely available. Radiographic or other image-based evaluations have been shown to be effective but may miss small or flat lesions, and colonoscopy is often still indicated if a large lesion is identified. The purpose of this study was to develop and validate an algorithm to determine the optimum endoscope to ensure completion of the examination in patients with prior incomplete colonoscopy.

Patients and methods This was a prospective cohort study of 175 patients with prior incomplete colonoscopy who were referred to a single endoscopist at a single academic medical center over a 3-year period from 2012 through 2015. Colonoscopy outcomes from the initial 50 patients were used to develop an algorithm to determine the optimal standard endoscope and technique to achieve cecal intubation. The algorithm was validated on the subsequent 125 patients.

Results The overall repeat colonoscopy success rate using a standard endoscope was 94 %. The initial standard endoscope specified by the algorithm was used and completed the colonoscopy in 90 % of patients.

Conclusions This study identifies an effective strategy for completing colonoscopy in patients with prior incomplete examination, using widely available standard endoscopes and an algorithm based on patient characteristics and reasons for prior incomplete colonoscopy.
Comparison of two fluoroscopic images to ensure efficient scope insertion for biliary intervention in patients with Roux-en-Y hepaticojejunostomy
Authors: Tsutsumi Koichiro , Kato Hironari , Hirao Ken , Mizukawa Sho , Muro Shinichiro , Akimoto Yutaka , Uchida Daisuke , Matsumoto Kazuyuki , Tomoda Takeshi , Horiguchi Shigeru , Yabe Shuntaro , Seki Hiroyuki , Noma Yasuhiro , Yamamoto Naoki , Harada Ryo , Ogawa Tsuneyoshi , Okada Hiroyuki
Published: September 2017

Background and study aims No standard procedure for endoscopic retrograde cholangiopancreatography is available for patients with Roux-en-Y hepaticojejunostomy (RYHJ) with side-to-end hepaticojejunostomy. We therefore explored methods of efficient scope insertion at a hepaticojejunostomy site.

Patients and methods Patients with suspected biliary disease were prospectively enrolled. Based on two fluoroscopic images obtained on scope insertion into each lumen of a two-pronged Roux-en-Y anastomosis, we selected the lumen in which the distal end of the scope progressed toward the patient’s liver or head. The accuracy of this method for selecting the correct lumen leading to the hepaticojejunostomy site was investigated.

Results Of the 33 included patients, successful insertion to the hepaticojejunostomy site was achieved in 32 (97 %), 26 (81 %) of whom had undergone the imaging method. The accuracy of the method was 88 % (23/26). The time required for insertion between the anastomotic site and the hepaticojejunostomy site was shorter when the lumen selection had been correct (13 minutes [7 – 30] (n = 23) vs. 18 minutes [8 – 28] (n = 9); P = 0.95).

Conclusion This method based on two fluoroscopic images was useful for achieving efficient scope insertion in patients with RYHJ.

Trial registered at University Hospital Medical Information Network Clinical Trials Registry (UMIN000014183).
Negative Effekte von Psychotherapie: Häufigkeit und Korrelate in einer klinischen Stichprobe
Authors: Abeling Britta , Müller Astrid , Stephan Michael , Pollmann Iris , de Zwaan Martina
Published: September 2017

Einleitung Die Häufigkeit negativer Effekte von Psychotherapie und die Korrelate ihrer Anzahl wurden bislang selten systematisch untersucht. Die Häufigkeit negativer Effekte variiert zwischen 3 Studien mit dem Inventar zur Erfassung negativer Effekte von Psychotherapie (INEP) mit 20, 84 und 93,8% erheblich. Ob Bias-Effekte daran beteiligt waren, bleibt ungeklärt. Diese Studie hatte daher zum Ziel, die Häufigkeit negativer Effekte mit dem INEP in einer konsekutiven Stichprobe zu erheben. Zudem sollten in Vorstudien berichtete Korrelate der Anzahl negativer Effekte überprüft und um weitere mögliche Korrelate ergänzt werden.

Material und Methoden Eine klinische Stichprobe (teil)stationärer Patienten (N=200) beurteilte die letzte Psychotherapie vor der aktuellen Behandlung retrospektiv mit dem INEP, das anhand von 21 Items 6 Dimensionen negativer Effekte abbildet. Soziodemografische und klinische Daten der Patienten und Therapeuten sowie zeitliche und methodische Aspekte der Therapie wurden als mögliche Korrelate der Anzahl negativer Effekte untersucht.

Ergebnisse 70,5% (n=141) der Patienten berichtete über mind. einen negativen Therapieeffekt (INEP: MW=2,11; SD=2,23) in ihrer letzten Psychotherapie. Am häufigsten wurden „längere Phasen in schlechter psychischer Verfassung“ (39,9%) und „Verletztheit durch Aussagen des Therapeuten“ (28%) angegeben. Eine höhere Symptombelastung, ein als gering eingeschätzter „allgemeiner Therapieerfolg“ und „unerfüllte Therapieerwartungen“ nicht aber die „Qualität der therapeutischen Beziehung“ waren mit einer höheren Anzahl an negativen Effekten assoziiert. Eine negative Assoziation konnte auch für weibliches Geschlecht sowohl bei Patienten als auch Therapeuten und ein jüngeres Therapeutenalter gefunden werden.

Diskussion Die Häufigkeit von selbst berichteten negativen Therapieeffekten war nicht unerheblich. Am häufigsten betroffen waren übereinstimmend mit Vorstudien die INEP-Dimensionen „Symptomatik“ und „therapeutische Beziehung“. Die Studie konnte einige Korrelate für die Anzahl retrospektiv angegebener negativer Effekte bestätigen. Patienten sollten zu Beginn einer Psychotherapie über mögliche negative Effekte informiert werden.
Neue Untersuchungsmöglichkeiten in der Beurteilung retinaler Arterienverschlüsse mittels OCT-Angiografie
Authors: Loidl Max , Enders Christian , Werner Jens , Lang Gerhard , Lang Gabriele
Published: September 2017

Hintergrund Retinale Arterienverschlüsse (RAV) stellen die häufigsten primären Gefäßerkrankungen der Netzhaut dar. Sie treten mit einer Inzidenz von 0,01 – 0,15% jedoch insgesamt selten auf. Meist entsteht ein irreversibler Netzhautschaden, der mit einer schlechten Visusprognose einhergeht. Bereits seit der Entwicklung in den 1960er-Jahren stellt die FA (Fluoreszenzangiografie) das Standardverfahren zur Diagnosesicherung bei RAV dar. Im Bereich der Diagnostik zeigte sich zuletzt nur wenig Fortschritt. Mit der Einführung der OCT-Angiografie (OCT-A) hat aktuell ein neues, multimodales, nicht invasives Bildgebungsverfahren Einzug gefunden.

Patienten/Methoden Zur Anwendung kam die AngioPlex®-OCT-A-Technologie von Zeiss in Kombination mit dem CIRRUS™ HD-OCT 5000 (Carl Zeiss Meditec, Inc., Dublin, USA). Es wurden 6 × 6-mm- und 3 × 3-mm-Volumenscans im Verschlussgebiet erstellt. Segmentierungen zwischen den einzelnen Netzhautschichten ermöglichen eine En-face-Darstellung des Gefäßsystems in beliebiger Tiefe. Die Perfusionsanalyse des untersuchten Netzhautareals erfolgte qualitativ anhand einer Beurteilung des superfiziellen und tiefen Kapillarplexus. Anhand von 4 Fallbeispielen soll die Anwendbarkeit bei RAV sowie deren typische Befunde in der OCT-A gezeigt werden.

Ergebnisse Die OCT-A eignet sich gut dafür, die durch retinale Arterienverschlüsse hervorgerufenen ischämischen Bereiche darzustellen. Hinsichtlich einer vorliegenden Durchblutungsstörung können sich Verteilungsunterschiede im superfiziellen und tiefen kapillären Gefäßplexus finden. Sowohl bei akuten als auch chronischen Arterienverschlüssen liefert die OCT-A wichtige Informationen über die Perfusion.

Schlussfolgerung Die OCT-A kann bei Patienten mit akutem oder chronischem retinalen Zentralarterien- oder Arterienastverschluss eingesetzt werden. Die OCT-A stellt ein äußerst vielversprechendes, innovatives bildgebendes Verfahren dar und eignet sich zur Diagnosestellung von akuten und chronischen RAV. Im klinischen Einsatz sind vor allem der nicht invasive Charakter und die rasche Durchführbarkeit von Vorteil. Auch wenn auftretende Artefakte und das aktuell noch eingeschränkte Sichtfeld eine Herausforderung bei der Interpretation darstellen, so scheint gerade hinsichtlich RAV die OCT-A die FA in Zukunft bei der Diagnostik häufig ersetzen zu können.
OCT-Angiografie bei exsudativer AMD mit vaskularisierter Pigmentepithelabhebung
Authors: Gunnemann Frederic , Rothaus Kai , Farecki Marie-Louise , Faatz Henrik , Book Benedikt , Lommatzsch Albrecht , Pauleikhoff Daniel
Published: September 2017

Hintergrund Ziel der vorliegenden erweiterten Fallbeschreibung ist die Darstellung choroidaler Neovaskularisationen (CNV) bei vaskularisierten Pigmentepithelabhebungen (PE-Abhebung) initial und unter Anti-VEGF-Therapie mittels OCT-Angiografie (OCT-A) im Vergleich zur konventionellen Diagnostik. CNV-Größe und Flow-Areal wurden in der OCT-A quantifiziert und diese Befunde mit anderen SD-OCT-Charakteristika der Läsion verglichen.

Patienten und Methode Bei 8 Patienten mit vaskularisierter PE-Abhebung wurde zusätzlich zur konventionellen Bildgebung eine OCT-A (Avanti, Optovue) durchgeführt. Auf diesen Aufnahmen wurde mit einer zum retinalen Pigmentepithel parallelen (RPE-parallel) Segmentierung das CNV-Areal manuell umgrenzt und die Größe sowie der Gefäßanteil (Flow-Areal) initial und nach der durchgeführten Anti-VEGF-Therapie ausgemessen. Gleichzeitig wurden der Visus (logMAR) und im SD-OCT die Höhe der PE-Abhebung und die NH-Dicke im Verlauf bestimmt und statistisch verglichen.

Ergebnisse Initial zeigte die Größe der CNV in der OCT-A eine große phänotypische Variationsbreite (0,33 – 1,35 mm2; Mittel 0,71 mm2) mit signifikanter Abnahme unter Therapie (0,44 – 0,84 mm2; Mittel 0,57 mm2; p = 0,02). Das Flow-Areal variierte ebenso initial (0,21 – 0,88 mm2; Mittel 0,45 mm2) und reduzierte sich unter Therapie (nach Therapie 0,08 – 0,44 mm2; Mittel 0,27 mm2; p = 0,07). Die Höhe der PE-Abhebung im SD-OCT war initial unterschiedlich (initial 274 – 1459 µm; Mittel 607 µm), zeigte unter Therapie aber nur eine geringe Veränderung (132 – 1317 µm; Mittel 524 µm; p = 0,09). Dies galt ebenso für die mittlere Netzhautdicke (vor der Therapie 315 µm, nach der Therapie 294 µm; p = 0,5). Der Visus verbesserte sich nach der Therapie im Mittel von initial 0,51 auf 0,45 logMAR ebenfalls nur gering (p = 0,7).

Schlussfolgerungen Die Kombination aus SD-OCT und OCT-A ermöglicht eine verbesserte Darstellung und Quantifizierung von CNV-Arealen bei vaskularisierten PE-Abhebungen. Hierdurch können Veränderungen in der Perfusion und Größe der CNV quantifiziert werden. Dies könnte neben den retinalen Aktivitätszeichen eine 2. Aktivitätsbeurteilung des CNV-Anteils unter einer Anti-VEGF-Therapie ergeben. Aufgrund der dreidimensionalen Grundstruktur können insbesondere bei diesem Subtyp der exsudativen AMD zukünftige dreidimensionale Darstellungsmöglichkeiten sowohl des strukturellen SD-OCT als auch der OCT-A von großer Bedeutung sein.
Editorial to Driving Ability and Psychotropic Drugs
Authors: Laux Gerd , Bauer Michael
Published: September 2017

Pharmacoepidemiological data show the highly frequent use of psychotropic drugs. According to the „Arzneiverordnungs-Report“ psychotropic drugs range second among the most prescribed medicines in Germany with antidepressants being the dominating class by far 1. Modern societies demand a high grade of mobility, driving a car is vital for the functional autonomy of patients to take part in activities of daily living and are frequently obligatory for many professions. Psychiatric illness and psychopharmacological treatments may impair driving ability 2
3
4
5
6forreview]. Therefore, road safety under psychotropic treatment is of high societal relevance, and the reason for highlighting this rarely covered field of psychopharmacology in this special issue of Pharmacopsychiatry.
Storytelling and evidence-based policy: lessons from the grey literature
Authors: Davidson Brett
Published: September 2017

A number of authors interested in how to translate evidence into policy identify the importance of policy narrative and argue that advocates of scientific evidence need to tell good stories to grab the attention and appeal to the emotions of policymakers. Yet, this general call for better narratives is incomplete without concrete examples and evidence of their effectiveness. This article shows how these processes are described in the “grey” literature—defined as literature which is produced by all levels of government, academics, business and industry, but which is not controlled by commercial publishers. This literature is often missed by scientists but more important to activists and advocates within social movements and the non-profit sector who frequently engage with or seek to influence policymakers. The article outlines some of the ways in which an understanding of policymaker psychology and factors such as group dynamics and political context are reflected in the grey literature, and the implications of this for understanding the role of storytelling in political advocacy. It highlights practical advice about storytelling that emerges from the literature, and presents four case studies illustrating aspects of storytelling in action. It concludes by identifying the implications for scientists and other advocates of “evidence informed policymaking”, practitioners and policymakers.
Boosting surface charge-transfer doping efficiency and robustness of diamond with WO3 and ReO3
Authors: Tordjman Moshe , Weinfeld Kamira , Kalish Rafi
Published: September 2017

An advanced charge-transfer yield is demonstrated by employing single monolayers of transition-metal oxides—tungsten trioxide (WO3) and rhenium trioxide (ReO3)—deposited on the hydrogenated diamond surface, resulting in improved p-type sheet conductivity and thermal stability. Surface conductivities, as determined by Hall effect measurements as a function of temperature for WO3, yield a record sheet hole carrier concentration value of up to 2.52 × 1014 cm−2 at room temperature for only a few monolayers of coverage. Transfer doping with ReO3 exhibits a consistent narrow sheet carrier concentration value of around 3 × 1013 cm−2, exhibiting a thermal stability of up to 450 °C. This enhanced conductivity and temperature robustness exceed those reported for previously exposed surface electron acceptor materials used so far on a diamond surface. X-ray photoelectron spectroscopy measurements of the C1s core level shift as a function of WO3 and ReO3 layer thicknesses are used to determine the respective increase in surface band bending of the accumulation layers, leading to a different sub-surface two-dimensional hole gas formation efficiency in both cases. This substantial difference in charge-exchange efficiency is unexpected since both surface acceptors have very close work functions. Consequently, these results lead us to consider additional factors influencing the transfer doping mechanism. Transfer doping with WO3 reveals the highest yet reported transfer doping efficiency per minimal surface acceptor coverage. This improved surface conductivity performance and thermal stability will promote the realization of 2D diamond-based electronic devices facing process fabrication challenges.
A diffusive atmospheric pressure glow discharge in a coaxial pin-to-ring gap with a transverse magnetic field
Authors: Wang YongSheng , Ding WeiDong , Yan JiaQi , Wang YaNan
Published: September 2017

Atmospheric pressure glow discharge (APGD) has been widely used in the industrial field. The industrial applications are based on achieving stable and diffusive APGD in a relatively large space. The existing sources only achieved stable and diffusive APGD between a short inter-electrode distance within 5 millimeters. In this paper, the effect of a transverse stationary magnetic field on the diffusion of filamentary APGD was studied in a pin-to-ring coaxial gap. The APGD was driven by a high-voltage resonant power supply, and the stationary magnetic field was supplied by a permanent magnet. The stable and diffusive APGD was achieved in the circular area, which diameter was 20 millimeters. The experimental results revealed that more collision ionization occurred and the plasma was distributed diffusively in the discharge gap by applying the external transverse magnetic field. Besides, it is likely to obtain more stable and diffusive APGD in the coaxial pin-to-ring discharge gap when adjusting the input voltage, transverse magnetic flux density and resonant frequency of the power supply.
Broadband and high-efficiency circular polarizer based on planar-helix chiral metamaterials
Authors: Wang Jiang , Shen Zhongxiang , Wu Wen
Published: September 2017

We reveal a broadband and high-efficiency circular polarizer based on chiral metamaterials composed of an array of planar helices, which can effectively reject the incident left-hand circularly polarized (LCP) wave, while allowing the right-hand circularly polarized (RCP) wave to pass through it. The physical mechanism of the proposed circular polarizer is explained with the aid of the current distributions under the excitations of LCP and RCP waves. Microwave experiments are performed to verify this idea, and measured results are in good agreement with the numerical ones. Experimental results show that a fractional bandwidth of 75.6% for the transmittance of the LCP wave lower than 0.2 can be obtained. Moreover, the proposed circular polarizer exhibits a high transmittance of over 0.9 for the RCP incident wave and a high circular polarization selection efficiency of over 0.95. The proposed circular polarizer will be potentially very useful for satellite and optical communications.
Effect of soda lime flux on evaluation of the critical cooling rate of Pd82Si18 amorphous ribbon
Authors: Wang Xutong , Tian Zhuang , Zeng Mo , Nollmann Niklas , Wilde Gerhard , Tang Chengying
Published: September 2017

Herein, we propose an experimental method based on the Barandiaran–Colmenero relation for evaluating the critical cooling rate (Rc) of Pd82Si18 amorphous ribbon. In this method, to determine the inherent Rc of glass ribbon, heterogeneous nucleation is suppressed during the differential scanning calorimeter measurement process by adding soda lime flux. The Rc values of Pd82Si18 amorphous ribbon were determined before and after soda lime treatment. The experimental results indicate that the Rc values of the treated and non-treated ribbon are 10.27 and 148.39 K/s, respectively. The Rc value of the treated sample is in good agreement with a previous experimental result. Johnson’s relation gives Rc = 22.86 K/s, which confirms the validity of the present results. The results indicate that soda lime flux greatly suppresses heterogeneous nucleation during the measurement process and the inherent Rc of Pd82Si18 is revised. This method provides a new way for evaluating the critical cooling rate by suppressing heterogeneous nucleation.
High temperature gradient nanogap-Pirani micro-sensor with maximum sensitivity around atmospheric pressure
Authors: Ghouila-Houri C. , Talbi A. , Viard R. , Moutaouekkil M. , Elmazria O. , Gallas Q. , Garnier E. , Merlen A. , Pernod P.
Published: September 2017

This letter describes and discusses the design and testing of an efficient nanogap Pirani micro-sensor for pressure measurements in a wide range with a maximum sensitivity around atmospheric pressure. The structure combines a substrate-free heated wire and a mechanical support made of silicon oxide micro-bridges allowing both a constant nanoscale gap between the wire and the substrate and a 1 mm long and 3 μm wide wire. The high aspect ratio of the wire provides a uniform heating profile along the wire and contributes to low pressure detection. On the contrary, both the nanoscale gap and the short wire length between two micro-bridges contribute to shift the high limit of the pressure range. When tested between 10 kPa and 800 kPa, the sensor presents a wide measurement range, not fully reached by the experiments, with a maximum of sensitivity close to the atmospheric pressure and performances with up to 38%/dec sensitivity when operating in a constant temperature mode with an overheat of 20 °C.
An experimental study of the dynamics of librating bodies
Authors: Lugo Ryan
Published: September 2017

Russian researchers study and present findings regarding the dynamics of librating bodies – bodies with rotational oscillations.
Synthesis of Star Polymers by RAFT Polymerization as Versatile Nanoparticles for Biomedical Applications
Authors: Hu Jinming , Qiao Ruirui , Whittaker Michael R. , Quinn John F. , Davis Thomas P.
Published: September 2017

The precise control of polymer chain architecture has been made possible by developments in polymer synthesis and conjugation chemistry. In particular, the synthesis of polymers in which at least three linear polymeric chains (or arms) are tethered to a central core has yielded a useful category of branched architecture, so-called star polymers. Fabrication of star polymers has traditionally been achieved using either a core-first technique or an arm-first approach. Recently, the ability to couple polymeric chain precursors onto a functionalized core via highly efficient coupling chemistry has provided a powerful new methodology for star synthesis. Star syntheses can be implemented using any of the living polymerization techniques using ionic or living radical intermediates. Consequently, there are innumerable routes to fabricate star polymers with varying chemical composition and arm numbers. In comparison with their linear counterparts, star polymers have unique characteristics such as low viscosity in solution, prolonged blood circulation, and high accumulation in tumour regions. These advantages mean that, far beyond their traditional application as rheology control agents, star polymers may also be useful in the medical and pharmaceutical sciences. In this account, we discuss recent advances made in our laboratory focused on star polymer research ranging from improvements in synthesis through to novel applications of the product materials. Specifically, we examine the core-first and arm-first preparation of stars using reversible addition–fragmentation chain transfer (RAFT) polymerization. Further, we also discuss several biomedical applications of the resulting star polymers, particularly those made by the arm-first protocol. Emphasis is given to applications in the emerging area of nanomedicine, in particular to the use of star polymers for controlled delivery of chemotherapeutic agents, protein inhibitors, signalling molecules, and siRNA. Finally, we examine possible future developments for the technology and suggest the further work required to enable clinical applications of these interesting materials.
Internal Energy Deposition in Dielectric Barrier Discharge Ionization is Significantly Lower than in Direct Analysis in Real-Time Mass Spectrometry
Authors: Dumlao Morphy , Khairallah George N. , Donald W. Alexander
Published: September 2017

The extent of internal energy deposition using three different plasma-based ionization mass spectrometry (MS) methods, atmospheric pressure chemical ionization (APCI), direct analysis in real time (DART), and active capillary dielectric barrier discharge ionization (DBDI), was investigated using benzylammonium ‘thermometer’ ions. Ions formed by DBDI were activated significantly less than those that were formed by DART and APCI under these conditions. Thermal ion activation by DART can be reduced slightly by positioning the DART source further from the capillary entrance to the MS and reducing the heat that is applied to metastable atoms exiting the DART source. For example, the average ion internal energy distribution decreased by less than 10 % (166.9 ± 0.3 to 152.2 ± 1.0 kJ mol−1) when the distance between the DART source and the MS was increased by 250 % (10 to 25 mm). By lowering the DART temperature from 350 to 150°C, the internal energy distributions of the thermometer ions decreased by ~15 % (169.93 ± 0.83 to 150.21 ± 0.52 kJ mol−1). Positioning the DART source nozzle more than 25 mm from the entrance to the MS and decreasing the DART temperature further resulted in a significant decrease in ion signal. Thus, varying the major DART ion source parameters had minimal impact on the ‘softness’ of the DART ion source under these conditions. Overall, these data indicate that DBDI can be a significantly ‘softer’ ion source than two of the most widely used plasma-based ion sources that are commercially available.
New evidence on the impact of sustained exposure to air pollution on life expectancy from China’s Huai River Policy
Authors: Ebenstein Avraham , Fan Maoyong , Greenstone Michael , He Guojun , Zhou Maigeng
Published: September 2017

Significance

An estimated 4.5 billion people are currently exposed to particulate matter (PM) levels at least twice the concentration that the WHO considers safe. Existing evidence linking health to air pollution is largely based on populations exposed to only modest levels of PM and almost entirely composed of observational studies, which are likely to confound air pollution with other unobserved determinants of health. This study uses quasiexperimental variation in particulate matter smaller than 10 μm (PM
10
) generated by an arbitrary Chinese policy to find that a 10-μg/m
3
increase in PM
10
reduces life expectancy by 0.64 years. The estimates imply that bringing all of China into compliance with its Class I standards for PM
10
would save 3.7 billion life-years.
Dysregulation of spliceosome gene expression in advanced prostate cancer by RNA-binding protein PSF
Authors: Takayama Ken-ichi , Suzuki Takashi , Fujimura Tetsuya , Yamada Yuta , Takahashi Satoru , Homma Yukio , Suzuki Yutaka , Inoue Satoshi
Published: September 2017

Significance

Elevated downstream signals of androgen receptor (AR) and its variants are important for prostate cancer progression. We show that an RNA-binding transcriptional and splicing factor, splicing factor proline and glutamine-rich (PSF/SFPQ), predicts worse prognosis of prostate cancer patients. Inhibition of PSF expression repressed treatment-resistant prostate tumor growth in our animal model. Our global analysis of PSF-binding RNAs revealed that PSF enhances AR-regulated genes and noncoding RNAs associated with prostate cancer progression. Interestingly, various splicing factors, which are primary targets of PSF, are upregulated in metastatic prostate tumors. These enhanced factors form complexes with PSF to promote AR expression and splicing. Our findings suggest a role of RNA-binding protein for AR activation for prostate cancer progression.
Acidophilic green algal genome provides insights into adaptation to an acidic environment
Authors: Hirooka Shunsuke , Hirose Yuu , Kanesaki Yu , Higuchi Sumio , Fujiwara Takayuki , Onuma Ryo , Era Atsuko , Ohbayashi Ryudo , Uzuka Akihiro , Nozaki Hisayoshi , Yoshikawa Hirofumi , Miyagishima Shin-ya
Published: September 2017

Significance

Extremely acidic environments are scattered worldwide, and their ecosystems are supported by acidophilic microalgae as primary producers. To understand how acidophilic algae evolved from their respective neutrophilic ancestors, we determined the draft genome sequence of the acidophilic green algaChlamydomonas eustigmaand performed comparative genome analyses betweenC.eustigmaand its neutrophilic relativeChlamydomonas reinhardtii. The results suggest that higher expression of heat-shock proteins and H+-ATPase, loss of some metabolic pathways that acidify cytosol, and acquisition of metal-detoxifying genes by horizontal gene transfer have played important roles in the adaptation to acidic environments. These features are also found in other acidophilic green and red algae, suggesting the existence of common mechanisms in the adaptation to acidic environments.
Prestige auditing and the market for academic esteem: a framework and an appeal
Authors: Elliott J. E.
Published: September 2017

Much has been written about the remarkable rise of global university rankings from their initial appearance in the Academic Ranking of World Universities (Shanghai) tables in 2003. The examination of all things rankings, however, has arguably outpaced its conceptual uptake. This paper addresses this imbalance by reviewing prestige audits as resource management tools and status allocation measures. The paper argues that audit ambition has courted audit failure in both dimensions. The resource management justification underestimates the challenge of devising reliable proxy variables across international higher education sectors, organizational types, and disciplinary/departmental objectives. Evidential data sets are duly recast as data narratives that compete with each other and cloud the ordinal clarity aspired to in ranking tables. The status competition approach generates Matthew effects and encourages factor gaming. Positional goods investments are also socially and economically wasteful. In either strict (rigid) or relaxed (normed) form, finally, their zero-sum logic fails to account for private and public externalities. The paper closes with an appeal to soft-variable evaluations in higher education contexts as well as to closer scrutiny of the vocabulary informing both quantitative and qualitative assessments.
Poor metacognitive awareness of belief change
Authors: Wolfe Michael B , Williams Todd J
Published: September 2017

When people change beliefs as a result of reading a text, are they aware of these changes? This question was examined for beliefs about spanking as an effective means of discipline. In two experiments, subjects reported beliefs about spanking effectiveness during a prescreening session. In a subsequent experimental session, subjects read a one-sided text that advocated a belief consistent or inconsistent position on the topic. After reading, subjects reported their current beliefs and attempted to recollect their initial beliefs. Subjects reading a belief inconsistent text were more likely to change their beliefs than those who read a belief consistent text. Recollections of initial beliefs tended to be biased in the direction of subjects’ current beliefs. In addition, the relationship between the belief consistency of the text read and accuracy of belief recollections was mediated by belief change. This belief memory bias was independent of on-line text processing and comprehension measures, and indicates poor metacognitive awareness of belief change.
Heterodimeric capping protein is required for stereocilia length and width regulation
Authors: Avenarius Matthew R. , Krey Jocelyn F. , Dumont Rachel A. , Morgan Clive P. , Benson Connor B. , Vijayakumar Sarath , Cunningham Christopher L. , Scheffer Deborah I. , Corey David P. , Müller Ulrich , Jones Sherri M. , Barr-Gillespie Peter G.
Published: September 2017

Control of the dimensions of actin-rich processes like filopodia, lamellipodia, microvilli, and stereocilia requires the coordinated activity of many proteins. Each of these actin structures relies on heterodimeric capping protein (CAPZ), which blocks actin polymerization at barbed ends. Because dimension control of the inner ear’s stereocilia is particularly precise, we studied the CAPZB subunit in hair cells. CAPZB, present at ∼100 copies per stereocilium, concentrated at stereocilia tips as hair cell development progressed, similar to the CAPZB-interacting protein TWF2. We deleted Capzb specifically in hair cells using Atoh1-Cre, which eliminated auditory and vestibular function. Capzb-null stereocilia initially developed normally but later shortened and disappeared; surprisingly, stereocilia width decreased concomitantly with length. CAPZB2 expressed by in utero electroporation prevented normal elongation of vestibular stereocilia and irregularly widened them. Together, these results suggest that capping protein participates in stereocilia widening by preventing newly elongating actin filaments from depolymerizing.
Autism-like behavior caused by deletion of vaccinia-related kinase 3 is improved by TrkB stimulation
Authors: Kang Myung-Su , Choi Tae-Yong , Ryu Hye Guk , Lee Dohyun , Lee Seung-Hyun , Choi Se-Young , Kim Kyong-Tai
Published: September 2017

Vaccinia-related kinases (VRKs) are multifaceted serine/threonine kinases that play essential roles in various aspects of cell signaling, cell cycle progression, apoptosis, and neuronal development and differentiation. However, the neuronal function of VRK3 is still unknown despite its etiological potential in human autism spectrum disorder (ASD). Here, we report that VRK3-deficient mice exhibit typical symptoms of autism-like behavior, including hyperactivity, stereotyped behaviors, reduced social interaction, and impaired context-dependent spatial memory. A significant decrease in dendritic spine number and arborization were identified in the hippocampus CA1 of VRK3-deficient mice. These mice also exhibited a reduced rectification of AMPA receptor–mediated current and changes in expression of synaptic and signaling proteins, including tyrosine receptor kinase B (TrkB), Arc, and CaMKIIα. Notably, TrkB stimulation with 7,8-dihydroxyflavone reversed the altered synaptic structure and function and successfully restored autism-like behavior in VRK3-deficient mice. These results reveal that VRK3 plays a critical role in neurodevelopmental disorders and suggest a potential therapeutic strategy for ASD.
Using satellite data to identify the causes of and potential solutions for yield gaps in India’s Wheat Belt
Authors: Jain M , Singh Balwinder , Srivastava A A K , Malik R K , McDonald A J , Lobell D B
Published: September 2017

Food security will be increasingly challenged by climate change, natural resource degradation, and population growth. Wheat yields, in particular, have already stagnated in many regions and will be further affected by warming temperatures. Despite these challenges, wheat yields can be increased by improving management practices in regions with existing yield gaps. To identify the magnitude and causes of current yield gaps in India, one of the largest wheat producers globally, we produced 30 meter resolution yield maps from 2001 to 2015 across the Indo-Gangetic Plains (IGP), the nation’s main wheat belt. Yield maps were derived using a new method that translates satellite vegetation indices to yield estimates using crop model simulations, bypassing the need for ground calibration data. This is one of the first attempts to apply this method to a smallholder agriculture system, where ground calibration data are rarely available. We find that yields can be increased by 11% on average and up to 32% in the eastern IGP by improving management to current best practices within a given district. Additionally, if current best practices from the highest-yielding state of Punjab are implemented in the eastern IGP, yields could increase by almost 110%. Considering the factors that most influence yields, later sow dates and warmer temperatures are most associated with low yields across the IGP. This suggests that strategies to reduce the negative effects of heat stress, like earlier sowing and planting heat-tolerant wheat varieties, are critical to increasing wheat yields in this globally-important agricultural region.
Effect of Transfusion on Mortality and Other Adverse Events Among Critically Ill Septic Patients: An Observational Study Using a Marginal Structural Cox Model*
Authors: Dupuis Claire , Garrouste-Orgeas Maité , Bailly Sébastien , Adrie Christophe , Goldgran-Toledano Dany , Azoulay Elie , Ruckly Stéphane , Marcotte Guillaume , Souweine Bertrand , Darmon Michael , Cohen Yves , Schwebel Carole , Lacave Guillaume , Bouadma Lila , Timsit Jean-Francois
Published: September 2017

Objectives:

RBC transfusion is often required in patients with sepsis. However, adverse events have been associated with RBC transfusion, raising safety concerns. A randomized controlled trial validated the 7 g/dL threshold, but previously transfused patients were excluded. Cohort studies led to conflicting results and did not handle time-dependent covariates and history of treatment. Additional data are thus warranted to guide patient’s management.

Design:

To estimate the effect of one or more RBC within 1 day on three major outcomes (mortality, ICU-acquired infections, and severe hypoxemia) at day 30, we used marginal structural models. A trajectory modeling, based on hematocrit evolution pattern, allowed identification of subgroups. Secondary analyses were performed into each of them.

Setting:

A prospective French multicenter database.

Patients:

Patients with sepsis at admission. Patients with hemorrhagic shock at admission were excluded.

Interventions:

None.

Measurements and Main Results:

Overall, in our cohort of 6,016 patients, RBC transfusion was not associated with death (hazard ratio, 1.07; 95% CI, 0.88–1.30; p = 0.52). However, RBC transfusion was associated with increased occurrence of ICU-acquired infections (hazard ratio, 2.77; 95% CI, 2.33–3.28; p < 0.01) and of severe hypoxemia (hazard ratio, 1.29; 95% CI, 1.14–1.47; p < 0.01). A protective effect from death by the transfusion was found in the subgroup with the lowest hematocrit level (26 [interquartile range, 24–28]) (hazard ratio, 0.72; 95% CI, 0.55–0.95; p = 0.02).

Conclusions:

RBC transfusion did not affect overall mortality in critically ill patients with sepsis. Increased occurrence rate of ICU-acquired infection and severe hypoxemia are expected outcomes from RBC transfusion that need to be weighted with its benefits in selected patients.
Patient Characteristics and Prevalence of Unplanned Postoperative Pediatric Intensive Care Unit Admissions
Authors: McHenry Amy , Forbes Michael , Brown Mira
Published: September 2017

Objectives:

The aim of this study was to identify the prevalence of unplanned postoperative pediatric intensive care unit (PICU) admissions (UPPAs) and associated patient characteristics.

Design:

A retrospective, descriptive study at a single institution was conducted from January 1, 2011, to December 31, 2014. Trauma, medical, and weekend admissions were excluded. In addition, cardiac, orthopedic, and urology surgical admissions were excluded. A derived disability level was calculated using the baseline Pediatric Overall and Cognitive Performance Criteria. Mortality risk and acuity scores were compared between UPPAs and planned PICU admissions (PPAs). Outcomes as a function of patient origin (operating room [OR], postanesthesia care unit [PACU], and acute care floor [ACF]) and surgical services were compared.

Setting:

This study was conducted in a free-standing, tertiary care children's hospital.

Patients:

Patients admitted to the PICU within 24 hours following an operative procedure.

Measurements and Main Results:

There were 158 (34%) UPPAs. Compared with postoperative PPAs, UPPAs had higher acuity and mortality scores (p < .05). UPPAs were highest from the OR (58%), followed by those from the PACU (PACU-UPPA, 27%) and ACF (13%). There was no difference in the odds of UPPAs from the OR among surgical services. There was increased odds of PACU-UPPA after otolaryngology (odds ratio = 1.15, p < .0001) and pediatric surgery (odds ratio = 2.19, p < .0001) and the presence of disability (odds ratio = 3.67, p = .011). None of the variables were associated with UPPAs from the ACF.

Conclusions:

This study identified surgical services and moderate disability as independent risk factors for UPPA. PACU-UPPA may represent an improvement opportunity. It is feasible to derive a risk stratification model for UPPA.
Two Innovative Cancer Care Programs Have Potential to Reduce Utilization and Spending
Authors: Colligan Erin M. , Ewald Erin , Keating Nancy L. , Parashuram Shriram , Spafford Michelle , Ruiz Sarah , Moiduddin Adil
Published: September 2017

Background:

Cancer patients often present to the emergency department (ED) and hospital for symptom management, but many of these visits are avoidable and costly.

Objective:

We assessed the impact of 2 Health Care Innovation Awards that used an oncology medical home model [Community Oncology Medical Home (COME HOME)] or patient navigation model [Patient Care Connect Program (PCCP)] on utilization and spending.

Methods:

Participants in COME HOME and PCCP models were matched to similar comparators using propensity scores. We analyzed utilization and spending outcomes using Medicare fee-for-service claims with unadjusted and adjusted difference-in-differences models.

Results:

In the adjusted models, both COME HOME and PCCP were associated with fewer ED visits than a comparison group (15 and 22 per 1000 patients/quarter, respectively; P<0.01). In addition, COME HOME had lower spending ($675 per patient/quarter; P<0.01), and PCCP had fewer hospitalizations (11 per 1000 patients/quarter; P<0.05), relative to the comparison group. Among patients undergoing chemotherapy, fewer COME HOME and PCCP patients had ED visits (18 and 28 per 1000 patients/quarter, respectively; P<0.01) and fewer PCCP patients had hospitalizations (13 per 1000 patients/quarter; P<0.05), than comparison patients.

Conclusions:

The oncology medical home and patient navigator programs both showed reductions in spending or utilization. Adoption of such programs holds promise for improving cancer care.
Quality of Care in the United States Territories, 1999–2012
Authors: Nuti Sudhakar V. , Wang Yun , Masoudi Frederick A. , Nunez-Smith Marcella , Normand Sharon-Lise T. , Murugiah Karthik , Rodríguez-Vilá Orlando , Ross Joseph S. , Krumholz Harlan M.
Published: September 2017

Background:

Millions of Americans live in the US territories, but health outcomes and payments among Medicare beneficiaries in these territories are not well characterized.

Methods:

Among Fee-for-Service Medicare beneficiaries aged 65 years and older hospitalized between 1999 and 2012 for acute myocardial infarction (AMI), heart failure (HF), and pneumonia, we compared hospitalization rates, patient outcomes, and inpatient payments in the territories and states.

Results:

Over 14 years, there were 4,350,813 unique beneficiaries in the territories and 402,902,615 in the states. Hospitalization rates for AMI, HF, and pneumonia declined overall and did not differ significantly. However, 30-day mortality rates were higher in the territories for all 3 conditions: in the most recent time period (2008–2012), the adjusted odds of 30-day mortality were 1.34 [95% confidence interval (CI), 1.21–1.48], 1.24 (95% CI, 1.12–1.37), and 1.85 (95% CI, 1.71–2.00) for AMI, HF, and pneumonia, respectively; adjusted odds of 1-year mortality were also higher. In the most recent study period, inflation-adjusted Medicare in-patient payments, in 2012 dollars, were lower in the territories than the states, at $9234 less (61% lower than states), $4479 less (50% lower), and $4403 less (39% lower) for AMI, HF, and pneumonia hospitalizations, respectively (P<0.001 for all).

Conclusions and Relevance:

Among Medicare Fee-for-Service beneficiaries, in 2008–2012 mortality rates were higher, or not significantly different, and hospital reimbursements were lower for patients hospitalized with AMI, HF, and pneumonia in the territories. Improvement of health care and policies in the territories is critical to ensure health equity for all Americans.
Secondary Loss of Response to Infliximab in Pediatric Crohn Disease
Authors: Bolia Rishi , Rosenbaum Jeremy , Schildkraut Vered , Hardikar Winita , Oliver Mark , Cameron Donald , Alex George
Published: September 2017

Objectives:

A significant proportion of children with Crohn disease develop a secondary loss of response (LOR) to infliximab. Our aim was to study the impact of initial treatment strategies on secondary LOR.

Methods:

We reviewed the medical records of children with Crohn disease who received scheduled maintenance infliximab therapy for at least 12 months. We compared children who developed LOR with those who did not; with regards to their clinical and laboratory parameters, disease phenotype, and treatment strategy before developing LOR.

Results:

A total of 73 children (median age at diagnosis 11 (2–16) years, 41 boys) who had received a median duration of 33 (13–110) months of infliximab therapy were included in the final analysis. LOR was seen in 25(34.2%). Demographic variables, disease phenotype (age, disease location, and behavior), inflammatory parameters, and pediatric Crohn disease activity index at induction with infliximab were similar between both groups. Children with LOR had a significantly greater number of flares of the disease when compared to those who did not have LOR (4 [1–8] vs 2 [1–5] P = 0.03). The choice of the concomitant immunomodulator—methotrexate (11/29 [37.9%]) versus azathioprine (11/36 [30.5%]) (P = 0.6) did not affect LOR rates. The median time‐lag between diagnosis and induction with infliximab was significantly longer in children with LOR as compared to those who did not have an LOR (28 [4–90] months vs 12.5 [1–121] months, P = 0.004).

Conclusion:

Early use of infliximab in pediatric Crohn disease is associated with a decrease in secondary LOR. The type of concomitant immunomodulator used does not make a difference to LOR rates.