bluuebunny/crossref_metadata_2025 huggingface dataset:
On the tertiary instability formalism of zonal flows in magnetized plasmas
Authors: Rath F. , Peeters A. G. , Buchholz R. , Grosshauser S. R. , Seiferling F. , Weikl A.
Published: May 2018

This paper investigates the so-called tertiary instabilities driven by the zonal flow in gyro-kinetic tokamak core turbulence. The Kelvin Helmholtz instability is first considered within a 2D fluid model and a threshold in the zonal flow wave vector kZF>kZF,c for instability is found. This critical scale is related to the breaking of the rotational symmetry by flux-surfaces, which is incorporated into the modified adiabatic electron response. The stability of undamped Rosenbluth-Hinton zonal flows is then investigated in gyro-kinetic simulations. Absolute instability, in the sense that the threshold zonal flow amplitude tends towards zero, is found above a zonal flow wave vector kZF,cρi≈1.3 (ρi is the ion thermal Larmor radius), which is comparable to the 2D fluid results. Large scale zonal flows with kZF<kZF,c are unstable for sufficiently large amplitudes with increasing trend for an increasing radial scale. However, the critical E × B-shearing rate associated with the stability boundary ωE×B,c exceeds typical values connected to the pure flow state at marginal stability by more than an order of magnitude, which therefore lies deeply in the stable parameter region. Furthermore, the impact of zonal temperature perturbations on the tertiary instability is examined. Although temperature perturbations favor instability, the realistic values of gradient-driven gyro-kinetic simulations still lie deeply in the stable parameter regime. Therefore, the relevance of the tertiary instability as a saturation mechanism to the zonal flow amplitude is questioned, as most of the zonal flow intensity is concentrated in modes satisfying kZF≪kZF,c as well as ωE×B≪ωE×B,c.

At the request of the authors, this article is being retracted effective 11 June 2020.
Nonlinear core deflection in injection molding
Authors: Poungthong P. , Giacomin A. J. , Saengow C. , Kolitawong C. , Liao H.-C. , Tseng S.-C.
Published: May 2018

Injection molding of thin slender parts is often complicated by core deflection. This deflection is caused by molten plastics race tracking through the slit between the core and the rigid cavity wall. The pressure of this liquid exerts a lateral force of the slender core causing the core to bend, and this bending is governed by a nonlinear fifth order ordinary differential equation for the deflection that is not directly in the position along the core. Here we subject this differential equation to 6 sets of boundary conditions, corresponding to 6 commercial core constraints. For each such set of boundary conditions, we develop an explicit approximate analytical solution, including both a linear term and a nonlinear term. By comparison with finite difference solutions, we find our new analytical solutions to be accurate. We then use these solutions to derive explicit analytical approximations for maximum deflections and for the core position of these maximum deflections. Our experiments on the base-gated free-tip boundary condition agree closely with our new explicit approximate analytical solution.
Nascent energy distribution of the Criegee intermediate CH2OO from direct dynamics calculations of primary ozonide dissociation
Authors: Pfeifle Mark , Ma Yong-Tao , Jasper Ahren W. , Harding Lawrence B. , Hase William L. , Klippenstein Stephen J.
Published: May 2018

Ozonolysis produces chemically activated carbonyl oxides (Criegee intermediates, CIs) that are either stabilized or decompose directly. This branching has an important impact on atmospheric chemistry. Prior theoretical studies have employed statistical models for energy partitioning to the CI arising from dissociation of the initially formed primary ozonide (POZ). Here, we used direct dynamics simulations to explore this partitioning for decomposition of c–C2H4O3, the POZ in ethylene ozonolysis. A priori estimates for the overall stabilization probability were then obtained by coupling the direct dynamics results with master equation simulations. Trajectories were initiated at the concerted cycloreversion transition state, as well as the second transition state of a stepwise dissociation pathway, both leading to a CI (H2COO) and formaldehyde (H2CO). The resulting CI energy distributions were incorporated in master equation simulations of CI decomposition to obtain channel-specific stabilized CI (sCI) yields. Master equation simulations of POZ formation and decomposition, based on new high-level electronic structure calculations, were used to predict yields for the different POZ decomposition channels. A non-negligible contribution of stepwise POZ dissociation was found, and new mechanistic aspects of this pathway were elucidated. By combining the trajectory-based channel-specific sCI yields with the channel branching fractions, an overall sCI yield of (48 ± 5)% was obtained. Non-statistical energy release was shown to measurably affect sCI formation, with statistical models predicting significantly lower overall sCI yields (∼30%). Within the range of experimental literature values (35%-54%), our trajectory-based calculations favor those clustered at the upper end of the spectrum.
Phase-locked, high power, mid-infrared quantum cascade laser arrays
Authors: Zhou W. , Slivken S. , Razeghi M.
Published: May 2018

We demonstrate phase-locked, high power quantum cascade laser arrays, which are combined using a monolithic, tree array multimode interferometer, with emission wavelengths around 4.8 μm. A maximum output power of 15 W was achieved from an eight-element laser array, which has only a slightly higher threshold current density and a similar slope efficiency compared to a Fabry-Perot laser of the same length. Calculated multimode interferometer splitting loss is on the order of 0.27 dB for the in-phase supermode. In-phase supermode operation with nearly ideal behavior is demonstrated over the working current range of the array.
High-resolution sub-Doppler infrared spectroscopy of atmospherically relevant Criegee precursor CH2I radicals: CH2 stretch vibrations and “charge-sloshing” dynamics
Authors: Kortyna A. , Lesko D. M. B. , Nesbitt D. J.
Published: May 2018

The combination of a pulsed supersonic slit-discharge source and single-mode difference frequency direct absorption infrared spectroscopy permit first high resolution infrared study of the iodomethyl (CH2I) radical, with the CH2I radical species generated in a slit jet Ne/He discharge and cooled to 16 K in the supersonic expansion. Dual laser beam detection and collisional collimation in the slit expansion yield sub-Doppler linewidths (60 MHz), an absolute frequency calibration of 13 MHz, and absorbance sensitivities within a factor of two of the shot-noise limit. Fully rovibrationally resolved direct absorption spectra of the CH2 symmetric stretch mode (ν2) are obtained and fitted to a Watson asymmetric top Hamiltonian with electron spin-rotation coupling, providing precision rotational constants and spin-rotation tensor elements for the vibrationally excited state. Analysis of the asymmetric top rotational constants confirms a vibrationally averaged planar geometry in both the ground- and first-excited vibrational levels. Sub-Doppler resolution permits additional nuclear spin hyperfine structures to be observed, with splittings in excellent agreement with microwave measurements on the ground state. Spectroscopic data on CH2I facilitate systematic comparison with previous studies of halogen-substituted methyl radicals, with the periodic trends strongly correlated with the electronegativity of the halogen atom. Interestingly, we do not observe any asymmetric CH2 stretch transitions, despite S/N ≈ 25:1 on strongest lines in the corresponding symmetric CH2 stretch manifold. This dramatic reversal of the more typical 3:1 antisymmetric/symmetric CH2 stretch intensity ratio signals a vibrational transition moment poorly described by simple “bond-dipole” models. Instead, the data suggest that this anomalous intensity ratio arises from “charge sloshing” dynamics in the highly polar carbon-iodine bond, as supported by ab initio electron differential density plots and indeed consistent with observations in other halomethyl radicals and protonated cluster ions.
Low-frequency and multiple-bands sound insulation using hollow boxes with membrane-type faces
Authors: Yu Wei-wei , Fan Li , Ma Ren-hao , Zhang Hui , Zhang Shu-yi
Published: May 2018

Hollow boxes with their faces made up of elastic membranes are used to block acoustic waves. It is demonstrated that placing a cuboid membrane-type box inside a pipe can effectively insulate acoustic waves even if the box is smaller than the cross-section of the pipe. The sound insulation is achieved within multiple frequency-bands below 500 Hz based on different mechanisms, which originate from the coaction of the cavity, membrane-type faces, and the intervals between the box and pipe walls. Furthermore, by adjusting the structural parameters and establishing an array of boxes, we can achieve better sound insulation at more frequency-bands.
Tourism security: the evolution of theory.
Authors: Korstanje M. E.
Published: May 2018

This chapter discusses not only the evolution of the tourism literature on terrorism and security but also focuses on the new tactics of modern terrorism. Each generation of academics regarded terrorism in different ways, forging a much deeper collective discourse, which this chapter attempts to unravel.
Rethinking safety issues within the context of pilgrimage routes.
Authors: Fernandes C. , Silva G. , Gómez-Ullate M.
Published: May 2018

The aim of this chapter is to design a conceptual framework based on the tourism system and apply it to religious tourism and pilgrimage. The framework takes into consideration three fundamental aspects: (1) the concept of pilgrimage and the spiritual fulfilment of traditional religious pilgrims; (2) the changing motivations, needs and behaviour of religious pilgrims and the experience-seeking secular pilgrim; and (3) the factors associated with ensuring that the undertaking of such physical and spiritual journeys takes place in the context of safe and secure environments.
Terrorists and the dehumanization of the other.
Authors: Korstanje M. E.
Published: May 2018

This chapter discusses the roots of terrorism and its effects in a globalized world. Firstly, some studies within the main literature are placed under scrutiny. The problems states have in keeping fear under control and avoiding domestic chaos are examined. Secondly, the intersection of Islam and terrorism is examined, in order to expand the current understanding of this issue. Thirdly, the problem of instrumentality, which is ingrained in the Western psyche, is addressed. The nature of terrorism is explored together with its targeting of innocent tourists at religious festivals.
Hospitality, tourism, terrorism: creating a security-conscious culture.
Authors: Peter C.
Published: May 2018

This chapter analyses and examines how the hospitality and tourism industries must work towards creating and ingraining a security-conscious culture where a duty of care towards tourists exists. Possible terrorist targets in tourism are discussed, as well as the different methods of attack.
Pilgrimage: a distinctive practice.
Authors: LeSueur R.
Published: May 2018

Drawing on more than 25 years' experience facilitating programmes of pilgrimage, the author presents a practical philosophical construct for locating pilgrimage within the spectrum of contemporary travel. A model is presented that consists of horizontal and vertical axes creating four quadrants. The horizontal axis represents a continuum between hardship, risk and privation on the right; and ease, comfort and abundance on the left. The vertical axis represents a continuum between immersion in a local culture at the bottom of the diagram, and the choice of isolation from the local culture at the top. The upper-left quadrant represents the traveller who seeks primarily an experience of comfort and rest. This is the realm of the sun holiday, Club Med and cruise ships. The upper-right quadrant represents the realm of adventure tourism where one primarily seeks experiences of risk and adventure in a particular geography. The lower left represents the realm of cultural tourism where the principle aim is to 'see sites', learn history and encounter the local culture, but also be back at a pleasant hotel by 5 o'clock for cocktails. The lower-right quadrant expresses the intent of pilgrimage: one elects to enter an experience of risk, challenge and even hardship over a sustained process of walking, in anticipation of the unknown, but ready to be changed. The lower-right quadrant, the principal focus of this chapter, highlights the nine characteristics that point to the unique domain of pilgrimage.
Medieval pilgrims in modern times: Buñuel's The Milky Way.
Authors: Smith A. T.
Published: May 2018

Luis Buñuel's surrealist film The Milky Way (1969) is posited as a modern pilgrimage to Santiago de Compostela, and it is most often evaluated according to its thematic content or its filmic structure. The film follows two modern pilgrims, Pierre and Jean, as they make their way from Paris to Santiago. Grounded in surrealist film-making practices, the plot ignores conventions of time and space, and the protagonists inexplicably travel across centuries and continents. The film uses the pilgrimage motif as a means of highlighting and examining the principal heresies of the Catholic faith, and the pilgrims Pierre and Jean at times appear to be of peripheral importance as these weighty themes are explored. Pierre and Jean are far from superfluous, however, and although they appear to be quite average 20th-century men, they are in fact emblematic of the pilgrims of the Middle Ages in certain ways. Drawing on examples from the Codex Calixtinus (12th century) and additional documentation of pilgrim life in the Middle Ages, this chapter explores the commonalities that Buñuel's pilgrims from the 1960s share with medieval pilgrims. While contemporary critics have seen Pierre and Jean as reminiscent of Laurel and Hardy, I will consider the similarities between Buñuel's pilgrims and those for whom the Codex Calixtinus was written.
Spain's mystical adventure: walking in the footsteps of Teresa of Ávila.
Authors: Farrelly M.
Published: May 2018

While promoting Huellas de Teresa, a new pilgrimage route opening in October 2014 to commemorate the fifth centenary of Teresa of Ávila's birth, Spain's Interior Minister Jorge Fernando Díaz remarked that he felt sure the saint, 'from above, where she has great power', would ensure the success of the project just as she was interceding for Spain during these 'tough times'. The minister's comments sparked controversy concerning Spain's increasingly blurred lines between church and state and reignited the tension between the country's dual traditions of mystic spirituality and institutionalized religion. Indeed, Teresa's journey has always been one that traces the lines of intersection between these planes. The interior voyage mapped out in her literary work and her physical journeys around Spain as a foundress of convents combine to produce a uniquely dynamic sacred geography, equipped to shift between planes of metaphorical, physical and virtual experience. However, for nearly 40 years the Francoist regime laid claim to both her literary work and the Discalced Carmelite convents that will now form the main attractions along this new route, robbing Teresa's mystical landscape of its polysemic value in order to assimilate it into a more politically useful, monophonic national narrative. Focusing particularly on filmic representations of the Teresian journey, this chapter considers the new Huellas de Teresa tour in the context of the many attempts to restore semantic dynamism and mystic vitality to the Teresian journey since Spain's transition to democracy.
Dreaming of Al-Quds (Jerusalem): pilgrimage and visioning.
Authors: McIntosh I. S.
Published: May 2018

A visioning process pursued by students at Gaza University in a virtual classroom from 2012 to 2014 recognized the potential of pilgrimage to deliver positive outcomes in three critical areas, namely: (i) healing; (ii) marketplace development; and (iii) building a culture of peace. Gaza students were inspired by their shared vision for the future. In 2050 the now forbidden pilgrimage to Al-Quds (Jerusalem) was attracting over 3 million pilgrims from across the Muslim world. This pilgrimage, one of the largest in Islam, was now the cornerstone of a vibrant and sustainable tourist industry in the Gaza Strip, a bridge to interfaith cooperation, and a catalyst for peace in the region. Gaza, in this vision of the future, had itself undergone an astonishing transformation. Its seaport and airport were now among the busiest in the Mediterranean and the gateway for pilgrims and tourists alike. By drawing upon student reflections on the visioning process, and case studies of other pilgrimages - both peace-related and 'forbidden' - this chapter highlights the relationship between this wished-for journey of pilgrims to the sacred centre in Al-Quds and the journey of the Gaza Strip itself from its current state of crisis to its liberation and prosperity.
The land–water nexus: a critical perspective from South Africa
Authors: Marcatelli Michela
Published: May 2018

This article identifies a ‘land–water nexus’ in South Africa, whereby access to water is dependent upon access to land and therefore property relations. It argues that the post-apartheid water reform has strengthened the land–water nexus by causing an overlap of property regimes in water to the benefit of white commercial farmers and by favouring the use of water for accumulation purposes. The case study of the Waterberg is employed to illustrate three specific ways in which the nexus currently manifests, namely water commodification; the tightening of private control over water in private nature conservation; and water access via labour relations.
An integrated model for analysing the effects of ultrasonic vibration on tool torque and thermal processes in friction stir welding
Authors: Shi L. , Wu C. S. , Sun Z.
Published: May 2018

An integrated model of ultrasonic vibration enhanced friction stir welding (UVeFSW) is developed by integrating the thermal-fluid model with the ultrasonic field model and tool torque model. The tool torque and the heat generation rate at tool/workpiece contact interfaces are coupled with the interfacial temperature, strain rate and ultrasonic energy density. The model is used in quantitatively analysing the effects of ultrasonic vibration on tool torque and thermal processes in friction stir welding (FSW). The results show that ultrasonic vibration reduces the flow stress, which results in a decreasing of tool torque, interfacial heat generation rate and interfacial temperature. The complicated interaction of ultrasonic energy with the thermal processes in FSW leads to a gentle thermal gradient and an enhanced plastic material flow in UVeFSW. The model is validated by a comparison of the calculated thermal cycles and tool torque at various welding parameters with the experimentally measured ones.
Autoinhibition of kinesin-1 is essential to the dendrite-specific localization of Golgi outposts
Authors: Kelliher Michael T. , Yue Yang , Ng Ashley , Kamiyama Daichi , Huang Bo , Verhey Kristen J. , Wildonger Jill
Published: May 2018

Neuronal polarity relies on the selective localization of cargo to axons or dendrites. The molecular motor kinesin-1 moves cargo into axons but is also active in dendrites. This raises the question of how kinesin-1 activity is regulated to maintain the compartment-specific localization of cargo. Our in vivo structure–function analysis of endogenous Drosophila melanogaster kinesin-1 reveals a novel role for autoinhibition in enabling the dendrite-specific localization of Golgi outposts. Mutations that disrupt kinesin-1 autoinhibition result in the axonal mislocalization of Golgi outposts. Autoinhibition also regulates kinesin-1 localization. Uninhibited kinesin-1 accumulates in axons and is depleted from dendrites, correlating with the change in outpost distribution and dendrite growth defects. Genetic interaction tests show that a balance of kinesin-1 inhibition and dynein activity is necessary to localize Golgi outposts to dendrites and keep them from entering axons. Our data indicate that kinesin-1 activity is precisely regulated by autoinhibition to achieve the selective localization of dendritic cargo.
Peripheral PDGFRα+gp38+ mesenchymal cells support the differentiation of fetal liver–derived ILC2
Authors: Koga Satoshi , Hozumi Katsuto , Hirano Ken-ichi , Yazawa Masaki , Terooatea Tommy , Minoda Aki , Nagasawa Takashi , Koyasu Shigeo , Moro Kazuyo
Published: May 2018

Group 2 innate lymphoid cells (ILC2s) are derived from common lymphoid progenitors (CLPs) via several specific precursors, and the transcription factors essential for ILC2 differentiation have been extensively studied. However, the external factors regulating commitment to the ILC lineage as well as the sites and stromal cells that constitute the optimal microenvironment for ILC2-specific differentiation are not fully defined. In this study, we demonstrate that three key external factors, the concentration of interleukin 7 (IL-7) and strength and duration of Notch signaling, coordinately determine the fate of CLP toward the T, B, or ILC lineage. Additionally, we identified three stages of ILC2 in the fetal mesentery that require STAT5 signals for maturation: ILC progenitors, CCR9+ ILC2 progenitors, and KLRG1− immature ILC2. We further demonstrate that ILC2 development is supported by mesenteric platelet-derived growth factor receptor α (PDGFRα)+ glycoprotein 38 (gp38)+ mesenchymal cells. Collectively, our results suggest that early differentiation of ILC2 occurs in the fetal liver via IL-7 and Notch signaling, whereas final differentiation occurs in the periphery with the aid of PDGFRα+gp38+ cells.
Reference‐Dependent Hedging: Theory and Evidence from Iowa Corn Producers
Authors: Jacobs Keri L. , Li Ziran , Hayes Dermot J.
Published: May 2018

We develop a theoretical model of optimal hedging that nests expected utility and expected target utility theories. We use this model to characterize optimal hedging with and without reference price dependence. The model's theoretical predictions are tested with a unique database consisting of every forward contract written with a major grain marketing firm by Iowa corn producers over a five‐year period. Our results suggest that a current December futures price higher than a reference price triggers hedging activity. A likely candidate for producers’ reference price is a rolling average of the current futures price. We then use trading activity implied by the producers to determine if they benefit from the way they hedge. The evidence is mixed. Finally, we compare the producer forward contract data to the only publicly available data on producer hedging: The Commodity Futures Trading Commission Disaggregated Commitment of Traders Report (DCOT) for Short Hedgers. A hedge ratio constructed from the open interest in new futures contracts of the DCOT report is highly correlated with the producer hedge series in the Iowa data, providing evidence that DCOT data represent farmers’ hedging behavior reasonably well. This work has important implications for future research that uses the DCOT data, and provides new evidence about producers’ hedging behavior that marketing specialists and extension agents can use to enhance their educational efforts related to risk management.
Lyman continuum leakage versus quenching with the James Webb Space Telescope: the spectral signatures of quenched star formation activity in reionization-epoch galaxies
Authors: Binggeli Christian , Zackrisson Erik , Pelckmans Kristiaan , Cubo Rubén , Jensen Hannes , Shimizu Ikko
Published: May 2018

In this paper, we study the effects of a recent drop in star formation rate (SFR) on the spectra of epoch of reionization (EoR) galaxies, and the resulting degeneracy with the spectral features produced by extreme Lyman continuum leakage. In order to study these effects in the wavelength range relevant for the upcoming James Webb Space Telescope (JWST), we utilize synthetic spectra of simulated EoR galaxies from cosmological simulations together with synthetic spectra of partially quenched mock galaxies. We find that rapid declines in the SFR of EoR galaxies could seriously affect the applicability of methods that utilize the equivalent width of Balmer lines and the ultraviolet spectral slope to assess the escape fraction of EoR galaxies. In order to determine if the aforementioned degeneracy can be avoided by using the overall shape of the spectrum, we generate mock NIRCam observations and utilize a classification algorithm to identify galaxies that have undergone quenching. We find that while there are problematic cases, JWST/NIRCam or NIRSpec should be able to reliably identify galaxies with redshifts z∼ 7 that have experienced a significant decrease in the SFR (by a factor of 10–100) in the past  50–100 Myr with a success rate ${\gtrsim } 85\,{per\,cent}$. We also find that uncertainties in the dust-reddening effects on EoR galaxies significantly affect the performance of the results of the classification algorithm. We argue that studies that aim to characterize the dust extinction law most representative in the EoR would be extremely useful.
Labour shares, employment protection and unions in European economies
Authors: Damiani Mirella , Pompei Fabrizio , Ricci Andrea
Published: May 2018

We analyse the role that the liberalization of temporary contracts plays in labour share in some EU countries. The empirical analysis mainly relies on the EUKLEMS database and applies a difference-in-difference approach. Our results, focused on periods of different length (1996–2007 and 1996–2013), show that legislative innovations that favour the extensive use of temporary contracts negatively affect the labour share, likely because they lower employees’ average compensations. We hypothesize that these labour reforms, which lead to enduring skill deficits, thus failing to halt the erosion of the labour share of previous decades.
Warming and CO2 enrichment modified the ecophysiological responses of Dahurian larch and Mongolia pine during the past century in the permafrost of northeastern China
Authors: Liu Xiaohong , Zhao Liangju , Voelker Steven , Xu Guobao , Zeng Xiaomin , Zhang Xuanwen , Zhang Lingnan , Sun Weizhen , Zhang Qiuliang , Wu Guoju , Li Xiaoqin
Published: May 2018

Tree-ring δ13C and δ18O of dominant Dahurian larch and Mongolia pine in the permafrost region of the northern Great Higgnan Mountains, China were used to elucidate species-specific ecophysiological responses to warming temperatures and increasing CO2 over the past century. Larch and pine stable carbon discrimination (Δ13C) 13C and δ18O in tree rings both showed synchronous changes during the investigated period (1901–2010), but with species-specific isotopic responses to atmospheric enriched CO2 and warming. Tree-ring Δ13C and δ18O were controlled by both maximum temperature and moisture conditions (precipitation, relative humidity and vapor pressure deficit), but with different growth periods (Δ13C in June–July and δ18O in July–August, respectively). In addition, stable isotopes of larch showed relatively greater sensitivity to moisture deficits than pine. Climatic conditions from 1920 to 1960 strongly and coherently regulated tree-ring Δ13C and δ18O through stomatal conductance. However, climatic-sensitivities of tree-ring Δ13C and δ18O recently diverged, implying substantial adjustments of stomatal conductance, photosynthetic rate and altered water sources over recent decades, which reveal the varied impacts of each factor on tree-ring Δ13C and δ18O over time. Based on expected changes in leaf gas-exchange, we isolated the impacts of atmospheric CO2 and climate change on intrinsic water-use efficiency (iWUE) over the past century. Higher intracellular CO2 in pine than larch from 1960 onwards suggests this species may be more resilient to severe droughts in the future. Our data also illustrated no weakening of the iWUE response to increasing CO2 in trees from this permafrost region. The overall pattern of CO2 enrichment and climate impacts on iWUE of pine and larch were similar, but warming increased iWUE of larch to a greater extent than that of pine over recent two decades. Taken together, our findings highlight the importance of considering how leaf gas-exchange responses to atmospheric CO2 concentration influence species-specific responses to climate and the alteration of the hydrological environment in forests growing in regions historically dominated by permafrost that will be changing rapidly in response to future warming and increased CO2.
Effect of a Perioperative Intra-Aortic Balloon Pump in High-Risk Cardiac Surgery Patients: A Randomized Clinical Trial
Authors: Rocha Ferreira Graziela Santos , de Almeida Juliano Pinheiro , Landoni Giovanni , Vincent Jean Louis , Fominskiy Evgeny , Gomes Galas Filomena Regina Barbosa , Gaiotto Fabio A. , Dallan Luís Oliveira , Franco Rafael Alves , Lisboa Luiz Augusto , Palma Dallan Luis Roberto , Fukushima Julia Tizue , Rizk Stephanie Itala , Park Clarice Lee , Strabelli Tânia Mara , Gelas Lage Silvia Helena , Camara Ligia , Zeferino Suely , Jardim Jaquelline , Calvo Arita Elisandra Cristina Trevisan , Caldas Ribeiro Juliana , Ayub-Ferreira Silvia Moreira , Costa Auler Jose Otavio , Filho Roberto Kalil , Jatene Fabio Biscegli , Hajjar Ludhmila Abrahao
Published: May 2018

Objectives:

The aim of this study was to evaluate the efficacy of perioperative intra-aortic balloon pump use in high-risk cardiac surgery patients.

Design:

A single-center randomized controlled trial and a meta-analysis of randomized controlled trials.

Setting:

Heart Institute of São Paulo University.

Patients:

High-risk patients undergoing elective coronary artery bypass surgery.

Intervention:

Patients were randomized to receive preskin incision intra-aortic balloon pump insertion after anesthesia induction versus no intra-aortic balloon pump use.

Measurements and Main Results:

The primary outcome was a composite endpoint of 30-day mortality and major morbidity (cardiogenic shock, stroke, acute renal failure, mediastinitis, prolonged mechanical ventilation, and a need for reoperation). A total of 181 patients (mean [sd] age 65.4 [9.4] yr; 32% female) were randomized. The primary outcome was observed in 43 patients (47.8%) in the intra-aortic balloon pump group and 42 patients (46.2%) in the control group (p = 0.46). The median duration of inotrope use (51 hr [interquartile range, 32–94 hr] vs 39 hr [interquartile range, 25–66 hr]; p = 0.007) and the ICU length of stay (5 d [interquartile range, 3–8 d] vs 4 d [interquartile range, 3–6 d]; p = 0.035) were longer in the intra-aortic balloon pump group than in the control group. A meta-analysis of 11 randomized controlled trials confirmed a lack of survival improvement in high-risk cardiac surgery patients with perioperative intra-aortic balloon pump use.

Conclusions:

In high-risk patients undergoing cardiac surgery, the perioperative use of an intra-aortic balloon pump did not reduce the occurrence of a composite outcome of 30-day mortality and major complications compared with usual care alone.
Longitudinal study of advanced practice nurses' implementation of screening intervals for cervical cancer screening
Authors: Cappiello Joyce D. , Boardman Maureen
Published: May 2018

Background and purpose:

The past two decades brought changes in cervical cancer screening guidelines. Frequent modifications and earlier lack of agreement about recommendations created confusion. The purpose of this study was to explore to what extent advanced practice nurses (APNs) adopted cervical cancer screening guidelines.

Methods:

A longitudinal survey of 358 APNs conducted in three New England states regarding cervical cancer screening practices in 2008, 2012, and 2015.

Conclusions:

Advanced practice nurses are incorporating guidelines at a high rate. Advanced practice nurses found it easier to incorporate guidelines to delay screening until the age of 21 years, to discontinue screening after total hysterectomy for benign reasons, and to discontinue screening at the age of 65 years. In 2012, 15% of APNs were screening women aged 21–29 years every 3 years; by 2015, this rate rose to 72%. By 2015, half of APNs were screening low-risk women aged 30–64 every 5 years. Because screening practices changed, APNs questioned the need to perform screening pelvic and breast examinations. Advanced practice nurses no longer perform screening pelvic examinations (93%) or breast examinations (75%) in adolescents.

Implications for practice:

Some APNs indicated that office-based practice standards are barriers to adherence to guidelines. Advanced practice nurses need to be involved in practice committees to ensure that evidence guides practice decisions.
Attitudes and perceptions about cigarette smoking among nonsmoking high school students
Authors: Hanson Mary Jane S.
Published: May 2018

Purpose:

To explore the association between cigarette smoking intention and attitude, subjective norm, and perceived behavioral control as identified by the Theory of Planned Behavior (TPB) in a cohort of nonsmoking teenagers.

Methods:

A convenience sample of 76 nonsmoking students from a rural Northeastern Pennsylvania high school completed a self-administered questionnaire based on the TPB, which included cigarette smoking behavior, intention, and the direct measures of attitude, subjective norm, and perceived behavioral control.

Conclusions:

Regression analyses demonstrated that all three independent variables (attitude, subjective norm, and perceived behavioral control) contributed significantly to the respondents' intention to not smoke cigarettes, accounting for 64% of the variance. These findings may have implications for promoting nonsmoking behavior.

Implications for practice:

This is the first study to examine the efficacy of the TPB in predicting the intention to not smoke in a cohort of all nonsmokers. The intention to not smoke was significantly correlated with the respondents' negative general attitudes toward cigarette smoking, belief that significant others would disapprove of their cigarette smoking, and positive tobacco refusal self-efficacy. Understanding the factors associated with nonsmoking behavior in teenagers is important information for nurse practitioners, as we develop strategies to encourage and reinforce cigarette smoking abstinence.
Screening for childhood adversity among adult primary care patients
Authors: Kalmakis Karen A. , Shafer Mary B. , Chandler Genevieve E. , Aponte Elizabeth V. , Roberts Susan J.
Published: May 2018

Background and purpose:

Over half of Americans reports a history of adverse childhood experiences (ACEs), which have been associated with many chronic health conditions. Yet primary care providers infrequently screen patients for ACEs and fail to consider the relationship between ACEs and adult health. Therefore, the purposes of this study were to test the effectiveness and feasibility of a screening interview for ACEs and to confirm the prevalence of ACEs among individuals with chronic health conditions.

Methods:

Screening interviews were conducted with 71 adults in a primary care setting. Patients' ACE history, nurse practitioner comfort with screening, time to screen, and patient follow-up care recommendations were gathered through questionnaires. Adverse childhood experience prevalence was analyzed by descriptive statistics. Relationships between ACEs, number of clinic visits, time to screen, and follow-up care recommendations were analyzed by bivariate statistics.

Conclusions:

Over half of participants reported more than four ACEs, with ACEs common among participants with chronic health conditions (93%). Adverse childhood experience scores were positively correlated with number of clinic visits, time to screen, and recommendations for follow-up care. Findings support screening primary care patients for ACEs.

Implications for practice:

Adverse childhood experiences are prevalent among primary care patients with chronic conditions. Using interviews to screen for ACEs in primary care settings is effective and feasible.
A return to harmful alcohol consumption impacts on portal hemodynamic changes following alcoholic hepatitis
Authors: Spahr Laurent , Goossens Nicolas , Furrer Flavie , Dupuis Melissa , Vijgen Sandrine , Elkrief Laure , Giostra Emiliano , Rubbia-Brandt Laura , Frossard Jean-Louis
Published: May 2018

Background

Increased hepatic venous pressure gradient (HVPG) plays a role in the clinical manifestations of alcoholic hepatitis (AH). The evolution of HVPG and the influence of alcohol use in the intermediate term are unclear.

Aim

The aim of this study was to explore HVPG modifications following AH taking into consideration alcohol use and clinical manifestations.

Patients and methods

Patients with AH (n=37; age 52 years; model for end-stage liver disease: 18.5; Maddrey score: 43) and chronic excessive drinkers with compensated cirrhosis (n=19; age: 54 years; model for end-stage liver disease: 9.2) underwent HVPG measurement and liver biopsy. Ten long-standing abstinent alcoholic cirrhotics served as controls. After discharge, patients were monitored for alcohol use and clinical complications, with repeated HVPG after a median duration of 100 days. Inflammation was determined using plasma C-reactive protein.

Results

At baseline, compared with chronic excessive drinkers and alcoholic cirrhotics, patients with AH had increased HVPG (18.1±0.6 vs. 13.8±1.4 vs. 15±1.3 mmHg, P<0.05). During follow-up, patients who became abstinent or reported occasional drinking were more likely to achieve a greater than 20% reduction in HVPG compared with those returning to harmful alcohol (45 vs. 0%, P<0.01), and suffered from fewer complications (25 vs. 68%, P<0.03). High baseline C-reactive protein levels correlated to the Maddrey (r=0.38), but no relationship was observed between changes in inflammation and HVPG.

Conclusion

Elevated HVPG is a feature of AH, with a clinically significant reduction in values in abstinent or occasional drinkers after weeks of follow-up. A return to harmful alcohol has a negative impact on portal hemodynamics and associated clinical complications.
Looking for Control at the End of Life Through the Bond
Authors: Carrillo Gloria Mabel , Arias-Rojas Mauricio , Carreño Sonia Patricia , Gómez Olga Janeth , López Rocío , Cárdenas Diana Carolina
Published: May 2018

The hospital-to-home transition in palliative care is a vital process that requires continuity of care through the discharge process. However, little is known about the perceptions of patients with cancer and their family caregivers during this important palliative care transition in the Colombian health care context. The purpose of this study was to explore the experiences of the patient-family caregiver dyad in palliative care during the transition process between hospital and home in a health care institution in Bogota, Colombia. Using a grounded constructivist theory design, 30 patients with cancer receiving palliative care and 30 family caregivers participated in this study. The data were collected through 36 dyad interviews conducted in either the hospital or home of the participants. For the analysis, the constructivist analytical method was used. Findings revealed that “Looking for control at the end of life through the bond” was the main category of the study. This category could be further elaborated into 4 categories: (1) yearning for home; (2) recognizing burden; (3) experiencing uncertainty, a lack of control; and (4) achieving control. By understanding the patient and family caregiver perspective of care during the hospital-to-home transition, health care systems have the possibility to implement care programs in palliative care with an innovative educational component for health care professionals.
Neuroinvasive Listeriosis
Authors: Diker Sevda , Okar Serhat , Mehdikhanova Lale , Arsava Ethem Murat , Kurne Asli , Çevik Işin Ünal , Akyön Yakut , Alp Şehnaz , İnkaya Çağkan , Akova Murat , Mut Melike , Göçmen Rahşan , Oğuz Kader Karli , Topçuoğlu Mehmet Akif
Published: May 2018

Introduction:

Listeria monocytogenes–related central nervous system infections may involve the cerebral parenchyma. Meningitis and meningoencephalitis are the most commonly seen forms and mainly affect immunocompromised patients; however, a less frequent form, rhombencephalitis, can occur in otherwise healthy people. Early treatment with appropriate antibiotic therapy is crucial for this otherwise fatal disorder. However, it is not always possible to rapidly establish the diagnosis because of varying presentations and discrepancies in diagnostic tests.

Case Report:

Herein we report 3 cases of listerial infections involving the central nervous system parenchyma, with versatile diagnostic challenges and related possible solutions and radiologic hints to overcome similar issues in the future.

Conclusions:

We point out the importance of nonconventional magnetic resonance imaging techniques in the diagnosis, as we detected petechial hemorrhages in the brain parenchyma in all cases, which can be a diagnostic clue.
Analysis of Risk Factors in Patients With Peripheral Vertigo or Central Vertigo
Authors: Wang Yunlin , Liu Jing , Cui Zhijie , Yan Lili , Si Jianping
Published: May 2018

Introduction:

This study was aimed to determine risk factors for central vertigo (CV) in patients with isolated vertigo accompanied by hearing loss or not.

Patients and Methods:

Patients with CV or peripheral vertigo (PV) who were admitted to our hospital between January 2014 and July 2016 were retrospectively reviewed. All patients underwent thorough physical examination with detailed medical histories recorded, including smoking, hypertension, diabetes, cardiovascular disease, and stroke history. Logistic regression estimated odds ratio (OR) of the risk factors.

Results:

Eighty-seven patients were enrolled into the study, including 41 cases of CV and 46 cases of PV. There was significant difference in sex, age above 60, hypertension, diabetes, smoking, and stroke history between the 2 groups. The patients without any risk factors did not have CV. The risk for CV in the patients with ≥3 risk factors was greater (OR, 11.43; 95% confidence interval, 3.27-39.93; P<0.001) than the patients with 1 risk factor. The risk for CV in the patients with 2 risk factors was similar (OR, 0.833; 95% confidence interval, 0.17-4.28; P=0.825) to the patients with 1 risk factor.

Conclusion:

The patients with isolated vertigo (accompanied by hearing loss or not) and 3 or more risk factors are at higher risk for CV. They should have a comprehensive neurological examination and be closely followed up.
Association of Academic Physiatrists Women’s Task Force Report
Authors: Silver Julie K. , Cuccurullo Sara J. , Ambrose Anne Felicia , Bhatnagar Saurabha , Bosques Glendaliz , Fleming Talya K. , Frontera Walter R. , Karimi Danielle Perret , Oh-Park Mooyeon , Sowa Gwendolyn , Visco Christopher , Weiss Lyn , Knowlton Tiffany
Published: May 2018

The Association of Academic Physiatrists (AAP) convened a women's task force in 2016, and the members agreed on a list of metrics that would permit retrospective data review pertaining to the representation and inclusion of women physicians in the society. Examples of categories examined included leadership positions (i.e., board membership, board presidents, committee membership, committee chairs, and resident fellow physician chairs), conference presentations (i.e., annual meeting session proposals, annual meeting faculty, annual meeting plenary speakers), and recognition awards (i.e., recognition award nominations and recipients). The findings highlight areas in which the Association of Academic Physiatrists has been successful in supporting gender equity and other areas in which women physiatrists have been underrepresented. The task force worked with the Board of Trustees to construct an action plan, asking the respective committees to address areas of underrepresentation. A volunteer from each committee was deemed a “diversity steward” and going forward will work directly with the task force as a liaison to document an action plan and collect data. The board plans to transparently report progress to members and other stakeholders, and the task force aims to publish a follow-up report within the next 5 years.
S100A8/A9 mediate the reprograming of normal mammary epithelial cells induced by dynamic cell-cell interactions with adjacent breast cancer cells
Authors: Jo Seol Hwa , Heo Woo Hang , Quan Mingji , Hong Bok Sil , Kim Ju Hee , Lee Han-Byoel , Han Wonshik , Park Yeonju , Lee Dong-Sup , Kwon Nam Hoon , Park Min Chul , Chae Jeesoo , Kim Jong-Il , Noh Dong-Young , Moon Hyeong-Gon
Published: May 2018

To understand the potential effects of cancer cells on surrounding normal mammary epithelial cells, we performed direct co-culture of non-tumorigenic mammary epithelial MCF10A cells and various breast cancer cells. Firstly, we observed dynamic cell-cell interactions between the MCF10A cells and breast cancer cells including lamellipodia or nanotube-like contacts and transfer of extracellular vesicles. Co-cultured MCF10A cells exhibited features of epithelial-mesenchymal transition, and showed increased capacity of cell proliferation, migration, colony formation, and 3-dimensional sphere formation. Transcriptome analysis and phosphor-protein array suggested that several cancer-related pathways are significantly dysregulated in MCF10A cells after the direct co-culture with breast cancer cells. S100A8 and S100A9 showed distinct up-regulation in the co-cultured MCF10A cells and their microenvironmental upregulation was also observed in the orthotropic xenograft of syngeneic mouse mammary tumors. When S100A8/A9 overexpression was induced in MCF10A cells, the cells showed phenotypic features of directly co-cultured MCF10A cells in terms ofin vitrocell behaviors and signaling activities suggesting a S100A8/A9-mediated transition program in non-tumorigenic epithelial cells. This study suggests the possibility of dynamic cell-cell interactions between non-tumorigenic mammary epithelial cells and breast cancer cells that could lead to a substantial transition in molecular and functional characteristics of mammary epithelial cells.