bluuebunny/crossref_metadata_2025 huggingface dataset:
Combined Venography And Arthrography In Patients With Joint Pains And A Swollen Calf
Authors: Belch J J F , McMillan N , Lowe G D O , Forbes C D
Published: July 2018

Ruptured Baker’s cyst is a well recognised cause of confusion in the diagnosis of deep vein thrombosis (D.V.T.) in patients with arthralgia. Many workers have stressed the need for a high index of clinical suspicion combined with either venography or arthrography, yet in no study has simultaneous arthrography and venography been performed. Ten patients with joint pains admitted because of a swollen calf underwent bilateral ascending venography and unilateral arthrography within 24 hours of admission. Results were compared with the initial clinical diagnosis. On only one out of 10 occasions was the original clinical diagnosis correct. One patient had a D.V.T. alone, 5 patients had a Baker’s cyst and 3 patients had both D.V.T. and Baker’s cyst. One patient had no evidence of either. We conclude that any patient with a history of joint pain who develops a swollen calf should have both a venogram and an arthrogram performed in order to establish the correct diagnosis.
An Intrinsic Blood Platelet Abnormality in an Homocystinuric Boy, Corrected by Pyridoxine Administration
Authors: Zweifler A. J , Allen R. J
Published: July 2018

Platelet aggregation in a boy with homocystinuria (HCU) was compared to that found in normal subjects. Response to adenosine diphosphate (ADP) was diminished while aggregation with collagen and adrenalin was normal. The impaired response to ADP was not corrected by resuspension of HCU platelets in normal plasma or by a period of therapy with a low protein diet, but it was enhanced promptly with pyridoxine 750 mg/day. The increase of platelet sensitivity to ADP during B6 administration could not be correlated with plasma concentrations of either homocystine or methionine.
Formation, Viscosity and Degradation of Artificial Thrombi after Cadaveric-Donor Kidney Transplantation
Authors: Dintenfass L , Stewart J. H
Published: July 2018

Dynamic (VFTV) coagulation and thrombus formation studies were carried out on 15 patients who had undergone cadaveric-donor kidney transplantation and 6 patients with end-stage renal failure awaiting transplantation.

All patients whose kidney graft functioned successfully and without major medical complications showed a coagulation VFTV pattern similar to that of healthy normals. This pattern was present as early as 1 week after transplantation.

Abnormal VFTV pattern (i.a., greatly elevated viscosity), characterised patients awaiting transplantation (6 patients) and 4 patients with serious medical complications following transplantation.

Viscosities of thrombi were two and a half to three-fold higher, and rates of thrombus degradation two to ten fold higher, in the complicated than in the successful kidney transplants.

The viscosity increase is not counteracted by haemodialysis or immunosuppressive drugs.

The difference of VFTV parameters between patients awaiting transplantation and normals and between complicated transplant patients and normals were significant to p <0.005 and p <0.001 respectively.
Haemophilia in a Female
Authors: McBride J. A , Hunter J , Pearse Elizabeth , Sultan Yvette , Caen J. P
Published: July 2018

A case of haemophilia in a female is described together with the response of the patient’s level of antihaemophilic factor in the plasma following transfusion of fresh frozen plasma, fibrinogen and cryoprecipitate.
Dosage Photomètrique Rapide du Plasminogène dans le Plasma Citraté
Authors: Berthoud S , Bouvier C. A
Published: July 2018

Nous avons établi dans une étude antérieure la validité d’une mesure photométrique de l’activité estérasique de la plasmine respectivement du plasminogène activable en utilisant comme substrat l’ester de N.α -Benzoyl-arginine (BAEe). Dans le présent travail, nous proposons une modification permettant l’emploi du plasma citraté comme source d’enzyme et de proenzyme et d’une concentration optimale (1 • 10–3 M) de substrat. Les courbes obtenues ainsi sont des droites correspondant à la vélocité initiale de la réaction, et fournissent une mesure directe de l’activité enzymatique. Cette méthode a l’avantage de donner des résultats plus rapidement qu’aucune de celles employées jusqu’ici.
Defekte Thrombusstruktur und Hemmung der Thrombusbildung bei Defibrinierungsblutungen infolge ungerinnbarer Fibrinogebderivate
Authors: Steichele D. F
Published: July 2018

Zussammenfassung

Bei 8 Patientinnen mit Defibrinierungssyndrom wurden neben der Thrombinzeit, dem Fibrinogenspiegel und der Thrombelastographie die Fibrinogenderivate im Serum bestimmt. Anhand der thrombelastographischen Untersuchungen konnte gezeigt werden, daß bei Hypofibrinogenämien mit stark erhöhter Konzentration der Fibrinogenderivate ein funktionell defektes Gerinnsel entsteht. Die AntikoagulansWirkung der Fibrinogenderivate ließ sich bei diesen Patientinnen durch die stark verlängerten Werte der Thrombinzeit nachweisen. Eine Differenzierung zwischen der Antithrombin-VI-Aktivität und der Antipolymerasewirkung der Fibrinogenderivate wird versucht.
Activation of Factor X in Bovine Prothrombin Preparations
Authors: Landaburu R. H , Albado Emilia
Published: July 2018

Chromatographic fractionation of factor X (autoprothrombin III) and factor Xa (autoprothrombin C), obtained from bovine prothrombin preparations, on amberlite IRC-50 demonstrates activation of factor X under the conditions of prothrombin activation. The increase in factor Xa protein during prothrombin activation is due to incorporation of a non-active protein into the fraction. Prothrombin Activating Derivative B (PAD-B) is activated by concentrated salt solutions and not by stypven.
γ M Globulin and Thrombasthenie Platelets
Authors: Cronberg S , Hurez D , Caen J. P
Published: July 2018

In the contrary to previous findings (3), it was not found any evident differences in the content of γ-M globulins between thrombastheniec and normal platelets.
Über das Verhalten der Gerinnungsfaktoren Prothrombin, Faktor V und Faktor VII bei Ratten nach Ganzkörperbestrahlung
Authors: Klesper R , Kessler F.-J , Felderhoff B , Parchwitz H. K , Wittekind E
Published: July 2018

Bei einer Ganzkörperbestrahlung weißer Wistarratten mit 1000 r tritt nach 72 Stunden eine Aktivitätszunahme der Blutgerinnungsfaktoren Prothrombin, Faktor V und VII, ein. Erhöht man die Strahlendosis auf das Zehnfache, wird der Faktorenanstieg bereits nach 48 Stunden beobachtet. Diese Dosisabhängigkeit besteht nur in zeitlicher, nicht in quantitativer Hinsicht. Bei milzexstirpierten Tieren ist nach der Bestrahlung ein gleichartiges Verhalten der Gerinnungsfaktoren festzustellen. Den größten Aktivitätszuwachs zeigt das Prothrombin.
Phospholipid-Protein Interactions in the Formation of Prothrombin Activator
Authors: Cole E. R , Koppel J. L , Olwin J. H
Published: July 2018

Since Ac-globulin (factor V) is involved in the formation of prothrombin activator, its ability to complex with phospholipids was studied. Purified bovine Ac-globulin was complexed to asolectin, there being presumably a fixed number of binding sites on the phospholipid micelle for Ac-globulin. In contrast to the requirement for calcium ions in the formation of complexes between asolectin and autoprothrombin C, calcium ions were not required for complex formation between asolectin and Ac-globulin to occur ; in fact, the presence of calcium prevented complex formation occurring, the degree of inhibition being dependent on the calcium concentration. By treating isolated, pre-formed aso- lectin-Ac-globulin complexes with calcium chloride solutions, Ac-globulin could be recovered in a much higher state of purity and essentially free of asolectin.

Complete activators were formed by first preparing the asolectin-calcium- autoprothrombin C complex and then reacting the complex with Ac-globulin. A small amount of this product was very effective as an activator of purified prothrombin without further addition of calcium or any other cofactor. If the autoprothrombin C preparation used to prepare the complex was free of traces of prothrombin, the complete activator was stable for several hours at room temperature. Stable preparations of the complete activator were centrifuged, resulting in the sedimentation of most of the activity. Experimental evidence also indicated that activator activity was highest when autoprothrombin C and Ac-globulin were complexed to the same phospholipid micelle, rather than when the two clotting factors were complexed to separate micelles. These data suggested that the in vivo prothrombin activator may be a sedimentable complex composed of a thromboplastic enzyme, calcium, Ac-globulin and phospholipid.
Heparin, Protamine and Polybrene
Authors: Britten Anthony
Published: July 2018

The effects of incubating heparin, protamine or Polybrene with plasma were studied. All three drugs cause rapid loss of factor V from decalcified plasma, while Polybrene also accelerates the loss of factor VIII activity. These changes are related to temperature, the period of incubation and the dose of the drug used, and can be partially prevented by inclusion of neutralizing doses of the appropriate antagonist in the incubation mixture.

The implications of these findings are discussed.
Swallowing in Patients with Mental Disability - Analysis of 189 Swallowing Video Endoscopies
Authors: Pirana Sulene , Oliveira Marcela , Pissini Fabiana , Andrade Raíssa
Published: July 2018

Introduction Feeding, swallowing and breathing are fundamental activities for the survival and well-being of humans; these functions are performed by the most complex neuromuscular unit of the human body, which, when altered, may raise morbidity and mortality rates.

Objective To evaluate deglutition in patients with mental disability in order to determine the incidence and the severity of dysphagia.

Methods A total of 189 institutionalized adult patients with mental disability were analyzed using a 3.2 mm flexible fiberscope (Machida, Japan 1995). The following food consistencies were tested: pasty, thickened liquid and liquid.

Results Among the total of 189 patients, 101 (53.4%) were female aged between 14 and 55 years old. Most of them 120 (63.5%) had profound mental deficiency, 58 (30.7%) had severe mental deficiency, 9 (4.8%) had moderate mental deficiency, and 2 (1.1%) had mild mental deficiency. Gender and the degree of mental deficiency did not influence significantly the degree of dysphagia. Age, degree of disability and interaction between age groups and degrees of disability influenced significantly the degree of dysphagia. Younger patients are more likely to present more severe dysphagia. Stabilization occurs between 31 and 40 years of age, and above this age, a greater chance of less severe dysphagia, because the increase in the degree of mental deficiency decreases the probability of more severe dysphagia.

Conclusion The population that mostly presented severe dysphagia was characterized by being mostly female, with profound mental deficiency, with an average age of 36.7 years. There was no relationship between gender and the degree of mental disability concerning the degree of dysphagia.
Training to Optimize Collaborative Use of an Inpatient Portal
Authors: Hefner Jennifer , Sieck Cynthia , McAlearney Ann
Published: July 2018

Background Inpatient portals are an emerging technology that can facilitate collaborative interactions between patients and care teams, but little is known about how organizations attempt to implement and facilitate inpatient portal use for their providers.

Methods We held in-person, semistructured interviews with care team members and information technology (IT) staff and conducted rigorous thematic analysis of transcripts.

Results Interviews with 220 care team members and 4 IT staff identified 3 new areas of training needed to optimize inpatient portal implementation and use that extend beyond training to use other technologies: (1) teaching staff to train patients about tool use; (2) training about how to promote tool use to patients; and (3) training about optimal use of secure messaging.

Discussion Our findings show that inpatient portals are implemented within a collaborative multistakeholder context. Training efforts must consider the importance of this collaborative context to help providers learn to both incorporate the technology into their workflow and assist patients with portal use.
Side extraction: A novel method of filtering ions or macro-particles for vacuum arc ion sources
Authors: Wang Zhenguo , Huang Jie , Zeng Xiaomei , Zuo Wenbin , Fu Dejun
Published: July 2018

A novel ion-extraction method named side extraction, i.e., extracting ions from the direction perpendicular to that of plasma expansion, is proposed in this paper, which can be used to filter ions or macro-particles for vacuum arc ion sources. Particle-in-cell simulations were performed to study filtering effects of side extraction on ions with different mass, different charges, and different initial kinetic energies. The results indicate that side extraction can separate ions by their charge states or initial kinetic energies and the extracting efficiency for different ion species is identical. Influences of extraction voltages, extraction interval, and the aspect ratio of the extraction aperture on ion filtering effects were also studied, which suggests that lower extraction voltages and longer extraction interval are beneficial for ion filtering and a high-aspect-ratio aperture contributes to the increase in the ratio of lighter ions in extracted beams. A theoretical analysis on the deflected distance of beams in the y direction was made and shows good agreement with the simulation results.
A large-area plate radiator with in situ temperature homogenization for thermographic imager calibration
Authors: König Sebastian , Gutschwager Berndt , Hollandt Jörg
Published: July 2018

Large-area plate radiators with a high emissivity and uniform temperature distribution are needed as reference sources for calibrating infrared imagers and camera systems. However, achieving very uniform temperature distribution over a large area is technically challenging, especially at high temperatures. We present a large-area plate radiator with an improved uniformity in its surface temperature distribution for the calibration of infrared thermographic imagers. It is based on an industrial plate radiator which is temperature homogenized in situ by using the Data Reference Method (DRM) developed at the Physikalisch-Technische Bundesanstalt. The DRM takes three spatially shifted pictures of the plate radiator with a thermographic imager, and using this information, it calculates both the nonuniformity in the temperature distribution of the plate radiator and the nonuniformity in the response of the thermographic imager used for imaging the scene. The surface of the applied plate radiator is 300 mm × 300 mm and it operates in a temperature range from 30 °C to 600 °C. The surface is segmented into 9 different parts of identical size whose temperature can be individually controlled. The in situ controlled plate radiator system developed uses an infrared camera, whose detector is corrected for its response inhomogeneity using the DRM. This camera permanently monitors the plate radiator, and from these data, the temperature distribution of the plate is homogenized. Through this method, the homogeneity of the plate radiator can be considerably improved compared to the non-actively regulated mode of operation. For example, at a nominal temperature of 400 °C, without the in situ homogenization procedure, 90% of the plate area has a radiation temperature in the range from 391.7 °C to 403.6 °C. Applying the in situ homogenization procedure leads to 90% of the plate area having a radiation temperature in the range from 394.2 °C to 401.2 °C.
On the occurrence of superimposed density wave oscillations on pressure drop oscillations and the influence of a compressible volume
Authors: Park Il Woong , Fernandino Maria , Dorao Carlos A.
Published: July 2018

Although two-phase flow instabilities are attributed to be one of the impediments for achieving high heat flux in boiling systems, most of their fundamental characteristics remain uncharted. In particular, pressure drop oscillations and density wave oscillations are two types of dynamic two-phase flow instabilities that can cause large variations in pressure and temperature. Under particular working conditions, both oscillations have been observed to interact, resulting in long-period pressure drop oscillations with superimposed short-period density wave oscillations. However, in this situation, the amplitude of the density wave oscillations is typically larger than the corresponding to a pure density wave oscillation. Here, we show that a compressible volume in the system, essential for the occurrence of pressure drop oscillations, plays a major role in amplifying the amplitude of the superimposed density wave oscillations.
Efficient charge separation at multiple quantum well perovskite/PCBM interface
Authors: Wei Yingqiang , Li Meijin , Li Renzhi , Zhang Li , Yang Rong , Zou Wei , Cao Yu , Xu Mengmeng , Yi Chang , Wang Nana , Wang Jianpu , Huang Wei
Published: July 2018

Low-dimensional organometal halide perovskites have attracted more and more attention because of their good optoelectronic properties and improved stability compared to three-dimensional analogues. In this work, we investigated the charge separation mechanism in multiple quantum well (MQW) perovskite films, which are composed of a mixture of layered perovskites (or quantum wells) with different bandgaps. Despite inefficient dissociation of photo-generated excitons in large-bandgap quantum wells due to the large exciton binding energy, efficient charge separation can occur at the MQW perovskite/electron-extracted-layer interface via energy and/or charge transfer from large-bandgap quantum wells to small-bandgap quantum wells. The MQW perovskite solar cell exhibits a 25-fold improvement in device efficiency, as compared to a pure 2D analogue.
Nonverbal predication and the nonverbal clause type of Mojeño Trinitario
Authors: Rose Françoise
Published: July 2018

Mojeño Trinitario, an Arawak language spoken in Bolivia, makes frequent use of clauses without a verb or a copula. These encode some of the most common semantic types of nonverbal predication – equation, inclusion, attribution (as understood by Payne 1997), but also typologically neglected types, like quantification and temporality. Possession, existence, and two unattested semantic types – motion-presentational and quantified existential, are actually encoded in Mojeño Trinitario with verbal clauses and copular clauses. The non-copular nonverbal constructions present a very regular morphosyntactic pattern, even though they make use of predicates that belong to different classes (nouns, adjectives, adverbs, numerals, demonstratives and prepositional phrases). These constructions can be subsumed under a major clause type distinct from the verbal clause type, and are characterized by a nonverbal predicate either juxtaposed to its argument, or standing by itself if it is suffixed with a person index. Nonverbal clauses share some properties with verbal clauses, like some of the inflectional morphology (e.g. negation, plural, TAM), but they however neatly differ in three respects – constituent order, argument indexing, and irrealis marking. In conclusion, Mojeño Trinitario shows a nonverbal clause type clearly distinct from the verbal clause type, and this draws a robust major distinction among lexical classes between on the one hand, verbs, and on the other hand, non-verbs (nouns, adjectives, adverbs, and numerals).
Nonverbal predicates and copula constructions in Aguaruna (Chicham)
Authors: Overall Simon E.
Published: July 2018

This chapter focuses primarily on the formal expression of equative, proper inclusion and attributive relations in Aguaruna, all three of which are encoded as copula clauses. The copula clause involves two arguments that both take nominative case; the copula element may be a full verb, it may be an enclitic to the copula complement argument, or the clause may be truly verbless, formed by simple juxtaposition of the arguments. The copula verb itself is homophonous with an existential verb that forms a simple intransitive clause, and a few other intransitive verbs may also function as copulas. Finally, I show that the formal structures associated with copula clauses also feature in auxiliary constructions and as a means of marking finite verbal categories in clauses with nominalized verbs.
To hi or not to hi?
Authors: Stenzel Kristine
Published: July 2018

This chapter describes nonverbal predication in the Kotiria-Wa’ikhana sub-branch of the East Tukano family of northwestern Amazonia. It begins with a general overview of use of the copulas hi/ihi in sentences coding the main functional categories of nonverbal predication. Copular sentences with predicate nominals express notions of ‘identity’ and ‘existence’; those with predicate locatives indicate temporary or permanent locational association. ‘Adjectival’ notions – nominalizations derived from stative verb roots or from nouns by means of the attributive suffix -ti – are also expressed in copular sentences. This general profile also highlights the inflectional properties of copular verbs and their productive use as the head roots in derivations of nominals of various types. The second section presents the predicative alternatives to copular constructions, including productively used ‘nonexistence’, possessive, and positional-locative predicates. The final section discusses a second copular form, ni, a clear cognate to the general copula (a)ni found in many other East Tukano languages, synchronically used as an auxiliary in the Kotiria/Wa’ikhana progressive constructions. It briefly explores two hypotheses regarding the retention of ni and origin of the innovative hi/ihi copulas in Kotiria and Wa’ikhana.
Nonverbal predication in Ninam (northern Brazil)
Authors: Gómez Gale Goodwin
Published: July 2018

Although complex verbal morphology characterizes the languages in the Yanomami family, nonverbal predication is used when no verb or only a copula is present. Nonverbal predicates are distinguished from nonverbal clauses, which do not include a copula. The nonverbal predicates in Ninam fulfill the following four functions: existence, equation, possession, and location. Attributive constructions in nonverbal clauses that were presumed to be predicate adjectives are more appropriately categorized as adjectival verbs. The possibility of flexible word classes (Hengeveld et al. 2004; Haspelmath 2007) is evaluated in light of nonverbal clauses and the existence of derived attributive modifiers. The author concludes that Ninam has a fixed rather than flexible parts-of-speech system with verbs and nouns as the main word classes with semantic adjectives forming a subclass of verbs.
Reconstructing the copulas and nonverbal predicate constructions in Cariban
Authors: Gildea Spike
Published: July 2018

This paper represents a first effort to characterize the different kinds of nonverbal predicate constructions in the Cariban family, to identify the functions served by copulas, and then to reconstruct the various attested copular forms to a limited number of source forms in Proto-Cariban. Given limitations of space, it is not possible to illustrate all of the cognate nonverbal predicate constructions attested in all of the languages, so the comparative look at the constructions is more programmatic, offering illustrations of the alternatives attested so far in the literature as a way to orient future field studies of nonverbal predication in Cariban languages. In contrast, the reconstruction of the copulas is as detailed as possible given the forms available in the current descriptive literature.
Is knowledge of causes sufficient for understanding?
Authors: Hu Xingming
Published: July 2018

According to a traditional account, understanding why X occurred is equivalent to knowing that X was caused by Y. This paper defends the account against a major objection, viz., knowing-that is not sufficient for understanding-why, for understanding-why requires a kind of grasp while knowledge-that does not. I discuss two accounts of grasp in recent literature and argue that if either is true, then knowing that X was caused by Y entails at least a rudimentary understanding of why X occurred. If my defense is successful, it would cast doubt on an influential account of the epistemic value of understanding.
Oxygen consumption, rate of perceived exertion and enjoyment in high‐intensity interval eccentric cycling
Authors: Lipski Marcin , Abbiss Chris R. , Nosaka Kazunori
Published: July 2018

The objectives of this article are to compare oxygen consumption (VO2) and perceptual responses between continuous and interval eccentric cycling protocols in order to test the hypothesis that metabolic demand and enjoyment would be greater for interval than continuous eccentric cycling protocols. Eleven recreationally active men (n = 9) and women (32.6 ± 9.4 years) performed a concentric cycling test to determine peak power output (PPO) followed by five eccentric cycling protocols on separate occasions: continuous eccentric cycling at 60% of PPO for 20 min at 60 rpm (CONT20@60%) and 13.2 min at 90 rpm (CONT13@60%), 4 × 4 min at 75% of PPO with 2‐min rest (INT4×4@75%), 12 × 1 min at 100% of PPO with 1‐min rest (INT1×12@100%) and 10 × 1 min at 150% of PPO with 1‐min rest (INT1×10@150%). Gas exchange and power output were recorded continuously, and rate of perceived exertion (RPE) and enjoyment were assessed after each exercise. Total VO2 including the rest periods was the greatest (p < 0.0001) during INT1×10@150% (382 ± 73 ml kg−1) and lowest (p < 0.0001) during CONT13@60% (146 ± 27 ml kg−1). Total VO2 during INT1×12@100% (312 ± 59 ml kg−1) was greater (p < 0.0001) than CONT20@60% (246 ± 63 ml kg−1) and INT4×4@75% (257 ± 42 ml kg−1). RPE was greater (p < 0.0001) after INT1×10@150% (17 ± 2) than other conditions, but perceived enjoyment was not significantly different between protocols. It was concluded that the interval protocols increased metabolic demand without increasing RPE and enjoyment. It appears that high‐intensity interval protocols can be used in eccentric cycling prescription.
Effect of carrying different military equipment during a fatigue test on shooting performance
Authors: Gil‐Cosano J.J. , Orantes‐Gonzalez E. , Heredia‐Jimenez J.
Published: July 2018

This study investigated the effect of a 3‐km walking test (3kWT) carrying different military equipment on shooting performance, rating of perceived exertion (RPE), heart rate (HR), and test time. The relative combat wear and backpack weight (as percentage of soldier's body weight [%BW]) was reported and, along with HR, its relationship to marksmanship variables was tested. Thirty‐nine Spanish Army males walked as fast as possible to complete the 3kWT in the following conditions in a randomized order: unloaded walking; wearing the combat uniform; and carrying the combat uniform plus combat backpack. A shooting test was completed before and after the 3kWT. The HR and RPE were evaluated. The marksmanship variables and HR were analysed using a two‐way repeated measures ANOVA, and a repeated ANOVA was also used for 3kWT completion time and HR reserve analysis. Correlation analyses were performed between the equipment's weight, HR, and marksmanship variables. The results showed that shooting score decreased after the 3kWT in both load conditions (p < 0.001). The 3kWT time, RPE, and HR increased from control to load conditions, and also between load conditions. The HR reserve showed no significant effects between conditions. The %BW of the backpack condition negatively influenced aiming accuracy (r = −0.35; p = 0.04) and cleanness triggering (r = 0.37; p = 0.03). Correlations between HR and shooting variables were non‐significant. In conclusion, wearing the Spanish Army combat wear and backpack resulted in shooting performance degradation. Furthermore, fatigue and RPE increased and this could decrease physical marksmanship and performance capacity in combat situations.
Commentary on “A brief history of the classification of the finite simple groups” by Ronald Solomon
Authors: Guralnick Robert
Published: July 2018

Immediately following the commentary below, the previously published article is reprinted in its entirety: Ronald Solomon, “A brief history of the classification of the finite simple groups”, Bull. Amer. Math. Soc. (N.S) 38 (2001), no. 3, 315–352.
Outer automorphisms of adjoint groups of type 𝖣 and nonrational adjoint groups of outer type 𝖠
Authors: Barry Demba , Tignol Jean-Pierre
Published: July 2018

For a classical group

G
G

of type

D

n

\mathsf {D}_n

over a field

k
k

of characteristic different from

2
2

, we show the existence of a finitely generated regular extension of

k
k

over which

G
G

admits outer automorphisms. Using this result and a construction of groups of type

A

\mathsf {A}

from groups of type

D

\mathsf {D}

, we construct new examples of groups of type

2

A

n

^2\mathsf {A}_n

with

n
≡
3
mod
4

n\equiv 3\bmod 4

and the first examples of type

2

A

n

^2\mathsf {A}_n

with

n
≡
1
mod
4

n\equiv 1\bmod 4

(
n
≥
5
)

(n\geq 5)

that are not

R
R

-trivial, hence not rational (nor stably rational).
A minimal “push–pull” bistability model explains oscillations between quiescent and proliferative cell states
Authors: Krishna Sandeep , Laxman Sunil
Published: July 2018

A minimal model for oscillating between quiescent and growth/proliferation states, dependent on the availability of a central metabolic resource, is presented. From the yeast metabolic cycles, metabolic oscillations in oxygen consumption are represented as transitions between quiescent and growth states. We consider metabolic resource availability, growth rates, and switching rates (between states) to model a relaxation oscillator explaining transitions between these states. This frustrated bistability model reveals a required communication between the metabolic resource that determines oscillations and the quiescent and growth state cells. Cells in each state reflect memory, or hysteresis of their current state, and “push–pull” cells from the other state. Finally, a parsimonious argument is made for a specific central metabolite as the controller of switching between quiescence and growth states. We discuss how an oscillator built around the availability of such a metabolic resource is sufficient to generally regulate oscillations between growth and quiescence through committed transitions.
Preloss Spirituality Predicts Postloss Distress of Bereaved Cancer Caregivers
Authors: Ting Amanda , Lucette Aurelie , Carver Charles S , Cannady Rachel S , Kim Youngmee
Published: July 2018

Background

Although spirituality has been identified as a psychological resource relevant to coping with caregiving stress, little is known about the differential roles of spirituality’s facets in bereaved caregivers’ adjustment.

Purpose

This study examined this question with regard to bereavement-specific and general distress in cancer caregivers.

Methods

Cancer caregivers provided data at 2 years after their relative’s diagnosis when all the patients were alive (Time 1, preloss) and 3 years later, after the patient had died (Time 2, postloss: N = 128). Demographics and three facets of spirituality (meaning, peace, and faith) were measured at Time 1. Psychological distress and time since the death were measured at Time 2.

Results

Younger age, less education, and being a spousal caregiver of the patient related to greater bereavement-specific and general distress (ts ≥ 2.02, ps < .05, partial η2 ≥ .15). Above and beyond these demographic factors, two preloss spirituality facets related to postloss distress. Specifically, a greater sense of inner peace at preloss was prospectively associated with less bereavement-specific distress (both intrusive thoughts and hyperarousal, ts ≥ 2.24, ps < .05, partial η2 ≥ .41). Greater reliance on faith at preloss was also prospectively associated with lower intrusive thoughts (t = 2.24, p < .05, partial η2 = .34).

Conclusion

Findings highlight the importance of preloss sense of peace as a predictor of psychological distress during bereavement. Programs and interventions might be designed to help caregivers find inner peace while caregiving, in an effort to augment their resiliency against psychological distress when facing the loss of the patient.
Current Trends in Breast Augmentation: Analysis of 2011–2015 Maintenance of Certification (MOC) Tracer Data
Authors: Ballard Tiffany N S , Hill Sean , Nghiem Bao Tram , Lysikowski Jerzy R , Brandt Keith , Cederna Paul S , Kenkel Jeffrey M
Published: July 2018

Background

Breast augmentation is the most common aesthetic surgery performed in the United States. Despite its popularity, there is no consensus on many aspects of the procedure.

Objectives

The authors assessed current trends and changes in breast augmentation from January 1, 2011 to December 31, 2015.

Methods

A retrospective cross-sectional study of 11,756 women who underwent breast augmentation based on the American Board of Plastic Surgery (ABPS) Maintenance of Certification Tracer Database was performed.

Results

There were clearly dominant trends in how ABPS-certified plastic surgeons performed breast augmentations. Most surgeries were performed in freestanding outpatient (47.3%) or office operating room (33.7%). The inframammary fold incision was most popular (75.1%), followed by periareolar (17.8%) and transaxillary approaches (4.1%). Implants were more commonly placed in a submuscular pocket (30.6%) compared with dual plane (26.7%) or subglandular (6.7%). Silicone implants (66.8%) were favored over saline (25.1%), with a statistically significant increase in silicone prostheses from 2011 to 2015. Data were “not applicable” or “other” in the remainder of cases. Administration of both preoperative antibiotics (3.8% in 2011, 98.7% in 2015, P < 0.05) and deep venous thromboembolism (DVT) prophylaxis (3.8% in 2011, 90.6% in 2015, P < 0.05) dramatically increased during the study period. Overall adverse events (7.4%) and reoperation rates (2.2%) were low.

Conclusions

Changes in standard of care for breast augmentation are reflected by the evolving practice patterns of plastic surgeons. This is best evidenced by the dramatic increase in use of antibiotic and DVT prophylaxis from 2011 to 2015.

Level of Evidence: 4
An audit of healthcare provision in internally displaced population camps in Nigeria
Authors: Ekezie Winifred , Timmons Stephen , Myles Puja , Siebert Penelope , Bains Manpreet , Pritchard Catherine
Published: July 2018

Background

Armed conflict in Nigeria resulted in more than 2 million internally displaced persons (IDPs). IDPs live in poor conditions lacking basic resources with variable provision across different locations. This audit aimed to determine the health-related resources available to IDPs in camp-like settings in Nigeria and whether these met international standards.

Methods

Using a cross-sectional study approach, information was collected in nine camps across seven states from camp managers, and direct observation in September–October 2016. The Sphere minimum standards in humanitarian crises were used as the audit standards.

Findings

The 5 of 15 assessed standards were met to some extent, including the availability of water and shelter. Sanitation and vaccination were unmet in five camps, with severe overcrowding in five camps, and inadequate waste disposal in all camps. Health programme implementation was uneven, and especially poor in self-settled and dispersed settlements.

Conclusion

Inequality in distribution of humanitarian support was observed across different settings, which could lead to a higher likelihood of water, food and air-related diseases and thereby, a poorer quality of life for IDPs. Ensuring standardized health assessments could promote a more even distribution of resources across IDP locations.
Cost-Effectiveness of Curettage Versus Expectant Management in Women With an Incomplete Evacuation After Misoprostol Treatment for First-Trimester Miscarriage: A Randomized Controlled Trial and Cohort Study
Authors: Lemmers Marike , Verschoor Marianne A. C. , Bossuyt Patrick M. , Huirne Judith A. F. , Spinder Teake , Nieboer Theodoor E. , Bongers Marlies Y. , Janssen Ineke A. H. , Van Hooff Marcel H. A. , Mol Ben W. J. , Ankum Willem M. , Bosmans Judith E.
Published: July 2018

(Abstracted from Acta Obstet Gynecol Scand 2018;97(3):294–300)

Misoprostol was introduced over 10 years ago as a treatment option for women with first-trimester miscarriages alongside expectant management and curettage. It is an effective treatment for 50% to 85% of these women.
Opioid Utilization Following Lumbar Arthrodesis
Authors: Kalakoti Piyush , Hendrickson Nathan R. , Bedard Nicholas A. , Pugely Andrew J.
Published: July 2018

Study Design.

A retrospective, observational cohort study.

Objective.

In patients undergoing lumbar spine arthrodesis, we sought to establish perioperative trends in chronic versus naive opioid users (OUs) and identify modifiable risk factors associated with prolonged consumption.

Summary of Background Data.

The morbidity associated with excessive opioid use for chronic conditions continues to climb and has been identified as a national epidemic. Limiting excessive perioperative opioid use after procedures such as lumbar fusion remains a national health strategy.

Methods.

A national commercial claims dataset (2007–2015) was queried for all patients undergoing anterior lumbar interbody fusion (ALIF) and/or lumbar [posterior/transforaminal lumbar interbody fusion (P/TLIF) or posterolateral fusion (PLF)] spinal fusion procedures. Patients were labeled as either an OU (prescription within 3 months pre-surgery) or opioid naive (ON, no prescription). Rates of opioid use were evaluated preoperatively for OU, and longitudinally tracked up to 1-year postoperatively for both OU and ON. Multivariable regression techniques investigated factors associated with opioid use at 1-year following surgery. In addition, a clinical calculator (app) was created to predict 1-year narcotic use.

Results.

Overall, 26,553 patients (OU: 58.3%) underwent lumbar surgery (ALIF: 8.5%; P/TLIF: 43.8%; PLF: 41.5%; ALIF+PLF: 6.2%). At 1-month postop, 60.2% ON and 82.9% OUs had a filled opioid prescription. At 3 months, prescription rates declined significantly to 13.9% in ON versus 53.8% in OUs, while plateauing at 6 to 12-month postoperative period (ON: 8.4–9.6%; OU: 42.1–45.3%). At 1 year, significantly higher narcotic prescription filling rates were observed in OUs than in ON (42.4% vs. 8.6%; P < 0.001). Preoperative opioid use was the strongest driver of 1-year narcotic use following ALIF [odds ratio (OR): 7.86; P < 0.001], P/TLIFs (OR: 4.62; P < 0.001), or PLF (OR: 7.18; P < 0.001).

Conclusion.

Approximately one-third patients chronically use opioids before lumbar arthrodesis and nearly half of the pre-op OUs will continue to use at 1 year. Our findings serve as a baseline in identifying patients at risk for chronic use and alter surgeons to work toward discontinuation of opioids before lumbar spinal surgery.

Level of Evidence: 3
Intraoperative Neuromonitoring (IONM)
Authors: Kumar Naresh , G Vijayaraghavan , Ravikumar Nivetha , Ding Yan , Yin May Lin , Patel Ravish Shammi , Naresh Nandika , Hey Hwee Weng Dennis , Lau Leok-Lim , Liu Gabriel
Published: July 2018

Study Design.

A retrospective design.

Objective.

We aim to report our experience with multimodal intraoperative neuromonitoring (IONM) in metastatic spine tumor surgery (MSTS).

Summary of Background Data.

IONM is considered as standard of care in spinal deformity surgeries. However, limited data exist about its role in MSTS.

Methods.

A total of 135 patients from 2010 to 2017, who underwent MSTS with IONM at our institute, were studied retrospectively. After excluding seven with no baseline signals, 128 patients were analyzed. The data collected comprised of demographics, pre and postoperative American Spinal Injury Association (ASIA) grades and neurological status, indications for surgery, type of surgical approach. Multimodal IONM included somatosensory-evoked potentials (SSEPs), transcranial electric motor-evoked potentials (tcMEP), and free running electromyography (EMG).

Results.

The 128 patients included 61 males and 67 females with a mean age of 61 years. One hundred sixteen underwent posterior procedures; nine anterior and three both. The frequency of preoperative ASIA Grades were A = 0, B = 0, C = 10, D = 44, and E = 74 patients. In total, 54 underwent MSTS for neurological deficit, 66 for instability pain, and 8 for intractable pain.

Of 128 patients, 13 (10.2%) had significant IONM alerts, representing true positives; 114 true negatives, one false negative, and no false positives. Among the 13 true positives, four (30%) underwent minimally invasive and nine (70%) open procedures. Eight (69.2%) patients had posterior approach. Seven (53.84%) true positive alerts were during decompression, which resolved to baseline upon completion of decompression, while five (38.46%) were during instrumentation, which recovered to baseline after adjusting/downsizing the instrumentation, and one (8.3%) during lateral approach, which reversed after changing the plane of dissection. Of the seven patients without baseline, five were ASIA-A and two were ASIA-C. The sensitivity, specificity, positive, and negative predictive values were 99.1%, 100%, 100%, and 92.9%, respectively.

Conclusion.

Multimodal IONM in MSTS helped in preventing postoperative neurological deficit in 9.4% of patients. Its high sensitivity and specificity to detect intraoperative neurological events envisage its use in ASIA-grade D/E patients requiring instrumented decompression.

Level of Evidence: 3
Lack of Cost Savings for Lumbar Spine Fusions After Bundled Payments for Care Improvement Initiative
Authors: Bronson Wesley H. , Kingery Matthew T. , Hutzler Lorraine , Karia Raj , Errico Thomas , Bosco Joseph , Bendo John A.
Published: July 2018

Study Design.

Retrospective analysis of Medicare claims and procedure details from a single institution participation in the Bundled Payments for Care Improvement (BPCI) program.

Objective.

To analyze the effects of the BPCI program on patient outcome metrics and cost data.

Summary of Background Data.

The BPCI program was designed to improve the value of care provided to patients, but the financial consequences of this system remain largely unknown. We present 2 years of data from participation in the lumbar spine fusion bundle at a large, urban, academic institution.

Methods.

In 2013 and 2014, all Medicare patients undergoing lumbar spine fusions for DGR 459 (spinal fusion except cervical with major complication or comorbidity [MCC]) and 460 (without MCC) at our institution were enrolled in the BPCI program. We compared the BPCI cohort to a baseline cohort of patients under the same diagnosis related groups (DRGs) from 2009 to 2012 from which the target price was established.

Results.

Three hundred fifty patients were enrolled into the BPCI program, while the baseline group contained 518 patients. When compared with the baseline cohort, length of stay decreased (4.58 ± 2.51 vs. 5.13 ± 3.75; P = 0.009), readmission rate was unchanged, and discharges with home health aid increased. Nonetheless, we were unable to effect an episode-based cost savings ($52,655 ± 27,028 vs. $48,913 ± 24,764). In the larger DRG 460 group, total payments increased in the BPCI group ($51,105 ± 26,347 vs. $45,934 ± 19,638, P = 0.001). Operative data demonstrated a more complex patient mix in the BPCI cohort. The use of interbody fusions increased from 2% to 16% (P < 0.001), and the percentage of complex spines increased from 23% to 45% (P < 0.001).

Conclusion.

Increased case complexity was responsible for increasing costs relative to the negotiated baseline target price. This payment system may discourage advancement in spine surgery due to the financial penalty associated with novel techniques and technologies.

Level of Evidence: 3
A Mobile Application for Patients With Heart Failure
Authors: Foster Marva
Published: July 2018

Self-care is vital for the successful management of heart failure. Mobile health can enable patients with heart failure to perform effective self-care. This article describes the theory-guided development and beta testing of a mobile application intervention to support self-care and increase symptom awareness in community-dwelling patients with heart failure. Ten participants entered physiologic data, answered qualitative questions about symptoms, and reviewed heart failure education within the HF App daily. Two validated instruments, the Self-care of Heart Failure Index and Heart Failure Somatic Awareness Scale, were administered both before and after the intervention, and results were compared using t tests. Results indicated that there were clinically significant changes from preintervention to postintervention in self-care scores in each subscale, with a statistically significant difference in the confidence subscale scores (P = .037). However, there were no statistically significant differences between preintervention and postintervention symptom awareness scores. These results indicate that incorporating mobile applications that comprise symptom monitoring, reminders, education, and the ability to track trends in physiologic data is most useful to assist individuals with heart failure to perform effective self-care.
Primary malignant melanoma of the cervix: 14 cases and literature overview
Authors: Sun Haiyan , Chen Yanfang , Chen Ying , Liu Dongying , Yan Zhuchen , Bin Meng  , Zhao Gang , Pan Zhanyu , Li Qiang
Published: July 2018

Primary malignant melanoma of the cervix (PMMC) is a rare and aggressive tumor. Studies on clinicopathological findings, treatment outcomes, and prognostic factors of this disease are lacking. We reviewed 14 cases of PMMC recorded from January 1972 to February 2017 at the Tianjin Medical University Cancer Institute and Hospital. Twelve (85.7%) of the 14 patients presented a history of vaginal bleeding and 11 (78.6%) underwent surgery. The overall survival was 3–70 months, with a median time of 13.7 months. Patients who underwent surgery (P=0.035) had high survival rates, whereas those with lymph node metastasis and late International Federation of Gynecology and Obstetrics stage had poor survival rates, but did not show a significant difference (P=0.187 and 0.053, respectively) compared with those without node metastasis and early International Federation of Gynecology and Obstetrics stage. PMMC is a highly aggressive tumor with a poor prognosis. Surgical resection is the main treatment of choice for PMMC.