bluuebunny/crossref_metadata_2025 huggingface dataset:
The Differential Effects of Three Verbal Punishers on the Disfluencies of Normal Speakers
Authors: Brookshire Robert H. , Martin Richard R.
Published: July 2016

One hundred normal subjects, divided into five groups, read aloud for 40 minutes. For the first 10 minutes (Baserate), subjects read without interruption. For the next 20 minutes (Conditioning), verbal stimuli contingent upon disfluency were delivered to three groups. One group received “wrong”; the second, “no”; and the third “huh-uh” for disfluency. A fourth group received “wrong” on a random schedule during Conditioning, while the fifth (control) received no verbal stimuli. During the last 10 minutes (Extinction), no verbal stimuli were delivered to any group. Random and Control subjects did not change disfluency rates, while subjects in all contingent conditions decreased disfluency in Conditioning. Contingent “wrong” produced the greatest decrement in disfluency, “no” the least, and “huh-uh” occupied a midpoint.
Interrelationships Among Oral Breath Pressure Ratios and Articulation Skills for Individuals with Cleft Palate
Authors: Barnes Ida Jones , Morris Hughlett L.
Published: July 2016

Interrelationships among four breath pressure ratios, eight measures of articulation proficiency, age, intelligence, and hearing acuity were computed for 85 children from four to 18 years who had cleft lip and palate. Of the breath pressure ratios, the ratio based on positive readings with bleed relates highest to the measures of articulation skill. Of the measures of articulation skill, the plosive—elements test and the stimulation test correlate most highly with the pressure ratios. The stimulation test is the single measure which correlates highest with both articulation and pressure ratios, and can be considered to most clearly reflect ability to achieve velopharyngeal closure in speech.
Effects of Two CS-US Intervals on Conditioning and Response Decay in Electrodermal Audiometry
Authors: Tait Charles A. , Dixon Richard F. , Chaiklin Joseph B.
Published: July 2016

Electrodermal responses to low level, intermittently reinforced pure tones were obtained on 60 normal-hearing subjects. Thirty subjects received shock reinforcement 0.5 sec following onset of tone, while the remaining subjects received shock reinforcement 5 sec following onset of tone. Subject conditionability appeared to be unaffected by CS-US interval differences, but response decay increased as a function of CS-US interval.
Tone 3 in Pekinese
Authors: Wang William S-Y. , Li Kung-Pu
Published: July 2016

This article treats the problem of tone sandhi in Pekinese phonology in terms of a perception experiment. The various shapes of tone 3 in different environments are illustrated by the use of spectrograms. The issue is whether the tone sequence 3–3 is homophonous with the sequence 2–3. There were 130 pairs of test items. The two members of each pair share the same phonological features except that of pitch contour. In other words, one member carries the tone sequence 2–3 while the other carries 3–3. Each test item was given twice, thus yielding a total of 520 items arranged in random order on a reading list from which tape recordings were made. Upon hearing an item on the tape, a subject is required to identify from each pair of 2–3 and 3–3 test items the member he hears. Should there be a phonemic distinction between the two types of tone sequences, a native speaker should have no difficulty in perceiving them as distinct. Then, it would be expected that the subjects could identify correctly in most cases, and that their responses should be reinforced by other phonetic properties and unbiased by semantic plausibility. However, the results of this experiment led to the opposite conclusion.
Hearing in Mice by GSR Audiometry: I. Magnitude of Unconditioned GSR as an Index of Frequency Sensitivity
Authors: Berlin Charles I. , Gill Alan , Leffler Martha
Published: July 2016

Three experiments show that the magnitude of the unconditioned GSR to tones of equal intensity is largest between 10,000 and 20,000 Hz and is a valid index of the frequency sensitivity of the mouse. These findings agree well with cochlear potential findings and single unit response areas, and suggest that the magnitude of the unconditioned GSR might be used as a screening device for frequency sensitivity. A fourth experiment, studying responses of humans to a similar regiment of 100 dB SPL tones, showed a relatively flat response curve unrelated to frequency sensitivity and more closely related to equal loudness contouring. Habituation of the unconditioned GSR in the human was more rapid than in the mouse, suggesting marked differences between the species in either the auditory systems and/or the mechanisms of auditory inhibition and GSR excitation.
Picture-Sound Association in Deaf Children
Authors: Doehring Donald G.
Published: July 2016

Programmed instruction in picture-sound association was given to 26 deaf children aged 4 to 10, 20 hearing children with learning disorders aged 7 to 15, and 18 normal children aged 4 to 6 from day nurseries. The learning task involved tape-recorded presentation of a meaningful nonverbal sound in conjunction with three pictures projected on the response windows of a viewing-response device. The subject was required to match the picture with the sound.

The majority of deaf children (19 of 26) learned the task in from 1 to 11 sessions. All but two of the children with learning disorders learned on the first session, and 13 of the 18 younger normal children learned in from 1 to 6 sessions. The performance of the deaf children bore some relation to age, hearing loss, and aided hearing ability but not to teacher rating of intelligence. The results indicated that even profoundly deaf children might benefit from auditory nonverbal perceptual training.
Control the cost, touch and step voltages of the grounding grids design
Authors: Ghoneim Sherif S.M. , Taha Ibrahim B.M.
Published: July 2016

In this study, an evolutionary strategy is presented to get the optimal grounding grid design to minimise the design cost, the touch and step voltages of the grounding grid to ensure the economical constraint as well as the safety conditions. The proposed technique is used for one and two‐layer soil. This technique is based on the comparison between the quality factors of the initial grid dimension according to the cost, touch and step voltages with the other quality factors obtained from new generations (offspring) of the grid dimensions. Effects of top layer thickness, number of grid meshes, vertical rods number and length, and the soil resistivity of the top and bottom layers on grounding resistance (Rg) and earth surface potential are studied. Different case studies are introduced to evaluate the performance of the proposed technique and to provide the knowledge about the grid dimensions that is substantial for the economical design of the grounding grids.
What interactions can distort the orientational distribution of interfacial water molecules as probed by second harmonic and sum frequency generation?
Authors: de Beer Alex G. F. , Roke Sylvie
Published: July 2016

Aqueous interfaces are omnipresent in nature. Nonlinear optical methods such as second harmonic and sum frequency generation (SHG/SFG) are valuable techniques to access molecular level information from these interfaces. In the interpretation of SHG and SFG data for both scattering and reflection mode experiments, the relation between the second-order hyperpolarizability tensor β2, a molecular property, and the surface second-order susceptibility χ2, a surface averaged property, plays a central role. To correctly describe the molecular details of the interface, it needs to be determined how molecules are oriented, and what the influence is of interfacial electrostatic fields and H-bonding on the orientational distribution. Here, we revisit the relations between β2 and χ2 and show, by means of a Boltzmann average, that significant energy differences are needed to generate measurable changes in the molecular orientational distribution at the interface. In practice, H-bonding and surface pressure such as applied in a Langmuir trough can be strong enough to alter the shape of the orientational distribution function of water. In contrast, electrostatic fields, such as those present in the Stern layer, will not have a significant impact on the shape of the orientational distribution function of water molecules.
Freezing effects of oil-in-water emulsions studied by sum-frequency scattering spectroscopy
Authors: Smit W. J. , Smolentsev N. , Versluis J. , Roke S. , Bakker H. J.
Published: July 2016

Temperature-dependent sum-frequency scattering spectroscopy is used to study the properties of hexadecane and dodecane oil droplets in water. The sum-frequency scattering spectra contain vibrational bands that correspond to the symmetric and antisymmetric CH stretching vibrations of the methylene (CH2) and methyl (CH3) groups of the alkane molecules. The relative amplitudes of the vibrational bands provide information on the surface structure and the shape of the oil droplets. We study the sum-frequency scattering spectra over a temperature range of −48 to 24 °C, including the freezing transitions of the water matrix and the oil droplets. Hexadecane oil droplets freeze at a higher temperature than the surrounding water, whereas dodecane oil droplets freeze at a lower temperature than the surrounding water. This allows us to independently study the freezing effect of oil and water on the surface structure of the oil droplets. In both cases, freezing leads to a change in the polarization dependencies that are valid in the case of the spherical-symmetric shapes that the oil droplets assume when both water and oil are liquid. We find that the freezing of water leads to a strong distortion of the liquid dodecane surface but has little effect on the surface of already solidified hexadecane. For completely frozen emulsions a further decrease in temperature is observed to lead to a further distortion of the surface of the solid oil particles, which might be caused by increasing hardness of the ice matrix encapsulating the particles.
Enhancement in magnetocaloric properties of holmium chromite by gadolinium substitution
Authors: Yin S. , Jain M.
Published: July 2016

HoCrO3, Ho0.67Gd0.33CrO3, and GdCrO3 bulk powder samples were prepared by citrate route. The phase purity and the structural properties of the samples were examined by x-ray diffraction and Raman spectroscopic measurements. The dc magnetization data revealed that the Cr3+ ordering temperatures (Néel temperature) for the HoCrO3, Ho0.67Gd0.33CrO3, and GdCrO3 samples are 140 K, 148 K, and 167 K, respectively, while the ac magnetization data revealed that the rare-earth (Ho) ordering occurs at ∼8 K for HoCrO3 and Ho0.67Gd0.33CrO3 samples. Temperature-induced magnetization reversal and spin reorientation were observed in GdCrO3 bulk sample, which depends on applied magnetic field and disappears at ∼1500 Oe and 500 Oe, respectively. By fitting the dc magnetic data with Curie-Weiss law, the effective magnetic moments were calculated to be 11.66 μB, 10.23 μB, and 9.90 μB for the HoCrO3, Ho0.67Gd0.33CrO3, and GdCrO3 samples, respectively. The isothermal magnetization data showed that the magnetic behavior changed from canted antiferromagnetic in low temperature region (below Néel temperature) to paramagnetic at high temperature. It was found that Gd substitution considerably improves the magnetocaloric effect of HoCrO3. Pure GdCrO3 bulk sample showed giant magnetocaloric entropy change (31.6 J/kg K at temperature ∼5 K and at ∼70 kOe), which is higher than that for polycrystalline RMnO3, RCrO3, and RFeO3 bulk powder samples. This renders GdCrO3 useful for potential applications in low-temperature magnetic refrigeration.
Homogeneous double-layer amorphous Si-doped indium oxide thin-film transistors for control of turn-on voltage
Authors: Kizu Takio , Aikawa Shinya , Nabatame Toshihide , Fujiwara Akihiko , Ito Kazuhiro , Takahashi Makoto , Tsukagoshi Kazuhito
Published: July 2016

We fabricated homogeneous double-layer amorphous Si-doped indium oxide (ISO) thin-film transistors (TFTs) with an insulating ISO cap layer on top of a semiconducting ISO bottom channel layer. The homogeneously stacked ISO TFT exhibited high mobility (19.6 cm2/V s) and normally-off characteristics after annealing in air. It exhibited normally-off characteristics because the ISO insulator suppressed oxygen desorption, which suppressed the formation of oxygen vacancies (VO) in the semiconducting ISO. Furthermore, we investigated the recovery of the double-layer ISO TFT, after a large negative shift in turn-on voltage caused by hydrogen annealing, by treating it with annealing in ozone. The recovery in turn-on voltage indicates that the dense VO in the semiconducting ISO can be partially filled through the insulator ISO. Controlling molecule penetration in the homogeneous double layer is useful for adjusting the properties of TFTs in advanced oxide electronics.
Low temperature aluminum nitride thin films for sensory applications
Authors: Yarar E. , Hrkac V. , Zamponi C. , Piorra A. , Kienle L. , Quandt E.
Published: July 2016

A low-temperature sputter deposition process for the synthesis of aluminum nitride (AlN) thin films that is attractive for applications with a limited temperature budget is presented. Influence of the reactive gas concentration, plasma treatment of the nucleation surface and film thickness on the microstructural, piezoelectric and dielectric properties of AlN is investigated. An improved crystal quality with respect to the increased film thickness was observed; where full width at half maximum (FWHM) of the AlN films decreased from 2.88 ± 0.16° down to 1.25 ± 0.07° and the effective longitudinal piezoelectric coefficient (d33,f) increased from 2.30 ± 0.32 pm/V up to 5.57 ± 0.34 pm/V for film thicknesses in the range of 30 nm to 2 μm. Dielectric loss angle (tan δ) decreased from 0.626% ± 0.005% to 0.025% ± 0.011% for the same thickness range. The average relative permittivity (εr) was calculated as 10.4 ± 0.05. An almost constant transversal piezoelectric coefficient (|e31,f|) of 1.39 ± 0.01 C/m2 was measured for samples in the range of 0.5 μm to 2 μm. Transmission electron microscopy (TEM) investigations performed on thin (100 nm) and thick (1.6 μm) films revealed an (002) oriented AlN nucleation and growth starting directly from the AlN-Pt interface independent of the film thickness and exhibit comparable quality with the state-of-the-art AlN thin films sputtered at much higher substrate temperatures.
On the way to enhance the optical absorption of a-Si in NIR by embedding Mg2Si thin film
Authors: Chernev I. M. , Shevlyagin A. V. , Galkin K. N. , Stuchlik J. , Remes Z. , Fajgar R. , Galkin N. G.
Published: July 2016

Mg2Si thin film was embedded in amorphous silicon matrix by solid phase epitaxy. The structure and optical properties were investigated by electron energy loss, X-ray photoelectron, Raman, and photo thermal deflection spectroscopy measurements. It was found that in the photon energy range of 0.8–1.7 eV, the light absorption of the structure with magnesium silicide (Mg2Si) film embedded in a-Si(i) matrix is 1.5 times higher than that for the same structure without Mg2Si.
Structures of mammalian ER α-glucosidase II capture the binding modes of broad-spectrum iminosugar antivirals
Authors: Caputo Alessandro T. , Alonzi Dominic S. , Marti Lucia , Reca Ida-Barbara , Kiappes J. L. , Struwe Weston B. , Cross Alice , Basu Souradeep , Lowe Edward D. , Darlot Benoit , Santino Angelo , Roversi Pietro , Zitzmann Nicole
Published: July 2016

Significance

Most pathogenic enveloped viruses crucially depend on the quality control (QC) machinery in the endoplasmic reticulum (ER) of the host cell. ERQC inhibitors therefore have the double potential benefit of targeting a wide variety of viruses (“broad-spectrum antivirals”) without the risk of losing efficacy due to escape mutations in the viral genome. Our recent work has proven that inhibition of the central enzyme of ERQC, α-glucosidase II (α-GluII), is sufficient for antiviral activity against dengue fever in vitro and in vivo. Here, we show how antiviral inhibitors bind to portions of α-GluII that are unique to this enzyme, and we open the way to the development of potent and selective antivirals against existing and emerging infectious disease.
Peripheral tolerance can be modified by altering KLF2-regulated Treg migration
Authors: Pabbisetty Sudheer K. , Rabacal Whitney , Volanakis Emmanuel J. , Parekh Vrajesh V. , Olivares-Villagómez Danyvid , Cendron Delphine , Boyd Kelli L. , Van Kaer Luc , Sebzda Eric
Published: July 2016

Significance

Tregs are necessary to prevent autoimmunity; however, these same cells suppress tumor-specific immune responses and contribute to malignancy. Before Treg-based therapies are devised to treat these diseases, it is important to understand how Tregs function under physiological conditions. We now report that Tregs carry out their immune-suppressive functions in secondary lymphoid organs (e.g. spleen, lymph nodes) and factors that impair or enhance Treg homing to these sites diminish or increase self-tolerance, respectively. Importantly, Treg migration patterns are regulated by Kruppel-like factor 2 (KLF2), and increasing expression of this transcription factor within the Treg compartment promotes self-tolerance. The present study demonstrates that Treg trafficking to lymphoid tissues underpins peripheral tolerance, which can be modified by targeting KLF2 with therapeutic drugs.
Dimerization of visual pigments in vivo
Authors: Zhang Tao , Cao Li-Hui , Kumar Sandeep , Enemchukwu Nduka O. , Zhang Ning , Lambert Alyssia , Zhao Xuchen , Jones Alex , Wang Shixian , Dennis Emily M. , Fnu Amrita , Ham Sam , Rainier Jon , Yau King-Wai , Fu Yingbin
Published: July 2016

Significance

Despite in vitro evidence, it remains unclear whether the rod visual pigment rhodopsin exists as dimers in vivo. With a unique mouse line that expresses the blue cone opsin transgenically in rods, we showed that, in the absence of chromophore, the transgenic cone opsin can mature and target to the outer segment if and only if rhodopsin is present to help it along (i.e., forming heterodimers in the endoplasmic reticulum). Furthermore, we have confirmed a key interaction domain for rhodopsin dimerization and show that, again in vivo, rhodopsin maturation and targeting to the outer segment becomes defective when dimerization is disrupted. This work provides in vivo evidence for rhodopsin existing as a dimer.
An extract from pork bones containing osteocalcin improves glucose metabolism in mice by oral administration
Authors: Mizokami Akiko , Wang DaGuang , Tanaka Mitsuru , Gao Jing , Takeuchi Hiroshi , Matsui Toshiro , Hirata Masato
Published: July 2016

Osteocalcin (OC) is a bone-derived hormone that regulates energy metabolism. OC exists in two forms, carboxylated (GlaOC) and uncaboxylated (GluOC), but only the latter appears to have an endocrine function. In this study, we prepared an extract containing both Gla- and GluOC from boiled pork bone using 0.2 M carbonate buffer at pH 9.5, and tested whether the extract had beneficial effects on improving metabolic parameters in obese mice. The extract equivalent of 1.2 μg of GluOC/mouse was orally administrated to C57BL/6 female mice fed a high-fat, high-sucrose diet. Daily oral administration of the extract for four weeks decreased blood glucose levels and promoted glucose tolerance as well as insulin sensitivity. Our study shows for the first time that boiled pork bones are a source material for osteocalcin in the large-scale production of supplements designed to improve glucose metabolism.
Individual action, world society, and environmental change: 1993–2010
Authors: Hadler Markus
Published: July 2016

This article studies the question of how global cultural models shape individual environmental behaviours. The analysis applies a novel, cross-sectional, longitudinal, multilevel model that combines individual-level survey data from sixteen countries collected by the International Social Survey Programme (ISSP) with contextual characteristics such as the presence of international organisations, the national institutionalisation of environmentalism, and polities’ demands on individual participation. The analysis provides only limited support for the direct effects of ties to world society. It rather suggests indirect effects via the institutionalisation of environmentalism at the national level and via various individual exposure variables. In addition, both public and private behaviours are positively influenced by attitudinal alignment with global models, whereas certain individualisation processes have negative effects.
Local variation in world society: six characteristics of global diffusion
Authors: Pope Shawn , Meyer John W.
Published: July 2016

We review world society research that theorises differences rather than similarities in diffusion into local settings. Six characteristics of global diffusion processes, most of which contribute directly to local variation, are featured: structural embeddedness, decoupling, domestication, multiple diffusion, contingent diffusion, and multi-level diffusion. We illustrate each characteristic with examples from, and applications to, the global movement for corporate social responsibility.
Habitat preferences of two sparrow species are modified by abundances of other birds in an urban environment
Authors: Skórka Piotr , Sierpowska Katarzyna , Haidt Andżelika , Myczko Łukasz , Ekner-Grzyb Anna , Rosin Zuzanna M. , Kwieciński Zbigniew , Suchodolska Joanna , Takacs Viktoria , Jankowiak Łukasz , Wasielewski Oskar , Graclik Agnieszka , Krawczyk Agata J. , Kasprzak Adam , Szwajkowski Przemysław , Wylegała Przemysław , Malecha Anna W. , Mizera Tadeusz , Tryjanowski Piotr
Published: July 2016

Every species has certain habitat requirements, which may be altered by interactions with other co-occurring species. These interactions are mostly ignored in predictive models trying to identify key habitat variables correlated with species population abundance/occurrence. We investigated how the structure of the urban landscape, food resources, potential competitors, predators, and interaction between these factors influence the abundance of house sparrow Passer domesticus and the tree sparrow P. montanus in sixty 25 ha plots distributed randomly across residential areas of the city of Poznań (Poland). The abundance of the house sparrow was positively correlated with the abundance of pigeons but negatively correlated with human-related food resources. There were significant interaction terms between abundances of other urban species and habitat variables in statistical models. For example, the abundance of house sparrow was negatively correlated with the abundance of corvids and tree sparrows but only when food resources were low. The abundance of tree sparrows positively correlated with density of streets and the distance from the city center. The abundance of this species positively correlated with the abundance of corvids when food resources were low but negatively correlated at low covers of green area. Our study indicates that associations between food resources, habitat covers, and the relative abundance of two sparrow species are altered by the abundance of other urban species. Competition, niche separation and social facilitation may be responsible for these interactive effects. Thus, biotic interactions should be included not only as an additive effect but also as an interaction term between abundance and habitat variables in statistical models predicting species abundance and occurrence.
Competent for Unsupervised Practice: Use of Pediatric Residency Training Milestones to Assess Readiness
Authors: Li Su-Ting T. , Tancredi Daniel J. , Schwartz Alan , Guillot Ann P. , Burke Ann E. , Trimm R. Franklin , Guralnick Susan , Mahan John D. , Gifford Kimberly A.
Published: July 2016

Purpose

To describe clinical skills progression during pediatric residency using the distribution of pediatric milestone assessments by subcompetency and year of training and to determine reasonable milestone expectations at time of graduation.

Method

Multi-institutional cohort study of the milestones reported to the Accreditation Council for Graduate Medical Education for all 21 pediatric subcompetencies. Most subcompetencies were measured using five milestone levels (1 = novice, 2 = advanced beginner, 3 = competent, 4 = proficient, 5 = master); 3 subcompetencies had only four levels defined.

Results

Milestone assessments for 2,030 pediatric residents in 47 programs during academic year 2013–2014 were obtained. There was significant variation in end-of-year milestone ratings for residents within each level of training, which decreased as training level increased. Most (78.9%; 434/550) graduating third-year pediatric residents received a milestone rating of ≥ 3 in all 21 subcompetencies; fewer (21.1%; 116/550) received a rating of ≥ 4 in all subcompetencies. Across all training levels, professionalism and interpersonal communication skills were rated highest; quality improvement was rated lowest.

Conclusions

Trainees entered residency with a wide range of skills. As they advanced, skill variability within a training level decreased. Most graduating pediatric residents were still advancing on the milestone continuum toward proficiency and mastery, and an expectation of milestone ratings ≥ 4 in all categories upon graduation is unrealistic; milestone ratings ≥ 3 upon graduation may be more realistic. Understanding current pediatric residents’ and graduates’ skills can help to identify key areas that should be specifically targeted during training.
An Argument for Change in Tobacco Treatment Options Guided by the ASAM Criteria for Patient Placement
Authors: Williams Jill M. , Steinberg Marc L. , Kenefake Alexandra N. , Burke Michael V.
Published: July 2016

Tobacco use is a major threat to public health in the United States, and the number one cause of preventable death. Although most smokers try to quit unaided, robust data indicate that pairing behavioral support to US Food Drug Administration-approved cessation medications significantly increase cessation rates. Those who do receive assistance in quitting usually receive very low intensity treatment, regardless of the severity of their dependence or their medical and environmental circumstances. This is in stark contrast to how other substance use disorders are treated, where there are varying levels of care depending on addiction severity and biopsychosocial circumstances. The American Society of Addiction Medicine (ASAM) developed a formal algorithm for assessing substance use disorders and determining the optimal level of care. The ASAM Patient Placement Criteria are regularly used to determine the appropriate level of care for all substance use disorders except tobacco. This paper will review key aspects of the ASAM dimensions of care and placement levels, with emphasis on how they apply to tobacco use and present case examples of typical smokers who would benefit from a higher intensity of tobacco dependence treatment. We also present current barriers to reimbursing healthcare providers for these services. We conclude with a commentary and discussion regarding recommendations for improvements in tobacco dependence treatment care.
A Retrospective Analysis of the Treatment of Melasma Using a Fractional Long-Pulsed Alexandrite Laser in Korean Patients
Authors: Lee Min Kyung , Min Kyung Sik , Park Eun Joo , Kim Kwang Ho , Kim Kwang Joong
Published: July 2016

BACKGROUND

Long-pulsed, 755-nm, alexandrite lasers have been shown to be effective and safe in the treatment of pigmentary lesions.

OBJECTIVE

Clinical outcomes and side effects in the treatment of melasma using a fractional, long-pulsed, alexandrite laser were assessed.

MATERIALS AND METHODS

Forty-eight patients with melasma received 2 to 4 treatment sessions of fractional, long-pulsed, alexandrite laser at 2 to 3 weeks intervals. The parameter of treatment was 60 to 80 J/cm2 without dynamic cooling device using 15-mm spot size of fractional hand piece, with a 0.5- to 1-millisecond pulse width.

RESULTS

The mean modified melasma area and severity index score decreased significantly 2 months after the final treatment compared with baseline (16.5 ± 8.2 vs 11.5 ± 7.0; p = .002). The patients with epidermal type melasma were more effective compared to dermal type (p < .001).

CONCLUSION

Long-pulsed alexandrite lasers using a fractional hand piece are moderately effective in the treatment of melasma with low risk of adverse effects, and it is suggested that fractional, long-pulsed, alexandrite laser with combination of other modalities can be an additional therapeutic option in patients with melasma.
Metastatic Cutaneous Squamous Cell Carcinoma: The Importance of T2 Stratification and Hematologic Malignancy in Prognostication
Authors: Stevenson Mary L. , Kim Randie , Meehan Shane A. , Pavlick Anna C. , Carucci John A.
Published: July 2016

BACKGROUND

While infrequent, nodal metastases in cutaneous squamous cell carcinoma (cSCC) can result in death from disease. Identification of those at risk for metastases is key to improved prognostication and treatment.

OBJECTIVE

To review metastatic cSCC at the study institution.

METHODS AND MATERIALS

Sixteen patients with metastatic cSCC were identified at the New York University Dermatologic Associates and Cancer Associates from 1998 to 2013. Patients were staged with American Joint Committee on Cancer (AJCC) and modified Brigham and Women's Hospital (BWH) criteria and compared to 32 control subjects.

RESULTS

Seven of 16 patients were identified as Stage T2 by AJCC criteria and Stage T2b by BWH criteria; two patients were on Stage T1, three patients were on more advanced T stages, and four patients lacked primary tumor data. Five patients had hematologic malignancy, and one patient had a solid-organ transplant.

CONCLUSION

The modified BWH criteria aims to better prognosticate the large group of T2 AJCC tumors, resulting in the majority of mortality. In the experience of the authors, the majority of patients with metastatic disease were on T2, stratifying to stage T2b by BWH criteria, or more advanced T stages. The findings of this study support BWH stratification of T2 tumors and also indicate that hematologic malignancy is a significant comorbidity associated with a poor outcome.
Cannabis Use Surveillance by Sweat Analysis
Authors: Gambelunghe Cristiana , Fucci Nadia , Aroni Kyriaki , Bacci Mauro , Marcelli Antonio , Rossi Riccardo
Published: July 2016

Background:

Sweat testing, an alternative matrix for establishing drug abuse, offers additional benefits to the more common biological samples. The authors developed a procedure using gas chromatography–mass spectrometry to test for Δ9-tetrahydrocannabinol, 11-nor-Δ9-tetrahydrocannabinol-9-carboxylic acid, cannabinol (CBN), and cannabidiol (CBD) in a sweat patch. The results were compared with urine and hair sample results.

Methods:

Urine, hair, and sweat samples were simultaneously collected from 12 patients who were involved, respectively, in forensic case and monitoring abuse. Selectivity, linearity, limit of detection (LOD), limit of quantification (LOQ), recovery, intraday and interday imprecision, and inaccuracy of the quantification procedure were validated. LODs in hair were 0.05 ng/mg for Δ9-tetrahydrocannabinol, CBN, and CBD, and 0.005 ng/mg for 11-nor-Δ9-tetrahydrocannabinol-9-carboxylic acid. The LOD for sweat was 0.30 ng/patch for all substances. The LOQ in hair was 0.1 ng/mg for Δ9-tetrahydrocannabinol, CBN, and CBD, and 0.01 ng/mg for 11-nor-Δ9-tetrahydrocannabinol-9-carboxylic acid. The LOQ was 0.4 ng/patch in sweat for each analyte. Cannabinoid in urine was determined by means of immunochemical screening (cutoff 11-nor-Δ9-tetrahydrocannabinol-9-carboxylic acid 50 ng/mL).

Results:

All subjects tested positive for 11-nor-Δ9-tetrahydrocannabinol-9-carboxylic acid and Δ9-tetrahydrocannabinol in urine and hair. In sweat samples, Δ9-tetrahydrocannabinol was found in all patches (0.4–2.0 ng/patch); 6 cases were positive for CBN (0.4–0.5 ng/patch) and 3 for CBD (0.4–0.6 ng/patch); 11-nor-Δ9-tetrahydrocannabinol-9-carboxylic acid was never detected in patches.

Conclusions:

Present sweat analysis results integrated the information from hair and urine and showed that sweat analysis is a suitable, noninvasive method for monitoring compliance with rehabilitation therapy and for detecting recent cumulative use of cannabinoids.
In-hospital complications of vaginal versus laparoscopic-assisted benign hysterectomy among older women: a propensity score-matched cohort study
Authors: Lai Jerry Cheng-Yen , Chen Hung-Hui , Huang Sheng-Miauh , Wang Kung-Liahng , Huang Nicole , Hu Hsiao-Yun , Chou Yiing-Jenq
Published: July 2016

Objective:

This investigation compared the outcomes of vaginal and laparoscopic hysterectomies for nonprolapsed benign indications in older women.

Methods:

We conducted a population-based, retrospective propensity score-matched cohort study using data from the Taiwan's National Health Insurance program. Women who were aged 65 years or older with vaginal hysterectomy (n = 290) were compared with women who had laparoscopic hysterectomy for nonprolapsed benign indications (n = 290). Propensity score was calculated based on both patient- (age, socioeconomic status, residential urbanicity, comorbidity, status of any prior catastrophic illness, surgical diagnosis, and year of hysterectomy) and provider-related characteristics (physician's age and sex, hospital accreditation level, and ownership type).

Results:

Women undergoing laparoscopic hysterectomy were not associated with increased risk of inpatient readmission within 30 days, in-hospital mortality, and in-hospital (including intraoperative) complications when compared with those who had vaginal hysterectomy. Women in the laparoscopic group had significantly shorter hospital stays than those in the vaginal group. The bleeding complications were mostly due to blood transfusion (2.1% in vaginal and 0.7% in laparoscopic hysterectomy groups) and urinary tract infection (1.0% in vaginal and 1.7% in laparoscopic hysterectomy groups). The surgical injury (intraoperative) complications included mostly surgical laceration of the urinary tract (0.7% in vaginal and 0.3% in laparoscopic hysterectomy groups).

Conclusions:

Advanced age alone should not be the limiting factor for surgical referral of laparoscopic hysterectomy. The shorter hospital stay and low in-hospital complications associated with laparoscopic, as opposed to vaginal hysterectomies, are important attributes of a surgical procedure essential to the postoperative care in older women aged 65 years or more.
Comparison of 1-year Major Adverse Cardiac Events in Patients Undergoing Primary Percutaneous Coronary Intervention Receiving Intracoronary Bolus Only Versus Intracoronary Bolus Plus Infusion of Glycoprotein IIb/IIIa Inhibitors
Authors: Kassaian Seyed Ebrahim , Fathi Yadollah , Lotfi-Tokaldany Masoumeh , Salarifar Mojtaba , Alidoosti Mohammad , Haji-Zeinali Ali-Mohammad , Aghajani Hassan , Amirzadegan Alireza , Nozari Younes , Mortazavi Seyedeh Hamideh , Jalali Arash , Saroukhani Sepideh
Published: July 2016

Objective:

The aim of this study is to compare intracoronary (IC) bolus only with IC bolus plus maintenance intravenous (IV) infusion of glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors with respect to 1-year major adverse cardiac events including mortality, nonfatal myocardial infarction, revascularization, and bleeding events after primary percutaneous coronary intervention (PCI).

Methods:

This is an observational study of 233 consecutive patients who presented with ST-elevation myocardial infarction and underwent primary PCI between April 2009 and December 2012. Patients were grouped into (1) patients who received IC bolus only (n = 102) and (2) patients who received IC bolus plus maintenance IV infusion of GP IIb/IIIa inhibitors (n = 131). In-hospital post procedural myocardial infarction occurred in 4 (1.7 %) of patients.

Results:

Mortality occurred in one patient who was treated with IV infusion. Major bleeding occurred in only 5 patients, among whom 4 patients had received GP IIb/IIIa inhibitors IV infusion. However, the difference was not statistically significant (P = 0.389).

Conclusion:

Both univariate analysis and the adjusted model for the potential confounders revealed no significant association between the way of GP IIb/IIIa inhibitors administration and 1-year major adverse cardiac events. Our findings suggested that IV infusion of GP IIb/IIIa inhibitors after the bolus dose is not associated with better 1-year outcome after adjustment for confounding variables. Moreover, IV infusion may increase the risk of major bleedings after primary PCI. This finding implies that the need for IV infusion of GP IIb/IIIa inhibitors in patients undergoing primary PCI is under question.
Impact of a “Team-focused CPR” Protocol on Out-of-hospital Cardiac Arrest Survival in a Rural EMS System
Authors: Stopyra Jason P. , Courage Cheryl , Davis Christopher A. , Hiestand Brian C. , Nelson Robert D. , Winslow James E.
Published: July 2016

Background:

More than 300,000 persons in the United States experience an out-of-hospital cardiac arrest every year. The American Heart Association emphasizes on the rapid, effective delivery of cardiac arrest interventions by bystanders and emergency medical services (EMS) on scene. In July 2013, the EMS of Randolph County, a rural county in central North Carolina, implemented a team-focused cardiopulmonary resuscitation(CPR) protocol. The protocol emphasized early chest compressions and resuscitation on scene until the return of spontaneous circulation (ROSC) or until efforts were deemed futile.

Methods:

Data were collected on all cardiac out-of-hospital cardiac arrest cases from June 30, 2012 to June 30, 2014. Outcomes for the year before the institution of the team-focused CPR protocol were compared with rates for the year following implementation.

Results:

A significantly higher proportion of patients achieved ROSC after protocol implementation: 25/38 [66%, 95% confidence interval (CI), 49%–80%] versus 19/67 (28%; 95% CI, 18–41%, P < 0.001). More patients survived to hospital admission in the team-focused CPR group (16/38, 42.1%, 95% CI, 26%–59%) versus the preprotocol period (10/67, 14.9%, 95% CI, 7.4%–26%, P = 0.004). Although survival to discharge was higher in the team-focused protocol period (6/38, 15.8%, 95% CI, 6.0%–31%) than the preprotocol period (4/67, 6.0%, 95% CI, 1.7%–14.6%), this did not meet statistical significance (P = 0.16).

Conclusion:

The introduction of a team-focused CPR protocol in a single rural county-based EMS system dramatically improved ROSC and hospital admission rates, but not survival to discharge. Continued surveillance, as well as evaluation and optimization of inpatient care, is warranted.
Transarterial Embolization of a Spontaneous Intraorbital Arteriovenous Fistula With n-BCA Glue
Authors: Konstas Angelos A. , Rootman Daniel B. , Quiros Peter A. , Ross Ian B.
Published: July 2016

Arteriovenous fistulae of the orbit are exceedingly rare. They are high-flow vascular malformations involving a fistula from the ophthalmic artery to one of the draining ophthalmic veins. Presenting symptoms can mimic those of carotid cavernous fistulae or of ophthalmic venous varices, and include diplopia, proptosis, chemosis, decreased visual acuity, and retro-orbital pain. Very few case reports are published on the treatment of this aggressive vascular malformation, and they uniformly describe techniques involving a transvenous access for the embolization of the fistula.
1–6
To the best of authors’ knowledge, they report the first case of transarterial embolization of an intraorbital AVF.
Outcome of Persistent Low-Grade Cervical Intraepithelial Neoplasia Treated With Loop Electrosurgical Excision Procedure
Authors: Spinillo Arsenio , Gardella Barbara , Iacobone Anna Daniela , Dominoni Mattia , Cesari Stefania , Alberizzi Paola
Published: July 2016

Objective

The aim of the study was to evaluate the outcome of persistent (≥2 years) low-grade cervical intraepithelial neoplasia (CIN 1) treated with loop electrosurgical excision procedure (LEEP).

Materials and Methods

A study of 252 subjects with persistent biopsy-confirmed CIN 1 diagnosed after low-grade squamous intraepithelial lesions or atypical squamous lesions of undetermined significance on Papanicolaou test and treated with LEEP. Post-LEEP follow-up cytological, colposcopic, and molecular diagnostic examinations were scheduled at 6 months, 1 year, and yearly thereafter.

Results

The 252 subjects enrolled had a total number of 1,008 visits per colposcopies (median = 3, range = 1–7) during a median post-LEEP follow-up of 25 months (range = 12–121). The cumulative incidence of CIN 2+ at 2 years and at 3 years of follow-up was 2.3% (4/176) and 5.5% (7/128), respectively, or 1.7 cases (95% CI = 1–2.8) per 100 woman-years. Low-grade cervical lesions during post-LEEP follow-up were diagnosed in 70 subjects (27.8%) or 10 cases (95% CI = 7.9–12.6) per 100 woman-years. Overall, persistent and multiple high-risk HPV infections during follow-up were associated with increased rates of CIN persistence or progression.

Conclusions

Women with persistent CIN 1 after atypical squamous lesions of undetermined significance/low-grade squamous intraepithelial lesion treated with LEEP had a low rate of progression to CIN 2+ but remained at a high risk of low-grade cervical abnormalities during follow-up. This information should be taken into account when deciding on the treatment strategy and counseling women with persistent CIN 1.
Mechanisms underpinning remission of albuminuria following bariatric surgery
Authors: Nair Meera , le Roux Carel W. , Docherty Neil G.
Published: July 2016

Purpose of review

Albuminuria is a biomarker of renal injury commonly used to monitor progression of diabetic kidney disease. The appearance of excess albumin in the urine reflects alterations in the structure and permeability of the glomerular filtration barrier. The present article summarizes the clinical evidence base for remission of albuminuria after bariatric surgery. It furthermore focuses on how beneficial impacts on glomerular podocyte structure and function may explain this phenomenon.

Recent findings

A coherent clinical evidence base is emerging demonstrating remission of albuminuria following bariatric surgery in patients with obesity and diabetes. The impaired metabolic milieu in diabetic kidney disease drives podocyte dedifferentiation and death through glucotoxic, lipotoxic proinflammatory, and pressure-related stress. Improvements in these parameters after surgery correlate with improvements in albuminuria and preclinical studies provide mechanistic data that support the existence of cause–effect relationship.

The benefits of bariatric surgery extend beyond weight loss in diabetes to encompass beneficial effects on diabetic renal injury. Attenuation of the toxic metabolic milieu that the podocyte is exposed to postbariatric surgery suggests that the restitution of podocyte health is a key cellular event underpinning remission of albuminuria.
Autoimmune Hepatitis and Seronegative Hepatitis Associated With Myelodysplastic Syndrome in Children
Authors: Rasmussen Line K. , Stenbøg Elisabeth V. , Kerndrup Gitte B. , Hasle Henrik
Published: July 2016

An association between hepatitis and aplastic anemia (AA) is known as hepatitis-associated AA, and is characterized by an acute attack of hepatitis followed by the development of AA. We report 2 clinical cases of acute seronegative hepatitis in which pancytopenia with mild dysplasia developed after 3 months; however, neither of our cases fulfilled the histological criteria of AA, but rather myelodysplastic syndrome. This novel association bears considerable resemblance to hepatitis-associated AA, and raises the question of whether hepatitis-associated dysmyelopoiesis should be included in the spectrum of hypocellular myelodysplastic syndrome.
King-Devick and Pre-season Visual Function in Adolescent Athletes
Authors: Weise Katherine K. , Swanson Mark W. , Penix Kimberly , Hale Matthew Heath , Ferguson Drew
Published: July 2016

Purpose

The King-Devick test (KD) has been studied as a remove-from-play sideline test in college-age athletes and older; however, studies in younger athletes are limited. A cross-sectional study of the KD and other vision correlates was completed on school-aged athletes during pre-season physicals for a variety of sports to determine the repeatability of the KD. The study also evaluated how convergence, alignment, or pupil function contributed to a slower King-Devick baseline reading.

Methods

Seven hundred eighty-five athletes underwent vision screenings in a hospital or school setting by trained/certified staff as part of pre-season physicals. Six hundred nineteen had KD testing completed per the manufacturer’s suggested protocol and repeated. Other baseline vision testing included visual acuity, Modified Thorington testing for alignment, convergence testing, and pupil function using the NeurOptics (NPI-200) NPi.

Results

The mean fastest, error-minimized KD time for all participants was 43.9 seconds(s) (SD ± 11.6, range 24–120). Median KD time got faster (+) with age (p < 0.0001). The inter-class correlation coefficient for all scores was 0.92. The absolute mean time difference for any two tests was 3.5 s (SD ± 2.5, range 0–23). There was no association between the best KD time and reduced NPC (p = 0.63), Modified Thorington measure of alignment (p = 0.55), or NPi pupil function (p = 0.79). The Bland Altman repeated measure limits of agreement was ±6.5 seconds for those in the 10th to12th grades, and ±10.2 seconds for those in the 6th to 9th grades.

Conclusions

King-Devick score in junior high and high school athletes is variable but gets faster and more repeatable with increasing age. The KD does not correlate significantly with reduced convergence, alignment, or pupil function. Based on grouped data, a slowing of 10 seconds for younger athletes and 6 seconds for older athletes on a second administration represents a true difference in testing speed. Within-player variability should be considered when removal-from-play decisions are influenced by KD results.
Bone Healing Promotion by Negatively Charged Polysterene Microspheres
Authors: Bar Droma Eitan , Shaco-Levy Ruth , Sukmanov Oleg , Rosenberg Lior , Silberstein Eldad
Published: July 2016

Bone healing under optimal conditions is fairly predictable. Yet when the healing process is disturbed by inadequate immobilization, inadequate blood supply, or scar tissue, little therapeutic alternatives to surgery exist.

It appears that redistribution of electric charges along the bone during a callus consolidation promotes bone healing. It has been shown in the past that negatively charged polysterene spheres promote bone growth in animal models.

In this preliminary report, we tested weather or not a commercial device of negatively charged polysterene spheres promotes bone healing in a porcine model.

This preliminary study seems to suggest that the negatively charged polystyrene microspheres may have a potential in promoting bone healing, either alone or as an adjunct to other bone graft materials. These speculations should be further validated by large-scale studies in animal models and clinical trials.
A Nutrition Intervention to Increase Whole Grain Intake in College Students
Authors: Arts Jennifer , English Catherine , Greene Geoffrey W. , Lofgren Ingrid E.
Published: July 2016

This study aimed to improve whole grain (WG) intake and coronary heart disease risk factors in 98 college students through an intervention in campus dining halls. The exploratory aim was to evaluate the impact of text messaging on diet and coronary heart disease risk. The 6-week intervention consisted of WG and low-fat dairy messages in campus dining halls and text messages to a subsample (n = 26). WG intake, high-density lipoprotein cholesterol, body weight, and body mass index significantly increased over time. Total dairy intake decreased over time. Overall, the intervention had a positive impact on WG consumption and on high-density lipoprotein cholesterol.