bluuebunny/crossref_metadata_2025 huggingface dataset:
New nearby white dwarfs from Gaia DR1 TGAS and UCAC5/URAT
Authors: Scholz R.-D. , Meusinger H. , Jahreiß H.
Published: December 2017

Aims. Using an accurate Tycho-Gaia Astrometric Solution (TGAS) 25 pc sample that is nearly complete for GK stars and selecting common proper motion (CPM) candidates from the 5th United States Naval Observatory CCD Astrograph Catalog (UCAC5), we search for new white dwarf (WD) companions around nearby stars with relatively small proper motions.

Methods. To investigate known CPM systems in TGAS and to select CPM candidates in TGAS+UCAC5, we took into account the expected effect of orbital motion on the proper motion and proper motion catalogue errors. Colour-magnitude diagrams (CMDs) MJ ∕J − Ks and MG ∕G − J were used to verify CPM candidates from UCAC5. Assuming their common distance with a given TGAS star, we searched for candidates that occupied similar regions in the CMDs as the few known nearby WDs (four in TGAS) and WD companions (three in TGAS+UCAC5). The CPM candidates with colours and absolute magnitudes corresponding neither to the main sequence nor to the WD sequence were considered as doubtful or subdwarf candidates.

Results. With a minimum proper motion of 60 mas yr−1, we selected three WD companion candidates; two of which are also confirmed by their significant parallaxes measured in URAT data, whereas the third may also be a chance alignment of a distant halo star with a nearby TGAS star that has an angular separation of about 465 arcsec. One additional nearby WD candidate was found from its URAT parallax and GJKs photometry. With HD 166435 B orbiting a well-known G1 star at ≈24.6 pc with a projected physical separation of ≈700 AU, we discovered one of the hottest WDs, classified by us as DA2.0 ± 0.2, in the solar neighbourhood. We also found TYC 3980-1081-1 B, a strong cool WD companion candidate around a recently identified new solar neighbour with a TGAS parallax corresponding to a distance of ≈8.3 pc and our photometric classification as ≈M2 dwarf. This raises the question of whether previous assumptions on the completeness of the WD sample to a distance of 13 pc were correct.
Microstructure and properties of A357 aluminium alloy treated by pulsed magnetic field
Authors: Zhang L. , Zhan W. , Jin F. , Zhou Q.
Published: December 2017

This study examined the effects of a pulsed magnetic field (PMF) on the solidified microstructure and properties of A357 aluminium alloy. Results showed that the solidified microstructure of the alloy treated by a PMF was refined. The treated alloy in the T6 state had superior mechanical properties, with the ultimate tensile strength, yield strength and elongation increasing by 48 MPa (18.5%), 46 MPa (16.4%) and 4.8% (142%), respectively, when compared with the untreated alloy. When testing at room temperature, with a strain amplitude of 1 × 10−4 and at a frequency of 1 Hz, the damping capacity value was 14.2 × 10−3 for the alloy subjected to a PMF treatment, which increased by nearly 170% when compared with the untreated alloy.
The formation mechanism of intermetallic compounds in Al/Mg friction-stir weld joint
Authors: Chen Bing , Wang Yuhui , Xiao Changyuan , Zhang Minmin , Ni Guoli , Li Da
Published: December 2017

The mechanical properties of dissimilar metal joints are strongly related to the brittle intermetallic compounds (IMCs) that form at the weld interfaces. In this study, the effects of temperature, local composition and plastic strain on the formation mechanism of IMCs in a welded joint between 6061 Al and AZ31 Mg were investigated. The results demonstrate that Al3Mg2 is formed when the strain rate reaches 10 s−1, even though the temperature is lower than the Al–Mg eutectic temperature, which suggests that plastic deformation may accelerate the formation of IMCs in the deformation zone. Meanwhile, the formation of Al–Mg IMCs can be suppressed by Mg–Zn and Al–Mg–Zn compounds when Zn filler is added at the Al/Mg interfaces.
Correlation between microstructures and mechanical properties in Ni-rich Ni–Mn–Ga high-temperature shape-memory alloys
Authors: Hou Long , Tong Hui , Dai Yanchao , Fautrelle Yves , Moreau Rene , Ren Zhongming , Li Xi
Published: December 2017

Microstructures and mechanical properties of polycrystalline and single-crystalline Ni55+ xMn25Ga20− x ( x = 1, 2, 3) alloys are investigated. The alloys exhibit a single martensite phase for x = 1, and two phases containing tetragonal martensite phase and face-centered γ phase for x = 2 and 3. The appearance of γ phase can apparently raise the strength and plasticity of the alloys. Moreover, single crystals show better mechanical properties compared with the polycrystals with the same composition. Furthermore, a kind of net-like γ phase is observed in directionally solidified Ni58Mn25Ga17 single crystal. This alloy exhibits excellent plasticity due to that the crack propagation is seriously hindered by the plastic net-like γ phase.
Martensitic transformation in TiNi alloy after surface modification done by hydroxyapatite layer deposition
Authors: Goryczka Tomasz , Zubko Maciej , Dudek Agata
Published: December 2017

A hydroxyapatite (HAp) layer was deposited on the surface of an NiTi alloy using a spark plasma technique. The effects of spraying conditions on the martensitic transformation were investigated in three heat-affected zones: the zone under the handle, the transition zone and in a representative zone with HAp coverage. In the representative area, a reduction in the amount of non-transformable phases was observed. A part of the sublayer showed a nanocrystalline or completely amorphous structure. This sublayer was approximately 30 µm thick. Structural changes contributed to the reduction of the temperature of the reverse martensitic transition down to 25°C. Moreover, modification of the surface revealed a positive influence on the transformation course by narrowing its temperature range and increasing its enthalpy.

This paper is part of a thematic issue on Titanium.
Properties and microstructure of copper-alloyed solid solution-strengthened ductile iron
Authors: Riebisch Moritz , Weiß Philipp , Cremer Clemens , Aboulkhair Ibrahim , Bührig-Polaczek Andreas
Published: December 2017

Solid solution-strengthened ductile iron (DI) exhibits outstanding mechanical properties due to the high silicon content. The strengthening by silicon addition is limited since additions above 4.3 wt-% lead to embrittlement. For a further improvement of mechanical properties, other alloying elements need to be considered. In the present work, the effect of various copper additions on the microstructure and the mechanical properties of solid solution-strengthened DI were investigated. The results show that no appreciable strengthening can be achieved by copper addition without the formation of pearlite in the matrix. The pearlite content increases considerably for Cu-additions above 0.23 wt-% and is independent of the cooling rate for the cooling conditions analysed.
Residual stress control of multipass welds using low transformation temperature fillers
Authors: Moat R. J. , Ooi S. , Shirzadi A. A. , Dai H. , Mark A. F. , Bhadeshia H. K. D. H. , Withers P. J.
Published: December 2017

Low transformation temperature (LTT) weld fillers can be used to replace tensile weld residual stresses with compressive ones and reduce the distortion of single-pass welds in austenitic plates. By contrast, weld fillers in multipass welds experience a number of thermal excursions, meaning that the benefit of the smart LTT fillers may not be realised. Here, neutron diffraction and the contour method are used to measure the residual stress in an eight pass groove weld of a 304 L stainless steel plate using the experimental LTT filler Camalloy 4. Our measurements show that the stress mitigating the effect of Camalloy 4 is indeed diminished during multipass welding. We propose a carefully selected elevated interpass hold temperature and demonstrate that this restores the LTT capability to successfully mitigate residual tensile stresses.

This paper is part of a thematic issue on Nuclear Materials.
New algorithms to represent complex pseudoknotted RNA structures in dot-bracket notation
Authors: Antczak Maciej , Popenda Mariusz , Zok Tomasz , Zurkowski Michal , Adamiak Ryszard W , Szachniuk Marta
Published: December 2017

Motivation

Understanding the formation, architecture and roles of pseudoknots in RNA structures are one of the most difficult challenges in RNA computational biology and structural bioinformatics. Methods predicting pseudoknots typically perform this with poor accuracy, often despite experimental data incorporation. Existing bioinformatic approaches differ in terms of pseudoknots’ recognition and revealing their nature. A few ways of pseudoknot classification exist, most common ones refer to a genus or order. Following the latter one, we propose new algorithms that identify pseudoknots in RNA structure provided in BPSEQ format, determine their order and encode in dot-bracket-letter notation. The proposed encoding aims to illustrate the hierarchy of RNA folding.

Results

New algorithms are based on dynamic programming and hybrid (combining exhaustive search and random walk) approaches. They evolved from elementary algorithm implemented within the workflow of RNA FRABASE 1.0, our database of RNA structure fragments. They use different scoring functions to rank dissimilar dot-bracket representations of RNA structure. Computational experiments show an advantage of new methods over the others, especially for large RNA structures.

Availability and implementation

Presented algorithms have been implemented as new functionality of RNApdbee webserver and are ready to use at http://rnapdbee.cs.put.poznan.pl.

Supplementary information

Supplementary data are available at Bioinformatics online.
The genomic landscape of language: Insights into evolution
Authors: Mountford Hayley S , Newbury Dianne F
Published: December 2017

Studies of severe, monogenic forms of language disorders have revealed important insights into the mechanisms that underpin language development and evolution. It is clear that monogenic mutations in genes such as FOXP2 and CNTNAP2 only account for a small proportion of language disorders seen in children, and the genetic basis of language in modern humans is highly complex and poorly understood. In this review, we examine why we understand so little of the genetic landscape of language disorders, and how the genetic background of an individual greatly affects the way in which a genetic change is expressed. We discuss how the underlying genetics of language disorders has informed our understanding of language evolution, and how recent advances may obtain a clearer picture of language capacity in ancient hominins.
Direct-Acting Antivirals Improve Access to Care and Cure for Patients With HIV and Chronic HCV Infection
Authors: Collins Lauren F , Chan Austin , Zheng Jiayin , Chow Shein-Chung , Wilder Julius M , Muir Andrew J , Naggie Susanna
Published: December 2017

Background

Direct-acting antivirals (DAA) as curative therapy for hepatitis C virus (HCV) infection offer >95% sustained virologic response (SVR), including in patients with human immunodeficiency virus (HIV) infection. Despite improved safety and efficacy of HCV treatment, challenges remain, including drug-drug interactions between DAA and antiretroviral therapy (ART) and restrictions on access by payers.

Methods

We performed a retrospective cohort study of all HIV/HCV co-infected and HCV mono-infected patients captured in care at our institution from 2011–2015, reflecting the DAA era, to determine treatment uptake and SVR, and to elucidate barriers to accessing DAA for co-infected patients.

Results

We identified 9290 patients with HCV mono-infection and 507 with HIV/HCV co-infection. Compared to mono-infected patients, co-infected patients were younger and more likely to be male and African-American. For both groups, treatment uptake improved from the DAA/pegylated interferon (PEGIFN)-ribavirin to IFN-free DAA era. One-third of co-infected patients in the IFN-free DAA era required ART switch and nearly all remained virologically suppressed after 6 months. We observed SVR >95% for most patient subgroups including those with co-infection, prior treatment-experience, and cirrhosis. Predictors of access to DAA for co-infected patients included Caucasian race, CD4 count ≥200 cells/mm3, HIV virologic suppression and cirrhosis. Time to approval of DAA was longest for patients insured by Medicaid, followed by private insurance and Medicare.

Conclusions

DAA therapy has significantly improved access to HCV treatment and high SVR is independent of HIV status. However, in order to realize cure for all, barriers and disparities in access need to be urgently addressed.
Current views on the pathogenesis of Sjögren's syndrome
Authors: Pontarini Elena , Lucchesi Davide , Bombardieri Michele
Published: December 2017

Purpose of review

The purpose of this review is to provide an insight into the pathophysiological mechanisms involved in the pathogenesis of primary Sjögren's Syndrome (pSS), highlighting recent findings with potential therapeutic repercussions.

Recent findings

In the last 2 years, epigenetic analyses provided new insights into pSS pathogenesis. Characterization of DNA methylation patterns, chromatin structures and microRNA confirmed the importance of aberrant interferon and B-cell responses in the development of the disease. The formation of ectopic B-cell follicles with germinal centers is now a well recognized pathogenic mechanism within salivary glands of pSS. In the context of ectopic germinal centers reaction, T/B-cell interactions, that is regarding T-helper 17 and T-follicular helper cells, and their respective counterparts, T-regulatory and T-follicular regulatory cells, appear particularly relevant in pSS pathogenesis as their imbalance is associated with a dysregulation of B-cell dynamics and the production of autoantibodies.

Advances in the understanding of pSS pathogenesis have paved the way for clinical trials with novel biologic agents targeting immune pathways regulating T/B-cell interactions and downstream B-cell activation. Reverse translation from these studies provides invaluable novel information of the mechanisms sustaining autoimmunity and chronic inflammation in pSS.
Epidemiology of osteoarthritis: literature update
Authors: Vina Ernest R. , Kwoh C. Kent
Published: December 2017

Purpose of review

The purpose of this review is to highlight recent studies of osteoarthritis epidemiology, including research on prevalence, disease impact, and potential risk factors.

Recent findings

Osteoarthritis is highly prevalent in the United States and around the globe. It is a leading cause of disability and can negatively impact people's physical and mental well being. Healthcare resources and costs associated with managing the disease can be substantial. There is increasing evidence that there are different osteoarthritis phenotypes that reflect different mechanisms of the disease. Various person-level risk factors are recognized, including sociodemographic characteristics (e.g. female sex, African-American race), genetic predispositions, obesity, diet-related factors, and high bone density/mass. Joint-level risk factors include specific bone/joint shapes, thigh flexor muscle weakness, joint malalignment, participation in certain occupational/sports activities, and joint injury. Recent studies have enhanced our understanding of preradiographic lesions associated with osteoarthritis.

Application of these new findings may allow us to develop innovative strategies and novel therapies with the purpose of preventing new disease onset and minimizing disease progression.
C1-C2 Pedicle Screw Fixation for Pediatric Atlantoaxial Dislocation: Initial Results and Long-term Follow-up
Authors: Chen Zhi-Da , Wu Jin , Lu Cheng-Wu , Zeng Wen-Rong , Huang Zhuan-Zhi , Lin Bin
Published: December 2017

Background:

There are few studies reporting the use of atlantoaxial pedicle screws and the long-term effects of C1-C2 posterior fusion in children. Our study is to investigate the initial results of C1-C2 pedicle screw fixation for pediatric atlantoaxial dislocation (AAD) and assessed spontaneous change of postoperative radiography after a long-term follow-up period.

Methods:

Posterior pedicle screw fixations were performed in 21 pediatric patients with AAD. All the patients underwent implant removal 1 year after their initial surgery and had regular follow-up with an average duration of 76.4 months (range, 52 to 117 mo). Clinical and radiographic data were then collected and compared.

Results:

Frankel Grade was significantly improved at 3 months follow-up compared with pretreatment values. All patients had good bony fusion at a mean of 4.2±0.9 months (range, 3 to 6 mo) after treatment. None of the patients experienced worsening neurological symptoms or injury to the vertebral artery. However, 2 cases experienced minor complications. Following removal of the implants, no spinal deformities or subaxial instabilities were found. The mean angle of sagittal curvature increased from 12.1±2.4 degrees (range, 0 to 22 degrees) immediately postoperatively to 19.1±2.7 degrees (range, 6 to 31 degrees) at the final follow-up (P>0.05).

Conclusions:

The results demonstrated that C1-C2 pedicle screw fixation could achieve satisfactory initial results for the management of the pediatric AAD. Moreover, removal of the metal implant after bony fusion did not increase the risk of spinal deformity or subaxial instability at long-term follow-up.
Osteofibrous Dysplasia of the Tibia in Children: Outcome Without Resection
Authors: Westacott Daniel , Kannu Peter , Stimec Jennifer , Hopyan Sevan , Howard Andrew
Published: December 2017

Background:

The proposed association between osteofibrous dysplasia and adamantinoma has led some to advocate resection of the entire lesion, which can require major subsequent reconstruction. However, this link remains unproven and there is some support in more recent literature for a less aggressive approach. This study aims to describe our experience managing pediatric tibial osteofibrous dysplasia with such an approach and to report functional outcomes in children treated thus.

Methods:

A total of 28 cases of osteofibrous dysplasia in 25 patients were managed at a referral center for pediatric bone tumors with observation in the first instance, then limited surgical intervention if required to address pain and deformity. Surgery aimed to restore stability and alignment without excising the lesion. Clinical records provided basic clinical outcome measures involving walking, recreation, orthoses and school/work participation and patients provided a Musculoskeletal Tumour Society score (MSTS) where contactable.

Results:

Mean age at presentation was 6.0 years and mean follow-up was 8.3 years. Only 8 patients required surgery. According to basic outcome measures, 13 patients were symptom-free. About 15 patients (17 cases) provided a MSTS and the mean score was 24 of 30. No transformation to adamantinoma was observed. Those who presented at a younger age and with bilateral disease more often required surgery and remained symptomatic.

Conclusions:

A less aggressive approach to pediatric tibial osteofibrous dysplasia achieves good functional outcomes and patient satisfaction in most cases. Surgery is required in the minority of cases. Transformation to adamantinoma was not observed in this series. We recommend patient education, clinical observation and reactive intervention if required, rather than proactive resection and reconstruction.

Level of Evidence:

Level IV—case series.
A Quality Improvement Initiative Reduces Cast Complications in a Pediatric Hospital
Authors: Balch Samora Julie , Samora Walter P. , Dolan Kevin , Klingele Kevin E.
Published: December 2017

Background:

Casts, while frequently used as routine treatment in pediatric orthopaedic practice, are not without complications. At our large tertiary care pediatric hospital, the baseline rate of all casting complications was 5.6 complications per 1000 casts applied (0.56%). We tested the hypothesis that we could use quality improvement (QI) methodology to decrease the overall cast complication rate and improve patient care.

Methods:

We initiated a QI program implementing concepts derived from the Institute for Healthcare Improvement models, including Plan-Do-Study-Act cycles, to decrease our cast complication rate. A resident casting education program was developed with a competency “checklist” to ensure that casts are applied, bivalved, and removed in a safe and standardized manner to prevent patient harm. AquaCast Saw Stop Protective Strips were required to be applied with every cast application. A review of our facility’s processes and procedures determined adequate measures were in place to effectively manage inventory and maintenance of cast-saw blades.

Results:

With the multimodal QI intervention, our cast complication rate was reduced to 1.61 complications per 1000 applications, a >90% improvement.

Conclusions:

Implementation of QI concepts to perform a QI initiative resulted in a shift toward fewer cast complications, leading to overall improved patient care at a large tertiary pediatric hospital.

Level of Evidence:

Level II—prospective cohort study.
Psychosocial Factors and Surgical Outcomes in Adult Spinal Deformity
Authors: Toombs Courtney S. , Paul Justin C. , Lonner Baron S.
Published: December 2017

Study Design.

Retrospective analysis of a prospectively collected, national inpatient hospital database.

Objective.

We aimed to investigate comorbid psychiatric disorders in the adult spinal deformity (ASD) population. We hypothesized that a high incidence of comorbid psychiatric disorders in ASD would negatively impact perioperative outcomes.

Summary of Background Data.

Patients with adult spinal fusion (ASF) suffer from severe back pain and often depression. Psychiatric comorbidities in the ASD population are not well understood, despite the apparent psychological effects of spinal deformity–related self-image.

Methods.

The Nationwide Inpatient Sample databases from 2001 to 2009 were queried for patients ages 18 years or older with in-hospital stays including a spine arthrodesis. Patients were divided into two groups: ASD (diagnosis of scoliosis, excluding neuromuscular and congenital) and all other ASF. Subjects were further stratified by presence of a comorbid psychiatric diagnosis. Differences between each surgical group in psychiatric frequency and complications were calculated using analysis of variance, adjusted for operative complexity. A binary logistic regression analyzed the association between psychiatric diagnoses and likelihood of complications.

Results.

A total of 3,366,352 ASF and 219,975 ASD patients were identified. The rate of comorbid psychiatric diagnoses in ASD was significantly higher (23.5%) compared to ASF patients (19.4%, P < 0.001). Complication rates were higher for ASD compared to ASF; patients without a psychiatric diagnosis had lower (or comparable) complication rates than psychiatric patients, across all disorder categories. Patients with psychotic disorders and dementia showed more complications than controls; patients with mood, anxiety and alcohol disorders showed fewer.

Conclusion.

Psychiatric comorbidities are more common in the ASD population than in adult fusion patients. ASD and ASF patients with the most common psychiatric disorders (mood, anxiety, and alcohol abuse) are not at increased risk for complications compared to controls. Those patients with psychotic disorders and dementia are at a significant risk for increased complications and surgeons should be aware of these specific risks.

Level of Evidence: 2
Posterolateral Diskectomies for Treatment of Pediatric Spinal Deformities
Authors: Jain Amit , Sullivan Brian T. , Hassanzadeh Hamid , Hsu Nigel N. , Sponseller Paul D.
Published: December 2017

Study Design.

Retrospective.

Objective.

To investigate the indications, radiographic outcomes, and complications in children with spinal deformities treated with posterolateral diskectomy with posterior fusion (PLDF), and to compare them against those of patients treated with anteroposterior spinal fusion (APSF).

Summary of Background Data.

A novel technique for treating large, rigid spinal deformities in children has been proposed, consisting of PLDF at the apex of the deformity using an all-posterior approach.

Methods.

We evaluated records of all patients 21 years or younger who underwent treatment for spinal deformity between 2010 and 2015 by one surgeon using PLDF (n = 56) or APSF (n = 21).

Results.

The indications for PLDF were large, rigid curves (37 patients); focal curves with severe rotation (10 patients); or large curves with open triradiate cartilage (nine patients). PLDF patients had a mean (± standard deviation) of 3 ± 1 diskectomies and 14 ± 3 posterior spinal levels fused. Compared with the APSF group, the PLDF group had significantly greater major curve correction (86% vs. 57%, P = 0.006), less blood transfused (mean, 2.5 ± 2.6 vs. 4.0 ± 3.3 units, P = 0.038), and a lower rate of staged surgery (1.8% vs. 86%, P < 0.001). There were no significant differences between the PLDF and APSF groups in T1-S1 length gained (mean, 6.2 ± 3.4 vs. 6.6 ± 8.8 cm, respectively; P = 0.77) or in the rate of major complications (P = 0.557).

Conclusion.

PLDF is an effective alternative to APSF for treating children with severe spinal deformities. It is effective for treating large, rigid curves with severe rotation and may be useful for treating large curves in children with open triradiate cartilage.

Level of Evidence: 4
Septic Cardiomyopathy
Authors: Beesley Sarah J. , Weber Gerhard , Sarge Todd , Nikravan Sara , Grissom Colin K. , Lanspa Michael J. , Shahul Sajid , Brown Samuel M.
Published: December 2017

Objectives:

To describe, with an emphasis on clinical applications, what is known about the pathophysiology, management, and implications of septic cardiomyopathy in the adult ICU.

Data Sources and Study Selection:

A PubMed literature review was performed for relevant articles. Only articles in English that studied human adults with sepsis were included.

Data Extraction and Data Synthesis:

Multiple competing definitions for septic cardiomyopathy hinder understanding of this entity. Although many patients with sepsis develop cardiac dysfunction, the impact of septic cardiomyopathy on prognosis and therapy remains to be demonstrated. Treatment of septic cardiomyopathy is aimed at treating the underlying sepsis and providing specific supportive care for cardiogenic shock when present.

Conclusions:

Septic cardiomyopathy is an important contributor to organ dysfunction in sepsis. Guided treatment of septic cardiomyopathy may affect patients’ prognosis, especially when their cardiac index is substantially decreased. The implication of septic cardiomyopathy for both short- and long-term outcomes is an important area for future investigation.
Practice Patterns and Outcomes Associated With Early Sedation Depth in Mechanically Ventilated Patients: A Systematic Review and Meta-Analysis*
Authors: Stephens Robert J. , Dettmer Matthew R. , Roberts Brian W. , Ablordeppey Enyo , Fowler Susan A. , Kollef Marin H. , Fuller Brian M.
Published: December 2017

Objectives:

Emerging data suggest that early deep sedation may negatively impact clinical outcomes. This systematic review and meta-analysis defines and quantifies the impact of deep sedation within 48 hours of initiation of mechanical ventilation, as described in the world’s literature. The primary outcome was mortality. Secondary outcomes included hospital and ICU lengths of stay, mechanical ventilation duration, and delirium and tracheostomy frequency.

Data Sources:

The following data sources were searched: MEDLINE, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews and Effects, Cochrane Database of Systematic Reviews databases, ClinicalTrials.gov, conference proceedings, and reference lists.

Study Selection:

Randomized controlled trials and nonrandomized studies were included.

Data Extraction:

Two reviewers independently screened abstracts of identified studies for eligibility.

Data Synthesis:

Nine studies (n = 4,521 patients) published between 2012 and 2017 were included. A random effects meta-analytic model revealed that early light sedation was associated with lower mortality (9.2%) versus deep sedation (27.6%) (odds ratio, 0.34 [0.21–0.54]). Light sedation was associated with fewer mechanical ventilation (mean difference, –2.1; 95% CI, –3.6 to –0.5) and ICU days (mean difference, –3.0 (95% CI, –5.4 to –0.6). Delirium frequency was 28.7% in the light sedation group and 48.5% in the deep sedation group, odds ratio, 0.50 (0.22–1.16).

Conclusions:

Deep sedation in mechanically ventilated patients, as evaluated in a small number of qualifying heterogeneous randomized controlled trials and observational studies, was associated with increased mortality and lengths of stay. Interventions targeting early sedation depth assessment, starting in the emergency department and subsequent ICU admission, deserve further investigation and could improve outcome.
CPD and KT: Models Used and Opportunities for Synergy
Authors: Sargeant Joan , Borduas Francine , Sales Anne , Klein Doug , Lynn Brenna , Stenerson Heather
Published: December 2017

The two fields of continuing professional development (CPD) and knowledge translation (KT) within the health care sector, and their related research have developed as somewhat parallel paths with limited points of overlap or intersection. This is slowly beginning to change. The purpose of this paper is to describe and compare the dominant conceptual models informing each field with the view of increasing understanding and appreciation of the two fields, how they are similar and where they differ, and the current and potential points of intersection. The models include the “knowledge-to-action” (KTA) cycle informing KT, models informing CPD curriculum design and individual self-directed learning, and the Kirkpatrick model for evaluating educational outcomes. When compared through the perspectives of conceptual designs, processes, and outcomes, the models overlap. We also identify shared gaps in both fields (eg, the need to explore the influence of the context in which CPD and KT interventions take place) and suggest opportunities for synergies and for moving forward.
Integrating Essential Components of Quality Improvement into a New Paradigm for Continuing Education
Authors: Van Hoof Thomas J. , Meehan Thomas P.
Published: December 2017

Continuing education (CE) that strives to improve patient care in a complex health care system requires a different paradigm than CE that seeks to improve clinician knowledge and competence in an educational setting. A new paradigm for CE is necessary in order to change clinician behavior and to improve patient outcomes in an increasingly patient-centered, quality-oriented care context. The authors assert that a new paradigm should focus attention on an expanded and prioritized list of educational outcomes, starting with those that directly affect patients. Other important components of the paradigm should provide educational leaders with guidance about what interventions work, reasons why interventions work, and what contextual factors may influence the impact of interventions. Once fully developed, a new paradigm will be helpful to educators in designing and implementing more effective CE, an essential component of quality improvement efforts, and in supporting policy trends and in promoting CE scholarship. The purpose of this article is to rekindle interest in CE theory and to suggest key components of a new paradigm.
Illustrative cases for monitoring by quantitative analysis of BRAF/NRAS ctDNA mutations in liquid biopsies of metastatic melanoma patients who gained clinical benefits from anti-PD1 antibody therapy
Authors: Seremet Teofila , Planken Simon , Schreuer Max , Jansen Yanina , Delaunoy Mélanie , El Housni Hakim , Lienard Danielle , Del Marmol Véronique , Heimann Pierre , Neyns Bart
Published: December 2017

Anti-programmed death 1 (PD-1) monoclonal antibodies improve the survival of metastatic melanoma patients. Predictive or monitoring biomarkers for response to this therapy could improve the clinical management of these patients. To date, no established biomarkers are available for monitoring the response to immunotherapy. Tumor- specific mutations in circulating tumor DNA (ctDNA) such asBRAFandNRASmutations for melanoma patients have been proposed for monitoring of immunotherapy response. We present seven illustrative cases for the use of ctDNABRAFandNRASmutations’ monitoring in plasma. The cases described exemplify four distinct clinical benefit patterns: rapid and durable complete response (CR), early progression, followed by CR, CR followed by early progression after interrupting treatment and long-term disease stabilization. These representative cases suggest that comprehensiveBRAF/NRASctDNA monitoring during anti-PD1 therapy is informative and can be of added value for the monitoring of melanoma patients gaining clinical benefit on anti-PD1 treatment. An important advantage of our approach is that using the cartridge system on the Idylla platform for mutation analysis, the results become available the same day 2 h after plasma collection. Therefore, in the future, the ctDNA level can be an element in the clinical management of the patients.
12 Hour Shifts
Authors: Kupperschmidt Betty
Published: December 2017

Concern is reported about the negative outcomes of 12-hour shifts for nurses, including sleep-deprived fatigue, negative neurobehavioral outcomes, and patient safety. However, 12-hour shifts remain the prevailing staffing method. When should the concern for nurses' health and well-being be factored into staffing decisions? If the 12-hour model was used more wisely, that is, nurses were not working too much and/or too long, would there be a need for change? Will nurses and researchers pursue ways to address the negative outcomes of 12-hour shifts?
Learning Cultural Humility Through Stories and Global Service-Learning
Authors: Matthew Stephanie , Hockett Eloise , Samek Linda
Published: December 2017

Service-learning experiences are utilized by nursing programs to increase cultural learning for students. Through storytelling, the concept of cultural humility can be explained to students preparing for upcoming intercultural experiences. This case study describes the experience of nursing students and educators on their first service-learning trip to Kenya, and how intercultural issues were navigated as students developed cultural humility. The story now is shared in preparation for subsequent international student nursing trips. The utilization of storytelling can be a model for others preparing for service-learning experiences.
Preparing Clinical Nurses for Nursing Research
Authors: Pittroff Gail Elaine , Hendricks-Ferguson Verna L.
Published: December 2017

The importance of academic nurse researchers partnering with clinical nurses for clinical research has been well articulated. A 4-hour training program designed to equip staff nurses to become fully engaged researchers in a palliative care end of life communication-focused research study resulted in enriched human caring skills and professional growth. Results indicate that the training (didactic lecture, group reflection, role-playing) was adequate to prepare the nurses to deliver the study protocol. Relevance for primary investigators, nurses, clinical institutions, those interested in partnered research, and professional growth are discussed.
Reflections on Global Service Learning in India
Authors: Simon Elizabeth B.
Published: December 2017

Global service learning is an action-oriented, pedagogical approach that engages students in the core values of academic excellence, social relevance, personal transformation, intentional diversity, and cultural competence. The experience of students and nurse educators who have participated in global service-learning trips to India is relayed, along with the healthcare system of several Indian states.
Workplace Incivility in Nursing
Authors: Phillips Gwenda Smith , MacKusick Carol Isaac , Whichello Ramona
Published: December 2017

A literature review was conducted to evaluate existing knowledge of incivility in the nursing workplace through the lens of nursing ethics and spirituality. Study articles presented a consistent theme of improved organizational commitment and job satisfaction when spirituality was injected into the workplace. It seems plausible to suggest a positive correlation between spirituality and more civil environments in nursing workplaces.
Disruptive Behavior, Global Developmental Delay, and Obesity in a 5-Year-Old Boy with a Chromosome Microduplication
Authors: Braddock Adam , del Campo Miguel , Reiff Michael I. , Stein Martin T.
Published: December 2017

CASE:

Ryan is a 5-year-old boy who was seen in a Developmental Behavioral Pediatrics clinic for disruptive behavior and developmental delay. His medical history was notable for a tethered spinal cord repaired at age 4 months, alternating exotropia with multiple surgeries, and obesity (body mass index at 99%). Ryan's development was globally delayed. He sat at age 10 months and walked at 24 months. An Autism Diagnostic Observation Schedule-Toddler module (ADOS-T) was completed at age 19 months and demonstrated little-to-no concern for autism spectrum disorder.

Ryan's parents described behavioral challenges including hyperactivity, impulsivity, aggression toward him self and others, severe tantrums, a short attention span, and difficulty sleeping. They also endorsed repetitive behaviors including head rocking, walking in circles, and perseverative speech. Expressive language was significantly limited. There was no family history of autism or intellectual disability.

Ryan's physical examination was notable for alternating exotropia, hypertelorism, upslanting palpebral fissures, and obesity. His speech was limited to 1-word utterances. Neurological and general examinations were normal.

He was referred for repeat psychological testing at age 5 years. The ADOS-2 (Module 2) was consistent with a classification of autism with a high level of autism-related symptoms. A fragile X test was negative, and microarray demonstrated a microduplication in the region of 2p25.3 including the myelin transcription factor 1–like gene.
Perceived Toddler Sleep Problems, Co-sleeping, and Maternal Sleep and Mental Health
Authors: Covington Lauren B. , Armstrong Bridget , Black Maureen M.
Published: December 2017

Objective:

Childhood sleep problems are associated with insufficient parental sleep and adverse maternal mental health symptoms, which may be exacerbated when mothers/toddlers co-sleep (i.e., bed/room sharing). This study examines maternal sleep duration as a mechanism linking perceived toddler sleep problems with maternal mental health and examines whether these associations vary by co-sleeping, in addition to exploring alternative models.

Methods:

Low-income mothers of toddlers (n = 280) (age 12–32 months) recruited from Women, Infants, and Children and pediatric clinics provided demographic information and completed questionnaires on their toddler's sleep and their own sleep duration and mental health symptoms (depressive symptoms, anxiety, and stress). Indirect and conditional indirect models were conducted to examine the relation between perceived toddler sleep problems and maternal mental health.

Results:

Perceived toddler sleep problems were associated with an average decrease of 51 minutes in maternal sleep when co-sleeping (mean = 6.1 h). Maternal sleep duration mediated the relation between perceived toddler sleep problems and maternal symptoms of depression, anxiety, and stress for co-sleeping mothers. Maternal sleep duration did not mediate relations between maternal mental health symptoms and perceived toddler sleep problems.

Conclusion:

This study provides a conceptual model by which parent and child sleep is related to parental mental health. Practitioners might consider alternatives to co-sleeping when discussing sleep arrangements with parents. Future studies should replicate results longitudinally and examine whether reducing co-sleeping improves maternal sleep duration and reduces perceptions of toddler sleep problems.
Use and Nondisclosure of Complementary Health Approaches Among US Children with Developmental Disabilities
Authors: Lindly Olivia , Thorburn Sheryl , Zuckerman Katharine
Published: December 2017

Objectives:

Many US children use complementary health approaches (CHAs), including some modalities that may be ineffective, unsafe, and/or costly. Yet, little is known about the prevalence and correlates of CHA use among children with developmental disabilities (DDs), as well as parent nondisclosure of CHAs used for children with DDs to health care providers. We, therefore, aimed to profile the use and nondisclosure of CHAs among US children with DDs.

Methods:

We analyzed data from the 2012 National Health Interview Survey, which included the most recent Child Complementary and Alternative Medicine Supplement. The study sample was comprised of 2141 children with DDs aged 4 to 17 years.

Results:

Nearly one-quarter (23%) of US children with DDs used CHAs. Among those with a personal health provider, 42% of parents did not disclose some or all CHAs used to the child's provider. The adjusted odds ratios of using CHAs were greater among those with female sex, higher household income, residences not in the South, difficulty accessing care, or comorbid conditions. CHA was most commonly used because “it is natural.” Nondisclosure was associated with female sex, older age, having no functional limitations, less conventional services use, and use of fewer CHAs. The most common reason for nondisclosure was that the child's provider did not ask.

Conclusion:

Complementary health approach use is prevalent among US children with DDs, and nondisclosure is likely among those who use CHAs. Future intervention targeting education and communication about CHAs for parents of children with DDs and their health care providers may promote disclosure.
The Cellular Response of Keloids and Hypertrophic Scars to Botulinum Toxin A: A Comprehensive Literature Review
Authors: Austin Evan , Koo Eugene , Jagdeo Jared
Published: December 2017

BACKGROUND

Keloids and hypertrophic scars are conditions of pathologic scarring characterized by fibroblast hyperproliferation and excess collagen deposition. These conditions significantly impact patients by causing psychosocial, functional, and aesthetic distress. Current treatment modalities have limitations. Clinical evidence indicates that botulinum toxin A (BoNT-A) may prevent and treat keloids and hypertrophic scars.

OBJECTIVE

To examine investigated cellular pathways involved in BoNT-A therapeutic modulation of keloids and hypertrophic scars.

METHODS

The authors searched PubMed, Embase, and Web of Science for basic science articles related to botulinum toxin therapy, scarring, fibroblasts, keloids, and hypertrophic scars.

RESULTS

Eleven basic science articles involving keloids and hypertrophic scars were reviewed.

DISCUSSION

BoNT-A may reduce skin fibrosis by decreasing fibroblast proliferation, modulating the activity of transforming growth factor-β, and reducing transcription and expression of profibrotic cytokines in keloid-derived and hypertrophic scar–derived dermal fibroblasts. BoNT-A may modulate collagen deposition, but there is a paucity of evidence regarding specific mechanisms of action.

CONCLUSION

Overall, BoNT-A has the potential to prevent or treat pathologic scars in patients with a known personal or family history of keloids and hypertrophic scars, which may improve patient psychosocial distress and reduce clinic visits and health care costs. Variability in keloid and hypertrophic scar response to BoNT-A may be due to interexperiment differences in dosing, tissue donors, and assay sensitivity.
Platelet-Rich Plasma Versus Tretinoin in Treatment of Striae Distensae: A Comparative Study
Authors: Gamil Hend D. , Ibrahim Samia A. , Ebrahim Howyda M. , Albalat Waleed
Published: December 2017

BACKGROUND

Striae distensae (SD) are dermal scars associated with atrophy of the epidermis.

OBJECTIVE

To evaluate the effect and safety of intralesional injection of platelet-rich plasma (PRP) versus topical tretinoin 0.05% in treatment of SD.

METHODS

Thirty patients (27 females and 3 males) had bilateral striae distensae were enrolled in this study. In every patient, half of the selected striae were treated with PRP intralesional injection. The other half was treated by topical tretinoin. Skin biopsies were taken from both sides before and after the treatment. Digital photographs were taken at the baseline and at the end of follow-up period. Clinical improvement was evaluated by 2 blind dermatologists in addition to the patient's satisfaction rating.

RESULTS

There was statistically significant improvement in the SD treated with PRP and topical tretinoin cream. The improvement was more in the SD treated with PRP injections (p = .015). Patient's satisfaction showed that the improvement was more in the PRP-treated side (p = .003). Collagen and elastic fibers in the dermis were increased in all biopsies after treatment.

CONCLUSION

PRP injection and topical tretinoin are safe for the treatment of SD, but PRP is more effective and it gives better therapeutic response than tretinoin.
Evaluating Perceived Naturalness of Facial Expression After Fillers to the Nasolabial Folds and Lower Face With Standardized Video and Photography
Authors: Philipp-Dormston Wolfgang G. , Wong Cindy , Schuster Bernd , Larsson Markus K. , Podda Maurizio
Published: December 2017

BACKGROUND

Hyaluronic acid (HA) fillers are commonly used in treating facial wrinkles and folds but have not been studied with standardized methodology to include assessment of standard facial expressions.

OBJECTIVE

To assess perceived naturalness of facial expression after treatment with 2 HA fillers manufactured with XpresHAn Technology (also known as Optimal Balance Technology).

MATERIALS AND METHODS

Treatment was directed to the nasolabial folds (NLFs) and at least 1 additional lower face wrinkle or fold. Maintenance of naturalness, attractiveness, and age at 1 month after optimal treatment were assessed using video recordings and photographs capturing different facial animations. Global aesthetic improvement, subjects' satisfaction, and safety were also evaluated.

RESULTS

The treatment was well tolerated. Naturalness of facial expression in motion was determined to be at least maintained in 95% of subjects. Attractiveness was enhanced in 89% of subjects and 79% of subjects were considered to look younger. Most subjects assessed their aesthetic appearance as improved and were satisfied with their treatment.

CONCLUSION

Naturalness and attractiveness can be assessed using video recordings and photographs capturing different facial animations. XpresHAn Technology HA filler treatments create natural-looking results with high subject satisfaction.