bluuebunny/crossref_metadata_2025 huggingface dataset:
Energy Levels of Core-Excited 1s2l2l′ States in Lithium-Like Ions: Argon to Uranium
Authors: Yerokhin V. A. , Surzhykov A.
Published: June 2018

Energy levels and fine-structure intervals of the 1s2l2l′ core-excited states are calculated for ions along the Li isoelectronic sequence from argon to uranium. The calculation is performed by the relativistic configuration-interaction method adapted for treatment of autoionizing core-excited states. The calculational approach includes the relativistic treatment of the nuclear recoil effect, the leading quantum electrodynamics (QED) shifts as delivered by the model QED operator, and the frequency dependence of the Breit interaction. The 1s2l2l′–1s22l transition energies are obtained by combining the present results for the 1s2l2l′ states with energies of the 1s22l states compiled from previous calculations. All theoretical energies are supplied with uncertainty estimates. Our theoretical predictions for the 1s2l2l′–1s22l transitions are significantly more accurate than the best experimental results available today and can be used for calibrating experimental X-ray spectra.
Exponential propagators for the Schrödinger equation with a time-dependent potential
Authors: Bader Philipp , Blanes Sergio , Kopylov Nikita
Published: June 2018

We consider the numerical integration of the Schrödinger equation with a time-dependent Hamiltonian given as the sum of the kinetic energy and a time-dependent potential. Commutator-free (CF) propagators are exponential propagators that have shown to be highly efficient for general time-dependent Hamiltonians. We propose new CF propagators that are tailored for Hamiltonians of the said structure, showing a considerably improved performance. We obtain new fourth- and sixth-order CF propagators as well as a novel sixth-order propagator that incorporates a double commutator that only depends on coordinates, so this term can be considered as cost-free. The algorithms require the computation of the action of exponentials on a vector similar to the well-known exponential midpoint propagator, and this is carried out using the Lanczos method. We illustrate the performance of the new methods on several numerical examples.
Geodesic mode instability driven during ion cyclotron heating in tokamaks
Authors: Elfimov A. G.
Published: June 2018

The effect of a minor concentration of energetic particles produced by ion cyclotron resonance (ICR) heating on the stability of Geodesic Acoustic Modes (GAM) is studied using fully drift kinetic equation. Assuming the ICR layer position on the high field side of the tokamak magnetic axis, a minority ion distribution is modeled by the energetic ion tail and “triangle”-like pitch angle distribution with the maximum at the trapped-passing ion boundary. The resulting GAM instability is found when the hot ion thermal velocity is larger than the effective parallel GAM phase velocity Rqω and the geodesic frequency has the order of the energetic ion bounce frequency. The standard GAM frequency may be strongly reduced by some small concentration of the energetic ions allowing the mode to be unstable. Respective neoclassical polarization corrections (residual flow) driven by energetic ions are found to be negative and larger than that calculated by Rosenbluth and Hinton [Phys. Rev. Lett. 80, 724 (1998)]. Qualitative comparison of the theory with ICR heating experiments in tokamak is discussed.
Conservation challenges and benefits of multispecies reintroductions to a national park – a case study from New South Wales, Australia
Authors: Pedler Reece D. , West Rebecca S. , Read John L. , Moseby Katherine E. , Letnic Michael , Keith David A. , Leggett Keith D. , Ryall Sharon R. , Kingsford Richard T.
Published: June 2018

Species reintroductions into predator-controlled areas are an increasingly used conservation tool. Typically, ecological outcomes of such projects (e.g. recruitment, predation) are the focus but seldom necessary legislative, policy, social and institutional processes required for establishing large projects. This particularly applies to protected areas, managed by governments for conservation. Reintroductions are recommended for a third of threatened Australian vertebrates, with the New South Wales Government boldly embarking on a 2013 initiative to return locally extinct mammals to three protected areas. We detail the legislative, policy, social and institutional processes required for one of these sites, Wild Deserts, in Sturt National Park. Seven locally extinct species, including the greater bilby (Macrotis lagotis), western barred bandicoot (Perameles bougainville), golden bandicoot (Isoodon auratus), greater stick-nest rat (Leporillus conditor), crest-tailed mulgara (Dasycercus cristicauda), western quoll (Dasyurus geoffroii) and burrowing bettong (Bettongia lesueur) will be reintroduced into two exclosures. The scale of the project required identification of an appropriate location, satisfaction of statutory requirements for major infrastructure in a national park, assessments of potential ecological costs and benefits, engagement of the national park agency and other stakeholders (Traditional Owners, other government agencies, neighbours), and staff training to meet government agency requirements. We outline the resourcing, costs and benefits of such a project on government-managed land along with lessons learnt for similar large-scale restoration and reintroduction projects. Future projects would benefit from understanding legislative and policy frameworks and the need for transparency, while maximising efficiencies.
Initiating a conflict with wildlife – the reintroduction and feeding of kākā, Wellington City, New Zealand
Authors: Linklater Wayne , Chapman Holly , Gregor Andrea , Calder-Flynn Rebecca , Gouws Johan , Quigan Olivia , Rustandi Anindita , Brian-Molitaviti June , Ying Yile
Published: June 2018

Wildlife reintroductions to peopled landscapes pose socio-ecological opportunities and risks, and a responsibility to people as well as wildlife. Human–wildlife conflicts can escalate rapidly where anthropogenic foods and feeding cause wildlife to congregate and damage property. Those conflicts polarise attitudes to the wildlife and may cascade into conflicts between people over wildlife. The native parrot, kākā (Nestor meridionalis), was reintroduced to Wellington City in 2002 and we suspect that it initiated a classical human–wildlife conflict cascade. We tested for feeding-induced damage, and different attitude scores amongst neighbours using a postal household survey. We received 313 completed surveys, a 55.9% response rate, across eight suburbs. Minor to severe damage, costing up to NZ$3000 to repair, was reported to trees, buildings, and outdoor furniture. Seventeen respondents reported feeding kākā, mostly fruit and vegetables, but also sugar water, bread, and nuts and seeds, and we received surveys from 33 of their non-feeding neighbours. Feeding significantly increased reports of kākā, and kākā abundance was positively associated with kākā damage. Neighbourhoods closer to Zealandia (the wildlife sanctuary where kākā are fed) and the neighbours of people who fed kākā were statistically more likely to incur property damage than more distant suburbs and residents. Neighbours’ attitudinal scores about kākā and native birds were significantly negatively associated with greater kākā damage. The reintroduction of kākā has initiated a feeding-induced wildlife–human conflict. We discuss what can be learned from the experience with kākā in Wellington City for urban wildlife conservation in the future.
French anthroponyms as a heterogeneous category
Authors: Elmiger Daniel
Published: June 2018

In natural languages, personal nouns (e.g.,madame, ministre) are used very frequently and it is usually not very difficult to identify and interpret them in texts. If one tries to define them more precisely, however, one is confronted with a series of challenges. This contribution gives an overview of several types of difficulties that can be observed when trying to establish distinctions between personal nouns and other words. They are related to lexical differences between (personal) nouns and (personal) names, the referential boundaries of humanness, some morphological and semantic properties of French personal names, their syntactic behavior as personal nouns in French as well as the types of predications that may be used in order to distinguish between personal noun use and other uses.1
Hedging in political interviewing
Authors: Ponterotto Diane
Published: June 2018

This study presents an analysis of hedging strategies employed by the former president of the United States, Barack Obama, in political interviewing. Using a discourse-analytic procedure, the study investigates a corpus of 22 press interviews and verifies the presence of hedging-related discursive strategies in the President’s responses. It also identifies four specific interrelated discourse moves: ‘Reformulating the interviewer’s question’, ‘Expanding the scope of the original question sequence’, ‘Switching the time frame of the question context’, ‘Recasting the question reference from specific to general terms’. It is suggested that President Obama manages to avoid explicit responses to questions about controversial issues through hedging strategies, which shift the focus of the interviewer’s question to different interrogative formats, time frames and reference perspectives.
Does a corpus informed analysis provide any insights as to why Robert Phillipson’s theory of Linguistic Imperialism is labelled by some as a conspiracy theory?
Authors: Thornton Sean
Published: June 2018

This paper uses the corpus tools DOTA and WordSmith to see if they can provide any indication as to why some label Phillipson’s theory of Linguistic Imperialism as a conspiracy theory. The tools were applied to multiple corpora composed of texts drawn from: Phillipson’s works, conspiracy theory books, and a control corpus of general academic papers. The quantitative data generated was subjected to a corpus informed qualitative analysis with the tools being applied to facilitate a corpus-assisted discourse study of Linguistic Imperialism.
Nowruz
Authors: Shariati Ali
Published: June 2018

In Esfand of 1346 (March 1967) the history students of the university went to Iraq on a scientific excursion. I had planned to accompany them, but at the last moment, “destiny” (!) ruled otherwise. Because they were to celebrate Nowruz on the trip, by the request of my dear colleagues, I composed this article upon their departure, so that it might be read in that assembly.

And now, in commemoration of that “incident“! … .

It is difficult to say something new about Nowruz. It is a national festival, and everyone knows what a national festival is. Nowruz takes place and is spoken of every year. Much has been told and much you have heard. Then is repetition appropriate?! Yes it is! Doesn't Nowruz repeat itself? Then you should attend to what is repeatedly said of Nowruz. In science and literature, repetition is boring and useless.
Seave: a comprehensive web platform for storing and interrogating human genomic variation
Authors: Gayevskiy Velimir , Roscioli Tony , Dinger Marcel E , Cowley Mark J
Published: June 2018

Motivation

Genome sequencing has had a remarkable impact on our ability to study the effects of human genetic variation, however, variant interpretation remains the major bottleneck. Understanding the potential impact of variants, including structural variants, requires extensive annotation from disparate sources of knowledge, and in silico prediction algorithms.

Results

We introduce Seave, an intuitive web platform that enables all types of variants to be securely stored, annotated and filtered. Variants are annotated with allele frequencies and pathogenicity assessments from many popular databases and in silico pathogenicity prediction scores. Seave enables filtering of variants with specific inheritance patterns, including somatic variants, by quality, allele frequencies and gene lists which can be curated and saved. Seave was made for whole genome data and is capable of storing and querying copy number and structural variants.

Availability and implementation

To demo Seave with public data, see https://www.seave.bio. Source code is available at http://code.seave.bio and extensive documentation is available at http://documentation.seave.bio. Seave can be locally installed on an Apache server with PHP and MySQL, or we provide an Amazon Machine Image for quick deployment. For commercial and clinical diagnostic licensing, contact the corresponding author.

Supplementary information

Supplementary data are available at Bioinformatics online.
Renal albumin excretion in healthy young adults and its association with mortality risk in the US population
Authors: Chong Jiehan , Fotheringham James , Tomson Charles , Ellam Timothy
Published: June 2018

Background

Current classification systems do not specify a healthy normal range for urinary albumin excretion. Occult microvascular disease induced by a Western lifestyle may mean that normal values for apparently healthy adults exceed optimal levels defined by mortality risk.

Methods

Using a national population sample [the US Third National Health and Nutrition Examination Survey (NHANES III) cohort; n = 11 887], the distributions of albumin:creatinine ratio (ACR) and fractional excretion of albumin (FEalb) were studied in healthy young adults [ages 20–40 years, without cardiovascular disease (CVD) or risk factors]. The threshold for mortality risk prediction in the whole adult population sample was then studied across ACR/FEalb categories corresponding to quartiles for healthy young adults.

Results

ACR quartiles for healthy young adults were 2.7, 4.2 and 5.9 mg/g in men and 3.8, 6.2 and 9.8 mg/g in women. Increases in ACR below the medians for healthy young adults were not associated with increased mortality or with cardiovascular risk factors when tested in the whole adult population. Increases above this threshold were independently associated with mortality risk [hazard ratio 1.2 (95% confidence interval 1.1–1.4) and 1.8 (1.6–2.0) for Quartiles 3 and 4, respectively]. The prevalence of an optimal ACR below the mortality risk threshold was <25% in the setting of diabetes, hypertension, age >70 years or CVD. Using FEalb to define quartiles of albuminuria gave the same findings.

Conclusion

Based on mortality risk in the whole adult population, there is an optimal range of albumin excretion (ACR < 6 mg/g and 4 mg/g for women and men, respectively). However, only half of even apparently healthy young US adults fall within this range.
Implementation of a Rapid Entry Program Decreases Time to Viral Suppression Among Vulnerable Persons Living With HIV in the Southern United States
Authors: Colasanti Jonathan , Sumitani Jeri , Mehta C Christina , Zhang Yiran , Nguyen Minh Ly , del Rio Carlos , Armstrong Wendy S
Published: June 2018

Background

Rapid entry programs (REPs) improve time to antiretroviral therapy (ART) initiation (TAI) and time to viral suppression (TVS). We assessed the feasibility and effectiveness of a REP in a large HIV clinic in Atlanta, Georgia, serving a predominately un- or underinsured population.

Methods

The Rapid Entry and ART in Clinic for HIV (REACH) program was implemented on May 16, 2016. We performed a retrospective cohort study with the main independent variable being period of enrollment: January 1, 2016, through May 15, 2016 (pre-REACH); May 16, 2016, through July 31, 2016 (post-REACH). Included individuals were HIV-infected and new to the clinic with detectable HIV-1 RNA. Six-month follow-up data were collected for each participant. Survival analyses were conducted for TVS. Logistic and linear regression analyses were used to evaluate secondary outcomes: attendance at first clinic visit, viral suppression, TAI, and time to first attended provider visit.

Results

There were 117 pre-REACH and 90 post-REACH individuals. Median age (interquartile range [IQR]) was 35 (25–45) years, 80% were male, 91% black, 60% men who have sex with men, 57% uninsured, and 44% active substance users. TVS decreased from 77 (62–96) to 57 (41–70) days (P < .0022). Time to first attended provider visit decreased from 17 to 5 days, and TAI from 21 to 7 days (P < .0001), each remaining significant in adjusted models.

Conclusions

This is the largest rapid entry cohort described in the United States and suggests that rapid entry is feasible and could have a positive impact on HIV transmission at the population level.
Association Between Carbapenem Resistance and Mortality Among Adult, Hospitalized Patients With Serious Infections Due to Enterobacteriaceae: Results of a Systematic Literature Review and Meta-analysis
Authors: Martin Amber , Fahrbach Kyle , Zhao Qi , Lodise Thomas
Published: June 2018

This study quantified mortality associated with serious infections caused by carbapenem-resistant (CRE) and carbapenem-susceptible Enterobacteriaceae (CSE). A systematic literature review was conducted, evaluating outcomes in hospitalized patients with CRE infections from a blood, urinary, pulmonary, or intra-abdominal source. A meta-analysis (MA) calculating odds ratios (ORs) for mortality was performed. Twenty-two studies met the criteria for inclusion in the MA: 12 included mortality data for CRE vs CSE populations. Compared with CSE, CRE was associated with a significantly higher risk of overall mortality (OR, 3.39; 95% confidence interval [CI], 2.35–4.89), as was monotherapy (vs combination therapy) treatment of patients with CRE infections (OR, 2.19; 95% CI, 1.00–4.80). These results document the increased mortality associated with serious CRE infections compared with CSE infections among hospitalized adults. It will be important to reevaluate the mortality in CRE and CSE populations, especially among patients who receive early appropriate therapy, as new antibiotics become available.
Association Between Rates of Caesarean Section and Maternal and Neonatal Mortality in the 21st Century: A Worldwide Population-based Ecological Study With Longitudinal Data
Authors: Ye J. , Zhang J. , Mikolajczyk R. , Torloni M.R. , G€ulmezoglu A.M. , Betran A.P.
Published: June 2018

(BJOG. 2016;123:745–753)

A significant increase in cesarean deliveries has been reported worldwide over the past few decades. Earlier studies analyzed the association between delivery mode and maternal and neonatal mortality using various statistical methods and found a nonlinear relationship between the 2. However, these studies did not control for socioeconomic conditions. The objective of this study was to compile the data available on cesarean section rates worldwide, determine the association between mode of delivery and maternal and neonatal mortality when adjusting for socioeconomic development, and determine a population level cesarean section rate that is associated with the least maternal and neonatal mortality.
Impact of Very Early Physical Therapy During Septic Shock on Skeletal Muscle: A Randomized Controlled Trial
Authors: Hickmann Cheryl E. , Castanares-Zapatero Diego , Deldicque Louise , Van den Bergh Peter , Caty Gilles , Robert Annie , Roeseler Jean , Francaux Marc , Laterre Pierre-François
Published: June 2018

Objectives:

As the catabolic state induced by septic shock together with the physical inactivity of patients lead to the rapid loss of muscle mass and impaired function, the purpose of this study was to test whether an early physical therapy during the onset of septic shock regulates catabolic signals and preserves skeletal muscle mass.

Design:

Randomized controlled trial.

Setting:

Tertiary mixed ICU.

Patients:

Adult patients admitted for septic shock within the first 72 hours.

Interventions:

Patients were assigned randomly into two groups. The control group benefited from manual mobilization once a day. The intervention group had twice daily sessions of both manual mobilization and 30-minute passive/active cycling therapy.

Measurements and Main Results:

Skeletal muscle biopsies and electrophysiology testing were performed at day 1 and day 7. Muscle biopsies were analyzed for histology and molecular components of signaling pathways regulating protein synthesis and degradation as well as inflammation markers. Hemodynamic values and patient perception were collected during each session. Twenty-one patients were included. Three died before the second muscle biopsy. Ten patients in the control and eight in the intervention group were analyzed. Markers of the catabolic ubiquitin-proteasome pathway, muscle atrophy F-box and muscle ring finger-1 messenger RNA, were reduced at day 7 only in the intervention group, but without difference between groups (muscle atrophy F-box: –7.3% ± 138.4% in control vs –56.4% ± 37.4% in intervention group; p = 0.23 and muscle ring finger-1: –30.8% ± 66.9% in control vs –62.7% ± 45.5% in intervention group; p = 0.15). Muscle fiber cross-sectional area (µm2) was preserved by exercise (–25.8% ± 21.6% in control vs 12.4% ± 22.5% in intervention group; p = 0.005). Molecular regulations suggest that the excessive activation of autophagy due to septic shock was lower in the intervention group, without being suppressed. Markers of anabolism and inflammation were not modified by the intervention, which was well tolerated by the patients.

Conclusions:

Early physical therapy during the first week of septic shock is safe and preserves muscle fiber cross-sectional area.
Use of a Novel, Electronic Health Record–Centered, Interprofessional ICU Rounding Simulation to Understand Latent Safety Issues*
Authors: Bordley James , Sakata Knewton K. , Bierman Jesse , McGrath Karess , Mulanax Ashley , Nguyen Linh , Mohan Vishnu , Gold Jeffrey A.
Published: June 2018

Objectives:

The electronic health record is a primary source of information for all professional groups participating in ICU rounds. We previously demonstrated that, individually, all professional groups involved in rounds have significant blind spots in recognition of patient safety issues in the electronic health record. However, it is unclear how team dynamics impacts identification and verbalization of viewed data. Therefore, we created an ICU rounding simulation to assess how the interprofessional team recognized and reported data and its impact on decision-making.

Design:

Each member of the ICU team reviewed a simulated ICU chart in the electronic health record which contained embedded patient safety issues. The team conducted simulated rounds according to the ICU’s existing rounding script and was assessed for recognition of safety issues.

Setting:

Academic medical center.

Subjects:

ICU residents, nurses, and pharmacists.

Intervention:

None.

Measurements and Main Results:

Twenty-eight teams recognized 68.6% of safety issues with only 50% teams having the primary diagnosis in their differential. Individually, interns, nurses, and pharmacists recognized 30.4%, 15.6%, and 19.6% of safety items, respectively. However, there was a negative correlation between the intern’s performance and the nurse’s or the pharmacist’s performance within a given team. The wide variance in recognition of data resulted in wide variance in orders. Overall, there were 21.8 orders requested and 21.6 orders placed per case resulting in 3.6 order entry inconsistencies/case. Between the two cases, there were 145 distinct orders place with 43% being unique to a specific team and only 2% placed by all teams.

Conclusions:

Although significant blind spots exist in the interprofessional team’s ability to recognize safety issues in the electronic health record, the inclusion of other professional groups does serve as a partial safety net to improve recognition. Electronic health record–based, ICU rounding simulations can serve as a test-bed for innovations in ICU rounding structure and data collection.
Environmentally Friendly Measurement of Airborne Radon Using a Nonvolatile Liquid Scintillation Absorbent
Authors: Kato Takahisa , Janik Miroslaw , Kanda Reiko , Ishikawa Tetsuo , Kawase Masaya , Kawamoto Takuo
Published: June 2018

The practicality of using a liquid scintillation method with a nonvolatile liquid scintillation absorbent for the measurement of airborne 222Rn (radon) in a residence was examined. The relationship between the radioactivity absorbed by the liquid scintillation absorbent and the radon concentration in the air was investigated in a calibrated walk-in radon chamber. The equivalent radioactivity of radon was calculated for 214Po radioactivity immediately after radioactive equilibrium was attained using successive decay equations via alpha-particle spectrometry based on the 1 h, indirect, selective measurement of the 214Po alpha-particle spectrum generated after sampling radon. We confirmed that the amounts of radon absorbed in the liquid scintillation absorbent were proportional to the radon concentration in the air. The calibration curve that exhibited reliable quantitative linearity from 500 to 8,000 Bq m−3 in air was extrapolated to the region between 0 and 500 Bq m−3 using the least-squares method with data from 500 to 8,000 Bq m−3. The validity of the extrapolated curve at less than 500 Bq m−3 was confirmed by comparison of the measured radon concentrations in the room and atmosphere with those determined using an existing ionization chamber. Variations in the absorption of radon were observed due to changes in temperature and humidity. The health and environmental safety of nonvolatile liquid scintillation absorbent was also considered.
Effectiveness of an Imaging Plate System in Emergency 131I Thyroid Monitoring
Authors: Deji Shizuhiko , Li Xiaojuan , Ito Shigeki , Hirota Masahiro , Saze Takuya , Nishizawa Kunihide
Published: June 2018

The effect of temperature and shielding on the lower detection limit of a thyroid 131I monitoring system was investigated in an anthropomorphic thyroid-neck phantom fitted with an imaging plate. The phantom was loaded with an 131I aqueous solution and monitored with the imaging plate for 10 min. After exposure, the plates were incubated with or without the shield at 0, 10, 20, 25, 30, or 40°C. The latent image was read out at 0 min to 7 d after exposure. The thyroid equivalent doses corresponding to the detection limit were calculated in six age categories, using the inhalation equivalent dose coefficients recommended by the International Commission on Radiological Protection. The detection limit was distributed between 0.13 and 4.2 kBq, and depended on the age of subjects, elapsed time, temperature, and shielding provision. The maximum detection limit of 4.2 kBq was below the emergency screening level of 30 kBq in Japan. The thyroid equivalent dose corresponding to the detection limit ranged from 0.17 to 46 mSv. From the maximum equivalent dose of 46 mSv, the effective dose was estimated as 1.8 mSv, lower than the annual effective dose limit of 20 mSv for radiation workers. At 2 d after exposure, the measured dose was below the annual effective dose limit of 1 mSv for the public, regardless of age, temperature, and shielding provision. The imaging plate system effectively monitors the 131I thyroid levels in emergency situations.
RESOLUTION, DEPTH OF FIELD, AND PHYSICIAN SATISFACTION DURING DIGITALLY ASSISTED VITREORETINAL SURGERY
Authors: Freeman William R. , Chen Kevin C. , Ho Joseph , Chao Daniel L. , Ferreyra Henry A. , Tripathi A. Burton , Nudleman Eric , Bartsch Dirk-Uwe
Published: June 2018

Purpose:

To evaluate depth of field, lateral resolution, and image quality of a heads-up 3D visualization system for vitreoretinal surgery using physician survey and optical measurement outcomes.

Methods:

Depth of field and lateral resolution were compared between the standard ocular viewing system and the digital 3D system at ×5, ×13, and ×18 magnification by 6 retinal surgeons. Optical techniques were used as well as a survey of surgeon impression. Surgeon impression surveys were performed after 6 weeks of surgical use of the device.

Results:

Physician questionnaire survey scores for depth of field at high magnification were better for the digital 3D system and equivalent for all other categories. Measured lateral resolution was 36.7 mm and 16.6 mm at ×5 magnification (P < 0.001), 14.3 mm and 6.4 mm at ×13 magnification (P < 0.001), and 9.8 mm and 4.2 mm (P < 0.001) at ×18 magnification for the digital 3D and oculars, respectively. Measured depth of field was 4.00 mm and 6.78 mm at ×5 magnification (P = 0.027), 0.72 mm and 0.86 mm at ×13 (P = 0.311), and 0.28 mm and 0.40 mm at ×18 magnification (P = 0.235) for the oculars and digital 3D, respectively.

Conclusion:

Lateral resolution of the digital 3D system was half that of the ocular viewing system and there was some improvement in depth of field with the digital system. Surgeon impression suggested that the digital system was superior when evaluating depth of field at high magnification.
Prosthetic Foot Selection for Individuals with Lower-Limb Amputation: A Clinical Practice Guideline
Authors: Stevens Phillip M. , Rheinstein John , Wurdeman Shane R.
Published: June 2018

Introduction

This guideline was developed to present current evidence and to provide associated clinical recommendations on prosthetic foot selection for individuals with lower-limb amputation.

Materials

NA

Methods

The guideline is based upon the best available evidence as it relates prosthetic foot selection during the provision of definitive lower-limb prostheses. Where possible, recommendations are drawn from Cochrane Review, meta-analysis, systematic and narrative literature reviews, and published evidence-based guidelines. Where this standard is unavailable, alternate academic literature has been used to support individual recommendations.

Results

Recommendation 1: For patients ambulating at a single speed who require greater stability during weight acceptance because of weak knee extensors or poor balance, a single-axis foot should be considered. Recommendation 2: Patients at elevated risks for overuse injury (i.e., osteoarthritis) to the sound-side lower limb and lower back are indicated for an energy-storage-and-return (ESAR) foot to reduce the magnitude of the cyclical vertical impacts experienced during weight acceptance. Recommendation 3: Neither patient age nor amputation etiology should be viewed as primary considerations in prosthetic foot type. Recommendation 4: Patients capable of variable speed and/or community ambulation are indicated for ESAR feet.

Conclusions

These clinical practice guidelines summarize the available evidence related to prosthetic foot selection for individuals with lower limb amputation. The noted clinical practice guidelines are meant to serve only as “guides.” They may not apply to all patients and clinical situations.
Comparative Evaluation of Foveal Avascular Zone on Two Optical Coherence Tomography Angiography Devices
Authors: Dave Prachi A. , Dansingani Kunal K. , Jabeen Ayesha , Jabeen Asiya , Hasnat Ali M. , Vupparaboina Kiran Kumar , Peguda Hari Kumar , Pappurru Rajeev Reddy , Agrawal Rupesh , Chhablani Jay
Published: June 2018

SIGNIFICANCE

This study compares foveal avascular zone (FAZ) geometry in healthy eyes as imaged by two commercially available optical coherence tomography angiography (OCTA) devices. Foveal avascular zone measurements are repeatable and reproducible with each OCTA device, but interdevice agreement was poor. We provide conversion factors between devices.

PURPOSE

The purpose of this study was to perform comparative evaluation of FAZ geometry in healthy eyes as imaged by two commercially available OCTA devices.

METHODS

Ninety-six eyes of 48 healthy subjects were imaged prospectively on each of two OCTA devices (DRI-OCT [Topcon Corporation, Tokyo, Japan]; Cirrus 5000 [Carl Zeiss Meditec Inc., Dublin, CA]). The FAZ was evaluated in the superficial capillary plexus layer of 6 × 6-mm foveal scans by two masked observers. Intraobserver and interobserver agreement was determined using intraclass correlation by using linear mixed models and Bland-Altman plots. K-means clustering was used to provide conversion values between two devices. Foveal avascular zone acircularity was calculated using scans from each device and compared.

RESULTS

The intraobserver repeatability for DRI-OCT was 0.95 (95% confidence interval [CI], 0.90 to 0.98) for observer A and 0.92 (95% CI, 0.83 to 0.96) for observer B. Intraobserver repeatability for Cirrus 5000 was 0.988 (95% CI, 0.972 to 0.995) for observer A and 0.993 (95% CI, 0.983 to 0.997) for observer B. The interobserver variability between observers A and B for DRI-OCT was 0.87 (0.73 to 0.94) and for Cirrus 5000 was 0.984 (95% CI, 0.964 to 0.993). Poor interdevice agreement (0.205 [95% CI, −0.202 to 0.554]) was noted, and conversion formulas were devised to convert FAZ area measurements from one device to another. No significant correlation was found when comparing FAZ acircularity indices between devices (P = .39).

CONCLUSIONS

Repeatable and reproducible FAZ area measurements were obtained with each respective OCTA device, but interdevice agreement was poor, yet quantifiable and systematic with calculable conversion factors between devices.
Monocular Ghost Image Offset Thresholds: Dependent on Target Size and Ghost Image Relative Brightness
Authors: Webster Anna B. , Lyon Georgia M. , Blowers Kathryn A. , Roth Gillian N. , Deacon Jacinta A. , Baan Cassandra L. , Carkeet Andrew
Published: June 2018

SIGNIFICANCE

This is the first report of monocular ghost image offset thresholds measured using O optotypes. Monocular diplopia is a complaint of patients and is the result of a variety of etiologies. Furthermore, monocular image doubling also can be a confounding variable of vectographic stereoacuity tests, warranting an investigation of ghost image offset thresholds.

PURPOSE

To measure ghost image offset thresholds of normal observers and how they are affected by offset orientation, target size, and ghost image relative luminance.

METHODS

Participants were five individuals without ocular abnormalities aged 21 to 32 years. Stimuli were viewed monocularly and consisted of Sloan “O” optotypes generated on a computer monitor with varying levels of image doubling. Ghost image offset thresholds were determined using a spatial 2-alternative forced-choice paradigm and probit analysis of the frequency of seeing data.

RESULTS

Under close-to-optimal conditions, monocular ghost image offset thresholds ranged between 14 and 22 arc seconds, a level that might be considered a hyperacuity. Ghost image offset detection thresholds demonstrated a U-shaped relationship with optotype size, with optimum thresholds occurring for optotypes sizes of approximately −0.15 logarithmic minimum angle of resolution. There was no measurable effect of offset orientation on ghost image offset detection thresholds. Monocular ghost image offset detection thresholds decreased as ghost image relative luminance increased.

CONCLUSIONS

Ghost image offset detection thresholds can be quite low even when viewing under monocular conditions and relatively low ghost image relative luminance. This should be considered when designing and interpreting the results of vectographic stereoacuity tests.
Do Adolescents with Gynecomastia Require Routine Evaluation by Endocrinology?
Authors: Malhotra Armaan K. , Amed Shazhan , Bucevska Marija , Bush Kevin L. , Arneja Jugpal S.
Published: June 2018

Background:

Primary evidence for the role of endocrinologic investigations in patients with adolescent gynecomastia is lacking in the current literature. The objective of this study was to assess the yield of endocrinologic investigations in the evaluation of adolescent gynecomastia to inform current practice for this common condition.

Methods:

A 26-year retrospective review was conducted. Data collection included patients with gynecomastia presenting to endocrinology at a quaternary children's hospital with a catchment area of 1 million. Clinical metrics, endocrinologic results, treatments, and costs were reviewed.

Results:

One hundred ninety-seven patients met inclusion criteria. Ninety-eight (50 percent) were overweight or obese and 29 (15 percent) had a positive family history. The median age at onset was 11.5 years; 25 cases (13 percent) were prepubertal. A total of 15 patients (7.6 percent) were diagnosed with secondary gynecomastia (10 related to exogenous substance use). Endocrine investigations were performed in 173 patients (87 percent), with positive findings in three cases (1.7 percent). One hundred one patients were observed, with a median age at resolution of 14.6 years; 86 patients underwent surgery at a median age of 16.5 years. The case-cost of endocrine evaluation was $389.

Conclusions:

Endocrinologic workup identified secondary gynecomastia in 7.6 percent of patients, of which only 1.7 percent were evident on blood work. This workup is associated with an avoidable case-cost burden to the health care system and largely unnecessary testing for the child. Because a majority of secondary gynecomastia cases (67 percent) were drug-induced, we do not suggest routine endocrinology workup, as it adds little value. The authors’ data suggest that referral for surgery is warranted if gynecomastia persists beyond 16 years of age.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Diagnostic, IV.
Personal Safety of the Plastic Surgeon: Keeping Yourself Healthy While You Work
Authors: Nagarkar Purushottam
Published: June 2018

Learning Objectives:

After reading this study, the participant should be able to: 1. Recognize the primary physical and mental risks faced by the practicing plastic surgeon. 2. State the primary risk factors for cervical spine disease and back pain. 3. State the critical steps for protection from ionizing and nonionizing radiation. 4. List the characteristics of a surgeon exhibiting signs of burnout. 5. Develop a plan for mitigating personal risk of musculoskeletal, exposure, and other injuries.

Health care workers are exposed to significant occupational hazards, and have a risk of injury similar to that of construction, mining, and manufacturing employees. Plastic surgeons must have a clear understanding of the types of risks they face and the techniques for mitigating them. Exposure to some risks is attributable to unavoidable occupational conditions, but others can be avoided completely. The sources of injury risk from musculoskeletal, exposure, and other causes are discussed in this article, and evidence-based recommendations to ameliorate these risks are presented.
Treatment of Paradoxical Adipose Hyperplasia following Cryolipolysis: A Single-Center Experience
Authors: Kelly Michael E. , Rodríguez-Feliz Jose , Torres Carolina , Kelly Emma
Published: June 2018

Paradoxical adipose hyperplasia is a rare adverse event associated with cryolipolysis. No evidence of spontaneous resolution has been described and little has been written about its treatment. The purpose of this report is to share the authors’ experience treating patients with paradoxical adipose hyperplasia after cryolipolysis. A retrospective chart review was performed for all paradoxical adipose hyperplasia patients seen in the authors’ practice between May of 2013 and May of 2016. The treatment parameters, demographics, onset of findings, and subsequent treatment were chronicled. Eleven cases of paradoxical adipose hyperplasia were identified (eight men and three women). All patients were of Hispanic background. Seven patients were treated surgically (six cases of liposuction alone and one case of liposuction and abdominoplasty). Average follow-up was 9.6 months (range, 2 to 32 months). Three of the patients treated with liposuction required a secondary procedure. All surgically treated patients were very satisfied with their final appearance. Paradoxical adipose hyperplasia is a rare complication of cryolipolysis that may occur more frequently than in the manufacturer’s reported data. Treatment is best delayed until the affected area has softened, which normally occurs in 6 to 9 months after the initial cryolipolysis procedure. Power-assisted liposuction is the preferred method of treatment, but in some cases, abdominoplasty may be necessary. Secondary treatments might be needed for recurrence or persistent bulge. One must be sensitive to heightened patient concerns when offering an invasive procedure to correct the complications from a noninvasive one.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Longitudinal Follow-up of Patients With Tracheobronchomalacia After Undergoing Tracheobronchoplasty
Authors: Bezuidenhout Abraham F. , Boiselle Phillip M. , Heidinger Benedikt H. , Alape Daniel , Buitrago Daniel H. , Majid Adnan , Gangadharan Sidhu P. , Litmanovich Diana E.
Published: June 2018

Purpose:

The purpose of this study was to evaluate intermediate and long-term changes in expiratory tracheal collapsibility by computed tomography (CT) in patients with tracheobronchomalacia following surgical treatment with tracheobronchoplasty and to correlate CT findings with clinical findings.

Materials and Methods:

Between 2003 and 2016, 18 patients with tracheobronchomalacia underwent tracheobronchoplasty and were imaged preoperatively and postoperatively at both intermediate and long-term intervals. Imaging included end-inspiratory and dynamic expiratory phase scans. The cross-sectional area of the airway lumen was measured at 2 standard levels (1 cm above the aortic arch and carina). These measurements were used to calculate % collapsibility. Clinical findings recorded included a questionnaire on symptomatology and a 6-minute walk test.

Results:

Before surgery, expiratory collapsibility of the upper trachea was 72%±25% (mean±SD) and that of the lower trachea was 68%±22%. On intermediate follow-up (mean, 1.5 y), collapsibility significantly decreased to 37%±21% at the upper trachea and 35%±19% at the lower trachea (P<0.001). On long-term follow-up (mean, 6 y), collapsibility increased to 51%±20% at the upper trachea and 47%±17% at the lower trachea and was significantly worse than on intermediate follow-up (P=0.002). However, collapsibility on long-term follow-up remained significantly lower than preoperative collapsibility (P=0.015). Clinical findings showed a similar trend as quantitative CT measurements.

Conclusion:

Expiratory tracheal collapsibility substantially decreases after tracheobronchoplasty on intermediate follow-up. At long-term follow-up, tracheal collapsibility shows a modest increase, but remains significantly lower than the preoperative baseline. Quantitative measurements from dynamic CT have the potential to play an important role as imaging biomarkers for assessing response to tracheobronchoplasty.
A Comparison of Outcomes of Trauma Patients With Ventilator-Associated Events by Diagnostic Criteria Set
Authors: Younan Duraid , Griffin Russell , Zaky Ahmed , Pittet Jean-Francois , Camins Bernard
Published: June 2018

Background:

The Centers for Disease Control and Prevention replaced the definition for ventilator-associated pneumonia with an algorithm comprised of three categories: ventilator-associated condition (VAC), infection-related ventilator associated complication (IVAC), and possible ventilator-associated pneumonia (PVAP). We sought to compare the outcome of trauma patients with VAEs to those with no VAEs.

Methods:

Patients admitted from 2013 to 2017 were identified from trauma registry. Logistic regression was performed for the association between VAEs and mortality.

Results:

Two thousand six hundred eighty patients were admitted to our trauma center, 2,290 had no VAE, 100 had VACs, 85 had IVACs, and 205 had PVAPs. Adjusted for race, sex, blunt injury mechanisms, and Injury Severity Score, all VAEs had a longer hospital length of stay, intensive care unit stay, and days of ventilator support when compared with those with no VAE (all P < 0.0001). Nosocomial complication rates were not different by VAE group. Compared with patients with no VAE, an over 2-fold increased mortality odds was observed for VAC (OR 2.39, 95% CI 1.50–3.80) and IVAC patients (OR 2.07, 95% CI 1.23–3.47), and a 50% mortality increased was observed for PVAP patients (OR 1.46, 95% CI 1.00–2.12). These associations became similar with an approximate 2.5-fold increased mortality odds among patients with at least 1 week on ventilator support.

Conclusion:

VAEs increase the odds of mortality, particularly for patients with VACs and IVACs. Among patients on ventilator support for at least a week, the associations are similar among VAE types, suggesting no single VAE type is more severe than others.
Classification of mouse ultrasonic vocalizations using deep learning
Authors: Ivanenko A. , Watkins P. , van Gerven M. A. J. , Hammerschmidt K. , Englitz B.
Published: June 2018

Vocalizations are a widespread means of communication in the animal kingdom. Mice use a large repertoire of ultrasonic vocalizations (USVs) in different social contexts, for instance courtship, territorial dispute, dominance and mother-pup interaction. Previous studies have pointed to differences in the USVs in different context, sexes, strains and individuals, however, in many cases the outcomes of the analyses remained inconclusive.

We here provide a more general approach to automatically classify USVs using deep neural networks (DNN). We classified the sex of the emitting mouse (C57Bl/6) based on the vocalization’s spectrogram, reaching unprecedented performance (~84% correct) in comparison with other techniques (Support Vector Machines: 64%, Ridge regression: 52%). Vocalization characteristics of individual mice only contribute mildly, and sex-only classification reaches ~78%. The performance can only partially be explained by a set of classical shape features, with duration, volume and bandwidth being the most useful predictors. Splitting estimation into two DNNs, from spectrograms to features (57-82%) and features to sex (67%) does not reach the single-step performance.

In summary, the emitter’s sex can be successfully predicted from their spectrograms using DNNs, excelling over other classification techniques. In contrast to previous research, this suggests that male and female vocalizations differ in their spectrotemporal structure, recognizable even in single vocalizations.
KRASG12D and TP53R167H Cooperate to Induce Pancreatic Ductal Adenocarcinoma in Sus Scrofa Pigs
Authors: Principe Daniel R. , Overgaard Nana Haahr , Park Alex J. , Diaz Andrew M. , Torres Carolina , McKinney Ronald , Dorman Matthew J. , Castellanos Karla , Schwind Regina , Dawson David W. , Rana Ajay , Maker Ajay , Munshi Hidayatullah G. , Rund Laurie A. , Grippo Paul J. , Schook Lawrence B.
Published: June 2018

Although survival has improved in recent years, the prognosis of patients with advanced pancreatic ductal adenocarcinoma (PDAC) remains poor. Despite substantial differences in anatomy, physiology, genetics, and metabolism, the overwhelming majority of preclinical testing relies on transgenic mice. Hence, while mice have allowed for tremendous advances in cancer biology, they have been a poor predictor of drug performance/toxicity in the clinic. Given the greater similarity of sus scrofa pigs to humans, we engineered transgenic sus scrofa expressing a LSL-KRASG12D-TP53R167H cassette. By applying Adeno-Cre to pancreatic duct cells in vitro, cells self-immortalized and established tumors in immunocompromised mice. When Adeno-Cre was administered to the main pancreaticduct in vivo, pigs developed extensive PDAC at the injection site hallmarked by excessive proliferation and desmoplastic stroma. This serves as the first large animal model of pancreatic carcinogenesis, and may allow for insight into new avenues of translational research not before possible in rodents.