bluuebunny/crossref_metadata_2025 huggingface dataset:
Improvement of magnetorheological greases with superparamagnetic nanoparticles
Authors: Mohamad Norzilawati , Ubaidillah  , Mazlan Saiful Amri , Choi Seung-Bok , Halim Naim Abdul
Published: March 2018

Magnetorheological greases (MRGs) is a viscoelastic suspension comprised of carbonyl iron (CI) particles in a thixotropic medium; grease, which able to solve the instability problem that occurs in oil medium like MRFs. The primary purpose introduction of superparamagnetic nanoparticles γ-Fe2O3 in MRGs suspension is to investigate the effect of additives toward MRGs characteristics. Two types of MRGs suspension with and without nanoparticles γ-Fe2O3 were prepared in the same CI particles concentration for comparison purpose. It was observed that MRGs with incorporated of 1 wt% nanoparticles γ-Fe2O3 showed an increment regarding magnetic properties. In the meantime, the off-state viscosity of MRGs containing nanoparticles γ-Fe2O3 was reduced, however, increased during on-state condition. This fact indicates that the interspaces between CI particles are filled by the nanoparticles γ-Fe2O3. Therefore, the introduction of the nanoparticles indirectly improved the MRGs properties.
Hahnemann's Organon Alive in Practice
Authors: Shukla Chetna
Published: March 2018

‘When the student is ready the teacher will appear’. This saying is attributed to Buddha Siddhartha Gautama Shakyamuni and the Theosophists. This case is a proof for me for a quote I would like to formulate ‘When the sick is ready to heal the remedy will appear’. The all-wise preserver of human life works its miracles unconditionally to assist the sick to restore health. Uniqueness surrounds this case. When I treated this boy with alopecia I only had the 30th CK potency that I had potentised. This was the potency that also completed the cure. The emphasis of this article is to elicit §14 and 138 in my practice during the proving of Hippocampus kuda that I conducted in 1996. Since then during some of my provings I witnessed them come alive. The most recently was during the proving of the blood of Indian grey mongoose in July 2016.
A Proving and Case of Encyclia cordigera
Authors: Williams Sally
Published: March 2018

This article presents the proving and a case of the Central American orchid Encyclia cordigera. Features of the proving are discussed along with a case of vertigo and scoliosis, including an analysis using the Plant Theory.
PROTEUS VULGARIS: Proving and Clinical Use in Paediatrics
Authors: Dominici Gustavo
Published: March 2018

Introduction The Homeopathic School of Verona in Italy organises Hahnemannian provings for experimental and educational purposes. In 2013 Proteus vulgaris was tested. The results of the proving and the data in the literature allowed the clinical use of the remedy.

Methods Participants: 15 experienced provers, 10 expert supervisors, 1 coordinator, 1 director. Potency tested: 200K; 3 placebos or blank (20%). It was a triple-blind proving. Observation time: 30 days; periodical checks up to 1 year.

Findings The mental symptoms of the proving of Proteus vulgaris are characterised by extreme violence in any event. There is restlessness, uncontrollable mobility; it is polemic, hard and aggressive; there is destructive criticism. It breaks consolidated relationships. There is insomnia. The most affected systems are gastrointestinal and urinary tracts. Finger joints are affected. Headaches also occur. The symptoms in the literature complete the pathogenesis–clinical picture and allow the prescription.

Differential diagnosis: Iodum, Hyoscyamus, Medorrhinum, Mercurius solubilis and corrosivus, Staphisagria, Syphilinum, Tarentula. The author shows two clinical cases of children: the first with many behavioural problems and mild autism; the second with attention deficit hyperactivity disorder (ADHD) syndrome.

Conclusions The proving is the best method for defining the pathogenesis of a new substance. The results must be completed with the literature data. Proteus is a homeopathic remedy with very intense and characteristic symptoms and can be used successfully in clinical practice, particularly in children with behavioural disorders including ADHD syndrome.
Analyse This: The Eight-Box Method of Case Analysis
Authors: Sankaran Rajan
Published: March 2018

The main problem which students face is to synthesise the data received in case-taking and arrive at a remedy. Classifying the data of the chief complaint, the physical and mental generals, and the particulars into eight boxes has been developed as a tool in establishing the simillimum. This tool also proves extremely useful in the evaluation of symptoms when a case is re-taken and also in evaluating the progress of the patient during a follow-up.
Fachliche Expertise und individuelles Patientenwohl
Authors: Baierl Bettina
Published: March 2018

Die Zahl der Studien und Publikationen und das verfügbare Wissen in der modernen Herzmedizin vervielfachen sich in rasantem Tempo. Das erfordert ein hohes Maß an fachlicher Expertise, die auch laufend aktualisiert werden muss. In diesem Sinne nutzten mehr als 3000 Mediziner, ein neuer Rekord, die Herztage der Deutschen Gesellschaft für Kardiologie (DGK) im Oktober 2017 in Berlin für fachlichen Austausch und Weiterbildung.
Symptomatischer Clusterkopfschmerz
Authors: Holle-Lee D. , Gaul C.
Published: March 2018

Die Erstdiagnose eines Clusterkopfschmerzes macht immer eine weitere Diagnostik zum Ausschluss einer sekundären Ursache notwendig. Eine ungewöhnliche Anamnese oder ein auffälliger neurologischer Untersuchungsbefund können auf eine symptomatische Kopfschmerzursache hinweisen, eine typische Anamnese und ein unauffälliger Untersuchungsbefund schließen jedoch einen sekundären Clusterkopfschmerz keinesfalls aus. Eine Zusatzuntersuchung mittels cMRT sollte bei Erstdiagnose immer durchgeführt werden. Hypophysäre Raumforderungen und Dissektionen der Hirnversorgenden Gefäße sind häufige Grunderkrankungen, die phänomenologisch als Clusterkopfschmerz erscheinen können. Die Therapie richtet sich nach der Ursache der Clusterkopfschmerzen.
A simple, space constrained NIRIM type reactor for chemical vapour deposition of diamond
Authors: Thomas Evan L. H. , Ginés Laia , Mandal Soumen , Klemencic Georgina M. , Williams Oliver A.
Published: March 2018

In this paper the design of a simple, space constrained chemical vapour deposition reactor for diamond growth is detailed. Based on the design by NIRIM, the reactor is composed of a quartz discharge tube placed within a 2.45 GHz waveguide to create the conditions required for metastable growth of diamond. Utilising largely off-the-shelf components and a modular design, the reactor allows for easy modification, repair, and cleaning between growth runs. The elements of the reactor design are laid out with the CAD files, parts list, and control files made easily available to enable replication. Finally, the quality of nanocrystalline diamond films produced are studied with SEM and Raman spectroscopy, with the observation of clear faceting and a large diamond fraction suggesting the design offers deposition of diamond with minimal complexity.
Temperature controlled evolution of monoclinic to super-tetragonal phase of epitaxial BiFeO3 thin films on La0.67Sr0.33MnO3 buffered SrTiO3 substrate
Authors: Singh Anar , Kaifeng Dong , Chen Jing-Sheng
Published: March 2018

Epitaxial BiFeO3 thin films of 130nm were deposited by pulsed laser deposition (PLD) technique on La0.67Sr0.33MnO3 buffered SrTiO3 (001) substrate at various temperatures under different ambient oxygen pressures. Reciprocal space mapping reveals that, with decreasing temperature and oxygen pressure, the broadly reported monoclinic phase (MA) of BiFeO3 thin film initially transforms to a tetragonal phase (T1) with c/a =1.05 (1) in a narrow girth of deposition condition and then to a super-tetragonal phase (T2) with giant c/a = 1.24 (1), as confirmed by reciprocal space mapping using high resolution x-ray diffraction. The surface morphology of the films reveals the island growth of the BiFeO3 films deposited at low temperatures. We propose that the transformation from monoclinic to the super-tetragonal phase is essentially due to the manifestation of excess local strain as a result of the island growth. This study offers a recipe to grow the super-tetragonal phase of BiFeO3, with giant c/a =1.24 (1) which exhibits exceptionally large ferroelectric polarization, on ferromagnetic layer La0.67Sr0.33MnO3. This phase of BiFeO3 can be utilized for the ferroelectric control of magnetism at the interface of BiFeO3 and La0.67Sr0.33MnO3.
Single crystalline electronic structure and growth mechanism of aligned square graphene sheets
Authors: Yang H. F. , Chen C. , Wang H. , Liu Z. K. , Zhang T. , Peng H. , Schröter N. B. M. , Ekahana S. A. , Jiang J. , Yang L. X. , Kandyba V. , Barinov A. , Chen C. Y. , Avila J. , Asensio M. C. , Peng H. L. , Liu Z. F. , Chen Y. L.
Published: March 2018

Recently, commercially available copper foil has become an efficient and inexpensive catalytic substrate for scalable growth of large-area graphene films for fundamental research and applications. Interestingly, despite its hexagonal honeycomb lattice, graphene can be grown into large aligned square-shaped sheets on copper foils. Here, by applying angle-resolved photoemission spectroscopy with submicron spatial resolution (micro-ARPES) to study the three-dimensional electronic structures of square graphene sheets grown on copper foils, we verified the high quality of individual square graphene sheets as well as their merged regions (with aligned orientation). Furthermore, by simultaneously measuring the graphene sheets and their substrate copper foil, we not only established the (001) copper surface structure but also discovered that the square graphene sheets’ sides align with the ⟨110⟩ copper direction, suggesting an important role of copper substrate in the growth of square graphene sheets—which will help the development of effective methods to synthesize high-quality large-size regularly shaped graphene sheets for future applications. This work also demonstrates the effectiveness of micro-ARPES in exploring low-dimensional materials down to atomic thickness and sub-micron lateral size (e.g., besides graphene, it can also be applied to transition metal dichalcogenides and various van der Waals heterostructures)
Extensive study of electron acceleration by relativistic surface plasmons
Authors: Cantono G. , Sgattoni A. , Fedeli L. , Garzella D. , Réau F. , Riconda C. , Macchi A. , Ceccotti T.
Published: March 2018

The excitation of surface plasmons with ultra-intense (I ∼ 5 × 1019 W/cm2), high contrast (∼1012) laser pulses on periodically modulated solid targets has been recently demonstrated to produce collimated bunches of energetic electrons along the target surface [Fedeli et al., Phys. Rev. Lett. 116, 015001 (2016)]. Here, we report an extensive experimental and numerical study aimed to a complete characterization of the acceleration mechanism, demonstrating its robustness and promising characteristics for an electron source. By comparing different grating structures, we identify the relevant parameters to optimize the acceleration and obtain bunches of ∼650 pC of charge at several MeV of energy with blazed gratings.
Computational analysis for selectivity of histone deacetylase inhibitor by replica-exchange umbrella sampling molecular dynamics simulations
Authors: Tsukamoto Shuichiro , Sakae Yoshitake , Itoh Yukihiro , Suzuki Takayoshi , Okamoto Yuko
Published: March 2018

We performed protein-ligand docking simulations with a ligand T247, which has been reported as a selective inhibitor of a histone deacetylase HDAC3, by the replica-exchange umbrella sampling method in order to estimate the free energy profiles along ligand docking pathways of HDAC3-T247 and HDAC2-T247 systems. The simulation results showed that the docked state of the HDAC3-T247 system is more stable than that of the HDAC2-T247 system although the amino-acid sequences and structures of HDAC3 and HDAC2 are very similar. By comparing structures obtained from the simulations of both systems, we found the difference between structures of hydrophobic residues at the entrance of the catalytic site. Moreover, we performed conventional molecular dynamics simulations of HDAC3 and HDAC2 systems without T247, and the results also showed the same difference of the hydrophobic structures. Therefore, we consider that this hydrophobic structure contributes to the stabilization of the docked state of the HDAC3-T247 system. Furthermore, we show that Tyr209, which is one of the hydrophobic residues in HDAC2, plays a key role in the instability from the simulation results of a mutated-HDAC2 system.
The high velocity, high adiabat, “Bigfoot” campaign and tests of indirect-drive implosion scaling
Authors: Casey D. T. , Thomas C. A. , Baker K. L. , Spears B. K. , Hohenberger M. , Khan S. F. , Nora R. C. , Weber C. R. , Woods D. T. , Hurricane O. A. , Callahan D. A. , Berger R. L. , Milovich J. L. , Patel P. K. , Ma T. , Pak A. , Benedetti L. R. , Millot M. , Jarrott C. , Landen O. L. , Bionta R. M. , MacGowan B. J. , Strozzi D. J. , Stadermann M. , Biener J. , Nikroo A. , Goyon C. S. , Izumi N. , Nagel S. R. , Bachmann B. , Volegov P. L. , Fittinghoff D. N. , Grim G. P. , Yeamans C. B. , Gatu Johnson M. , Frenje J. A. , Rice N. , Kong C. , Crippen J. , Jaquez J. , Kangas K. , Wild C.
Published: March 2018

The Bigfoot approach is to intentionally trade off high convergence, and therefore areal-density, in favor of high implosion velocity and good coupling between the laser, hohlraum, shell, and hotspot. This results in a short laser pulse that improves hohlraum symmetry and predictability, while the reduced compression reduces hydrodynamic instability growth. The results thus far include demonstrated low-mode symmetry control at two different hohlraum geometries (5.75 mm and 5.4 mm diameters) and at two different target scales (5.4 mm and 6.0 mm hohlraum diameters) spanning 300–405 TW in laser power and 0.8–1.6 MJ in laser energy. Additionally, by carefully scaling the 5.4 mm design to 6.0 mm, an increase in target scale of 13%, equivalent to 40% increase in laser energy, has been demonstrated.
Multi-scale texturing for a-Si/mc-Si thin-film tandem solar cells
Authors: He Song , Li Meixiang
Published: March 2018

Glass texturing by sandblasting or cream etching methods was introduced for the light trapping purpose for a-Si/mc-Si thin-film tandem solar cells. The nm-scale features of transparent conductive oxide (TCO) front electrode and μm-scale features of textured glass form a multi-scale texturing scheme, which is potentially beneficial to the longer wavelength absorption in mc-Si cell and hence increase the total current of the tandem solar cell. Conformal growth model was applied successfully to analyze thin film growth on textured glass in this work. Power conversion efficiency improvements of ∼1.0% and ∼0.8% have been achieved with solar cells on sandblasting and cream-etching textured glass, respectively.
On the instability of a liquid sheet moving in vacuum
Authors: Sisoev G. M. , Osiptsov A. N. , Koroteev A. A.
Published: March 2018

A linear stability analysis of a non-isothermal liquid sheet moving in vacuum is studied taking into account the temperature dependencies of the liquid viscosity, thermal conductivity, and surface tension coefficients. It is found that there are two mechanisms of instability. The short-wave instability is caused by viscosity stratification across the sheet due to nonuniform temperature profiles developed downstream in the cooling sheet. The long-wave thermocapillary instability is caused by the temperature gradient along the sheet surfaces. Computed examples of steady flows and their instabilities demonstrated that the unstable short waves have much larger amplification factors.
Multistability and tipping: From mathematics and physics to climate and brain—Minireview and preface to the focus issue
Authors: Feudel Ulrike , Pisarchik Alexander N. , Showalter Kenneth
Published: March 2018

Multistability refers to the coexistence of different stable states in nonlinear dynamical systems. This phenomenon has been observed in laboratory experiments and in nature. In this introduction, we briefly introduce the classes of dynamical systems in which this phenomenon has been found and discuss the extension to new system classes. Furthermore, we introduce the concept of critical transitions and discuss approaches to distinguish them according to their characteristics. Finally, we present some specific applications in physics, neuroscience, biology, ecology, and climate science.
Chemoattracted pollen tubes separated from randomly growing with new technique
Authors: Liebendorfer Adam
Published: March 2018

Leveraging findings in microfluidics, researchers have announced an assay to separate randomly growing pollen tubes from chemoattracted ones, allowing for quantification of the chemoattractant effect.
Insight from the maximal activation of the signal transduction excitable network in
Dictyostelium discoideum
Authors: Edwards Marc , Cai Huaqing , Abubaker-Sharif Bedri , Long Yu , Lampert Thomas J. , Devreotes Peter N.
Published: March 2018

Significance

Directed cell migration is at the center of the pathophysiology of many diseases such as cancer. It requires the coordination of a signal transduction network and an underlying cytoskeleton. Understanding the composition of these networks and the mechanism by which they are coupled is critical to furthering our understanding of how cells move. Here, we have developed a cell-based tool which maximizes the activation of the signal transduction system. This has provided us with insight into its composition and the mechanism by which it controls the activity of the actin cytoskeletal activity, which drives migration. Most striking, the persistent activation of the signal transduction apparatus was discovered to have severe consequences for cell viability.
Reshaping of the Nominal Inflection in Early Northern West Germanic
Authors: Adamczyk Elżbieta
Published: March 2018

The book is a comprehensive corpus study of analogical developments in the nominal morphology of four Northern West Germanic languages: Old English, Old Frisian, Old Saxon and Old Low Franconian. It examines the patterns of reorganisation of the nominal paradigms, focusing on the analogical interdeclensional shifts of nouns affiliated with historical minor classes. The wide scope and comparative nature of the study facilitate identifying the major patterns of inflectional restructuring, both language-specific and those of a more general character, demonstrating that the process was far from random. By framing the investigated phenomena quantitatively, the study affords insight into the dynamics of the changes, their scope in individual languages, the mechanisms underlying the restructuring process and the factors conditioning it. The book may be of interest to both historical linguists who may appreciate its descriptive aspects as well as morphologists concerned with the mechanisms of morphological processes, especially analogy.
Iconicity in the lexicon
Authors: Mattes Veronika
Published: March 2018

This paper presents a study on the form-meaning relationship within a subpart of the lexicon, namely lexical reduplication. It compares the semantic classification of lexical reduplication in diverse languages, focusing on three quantitative studies on the distributions of semantic categories in three typologically and genetically unrelated languages, Bikol, Tibetan and Arabic. On this basis, it is argued that the common view that lexical reduplications are a “semantically arbitrary class” and as such irrelevant for studies on reduplication is not justified. It is in contrast claimed that the mapping of certain meanings on this specific phonological pattern is highly iconic, and that these word forms can be classified as a specific subgroup ofexpressives.This group even shows remarkable parallels with the prototypical meanings of morphological reduplication. An explanation for this – certainly controversially discussed – observation could be provided by the cognitive semiotic concept of “cross-modal iconicity” (Ahlner & Zlatev 2010).
A synchronic and diachronic typology of Hittite reciprocal constructions
Authors: Inglese Guglielmo
Published: March 2018

This paper discusses reciprocal constructions in Hittite, framed within the typology of reciprocals laid out by Nedjalkov (2007),König & Gast (2008), andEvans et al. (2011). Hittite attests to at least three reciprocal markers, that is, the middle voice, the particle =za, and three different polyptotic constructions, based on the iteration of the numeralšia- ‘one’, the demonstrativeka- ‘this’, and the nounara- ‘fellow, comrade’ respectively. Synchronically, these three strategies cover different sub-domains of reciprocity, as they encode different kinds of reciprocal situations and display different syntactic properties. These differences can be accounted for by taking into account the processes out of which these constructions developed, which can be described in terms of grammaticalization (Heine & Miyashita 2008). In this respect, beside enriching our knowledge of reciprocals in Indo-European languages, this paper also contributes to our general understanding of the diachronic typology of reciprocal constructions.
Gene silencing of heparanase results in suppression of invasion and migration of gallbladder carcinoma cells
Authors: Jin Hao , Cui Min
Published: March 2018

This study investigated the effect of transcriptional gene silencing of the heparanase gene on standard gallbladder carcinoma cells (GBC-SD). The miRNAs targeting the promoter region and coding region of the heparanase gene were designed and synthesized. We transfected four recombinant miRNA vectors into GBC-SD. We performed the wound healing assays and invasion assays. The result shows that the heparanase expression was significantly decreased by recombinant vectors in transfected GBC-SD cells (p < 0.01), of which pmiR-Hpa-2 showed best interference effect (p < 0.05). The penetrated and migrating cells numbers and adherence rate of GBC-SD cells were significantly decreased by pmiR-Hpa-2 (p < 0.05).
Spermatogonial stem cells†
Authors: Kubota Hiroshi , Brinster Ralph L
Published: March 2018

Spermatogonial stem cells (SSCs) are the most primitive spermatogonia in the testis and have an essential role to maintain highly productive spermatogenesis by self-renewal and continuous generation of daughter spermatogonia that differentiate into spermatozoa, transmitting genetic information to the next generation. Since the 1950s, many experimental methods, including histology, immunostaining, whole-mount analyses, and pulse-chase labeling, had been used in attempts to identify SSCs, but without success. In 1994, a spermatogonial transplantation method was reported that established a quantitative functional assay to identify SSCs by evaluating their ability to both self-renew and differentiate to spermatozoa. The system was originally developed using mice and subsequently extended to nonrodents, including domestic animals and humans. Availability of the functional assay for SSCs has made it possible to develop culture systems for their ex vivo expansion, which dramatically advanced germ cell biology and allowed medical and agricultural applications. In coming years, SSCs will be increasingly used to understand their regulation, as well as in germline modification, including gene correction, enhancement of male fertility, and conversion of somatic cells to biologically competent male germline cells.
Spatiotemporal Distribution Pattern of Sclerotinia sclerotiorum Apothecia is Modulated by Canopy Closure and Soil Temperature in an Irrigated Soybean Field
Authors: Fall Mamadou L. , Willbur Jaime F. , Smith Damon L. , Byrne Adam M. , Chilvers Martin I.
Published: March 2018

Identifying the optimal timing for fungicide application is crucial in order to maximize the control of Sclerotinia stem rot (SSR), which is caused by Sclerotinia sclerotiorum. In this study, the impact of canopy closure and soil temperature on apothecia production was investigated to optimize fungicide application timing. Replicated soybean plots with a row spacing of 0.36 and 0.38 or 0.76 m were established in 2015 and 2016 in an irrigated soybean field at Michigan State University’s Montcalm Research Center. The number of apothecia and ascospores and the incidence of SSR were monitored two times per week for 10 to 12 weeks. In both row-spacing trials, apothecia were observed earlier in 2016 (before the R1 growth stage) than in 2015 (between R1 and R2). The maximum number of apothecia was 50 times higher with the 0.36-m row spacing than with the 0.76-m row spacing in 2015 but was 2.5 times higher with the 0.76-m row spacing than with the 0.38-m row spacing in 2016, though the overall numbers were much lower in 2016. The apothecia distribution pattern was synchronized with the canopy closure pattern and the soil temperature profile. The peak number of apothecia was observed when canopy closure reached at least 50% and when average soil temperature in the row was between 21.5 and 23.5°C. In 91% of the cases, the presence of apothecia was observed when the percentage of light blocked was 70%, and no apothecia germinated in the absence of light or under full light exposure. During the first 50 days after plant emergence, the rate of canopy closure was higher in 2016 than in 2015, and the first diseased plant was observed earlier in 2016 (R2) than in 2015 (R5). Canopy closure and the distance of the sampling point from the soybean row explained much of the variability in the number of apothecia. These results can partially explain the inconsistent efficacy of fungicide applications based on the soybean growth stage and will be helpful for informing disease models and fine-tuning fungicide application strategies.
Scout, Snap, and Share: First Impressions of Plant Disease Monitoring Using Social Media
Authors: Mueller Daren S. , Sisson Adam J. , Kempker Rachel , Isard Scott , Raymond Conner , Gennett Andrew J. , Sheffer William , Bradley Carl A.
Published: March 2018

The social media platform Twitter was used to monitor corn and soybean diseases in the United States during 2016 and 2017 as part of a campaign to involve crop scouts, farmers, educators, and agricultural advisors in disease data sharing. The purpose was to explore the feasibility of providing farmers and crop consultants with an easily accessible, user-friendly, no-cost platform for sharing disease observations with rapid information transfer and early warning capabilities. Two Twitter accounts were created, @soydisease and @corndisease, as part of an accessible data collection method for later input into the Integrated Pest Information Platform for Extension and Education (iPiPE). Multiple methods were employed to create awareness and recruit users, which included writing articles for extension and popular farm news outlets and directly contacting potential agribusiness and extension stakeholders. From the creation of the accounts in February 2016 through September 2017, there were 738 followers and 8,668 profile visits for @soydisease; and 1,149 followers and 17,294 profile visits for @corndisease, with a variety of contributors including university extension, industry agronomists and service providers, students, a commodity group, and agricultural news. During the 2016 and 2017 growing seasons, use of the Twitter disease-monitoring campaign successfully helped track the movement of southern rust (caused by Puccinia polysora) of corn northward, allowing for advanced notice for scouting efforts. Although this is only an initial attempt, it shows that representatives from across a wide variety of agricultural sectors can contribute to a plant disease monitoring system using a common social media engine.
Genetic Variation of ‘Candidatus Liberibacter solanacearum’ Haplotype C and Identification of a Novel Haplotype from Trioza urticae and Stinging Nettle
Authors: Haapalainen M. , Wang J. , Latvala S. , Lehtonen M. T. , Pirhonen M. , Nissinen A. I.
Published: March 2018

‘Candidatus Liberibacter solanacearum’ (CLso) haplotype C is associated with disease in carrots and transmitted by the carrot psyllid Trioza apicalis. To identify possible other sources and vectors of this pathogen in Finland, samples were taken of wild plants within and near the carrot fields, the psyllids feeding on these plants, parsnips growing next to carrots, and carrot seeds. For analyzing the genotype of the CLso-positive samples, a multilocus sequence typing (MLST) scheme was developed. CLso haplotype C was detected in 11% of the T. anthrisci samples, in 35% of the Anthriscus sylvestris plants with discoloration, and in parsnips showing leaf discoloration. MLST revealed that the CLso in T. anthrisci and most A. sylvestris plants represent different strains than the bacteria found in T. apicalis and the cultivated plants. CLso haplotype D was detected in 2 of the 34 carrot seed lots tested, but was not detected in the plants grown from these seeds. Phylogenetic analysis by unweighted-pair group method with arithmetic means clustering suggested that haplotype D is more closely related to haplotype A than to C. A novel, sixth haplotype of CLso, most closely related to A and D, was found in the psyllid T. urticae and stinging nettle (Urtica dioica, Urticaceae), and named haplotype U.
The Kids Are Not Alright
Authors: Kennedy Maureen Shawn
Published: March 2018

Several articles highlight the need for more child-friendly policies, programs, and practices.
HHS Division to Enforce ‘Conscience and Religious Freedom’
Authors: Sofer Dalia
Published: March 2018

When do a clinician's rights deny those of the patient?
States Can Now Add Work Requirements for Medicaid Recipients
Authors: Kritz Fran
Published: March 2018

Health advocates fear new hurdles will leave thousands more uninsured.
Retiring with Intention
Authors: Morin Karen
Published: March 2018

An increasing number of nurses are approaching retirement age and finding themselves faced with numerous challenges and opportunities. Yet many avoid thinking about and preparing for this important professional and personal transition. Some cannot imagine what they will do when their career ends, whereas others do not believe they are financially ready to retire. This article discusses strategies to address these and other common concerns and will help nurses embrace this new and exciting stage of their lives with deliberation, confidence, and financial security.
No Fracture Benefit with Vitamin D, Calcium Supplements
Authors: Rosenberg Karen , Mechcatie Elizabeth
Published: March 2018

According to this study:

Vitamin D and calcium supplements, alone or in combination, do not reduce the risk of fracture in adults older than age 50 and living in the community.
Easter Egg Hunt on the Oncology Unit
Authors: Adams Barbara
Published: March 2018

The smallest gesture has the capacity to create expansive love.
Supporting successful mentoring
Authors: Goodyear Caryl , Goodyear Marilu
Published: March 2018

In the first installment of our two-part series, we discussed organizing a mentor program for nurse managers who want to develop their careers. In part 2, we examine how nurse managers can assist staff members with their own mentoring program.
Level of Evidence Descriptions With Examples
Authors: Luksanapruksa Panya , Millhouse Paul W.
Published: March 2018

The level of evidence (LOE) method provides journal readers with a quick appraisal of study quality. The most widely recognized LOE assessment tool is that from the Oxford Centre for Evidence-Based Medicine, and these guidelines are often adapted for other purposes. The assigned LOE typically depends on the design and quality of the study as well as the impact of the results. Because of the differing methods for classifying LOE, the author or journal reader should fully understand the criteria before assimilating data.
Performing an Anterior Cervical Discectomy and Fusion
Authors: Schroeder Gregory D. , Kurd Mark F. , Millhouse Paul W. , Vaccaro Alexander R. , Hilibrand Alan S.
Published: March 2018

An anterior cervical discectomy and fusion is one of the most common procedures performed in spine surgery. It allows for a direct decompression of the spinal cord and the neural foramen. When performed properly, the results of this procedure are some of the best in spine surgery.
Surgical Treatment of Thoracic Spinal Cord Herniation
Authors: Corredor José A. , Härtl Roger
Published: March 2018

Thoracic spinal cord herniation (TSCH) is an unusual condition characterized by central displacement of the spinal cord through a dural defect, resulting in neurological impairment due to compression and vascular compromise. Different surgical techniques have been described to treat symptomatic patients with TSCH such as closure of the defect by primary sutures after reducing the spinal cord, widening the dural defect to prevent cord strangulation, or reducing the spinal cord and using a dural patch. Through a case presentation of a 62-year-old woman with TSCH, we describe step-by-step, a surgical technique for repair by reducing the spinal cord and using a dural patch. In our experience surgical reduction of the hernia will frequently improve the patient’s symptoms and signs even in patients with longstanding deficits. The final objective of this surgical technique is to prevent recurrent herniation and progressive deficit.
A Comparison of Different Minimally Invasive and Open Posterior Spinal Procedures Using Volumetric Measurements of the Surgical Exposures
Authors: Regev Gilad J. , Kim Choll W. , Salame Khalil , Behrbalk Eyal , Keynan Ory , Lador Ran , Mangel Laurence , Lidar Zvi
Published: March 2018

Study Design:

A Prospective observational study.

Summary of the Background Data:

Minimally invasive (MI) spine surgery techniques strive to minimize the damage to paraspinal soft tissues. Previous studies used only the length of the surgical incision to quantify the invasiveness of certain MI procedures. However, this method does not take into account the volume of muscle tissue that is dissected and retracted from the spine to achieve sufficient exposure. To date, no simple method has been reported to measure the volume of the surgical exposure and to quantify the degree of surgery invasiveness.

Study Objectives:

To obtain and compare volumetric measures of various MI and open posterior-approached spinal surgical exposures.

Methods:

The length, the depth, and the volume of the surgical exposure were obtained from 57 patients who underwent either open or MI posterior lumbar surgery. MI procedures included the following: tubular discectomy, laminotomy, and transforaminal interbody fusion. Open procedures included the following: discectomy, laminectomy, transforaminal interbody fusion, or posterior-lateral instrumented fusion. Four attending spine surgeons at our unit performed the surgeries. To reduce variability, only single-level procedures performed between L4 and S1 vertebrae were used. The volume of exposure was obtained by measuring the amount of saline needed to fill the surgical wound completely once the surgical retractors were deployed and opened.

Results:

The average volumes in mililiters of exposure for a single-level MI procedure ranged from 9.8±2.8 to 75±11.7 mL and were significantly smaller than the average volumes of exposure for a single level open procedures that ranged from 44± 21 to 277±47.9 P<0.001. The average skin-incision lengths for single-level MI procedures ranged from 1.7±0.2 to 7.7±1.6 cm and were significantly smaller than the average skin-incision lengths for open procedures [5.2±1.4 (Table 3) to 11.3±2 cm, P<0.001]. The measured surgical depths were similar in MI and open groups (P=0.138). MI decompression and posterior fusion procedures yielded 92% and 73% reductions in the volumes of exposure, respectively. However, absolute differences in exposure volumes were larger for fusion (202 mL) compared with decompression alone (110.7 mL).

Conclusions:

Direct volumetric measurement of the surgical exposure is obtained easily by measuring the amount of saline needed to fill the exposed cavity. Using this method, the needed surgical exposure of different spinal procedures can be quantified and compared. This volumetric measurement combined with the measure of retraction force, the duration of retraction, and the impact on soft tissue vascularity can help build a model that assesses the relative invasiveness of different spinal procedures.
Predicting Postoperative Morbidity and Readmission for Revision Posterior Lumbar Fusion
Authors: Basques Bryce A. , Ibe Izuchukwu , Samuel Andre M. , Lukasiewicz Adam M. , Webb Matthew L. , Bohl Daniel D. , Grauer Jonathan N.
Published: March 2018

Study Design:

Retrospective cohort study.

Objective:

The primary aim of this study was to determine the incidence and risk factors for 30-day adverse events after revision posterior lumbar fusion. The secondary aim was to determine the incidence and risk factors for 30-day readmission after revision posterior lumbar fusion.

Summary of Background Data:

The need for revision of a lumbar fusion is an unfortunate occurrence, and there is little known about specific risk factors for morbidity and readmission after this procedure. The purpose of this study is to use a large, national sample to identify patient and operative factors that may contribute to the development of these adverse outcomes.

Methods:

The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients undergoing revision posterior lumbar fusion from 2005 to 2013. Patient characteristics were tested for association with any adverse event (AAE), severe adverse events (SAEs), minor adverse events (MAEs), and readmission within 30 days postoperatively using multivariate analysis.

Results:

Of the 1287 patients identified, 8.2% had an AAE, 5.6% had an SAE, and 3.2% had an MAE. AAE was independently associated with American Society of Anesthesiologists (ASA) classification ≥3 and operative time ≥310 minutes (P<0.05 for each). SAEs were associated with only ASA classification ≥3 (P=0.047). MAEs were associated with insulin-dependent diabetes, operative time ≥310 minutes, and 3 or more levels of fusion (P<0.05 for all).

Sixty-five patients (5.6%) were readmitted. On multivariate analysis, body mass index (BMI) 25–30, BMI 30–35, BMI≥35, ASA classification ≥3, insulin-dependent diabetes, a 2-level fusion, and 3 or more levels of fusion were associated with readmission (P<0.05 for all).

Conclusions:

In general, longer, more extensive procedures on sicker patients were associated with increased risk of postoperative complications and readmission.
Patterns of Neurological Recovery After Anterior Decompression With Fusion and Posterior Decompression With Laminoplasty for the Treatment of Multilevel Cervical Spondylotic Myelopathy
Authors: Ren Hu , Liu Fajing , Yu Dahai , Cao Jianhui , Shen Yong , Li Ximing , Pan Shuo
Published: March 2018

Study Design:

The pattern of neurological recovery in the overall modified Japanese Orthopedic Association scores, upper limb function score, and lower limb function score after surgical decompression for patients suffering from multilevel cervical spondylotic myelopathy (CSM) were analyzed in this independent retrospective study.

Objective:

The primary objective of this retrospective study was to compare the upper and lower limb function changes after anterior decompression with fusion versus posterior decompression with laminoplasty for patients suffering from multilevel CSM. An additional objective was to describe the neural recovery speed.

Summary of Background Data:

Few comparative studies have been conducted to evaluate the outcome of anterior versus posterior surgery in multilevel CSM. However, these assessments tend to be of a more global perspective, looking at a composite score for upper limb, lower limb, and bladder function. No reports have separately analyzed the upper and lower limb function changes after anterior and posterior decompression for multilevel CSM.

Materials and Methods:

A total of 132 patients were classified into anterior and posterior decompression groups based on the different surgical approach they underwent. The pattern of neurological recovery in the overall modified Japanese Orthopedic Association scores, upper limb function score, and lower limb function score after surgical decompression were documented and analyzed.

Results:

There was no significant difference in the overall neurological recovery between anterior and posterior decompression groups. But in terms of the upper or lower limb function changes after operation, it appeared that the upper limbs recovered better with anterior decompression. The surgical approach did not significantly alter lower extremity recovery potential. In addition, most of the neurological recovery occurred in the first 9 months after surgical decompression.

Conclusions:

We recommend a individualized approach when it is difficult to determine an anterior or posterior surgery for multilevel CSM. Rehabilitation training should be carried out as early as possible.
Comparisons of Safety and Clinical Outcomes Between Multiple-level and Single-level Cervical Disk Replacement for Cervical Spondylosis
Authors: Jiang Lianghai , Tan Mingsheng , Yang Feng , Yi Ping , Tang Xiangsheng , Hao Qingying
Published: March 2018

Study Design:

This is a systematic review and meta-analysis.

Objective:

The aim of this study was to evaluate the efficacy and safety of multiple-level cervical disk replacement (CDR) over single-level CDR for the treatment of cervical spondylosis.

Summary of Background Data:

Some authors advocate for the multiple-level CDR instead of anterior decompression and fusion in cervical multiple-level spondylosis. However, whether the efficacy and safety of multi-level CDR are as favorable as that of single-level CDR remains controversial.

Methods:

MEDLINE, EMBASE, and Cochrane library databases were searched up to November 2015 for controlled studies that compared the clinical outcomes of single-level and multiple-level CDR for the treatment of cervical spondylosis. The following outcomes were extracted and analyzed: prevalence of heterotopic ossification and reoperation, preoperative and postoperative Neck Disability Index scores, preoperative and postoperative Visual Analog Scale scores, and success rate using the Odom grading system.

Results:

Ten studies involving 1402 patients were included: including 3 randomized controlled trials, 5 prospective studies, and 3 retrospective studies. No significant differences between single-level and multiple-level groups were found in terms of the prevalence of heterotopic ossification and reoperation rate, Neck Disability Index score, Visual Analog Scale score, and success rate using the Odom grading system.

Conclusions:

On the basis of this meta-analysis, clinical outcomes of multiple-level CDR are similar to those of single-level CDR for cervical spondylosis, which suggests the multiple-level CDR is as effective and safe as the single-level CDR. Nonetheless, more well-designed studies are needed for further evaluation.
Propensity-matched Analysis of Outcomes and Hospital Charges for Anterior Versus Posterior Cervical Fusion for Cervical Spondylotic Myelopathy
Authors: Tanenbaum Joseph E. , Lubelski Daniel , Rosenbaum Benjamin P. , Benzel Edward C. , Mroz Thomas E.
Published: March 2018

Study Design:

Retrospective analysis of data from the Nationwide Inpatient Sample, a nationally representative, all-payer database of inpatient diagnoses and procedures in the United States.

Objective:

The objective of this study is to compare anterior cervical fusion (ACF) to posterior cervical fusion (PCF) in the treatment of cervical spondylotic myelopathy (CSM).

Summary of Background Data:

Previous studies used retrospective single-institution level data to quantify outcomes for CSM patients fusion. It is unclear whether ACF or PCF is superior with regards to charges or outcomes for the treatment of CSM.

Materials and Methods:

We used Nationwide Inpatient Sample data to compare ACF to PCF in the management of CSM. All patients 18 years or older with a diagnosis of CSM between 1998 and 2011 were included. ACF patients were matched to PCF patients using propensity scores based on patient characteristics (number of levels fused, spine alignment, comorbidities), hospital characteristics, and patient demographics. Multivariable regression was used to measure the effect of treatment assignment on in-hospital charges, length of hospital stay, in-hospital mortality, discharge disposition, and dysphagia diagnosis.

Results:

From 1998 to 2011, we identified 109,728 hospitalizations with a CSM diagnosis. Of these patients, 45,629 (41.6%) underwent ACF and 14,439 (13.2%) underwent PCF. The PCF cohort incurred an average of $41,683 more in-hospital charges (P<0.001, inflation adjusted to 2011 dollars) and remained in hospital an average of 2.4 days longer (P<0.001) than the ACF cohort. The ACF cohort was just as likely to die in the hospital [odds ratio 0.91; 95% confidence interval (CI), 0.68–1.2], 3.0 times more likely to be discharged to home or self-care (95% CI, 2.9–3.2), and 2.5 times more likely to experience dysphagia (95% CI, 2.0–3.1) than the PCF cohort.

Conclusions:

In treating CSM, ACF led to lower hospital charges, shorter hospital stays, and an increased likelihood of being discharged to home relative to PCF.
Influence of Hydroxyapatite Stick on Pedicle Screw Fixation in Degenerative Lumbar Spine
Authors: Shin Sung Joon , Lee Ji-Ho , Lee Jae Hyup
Published: March 2018

Study Design:

A prospective, within-patient, left-right comparative study.

Objective:

To evaluate the efficacy of hydroxyapatite (HA) stick augmentation method by comparing the insertional torque of the pedicle screw in osteoporotic and nonosteoporotic patients.

Summary of Background Data:

Unsatisfactory clinical outcomes after spine surgery in osteoporotic patients are related to pedicle screw loosening or pull-outs. HA, as a bone graft extender, has a possibility to enhance the fixation strength at the bone-screw interface.

Methods:

From November 2009 to December 2010, among patients who required bilateral pedicle screw fixation for lumbar spine surgery, 22 patients were enrolled, who recieved unilateral HA stick augmentation and completed intraoperative insertional torque measurement of each pedicle screws. On the basis of preoperative evaluation of bone mineral density, patients with osteoporosis had 2 HA sticks inserted unilaterally, and 1 stick for patients without osteoporosis. Pedicle screw loosening and pull-outs were assessed using 12-month postoperative CT scans and follow-up radiographs. Clinical evaluation was done preoperatively and at 1 year postoperatively, based on Visual Analog Scale score, Oswestry Disability Index, and Short Form-36 Health Survey.

Results:

Regardless of bone mineral density, the average torque value of all pedicle screws with HA stick insertion (HA stick inserted group) was significantly higher than that of all pedicle screws without HA insertion (control group) (P<0.0001). Same results were seen in the HA stick inserted subgroups and the control subgroups within both of the osteoporosis group (P=0.009) and the nonosteoporosis group (P=0.0004). There was no statistically significant difference of the rate of pedicle screw loosening in between the HA stick inserted group and the control group. Clinical evaluation also showed no statistically significant difference in between patients with loosening and those without.

Conclusions:

The enhancement of initial pedicle screw fixation strength in osteoporotic patients can be achieved by HA stick augmentation.