bluuebunny/crossref_metadata_2025 huggingface dataset:
Flexible high-energy asymmetric supercapacitors based on MnO@C composite nanosheet electrodes
Authors: Yu Neng , Guo Kai , Zhang Wei , Wang Xianfu , Zhu Ming-Qiang
Published: November 2016

A flexible asymmetric supercapacitor assembled with novel MnO@C composite nanosheets and Co3O4 nanosheets as negative and positive electrodes achieves an exceptional energy density of 59.6 W h kg−1 at a power density of 1529.8 W kg−1.
Cu-based quaternary chalcogenide Cu2BaSnS4 thin films acting as hole transport layers in inverted perovskite CH3NH3PbI3 solar cells
Authors: Ge Jie , Grice Corey R. , Yan Yanfa
Published: November 2016

p-Type wide-bandgap Cu2BaSnS4 holds promise for use as hole transport material in inverted perovskite CH3NH3PbI3 thin-film solar cells.
Imaging oxygen metabolism with hyperpolarized magnetic resonance: a novel approach for the examination of cardiac and renal function
Authors: Schroeder Marie , Laustsen Christoffer
Published: November 2016

Every tissue in the body critically depends on meeting its energetic demands with sufficient oxygen supply. Oxygen supply/demand imbalances underlie the diseases that inflict the greatest socio-economic burden globally. The purpose of this review is to examine how hyperpolarized contrast media, used in combination with MR data acquisition methods, may advance our ability to assess oxygen metabolism non-invasively and thus improve management of clinical disease. We first introduce the concept of hyperpolarization and how hyperpolarized contrast media have been practically implemented to achieve translational and clinical research. We will then analyse how incorporating hyperpolarized contrast media could enable realization of unmet technical needs in clinical practice. We will focus on imaging cardiac and renal oxygen metabolism, as both organs have unique physiological demands to satisfy their requirements for tissue oxygenation, their dysfunction plays a fundamental role in society’s most prevalent diseases, and each organ presents unique imaging challenges. It is our aim that this review attracts a multi-disciplinary audience and sparks collaborations that utilize an exciting, emergent technology to advance our ability to treat patients adversely affected by an oxygen supply/demand mismatch.
Synthetic biology approaches to biological containment: pre-emptively tackling potential risks
Authors: Torres Leticia , Krüger Antje , Csibra Eszter , Gianni Edoardo , Pinheiro Vitor B.
Published: November 2016

Biocontainment comprises any strategy applied to ensure that harmful organisms are confined to controlled laboratory conditions and not allowed to escape into the environment. Genetically engineered microorganisms (GEMs), regardless of the nature of the modification and how it was established, have potential human or ecological impact if accidentally leaked or voluntarily released into a natural setting. Although all evidence to date is that GEMs are unable to compete in the environment, the power of synthetic biology to rewrite life requires a pre-emptive strategy to tackle possible unknown risks. Physical containment barriers have proven effective but a number of strategies have been developed to further strengthen biocontainment. Research on complex genetic circuits, lethal genes, alternative nucleic acids, genome recoding and synthetic auxotrophies aim to design more effective routes towards biocontainment. Here, we describe recent advances in synthetic biology that contribute to the ongoing efforts to develop new and improved genetic, semantic, metabolic and mechanistic plans for the containment of GEMs.
Properties of alternative microbial hosts used in synthetic biology: towards the design of a modular chassis
Authors: Kim Juhyun , Salvador Manuel , Saunders Elizabeth , González Jaime , Avignone-Rossa Claudio , Jiménez Jose Ignacio
Published: November 2016

The chassis is the cellular host used as a recipient of engineered biological systems in synthetic biology. They are required to propagate the genetic information and to express the genes encoded in it. Despite being an essential element for the appropriate function of genetic circuits, the chassis is rarely considered in their design phase. Consequently, the circuits are transferred to model organisms commonly used in the laboratory, such as Escherichia coli, that may be suboptimal for a required function. In this review, we discuss some of the properties desirable in a versatile chassis and summarize some examples of alternative hosts for synthetic biology amenable for engineering. These properties include a suitable life style, a robust cell wall, good knowledge of its regulatory network as well as of the interplay of the host components with the exogenous circuits, and the possibility of developing whole-cell models and tuneable metabolic fluxes that could allow a better distribution of cellular resources (metabolites, ATP, nucleotides, amino acids, transcriptional and translational machinery). We highlight Pseudomonas putida, widely used in many different biotechnological applications as a prominent organism for synthetic biology due to its metabolic diversity, robustness and ease of manipulation.
Construction of a minimal genome as a chassis for synthetic biology
Authors: Sung Bong Hyun , Choe Donghui , Kim Sun Chang , Cho Byung-Kwan
Published: November 2016

Microbial diversity and complexity pose challenges in understanding the voluminous genetic information produced from whole-genome sequences, bioinformatics and high-throughput ‘-omics’ research. These challenges can be overcome by a core blueprint of a genome drawn with a minimal gene set, which is essential for life. Systems biology and large-scale gene inactivation studies have estimated the number of essential genes to be ∼300–500 in many microbial genomes. On the basis of the essential gene set information, minimal-genome strains have been generated using sophisticated genome engineering techniques, such as genome reduction and chemical genome synthesis. Current size-reduced genomes are not perfect minimal genomes, but chemically synthesized genomes have just been constructed. Some minimal genomes provide various desirable functions for bioindustry, such as improved genome stability, increased transformation efficacy and improved production of biomaterials. The minimal genome as a chassis genome for synthetic biology can be used to construct custom-designed genomes for various practical and industrial applications.
Dynamic Decompressive Craniotomy with a Novel Reversibly Expandable Plate
Authors: Khanna Rohit
Published: November 2016

Objective To assess the feasibility of a dynamic craniotomy procedure with the use of a novel reversibly expandable cranial bone flap fixation plate. The expandable plate allows outward bone flap migration with an increase in intracranial volume or intracranial pressure (ICP).

Methods Dynamic craniotomy intracranial hypertension compliance was evaluated in a skull model with progressive increase in intracranial volume and compared with the standard craniotomy with fixed plates.

Results Dynamic craniotomy provided significant control of ICP with increasing intracranial volume compared with the standard craniotomy. With an incremental increase in intracranial volume from 360 mL to 600 mL, the ICP increased from 2.6 to 91.9 mm Hg with the standard craniotomy, whereas with the dynamic craniotomy the ICP for similar intracranial volume increased from 2.5 to 25 mm Hg (p < 0.00001).

Conclusions The dynamic craniotomy procedure provides superior control of ICP with an abrupt intracranial volume increase when compared with the standard craniotomy.
Osteochondroma Presenting as a Calcified Mass in the Sellar Region and Review of the Literature
Authors: Sekiguchi Kazuya , Arai Sho , Nonaka Senshu , Suzuki Takamoto , Ishii Hisato , Izumi Hiroshi , Yasumoto Yukimasa , Tsutsumi Satoshi
Published: November 2016

Objective Osteochondroma (OC) is the most common benign bone neoplasm. It infrequently occurs in the cranial cavity as a calcified lesion and very rarely presents in the sellar region. The present study summarizes the knowledge about OCs of the sellar region.

Methods We searched the literature search for the clinical appearance of OCs and other calcified pathologies occurring in the sellar region.

Results A total of 21 English-language articles published from 1961 to 2015 documented cases of calcified lesions in the sellar region including cerebral aneurysm, chondroid chordoma, chondroma, craniopharyngioma, OC, odontome, osteoma, pituitary adenoma, pituitary stone, Rathke cleft cyst, retinoblastoma, schwannoma, and xanthogranuloma. Among them, six were OC cases: three in the parasellar region and three in the sellar-suprasellar region. Patients with sellar-suprasellar OCs presented with visual loss and hypopituitarism; patients with parasellar OCs did not show these symptoms. OCs appeared as irregular and multilobulated calcifications on X-ray and computed tomography. On magnetic resonance imaging, OCs showed variable intensity on T1-weighted sequences and consistently heterogenous intensity on T2. Four patients underwent transcranial tumor resection, and the transsphenoidal route was selected for one. Five of the six resulted in a partial resection or internal decompression with a satisfactory outcome.

Conclusions Calcified tumors occurring in the sellar region may be OCs, especially if they appear as irregular multilobulated calcification.
The derivation and approximation of coarse-grained dynamics from Langevin dynamics
Authors: Ma Lina , Li Xiantao , Liu Chun
Published: November 2016

We present a derivation of a coarse-grained description, in the form of a generalized Langevin equation, from the Langevin dynamics model that describes the dynamics of bio-molecules. The focus is placed on the form of the memory kernel function, the colored noise, and the second fluctuation-dissipation theorem that connects them. Also presented is a hierarchy of approximations for the memory and random noise terms, using rational approximations in the Laplace domain. These approximations offer increasing accuracy. More importantly, they eliminate the need to evaluate the integral associated with the memory term at each time step. Direct sampling of the colored noise can also be avoided within this framework. Therefore, the numerical implementation of the generalized Langevin equation is much more efficient.
Integrable multi-component generalization of a modified short pulse equation
Authors: Matsuno Yoshimasa
Published: November 2016

We propose a multi-component generalization of the modified short pulse (SP) equation which was derived recently as a reduction of Feng’s two-component SP equation. Above all, we address the two-component system in depth. We obtain the Lax pair, an infinite number of conservation laws and multisoliton solutions for the system, demonstrating its integrability. Subsequently, we show that the two-component system exhibits cusp solitons and breathers for which the detailed analysis is performed. Specifically, we explore the interaction process of two cusp solitons and derive the formula for the phase shift. While cusp solitons are singular solutions, smooth breather solutions are shown to exist, provided that the parameters characterizing the solutions satisfy certain conditions. Last, we discuss the relation between the proposed system and existing two-component SP equations.
Ionic adsorption on the brucite (0001) surface: A periodic electrostatic embedded cluster method study
Authors: Makkos Eszter , Kerridge Andrew , Austin Jonathan , Kaltsoyannis Nikolas
Published: November 2016

Density functional theory (DFT) at the generalised gradient approximation level is employed within the periodic electrostatic embedded cluster method (PEECM) to model the brucite (0001) surface. Three representative studies are then used to demonstrate the reliability of the PEECM for the description of the interactions of various ionic species with the layered Mg(OH)2 structure, and its performance is compared with periodic DFT, an approach known to be challenging for the adsorption of charged species. The adsorption energies of a series of s block cations, including Sr2+ and Cs+ which are known to coexist with brucite in nuclear waste storage ponds, are well described by the embedded cluster model, provided that basis sets of triple-zeta quality are employed for the adsorbates. The substitution energies of Ca2+ and Sr2+ into brucite obtained with the PEECM are very similar to periodic DFT results, and comparison of the approaches indicates that two brucite layers in the quantum mechanical part of the PEECM are sufficient to describe the substitution. Finally, a detailed comparison of the periodic and PEECM DFT approaches to the energetic and geometric properties of differently coordinated Sr[(OH)2(H2O)4] complexes on brucite shows an excellent agreement in adsorption energies, Sr–O distances, and bond critical point electron densities (obtained via the quantum theory of atoms-in-molecules), demonstrating that the PEECM can be a useful alternative to periodic DFT in these situations.
Nuclear quantum effects in a HIV/cancer inhibitor: The case of ellipticine
Authors: Sappati Subrahmanyam , Hassanali Ali , Gebauer Ralph , Ghosh Prasenjit
Published: November 2016

Ellipticine is a natural product that is currently being actively investigated for its inhibitory cancer and HIV properties. Here we use path-integral molecular dynamics coupled with excited state calculations to characterize the role of nuclear quantum effects on the structural and electronic properties of ellipticine in water, a common biological solvent. Quantum effects collectively enhance the fluctuations of both light and heavy nuclei of the covalent and hydrogen bonds in ellipticine. In particular, for the ellipticine-water system, where the proton donor and acceptor have different proton affinities, we find that nuclear quantum effects (NQEs) strengthen both the strong and the weak H bonds. This is in contrast to what is observed for the cases where the proton affinity of the donors and acceptors is same. These structural fluctuations cause a significant red-shift in the absorption spectra and an increase in the broadening, bringing it into closer agreement with the experiments. Our work shows that nuclear quantum effects alter both qualitatively and quantitatively the optical properties of this biologically relevant system and highlights the importance of the inclusion of these effects in the microscopic understanding of their optical properties. We propose that isotopic substitution will produce a blue shift and a reduction in the broadening of the absorption peak.
Efficient singlet exciton fission in pentacene prepared from a soluble precursor
Authors: Tabachnyk Maxim , Karani Arfa H. , Broch Katharina , Pazos-Outón Luis M. , Xiao James , Jellicoe Tom C. , Novák Jiří , Harkin David , Pearson Andrew J. , Rao Akshay , Greenham Neil C. , Böhm Marcus L. , Friend Richard H.
Published: November 2016

Carrier multiplication using singlet exciton fission (SF) to generate a pair of spin-triplet excitons from a single optical excitation has been highlighted as a promising approach to boost the photocurrent in photovoltaics (PVs) thereby allowing PV operation beyond the Shockley-Queisser limit. The applicability of many efficient fission materials, however, is limited due to their poor solubility. For instance, while acene-based organics such as pentacene (Pc) show high SF yields (up to200%), the plain acene backbone renders the organic molecule insoluble in common organic solvents. Previous approaches adding solubilizing side groups such as bis(tri-iso-propylsilylethynyl) to the Pc core resulted in low vertical carrier mobilities due to reduction of the transfer integrals via steric hindrance, which prevented high efficiencies in PVs. Here we show how to achieve good solubility while retaining the advantages of molecular Pc by using a soluble precursor route. The precursor fully converts into molecular Pc through thermal removal of the solubilizing side groups upon annealing above 150 °C in the solid state. The annealed precursor shows small differences in the crystallinity compared to evaporated thin films of Pc, indicating that the Pc adopts the bulk rather than surface polytype. Furthermore, we identify identical SF properties such as sub-100 fs fission time and equally long triplet lifetimes in both samples.
Optically active semiconductor nanopores for parallel molecule detection
Authors: Gwozdz Paul V. , Ramachandran Sujatha , Dorn August , Drews André , Bhat Abhishek , Blick Robert H.
Published: November 2016

We propose a detection scheme for charged molecules or particles based on optically excited semiconductor nanopores. By means of numerical simulations, we show that the band gap of the semiconductor nanopore can be tuned allowing actuation by light. Molecules translocating through the semiconductor nanopore modulate the fluorescence from the nanopore enabling molecule detection. Our approach will enable us to perform a parallel readout of a translocating molecule without the need of chemical modification of the translocating molecules.
Molecular floating-gate organic nonvolatile memory with a fully solution processed core architecture
Authors: Wu Chao , Wang Wei , Song Junfeng
Published: November 2016

In this paper, we demonstrated a floating-gate organic thin film transistor based nonvolatile memory, in which the core architecture was processed by a sequential three-step solution spin-coating method. The molecular semiconductor 6,13-bis(triisopropylsilylethynyl)pentacene (TIPS-Pen) distributing in the matrix of polymer poly(styrene) (PS), acting as the floating-gate and tunneling layer, respectively, was processed by one-step spin-coating from their blending solution. The effect of the proportion of TIPS-Pen in the matrix of PS on the memory performances of devices was researched. As a result, a good nonvolatile memory was achieved, with a memory window larger than 25 V, stable memory endurance property over 500 cycles and retention time longer than 5000 s with a high memory ratio larger than 102, at an optimal proportion of TIPS-Pen in the matrix of PS.
Optimising the design of large-scale acoustic telemetry curtains
Authors: Steckenreuter Andre , Hoenner Xavier , Huveneers Charlie , Simpfendorfer Colin , Buscot Marie J. , Tattersall Katherine , Babcock Russell , Heupel Michelle , Meekan Mark , van den Broek James , McDowall Phillip , Peddemors Vic , Harcourt Robert
Published: November 2016

Broad-scale acoustic telemetry networks are being established worldwide. The 10-year anniversary of the Integrated Marine Observing System’s Animal Tracking Facility provided the opportunity to assess the efficiency of one of the first national-scale acoustic telemetry networks. Acoustic networks are comprised of acoustic receiver arrays that detect high-frequency transmitters attached to animals that pass within detection range. Herein we assessed the efficiency of eight curtains to detect passing animals by calculating the standardised mean number of detections and transmitters detected at each station. The aim was to determine how many receivers could be decommissioned from each curtain while maintaining its integrity (i.e. detection of all species passing the array). Pivotal locations were defined as the furthest station at which all species would still be detected and where at least 75% of the detections and transmitters would still be detected. By applying these criteria, we were able to improve the cost-effectiveness of our network significantly, reducing the number of stations from 132 to 85 (64% of the original network), yet still retaining 84% of total detections, 86% of transmitters and 100% of detected species. The present study provides a useful framework for refining acoustic telemetry networks.
Meeting the Sustainable Development Goals leads to lower world population growth
Authors: Abel Guy J. , Barakat Bilal , KC Samir , Lutz Wolfgang
Published: November 2016

Significance

The future of world population growth matters for future human well-being and interactions with the natural environment. We show the extent to which world population growth could be reduced by fully implementing the Sustainable Development Goals (SDGs) whose health and education targets have direct and indirect consequences on future mortality and fertility trends. Although this assessment is consistent with the Shared Socioeconomic Pathways scenarios used in the Intergovernmental Panel on Climate Change context, it is inconsistent with the prediction range of the United Nations projections for which we present sensitivity analyses and suggests that their range is likely too narrow. Given our assumptions, the SDGs have a sizable effect on global population growth, providing an additional rationale for vigorously pursuing their implementation.
In vivo bioluminescence imaging reveals copper deficiency in a murine model of nonalcoholic fatty liver disease
Authors: Heffern Marie C. , Park Hyo Min , Au-Yeung Ho Yu , Van de Bittner Genevieve C. , Ackerman Cheri M. , Stahl Andreas , Chang Christopher J.
Published: November 2016

Significance

Like all essential metals in mammals, deficiency or excess of copper can be detrimental to health. We present a bioluminescent reporter based on copper-dependent uncaging of a
d
-luciferin substrate for selective, sensitive, and tissue-specific longitudinal imaging of labile copper pools in animal model systems. Application of this technology to monitor a diet-induced mouse model of nonalcoholic fatty liver disease, a disorder affecting
ca
. 100 million Americans, reveals hepatic copper deficiency and altered expression levels of copper homeostatic proteins that accompany glucose intolerance and weight gain. The results demonstrate the viability of this molecular imaging approach and connect copper dysregulation to metabolic liver disease, providing a platform for designing reactivity-based reporters for cell- and tissue-specific in vivo metal imaging.
EphA2 is a functional receptor for the growth factor progranulin
Authors: Neill Thomas , Buraschi Simone , Goyal Atul , Sharpe Catherine , Natkanski Elizabeth , Schaefer Liliana , Morrione Andrea , Iozzo Renato V.
Published: November 2016

Although the growth factor progranulin was discovered more than two decades ago, the functional receptor remains elusive. Here, we discovered that EphA2, a member of the large family of Ephrin receptor tyrosine kinases, is a functional signaling receptor for progranulin. Recombinant progranulin bound with high affinity to EphA2 in both solid phase and solution. Interaction of progranulin with EphA2 caused prolonged activation of the receptor, downstream stimulation of mitogen-activated protein kinase and Akt, and promotion of capillary morphogenesis. Furthermore, we found an autoregulatory mechanism of progranulin whereby a feed-forward loop occurred in an EphA2-dependent manner that was independent of the endocytic receptor sortilin. The discovery of a functional signaling receptor for progranulin offers a new avenue for understanding the underlying mode of action of progranulin in cancer progression, tumor angiogenesis, and perhaps neurodegenerative diseases.
Interferon regulatory factor 2 protects mice from lethal viral neuroinvasion
Authors: Li Melody M.H. , Bozzacco Leonia , Hoffmann Hans-Heinrich , Breton Gaëlle , Loschko Jakob , Xiao Jing W. , Monette Sébastien , Rice Charles M. , MacDonald Margaret R.
Published: November 2016

The host responds to virus infection by activating type I interferon (IFN) signaling leading to expression of IFN-stimulated genes (ISGs). Dysregulation of the IFN response results in inflammatory diseases and chronic infections. In this study, we demonstrate that IFN regulatory factor 2 (IRF2), an ISG and a negative regulator of IFN signaling, influences alphavirus neuroinvasion and pathogenesis. A Sindbis virus strain that in wild-type (WT) mice only causes disease when injected into the brain leads to lethal encephalitis in Irf2−/− mice after peripheral inoculation. Irf2−/− mice fail to control virus replication and recruit immune infiltrates into the brain. Reduced B cells and virus-specific IgG are observed in the Irf2−/− mouse brains despite the presence of peripheral neutralizing antibodies, suggesting a defect in B cell trafficking to the central nervous system (CNS). B cell–deficient μMT mice are significantly more susceptible to viral infection, yet WT B cells and serum are unable to rescue the Irf2−/− mice. Collectively, our data demonstrate that proper localization of B cells and local production of antibodies in the CNS are required for protection. The work advances our understanding of host mechanisms that affect viral neuroinvasion and their contribution to immunity against CNS infections.
Ebola Virus Persistence in Breast Milk After No Reported Illness: A Likely Source of Virus Transmission From Mother to Child
Authors: Sissoko Daouda , Keïta Mory , Diallo Boubacar , Aliabadi Negar , Fitter David L. , Dahl Benjamin A. , Akoi Bore Joseph , Raymond Koundouno Fara , Singethan Katrin , Meisel Sarah , Enkirch Theresa , Mazzarelli Antonio , Amburgey Victoria , Faye Ousmane , Alpha Sall Amadou , Magassouba N’Faly , Carroll Miles W. , Anglaret Xavier , Malvy Denis , Formenty Pierre , Bruce Aylward Raymond , Keïta Sakoba , Harouna Djingarey Mamoudou , Loman Nicholas J. , Günther Stephan , Duraffour Sophie
Published: November 2016

A 9-month-old infant died from Ebola virus (EBOV) disease with unknown epidemiological link. While her parents did not report previous illness, laboratory investigations revealed persisting EBOV RNA in the mother’s breast milk and the father’s seminal fluid. Genomic analysis strongly suggests EBOV transmission to the child through breastfeeding.
Effects of Fungicides and Spray Application Interval on Controlling Marssonina Blotch of Apple in the Loess Plateau Region of China
Authors: Dang J. L. , Gleason M. L. , Niu C. K. , Liu X. , Guo Y. Z. , Zhang R. , Sun G. Y.
Published: November 2016

Marssonina blotch, caused by the fungus Marssonina coronariae, is a serious foliar disease on apple in East Asia as well as in other moist temperate regions in Asia, Europe, and South America. Several fungicides were investigated for their toxicity to mycelial growth and conidial germination of the pathogen in vitro. Tebuconazole, kresoxim-methyl, hexaconazole, propiconazole, and a mixture of tebuconazole and benziothiazolinone sharply inhibited mycelial growth but had less effect on conidial germination. Field tests were conducted in a commercial orchard in Baishui County, Shaanxi Province, China, during 2012, 2013, 2014, and 2015 in order to develop recommendations for apple growers. Three applications of tebuconazole, hexaconazole, propiconazole, or a mixture of tebuconazole and benziothiazolinone at 20-day intervals from early July to late August resulted in defoliation incidence of <5%. When sprays of Bordeaux mixture + tebuconazole, Bordeaux mixture + propiconazole, and Bordeaux mixture + tebuconazole and benziothiazolinone were alternated, the spray interval was extended to 25 days and defoliation incidence remained <5%. Based on historical records and our results, scouting for symptoms should begin in mid-June. We recommend commencing the spray period in early July in years with normal rainfall patterns, and spraying in mid- to late June in years with much rainfall. The findings of this study create a foundation for implementation of an efficient spray program against Marssonina leaf blotch in apple orchards in the Loess Plateau Region of China.
Alpha-1 antitrypsin deficiency
Authors: McCosh Kelly
Published: November 2016

Alpha-1 antitrypsin deficiency is an inherited disorder that may lead to early development of emphysema and also can cause serious hepatic disease. Because the condition is underrecognized, diagnosis may be delayed. This article aims to increase awareness about alpha-1 antitrypsin deficiency and screening guidelines that can help primary care providers identify patients early for better outcomes.
Patient-centered treatment in atrial fibrillation
Authors: Cox Mary C. , Gulati Vijay K.
Published: November 2016

Patients with atrial fibrillation (AF) and clinicians treating them are faced with innumerable management choices. Minimizing thromboembolic events and strokes related to AF is paramount. Estimating the risks with the various therapies is important for optimal therapy. Also, patients must choose a rate control or a rhythm control strategy. With so many options, clinical presentations, and patient desires, patients with AF are rarely treated identically. This allows for shared decision-making and patient-centered care.
Integrating and Assessing Structural Competency in an Innovative Prehealth Curriculum at Vanderbilt University
Authors: Metzl Jonathan M. , Petty JuLeigh
Published: November 2016

Problem

Structural competency is a framework for conceptualizing and addressing health-related social justice issues that emphasizes diagnostic recognition of economic and political conditions producing and racializing inequalities in health. Strategies are needed to teach prehealth undergraduate students concepts central to structural competency (e.g., structural inequity, structural racism, structural stigma) and to evaluate their impact.

Approach

The curriculum for Vanderbilt University’s innovative prehealth major in medicine, health, and society (MHS) was reshaped in 2013 to incorporate structural competency concepts and skills into undergraduate courses. The authors developed the Structural Foundations of Health (SFH) evaluation instrument, with closed- and open-ended questions designed to assess undergraduate students’ core structural competency skills. They piloted the SFH instrument in 2015 with MHS seniors.

Outcomes

Of the 85 students included in the analysis, most selected one or more structural factors as among the three most important in explaining U.S. regional childhood obesity rates (85%) and racial disparities in heart disease (92%). More than half described individual- or family-level structural factors (66%) or broad social and political factors (56%) as influencing geographic disparities in childhood obesity. Nearly two-thirds (66%) described racial disparities in heart disease as consequences of socioeconomic differences, discrimination/stereotypes, or policies with racial implications.

Next Steps

Preliminary data suggest that the MHS major trained students to identify and analyze relationships between structural factors and health outcomes. Future research will include a comparison of structural competency skills among MHS students and students in the traditional premedical track and assessment of these skills in incoming first-year students.
The Medical–Legal Partnership Approach to Teaching Social Determinants of Health and Structural Competency in Residency Programs
Authors: Paul Edward G. , Curran Mallory , Tobin Tyler Elizabeth
Published: November 2016

Medical–legal partnerships (MLPs) embed civil legal services lawyers into health care settings and interprofessional health care teams delivering care to low-income or otherwise vulnerable patients and communities. MLPs present the opportunity to instill in residents a practical understanding of the social determinants of health and provide them with concrete tools to address them. MLP training helps residents develop structural competency and build the skills necessary to address barriers to health at the patient, institutional, and population levels. Through a case study, this Perspective explores how residents can address health-harming legal needs working in partnership with interprofessional health care teams that include lawyers, and illustrates how such MLP experiences can relate to competency-based Milestones that are applicable to training residents in all specialties.
Hittability: The Leader’s Edge
Authors: Souba Wiley
Published: November 2016

Mastery of any discipline entails both the requisite skills and the ability to see things as “hittable.” However, the concept of “hittability,” which, in the context of leadership, refers to whether or not a specific leadership challenge shows up as hittable (or solvable) for those who are responsible for taking it on, is consistently overlooked. Nevertheless, it is a critical determinant of leadership effectiveness. Hittability is a function of the framing lenses—a person’s beliefs, values, and worldviews—which frame the way a person “sees” a leadership challenge. Additionally, the future a person is “living into” is the framing lens for the present. In other words, a person’s view of the future shapes his or her view of the present and his or her actions within it. Because the beliefs, values, and worldviews that constitute our framing lenses are constituted in and accessible through language (i.e., in the day-to-day stories, or narratives, a person tells him- or herself), reframing them to create a new future requires a new narrative. The ability to shift the previously unhittable to the hittable won’t be, primarily, due to some newly acquired knowledge. Rather, it will be the result of reframing our challenges so they show up as hittable.
Unmatched U.S. Allopathic Seniors in the 2015 Main Residency Match: A Study of Applicant Behavior, Interview Selection, and Match Outcome
Authors: Liang Mei , Curtin Laurie S. , Signer Mona M. , Savoia Maria C.
Published: November 2016

Purpose

The application and interview behaviors of unmatched U.S. allopathic medical school senior students (U.S. seniors) participating in the 2015 National Resident Matching Program (NRMP) Main Residency Match were studied in conjunction with their United States Medical Licensing Examination (USMLE) Step 1 scores and ranking preferences to understand their effects on Match outcome.

Method

USMLE Step 1 score and preferred specialty information were reviewed for U.S. seniors who responded to the 2015 NRMP Applicant Survey. Unmatched U.S. seniors were categorized as “strong,” “solid,” “marginal,” or “weak” based on the perceived competitiveness of their Step 1 scores compared with U.S. seniors who matched in the same preferred specialty. The numbers of applications sent, interviews obtained, and programs ranked also were examined by Match outcome.

Results

Strong unmatched U.S. seniors submitted significantly more applications to achieve and attend approximately the same number of interviews as strong matched U.S. seniors. Strong unmatched seniors ranked fewer programs than their matched counterparts. As a group, unmatched U.S. seniors were less likely than their matched counterparts to rank a mix of competitive and less competitive programs and more likely to rank programs based on their perceived likelihood of matching. A small number of unmatched U.S. seniors would have matched if they had ranked programs that ranked them.

Conclusions

U.S. seniors’ Match outcomes may be affected by applicant characteristics that negatively influence their selection for interviews, and their difficulties may be exacerbated by disadvantageous ranking behaviors.
Intravenous Amisulpride for the Prevention of Postoperative Nausea and Vomiting
Authors: Gan Tong J. , Kranke Peter , Minkowitz Harold S. , Bergese Sergio D. , Motsch Johann , Eberhart Leopold , Leiman David G. , Melson Timothy I. , Chassard Dominique , Kovac Anthony L. , Candiotti Keith A. , Fox Gabriel , Diemunsch Pierre
Published: November 2016

Background

Two essentially identical, randomized, double-blind, placebo-controlled, parallel-group phase III studies evaluated the efficacy of intravenous amisulpride, a dopamine D2/D3 antagonist, in the prevention of postoperative nausea and vomiting in adult surgical patients.

Methods

Adult inpatients undergoing elective surgery during general anesthesia and having at least two of the four Apfel risk factors for postoperative nausea and vomiting were enrolled at 9 U.S. and 10 European sites. A single 5-mg dose of amisulpride or matching placebo was given at induction of anesthesia. The primary endpoint was complete response, defined as no vomiting/retching and no use of antiemetic rescue medication in the 24-h postoperative period. Nausea incidence was a secondary endpoint.

Results

Across the two studies, 689 patients were randomized and dosed with study medication, of whom 626 were evaluable per protocol. In the U.S. study, 46.9% (95% CI, 39.0 to 54.9) of patients achieved complete response in the amisulpride group compared to 33.8% (95% CI, 26.2 to 42.0) in the placebo group (P = 0.026). In the European study, complete response rates were 57.4% (95% CI, 49.2 to 65.3) for amisulpride and 46.6% (95% CI, 38.8 to 54.6) for placebo (P = 0.070). Nausea occurred less often in patients who received amisulpride than those who received placebo. There was no clinically significant difference in the safety profile of amisulpride and placebo; in particular, there were no differences in terms of QT prolongation, extrapyramidal side effects, or sedation.

Conclusions

One of the two trials demonstrated superiority, while pooling both in a post hoc change to the plan of analysis supported the hypothesis that amisulpride was safe and superior to placebo in reducing the incidence of postoperative nausea and vomiting in a population of adult inpatients at moderate to high risk of postoperative nausea and vomiting.
A Password-Protected Web Site for Mothers Expressing Milk for Their Preterm Infants
Authors: Blatz MaryAnn , Dowling Donna , Underwood Patricia W. , Bieda Amy , Graham Gregory
Published: November 2016

Background:

Research has demonstrated that breast milk significantly decreases morbidities that impact length of stay for preterm infants, but there is a need to test interventions to improve breastfeeding outcomes. Since many Americans are using technologies such as the Intranet and smartphones to find health information and manage health, a Web site was developed for mothers who provide breast milk for their preterm hospitalized infants.

Purpose:

This study examined the efficacy of a Web site for mothers to educate them about breast milk expression and assist them in monitoring their breast milk supply.

Methods:

Quantitative and qualitative data were collected from mothers whose preterm infants were hospitalized in a level IV neonatal intensive care unit (NICU) or transitional care unit (TCU) in an urban academic medical center in the Midwest.

Results:

Eighteen mothers participated in evaluation of the Web site. Thirteen mothers consistently logged on to the password-protected Web site (mean [standard deviation] = 13.3 [11.7]) times. Most participants, (69.2%), reported they used the breast milk educational information. Most mothers indicated that using the Web site log helped in tracking their pumping. These findings can be used to direct the design and development of web-based resources for mothers of preterm infants

Implications for Practice:

NICU and TCU staffs need to examine and establish approaches to actively involve mothers in monitoring the establishment and maintenance of an adequate supply of breast milk to improve neonatal health outcomes.

Implications for Research:

An electronic health application that incorporates the features identified in this study should be developed and tested.
Geriatric complex proximal humeral fracture: intraoperative locking plate problems and proposed solutions
Authors: Ayoub Mostafa A. , Gad Hossam , El-Tantawy Ahmad , Atef Ashraf , Seleem Osama A.
Published: November 2016

Background:

Surgical treatment of complex proximal humeral fractures in the elderly is controversial. There are no clear criteria on whether to preserve the humeral head or replace it. The aim of this study was to evaluate the results of locking-plate internal fixation and to clarify the encountered intraoperative problems with their suggested solutions.

Methods:

The study included 34 patients older than 60 yr of age. Eighteen had three-part fractures and 16 had four-part fractures according to Neer’s classification. All patients had internal fixation with locking plates and according to the encountered problems additional procedures were added to obtain stable reduction and rigid fixation. The clinical evaluation depended on the objective Constant-Murley score (CMS) and the subjective Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.

Results:

The mean follow up was 27.7±5.6 mo, and the mean age was 69.9±4.4 yr. The mean CMS was 70.9±14.8 points, and the mean DASH score was 28.2±17.8 points. Humeral head avascular necrosis occurred in three (8.8%) with significant reduction in CMS (P=0.001). Partial loss of initial reduction occurred in four patients (11.8%) with significant reduction in CMS (P=0.007). Secondary surgery was mandatory for six patients (17.6%).

Conclusions:

We believe that locking plate osteosynthesis with preservation of the humeral head is worth considering in elderly patients with complex injuries provided the surgeon and facility are prepared for any problems that may arise.
Tibiofemoral chondromalacia treated with platelet-rich plasma and hyaluronic acid
Authors: Hart Radek , Safi Adel , Jajtner Pavel , Puskeiler Miloš , Hartová Petra , Komzák Martin
Published: November 2016

Background:

The objective of the present study was to determine if platelet rich plasma (PRP) can increase tibiofemoral cartilage regeneration and improve knee function.

Methods:

Fourty consecutive and strictly selected patients affected by grade II or III chondromalacia underwent 1 yr of treatment (nine injections) with autologous PRP in a liquid form with 2.0 to 2.5-fold platelet concentration (20 cases) or with hyaluronic acid (HA) (20 patients). Outcome measures included the Lysholm, Tegner, International Knee Documentation Committee (IKDC), Western Ontario and McMaster (WOMAC) Osteoarthritis Index, and Short Form (SF)-36 scores. MRI arthroscopic and histologic assessment were used to evaluate cartilage thickness and degree of degeneration before and after treatment (1 yr after the primary arthroscopy).

Results:

The study demonstrated significant improvement in Lysholm, Tegner, IKDC, WOMAC, and SF-36 scores in both groups. Cartilage assessment revealed no significant macroscopic or microscopic structural regeneration as well as no cartilage height increase in either group. Higher content of chondrocytes and proteoglycans in cartilage was proven in both groups after treatment without a statistically significant difference between the groups. There were no adverse events observed.

Conclusions:

PRP and HA significantly reduced pain and improved quality of life in patients with a low degree of cartilage degeneration. MRI and arthroscopic assessment did not confirm any significant cartilage structural improvement. The content of chondrocytes and proteoglycans in cartilage was higher in the PRP group than in the HA group after the treatment but did not reach statistical significance.
Surgical management of Pott’s spine induced kyphosis in older children or adults
Authors: Kanna Rishi Mugesh , Shetty Ajoy Prasad , Rajasekaran S.
Published: November 2016

Kyphosis is one a sequelae of spinal tuberculosis. Tuberculosis affects the anterior vertebral body in at least 95% of the patients, which portends the development of kyphosis of varying degrees. Patients with severe disease, contiguous vertebral body destruction, young age, and thoracic-level affliction are more prone to severe kyphosis, which can cause cosmetic problems, costopelvic impingement pain, pulmonary dysfunction, and neurological deficit. Surgical correction is required in both active and healed stages in patients with severe kyphosis. In patients with active disease, surgical correction of kyphosis is less extensive and is based on principles of debridement, stabilization, and anterior reconstruction so that the spine heals in appropriate sagittal alignment. Different surgical techniques, including direct anterior corpectomy and stabilization, an all-posterior approach for posterior stabilization, and anterior decompression and reconstruction, and combined anterior and posterior reconstruction performed through two separate approaches, have been described. In the healed stages, patients can have severe kyphosis with or without neurological deficit. Corrective osteotomy (transpedicular decancellation osteotomy, pedicle subtraction osteotomy, posterior vertebral column resection, closing or opening wedge osteotomy, or rarely combined anterior-posterior technique) is performed to correct the deformity. Surgical correction in healed stages is an extensive and complex undertaking.
Neuromuscular scoliosis: how decision making and treatment are different
Authors: Chua Kenon , Lau Leok-Lim , Hui James Hoi Po , Lee Eng Hin
Published: November 2016

Neuromuscular scoliosis is caused by a muscle imbalance as the result of an underlying neuropathic or myopathic cause. This review focuses primarily on recent innovations in the treatment of Duchenne muscular dystrophy (DMD) and spinal muscular atrophy (SMA). The increase in life span of patients with DMD has largely been attributed to the use of steroids and noninvasive ventilator support. Steroids also delay the onset and retard the progression of scoliosis in DMD. The management of NMS requires a multidisciplinary approach, with the involvement of the medical and surgical teams as well as the patient and the caregivers. There is little evidence to support the use of bracing, but appropriate seating strategies can benefit certain patients. Surgery in NMS prevents progression of the scoliosis, improves sitting posture, comfort, and quality of life, and facilitates nursing care. The decision for surgery has to be made before the decrease in respiratory function and increase in scoliosis present significant operative and postoperative risk. The ideal instrumentation system should be inexpensive while allowing the scoliosis and pelvic obliquity to be safely and easily corrected with minimal complications. The choice of surgical technique and implants should allow for efficiency in terms of operative time because there is an increased risk of bleeding with prolonged operative time. Postoperative intensive care usually is required.
Bilateral congenital torticollis: a case report with 25 years of follow-up
Authors: Matuszewski Lukasz , Pietrzyk Damian , Kandzierski Grzegorz , Wilczynski Michal
Published: November 2016

Unilateral congenital sternocleidomastoid muscle (SCM) contracture causing torticollis is well known. Although the unilateral muscular torticollis is quite often recognized, a bilateral contracture of SCM muscle is very rare. A review of the literature showed only three cases of bilateral congenital torticollis reported over the last two decades. We present a case report of a boy with congenital bilateral torticollis with 25 years of follow-up. Bilateral tenotomies of the right SCM were performed and the child was immobilized in Schanz’s cervical orthosis. Three months after operative procedure, the physical examination indicated an increasing contracture of the left SCM with time. A similar operative procedure was applied to the left SCM. The follow-up examinations showed good wound healing and a positive outcome. Bilateral congenital muscular torticollis is a very rare form of muscle skeletal disorder. We describe a surgical treatment of such deformation that ended with a satisfactory result confirmed through a 25-year follow-up.