bluuebunny/crossref_metadata_2025 huggingface dataset:
CuO/V2O5 hybrid nanowires for highly sensitive and selective H2S gas sensor
Authors: Yeh Bu-Yu , Jian Bo-Sung , Wang Gou-Jen , Tseng Wenjea J.
Published: October 2017

Vanadium pentoxide (V2O5) nanowires decorated with CuO nanoparticles on their surface have been prepared by a facile chemical route.
Monothiatruxene: a new versatile core for functional materials
Authors: Maciejczyk Michal R. , Williams J. A. Gareth , Robertson Neil , Pietraszkiewicz Marek
Published: October 2017

A monothiatruxene and its oxidized and/or brominated derivatives were prepared through an efficient route.
Characterization of the crystalline regions of cured urea formaldehyde resin
Authors: Liu Ming , Thirumalai Rooban Venkatesh K. G. , Wu Yiqiang , Wan Hui
Published: October 2017

Urea formaldehyde (UF) resins are widely used thermosetting polymers in adhesives, finishes, molded objects,etc.
A novel flexible sensor for respiratory monitoring based on in situ polymerization of polypyrrole and polyurethane coating
Authors: Zhao Yixia , Li Yafang , Kang Weimin , He Yin , Liu Wei , Liu Hao , Cheng Bowen
Published: October 2017

A novel flexible sensor for respiratory monitoring was prepared based on in situ polymerization of polypyrrole and polyurethane coating.
High-performance N-doped MWCNT/GO/cellulose hybrid composites for supercapacitor electrodes
Authors: Ramesh Sivalingam , Sivasamy Arumugam , Kim Heung Soo , Kim Joo-Hyung
Published: October 2017

A nitrogen-doped MWCNT/GO/cellulose hybrid composite was prepared via an in situ hydrothermal process, and its electrochemical performance was evaluated by conducting cyclic voltammetry (CV).
Alternating and regioregular copolymers with high refractive index from COS and biomass-derived epoxides
Authors: Hu Lan-Fang , Li Yang , Liu Bin , Zhang Ying-Ying , Zhang Xing-Hong
Published: October 2017

The catalytic synthesis of well-defined COS- and biomass-derived copolymer with a high refractive index is described.
Reversible mechanofluorochromism and acidochromism using a cyanostyrylbenzimidazole derivative with aggregation-induced emission
Authors: Zhan Yong , Wei Quanpeng , Zhao Jinyu , Zhang Xiaojing
Published: October 2017

AIE-active cyanostyrylbenzimidazole derivative TBM exhibited reversible mechanofluorochromism and acidochromism characteristics.
Density functional theoretical studies on the ring-opening polymerization mechanism of oxetane cation series compounds
Authors: Wang Hai-Xia , Pu Min , Ding Yu-Cheng
Published: October 2017

The mechanism of ring-opening polymerization of oxetane cation series compounds was investigated using the B3LYP and MP2 methods of density functional theory andab initiomethods, at the basis set levels of 6-31G(d,p) and 6-311++G(d,p).
Influence of bicarbonate on the abundance of microbial communities capable of reducing U(vi) in groundwater
Authors: Li Dianxin , Hu Nan , Sui Yang , Ding Dexin , Li Ke , Li Guangyue , Wang Yongdong
Published: October 2017

7 experiments amended with 0, 5, 10, 15, 20, 25 and 30 mM initial concentrations of bicarbonate were conducted to investigate the influence of different concentrations of bicarbonate on the abundance of microbial communities capable of reducing U(vi) in groundwater.
Efficient and stable white fluorescent carbon dots and CD-based glass thin-films via screen-printing technology for use in W-LEDs
Authors: Zhang Yijun , Feng Jiali , He Meiling , Jiang Jutao , Xu Tao , Zhou Lei , Chen Wei , Xiang Weidong , Liang Xiaojuan
Published: October 2017

White fluorescent carbon dots (WCDs) were synthesized by combining red carbon dots (RCDs) with ethanol or N-(β-aminoethyl)-γ-aminopropyl methldimethoxy silane (AEAPMS) for the first time.
Ultra-simple white organic light-emitting diodes employing only two complementary colors with color-rendering index beyond 90
Authors: Miao Yanqin , Wang Kexiang , Zhao Bo , Gao Long , Xu Jiacong , Wang Hua , Xu Bingshe
Published: October 2017

This ultra-simple di-chromatic WOLED, using only three organic materials, achieves an ultra-high CRI of 90, which is even comparable with other reported three-color, four-color, and five-color WOLEDs.
Characterization of the adsorption dynamics of trisodium citrate on gold in water solution
Authors: Monti Susanna , Barcaro Giovanni , Sementa Luca , Carravetta Vincenzo , Ågren Hans
Published: October 2017

Functionalization of a gold nanoparticle with citric acid.
Protein droplet actuation on superhydrophobic surfaces: a new approach toward anti-biofouling electrowetting systems
Authors: Latip E. N. Abdul , Coudron L. , McDonnell M. B. , Johnston I. D. , McCluskey D. K. , Day R. , Tracey M. C.
Published: October 2017

Anti-biofouling behaviour of an electrowetting device using off-the-shelf superhydrophobic materials is demonstrated through protein adsorption measurement and protein-laden droplet actuation.
A dual-functional surface with hierarchical micro/nanostructure arrays for self-cleaning and antireflection
Authors: Mao Zhenwei , Cao Wei , Hu Jie , Jiang Lan , Wang Andong , Li Xin , Cao Jing , Lu Yongfeng
Published: October 2017

A dual-functional surface with patterned hierarchical micro/nanostructure arrays has been fabricated by femtosecond laser and thermal oxidation.
Unveiling hole trapping and surface dynamics of NiO nanoparticles
Authors: D'Amario Luca , Föhlinger Jens , Boschloo Gerrit , Hammarström Leif
Published: October 2017

Mesoporous NiO is used as p-type material in photoelectrochemical energy conversion devices. The presence of two kinds of hole traps can affect device performance. Here, after band-gap excitation, the relaxation of the hole into two different traps was observed and characterized.
Amorphous NiFe(oxy)hydroxide nanosheet integrated partially exfoliated graphite foil for high efficiency oxygen evolution reaction
Authors: Ye Yin-Jian , Zhang Ning , Liu Xiao-Xia
Published: October 2017

Superior OER performance of NiFe(oxy)hydroxide integrated into EG with 21 mV dec−1 Tafel slope and 251 mV overpotential at 500 mA cm−2.
Bifunctional NH2-MIL-88(Fe) metal–organic framework nanooctahedra for highly sensitive detection and efficient removal of arsenate in aqueous media
Authors: Xie Donghua , Ma Yue , Gu Yue , Zhou Hongjian , Zhang Haimin , Wang Guozhong , Zhang Yunxia , Zhao Huijun
Published: October 2017

Bifunctional NH2-MIL-88(Fe) nanooctahedra have been successfully fabricated for highly sensitive and specific recognition as well as efficient removal of arsenate.
Combined Effects of Noise and Reverberation on Sound Localization for Listeners With Normal Hearing and Bilateral Cochlear Implants
Authors: Zheng Yunfang , Koehnke Janet , Besing Joan
Published: October 2017

Purpose

This study examined the individual and combined effects of noise and reverberation on the ability of listeners with normal hearing (NH) and with bilateral cochlear implants (BCIs) to localize speech.

Method

Six adults with BCIs and 10 with NH participated. All subjects completed a virtual localization test in quiet and at 0-, −4-, and −8-dB signal-to-noise ratios (SNRs) in simulated anechoic and reverberant (0.2-, 0.6-, and 0.9-s RT
60
) environments. BCI users were also tested at +8- and +4-dB SNR. A 3-word phrase was presented at 70 dB SPL from 9 simulated locations in the frontal horizontal plane (±90°), with the noise source at 0°.

Results

BCIs users had significantly poorer localization than listeners with NH in all conditions. BCI users' performance started to decrease at a higher SNR (+4 dB) and shorter RT
60
(0.2 s) than listeners with NH (−4 dB and 0.6 s). The combination of noise and reverberation began to degrade localization of BCI users at a higher SNR and a shorter RT
60
than listeners with NH.

Conclusion

The clear effect of noise and reverberation on the performance of BCI users provides information that should be useful for refining cochlear implant processing strategies and developing cochlear implant rehabilitation plans to optimize binaural benefit for BCI users in everyday listening situations.
Continuously tunable crossover based on HMSIW
Authors: Cui Qian , Lin Feng
Published: October 2017

A frequency‐tuning crossover based on half‐mode substrate‐integrated waveguide (HMSIW) is presented for the first time. Two HMSIW transmission lines are parallelly arranged to form the four‐port crossover. Three tunable capacitors placed between the HMSIW transmission lines are used to obtain the tunable passband. For verification, both simulated and measured results are given and good agreement between the simulation and measurement is observed. The measured passband can be tuned in a frequency range from 2.2 to 5.0 GHz (tuning range of 78%) with better than 19 dB return loss and 15 dB isolation, while the insertion loss varies from 0.93 to 1.97 dB.
Proactive operation of electric vehicles in harmonic polluted smart distribution networks
Authors: Pirouzi Sasan , Aghaei Jamshid , Niknam Taher , Farahmand Hossein , Korpås Magnus
Published: October 2017

This study proposes combined framework for proactive operation, i.e. bidirectional active and reactive power management, of the smart distribution network as well as harmonic compensation of non‐linear loads using electric vehicles (EVs) equipped with bidirectional chargers. The problem is in the form of non‐linear programming (NLP) where the objective function is to minimise the voltage deviation at the fundamental frequency and the total harmonic distortion. The harmonic load flow equations, EVs constraints, system operation and harmonic indexes limits are formulated as problem constraints. The proposed NLP problem is converted to an equivalent mixed integer linear programming (MILP) model using Taylor series and linearisation techniques for AC power flow formulation. Also, the Benders decomposition (BD) algorithm is used to solve the proposed MILP problem that is tested on different distribution test networks to demonstrate its efficiency and performance. The results show that the NLP model can be substituted with the high‐speed linear programming model. Moreover, the computation speed is improved by using the BD method. Finally, the network and harmonic indexes improved and charging cost reduced using the proposed idea.
Calvarial Reconstruction
Authors: Badhey Arvind , Kadakia Sameep , Mourad Moustafa , Inman Jared , Ducic Yadranko
Published: October 2017

Calvarial reconstruction is a challenge to reconstructive surgeons, especially considering protection of intracranial contents. In recent years, the advent of multiple reconstructive materials adds tools to the surgical armamentarium. Options include autologous split calvarial and rib grafts and alloplastic materials such as titanium mesh, methyl methacrylate, calcium hydroxyapatite, and polyetheretherketone. The most important aspect of cranial reconstruction still lies in finding the most aesthetic, safe, and reliable means of filling a defect.
Complications of Skull Base Surgery
Authors: Sokoya Mofiyinfolu , Mourad Moustafa , Ducic Yadranko
Published: October 2017

Approaches to surgical management of skull base pathology and reconstruction of skull base defects have evolved over the past several decades. The goal, however, remains the same—to effectively address the pathology with minimal complications. In this article, the authors try to explore multiple complications of skull base surgery, discussing their incidence, natural course, and prevention. This will prove beneficial in optimal management of patients with a myriad of skull base disorders.
Corrección de genu valgo postraumático con osteotomía de cierre en tibia proximal
Authors: Laso José , Rojas Carlos , Valenzuela Álvaro , Álvarez Santiago , Gaggero Nicolás
Published: October 2017

Objetivo Presentar un caso de complicación de fractura de platillos tibiales Schatzker VI y su manejo quirúrgico.

Material y Método Se presenta un caso de fractura de platillos tibial Schatzker VI que evoluciona con malalineamiento en valgo secundario a hundimiento del platillo tibial, junto a una revisión de la literatura y la descripción del manejo quirúrgico.

Resultados Se realizó una osteotomía en cuña de cierre medial de tibia proximal y se estabilizó con placa bloqueada (TomoFix), con una corrección completa de la deformidad sin complicaciones.

Discusión La osteotomía en cuña de cierre medial en tibia proximal es una técnica descrita en el manejo de artrosis secundaria a malalineamiento en valgo de la rodilla. Mediante dos osteotomías iniciadas por la cortical medial hacia la lateral con un fulcro esa última, se retira una cuña de dimensiones conocidas y se mantiene la reducción con algún elemento de osteosíntesis. De esa forma, se permite la corrección angular de la deformidad, previamente planificada. Los resultados en distintas series son en general favorables.

Conclusión El malalineamiento de la extremidad posterior a una fractura de platillos tibiales y la consecuente sobrecarga del compartimento afectado en la rodilla, asociado al daño articular, evoluciona con degeneración articular que termina en una artrosis unicompartimental secundaria, la cual puede ser prevenida con el uso de osteotomías correctoras de ejes como la osteotomía de tibia proximal, permitiendo normalizar la distribución de las cargas en los compartimentos mediante la corrección del eje mecánico alterado y así prolongar la sobrevida articular.

Nivel de Evidencia Tipo IV, Caso Clínico.
Reinvestierte Gewinne steuerlich begünstigt
Authors: Dornbusch Hans-Ludwig
Published: October 2017

Nach § 6b Einkommensteuergesetz (EStG) kann der Tierarzt den Gewinn aus der Veräußerung
langlebiger Anlagegüter auf bestimmte Reinvestitionsgüter ganz oder teilweise übertragen
oder in eine steuerfreie Rücklage überführen. Begünstigt sind vor allem Gewinne aus der
Veräußerung von Grund und Boden sowie Gebäuden (§ 6b Abs. 1 Satz 1 EStG). Zum Zeitpunkt
der Veräußerung müssen die verkauften Wirtschaftsgüter mindestens 6 Jahre ununterbrochen
zum Praxisvermögen des Tierarztes gehört haben (§ 6b Abs. 4 Nr. 2 EStG). Kurzfristig
nutzbares Anlagevermögen, immaterielles Anlagevermögen und das Umlaufvermögen sind
ausgenommen von dieser Steuervergünstigung.
Bluttransfusion bei Hund und Katze – Ein Überblick
Authors: Prümmer Julia , Adamik Katja-Nicole
Published: October 2017

Die Möglichkeit der Bluttransfusion zur Stabilisierung von Notfall- und Intensivpatienten ist
mittlerweile in jeder Tierklinik sowie größeren Praxis nicht mehr wegzudenken. Immer häufiger werden
deshalb auch klinikeigene Blutbanken aufgebaut. Dieser Artikel soll einen Überblick zu den Hintergründen,
den Spendertieren, der Blutentnahme, der Konservierung von Blutprodukten sowie der eigentlichen
Transfusion ins Empfängertier geben.
Gesundheitsförderung und Prävention
Authors: Thaiss Heidrun , von Rüden Ursula , Wildner Manfred
Published: October 2017

Der Anstieg der sogenannten Zivilisationskrankheiten macht deutlich, dass die Systeme der gesundheitlichen Versorgung erkrankter Menschen alleine nicht ausreichen, die damit verbundene Herausforderung zur Gesunderhaltung der Bevölkerung zu bewältigen. Notwendig ist eine spürbare proaktive Neuausrichtung der gesundheitlichen Versorgungsstrukturen hin zu mehr Prävention, Gesundheitsförderung und Gesundheitsschutz. Eine zentrale Rolle in der Vermittlung spielen dabei neben bundesweiten insbesondere die kommunalen staatlichen und nicht-staatlichen Selbstverwaltungs-bzw. Governance-Strukturen (Gesundheitskonferenzen, ÖGD u.a.m.) als bürgernahe gesellschaftliche Organisationsformen.
Ergebnisse der Evaluation der hochschulischen Erstausbildung in den therapeutischen Berufen
Authors: Darmann-Finck Ingrid , Reuschenbach Bernd
Published: October 2017

Ziel Ziel des Beitrags ist es, die Ergebnisse der Evaluation von insgesamt 13 Modellstudiengängen in den therapeutischen Gesundheitsfachberufen (tGFB) darzustellen. Beleuchtet wer-den dabei 2 Evaluationsschwerpunkte: Die strukturelle Konzeption der Studiengänge sowie die Kompetenzen der Absolventinnen und Absolventen.

Methodik Zur Strukturanalyse wurden offiziell bindende Dokumente, wie Akkreditierungsberichte, Evaluationsberichte und Modulpläne der jeweiligen Studiengänge qualitativ inhaltsanalytisch ausgewertet. Zur Kompetenzdiagnostik kamen neben validierten Fragebögen zu Selbsteinschätzungen der Studierenden (N=286) auf der Critical Incident Technique basierende Interviews mit berufserfahrenen und praktisch tätigen Therapeutinnen/Therapeutinnen, anhand derer Fremdeinschätzungen erhoben wurden (N=29), zur Anwendung.

Ergebnisse Bei der strukturellen Konzeption gelangen die Studiengänge zu Lösungen, die stark davon geprägt sind, das derzeitige Berufsrecht umzusetzen, das an vielen Stellen nicht mit hochschulischen Standards kompatibel ist. Hinsichtlich der Kompetenzen ergibt sich im Selbst- und Fremdbild ein Mehrwert durch eine hochschulische Erstausbildung v. a. bezogen auf die Befähigung zur wissenschaftlichen Arbeit. Die studiengangübergreifenden Kompetenzziele werden in der Sichtweise der befragten Absolventinnen und Absolventen und der Expertinnen und Experten in der Versorgungspraxis erreicht. Damit gelingt es den Studiengängen, diejenigen Kompetenzen aufzubauen, die erforderlich sind, um den gegenwärtigen Versorgungsanforderungen zu entsprechen.

Schlussfolgerungen Die Ergebnisse unterstützen die Empfehlung, die hochschulische Ausbildung regelhaft berufsgesetzlich zu verankern.
Infektionen des oberen Respirationstrakts bei Schildkröten
Authors: Kolesnik Ekaterina , Marschang Rachel
Published: October 2017

Erkrankungen der oberen Atemwege (URTD = upper respiratory tract disease) sind eines der
häufigsten Probleme bei Schildkröten. Rhinitis, Konjunktivitis, Stomatitis und Glossitis
werden regelmäßig beobachtet. Die Symptome reichen von Anorexie und allgemeiner Lethargie
bis hin zu Lidödemen sowie Augen- und Nasenausfluss. Als Ursache werden vor allem
Mykoplasmeninfektionen angesehen. Differenzialdiagnostisch sollten auch Herpes- oder
Ranaviren in Betracht gezogen werden. Seltener und nur bei bestimmten Spezies sind auch
Picornaviren und intranukleäre Kokzidien möglich. Zusätzlich spielen Hygiene, Temperatur
und Luftfeuchtigkeit sowie fakultativ pathogene Bakterien und Pilze eine Rolle.
Concise presentations of direct products
Authors: Bridson Martin
Published: October 2017

Direct powers of perfect groups admit more concise presentations than one might naively suppose. If

H
1

(
G
,

Z

)
=

H
2

(
G
,

Z

)
=
0

H_1(G,\mathbb {Z})=H_2(G,\mathbb {Z})=0

, then

G
n

G^n

has a presentation with

O
(
log
⁡
n
)

O(\log n)

generators and

O
(
log
⁡
n

)
3

O(\log n)^3

relators. If, in addition, there is an element

g
∈
G

g\in G

that has infinite order in every non-trivial quotient of

G
G

, then

G
n

G^n

has a presentation with

d
(
G
)
+
1

d(G) +1

generators and

O
(
log
⁡
n
)

O(\log n)

relators. The bounds that we obtain on the deficiency of

G
n

G^n

are not monotone in

n
n

; this points to potential counterexamples for the Relation Gap Problem.
Asymptotic gcd and divisible sequences for entire functions
Authors: Guo Ji , Wang Julie
Published: October 2017

Let

f
f

and

g
g

be algebraically independent entire functions. We first give an estimate of the Nevanlinna counting function for the common zeros of

f
n

−
1

f^n-1

and

g
n

−
1

g^n-1

for sufficiently large

n
n

. We then apply this estimate to study divisible sequences in the sense that

f
n

−
1

f^n-1

is divisible by

g
n

−
1

g^n-1

for infinitely many

n
n

. For the first part of establishing our gcd estimate, we need to formulate a truncated second main theorem for effective divisors by modifying a theorem from a paper by Hussein and Ru and explicitly computing the constants involved for a blowup of

P

1

×

P

1

\mathbb {P}^1\times \mathbb {P}^1

along a point with its canonical divisor and the pull-back of vertical and horizontal divisors of

P

1

×

P

1

\mathbb {P}^1\times \mathbb {P}^1

.
Person-Centered and Experiential Psychotherapies: From Carl Rogers to Contemporary Practice
Authors: Lago Colin , Behr Michael , Charura Divine , Murphy David , Stumm Gerhard
Published: October 2017

The foundations of this humanistic approach to counseling and psychotherapy were laid down in the 1940s by Carl Rogers in the United States. While this approach has seen the evolution of names ascribed to it (e.g., nondirective counseling, Client-Centered Therapy [CCT], Person-Centered Therapy [PCT], etc.), the essential guiding philosophy has been based upon a deep trusting of each individual’s capacity for resilience and growth within the context of a “helping” relationship (where both persons are in psychological contact), a relationship that was characterized by particular attitudinal elements of the therapist (unconditional positive regard, authenticity, and empathic understanding) and the client’s psychological processes, (current in-authenticity causing vulnerability or anxiety and their perception of the therapist’s intentions). Rogers recognized the importance of client experience as a reliable referent in personal change and development. His publication of several key texts in the 1950s proved influential within the field of counseling and psychotherapy and helped to disseminate the core philosophy, theoretical ideas, and emerging research outcomes emanating from the practice of Client-Centered Therapy (as it was then known). As a theory grounded within the context of interpersonal relationships, Rogers later expanded his theory building to the settings of family relationships, education, small and large group work, and groups in conflict. From early in his career, Rogers was a keen researcher, and such research activity expanded considerably upon his move into the university sector where he stimulated innovative approaches and vigorous research programs into the counseling/psychotherapy process, frequently involving other colleagues who, themselves, went on to develop specific applications of this relational approach that included play therapy, conflict resolution, student-centered teaching and group-centered leadership, and administration. Person-Centered Therapy has continued to grow and develop in the intervening decades with the addition of a wide range of theoretical and clinical postulates, with the development of differing named “tribes” of theoretical practice sharing common values and the reinvigoration of impressive research activity. This article also demonstrates clearly that this field of professional psychotherapeutic practice continues to grow apace around the world as evidenced by the publication of many new books, chapters, and articles in recent years.
Reflective Practice in the Clinical Setting: A Multi-Institutional Qualitative Study of Pediatric Faculty and Residents
Authors: Plant Jennifer , Li Su-Ting T. , Blankenburg Rebecca , Bogetz Alyssa L. , Long Michele , Butani Lavjay
Published: October 2017

Purpose

To explore when and in what form pediatric faculty and residents practice reflection.

Method

From February to June 2015, the authors conducted focus groups of pediatric faculty and residents at the University of California, Davis; Stanford University; and the University of California, San Francisco, until thematic saturation occurred. Transcripts were analyzed based on Mezirow’s and Schon’s models of reflection, using the constant comparative method associated with grounded theory. Two investigators independently coded transcripts and reconciled codes to develop themes. All investigators reviewed the codes and developed a final list of themes through consensus. Through iterative discussions, investigators developed a conceptual model of reflection in the clinical setting.

Results

Seventeen faculty and 20 residents from three institutions participated in six focus groups. Five themes emerged: triggers of reflection, intrinsic factors, extrinsic factors, timing, and outcome of reflection. Various triggers led to reflection; whether a specific trigger led to reflection depended on intrinsic and extrinsic factors. When reflection occurred, it happened in action or on action. Under optimal conditions, this reflection was goal and action directed and became critical reflection. In other instances, this process resulted in unproductive rumination or acted as an emotional release or supportive therapy.

Conclusions

Participants reflected in clinical settings, but did not always explicitly identify it as reflection or reflect in growth-promoting ways. Strategies to enhance critical reflection include developing knowledge and skills in reflection, providing performance data to inform reflection, creating time and space for safe reflection, and providing mentorship to guide the process.
Commentary: Racism and Bias in Health Professions Education: How Educators, Faculty Developers, and Researchers Can Make a Difference
Authors: Karani Reena , Varpio Lara , May Win , Horsley Tanya , Chenault John , Miller Karen Hughes , O’Brien Bridget
Published: October 2017

The Research in Medical Education (RIME) Program Planning Committee is committed to advancing scholarship in and promoting dialogue about the critical issues of racism and bias in health professions education (HPE). From the call for studies focused on underrepresented learners and faculty in medicine to the invited 2016 RIME plenary address by Dr. Camara Jones, the committee strongly believes that dismantling racism is critical to the future of HPE.

The evidence is glaring: Dramatic racial and ethnic health disparities persist in the United States, people of color remain deeply underrepresented in medical school and academic health systems as faculty, learner experiences across the medical education continuum are fraught with bias, and current approaches to teaching perpetuate stereotypes and insufficiently challenge structural inequities. To achieve racial justice in HPE, academic medicine must commit to leveraging positions of influence and contributing from these positions. In this Commentary, the authors consider three roles (educator, faculty developer, and researcher) represented by the community of scholars and pose potential research questions as well as suggestions for advancing educational research relevant to eliminating racism and bias in HPE.
Who Am I, and Who Do I Strive to Be? Applying a Theory of Self-Conscious Emotions to Medical Education
Authors: Bynum William E. , Artino Anthony R.
Published: October 2017

The self-conscious emotions of shame, guilt, and pride are a distinct set of cognitively complex, powerful, and ubiquitous emotions that arise when an individual engages in self-evaluation. Currently, little is known about the influence or outcomes of self-conscious emotions in medical learners. In this article, the authors present a leading theory of self-conscious emotions that outlines the appraisals and attributions that give rise to and differentiate shame, guilt, and two forms of pride. The authors then apply the theory to three relevant topics in medical education: perfectionism, professional identity formation, and motivation. In doing so, the authors present novel ways of viewing these topics through the lens of self-conscious emotion, suggest areas of future research, and outline a framework for emotional resilience training. Ultimately, the goal of this article is to highlight the fundamental nature of shame, guilt, and pride, which the authors believe are underappreciated and understudied in medical education, and to inform future empirical study on the role that these emotions might play in medical education. Additionally, from a practical standpoint, this article aims to encourage educators and learners to recognize self-conscious emotions in themselves and their colleagues, and to begin developing more resilient approaches to learning—approaches that acknowledge and confront shame, guilt, and pride in medical education.
The Shared Goals and Distinct Strengths of the Medical Humanities: Can the Sum of the Parts Be Greater Than the Whole?
Authors: Greene Jeremy A. , Jones David S.
Published: October 2017

Since the 1960s, faculty from diverse fields have banded together under the banner of the medical humanities, a term which unites art, literature, history, anthropology, religious studies, philosophy, and other disciplines. Arguments for the relevance of medical humanities often emphasize contributions that any of these disciplines can make to medical education, whether those involve empathy, professionalism, critical reasoning, or tolerating ambiguity. The authors argue that the constituent disciplines of the medical humanities are not interchangeable parts, but represent different perspectives and methodologies that offer their own distinct contributions to medical training. Efforts to define a role for medical humanities in medical education should pursue two strategies in parallel. On the one hand, advocates of the medical humanities should continue to make the case for the shared contributions that all of the disciplines can make to medical education. But advocates for the medical humanities should also emphasize the valuable contributions of each specific discipline, in terms that medical educators can understand. The authors illustrate this point by delineating contributions of their own discipline, medical history. Historical analysis contributes essential insights to the understanding of disease, therapeutics, and institutions—things that all physicians must know in order to be effective as clinicians, just as they must learn anatomy or pathophysiology. Analogous but different arguments can be made for literature, philosophy, and the other disciplines that constitute the medical humanities. The field of medical humanities will be most successful if it builds on both the shared and the distinct contributions of its disciplines.
Mutational and epigenetic signatures in cancer tissue linked to environmental exposures and lifestyle
Authors: Perduca Vittorio , Omichessan Hanane , Baglietto Laura , Severi Gianluca
Published: October 2017

Purpose of review

In this article, we describe how recent advances in the study of mutational and epigenetic signatures in tumours provide new opportunities to understand the role of the environment and lifestyle in cancer development.

Recent findings

Cancer-related mutational events have been investigated for decades but only recently the wide availability of genomic sequences and epigenomic data from thousands of cancer genomes has made it possible to identify numerous distinct mutational and epigenetic signatures through the application of advanced mathematical models. Some of these signatures have been linked to endogenous factors such as defective DNA repair or the action of APOBEC cytidine deaminases and to exogenous factors such as tobacco smoke, ultraviolet light, aflatoxins, aristolochic acid and ionizing radiation. More recently, it has been shown that exposure to factors such as tobacco smoke may also leave marks in the DNA methylation profile of both normal and tumour tissue in target organs.

The analysis of mutational and epigenetic signatures is a novel and useful tool to study cancer. Their application to experimental studies and to studies with detailed data on environmental exposures and lifestyle is likely to improve our understanding of how the environment and lifestyle influence cancer development and its evolution.
Lysine methylation signaling in pancreatic cancer
Authors: Roth Gaël S. , Casanova Alexandre G. , Lemonnier Nathanaël , Reynoird Nicolas
Published: October 2017

Purpose of review

Despite better knowledge of its genetic basis, pancreatic cancer is still highly lethal with very few therapeutic options. In this review, we discuss the potential impact of epigenetic therapies, focusing on lysine methylation signaling and its implication in pancreatic cancer.

Recent findings

Protein lysine methylation, a key mechanism of posttranslational modifications of histone proteins, has emerged as a major cell signaling mechanism regulating physiologic and pathologic processes including cancer. This finely tuned and dynamic signaling mechanism is regulated by lysine methyltransferases (KMT), lysine demethylases (KDM) and signal transducers harboring methyl-binding domains. Recent evidence demonstrates that overexpression of cytoplasmic KMT and resulting enhanced lysine methylation is a reversible event that enhances oncogenic signaling through the Ras and Mitogen-Activated Protein Kinases pathway in pancreatic cancer, opening perspectives for new anticancer chemotherapeutics aimed at controlling these activities.

The development of potent and specific inhibitors of lysine methylation signaling may represent a hitherto largely unexplored avenue for new forms of targeted therapy in cancer, with great potential for yet hard-to-treat cancers such as pancreatic cancer.
Cisplatin, dacarbazine and vinblastine as first line chemotherapy for liver metastatic uveal melanoma in the era of immunotherapy: a single institution phase II study
Authors: Schinzari Giovanni , Rossi Ernesto , Cassano Alessandra , Dadduzio Vincenzo , Quirino Michela , Pagliara Monica , Blasi Maria A. , Barone Carlo
Published: October 2017

No standard therapy is established for metastatic uveal melanoma. Liver involvement in uveal melanoma may lead to organ impairment, which represents a common cause of death. Tumor shrinkage might improve survival by delaying hepatic failure. Since the combination of cisplatin, vinblastine, dacarbazine allowed a high response rate in metastatic cutaneous melanoma, we explored efficacy and safety of this regimen in unresectable liver metastases of uveal melanoma. In the present phase II study we administered intravenously cisplatin (80 mg/mq, day 1), dacarbazine (250 mg/mq/day, days 1–3), vinblastine (2 mg maximum, day 1) every 21 days as first line treatment for patients with unresectable metastases of uveal melanoma and BRAF wild type. Primary endpoint was objective response rate; overall survival (OS), progression-free survival and toxicity were secondary endpoints. Partial responses were observed in five (20%) patients, stable disease in 12 (48%) patients; disease control rate was 68%. Median OS of all the patients was 13 months, median progression free survival was 5.5 months. OS of responding patients was 21 months; OS of patients with disease control was 18 months, significantly longer than survival of progressing patients (7 months, P=0.0003). Five (20%) patients experienced grade 3–4 toxicity. Combination of cisplatin, vinblastine and dacarbazine was feasible and demonstrate both an interesting objective response rate and a survival benefit for patients achieving a disease control. This regimen could be considered for patients with good performance status and unresectable liver limited disease.
Overexpression of mRNA-decapping enzyme 1a predicts disease-specific survival in malignant melanoma
Authors: Tang Yong , Xie Chao , Zhang Yu , Qin You , Zhang Weikang
Published: October 2017

Our previous study identified that rs11551405 A allele located at the 3′ UTR of mRNA-decapping enzyme 1a (DCP1A) was associated with an increased risk for malignant melanoma (MM). The aim of this study was to investigate whether that association is manifested at the DCP1A expression and whether an altered DCP1A expression can predict disease-specific survival (DSS) of MM patients. The DCP1A expression in specimens of 56 cases of primary MM (23 cases at TNM stage I–II and 33 cases at TNM stage III–IV) and 43 cases of benign nevi (BN) was measured by quantitative RT-PCR (qRT-PCR), immunohistochemistry, and western blotting. The levels of DCP1A expression and the clinical characteristics of the patients were recorded and compared, along with the DSS within the 3 years of follow-up. The average relative mRNA level of DCP1A was significantly (P=0.002) higher in the MM tissues (0.159±0.007) than that shown in the BN tissues (0.122±0.009). The DCP1A immunohistochemistry scores of MM samples (5.55±2.56) were significantly (P<0.001) higher than those of the BN samples (3.58±3.66). Tissue protein levels of DCP1A in MM (0.378±0.021) were much (P<0.05) higher than those in BN tissues (0.265±0.017). Higher DCP1A expression was significantly correlated with shorter DSS time in patients with MM (P<0.05). The multivariate Cox regression analysis revealed that DCP1A expression was an independent prognostic factor for DSS (hazard ratio=1.648, P=0.021). Elevation of DCP1A expression may be an epigenetic contributing factor for oncogenesis of MM, and high DCP1A level may predict an unfavorable prognosis for MM.
Effect of Histocompatibility Y Antigen Matching on Graft Survival in Primary Penetrating Keratoplasty
Authors: Kim Mi Jin , Kim Joo Hyun , Jeon Hyun Sun , Wee Won Ryang , Hyon Joon Young
Published: October 2017

Purpose:

To investigate the influence of histocompatibility Y (H-Y) antigen matching on corneal graft survival in primary penetrating keratoplasty (PK).

Methods:

Medical records of patients who underwent primary PK at Seoul National University Bundang Hospital between June 2005 and October 2015 were retrospectively analyzed. The eyes were classified into 2 groups: H-Y-compatible (115 eyes) and H-Y-incompatible (23 eyes). The H-Y-compatible group included donor/recipient combinations of male/male (57 eyes), female/male (44 eyes), and female/female (14 eyes). The H-Y-incompatible group included the male/female (23 eyes) combination alone. A subgroup analysis of low- and high-risk patients according to preoperative diagnoses was also performed. Survival analysis was conducted using the Kaplan–Meier method; differences between groups were assessed with a log-rank test.

Results:

A total of 138 eyes from 136 patients (age: 58 ± 18 years) were enrolled. Rejection-free graft survival and graft survival were not significantly different between H-Y-compatible and H-Y-incompatible groups (χ2 = 0.4, P = 0.548; χ2 = 1.9; P = 0.17, respectively). Preoperative diagnoses of high-risk cases included those with corneal perforation or thinning (8.7%) and infectious keratitis (7.2%). Low-risk cases included corneal opacity (50.0%), bullous keratopathy (25.4%), keratoconus (5.8%), and corneal dystrophy (2.9%). In the high-risk group, rejection-free graft survival rate was significantly higher in the H-Y-compatible group (χ2 = 3.9, P = 0.049).

Conclusions:

H-Y antigen matching does not influence graft rejection and failure in cases of primary PK. However, matching the H-Y antigen could help reduce graft rejection, especially in preoperatively high-risk patients.
Hypoxia and the Prolyl Hydroxylase Inhibitor FG-4592 Protect Corneal Endothelial Cells From Mechanical and Perioperative Surgical Stress
Authors: Bhadange Yogesh , Lautert Jeferson , Li Shimin , Lawando Edward , Kim Edward T. , Soper Mark C. , Price Francis W. , Price Marianne O. , Bonanno Joseph A.
Published: October 2017

Purpose:

To determine whether hypoxia preconditioning can protect corneal endothelial cells from mechanical stress and perioperative procedures mimicking Descemet stripping automated endothelial keratoplasty (DSAEK).

Methods:

Preconditioning was delivered by 2 hours of 0.5% oxygen incubation in a hypoxia chamber or by exposure to the prolyl hydroxylase inhibitor FG-4592, which prevents hypoxia-inducible factor-1 alpha degradation. Damage to whole corneas was produced by brief sonication. To mimic use with DSAEK, FG-4592-preconditioned and control donor corneas were dissected with a microkeratome, and the posterior donor button was pulled through a transplant insertion device (Busin glide). The area of endothelial damage was determined by trypan blue staining.

Results:

In all cases, hypoxia preconditioning or incubation with FG-4592 protected corneal endothelial cells from death by mechanical stress. Hypoxia-preconditioned human and rabbit corneas showed 19% and 29% less cell loss, respectively, relative to controls, which were both significant at P < 0.05. FG-4592 preconditioning reduced endothelial cell loss associated with preparation and insertion of DSAEK grafts by 23% relative to the control (P < 0.01).

Conclusions:

These results support the hypothesis that preconditioning by hypoxia or exposure to FG-4592 improves corneal endothelial cell survival and may also provide protection during surgical trauma.
Absence of Zika virus in abortion and placental tissue in a German cohort
Authors: Mletzko Judith , Schildgen Oliver
Published: October 2017

In this study, we verified the hypothesis that the Zika virus (ZIKV) so far solely occurs as an imported zoonosis and is not yet circulating in a cohort in Germany. We have tested tissue specimens from abortions and placentas collected from 300 patients treated at the gynecology department of our hospital. Not surprisingly, although control specimens tested positive for ZIKV by reverse transcription-PCR, none of the tissue specimens contained viral RNA, thus supporting the hypothesis that ZIKV spread is limited to tropical and subtropical areas.
Examination of the reliability of Gait Assessment and Intervention Tool in patients with a stroke
Authors: Molina-Rueda Francisco , Carratalá-Tejada María , Cano de la Cuerda Roberto , Alguacil-Diego Isabel M. , Miangolarra Page Juan Carlos , Cuesta-Gómez Alicia
Published: October 2017

The Gait Assessment and Intervention Tool (GAIT) has been recently developed for gait assessment in patients with stroke, and it is considered as a tool that may identify clinically relevant deviations from normal gait and quantifies relevant changes in gait because of an intervention. The objective was to analyze the GAIT psychometric properties in participants with stroke. A convenience sample of 15 adults with stroke was selected (58.15±7.8 years; 5.38±3.3 years from injury). We used the GAIT for evaluating the gait in patients with stroke. GAIT scoring is based on observations of anterior/posterior and lateral-view video documents. Inter-rater reliability of the GAIT between trained raters was good (intraclass correlation coefficient=0.762; P=0.008; 95% confidence interval=0.749–0.926). The minimal detectable change was 7.68 points (12.39%). Inter-rater reliability for the hip, knee, and ankle items was also good. In conclusion, the current study demonstrated that GAIT has good inter-rater reliability and good internal consistency.
Recurrent RET Gene Rearrangements in Intraductal Carcinomas of Salivary Gland
Authors: Weinreb Ilan , Bishop Justin A. , Chiosea Simion I. , Seethala Raja R. , Perez-Ordonez Bayardo , Zhang Lei , Sung Yun-Shao , Chen Chun-Liang , Assaad Adel , Oliai Bahram R. , Antonescu Cristina R.
Published: October 2017

Intraductal carcinoma (IC) is the World Health Organization designation for lesions previously called low-grade cribriform cystadenocarcinoma. The relationship of IC to salivary duct carcinoma (SDC) is controversial, but currently these are considered distinct entities. It is hypothesized that IC and SDC should have different genomic signatures that may be identifiable by next-generation sequencing. A total of 23 ICs were identified: 14 pure IC and 9 invasive carcinomas with an intraductal component. Five invasive carcinomas were subjected to next-generation paired-end RNA sequencing. Data analysis was performed using FusionSeq and Mutation detection algorithms (MuTect and VarScan) for variant callers. Gene fusion candidates were validated by fluorescence in situ hybridization and reverse transcription polymerase chain reaction, and mutations by Sanger sequencing. Among the 9 invasive carcinomas, all except 1 were apocrine SDCs with an intraductal component. The remaining case showed typical intercalated duct type IC with invasive adenocarcinoma. The 14 pure ICs had typical intercalated duct features (2 showed hybrid intercalated/apocrine features). RNA sequencing predicted a NCOA4-RET fusion, confirmed by reverse transcription polymerase chain reaction, in the intercalated duct type IC invasive component. Six additional cases of pure IC showed RET rearrangement by fluorescence in situ hybridization (7/15=47%). No apocrine carcinomas showed RET rearrangement. RNA sequencing and Sanger sequencing identified PIK3CA (p.E545K/p.H1047R) and/or HRAS (p.Q61R) hotspot mutations in 6 of 8 (75%) apocrine carcinomas. In conclusion, 2 distinctive types of intraductal lesions are emerging based on molecular analysis. Classic intercalated type ICs commonly harbor fusions involving RET and rarely show widespread invasion. Apocrine intraductal lesions are typically associated with widespread invasion with no pure examples and show similar PIK3CA and HRAS mutations to SDC.
A “Trans-Dyadic” Perspective on the Goldwater Rule
Authors: PLAKUN ERIC M.
Published: October 2017

The Goldwater Rule has been debated, redefined, and debated further since the election of Donald Trump as President of the United States. This column offers a perspective on the Goldwater Rule that moves beyond psychiatry’s current preoccupation with precision DSM-5 diagnosis of individuals, which ethically requires consent or other legal authorization for release of diagnostic information to others, and into the realm of leadership as seen through the “trans-dyadic” lens of psychoanalytic understanding of large group processes on a societal level. Concepts from large group psychology are introduced to illustrate “trans-dyadic” perspectives on leadership that do not challenge the Goldwater Rule.
The Role of Computed Tomographic Angiography in Predicting Left Anterior Descending Artery Graftability When Catheter Angiography is Inconclusive
Authors: Abazid Rami M. , Smettei Osama A. , Khalaf Hassan H. , Soomro Tariq , Ali Dar Mehboob , Tamim Muhammad , Farouk Khaled , Ahmed Fazel , Al-Mallah Mouaz H.
Published: October 2017

Purpose:

Graftability of the left anterior descending artery (LAD) has important prognostic value for coronary artery bypass graft (CABG) surgery. However, with a chronic total occlusion (CTO) of the LAD, invasive coronary angiography (ICA) may be insufficient to determine its graftability. We evaluated the role of coronary computed tomographic angiography (CTA) in the assessment of CTO and LAD graftability when the distal vessel segment was incompletely visualized by ICA.

Materials and Methods:

We enrolled 31 patients with equivocal eligibility for CABG due to CTO of the LAD with poor distal flow defined by ICA. Patients with LAD diameters ≥1.5 mm by CTA underwent CABG surgery, and the vessel diameter was reassessed intraoperatively.

Results:

The mean age was 54±14 years. Seven patients (23%) had suitable LAD targets on CTA and underwent successful CABG. Another 24 patients (77%) had nongraftable LADs. Patients with a graftable LAD showed no significant difference between mean LAD diameter measured by CTA and during surgery (1.6±0.3 vs. 1.5±0.3 mm, P=0.21). The preoperative left ventricular ejection fraction was not significantly different between groups (35%±8% vs. 35%±7%, P=0.2). However, after a mean follow-up of 21±7 months, left ventricular ejection fraction was significantly higher in vascularized patients (41%±5.8% vs. 34%±8%, P=0.01, respectively). Six of 7 patients had patent LAD grafts on CTA at 1-year follow-up.

Conclusion:

CTA may provide valuable information about chronically occluded LAD size and graftability when ICA is inconclusive.