bluuebunny/crossref_metadata_2025 huggingface dataset:
Bidirectional tunable ferrite-piezoelectric trilayer magnetoelectric inductors
Authors: Zhang Jitao , Chen Dongyu , Filippov D. A. , Li Kang , Zhang Qingfang , Jiang Liying , Zhu Weiwei , Cao Lingzhi , Srinivasan Gopalan
Published: September 2018

A tunable magnetoelectric inductor composed of a symmetrical trilayer of Ga-doped NiZn ferrite and PZT in a solenoid has been developed. Under the influence of external electric/magnetic fields, the permeability variation arising from magnetostriction and piezoelectric strain in the composite results in a bidirectional tuning of the inductance L with a maximum tunability of 571% at a lower magnetic field. The largest variation in L occurs for frequencies centered around longitudinal acoustic resonance. The dual and large tunability of L is of importance for applications in compact and power-efficient integrated circuits.
LaInO3/BaSnO3 polar interface on MgO substrates
Authors: Kim Youjung , Kim Young Mo , Shin Juyeon , Char Kookrin
Published: September 2018

We report on a new property of the LaInO3 (LIO)/(Ba,La)SnO3 (BLSO) polar interface using MgO substrates. The growth of well-formed LIO/BLSO interface structures on non-perovskite MgO substrates was confirmed by reciprocal space mapping image and transmission electron microscopy. Subsequently, we measured electrical properties as a function of the La doping rate of the BLSO layer and found that the LIO/BLSO polar interface shows conductance enhancement after the deposition of the polar LaInO3 layer on the BLSO layer, in agreement with our earlier results on SrTiO3 (STO) substrates. However, different electrical properties of the interfaces were found on MgO from those on STO substrates; we observed conductance enhancement even at the interface with undoped BaSnO3 (BSO) on the MgO substrates. We attribute such different behavior to the difference in the Fermi levels of BSO on MgO and STO substrates, either due to the larger donor density or the smaller acceptor density in BSO on MgO. Using such a nominally undoped interface, we fabricated the field effect transistors and presented their performances with Ion/Ioff ∼ 109.
On the memory kernel and the reduced system propagator
Authors: Kidon Lyran , Wang Haobin , Thoss Michael , Rabani Eran
Published: September 2018

We relate the memory kernel in the Nakajima–Zwanzig–Mori time-convolution approach to the reduced system propagator which is often used to obtain the kernel in the Tokuyama–Mori time-convolutionless approach. The connection provides a robust and simple formalism to compute the memory kernel for a generalized system-bath model circumventing the need to compute high order system-bath observables, thus streamlining the use of numerically exact solvers for calculating the memory kernel. We illustrate this for a model system with electron-electron and electron-phonon couplings, driven away from equilibrium.
Effect of supplementing moringa (Moringa oleifera) leaf meal and pomegranate (Punica granatum) peel meal on performance, carcass attributes, immune and antioxidant responses in broiler chickens
Authors: Rama Rao S. V. , Raju M. V. L. N. , Prakash B. , Rajkumar U. , Reddy E. P. K.
Published: September 2018

An experiment was conducted to study the benefits of dietary supplementation of moringa (Moringa oleifera) leaf meal (MLM) and pomegranate (Punica granatum) peel meal (PPM) on the performance, carcass attributes, immune and antioxidant responses in commercial broiler chickens during 1–42 days of age. In total, 450 Cobb-400 broiler male chicks raised in wire-floor stainless-steel battery brooder pens in an open-side poultry house were divided into five experimental groups with 18 replicates of five chicks each and fed a standard control diet (CD) and the test diets supplemented with MLM (500 and 1000 mg/kg) or PPM (250 and 500 mg/kg), each at two different concentrations. Bodyweight gain, feed conversion efficiency and carcass attributes were not affected (P > 0.05). The cell-mediated immune response to phytohaemagglutinin phosphate was not influenced (P > 0.05), but the antibody titre against Newcastle disease (ND) vaccine was significantly (P < 0.05) improved by supplementation of MLM or PPM in broiler diet at 42 days of age. However, at 21 days of age, the ND titre was similar in broilers fed CD and 500 mg/kg PPM fed group. Activities of glutathione reductase and super oxide dismutase in liver were not influenced (P > 0.05), while lipid peroxidation (LP) reduced significantly (P < 0.05) with the herbal additives. The LP in the PPM group was significantly (P < 0.05) lower than that in groups fed MLM. The activity of glutathione peroxidase (GSHPx) was significantly (P < 0.05) improved in the PPM group. Activities of antioxidant enzymes (super oxide dismutase, glutathione reductase, GSHPx) in spleen were not influenced (P > 0.05). The degree of LP in the 500 mg/kg PPM group was significantly (P < 0.05) lower than that in groups fed the CD. It is concluded that supplementation of MLM (500 and 1000 mg/kg) or PPM (250 and 500 mg/kg) in diets improved humoral immune response (against ND vaccine) at 42 days of age and reduced LP in liver in commercial broilers, without showing any negative effects on performance and carcass attributes. Supplementation of PPM (250 and 500 mg/kg) significantly improved the activity of GSHPx in the liver of broiler chickens.
Homologous recombination is an intrinsic defense against antiviral RNA interference
Authors: Aguado Lauren C. , Jordan Tristan X. , Hsieh Emily , Blanco-Melo Daniel , Heard John , Panis Maryline , Vignuzzi Marco , tenOever Benjamin R.
Published: September 2018

RNA interference (RNAi) is the major antiviral defense mechanism of plants and invertebrates, rendering the capacity to evade it a defining factor in shaping the viral landscape. Here we sought to determine whether different virus replication strategies provided any inherent capacity to evade RNAi in the absence of an antagonist. Through the exploitation of host microRNAs, we recreated an RNAi-like environment in vertebrates and directly compared the capacity of positive- and negative-stranded RNA viruses to cope with this selective pressure. Applying this defense against four distinct viral families revealed that the capacity to undergo homologous recombination was the defining attribute that enabled evasion of this defense. Independent of gene expression strategy, positive-stranded RNA viruses that could undergo strand switching rapidly excised genomic material, while negative-stranded viruses were effectively targeted and cleared upon RNAi-based selection. These data suggest a dynamic relationship between host antiviral defenses and the biology of virus replication in shaping pathogen prevalence.
Organizational change: insights from Buddhism and Acceptance and Commitment Therapy(ACT)
Authors: Goltz Sonia M.
Published: September 2018

Adaptation to change takes longer because of emotions employees experience such as discomfort, anxiety, or grief. Research suggests experiencing rather than avoiding discomfort and experiencing it within the psychological safety of nonjudgment help individuals adapt to change. However,
the large literature on resistance to change suggests that avoidance is more common. This paper describes two practices that are effective at allowing for discomfort with nonjudgment, Buddhism and Acceptance and Commitment Therapy (ACT), and proposes that insights from these practices be used
to help organizations implement change. Specifically, it is important to view suffering as inherent and accept this suffering as well as to pursue values in the midst of this discomfort using the transcendent self. Implications for the practice and study of organizational change are discussed.
Do Walmart Supercenters Improve Food Security?
Authors: Courtemanche Charles , Carden Art , Zhou Xilin , Ndirangu Murugi
Published: September 2018

This paper examines the effect that Walmart Supercenters, which lower food prices and expand food availability, have on food insecurity. Data come from the 2001–2012 Current Population Survey Food Security Supplements matched to Walmart Supercenter entry dates and locations. Using instrumental variables models that leverage Walmart’s predictable expansion pattern outward from corporate headquarters, we find that closer proximity to a Walmart Supercenter improves household and child food security, as measured by affirmative responses to a food insecurity questionnaire and an indicator for food insecurity. The effects are largest among low‐income households and children but are also sizeable for middle‐income children.
Explaining the 2016 Vote for President Trump across U.S. Counties
Authors: Goetz Stephan J. , Davlasheridze Meri , Han Yicheol , Fleming-Muñoz David A.
Published: September 2018

We examine how county characteristics affected voting outcomes in the 2016 presidential election, including the populist component represented by the President Trump to Mitt Romney vote difference. Different voter groups could be harmed or helped by policies proposed during the campaign, such as withdrawal from trade agreements, environmental deregulation, and spending cuts. We investigate whether average county‐level voting patterns reflected such proposals. Race and educational attainment had large statistical impacts, but economic factors and religious adherence also mattered. The Trump vote share and Trump‐Romney vote margin were larger in counties with more farming and coal employment.
Chromosome-level reference genome and alternative splicing atlas of moso bamboo (Phyllostachys edulis)
Authors: Zhao Hansheng , Gao Zhimin , Wang Le , Wang Jiongliang , Wang Songbo , Fei Benhua , Chen Chunhai , Shi Chengcheng , Liu Xiaochuan , Zhang Hailin , Lou Yongfeng , Chen LianFu , Sun Huayu , Zhou Xianqiang , Wang Sining , Zhang Chi , Xu Hao , Li Lichao , Yang Yihong , Wei Yanli , Yang Wei , Gao Qiang , Yang Huanming , Zhao Shancen , Jiang Zehui
Published: September 2018

Background

Bamboo is one of the most important nontimber forestry products worldwide. However, a chromosome-level reference genome is lacking, and an evolutionary view of alternative splicing (AS) in bamboo remains unclear despite emerging omics data and improved technologies.

Results

Here, we provide a chromosome-level de novo genome assembly of moso bamboo (Phyllostachys edulis) using additional abundance sequencing data and a Hi-C scaffolding strategy. The significantly improved genome is a scaffold N50 of 79.90 Mb, approximately 243 times longer than the previous version. A total of 51,074 high-quality protein-coding loci with intact structures were identified using single-molecule real-time sequencing and manual verification. Moreover, we provide a comprehensive AS profile based on the identification of 266,711 unique AS events in 25,225 AS genes by large-scale transcriptomic sequencing of 26 representative bamboo tissues using both the Illumina and Pacific Biosciences sequencing platforms. Through comparisons with orthologous genes in related plant species, we observed that the AS genes are concentrated among more conserved genes that tend to accumulate higher transcript levels and share less tissue specificity. Furthermore, gene family expansion, abundant AS, and positive selection were identified in crucial genes involved in the lignin biosynthetic pathway of moso bamboo.

Conclusions

These fundamental studies provide useful information for future in-depth analyses of comparative genome and AS features. Additionally, our results highlight a global perspective of AS during evolution and diversification in bamboo.
Mayo Clinic Antimicrobial Therapy
Authors: Wilson John W. , Estes Lynn L.
Published: September 2018

The medical management of infectious diseases and antimicrobial therapy can be a daunting task for health care professionals. Although expansive textbooks and online resources are available, we believe that a more simplified, quick reference guide is needed for the day-to-day office and hospital clinical practice. This book is designed to provide information about infectious diseases and antimicrobial therapy in a format that is readily accessible and easily applicable to the clinical environment. Highlights of this book include simplified and thorough drug dosing recommendations for renal function and renal replacement therapies, drugs of choice for specific organisms (including bacteria, fungi, and viruses), and simplified antimicrobial and management recommendations for specific infectious syndromes.
Treatment of Specific Organisms
Authors: Wilson John W. , Estes Lynn L.
Published: September 2018

This section contains tables covering spectrum of activity, preferred treatment and alternate treatment options various classes of bacteria, fungi, and viruses. Bacterial drug resistance issues are also reviewed.
Aetiology of fetal heart disease
Authors: Archer Nick , Manning Nicky
Published: September 2018

This chapter discusses the aetiology of fetal heart disease, including discussion on maternal factors, genetic factors, genetic causes, risk of associated non-cardiac anomalies, prevention of congenital heart disease, and the fetal origins of health and disease.
The normal heart
Authors: Archer Nick , Manning Nicky
Published: September 2018

This chapter discusses the normal heart, including discussing embryology, anatomy, fetal circulation, physiology, and changes at birth.
Indications for fetal echocardiography
Authors: Archer Nick , Manning Nicky
Published: September 2018

This chapter discusses indications for fetal echocardiography, and includes indications for a detailed cardiac scan.
Fetal echocardiography
Authors: Archer Nick , Manning Nicky
Published: September 2018

This chapter considers fetal echocardiography, including discussion on clinical application of relevant physics, general principles of performing a fetal cardiac scan, the basic cardiac scan, fetal echocardiography, and advanced imaging.
Abnormal ventriculoarterial connections
Authors: Archer Nick , Manning Nicky
Published: September 2018

This chapter explores abnormal ventriculoarterial connections, including an introduction, transposition of the great arteries, congenitally corrected transposition of the great arteries, and the common arterial trunk.
Cardiac function
Authors: Archer Nick , Manning Nicky
Published: September 2018

This chapter explores cardiac function, including assessment of cardiac function (comprising introduction, a discussion of ductus venosus, and general methods).
Cardiac tumours
Authors: Archer Nick , Manning Nicky
Published: September 2018

This chapter explores cardiac tumours, including an introduction, and discussion on echogenic foci, rhabdomyoma, teratoma, fibroma, haemangioma, and myxoma.
Hydrops and the heart
Authors: Archer Nick , Manning Nicky
Published: September 2018

This chapter explores hydrops and the heart, including an introduction, and discussion on pathophysiology, aetiology, assessment and monitoring, and management.
Twins and the heart
Authors: Archer Nick , Manning Nicky
Published: September 2018

This chapter explores twins and the heart, including an introduction, and discussion on antenatal diagnosis of types of twin, cardiac complications of monochorionic twins, the twin-twin transfusion syndrome and the heart, and the role of fetal echo-cardiography in twin pregnancies.
Basics of Statistics
Authors: Suemoto Claudia Kimie , Lee Catherine , Fregni Felipe
Published: September 2018

This chapter discusses the first step in statistical analysis: the descriptive statistics and data classification. It is the first contact of the researcher with the data, and it is very important to understand the characteristics of the sample, including the presence of missing data and outliers. To perform this step, the investigator needs to learn the types of variables (i.e. numerical and categorical), and the measures to summarize them. In the case of numerical variables, it is also important to check whether the data follow a normal distribution. Researchers usually use mean and standard deviation for numerical variables, and absolute and relative frequencies for categorical ones. In addition to summary measures, different graphs are used to represent the data. Understanding the data is a critical step in choosing the statistical test, as is discussed further in the next chapters.
Other Issues in Statistics I
Authors: Jorquiera Tamara , Lee Hang , Fregni Felipe , Brunoni Andre
Published: September 2018

This chapter discusses the problem of incomplete or missing data. The three types of missing data mechanisms are examined: missing completely at random (MCAR), missing at random (MAR), and missing not at random (MNAR). It discusses how to reduce its occurrence using trial design and improving the data collection process. The chapter also provides methods to control this factor during the analysis stage, using some strategies such as not replacing the lost data (complete case analysis), replacing each lost value with a single value (single imputation), replacing the lost data with multiple values for each lost observation (multiple imputation). It then discusses sensitivity analysis, which measures the impact on the results from different methods of handling missing data, and it helps to justify the choice of the particular method applied. Finally, it reviews covariate adjustment as another topic in statistics.
Other Issues in Statistics II
Authors: Leite Jorge , Boodhwani Munir , Fregni Felipe
Published: September 2018

This chapter focuses on two important concepts: subgroup analysis and meta-analysis. Subgroup analysis is especially concerned about variability and how treatment effects can differ due to specific characteristics of the population. Important issues, however, arise when planning for subgroup analysis, such as dealing with false positives and methods for dealing with multiple statistical comparisons. The chapter also points out that the analysis of data from subgroups of patients with certain baseline characteristics is typically insufficient to change general clinical practice. The second section of this chapter focuses on meta-analysis, which is a method of pooling data from several studies in order to quantify the overall effect of an intervention or exposure, and thus potentially change clinical practice. This section discusses data search and synthesis, quantification of heterogeneity, choice of fixed or random model, as well as sensitivity analysis.
Adaptive Trials and Interim Analysis
Authors: Andrade Priscila Caldeira , Atassi Nazem , Castillo-Saavedra Laura , Brunoni Andre , Fregni Felipe
Published: September 2018

This chapter discusses the important aspect of changing trial aspects, including analyzing data, before formal completion of a trial. Interim analysis (or analyses before trial is finished) should be planned and described in the study protocol, before starting the trial, to ensure the potential penalties for doing such analyses do not invalidate trial results and/or satisfy ethical requirements. The chapter discusses reasons and methods to perform interim analysis. Based on the results from interim analysis, some adjustments in the trial should be required, including early termination. Although the main goal of adaptive design is to increase the success of clinical development, making the studies more efficient and more likely to demonstrate the effect of a treatment, the investigator needs to be careful when using these methods as they can also introduce other potential biases in the study.
Integrity in Research
Authors: Carvalho Sandra , Rivara Gustavo , Brunoni Andre , Fregni Felipe
Published: September 2018

This chapter discusses authorship, ethics in research, plagiarism, and misconduct. It summarizes the general criteria for scientific report authorship according to the International Committee of Medical Journal Editors (ICMJE) and Ethics in Research. It discusses ethics in research, based on the famous Tuskegee syphilis study, and the Belmont Report that followed it. Three basic ethical principles derived from the Belmont Report—respect for persons, beneficence, and justice—and their impact on research with human subjects are discussed, along with the direct applications of these three ethical principles: informed consent, risk/benefit ratio, and subject selection. Finally, the chapter reviews the main aspects of research misconduct and presents some examples. Research integrity requires that the research process is governed by honesty, objectivity, and verifiable methods, instead of preconceived ideas and expectations. It is an important topic to be reviewed and discussed before anyone decides to pursue the field of clinical research.
Association of thyroid status prior to transition to end-stage renal disease with early dialysis mortality
Authors: You Amy S , Sim John J , Kovesdy Csaba P , Streja Elani , Nguyen Danh V , Brent Gregory A , Kalantar-Zadeh Kamyar , Rhee Connie M
Published: September 2018

Background

Advanced chronic kidney disease (CKD) patients, including those receiving dialysis, have a high prevalence of thyroid dysfunction. Although hypothyroidism is associated with higher death risk in end-stage renal disease (ESRD) patients, no studies have examined whether thyroid status in the pre-ESRD period impacts mortality after dialysis initiation.

Methods

Among US veterans with CKD identified from the national Veterans Affairs database that transitioned to dialysis over the period from October 2007 to September 2011, we examined the association of pre-ESRD serum thyrotropin (TSH) levels averaged over the 1-year pre-dialysis (‘prelude’) period with all-cause mortality in the first year following dialysis initiation.

Results

Among 15 335 patients in the 1-year prelude cohort, TSH levels >5.0 mIU/L were associated with higher mortality in expanded case-mix Cox models (reference: TSH 0.5–5.0 mIU/L): adjusted hazard ratio (aHR) [95% confidence interval (CI) 1.20 (1.07–1.33). Similar findings were observed for TSH >5.0 mIU/L and mortality in the 2- and 5-year cohorts: aHRs (95% CI) 1.11 (1.02–1.21) and 1.15 (1.07–1.24), respectively. Analyses of finer gradations of TSH in the 1-year prelude cohort demonstrated that incrementally higher levels >5.0 mIU/L were associated with increasingly higher mortality in expanded case-mix models (reference: TSH 0.5–3.0 mIU/L): aHRs (95% CI) 1.18 (1.04–1.33) and 1.28 (1.03–1.59) for TSH levels >5.0–10.0 mIU/L and >10.0 mIU/L, respectively. In the 2- and 5-year cohorts, mortality associations persisted most strongly for those with TSH >10.0 mIU/L, particularly after laboratory covariate adjustment.

Conclusions

Among new ESRD patients, there is a dose-dependent relationship between higher pre-ESRD TSH levels >5.0 mIU/L and post-ESRD mortality. Further studies are needed to determine the impact of TSH reduction with thyroid hormone supplementation in this population.
Rapid Development of High-Level Resistance to Dolutegravir With Emergence of T97A Mutation in 2 Treatment-Experienced Individuals With Baseline Partial Sensitivity to Dolutegravir
Authors: George Jomy M , Kuriakose Safia S , Dee Nicola , Stoll Pam , Lalani Tahaniyat , Dewar Robin , Khan Muhammad A , Rehman Muhammad T , Grossman Zehava , Maldarelli Frank , Pau Alice K
Published: September 2018

HIV integrase mutation T97A emerges after suboptimal therapy with integrase strand transfer inhibitors (INSTIs), but the contribution of T97A to dolutegravir resistance remains uncertain. Here we report >10-fold increase in dolutegravir resistance after the single addition of T97A in 2 individuals with prior INSTI resistance receiving dolutegravir salvage therapy.
Expanding the Spectrum of Robotic Assistance in Cranial Neurosurgery
Authors: Pillai Ashok , Ratnathankom Ayyadurai , Ramachandran Sreehari N , Udayakumaran Suhas , Subhash Pramod , Krishnadas Arjun
Published: September 2018

BACKGROUND

Robotic automation and haptic guidance have multiple applications in neurosurgery.

OBJECTIVE

To define the spectrum of cranial procedures potentially benefiting from robotic assistance in a university hospital neurosurgical practice setting.

METHODS

Procedures utilizing robotic assistance during a 24-mo period were retrospectively analyzed and classified as stereotactic or endoscopic based on the mode utilized in the ROSA system (Zimmer Biomet, Warsaw, Indiana). Machine log file data were retrospectively analyzed to compare registration accuracy using 3 different methods: (1) facial laser scanning, (2) bone fiduciary, or (3) skin fiduciary.

RESULTS

Two hundred seven cranial neurosurgical procedures utilizing robotic assistance were performed in a 24-mo period. One hundred forty-five procedures utilizing the stereotactic mode included 33% stereotactic biopsy, 31% Stereo-EEG electrode insertion, 20% cranial navigation, 7% stereotactic catheter placement, 6% craniofacial stereotactic wire placement, 2% deep brain stimulation lead placement, and 1% stereotactic radiofrequency ablation. Sixty-two procedures utilizing the haptic endoscope guidance mode consisted of 48% transnasal endoscopic, 29% ventriculoscopic, and 23% endoport tubular access. Statistically significant differences in registration accuracies were observed with 0.521 ± 0.135 mm (n = 132) for facial laser scanning, 1.026 ± 0.398 mm for bone fiduciary (n = 22), and 1.750 ± 0.967 mm for skin fiduciary (n = 30; ANOVA, P < .001).

CONCLUSION

The combination of accurate, automated stereotaxy with image and haptic guidance can be applied to a wide range of cranial neurosurgical procedures. The facial laser scanning method offered the best registration accuracy for the ROSA system based on our retrospective analysis.
Optical follow-up observation of Fast Radio Burst 151230
Authors: Tominaga Nozomu , Niino Yuu , Totani Tomonori , Yasuda Naoki , Furusawa Hisanori , Tanaka Masayuki , Bhandari Shivani , Dodson Richard , Keane Evan , Morokuma Tomoki , Petroff Emily , Possenti Andrea
Published: September 2018

The origin of fast radio bursts (FRBs), bright millisecond radio transients, is still somewhat of a mystery. Several theoretical models expect that the FRB accompanies an optical afterglow (e.g., Totani et al., 2013, PASJ, 65, L12; Kashiyama 2013, ApJ, 776, L39). In order to investigate the origin of FRBs, we perform gri-band follow-up observations of FRB 151230 (estimated $z$ ≲ 0.8) with Subaru/Hyper Suprime-Cam at 8, 11, and 14 days after discovery. The follow-up observation reaches a 50% completeness magnitude of 26.5 mag for point sources, which is the deepest optical follow-up of FRBs to-date. We find 13 counterpart candidates with variabilities during the observation. We investigate their properties with multi-color and multi-wavelength observations and archival catalogs. Two candidates are excluded by the non-detection of FRB 151230 in the other radio feed horns that operated simultaneously to the detection, as well as the inconsistency between the photometric redshift and that derived from the dispersion measure of FRB 151230. Eight further candidates are consistent with optical variability seen in active galactic nuclei (AGNs). Two more candidates are well fitted with transient templates (Type IIn supernovae), and the final candidate is poorly fitted with all of our transient templates and is located off-center of an extended source. It can only be reproduced with rapid transients with a faint peak and rapid decline, and the probability of chance coincidence is ∼3.6%. We also find that none of our candidates are consistent with Type Ia supernovae, which rules out the association of Type Ia supernovae to FRB 151230 at $z$ ≤ 0.6 and limits the dispersion measure of the host galaxy to ≲300 pc cm−3 in a Type Ia supernova scenario.
Police Chiefs and Their Political Bosses: Discussions in Ontario
Authors: Stenning Philip
Published: September 2018

In this article, I review debates about relations between police chiefs and their governing authorities in Ontario over the last 70 years, beginning with the enactment of the Ontario Police Act in 1946, through its replacement by the Ontario Police Services Act in 1990, to the enactment of a new Police Services Act in 2018. I discuss how the respective roles and responsibilities of municipal and regional police chiefs and their police governing authorities, and the relationships between them, have evolved and changed over this period. I also discuss comparable developments in the relations between commissioners of the Ontario Provincial Police and provincial ministers responsible for policing in the province during the same period. The arguments and justifications that have been advanced for these developments by politicians, commissions of inquiry, police scholars, and representative bodies of police chiefs and police governing authorities, as well as in key court decisions, are reviewed, and their implications for the concept of ‘police independence’ are discussed. I conclude that although that concept has been the subject of much critique during these years, it so far remains intact as the key principle underlying police governance and accountability in Ontario.
Nasal challenges in allergen immunotherapy trials
Authors: Tenn Mark W. , Rawls Matthew , Ellis Anne K.
Published: September 2018

Purpose of review

The nasal allergen challenge (NAC) model can be a valuable diagnostic tool for allergic rhinitis. Alongside its clinical use, NACs can be used as primary and secondary endpoints in studies evaluating allergen immunotherapy (AIT) products for allergic rhinitis treatment. This review will discuss the technical aspects of the NAC model and provide a summary of recent studies using NACs to assess existing and new AIT treatments.

Recent findings

Over the last 2 years, both titrated and single-dose nasal challenge protocols have been used to evaluate immunotherapies targeting grass, birch, house dust mite, and cat allergens. Early efficacy and dose-finding trials showed improvements in allergic symptoms and nasal tolerance to allergens after AIT treatment with standardized extracts or modified forms of whole allergen. NACs were also used in two proof-of-concept studies to illustrate the efficacy of intralymphatic immunotherapy with two concomitant allergens and subcutaneous immunotherapy with Fel d 1-specific IgG-blocking antibodies.

Along with existing therapies, nasal challenges are useful in evaluating AIT treatments in the very early stages of clinical development. However, because of the variety in challenge techniques and symptom assessments available, special attention must be placed in the protocol design in order to compare the study results with existing NAC publications.
Medication Treatment With Methadone or Buprenorphine: Differential Reasons for Premature Discharge
Authors: Proctor Steven L. , Birch Autumn , Herschman Philip L.
Published: September 2018

Objectives:

Medication treatment with methadone or buprenorphine has shown demonstrated effectiveness for opioid dependence; while premature discharge is associated with adverse outcomes. Specific reasons for premature discharge generally fall into 2 broad categories (ie, patient- and program-initiated). Previous studies have typically failed to distinguish between different types of discharge reasons among patients who leave treatment early. This study sought to determine whether type of medication was associated with differential discharge reasons among medication treatment patients who were prematurely discharged.

Methods:

Data were derived from electronic health records for 5486 patients prematurely discharged from 41 for-profit licensed opioid treatment programs in the United States from 2012 to 2013. All patients were treated with methadone or buprenorphine. Patients were studied through retrospective chart review until premature discharge.

Results:

Buprenorphine patients who left treatment prematurely were 2.18 times (95% confidence interval [CI] 1.89–2.53) more likely to be discharged against medical advice relative to methadone patients after controlling for intake differences. Methadone patients were 1.76 times (95% CI 1.47–2.10) more likely to be administratively discharged after adjustment for covariates.

Conclusions:

Further research is warranted to determine whether individually-tailored strategies may improve retention for certain patients based on medication. Ongoing review of program rules and policies may benefit methadone patients, who are nearly twice as likely to be discharged for an administrative, program-initiated reason. Strategies including contingency management, motivational incentives, and psychoeducation regarding the advantages of retention may benefit buprenorphine patients who are over 2 times more likely to leave treatment early due to a patient-initiated reason.
Simultaneous treatment for patellar instability and genu valgum in skeletally immature patients: a preliminary study
Authors: Parikh Shital N. , Redman Christopher , Gopinathan Nirmal R.
Published: September 2018

Genu valgum is a risk factor for patellar instability. The study purpose was to report on preliminary results of medial patellofemoral ligament (MPFL) reconstruction and simultaneous growth modulation, in patients with patellar instability and genu valgum. A total of seven patients (eight knees) with MPFL reconstruction and medial transphyseal screw insertion for genu valgum correction were assessed using full-length radiographs. Genu valgum corrected from 13.1° to 3.7° at mean 11.7 months, without compromising patellar stability. One patient each had 6° overcorrection and 5° rebound valgus. Guided growth using transphyseal screw during MPFL reconstruction could achieve deformity correction without interference with MPFL graft placement.
Minimizing Spine Autofusion With the Use of Semiconstrained Growing Rods for Early Onset Scoliosis in Children
Authors: Bouthors Charles , Izatt Maree T. , Adam Clayton J. , Pearcy Mark J. , Labrom Robert D. , Askin Geoffrey N.
Published: September 2018

Background:

A new growing rod (GR) design, the semiconstrained growing rod (SCGR), with the added advantage of axial rotation freedom within the components, has been introduced at our center which has been shown to be growth friendly. We hypothesize that the SCGR system would reduce autofusion in vivo, thereby maximizing the coronal plane correction, T1-S1 growth, and the final correction achieved at definitive fusion for children with an early onset scoliosis.

Methods:

In total, 28 patients had either single or dual 5.5 mm diameter SCGR placed minimally invasively through a submuscular approach. Surgical lengthening procedures occurred approximately every 6 months until the definitive fusion procedure was performed for 18 patients. Scoliosis, kyphosis, and lordosis angles, T1-S1 trunk length, and any complications encountered were evaluated.

Results:

For the full cohort, before GR insertion, the mean major Cobb curve angle was 72.4 degrees (SD, 18.8; range, 45 to 120), mean T1-S1 trunk length was 282 mm (SD, 59; range, 129 to 365), and at the latest follow-up (mean 6.9 y, SD 3.3, range 2.0 to 13.0), 38.8 degrees (SD, 17.5; range 10 to 90) and 377 mm (SD, 62; range, 225 to 487), respectively. For the subset of 18 patients who have had their final instrumented fusion surgery, the definitive surgery procedure alone produced a correction of the major Cobb curve angle by mean 20.3 degrees (SD, 16.1; P<0.0001), and an increase in the T1-S1 trunk length of mean 31.7 mm (SD, 23.1; P<0.0001). There were 14 complications involving 11 of the 28 patients, giving rise to 5 unplanned surgical interventions and 1 case where GR treatment was abandoned.

Conclusions:

SCGR patients exhibited statistically significant increase in T1-S1 trunk length and statistically significant decrease in the severity of scoliosis over the course of GR treatment and again, importantly, with the definitive fusion surgery, suggesting that autofusion had been minimized during GR treatment with relatively low complication rates.

Level of Evidence:

Level IV—case series.
Transepiphyseal (Type VII) Ankle Fracture Versus Os Subfibulare in Pediatric Ankle Injuries
Authors: Sugi Michelle T. , Tileston Kali , Krygier Jeffery E. , Gamble James
Published: September 2018

Background:

Pediatric ankle injuries are common, giving rise to ∼17% of all physeal injuries. An os subfibulare in a child with an ankle sprain may be confused with a type VII transepiphyseal fracture. Here, we evaluate the clinical and radiographic features of type VII transepiphyseal fractures to those of os subfibulare presenting with acute ankle trauma with the hypothesis that radiographs are necessary for final diagnosis and neither clinical history nor examination would be diagnostic.

Methods:

We performed an internal review board-approved, retrospective chart review of patients identified with a traumatic os subfibulare or type VII ankle fracture over an 18-month period. Charts were reviewed for demographics, mechanism, and clinical findings on initial presentation. Radiographic measurements of the distal fibular fragment as well as epiphysis were made on presenting ankle series radiographs.

Results:

A total of 23 patients were identified. Eleven patients had a traumatic type VII ankle fracture and 12 had trauma associated with an os subfibulare on initial radiographs. The history and clinical presentations were similar and were nondiagnostic. The ratio of the width of the fibula at its largest point on the anterior posterior view to the width of the fibular fragment was significantly larger in the type VII ankle fractures (P=0.05). All os subfibulare were located within the inferior third of the epiphysis, whereas all type VII fractures were either at the equator or within the middle third of the fibular epiphysis.

Conclusions:

Radiographs, not clinical presentation, can differentiate an os subfibulare from a type VII transepiphyseal fracture. Children with type VII fractures have a long, irregular fracture line within the middle third of the distal fibular epiphysis. Those with an ankle sprain and os subfibulare have a smooth-edged ossicle of relatively short length located within the inferior pole of the epiphysis. Furthermore, the radiographic width of the fragment in the type VII fractures is significantly larger in width than the os subfibulare.

Level of Evidence:

Level II.
Height-Width Ratio of Proximal Femoral Epiphysis: Estimation of Lateral Pillar Involvement in Bilateral Perthes Disease
Authors: Woratanarat Patarawan , Lorungroj Khongchai , Dechosilpa Chayanee , Jaovisidha Suphaneewan , Danpakdeekul Nattaporn , Woratanarat Thira , Thakkinstian Ammarin
Published: September 2018

Background:

The standard evaluation of epiphyseal involvement in Perthes disease is lateral pillar classification. However, it needs to be compared with contralateral normal hip leading to limited use in bilateral disease. We, therefore, develop a ratio between epiphyseal height and metaphyseal width of affected hips to estimate lateral pillar involvement. This study aimed to assess the height-width ratio of the proximal femoral epiphysis in non-Perthes children, and to find the relationship between the height-width ratio and lateral pillar classification in Perthes disease.

Methods:

A cross-sectional study was conducted between 2009 and 2015. Phase I included children aged 2 to 15 years who did not have Perthes disease. Phase II included children aged 2 to 15 years who had Perthes disease. Other abnormal proximal femoral epiphysis was excluded. Lateral pillar height and metaphyseal width were independently measured twice by 2 assessors in each phase. Intraobserver and interobserver levels of agreement, height-width ratio and cut-off points to differentiate lateral pillar types were determined.

Results:

There were 69 children (87 hip radiographs) who had non-Perthes hips, and 18 boys with Perthes disease (20 hip radiographs). Height-width ratio in the non-Perthes group increased from 0.38 to 0.48 at 2 to 10 years of age and remained constant until maturity. Average height-width ratio in lateral pillar A/non-Perthes hip was 0.47±0.05, lateral pillar B or B/C 0.32±0.05, and lateral pillar C 0.18±0.05. Intraobserver and interobserver level of agreements of height-width ratio in Perthes disease were 0.007 (95% confidence interval, −0.030 to 0.043) and 0.006 (95% confidence interval, −0.119 to 0.107), respectively. Cut-off values to differentiate lateral pillar A and B or B/C was 0.40, and to differentiate lateral pillar B or B/C, and C was 0.25 with 90% accuracy and area under receiver operating characteristic curve of 0.9.

Conclusions:

Height-width ratio is useful for grading severity in unilateral and bilateral Perthes disease. It has excellent reliability and validity with exact cutoff values to estimate lateral pillar classification.

Level of Evidence:

Level II—diagnostic study.
Epidemiology of Slipped Capital Femoral Epiphysis in Ontario, Canada
Authors: Ravinsky Robert , Rofaiel James , Escott Benjamin G. , Lim Zachary , Ravi Bheeshma , Howard Andrew
Published: September 2018

Background:

Slipped capital femoral epiphysis (SCFE) is a well-characterized disorder of the hip seen in adolescent patients. It is characterized by deformity secondary to failure through the proximal femoral growth plate, which results in posterior-inferior displacement of the epiphysis on the proximal femoral metaphysis. Long-term sequelae of SCFE may include osteonecrosis, residual deformity, leg length discrepancy, degenerative joint disease, and chronic pain. The long-term consequences of SCFE may be the source of significant morbidity for the patient, and depending of the local incidence of this condition, may represent a significant expenditure of health care resources. Historically, the true incidence of SCFE within Ontario has been approximated using US-based studies of arguably comparable patient populations. In our study, we aimed to characterize the epidemiology of SCFE in the province of Ontario.

Methods:

We used a prospectively collected, not-for-profit Ontario research database to identify recorded cases of SCFE between April 1, 2002 and March 31, 2011. Specifically, we identified all hospital discharges with an ICD-9 or 10 diagnostic codes for SCFE in the Canadian Institute for Health Information Discharge Abstract database.

Results:

Over the 10-year study period, there were 648 cases of SCFE with an average annual incidence rate of 5.68/100,000 in Ontario.

Conclusions:

We have observed a trend toward decreasing incidence rates of SCFE in Ontario over the last 10 years. The determination for the underlying causes for the changing trends of SCFE may be relevant for initiating public health campaigns directed at reducing the incidence of SCFE

Level of Evidence:

Level IV—epidemiological study.
Nursing-Related Smartphone Activities in the Italian Nursing Population
Authors: Pucciarelli Gianluca , Simeone Silvio , Virgolesi Michele , Madonna Giuseppe , Proietti Maria Grazia , Rocco Gennaro , Stievano Alessandro
Published: September 2018

In this study, we describe smartphone-related activities for nurses' work and nonwork purposes; analyzed the differences between smartphone use and nurses' age, gender, and working environment; and observed the influences that personal digital devices have on nurses' performance. We conducted a cross-sectional and correlational study. A convenience sample of nurses was recruited, composed of 256 nurses, mostly women (74.6%) younger than 30 years of age (59%). This study showed that the most frequent work-related smartphone activity was searching for work-related drug references. Smartphones also helped nurses reduce work-related stress and improve unit cohesion and teamwork. Younger nurses and male nurses were more likely than female nurses to use their digital devices during healthcare activities. In addition, 42% of nurses reported that they were distracted by the use of smartphones. If smartphones are used properly, they are certainly helpful tools for improving patient safety and enabling communication among healthcare staff. Otherwise, smartphones can constitute an important source of distraction and endanger patient safety.
Micrographic Surgery and Dermatologic Oncology Fellowship Selection Criteria
Authors: Feng Hao , Belkin Daniel A. , Feng Paula W. , Geronemus Roy G.
Published: September 2018

BACKGROUND

Obtaining a fellowship position for Micrographic Surgery and Dermatologic Oncology (MSDO) is becoming very competitive. Applicant qualities desired by MSDO fellowship directors have not been previously explored in a systematic way.

OBJECTIVE

To characterize the prevailing practices of selecting MSDO fellows.

METHODS AND MATERIALS

Cross-sectional study based on an anonymous online survey of MSDO fellowship directors.

RESULTS

There were 34 completed surveys. Selection criteria with the highest importance to fellowship directors were the ability to work well and get along with others, interview, work ethic, and letter of recommendation from the Mohs micrographic surgery director at the applicant's residency. The criteria with the lowest importance were advanced degrees, medical licensing examination scores, and membership in Alpha Omega Alpha. Specific applicant factors that were looked upon most positively by fellowship directors include applicant from own institution and applicant's personal reasons and circumstances, whereas factors that were most unfavorable include applicant's desire to practice in the same city/area as the fellowship location and graduate of foreign medical school.

CONCLUSION

Although variations existed, MSDO fellowship directors collectively placed greater importance on criteria that reflect interpersonal skills than on objective measures of academic performance, which highlights the importance of “fit.”
Ocular Surface Disease and Glaucoma Medications: A Clinical Approach
Authors: Zhang Xuemin , Vadoothker Saujanya , Munir Wuqaas M. , Saeedi Osamah
Published: September 2018

Objectives:

Ocular surface disease frequently coexists with glaucoma and may be initiated or exacerbated by topical glaucoma medications. We performed a review of current literature to assess the prevalence, causes, and treatment of ocular surface disease in glaucoma patients, specifically those on topical therapy.

Methods:

A Pubmed database search was conducted. A total of 720 articles published from 1972 to 2018 were found in relation with ocular surface disease, glaucoma, and glaucoma medications. Of these, 102 articles were included in this analysis. We included primary and empirical studies for patients on topical glaucoma medications. Exclusion criteria included case reports, non-English studies, and articles unrelated to the primary subject of this review.

Results:

Ocular surface disease among normal and glaucomatous eyes was evaluated based on diagnostic testing including clinical examination and questionnaires to determine visual function and quality of life. Glaucoma medications can be associated with toxicities to the ocular surface, most often due to the nature of the preservative included in the medication; however, the incidence of toxicity can be mitigated by the use of preservative free medications, decreased preservative medications, or treatment of dry eye disease. Treatment of glaucoma with laser trabeculoplasty or minimally invasive glaucoma surgeries that spare the conjunctiva and the cornea may avoid or decrease reliance on topical glaucoma medications, potentially avoiding the initiation or progression of ocular surface disease.

Conclusions:

Recognition and treatment of ocular surface disease in glaucoma patients may improve patient quality of life and medication adherence. This may ultimately improve glaucoma treatment outcomes.