bluuebunny/crossref_metadata_2025 huggingface dataset:
Genomeditierung in der Zell- und Gentherapie
Authors: Pruszak Jan , Müller Maximilian , König Saskia , Cathomen Toni
Published: August 2017

Gen- und zelltherapeutische Behandlungsansätze dienen als vielversprechende Grundlage zur Entwicklung neuer Therapieoptionen bei erworbenen und angeborenen Erkrankungen, für die bislang keine kurativen Behandlungsmethoden zur Verfügung stehen. Mit der Etablierung humaner induzierter pluripotenter Stammzellen vor 10 Jahren sowie der rasanten Entwicklung der Genomeditierung mittels Designernukleasen, insbesondere des CRISPR/Cas9-Systems, bieten sich der klinischen Medizin vielfältige Therapieoptionen an, die sich in noch nie dagewesener Geschwindigkeit weiterentwickeln und im Begriff stehen, klinische Routine verschiedenster Fachrichtungen auf revolutionäre Weise zu verändern. Auch für die Transfusionsmedizin, als klassisch zelltherapeutischem Fachgebiet, bedeuten diese Technologieplattformen ein weites Spektrum an Entwicklungsmöglichkeiten. Mit diesem Übersichtsartikel fassen wir die wesentlichen Grundlagen und den aktuellen Stand der Forschung, einschließlich experimenteller klinischer Studien, zusammen und bieten einen Ausblick auf mögliche Szenarien der Zukunft für die Stammzellforschung und die Gentherapie.
Colitis ulcerosa und Adenokarzinom der Appendix vermiformis: Kausaler Zusammenhang?
Authors: Stahn Bonnie , Hartmann Catharina , Heinig Thomas , Scheit Lorenz
Published: August 2017

Anamnese Wir berichten von einem 57-jährigen Patienten, der sich mit ausgeprägter Gewichtszunahme in kurzer Zeit und Stuhlunregelmäßigkeiten vorstellte.

Diagnostik In der anschließenden Diagnostik zeigte sich eine vermutlich seit Jahren bestehende Colitis ulcerosa sowie bei Nachweis von Adenokarzinomzellen im Aszitespunktat die Diagnose eines CUP-Syndroms.

Es folgten weitere umfangreiche diagnostische Maßnahmen ohne sichere Identifizierung eines Primarius. Schließlich wurde der Entschluss zur Kolektomie gefasst. In der histopathologischen Aufbereitung wurde ein Appendix-Karzinom im fortgeschrittenen Stadium festgestellt.

Therapie und Verlauf Die geplante Chemotherapie konnte aufgrund des sich rapide verschlechternden Zustands des Patienten nicht mehr durchgeführt werden. Es erfolgte die Entlassung in die Häuslichkeit zur palliativen Versorgung.

Folgerung Ein Appendix-Karzinom ist eine sehr seltene Erkrankung, der Zusammenhang mit einer Colitis ulcerosa ungewiss. Dennoch sollte insbesondere bei einem CUP-Syndrom eine Neoplasie der Appendix als möglicher Primarius in Erwägung gezogen werden.
Klinischer Einsatz von Cannabinoiden
Authors: Likar R. , Pipam W. , Köstenberger M. , Neuwersch S.
Published: August 2017

Hintergrund Cannabinoide gelten als wirksam in der Behandlung der chemotherapieinduzierten Übelkeit und Emesis (CINV). Palliativpatienten leiden neben einer Vielzahl anderer Begleitsymptome vor allem an Übelkeit und Erbrechen, deren Ursache vielseitig sein kann. Über den Einsatz von Dronabinol bei nicht chemotherapieinduzierter Übelkeit und Emesis gibt es nur wenige Berichte.

Methodik In einer retrospektiven Erhebung von 2012 – 2013 wurden Daten von Palliativpatienten mit therapierefraktärer Übelkeit und Emesis ausgewertet, die mit Dronabinol behandelt wurden. Übelkeit, Erbrechen und Appetitlosigkeit wurde dreimal täglich dokumentiert.

Ergebnisse Insgesamt wurden 33 Patienten mit Dronabinol behandelt. Im Verlauf der Dronabinol-Therapie zeigte sich eine Verbesserung in allen drei Symptomen. Der Anteil der Patienten, die stark unter Übelkeit, Erbrechen bzw. Appetitlosigkeit litten, nahm ab.

Schlussfolgerung Bei therapierefraktärer Übelkeit und Emesis ist die Behandlung mit Dronabinol zusätzlich zu etablierten Antiemetika sinnvoll. Für die Therapie des reduzierten Appetits ist Dronabinol erste Wahl, da hier kaum andere Optionen in der Palliativmedizin zur Verfügung stehen.
Hospitalisationsraten
Authors: Alscher Mark
Published: August 2017

Aktuell findet eine breite Diskussion statt, ob die Form der assistierten Peritonealdialyse (Durchführung mit Unterstützung durch Familie, Pflegedienst oder weitere Gesundheitsberufe) eine Hilfe zur verbreiterten Einführung der Peritonealdialyse gerade für ältere Patienten sein kann, bei welchen häufig Hindernisse für eine selbstständige Peritonealdialyse festzustellen sind. Die wenigen Daten, die es zu dieser Methode gibt, haben den Verdacht nahegelegt, dass bei einer assistierten Peritonealdialyse vermehrt stationäre Aufenthalte notwendig werden.
Shuntinfekt nach plastischer Rekonstruktion der Shuntvene
Authors: Krönung Gerhard
Published: August 2017

Der Erhalt der Shuntfunktion hat eine hohe Priorität und erfordert nicht selten die Inkaufnahme eines erhöhten Therapierisikos. Dies führt zwangsläufig zur Entwicklung eines differenzierten Komplikationsmanagements, um den Shunterhalt auch bei Komplikationen in der Mehrzahl der Fälle zu erreichen.
Evidenzbasierte Pflege
Authors: Wiederhold Dietmar
Published: August 2017

Im Sinne einer evidenzbasierten Praxis sollte die moderne Pflege ihr Handeln auf beste wissenschaftliche Belege gründen. Hierzu liefern Fachzeitschriftenartikel im Vergleich zu anderen Publikationsarten besonders aktuelle Informationen. Auch wenn Fachartikel über Spezial-Suchmaschinen und Spezial-Datenbanken schnell identifiziert werden können, gestalten sich der Umgang und die Einschätzung der Qualität der vorgefundenen Literatur oft schwer. Um das Finden, Lesen und Beurteilen der Artikel zu erleichtern, werden in diesem Artikel nützliche Hinweise vorgestellt, die gerade im Literaturstudium im Rahmen von Pflegefacharbeiten hilfreich sind.
Welche Strategie sollten wir nutzen, um das (Über-)Leben unserer Patienten zu verbessern?
Authors: Tölle Markus
Published: August 2017

Das Überleben von Patienten mit dialysepflichtiger Niereninsuffizienz konnte in den zurückliegenden Jahrzehnten trotz Optimierungen bei den technischen Möglichkeiten der Hämodialyse (HD) nur unzureichend im Vergleich zur nierengesunden Bevölkerung verbessert werden. Damit rückt die Lebensqualität unserer Patienten zunehmend in den Vordergrund. Bis weitere technische Innovationen vorhanden sind, um die komplexen physiologischen Funktionen der Niere besser nachahmen zu können, wird noch Zeit vergehen. Daher ist es wichtig, für den individuellen Patienten das beste Dialyseregime zu wählen. In dieser Übersichtsarbeit wird die aktuelle Datenlage in Bezug auf den rechtzeitigen HD-Beginn, die Behandlungsfrequenz und -dauer, die Bedeutung der residualen Nierenfunktion, die Wahl des HD-Verfahrens und der HD-Filter zusammenfassend dargestellt. Daneben wird auf die Empfehlungen der 2015 aktualisierten Empfehlung der „Kidney Disease Outcomes Quality Initiative“ (KDOQI) und der 2007 veröffentlichten „European Renal Best Practice“ (ERBP) zum Thema Hämodialyse eingegangen.
Epidemiologie chronischer Nierenerkrankungen – werden es immer mehr Patienten?
Authors: Kraus Daniel , Wanner Christoph
Published: August 2017

Chronic kidney disease (CKD) is a common disorder that often occurs as a complication of other common diseases such as diabetes, obesity, hypertension, or heart failure. Here we review the methodological pitfalls both in measuring kidney function and in determining the epidemiology of kidney disease. CKD is defined as the coincidence of three criteria: A reduced glomerular filtration rate, an anatomical lesion, and a duration of more than three months. Glomerular filtration rate declines with increasing age, but this alone does not constitute kidney disease. In epidemiological studies, exact measurement of glomerular filtration rate is often not feasible. Estimates of glomerular filtration rate depend on serum levels of creatinine or cystatin C, both of which are influenced by extrarenal factors. Anatomical lesion and duration of disease are almost never ascertained in epidemiological studies. Somewhat surprisingly, large-scale statistical modeling by the Global Burden of Disease Study suggests a decline in the world-wide prevalence of CKD in the past decades. In Germany, no longitudinal data is available for lack of a national register. Cross-sectional investigations report prevalences between 6 and 26 percent, depending on age, comorbidities, and geographical region. In the future, better control of risk factors may precede a decline in the incidence of CKD, with prevalences remaining stable due to better medical care and improved survival. In the long run, there is reason to believe that there will not be ever more patients with CKD.
Die Behandlung des M. Menière mit Betahistin: Kritische Anmerkungen zur BEMED-Studie
Authors: Ernst A. , Schlattmann P. , Waldfahrer F. , Westhofen M.
Published: August 2017

Die BEMED-Studie (BMJ 2016; 352: DOI 10.1136) war eine multizentrische, mehrarmige, placebokontrollierte Doppelblindstudie, die Patienten
(zwischen 18 – 80 Jahren) mit einem ein- oder bds. M. Menière einschließen sollte, bei der eine Niedrig- (2 × 24 mg/d)- vs. Hochdosis
(3 × 48 mg/d) Betahistintherapie vs. Placebo verglichen wurden. Der primäre Endpunkt sollte die „per Tagebuch dokumentierte Rate von
Schwindelattacken, die länger als 20 min dauerten“ sein. Der Hauptbefund der Studie war, daß Betahistin im Vergleich zu Placebo beim M.
Meniére nicht wesentlich besser in der Reduktion der Anfallshäufigkeit abschnitt. Dies soll in der vorliegenden Arbeit kritisch diskutiert
werden.
Spezifische Hautbeteiligung als erstes klinisches Symptom eines Hodgkin-Lymphoms
Authors: Troyanova-Slavkova S. , Stassart R. , Slavkov D. , Beloia S.-D. , Monecke A. , Hammerschmidt D. , Bielfeld C. , Ziegler H. , Soos L. , Eickenscheidt L. , Kowalzick L.
Published: August 2017

Das Hodgkin-Lymphom ist eine maligne Erkrankung der Lymphknoten und des lymphatischen Systems, bei der zusätzlich weitere Organe befallen sein können. Bei etwa 15 % aller Lymphome handelt es sich um ein Hodgkin-Lymphom. Die Prognose des Hodgkin-Lymphoms ist im Allgemeinen gut. Auch in fortgeschritteneren Stadien beträgt die 5-Jahres-Überlebensrate immer noch über 90 %. Eine Hautbeteiligung beim Hodgkin-Lymphom ist extrem selten und tritt vor allem im fortgeschrittenen Stadium der Krankheit auf. Die Prognose ist in diesen Fällen sehr schlecht. Die Behandlung von Patienten mit kutaner Beteiligung des Hodgkin-Lymphoms hängt vom Stadium der Erkrankung ab. Die Mehrheit der Daten basiert auf Einzelfällen oder Fallsammlungen. Wir berichten über einen Fall eines 37-jährigen Patienten, der aufgrund multipler Ulzerationen am vorderen Stamm bei uns vorstellig wurde und bei dem histologisch eine Hautbeteiligung eines noch nicht vorher bekannten Hodgkin-Lymphoms im Stadium IVAE nach modifizierter Ann-Arbor-Klassifikation diagnostiziert wurde.
Laser induced rapid decontamination of aromatic compound from porous soil simulant
Authors: Zheng Wenjun , Hou Sichao , Su Ming
Published: August 2017

Soil contamination with organic compounds can lead to the loss of farmable and habitable lands and cause long-term human and animal exposure to toxins. This paper reports a new laser based method for in situ soil decontamination at high efficiency, in which a focused excimer laser is used to remove organic contaminants from soil through burning by generating a local high temperature region. An aromatic compound, 1,1-dichloro-2,2-bis(4-chlorophenyl) ethylene, is used as an organic contaminant, and a porous silica plate is used as a soil simulant. A heat transfer model is created to simulate the interaction between the laser and the organic compound. The lithographic mode of operation allows the accurate quantitation of laser effects. The effects of power, speed, frequency, and energy consumption on the efficiency of decontamination have been examined with high accuracy. The decomposition area increases with the increase in the laser power and the decrease in the scan speed and frequency. Given the high energy conversion yield of the high power laser, this method would be promising for large scale in situ soil decontamination.
Effects of asymmetric Schottky contacts on photoresponse in tungsten diselenide (WSe2) phototransistor
Authors: Islam Arnob , Feng Philip X.-L.
Published: August 2017

We present an investigation of the effects of asymmetric contacts on the photoresponse of a thin film tungsten diselenide (WSe2) phototransistor. We observe different scenarios in photoresponse during gate modulation depending on the metal-semiconductor contacts through which majority carrier (hole) injection occurs. Under illumination, a peak in drain current is observed during gate modulation when hole injection occurs from the higher Schottky barrier contact. On the other hand, regular behavior in photoresponse during gate modulation is observed when hole injection occurs from the opposite direction, the lower Schottky barrier contact. Further, we analyze the possibilities of realizing WSe2 phototransistors with improved performance in terms of responsivity, response time, and detectivity by utilizing asymmetric contact engineering and proper gating. In addition, an interesting shift of the aforementioned peak is detected, with increasing incident light intensity during gate modulation. We demonstrate that this peak shift can be explained by the photogating effect caused by trapped charges.
Influence of hydration and annealing on structure, PSL yield and spatial resolution of pressed powder imaging plates of the X-ray storage phosphor CsBr:Eu2+
Authors: Kersting E. , von Seggern H.
Published: August 2017

A new production route for europium doped cesium bromide (CsBr:Eu2+) imaging plates has been developed, synthesizing CsBr:Eu2+ powder from a precipitation reaction of aqueous CsBr solution with ethanol. This new route allows the control of features like homogeneous grain size and grain shape of the obtained powder. After drying and subsequent compacting the powder, disk-like samples were fabricated, and their resulting photostimulated luminescence (PSL) properties like yield and spatial resolution were determined. It will be shown that hydration of such disks causes the CsBr:Eu2+ powder to recrystallize starting from the humidity exposed surfaces to the sample interior up to a completely polycrystalline sample resulting in a decreasing PSL yield and an increasing resolution. Subsequent annealing leads to grain refinement combined with a large PSL yield increment and a minor effect on the spatial resolution. By first annealing the “as made” disk, one observes a strong increment of the PSL yield and almost no effect on the spatial resolution. During subsequent hydration, the recrystallization is hindered by minor structural changes of the grains. The related PSL yield drops slightly with increasing hydration time, and the spatial resolution drops considerably. The obtained PSL properties with respect to structure will be discussed with a simple model.
High performance MoS2 TFT using graphene contact first process
Authors: Chang Chien Chih-Shiang , Chang Hsun-Ming , Lee Wei-Ta , Tang Ming-Ru , Wu Chao-Hsin , Lee Si-Chen
Published: August 2017

An ohmic contact of graphene/MoS2 heterostructure is determined by using ultraviolet photoelectron spectroscopy (UPS). Since graphene shows a great potential to replace metal contact, a direct comparison of Cr/Au contact and graphene contact on the MoS2 thin film transistor (TFT) is made. Different from metal contacts, the work function of graphene can be modulated. As a result, the subthreshold swing can be improved. And when Vg<VFB, the intrinsic graphene changes into p-type, so graphene contact can achieve lower off current by lowering the Fermi level. To further improve the performance of MoS2 TFT, a new method using graphene contact first and MoS2 layer last process that can avoid PMMA residue and high processing temperature is applied. MoS2 TFT using this method shows on/off current ratio up to 6×106 order of magnitude, high mobility of 116 cm2/V-sec, and subthreshold swing of only 0.515 V/dec.
Andronov–Hopf bifurcation with and without parameter in a cubic memristor oscillator with a line of equilibria
Authors: Korneev Ivan A. , Semenov Vladimir V.
Published: August 2017

The model of a memristor-based oscillator with cubic nonlinearity is studied. The considered system has infinitely many equilibrium points, which build a line of equilibria in the phase space. Numerical modeling of the dynamics is combined with the bifurcational analysis. It has been shown that the oscillation excitation has distinctive features of the supercritical Andronov–Hopf bifurcation and can be achieved by changing of a parameter value as well as by variation of initial conditions. Therefore, the considered bifurcation is called Andronov-Hopf bifurcation with and without parameter.
Unraveling interfacial strain and interfacial lattice reconstruction mechanism of ultrathin LaMnO3+δ layers in LaMnO3+δ/SrTiO3 superlattices
Authors: Cao Hui , Liu Yang , Liang Genhao , Zhao Aidi , Zhai Xiaofang
Published: August 2017

Understanding the interfacial lattice-reconstruction mechanism is a crucial step to purposely design functional oxide interfaces with emergent properties. Here we propose an approach using Poisson's ratio to determine the interfacial strain and unravel the underlying mechanism of lattice distortions of ultrathin LaMnO3+δ layers interposed in short period (LaMnO3+δ)N/(SrTiO3)N(2) superlattices. The lattice structure of a virtual bulk, with identical stoichiometry to the LaMnO3+δ interfacial layer, was derived using Poisson's ratio. Thus the quantitative biaxial strain and the hydrostatic strain were obtained. Moreover, we found that changes of octahedral rotations along the in-plane and out-of-plane directions are roughly compensated, and the average rotation angle is always close to that of the virtual bulk. The study demonstrates the importance of using Poisson's ratio to understand the lattice reconstruction mechanism near oxides' interface.
Annealing of amorphous yttrium iron garnet thin films in argon atmosphere
Authors: Hauser Christoph , Eisenschmidt Christian , Richter Tim , Müller Alexander , Deniz Hakan , Schmidt Georg
Published: August 2017

We report the recrystallization of amorphous Yttrium Iron Garnet (YIG) thin films by annealing in an argon atmosphere. Our results show that the amorphous film transforms into a fully epitaxial layer. Compared to annealing in oxygen, the argon atmosphere has no significantly deteriorating influence on the structural and magnetic properties of the YIG thin films. In ferromagnetic resonance experiments, low damping and narrow linewidth can be obtained. For a 65 nm thick layer, a damping constant of α = (1.61 ± 0.25) × 10–4 is found and the linewidth at 9.6 GHz is as small as 2.26 ± 0.10 Oe. These values are comparable to the best results for YIG thin films grown at high temperature pulsed laser deposition and almost as good as for thin YIG films deposited at room temperature and annealed in oxygen. Annealing in vacuum or growth in argon atmosphere, however, results in non-magnetic material.
Methanal Extrusion in ipso-Substitution Reactions of Hydroxymethylindoles
Authors: Dobrowolski Jeremy C. , Somphol Kittiya , Santoso Mardi , Duong Hung , Gardner Christopher R. , Kumar Naresh , Black David StC.
Published: August 2017

A range of 3-hydroxymethylindoles undergo acid-catalysed reactions involving ipso-electrophilic substitution with the extrusion of methanal and the formation of diindolylmethane moieties. Both inter- and intramolecular processes lead to macrocyclic compounds 10 and 14.
LATERAL FLORET 1
induced the three-florets spikelet in rice
Authors: Zhang Ting , Li Yunfeng , Ma Ling , Sang Xianchun , Ling Yinghua , Wang Yantong , Yu Peng , Zhuang Hui , Huang Junyang , Wang Nan , Zhao Fangming , Zhang Changwei , Yang Zhenglin , Fang Likui , He Guanghua
Published: August 2017

Significance

In cereal crops, the number of florets in a spikelet is an important factor affecting the grain number per panicle and then the grain yield. In wild-type rice, one spikelet produces one fertile floret. This study characterized a gain-of-function mutant
lateral florets 1
(
lf1
) in rice. In
lf1
, the spikelet developed lateral florets with proper floral organ identities in the axil of the sterile lemma, showing that the rice spikelet has the potential to restore the “three-florets spikelet” which may have existed in ancestors. Therefore, it provides strong evidence supporting the three-florets spikelet hypothesis and presents a prospect for increasing grain number per panicle by breeding rice with three-floret spikelets.
Clipping of arginine-methylated histone tails by JMJD5 and JMJD7
Authors: Liu Haolin , Wang Chao , Lee Schuyler , Deng Yu , Wither Matthew , Oh Sangphil , Ning Fangkun , Dege Carissa , Zhang Qianqian , Liu Xinjian , Johnson Aaron M. , Zang Jianye , Chen Zhongzhou , Janknecht Ralf , Hansen Kirk , Marrack Philippa , Li Chuan-Yuan , Kappler John W. , Hagman James , Zhang Gongyi
Published: August 2017

Significance

Enzymes responsible for the clipping of histone tails and removal of arginine-methylated histone tails still remain elusive. The underlying mechanism of high histone turnover rate in nonproliferated cells is still a mystery. How RNA polymerase II overcomes nucleosome barriers during transcription is unknown. This article described the discovery of a JmjC domain containing subfamily members JMJD5 and JMJD7, which could be responsible for these unsolved puzzles in epigenetics and transcription fields.
Origin, paleoecology, and extirpation of bluebirds and crossbills in the Bahamas across the last glacial–interglacial transition
Authors: Steadman David W. , Franklin Janet
Published: August 2017

Significance

On tropical islands, extensive extirpation of birds and other vertebrates occurred during the Holocene, following human arrival. Much less is known about pre-Holocene extirpation on islands. We focus on two species (Eastern bluebird
Sialia sialis
and Hispaniolan crossbill
Loxia megaplaga
) that were lost in the Bahamas to changes in sea level (becoming higher), land area (getting smaller), climate (becoming warmer and wetter), and habitat (loss of pine grassland) that took place during the last glacial–interglacial transition, many millennia before peopling of the islands. While volant, the bluebird evolved a short wing in the Bahamas, whereas the crossbill retained a similar morphology to the surviving population on Hispaniola. Each major glacial–interglacial shift reconfigured the resident Bahamian flora and fauna.
Adaptive-illumination STED nanoscopy
Authors: Heine Jörn , Reuss Matthias , Harke Benjamin , D’Este Elisa , Sahl Steffen J. , Hell Stefan W.
Published: August 2017

Significance

We demonstrate DyMIN (Dynamic Intensity Minimum), a versatile illumination concept for coordinate-targeted superresolution fluorescence imaging. Dynamically adapting the illumination (and therefore resolution) for the probing of molecular signals to local structural features entails major reductions in the light dose applied to the sample over the duration of the image scan. The resulting strong photobleaching reduction benefits signal and image contrast, as well as resolution, in biological nanoscale imaging. We show DyMIN stimulated emission depletion nanoscopy of different challenging samples in two and three dimensions.
Surveying the sequence diversity of model prebiotic peptides by mass spectrometry
Authors: Forsythe Jay G. , Petrov Anton S. , Millar W. Calvin , Yu Sheng-Sheng , Krishnamurthy Ramanarayanan , Grover Martha A. , Hud Nicholas V. , Fernández Facundo M.
Published: August 2017

Significance

Peptides and proteins are essential for life as we know it, and likely played a critical role in the origins of life as well. In recent years, much progress has been made in understanding plausible routes from amino acids to peptides. However, little is known about the diversity of sequences that could have been produced by abiotic condensation reactions on the prebiotic earth. In this study, multidimensional separations were coupled with mass spectrometry to detect and sequence mixtures of model proto-peptides. It was observed that, starting with a few monomers, proto-peptide diversity increased rapidly following cycling. Experimental proto-peptide sequences were compared with theoretically random sequences, revealing a high sequence diversity of plausible monomer combinations.
A Clinical Instrument to Guide Brief Interventions for Adolescents with Substance use Concerns
Authors: Ramos Mary M. , Warner Teddy , Daisy V. Rosero , Condon Timothy P.
Published: August 2017

Background

Adolescent substance use is an important public health problem in New Mexico and the United States. The New Mexico Department of Health school-based health centers (SBHCs) universally administer a validated screen, the CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble), for adolescent substance use concerns; however, quality assurance efforts revealed that SBHC providers needed more information at the point of screening to initiate brief interventions for students with positive CRAFFT screens. The CHISPA (Cocaine, Heroin, IV drugs, Synthetic pot, Pot, Alcohol) was developed to gather specific information on recent substance use experience to guide brief interventions. This paper describes the development and initial reliability and validity of data obtained using the CHISPA instrument.

Methods

In 2015, 99 high school–aged SBHC users in Albuquerque, New Mexico, completed the CRAFFT and CHISPA twice over 2 weeks using standard test-retest methods. Using the CHISPA, students reported for the prior 3 months substances used, frequency of use, and signs of addiction or acute danger (adverse events).

Results

Retest reliability for the CRAFFT score was 0.82. CHISPA retest reliabilities were 0.75 for alcohol use; 0.91 for having used any substances; 0.92 for number of substances used; 0.81 for frequency of substance use; and 0.79 for number of adverse events. CRAFFT scores correlated with CHISPA measures of number of substances used at 0.62; with frequency of substance use at 0.58; and with number of adverse events at 0.64.

Conclusions

CHISPA measures show preliminary evidence of reliability and validity. SBHC providers and other providers in primary care settings who use the CRAFFT screen may benefit from using the CHISPA to define recent substance use experience to guide brief interventions for adolescents with substance use concerns. The CHISPA instrument is currently being tested in electronic form in selected SBHCs in the state of New Mexico.
Heredity: A Very Short Introduction
Authors: Waller John
Published: August 2017

The idea of heredity—that qualities of body and mind are somehow inherited from one’s parents—has profoundly shaped many aspects of the human experience: from our attempts to understand variation in personality and intelligence, to popular attitudes about gender, race, and social hierarchy, to the methods employed to increase crop yields and the value of horses and cattle. Heredity: A Very Short Introduction traces both the technical study of biological inheritance and the ideological use of the concept of heredity from antiquity into a modern age of molecular biology in which a brave new prospect is emerging: the capacity to manipulate the human genome itself.
Freemasonry: A Very Short Introduction
Authors: Önnerfors Andreas
Published: August 2017

Freemasonry is one of the world’s oldest, most widespread voluntary organizations. With a strong sense of liberation, moral enlightenment, cosmopolitan openness, and forward-looking philanthropy, freemasonry has attracted some of the sharpest minds in history and created a strong platform for nascent civil societies worldwide. With the secrecy of internally communicated knowledge, its clandestine character, the enactment of rituals, and elaborate use of symbols, freemasonry has also opened up feelings of distrust, along with allegations of secretiveness and conspiracy. Freemasonry: A Very Short Introduction introduces the organization, rituals, and symbols of freemasonry, navigating through the prevalent fictions and conspiracy theories. It also sheds light on the participation of women in freemasonry.
TUBB4A mutations result in specific neuronal and oligodendrocytic defects that closely match clinically distinct phenotypes
Authors: Curiel Julian , Rodríguez Bey Guillermo , Takanohashi Asako , Bugiani Marianna , Fu Xiaoqin , Wolf Nicole I , Nmezi Bruce , Schiffmann Raphael , Bugaighis Mona , Pierson Tyler , Helman Guy , Simons Cas , van der Knaap Marjo S , Liu Judy , Padiath Quasar , Vanderver Adeline
Published: August 2017

Hypomyelinating leukodystrophies are heritable disorders defined by lack of development of brain myelin, but the cellular mechanisms of hypomyelination are often poorly understood. Mutations in TUBB4A, encoding the tubulin isoform tubulin beta class IVA (Tubb4a), result in the symptom complex of hypomyelination with atrophy of basal ganglia and cerebellum (H-ABC). Additionally, TUBB4A mutations are known to result in a broad phenotypic spectrum, ranging from primary dystonia (DYT4), isolated hypomyelination with spastic quadriplegia, and an infantile onset encephalopathy, suggesting multiple cell types may be involved. We present a study of the cellular effects of TUBB4A mutations responsible for H-ABC (p.Asp249Asn), DYT4 (p.Arg2Gly), a severe combined phenotype with hypomyelination and encephalopathy (p.Asn414Lys), as well as milder phenotypes causing isolated hypomyelination (p.Val255Ile and p.Arg282Pro). We used a combination of histopathological, biochemical and cellular approaches to determine how these different mutations may have variable cellular effects in neurons and/or oligodendrocytes. Our results demonstrate that specific mutations lead to either purely neuronal, combined neuronal and oligodendrocytic or purely oligodendrocytic defects that closely match their respective clinical phenotypes. Thus, the DYT4 mutation that leads to phenotypes attributable to neuronal dysfunction results in altered neuronal morphology, but with unchanged tubulin quantity and polymerization, with normal oligodendrocyte morphology and myelin gene expression. Conversely, mutations associated with isolated hypomyelination (p.Val255Ile and p.Arg282Pro) and the severe combined phenotype (p.Asn414Lys) resulted in normal neuronal morphology but were associated with altered oligodendrocyte morphology, myelin gene expression, and microtubule dysfunction. The H-ABC mutation (p.Asp249Asn) that exhibits a combined neuronal and myelin phenotype had overlapping cellular defects involving both neuronal and oligodendrocyte cell types in vitro. Only mutations causing hypomyelination phenotypes showed altered microtubule dynamics and acted through a dominant toxic gain of function mechanism. The DYT4 mutation had no impact on microtubule dynamics suggesting a distinct mechanism of action. In summary, the different clinical phenotypes associated with TUBB4A reflect the selective and specific cellular effects of the causative mutations. Cellular specificity of disease pathogenesis is relevant to developing targeted treatments for this disabling condition.
Secondary use of electronic health record data for clinical workflow analysis
Authors: Hribar Michelle R , Read-Brown Sarah , Goldstein Isaac H , Reznick Leah G , Lombardi Lorinna , Parikh Mansi , Chamberlain Winston , Chiang Michael F
Published: August 2017

Objective

Outpatient clinics lack guidance for tackling modern efficiency and productivity demands. Workflow studies require large amounts of timing data that are prohibitively expensive to collect through observation or tracking devices. Electronic health records (EHRs) contain a vast amount of timing data – timestamps collected during regular use – that can be mapped to workflow steps. This study validates using EHR timestamp data to predict outpatient ophthalmology clinic workflow timings at Oregon Health and Science University and demonstrates their usefulness in 3 different studies.

Materials and Methods

Four outpatient ophthalmology clinics were observed to determine their workflows and to time each workflow step. EHR timestamps were mapped to the workflow steps and validated against the observed timings.

Results

The EHR timestamp analysis produced times that were within 3 min of the observed times for >80% of the appointments. EHR use patterns affected the accuracy of using EHR timestamps to predict workflow times.

Discussion

EHR timestamps provided a reasonable approximation of workflow and can be used for workflow studies. They can be used to create simulation models, analyze EHR use, and quantify the impact of trainees on workflow.

Conclusion

The secondary use of EHR timestamp data is a valuable resource for clinical workflow studies. Sample timestamp data files and algorithms for processing them are provided and can be used as a template for more studies in other clinical specialties and settings.
Happy Wife, Happy Life: Food Choices in Romantic Relationships
Authors: Hasford Jonathan , Kidwell Blair , Lopez-Kidwell Virginie
Published: August 2017

The authors extend research on dyadic decision making by examining how relationship partners influence consumer eating patterns. Using research from relationship science and evolutionary psychology, the authors find that romantic relationship motives of formation and maintenance influence eating behaviors. Specifically, females are influenced by the eating patterns (i.e., healthiness/unhealthiness) of males when relationship formation motives are active, while males are influenced by the eating patterns of females when relationship maintenance motives are active. Furthermore, perceptions of relational influence differ between relationship formation and maintenance, which underlies these observed effects. This research contributes to the consumer behavior literature by revealing the powerful influence of relationships on food consumption.
Featured Article: Community Crime Exposure and Risk for Obesity in Preschool Children: Moderation by the Hypothalamic–Pituitary–Adrenal-Axis Response
Authors: Gartstein Maria A , Seamon Erich , Thompson Stephanie F , Lengua Liliana J
Published: August 2017

Objective

Identification of early risk factors related to obesity is critical to preventative public health efforts. In this study, we investigated links between the Hypothalamic–Pituitary–Adrenal (HPA)-axis activity (diurnal cortisol pattern), geospatially operationalized exposure to neighborhood crime, and body mass index (BMI) for a sample of 5-year-old children. Greater community crime exposure and lower HPA-axis activity were hypothesized to contribute to higher BMI, with child HPA-axis moderating the association between crime exposure and BMI.

Method

Families residing within the boundaries of the City of Seattle (N = 114) provided information concerning demographic/psychosocial risk factors, used to calculate a Cumulative Risk Index, indicating the number of contextual adversities present. Child BMI and diurnal cortisol pattern (derived from assays of saliva samples) were examined, along with neighborhood crime indices computed with publically available information, based on participants’ locations.

Results

Hierarchical multiple regression analyses, adjusted for covariates (cumulative risk, age, and sex), indicated that crime proximity made a unique contribution to child BMI, in the direction signaling an increase in the risk for obesity. Consistent with our hypothesis, a significant interaction was observed, indicative of moderation by diurnal cortisol pattern. Follow-up simple slope analyses demonstrated that crime exposure was significantly related to higher BMI for children with low-flat (blunted) diurnal cortisol patterns, where community crime and BMI were not significantly associated at higher levels of cortisol.

Conclusion

Community crime exposure contributes to higher BMI as early as the preschool period, and blunted diurnal cortisol patterns may place children experiencing neighborhood adversity at greater risk for obesity.
Risk of Tuberculosis Infection and Disease for Health Care Workers: An Updated Meta-Analysis
Authors: Uden Lydia , Barber Ella , Ford Nathan , Cooke Graham S
Published: August 2017

Background

Tuberculosis (TB) remains a major challenge to global health. Healthcare workers (HCWs) appear to be at increased risk of TB compared with the general population, despite efforts to scale up infection control and reduce nosocomial TB transmission. This review aims to provide an updated estimate of the occupational risk of latent TB infection (LTBI) and active TB among HCWs compared with the general population.

Methods

A systematic review was performed to identify studies published over the last 10 years reporting TB prevalence or incidence among HCWs and a control group. Pooled effect estimates were calculated to determine the risk of infection.

Results

Twenty-one studies met the inclusion criteria, providing data on 30961 HCWs across 16 countries. Prevalence of LTBI among HCWs was 37%, and mean incidence rate of active TB was 97/100000 per year. Compared with the general population, the risk of LTBI was greater for HCWs (odds ratio [OR], 2.27; 95% confidence interval [CI], 1.61–3.20), and the incidence rate ratio for active TB was 2.94 (95% CI, 1.67–5.19). Comparing tuberculin skin test and interferon-gamma release assay, OR for LTBI was found to be 1.72 and 5.61, respectively.

Conclusions

The overall risk of both LTBI and TB to HCWs continues to be significantly higher than that of the general population, consistent with previous findings. This study highlights the continuing need for improvements in infection control and HCW screening programs.
Weather-Based Models for Assessing the Risk of Sclerotinia sclerotiorum Apothecial Presence in Soybean (Glycine max) Fields
Authors: Willbur Jaime F. , Fall Mamadou L. , Bloomingdale Christopher , Byrne Adam M. , Chapman Scott A. , Isard Scott A. , Magarey Roger D. , McCaghey Megan M. , Mueller Brian D. , Russo Joseph M. , Schlegel Jay , Chilvers Martin I. , Mueller Daren S. , Kabbage Mehdi , Smith Damon L.
Published: August 2017

Sclerotinia stem rot (SSR) epidemics in soybean, caused by Sclerotinia sclerotiorum, are currently responsible for annual yield reductions in the United States of up to 1 million metric tons. In-season disease management is largely dependent on chemical control but its efficiency and cost-effectiveness depends on both the chemistry used and the risk of apothecia formation, germination, and further dispersal of ascospores during susceptible soybean growth stages. Hence, accurate prediction of the S. sclerotiorum apothecial risk during the soybean flowering period could enable farmers to improve in-season SSR management. From 2014 to 2016, apothecial presence or absence was monitored in three irrigated (n = 1,505 plot-level observations) and six nonirrigated (n = 2,361 plot-level observations) field trials located in Iowa (n = 156), Michigan (n = 1,400), and Wisconsin (n = 2,310), for a total of 3,866 plot-level observations. Hourly air temperature, relative humidity, dew point, wind speed, leaf wetness, and rainfall were also monitored continuously, throughout the season, at each location using high-resolution gridded weather data. Logistic regression models were developed for irrigated and nonirrigated conditions using apothecial presence as a binary response variable. Agronomic variables (row width) and weather-related variables (defined as 30-day moving averages, prior to apothecial presence) were tested for their predictive ability. In irrigated soybean fields, apothecial presence was best explained by row width (r = −0.41, P < 0.0001), 30-day moving averages of daily maximum air temperature (r = 0.27, P < 0.0001), and daily maximum relative humidity (r = 0.16, P < 0.05). In nonirrigated fields, apothecial presence was best explained by using moving averages of daily maximum air temperature (r = –0.30, P < 0.0001) and wind speed (r = –0.27, P < 0.0001). These models correctly predicted (overall accuracy of 67 to 70%) apothecial presence during the soybean flowering period for four independent datasets (n = 1,102 plot-level observations or 30 daily mean observations).
Immune-mediated necrotizing myopathy associated with statins: history and recent developments
Authors: Tiniakou Eleni , Christopher-Stine Lisa
Published: August 2017

Purpose of review

The use of statins has increased exponentially over the last 2 decades. Consequently, side effects have also increased, with muscle-related side effects commonly reported.

Recent findings

Although once thought to be only associated with self-limited direct myotoxicity, statins have recently been described in association with an autoimmune myopathy in association with antibodies directed against 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR), the rate limiting enzyme in cholesterol synthesis and the pharmacologic target of statins. Since this discovery, various cohorts have been identified worldwide and highlight both similarities and differences among them.

Recent studies from different fields have revealed diverse aspects of anti-HMGCR-associated immune-mediated necrotizing myopathy (IMNM). HMGCR IMNM is a unique autoimmune disease characterized by a well defined environmental trigger (statins) and a strong association with a genetic risk factor (Human leukocyte antigen D related B 1∗11 : 01). New diagnostic modalities have been established to confirm the presence of anti-HMGCR antibody and confirm the diagnosis of HMGCR IMNM. Clinical studies have shown that disease severity, as measured by muscle strength, as well as the rate of response to treatment have been associated with age at disease onset. Furthermore, a case series supported that intravenous immunoglobulin administration, perhaps even as monotherapy, may be a beneficial therapeutic intervention for selected patients.
Poorer Fusion Outcomes in Diabetic Cervical Spondylotic Myelopathy Patients Undergoing Single-level Anterior Cervical Discectomy and Fusion Does Not Compromise Functional Outcomes and Quality of Life
Authors: Liow Ming Han Lincoln , Lee Merrill , Goh Graham Seow-Hng , Chen Li Tat John , Yue Wai-Mun , Guo Chang Ming , Tan Seang Beng
Published: August 2017

Study Design.

Retrospective matched pair cohort study using prospectively collected registry data.

Objectives.

The aim of this study was to determine whether patients with DM have poorer patient-reported outcomes and poorer fusion rates after undergoing a single-level anterior cervical discectomy and fusion (ACDF) for cervical myelopathy.

Summary of Background Data.

ACDF remains the most common procedure in the treatment of cervical spondylotic myelopathy (CSM); however, there is a paucity of literature with regards to patient-reported outcome measures (PROMs), health-related quality-of-life (HRQOL) scores, and fusion rates post-ACDF in diabetic patients with CSM.

Methods.

From 2002 to 2012, 29 diabetic patients were matched with 29 nondiabetic controls. Patient demographics, perioperative data, and validated spine-specific scores including the Numerical Pain Rating Scale on Neck Pain and Upper Limb Pain, American Academy of Orthopaedic Surgeons (AAOS) neck pain and disability scores, AAOS Neurogenic Symptoms Score, Neck Disability Index, Japanese Orthopaedic Association Cervical Myelopathy Score, and Short Form 36 Physical/Mental Component Summaries were recorded. Fusion rates based on Bridwell grading were assessed at 2 years.

Results.

After matching, there were no significant preoperative differences in patient demographics, clinical outcomes, PROMs or HRQoL measures between the DM and control group (P > 0.05). There was no difference in either length of hospital stay (P = 0.92) or length of surgery (P = 0.92) between the two groups. At 2 years postoperatively, there were no significant differences between validated spine-specific scores, PROMs, HRQoL scores, satisfaction rates, or fulfilment of expectations between the two groups. Significant poorer Bridwell fusion grades were noted in the DM group at 2 years postoperatively (P < 0.05). Subgroup analysis within the DM group demonstrated that glycated hemoglobin levels had no impact on functional outcomes, fulfilment of expectations, or patient satisfaction at 2 years (P > 0.05).

Conclusion.

Despite poorer fusion outcomes following single-level ACDF for symptomatic CSM, there was no significant difference in validated spine outcome scores, PROMs, HRQoL measures, or satisfaction levels when compared to nondiabetic controls at short-term follow-up.

Level of Evidence: 3
Heparin-Free Prolonged Intermittent Hemodialysis Using Calcium-Free Citrate Dialysate in Critically Ill Patients
Authors: Faguer Stanislas , Saint-Cricq Morgane , Nogier Marie-Béatrice , Labadens Isabelle , Lavayssiere Laurence , Kamar Nassim , Cointault Olivier
Published: August 2017

Objectives:

Critically ill patients who have a high risk of bleeding but require prolonged intermittent dialysis need a heparin-free easy-to-use alternative type of anticoagulation within the dialysis circuit. We assessed the safety and efficiency of heparin-free regional citrate anticoagulation of the dialysis circuit using a calcium-free citrate-containing dialysate, with calcium reinjected according to ionic dialysance.

Design:

Prospective cohort study.

Setting:

Critical care units.

Patients:

Critically ill patients who required renal replacement therapy.

Interventions:

None.

Measurements and Main Results:

A total of 101 dialysis sessions were performed in 35 patients (mechanical ventilation n = 78; norepinephrine n = 13). Median duration of dialysis was 294 minutes (interquartile range, 240–300), and median ultrafiltration volume was 2.3 L (1–2.8). Urea and β2-microglobulin reduction rates were 64.5% ± 0.4% and 48% ± 0.13%, respectively. Postfilter ionized calcium was 0.35 ± 0.17 and 0.38 ± 0.14 mmol/L at 1 and 3 hours, respectively, within the extracorporeal circuit. A major clotting event that led to premature termination of the session occurred in only three of 101 sessions. In these three cases, major catheter dysfunction occurred before clotting within the circuit. Prefilter ionized calcium remained within narrow ranges (before/after change +0.07 ± 0.006 mmol/L), and total-to-ionized calcium ratio, a surrogate marker for citratemia, was unchanged.

Conclusions:

Dialysis anticoagulation with calcium-free citrate-containing dialysate and calcium reinjection according to ionic dialysance is an easy-to-use, efficient, and inexpensive form of heparin-free regional anticoagulation. It allows prolonged hemodialysis sessions in critically ill patients without the need to systemically monitor ionized calcium. Furthermore, sessions can be safely extended according to the hemodynamic tolerance to ensure an adequate dose of dialysis and a negative water balance, a major point in patients with severe acute kidney disease.