bluuebunny/crossref_metadata_2025 huggingface dataset:
Transcatheter aortic valve implantation in the United States: Predictors of early hospital discharge
Authors: Mallikethi‐Reddy Sagar , Akintoye Emmanuel , Telila Tesfaye , Sudhakar Rajeev , Jagadeesh Kavyashri , Briasoulis Alexandros , Rubenfire Melvyn , Afonso Luis , Grines Cindy L.
Published: March 2017

BACKGROUND

There is a concerted push for adopting a minimalist strategy with emphasis on early hospital discharge for patients undergoing Transcatheter aortic valve implantation (TAVI). However, studies on discharge patterns and predictors of early discharge (≤3 days post‐TAVI) are sparse, in the United States.

METHODS

We analyzed using Healthcare Utilization Project, Nationwide Inpatient Sample database, 2011‐2012. A total of 7321 TAVI procedures were identified. We compared in‐hospital outcomes between early and late discharge cohorts, and determined the predictors of early discharge. Correlation of costs and post‐TAVI length of stay was also performed.

RESULTS

Early discharge rate post‐TAVI was about 21% in the United States, in 2011‐2012. Overall mean age was 81 years. In‐hospital adverse outcomes post‐TAVI were higher in late discharge cohort (P < 0.001). Mean length of stay post‐TAVI (7.7 days vs 2.6 days) and costs ($208 752 vs $157 663) were significantly higher in late discharge than early discharge cohort. Females, bleeding, blood transfusions, stroke, permanent pacemakers, mechanical circulatory support, acute kidney injury were associated with significantly lower adjusted odds for early discharge. Transfemoral TAVI approach, prior aortic valvuloplasty, and procedure year 2012 were associated with significantly higher odds for early discharge. We observed positive correlation between costs of hospitalization and post‐TAVI length of stay (R = 0.58; P < 0.001).

CONCLUSIONS

Females, bleeding, blood transfusions, stroke, permanent pacemakers, mechanical circulatory support devices, renal failure were associated with lower odds for early discharge. Transfemoral approach and prior aortic valvuloplasty increased the likelihood for early discharge. Post‐TAVI length of stay was associated with significantly higher hospitalization costs.
Understanding Value Creation in Public‐Private Partnerships: A Comparative Case Study
Authors: Villani Elisa , Greco Luciano , Phillips Nelson
Published: March 2017

Public‐Private Partnerships (PPPs) are an important form of hybrid organization that may, if properly designed and managed, generate innovative solutions to complex problems by combining different institutional logics. Using data from a comparative case study of the creation of two PPPs in the Italian healthcare sector, we draw on ideas from business model design and organizational hybridity to explore how complexity can be managed inside PPPs and how this drives the creation of value for stakeholders. We link the literature on hybrid organizations with the one on business models by looking at the organizational mechanisms and processes that are implemented in PPP project governance, assets and processes. We go on to develop a theoretical model showing how effective business model design can help to bridge different logics and create value for stakeholders in the creation and operation of PPPs.
Alliances between Firms and Non‐profits: A Multiple and Behavioural Agency Approach
Authors: Rivera‐Santos M. , Rufín C. , Wassmer U.
Published: March 2017

We analyse business‐NGO (B2N) alliances through the lenses of multiple agency and behavioural agency theories to identify the sources of agency problems and the most effective choice of mitigation mechanisms. We contend that three types of agency relationships constitute B2N alliances: the relationship between the firm's managers and B2N alliance employees; the relationship between the NGO's managers and the B2N alliance employees; and the novel ‘claimed principal‐agent relationship’ involving the external beneficiary, the NGO's managers and the alliance employees. We argue that B2N alliances’ three types of agency problems stem from (1) the relative emphasis on public vs. private goods, both at the employee and at the partner levels, and (2) the level of the external beneficiary's voice. We then predict the mechanisms to mitigate these problems: hiring altruistic over self‐interested individuals; narrowly specifying the employees’ activities; emphasizing input‐based and intrinsic incentive mechanisms; and investing significantly into non‐intrusive monitoring mechanisms.
Mental health symptoms predict competency to stand trial and competency restoration success
Authors: Gay Jeremy G. , Vitacco Michael J. , Ragatz Laurie
Published: March 2017

Purpose

Although several studies have examined demographic and clinical variables associated with findings of incompetency to stand trial (IST), few studies have examined factors influencing competency restoration success. This study is among the first to longitudinally examine demographic variables and mental health symptoms’ impact on both IST and competency non‐restoration. This study fills a gap in the competency to stand trial literature by utilizing the same defendants to examine progression through initial competency decisions to their eventual restoration outcomes.

Methods

This study examined demographic variables and mental health symptoms differentiating defendants deemed competent to stand trial, not competent and restored, and not competent and not restored. We coded and analysed 237 competency evaluations consecutively conducted over a 3‐year period.

Results

Specific psychotic (e.g., thought derailment, delusions, auditory/visual hallucinations) and neuropsychological symptoms (e.g., impaired executive functioning, impaired mental status) were independently associated with findings of IST and non‐restoration. Additional analyses revealed an intellectual disability diagnosis and a greater number of psychotic and manic symptoms predicted a decreased likelihood of competency restoration.

Conclusions

These findings suggest more severe symptom combinations (e.g., psychotic and manic symptoms) are predictors of both initial findings of incompetency and non‐restorability.
Assessment, accountability and the literacy curriculum: reimagining the future in the light of the past
Authors: Moss Gemma
Published: March 2017

This paper explores the dynamic to education system reform in England, highlighting the challenges the range of policy tools in use have created for policymakers, practitioners and researchers alike. Taking literacy policy in England as a ‘telling case’, I will argue that far from holding the answer to successful system reform, high‐stakes testing and the migration of system‐level data into the public domain create a series of challenges for politicians that they cannot satisfactorily solve. In turn, policymakers' attempts to manage the problems away are further compounding the difficulties teachers face. As policymakers' commitments to bringing about well‐motivated change waver, research and practitioner communities need to work more closely together to successfully reimagine a purposeful and engaged literacy curriculum for all.
Combination of Leflunomide and Everolimus for treatment of BK virus nephropathy
Authors: Jaw Juli , Hill Prue , Goodman David
Published: March 2017

BK nephropathy (BKN) is a common cause of graft dysfunction following kidney transplantation. Minimization of immunosuppressive therapy remains the first line of therapy, but this may lead to rejection and graft loss. In some cases, despite lowering immunosuppression, BK infection can persist, leading to chronic damage and kidney failure. Currently, there is no specific anti‐BK viral therapy. Recent in vitro experiments have demonstrated a reduction in BK viral replication when infected cells are treated with the combination of Leflunomide and Everolimus. This study aims to explore the effect of this drugs combination on viral clearance and graft function in patients with persistent disease despite reduction in immunosuppression. We treated three patients with combination Leflunomide and Everolimus. Data on medical history, biochemical parameters and viral loads were collected. Significant improvement in viral loads was observed in two cases with resolution of viremia in another (Table 1). Two recipients had preserved allograft function. The remaining graft was lost because of combination of obstruction and BKN. No adverse reactions such as bone marrow toxicity were observed. Combination of Leflunomide and Everolimus is safe and should be considered as a rescue therapy in treatment of BKN, especially in those who fail to clear this infection despite reduction of immunosuppressive therapy.
Is there a broader role for independent mental capacity advocates in critical care? An exploratory study
Authors: Chatfield Doris A , Lee Sue , Cowley Jakki , Kitzinger Celia , Kitzinger Jenny , Menon David K
Published: March 2017

Background

This research explores the current and potential future role of independent mental capacity advocates (IMCAs) in critical care. The Mental Capacity Act (MCA) of 2005 introduced IMCAs as advocates for patients without anyone to represent their best interests, but research suggests that this role is not well understood or implemented. No existing research explores the role of IMCAs in critical care or their potential use when families are judged ‘appropriate to act’ on the patient's behalf. It is suggested that families may not be best placed to advocate for their sick family member when they themselves are in a state of shock.

Aim

To investigate existing levels of knowledge and awareness of the MCA and understanding of the role of IMCAs in critical care as a prelude to considering whether the role of IMCAs might usefully be extended. The concept of ‘IMCA clinics’ is introduced and explored.

Design and methods

A small‐scale qualitative study using thematic analysis of 15 interviews across two NHS sites and a survey of IMCA services were undertaken.

Results

Some knowledge of the MCA was evident across both study sites, but training on MCA remains unsatisfactory, with confusion about the role of IMCAs and when they should become involved. Overall, participants felt that the broader involvement of IMCAs on a regular basis within critical care could be useful.

Conclusions

There was evidence of good practice when instructing IMCAs, but further work needs to be conducted to ensure that critical care staff are informed about the referral process. It was clear that expanding the role of an advocate warrants further investigation.

Relevance to clinical practice

Further training on the role of IMCAs within critical care is required, and good practice examples should be shared with other units to improve referral rates to the IMCA service and ensure that vulnerable patients are properly represented.
Burning mouth syndrome: a systematic review of treatments
Authors: Liu YF , Kim Y , Yoo T , Han P , Inman JC
Published: March 2017

Burning mouth syndrome (BMS) is a chronic oral pain syndrome that primarily affects peri‐ and postmenopausal women. It is characterized by oral mucosal burning and may be associated with dysgeusia, paresthesia, dysesthesia, and xerostomia. The etiology of the disease process is unknown, but is thought to be neuropathic in origin. The goal of this systematic review was to assess the efficacy of the various treatments for BMS. Literature searches were conducted through PubMed, Web of Science, and Cochrane Library databases, which identified 22 randomized controlled trials. Eight studies examined alpha‐lipoic acid (ALA), three clonazepam, three psychotherapy, and two capsaicin, which all showed modest evidence of potentially decreasing pain/burning. Gabapentin was seen in one study to work alone and synergistically with ALA. Other treatments included vitamins, benzydamine hydrochloride, bupivacaine, Catuama, olive oil, trazodone, urea, and Hypericum perforatum. Of these other treatments, Catuama and bupivacaine were the only ones with significant positive results in symptom improvement. ALA, topical clonazepam, gabapentin, and psychotherapy may provide modest relief of pain in BMS. Gabapentin may also boost the effect of ALA. Capsaicin is limited by its side effects. Catuama showed potential for benefit. Future studies with standardized methodology and outcomes containing more patients are needed.
Iron overload induces apoptosis of murine preosteoblast cells via ROS and inhibition of AKT pathway
Authors: Ke J‐Y , Cen W‐J , Zhou X‐Z , Li Y‐R , Kong W‐D , Jiang J‐W
Published: March 2017

Objective

This study investigates the inhibitory effect of iron overload on MC3T3‐E1 cells and its molecular mechanism.

Methods

MC3T3‐E1 cells were grown under different concentrations of FAC (ferric ammonium citrate), and the WST‐8 assay was used to investigate the proliferation of cells following FAC with or without deferasirox. DCFH‐DA fluorescence probe was applied to detect the cellular reactive oxygen species (ROS) level. The apoptotic cells were analyzed with Annexin V‐FITC/PI and the Hoechst 33258 nuclear staining assay. The JC‐1 staining assay was applied to observe the change in the mitochondrial transmembrane potential. The expression levels of caspase‐3, PARP, Bcl‐2 family proteins, and AKT kinase were detected with the Western blot assay.

Results

Iron overload had a cytotoxic effect on MC3T3‐E1 cells in a dosage‐dependent way and resulted in increasing level of intracellular ROS. Iron overload induced apoptosis in MC3T3‐E1 cells via a caspase‐dependent mechanism that is accompanied by mitochondria dysfunction and decreased expression of anti‐apoptotic proteins. The expression levels of cleaved‐caspase‐3 and cleaved‐PARP were upregulated, while the expression levels of caspase‐9, caspase‐7, caspase‐3, and PARP were downregulated. Phosphorylation of AKT kinase decreased.

Conclusion

Iron overload can generate ROS in cells, inhibit AKT kinase and its downstream proteins activity, and subsequently initiate apoptotic events.
The Role of Metropolitan Cooperation and Administrative Capacity in Subnational Debt Dynamics: Evidence From Municipal Mexico
Authors: Smith Heidi Jane M. , Benton Allyson Lucinda
Published: March 2017

Research on subnational capital markets in developing nations has tended to focus on designing regulatory frameworks that compensate for structural economic, fiscal, and political factors. However, research on public investment in the United States shows that functional factors, like administrative capacity and metropolitan cooperation, are also important. Using a panel dataset of Mexican municipal debt (2005–2012), the study examines whether metropolitan cooperation and administrative capacity affect subnational debt decisions in this developing nation. Cross‐sectional time‐series analysis of different types of municipal debt (public development bank loans, private commercial bank debt, bond emissions, and trust instruments) reveals that municipalities in metropolitan areas avoid costlier credits but that they do not cooperate to access cheaper loans. The research reveals that administrative capacity plays little to no role in municipal debt decisions.
Gene discovery and marker resource development by transcriptome sequencing from a short‐rotation coppice willow, Salix suchowensis
Authors: Dai Xiaogang , Zhu Tiwen , Li Xiaoping , Yin Tongming
Published: March 2017

Many willow species, especially the short‐rotation coppice willows, are suitable for development into renewable bioenergy crops. In this study, we conducted high‐throughput transcriptome sequencing of a shrub willow, S. suchowensis, to generate expressed sequence tags (ESTs) for gene discovery and molecular marker development. Totally, 136.1 million clean reads were generated from five different tissues of S. suchowensis using Illumina RNA‐seq technology. De novo sequence assembly produced 90 269 unigenes, among which 64 127 unigenes were annotated in one or more of the NR, Swiss‐Prot, GO, COG and KEGG databases. A total of 21 052 simple sequence repeats were identified in the expressed sequence assemblies, and a primer database containing 36 912 EST‐SSR markers were developed for 12 304 SSR loci. Subsequently, 25 primers were randomly selected for experimental test. Among which, 24 primers succeeded in PCR amplification and 21 produced amplicons in expected sizes, suggesting that the sequence assemblies were of high quality. The established sequence database and marker resource are useful for different aspects of genetic studies on Salix spp., and particularly valuable for marker‐assisted breeding of willows.
Back to the roots? Dual cannulation strategy for ambulatory ECMO in adolescent lung transplant candidates: An alternative?
Authors: Schmidt F. , Jack T. , Sasse M. , Mueller C. , Schwerk N. , Bobylev D. , Beerbaum P. , Koeditz H.
Published: March 2017

Bridging critically ill pediatric patients to lung transplantation still remains a major challenge. Although still controversial, within the last 5 years, ECMO has been increasingly used as a bridge to lung transplantation concept in adult and pediatric patients with acceptable outcomes. The outstanding developments in the field of extracorporeal devices and the introduction of awake ECMO concepts with the avoidance of mechanical ventilation have led to a real paradigm shift in the ICU management of pretransplant candidates with severe respiratory failure. Therefore, ECMO is no longer seen as a contraindication for lung transplantation at least at our center. Nevertheless, how to bridge these patients on ECMO still remains controversial. Thus, we introduced an ambulatory ECMO approach in adolescent lung transplant candidates with acute respiratory failure using a dual cannulation strategy and hereby present first results from this procedure.
Tobacco TTG2 and ARF8 function concomitantly to control flower colouring by regulating anthocyanin synthesis genes
Authors: Li P. , Chen X. , Sun F. , Dong H.
Published: March 2017

Recently we elucidated that tobacco TTG2 cooperates with ARF8 to regulate the vegetative growth and seed production.

Here we show that TTG2 and ARF8 control flower colouring by regulating expression of ANS and DFR genes, which function in anthocyanin biosynthesis.

Genetic modifications that substantially altered expression levels of the TTG2 gene and production quantities of TTG2 protein were correlated with flower development and colouring. Degrees of flower colour were increased by TTG2 overexpression but decreased through TTG2 silencing, in coincidence with high and low concentrations of anthocyanins in flowers. Of five genes involved in the anthocyanin biosynthesis pathway, only ANS and DFR were TTG2‐regulated and displayed enhancement and diminution of expression with TTG2 overexpression and silencing, respectively. The floral expression of ANS and DFR also needed a functional ARF8 gene, as ANS and DFR expression were attenuated by ARF8 silencing, which concomitantly diminished the role of TTG2 in anthocyanin production. While ARF8 required TTG2 to be expressed by itself and to regulate ANS and DFR expression, the concurrent presence of normally functional TTG2 and ARF8 was critical for floral production of anthocyanins and also for flower colouration.

Our data suggest that TTG2 functions concomitantly with ARF8 to control degrees of flower colour by regulating expression of ANS and DFR, which are involved in the anthocyanin biosynthesis pathway. ARF8 depends on TTG2 to regulate floral expression of ANS and DFR with positive effects on anthocyanin production and flower colour.
Links Between Education and Age at Marriage among Palestinian Women in Israel: Changes Over Time
Authors: Sabbah‐Karkaby Maha , Stier Haya
Published: March 2017

This study focuses on the link between education and marriage timing among Israeli‐Palestinian women. Theoretical discussions on marriage timing center on the effect of the time women spend in educational institutions on their age at marriage, and on the change in the desirable traits of women in the marriage market. But most of these arguments overlook situations where significant changes in education take place alongside retention of traditional patriarchal values. Based on data from three population censuses – in 1983, 1995 and 2008—our results suggest that staying longer in schooling delays marriage, so women with less education are more likely to marry earlier than others. While young age is still considered an important characteristic in the Israeli‐Palestinian marriage market, and women who delay marriage face a greater risk of remaining single, education becomes more important over the years so that postponing marriage becomes especially problematic for low‐educated women. Our findings suggest that traditional norms and structural conditions together shape marriage timing.
What is new with old? What old age teaches us about inequality and stratification
Authors: Abramson Corey M. , Portacolone Elena
Published: March 2017

Aging is remarkably unequal. Who survives to grow old in America and the circumstances they face once there reflect durable racial, socioeconomic, and gender inequalities that structure our lives from birth. Yet within the field of social stratification and mainstream sociology proper, examinations of the rapidly growing population of older Americans are often relegated to a “gerontological” periphery. This essay posits that the failure to place aging as a core concern in stratification and inequality is a missed opportunity. We argue for the importance of reintegrating studies on the stratification of aging and explain why such a move is necessary. Specifically, we posit that (a) examining the aging population is necessary for understanding American inequality because aging is an outcome that is ubiquitous yet highly stratified; (b) aging and being seen as “old” in a youth‐focused society are stratifying processes in their own right; and (c) later life provides for analytical comparisons that are illustrative of how key mechanisms of inequality structure and stratify. After examining insights provided by a new wave of research on the aging U.S. population, we revisit the implications for understanding inequality and stratification in a graying and unequal America.
Why social status matters for understanding the interrelationships between testosterone, economic risk‐taking, and gender
Authors: Fisk Susan Rebecca , Miller Brennan J. , Overton Jon
Published: March 2017

We conduct an extensive review of the literature on testosterone and economic risk‐taking behavior. In sum, there is evidence of a positive association between testosterone and economic risk taking, although it is unlikely to be a strong association given the abundance of null results. However, we argue that the existing literature may overstate the causal effects of testosterone on economic risk taking (or even report a spurious correlation) because this research has not considered the potentially confounding role of social status. Status could concurrently influence both testosterone and economic risk taking, given that testosterone is a social hormone with a reciprocal relationship with social status, and social status has been found to drive risk‐taking behavior. We also argue against using findings from this literature to make gender essentialist claims, primarily because social phenomena influence the size—and existence—of gender differences in economic risk‐taking behavior. We conclude with suggestions for future research.
Blurring the boundaries: Using Gamergate to examine “real” and symbolic violence against women in contemporary gaming culture
Authors: Gray Kishonna L. , Buyukozturk Bertan , Hill Zachary G.
Published: March 2017

Recent controversies in gaming culture (i.e., Gamergate) highlight the lack of attention devoted to discussions of actual violence women experience in gaming. Rather, the focus is often situated on in‐game violence; however, we must extend discussions of in‐game violence and increased aggression to account for the “real world,” violent, realities of women as gamers, developers, and even critics of the medium. As such, we provide context with a brief introduction to the events of Gamergate. We then discuss the connections between the continued marginalization of women both in video games and in “real life.” Drawing from a range of sociological and ludological research, especially Bourdieu and Wacquant's conceptualization of symbolic violence, we examine the normalization of violence towards women in gaming culture. We conclude with considerations for future work involving symbolic violence and other conceptualizations of violence. This focus allows for a more impactful consideration as to why and how codified simulated violence affects marginalized members of communities. Using symbolic violence to connect trends within games to the lived experiences of women in gaming communities binds virtual experiences to “real” ones.
Protein transport in growing and steady‐state cilia
Authors: Lechtreck Karl F. , Van De Weghe Julie C. , Harris James Aaron , Liu Peiwei
Published: March 2017

Cilia and eukaryotic flagella are threadlike cell extensions with motile and sensory functions. Their assembly requires intraflagellar transport (IFT), a bidirectional motor‐driven transport of protein carriers along the axonemal microtubules. IFT moves ample amounts of structural proteins including tubulin into growing cilia likely explaining its critical role for assembly. IFT continues in non‐growing cilia contributing to a variety of processes ranging from axonemal maintenance and the export of non‐ciliary proteins to cell locomotion and ciliary signaling. Here, we discuss recent data on cues regulating the type, amount and timing of cargo transported by IFT. A regulation of IFT‐cargo interactions is critical to establish, maintain and adjust ciliary length, protein composition and function.
Intraocular pressure in American Bullfrogs (Rana catesbeiana) measured with rebound and applanation tonometry
Authors: Cannizzo Sarah A. , Lewbart Gregory A. , Westermeyer Hans D.
Published: March 2017

Objective

To measure the intraocular pressure (IOP) in normal American Bullfrogs (Rana catesbeiana) with rebound and applanation tonometry and to create calibration curves for both tonometers to determine the actual IOP of bullfrogs.

Procedures

Twenty bullfrogs were evaluated with slip‐lamp biomicroscopy, indirect ophthalmoscopy, rebound tonometry, and applanation tonometry. Axial globe length and corneal thickness were measured in the three largest and the three smallest frogs with ultrasonography and optical coherence tomography, respectively. Two frogs were euthanized for direct manometry.

Results

The median IOP was 4 mmHg with the rebound tonometer and 16 mmHg with the applanation tonometer. The correlation coefficient (r2) between the manometry measurements and the tonometers was 0.95 and 0.91 for the rebound and applanation tonometers, respectively. The corresponding equations were y = 0.331x + 0.558 for the rebound tonometer and y = 0.675x + 1.907 for the applanation tonometer. The median axial globe length was 0.94 cm. The median corneal thickness was 0.093 mm.

Conclusions

The rebound tonometer is the preferable tonometer for American Bullfrogs. Neither tonometer produced IOP readings that matched the manometer. The rebound tonometer was more precise and it was faster and easier to use.
Boundary Control of Slender Beams Under Deterministic and Stochastic Loads
Authors: Do K. D.
Published: March 2017

This paper first derives equations of motion of extensible and shearable slender beams with large motions under both deterministic and stochastic external loads. Boundary feedback controllers are then proposed to achieve almost surely globally practically asymptotic stability. The control design, well-posedness, and stability analysis are based on a Lyapunov-type theorem developed for a class of stochastic evolution systems (SESs) in Hilbert space.
H∞ Optimal Controller Design With Closed-Loop Positive Real Constraints
Authors: Hewing L. , Leonhardt S. , Apkarian P. , Misgeld B. J. E.
Published: March 2017

Positive real constraints on the closed-loop of linear systems guarantee stable interaction with arbitrary passive environments. Two such methods of H∞ optimal controller synthesis subject to a positive real constraint are presented and demonstrated on numerical examples. The first approach is based on an established multi-objective optimal control framework using linear matrix inequalities and is shown to be overly restrictive and ultimately infeasible. The second method employs a sector transformation to substitute the positive real constraint with an equivalent H∞ constraint. In two examples, this method is shown to be more reliable and displays little change in the achieved H∞ norm compared to the unconstrained design, making it a promising tool for passivity-based controller design.
Water Evaporation and Condensation in Air With Radiation: The Self-Similar Spalding Model
Authors: Brewster M. Q.
Published: March 2017

Several simple ways of improving the accuracy of Spalding model predictions over common textbook conventions for air/water evaporation/condensation problems are illustrated using open-literature examples. First is the choice of thermodynamic reference state for enthalpy evaluation. The common practice of choosing the steam table reference point (0.01 °C) with water-vapor enthalpy of hfg (2501 kJ/kg) and air enthalpy of zero introduces an enthalpy mismatch between air and water vapor that unnecessarily compromises accuracy. Choosing the air/water interface temperature as the reference point and setting both air and water-vapor enthalpies at this point to the same numerical value gives the most accurate results of several methods tried. Second is judicious choice of the blowing factor in high-rate mass transfer situations. The laminar boundary layer blowing factor is more accurate than the common stagnant-film (Couette flow) blowing factor for flat-plate flow and may be more accurate for a cylinder in crossflow under laminar conditions, as illustrated by the example of air leak effect on steam condenser tube performance. Third is radiation modeling, often a problematic or ignored feature in this type of problem. Two common, but opposite, assumptions about radiation participation in water—transparent interface and opaque interface—are shown to be equivalent for most purposes. A methodology is introduced for modeling true interfacial absorption/emission associated with phase change if/when the amount of this effect becomes known well enough to justify its inclusion. The importance of including radiation is illustrated by several examples: cloud droplet evaporation–condensation, sweat cooling, and the wet-bulb psychrometer. Fourth is inaccuracy introduced by unnecessarily setting Lewis number to unity.
Design and implementation of a head‐and‐neck phantom for system audit and verification of intensity‐modulated radiation therapy
Authors: Webster Gareth J. , Hardy Mark J. , Rowbottom Carl G. , Mackay Ranald I.
Published: March 2017

The head and neck is a challenging anatomic site for intensity‐modulated radiation therapy (IMRT), requiring thorough testing of planning and treatment delivery systems. Ideally, the phantoms used should be anatomically realistic, have radiologic properties identical to those of the tissues concerned, and allow for the use of a variety of devices to verify dose and dose distribution in any target or normal‐tissue structure.

A phantom that approaches the foregoing characteristics has been designed and built; its specific purpose is verification for IMRT treatments in the head‐and‐neck region. This semi‐anatomic phantom, HANK, is constructed of Perspex (Imperial Chemical Industries, London, U.K.) and provides for the insertion of heterogeneities simulating air cavities in a range of fixed positions. Chamber inserts are manufactured to incorporate either a standard thimble ionization chamber (0.125 cm3: PTW, Freiburg, Germany) or a smaller PinPoint chamber (0.015 cm3: PTW), and measurements can be made with either chamber in a range of positions throughout the phantom. Coronal films can also be acquired within the phantom, and additional solid blocks of Perspex allow for transverse films to be acquired within the head region.

Initial studies using simple conventional head‐and‐neck plans established the reproducibility of the phantom and the measurement devices to within the setup uncertainty of mm. Subsequent verification of 9 clinical head‐and‐neck IMRT plans demonstrated the efficacy of the phantom in making a range of patient‐specific dose measurements in regions of dosimetric and clinical interest. Agreement between measured values and those predicted by the Pinnacle3 treatment planning system (Philips Medical Systems, Andover, MA) was found to be generally good, with a mean error on the calculated dose to each point of (range: to ) for the primary planning target volume (PTV), (range: to ) for the nodal PTV, and (range: to ) for the spinal cord. The suitability of the phantom for measuring combined dose distributions using radiographic film was also evaluated.

The phantom has proved to be a valuable tool in the development and implementation of clinical head‐and‐neck IMRT, allowing for accurate verification of absolute dose and dose distributions in regions of clinical and dosimetric interest.

PACS numbers: 87.53.‐j, 87.53.Xd, 87.56.Fc
Cylindrical coordinate‐based TG‐43U1 parameters for dose calculation around elongated brachytherapy sources
Authors: Awan Shahid B. , Dini Sharifeh A. , Hussain Manzoor , Soleimani‐Meigooni David , Meigooni Ali S.
Published: March 2017

In 2001, the use of cylindrical coordinates was demonstrated to be more suitable than was the use of polar coordinates for accurate computer calculations during treatment planning for intravascular brachytherapy sources. In the present work, we investigated the applicability of cylindrical coordinate–based TG‐43U1 parameters for dosimetric evaluation and dose calculations for RadioCoil sources (RadioMed Corporation, Tyngsboro, MA) 1.0‐cm to 6.0‐cm long. For brevity, only the results for sources 1.0‐cm, 3.0‐cm, and 5.0‐cm long are presented here. Dosimetric characteristics of RadioCoil sources were calculated in liquid water using the Monte Carlo simulation technique. To demonstrate the suitability of this methodology, the Monte Carlo–simulated dose profiles for a RadioCoil source 5.0‐cm long at radial distances of 0.5 cm, 0.9 cm, and 1.25 cm were compared with calculated data using TG‐43U1 parameters in the polar and cylindrical coordinate systems. In addition, we also used a source 1.0‐cm long parameterized using cylindrical coordinates to investigate the application of a linear segmented source (LSS) model originally introduced by our group. The results indicate that, for dose calculation around elongated brachytherapy sources, cylindrical coordinate–based TG‐43U1 parameters more accurately represent the dose distribution around an elongated source than the polar coordinate–based parameters. In addition, the LSS model, in conjunction with the cylindrical coordinate–based parameters for a source 1.0‐cm long, can be used to replicate the dose distribution around any integral source length. This process eliminates the need to collect and enter data for multiple source lengths into treatment planning systems.

PACS number: 87.66.Jj
Target acquired: Selective autophagy in cardiometabolic disease
Authors: Evans Trent D. , Sergin Ismail , Zhang Xiangyu , Razani Babak
Published: March 2017

Boosting the autophagic degradation of dysfunctional organelles could be used to treat various cardiometabolic diseases.
Mitochondrial homeostasis in adipose tissue remodeling
Authors: Altshuler-Keylin Svetlana , Kajimura Shingo
Published: March 2017

Degradation of mitochondria through autophagy determines adipocyte identity and function.
Transplantation of fecal microbiota from patients with irritable bowel syndrome alters gut function and behavior in recipient mice
Authors: De Palma Giada , Lynch Michael D. J. , Lu Jun , Dang Vi T. , Deng Yikang , Jury Jennifer , Umeh Genevieve , Miranda Pedro M. , Pigrau Pastor Marc , Sidani Sacha , Pinto-Sanchez Maria Ines , Philip Vivek , McLean Peter G. , Hagelsieb Moreno-Gabriel , Surette Michael G. , Bergonzelli Gabriela E. , Verdu Elena F. , Britz-McKibbin Philip , Neufeld Josh D. , Collins Stephen M. , Bercik Premysl
Published: March 2017

Fecal microbiota transplants from patients with irritable bowel syndrome and anxiety alter gut function and behavior in germ-free mice.
50 shades of red
Authors: Jewell Christopher M.
Published: March 2017

Synthetic heart valves designed from slowly degrading polymer enable gradual replacement by new host tissue during a 12-month study in sheep.
Multiple Histone Lysine Methyltransferases Are Required for the Establishment and Maintenance of HIV-1 Latency
Authors: Nguyen Kien , Das Biswajit , Dobrowolski Curtis , Karn Jonathan
Published: March 2017

We showed previously that the histone lysine methyltransferase (HKMT) H3K27me3 (EZH2) is the catalytic subunit of Polycomb repressive complex 2 (PRC2) and is required for the maintenance of HIV-1 latency in Jurkat T cells. Here we show, by using chromatin immunoprecipitation experiments, that both PRC2 and euchromatic histone-lysine
N
-methyltransferase 2 (EHMT2), the G9a H3K9me2-3 methyltransferase, are highly enriched at the proviral 5′ long terminal repeat (LTR) and rapidly displaced upon proviral reactivation. Clustered regularly interspaced short palindromic repeat(s) (CRISPR)-mediated knockout of EZH2 caused depletion of both EZH2 and EHMT2, but CRISPR-mediated knockout of EHMT2 was selective for EHMT2, consistent with the failure of EHMT2 knockouts to induce latent proviruses in this system. Either (i) knockout of methyltransferase by short hairpin RNA in Jurkat T cells prior to HIV-1 infection or (ii) inhibition of the enzymes with drugs significantly reduced the levels of the resulting silenced viruses, demonstrating that both enzymes are required to establish latency. To our surprise, inhibition of EZH2 (by GSK-343 or EPZ-6438) or inhibition of EHMT2 (by UNC-0638) in the Th17 primary cell model of HIV latency or resting memory T cells isolated from HIV-1-infected patients receiving highly active antiretroviral therapy, was sufficient to induce the reactivation of latent proviruses. The methyltransferase inhibitors showed synergy with interleukin-15 and suberanilohydroxamic acid. We conclude that both PRC2 and EHMT2 are required for the establishment and maintenance of HIV-1 proviral silencing in primary cells. Furthermore, EZH2 inhibitors such as GSK-343 and EPZ-6438 and the EHMT2 inhibitor UNC-0638 are strong candidates for use as latency-reversing agents in clinical studies.

IMPORTANCE
Highly active antiretroviral therapy (HAART) reduces the circulating virus to undetectable levels. Although patients adhering to the HAART regimen have minimal viremia, HIV persists because of the existence of latent but replication-competent proviruses in a very small population of resting memory CD4
+
T cells (~1 in 10
6
cells). Latency remains the major obstacle to a functional cure for HIV infection, since the persistent reservoir almost invariably rebounds within 2 to 8 weeks when HAART is interrupted. In latently infected cells, the HIV genome is stably integrated into the host chromosome but transcriptionally repressed because of epigenetic silencing mechanisms. We demonstrate here that multiple histone lysine methyltransferases play a critical role in both the establishment and maintenance of proviral silencing in cells obtained from well-suppressed patients. Drugs that inhibit these enzymes are available from oncology applications and may find a use in reversing latency as part of a reservoir reduction strategy.
Gastric malignancy presenting as a neck swelling to the otorhinolaryngologists: a case of internal jugular venous thrombosis
Authors: Richardson-May James , Rogers James , Parker Thomas
Published: March 2017

A woman aged 69 years presented with a 2-week history of left-sided neck swelling, dysphagia and night sweats. CT revealed an internal jugular venous thrombosis, multiple pulmonary emboli and gastric thickening. Endoscopy found a haemorrhagic fundal polypoidal tumour; biopsies diagnosed a gastric adenocarcinoma, Lauren's intestinal type. She was managed with radiotherapy and low molecular weight heparin.
Heart failure in patients presenting with dyspnoea to the emergency department in the Asia Pacific region: an observational study
Authors: Keijzers Gerben , Kelly Anne-Maree , Cullen Louise , Klim Sharon , Graham Colin A , Craig Simon , Kuan Win Sen , Jones Peter , Holdgate Anna , Lawoko Charles , Laribi Said
Published: March 2017

Objectives

To describe demographic features, assessment, management and outcomes of patients who were diagnosed with heart failure after presenting to an emergency department (ED) with a principal symptom of dyspnoea.

Design

Planned substudy of the prospective, descriptive cohort study: Asia, Australia and New Zealand Dyspnoea in Emergency Departments (AANZDEM).

Setting

46 EDs in Australia, New Zealand, Singapore, Hong Kong and Malaysia collected data over 3 72-hour periods in May, August and October 2014.

Participants

Patients with an ED diagnosis of heart failure.

Outcome measures

Outcomes included patient epidemiology, investigations ordered, treatment modalities used and patient outcomes (hospital length of stay (LOS) and mortality).

Results

455 (14.9%) of the 3044 patients had an ED diagnosis of heart failure. Median age was 79 years, half were male and 62% arrived via ambulance. 392 (86%) patients were admitted to hospital. ED diagnosis was concordant with hospital discharge diagnosis in 81% of cases. Median hospital LOS was 6 days (IQR 4–9) and in-hospital mortality was 5.1%. Natriuretic peptide levels were ordered in 19%, with lung ultrasound (<1%) and echocardiography (2%) uncommonly performed. Treatment modalities included non-invasive ventilation (12%), diuretics (73%), nitrates (25%), antibiotics (16%), inhaled β-agonists (13%) and corticosteroids (6%).

Conclusions

In the Asia Pacific region, heart failure is a common diagnosis among patients presenting to the ED with a principal symptom of dyspnoea. Admission rates were high and ED diagnostic accuracy was good. Despite the seemingly suboptimal adherence to investigation and treatment guidelines, patient outcomes were favourable compared with other registries.
Commissioning of specialist palliative care services in England
Authors: Lancaster Harriet , Finlay Ilora , Downman Maxwell , Dumas James
Published: March 2017

Objectives

Some failures in end-of-life care have been attributed to inconsistent provision of palliative care across England. We aimed to explore the variation in commissioning of services by Clinical Commissioning Groups (CCGs) using a data collection exercise.

Methods

We sent a Freedom of Information request in the form of an open questionnaire to all 209 CCGs in England to assess their commissioning of palliative and end-of-life care services, mainly focused on the provision of specialist palliative care services.

Results

29 CCGs provided information about the number of patients with some form of palliative care needs in their population. For specialist palliative care services, CCGs allocated budgets ranging from £51.83 to £2329.19 per patient per annum. 163 CCGs (77.90%) currently commission 7-day admission to their specialist palliative care beds. 82.84% of CCGs commission 7-day specialist palliative care services in patients' own homes and out-of-hours services rely heavily on hospice provision. 64 CCGs (31.37%) commission pain control teams, the majority of whom only operate in regular working hours. 68.14% of CCGs reported commissioning palliative care education of any sort for healthcare professionals and 44.85% of CCGs had no plans to update or review their palliative care services.

Conclusions

The most important finding from this exercise is that the information CCGs hold about their population and services is not standardised. However, information based on data that are more objective, for example, population and total budget for palliative care, demonstrate wide variations in commissioning.
Survivorship of severe medically unexplained symptoms in palliative care
Authors: Dwyer Justin , Taylor Keryn , Boughey Mark
Published: March 2017

Objectives

Patients who articulate their psychological distress primarily through physical symptoms (referred to as medically unexplained symptoms (MUS)) pose a challenge to the skills of most clinicians, including palliative care physicians. The philosophical underpinnings of palliative care with a stated focus on symptom management and care of the person in their psychosociospiritual context lend itself to the care of these patients. The aim of this study was to investigate the characteristics to improve identification of this patient group within palliative care.

Methods

Here, we report a case series of 6 patients with severe MUS who were referred to palliative care. We use illustrative case vignettes, examine clinical and demographic characteristics and review the perspectives of the multidisciplinary team to identify the common threads.

Results

This case series highlights the complexities and challenges that are inherent in providing assessment and care for patients with MUS that present to palliative care. Characteristics that were identified included the clustering of ‘trigger’ symptoms, backgrounds of multiple chronic illnesses and relationship dysfunction. Patient outcomes in this group were universally poor, including the death of 2 patients.

Conclusions

Knowledge of this patient group is vital given the likely increase in prevalence of MUS as palliative care broadens its focus earlier in the trajectory of illness. The strengths of palliative care, including psychosociospiritual assessment, multidisciplinary input and communication skills holds the potential to accurately identify patients with MUS and allow the opportunity for specialist psychiatric input with the hope of improving outcomes for patients and their families.
A neuro-dynamic programming approach to the optimal stand management problem
Authors: Comeau Jules , Gunn Eldon
Published: March 2017

Some ideas of neuro-dynamic programming (NDP) are illustrated by considering the problem of optimally managing a forest stand under uncertainty. Because reasonable growth models require state information such as height (or age), basal area, and stand diameter, as well as an indicator variable for treatments that have been performed on the stand, they can easily lead to very large state spaces that include continuous variables. Realistic stand management policies include silvicultural options such as pre-commercial and commercial thinning as well as post-harvest treatments. We are interested in problems that are stochastic in their basic growth dynamics, in market prices, and in disturbances, ranging from insects to fire to hurricanes. NDP algorithms are appropriate for problems with large dimensions that may lack a simple model of dynamics and stochastic processes. This paper looks at applying these ideas in the context of a multispecies model. Results show that policies obtained using NDP are optimal within a 95% confidence interval or better. The set of states and controls incorporated into our NDP model allows us to develop optimal policies with a level of detail not typically seen in the forestry literature.
E11, Romans theory and higher level duality relations
Authors: Tumanov Alexander G. , West Peter
Published: March 2017

From the underlying nonlinear realisation, we compute the complete E[Formula: see text] invariant equations of motion in eleven dimensions, at the linearised level, up to and including level four in the fields. Thus, we include the metric, the three and six forms, the dual graviton and three fields at level four. The fields are linked by a set of duality equations, which are first-order in derivatives and transform into each other under the E[Formula: see text] symmetries. From these duality relations, we deduce second-order equations of motion, including those for the usual supergravity fields. As a result the on-shell degrees of freedom are those of the eleven-dimensional supergravity. We also show that the level four fields provide an eleven-dimensional origin of Romans theory and lead to a novel duality relation.