bluuebunny/crossref_metadata_2025 huggingface dataset:
Custom designed photovoltaic modules for PIPV and BIPV applications
Authors: Adamovic N. , Zimmermann A. , Caviasca A. , Harboe R. , Ibanez F.
Published: April 2017

The vision to use Photovoltaics (PV) as a decentralized and sustainable source of energy in their products is shared by thousands of designers, architects, and manufacturers worldwide. In principle, PV can be integrated directly in products, such as devices, vehicles, and buildings. Nowadays, the development of photovoltaic modules is still primarily driven by the idea of economies of scales, which leads to unvaried PV modules that are only good for large-area installations. These photovoltaic modules are not suitable for the integration into building skins, roof tiles, or electric devices because of their rigidness and their electrical constraints. Even companies which could provide a solution for these applications (flexible thin-film PV firms) are not providing customized PV modules because of the associated set-up times. This paper addresses these obstacles and the development of novel solar cell materials and manufacturing processes. A novel manufacturing process is designed to enable the adjustment of all the properties of a thin-film module on-the-fly and facilitates the production of customized photovoltaic modules with the desired voltage, size, and shape. Combined with the material characteristics given by the underlying thin-film solar cell technology, a new-breed of design-led, sustainable, and decentralised energy solutions will be able to realize. The novel PV material was demonstrated in design driven prototypes ranging from solar charged mobile devices, solar lighting, and building integrated PV to full integration in textiles.
Roll type conducting polymer legs for rigid-flexible thermoelectric generator
Authors: Park Teahoon , Lim Hanwhuy , Hwang Jong Un , Na Jongbeom , Lee Hyunki , Kim Eunkyoung
Published: April 2017

A roll-type conducting polymer film was explored as a flexible organic p-type thermoelectric leg using poly(3,4-ethylenedioxythiophene) (PEDOT) doped with tosylate. The PEDOT films were prepared through solution casting polymerization and rolled up for a roll-type leg. Due to the high flexibility, the roll-type PEDOT leg enabled easy contact to both top and bottom electrodes. Simulation on the dynamic heat transfer and convective cooling for a vertically roosted rod- and roll-type PEDOT leg showed that the temperature difference (ΔT) between the hot and cold sides of the leg was much higher in the roll than that of the rod. The PEDOT legs were integrated with n-type Bi2Te3 blocks, to give a 36-couple rigid-flexible thermoelectric generator (RF-TEG). The maximum output voltage from the 36-couple RF-TEG under a ΔT of 7.9 K was determined as 36.7 mV along with a high output power of 115 nW. A wearable RF-TEG was prepared upon the combination of the 36-couple RF-TEG with an arm warmer, to afford an output voltage of 10.6 mV, which was generated constantly and steadily from human wrist heat.
High-efficient and low-cost catalyst for hydrogen evolution reaction: Nickel phosphide nano-spheres
Authors: Abdalla S. , Al-Marzouki Fahd , Obaid A.
Published: April 2017

Catalysts have been a bottleneck in hydrogen evolution reaction (HER)—a half reaction of water splitting. Hitherto, the most efficient HER catalyst in terms of catalytic capacity remains to be platinum group metals, especially platinum; however, rare metals' exorbitant cost and scarcity inhibit their further application in industry, which therefore call for catalysts prepared from earth-abundant elements. Herein, we introduce nickel phosphide nano-spheres (NPNs) bearing excellent HER activity. Prepared via a facile, inexpensive, and eco-friendly preparation procedure, the as-synthesized NPNs have perfect over-potential to reach −100 mA/cm2 (η100), with η100 reaching 251 mV in 0.5 M H2SO4. A series of durability tests, including cyclic voltammetry and chronoamperometry, also indicate NPNs' favorable stability in both acidic and alkaline conditions. After taking into account a string of factors, including NPNs' mass density, handy preparation process, superior catalytic activity, and favorable durability, the NPNs bear probable potentiality of taking traditional noble metals' place as the HER catalyst and are worth studying further.

At the request of the Editors-in-Chief and AIP Publishing this article is being retracted. The article had a high degree of overlap with an article published in the International Journal of Hydrogen Energy. The article is retracted from the scientific record effective 30 June 2017.
Positron scattering from hydrogen atom in dense quantum plasmas: Positronium formation in Rydberg states
Authors: Rej Pramit , Ghoshal Arijit
Published: April 2017

Effects of dense quantum plasmas on positronium (Ps) formation in an arbitrary nlm–state in the scattering of positrons from the ground state of hydrogen atoms have been investigated within the framework of a distorted wave theory that incorporates the effect of screened dipole polarization potential. The interaction of charged particles in plasmas has been modeled by a modified Debye-Huckel potential. Effects of plasma screening on the structures of differential and total cross sections have been explored for various incident positron energies in the range 20–300 eV. For the free atomic case, our results are in conformity with the existing results available in the literature. It has been found that for small screening effects, the cross section presents the oscillatory behaviour. To the best of our knowledge, this is the first attempt to estimate the screening effects on the differential and total cross sections for Ps formation in Rydberg states in dense quantum plasmas.
Tunable organic PV parallel tandem with ionic gating
Authors: Saranin Danila , Ishteev Artur , Cook Alexander B. , Yuen Jonathan D. , Kuznetsov Denis , Orlova Marina , Didenko Sergey , Zakhidov Anvar
Published: April 2017

A novel type of tunable organic photovoltaic (OPV) tandem device with ionic gating by in-situ ionic liquid is presented. This device is comprised of two solution-processed polymeric OPV cells connected in parallel by a dry-laminated transparent multiwall carbon nanotube (MWCNT) interlayer. The interlayer MWCNT of this 3-terminal tandem device plays a role of a common electrode with a Fermi level that can be tuned via ionic gating to turn it into a common cathode, collecting photo-generated electrons from both sub-cells. Ionic gating employs electric double layer charging of the MWCNT in order to lower the work function of the common CNT electrode and increase its n-type conductivity. This tandem device is fabricated in ambient conditions via dry-lamination of MWCNT transparent sheets The new results demonstrating the different regimes of ionic gating at low, medium, and high gating voltages Vgate are presented, showing the optimal doping of the MWCNT, then favorable doping of acceptor PCBM ([6,6]-phenyl-C61-butyric acid methyl ester), followed by the deterioration of performance at Vgate over the threshold voltage when doping of polymeric layers of sub-cell OPVs starts taking place. The doping of PCBM and polymers is additionally confirmed by the change in the charging and discharging current dynamics at high Vgate above the threshold.
Controlling single harmonic enhancement in laser-produced plasmas
Authors: Ganeev R. A.
Published: April 2017

We compare the plasma emission and harmonic generation spectra in the cases of resonance enhancement of single harmonic using various laser-produced plasmas. The analysis of these spectra showed that the enhancement of harmonics depended on the oscillator strengths of the nearby ionic transitions rather than the plasma emission transitions. To prove it, we used the tunable source of mid-infrared radiation from an optical parametric amplifier (1200–1600 nm) and the fixed wavelength source (810 nm) of femtosecond pulses. The comparison of resonantly enhanced and featureless plateaulike harmonic spectra from different laser-produced plasmas, as well as their plasma emissions, confirmed this assumption.
Defect-mediated leakage in lithium intercalated bilayer graphene
Authors: O’Hara Andrew , Kahn R. Emmett , Zhang Yu-Yang , Pantelides Sokrates T.
Published: April 2017

Lithium intercalation in bilayer graphene has been investigated for battery applications, but it also provides a potentially stable method for n-type doping for electronics applications. Here, we use density functional theory to investigate the stability of lithium-intercalated bilayer graphene with respect to migration through lattice defects. By calculating energy barriers for through-defect migration, we find that only multivacancies with more than two missing atoms pose a significant threat for lithium egress. Furthermore, entry through a divacancy is significantly more energetically favorable than exit, implying that divacancies may be beneficial for thermal creation of intercalated bilayers. The calculations also show that, though energy barriers for through-defect Li diffusion are significantly different in monolayer and bilayer graphene, additional over-layers (such as hexagonal boron nitride) do not significantly alter the exit barrier in an intercalated bilayer.
Microstructural and component evolution of self-assembled nanoperiod multilayered carbon-copper films with deposition pressure
Authors: Wang Weiqi , Ji Li , Li Hongxuan , Zhao Yiman , Zhou Huidi , Chen Jianmin
Published: April 2017

Here, we report a facile synthesis method for the fabrication of various nanoperiod multilayers in carbon-copper films only by conveniently changing the deposition pressure from the reactive magnetron sputter process. To obtain the nano-multilayered structure with different number of layers, only one single sputtering target of copper is used at gas pressure varied from 0.4 Pa to 1.2 Pa by flowing gas mixture of argon and methane, while 600W DC input power is applied to a copper target. The influence of deposition pressure on the microstructure and constitution of the films are investigated by X-ray photoelectron spectroscopy (XPS), field emission scanning electron microscopy (FESEM) and high-resolution transmission electron microscopy (HRTEM). The results show that carbon-rich layers and copper-rich layers are alternately arranged to self-organize the multilayered structure in the carbon-copper films, both of the carbon-rich layer and copper-rich layer constitute a period. The amount of layers in the multilayered structure is found to decrease with the deposition pressure, the film deposited with 0.4 Pa has the maximum layers and the highest copper content compared with the other deposition pressure. Effects of the growth condition on the growth rate, the number of the layers and the energy of plasmas during deposition process are discussed. Based on the (a) influence of the effect of carbon absorbed on the copper target leading to target poisoning, (b) influence of deposition pressure on the energy of etching ions and (c) the energetic ions bombardment enhanced inter diffusion of deposition ions, the mechanism of self-organized formation of nano-multilayer in the carbon-copper films with various number of layer is proposed.
Influences of dietary supplementation of peanut skin powder (Arachis Hypogaea) on growth performance, carcass traits, blood chemistry, antioxidant activity and meat quality of broilers
Authors: Abd El-Hack M. E. , Ashour E. A. , Elaraby Gh. M. , Osman A. O. , Arif M.
Published: April 2017

The present study aimed to investigate the effects of dietary supplementation with powdered peanut skin (PS) as natural antioxidant and growth promoter on growth performance, carcass characteristics, serum metabolites and meat quality of Cobb broiler chickens. A total of 240 unsexed Cobb 500 1-week-old broiler chicks were randomly assigned to four treatment groups with six replicates. The dietary treatments consisted of the basal diet as control and PS groups (1.0, 2.0, and 3.0 PS g/kg). Results showed that the highest values (P < 0.01) of live bodyweight and bodyweight gain were observed in the control group at 3 weeks of age and during the period of 1–3 weeks of age, respectively compared with all levels of PS. During 1–3 weeks of age, feed intake per day chicks fed the diet containing PS levels decreased numerically (P > 0.01) with increased levels of PS compared with the control. Supplementing 1.0 or 3.0 g/kg of PS insignificantly enhanced feed conversion ratio at 1–6 weeks of age. Dietary treatments significantly depressed giblets (P = 0.002), thigh (P = 0.0.027) and abdominal fat percentages (P > 0.0.1), however, increased (P = 0.004) breast percentage of broiler chicks at 6 weeks of age. The lowest value of serum creatinine and urea achieved by chicks fed diet contained 3.0 PS g/kg diet. Also, high density lipoprotein cholesterol in addition to triglycerides were significantly (P < 0.05 and P < 0.01) decreased with increasing level of PS supplementation. It can be concluded that PS as a phytogenic additive could be used as a supplementation to broiler diets to lower abdominal fat in carcass and cholesterol, creatinin and urea in blood. Sensory characteristics were not affected except that appearance was improved. Water-holding capacity was also improved.
Competing modal periphrases in Spanish between the 16th and the 18th centuries
Authors: Blas Arroyo José Luis , Schulte Kim
Published: April 2017

The history of Spanish modal constructions has been widely discussed in the literature, focusing primarily on the semantic differences between the available alternatives. This paper offers an innovative analysis of the evolution of these constructions by adopting a diachronic variationist approach that takes into account a wider range of semantic, syntactic, morphological and stylistic factors that influence the choice between the competing modal periphrases during two key stages in the evolution of Spanish. The data is drawn from a diachronic corpus of personal correspondence, reflecting actual language usage during the respective periods as closely as possible. Particular attention is paid to the question of whether the influence of different factor groups remains stable over time or not, and it is shown that the most frequent form – context pairings are particularly resistant to innovation. This can be explained by cognitive entrenchment of the respective variant in specific linguistic environments.
Language mixing and genetic similarity
Authors: Law Danny
Published: April 2017

Definitions of ‘mixed’ or ‘intertwined’ languages derive almost entirely from studies of languages that combine elements from genetically unrelated sources. The Mayan language Tojol-ab’al displays a mixture of linguistic features from two related Mayan languages, Chuj and Tseltal. The systematic similarities found in related languages not only make it methodologically difficult to identify the source of specific linguistic features but also mean that inherited similarity can alter the processes and outcomes of language mixing in ways that parallel observed patterns of code-switching between related languages. Tojol-ab’al, therefore, arguably represents a distinct type of mixed language, one that may only result from mixture involving related languages.
Context-appropriate crosslinguistic pedagogy
Authors: Ballinger Susan , Lyster Roy , Sterzuk Andrea , Genesee Fred
Published: April 2017

In the field of second language education, researchers increasingly call for crosslinguistic pedagogical practices meant to encourage bilingual learners to draw on all of their linguistic resources regardless of the focus of instruction or the status of the target language. These recommendations include a relaxation of the strict language separation common in many bilingual education programs. Specifically, some Canadian French immersion researchers suggest that it may be beneficial to allow immersion students to use English for peer interaction during instructional time allotted to French. In this position paper, we argue that researchers should proceed with caution in calling for increased majority language use in the minority language classroom. We use Canadian French immersion as a case in point to contend that until empirical evidence supports increased use of English in immersion, crosslinguistic approaches that maintain a separate space for the majority language may represent ideal pedagogical practices in these contexts.
Liberal articulations of the ‘Enlightenment’ in the Greek public sphere
Authors: Mylonas Yiannis
Published: April 2017

This study presents a scrutiny of ‘liberal’ discursive constructions of the ‘Enlightenment’ in the Greek public sphere. The study is based on the analysis of articles published in two news/lifestyle websites, ‘AthensVoice’ and ‘Protagon’, during the (ongoing), so-called, ‘Greek crisis’. Discourse theory, informed by critical discourse analysis, is deployed to analyze these discursive constructions. The analysis shows that Greece’s economic/social/political problems are constructed as symptoms that underline Greece’s fundamental deficit, which is the country’s alleged ‘lack of ‘Enlightenment’, as perceived by ‘liberal’ voices in Greece and elsewhere. The article concludes that such discourses are part of a biopolitical, disciplinary framework producing the object to be reformed by austerity: an ‘un-Enlightened’ ‘Greek character’, ‘guilty’ for ‘self-inflicting’ Greece’s crisis. This ‘reform of character’ envisioned by liberals in Greece and elsewhere, is supposed to emerge through the institutional advance of neoliberal restructuring processes that include austerity reforms, privatizations, and loss of labor and civic rights, conditions to foster the neoliberal, entrepreneurial, mobile and austere subject, to potentially meet the socio-political requirements of late capitalist growth.
Using shadowing with mobile technology to improve L2 pronunciation
Authors: Foote Jennifer A. , McDonough Kim
Published: April 2017

Shadowing has been demonstrated to improve various aspects of second language learners’ pronunciation but few studies have investigated whether these changes impact untrained listeners’ perceptions. In the present study, sixteen participants used iPods to practice shadowing short dialogues for eight weeks. The participants practiced at least four times per week for a minimum of 10 minutes each time, and recorded themselves while shadowing. Two tasks (a shadowing task and an extemporaneous speaking task) were administered as pre-, mid-, and post-tests, and were rated by 22 speakers of English. The shadowing task was rated for learners’ ability to imitate a speech model and the extemporaneous speaking task was rated for comprehensibility, accentedness, and fluency. Interview data were also collected during the study to gauge participants’ opinions of the activities. Results indicated that the participants improved significantly on all speaking measures apart from accentedness and were largely positive about the activities.
Phonological development in two-way bilingual immersion
Authors: Menke Mandy Renee
Published: April 2017

In spite of the well-documented advantage of an early age of acquisition, findings from one-way (foreign language) immersion programs suggest that this instructional context is insufficient for acquisition of nativelike articulations by child foreign language learners. It has been suggested that the lack of exposure to native speaking peers may contribute to reported non-native pronunciation. This study expands upon the previous research with child second language learners of Spanish, exploring how children, who learn academic content in Spanish, alongside native Spanish-speaking peers produce the Spanish vowels. Few differences are observed between the learner and peer native speaker groups, suggesting that the direct contact with native speakers of Spanish afforded by two-way bilingual immersion promotes phonological acquisition.
A cross-linguistic preference for torso stability in the lexicon
Authors: Sanders Nathan , Napoli Donna Jo
Published: April 2017

When the arms move in certain ways, they can cause the torso to twist or rock. Such extraneous torso movement is undesirable, especially during sign language communication, when torso position may carry linguistic significance, so we expend effort to resist it when it is not intended. This so-called “reactive effort” has only recently been identified by Sanders and Napoli (2016), but their preliminary work on three genetically unrelated languages suggests that the effects of reactive effort can be observed cross-linguistically by examination of sign language lexicons. In particular, the frequency of different kinds of manual movements in the lexicon correlates with the amount of reactive effort needed to resist movement of the torso. Following this line of research, we present evidence from 24 sign languages confirming that there is a cross-linguistic preference for minimizing the reactive effort needed to keep the torso stable.
Crocin reduces the inflammation response in rheumatoid arthritis
Authors: Li Xiang , Jiang Chao , Zhu Wenyong
Published: April 2017

This study is to determine the role and mechanism of crocin in rheumatoid arthritis (RA). Totally 60 Wistar SD rats were randomly divided into control group, RA model group, methotrexate group, crocin high dose, middle dose, and low dose groups. The paw swelling degree, arthritis score, thymus and spleen index, the mRNA and protein levels of iNOS, and the serum content of TNF-α, IL-1β, and IL-6 were evaluated. Crocin treatment significantly alleviated the paw swelling of RA rats. The arthritis score in crocin treatment groups was significantly lower than that in RA model group. Additionally, the thymus index, but not the spleen index, declined remarkably in crocin treatment groups than in RA model group. Besides, crocin administration significantly reduced the iNOS production and the serum content of TNF-α, IL-1β, and IL-6. Crocin may exert potent anti-RA effects through inhibiting cytokine.
DC subset–specific induction of T cell responses upon antigen uptake via Fcγ receptors in vivo
Authors: Lehmann Christian H.K. , Baranska Anna , Heidkamp Gordon F. , Heger Lukas , Neubert Kirsten , Lühr Jennifer J. , Hoffmann Alana , Reimer Katharina C. , Brückner Christin , Beck Simone , Seeling Michaela , Kießling Melissa , Soulat Didier , Krug Anne B. , Ravetch Jeffrey V. , Leusen Jeanette H.W. , Nimmerjahn Falk , Dudziak Diana
Published: April 2017

Dendritic cells (DCs) are efficient antigen-presenting cells equipped with various cell surface receptors for the direct or indirect recognition of pathogenic microorganisms. Interestingly, not much is known about the specific expression pattern and function of the individual activating and inhibitory Fcγ receptors (FcγRs) on splenic DC subsets in vivo and how they contribute to the initiation of T cell responses. By targeting antigens to select activating and the inhibitory FcγR in vivo, we show that antigen uptake under steady-state conditions results in a short-term expansion of antigen-specific T cells, whereas under inflammatory conditions especially, the activating FcγRIV is able to induce superior CD4+ and CD8+ T cell responses. Of note, this effect was independent of FcγR intrinsic activating signaling pathways. Moreover, despite the expression of FcγRIV on both conventional splenic DC subsets, the induction of CD8+ T cell responses was largely dependent on CD11c+CD8+ DCs, whereas CD11c+CD8− DCs were critical for priming CD4+ T cell responses.
Control of Kir channel gating by cytoplasmic domain interface interactions
Authors: Borschel William F. , Wang Shizhen , Lee Sunjoo , Nichols Colin G.
Published: April 2017

Inward rectifier potassium (Kir) channels are expressed in almost all mammalian tissues and play critical roles in the control of excitability. Pancreatic ATP-sensitive K (KATP) channels are key regulators of insulin secretion and comprise Kir6.2 subunits coupled to sulfonylurea receptors. Because these channels are reversibly inhibited by cytoplasmic ATP, they link cellular metabolism with membrane excitability. Loss-of-function mutations in the pore-forming Kir6.2 subunit cause congenital hyperinsulinism as a result of diminished channel activity. Here, we show that several disease mutations, which disrupt intersubunit salt bridges at the interface of the cytoplasmic domains (CD-I) of adjacent subunits, induce loss of channel activity via a novel channel behavior: after ATP removal, channels open but then rapidly inactivate. Re-exposure to inhibitory ATP causes recovery from this inactivation. Inactivation can be abolished by application of phosphatidylinositol-4,5-bisphosphate (PIP2) to the cytoplasmic face of the membrane, an effect that can be explained by a simple kinetic model in which PIP2 binding competes with the inactivation process. Kir2.1 channels contain homologous salt bridges, and we find that mutations that disrupt CD-I interactions in Kir2.1 also reduce channel activity and PIP2 sensitivity. Kir2.1 channels also contain an additional CD-I salt bridge that is not present in Kir6.2 channels. Introduction of this salt bridge into Kir6.2 partially rescues inactivating mutants from the phenotype. These results indicate that the stability of the intersubunit CD-I is a major determinant of the inactivation process in Kir6.2 and may control gating in other Kir channels.
Evaluation and management of orofacial pain
Authors: Gilkey Stephanie Joseph , Plaza-Villegas Francisco
Published: April 2017

Challenging to diagnose and manage, orofacial pain is a common and costly problem with a profound effect on quality of life. Delayed diagnosis and management can lead to prolonged patient suffering and disability. This article describes the background, assessment, differential diagnosis, management, and referral of patients with orofacial pain.
Keep them breathing
Authors: Brown Sheena D. , White Rachel , Tobin Phil
Published: April 2017

Cystic fibrosis (CF) affects more than 30,000 people in the United States and 80,000 people worldwide. This life-threatening genetic disorder causes a buildup of thick, viscous mucus secretions in various organ systems, most commonly the gastrointestinal, pulmonary, and genitourinary systems. This article reviews the clinical manifestations, diagnosis, and monitoring of patients with CF as well as guidelines for management and emerging pharmacologic treatments.
From microbiome to infectome in autoimmunity
Authors: Bogdanos Dimitrios P. , Sakkas Lazaros I.
Published: April 2017

Purpose of review

The current review discusses the pros and cons of the microbiome studies conducted in search of the association between microbiota and autoimmunity.

Recent findings

We focus on the role of infectome and autoinfectome as a bridge to link the findings of microbiome studies with those emerging from investigations of the role of specific viruses and antiviral responses as triggers of autoimmunity (through various mechanisms such as molecular mimicry). The ‘usual suspects’, such as herpetoviruses and Escherichia coli, are thoroughly discussed in light of the data emerged by the microbiome studies, using as examples specific autoimmune rheumatic diseases and inflammatory bowel diseases.

We conclude that the studies of the oral cavity, gastrointestinal, and urinary tract microbiome are informative but can only be useful if further explored from the infectome perspective. This means that the plethora of bacteria associated with autoimmune diseases from microbiome studies can be and must be tested experimentally. If certain bacteria are associated directly or indirectly with autoimmune diseases, specific immunological mechanisms must be identified.
Osteoporosis in premenopausal women
Authors: Langdahl Bente L.
Published: April 2017

Purpose of review

The scope of this review was to review the newest developments in the context of the existing knowledge on premenopausal bone fragility. Fragility fractures are common in postmenopausal women and men and diagnostic criteria for osteoporosis have been agreed and multiple pharmacological treatments have been developed over the last 25 years. In premenopausal women, fragility fractures and very low bone mass are uncommon and osteoporosis in premenopausal women has therefore attracted much less interest.

Recent findings

Recent studies have highlighted that lifestyle and dietary habits affect premenopausal bone mass. Bone mass may be improved by sufficient intake of calcium and vitamin D together with increased physical activity in premenopausal women with idiopathic osteoporosis. If pharmacological treatment is needed, teriparatide has been demonstrated to efficiently increase bone mass; however, no fracture studies and no comparative studies against antiresorptive therapies have been conducted. Pregnancy affects bone turnover and mass significantly, but pregnancy-associated osteoporosis is a rare and heterogeneous condition.

The diagnosis of osteoporosis should only be considered in premenopausal women with existing fragility fractures, diseases or treatments known to cause bone loss or fractures. Secondary causes of osteoporosis should be corrected or treated if possible. The women should be recommended sufficient intake of calcium and vitamin and physical activity. In women with recurrent fractures or secondary causes that cannot be eliminated, for example glucocorticoid or cancer treatment, pharmacological intervention with bisphosphonates or teriparatide (not in the case of cancer) may be considered.
Postoperative Complications and Outcomes Associated With a Transition to 24/7 Intensivist Management of Cardiac Surgery Patients
Authors: Benoit Marc A. , Bagshaw Sean M. , Norris Colleen M. , Zibdawi Mohamad , Chin Wu Dat , Ross David B. , van Diepen Sean
Published: April 2017

Objectives:

Nighttime intensivist staffing does not improve patient outcomes in general ICUs. Few studies have examined the association between dedicated in-house 24/7 intensivist coverage on outcomes in specialized cardiac surgical ICUs. We sought to evaluate the association between 24/7 in-house intensivist-only management of cardiac surgical patients on postoperative complications and health resource utilization.

Design:

Before-and-after propensity matched cohort study.

Setting:

Tertiary care cardiac surgical ICU.

Patients:

Patients greater than 18 years old who underwent cardiac surgery between January 1, 2006, and April 30, 2013 (nighttime resident model), were propensity-matched (1:1) to patients from August 1, 2013, to December 31, 2014 (24/7 in-house intensivist model).

Interventions:

Cardiac surgical ICU coverage change from a nighttime resident physician coverage model to a 24/7 in-house intensivist staffing model.

Measurements and Main Results:

The primary outcome of interest was a composite of postoperative major complications. Secondary outcomes included duration of mechanical ventilation, all-cause cardiac surgical ICU readmissions, and surgical postponements attributed to lack of cardiac surgical ICU bed availability. A total of 1,509 patients during the nighttime resident model were matched to 1,509 patients during the intensivist model. The adjusted risk of major complications (26.3% vs 19.3%; odds ratio, 0.73; 95% CI, 0.36–0.85;p< 0.01), mean mechanical ventilation time (25.2 vs 19.4 hr;p< 0.01), cardiac surgical ICU readmissions (5.3% vs 1.6%; odds ratio, 0.31; 95% CI, 0.19–0.48;p< 0.01), and surgical postponements (3.4 vs 0.3 per mo;p< 0.01) were lower with the intensivist model.

Conclusions:

A transition to a 24/7 in-house intensivist care model was associated with a reduction in postoperative major complications, duration of mechanical ventilation, cardiac surgical ICU readmissions, and surgical postponements. These findings suggest that 24/7 intensivist physician care models may improve patient outcomes and health resource utilization in specialized cardiac surgical ICUs.
Core Domains for Clinical Research in Acute Respiratory Failure Survivors: An International Modified Delphi Consensus Study
Authors: Turnbull Alison E. , Sepulveda Kristin A. , Dinglas Victor D. , Chessare Caroline M. , Bingham Clifton O. , Needham Dale M.
Published: April 2017

Objectives:

To identify the “core domains” (i.e., patient outcomes, health-related conditions, or aspects of health) that relevant stakeholders agree are essential to assess in all clinical research studies evaluating the outcomes of acute respiratory failure survivors after hospital discharge.

Design:

A two-round consensus process, using a modified Delphi methodology, with participants from 16 countries, including patient and caregiver representatives. Prior to voting, participants were asked to review 1) results from surveys of clinical researchers, acute respiratory failure survivors, and caregivers that rated the importance of 19 preliminary outcome domains and 2) results from a qualitative study of acute respiratory failure survivors’ outcomes after hospital discharge, as related to the 19 preliminary outcome domains. Participants also were asked to suggest any additional potential domains for evaluation in the first Delphi survey.

Setting:

Web-based surveys of participants representing four stakeholder groups relevant to clinical research evaluating postdischarge outcomes of acute respiratory failure survivors: clinical researchers, clinicians, patients and caregivers, and U.S. federal research funding organizations.

Subjects:

None.

Interventions:

None.

Measurements and Main Results:

Survey response rates were 97% and 99% in round 1 and round 2, respectively. There were seven domains that met the a priori consensus criteria to be designated as core domains: physical function, cognition, mental health, survival, pulmonary function, pain, and muscle and/or nerve function.

Conclusions:

This study generated a consensus-based list of core domains that should be assessed in all clinical research studies evaluating acute respiratory failure survivors after hospital discharge. Identifying appropriate measurement instruments to assess these core domains is an important next step toward developing a set of core outcome measures for this field of research.
Transforming Growth Factor β is a Poor Prognostic Factor and Inhibits the Favorable Prognostic Value of CD8+ CTL in Human Hepatocellular Carcinoma
Authors: Huang Chun-yu , Wang Hua , Liao Wei , Han Feng , Li Yong-qiang , Chen Shu-wei , Lao Xiang-ming
Published: April 2017

It is widely understood that transforming growth factor β (TGF-β) has dual functions in tumors—tumor promoter or tumor suppressor. As a tumor promoter, TGF-β drives tumor initiation and progression partially by suppressing the antitumor responses of CD8+ cytotoxic T lymphocytes (CTLs) in the tumor microenvironment. Here, we investigated the prognostic value of measuring TGF-β and CD8+ CTLs levels and their relationship in human hepatocellular carcinoma (HCC). Immunohistochemical staining was conducted to analyze the prognostic value of TGF-β expression and/or CD8+ CTLs levels in 407 HCC patients. The relationship between TGF-β and CD8+ T-cell was also evaluated using HCC cell lines and patients’ peripheral blood. Lower TGF-β expression or a higher CD8+ CTL density was associated with better overall survival and recurrence-free survival, and the patients with low TGF-β expression and more CD8+ CTLs had the best prognosis. Although there was no correlation between TGF-β expression and the density of CD8+ CTLs, the survival of patients with more CD8+ CTL cells was only significantly improved when the tumor expressed low levels of TGF-β. Furthermore, the TGF-β levels was not associated with the proportion of CD8+ T cells, but negatively related to interferon γ secretion by CD8+ T cells in peripheral blood of HCC patients. Higher TGF-β also resulted in decreased interferon γ secreted by CD8+ T cells in vitro. In conclusion, our study suggests that TGF-β is a poor prognostic factor for patients and negatively affect the prognostic value of CD8+ CTLs through suppressing antitumor activity of CD8+ T-cell in HCC.
Concurrent Chemoradiotherapy in the Adjuvant Treatment of High-risk Primary Salivary Gland Malignancies
Authors: Gebhardt Brian J. , Ohr James P. , Ferris Robert L. , Duvvuri Umamaheswar , Kim Seungwon , Johnson Jonas T. , Heron Dwight E. , Clump David A.
Published: April 2017

Objectives:

Adjuvant radiation therapy (RT) is indicated for patients with salivary gland malignancies with risk factors for recurrence following resection. We analyzed patients treated with adjuvant RT with or without concurrent chemotherapy to determine the impact of prognostic and treatment factors.

Materials and Methods:

Retrospective analysis was performed of 128 patients treated with surgical resection followed by intensity-modulated radiotherapy. In total, 31 (24.2%) patients were treated with concurrent chemoradiotherapy. The Kaplan-Meier method was used to estimate rates of progression-free survival (PFS), local-regional control, distant control, overall survival. Multivariable Cox regression was performed to evaluate factors significant on univariate analysis.

Results:

The 5-year rates of PFS, local-regional control, freedom-from distant metastasis, and overall survival were 61.2%, 85.8%, 76.5%, and 73.7%, respectively. Predictors of decreased PFS on univariate analyses were age, tumor stage, nodal stage, positive surgical margins, histology, high grade, perineural invasion, lymphovascular space invasion, extranodal extension, and use of chemoradiotherapy. On multivariable analysis, elevated T-stage, positive surgical margins, and presence of extranodal extension were predictive of decreased PFS. The acute toxicity rates were 30.3% grade 1, 51.5% grade 2, 11.4% grade 3, and 0.8% grade 4. There was no difference in rates of grade 3 or higher acute toxicity with use of RT alone versus chemoradiotherapy (P=0.183).

Conclusions:

Use of chemoradiotherapy for adjuvant treatment of salivary gland malignancies was well-tolerated, but no improvement in survival was seen with the use of chemoradiotherapy in both the overall study population and a subset with high-risk features. Caution should be used when using this modality until randomized evidence becomes available.
Striae Distensae: Preventative and Therapeutic Modalities to Improve Aesthetic Appearance
Authors: Ross Nicholas A. , Ho Derek , Fisher Juliya , Mamalis Andrew , Heilman Edward , Saedi Nazanin , Jagdeo Jared
Published: April 2017

BACKGROUND

Striae distensae (SD) are aesthetically troublesome to patients and therapeutically challenging.

OBJECTIVE

Herein, the authors comprehensively review the literature pertaining to the history, pathogenesis, clinical presentation, clinical rating scales, and laboratory, imaging, and histologic features of SD.

METHODS AND MATERIALS

A review of PubMed, MEDLINE, Scopus, Embase, and Google scholar was conducted, including literature published from 1773 to August 6, 2016.

RESULTS

The authors identified 68 articles that met inclusion and exclusion criteria.

CONCLUSION

There are few randomized controlled trials evaluating the long-term efficacy and safety of various topical and energy-based devices. Based on clinical and anecdotal experience, both nonablative and ablative fractionated lasers have shown modest SD improvement compared with other treatment modalities (including Excimer laser, CuBr laser, pulsed dye laser, and 1,064-nm Nd:YAG laser). In the authors' experience, 1,540-nm nonablative fractionated laser is a worthy first-line modality for the treatment of SD. Future researchers may consider greater focus on enhanced study design, including larger, long-term split-body, or split-SD head-to-head randomized comparative trials with objective outcome measures and end points, such as biopsy and molecular studies demonstrating increased collagen and elastic fibers that correlate to clinical improvement.
Autologous Pure Platelet-Rich Plasma Dermal Injections for Facial Skin Rejuvenation: Clinical, Instrumental, and Flow Cytometry Assessment
Authors: Cameli Norma , Mariano Maria , Cordone Iole , Abril Elva , Masi Serena , Foddai Maria Laura
Published: April 2017

BACKGROUND

Platelet-rich plasma (PRP) is an emerging treatment in dermatology recently proposed for skin rejuvenation.

OBJECTIVE

To evaluate the efficacy and safety of autologous pure PRP dermal injections on facial skin rejuvenation, investigating the cellularity of PRP samples.

MATERIALS AND METHODS

Twelve patients underwent 3 sessions of PRP injection at 1-month intervals. The clinical and instrumental outcomes were evaluated before (T0) and 1 month (T1) after the end of treatment by means of transepidermal water loss, corneometry, Cutometer, Visioscan, and Visioface. A flow cytometry characterization on PRP and peripheral blood (PB) samples was performed.

RESULTS

Clinical and patient evaluation showed improvement of skin texture. Skin gross elasticity, skin smoothness parameters, skin barrier function, and capacitance were significantly improved. No difference between PRP and PB lymphocyte immunological asset was observed. A leukocyte population (mainly CD3+) and neutrophils depletion were documented in all the PRP samples.

CONCLUSION

This instrumental study demonstrated that PRP poor in leukocytes can provide objective improvements in skin biostimulation. Flow cytometry showed no variability among the PRP samples using a reproducible separation system and a low content in proinflammatory cells. Although a pilot study, it may be helpful for future investigations on PRP cellularity.
Randomized, Controlled Trial of Fractional Carbon Dioxide Laser Resurfacing Followed by Ultrashort Incubation Aminolevulinic Acid Blue Light Photodynamic Therapy for Actinic Keratosis
Authors: Alexiades Macrene
Published: April 2017

BACKGROUND

Aminolevulinic acid (ALA) photodynamic therapy (PDT) is an established treatment option for actinic keratosis (AK), and recently fractional carbon dioxide (CO2) laser was shown to improve outcomes; but studies of short incubation photosensitizer are lacking.

OBJECTIVE

Assess the efficacy of short incubation ALA followed by blue light PDT with and without previous fractional CO2 treatment for the treatment of AK.

METHODS

Randomized, paired split-design, controlled trial of fractional CO2 followed by ultrashort 15-minute versus 30-minute incubation ALA and blue light PDT for the treatment of AK on the face.

RESULTS

The complete clearance rates (CRs) at 8 weeks after ALA PDT with and without FxCO2 at 30- and 15-minute ALA incubation times were 89.78% (+FxCO2) versus 71.20% CR (−FxCO2) at 30′, and 86.38% (+FxCO2) versus 69.23% (−FxCO2) at 15′ ALA incubation. All lesion improvements were statistically significant.

CONCLUSION

This randomized, comparative paired group controlled clinical study demonstrates that ultrashort 15- and 30-minute incubation ALA PDTs are of limited efficacy for the treatment of AK. Pretreatment with fractional ablative resurfacing yields statistically significant greater AK clearance with ALA-PDT at ultrashort ALA incubations followed by blue light.
Development and validation of the self-reported PROMIS pediatric pain behavior item bank and short form scale
Authors: Cunningham Natoshia R. , Kashikar-Zuck Susmita , Mara Constance , Goldschneider Kenneth R. , Revicki Dennis A. , Dampier Carlton , Sherry David D. , Crosby Lori , Carle Adam , Cook Karon F. , Morgan Esi M.
Published: April 2017

Pain behaviors are important indicators of functioning in chronic pain; however, no self-reported pain behavior instrument has been developed for pediatric populations. The purpose of this study was to create a brief pediatric measure of patient-reported pain behaviors as part of the Patient-Reported Outcome Measurement Information System (PROMIS). A pool of 47 candidate items for this measure had been previously developed through qualitative research. In this study, youth with chronic pain associated with juvenile fibromyalgia, juvenile idiopathic arthritis, or sickle cell disease (ages 8-18 years) from 3 pediatric centers completed all 47 candidate items for development of the pain behavior item bank along with established measures of pain interference, depressive symptoms, fatigue, average pain intensity, and pain catastrophizing. Caregivers reported on sociodemographic information and health history. Psychometric properties of the pain behavior items were examined using an item response theory framework with confirmatory factor analysis and examination of differential item functioning, internal consistency, and test information curves. Results were used along with expert consensus and alignment with the adult PROMIS pain behavior items to arrive at an 8-item pediatric pain behavior short form, and all 47 items were retained in a calibrated item bank. Confirmatory factor analysis and correlations with validated measures of pain, pain interference, and psychosocial functioning provided support for the short form's reliability and validity. The new PROMIS pediatric pain behavior scale provides a reliable, precise, and valid measure for future research on pain behavior in school-aged children with chronic pain.
The pain course: a randomised controlled trial comparing a remote-delivered chronic pain management program when provided in online and workbook formats
Authors: Dear B.F. , Gandy M. , Karin E. , Ricciardi T. , Fogliati V.J. , McDonald S. , Staples L.G. , Perry K. Nicholson , Sharpe L. , Nicholas M.K. , Titov N.
Published: April 2017

This study compared a remote-delivered pain management program, the Pain Course, when delivered in online and workbook formats. Participants (n = 178) were randomised into 2 groups: (1) an Internet Group (n = 84) who were provided with secure accounts to the program in an online format; or (2) a Workbook Group (n = 94) who were mailed workbook versions of the program. The content of both programs was identical and comprised 5 core lessons, which participants were encouraged to work through over an 8-week period, according to a prescribed timetable. All participants were provided with weekly contact with a clinical psychologist through email and telephone throughout the program. The overall findings suggest that the workbook format was no less effective or acceptable than the validated online format. Significant improvements (avg. improvement; Internet Group vs Workbook Group) in levels of disability (PDI: 16% vs 24%; RMDQ: 12% vs 15%), anxiety (GAD-7: 36% vs 26%), and depression (PHQ-9: 36% vs 36%) were observed in both groups immediately posttreatment. Further improvements were observed in disability levels to 3-month follow-up, and improvements across the other primary outcomes were maintained until 12-month follow-up. High treatment completion rates and levels of satisfaction were reported in both groups, and both groups required a similarly small amount of clinician contact per participant (M = 74.85 minutes; SD = 41.03). These results highlight the public health potential of remote-delivered pain management programs, delivered in either workbook or online formats, as methods of increasing access to pain management.