bluuebunny/crossref_metadata_2025 huggingface dataset:
Poly(oxymethylene) dimethyl ether synthesis – a combined chemical equilibrium investigation towards an increasingly efficient and potentially sustainable synthetic route
Authors: Ouda M. , Yarce G. , White R. J. , Hadrich M. , Himmel D. , Schaadt A. , Klein H. , Jacob E. , Krossing I.
Published: December 2016

Poly(oxymethylene) dimethyl ethers (denoted as OME) are potential sustainable energy carriers and platform chemicals.
Supramolecular assembly of platinum-containing polyhedral oligomeric silsesquioxanes: an interplay of intermolecular interactions and a correlation between structural modifications and morphological transformations
Authors: Au-Yeung Ho-Leung , Tam Anthony Yiu-Yan , Leung Sammual Yu-Lut , Yam Vivian Wing-Wah
Published: December 2016

POSS-functionalized platinum(ii) complexes demonstrate systematically controllable morphological transformations through interplay of intermolecular interactions.
Carbon dioxide capture in amorphous porous organic polymers
Authors: Wang Wenjing , Zhou Mi , Yuan Daqiang
Published: December 2016

In this review, we aim to highlight the POPs for CO2 capture and summarize the factors influencing CO2 capture capacity.
Bio-friendly Maillard reaction fluorescent products from glutathione and ascorbic acid for the rapid and label-free detection of Fe3+in living cells
Authors: Dong Jiang Xue , Wang Zi Li , Yang Yue , Gao Zhong Feng , Li Bang Lin , Jiang Hui Hui , Li Nian Bing , Luo Hong Qun
Published: December 2016

Non-cytotoxic Maillard reaction fluorescent products were used as an imaging probe for Fe3+detection in living cells.
In situ identification of kinetic factors that expedite inorganic crystal formation and discovery
Authors: Jiang Zhelong , Ramanathan Arun , Shoemaker Daniel P.
Published: December 2016

In situ X-ray diffraction reveals key processes that can be utilized to direct the synthesis of complex inorganic crystals.
Reengineering of the human pyruvate dehydrogenase complex: from disintegration to highly active agglomerates
Authors: Guo Jin , Hezaveh Samira , Tatur Jana , Zeng An-Ping , Jandt Uwe
Published: December 2016

The pyruvate dehydrogenase complex (PDC) plays a central role in cellular metabolism and regulation. As a metabolite-channeling multi-enzyme complex it acts as a complete nanomachine due to its unique geometry and by coupling a cascade of catalytic reactions using ‘swinging arms'. Mammalian and specifically human PDC (hPDC) is assembled from multiple copies of E1 and E3 bound to a large E2/E3BP 60-meric core. A less restrictive and smaller catalytic core, which is still active, is highly desired for both fundamental research on channeling mechanisms and also to create a basis for further modification and engineering of new enzyme cascades. Here, we present the first experimental results of the successful disintegration of the E2/E3BP core while retaining its activity. This was achieved by C-terminal α-helixes double truncations (eight residues from E2 and seven residues from E3BP). Disintegration of the hPDC core via double truncations led to the formation of highly active (approximately 70% of wildtype) apparently unordered clusters or agglomerates and inactive non-agglomerated species (hexamer/trimer). After additional deletion of N-terminal ‘swinging arms’, the aforementioned C-terminal truncations also caused the formation of agglomerates of minimized E2/E3BP complexes. It is likely that these ‘swinging arm’ regions are not solely responsible for the formation of the large agglomerates.
Cross-talks via mTORC2 can explain enhanced activation in response to insulin in diabetic patients
Authors: Magnusson Rasmus , Gustafsson Mika , Cedersund Gunnar , Strålfors Peter , Nyman Elin
Published: December 2016

The molecular mechanisms of insulin resistance in Type 2 diabetes have been extensively studied in primary human adipocytes, and mathematical modelling has clarified the central role of attenuation of mammalian target of rapamycin (mTOR) complex 1 (mTORC1) activity in the diabetic state. Attenuation of mTORC1 in diabetes quells insulin-signalling network-wide, except for the mTOR in complex 2 (mTORC2)-catalysed phosphorylation of protein kinase B (PKB) at Ser473 (PKB-S473P), which is increased. This unique increase could potentially be explained by feedback and interbranch cross-talk signals. To examine if such mechanisms operate in adipocytes, we herein analysed data from an unbiased phosphoproteomic screen in 3T3-L1 adipocytes. Using a mathematical modelling approach, we showed that a negative signal from mTORC1-p70 S6 kinase (S6K) to rictor–mTORC2 in combination with a positive signal from PKB to SIN1–mTORC2 are compatible with the experimental data. This combined cross-branch signalling predicted an increased PKB-S473P in response to attenuation of mTORC1 – a distinguishing feature of the insulin resistant state in human adipocytes. This aspect of insulin signalling was then verified for our comprehensive model of insulin signalling in human adipocytes. Introduction of the cross-branch signals was compatible with all data for insulin signalling in human adipocytes, and the resulting model can explain all data network-wide, including the increased PKB-S473P in the diabetic state. Our approach was to first identify potential mechanisms in data from a phosphoproteomic screen in a cell line, and then verify such mechanisms in primary human cells, which demonstrates how an unbiased approach can support a direct knowledge-based study.
Behavior of plasma sheath with nonextensively distributed two-temperature electrons and isothermal ions
Authors: Borgohain Dima Rani , Saharia K. , Goswami K. S.
Published: December 2016

This paper presents the behavior of plasma profiles of a sheath in unmagnetized collisionless plasma in the presence of nonextensively distributed two-temperature electrons and isothermal ions. A theoretical model is developed where isothermal ions are described by the conventional hydrodynamic equations along with the effect of electron nonextensivity described by q-distribution function. The plasma sheath parameters like Bohm velocity, potential, and density profiles in the presence of nonextensively distributed two-temperature electrons and isothermal ions are investigated.
Re-appraisal and extension of the Gratton-Vargas two-dimensional analytical snowplow model of plasma focus. III. Scaling theory for high pressure operation and its implications
Authors: Auluck S. K. H.
Published: December 2016

Recent work on the revised Gratton-Vargas model (Auluck, Phys. Plasmas 20, 112501 (2013); 22, 112509 (2015) and references therein) has demonstrated that there are some aspects of Dense Plasma Focus (DPF), which are not sensitive to details of plasma dynamics and are well captured in an oversimplified model assumption, which contains very little plasma physics. A hyperbolic conservation law formulation of DPF physics reveals the existence of a velocity threshold related to specific energy of dissociation and ionization, above which, the work done during shock propagation is adequate to ensure dissociation and ionization of the gas being ingested. These developments are utilized to formulate an algorithmic definition of DPF optimization that is valid in a wide range of applications, not limited to neutron emission. This involves determination of a set of DPF parameters, without performing iterative model calculations, that lead to transfer of all the energy from the capacitor bank to the plasma at the time of current derivative singularity and conversion of a preset fraction of this energy into magnetic energy, while ensuring that electromagnetic work done during propagation of the plasma remains adequate for dissociation and ionization of neutral gas being ingested. Such a universal optimization criterion is expected to facilitate progress in new areas of DPF research that include production of short lived radioisotopes of possible use in medical diagnostics, generation of fusion energy from aneutronic fuels, and applications in nanotechnology, radiation biology, and materials science. These phenomena are expected to be optimized for fill gases of different kinds and in different ranges of mass density compared to the devices constructed for neutron production using empirical thumb rules. A universal scaling theory of DPF design optimization is proposed and illustrated for designing devices working at one or two orders higher pressure of deuterium than the current practice of designs optimized at pressures less than 10 mbar of deuterium. These examples show that the upper limit for operating pressure is of technological (and not physical) origin.
Effect of toroidal plasma rotation on double tearing modes in cylindrical geometry
Authors: Zhang R. B. , Lu X. Q. , Huang Q. H. , Dong J. Q. , Gong X. Y.
Published: December 2016

The effect of toroidal plasma rotation on q = 3 double tearing modes (DTMs) was studied numerically in cylindrical geometry using the method of reduced magnetohydrodynamic simulation. The results indicate that toroidal plasma rotation can reduce the growth rate of DTMs, but the magnitude of toroidal velocity has weak effect, especially without shear. When the shear of toroidal velocity exists, the suppression effect becomes better. Whether the velocity flow has shear or not, the growth rate of DTMs decreases as the magnitude of toroidal velocity increases. With the increase of velocity shear, the DTMs grow slowly. And the suppression effect of toroidal plasma rotation in early growth and transition stage is better, which means that the toroidal plasma rotation can suppress the linear growth of islands. Furthermore, the toroidal plasma rotation can suppress the evolution of poloidal stream. And the toroidal velocity shear on the q = 3 rational surface is more dominant than the magnitude of toroidal velocity in determining the DTM characteristics.
Effect of the transverse magnetic field on spatiotemporal dynamics of quadruple Gaussian laser beam in plasma in weakly relativistic and ponderomotive regime
Authors: Vij Shivani , Gill Tarsem Singh , Aggarwal Munish
Published: December 2016

The spatiotemporal dynamics of a quadruple Gaussian laser beam in plasma is studied in the presence of an external magnetic field by taking into account the relativistic and ponderomotive nonlinearities. Using the paraxial approximation approach, two coupled equations for longitudinal (in time) and transverse (in space) beam width parameters are derived. Their evolution determines the pulse dynamics in time and space. The effects of the initial laser parameters, such as the lateral separation and laser intensity on self-focusing and self-compression mechanisms, are discussed. The results illustrate that the laser beam is focussed and compressed in an enhanced manner in the presence of an external magnetic field. The three dimensional spatiotemporal profile of the normalized intensity of the pulse is studied at different positions where the beam is either focussed or compressed. A three dimensional portrait of the normalized intensity as a function of distance and time is also shown.
Generation of electrostatic drift zonal flows under the action of mean sheared flows
Authors: Kaladze T. D. , Kharshiladze O.
Published: December 2016

Generation of large-scale zonal flows by the small-scale electrostatic drift wave turbulence in the magnetized plasma under the action of mean poloidal sheared flow is considered. Attention to large-scale (compared to the ion Larmor radius) drift structures is paid. To this end, the generalized Hasegawa-Mima equation containing both vector and scalar nonlinearities is derived, and the appropriate eigenvalue problem is solved numerically. Destabilizing role of the small amplitude mean shear flow and spatial inhomogeneity of electron temperature is shown.
Intraobserver and Interobserver Measurement Variability of the Rib-Vertebral Angle Difference
Authors: Tysklind Robert G. , Myung Karen , Gantsoudes George , Kishan Shyam , Turner Chad , Lee Stella , Wanner Matthew , Sabatino Meagan , Linger Scott , Loder Randall T.
Published: December 2016

Background:

The rib-vertebral angle (RVAD) differentiates between progressive and resolving infantile idiopathic scoliosis (IIS) curves. Those with a RVAD<20 degrees often resolve without treatment, whereas those >20 degrees often progress and require treatment. The mathematical magnitude of RVAD measurement variability has not been described, and was thus the purpose of this study. It is important to know the reliability of RVAD measurements so as to understand changes that can be attributed to observer error alone.

Purpose:

The purpose of the study was to mathematically determine the intraobserver and interobserver measurement variability of the RVAD difference in IIS.

Methods:

A convenience sample of 50 patients with IIS was selected. The RVAD was measured twice by 7 different observers separated by a minimum of 3 weeks. The 7 different readers chosen to measure the RVAD were 2 orthopaedic residents, 1 pediatric radiologist, and 4 attending pediatric orthopaedic surgeons. The same goniometer was used for all measurements. Intraobserver and interobserver measurement variability was determined using 3 well known used statistical methods.

Results:

The 3 different methods used to determine intraobserver and interobserver variability using 95% prediction/confidence limits gave very similar results. Intraobserver variability was ∼24 degrees and the interobserver variability was ∼23 degrees.

Discussion:

The utility of the RVAD in medical decision-making and counseling of patients with IIS should be approached with caution when used in isolation due to the large measurement variability.

Level of Evidence:

Level 3.
A Whole Exome Study Identifies Novel Candidate Genes for Vertebral Bone Marrow Signal Changes (Modic Changes)
Authors: Kraatari Minna , Skarp Sini , Niinimäki Jaakko , Karppinen Jaro , Männikkö Minna
Published: December 2016

Study Design.

A family-based study.

Objective.

The aim of this study was to identify rare genetic factors predisposing to Modic changes (MCs).

Summary of Background Data.

Lumbar disc degeneration (LDD) is one of the contributing factors behind low back pain (LBP). Lumbar MC visualized as bone marrow signal intensity changes on magnetic resonance imaging (MRI) represent a specific phenotype of LDD, which has a stronger association with LBP than LDD without MC.

Methods.

The study set consisted of two Finnish families: Family I included seven affected and four unaffected individuals and Family II eight affected and seven unaffected individuals. MCs were evaluated in 26 individuals using MRI. Whole exome sequencing was used to identify alleles cosegregating with MC. Annotate variation was used to carry out functional annotation of alleles and their frequencies were evaluated using 1000Genomes, Sequencing Initiative Suomi (SISu), and the Exome Aggregation Consortium (ExAC) databases.

Results.

We identified predisposing genetic alleles for MC in two Finnish families. In each family, only single allele cosegregated with MC. In Family I, the observed allele was an insertion and deletion in the HSPG2 gene, resulting in a premature termination codon. In Family II, a single nucleotide polymorphism (rs61753465) in the MAML1 gene was identified in all affected family members.

Conclusion.

We have identified two novel candidate genes, MAML1 and HSPG2, associating with MC. These genes are important in cartilage structure and joint cartilage maintenance. Our findings are novel among lumbar spine degenerative phenotypes.

Level of Evidence: N/A
Diagnostic Evaluation of Children with Autism Spectrum Disorders: Clinician Compliance with Published Guidelines
Authors: Tchaconas Alexis , Adesman Andrew
Published: December 2016

Objective:

To assess to what extent child neurologists (CNs) and developmental-behavioral pediatricians (DBPs) order diagnostic tests that are not recommended/indicated and/or fail to order tests that are recommended/indicated when evaluating children with an autism spectrum disorder (ASD).

Method:

CNs and DBPs in the United States were asked which laboratory tests they would “routinely order” for a preschool child with ASD and IQ = 58 (ASD + Intellectual Disability (ID)), and a preschool child with ASD and IQ = 85 (ASD-ID). Chi-square tests were performed to identify differences (CNs vs DBPs) in laboratory testing.

Results:

The sample consisted of 267 respondents (127 CN's; 140 DBPs). When evaluating ASD + ID or ASD − ID, inappropriate tests (≥1) were ordered by 76.8% and 76.4% of MDs, respectively. There was no significant difference between specialties in compliance with evaluation guidelines for ASD + ID (CN = 20.5% vs DBP = 16.4%; χ2 = 0.73). No significant differences were noted (DBP vs CN) regarding the percent ordering inappropriate tests for either clinical case or within each specialty when comparing testing for ASD + ID versus ASD − ID. Relative to DBPs, CNs were more likely to order EEGs and MRIs when evaluating children with ASD + ID or ASD − ID. 10% and 40% of respondents did not order any recommended genetic tests when evaluating ASD + ID and ASD − ID, respectively.

Conclusion:

When evaluating children with ASD, many CNs and DBPs fail to order tests that should be routinely performed and often order tests that are not routinely indicated yet are neither benign nor inexpensive. Recommended molecular genetic tests are often not ordered. Clinical guidelines must be updated and better promulgated.
SEMIAUTOMATED QUANTITATIVE APPROACH TO CHARACTERIZE TREATMENT RESPONSE IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Roberts Philipp K. , Nesper Peter L. , Gill Manjot K. , Fawzi Amani A.
Published: December 2016

Purpose:

To perform a quantitative study of the vascular microstructure in actively treated choroidal neovascularization by optical coherence tomographic angiography.

Methods:

Patients undergoing individualized anti–vascular endothelial growth factor therapy of minimum 12 months duration were included in this cross-sectional observational study and imaged using optical coherence tomographic angiography. En face optical coherence tomographic angiography images were analyzed for quantitative features, such as junction density, vessel length, and lacunarity using validated software (Angiotool). Patients were divided into 2 groups depending on their individualized treatment interval: “good responders, treated less frequently than 6 weeks” versus “poor responders, treated every 6 weeks or more frequently.” Nonparametric testing was used to assess differences between these groups.

Results:

Twenty-five eyes of 23 consecutive patients with a median 58-month history of choroidal neovascularization, treated by median of 34 anti–vascular endothelial growth factor injections, were included in the analysis. There was no significant difference between any of the microvascular choroidal neovascularization features between the 2 groups (P > 0.05).

Conclusion:

The semiautomated vessel segmentation software provides an objective and quantitative approach for choroidal neovascularization characterization. The consistently nonsignificant outcomes between the groups may provide evidence to support the “normalization hypothesis.” This would suggest that regardless of treatment interval, individualized therapy in these eyes established vessel stability.
ACUTE RETINAL NECROSIS AFTER ADMINISTRATION OF ADALIMUMAB, A SYSTEMIC ANTITUMOR NECROSIS FACTOR ANTIBODY
Authors: Schechet Sid A. , Garff Kevin , Klima Karen , Campbell Wayne , Schocket Lisa S.
Published: December 2016

Purpose:

To report a case of acute retinal necrosis in a patient on anti–tumor necrosis factor α immunosuppressive therapy.

Methods:

Case report.

Results:

A 47-year-old man with psoriasis presented with blurred vision and floaters in the left eye 4 days after receiving his fourth dose of adalimumab, a tumor necrosis factor α antagonist. He was diagnosed with acute retinal necrosis and was treated with intravenous acyclovir as well as prophylactic laser barricade. Seven years later, he is 20/20 with no history of a retinal detachment.

Conclusion:

Physicians prescribing tumor necrosis factor α antagonist immunosuppressive therapy should be aware of the potential of developing acute retinal necrosis.
Laboratory Diagnosis of Breakthrough Varicella in Children
Authors: Watanabe Masahiro , Ochiai Hitoshi , Ito Masahiro , Negoro Manami , Suga Shigeru , Ihara Toshiaki
Published: December 2016

Background:

Breakthrough varicella (BV) develops in vaccinated persons as a result of infection by wild-type varicella-zoster virus more than 42 days after varicella vaccination. The clinical symptoms are atypical, and clinical diagnosis can be difficult. We investigated laboratory-based diagnostic methods that are relatively simple and highly precise to conduct accurate surveillance.

Subjects and Methods:

We enrolled 42 patients with suspected BV at 2 pediatric hospitals and performed a real-time polymerase chain reaction (PCR) on the skin lesions to confirm the BV diagnosis. We performed PCR on saliva and blood collected during the acute phase, as well as direct fluorescent antibody (DFA) imaging on lesions, and measured varicella-zoster virus immunoglobulin (Ig) G and IgM during the acute and convalescent phases.

Results:

We confirmed the BV diagnosis in 31 of 42 enrolled patients. The sensitivity of DFA imaging of the lesion, and PCR of saliva and blood were 93.5%, 87.1% and 61.3%, respectively. IgM was detected in 12.9% of patients during the acute phase and in 65.5% during the convalescent phase. IgG increased more than 4-fold in 86.2% of patients between the acute and convalescent phases. The sensitivity and specificity of the assay were 83.9% and 81.8%, respectively, when the diagnostic criteria for IgG were set to greater than 20 during the acute phase.

Conclusions:

The gold standard of laboratory-based diagnosis of BV has been the PCR of samples taken from lesions. However, DFA of the lesion showed equivalent sensitivity when compared with PCR. PCR using saliva samples is an effective, noninvasive method of diagnosis. We found that high values of IgG during the acute phase can aid in the diagnosis of BV.
Biomarkers of neuropathic pain in skin nerve degeneration neuropathy: contact heat-evoked potentials as a physiological signature
Authors: Wu Shao-Wei , Wang Yi-Chia , Hsieh Paul-Chen , Tseng Ming-Tsung , Chiang Ming-Chang , Chu Chih-Pang , Feng Fang-Ping , Lin Yea-Huey , Hsieh Sung-Tsang , Chao Chi-Chao
Published: December 2016

Contact heat-evoked potentials (CHEPs) have become an established method of assessing small-fiber sensory nerves; however, their potential as a physiological signature of neuropathic pain symptoms has not been fully explored. To investigate the diagnostic efficacy in examining small-fiber sensory nerve degeneration, the relationship with skin innervations, and clinical correlates with sensory symptoms, we recruited 188 patients (115 men) with length-dependent sensory symptoms and reduced intraepidermal nerve fiber (IENF) density at the distal leg to perform CHEP, quantitative sensory testing, and nerve conduction study. Fifty-seven age- and sex-matched controls were enrolled for comparison of CHEP and skin innervation. Among patients with neuropathy, 144 patients had neuropathic pain and 64 cases had evoked pain. Compared with quantitative sensory testing and nerve conduction study parameters, CHEP amplitudes showed the highest sensitivity for diagnosing small-fiber sensory nerve degeneration and exhibited the strongest correlation with IENF density in multiple linear regression. Contact heat-evoked potential amplitudes were strongly correlated with the degree of skin innervation in both patients with neuropathy and controls, and the slope of the regression line between CHEP amplitude and IENF density was higher in patients with neuropathy than in controls. Patients with evoked pain had higher CHEP amplitude than those without evoked pain, independent of IENF density. Receiver operating characteristic analysis showed that CHEP had better performance in diagnosing small-fiber sensory nerve degeneration than thermal thresholds. Furthermore, CHEPs showed superior classification accuracy with respect to evoked pain. In conclusion, CHEP is a sensitive tool to evaluate pathophysiology of small-fiber sensory nerve and serves as a physiological signature of neuropathic pain symptoms.
Reasons for discontinuation of long-term opioid therapy in patients with and without substance use disorders
Authors: Lovejoy Travis I. , Morasco Benjamin J. , Demidenko Michael I. , Meath Thomas H.A. , Frank Joseph W. , Dobscha Steven K.
Published: December 2016

Several factors may accelerate opioid discontinuation rates, including lack of information about the long-term effectiveness of opioids for chronic pain, heightened awareness about opioid-related adverse events, closer monitoring of patients for opioid-related aberrant behaviors, and greater restrictions around opioid prescribing. Rates of discontinuation may be most pronounced in patients deemed to be at “high risk.” The purpose of this study was to compare reasons for discontinuation of long-term opioid therapy (LTOT) between patients with and without substance use disorder (SUD) diagnoses receiving care within a major U.S. health care system. This retrospective cohort study assembled a cohort of Veterans Health Administration patients prescribed opioid therapy for at least 12 consecutive months who subsequently discontinued opioid therapy for at least 12 months. From this cohort, we randomly selected 300 patients with SUD diagnoses and propensity score–matched 300 patients without SUD diagnoses. A comprehensive manual review of patients' medical records ascertained reasons for LTOT discontinuation. Most patients (85%) were discontinued as a result of clinician, rather than patient, decisions. For patients whose clinicians initiated discontinuation, 75% were discontinued because of opioid-related aberrant behaviors. Relative to patients without SUD diagnoses, those with SUD diagnoses were more likely to discontinue LTOT because of aberrant behaviors (81% vs 68%), most notably abuse of alcohol or other substances. This is the first study to document reasons for discontinuation of LTOT in a sample of patients with and without SUD diagnoses. Treatments that concurrently address SUD and chronic pain are needed for this high-risk population.
Anti–nerve growth factor therapy increases spontaneous day/night activity in mice with orthopedic surgery–induced pain
Authors: Majuta Lisa A. , Guedon Jean-Marc G. , Mitchell Stefanie A.T. , Ossipov Michael H. , Mantyh Patrick W.
Published: December 2016

Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are 2 of the most common and successful surgical interventions to relieve osteoarthritis pain. Control of postoperative pain is critical for patients to fully participate in the required physical therapy which is the most influential factor in effective postoperative knee rehabilitation. Currently, opiates are a mainstay for managing postoperative orthopedic surgery pain including TKA or THA pain. Recently, issues including efficacy, dependence, overdose, and death from opiates have made clinicians and researchers more critical of use of opioids for treating nonmalignant skeletal pain. In the present report, a nonopiate therapy using a monoclonal antibody raised against nerve growth factor (anti-NGF) was assessed for its ability to increase the spontaneous activity of the operated knee joint in a mouse model of orthopedic surgery pain–induced by drilling and coring the trochlear groove of the mouse femur. Horizontal activity and velocity and vertical rearing were continually assessed over a 20 hours day/night period using automated activity boxes in an effort to reduce observer bias and capture night activity when the mice are most active. At days 1 and 3, after orthopedic surgery, there was a marked reduction in spontaneous activity and vertical rearing; anti-NGF significantly attenuated this decline. The present data suggest that anti-NGF improves limb use in a rodent model of joint/orthopedic surgery and as such anti-NGF may be useful in controlling pain after orthopedic surgeries such as TKA or THA.
Examination of an internet-delivered cognitive behavioural pain management course for adults with fibromyalgia: a randomized controlled trial
Authors: Friesen Lindsay N. , Hadjistavropoulos Heather D. , Schneider Luke H. , Alberts Nicole M. , Titov Nikolai , Dear Blake F.
Published: December 2016

Fibromyalgia (FM) is a common and often debilitating chronic pain condition. Research shows that symptoms of depression and anxiety are present in up to 3 quarters of individuals with FM. Of concern, most adults with FM cannot access traditional face-to-face cognitive behavioural pain management programs, which are known to be beneficial. Given known difficulties with treatment access, the present study sought to explore the efficacy and acceptability of a previously developed Internet-delivered cognitive behavioural pain management course, the Pain Course, for adults with FM. The five-lesson course was delivered over 8 weeks and was provided with brief weekly contact, via telephone and secure email, with a guide throughout the course. Participants were randomized either to the Pain Course (n = 30) or to a waiting-list control group (n = 30). Symptoms were assessed at pre-treatment, post-treatment and 4-week follow-up. Completion rates (87%) and satisfaction ratings (86%) were high. Improvements were significantly greater in treatment group participants compared to waiting-list group participants on measures of FM (Cohen's d = 0.70; 18% reduction), depression (Cohen's d = 0.63-0.72; 20%-28% reduction), pain (Cohen's d = 0.87; 11% improvement) and fear of pain (Cohen's d = 1.61; 12% improvement). Smaller effects were also observed on measures of generalized anxiety and physical health. The changes were maintained at 4-week follow-up. The current findings add to existing literature and highlight the specific potential of Internet-delivered cognitive behavioural pain management programs for adults with FM, especially as a part of stepped-care models of care. Future research directions are described.
Baseline Functional Mobility in Hospitalized Persons With Anorexia Nervosa: A Retrospective Study of Inpatient Physical Therapy During Medical Stabilization
Authors: Laging Michelle A. , Brinton John T. , Sabel Allison L. , Gaudiani Jennifer L. , Mehler Philip S.
Published: December 2016

Purpose:

This study evaluates potential associations of baseline physical function measures with anthropometrics and clinical outcomes in persons hospitalized with anorexia nervosa.

Methods:

We conducted a retrospective study in a single hospital on 176 seriously ill persons with anorexia nervosa who required definitive medical stabilization. Licensed physical therapists assessed functional transfers and ambulation using the Functional Independence Measure. Walking speed, Tinetti Performance-Oriented Mobility Assessment, demographic, and anthropometric measures were also collected.

Results:

Ninety-one percent of the participants were female (N = 161), with a median age of 28 years (interquartile range, 22-39) and mean body mass index upon admission of 12.7 kg/m2 (standard deviation, 1.8). Significant positive correlations were observed between all 3 in-room measures of physical function and admission weight, percent ideal body weight, and body mass index (all P < .02). Age was inversely correlated with ambulation per the FIM score (r =−0.15; P = .05). After adjusting for age and admission weight, in-room physical function measures were inversely associated only with length of hospitalization (R
2 = 0.30). For every 1.0-unit increase in bed mobility, the length of hospitalization decreased by 2.9 days (95% confidence interval, −5.0 to −0.8).

Conclusion:

A sizable proportion demonstrated modified dependence, or required assistance, in functional mobility skills. Lower initial bed mobility scores are associated with longer hospitalization.
Physical Therapy Intervention During a Red Blood Cell Transfusion in an Oncologic Population: A Preliminary Study
Authors: Rosenfeldt Anson B. , Pilkey Lauren M. , Butler Robert S.
Published: December 2016

Purpose:

There is little evidence to guide physical therapists regarding the safety of administering therapeutic intervention to individuals receiving a red blood cell (RBC) transfusion. The purpose of this preliminary study was to examine the number of adverse events that occurred among individuals with an oncologic diagnosis receiving physical therapy intervention during an RBC transfusion.

Methods:

Chart reviews were conducted, and physical therapy sessions were classified into the following groups: (1) physical therapy intervention alone (PT) (n = 26 events); (2) physical therapy intervention during an RBC transfusion (PT + RBC) (n = 26 events); and (3) RBC transfusion without physical therapist intervention (RBC) (n = 26 events).

Results:

There were 3 adverse events, all in the PT group: 2 episodes of symptomatic drop in systolic blood pressure of more than 10 mm Hg with position change, and 1 episode of the individual requesting to stop the therapy intervention. The difference in adverse events between the groups was not statistically significant (P = .10).

Conclusion:

This study provides preliminary evidence that participation in a well-monitored physical therapy session may be safe for individuals with hematologic malignancies who are receiving an RBC transfusion and that adverse events related to RBC transfusion are not influenced by physical therapy intervention.
Mixing It Up
Authors: Bishwakarma Raju , Shah Shiwan , Frank Luba , Zhang Wei , Sharma Gulshan , Nishi Shawn P.E.
Published: December 2016

Background:

A recent randomized controlled trial showed 12 serial doses of tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) is safe and effective in managing complicated parapneumonic pleural effusions and empyema (CPEE). However, this regimen is laborious, requiring trained personnel to open/close the chest tube 8 times daily for 3 days. We present our observational data using a simplified regimen of coadministered tPA/DNase.

Materials and Methods:

This is a retrospective observational study of patients who received coadministered tPA/DNase for CPEE from January 2012 to April 2015 at the University of Texas Medical Branch. Patient demographics, pleural fluid, radiologic and treatment characteristics, and outcomes were collected. Data are presented as proportions and percentages. Our primary outcome was successful treatment without need of surgery and discharge home alive. Secondary outcomes were dose and length of treatment and hospital stay, treatment complications, and 90-day mortality.

Results:

The study included 39 patients. All pleural effusions were loculated, 59% macroscopically purulent, 50% had a positive organism in Gram stain, and 40% were culture positive. A median of 6 (interquartile range, 3.5 to 6) doses were coadministered mainly via small bore chest tube (≤14 Fr in 79%) with a median of 14.5 (interquartile range, 9.5 to 21.5) hospital days. Overall, 85% were successfully treated without need for surgery. Treatment failures occurred in 15%: 3/39 (7%) received surgery; 3/39 (7%) died. Only 1 (2.5%) complication of hemorrhagic pleural effusion resolved after discontinuation of intrapleural treatment.

Conclusions:

Our study shows intrapleural coadministration of tPA/DNase was effective and safe in management of CPEE.
Conventional Transbronchial Needle Aspiration Versus Endobronchial Ultrasound–guided Transbronchial Needle Aspiration, With or Without Rapid On-Site Evaluation, for the Diagnosis of Sarcoidosis: A Randomized Controlled Trial
Authors: Madan Karan , Dhungana Ashesh , Mohan Anant , Hadda Vijay , Jain Deepali , Arava Sudheer , Pandey Ravindra M. , Khilnani Gopi C. , Guleria Randeep
Published: December 2016

Background:

Endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) as a standalone modality is superior to conventional TBNA (c-TBNA) for the diagnosis of sarcoidosis. However, the overall yield is not different if combined with endobronchial biopsy (EBB) and transbronchial lung biopsy (TBLB). The utility of rapid on-site evaluation (ROSE) in a comparative evaluation of EBUS-TBNA versus c-TBNA for the diagnosis of sarcoidosis has not been previously evaluated.

Methods:

Eighty patients with suspected sarcoidosis were randomized 1:1:1:1 into 4 groups: c-TBNA without ROSE (TBNA-NR), c-TBNA with ROSE (TBNA-R), EBUS-TBNA without ROSE (EBUS-NR), and EBUS-TBNA with ROSE (EBUS-R). EBB and TBLB were performed in all patients. Primary objective was detection of granulomas for combined procedure. Secondary objectives were individual procedure yields, sedation dose, and procedure duration. Patients without a diagnosis following c-TBNA subsequently underwent EBUS-TBNA.

Results:

A total of 74 patients were finally diagnosed with sarcoidosis. Overall, granuloma detection was not significantly different between the 4 groups (68% in TBNA-NR, 89% in TBNA-R, 84% in EBUS-NR, and 83% in EBUS-R groups, P=0.49). The yield of c-TBNA in the TBNA-NR group was lower compared with that in TBNA-R group and EBUS-TBNA in EBUS groups (32%, 72%, 68%, and 67% for TBNA-NR, TBNA-R, EBUS-NR, and EBUS-R groups, respectively, P=0.04). Additional 20% patients were diagnosed when EBUS-TBNA was performed following a nondiagnostic bronchoscopy procedure in the TBNA-NR group. Sedation requirement and procedure duration were significantly lower with c-TBNA as compared with EBUS-TBNA (P<0.001).

Conclusion:

When performing TBNA in the setting of suspected sarcoidosis, we found c-TBNA with ROSE and EBUS-TBNA (with or without ROSE) to be superior to c-TBNA alone. Whether c-TBNA with ROSE is equivalent to EBUS-TBNA cannot be determined from our study due to small sample size/low power.
Fatal Progressive Membranous Obliterative Bronchitis
Authors: Medrek Sarah , Bandi Venkata , Xu Ya , Sarkar Pralay , Guy Elizabeth , Kao Christina
Published: December 2016

Occlusion of the bronchial orifices by tissue-like structures is an uncommonly reported finding: it has been referred to as bronchial webs, bronchial synechiae, vanishing bronchus syndrome, or membranous obliterative bronchitis. It differs from bronchiolitis obliterans, a well-described clinical entity that involves smaller airways not visualized on bronchoscopy. Although initially only recognized as a congenital condition, later reports have described it in situations where chronic inflammation results in the irritation of the airways. Here we report a case of a woman with postinfectious bronchiectasis who developed membranous occlusion of multiple subsegmental bronchi, resulting in progressive airflow obstruction and postobstructive collapse of involved lung parenchyma. This process eventually caused her demise. It the first report of membranous occlusion of the bronchi in an adult who does not have cystic fibrosis or a history of lung transplantation. Clinicians should be aware of this entity, and further research could help illuminate its pathogenesis and management.
Extracorporeal Life Support Organization Registry International Report 2016
Authors: Thiagarajan Ravi R. , Barbaro Ryan P. , Rycus Peter T. , Mcmullan D. Michael , Conrad Steven A. , Fortenberry James D. , Paden Matthew L.
Published: December 2016

Data on extracorporeal life support (ECLS) use and survival submitted to the Extracorporeal Life Support Organization’s data registry from the inception of the registry in 1989 through July 1, 2016, are summarized in this report. The registry contained information on 78,397 ECLS patients with 58% survival to hospital discharge. Extracorporeal life support use and centers providing ECLS have increased worldwide. Extracorporeal life support use in the support of adults with respiratory and cardiac failure represented the largest growth in the recent time period. Extracorporeal life support indications are expanding, and it is increasingly being used to support cardiopulmonary resuscitation in children and adults. Adverse events during the course of ECLS are common and underscore the need for skilled ECLS management and appropriately trained ECLS personnel and teams.
SD-OCT and Adaptive Optics Imaging of Outer Retinal Tubulation
Authors: King Brett J. , Sapoznik Kaitlyn A. , Elsner Ann E. , Gast Thomas J. , Papay Joel A. , Clark Christopher A. , Burns Stephen A.
Published: December 2016

Purpose

To investigate outer retinal tubulation (ORT) using spectral domain optical coherence tomography (SD-OCT) and an adaptive optics scanning laser ophthalmoscope (AOSLO). To document the frequency of ORT in atrophic retinal conditions and quantify ORT dimensions versus adjacent retinal layers.

Methods

SD-OCT images were reviewed for the presence of retinal atrophy, scarring, and/or exudation. The greatest width of each ORT was quantified. Inner and outer retinal thicknesses adjacent to and within the area of ORT were measured for 18 patients. AOSLO imaged ORTs in five subjects with direct and scattered light imaging.

Results

ORT was identified in 47 of 76 subjects (61.8%) and in 65 eyes via SD-OCT in a wide range of conditions and ages, and in peripapillary atrophy. ORTs appeared as finger-like projections in atrophy, seen in the en face images. AOSLO showed some ORTs with bright cones that guide light within atrophic areas. Multiply scattered light mode AOSLO visualized variegated lines (18–35 μm) radiating from ORTs. The ORTs’ width on OCT b-scan images varied from 70 to 509 μm. The inner retina at the ORT was significantly thinner than the adjacent retina, 135 vs.170 μm (P = .004), whereas the outer retina was significantly thicker, 115 vs. 80 μm (P = .03).

Conclusions

ORTs are quite common in eyes with retinal atrophy in various disorders. ORTs demonstrate surviving photoreceptors in tubular structures found within otherwise nonsupportive atrophic areas that lack retinal pigment epithelium and choriocapillaris.
An Examination of the Self-directed Online Leadership Learning Choices of Public Health Professionals: The Maternal and Child Health Public Health Leadership Institute Experience
Authors: Fernandez Claudia S. P. , Noble Cheryl C. , Jensen Elizabeth T.
Published: December 2016

Objectives:

To assess the self-selected asynchronous leadership module-based learning choices of public health professionals participating in the Maternal and Child Health Public Health Leadership Institute (MCH PHLI).

Methods:

Online module completion and evaluation data were used to determine the topics most utilized by the Fellows; whether the topics and mode of training were acceptable, relevant, and practical; and whether participant characteristics explained any usage patterns.

Participants:

A total of 109 enrolled Fellows in the MCH PHLI program.

Main Outcome Measures:

Module frequency of selection by Fellows; Fellows' rating scores in regard to relevance, practicality, and acceptability of module topics.

Results:

All program titles were highly rated. The 5 most frequently selected module topics were employee engagement (87.2%), talent acquisition strategies (84.4%), employee motivation (79.8%), emotional intelligence (78.9%), and workforce development strategies (68.8%). The least accessed topics focused on cultural competence (15.6%), social marketing (25.7%), effective communication and advocacy (25.7%), family partnerships (25.9%), and creating learning organizations (31.2%). All module topics provided were rated as relevant, practical, and acceptable to these public health leaders.

Conclusion:

Self-directed computer-based learning was rated strongly by the MCH public health leaders in this study. Such an approach can be used to customize training to individual needs and interests. These findings suggest that inclusion of skills that enable public health leaders to effectively work with and through others was of core interest in the MCH PHLI. The finding of higher usage of topics related to workforce management can provide guidance for those developing leadership development programs for maternal and child health professionals. In addition, leadership needs and interests should be assessed regularly to ensure that competency-based leadership development guidelines are adapting to the evolving and complex challenges faced by leaders. While these results were tested in MCH professionals, they may be generalizable to other disciplines within the field of public health.
Health Care Provider Knowledge and Attitudes Regarding Reporting Diseases and Events to Public Health Authorities in Tennessee
Authors: Fill Mary-Margaret A. , Murphree Rendi , Pettit April C.
Published: December 2016

Context:

In the United States, state laws require health care providers to report specific diseases and events to public health authorities, a fundamental facet of disease surveillance. However, reporting by providers is often inconsistent, infrequent, and delayed.

Objective:

To examine knowledge, attitudes, and practices regarding provider disease reporting and to understand current barriers to provider disease reporting.

Design:

A cross-sectional study was conducted via an anonymous, standardized electronic survey.

Setting:

The survey was conducted at Vanderbilt University Medical Center, a large, tertiary academic medical center in Nashville, Tennessee.

Participants:

Health care providers in 4 specialties (internal medicine, pediatrics, obstetrics-gynecology, and emergency medicine).

Main Outcome Measure(s):

Knowledge of and attitudes regarding provider reporting of diseases to public health authorities in Tennessee.

Results:

The majority of providers acknowledged they cared for patients with reportable diseases (362/435, 83.2%) and believed that it was their responsibility to report to public health authorities (429/436, 98.4%); however, less than half had ever reported a case (206/436, 47.2%). The median percent correct on the knowledge assessment of Tennessee reportable diseases and conditions was 81.3% (interquartile range = 68.8-87.5). Providers cited a lack of knowledge of which diseases are reportable (186/429, 43.3%) and the logistics of reporting (153/429, 35.7%) as the primary barriers for compliance.

Conclusion:

Most providers acknowledged they cared for patients with reportable diseases and believed they had an obligation to report to public health authorities. However, a lack of knowledge about reporting was frequently described as a limitation to report effectively. Many knowledge deficits were significantly greater among residents than other providers.

The policy and practice implications of these findings include a demonstrated need for education of providers about disease reporting as well as development of more convenient reporting mechanisms. Fundamental knowledge of reportable disease requirements and procedures is critical for participation in the broader public health system.