bluuebunny/crossref_metadata_2025 huggingface dataset:
Surface chemistry of group 11 atomic layer deposition precursors on silica using solid-state nuclear magnetic resonance spectroscopy
Authors: Pallister Peter J. , Barry Seán T.
Published: November 2016

The use of chemical vapour deposition (CVD) and atomic layer deposition (ALD) as thin film deposition techniques has had a major impact on a number of fields. The deposition of pure, uniform, conformal thin films requires very specific vapour-solid reactivity that is largely unknown for the majority of ALD and CVD precursors. This work examines the initial chemisorption of several thin film vapour deposition precursors on high surface area silica (HSAS) using 13C, 31P, and quantitative 29Si nuclear magnetic resonance spectroscopy (NMR). Two copper metal precursors, 1,3-diisopropyl-imidazolin-2-ylidene copper (I) hexamethyldisilazide (1) and 1,3-diethyl-imidazolin-2-ylidene copper(I) hexamethyldisilazide (2), and one gold metal precursor, trimethylphosphine gold(III) trimethyl (3), are examined. Compounds 1 and 2 were found to chemisorb at the hydroxyl surface-reactive sites to form a ||–O–Cu–NHC surface species and fully methylated silicon (||–SiMe3, due to reactivity of the hexamethyldisilazane (HMDS) ligand on the precursor) at 150 °C and 250 °C. From quantitative 29Si solid-state NMR (SS-NMR) spectroscopy measurements, it was found that HMDS preferentially reacts at geminal disilanol surface sites while the copper surface species preferentially chemisorbed to lone silanol surface species. Additionally, the overall coverage was strongly dependent on temperature, with higher overall coverage of 1 at higher temperature but lower overall coverage of 2 at higher temperature. The chemisorption of 3 was found to produce a number of interesting surface species on HSAS. Gold(III) trimethylphosphine, reduced gold phosphine, methylated phosphoxides, and graphitic carbon were all observed as surface species. The overall coverage of 3 on HSAS was only about 10% at 100 °C and, like the copper compounds, had a preference for lone silanol surface reactive sites. The overall coverage and chemisorbed surface species have implications to the overall growth rate and purity of metal films grown with these precursors.
Solubility of NaCl in water and its melting point by molecular dynamics in the slab geometry and a new BK3-compatible force field
Authors: Kolafa Jiří
Published: November 2016

Saturated concentration of rock salt in water is determined by a simulation of brine in contact with a crystal in the slab geometry. The NaCl crystals are rotated to expose facets with higher Miller indices than [001] to brine. The rock salt melting point is obtained by both the standard and adiabatic simulations in the slab geometry with attention paid to finite size effects as well as to a possible influence of facets with higher Miller indices and applied stress. Two force fields are used, the Lennard-Jones-based model by Young and Cheatham with SPC/E water and the Kiss and Baranyai polarizable model with BK3 water. The latter model is refitted to thermomechanical properties of crystal NaCl leading to better values of solubility and the melting point.
Synthesis and characterization of low work function alkali oxide thin films for unconventional thermionic energy converters
Authors: Giorgis V. , Morini F. , Zhu T. , Robillard J.-F. , Wallart X. , Codron J.-L. , Dubois E.
Published: November 2016

In this work, we present the synthesis and the characterization of low work function thin films for Micro Thermionic Converters (MTC). The objective is producing a device operating at relatively low temperature (<1000 K). We aim at improving the MTC efficiency by reducing the work function of the electrodes and increasing the emitted current density by alkali metal oxides electrodes coating. In particular, in this work, we analyse and compare the performances of two alkali metal oxides: potassium and caesium oxides. Our choice to exploit those materials relies on their low work function and their abundance. For both materials, we present the results on the synthesis of the oxides under high vacuum and controlled temperature. The oxide thin films were characterized by X-ray photoelectron spectroscopy, photoemission, and thermionic emission measurements. By exploiting the latter technique, a quantitative evaluation of the current density, emitted by the heated oxides, is obtained as a function of temperature. Our results demonstrate that it is possible to decrease the silicon work function by almost 3 eV, enabling significant thermionic currents despite relatively low temperatures (below 850 K).
Propagation and attenuation characteristics of azimuthal symmetric surface waves in un-magnetized plasma column
Authors: Li Wenqiu , Wang Gang , Xiang Dong , Su Xiaobao
Published: November 2016

Phase and attenuation properties of azimuthal symmetric surface waves are investigated analytically in an un-magnetized cylindrical plasma column based on the transcendental dispersion relation. A novel method of calculating the wave power deposition in terms of complex electric conductivity is proposed. Electron density distribution is obtained theoretically through charged particle balance theory. It is shown that the effect of the electron temperature on the dispersion curve can be neglected when kzα < 1. Both the phase/attenuation characteristics and wave energy deposition properties of the azimuthal symmetric surface wave have an evident dependence on the electron density and the electron collision frequency.
Towards high performance CoFe2O4 isotropic nanocrystalline powder for permanent magnet applications
Authors: Pedrosa F. J. , Rial J. , Golasinski K. M. , Guzik M. N. , Quesada A. , Fernández J. F. , Deledda S. , Camarero J. , Bollero A.
Published: November 2016

We report on a comparative study of high performance isotropic cobalt ferrite (CoFe2O4) powder processed by dry and surfactant assisted (wet) ball milling. Milling times as short as 1.5 min (dry) and 6 min (wet) have resulted in a 4-fold increase in coercivity, with a maximum achieved value above 318 kA/m (4 kOe). The use of surfactant is shown to be advantageous in the formation of a more homogeneous structure constituted by non-agglomerated and strained nanoparticles. A record (BH) max value of 18.6 kJ m −3 (2.34 MGOe) has been obtained for isotropic powder after post-processing annealing. This magnetic performance combined with the required short processing times and the unnecessary requirement of oxygen avoidance in the milling process, makes this CoFe2O4 powder a good candidate for permanent magnet applications.
Comparing investigation of pattern formation in glow and streamer DBD
Authors: Li Ben , Ouyang Jiting
Published: November 2016

In this paper, we investigate the behaviors of patterns in dielectric barrier discharge (DBD) in glow and streamer regimes under different operating conditions (driving frequency and voltage) and external electric/magnetic field to explore the similarity and difference of pattern formation. It is found that patterns in both glow and streamer DBDs can be homogenized by decreasing the driving frequency to a low level. But filamentary streamers can still appear at low frequency when the voltage is much higher. With an additional lateral electric field, patterns in both regimes can be homogenized. However, an axial magnetic field makes the glow DBD homogeneous, while the streamer DBD decreases in filamentary size. In both regimes, dynamics and distribution of the space charges, rather than the surface charges, play the predominant role in the formation of DBD patterns. But the surface charges may also play an important role in pattern formation, especially in streamer DBD.
Communication: Stiffening of dilute alcohol and alkane mixtures with water
Authors: Ashbaugh Henry S. , Barnett J. Wesley , Saltzman Alexander , Langrehr Mae E. , Houser Hayden
Published: November 2016

We probe the anomalous compressibilities of dilute mixtures of alcohols and alkane gases in water using molecular simulations. The response to increasing solute concentration depends sensitively on temperature, with the compressibility decreasing upon solute addition at low temperatures and increasing at elevated temperatures. The thermodynamic origin of stiffening is directly tied to the solute’s partial compressibility, which is negative at low temperatures and rises above water’s compressibility with increasing temperature. Hydration shell waters concurrently tilt towards clathrate-like structures at low temperatures that fade with heating. Kirkwood-Buff theory traces the solute’s partial compressibility to changes in the solute-water association volume upon heating and incongruous packing of waters at the boundary between the more structured hydration shell and bulk water.
Dusty plasma (Yukawa) rings
Authors: Sheridan T. E. , Gallagher James C.
Published: November 2016

One-dimensional and quasi-one-dimensional strongly coupled dusty plasma rings have been created experimentally. Longitudinal (acoustic) and transverse (optical) dispersion relations for the one-ring are measured and found to be in excellent agreement with the theory for an unbounded straight chain of particles interacting through a Yukawa (i.e., screened Coulomb or Debye-Hückel) potential. These rings provide a new experimental system to directly study one-dimensional and quasi-one-dimensional linear and nonlinear phenomena.
Structural Systematics for Lanthanide(III) Systems: Interactions of the Achiral Hexamminecobalt(III) Cation with Tris(dipicolinato)lanthanate(III) Anions
Authors: Harrowfield Jack M. , Ling Irene , Skelton Brian W. , Sobolev Alexandre N. , White Allan H.
Published: November 2016

Extended structural studies, largely determinations at ~150 K, of the family of hydrates of [Co(NH3)6][Ln(dipic)3] (Ln = La–Lu, and Y; dipic = dipicolinate = pyridine-2,6-dicarboxylate) have provided detailed evidence of the nature of the interactions between the formally achiral cation and the chiral anions. They also provide a reference point for consideration of related systems incorporating chiral cations with and without the capacity to act as H-bond donors.
Geographic distribution of point-in-time access to subsidised dental services in Western Australia
Authors: Dudko Yevgeni , Kruger Estie , Tennant Marc
Published: November 2016

Dental Health Services (DHS) is the largest public primary oral healthcare provider in WA. The objective of this study was to calculate probable distance patients are expected to travel to the nearest clinic, gauge utilisation rates and predict the direction of likely changes in future demand for subsidised dental care. Eligible population data was collected from the Department of Human Services and the Australian Bureau of Statistics websites and integrated with the waiting list and the recall list data provided by the DHS. In total, 65% of the eligible WA population are residing in the metropolitan area; however, only 19% of those are either on the waiting list or have already received subsidised care. In all, 35% of the total eligible WA population are residing in country areas. A total of 30% of the eligible country WA patients are located within a 100-km range of a Government Dental Clinic, with only 11% of those either on the waiting list or having already received subsidised dental care. Country WA residents are at a significant disadvantage by comparison to their metropolitan counterparts. Eligible WA country residents are up to 40% less likely to receive treatment when compared to the metropolitan residents.
Near-atomic structural model for bacterial DNA replication initiation complex and its functional insights
Authors: Shimizu Masahiro , Noguchi Yasunori , Sakiyama Yukari , Kawakami Hironori , Katayama Tsutomu , Takada Shoji
Published: November 2016

Significance

Chromosomal DNA replication is initiated by unwinding duplex DNA via formation of dynamic higher-order protein–DNA complexes. Whereas biochemical analyzes have been performed for a long time, structural dynamics in those processes still remain elusive due to their complex nature. Here, using hybrid approaches of computational modeling and biochemical assays, we explore dynamic structures of the entire machinery and significance of spatial arrangement of every component in the replication initiation complex of
Escherichia coli
. We show the structural model of the crucial core part of the complex at near-atomic resolution. The complex is composed of three subcomplexes, and spatial arrangements of those as well as their components are important for efficient replication initiation.
Spatiotemporal imaging of small GTPases activity in live cells
Authors: Voss Stephanie , Krüger Dennis M. , Koch Oliver , Wu Yao-Wen
Published: November 2016

Significance

Ras-like small GTPases regulate a wide range of cellular processes involving signal transduction, cytoskeleton rearrangement, and membrane trafficking by switching between an active GTP-bound and an inactive GDP-bound form. In this study, we developed conformational sensors for GTPase activity (COSGAs) by combining protein engineering and chemical labeling. The COSGAs enable quantitative detection of the GDP/GTP binding state of Rab1 and K-Ras in living cells with spatiotemporal resolution to gain insights into Rab membrane cycling and Ras signaling at the plasma membrane. This approach paves a new avenue for imaging activity of signaling molecules in the cell, which could deliver valuable information regarding their function and dynamics.
Elucidating the druggable interface of protein−protein interactions using fragment docking and coevolutionary analysis
Authors: Bai Fang , Morcos Faruck , Cheng Ryan R. , Jiang Hualiang , Onuchic José N.
Published: November 2016

Significance

Protein−protein interfaces have become an emerging class of molecular targets for the design of therapeutic drugs. However, major challenges exist for the correct identification of binding sites on the protein surface as well as drug-like modulators of protein−protein interaction. An integrated approach using molecular fragment docking and coevolutionary analysis is presented to face these challenges. This approach can accurately predict and characterize the binding sites for protein−protein interactions as well as provide clusters of bound, fragment-sized molecules on the druggable regions of the predicted binding site. These bound, molecular fragments can be chemically combined to create candidate drugs.
Using the CRISPR/Cas9 system to eliminate native plasmids of Zymomonas mobilis ZM4
Authors: Cao Qing-Hua , Shao Huan-Huan , Qiu Hui , Li Tao , Zhang Yi-Zheng , Tan Xue-Mei
Published: November 2016

The CRISPR/Cas system can be used to simply and efficiently edit the genomes of various species, including animals, plants, and microbes. Zymomonas mobilis ZM4 is a highly efficient, ethanol-producing bacterium that contains five native plasmids. Here, we constructed the pSUZM2a-Cas9 plasmid and a single-guide RNA expression plasmid. The pSUZM2a-Cas9 plasmid was used to express the Cas9 gene cloned from Streptococcus pyogenes CICC 10464. The single-guide RNA expression plasmid pUC-T7sgRNA, with a T7 promoter, can be used for the in vitro synthesis of single-guide RNAs. This system was successfully employed to knockout the upp gene of Escherichia coli and the replicase genes of native Z. mobilis plasmids. This is the first study to apply the CRISPR/Cas9 system of S. pyogenes to eliminate native plasmids in Z. mobilis. It provides a new method for plasmid curing and paves the way for the genomic engineering of Z. mobilis.
Mitochondrial division occurs concurrently with autophagosome formation but independently of Drp1 during mitophagy
Authors: Yamashita Shun-ichi , Jin Xiulian , Furukawa Kentaro , Hamasaki Maho , Nezu Akiko , Otera Hidenori , Saigusa Tetsu , Yoshimori Tamotsu , Sakai Yasuyoshi , Mihara Katsuyoshi , Kanki Tomotake
Published: November 2016

Mitophagy is thought to play an important role in mitochondrial quality control. Mitochondrial division is believed to occur first, and autophagosome formation subsequently occurs to enwrap mitochondria as a process of mitophagy. However, there has not been any temporal analysis of mitochondrial division and autophagosome formation in mitophagy. Therefore, the relationships among these processes remain unclear. We show that the mitochondrial division factor Dnm1 in yeast or Drp1 in mammalian cells is dispensable for mitophagy. Autophagosome formation factors, such as FIP200, ATG14, and WIPIs, were essential for the mitochondrial division for mitophagy. Live-cell imaging showed that isolation membranes formed on the mitochondria. A small portion of the mitochondria then divided from parental mitochondria simultaneously with the extension of isolation membranes and autophagosome formation. These findings suggest the presence of a mitophagy process in which mitochondrial division for mitophagy is accomplished together with autophagosome formation.
A dividing matter: Drp1/Dnm1-independent mitophagy
Authors: Graef Martin
Published: November 2016

Whether or not mitophagy depends on prior mitochondrial fragmentation by the canonical mitochondrial division machinery is controversial. In this issue, Yamashita et al. (2016. J. Cell Biol. https://doi.org/10.1083/jcb.201605093) report that mitochondrial fragments start to bud and divide from mitochondrial tubules when in tight association with forming autophagosomes, but independently of the mitochondrial division factor Drp1/Dnm1.
RAB43 facilitates cross-presentation of cell-associated antigens by CD8α+ dendritic cells
Authors: Kretzer Nicole M. , Theisen Derek J. , Tussiwand Roxane , Briseño Carlos G. , Grajales-Reyes Gary E. , Wu Xiaodi , Durai Vivek , Albring Jörn , Bagadia Prachi , Murphy Theresa L. , Murphy Kenneth M.
Published: November 2016

In this study, to examine cross-presentation by classical dendritic cells (DCs; cDCs), we evaluated the role of RAB43, a protein found to be selectively expressed by Batf3-dependent CD8α+ and CD103+ compared with other DC subsets and immune lineages. Using a specific monoclonal antibody, we localized RAB43 expression to the Golgi apparatus and LAMP1− cytoplasmic vesicles. Mice with germline or conditional deletion of Rab43 are viable and fertile and have normal development of cDCs but show a defect for in vivo and in vitro cross-presentation of cell-associated antigen. This defect is specific to cDCs, as Rab43-deficient monocyte-derived DCs showed no defect in cross-presentation of cell-associated antigen. These results suggest that RAB43 provides a specialized activity used in cross-presentation selectively by CD8α+ DCs but not other antigen-presenting cells.
Early generated B1 B cells with restricted BCRs become chronic lymphocytic leukemia with continued c-Myc and low Bmf expression
Authors: Hayakawa Kyoko , Formica Anthony M. , Brill-Dashoff Joni , Shinton Susan A. , Ichikawa Daiju , Zhou Yan , Morse Herbert C. , Hardy Richard R.
Published: November 2016

In mice, generation of autoreactive CD5+ B cells occurs as a consequence of BCR signaling induced by (self)-ligand exposure from fetal/neonatal B-1 B cell development. A fraction of these cells self-renew and persist as a minor B1 B cell subset throughout life. Here, we show that transfer of early generated B1 B cells from Eμ-TCL1 transgenic mice resulted in chronic lymphocytic leukemia (CLL) with a biased repertoire, including stereotyped BCRs. Thus, B1 B cells bearing restricted BCRs can become CLL during aging. Increased anti-thymocyte/Thy-1 autoreactive (ATA) BCR cells in the B1 B cell subset by transgenic expression yielded spontaneous ATA B-CLL/lymphoma incidence, enhanced by TCL1 transgenesis. In contrast, ATA B-CLL did not develop from other B cell subsets, even when the identical ATA BCR was expressed on a Thy-1 low/null background. Thus, both a specific BCR and B1 B cell context were important for CLL progression. Neonatal B1 B cells and their CLL progeny in aged mice continued to express moderately up-regulated c-Myc and down-regulated proapoptotic Bmf, unlike most mature B cells in the adult. Thus, there is a genetic predisposition inherent in B-1 development generating restricted BCRs and self-renewal capacity, with both features contributing to potential for progression to CLL.
Antigen-dependent competition shapes the local repertoire of tissue-resident memory CD8+ T cells
Authors: Muschaweckh Andreas , Buchholz Veit R. , Fellenzer Anne , Hessel Christian , König Paul-Albert , Tao Sha , Tao Ronny , Heikenwälder Mathias , Busch Dirk H. , Korn Thomas , Kastenmüller Wolfgang , Drexler Ingo , Gasteiger Georg
Published: November 2016

Tissue-resident memory CD8+ T cells (TRM) constitute a major component of the immune-surveillance system in nonlymphoid organs. Local, noncognate factors are both necessary and sufficient to support the programming of TRM cell fate in tissue-infiltrating T cells. Recent evidence suggests that TCR signals received in infected nonlymphoid tissues additionally contribute to TRM cell formation. Here, we asked how antigen-dependent pathways influence the generation of skin-resident memory T cells that arise from a polyclonal repertoire of cells induced by infection with an antigenically complex virus and recombinant vaccine vector. We found that CD8+ T cells of different specificities underwent antigen-dependent competition in the infected tissue, which shaped the composition of the local pool of TRM cells. This local cross-competition was active for T cells recognizing antigens that are coexpressed by infected cells. In contrast, TRM cell development remained largely undisturbed by the presence of potential competitors when antigens expressed in the same tissue were segregated through infection with antigenically distinct viral quasispecies. Functionally, local cross-competition might serve as a gatekeeping mechanism to regulate access to the resident memory niche and to fine-tune the local repertoire of antiviral TRM cells.
Progressive Cl− channel defects reveal disrupted skeletal muscle maturation in R6/2 Huntington’s mice
Authors: Miranda Daniel R. , Wong Monica , Romer Shannon H. , McKee Cynthia , Garza-Vasquez Gabriela , Medina Alyssa C. , Bahn Volker , Steele Andrew D. , Talmadge Robert J. , Voss Andrew A.
Published: November 2016

Huntington’s disease (HD) patients suffer from progressive and debilitating motor dysfunction. Previously, we discovered reduced skeletal muscle chloride channel (ClC-1) currents, inwardly rectifying potassium (Kir) channel currents, and membrane capacitance in R6/2 transgenic HD mice. The ClC-1 loss-of-function correlated with increased aberrant mRNA processing and decreased levels of full-length ClC-1 mRNA (Clcn1 gene). Physiologically, the resulting muscle hyperexcitability may help explain involuntary contractions of HD. In this study, the onset and progression of these defects are investigated in R6/2 mice, ranging from 3 wk old (presymptomatic) to 9–13 wk old (late-stage disease), and compared with age-matched wild-type (WT) siblings. The R6/2 ClC-1 current density and level of aberrantly spliced Clcn1 mRNA remain constant with age. In contrast, the ClC-1 current density increases, and the level of aberrantly spliced Clcn1 mRNA decreases with age in WT mice. The R6/2 ClC-1 properties diverge from WT before the onset of motor symptoms, which occurs at 5 wk of age. The relative decrease in R6/2 muscle capacitance also begins in 5-wk-old mice and is independent of fiber atrophy. Kir current density is consistently lower in R6/2 compared with WT muscle. The invariable R6/2 ClC-1 properties suggest a disruption in muscle maturation, which we confirm by measuring elevated levels of neonatal myosin heavy chain (MyHC) in late-stage R6/2 skeletal muscle. Similar changes in ClC-1 and MyHC isoforms in the more slowly developing Q175 HD mice suggest an altered maturational state is relevant to adult-onset HD. Finally, we find nuclear aggregates of muscleblind-like protein 1 without predominant CAG repeat colocalization in R6/2 muscle. This is unlike myotonic dystrophy, another trinucleotide repeat disorder with similar ClC-1 defects, and suggests a novel mechanism of aberrant mRNA splicing in HD. These early and progressive skeletal muscle defects reveal much needed peripheral biomarkers of disease progression and better elucidate the mechanism underlying HD myopathy.
Rural‐Urban Interdependence: A Framework Integrating Regional, Urban, and Environmental Economic Insights
Authors: Wu JunJie , Weber Bruce A. , Partridge Mark D.
Published: November 2016

Economic development in rural areas affects the natural environment, which in turn affects economic growth—both rural and urban. These shared interests and feedback effects in the natural environment are increasingly recognized as important economic and political issues, and necessitate a new framework for better understanding them. This article asks why such a framework does not exist and why it should be developed. It then presents such a framework by integrating regional, urban, and environmental economic insights. The framework focuses on the interactive location decisions of firms and households and centripetal forces for concentration and centrifugal forces for decentralization. The article captures the economic and environmental consequences of rural‐urban relocation and feedback effects through changes in agglomeration economies, congestion costs, natural and social amenities, and the location of economic opportunities. Results show that some feedback effects reinforce the initial forces, but others weaken them. We present two examples to demonstrate the application of the framework. The first focuses on how agglomeration economies affect the effectiveness of environmental regulation and illustrates the benefits of incorporating regional and urban economic insights into environmental policy analysis. The second example focuses on how conservation policy can create localized amenities that help resource‐rich regions avoid the natural resource curse and illustrates how concepts and perspectives from resource and environmental economics can improve our understanding of regional and rural issues.
Clinical Impact and Cost-effectiveness of Xpert MTB/RIF Testing in Hospitalized Patients With Presumptive Pulmonary Tuberculosis in the United States
Authors: Cowan James F. , Chandler Aldine S. , Kracen Elizabeth , Park David R. , Wallis Carolyn K. , Liu Emelline , Song Chao , Persing David H. , Fang Ferric C.
Published: November 2016

Background.

Microscopic examination of acid-fast-stained sputum smears is the current standard of care in the United States to determine airborne infection isolation (AII) of inpatients with presumptive pulmonary tuberculosis (PTB). However, nucleic acid amplification testing (NAAT) with the Xpert MTB/RIF assay (Xpert) may be more efficient and less costly.

Methods.

This prospective observational cohort study enrolled a consecutive sample of 318 AII-eligible inpatients from a public hospital in Seattle, Washington, from March 2012 to October 2013. Sputum samples were collected from each inpatient and analyzed using smear microscopy, culture, drug susceptibility testing, and NAAT. The performance, clinical utility (AII duration and survival), and cost-effectiveness from an institutional perspective were compared for 5 testing strategies.

Results.

Among the 318 admissions with presumptive PTB, 20 (6.3%) were culture-positive for Mycobacterium tuberculosis. The sensitivity of 1 Xpert, 2 Xperts, 2 smears, or 3 smears compared to culture was 0.85 (95% confidence interval [CI], .61–.96), 0.95 (95% CI, .73–1.0), 0.70 (95% CI, .46–.88), and 0.80 (95% CI, .56–.93), respectively. A cost-effectiveness analysis of the study results demonstrated that an Xpert test on 1 unconcentrated sputum sample (assuming equivalent results for unconcentrated and concentrated sputum samples) is the most cost-effective strategy (99.9% preferred at willingness-to-pay of US$50000) and on average would save 51.5 patient-hours in AII and up to $11466 relative to microscopy without a compromise in sensitivity.

Conclusions.

In hospitalized patients with presumptive PTB in a low-burden setting, NAAT can reduce AII and is comparably sensitive, more specific, and more cost-effective than smear microscopy.
Treatment options in immune thrombocytopenia
Authors: Dubis Laura , Collins Miranda
Published: November 2016

Immune thrombocytopenia (ITP) is an autoimmune condition that can cause life-threatening bleeding. ITP may develop idiopathically, after an infection or administration of a medication, or as a comorbid condition. Treatment depends on whether life-threatening, active bleeding is occurring. Although corticosteroids remain a standard of care, new medications offer patients an alternative to splenectomy when other pharmacologic treatments fail.
A young woman with numbness in her feet
Authors: Pavlik Daniel , Huber Michael , Justice Melissa
Published: November 2016

This article describes a young, otherwise healthy woman who presented to the ED with numbness in her feet and was discharged. Twenty-four hours later, she returned because of difficulty walking; in 48 hours she could not walk without assistance. Although Guillain-Barré syndrome was suspected initially, the patient's weakness, sensory loss, and autonomic dysfunction eventually were diagnosed as transverse myelitis, a myelopathy often associated with infectious or autoimmune diseases. The article describes the presentation, diagnostic evaluation and criteria, treatment, and prognosis of transverse myelitis.
Enhancing Student Empathetic Engagement, History-Taking, and Communication Skills During Electronic Medical Record Use in Patient Care
Authors: LoSasso Alisa Alfonsi , Lamberton Courtney E. , Sammon Mary , Berg Katherine T. , Caruso John W. , Cass Jonathan , Hojat Mohammadreza
Published: November 2016

Purpose

To examine whether an intervention on proper use of electronic medical records (EMRs) in patient care could help improve medical students’ empathic engagement, and to test the hypothesis that the training would reduce communication hurdles in clinical encounters.

Method

Seventy third-year medical students from the Sidney Kimmel Medical College at Thomas Jefferson University were randomly divided into intervention and control groups during their six-week pediatric clerkship in 2012–2013. The intervention group received a one-hour training session on EMR-specific communication skills, including discussion of EMR use, the SALTED mnemonic and technique (Set-up, Ask, Listen, Type, Exceptions, Documentation), and role-plays. Both groups completed the Jefferson Scale of Empathy (JSE) at the clerkship’s start and end. At clerkship’s end, faculty and standardized patients (SPs) rated students’ empathic engagement in SP encounters, using the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE), and their history-taking and communication skills.

Results

Faculty mean ratings on the JSPPPE, history-taking skills, and communication skills were significantly higher for the intervention group than the control group. SP mean ratings on history-taking skills were significantly higher for the intervention group than the control group. Both groups’ JSE mean scores increased pretest to posttest, but the changes were not significant. The intervention group’s posttest JSE mean score was higher than the control group’s, but the difference was not significant.

Conclusions

The findings suggest that a simple intervention providing specialized training in EMR-specific communication can improve medical students’ empathic engagement in patient care, history-taking skills, and communication skills.
The Drivers of Discretionary Utilization: Clinical History Versus Physician Supply
Authors: Ruhnke Gregory W. , Manning Willard G. , Rubin David T. , Meltzer David O.
Published: November 2016

Purpose

Because the effect of physician supply on utilization remains controversial, literature based on non-Medicare populations is sparse, and a physician supply expansion is under way, the potential for physician-induced demand across diverse populations is important to understand. A substantial proportion of gastrointestinal endoscopies may be inappropriate. The authors analyzed the impact of physician supply, practice patterns, and clinical history on esophagogastroduodenoscopy (EGD, defined as discretionary) among patients hospitalized with lower gastrointestinal bleeding (LGIB).

Method

Among 34,344 patients hospitalized for LGIB from 2004 to 2009, 43.1% and 21.3% had a colonoscopy or EGD, respectively, during the index hospitalization or within 6 months after. Linking to the Dartmouth Atlas via patients’ hospital referral region, gastroenterologist density and hospital care intensity (HCI) index were ascertained. Adjusting for age, gender, comorbidities, and race/education indicators, the association of gastroenterologist density, HCI index, and history of upper gastrointestinal disease with EGD was estimated using logistic regression.

Results

EGD was not associated with gastroenterologist density or HCI index, but was associated with a history of upper gastrointestinal disease (OR 2.30; 95% CI 2.17–2.43), peptic ulcer disease (OR 4.82; 95% CI 4.26–5.45), and liver disease (OR 1.34; 95% CI 1.18–1.54).

Conclusions

Among patients hospitalized with LGIB, large variation in gastroenterologist density did not predict EGD, but relevant clinical history did, with association strengths commensurate with risk for upper gastrointestinal bleeding. In the scenario studied, no evidence was found that specialty physician supply increases will result in more discretionary care within commercially insured populations.
Bedside Placement of the Postpyloric Tube in Infants
Authors: Clifford Patricia , Ely Elizabeth , Heimall Lauren
Published: November 2016

Background:

Patients in the neonatal intensive care unit are a vulnerable population with specific nutritional requirements, which include increased protein and caloric needs for adequate growth. Some infants cannot tolerate gastric feeds and need to have postpyloric feeds to grow. Placement of a postpyloric tube can be done by gastric insufflation. Gastric insufflation is a technique where air is inserted into the stomach as a nasogastric tube is advanced through the pylorus to the duodenum. There is research to support this technique in pediatrics, but scant evidence exists for placement of postpyloric tubes in the infant population.

Purpose:

The aim of this quality improvement practice project was to determine whether the current practice for postpyloric tube placement by the bedside nurses in the neonatal intensive care unit is safe and effective.

Methods:

Data were prospectively collected on 38 infants requiring placement of 60 postpyloric tubes over an 8-week period.

Results:

The results indicate a success rate of 95.6% for tube placement when a subset of infants diagnosed with congenital diaphragmatic hernia (CDH) (n = 15) was excluded. Six (40%) of the 15 infants with CDH had postpyloric tubes placed successfully. Nursing years of experience did not affect successful postpyloric tube placement.

Implications for Practice:

The postpyloric tube placement policy was modified as a result of findings from this project. Placement of a postpyloric tube with one attempt by the bedside nurse was safe and effective in most preterm infants in our care excluding patients with CDH. The new policy reduced infants' exposure to radiation due to a decrease in the number of x-rays in comparison to interventional radiology placement.

Implications for Research:

Further research should be done by units that primarily care for low birth-weight premature infants.
Risk of infection and secondary displacement in pediatric supracondylar or lateral condyle fractures treated with unburied Kirchener-wires removed before complete bone healing
Authors: Aubret Sylvain , Lecointe Thibaut , Mansour Mounira , Rousset Marie , Andreacchio Antonio , Pereira Bruno , Charles Yann Philippe , Canavese Federico
Published: November 2016

This study evaluated the risk of infection and of secondary displacement among children with displaced lateral condyle or supracondylar fractures treated by surgery. The study included a consecutive sample of 84 supracondylar fractures and 21 lateral condyle fractures treated with closed reduction and percutaneous pinning. The mean time to Kirchener wire removal was 29 days (range: 25–37 days) postsurgery. Two out of 105 (1.9%) patients developed infectious complications and two of 105 (1.9%) patients had a secondary displacement. Removal of unburied Kirchener wires before complete bone healing in the physician’s office does not increase risk of infection or the risk of secondary displacement. The protocol does, however, enable significant savings and eliminates the need for additional anaesthetic.
An Innovative Program to Support Internationally Educated Health Professionals and Their Instructors: Role of the Clinical Practice Facilitator
Authors: Daniel Sylvia , Lee Annemarie L. , Switzer-McIntyre Sharon , Evans Cathy
Published: November 2016

Introduction:

Internationally educated health professionals immigrating to other countries may experience difficulty in clinical practice, due to linguistic and cultural factors. An important element of bridging is the opportunity for internationally educated health professionals to practice in a clinical environment. To support these health professionals and their clinical instructors, a Clinical Practice Facilitator (CPF) role was created. This study aimed to examine the CPF from internationally educated health professionals and clinical instructors' perspective.

Methods:

A quantitative survey was conducted with two cohorts (2013 and 2015) of internationally educated physical therapists and clinical instructors who were asked about the nature of interaction with CPFs, mentor, and education roles and the benefits and challenges of the role.

Results:

Thirty-five internationally educated physical therapists and 37 clinical instructors participated and were satisfied with the interaction with CPFs via face-to-face or e-mail communication. There was strong agreement (>80%) that the CPF educator role was to facilitate learner's reflection on clinical practice while the mentor role (>70%) was to answer questions, provide feedback, and investigate clinical concerns and conflicts. There was insufficient time for access to CPFs and resolution of learners' learning needs. There were differences (P = 0.04) in perspective on the benefit of the CPF in assisting with cultural differences.

Discussion:

An innovative CPF role provided support encouragement, clinical, and professional advice. There were discordant views regarding the benefits of the CPF role in addressing cultural issues, which requires further examination.
Miller's Pyramid and Core Competency Assessment: A Study in Relationship Construct Validity
Authors: Williams Betsy White , Byrne Phil D. , Welindt Dillon , Williams Michael V.
Published: November 2016

Introduction:

Continuous professional development relies on the link between performance and an educational process aimed at improving knowledge and skill. One of the most broadly used frameworks for assessing skills is Miller's Pyramid. This Pyramid has a series of levels of achievement beginning with knowledge (at the base) and ending with routine application in the clinical setting.

Methods:

The purpose of this study was to determine the degree of convergence of two measurement methods, one based on Miller's framework, the second using the Accreditation Council for Graduate Medical Education/American Board of Medical Specialties (ACGME/ABMS) Core Competency framework. The data were gathered from the faculty of a large, Midwestern regional health care provider and hospital system. Data from 264 respondents were studied. The 360° data were from raters of physicians holding supervisory roles in the organization. The scale items were taken from an instrument that has been validated for both structure and known group prediction.

Results:

The Miller scale was purposely built for this application. The questions were designed to describe each level of the model. The Miller scale was reduced to a single dimension. This result was then regressed on the items from the 360° item ratings. Results of a multivariate analysis of variance isolated a significant relationship between the Miller's Pyramid score and the competency items (P < 0.001).

Discussion:

These findings demonstrate a relationship between measures based on Miller's framework and behavioral measures based on the ABMS/ACGME core competencies. Equally important is the finding that while they are related they are not identical. These findings have implications for continuous professional development programing design.
Transfer of Mindfulness Training to the Work Setting: A Qualitative Study in a Health Care System
Authors: Lyddy Christopher J. , Schachter Yotam , Reyer Amy , Julliard Kell
Published: November 2016

Introduction:

Mindfulness training is now commonly offered as professional development for health care practitioners. Understanding how health care practitioners adopt mindfulness practices is limited, which poses a hurdle to the development of effective mindfulness training programs. To explore how health professionals use and perceive mindfulness practices at work, we conducted an exploratory qualitative study at a large multicomponent inner-city health system.

Methods:

All participants were self-selected health professionals who attended at least one mindfulness training. Training content was derived from the Tergar Meditation Community's nonsectarian Joy of Living program and focused on calming the mind using a flexible and broadly applicable approach. Transcribed interview data were examined using thematic analysis.

Results:

Individuals receiving mindfulness training varied substantially in their subsequent adoption and utilization of these practices. Interviewees' experiences overall suggest that the workplace presents a relatively challenging but nonetheless viable environment for being mindful. Health care workers relied on more informal practice models than on formal meditation practice routines while at work. Factors reported by some individuals to inhibit effective mindfulness practice supported mindfulness for others, and overall displayed equivocal effects.

Discussion:

Adoption and integration of mindfulness practices within the workplace are feasible yet vary significantly by practice type, situation, and the individual. Greater understanding of how individuals adopt workplace mindfulness training could improve future intervention research while clarifying optimal mindfulness training approaches.
Organizational Perspectives on Rapid Response Team Structure, Function, and Cost
Authors: Smith Patricia L. , McSweeney Jean
Published: November 2016

Background:

Understanding how an organization determines structure and function of a rapid response team (RRT), as well as cost evaluation and implications, can provide foundational knowledge to guide decisions about RRTs.

Objectives:

The objectives were to (1) identify influencing factors in organizational development of RRT structure and function and (2) describe evaluation of RRT costs.

Methods:

Using a qualitative, ethnographic design, nurse executives and experts in 15 moderate-size hospitals were interviewed to explore their decision-making processes in determining RRT structure and function. Face-to-face interviews were audio recorded and transcribed verbatim and verified for accurateness. Using content analysis and constant comparison, interview data were analyzed. Demographic data were analyzed using descriptive statistics.

Results:

The sample included 27 participants from 15 hospitals in 5 south-central states. They described a variety of RRT responders and functions, with the majority of hospitals having a critical care charge nurse attending all RRT calls for assistance. Others described a designated RRT nurse with primary RRT duties as responder to all RRT calls. Themes of RRT development from the data included influencers, decision processes, and thoughts about cost.

Discussion:

It is important to understand how hospitals determine optimal structure and function to enhance support of quality nursing care. Determining the impact of an RRT on costs and benefits is vital in balancing patient safety and limited resources. Future research should focus on clarifying differences between team structure and function in outcomes as well as the most effective means to estimate costs and benefits.
Lead Poisoning in Children and Adults
Authors: Miracle Vickie Ann
Published: November 2016

Lead poisoning is receiving much attention and increased awareness lately owing to the tainted water supply crisis in Flint, Michigan. This article provides an important review about lead poisoning in both children and adults, potential causes, signs and symptoms, long-term effects, prevention, and recommendations for nursing practice. This article is not an in-depth examination of the topic, but rather a quick review.
Should We Add Pravastatin to Aspirin for Preeclampsia Prevention in High-risk Women?
Authors: MARRS CAROLINE C. , COSTANTINE MAGED M.
Published: November 2016

Preeclampsia is a multisystem disorder that affects 3% to 5% of pregnant women and remains a significant source of short-term and long-term maternal and neonatal mortality and morbidity. Many professional societies recommend the use of low-dose aspirin to prevent preeclampsia in high-risk women. Owing to the similarities in pathophysiology between preeclampsia and atherosclerotic cardiovascular disease, and the encouraging data from preclinical and pilot clinical studies, pravastatin has been proposed for preventing preeclampsia. However, before statin administration becomes part of routine clinical practice, a large, well-designed, and adequately powered randomized-controlled trial is needed.
Rethinking Recovery
Authors: Peterson-Burch Frances , Reuter-Rice Karin , Barr Taura L.
Published: November 2016

Stroke is a life-changing experience. Current treatments focus on treating the condition, rather than the whole person. The goal of this report was to communicate the benefits of a holistic approach to the treatment and recovery of stroke. Our intent was to begin a conversation to transform our approach to stroke care to focus on the whole person, body, mind, and spirit. Wellness approaches are fiscally responsible ways of providing holistic care for patients and their family members to help them achieve optimal individualized recovery. Very few multidimensional programs for wellness exist for patients with stroke and brain injury. Given the changes in health care and the Call to Action set forth in the Institute of Medicine's 2010 report, it would behoove us to consider holistic approaches to stroke care and research programs. Nurses are uniquely positioned to implement multidisciplinary, innovative holistic approaches to address solutions for issues in stroke care. Wellness is a critically important area of stroke care and an opportunity for research. As advocates for patients, and nurses with personal experiences, we hope this commentary stimulates conversation around developing and testing multidimensional holistic programs of wellness for stroke prevention, treatment, and recovery.