bluuebunny/crossref_metadata_2025 huggingface dataset:
Submicron-quality cleaving of glass with elliptical ultrafast Bessel beams
Authors: Meyer R. , Giust R. , Jacquot M. , Dudley J. M. , Courvoisier F.
Published: December 2017

The material processing technique of “stealth” nanomachining is based on translating a longitudinally extended beam such as a Bessel beam into a transparent sample to generate extended nanochannels, which leads to subsequent internal stress that facilitates high quality cleaving. In this letter, we compare the quality of such cleaving in glass samples obtained using Bessel beams with both circularly symmetric and elliptical transverse profiles. We find that the use of an elliptical Bessel beam generates elliptical nanochannels, which greatly improves the cleavage quality and cuts material strength by aligning the centre of the cleavage plane with the centre of the machined channels. These results are interpreted using numerical simulations that show how elliptical nanochannels enhance the intensity and localization of the tensile stress distribution in glass under bending when compared to channels with circular cross-sections.
Production of intense, pulsed, and point-like neutron source from deuterated plastic cavity by mono-directional kilo-joule laser irradiation
Authors: Abe Y. , Sunahara A. , Lee S. , Yanagawa T. , Zhang Z. , Arikawa Y. , Morace A. , Nagai T. , Ikenouchi T. , Tosaki S. , Kojima S. , Sakata S. , Satoh N. , Watari T. , Nishihara K. , Kawashima T. , Yogo A. , Sakagami H. , Shiraga H. , Nishimura H. , Mima K. , Azechi H. , Norimatsu T. , Nakai M. , Fujioka S.
Published: December 2017

This paper reports an experimental investigation of a scheme to produce an intense, pulsed, point-like, and quasi-monoenergy neutron source. In this scheme, the inner wall of a deuterated plastic spherical cavity is mono-directionally irradiated by a 2.4 kJ laser beam through an open-tip gold cone inserted into the cavity. The whole inner wall of the cavity is illuminated by laser light owing to multiple laser reflections, and the laser-ablated plasma stagnates near the center of the cavity, at which a several keV hot spot is generated. Thermonuclear and beam D-D fusion reactions occur in the hot spot. We have demonstrated the neutron yield exceeding 107 neutrons per pulse from a <100 μm diameter hot spot with the deuterated plastic cavity and mono-directional GEKKO-XII laser irradiation.
Reassigning the CaH+ 11Σ → 21Σ vibronic transition with CaD+
Authors: Condoluci J. , Janardan S. , Calvin A. T. , Rugango R. , Shu G. , Sherrill C. D. , Brown K. R.
Published: December 2017

We observe vibronic transitions in CaD+ between the 11Σ and 21Σ electronic states by resonance enhanced multiphoton photodissociation spectroscopy in a Coulomb crystal. The vibronic transitions are compared with previous measurements on CaH+. The result is a revised assignment of the CaH+ vibronic levels and a disagreement with multi-state-complete-active-space second-order perturbation theory theoretical calculations by approximately 700 cm−1. Updated high-level coupled-cluster calculations that include core-valence correlations reduce the disagreement between theory and experiment to 300 cm−1.
Have droughts and increased water extraction from the Murray River (Australia) reduced coastal ocean productivity?
Authors: Auricht Hannah C. C. , Clarke Kenneth D. , Lewis Megan M. , Mosley Luke M.
Published: December 2017

River discharges are decreasing in many regions of the world; however, the consequences of this on water quality and primary productivity of receiving coastal oceans are largely unclear. We analysed satellite remote-sensing data (MODIS) of the coastal ocean zone that receives outflows from the Murray River, from 2002 to 2016. This system has experienced historical flow reductions and a recent extreme hydrological ‘Millennium’ drought. Remotely sensed chlorophyll-a and particulate organic carbon in the coastal ocean were strongly correlated with river outflows (R2>0.6) in an 8-km radial buffer zone from the Murray Mouth, and the river influence extended up to ~60km from the Murray Mouth during high-flow periods. This distance was approximately three times greater than the freshwater plume extent during maximum flows in 2011, suggesting that new primary productivity was created. In contrast, there was no additional coastal ocean productivity above background levels from 2007 to 2010 when river outflows ceased. Hindcast calculations based on historical flows from 1962 to 2002 suggest that declining Murray River flows have greatly reduced primary productivity in adjacent coastal waters. This has potential consequences for higher trophic levels and should be considered in future management planning.
The microstructure and mechanical properties of drawn and aged pearlitic steel wires
Authors: Yamasaki Shingo
Published: December 2017

Cold-drawn pearlitic steel wires exhibit the highest strength amongst steel products for commercially use. The microstructure and the mechanical properties of wires are influenced by the drawing and post-drawing aging process. The transition of lamellar structure, e.g. cementite fragmentation, dissolution and re-precipitation, ferrite refinement, by drawing and recovery and recrystallisation by aging are summarised. In addition, the corresponding changes in mechanical properties, e.g. yield strength, delamination, hydrogen embrittlement and fatigue are summarised.
Influence of nanostructure on titanium corrosion resistance in fluoridated medium
Authors: Sotniczuk Agata , Kuczyńska Donata , Kubacka Dorota , Królikowski Andrzej , Garbacz Halina
Published: December 2017

Nanocrystalline titanium, mainly owing to its high corrosion resistance, mechanical strength to density ratio and biocompatibility, has a great application potential in dental implantology. However, fluoridated agents commonly used for oral hygiene could have a destructive influence on the titanium protective passive films and lead to the formation of local corrosion damages. In this work, the effect of nanostructuring on titanium corrosion resistance in the concentration of F− which is typical for toothpastes, was evaluated by different electrochemical and surface characterisation techniques. It was found that nanostructure influences beneficially on titanium corrosion resistance in fluoride solution. Furthermore, the lower increase in nanocrystalline titanium surface roughness in corrosion solutions indicates better stability of passive film formed on its surface.

This paper is part of a thematic issue on Titanium.
Microstructure and alloy element distribution of dissimilar joint 316L and EH36 in laser welding
Authors: Rong Youmin , Xu Jiajun , Lei Ting , Wang Wenbin , Sabbar Ahmed Adil , Huang Yu , Wang Chunming , Chen Zhi
Published: December 2017

Microstructure and alloy element distribution of dissimilar joint 316L and EH36 in laser welding were researched, especially the influence of misalignment on weld profile and alloy element distribution. Weld zone (WZ) consisted of austensite and ferrite (F), and heat affected zone (HAZ) of EH36 side consisted of martensite, F, pearlite and carbide precipitation. Positive misalignment increased both upper and bottom widths (BWs), while negative misalignment made BW wider and upper width narrower. HAZ in steel EH36 side was clear and was narrowed and homogenised by negative misalignment. Alloy element contents of Cr and Ni in WZ was much more in negative misalignment. The interface transition gradient of alloy element between 316L and WZ was sharpened in the +0.8 mm misalignment, but diminished in the −0.8 mm misalignment. The influence of misalignment on alloy element distributions can be attributed to the effect of gravity on transient flow of weld pool.
A local converse theorem for 𝑈₂ᵣ₊₁
Authors: Zhang Qing
Published: December 2017

Let

E

/

F

E/F

be a quadratic extension of

p
p

-adic fields, and let

U

2
r
+
1

{\mathrm {U}}_{2r+1}

be the unitary group associated with

E

/

F

E/F

. We prove the following local converse theorem for

U

2
r
+
1

{\mathrm {U}}_{2r+1}

: given two irreducible generic supercuspidal representations

π
,

π
0

\pi ,\pi _0

of

U

2
r
+
1

{\mathrm {U}}_{2r+1}

with the same central character, if

γ
(
s
,
π
×
τ
,
ψ
)
=
γ
(
s
,

π
0

×
τ
,
ψ
)

\gamma (s,\pi \times \tau ,\psi )=\gamma (s,\pi _0\times \tau ,\psi )

for all irreducible generic representations

τ
\tau

of

G
L

n

(
E
)

{\mathrm {GL}}_n(E)

and for all

n
n

with

1
≤
n
≤
r

1\le n\le r

, then

π
≅

π
0

\pi \cong \pi _0

. The proof depends on analysis of the local integrals which defines local gamma factors and uses certain properties of partial Bessel functions developed recently by Cogdell, Shahidi, and Tsai.
Difference of modular functions and their CM value factorization
Authors: Yang Tonghai , Yin Hongbo
Published: December 2017

In this paper, we use Borcherds lifting and the big CM value formula of Bruinier, Kudla, and Yang to give an explicit factorization formula for the norm of
<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" alttext="normal upper Psi left-parenthesis StartFraction d 1 plus StartRoot d 1 EndRoot Over 2 EndFraction right-parenthesis minus normal upper Psi left-parenthesis StartFraction d 2 plus StartRoot d 2 EndRoot Over 2 EndFraction right-parenthesis">

Ψ
(

d
1

+

d
1

2

)
−
Ψ
(

d
2

+

d
2

2

)

\Psi (\frac {d_1+\sqrt {d_1}}2) -\Psi (\frac {d_2+\sqrt {d_2}}2)

, where

Ψ
\Psi

is the

j
j

-invariant or the Weber invariant

ω
2

\omega _2

. The

j
j

-invariant case gives another proof of the well-known Gross-Zagier factorization formula of singular moduli, while the Weber invariant case gives a proof of the Yui-Zagier conjecture for

ω
2

\omega _2

. The method used here could be extended to deal with other modular functions on a genus zero modular curve.
IMiQ: a novel protein quality control compartment protecting mitochondrial functional integrity
Authors: Bruderek Michael , Jaworek Witold , Wilkening Anne , Rüb Cornelia , Cenini Giovanna , Förtsch Arion , Sylvester Marc , Voos Wolfgang
Published: December 2017

Aggregated polypeptides accumulating inside mitochondria are sequestered in a single cellular quality compartment, called IMiQ. Its formation retains proteotoxic aggregates in a distinct cellular localization, increasing mitochondrial fitness by relieving the protein quality control system of misfolded polypeptides.
The Na+(K+)/H+ exchanger Nhx1 controls multivesicular body–vacuolar lysosome fusion
Authors: Karim Mahmoud Abdul , Brett Christopher Leonard
Published: December 2017

Endosomal Na+(K+)/H+ exchangers (NHEs) are important for endocytosis but it is unclear how they contribute. A cell-free assay was used to show that the yeast NHE Nhx1 regulates multivesicular body–lysosome fusion, the last step of endocytosis, demonstrating how mutations in human orthologues of Nhx1 may cause neurological disease.
2. What miracles are reported in religious texts?
Authors: Nagasawa Yujin
Published: December 2017

‘What miracles are reported in religious texts?’ provides examples of miracles classified into three broad types: material miracles, biological miracles, and mental miracles. Material miracles can involve the production, transformation, or multiplication of substances; the controlling of weather, the sun, moon, or geographical features; walking on water, teleportation, bilocation, and levitation; transfiguration; and the displaying of signs such as stigmata. Biological miracles include controlling animals and plants; extraordinary childbirth; healing; and raising the dead. Mental miracles can be classified into three further types: supernatural perception; control of immaterial beings, such as angels, ghosts, and spirits; and spiritual communication. But why do miracle workers perform these acts in the first place?
3. Why do so many people believe in miracles?
Authors: Nagasawa Yujin
Published: December 2017

‘Why do so many people believe in miracles?’ considers why it is that the belief in miracles is so widespread. It addresses a number of remarkable recent findings in psychology that seem to support the miracle bias hypothesis. According to this hypothesis, belief in miracles is widespread because humans are cognitively and developmentally biased towards forming and transmitting such a belief. The minimal counterintuitiveness theory suggests concepts that deviate slightly from intuitive expectations can be transmitted more successfully than common concepts that are compatible with expectations. This theory applies across cultures, which may be why miracle episodes are common irrespective of geographical location or religious tradition.
7. The immune system v2.0: biological and immune therapies
Authors: Klenerman Paul
Published: December 2017

This VSI examines the basic building blocks of the immune system, how they work as a team, and what happens when the teamwork breaks down. Researchers apply this basic knowledge working to influence outcomes of disease—immunologically and otherwise. ‘The immune system v2.0: biological and immune therapies’ considers three major inter-related areas where our knowledge of immunology is being applied to current challenges: boosting immunity in the case of vaccines, harnessing immunity for cancer treatment, and developing novel treatments for blocking immunity and auto-immunity. It also looks at the ageing immune response and how it may be corrected to treat or prevent disease.
2. Colonial India: impoverishment
Authors: Jeffrey Craig
Published: December 2017

‘Colonial India: impoverishment’ considers why India is poor and divided. India has been wealthy historically and so the ubiquity of poverty in contemporary India needs to be explained with reference to colonial history rather than imagined as somehow an inevitable feature of the subcontinent. Three phases in the imperial dominance of the English (then British after 1707) in India are identified and the ruinous impact of British imperialism is described. Despite the ‘impoverishment’ of India there were some positive aspects to British rule, particularly in infrastructural and institutional development. The combination of economic and political disempowerment seeded Indian nationalism, with self-rule finally achieved in 1947.
4. Making India work? 1947–1989
Authors: Jeffrey Craig
Published: December 2017

The emergence of India as an independent nation was associated with a new institutional drive, centred on the state, to cultivate hope. Yet the post-independence period also witnessed the successive failure of the state to address the problems of poverty and inequality that became so evident during British Rule. In some respects, successive political regimes have unwittingly exacerbated the scarcities and inequalities that affect many Indians. ‘Making India work? 1947–1989’ considers the first government under Prime Minister Nehru and the radical nature of the Constitution. It then discusses the poor economic climate at the time of Nehru’s death in 1964 and the governments of Indira Gandhi and her son, Rajiv.
Analytic Philosophy: A Very Short introduction
Authors: Beaney Michael
Published: December 2017

Analytic Philosophy: A Very Short Introduction introduces some of the key ideas of the founders of analytic philosophy—Gottlob Frege, Bertrand Russell, G. E. Moore, Ludwig Wittgenstein, and Susan Stebbing around the turn of the 20th century—by exploring certain fundamental philosophical questions and showing how those ideas can be used in offering answers. Considering the work of Susan Stebbing, it also explores the application of analytic philosophy to critical thinking, and emphasizes the conceptual creativity that lies at the heart of fruitful analysis. Throughout, this VSI illustrates why clarity of thinking, precision of expression, and rigour of argumentation are rightly seen as virtues of analytic philosophy.
How can we think more clearly?
Authors: Beaney Michael
Published: December 2017

Analytic philosophy places great emphasis on clarity. But what does ‘clarity’ mean and how can we think more clearly? How does clarity connect with other virtues of analytic philosophy? ‘How can we think more clearly?’ introduces L. Susan Stebbing (1885–1943) who published the first textbook of analytic philosophy in 1930, doing more than anyone to promote the development of analytic philosophy in Britain. Stebbing’s work outlines different types of thinking—purposive, logical, and critical—discussing a range of ways we can be misled, from logical fallacies and potted thinking to analogies and ambiguity. In drawing our attention to them, Stebbing shows how we can think more clearly by avoiding them.
Big Data: A Very Short Introduction
Authors: Holmes Dawn E.
Published: December 2017

Since long before computers were even thought of, data has been collected and organized by diverse cultures across the world. Once access to the Internet became a reality for large swathes of the world’s population, the amount of data generated each day became huge, and continues to grow exponentially. It includes all our uploaded documents, videos, and photos; all our social media traffic; our online shopping; even the GPS data from our cars. Big Data: A Very Short Introduction explains how big data works and is changing the world around us, the effect it has on our everyday lives and in the business world, and it considers the attendant security risks.
7. Big data security and the Snowden case
Authors: Holmes Dawn E.
Published: December 2017

‘Big data security and the Snowden case’ looks at some of the security issues surrounding big data and the importance of encryption. Some of the problems facing big data systems include ensuring they actually work as intended, can be fixed when they break down, and are tamper-proof and accessible only to those with the correct authorization. Hacking and data theft have become the main problem facing big data. The hacks of Home Depot in 2014 and of Yahoo! in 2016 are described, as well as the Edward Snowden case, Wikileaks, TOR, and the Dark Web. If we want to make big data secure, encryption is vital.
DaMiRseq—an R/Bioconductor package for data mining of RNA-Seq data: normalization, feature selection and classification
Authors: Chiesa Mattia , Colombo Gualtiero I , Piacentini Luca
Published: December 2017

RNA-Seq is becoming the technique of choice for high-throughput transcriptome profiling, which, besides class comparison for differential expression, promises to be an effective and powerful tool for biomarker discovery. However, a systematic analysis of high-dimensional genomic data is a demanding task for such a purpose. DaMiRseq offers an organized, flexible and convenient framework to remove noise and bias, select the most informative features and perform accurate classification.

Availability and implementation

DaMiRseq is developed for the R environment (R ≥ 3.4) and is released under GPL (≥2) License. The package runs on Windows, Linux and Macintosh operating systems and is freely available to non-commercial users at the Bioconductor open-source, open-development software project repository (https://bioconductor.org/packages/DaMiRseq/). In compliance with Bioconductor standards, the authors ensure stable package maintenance through software and documentation updates.

Supplementary information

Supplementary data are available at Bioinformatics online.
Not ‘radical’, but not ‘kailyard’ either: The Paisley Community Development Project reconsidered
Authors: Crow Graham , Rawcliffe Sue , Harris Bernard
Published: December 2017

Accounts of the Community Development Projects (CDPs) that ran as experimental interventions in twelve deprived UK localities in the 1970s concentrate on those projects identified as ‘radical’. Focusing on the often-neglected history of Paisley’s CDP, this article extends recent critical re-evaluations of how CDPs have been characterized. Ferguslie Park in Paisley was the most disadvantaged of the CDP areas on several criteria, and the only CDP to be based in an outer-urban area, as well as being distinct in further ways. This influenced how the CDP team devised its community development strategy, which is misunderstood when treated as embodying a parochial ‘kailyard’ mentality. Paisley’s CDP has continuing relevance to debates about area-based policy and public involvement in research as they are rehearsed in new contexts.
Endothelial permeability, LDL deposition, and cardiovascular risk factors—a review
Authors: Mundi Santa , Massaro Marika , Scoditti Egeria , Carluccio Maria Annunziata , van Hinsbergh Victor W M , Iruela-Arispe Marial Luisa , De Caterina Raffaele
Published: December 2017

Early atherosclerosis features functional and structural changes in the endothelial barrier function that affect the traffic of molecules and solutes between the vessel lumen and the vascular wall. Such changes are mechanistically related to the development of atherosclerosis. Proatherogenic stimuli and cardiovascular risk factors, such as dyslipidaemias, diabetes, obesity, and smoking, all increase endothelial permeability sharing a common signalling denominator: an imbalance in the production/disposal of reactive oxygen species (ROS), broadly termed oxidative stress. Mostly as a consequence of the activation of enzymatic systems leading to ROS overproduction, proatherogenic factors lead to a pro-inflammatory status that translates in changes in gene expression and functional rearrangements, including changes in the transendothelial transport of molecules, leading to the deposition of low-density lipoproteins (LDL) and the subsequent infiltration of circulating leucocytes in the intima. In this review, we focus on such early changes in atherogenesis and on the concept that proatherogenic stimuli and risk factors for cardiovascular disease, by altering the endothelial barrier properties, co-ordinately trigger the accumulation of LDL in the intima and ultimately plaque formation.
Etiology and Impact of Coinfections in Children Hospitalized With Community-Acquired Pneumonia
Authors: Nolan Vikki G , Arnold Sandra R , Bramley Anna M , Ampofo Krow , Williams Derek J , Grijalva Carlos G , Self Wesley H , Anderson Evan J , Wunderink Richard G , Edwards Kathryn M , Pavia Andrew T , Jain Seema , McCullers Jonathan A
Published: December 2017

Background

Recognition that coinfections are common in children with community-acquired pneumonia (CAP) is increasing, but gaps remain in our understanding of their frequency and importance.

Methods

We analyzed data from 2219 children hospitalized with CAP and compared demographic and clinical characteristics and outcomes between groups with viruses alone, bacteria alone, or coinfections. We also assessed the frequency of selected pairings of codetected pathogens and their clinical characteristics.

Results

A total of 576 children (26%) had a coinfection. Children with only virus detected were younger, more likely to be black, and more likely to have comorbidities such as asthma, compared with children infected with typical bacteria alone. Children with virus-bacterium coinfections had a higher frequency of leukocytosis, consolidation on chest radiography, parapneumonic effusions, intensive care unit admission, and need for mechanical ventilation and an increased length of stay, compared with children infected with viruses alone. Virus-virus coinfections were generally comparable to single-virus infections, with the exception of the need for oxygen supplementation, which was higher during the first 24 hours of hospitalization in some virus-virus pairings.

Conclusions

Coinfections occurred in 26% of children hospitalized for CAP. Children with typical bacterial infections, alone or complicated by a viral infection, have worse outcomes than children infected with a virus alone.
Characterization and photometric performance of the Hyper Suprime-Cam Software Pipeline
Authors: Huang Song , Leauthaud Alexie , Murata Ryoma , Bosch James , Price Paul , Lupton Robert , Mandelbaum Rachel , Lackner Claire , Bickerton Steven , Miyazaki Satoshi , Coupon Jean , Tanaka Masayuki
Published: December 2017

The Subaru Strategic Program (SSP) is an ambitious multi-band survey using the Hyper Suprime-Cam (HSC) on the Subaru telescope. The Wide layer of the SSP is both wide and deep, reaching a detection limit of i ∼ 26.0 mag. At these depths, it is challenging to achieve accurate, unbiased, and consistent photometry across all five bands. The HSC data are reduced using a pipeline that builds on the prototype pipeline for the Large Synoptic Survey Telescope. We have developed a Python-based, flexible framework to inject synthetic galaxies into real HSC images, called SynPipe. Here we explain the design and implementation of SynPipe and generate a sample of synthetic galaxies to examine the photometric performance of the HSC pipeline. For stars, we achieve 1% photometric precision at i ∼ 19.0 mag and 6% precision at i ∼ 25.0 in the i band (corresponding to statistical scatters of ∼0.01 and ∼0.06 mag respectively). For synthetic galaxies with single-Sérsic profiles, forced CModel photometry achieves 13% photometric precision at i ∼ 20.0 mag and 18% precision at i ∼ 25.0 in the i band (corresponding to statistical scatters of ∼0.15 and ∼0.22 mag respectively). We show that both forced point spread function and CModel photometry yield unbiased color estimates that are robust to seeing conditions. We identify several caveats that apply to the version of HSC pipeline used for the first public HSC data release (DR1) that need to be taking into consideration. First, the degree to which an object is blended with other objects impacts the overall photometric performance. This is especially true for point sources. Highly blended objects tend to have larger photometric uncertainties, systematically underestimated fluxes, and slightly biased colors. Secondly, >20% of stars at 22.5 < i < 25.0 mag can be misclassified as extended objects. Thirdly, the current CModel algorithm tends to strongly underestimate the half-light radius and ellipticity of galaxy with i > 21.5 mag.
Crisis Management Simulation: Establishing a Dual Neurosurgery and Anesthesia Training Experience
Authors: Ciporen Jeremy , Gillham Haley , Noles Michele , Dillman Dawn , Baskerville Mark , Haley Caleb , Spight Donn , Turner Ryan C. , Lucke-Wold Brandon P.
Published: December 2017

Background:

Simulation training has been shown to be an effective teaching tool. Learner management of an intraoperative crisis such as a major cerebrovascular bleed requires effective teamwork, communication, and implementation of key skill sets at appropriate time points. This study establishes a first of a kind simulation experience in a neurosurgery/anesthesia resident (learners) team working together to manage an intraoperative crisis.

Methods:

Using a cadaveric cavernous carotid injury perfusion model, 7 neurosurgery and 6 anesthesia learners, were trained on appropriate vascular injury management using an endonasal endoscopic technique. Learners were evaluated on communication skills, crisis management algorithms, and implementation of appropriate skill sets at the right time. A preanatomic and postanatomic examination and postsimulation survey was administered to neurosurgery learners. Anesthesia learners provided posttraining evaluation through a tailored realism and teaching survey.

Results:

Neurosurgery learners’ anatomic examination score improved from presimulation (33.89%) to postsimulation (86.11%). No significant difference between learner specialties was observed for situation awareness, decision making, communications and teamwork, or leadership evaluations. Learners reported the simulation realistic, beneficial, and highly instructive.

Conclusions:

Realistic, first of kind, clinical simulation scenarios were presented to a neurosurgery/anesthesia resident team who worked together to manage an intraoperative crisis. Learners were effectively trained on crisis management, the importance of communication, and how to develop algorithms for future implementation in difficult scenarios. Learners were highly satisfied with the simulation training experience and requested that it be integrated more consistently into their residency training programs.
Human Immunodeficiency Virus (HIV)– and Non-HIV–Associated Immunosuppression and Risk of Cervical Neoplasia
Authors: Silverberg Michael J. , Leyden Wendy A. , Chi Aileen , Gregorich Steven , Huchko Megan J. , Kulasingam Shalini , Kuppermann Miriam , Seto Anna , Smith-McCune Karen K. , Sawaya George F.
Published: December 2017

OBJECTIVE:

To estimate the risk of cervical intraepithelial neoplasia grade 2, 2–3, 3, adenocarcinoma in situ, or cancer (CIN 2 or worse) among women with human immunodeficiency virus (HIV)– and non-HIV–associated immunosuppression.

METHODS:

We performed a case–control study of 20,146 women with incident CIN 2 or worse and 5:1 age-matched, incidence-density selected women in a control group (n=100,144) enrolled in an integrated health care system from 1996 to 2014. Adjusted rate ratios (RRs) from conditional logistic regression were obtained for HIV status (stratified by CD4+ T-cells), solid organ transplant history, and immunosuppressive medication use.

RESULTS:

Risk of CIN 2 or worse was increased among women with HIV (n=36 women in the case group and 79 women in the control group; adjusted RR 2.0, 95% CI 1.3–3.0) compared with those without HIV and in solid organ transplant recipients (n=51 women in the case group and 68 women in the control group; RR 3.3, 95% CI 2.3–4.8) compared with women without a prior transplant. The highest risks were among women with HIV and less than 200 CD4+ T-cells/microliter (n=9 women in the case group and eight women in the control group; RR 5.6, 95% CI 2.1–14.7) compared with those without HIV and in solid organ transplant recipients prescribed three or greater immunosuppressive medication classes (n=32 women in the case group and 33 women in the control group; RR 4.1, 95% CI 2.5–6.8) compared with women without a prior transplant and zero medication classes. No increased risks were observed for women with HIV and 500 or greater CD4+ T-cells/microliter (n=9 women in the case group and 43 women in the control group; RR 0.8, 95% CI 0.4–1.7) compared with those without HIV or women without prior solid organ transplantation prescribed two or fewer immunosuppressive medication classes (n=1,262 women in the case group and 6,100 women in the control group; RR 0.95, 95% CI 0.89–1.01) compared with women without and a prior transplant and zero medication classes.

CONCLUSION:

Risk of CIN 2 or worse is increased in women with a prior solid organ transplant or who have HIV and CD4+ cells/microliter less than 500 but not in women with HIV and higher CD4+ levels or in women without a prior solid organ transplant but who are prescribed only one or two immunosuppressive medication classes.
Liposomal Bupivacaine During Robotic Colpopexy and Posterior Repair
Authors: Yeung Jennifer , Crisp Catrina C. , Mazloomdoost Donna , Kleeman Steven D. , Pauls Rachel N.
Published: December 2017

OBJECTIVE:

To evaluate the effect of liposomal bupivacaine on postoperative pain among patients undergoing robotic sacrocolpopexy with posterior repair.

METHODS:

This was a randomized, patient-blinded, placebo-controlled trial of women undergoing robotic sacrocolpopexy with posterior repair. Liposomal bupivacaine or normal saline placebo was injected into laparoscopic and vaginal incisions at completion of surgery. Perioperative care was standardized. Visual analog scales were collected at 4, 18, and 24 hours postoperatively in hospital. Starting on postoperative day 1, participants completed twice-daily pain scales and a pain medication diary up until the evening of postoperative day 3. The primary outcome was a 20-mm change in the visual analog scale 18 hours postoperatively. Secondary measures included additional pain scores, satisfaction, and narcotic use. Sample size calculation revealed that 32 patients per arm were required to detect the 20-mm difference with 90% power and an α of 0.05. To allocate for dropout, a goal of 70 was set.

RESULTS:

Between March 2015 and April 2016, 100 women were screened and 70 women were enrolled: 35 women were randomized to liposomal bupivacaine and 35 to placebo, of whom 64 (91%) were included in the final analysis: 33 liposomal bupivacaine and 31 placebo. No difference in demographics, surgical data, or satisfaction between groups was noted. Median VAS at 18 hours after surgery was not statistically different in those who received liposomal bupivacaine compared with normal saline (15 mm compared with 20 mm;P=.52). Other pain scales and total morphine equivalents were also similar (P=.90).

CONCLUSION:

In this study of robotic sacrocolpopexy with posterior repair, there were no differences in pain scores or narcotic use between liposomal bupivacaine and placebo injected into laparoscopic and vaginal incisions. Given its lack of clinical benefit, routine use of liposomal bupivacaine is not supported for this surgical intervention.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02449915.
Interval Female Sterilization
Authors: Stuart Gretchen S. , Ramesh Shanthi S.
Published: December 2017

Female sterilization is relied on by nearly one in three women aged 35–44 years in the United States. Sterilization procedures are among the most common procedures that obstetrician–gynecologists perform. The most frequent sterilization procedures include postpartum tubal ligation, laparoscopic tubal disruption or salpingectomy, and hysteroscopic tubal occlusion. The informed consent process for sterilization is crucial and requires shared decision-making between the patient and the health care provider. Counseling should include the specific risks and benefits of the specific surgical approaches. Additionally, women should be counseled on the alternatives to sterilization, including intrauterine contraceptives and subdermal contraceptive implants. Complications, including unplanned pregnancy after successful female sterilization, are rare. The objectives of this Clinical Expert Series are to describe the epidemiology of female sterilization, access to postpartum sterilization, advances in interval sterilization techniques, and clinical considerations in caring for women requesting sterilization.
Angiogenic Factor Profiles in Pregnant Women With a History of Early-Onset Severe Preeclampsia Receiving Low-Molecular-Weight Heparin Prophylaxis
Authors: Lecarpentier Edouard , Gris Jean Christophe , Cochery-Nouvellon Eva , Mercier Erick , Touboul Cyril , Thadhani Ravi , Karumanchi S. Ananth , Haddad Bassam
Published: December 2017

OBJECTIVE:

To evaluate whether daily low-molecular-weight (LMW) heparin prophylaxis during pregnancy alters profile of circulating angiogenic factors that have been linked with the pathogenesis of preeclampsia and fetal growth restriction.

METHODS:

This is a planned ancillary study of the Heparin-Preeclampsia trial, a randomized trial in pregnant women with a history of severe early-onset preeclampsia (less than 34 weeks of gestation). In the parent study, all women were treated with aspirin and then randomized to receive LMW heparin or aspirin alone. In this study, we measured serum levels of circulating angiogenic factors (soluble fms-like tyrosine kinase-1, placental growth factor, and soluble endoglin by immunoassay) at the following gestational windows: 10–13 6/7 weeks, 14–17 6/7 weeks, 18–21 6/7 weeks, 22–25 6/7 weeks, 26–29 6/7 weeks, 30–33 6/7 weeks, and 34–37 6/7 weeks.

RESULTS:

Samples were available from 185 patients: LMW heparin+aspirin (n=92) and aspirin alone (n=93). The two groups had comparable baseline characteristics and had similar adverse composite outcomes (35/92 [38.0%] compared with 36/93 [38.7%]; P=.92). There were no significant differences in serum levels of soluble fms-like tyrosine kinase-1, placental growth factor, and soluble endoglin in the participants who received LMW heparin and aspirin compared with those who received aspirin alone regardless of gestational age period. Finally, women who developed an adverse composite outcome at less than 34 weeks of gestation demonstrated significant alterations in serum angiogenic profile as early as 10–13 6/7 weeks that was most dramatic 6–8 weeks preceding delivery.

CONCLUSION:

Prophylactic LMW heparin therapy when beginning from before 14 weeks of gestation with aspirin during pregnancy is not associated with an improved angiogenic profile. This may provide a molecular explanation for the lack of clinical benefit noted in recent trials.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT00986765.
Misoprostol With Foley Bulb Compared With Misoprostol Alone for Cervical Ripening
Authors: Al-Ibraheemi Zainab , Brustman Lois , Bimson Brianne E. , Porat Natalie , Rosenn Barak
Published: December 2017

OBJECTIVE:

To test the hypothesis that cervical ripening using a combination of misoprostol and a transcervical Foley bulb leads to delivery within a shorter time compared with misoprostol alone.

METHODS:

This randomized controlled trial was offered to women admitted for cervical ripening. Inclusion criteria were gestational age 37 weeks or greater with intact membranes, singleton fetus, cephalic presentation, and Bishop score 6 or less. Exclusion criteria included, among others, prior uterine surgery, ruptured membranes, and any contraindication to vaginal delivery. Patients were randomized to cervical ripening using misoprostol and a transcervical Foley bulb simultaneously or misoprostol alone. Primary outcome was time from placement of the misoprostol to delivery. Secondary outcomes included time to active phase, time from active phase to delivery, cesarean delivery rate, uterine tachysystole, estimated blood loss, chorioamnionitis, cord pH, 5-minute Apgar score, and neonatal intensive care unit admission. Sample size calculation revealed that 94 participants were required in each group to detect a 3-hour difference with 80% power and α error of 0.05. Intention-to-treat analysis was performed.

RESULTS:

From September 2015 to July 2016, a total of 200 patients were randomized, 100 to each group. There were no differences between groups with respect to parity, body mass index, gestational age, Bishop score, birth weight, or indication for induction. Time to delivery was significantly shorter in the combined misoprostol–transcervical Foley group: 15.0 (11.0–21.8) hours (median [interquartile range]) vs 19.0 (14.0–27.3) hours in the misoprostol-only group (P=.001). This time difference remained significant after subanalysis by parity or after excluding cesarean deliveries. There was no difference between groups with respect to the rate or indication for cesarean delivery, estimated blood loss, rate of tachysystole, chorioamnionitis, or neonatal outcomes.

CONCLUSION:

Cervical ripening using misoprostol in combination with a transcervical Foley bulb is an effective method to shorten the course of labor compared with misoprostol alone.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02566005.
Term Elective Induction of Labor and Pregnancy Outcomes Among Obese Women and Their Offspring
Authors: Gibbs Pickens Cassandra M. , Kramer Michael R. , Howards Penelope P. , Badell Martina L. , Caughey Aaron B. , Hogue Carol J.
Published: December 2017

OBJECTIVE:

To evaluate whether elective induction of labor between 39 through 41 weeks of gestation, as compared with expectant management, is associated with reduced cesarean delivery and other adverse outcomes among obese women and their offspring.

METHODS:

We conducted a retrospective cohort study using the 2007–2011 California Linked Patient Discharge Data–Birth Cohort File of 165,975 singleton, cephalic, nonanomalous deliveries to obese women. For each gestational week (39–41), we used multivariable logistic regression models, stratified by parity, to assess whether elective induction of labor or expectant management was associated with lower odds of cesarean delivery and other adverse outcomes.

RESULTS:

At 39 and 40 weeks of gestation, cesarean delivery was less common in obese nulliparous women who were electively induced compared with those who were expectantly managed (at 39 weeks of gestation, frequencies were 35.9% vs 41.0%, respectively [P<.05]; adjusted odds ratio [OR] 0.82, 95% CI 0.77–0.88). Severe maternal morbidity was less frequent among electively induced obese nulliparous patients (at 39 weeks of gestation, 5.6% vs 7.6% [P<.05]; adjusted OR 0.75, 95% CI 0.65–0.87). Neonatal intensive care unit admission was less common among electively induced obese nulliparous women (at 39 weeks of gestation, 7.9% vs 10.1% [P<.05]; adjusted OR 0.79, 95% CI 0.70–0.89). Patterns were similar among obese parous women at 39 weeks of gestation (crude frequencies and adjusted ORs [95% CIs] were as follows: for cesarean delivery, 7.0% vs 8.7% [P<.05] and 0.79 [0.73–0.86]; for severe maternal morbidity, 3.3% vs 4.0% [P<.05] and 0.83 [0.74–0.94]; for neonatal intensive care unit admission: 5.3% vs 7.4% [P<.05] and 0.75 [0.68–0.82]). Similarly, elective induction at 40 weeks of gestation was associated with reduced odds of cesarean delivery, maternal morbidity, and neonatal intensive care unit admission among both obese nulliparous and parous patients.

CONCLUSION:

Elective labor induction after 39 weeks of gestation was associated with reduced maternal and neonatal morbidity among obese women. Further prospective investigation is necessary.
What Is New in Global Women's Health? (Part 1)
Authors: Ramsey Patrick S. , Stuart Gretchen S.
Published: December 2017

This month we focus on current research in global women's health. Drs. Ramsey and Stuart discuss four recent publications, which are concluded with a “bottom line” that is a take-home message. A complete reference for each can be found in Box 1 on this page along with direct links to abstracts.
A century of tibial intramedullary nailing
Authors: Whittle A. Paige
Published: December 2017

Intramedullary nailing is the mainstay of treatment for displaced closed or open tibial fractures. Acting as an internal splint, the nail facilitates healing and allows the patient early weight bearing. The use of metallic intramedullary devices dates back to World War I but this treatment was not fully accepted until Küntscher introduced his technique in the 1940s. The evolution with improvements in design and technique of intramedullary nailing has been ongoing since that time. This article examines the history, the advances, the outcomes, and controversies over the decades that have led to a treatment method that is largely successful if performed correctly and with appropriate indications.
Improving Patient-reported Pain During Radiotherapy Through Nurse Involvement and Patient Education
Authors: Holtzman Adam L. , Williams Jodie P. , Hutchinson Debra F. , Morris Christopher G. , Yeung Anamaria R.
Published: December 2017

Objectives:

Pain management during radiotherapy helps assess quality of care. By establishing an intervention to address pain during on-treatment visits (OTVs), we aim to lower patient-reported pain scores.

Methods:

A total of 171 patients were included in the analysis: 58 were retrospectively reviewed to provide a control and 113 were prospectively enrolled and evaluated after the intervention. The intervention included (1) a pain management in-service performed with the resident physician and nurses, (2) distribution of pain management educational materials, and (3) nurse consultation for patients with a pain score ≥5 within 2 days of the in-service. Study aims were to reduce the number of pain scores ≥5 by 30% and increase the number of pain scores documented during every OTV to >90%.

Results:

Median patient age was 65 years. Before the intervention, the average DVPRS score at initial consultation was 2 (range, 0 to 9) and 98% of patients had scores documented during OTVs. Overall, 26% (44/171) of OTV scores measured ≥5. Following the intervention, average DVPRS score at initial consultation was 2 (range, 0 to 10) and 99% of scores were documented during OTVs. About 14% (49/341) of patient-reported scores were ≥5, representing an ~50% relative reduction (P=0.023). The number of patients with 2+ pain scores ≥5 was reduced from 21% (12/58) before the intervention to 11% (12/109) after the intervention (P=0.1068).

Conclusion:

Involving nursing staff in the education and follow-up of patients with uncontrolled pain during radiotherapy led to an ~50% relative reduction in patient-reported DVPRS scores of 5+ during weekly OTVs.
CUTICULAR DRUSEN IN AN INDIGENOUS AUSTRALIAN
Authors: Cunningham William J. , Balaratnasingam Chandrakumar , Chen Yi , Chen Fred K.
Published: December 2017

Background/Purpose:

To report a case of cuticular drusen in an indigenous Australian.

Methods:

A 37-year-old indigenous (aboriginal) Australian woman from a remote Western Australian town presented with a 2-month history of vision loss. Clinical history, examination, and multimodal retinal imaging data from spectral domain optical coherence tomography, fundus autofluorescence, fluorescein angiography, and indocyanine green angiography were analyzed.

Results:

Multimodal imaging confirmed cuticular drusen complicated by a right choroidal neovascularization with pigment epithelial detachment and a left foveal vitelliform lesion. An unusual “negative-staining” pattern was noted on late phase indocyanine green angiography and this spared the regions affected by cuticular drusen.

Conclusion:

To the best of our knowledge, this is the first published report of cuticular drusen in an indigenous Australian. We hypothesize that this may be secondary to ancestral mixing of the gene pool. An unusual staining pattern witnessed on indocyanine green angiography suggests widespread disturbance of lipoprotein deposition in the Bruch membrane.
Prevalence and Factors Associated With Clozapine-Related Constipation
Authors: Chougule Amitkumar , Praharaj Samir Kumar , Bhat Shripathy M. , Sharma P.S. V.N.
Published: December 2017

Background

Despite being a very effective treatment for resistant schizophrenia and bipolar disorder, use of clozapine is limited by adverse effects. Constipation is a common but potentially life-threatening adverse effect of clozapine that is understudied. The objective was to study the prevalence and factors associated with constipation in those receiving clozapine compared with control subjects.

Methods

Fifty patients in age group of 18 to 55 years receiving clozapine were compared with 50 patients in the same age group receiving medications other than clozapine. Presence of constipation was ascertained using the World Gastroenterology Organization Practice Guidelines definition. The severity of constipation was assessed using Constipation Assessment Scale and Bristol Stool Form Scale, and anticholinergic burden was assessed using Anticholinergic Burden Scale.

Results

Among clozapine-treated patients, 28 (56%) had constipation as compared with 11 (22%) in the control subjects (P < 0.001); the odds of developing constipation was 4.5 (95% confidence interval, 1.9–10.8). Kaplan-Meier survival analysis showed median time to onset of constipation in clozapine-treated patients was 60 days (SE, 13.1 days; 95% confidence interval, 34.3–85.7 days) and median dose of clozapine was 300 mg/d (interquartile range, 312 mg/d). Clozapine group had high Constipation Assessment Scale scores (P = 0.005, Cohen d = 1.17) and higher prevalence of types 1 and 2 Bristol stool types (Fisher exact P = 0.005, Cramer V = 0.59).

Conclusions

Constipation was prevalent in more than half of patients receiving clozapine, which was severe and took longer time for recovery. Limitations include using a hospital-based sample and that dietary habits and lifestyle factors were not studied.