bluuebunny/crossref_metadata_2025 huggingface dataset:
Doping structure and degradation mechanism of polypyrrole–Nafion® composite membrane for vanadium redox flow batteries
Authors: Tan Qinglong , Lu Shanfu , Lv Yang , Xu Xin , Si Jiangju , Xiang Yan
Published: October 2016

The proton-acid doping structure of PPY endowed the HPPY–N212 membrane with enhanced conductivity as well as reduced vanadium ion permeability.
The polarization-dependent anisotropic Raman response of few-layer and bulk WTe2under different excitation wavelengths
Authors: Song Qingjun , Wang Haifeng , Xu Xiaolong , Pan Xingchen , Wang Yilun , Song Fengqi , Wan Xiangang , Dai Lun
Published: October 2016

WTe2, which is an orthorhombic semimetal crystallized in Td phase, exhibts distinct in-plane anisotropy. The Raman modes depict different anisotropic response by rotating the incident polarization under different excitation wavelengths.
Polymer-supported benzimidazolium based ionic liquid: an efficient and reusable Brønsted acid catalyst for Biginelli reaction
Authors: Khiratkar Avinash Ganesh , Muskawar Prashant Narayan , Bhagat Pundlik Rambhau
Published: October 2016

A polymer-supported benzimidazolium based ionic liquid (PSBIL) was synthesized by reaction of poly(vinylbenzyl chloride) and benzimidazole followed by ring opening of 1,4-butane sultone and acidification with sulphuric acid.
ALD/MLD fabrication of luminescent Eu-organic hybrid thin films using different aromatic carboxylic acid components with N and O donors
Authors: Giedraityte Z. , Johansson L.-S. , Karppinen M.
Published: October 2016

Atomic/molecular layer deposition (ALD/MLD) processes based on Eu(thd)3 and three different aromatic organic acids with O and N donors as precursors are systematically investigated for the growth of Eu-based inorganic–organic thin-film phosphors.
Fabrication of zirconia based durable superhydrophobic–superoleophilic fabrics using non fluorinated materials for oil–water separation and water purification
Authors: Singh Arun K. , Singh Jayant K.
Published: October 2016

Fluorine free superhydrophobic coating on cotton fabric by inexpensive dip coating method. The coated fabric exhibited high oil–water separation efficiency.
Enhanced water permeation based on nanoporous multilayer graphene membranes: the role of pore size and density
Authors: Kim Dae Woo , Choi Junghoon , Kim Daeok , Jung Hee-Tae
Published: October 2016

Nanoporous graphene (size: ca. 3 nm, density: ca. 1015 m−2) can be synthesized in bulk by KOH activation of pre-oxidized graphite.
Fe3O4-functionalized graphene nanosheet embedded phase change material composites: efficient magnetic- and sunlight-driven energy conversion and storage
Authors: Wang Wentao , Tang Bingtao , Ju Benzhi , Gao Zhanming , Xiu Jinghai , Zhang Shufen
Published: October 2016

Magnetic- and sunlight-driven energy conversion and storage can be realized by using Fe3O4–GNS/PCM under an alternating magnetic field or solar illumination.
Voltage-gated spin-filtering properties and global minimum of planar MnB6, and half-metallicity and room-temperature ferromagnetism of its oxide sheet
Authors: Li Jiao , Fan Xinyu , Wei Yanpei , Liu Jinxiang , Guo Jinghua , Li Xiaoxue , Wang Vei , Liang Yunye , Chen Gang
Published: October 2016

An Mn stabilized boron sheet shows many unique properties, such as novel voltage-gated spin-filtering properties and oxidization induced half-metallicity.
Gas/liquid interfacial manipulation by electrostatic inducing for nano-resolution printed circuits
Authors: Li Yifan , Su Meng , Huang Zhandong , Chen Shuoran , Gao Meng , Li Wenbo , Su Dan , Zhang Xingye , Ma Ying , Li Fengyu , Song Yanlin
Published: October 2016

Gas/liquid interfacial manipulation by electrostatic inducing achieves conductive nano-resolution circuits.
Distributed control of multi‐time scale DC microgrid based on ADRC
Authors: Yang Nanfang , Gao Fei , Paire Damien , Miraoui Abdellatif , Liu Weiguo
Published: October 2016

DC microgrid can obtain high efficiency due to the reduction of power processes from DC to AC at the generation side and from AC to DC at the consumption side. The distributed generators connected to DC‐bus via power converters usually have different dynamic characteristics, this leads to a multi‐time scale DC microgrid. This study proposes a time scale voltage droop control based on active disturbance rejection control (ADRC). It is not sensitive to system model uncertainties and external disturbances, moreover system dynamics can be tuned explicitly. Based on the proposed control method, a reduced‐order model is developed to analyse system stability. Some experimental tests carried out in the authors’ laboratory have verified the effectiveness of the proposed method.
Transoral Atlantoaxial Release and Posterior Reduction by Occipitocervical Plate Fixation for the Treatment of Basilar Invagination with Irreducible Atlantoaxial Dislocation
Authors: Wang Qingde , Mao Kezheng , Wang Chunli , Mei Wei
Published: October 2016

Background Prior studies have mainly assessed transoral odontoidectomy for basilar invagination with irreducible atlantoaxial dislocation. However, studies evaluating transoral release and posterior reduction with occipitocervical fixation in this setting are scarce.

Methods From 2008 to 2013, 11 patients (6 men and 5 women; 23–67 years of age) with basilar invagination and irreducible atlantoaxial dislocation underwent surgery. They presented signs and symptoms of myelopathy or significant spinal cord injury, and were treated by transoral soft tissue release without odontoidectomy, under skull traction with heavy weight and by posterior reduction with occipitocervical plate fixation.

Results Patients were followed up for 10 to 42 months (average: 25.4 months). All achieved bony fusion; radiologically complete reduction was achieved in 10 cases, and partial reduction in 1. All patients showed an improved postoperative neurologic condition, indicated by increased muscle strength and decreased or now absent pathologic symptoms. The average Japanese Orthopaedic Association preoperative score of 10.5 points increased to 15.5 points postoperatively. These findings indicated an improvement rate of 76.1%. The efficiency rate was 90.9%.

Conclusions Anterior transoral atlantoaxial release without odontoidectomy and posterior fixation is an efficient treatment of basilar invagination with irreducible atlantoaxial dislocation.
Influence of electron-ion collisions on Buneman instability in fully ionized plasma
Authors: Rostomyan E. V.
Published: October 2016

The stability of a fully ionized plasma with a relative electron-ion (e-i) motion is considered taking into account the e-i collisions of high level. The relative e-i drift speed is assumed to be much higher than the thermal spread of electrons, and in the absence of collisions the system is subject to the low frequency and strongly growing Buneman instability. The transport equation with the Landau collision integral is solved taking into account the dependence of the collision frequency on the velocity of colliding particles. The effective frequency of e-i collisions is determined as a function of the system parameters. It is shown that with an increase in the level of e-i collisions the Buneman instability gradually transforms to the instability of dissipative type. This transition is traced in detail. The dependence of the growth rate on collision frequency upon this transformation is obtained.
Backward dust-acoustic waves
Authors: Dubinov Alexander E. , Kitayev Ilya N.
Published: October 2016

This paper studies the peculiarities of Dust-acoustic wave (DAW) propagation in a plasma with a moving dusty flow. As a result of a dispersion relation analysis, it is shown that at definite conditions, the DAWs can exist in the form of backward waves with antiparallel group and phase velocities. The range of the dusty flow velocities is found for the backward DAW realization.
Nonlinear ion acoustic ring solitons in a multicomponent plasma with superthermal electrons: Propagation and collision
Authors: El-Labany S. K. , El-Shamy E. F. , El-Bedwehy N. A. , Shokry M.
Published: October 2016

In this paper, the propagation and the collision of ion acoustic ring solitons (IARSs) in a multicomponent plasma with superthermal electrons are theoretically investigated by employing an extended Poincaré–Lighthill–Kuo method. For the generic case, the dynamics and collisions of IARSs are studied via cylindrical Korteweg-de Vries (cKdV) equations and phase shift equations. It is found physically that both positive and negative polarity IARSs can propagate and collide, which usually leads to a time delay in propagation occurring during the collision, as compared to a single ion acoustic soliton (IARS) without collisions in the same physical model. Moreover, at a critical value of the negative ion-to-positive ion concentration, modified cylindrical Korteweg-de Vries (mcKdV) equations and their corresponding phase shifts have been derived. In general, it is observed that the trajectories of IARSs after collisions are significantly modified due to the influence of negative ion-to-positive ion density ratio, negative ion-to-positive ion mass ratio, the superthermal electron parameter, and the positions of IARSs. The numerical results are applied to the Earth's ionosphere, such as the D and F regions. The present investigation will be helpful in understanding the properties of the Earth's ionosphere containing positive and negative ions with superthermal electrons.
Solar optics-based active panel for solar energy storage and disinfection of greywater
Authors: Lee W. , Song J. , Son J. H. , Gutierrez M. P. , Kang T. , Kim D. , Lee L. P.
Published: October 2016

Smart city and innovative building strategies are becoming increasingly more necessary because advancing a sustainable building system is regarded as a promising solution to overcome the depleting water and energy. However, current sustainable building systems mainly focus on energy saving and miss a holistic integration of water regeneration and energy generation. Here, we present a theoretical study of a solar optics-based active panel (SOAP) that enables both solar energy storage and photothermal disinfection of greywater simultaneously. Solar collector efficiency of energy storage and disinfection rate of greywater have been investigated. Due to the light focusing by microlens, the solar collector efficiency is enhanced from 25% to 65%, compared to that without the microlens. The simulation of greywater sterilization shows that 100% disinfection can be accomplished by our SOAP for different types of bacteria including Escherichia coli. Numerical simulation reveals that our SOAP as a lab-on-a-wall system can resolve the water and energy problem in future sustainable building systems.
Prompt loss of beam ions in KSTAR plasmas
Authors: Kim Jun Young , Rhee T. , Kim Junghee , Yoon S. W. , Park B. H. , Isobe M. , Ogawa K. , Ko W. -H.
Published: October 2016

For a toroidal plasma facility to realize fusion energy, researching the transport of fast ions is important not only due to its close relation to the heating and current drive efficiencies but also to determine the heat load on the plasma-facing components. We present a theoretical analysis and orbit simulation for the origin of lost fast-ions during neutral beam injection (NBI) heating in Korea Superconducting Tokamak Advanced Research (KSTAR) device. We adopted a two-dimensional phase diagram of the toroidal momentum and magnetic moment and describe detectable momentums at the fast-ion loss detector (FILD) position as a quadratic line. This simple method was used to model birth ions deposited by NBI and drawn as points in the momentum phase space. A Lorentz orbit code was used to calculate the fast-ion orbits and present the prompt loss characteristics of the KSTAR NBI. The scrape-off layer deposition of fast ions produces a significant prompt loss, and the model and experimental results closely agreed on the pitch-angle range of the NBI prompt loss. Our approach can provide wall load information from the fast ion loss.
FractBias: a graphical tool for assessing fractionation bias following polyploidy
Authors: Joyce Blake L , Haug-Baltzell Asher , Davey Sean , Bomhoff Matthew , Schnable James C , Lyons Eric
Published: October 2016

Following polyploidy events, genomes undergo massive reduction in gene content through a process known as fractionation. Importantly, the fractionation process is not always random, and a bias as to which homeologous chromosome retains or loses more genes can be observed in some species. The process of characterizing whole genome fractionation requires identifying syntenic regions across genomes followed by post-processing of those syntenic datasets to identify and plot gene retention patterns. We have developed a tool, FractBias, to calculate and visualize gene retention and fractionation patterns across whole genomes. Through integration with SynMap and its parent platform CoGe, assembled genomes are pre-loaded and available for analysis, as well as letting researchers integrate their own data with security options to keep them private or make them publicly available.

Availability and Implementation

FractBias is freely available as a web application at https://genomevolution.org/CoGe/SynMap.pl. The software is open source (MIT license) and executable with Python 2.7 or iPython notebook, and available on GitHub (https://goo.gl/PaAtqy). Documentation for FractBias is available on CoGepedia (https://goo.gl/ou9dt6)

Supplementary information

Supplementary data are available at Bioinformatics online.
Transmission bottlenecks and RNAi collectively influence tick-borne flavivirus evolution
Authors: Grubaugh Nathan D. , Rückert Claudia , Armstrong Philip M. , Bransfield Angela , Anderson John F. , Ebel Gregory D. , Brackney Doug E.
Published: October 2016

Arthropod-borne RNA viruses exist within hosts as heterogeneous populations of viral variants and, as a result, possess great genetic plasticity. Understanding the micro-evolutionary forces shaping these viruses can provide insights into how they emerge, adapt, and persist in new and changing ecological niches. While considerable attention has been directed toward studying the population dynamics of mosquito-borne viruses, little is known about tick-borne virus populations. Therefore, using a mouse and Ixodes scapularis tick transmission model, we examined Powassan virus (POWV; Flaviviridae, Flavivirus) populations in and between both the vertebrate host and arthropod vector. We found that genetic bottlenecks, RNAi-mediated diversification, and selective constraints collectively influence POWV evolution. Together, our data provide a mechanistic explanation for the slow, long-term evolutionary trends of POWV, and suggest that all arthropod-borne viruses encounter similar selective pressures at the molecular level (i.e. RNAi), yet evolve much differently due to their unique rates and modes of transmission.
The Correlation Between Septoria Leaf Spot and Stem Canker Resistance in Hybrid Poplar
Authors: Dunnell Kelsey L. , LeBoldus Jared M.
Published: October 2016

Sphaerulina musiva is an important fungal pathogen that causes a leaf spot and stem canker disease of hybrid poplar. Stem cankers are widely regarded as the greatest threat to hybrid poplar plantations because of their ability to cause tree mortality; thus, the efforts of breeding programs have been focused on stem canker resistance. To explore the relationship between resistance to leaf spot and stem canker in Populus nigra × P. deltoides hybrids, two experiments were conducted. Initially, comparisons among leaves of different ages indicated that younger leaves were more susceptible to leaf spot infection than older leaves. Correlations between leaf spot severity and stem canker severity for both individual leaves and all leaves averaged together indicated that, in 10 of 11 comparisons, there were no significant correlations. The lack of correlation suggests that deploying genotypes resistant to stem canker may not affect the pathogen population causing leaf spot disease. To our knowledge, this is the first study specifically designed to test the correlation between stem canker resistance and leaf spot resistance by inoculating whole trees with a spore suspension in a controlled environment.
Fine-Scale Genetic Structure and Reproductive Biology of the Blueberry PathogenMonilinia vaccinii-corymbosi
Authors: Burchhardt Kathleen M. , Miller Megan E. , Cline William O. , Cubeta Marc A.
Published: October 2016

The fungus Monilinia vaccinii-corymbosi, a pathogen of Vaccinium spp., requires asexual and sexual spore production to complete its life cycle. A recent study found population structuring of M. vaccinii-corymbosi over a broad spatial scale in the United States. In this study, we examined fine-scale genetic structuring, temporal dynamics, and reproductive biology within a 125-by-132-m blueberry plot from 2010 to 2012. In total, 395 isolates of M. vaccinii-corymbosi were sampled from infected shoots and fruit to examine their multilocus haplotype (MLH) using microsatellite markers. The MLH of 190 single-ascospore isolates from 21 apothecia was also determined. Little to no genetic differentiation and unrestricted gene flow were detected among four sampled time points and between infected tissue types. Discriminant analysis of principal components suggested genetic structuring within the field, with at least K = 3 genetically distinct clusters maintained over four sampled time points. Single-ascospore progeny from eight apothecia had identical MLH and at least two distinct MLH were detected from 13 apothecia. Tests for linkage disequilibrium suggested that genetically diverse ascospore progeny were the product of recombination. This study supports the idea that the fine-scale dynamics of M. vaccinii-corymbosi may be complex, with genetic structuring, inbreeding, and outcrossing detected in the study area.
Depression, Anxiety, and Stress Among People With Chronic Hepatitis C Virus Infection and a History of Injecting Drug Use in New South Wales, Australia
Authors: Fortier Emmanuel , Alavi Maryam , Bruneau Julie , Micallef Michelle , Perram Jacinta , Sockalingam Sanjeev , Dunlop Adrian J. , Balcomb Annie C. , Day Carolyn A. , Treloar Carla , Bath Nicky , Haber Paul S. , Dore Gregory J. , Grebely Jason
Published: October 2016

Objective:

The aims of this study were to assess symptoms of depression, anxiety, and stress and associated sociodemographic factors among people living with chronic hepatitis C virus (HCV) infection with a history of injecting drug use and to assess the association between symptoms of depression, anxiety, or stress and HCV treatment intent, specialist assessment, or treatment uptake.

Methods:

The Enhancing Treatment for Hepatitis C in Opioid Substitution Settings was an observational cohort study evaluating the provision of HCV assessment and treatment among people with chronic HCV and a history of injecting drug use, recruited from 9 community health centers and opioid substitution therapy (OST) clinics (New South Wales, Australia). Symptoms were assessed using the Depression Anxiety Stress Scales (DASS-21). Analyses were performed using logistic regression.

Results:

Among 415 participants (mean age 41 years, 71% male), 47%, 52%, and 36% demonstrated moderate to extremely severe symptoms of depression, anxiety, and stress, respectively. In adjusted analyses, depression symptoms were associated with recent injecting drug use [adjusted odds ratio (aOR) 1.63, 95% confidence interval (CI) 1.07–2.49), whereas stress symptoms were associated with unemployment (aOR 2.99, 95% CI 1.09–8.15) and not living with a spouse or other relatives/friends (aOR 1.55, 95% CI 1.01–2.39). Symptoms of depression, anxiety, or stress or having a history of treated mental illness were not independently associated with HCV treatment intent, specialist assessment, or treatment uptake.

Conclusions:

Findings suggest a need for improved interventions and care regarding mental health among people living with chronic HCV with a history of injecting drug use, but suggest that symptoms of depression, anxiety, and stress should not be immediate contraindications to HCV assessment and treatment.
Effectiveness of an Electronic Alert for Hypotension and Low Bispectral Index on 90-day Postoperative Mortality
Authors: McCormick Patrick J. , Levin Matthew A. , Lin Hung-Mo , Sessler Daniel I. , Reich David L.
Published: October 2016

Background

We tested the hypothesis that an electronic alert for a “double low” of mean arterial pressure less than 75 mmHg and a bispectral index less than 45 reduces the primary outcome of 90-day mortality.

Methods

Adults having noncardiac surgery were randomized to receive either intraoperative alerts for double-low events or no alerts. Anesthesiologists were not blinded and not required to alter care based upon the alerts. The primary outcome was all-cause 90-day mortality.

Results

Patients (20,239) were randomized over 33 months, and 19,092 were analyzed. After adjusting for age, comorbidities, and perioperative factors, patients with more than 60 min of cumulative double-low time were twice as likely to die (hazard ratio, 1.99; 95% CI, 1.2 to 3.2; P = 0.005). The median number of double-low minutes (quartiles) was only slightly lower in the alert arm: 10 (2 to 30) versus 12 (2 to 34) min. Ninety-day mortality was 135 (1.4%) in the alert arm and 123 (1.3%) in the control arm. The difference in percent mortality was 0.18% (99% CI, −0.25 to 0.61).

Conclusions

Ninety-day mortality was not significantly lower in patients cared for by anesthesiologists who received automated alerts to double-low states. Prolonged cumulative double-low conditions were strongly associated with mortality.
Withholding versus Continuing Angiotensin-converting Enzyme Inhibitors or Angiotensin II Receptor Blockers before Noncardiac Surgery
Authors: Roshanov Pavel S. , Rochwerg Bram , Patel Ameen , Salehian Omid , Duceppe Emmanuelle , Belley-Côté Emilie P. , Guyatt Gordon H. , Sessler Daniel I. , Le Manach Yannick , Borges Flavia K. , Tandon Vikas , Worster Andrew , Thompson Alexandra , Koshy Mithin , Devereaux Breagh , Spencer Frederick A. , Sanders Robert D. , Sloan Erin N. , Morley Erin E. , Paul James , Raymer Karen E. , Punthakee Zubin , Devereaux P. J.
Published: October 2016

Background

The effect on cardiovascular outcomes of withholding angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in chronic users before noncardiac surgery is unknown.

Methods

In this international prospective cohort study, the authors analyzed data from 14,687 patients (including 4,802 angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker users) at least 45 yr old who had in-patient noncardiac surgery from 2007 to 2011. Using multivariable regression models, the authors studied the relationship between withholding angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers and a primary composite outcome of all-cause death, stroke, or myocardial injury after noncardiac surgery at 30 days, with intraoperative and postoperative clinically important hypotension as secondary outcomes.

Results

Compared to patients who continued their angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, the 1,245 (26%) angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker users who withheld their angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers in the 24 h before surgery were less likely to suffer the primary composite outcome of all-cause death, stroke, or myocardial injury (150/1,245 [12.0%] vs. 459/3,557 [12.9%]; adjusted relative risk, 0.82; 95% CI, 0.70 to 0.96; P = 0.01) and intraoperative hypotension (adjusted relative risk, 0.80; 95% CI, 0.72 to 0.93; P < 0.001). The risk of postoperative hypotension was similar between the two groups (adjusted relative risk, 0.92; 95% CI, 0.77 to 1.10; P = 0.36). Results were consistent across the range of preoperative blood pressures. The practice of withholding angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers was only modestly correlated with patient characteristics and the type and timing of surgery.

Conclusions

Withholding angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers before major noncardiac surgery was associated with a lower risk of death and postoperative vascular events. A large randomized trial is needed to confirm this finding. In the interim, clinicians should consider recommending that patients withhold angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers 24 h before surgery.
Impact of Methylprednisolone on Postoperative Quality of Recovery and Delirium in the Steroids in Cardiac Surgery Trial
Authors: Royse Colin F. , Saager Leif , Whitlock Richard , Ou-Young Jared , Royse Alistair , Vincent Jessica , Devereaux P. J. , Kurz Andrea , Awais Ahmed , Panjasawatwong Krit , Sessler Daniel I.
Published: October 2016

Background

Inflammation after cardiopulmonary bypass may contribute to postoperative delirium and cognitive dysfunction. The authors evaluated the effect of high-dose methylprednisolone to suppress inflammation on the incidence of delirium and postoperative quality of recovery after cardiac surgery.

Methods

Five hundred fifty-five adults from three hospitals enrolled in the randomized, double-blind Steroids in Cardiac Surgery trial were randomly allocated to placebo or 250 mg methylprednisolone at induction and 250 mg methylprednisolone before cardiopulmonary bypass. Each completed the Postoperative Quality of Recovery Scale before surgery and on days 1, 2, and 3 and 1 and 6 months after surgery and the Confusion Assessment Method scale for delirium on days 1, 2, and 3. Recovery was defined as returning to preoperative values or improvement at each time point.

Results

Four hundred eighty-two participants for recovery and 498 participants for delirium were available for analysis. The quality of recovery improved over time but without differences between groups in the primary endpoint of overall recovery (odds ratio range over individual time points for methylprednisolone, 0.39 to 1.45; 95% CI, 0.08–2.04 to 0.40–5.27; P = 0.943) or individual recovery domains (all P > 0.05). The incidence of delirium was 10% (control) versus 8% (methylprednisolone; P = 0.357), with no differences in delirium subdomains (all P > 0.05). In participants with normal (51%) and low baseline cognition (49%), there were no significant differences favoring methylprednisolone in any domain (all P > 0.05). Recovery was worse in patients with postoperative delirium in the cognitive (P = 0.004) and physiologic (P < 0.001) domains.

Conclusions

High-dose intraoperative methylprednisolone neither reduces delirium nor improves the quality of recovery in high-risk cardiac surgical patients.
Evidence for Implementation Strategies to Provide Palliative Care in the Neonatal Intensive Care Unit
Authors: Quinn Megan , Gephart Sheila
Published: October 2016

Background:

Palliative care is a holistic framework that is designed to improve quality of life by identifying and treating distressing symptoms of life-threatening or complex conditions. Neonatal palliative care (NPC) has potential benefits for parents, staff, and patients, yet evidence suggests that implementation and utilization of organized NPC services are low.

Purpose:

The purpose of this study is to answer the clinical question: In neonatal intensive care, what evidence can be used to guide implementation of palliative care protocols?

Search Strategy:

A literature search was conducted using CINAHL (Cumulative Index of Nursing and Allied Health Literature), PubMed, and the Cochrane Library databases. Publications with a focus on neonates, neonatal intensive care unit, and implementation or evaluation of a palliative care protocol, team, or educational intervention were retained.

Results:

The search yielded 17 articles that fit with the following themes: NPC protocols or teams (n = 8), healthcare team needs (n = 3), and barriers to implementation (n = 6). Approaches to NPC implementation were varied, and outcome data were inconsistently reported. Healthcare team members cited a need for education and consistent, ethical delivery of NPC. Common barriers were identified as lack of NPC education, poor communication, and lack of adequate resources such as staff and space.

Implications for Practice and Research:

Successful team approaches included standardized order sets to initiate NPC, NPC education for staff, and references to NPC guidelines or protocols. Barriers such as lack of interdisciplinary cooperation, lack of appropriate physical space, and lack of education should be addressed during program development. Further research priorities for NPC include seeking parent perceptions, shifting focus from mostly end-of-life to an integrated model, and collecting outcome data with rigor and consistency.
Intramedullary Nail Fixation of Distal Tibia Fractures: Tips and Tricks
Authors: Talerico Michael , Ahn Jaimo
Published: October 2016

The objective of this article is to highlight the salient points of preoperative planning, intraoperative considerations for fracture reduction methods, and implant fixation when treating distal diaphyseal or diametaphyseal tibia fractures with an intramedullary nail. Through review of the necessary preoperative considerations, techniques available to hold and maintain a reduction, and lastly how to maximize the selected implant of intramedullary nail, we hope to assist the treating surgeon in simplifying these sometimes complex fractures into manageable injuries that can be treated successfully with an intramedullary implant.
Definitive Management of Distal Tibia and Simple Plafond Fractures With Circular External Fixation
Authors: Quinnan Stephen Matthew
Published: October 2016

Obtaining optimal results in the treatment of extraarticular distal tibia fractures can be challenging. Plate and screw and intramedullary fixation have proven to be effective treatments, but are associated with significant complication rates when used for open fractures and patient with severe medical comorbidities. External fixation is a third alternative that is less often employed, but provides a very effective means of treatment. Circular external fixation offers great flexibility in obtaining anatomic alignment and stable fixation for even the most challenging distal tibia fractures. In addition, it provides advantages in limiting the risk of deep infection, dealing with bone loss, and obtaining soft tissue coverage. The greater ease of treatment and potential economic advantage in patient cohorts with low complication rates, such as closed fractures, supports the preferential use of internal fixation. However, circular external fixation may be the preferred treatment for patients with higher-grade open fractures, a poor soft tissue envelope with limited fixation options distally, and major comorbidities (diabetes, immune deficiency) with an associated high risk of complications.
Fibular Fixation in Distal Tibia Fractures: Reduction Aid or Nonunion Generator?
Authors: Torino Daniel , Mehta Samir
Published: October 2016

The role of fibular fixation in patients with distal tibia fractures is controversial. Although the stability of the fibula is critical in patients with syndesmotic instability or highly comminuted pilon fractures, fibular fixation in extraarticular distal tibia fractures or elementary intraarticular distal tibia fractures is more controversial. Biomechanical studies, as performed in sawbones or cadaveric models, denote advantages to fibular fixation with respect to specific uniplanar motion. However, the increased stability is susceptible to the fracture pattern of the tibia, fixation strategy for the tibia, fixation strategy for the fibula, and loading pattern of the entire construct. Clinical studies examining fibular fixation in patients with concomitant distal third tibia fractures have also not been definitive in their conclusions. Fibular fixation may improve the ability to obtain and maintain reduction in complex fractures of the distal tibia, but as a result of the increased stability of the construct, may also increase rates of nonunion in this challenging patient population.
Intramedullary Tibial Nail Fixation of Simple Intraarticular Distal Tibia Fractures
Authors: Scolaro John A. , Broghammer Francis H. , Donegan Derek J.
Published: October 2016

The optimal treatment strategy for distal tibia fractures, especially those with intraarticular extension, remains controversial. Although open reduction and internal fixation with a plate and screw device is commonly performed for these injuries, the risk of soft tissue complications using this approach is significant. Staged treatment protocols and alternative means of fixation have been proposed to address these undesired events. Although potentially more technically demanding than fixation of diaphyseal or extraarticular tibial fractures, intramedullary nail (IMN) fixation of simple intraarticular distal tibia fractures is a viable treatment alternative with unique advantages. This article presents a review of the literature and rationale for intramedullary tibial nail fixation of simple intraarticular distal tibia fractures and a surgical approach commonly utilized for successful implementation.
Intramedullary Nail and Plate Combination Fixation for Complex Distal Tibia Fractures: When and How?
Authors: Yoon Richard S. , Liporace Frank A.
Published: October 2016

Intramedullary nail and plate combination techniques have been described mostly for use in the proximal tibia. However, the nail and plate combination technique can also be used in the distal tibia, to counteract the deforming forces that cause construct failure and nonunion. In this article, we review pertinent anatomy and biomechanics and offer case examples that highlight the indications and applications of the nail and plate combination technique for distal tibia fractures.
The Infected Pilon: Assessment and Treatment Strategies
Authors: Kottmeier Stephen A. , Madison Randall D. , Divaris Nicholas , Row Elliot
Published: October 2016

Fractures of the distal tibial plafond (pilon) occur across broad ranges of injury mechanism, severity, and patient demographics. Patients often present with considerably comminuted fracture patterns and significant soft tissue compromise. Surgical intervention must be performed with respect for the exceedingly vulnerable soft tissue envelope and a properly established technical expertise. However, even in the presence of proper timing, favorable host factors, and expert surgical technique, restoration of function and the avoidance of complications may not be achievable. Infection is a relatively common sequela of operative treatment of these fractures and may prove disastrous, eventuating in amputation. Resolution of infection requires a multidisciplinary approach and a compliant patient who embraces the hardships of limb salvage. Surgical treatment of infection requires radical debridement of devitalized soft tissues and osseous structures and their subsequent reconstruction. In some cases, limb amputation may offer the most predictable and beneficial outcome. However, the methods of Ilizarov and their contemporary modifications are uniquely applicable to this complex treatment dilemma and can provide viable options for limb salvage in the setting of the infected pilon fracture.
Perceived Nonbeneficial Treatment of Patients, Burnout, and Intention to Leave the Job Among ICU Nurses and Junior and Senior Physicians
Authors: Schwarzkopf Daniel , Rüddel Hendrik , Thomas-Rüddel Daniel O. , Felfe Jörg , Poidinger Bernhard , Matthäus-Krämer Claudia T. , Hartog Christiane S. , Bloos Frank
Published: October 2016

Objectives:

Perceiving nonbeneficial treatment is stressful for ICU staff and may be associated with burnout. We aimed to investigate predictors and consequences of perceived nonbeneficial treatment and to compare nurses and junior and senior physicians.

Design:

Cross-sectional, multicenter paper-pencil survey on personal and work-related characteristics, perceived nonbeneficial treatment, burnout, and intention to leave the job.

Setting:

Convenience sample of 23 German ICUs.

Subjects:

ICU nurses and physicians.

Interventions:

None.

Measurements and Main Results:

A total of 847 questionnaires were returned (51% response); 778 had complete data for final multivariate analyses. Nonbeneficial treatment was in median perceived “sometimes.” Adjusted for covariates, it was perceived more often by nurses and junior physicians (both p ≤ 0.001 in comparison to senior physicians), while emotional exhaustion was highest in junior physicians (p ≤ 0.015 in comparison to senior physicians and nurses), who also had a higher intention to leave than nurses (p = 0.024). Nonbeneficial treatment was predicted by high workload and low quality collaboration with other departments (both p ≤ 0.001). Poor nurse-physician collaboration predicted perception of nonbeneficial treatment among junior physicians and nurses (both p ≤ 0.001) but not among senior physicians (p = 0.753). Nonbeneficial treatment was independently associated with the core burnout dimension emotional exhaustion (p ≤ 0.001), which significantly mediated the effect between nonbeneficial treatment and intention to leave (indirect effect: 0.11 [95% CI, 0.06–0.18]).

Conclusions:

Perceiving nonbeneficial treatment is related to burnout and may increase intention to leave. Efforts to reduce perception of nonbeneficial treatment should improve the work environment and should be tailored to the different experiences of nurses and junior and senior physicians.
Two cases of clinical myasthenia gravis associated with pembrolizumab use in responding melanoma patients
Authors: Nguyen Bella H.V. , Kuo James , Budiman Anadian , Christie Hayden , Ali Sayed
Published: October 2016

Immune checkpoint inhibitors have changed the landscape of the treatment of multiple solid malignancies, and have been used increasingly in the recent years. Although usually well tolerated, given the relative inexperience of using immune checkpoint inhibitors, we are still learning of new side effects from the treatment. We report on two cases of ocular myasthenia gravis that occurred after treatment with pembrolizumab, an antiprogrammed-death (anti-PD1) monoclonal antibody for advanced melanoma in responding patients. One case is in an 81-year-old man and the second case in an 86-year-old woman, both with BRAF-negative metastatic melanoma receiving pembrolizumab. These two cases of ocular only associated myasthenic syndrome appeared 7 and 11 weeks after the initiation of pembrolizumab. We conclude that the condition is most likely associated with pembrolizumab as symptoms started after treatment with pembrolizumab, neither patient had other evidence of neurological cause for presentation, and symptoms also improved rapidly with administration of steroids. Both patients showed good oncological response to anti-PD1 treatment and one patient successfully continued to receive ongoing treatment with no further complications.
Effectiveness of Delayed Cord Clamping in Reducing Postdelivery Complications in Preterm Infants
Authors: Chapman Jessica , Marfurt Stephanie , Reid Julie
Published: October 2016

This systematic review evaluates the effectiveness of delayed cord clamping in preterm infants on reducing postdelivery complications of anemia, hemodynamic instability, and the development of intraventricular hemorrhages. Interventions included varying durations of delayed cord clamping with and without cord milking as compared with immediate cord clamping, shorter delays in cord clamping, and delayed cord clamping without cord milking. A comprehensive search of randomized controlled trials, observational, cohort, and before-after studies was conducted between 1946 and 2015 in the electronic databases of Ovid MEDLINE, Embase, and Google Scholar. Studies were critically appraised using the Critical Appraisal Skills Program guidelines. Twenty-seven studies were included in the review from 1997 to 2015 from varying countries. Outcome measures included hematocrit/hemoglobin levels, measured or calculated blood volumes levels, number and volume of blood transfusions, presence of hypotension and need for treatment, and development of intraventricular hemorrhage. Delayed cord clamping can lead to improved outcomes measures in preterm infants. This review supports the current recommendation to perform delayed cord clamping during preterm deliveries.
Paternal and Maternal Testosterone in Parents of NICU Infants Transitioning Home
Authors: Garfield Craig F. , Simon Clarissa D. , Rutsohn Joshua , Lee Young S.
Published: October 2016

Lower testosterone during the transition to new parenthood is considered beneficial to help parents better engage with their infants. No data currently exist studying salivary testosterone of parents with infants in neonatal intensive care units (NICUs) during the transition to home. We examine testosterone levels for parents of very low-birth-weight infants, including links between salivary testosterone and infant factors (such as breast-feeding), psychosocial stress, and changes over time.

Testosterone salivary samples were assayed after self-collection by 86 parents (43 fathers and 43 mothers) with NICU infants at wakeup and bedtime prior to discharge and at 3 additional times at home. Self-reported survey measures, including psychosocial reports, were also collected at these times.

Using multilevel modeling approaches, we report significant associations between paternal testosterone by time and psychosocial adjustment and between both paternal and maternal testosterone and infant feeding mode (P < .05). Results were significant after accounting for covariates. Our study is the first to examine the time course of diurnal testosterone for parents of premature infants over the transition home; as such, we suggest further research into better understanding parental physiology in this vulnerable parent population.
Cost Analysis of Cerebrospinal Fluid Leaks and Cerebrospinal Fluid Leak Prevention in Patients Undergoing Cerebellopontine Angle Surgery
Authors: Chern Alexander , Hunter Jacob B. , Bennett Marc L.
Published: October 2016

Objective:

To determine if cranioplasty techniques following translabyrinthine approaches to the cerebellopontine angle are cost-effective.

Study Design:

Retrospective case series.

Patients:

One hundred eighty patients with available financial data who underwent translabyrinthine approaches at a single academic referral center between 2005 and 2015.

Intervention:

Cranioplasty with a dural substitute, layered fat graft, and a resorbable mesh plate secured with screws Main Outcome Measures: billing data was obtained for each patient's hospital course for translabyrinthine approaches and postoperative cerebrospinal fluid (CSF) leaks.

Results:

One hundred nineteen patients underwent translabyrinthine approaches with an abdominal fat graft closure, with a median cost of $25759.89 (range, $15885.65–$136433.07). Sixty-one patients underwent translabyrinthine approaches with a dural substitute, abdominal fat graft, and a resorbable mesh for closure, with a median cost of $29314.97 (range, $17674.28–$111404.55). The median cost of a CSF leak was $50401.25 (range, $0–$384761.71). The additional cost of a CSF leak when shared by all patients who underwent translabyrinthine approaches is $6048.15. The addition of a dural substitute and a resorbable mesh plate after translabyrinthine approaches reduced the CSF leak from 12 to 1.9%, an 84.2% reduction, and a median savings per patient of $2932.23. Applying our cohort's billing data to previously published cranioplasty techniques, costs, and leak rate improvements after translabyrinthine approaches, all techniques were found to be cost-effective.

Conclusion:

Resorbable mesh cranioplasty is cost-effective at reducing CSF leaks after translabyrinthine approaches. Per our billing data and achieving the same CSF leak rate, cranioplasty costs exceeding $5090.53 are not cost-effective.
Gastroparesis
Authors: Lacy Brian E. , Crowell Michael D. , Mathis Carole , Bauer David , Heinberg Leslie J.
Published: October 2016

Background and Aims:

Gastroparesis (GP) patients suffer from recurrent symptoms of nausea, vomiting, early satiety, and abdominal pain. The impact of GP on quality of life (QoL), health care utilization and daily activities is not well understood.

Materials and Methods:

Part 1: 398 adult patients (≥18 y) with documented GP (symptoms >6 mo) were surveyed to assess QoL and pain using the Short Form 36 and McGill pain questionnaires. Part 2: 491 adult GP patients were surveyed to evaluate employment status, work and daily activities, medication use, physician visits, diagnostic testing, emergency room visits, and hospitalizations related to their GP symptoms. Both protocols received Institutional Review Board approval.

Results:

Part 1: 250 fully evaluable surveys were returned (63%). The mean age was 46.8 years (range, 18 to 84 y); 78% were women. Mean Short Form 36 scores for mental health (56.9) and social functioning (68.1) were analogous to scores for patients with serious chronic medical disorders and depression. Pain scores were lower in patients with idiopathic GP compared with diabetic GP. Part 2: 228 evaluable surveys were analyzed (58.3% response rate). The mean age was 49.6 (19 to 86 y); 77.2% were women. GP symptoms reduced daily activities in 67.5% and lowered annual income in 28.5%. In total, 11% were disabled due to GP symptoms.

Conclusions:

GP reduces patients’ QoL and places a significant financial burden on the health care system. Treatment strategies for GP patients should be broad based and incorporate pain management, psychological evaluation and management, and strategies to improve overall well-being with a return to work and daily activities.
Predicting Efficacy of Plastic Stents for Posttransplantation Biliary Strictures
Authors: Santo Erwin , Itshak Anna , Mlynarsky Liat , Leshno Moshe , Gluck Nathan
Published: October 2016

Background:

Biliary strictures (BS) are a common complication of liver transplantation. The standard treatment is sequential insertion of increasing numbers of plastic stents by endoscopic retrograde cholangiopancreatography (ERCP). Despite high success rates, some strictures fail to resolve and require surgery as definitive treatment.

Goals:

To identify predictors of response or failure of standard endoscopic treatment, allowing earlier referral to alternative modalities when needed and avoiding unnecessary procedures.

Study:

Database of Gastroenterology Department at Tel Aviv Medical Center was retrospectively reviewed, and data regarding patients who underwent liver transplantation and developed BS were analyzed.

Results:

Thirty-one patients met the study criteria. Twenty-four (77.4%) resolved with plastic stenting and 7 ultimately required surgery. There were no significant differences between stent responders and nonresponders regarding demographics, transplant and postoperative hospitalization data, time from transplantation to presentation with stricture, total number of ERCP sessions, or maximal number of stents.

A trend toward difference was noted in the time elapsed between the first and the second ERCP, whereby ERCP nonresponders required a second procedure sooner than responders. Patients presenting to their second procedure as scheduled ultimately had a 95% endoscopic success rate, whereas those presenting urgently with acute cholangitis had a 55% failure rate (P=0.02).

Conclusions:

Urgent repeat ERCP is a harbinger of ultimate failure of plastic stent treatment for BS after liver transplant. This finding may assist earlier triage of these patients toward alternative treatment such as metal stents or surgery, thus sparing needless procedures and complications.