bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of Vocabulary Outcomes in Children Who Are Deaf or Hard of Hearing From Spanish-Speaking Families
Authors: de Diego-Lázaro Beatriz , Restrepo María Adelaida , Sedey Allison Lee , Yoshinaga-Itano Christine
Published: November 2018

Purpose

The goal of this study was to identify predictors of expressive vocabulary in young Spanish-speaking children who are deaf or hard of hearing living in the United States.

Method

This cross-sectional study considered 53 children with bilateral hearing loss between 8 and 34 months of age (
M =
24,
SD =
6.9). Demographic variables, variables related to the hearing loss, and intervention variables were included in a hierarchical regression analysis to predict expressive vocabulary quotients from the MacArthur Inventario del Desarrollo de Habilidades Comunicativas (Communicative Development Inventories;
Jackson-Maldonado et al., 2003
).

Results

Chronological age, degree of hearing loss, functional hearing ability ratings, age of enrollment in early intervention, and the interaction between chronological age and age of intervention accounted for 61.5% of the vocabulary variance. Children who received intervention by 6 months of age achieved significantly higher vocabulary outcomes than children who started intervention later.

Conclusion

The children's mean vocabulary outcomes were below average when compared with hearing peers. This was especially true for older children, children with moderately-severe-to-profound hearing loss, and children who began intervention after 6 months of age. This delay in vocabulary outcomes has the potential to interfere with future reading and academic outcomes.
Energy‐efficient leakage‐based oscillator with stacked structure for nW harvesters
Authors: Jang E. , Lee H. , Lee Y.
Published: November 2018

An ultra‐low‐power oscillator with 0.24 pJ/cycle energy efficiency is presented, suitable for nanowatt‐level energy harvesters. The sub‐pJ/cycle energy efficiency is comparable with the lowest energy per cycle costs of prior arts and is achieved by minimising short‐circuit current with a leakage‐based delay cell and minimising dynamic power consumption with a capacitively coupled stacked structure. The proposed oscillator is fabricated in 180 nm CMOS process. Under 2.2 V supply voltage, the energy per cycle is 0.24 pJ/cycle over a frequency range of 18.2–226 kHz.
Simple method for generating evaluation data for scene flow algorithms
Authors: Jang I.Y. , Lim H.S. , An S.C.
Published: November 2018

A method which simply generates evaluation data for scene flow testing is presented, in which most algorithms for scene flow estimation require a pair of depth and colour images. We scanned the 3D geometry of a real object and rendered it in graphical space to acquire its depth and colour information. Next, surface deformation to generate natural motion for the scene flow is employed. The surface deformation enabled the generation of non‐rigid as well as rigid motion. Next, barycentric coefficients were exploited to compute the ground truth scene flow. The coefficients enabled the acquired dense scene to flow accurately without dense point tracking and colour information. On the other hand, each flow vector was computed per pixel and a pixel could come from more than one point due to occlusion. We compute the flow maps dividing the geometry into the front area and the occluded area by modifying a z‐buffer algorithm. Experimental results showed that the proposed method reliably provided evaluation data (a pair of depth and colour images and a scene flow map) based on a scanned model with occlusion.
Joint prominent expression feature regions in auxiliary task learning network for facial expression recognition
Authors: Chen Wendong , Hu Haifeng
Published: November 2018

The key issue for facial expression recognition (FER) is to concentrate on the prominent expression feature regions where the expression changes. In this Letter, the authors propose a novel and effective FER framework jointing prominent expression feature regions in an auxiliary task learning network (ATLN). The proposed approach consists of two deep learning neural networks, one of which is the main network whose inputs are complete face images, and the other is the auxiliary learning network whose inputs are pre‐processed face images containing prominent expression feature regions. The main network structure of the ATLN improves its ability to focus on regions with prominent expressions changing by sharing parameters with their auxiliary network structure. They carry out experiments on two public facial expression databases, namely, CK+ and MMI. Experimental results demonstrate the superior performance of proposed method.
Nine‐level high‐frequency inverter
Authors: Ji Baojian , Hong Feng , Huang Xiaodong , Wu Yu
Published: November 2018

In the high‐frequency AC (HFAC) power distribution system, problems such as high switching frequency, a complicated circuit configuration and difficult parameter design still exist in the traditional inverters. A multi‐level high‐frequency inverter topology based on a forward converter is proposed in this study, which implements the electrical isolation of input and output. With the introduction of variable turns ratio technology, the nine‐level output is achieved, which is conductive to the decrease of output harmonics. The selected harmonic elimination method is also adopted to further reduce the output harmonic distortion through the Fourier analysis of output waveforms. Besides, the HFAC output can be achieved at a lower switching frequency for the maximum switching frequency is only double the output frequency. The detailed analysis on operating principles and parameter design of the proposed inverter are provided in this study. Finally, the feasibility of the inverter is verified by the simulations and experiments.
High‐gain LCL architecture based IPT system for wireless charging of EV
Authors: Varikkottil Sooraj , Febin Daya J.L.
Published: November 2018

In this study, a high‐gain LCL topology based inductive power transfer (IPT) system is proposed for wireless charging of electric vehicle (EV). The hybrid resonance topology is modified to achieve high gain in the proposed system. The duty ratio of semiconductor switches is adjusted to control the primary power flow in the IPT system. A detailed mathematical model of the proposed system is obtained and performances are analysed under contingency in misalignment of the inductive coil. The developed prototype of IPT system is tested and the experimental studies substantiate the results of numerical simulation.
The HARPS search for southern extra-solar planets
Authors: Udry S. , Dumusque X. , Lovis C. , Ségransan D. , Diaz R. F. , Benz W. , Bouchy F. , Coffinet A. , Lo Curto G. , Mayor M. , Mordasini C. , Motalebi F. , Pepe F. , Queloz D. , Santos N. C. , Wyttenbach A. , Alonso R. , Collier Cameron A. , Deleuil M. , Figueira P. , Gillon M. , Moutou C. , Pollacco D. , Pompei E.
Published: November 2018

Context. We present radial-velocity measurements of eight stars observed with the HARPS Echelle spectrograph mounted on the 3.6-m telescope in La Silla (ESO, Chile). Data span more than ten years and highlight the long-term stability of the instrument.

Aims. We search for potential planets orbiting HD 20003, HD 20781, HD 21693, HD 31527, HD 45184, HD 51608, HD 134060 and HD 136352 to increase the number of known planetary systems and thus better constrain exoplanet statistics.

Methods. After a preliminary phase looking for signals using generalized Lomb-Scargle periodograms, we perform a careful analysis of all signals to separate bona-fide planets from signals induced by stellar activity and instrumental systematics. We finally secure the detection of all planets using the efficient MCMC available on the Data and Analysis Center for Exoplanets (DACE web-platform), using model comparison whenever necessary.

Results. In total, we report the detection of twenty new super-Earth to Neptune-mass planets, with minimum masses ranging from 2 to 30 MEarth and periods ranging from 3 to 1300 days, in multiple systems with two to four planets. Adding CORALIE and HARPS measurements of HD20782 to the already published data, we also improve the characterization of the extremely eccentric Jupiter orbiting this visual companion of HD 20781.
Sexual Function of Women with Infertility
Authors: Salomão Priscilla Bianchini , Navarro Paula Andrea , Romão Adriana Peterson Mariano Salata , Lerri Maria Rita , Lara Lúcia Alves da Silva
Published: November 2018

Objective To assess the sexual function, anxiety, and depression of infertile women relative to a control group.

Methods Infertile women (infertile group, IG) of reproductive age were invited to participate in this controlled study. A control group (CG) of women was recruited from the general population of the same city. Sexual function was assessed by the Female Sexual Function Index (FSFI), and anxiety and depression were measured by the Hospital Anxiety and Depression Scale (HADS).

Results A total of 280 women participated in the present study, 140 in the IG and 140 in the CG. The analysis of the FSFI scores showed that 47 women (33.57%) in the IG and 49 women (35%) in the CG had sexual dysfunction (FSFI ≤ 26.55; p = 0.90). Women with anxiety or depression had a greater risk of sexual dysfunction, and sexual dysfunction increased the risk of anxiety and depression. Married women had a lower risk of depression than single women who were living with their partners.

Conclusion Infertile women had no increased risk of sexual dysfunction relative to controls. Anxiety and depression increased the risk of sexual dysfunction in the studied population.
Rare Branching Pattern of the Subscapular Artery
Authors: Tverskoi Alexey Vladimirovich , Morozov Vitaly Nikolaevich , Petrichko Svetlana Aleksandrovna , Pushkarskiy Vitaly Vladimirovich , Parichuk Aleksandr Sergeevich
Published: November 2018

Variations of the axillary artery and its branches are quite common. Some variations are clinically significant and having knowledge of them can be useful for the prevention of diagnostic errors during surgical interventions in the axillary fossa. Classically, the third part of the axillary artery presents three branches—the subscapular, the anterior, and the posterior circumflex humeral arteries. The subscapular artery is divided into the circumflex scapular and the thoracodorsal arteries. Our work presents a previously undescribed branching pattern of the right subscapular artery. It branched into the thoracodorsal, the circumflex scapular, the profunda brachii, and the anterior and posterior circumflex humeral arteries. The profunda brachii artery was 0.4 cm in diameter and ran inferiorly to the humeromuscular canal. No branches of the profunda brachii artery were found in the superior part of the arm before entering the humeromuscular canal. No variations in the other parts of the right axillary artery and of the left axillary artery were discovered. The described branching pattern of the subscapular artery can be important and essential for surgeons and radiologists.
Anatomic Variations of Mandibular Condyles in Brazilian Specimens
Authors: Fonseca Roberta , Schetino Luana , da Silva Janice , Almeida-Leite Camila
Published: November 2018

Objective To describe the morphological characteristics and asymmetries between the left and right mandibular condyles in Brazilian cadaveric specimens.

Material and Methods Thirty-two jaws were placed on a rigid support for image acquisition of the frontal and lateral views. The shapes of the mandibular condyles were classified, and measurements of the distance between the anatomical landmarks in the lateral and frontal views were performed.

Results Mandibular length and width were not different between the right and left sides. Regarding the shapes of the mandibular condyles, the rounded type was the most frequent, followed by marked medial slope; flattened; overhanging lateral and medial slopes; downward flattening of both slopes and their merger in a single, extensive surface; and deformity and marked lateral slope with flaring and flattening. Asymmetry between the left and right mandibular condyles was present in 40% of the specimens.

Conclusion The anatomy of mandibular condyles varies greatly, and this knowledge can avoid misdiagnosis by image examination of the anatomic variations.
Morphology of the Cervical Lymph Nodes of Agouti (Dasyprocta prymnolopha, Wagler, 1831)
Authors: de Carvalho Paulo , Guerra Sérgio , Rizzo Márcia , da Silva Andrezza , Cavalcante Maria , Conde Júnior Airton
Published: November 2018

In the scientific literature, works related to the morphology and histology of agoutis, Dasyprocta prymnolopha, Wagler, 1831, approach several organs and systems. However, none referenced the lymph nodes of this animal. The objectives of the present study were to perform morphological and histological analyses, under optical microscopy, of the cranial and cervical lymph nodes of agoutis, comparing them with the typical lymph nodes of already documented animal species. In the present work, four animals were used, respecting all the ethical and legal aspects, followed by the development of methodologies related to the morphology and histology in question. The results obtained did not show significant morphological and histological differences between the cranial and cervical lymph nodes of agoutis when compared with typical lymph nodes of the animal kingdom.
Evaluación de la vascularización del colgajo interoseo posterior mediante angiografía intraoperatoria con indocianina verde
Authors: Gutierrez Diego Fernando , Hartwig Denisse , Giachero Virginia
Published: November 2018

La angiografía con indocianina verde es una herramienta que permite, entre otros usos, valorar la vascularización de los colgajos en tiempo real. Presentamos el caso de un paciente con una herida en dorso de mano por extravasación de citostáticos, en el que se plantea una reconstrucción con un colgajo interóseo posterior. La ecografía Doppler preoperatoria no logró identificar la arteria interósea posterior a partir del tercio medio de antebrazo, por lo que realizamos una angiografía con indocianina verde intraoperatoria, que permitió identificar una hipoplasia de la arteria interósea posterior y comprobar la viabilidad del colgajo.
A repulsive skyrmion chain as a guiding track for a racetrack memory
Authors: Suess D. , Vogler C. , Bruckner F. , Heistracher P. , Abert C.
Published: November 2018

A skyrmion racetrack design is proposed that allows for thermally stable skyrmions to code information and dynamical pinning sites that move with the applied current. This concept solves the problem of intrinsic distributions of pinning times and pinning currents of skyrmions at static pinning sites due to geometrical constrictions or disordered film. The dynamical pinning sites are realized by a skyrmion carrying wire, where the skyrmion repulsion is used in order to keep the skyrmions at equal distances. The information is coded by an additional layer where the presence and absence of a skyrmion is used to code the information. The lowest energy barrier for a data loss is calculated to be ΔE = 55 kBT300 which is sufficient for a long time thermal stability.
Raman high-pressure study of butane isomers up to 40 GPa
Authors: Kudryavtsev Daniil A. , Kutcherov Vladimir G. , Dubrovinsky Leonid S.
Published: November 2018

Raman spectroscopy studies on n and i-butane were performed at pressures of up to 40 GPa at ambient temperatures using the DAC technique. Normal butane undergoes two phase transitions at 1.9(5) GPa and 2.9(5) GPa and isobutane at 2.7(5) GPa and 3.5(5) GPa. These phase transitions were identified based on observations of the splitting Raman modes and the appearance or disappearance of particular Raman peaks. Our results demonstrate the complex, high-pressure behavior of butane isomers.
Soot formation: A new mechanism for an old problem
Authors: Berkowitz Rachel
Published: November 2018

Gaseous hydrocarbons may cluster into sooty particles through a chain reaction.
Satellite repair and refueling demos may soon spur a new industry
Authors: Lopatka Alex
Published: November 2018

Technology has made it possible to robotically service satellites in orbit, but is it cost-effective?
Phylogenetic diversity and conservation of rainforests in the Sunshine Coast region, Queensland, Australia
Authors: Scanlan Liam , McDonald William J. F. , Shapcott Alison
Published: November 2018

The subtropical rainforests of South East Queensland are relatively understudied but their importance for conservation has recently been highlighted, with the Sunshine Coast region identified as an area of high diversity, second to the Border Ranges. We measured phylogenetic diversity at a fine scale to identify areas of high diversity and dissimilarity across the Sunshine Coast, within the Forest of East Australia biodiversity hotspot. Edaphic and climatic influences were incorporated in the analysis to test their relevance to diversity in the region, and to aid the identification of local diversity hotspots. The Sunshine Coast was found to be phylogenetically even overall and had a high proportion of even sites (91 out of 109), consistent with the identification of refugia at a larger scale. The Blackall Range was identified as a local centre of diversity but it has been extensively cleared. Contrary to expectation, coastal lowland sites were phylogenetically even, suggesting potential localised stability or strong connectivity to refugia. These results reiterate the high conservation value of the region in general, particularly for the remnant areas of rainforest on the Blackall Range.
Ticks in Australia: endemics; exotics; which ticks bite humans?
Authors: Barker Stephen C , Barker Dayana
Published: November 2018

At least 71 species of ticks occur in Australia; a further 33 or so species are endemic to its neighbours, New Guinea and New Zealand. The ticks of Australia and other parts of Australasia are phylogenetically distinct. Indeed, there are at least two lineages of ticks that are unique to Australasia: the genus Bothriocroton Klompen, Dobson & Barker, 2002; and the new genus Archaeocroton Barker & Burger, 2018. Two species of ticks that are endemic to Australia are notorious for feeding on humans: (i) Ixodes holocyclus, the eastern paralysis tick, in eastern Australia; and (ii) Amblyomma triguttatum triguttatum, the ornate kangaroo tick, in Western Australia, at one place in South Australia, and in parts of Queensland. Three of the other endemic species of ticks that feed on humans in Australia are also noteworthy: (i) Bothriocroton hydrosauri, the southern reptile tick, which is a vector of Rickettsia honei (Flinders Island spotted fever); (ii) Haemaphysalis novaeguineae, the New Guinea haemaphysalid; and (iii) Ornithodoros capensis, the seabird soft tick. Here, we present images of female Ixodes holocyclus, Amblyomma t. triguttatum, Bothriocroton hydrosauri and Haemaphysalis novaeguineae and our latest maps of the geographic distributions of Ixodes holocyclus, Amblyomma t. triguttatum and Bothriocroton hydrosauri. None of the five exotic species of ticks in Australia typically feed on humans.
Cr–Ag coatings: synthesis, microstructure and antimicrobial properties
Authors: Karami Afshin , Zhang Hu , Pederick Victoria G. , McDevitt Christopher A. , Kabir Mohammad Sharear , Xu Song , Munroe Paul , Zhou Zhifeng , Xie Zonghan
Published: November 2018

Cr–Ag coatings for antimicrobial surface applications were fabricated by magnetron sputtering. The coating microstructure and mechanical properties were characterised using XPS, XRD, FESEM, TEM and nanoindentation measurement as a function of Ag content. The antimicrobial efficacy of these Cr–Ag coatings was evaluated against the pathogenic bacteria Escherichia coli and Staphylococcus aureus, revealing varied levels of bacterial killing. This study warrants further investigation into the antimicrobial mechanism of action of silver and future applications of Cr–Ag as antimicrobial coating for healthcare settings.
Components of attack response inhibition in fencing: Components of attack response inhibition in fencing
Authors: Gutiérrez‐Davila Marcos , Rojas F. Javier , Gutiérrez‐Cruz Carmen , Navarro Enrique
Published: November 2018

Applying the Go/No‐Go paradigm to fencing, we investigated the relationship between the moment at which the No‐Go signal appeared after a movement had been initiated and the time required by fencers to suppress the motor execution of a step‐lunge. Secondarily, we determined a time threshold from which movement inhibition results in an error. The No‐Go stimulus was represented by a real attack movement. 18 elite fencers and a fencing master were included in the study. Four force plates measured the horizontal components of the fencer's and master's reaction forces, which were used to calculate the time components of the attack and the response inhibition process. Also, the velocity and displacement of the master's and fencer's respective centres of mass were estimated using inverse dynamics. In all cases, cognitive inhibition processes were completed after the onset of movement. Movement time was calculated using four time components (muscle activation, muscle deactivation, transition and braking time). The results obtained revealed that cognitive processes were not significantly affected by the timing of the appearance of the No‐Go signal. In contrast, movement time and its time components tended to decrease when the time delay between the No‐Go stimulus and the onset of the fencer's movement increased. In conclusion, any attempt to withhold an attack movement when it has already started leads to an error that increases the risk of being hit by the opponent, especially when attack is inhibited within 150 ms after the movement has started.
Belousov–Zhabotinsky reaction in liquid marbles
Authors: Fullarton Claire , Draper Thomas C , Phillips Neil , de Lacy Costello Ben P J , Adamatzky Andrew
Published: November 2018

In Belousov–Zhabotinsky (BZ) type reactions, chemical oxidation waves can
be exploited to produce reaction-diffusion processors. This paper reports on a
new method of encapsulating BZ solution in a powder coating of either
polyethylene (PE) or polytetrafluoroethylene (PTFE), to produce BZ liquid
marbles (LMs). BZ LMs have solid–liquid interfaces compared to previously
reported encapsulation systems, BZ emulsions and BZ vesicles. Oscillation
studies on individual LMs established PE-coated LMs were easier to prepare and
more robust than PTFE-coated LMs. Therefore, this coating was used to study BZ
LMs positioned in ordered and disordered arrays. Sporadic transfer of excitation
waves was observed between LMs in close proximity to each other. These results
lay the foundations for future studies on information transmission and
processing arrays of BZ LMs. Future work aims to elucidate the effect of other
physical stimuli on the dynamics of chemical excitation waves within these
systems.
Sharp affine weighted 𝐿^{𝑝} Sobolev type inequalities
Authors: Haddad J. , Jiménez C. , Montenegro M.
Published: November 2018

We establish sharp affine weighted

L
p

L^p

Sobolev type inequalities by using the

L
p

L_p

Busemann–Petty centroid inequality proved by Lutwak, Yang, and Zhang. Our approach consists of combining the latter with a suitable family of sharp weighted

L
p

L^p

Sobolev type inequalities obtained by Nguyen and allows us to characterize all extremizers in some cases. The new inequalities do not rely on any euclidean geometric structure.
Proof of a conjecture on induced subgraphs of Ramsey graphs
Authors: Kwan Matthew , Sudakov Benny
Published: November 2018

An

n
n

-vertex graph is called

C
C

-Ramsey if it has no clique or independent set of size

C
log
⁡
n

C\log n

. All known constructions of Ramsey graphs involve randomness in an essential way, and there is an ongoing line of research toward showing that in fact all Ramsey graphs must obey certain “richness” properties characteristic of random graphs. More than 25 years ago, Erdős, Faudree, and Sós conjectured that in any

C
C

-Ramsey graph there are

Ω
(

n

5

/

2

)

\Omega (n^{5/2})

induced subgraphs, no pair of which have the same numbers of vertices and edges. Improving on earlier results of Alon, Balogh, Kostochka, and Samotij, in this paper we prove this conjecture.
Set of approaches based on 3D structure and position specific-scoring matrix for predicting DNA-binding proteins
Authors: Nanni Loris , Brahnam Sheryl
Published: November 2018

Motivation

Because DNA-binding proteins (DNA-BPs) play a vital role in all aspects of genetic activity, the development of reliable and efficient systems for automatic DNA-BP classification is becoming a crucial proteomic technology. Key to this technology is the discovery of powerful protein representations and feature extraction methods. The goal of this article is to develop experimentally a system for automatic DNA-BP classification by comparing and combining different descriptors taken from different types of protein representations.

Results

The descriptors we evaluate include those starting from the position-specific scoring matrix (PSSM) of proteins, those derived from the amino-acid sequence (AAS), various matrix representations of proteins and features taken from the three-dimensional tertiary structure of proteins. We also introduce some new variants of protein descriptors. Each descriptor is used to train a separate support vector machine (SVM), and results are combined by sum rule. Our final system obtains state-or-the-art results on three benchmark DNA-BP datasets.

Availability and implementation

The MATLAB code for replicating the experiments presented in this paper is available at https://github.com/LorisNanni.
gwasurvivr: an R package for genome-wide survival analysis
Authors: Rizvi Abbas A , Karaesmen Ezgi , Morgan Martin , Preus Leah , Wang Junke , Sovic Michael , Hahn Theresa , Sucheston-Campbell Lara E
Published: November 2018

To address the limited software options for performing survival analyses with millions of SNPs, we developed gwasurvivr, an R/Bioconductor package with a simple interface for conducting genome-wide survival analyses using VCF (outputted from Michigan or Sanger imputation servers), IMPUTE2 or PLINK files. To decrease the number of iterations needed for convergence when optimizing the parameter estimates in the Cox model, we modified the R package survival; covariates in the model are first fit without the SNP, and those parameter estimates are used as initial points. We benchmarked gwasurvivr with other software capable of conducting genome-wide survival analysis (genipe, SurvivalGWAS_SV and GWASTools). gwasurvivr is significantly faster and shows better scalability as sample size, number of SNPs and number of covariates increases.

Availability and implementation

gwasurvivr, including source code, documentation and vignette are available at: http://bioconductor.org/packages/gwasurvivr.

Supplementary information

Supplementary data are available at Bioinformatics online.
Structure and functional interactions of INO80 actin/Arp module
Authors: Zhang Xuan , Wang Xuejuan , Zhang Zhihui , Cai Gang
Published: November 2018

The presence and functions of nuclear actin have been controversial due to the lack of molecular mechanisms. Nuclear actin and actin-related proteins (Arps) are subunits of several chromatin remodelers, including the evolutionarily conserved INO80 chromatin-remodeling complex. Here, we present an improved cryo-EM structure of the yeast INO80 complex and the first 3D reconstruction of the INO80 actin/Arp module. The modular and subunit architecture is defined using a combination of subunit deletion analysis and published crosslinking-mass spectrometry. The functional interactions of the INO80 actin/Arp module with a nucleosome is 3D EM reconstructed in two different binding states. Nucleosomes initially bind to the Arp8 subunit and the substantial conformational changes maximize nucleosome contacts of the actin/Arp module, which could promote the bound nucleosome to be engaged onto the INO80 ATPase domain. Our findings suggest that the conserved nuclear actin/Arp module acts a conformational switch of the INO80 for nucleosome binding.
Fatal Measles Virus Infection After Rituximab-Containing Chemotherapy in a Previously Vaccinated Patient
Authors: Jent Philipp , Trippel Mafalda , Frey Manuel , Pöllinger Alexander , Berezowska Sabina , Langer Rupert , Furrer Hansjakob , Béguelin Charles
Published: November 2018

We report the case of a young patient treated with rituximab-containing chemotherapy who was infected with measles despite previous vaccination. Treatment with vitamin A, ribavirin, and immunoglobulins was started; nevertheless he developed severe pneumonitis and deceased. Broad vaccination coverage is crucial in protecting vulnerable subjects.
How to treat Sjögren’s syndrome
Authors: Price Elizabeth J , Baer Alan N
Published: November 2018

SS is a chronic, autoimmune disease of unknown aetiology for which there is no known curative treatment. Although dryness of the eyes and mouth are the classically described features, patients often experience drying of other mucosal surfaces and systemic manifestations, including fatigue and arthralgia. There is an association with other autoimmune diseases, especially thyroid disease, coeliac disease and primary biliary cholangitis. Systemic features may affect up to 70% and include inflammatory arthritis, skin involvement, haematological abnormalities, neuropathies, interstitial lung disease and a 5–10% lifetime risk of B cell lymphoma. Treatment should aim to empower patients to manage their condition; conserve, replace and stimulate secretions; prevent damage; and suppress underlying systemic disease activity.
Effect of particle size of a mash concentrate on behavior, digestibility, and macroscopic and microscopic integrity of the digestive tract in Holstein bulls fed intensively1
Authors: Devant Maria , Solé Anna , Quintana Bruna , Pérez Armando , Ribó Josep , Bach Alex
Published: November 2018

Twenty-four individually housed Holstein bulls (456 ± 6.9 kg of body weight and 292 ± 1.4 d of age) were enrolled in a complete randomized experiment involving four dietary treatments to evaluate the potential effect of mash particle size of diets in finishing beef diets on behavior, digestibility, and macro- and microscopic changes of the digestive tract. The four treatments were all ingredients sieved at 2 mm (HM2), all ingredients sieved at 3 mm (HM3), all ingredients, but corn, sieved at 2 mm and corn at 10 mm (HM210), and all ingredients, but corn, sieved a 3 mm and corn at 10 mm (HM310). For the HM210 and HM310 mashes, corn ground at 10 mm was mixed with the remaining concentrate ingredients ground at 2 or 3 mm, respectively. Concentrate (36% corn, 19% barley, 15% corn gluten feed, 8.4% wheat; 14% crude protein, 3.28 Mcal of ME/kg) consumption was recorded daily and straw consumption weekly. To register behavior, animals were filmed for 24 h on a weekly basis. At day 49 of study nutrient digestibility was estimated. Bulls were slaughtered after 56 d of exposure to treatments. Digestive tract and hepatic lesions were recorded, and tissue samples from the digestive tract collected. Geometric mean particle size was 0.61 ± 0.041, 0.76 ± 0.041, 0.62 ± 0.041, 0.73 ± 0.041 mm, and percentage of particles between 0.5 and 1 mm were 68 ± 2.9, 46 ± 1.7, 46 ± 5.0, and 39 ± 3.3 g/100 g for HM2, HM210, HM3, and HM310, respectively. Performance, total tract digestibility, or digestive tract integrity did not differ when ingredients were ground at 2 or 3 mm. Grinding corn with a hammer mill sieve size of 10 mm reduced feed efficiency and decreased total tract apparent dry matter, and organic matter digestibility compared with treatments from which all ingredients were ground at 2 or 3 mm. Straw intake was greatest and starch digestibility was least in the HM210 treatment. Last, only minor differences among treatments in rumen wall color, rumen papillae fusion, and histological conformation were observed. In summary, to improve feed efficiency, grinding corn at 10 mm is not recommended. In the present study, grinding procedure did not have a great effect on behavior and/or digestive tract health; however, under commercial conditions (group housing), grinding procedures that cause small mean particle sizes or particle size heterogeneity may increase the risk to suffer digestive tract lesions.
Time to Reevaluate the Away Rotation: Improving Return on Investment for Students and Schools
Authors: Griffith Max , DeMasi Stephanie C. , McGrath Abigail J. , Love Jeffrey N. , Moll Joel , Santen Sally A.
Published: November 2018

Away rotations are common among senior medical students preparing to apply for residency. For competitive specialties, multiple away rotations may be viewed as a de facto requirement for a strong application. Although away rotations are often valuable learning experiences, a variety of noneducational factors motivate students to enroll, including the need for letters of recommendation, students’ uncertainty regarding their strength as applicants, perceived competitiveness of residency applications, and conflicting guidance from advisors.

Students who enroll in away rotations often benefit from a novel educational environment, opportunities for career exploration, and the chance to assess “fit” with a program. Yet away rotations also come at a significant cost. Students must deal with the time and expenses of rotating at multiple institutions. The application process for away rotations is expensive, disjointed, and inefficient. Students must work hard to make an impression on host institution faculty, and risk hurting their residency applications with a negative letter of recommendation.

To reduce the burden of away rotations, future research should assess the impact of multiple away rotations on success in the Match. Allowing students limited access to letters of recommendation content would allow students and advisors to make informed decisions regarding additional rotations. Students would benefit from greater standardization of the application process for away rotations, with uniform dates, timely acceptances and rejections, and a cap for the number of applications per student. Students can maximize their returns by targeting away rotations that provide the most diverse educational experiences and valuable letters of recommendation.
Validity Evidence for a Brief Online Key Features Examination in the Internal Medicine Clerkship
Authors: Lang Valerie J. , Berman Norman B. , Bronander Kirk , Harrell Heather , Hingle Susan , Holthouser Amy , Leizman Debra , Packer Clifford D. , Park Yoon Soo , Vu T. Robert , Yudkowsky Rachel , Monteiro Sandra , Bordage Georges
Published: November 2018

Purpose

Medical educators use key features examinations (KFEs) to assess clinical decision making in many countries, but not in U.S. medical schools. The authors developed an online KFE to assess third-year medical students’ decision-making abilities during internal medicine (IM) clerkships in the United States. They used Messick’s unified validity framework to gather validity evidence regarding response process, internal structure, and relationship to other variables.

Method

From February 2012 through January 2013, 759 students (at eight U.S. medical schools) had 75 minutes to complete one of four KFE forms during their IM clerkship. They also completed a survey regarding their experiences. The authors performed item analyses and generalizability studies, comparing KFE scores with prior clinical experience and National Board of Medical Examiners Subject Examination (NBME-SE) scores.

Results

Five hundred fifteen (67.9%) students consented to participate. Across KFE forms, mean scores ranged from 54.6% to 60.3% (standard deviation 8.4–9.6%), and Phi-coefficients ranged from 0.36 to 0.52. Adding five cases to the most reliable form would increase the Phi-coefficient to 0.59. Removing the least discriminating case from the two most reliable forms would increase the alpha coefficient to, respectively, 0.58 and 0.57. The main source of variance came from the interaction of students (nested in schools) and cases. Correlation between KFE and NBME-SE scores ranged from 0.24 to 0.47 (P < .01).

Conclusions

These results provide strong evidence for response-process and relationship-to-other-variables validity and moderate internal structure validity for using a KFE to complement other assessments in U.S. IM clerkships.
A Philosophical Approach to Addressing Uncertainty in Medical Education
Authors: Tonelli Mark R. , Upshur Ross E.G.
Published: November 2018

Conveying the uncertainty inherent in clinical practice has rightly become a focus of medical training. To date, much of the emphasis aims to encourage trainees to acknowledge and accept uncertainty. Intolerance of uncertainty is associated with medical student distress and a tendency in clinicians toward overtreatment. The authors argue that a deeper, philosophical understanding of the nature of uncertainty would allow students and clinicians to move beyond simple acceptance to explicating and mitigating uncertainty in practice.

Uncertainty in clinical medicine can be categorized philosophically as moral, metaphysical, and epistemic uncertainty. Philosophers of medicine—in a way analogous to ethicists a half century ago—can be brought into medical education and medical practice to help students and physicians explore the epistemic and metaphysical roots of clinical uncertainty. Such an approach does not require medical students to master philosophy and should not involve adding new course work to an already-crowded medical curriculum. Rather, the goal is to provide students with the language and reasoning skills to recognize, evaluate, and mitigate uncertainty as it arises. The authors suggest ways in which philosophical concepts can be introduced in a practical fashion into a variety of currently existing educational formats. Bringing the philosophy of medicine into medical education promises not only to improve the training of physicians but, ultimately, to lead to more mindful clinical practice, to the benefit of physicians and patients alike.
A Current Evaluation of the Economic Costs for Fetal Alcohol Spectrum Disorder (FASD): A Comment on the Systematic Review by Greenmeyer et al.
Authors: Sokol Robert J.
Published: November 2018

Fetal alcohol spectrum disorder is common and associated with economic costs greater than comparable other childhood and adult disorders. We need to turn our attention to prevention and mitigation.
Surgical and Health-related Quality-of-Life Outcomes of Growing Rod “Graduates” With Severe versus Moderate Early-onset Scoliosis
Authors: Helenius Ilkka J. , Sponseller Paul D. , McClung Anna , Pawelek Jeff B. , Yazici Muharrem , Emans John B. , Thompson George H. , Johnston Charles E. , Shah Suken A. , Akbarnia Behrooz A.
Published: November 2018

Study Design.

A retrospective review of a prospective, multicenter database.

Objective.

The aim of this study was to compare surgical and quality-of-life outcomes at the end of growing rod treatment in patients with severe versus moderate early-onset scoliosis (EOS).

Summary of Background Data.

Knowledge of the outcomes of severe EOS after growth-friendly treatment is limited because this condition is uncommon.

Methods.

We identified 40 children with severe EOS (major curve ≥90°) treated with growing rods before age 10 with minimum 2-year follow-up after last lengthening or final fusion. From the same registry, we matched 40 patients with moderate EOS (major curve < 90°). Twenty-seven patients in the severe group and 12 in the moderate group underwent final fusion (P < 0.001).

Results.

Mean preoperative curves were 102° (range, 90°–139°) in the severe group and 63° (range, 33°–88°) in the moderate group (P < 0.001). At final follow-up, mean curves were 56° (range, 10°–91°) and 36° (range, 12°–89°), respectively (P < 0.001). Fourteen (35%) children in the severe group and 32 (80%) in the moderate group had scoliosis of < 45° at final follow-up [risk ratio (RR), 0.44; 95% confidence interval (95% CI), 0.20–0.57]. At final follow-up, 30 (75%) children in the severe group and 35 (88%) in the moderate group had achieved T1-T12 length of ≥18 cm (RR, 0.86; 95% CI, 0.70–1.09). Thirty-five children in the severe group and 26 in the moderate group had at least one complication (RR, 1.35; 95% CI, 1.05–1.73). Mean 24-Item Early-Onset Scoliosis Questionnaire scores were similar between groups at final follow-up.

Conclusion.

Delaying surgery until the major curve has progressed beyond 90° is associated with larger residual deformity and more complications than treating at a lesser curve magnitude. Quality-of-life outcomes were similar between those with severe and moderate EOS.

Level of Evidence: 3
An Evaluation of the Influence of Body Mass Index on Severity Scoring*
Authors: Deliberato Rodrigo Octavio , Serpa Neto Ary , Komorowski Matthieu , Stone David J. , Ko Stephanie Q , Bulgarelli Lucas , Rodrigues Ponzoni Carolina , de Freitas Chaves Renato Carneiro , Celi Leo Anthony , Johnson Alistair E. W.
Published: November 2018

Objectives:

Although one third or more of critically ill patients in the United States are obese, obesity is not incorporated as a contributing factor in any of the commonly used severity of illness scores. We hypothesize that selected severity of illness scores would perform differently if body mass index categorization was incorporated and that the performance of these score models would improve after consideration of body mass index as an additional model feature.

Design:

Retrospective cohort analysis from a multicenter ICU database which contains deidentified data for more than 200,000 ICU admissions from 208 distinct ICUs across the United States between 2014 and 2015.

Setting:

First ICU admission of patients with documented height and weight.

Patients:

One-hundred eight-thousand four-hundred two patients from 189 different ICUs across United States were included in the analyses, of whom 4,661 (4%) were classified as underweight, 32,134 (30%) as normal weight, 32,278 (30%) as overweight, 30,259 (28%) as obese, and 9,070 (8%) as morbidly obese.

Interventions:

None.

Measurements and Main Results:

To assess the effect of adding body mass index as a risk adjustment element to the Acute Physiology and Chronic Health Evaluation IV and Oxford Acute Severity of Illness scoring systems, we examined the impact of this addition on both discrimination and calibration. We performed three assessments based upon 1) the original scoring systems, 2) a recalibrated version of the systems, and 3) a recalibrated version incorporating body mass index as a covariate. We also performed a subgroup analysis in groups defined using World Health Organization guidelines for obesity. Incorporating body mass index into the models provided a minor improvement in both discrimination and calibration. In a subgroup analysis, model discrimination was higher in groups with higher body mass index, but calibration worsened.

Conclusions:

The performance of ICU prognostic models utilizing body mass index category as a scoring element was inconsistent across body mass index categories. Overall, adding body mass index as a risk adjustment variable led only to a minor improvement in scoring system performance.
18F-FDG PET/CT longitudinal studies in patients with advanced metastatic melanoma for response evaluation of combination treatment with vemurafenib and ipilimumab
Authors: Sachpekidis Christos , Kopp-Schneider Annette , Hakim-Meibodi Lara , Dimitrakopoulou-Strauss Antonia , Hassel Jessica C.
Published: November 2018

Sixteen BRAF-mutation positive, metastatic melanoma patients with highly advanced disease received combination therapy of vemurafenib and ipilimumab as an individual treatment decision. Our aim was to assess the role of fluorine-18-fluorodeoxyglucose (18F-FDG) PET/computed tomography (PET/CT) in the evaluation of the clinical benefit (CB) of this combination treatment. After clinical improvement under vemurafenib monotherapy, four cycles of ipilimumab were additionally administered. 18F-FDG PET/CT was performed before the start, after two cycles and after completion of the combined ipilimumab/vemurafenib treatment. PET-based patient response evaluation to treatment was based on the European Organization for Research and Treatment of Cancer and the PET Response Evaluation Criteria for Immunotherapy criteria. Progression-free survival (PFS) from the end of combination treatment was calculated. According to their best clinical response at the end of combination treatment, eight patients showed CB and eight patients had no-CB. Two patients revealed extraordinary good clinical outcome with PFS of more than 5 years. Overall, 13 out of 16 patients were correctly classified by the European Organization for Research and Treatment of Cancer and 15 out of 16 by the PET Response Evaluation Criteria for Immunotherapy criteria. Median PFS was 8.8 months among PET-responders and 3.6 months among nonresponders. During immunotherapy administration seven patients developed radiologic signs of immune-related adverse events (irAEs), with colitis and arthritis being the most frequent ones; these patients had a significantly longer PFS than those without irAEs (P=0.036). 18F-FDG PET/CT is a valuable tool for the evaluation of patients receiving a combination of targeted treatment and immunotherapy. The appearance of irAEs on PET/CT might correlate with benefit to immunotherapy.
Trends in Pediatric Emergency Department Utilization for Mild Traumatic Brain Injury Before and After Legislation
Authors: Singichetti Bhavna , Leonard Julie C. , Janezic Alyssa R. , Li Hongmei , Yi Honggang , Yang Jingzhen
Published: November 2018

Objective:

To examine the effect of state youth traumatic brain injury (TBI) legislation on pediatric emergency department (ED) utilization for sports and recreation-related mild TBIs (mTBIs).

Participants:

ED visits by children ages 5 to 18 years between 2006 and 2014 in the Pediatric Health Information System database (N = 452 900).

Design:

Retrospective analysis.

Main Measures:

Rates of ED visits, and injury comparison groups (mTBI, moderate to severe TBI, minor head injury, and long bone fracture).

Results:

Of the 452 900 ED visits, 123 192 (27.2%) were for mTBI, along with visits for moderate to severe TBIs (n = 5190), minor head injuries (n = 54 566), and long bone fractures (n = 269 952). ED visits for mTBIs were more common among males (67.5%), children ages 10-14 years (42.1%), and the privately insured (50.6%). The proportion of mTBI ED visits increased significantly, particularly from 5 years prelegislation to immediately postlegislation (57.8 to 94.8 mTBI visits per 10 000 ED visits). A similar trend was observed for minor head injuries; however, no significant changes were observed for moderate to severe TBIs and long bone fractures.

Conclusion:

Pediatric ED utilization trends for the injury comparison groups differed from each other, and from pre- and post-TBI legislation. Further research assessing effects of TBI legislation on healthcare utilization is warranted.
MANAGEMENT OF NEOVASCULAR OCULAR HISTOPLASMOSIS
Authors: Blinder Kevin J.
Published: November 2018

Purpose:

To review the wide variety of treatment modalities available for choroidal neovascularization secondary to the presumed ocular histoplasmosis syndrome.

Methods:

A literature search was performed to review the multitude of studies conducted to investigate the efficacy and safety of treatment modalities available for choroidal neovascularization secondary to the presumed ocular histoplasmosis syndrome.

Results:

Each treatment modality is reviewed, with the studies summarized and presented to support or refute the method of treatment. Two case reports are presented to demonstrate the treatment regimens.

Conclusion:

This is a comprehensive review of the treatment modalities available to address choroidal neovascularization secondary to the presumed ocular histoplasmosis syndrome. Investigators will continue to strive toward higher efficacy and safety with future innovations in the field.