bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of herbage allowance on productive and reproductive responses of primiparous beef cows grazing on Campos grassland
Authors: Claramunt Martín , Fernández-Foren Andrea , Soca Pablo
Published: March 2017

The effects of two levels of herbage allowance (HA, kg DM/kg liveweight (LW)) on forage mass and chemical composition, cow body condition score, cow LW, stocking rate, productive and reproductive responses were evaluated during two consecutive years. Eighty primiparous spring-calving beef cows were allocated to a completely randomised block design of two HA that had an annual average of 2.5 (low) and 4.0 kg DM/kg LW (high) from –150 to 195 days postpartum. The grazing system was continuous, and the put-and-take method was employed to adjust HA. At 86 ± 12 days postpartum, all cows were submitted to calf suckling restrictions with nose plates (12 days) and dietary flushing (2 kg/cow.day of whole-rice bran for 22 days), 6 days before bull introduction. Forage mass was affected by HA (P = 0.004) and year (P = 0.014); the high HA had a greater forage mass than the low HA (1474 vs 1212 ± 86 kg DM/ha; P < 0.05), and Year 2 had a greater forage mass than Year 1 (1545 vs 1134 ± 78 kg DM/ha; P < 0.05). Stocking rate was affected by HA and season (P = 0.0004) interaction. The stocking rate during autumn and spring was greater in low than high HA, and no differences were identified in winter and summer. The body condition score was improved in high HA during autumn and resulted in a greater winter (mid-gestation) body condition score than the low HA without differences during spring-summer (postpartum). Cow LW was lower during autumn, winter and early postpartum (16 days postpartum) in low HA in Year 1 than high HA of Year 1 and high and low HA cows in Year 2. Furthermore, the probability of total pregnancies (0.88 vs 0.59 ± 0.07; P = 0.01) and the calf weight adjusted to 205 days (194 vs 175 ± 16 kg; P < 0.05) were greater in high HA. Calf weight adjusted to 205 days (Year 1: 192 vs Year 2: 177 ± 16 kg; P < 0.05) and survival curves of postpartum anoestrus (P = 0.01) were affected by year but did not affect the probability of conception, early or total pregnancies. In conclusion, the reproductive and productive responses of primiparous beef cows grazing Campos grasslands were improved in high HA and could contribute to alleviating adverse climatic conditions effects.
Variation and change in Toronto heritage Cantonese
Authors: Tse Holman
Published: March 2017

This paper presents the first sociophonetic study of Cantonese vowels using sociolinguistic interview data from the Heritage Language Variation and Change in Toronto Corpus. It focuses on four allophones [iː], [ɪk/ɪŋ], [uː], and [ʊk/ʊŋ] of two contrastive vowels /iː/ and /uː/ across two generations of speakers. The F1 and F2 of 30 vowel tokens were analyzed for these four allophones from each of 20 speakers (N = 600 vowel tokens). Results show inter-generational maintenance of allophonic conditioning for /iː/ and /uː/ as well as an interaction between generation and sex such that second-generation female speakers have the most retracted variants of [ɪk/ɪŋ] and the most fronted variants of [iː]. This paper will discuss three possible explanations based on internal motivation, phonetic assimilation, and phonological influence. This will illustrate the importance of multiple comparisons (including inter-generational, cross-linguistic, and cross-community) in the relatively new field of heritage language phonology research.
Reflections on the pedagogical imports of western practices for professionalizing ESL/EFL writing and writing-teacher education
Authors: Zhang Lawrence
Published: March 2017

The teaching of writing in English as a second/foreign language (ESL/EFL) has been a challenging task for many teachers due to its multifaceted nature. This paper is a reflection on ESL/EFL writing teaching in three countries, namely China, Singapore, and New Zealand, with particular reference to professionalizing ESL/EFL writing and ESL/EFL writing-teacher education. It first addresses issues facing EFL writing and writing-teacher education that relate to the offering of English at various levels in China. It then moves on to elaborate on how western pedagogical practices have been implemented in Singapore, especially that of a genre-based pedagogy. Nestled in the context of globalization, I focus on New Zealand, positing that globalization has exacerbated the challenge in teaching ESL writing because of large numbers of students who are seeking higher education in western countries in English as the medium of instruction, and yet their first language is not English. I conclude the paper with recommendations that professionalizing L2 writing (even in school settings) is a mission for all those who are in this enterprise. Proper teacher preparation programs for training L2 writing teachers should be in place in order for this to happen. China needs to critically appraise, and learn from, successful experiences such as Singapore and many institutions in the USA and Canada. New Zealand is yet to formalize ESOL writing teacher preparation programs, where English-as-an-L2 writing-teacher education for primary and secondary schools is still not a priority in most teacher-education institutions.
Learner perceptions and experiences of pride in second language education
Authors: Ross Andrew S. , Stracke Elke
Published: March 2017

Within applied linguistics, understanding of motivation and cognition has benefitted from substantial attention for decades, but the attention received by language learner emotions has not been comparable until recently when interest in emotions and the role they can play in language learning has increased. Emotions are at the core of human experience, so a greater understanding of their impact on language learners is critical. In particular, the role and impact of positive emotions on learners and their learning experience has been overlooked in favour of a focus on issues of confidence and anxiety. One particular positive emotion that has a meaningful connection with the learning experience is that of pride. Drawing on qualitative interview data from tertiary English language learners in Australian universities, this article singles out pride as a means of confirming the critical role of positive emotions in language learning. The interviews revealed that pride had a significant impact on the experiences of learners. It was also discovered that within the notion of pride there exists a degree of dimensionality. Pride is felt in communicative contexts whereas a feeling of ‘non-pride’ can occur in learning contexts. The article also presents implications arising from the study concerning the place of emotions in language teaching and learning.
Impaired B cell function during viral infections due to PTEN-mediated inhibition of the PI3K pathway
Authors: Getahun Andrew , Wemlinger Scott M. , Rudra Pratyaydipta , Santiago Mario L. , van Dyk Linda F. , Cambier John C.
Published: March 2017

Transient suppression of B cell function often accompanies acute viral infection. However, the molecular signaling circuitry that enforces this hyporesponsiveness is undefined. In this study, experiments identify up-regulation of the inositol phosphatase PTEN (phosphatase and tensin homolog) as primarily responsible for defects in B lymphocyte migration and antibody responses that accompany acute viral infection. B cells from mice acutely infected with gammaherpesvirus 68 are defective in BCR- and CXCR4-mediated activation of the PI3K pathway, and this, we show, is associated with increased PTEN expression. This viral infection-induced PTEN overexpression appears responsible for the suppression of antibody responses observed in infected mice because PTEN deficiency or expression of a constitutively active PI3K rescued function of B cells in infected mice. Conversely, induced overexpression of PTEN in B cells in uninfected mice led to suppression of antibody responses. Finally, we demonstrate that PTEN up-regulation is a common mechanism by which infection induces suppression of antibody responses. Collectively, these findings identify a novel role for PTEN during infection and identify regulation of the PI3K pathway, a mechanism previously shown to silence autoreactive B cells, as a key physiological target to control antibody responses.
Proliferation of latently infected CD4+ T cells carrying replication-competent HIV-1: Potential role in latent reservoir dynamics
Authors: Hosmane Nina N. , Kwon Kyungyoon J. , Bruner Katherine M. , Capoferri Adam A. , Beg Subul , Rosenbloom Daniel I.S. , Keele Brandon F. , Ho Ya-Chi , Siliciano Janet D. , Siliciano Robert F.
Published: March 2017

A latent reservoir for HIV-1 in resting CD4+ T lymphocytes precludes cure. Mechanisms underlying reservoir stability are unclear. Recent studies suggest an unexpected degree of infected cell proliferation in vivo. T cell activation drives proliferation but also reverses latency, resulting in productive infection that generally leads to cell death. In this study, we show that latently infected cells can proliferate in response to mitogens without producing virus, generating progeny cells that can release infectious virus. Thus, assays relying on one round of activation underestimate reservoir size. Sequencing of independent clonal isolates of replication-competent virus revealed that 57% had env sequences identical to other isolates from the same patient. Identity was confirmed by full-genome sequencing and was not attributable to limited viral diversity. Phylogenetic and statistical analysis suggested that identical sequences arose from in vivo proliferation of infected cells, rather than infection of multiple cells by a dominant viral species. The possibility that much of the reservoir arises by cell proliferation presents challenges to cure.
Supplementary comparison EURAMET.L-S25 (#1354) comparison of pocket type laser distance measuring instruments
Authors: Prieto Emilio , Pérez Mar , Ruíz Juan A , Matus Michael , Kotte Gerard
Published: March 2017

Supplementary comparison of distance measurements using pocket-type laser instruments (EDMs), following the previous comparison EURAMET.L-S20.

Originally proposed by the CEM (ES) as a bilateral comparison with BEV (AT), after the open call made at the 2014 EURAMET TC-L meeting, VSL (NL) joined the comparison too.

Registered as supplementary comparison EURAMET.L-S25 with CEM acting as coordinator and pilot laboratory.

Transfer devices were two Leica DISTO EDMs, being the measurands the distances from the rear part of the EDMs to a target plate situated at 0.3 m and every 5 m until covering a range of 50 m.

Main text

To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.

The final report has been peer-reviewed and approved for publication by the CCL, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).
On the origin of critical temperature enhancement in atomically thin superconductors
Authors: Talantsev E F , Crump W P , Island J O , Xing Ying , Sun Yi , Wang Jian , Tallon J L
Published: March 2017

Recent experiments showed that thinning gallium, iron selenide and 2H tantalum disulfide to single/several monoatomic layer(s) enhances their superconducting critical temperatures. Here, we characterize these superconductors by extracting the absolute values of the London penetration depth, the superconducting energy gap, and the relative jump in specific heat at the transition temperature from their self-field critical currents. Our central finding is that the enhancement in transition temperature for these materials arises from the opening of an additional superconducting gap, while retaining a largely unchanged ‘bulk’ superconducting gap. Literature data reveals that ultrathin niobium films similarly develop a second superconducting gap. Based on the available data, it seems that, for type-II superconductors, a new superconducting band appears when the film thickness becomes smaller than the out-of-plane coherence length. The same mechanism may also be the cause of enhanced interface superconductivity.
Positivity in 𝑇-equivariant 𝐾-theory of flag varieties associated to Kac-Moody groups II
Authors: Baldwin Seth , Kumar Shrawan
Published: March 2017

We prove sign-alternation of the structure constants in the basis of the structure sheaves of opposite Schubert varieties in the torus-equivariant Grothendieck group of coherent sheaves on the flag varietiesG/PG/Passociated to an arbitrary symmetrizable Kac-Moody groupGG, wherePPis any parabolic subgroup. This generalizes the work of Anderson-Griffeth-Miller from the finite case to the general Kac-Moody case, and affirmatively answers a conjecture of Lam-Schilling-Shimozono regarding the signs of the structure constants in the case of the affine Grassmannian.
Measurement of Aortic Pulse Wave Velocity With a Connected Bathroom Scale
Authors: Campo David , Khettab Hakim , Yu Roger , Genain Nicolas , Edouard Paul , Buard Nadine , Boutouyrie Pierre
Published: March 2017

BACKGROUND

Measurement of arterial stiffness should be more available. Our aim was to show that aortic pulse wave velocity can be reliably measured with a bathroom scale combining the principles of ballistocardiography (BCG) and impedance plethysmography on a single foot.

METHOD

The calibration of the bathroom scale was conducted on a group of 106 individuals. The aortic pulse wave velocity was measured with the SphygmoCor in the supine position. Three consecutive measurements were then performed on the Withings scale in the standing position. This aorta-leg pulse transit time (alPTT) was then converted into a velocity with the additional input of the height of the person. Agreement between the SphygmoCor and the bathroom scale so calibrated is assessed on a separate group of 86 individuals, following the same protocol.

RESULTS

The bias is 0.25 m·s−1 and the SE 1.39 m·s−1. This agreement with Sphygmocor is “acceptable” according to the ARTERY classification. The alPTT correlated well with cfPTT with (Spearman) R = 0.73 in pooled population (cal 0.79, val 0.66). The aorta-leg pulse wave velocity correlated with carotid-femoral pulse wave velocity with R = 0.76 (cal 0.80, val 0.70).

CONCLUSION

Estimation of the aortic pulse wave velocity is feasible with a bathroom scale. Further investigations are needed to improve the repeatability of measurements and to test their accuracy in different populations and conditions.
Regulation of mRNA stability by CCCH-type zinc-finger proteins in immune cells
Authors: Maeda Kazuhiko , Akira Shizuo
Published: March 2017

Current studies using knockout mice have revealed that some Cys–Cys–Cys–His (CCCH)-type zinc-finger proteins, namely tristetraprolin (TTP), Roquin and Regnase-1, play important roles in the immune system. These proteins are closely associated with the fate of their target RNAs in normal immune responses. However, the functions of many RNA-binding proteins have not been characterized precisely. To understand the molecular mechanisms of RNA metabolism in the immune system, investigation of TTP/Roquin/Regnase-1 might provide new knowledge. In this review, we will discuss the current understanding of these proteins in immune regulation and homeostasis and discuss RNA metabolism in the immune system.
Matched Comparison of Flow Diversion and Coiling in Small, Noncomplex Intracranial Aneurysms
Authors: Chalouhi Nohra , Daou Badih , Barros Guilherme , Starke Robert M. , Chitale Ameet , Ghobrial George , Dalyai Richard , Hasan David , Gonzalez L. Fernando , Tjoumakaris Stavropoula , Rosenwasser Robert H. , Jabbour Pascal
Published: March 2017

BACKGROUND: Flow diversion is typically reserved for large, giant, or morphologically complex aneurysms. Coiling remains a first-line treatment for small, morphologically simple aneurysms.

OBJECTIVE: To compare coiling and flow diversion in small, uncomplicated intracranial aneurysms (typically amenable to coiling).

METHODS: Forty patients treated with the pipeline embolization device (PED) for small (<10 mm), morphologically simple aneurysms that would have also been amenable to coiling were identified. These patients were matched in a 1:1 fashion with 40 patients with comparable aneurysms treated with coiling. Matching was based on age, gender, aneurysm size, and aneurysm morphology.

RESULTS: The 2 groups were comparable with regard to baseline characteristics including age, gender, and aneurysm size. The complication rate did not differ between the 2 groups (2.5% with coiling vs 5% with PED; P = .6). Multivariate analysis did not identify any predictor of complications. Complete occlusion (100%) at follow-up was significantly higher in patients treated with PED (70%) than coiling (47.5%, P = .04). In multivariate analysis, treatment with PED predicted aneurysm obliteration (P = .04). A significantly higher proportion of coiled patients (32.5%) required retreatment compared with flow diversion (5%, P = .003). In multivariate analysis, coiling predicted retreatment (P = .006). All patients achieved a favorable outcome (modified Rankin Scale: 0-2) regardless of group.

CONCLUSION: This matched analysis suggests that flow diversion provides higher occlusion rates, lower retreatment rates, and no additional morbidity compared with coiling in small, simple aneurysms amenable to both techniques. These results suggest a potential benefit for flow diversion over coiling even in small, uncomplicated aneurysms.
Analysis of Recurrent Stenosis After Carotid Endarterectomy Featuring Primary Plaque Calcification
Authors: Katano Hiroyuki , Mase Mitsuhito , Nishikawa Yusuke , Yamada Hiroshi , Yamada Kazuo
Published: March 2017

BACKGROUND: The relationship between calcification in primary plaque and restenosis after carotid endarterectomy (CEA) has been seldom investigated.

OBJECTIVE: To clarify the relationship between characteristics of calcified carotid plaque and recurrent stenosis after CEA, as well as the disease's natural course.

METHODS: Ninety-four plaques out of 107 consecutive CEAs were retrospectively analyzed with regard to calcification, employing calcium score as well as shape, location, and other characteristics of original plaques. CEA was performed in a standard fashion with primary closure using an internal shunt. Restenosis was assessed by direct measurement of stenosis mainly using multidetector row computed tomography (CT) angiography.

RESULTS: Univariate analysis revealed that calcium score and calcification circularity score were significantly lower in more than moderate restenosis (≥50%; 422.1 ± 551.6 vs 84.2 ± 92.0, P < .001; 1.8 ± 1.3 vs 1.1 ± 0.3, P < .001, respectively). Receiver operating characteristic analysis demonstrated a calcium score of 80, which was the optimal cutoff value for restenosis over 50% (sensitivity 0.70, specificity 0.68, pseudopositive ratio 0.32, area under curve 0.71, Youden's index 0.38). Low calcium score (OR 2.88, CI 1.06-7.79, P = .04) and low calcification circularity (OR 5.72, CI 1.42-23.1, P = .01) were independent predictors for more than moderate recurrent carotid stenosis 1 year postoperatively. Cases with decreasing tendency of restenosis showed higher calcium scores than those with increasing or unchanged tendency (217.2 ± 245.3 vs 164.5 ± 155.5, P < .001). Lower calcium score cases showed lower restenosis-free survival.

CONCLUSION: Carotid plaque calcification may be inversely associated with recurrent stenosis 1 year after CEA or later. Preoperative CT assessment for less calcification will benefit restenosis patients by early prediction and close follow-up.
Neurosurgical Education in a Changing Healthcare and Regulatory Environment: A Consensus Statement from 6 Programs
Authors: Kim Dong H. , Dacey Ralph G. , Zipfel Gregory J. , Berger Mitchel S. , McDermott Michael , Barbaro Nicholas M. , Shapiro Scott A. , Solomon Robert A. , Harbaugh Robert , Day Arthur L.
Published: March 2017

The purpose of neurosurgical education is to teach the clinical knowledge and surgical skills necessary to become a neurosurgeon. Another goal is to inculcate the principles of the scientific method. However, increasing expectations about attending involvement during surgery, duty hour requirements, and new curricular mandates have put programs under stress to ensure adequate training, in less time, in an environment of limited resident independence. More recently, the Accreditation Council for Graduate Medical Education has developed a new tracking process based on “milestones” or defined educational outcomes. At the same time, our healthcare system is undergoing a rapid socioeconomic transition in organization and payment models, which traditionally has not been a focus of formal teaching. A 2008 survey conducted by the Council of State Neurosurgical Societies found that graduating residents felt inadequately prepared in areas like contract negotiation, practice evaluation, and management.
Morbidity and Mortality Associated with Surgery of Traumatic C2 Fractures in Octogenarians
Authors: Dhall Sanjay S. , Yue John K. , Winkler Ethan A. , Mummaneni Praveen V. , Manley Geoffrey T. , Tarapore Phiroz E.
Published: March 2017

BACKGROUND: Management of axis fractures in the elderly remains controversial. As the US population increasingly lives past 80 years, published C2 fracture morbidity/mortality profiles in younger cohorts (55+) have become less applicable to octogenarians.

OBJECTIVE: To report associations between surgery and mortality, hospital length of stay and discharge disposition in octogenarians with traumatic C2 fractures.

METHODS: Retrospective cohort study of 3847 patients age ≥ 80 years representing 17 702 incidents nationwide, divided into surgery/nonsurgery cohorts, using the National Sample Program of the National Trauma Data Bank from 2003 to 2012. Inpatient complications, mortality, length of stay, and discharge disposition are characterized; multivariable regression was utilized to determine associations between surgery and outcomes.

Institutional Review Board (IRB): The National Sample Program dataset from the National Trauma Data Bank is fully deidentified and does not contain Health Insurance Portability and Accountability Act identifiers; therefore, this study is exempt from IRB review at the University of California, San Francisco.

RESULTS: Incidence of surgery was 10.3%. Surgery was associated with increased pneumonia, acute respiratory distress syndrome, and decubitus ulcer risks (P < .001). Inpatient mortality was 12.8% (nonsurgery—13.0%; surgery—10.3%; P = .120). Length of stay was 8.31 ± 9.32 days (nonsurgery 7.78 ± 9.21; surgery 12.86 ± 9.07; P < .001) and showed an adjusted mean increase of 5.68 days with surgery (95% confidence interval [4.74-6.61]). Of patients surviving to discharge, 26% returned home (nonsurgery—26.8%; surgery—18.8%; P = .001); surgery patients were less likely to return home (odds ratio 0.59 [0.44-0.78]).

CONCLUSION: The present study confirms that surgery of traumatic C2 fractures in octogenarians does not significantly affect inpatient mortality and increases discharge to institutionalized care. Patients undergoing surgery are more likely to require longer hospitalization and suffer increased medical complications during their stay. Given the retrospective nature of this study, it is unclear whether these conclusions reflect differences in injury severity between surgery cohorts. This question may be considered in a future prospective study.
Visual Deficit From Laser Interstitial Thermal Therapy for Temporal Lobe Epilepsy: Anatomical Considerations
Authors: Jermakowicz Walter J. , Ivan Michael E. , Cajigas Iahn , Ribot Ramses , Jusue-Torres Ignacio , Desai Mehul B. , Ruiz Armando , D’Haese Pierre-Francois , Kanner Andres M. , Jagid Jonathan R.
Published: March 2017

BACKGROUND: Laser interstitial thermal therapy (LITT) is quickly emerging as an effective surgical therapy for temporal lobe epilepsy (TLE). One of the most frequent complications of the procedure is postoperative visual field cuts, but the physiopathology of these deficits is unknown.

OBJECTIVE: To evaluate potential causes of visual deficits after LITT for TLE in an attempt to minimize this complication.

METHODS: This retrospective chart review compares the case of a 24-year-old male who developed homonymous hemianopsia following LITT for TLE to 17 prior patients who underwent the procedure and suffered no visual deficit. We examined both features of the surgical approach (trajectory, laser energy, ablation size) and of preoperative surgical anatomy, derived from volumetric tracings of mesiotemporal structures.

RESULTS: For the patient with postoperative homonymous hemianopsia imaging suggested inadvertent ablation of the lateral geniculate nucleus, although the laser was positioned entirely within the hippocampus. This patient's laser trajectory, ablation number, energy delivered, and ablation size were not significantly different from the prior patients. However, the subject with the visual deficit did have significantly smaller choroidal fissure cerebrospinal fluid volume.

CONCLUSION: Visual deficits are the most common complication of LITT for mesiotemporal epilepsy and patients at most risk may have small cerebrospinal fluid volume in the choroidal fissure, allowing heat to spread from the hippocampal body to the lateral geniculate nucleus. When such anatomy is identified on preoperative magnetic resonance imaging, we recommend lowering laser trajectory, decreasing ablation power through the hippocampal body, and using temperature safety markers at the lower thalamic border.
Fathers' Needs and Masculinity Dilemmas in a Neonatal Intensive Care Unit in Denmark
Authors: Noergaard Betty , Ammentorp Jette , Fenger-Gron Jesper , Kofoed Poul-Erik , Johannessen Helle , Thibeau Shelley
Published: March 2017

Background:

Most healthcare professionals in neonatal intensive care units typically focus on the infants and mothers; fathers often feel powerless and find it difficult to establish a father-child relationship. In family-centered healthcare settings, exploring fathers' experiences and needs is important because men's roles in society, especially as fathers, are changing.

Purpose:

To describe fathers' needs when their infants are admitted to a neonatal intensive care unit and to discuss these needs within a theoretical framework of masculinity to advance understanding and generate meaningful knowledge for clinical practices.

Methods:

This qualitative study used participant observation, interviews, multiple sequential interviews, and a focus group discussion. Data were analyzed using grounded theory principles.

Results:

Analysis of the fathers' needs generated 2 primary themes: (1) Fathers as caregivers and breadwinners and (2) fathers and emotions. Fathers wished to be involved and to take care of their infants but have to balance cultural and social norms and expectations of being breadwinners with their wishes to be equal coparents.

Implications for Practice/Research:

Health professionals in neonatal intensive care units must be aware of fathers' need and desire to be equal coparents. Nurses should play a key role by, for example, showing that fathers are as important to their infants as are the mothers, helping them become involved in childcare, and ensuring that they are directly informed about their children's progress. Further research in other cultural settings would contribute to knowledge regarding fatherhood and the role of fathers in childcare.
Burden of Hearing Loss on Communication Partners and Its Influence on Pursuit of Hearing Evaluation
Authors: Schulz Kristine A. , Modeste Naomi , Lee Jerry W. , Roberts Rhonda , Saunders Gabrielle H. , Witsell David L.
Published: March 2017

Objective:

Describe how the burden on the communication partner (CP) from the patient’s hearing loss, as perceived by both the patient and their CP, influences a patient’s pursuit of hearing evaluation.

Design:

Cross-sectional design. Demographics, perception of patient’s hearing loss, and associated burden on the CP were collected from both patient and CP via online questionnaires. Patients and their CPs from Duke University Medical Center Otolaryngology Clinic, 55 to 75 years of age, being seen for any reason, who indicated a CP has expressed concern about their hearing. Final sample was 245 matched pairs.

Results:

Based on completed questionnaires, on average, patients perceived their own hearing loss as more burdensome to the CP than the CP did. However, CPs of patients who believed themselves to have no hearing handicap scored the patient’s hearing loss 54.3% higher than the patient. The patient’s perspective about the amount of burden their hearing loss placed on the CP predicted patients seeking a hearing evaluation.

Conclusions:

Recognition of early stage hearing loss and associated burden on CPs may be delayed in patients; CPs may help elucidate unrecognized concerns. Educational approaches that raise awareness of burden of hearing loss on CPs along with hearing loss indications could be a feasible, multidimensional strategy to promote help seeking behaviors.
Infants’ and Adults’ Use of Temporal Cues in Consonant Discrimination
Authors: Cabrera Laurianne , Werner Lynne
Published: March 2017

Objectives:

Adults can use slow temporal envelope cues, or amplitude modulation (AM), to identify speech sounds in quiet. Faster AM cues and the temporal fine structure, or frequency modulation (FM), play a more important role in noise. This study assessed whether fast and slow temporal modulation cues play a similar role in infants’ speech perception by comparing the ability of normal-hearing 3-month-olds and adults to use slow temporal envelope cues in discriminating consonants contrasts.

Design:

English consonant–vowel syllables differing in voicing or place of articulation were processed by 2 tone-excited vocoders to replace the original FM cues with pure tones in 32 frequency bands. AM cues were extracted in each frequency band with 2 different cutoff frequencies, 256 or 8 Hz. Discrimination was assessed for infants and adults using an observer-based testing method, in quiet or in a speech-shaped noise.

Results:

For infants, the effect of eliminating fast AM cues was the same in quiet and in noise: a high proportion of infants discriminated when both fast and slow AM cues were available, but less than half of the infants also discriminated when only slow AM cues were preserved. For adults, the effect of eliminating fast AM cues was greater in noise than in quiet: All adults discriminated in quiet whether or not fast AM cues were available, but in noise eliminating fast AM cues reduced the percentage of adults reaching criterion from 71 to 21%.

Conclusions:

In quiet, infants seem to depend on fast AM cues more than adults do. In noise, adults seem to depend on FM cues to a greater extent than infants do. However, infants and adults are similarly affected by a loss of fast AM cues in noise. Experience with the native language seems to change the relative importance of different acoustic cues for speech perception.
Correlative Analysis of Vertebral Trabecular Bone Microarchitecture and Mechanical Properties
Authors: Guenoun Daphne , Fouré Alexandre , Pithioux Martine , Guis Sandrine , Le Corroller Thomas , Mattei Jean-Pierre , Pauly Vanessa , Guye Maxime , Bernard Monique , Chabrand Patrick , Champsaur Pierre , Bendahan David
Published: March 2017

Study Design.

High-resolution imaging and biomechanical investigation of ex-vivo vertebrae.

Objective.

The aim of this study was to assess bone microarchitecture of cadaveric vertebrae using ultra-high field (UHF) 7 Tesla magnetic resonance imaging (MRI) and to determine whether the corresponding microarchitecture parameters were related to bone mineral density (BMD) and bone strength assessed by dual-energy x-ray absorptiometry (DXA) and mechanical compression tests.

Summary of Background Data.

Limitations of DXA for the assessment of bone fragility and osteoporosis have been recognized and criteria of microarchitecture alteration have been included in the definition of osteoporosis. Although vertebral fracture is the most common osteoporotic fracture, no study has assessed directly vertebral trabecular bone microarchitecture.

Methods.

BMD of 24 vertebrae (L2, L3, L4) from eight cadavers was investigated using DXA. The bone volume fraction (BVF), trabecular thickness (Tb.Th), and trabecular spacing (Tb.Sp) of each vertebra were quantified using UHF MRI. Measurements were performed by two operators to characterize the inter-rater reliability. The whole set of specimens underwent mechanical compression tests to failure and the corresponding failure stress was calculated.

Results.

The inter-rater reliability for bone microarchitecture parameters was good with intraclass correlation coefficients ranging from 0.82 to 0.94. Failure load and stress were significantly correlated with BVF, Tb.Sp, and BMD (P < 0.05). Tb.Th was only correlated with the failure stress (P < 0.05). Multiple regression analysis demonstrated that the combination of BVF and BMD improved the prediction of the failure stress from an adjusted R
2 = 0.384 for BMD alone to an adjusted R
2 = 0.414.

Conclusion.

We demonstrated for the first time that the vertebral bone microarchitecture assessed with UHF MRI was significantly correlated with biomechanical parameters. Our data suggest that the multimodal assessment of BMD and trabecular bone microarchitecture with UHF MRI provides additional information on the risk of vertebral bone fracture and might be of interest for the future investigation of selected osteoporotic patients.

Level of Evidence: N /A
Role of Cx43-Mediated NFкB Signaling Pathway in Ossification of Posterior Longitudinal Ligament
Authors: Chen Dechun , Chen Yu , Li Tiefeng , Shi Lei , Pan Mengxiao , Chen Deyu
Published: March 2017

Study Design.

In vivo and in vitro experiments.

Objective.

To illustrate the further molecular mechanism of Cx43-mediated osteoblastic differentiation of ligament cells.

Summary of Background Data.

Ossification of the posterior longitudinal ligament (OPLL) is one of the main causes of myelopathy in Asians, but its etiology has not been clarified. We have previously found the mechanical stress can upregulate Cx43 expression in ligament cells, which transduces mechanical signal to promote osteoblastic differentiation.

Methods.

The posterior longitudinal ligaments were collected intraoperatively. Ligament fibroblasts were isolated and cultured, and an in vitro mechanical loading model was established. In vivo and in vitro expression levels of Cx43 protein were compared between OPLL and non-OPLL patients. The activation of nuclear factor (NF)-κB (p65) signal and related inflammatory responses were detected in ligament cells under mechanical loading. The mechanical stress-induced inflammatory response and osteoblastic differentiation of OPLL cells were investigated after the treatment with Cx43 siRNA or NFкB (p65) inhibitor.

Results.

We first confirmed higher Cx43 levels in both in vivo ligament tissue from OPLL patients and in vitro cultured OPLL cells. We also found NFκB (p65) signal and related inflammatory response were activated by mechanical stimulation. The activation of NFκB (p65) signal was dependent upon Cx43, as its knockdown reduced signal. Moreover, treatment with Cx43 siRNA or NFкB (p65) inhibitor significantly decreased the mechanical-induced inflammation response, but partly attenuated mechanical-stimulated osteoblastic differentiation of OPLL cells.

Conclusion.

Cx43-mediated NFкB (p65) signal played an important role in mechanical stress-induced OPLL by transduction of mechanical signal, while giving rise to the activation of inflammatory response in ligament fibroblasts

Level of Evidence: N/A
Weight Gain After Vertical Expandable Prosthetic Titanium Rib Surgery May Be From Nutritional Optimization Rather Than Improvement in Pulmonary Function
Authors: Li Ying , Shlykov Maksim A. , Robbins Christopher B. , Farley Frances A. , Caird Michelle S. , Burke Michelle C.
Published: March 2017

Study Design.

Prospective comparative study.

Objective.

To evaluate whether weight percentile (WP) increases after vertical expandable prosthetic titanium rib (VEPTR) insertion, and whether WP correlates with nutrition laboratories and pulmonary function.

Summary of Background Data.

Children with thoracic insufficiency syndrome often have “failure to thrive” (WP ≤5). Previous authors have reported an increase in WP after VEPTR surgery. Weight gain was hypothesized to be secondary to improved pulmonary function. The presence of a correlation between WP and nutrition laboratories and pulmonary function tests (PFT) after VEPTR insertion has not been studied.

Methods.

Demographic, nutrition, radiographic, and PFT data were collected on 35 VEPTR patients with a minimum follow-up of 2 years. The relationship between WP and nutrition laboratories and pulmonary function was analyzed.

Results.

Preoperative WP was ≤5 (PREOP≤5) in 13 patients (37%) and >5 (PREOP>5) in 22 patients (63%). Although all children gained weight, the PREOP≤5 group was more likely to have an increase in WP (P = 0.014). Sixty-eight percent of the PREOP>5 group had a decrease in WP and 32% of the PREOP>5 patients met the criteria for failure to thrive at final follow-up. Overall, there was no change in the number of children with a WP ≤5 (13 vs. 15). Forty-two percent of the children who maintained or increased their WP had a gastrostomy tube, compared to 19% of those who decreased their WP. Seventy-three percent of the patients with failure to thrive at final follow-up did not have a gastrostomy tube. No significant correlations were found between WP and nutrition laboratories, radiographic measures, or PFTs.

Conclusion.

We did not find an overall change in WP after VEPTR insertion. We did not find any correlation between WP and nutrition laboratories or pulmonary function. Weight gain after VEPTR surgery may be secondary to nutritional optimization in high-risk patients. Children who do not have failure to thrive at presentation also require attention.

Level of Evidence: 2
Drivers of Medicare Reimbursement for Thoracolumbar Fusion
Authors: Khanna Krishn , Padegimas Eric M. , Zmistowski Benjamin , Howley Michael , Verma Kushagra
Published: March 2017

Study Design.

A retrospective observational study.

Objective.

The purpose of this study is to examine the variation in thoracolumbar fusion (TLF) payment and determine the drivers of this variation.

Summary of Background Data.

As health care spending continues to increase, variation in surgical procedures reimbursements has come under more scrutiny. TLF is an example of a high-cost, proven-benefit procedure that is often the focus of Centers for Medicare and Medicaid Services (CMS) administrators. There is a wide variation in TLF charges, but the drivers for this variation are not clear.

Methods.

Claims for TLF were identified in the CMS data by analyzing Diagnosis Related Group (DRG) number 460 (“Spinal Fusion Except Cervical without Major Complications or Comorbidities”). Data on factors that may impact cost of care were collected from four sources: the United States Census Bureau, CMS, the Dartmouth Atlas, and WWAMI Rural Health Research Center. These were then grouped into seven categories: quality, supply, demand, substitute treatment availability, patient characteristics, competitive factors, and provider characteristics. Predictive reimbursement models were created from the data using multivariate linear regression to understand the factors that influence TLF reimbursement.

Results.

There was significant geographic variability in reimbursement. The largest contribution to reimbursement variation came from variables in the demand (ΔR

2
 
= 13.4%, P < 0.001), supply (ΔR

2
 
= 9.2%, P < 0.001), and competitive factor domains (ΔR

2
 
= 9.1%, P < 0.001). The top three drivers that increased reimbursement were provider charges (β = 0.37, P < 0.001), total Medicare reimbursement in the region (β = 0.19, P < 0.001), and the number of spinal surgeries per 1000 patients in that region (β = 0.06, P = 0.02). Institutional volume, a surrogate for quality was negatively associated with TLF reimbursement.

Conclusion.

There was wide variation in reimbursement for TLF across the U.S. The variables that drive TLF reimbursement variation include supply, demand, and competition. Interestingly, quality of care was not associated with increased TLF reimbursement.

Level of Evidence: N/A
Chronic Boutonniere Deformities, Supple, or Stiff: A New Surgical Technique With Early Mobilization in 11 Cases
Authors: Dubois Elodie , Teboul Frederic , Bihel Thomas , Goubier Jean-N.
Published: March 2017

Injuries to the central slip of the extensor mechanism can lead to a Boutonniere deformity with important functional consequences. We report a series of 11 patients treated by lengthening-dorsalizing the lateral bands and tightening the central slip with early mobilization. The average age of the patients was 42 years (14;52). The extension defect of the proximal interphalangeal (PIP) joint was 64 degrees (80;55) and the hyperextension of the distal interphalangeal joint was 10 degrees (15;5). The surgery was performed with peripheral nerve block (sensitive), allowing dynamic adjustment of the tendinous sutures. With a dorsal incision, a tenolysis of the extensor was performed. The central slip was tightened and the lateral bands dorsalized by cross-stitches over the PIP joint. The active flexion/extension was tested, and then lengthening of the lateral bands by “mesh graft” tenotomy was performed over the second phalange. There was no immobilization. The deformity was improved in 10 patients with a total flexion of the finger. The mean lack of extension in the PIP was 8 degrees (0;20) and the active flexion of the distal interphalangeal joint was 80 degrees (70;85). There was 1 failure. The majority of techniques necessitate an immobilization of 3 to 6 weeks. Our procedure uses the elastic properties of the elongation and allows immediate mobilization. The result can be compromised in case of insufficient tendinous surface or if postoperative instructions are not followed.
Using Selective Serotonin Reuptake Inhibitors and Serotonin-Norepinephrine Reuptake Inhibitors in Critical Care: A Systematic Review of the Evidence for Benefit or Harm*
Authors: Kelly John M. , Rubenfeld Gordon D. , Masson Neil , Min Arimie , Adhikari Neill K. J.
Published: March 2017

Objective:

Selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitors are among the most commonly prescribed drugs in patients admitted to the ICU. Our objective was to systematically review available literature for evidence of benefit or harm in ICU patients resulting from chronic effects, continued use, or withdrawal.

Data Sources:

Medline, Embase, and Cochrane Central Register of Controlled Trials (1990 to November 2014).

Study Selection:

We searched for studies of ICU patients with recorded selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor prescription before or during admission, and reporting morbidity, mortality, adverse events, and resource measures like ICU length of stay. We considered all study designs. We excluded studies of deliberate overdose and depression in non-ICU settings. Two authors independently and in duplicate screened citations and reviewed text of studies to apply selection criteria.

Data Extraction:

Two authors abstracted data on patient characteristics in exposed and control groups; use of selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitors previously or during ICU; comparator intervention; and outcomes, and also assessed methodologic quality.

Data Synthesis:

The database search retrieved 4,172 unique citations, of which 289 were reviewed, and 13 studies representing a total of 20,048 patients met selection criteria. There were five cohort studies, one case series, and seven case reports. Only one case report suggested benefit from selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor use and 11 studies reported morbidity in patients using these medications at admission to ICU. However, due to inadequate drug administration reporting, it was generally unclear if outpatient selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitors were continued in ICU, complicating interpretation.

Conclusions:

There may be excess morbidity in critically ill selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor users, but uncertainty remains whether this is due to chronic effects, ongoing use, or drug withdrawal. Further research with improved standards of drug administration reporting is needed to help clinicians decide when to use selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitors in critically ill patients.
Axillary Ultrasound Fine Needle Aspiration Biopsy
Authors: Pesek Sarah E. , King Heather M. , Koelliker Susan , Raker Christina , Edmonson David , Dizon Don S. , Gass Jennifer
Published: March 2017

Objectives:

Axillary ultrasound with fine needle aspiration (AXUSFNA) in early-stage breast cancer has required reappraisal. ACOSOG Z-0011 and after mapping of the axilla: radiotherapy or surgery have shown that women with limited nodal disease at sentinel lymph node biopsy got no survival advantage with completion axillary node dissection. We hypothesize that AXUSFNA may be sufficiently accurate for staging for some patients and sentinel lymph node biopsy need not be performed. We define the false negative rate (FNR) of AXUSFNA in different subsets of patients.

Materials and Methods:

This retrospective cohort study included node positive patients who also underwent AXUSFNA between 1/2006 and 12/2010 followed by axillary surgery. The FNR was calculated for the entire group and for subgroups determined by tumor, nodal, and ultrasound findings.

Results:

Out of ∼700 AXUSFNA patients, 128 node positive patients were included in the study. The overall AXUSFNA FNR was 35.9% (95% confidence interval, 28.1%-44.6%). There was a significantly higher FNR with smaller tumors and presence of ductal carcinoma in situ on multivariate analysis. On ultrasound, benign-appearing nodes had a higher FNR than indeterminate nodes (78.9% vs. 60.9%, P=0.2) and significantly higher than suspicious nodes (78.9% vs. 2.9%, P<0.0001).

Conclusions:

In our cohort, the FNR for AXUSFNA was comparable with the rate of residual disease in the control arms of Z-0011 (27.4%) and after mapping of the axilla: radiotherapy or surgery (33%). However, our analysis suggests that we may be able to identify more appropriate patients for AXUSFNA and halve the FNR. As primary tumor characteristics and genomics drive systemic therapeutic recommendations, there may be an ongoing role for AXUSFNA in axillary staging.