bluuebunny/crossref_metadata_2025 huggingface dataset:
Hidden Nambu mechanics II: Quantum/semiclassical dynamics
Authors: Horikoshi Atsushi
Published: November 2019

Nambu mechanics is a generalized Hamiltonian dynamics characterized by an extended phase space and multiple Hamiltonians. In a previous paper [Prog. Theor. Exp. Phys. 2013, 073A01 (2013)] we revealed that the Nambu mechanical structure is hidden in Hamiltonian dynamics, that is, the classical time evolution of variables including redundant degrees of freedom can be formulated as Nambu mechanics. In the present paper we show that the Nambu mechanical structure is also hidden in some quantum or semiclassical dynamics, that is, in some cases the quantum or semiclassical time evolution of expectation values of quantum mechanical operators, including composite operators, can be formulated as Nambu mechanics. We present a procedure to find hidden Nambu structures in quantum/semiclassical systems of one degree of freedom, and give two examples: the exact quantum dynamics of a harmonic oscillator, and semiclassical wave packet dynamics. Our formalism can be extended to many-degrees-of-freedom systems; however, there is a serious difficulty in this case due to interactions between degrees of freedom. To illustrate our formalism we present two sets of numerical results on semiclassical dynamics: from a one-dimensional metastable potential model and a simplified Henon–Heiles model of two interacting oscillators.
A Review of Techniques, Time Demand, Radiation Exposure, and Outcomes of Skin-anchored Intraoperative 3D Navigation in Minimally Invasive Lumbar Spinal Surgery
Authors: Vaishnav Avani S. , Merrill Robert K. , Sandhu Harvinder , McAnany Steven J. , Iyer Sravisht , Gang Catherine Himo , Albert Todd J. , Qureshi Sheeraz A.
Published: November 2019

Study Design.

Retrospective cohort.

Objective.

To describe our technique for and evaluate the time demand, radiation exposure and outcomes of skin-anchored intraoperative three-dimensional navigation (ION) in minimally invasive (MIS) lumbar surgery, and to compare these parameters to 2D fluoroscopy for MI-TLIF.

Summary of Background Data.

Limited visualization of anatomic landmarks and narrow access corridor in MIS procedures result in greater reliance on image guidance. Although two-dimensional fluoroscopy has historically been used, ION is gaining traction.

Methods.

Patients who underwent MIS lumbar microdiscectomy, laminectomy, or MI-TLIF using skin-anchored ION and MI-TLIF by the same surgeon using 2D fluoroscopy were selected. Operative variables, radiation exposure, and short-term outcomes of all procedures were summarized. Time-demand and radiation exposure of fluoroscopy and ION for MI-TLIF were compared.

Results.

Of the 326 patients included, 232 were in the ION cohort (92 microdiscectomies, 65 laminectomies, and 75 MI-TLIFs) and 94 in the MI-TLIF using 2D fluoroscopy cohort. Time for ION setup and image acquisition was a median of 22 to 24 minutes. Total fluoroscopy time was a median of 10 seconds for microdiscectomy, 9 for laminectomy, and 26 for MI-TLIF. Radiation dose was a median of 15.2 mGy for microdiscectomy, 16.6 for laminectomy, and 44.6 for MI-TLIF, of this, 93%, 95%, and 37% for microdiscectomy, laminectomy, and MI-TLIF, respectively were for ION image acquisition, with the rest attributable to the procedure. There were no wrong-level surgeries. Compared with fluoroscopy, ION for MI-TLIF resulted in lower operative times (92 vs. 108 min, P < 0.0001), fluoroscopy time (26 vs. 144 s, P < 0.0001), and radiation dose (44.6 vs. 63.1 mGy, P = 0.002), with equivalent time-demand and length of stay. ION lowered the radiation dose by 29% for patients and 55% for operating room personnel.

Conclusion.

Skin-anchored ION does not increase time-demand compared with fluoroscopy, is feasible, safe and accurate, and results in low radiation exposure.

Level of Evidence: 3.
Risk Factors for Postsurgical Foot Complaints One Year Following Degenerative Lumbar Spinal Surgery
Authors: Jang Hae-Dong , Lee Jae Chul , Choi Sung-Woo , Shin Byung-Joon
Published: November 2019

Mini

Postsurgical foot complaints occurred frequently in 853 degenerative lumbar surgeries (prevalence, 20.6%; n = 176). Risk factor analysis showed that the incidence of postsurgical foot complaint was significantly higher in patients with preoperative foot symptoms (adjusted odds ratio, 5.532) and in those with preoperative sensory deficits on the leg (adjusted odds ratio, 1.904).

Study Design.

Retrospective.

Objective.

To investigate the prevalence and risk factors of postsurgical foot complaints (PFCs) following spinal surgery by using a modified pain drawing (PD) instrument.

Summary of Background Data.

Although many patients report nonspecific foot symptoms with various clinical presentation, there is not a well defined diagnostic criterion. PDs are essential for measuring spinal surgery outcomes. We created a modified patient-physician communication-based PD instrument to overcome the limitations of the previous system.

Methods.

We included 853 consecutive patients who underwent decompression with or without fusion. PFCs were defined as sensory foot symptoms, including ambiguous sensations that were not clearly due to spinal pathology. Patients who complained of postoperative foot symptoms at more than two consecutive visits were assigned to the PFC group. The remaining patients were assigned to the asymptomatic group. We collected medical records using our PD instrument and compared variables between the two groups.

Results.

In total, 176 (20.6%) of the 853 patients had PFCs. The duration of preoperative leg pain was significantly longer in the PFC group than in the asymptomatic group (2.8 vs. 2.2 years; P = 0.048). The proportions of preoperative foot symptoms (82.9% vs. 43.3%) and sensory deficits on the leg (48.6% vs. 27%) were significantly greater in the PFC group than in the asymptomatic group (P < 0.001). Multivariable logistic regression analysis revealed two independent risk factors: the presence of preoperative foot symptoms (adjusted odds ratio, 5.532) and preoperative sensory deficits on the leg (adjusted odds ratio, 1.904).

Conclusion.

PFCs occurred frequently after degenerative lumbar spinal surgery (prevalence, 20.6%). Based on our data using PD instrument, it can help reduce the incidence of PFCs if patients are informed and educated that preoperatively existing foot symptom and sensory deficits on the leg are significant risk factors for PFC development.

Level of Evidence: 4
Acetylsalicylic acid and its metabolite gentisic acid may act as adjunctive agents in the treatment of psychiatric disorders
Authors: Altinoz Meric A. , Ozpinar Aysel
Published: November 2019

Neuropsychiatric disorders place a very high burden on the global health and economy. The efficacies of currently available drugs in the psychiatric armamentarium are suboptimal and almost all of them target several neurotransmitter pathways. But it is more and more recognized that the neuroinflammation and associated oxidative pathways are important players in the etiopathogenesis of psychiatric disorders. In parallel to this new concept, recent investigations indicate that adjunction of acetylsalicylic acid (ASA) to the orthodox psychiatric treatments augments therapeutic efficacy in bipolar disorder and schizophrenia. Gentisic acid is a redox active quinonoid ASA metabolite and an endogenously produced siderophore with much more potent antioxidant effects than its parent compound. Moreover, it harbours molecular features that provide its selective conversion to even more potent anti-inflammatory quinonoid molecules within the inflammatory micromilieu. We believe that ASA alone and its combination with gentisic acid should be studied in animal models of psychiatric disorders to reveal their potential in regard to the augmentation of currently available treatments. If several animal studies prove their potential, clinical trials could easily be conducted, as both ASA and gentisic acid have a relatively high biosafety and a long history of clinical use.
A Standardized Approach to Deep Inferior Epigastric Perforator Flap Marking
Authors: Xue Erica Y. , Cen Nicholas , Reece Edward , Chu Carrie K. , Winocour Sebastian
Published: November 2019

The deep inferior epigastric perforator (DIEP) flap is the most commonly utilized flap in autologous breast reconstruction. This perforator-based free flap includes the lower abdominal wall adipocutaneous layers while sparing the abdominal musculature. Several studies have looked at preoperative planning for DIEP flap reconstruction using CT angiography; however, no study to date has proposed a standardized approach to DIEP flap markings. We propose a novel technique to standardize DIEP flap marking that leads to greater symmetry and consistency in the donor site.
Nurse practitioner interventions for smokers with chronic hepatitis C
Authors: Reid Carol , Fenech Mary , Jones Lee , Salehi Nasim
Published: November 2019

Background:

Smoking is a grossly overlooked risk factor for people with chronic hepatitis C with regard to disease progression. It is unclear whether current smoking cessation interventions are effective for this population.

Purpose:

The purpose was to evaluate the effectiveness of a telephone counseling and nicotine replacement therapy (NRT) intervention for smokers with chronic hepatitis C to quit or reduce rates of smoking.

Methods:

A randomized controlled trial was conducted with participants randomized and stratified according to heaviness of smoking. Ninety-two eligible adults who smoked cigarettes and attended hepatology outpatient clinics were recruited. The intervention included NRT and telephone counseling compared with telephone counseling alone. Data collection occurred from December 2010 to November 2011. Data were collected at baseline, 6, and 12 weeks to assess smoking cessation. Change scores were analyzed using analysis of variance to examine the differences between smoking interventions.

Results:

At 6 weeks, both control and intervention groups had quit or reduced the number of cigarettes smoked daily. However, over 12 weeks, the intervention group showed sustained quitting or reduced smoking, with 5.8 (confidence interval [CI]: 2.4, 9.3) fewer cigarettes smoked per day from baseline. The control group maintained an average reduction of 1.6 (CI: −1.9, 5.2) fewer cigarettes per day.

Implications for practice:

Nicotine replacement therapy and individualized telephone counseling interventions increase the prospects of smoking cessation. Interventions such as these, introduced at routine clinic appointments in the outpatients' setting, by a nurse practitioner (hepatology) showed clinically important results for smoking cessation in this population.
APRISMA-compliant systematic review and meta-analysis determining the association of miRNA polymorphisms and risk of congenital heart disease
Authors: Li Xing-Yan , Chen Kun , Lv Zheng-Tao
Published: November 2019

Purpose:

Recent genetic association studies showed conflicting results on the relationship of miRNA single-nucleotide polymorphisms (SNPs) and congenital heart disease (CHD) risk. The purpose of the present systematic review was to collect the current available evidences to evaluate the association between miRNA polymorphisms and CHD risk.

Methods:

Four electronic databases including PubMed, EMBASE, ISI Web of Science, and CENTRAL were extensively searched for relevant studies published before February, 2019. Observational studies determining the association between miRNA polymorphisms and risk of CHD were included. Risk of bias was evaluated using the Newcastle-Ottawa Scale by 2 independent researchers. Major characteristics of each study and estimation of effect size of individual locus polymorphism were summarized. In addition, meta-analysis was performed to quantify the associations between miRNA polymorphisms and CHD risk.

Results:

Nine studies containing 6502 CHD patients and 6969 healthy controls were included in this systematic review. Ten loci in 9 miRNAs were reported. Only rs11614913 in miR-196a2 was determined to have significant associations with CHD susceptibility, which was supported by meta-analysis (CC vs CT+TT: odds ratio 1.54, 95% confidence interval 1.30, 1.82; P < .00001). A strong evidence indicated lack of association between rs2910164 in miR-146a and CHD. Limited or conflicting evidences were found for the associations of the other variants (rs11134527, rs139365823, rs76987351, rs3746444, rs4938723, rs2292832, rs41291957, rs895819) and risk of CHD.

Conclusions:

Locus polymorphisms in miRNAs are not generally associated with CHD. Only rs11614913 was found to have significant associations with CHD. Further studies will be needed, using larger populations of different ethnicities, to obtain a better understanding of these associations.
Effectiveness and safety of acupuncture for insomnia
Authors: Zhang Mingming , Zhao Jingwei , Li Xiao , Chen Xinwang , Xie Jin , Meng Lingyan , Gao Xiyan
Published: November 2019

Background:

Insomnia is one of the most common diseases in modern society, the main characteristics of the patients were difficulty in falling asleep at night and/or failure to maintain effective sleep after falling asleep. It can lead to early awakening, short sleep, heavy sleeplessness, dreaming, poor sleep quality, and working hours after waking up, causes a series of negative emotions, such as fatigue, inefficiency, cognitive decline, social interaction, tension, and anxiety, which affect social harmony and stability. So Insomnia has gained more and more attention. At present, acupuncture has been proved effective in the treatment of insomnia by many studies. The purpose of this study is to evaluate the efficacy and safety of acupuncture in the treatment of insomnia, and to provide the latest evidence for clinical application.

Methods and analysis:

We collected the qualified literature on acupuncture treatment of insomnia by electronic retrieval of Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biomedical Disc (CBMDISC), PubMed, China Science and Technology Journal Database (VIP) and Wanfang Database, and manual retrieval of papers and internal reports. We will select the eligible studies published up to September 30, 2019. We use Insomnia Severity Index (ISI) as the main outcome of insomnia and Pittsburgh Sleep Quality Index (PSQI), Hamilton Depression Scale(HAMD) and Self-Rating Anxiety Scale (SAS) as secondary indicators to evaluate the efficacy and safety of acupuncture treatment of insomnia, we will use Revman v.5.3 software to calculate data synthesis, and if the results are appropriate, meta-analysis can also be carried out.

Results:

This study will provide comprehensive evidence of high quality of acupuncture treatment for insomnia from ISI, PSQI, HAMD, SAS, and adverse reactions.

Conclusion:

The systematic review will provide a basis for evaluating the efficacy and safety of acupuncture in the treatment of insomnia.

Trial registration number:

PROSPERO CRD42019131957.
Botulinum toxin injection for internal anal sphincter achalasia after pull-through surgery in Hirschsprung disease
Authors: Youn Joong Kee , Han Ji-Won , Oh Chaeyoun , Kim So-Young , Jung Sung-Eun , Kim Hyun-Young
Published: November 2019

Botulinum toxin (Botox) was introduced for the management of internal anal sphincter (IAS) achalasia after a pull-through procedure in Hirschsprung disease (HD). We conducted a prospective evaluation of the efficacy and safety of this Botox treatment.

Our study group included 15 patients with HD (median age, 4.8 years; range, 1.7–7.4 years) who experienced persistent constipation after pull-through surgery. Rectal biopsy and colon study were performed before Botox injection to exclude agangliosis. Intersphincteric Botox injections (dose, 4 IU/kg) were performed at 3 sites, (3, 6, and 9 o’clock) under general anesthesia. Measured outcomes of efficacy included anorectal manometry, Wexner constipation score and the quality of life score for defecation, measured at baseline and at 2 weeks and 3 months after injection. The Holschneider incontinence score and an assessment of pain, bleeding, heating sensation, and swelling were also performed at follow-up as outcomes of safety.

There was no significant change in measured outcomes with Botox treatment. Botox did decrease the number of patients who experienced abdominal distension at 3 months, compared to 2-weeks, post-injection. No major complications were identified, with only 2 cases of anal bleeding that resolved spontaneously. Local tenderness at the injection site was reported by 4 patients, recovering without treatment.

The efficacy of Botox, injected into the IAS, for the treatment of achalasia is questionable on short-term follow-up. Larger studies with a longer follow-up period and the use of repeated injections are required to evaluate the evidence for this treatment.
Effects of rhythmic auditory cueing on stepping in place in patients with Parkinson's disease
Authors: Chang Hsiu-Yun , Lee Ya-Yun , Wu Ruey-Meei , Yang Yea-Ru , Luh Jer-Junn
Published: November 2019

Background:

Stepping in place (SIP) is a useful locomotor training intervention. The purpose of this study was to investigate the effects of single auditory-cued SIP training on cortical excitability, rhythmic movements and walking ability in patients with Parkinson's disease

(PD).

Methods:

Cross-over randomized control trial. Each participant completed two interventions with at least one-week washout period in between: (1) SIP with concurrent auditory cues (AC condition) and (2) SIP without auditory cues (NC condition).

Results:

In the primary outcome, the cortical silent period (CSP) duration increased (P = .005), whereas short intracortical inhibition (SICI) decreased after training (P = .001). Freezers demonstrated enhanced inhibition in the resting motor threshold and CSP duration. SICI and intracortical facilitation were modulated in both groups under the AC condition. In the secondary outcomes, the stepping variability decreased significantly (AC: P = .033; NC: P = .009), whereas walking cadence increased after training (AC: P = .019; NC: P = .0023).

Conclusions:

Auditory-cued SIP training improved the lower-limb movement variability and modulated the cortical excitability in patients with PD. Freezers may benefit more from this training than nonfreezers.
Utility of hepatic vein waveform and transient elastography in patients with Budd–Chiari syndrome who require angioplasty
Authors: Nakatsuka Takuma , Soroida Yoko , Nakagawa Hayato , Okura Naoki , Sato Jiro , Akahane Masaaki , Sato Masaya , Yatomi Yutaka , Abe Osamu , Tateishi Ryosuke , Koike Kazuhiko
Published: November 2019

Rationale:

Budd–Chiari syndrome (BCS), which causes congestive hepatopathy and aggravates cirrhosis, is typically treated by interventional angioplasty to ameliorate blood flow. X-ray venography is useful for the evaluation of inferior vena cava (IVC) stenosis and determination of treatment timing, but it is invasive and thus unsuitable for repeated examinations. The development of a simple method for the prediction of IVC stenosis would reduce the burden on patients with BCS.

Patient concerns:

We report here our experience of 2 patients with BCS who underwent percutaneous transluminal angioplasty (PTA). The first patient was a 39-year-old male who underwent PTA to expand his stenotic IVC. The second patient was a 19-year-old male who underwent PTA 3 times due to restenosis of his IVC.

Diagnoses:

Both patients were diagnosed with BCS with severe obstruction of the IVC.

Interventions:

We evaluated the hepatic vein (HV) waveform by Doppler ultrasonography and measured liver stiffness (LS) using transient elastography (TE) before and after PTA.

Outcomes:

In case 1, the phasic oscillation of the HV waveform recovered and the LS value decreased after PTA. Both improvements were maintained for ∼3 years, reflecting the long-term patency of the IVC. In case 2, the HV waveform and the LS value improved temporarily after PTA, but then deteriorated gradually. Monitoring of the HV waveform and LS value allowed retreatment prior to total occlusion of the IVC and abrogated the risk of intravascular needle puncture.

Lessons:

Monitoring of the HV waveform and the LS value enables safe management of patients with BCS who may require PTA.
Dysplasia epiphysealis hemimelica combined with contralateral accessory scaphoid bone
Authors: Li Bo , Wen Jie , Liu Hong , Xiao Sheng , Li Xin , Fang Ke , Zeng Ming , Tang Zhongwen , Cao Shu , Lee Bo , Li Fanling
Published: November 2019

Rationale:

Dysplasia epiphysealis hemimelica (DEH), also known as Trevor disease, is a rare, developmental bone disorder of childhood.

Patient concerns:

A 9-year-old girl was admitted due to pain in front of the medial malleolus of her right foot after a long walk or distance movement, in which the pain could be relieved after rest, while it was repeated and lasted for several months.

Diagnosis:

Dysplasia epiphysealis hemimelica

Interventions:

The patient underwent an open resection surgery. After operation, the pain was totally relieved. Postoperative pathological diagnosis showed DEH.

Outcomes:

At the 6-month follow-up, pain and claudication symptoms fully disappeared, and range of motion of the right foot returned to normal level.

Conclusions:

Dysplasia epiphysealis hemimelica is an uncommon disease which can cause pain of foot in children.

Lessons:

When the pediatric orthopedic surgeon treated the children suffered with foot pain should be aware of this rare disease, especially accessory scaphoid bone was found in another foot.
Careful dose modification of apatinib as third or further-line treatment in advanced gastric cancer patients with poor performance status
Authors: Chen Jianxin , Wang Junhui , Miao Qian
Published: November 2019

The retrospective study was conducted to evaluate the efficacy and safety of careful dose modification of apatinib as third or further-line treatment in advanced gastric cancer (aGC) patients with poor performance status (PS = 2 or 3).

Patients with aGC of poor PS who had received at least 2 lines of chemotherapy were treated with apatinib at a dose of 250 mg initially and best supportive care (BSC). During the whole treatment, the dose of apatinib was adjusted according to the status of PS (group treatment). Meanwhile, patients of poor PS (PS = 2 or 3) with aGC who received BSC alone after second or further-line treatment in the recent 5 years in our institution have been investigated for their median overall survival (mOS) as control. Kaplan–Meier curve was adopted for the description of OS in the 2 groups. Univariate analysis was conducted with log-rank test between OS and the potential characteristics including gender, age, PS status, primary tumor lesion, Her-2 status, and previous lines of treatment. Toxicities were assessed with the criteria of National Cancer Institute Common Toxicity Criteria (NCI CTC) version 4.0.

A total of 23 patients who received apatinib plus BSC treatment and 41 patients treated with BSC alone were reviewed in the present study. Median exposure time of apatinib was 2.4 months ranging from 0.2 to 5.1 months. The median OS in the group treatment was 4.3 months (95% CI, 2.735–5.865) comparing to the control as 2.1 months (95% CI, 1.473–2.727, P = .0004). In addition, PS status was shown as the only independently significant factor to influence the OS (P = .049). Fatigue (82.6%), appetite decrease (73.9%), and anemia (69.6%) appeared to be the most common adverse events at any grade during the therapy of apatinib.

The outcomes of the present study revealed that therapeutic model of careful dose modification of apatinib therapy initiated with low dose plus BSC as third or further-line treatment might be more beneficial on survival time comparing to BSC alone in patients with aGC of poor PS, however, as well as apparent adverse events.
Compound Kushen Injection for gastric cancer
Authors: Huang Zhihong , Wei Ping
Published: November 2019

Background and aims:

In recent years, the clinical research about Compound Kushen Injection (CKI) treatment of Gastric cancer (GC) has been increased, but the conclusion is different. The aim of our study is to objective comment the efficacy and adverse effects of CKI treatment of GC.

Methods:

We will retrieve the Randomized controlled trials from the following 6 electronic databases on their inception to April 2019: PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wangfang and Chinese Biomedical Literature Database. Study selection and data collection will be performed independently by 2 reviewers. Cochrane Risk of Bias tool will be used to assess the risk of bias of included studies. The outcomes included overall response rate, complete response rate, 3–year progression–free survival rate, 3–year overall survival rate, and different types of treatment–related adverse events. We calculated the risk ratios as well as their 95% confidence intervals of these outcomes and pooled the results using RevMan 5.2 software and Stata 14.0 software.

Results:

The results will be published in a peer-reviewed journal.

Conclusion:

The results of this review will be widely disseminated through peer-reviewed publications and conference presentations. This evidence may also provide helpful evidence for clinical practice and health policy-makers for the treatment of GC.

PROSPERO registration number:

CRD42019133770.
Very Long-Term Outcome of Community-Dwelling Patients With Schizophrenia Spectrum Disorders in Rural Greece
Authors: Peritogiannis Vaios , Grammeniati Aikaterini , Gogou Afroditi , Gioti Panagiota , Mavreas Venetsanos
Published: November 2019

The objective of the present study was to measure the very long-term outcome in community-dwelling patients with a diagnosis of psychosis and to search for possible correlations of outcome with clinical factors. The sample included 55 psychotic patients with at least 15 years of disease duration (M = 32.1 years). For the estimation of the outcome, the Health of the Nations Outcome Scale and the Clinical Global Impression Scale were used. A total of 34.5% of the patients had a good outcome, whereas 27.3% had poor outcome. Outcome was found to be correlated to symptoms, and it was significantly worse in patients living with other severely mentally ill family members. In our study, outcome was good in more than a third of patients. Both symptoms and social functioning were associated with outcome. This study may have some implications for mental healthcare delivery.
A National Survey on Physician Trainee Participation in Pediatric Interfacility Transport*
Authors: Herrup Elizabeth A. , Klein Bruce L. , Schuette Jennifer , Costabile Philomena M. , Noje Corina
Published: November 2019

Objectives:

To ascertain the national experience regarding which physician trainees are allowed to participate in pediatric interfacility transports and what is considered adequate education and training for physician trainees prior to participating in the transport of children.

Design:

Self-administered electronic survey.

Setting:

Pediatric transport teams listed with the American Academy of Pediatrics Section on Transport Medicine.

Subjects:

Leaders of U.S. pediatric transport teams.

Interventions:

None.

Measurements and Main Results:

Forty-four of the 90 U.S. teams surveyed (49%) responded. Thirty-nine (89%) were university hospital-affiliated. Most programs (26/43, 60%) allowed trainees to participate in pediatric transport in some capacity. Mandatory transport rotations were reported for pediatric critical care (PICU) fellows (9/42, 21%), neonatology (neonatal ICU) fellows (6/42, 14%), pediatric emergency medicine fellows (4/41, 10%), emergency medicine residents (3/43, 7%), and pediatric residents (2/43, 5%). Fellow participation was reported by 19 of 28 programs (68%) with PICU fellowships, 12 of 25 programs (48%) with pediatric emergency medicine fellowships, and 10 of 34 programs (29%) with neonatal ICU fellowships. Transport programs with greater than or equal to 1,000 annual incoming transports were more likely to include PICU and pediatric emergency medicine fellows as providers (p = 0.04; 95% CI, 1.04–25.71 and p = 0.02; 95% CI, 1.31–53.75). Most commonly, trainees functioned as medical control physicians (86%), provided minute-to-minute medical direction for critically ill patients (62%), performed intubations (52%), and were code leaders for patients undergoing cardiopulmonary resuscitation during transport (52%). Most transport programs required pediatric residents, PICU, and pediatric emergency medicine fellows to complete a PICU rotation prior to participating in pediatric transports. The majority of transport programs did not use any metrics to determine airway proficiency of physician trainees.

Conclusions:

There is heterogeneity with regard to the types of physician trainees allowed to participate in pediatric interfacility transports, the roles played by physician trainees during pediatric transport, and the training (or lack thereof) provided to physician trainees prior to their participating in pediatric transports.
Electrophysiological Changes After Human Muscle Tear
Authors: Hearn Sandra L. , Berri Hassen M. , Little Ann A. , Teener James W. , Richardson James K.
Published: November 2019

The goal of this prospective electrophysiologic study is to describe the chronological electromyographic findings observed in a human gastrocnemius muscle after a traumatic tear. A 30-yr-old man sustained a tear of the medial gastrocnemius. Needle electromyography was performed serially at 5, 15, and 26 wks after injury, with the contralateral gastrocnemius muscle serving as a control. Audiovisual recordings of the studies were analyzed in a blinded manner. Five weeks after injury, the affected gastrocnemius displayed increased insertional activity on electromyography. By 15-wk postinjury, insertional activity had diminished. However, motor unit action potentials showed chronic neurogenic morphological changes not previously observed. These changes persisted 26 wks after injury. The study findings reveal a chronological trajectory of increased insertional activity followed by reinnervation changes in a human muscle after local trauma, paralleling a course previously observed in a rat model. Electrodiagnosticians unaware of this phenomenon are at risk for making erroneous interpretations when examining patients with a history of muscle trauma.
Impact of Integrating a Neonatal Early-Onset Sepsis Risk Calculator into the Electronic Health Record
Authors: Fowler Nyles T. , Garcia Michael , Hankins Cynthia
Published: November 2019

Introduction:

Investigators from Kaiser Permanente developed a risk-assessment calculator as a tool for evaluation of early-onset sepsis (EOS) to narrow antibiotic use for the treatment of EOS. The integration of the EOS risk calculator into an electronic health record will minimize manual calculations and data entry and improve compliance and accuracy through automation.

Methods:

We performed a retrospective chart review for neonates ≥34 weeks and 0 days gestational age. We collected data pre-integration and post-integration of the EOS risk calculator. The primary outcome measure is the accuracy of user input into the calculator. Secondary outcomes include compliance with using the EOS risk calculator, impact on clinical recommendation when incorrectly calculated, assessment of antibiotic utilization rate (AUR), and comparison of EOS risk calculator recommendations with Centers for Disease Control and American Academy of Pediatrics recommendations.

Results:

Miscalculations occurred in 52% of instances pre-integration and 19% of instances post-integration; P < 0.001. Compliance was 93% pre-integration and 98% post-integration; P = 0.138. Clinical recommendations were changed for 21% (13/62) of miscalculations pre-integration and 4% (1/23) of miscalculations post-integration; P = 0.099. The AUR for combined NICU and nursery patients was 47 pre-integration and 47 post-integration; P > 0.999. Six cases of culture-positive sepsis were identified, and all recommendations generated by the EOS risk calculator were in alignment with current Centers for Disease Control/American Academy of Pediatrics treatment guidelines.

Conclusions:

Integration of the EOS risk calculator into the electronic health record significantly increased calculator accuracy, although it did not show statistically significant differences with regards to compliance, clinical recommendations, or AUR.
Tensor Fasciae Suralis – Prevalence Study and Literature Review
Authors: Bale Logan S. , Herrin Sean O.
Published: November 2019

Tensor fasciae suralis (TFS) is an accessory muscle of the posterior lower extremity. Although TFS has been documented in cadaveric and radiological reports, its prevalence remains unknown. The TFS variant is noteworthy to anatomists, as it may be encountered in the dissection laboratory, and clinicians, as the muscle could potentially cause confusion during physical examination or diagnostic imaging. Multiple variations of TFS have been reported in the literature, suggesting the need for a classification system. We dissected 236 formalin-fixed cadaveric lower limbs to determine the prevalence of TFS. The PubMed and MEDLINE databases were searched to compare the anatomical features of independent TFS case reports. In our prevalence study, the TFS muscle was identified in three lower limbs (1.3%). In total, 35 cases of TFS (31 cadaveric and four radiological) were identified in the literature. Our literature review revealed that the accessory muscle most often arises as a single head from the long head of the biceps femoris, yet many other presentations have been documented. The need for a classification system to distinguish between the subtypes of TFS became apparent during the literature review. Tensor fasciae suralis is a rare muscle, present in only 3 of 236 (1.3%) cadaveric lower limbs dissected in this study. We propose the use of a classification system, based on muscle origin and number of heads, to better organize the subtypes of TFS.
Cytoplasm localized ARID1B promotes oncogenesis in pancreatic cancer by activating RAF-ERK signaling
Authors: Animireddy Srinivas , Kavadipula Padmavathi , Kotapalli Viswakalyan , Gowrishankar Swarnalata , Rao Satish , Bashyam Murali Dharan
Published: November 2019

The ARID1B/BAF250b subunit of the human SWI/SNF chromatin remodeling complex is a canonical nuclear tumor suppressor. Immunohistochemistry on a pancreatic cancer tissue microarray revealed significant ARID1B cytoplasmic localization that correlated with advanced tumor stage and lymph node positivity. Identification of the nuclear localization signal (NLS) using in silico prediction and subcellular localization studies facilitated evaluation of a possible cytoplasmic function for ARID1B. A cytoplasm-restricted ARID1B-NLS mutant was significantly compromised to regulate transcription activation and tumor suppression functions, as expected. Surprisingly however, cytoplasm-localized ARID1B could bind c-RAF and PPP1CA causing stimulation of RAS-RAF-ERK signaling and β-catenin transcription activity in pancreatic cancer cells. More importantly, cytoplasmic ARID1B resulted in an induction of cell growth and migration in pancreatic cancer cell lines that was dependent on ERK signaling and caused increased tumorigenesis in nude mice. NLS peptides representing mutations identified from pancreatic cancer samples exhibiting ARID1B cytoplasmic localization or curated from cancer somatic mutation database were significantly compromised to effect nuclear localization of a reporter protein. ARID1B cytoplasmic localization correlated significantly with active forms of ERK and β-catenin in primary pancreatic tumor samples. ARID1B may therefore promote oncogenesis through non-canonical cytoplasm-based gain of function mechanisms in addition to dysregulation in the nucleus.
Genetic architecture of male courtship behavior differences in the parasitoid wasp genusNasonia(Hymenoptera; Pteromalidae)
Authors: Gadau J , Pietsch C. , Gerritsma S. , Ferber S. , van de Zande L. , van den Assem J. , Beukeboom L.W.
Published: November 2019

Very little is known about the genetic basis of behavioral variation in courtship behavior, which can contribute to speciation by prezygotic isolation of closely related species. Here, we analyze the genetic basis and architecture of species differences in the male courtship behavior of two closely related parasitoid waspsNasonia vitripennisandN. longicornis.Both species occur microsympatrically in parts of their ranges and have been found in the same host pupae. Despite strong postzygotic isolation mechanisms between these twoNasoniaspecies, viable hybrid females can be produced in the laboratory if both species are cured of theirWolbachiaendosymbionts. We used haploid F2hybrid males derived from virgin F1hybrid females of two independent mapping populations to study the genetic architecture of five quantitative and two qualitative components of their courtship behavior. A total of 14 independent Quantitative Trait Loci (QTL) were found in the first mapping population (320 males), which explained 4-25% of the observed phenotypic variance. Ten of these QTL were confirmed by a second independent mapping population (112 males) and no additional ones were found. A genome-wide scan for two-loci interactions revealed many unique but mostly additive interactions explaining an additional proportion of the observed phenotypic variance. Courtship QTL were found on all five chromosomes and four loci were associated with more than one QTL, indicating either possible pleiotropic effects of individual QTL or individual loci contributing to multiple courtship components. Our results indicate that these two evolutionary young species have rapidly evolved multiple significant phenotypic differences in their courtship behavior that have a polygenic and highly interactive genetic architecture. Based on the location of the QTL and the publishedNasoniagenome sequence we were able to identify a series of candidate genes for further study.
RNF219 regulates CCR4-NOT function in mRNA translation and deadenylation
Authors: Guénolé Aude , Velilla Fabien , Chartier Aymeric , Sardet Claude , Simonelig Martine , Sobhian Bijan
Published: November 2019

Post-transcriptional regulatory mechanisms play a role in many biological contexts through the control of mRNA degradation, translation and localization. Here, we show that the uncharacterized RING finger protein RNF219 co-purifies and strongly associates with the CCR4-NOT complex, the major mRNA deadenylase in eukaryotes, that mediates translational repression in a deadenylase activity-dependent and -independent manner. Strikingly, although RNF219, inhibits the deadenylase activity of CCR4-NOT, it enhances its capacity to repress translation of a targeted mRNA, an effect of RNF219 that requires its interaction with CCR4-NOT. We propose that RNF219 is an interacting partner of the CCR4-NOT complex that switches the translational repressive activity of CCR4-NOT from a deadenylation-dependent to a deadenylation-independent mechanism.
Engineered niches support the development of human dendritic cells in humanized mice
Authors: Anselmi Giorgio , Vaivode Kristine , Dutertre Charles-Antoine , Bourdely Pierre , Missolo-Koussou Yoann , Newell Evan , Hickman Oliver , Wood Kristie , Saxena Alka , Helft Julie , Ginhoux Florent , Guermonprez Pierre
Published: November 2019

Classical dendritic cells (cDCs) are rare sentinel cells specialized in the regulation of adaptive immunity. Modeling cDC development is both crucial to study cDCs and harness their potential in immunotherapy. Here we addressed whether cDCs could differentiate in response to trophic cues delivered by mesenchymal components of the hematopoietic niche where they physiologically develop and maintain. We found that expression of the membrane bound form of human FLT3L and SCF together with CXCL12 in a bone marrow mesenchymal stromal cell line is sufficient to induce the contact-dependent specification of both type 1 and type 2 cDCs from CD34+ hematopoietic stem and progenitor cells (HSPCs). Engraftment of these engineered mesenchymal stromal cells (eMSCs) together with CD34+ HSPCs creates an in vivo synthetic niche in the dermis of immunodeficient mice. Cell-to-cell contact between HSPCs and stromal cells within these organoids drive the local specification of cDCs and CD123+AXL+CD327+ pre/AS-DCs. cDCs generated in vivo display higher levels of resemblance with human blood cDCs unattained by in vitro generated subsets. Altogether, eMSCs provide a novel and unique platform recapitulating the full spectrum of cDC subsets enabling their functional characterization in vivo.
Aircraft positioning using GPS/GLONASS code observations
Authors: Krasuski Kamil , Cwiklak Janusz , Grzegorzewski Marek
Published: November 2019

Purpose

This paper aims to present the problem of the integration of the global positioning system (GPS)/global navigation satellite system (GLONASS) data for the processing of aircraft position determination.

Design/methodology/approach

The aircraft coordinates were obtained based on GPS and GLONASS code observations for the single point positioning (SPP) method. The numerical computations were executed in the aircraft positioning software (APS) package. The mathematical scheme of equation observation of the SPP method was solved using least square estimation in stochastic processing. In the research experiment, the raw global navigation satellite system data from the Topcon HiperPro onboard receiver were applied.

Findings

In the paper, the mean errors of an aircraft position from APS were under 3 m. In addition, the accuracy of aircraft positioning was better than 6 m. The integrity term for horizontal protection level and vertical protection level parameters in the flight test was below 16 m.

Research limitations/implications

The paper presents only the application of GPS/GLONASS observations in aviation, without satellite data from other navigation systems.

Practical implications

The presented research method can be used in an aircraft based augmentation system in Polish aviation.

Social implications

The paper is addressed to persons who work in aviation and air transport.

Originality/value

The paper presents the SPP method as a satellite technique for the recovery of an aircraft position in an aviation test.
Family directors, independent directors, remuneration committee and executive remuneration in Malaysian listed family firms
Authors: Jong Ling , Ho Poh-Ling
Published: November 2019

Purpose

The purpose of this paper is to examine the influence of family directors and independent directors on executive remuneration of listed family firms in Malaysia, and their involvement in remuneration committee on executive remuneration.

Design/methodology/approach

Fixed effect estimation is employed to examine 1,395 firm-year observations from 2010 to 2014.

Findings

Family and independent directors do not have statistically significant influence on executive remuneration. Rather, family ownership exerts a significant positive influence on executive remuneration. This study also reveals that the interaction of family CEOs with the family directors on remuneration committee exerts a significant positive influence on executive remuneration.

Research limitations/implications

The measurement of executive remuneration excludes the share options due to the non-disclosure of this information in the annual reports.

Practical implications

The findings would be useful to the policy-makers and regulators in appraising the governance measures of remuneration arrangement.

Originality/value

This study premises on the Type II agency conflict between controlling shareholders and minority shareholders. Independent directors could not mitigate the Type II agency conflict via the governance of executive remuneration. They are not the effective governance mechanism that the minority shareholders can rely on. The additional analyses provide theoretical implication that the pervasive Type II agency conflict is ameliorated when the CEOs do not have family relationships with the controlling family shareholders.
Accumulated (integrated) interest and the square root process
Authors: Ma Diandian , Song Xiaojing , Tippett Mark , Truong Thu Phuong
Published: November 2019

Purpose

The purpose of this study is to determine distributional properties of the accumulated rate of interest when the instantaneous rate of interest evolves in terms of the Cox et al. (1985) square root process.

Design/methodology/approach

The law of iterated (or double) expectations is used to determine the mean and variance of the accumulated rate of interest on a cash management (or loan) account when interest accumulates at the instantaneous rates of interest implied by the square root process.

Findings

This study demonstrates how the accumulated rate of interest does not satisfy the strong mixing conditions necessary for convergence in distribution to the normal density function.

Originality/value

This study has strong educational value in determining distributional properties of the accumulated rate of interest when the instantaneous rate of interest evolves in terms of the Cox et al. (1985) square root process and demonstrating how the accumulated rate of interest does not satisfy the strong mixing conditions necessary for convergence in distribution to the normal density function.
Crisis communication consulting: rethinking the role of PR firms in solving organizational crises
Authors: Jugo Damir , Pakozdi Ivan , Milas Zdeslav
Published: November 2019

Purpose

The purpose of this paper is to explore the relationship between organizations and their PR firms during crisis situations. It contributes to the field by identifying the role of communication consultants in contemporary organizational crises, tasks they are entrusted by their clients, as well as providing their perspective on current crisis communication practice and its future development.

Design/methodology/approach

The research is based on 13 semi-structured in-depth interviews with two groups of senior staff in 11 Croatian PR agencies: CEOs, directors, managing partners and senior consultants, all in charge of their clients’ crisis communication projects.

Findings

The research results suggest that PR firms define crisis differently than their clients, who tend to consider every risk a crisis, which causes a significantly broadened scope of work for their PR firms. The findings also suggest crises to be periods when new PR firm–client relations are often established and caution PR firms to balance between openly expressing their opinion when unfavorable for their clients and providing the best advice possible to achieve a sustainable business model with the clients that they consult.

Originality/value

This research provides rare insight into crisis communication consulting practice, especially consultant–client relations during crises. Methodologically, it includes a representative group of senior communication practitioners acting as consultants and can provide the management of PR firms and scholars valuable insight into the current and future trends of the crisis communication field in Croatia.