bluuebunny/crossref_metadata_2025 huggingface dataset:
Modification of carbon fibers surfaces with polyetheramines: The role of interphase microstructure on adhesion properties of CF/epoxy composites
Authors: Ma Lichun , Wu Guangshun , Zhao Min , Li Xiaoru , Han Ping , Song Guojun
Published: November 2017

Interface construct plays a vital role in developing superior mechanical performance of carbon fibers (CFs)/resin composites. Herein, a facile approach for incorporation of polyetheramine (PEA) onto CFs surface by covalent bond (CF‐g‐PEA) was proposed, and compared to the adsorption one via Van der Waals' force (CF‐c‐PEA). FTIR, X‐ray photoelectron spectroscopy, Raman spectra, scanning electron microscopy, atomic force microscopy, dynamic contact angle analysis, single fiber tensile testing, and interfacial shear strength were carried out to characterize the CF reinforcements and composites. Experimental results showed that both of coating and grafting PEA on CFs increased the polarity, wettability, roughness of CF surface, and interfacial shear strength, especially CF‐g‐PEA, which indicated covalent bond interaction can combine more PEA on CF surface than that of Van der Waals. While single fiber tensile strength of CF‐c‐PEA increased due to the structure of CF without destruction. Meanwhile, the reinforcing mechanisms and interfacial failure modes of composites were also explored. The results suggest that the interphases between the CFs and resin matrix can be adjusted by varying the bonding natures between CF and grafted modifiers, thereby offering a new route for appropriate designing and development of CF‐based composite materials. POLYM. COMPOS., 39:E2346–E2355, 2018. © 2017 Society of Plastics Engineers
Within and beyond: Some implications of developmental contexts for reframing school psychology
Authors: Hacker Andrew H. , Hayes Alan
Published: November 2017

Disadvantage negatively affects human development but is amenable to change. Education is important in reducing disadvantage and school psychologists and counselors make critical contributions to reducing inequity and maximizing social mobility. Counselors and psychologists can further enhance their contributions in two ways. The first is to prioritize synergizing the strengths and resilience that all students bring. The second is to reconceptualize “the client” as the ecosystem in which all students develop and learn. Considering evidence through the lens of Bronfenbrenner's bioecological (Process–Person–Context–Time) model, this article presents promising evidence that where deliberate, collaborative efforts are made to strengthen multiple developmental contexts, both within and beyond schools, these can successfully improve student outcomes across multiple domains and have a greater likelihood of achieving scale and sustainability than traditional, individual‐focused therapeutic approaches.
An Approach to Incorporate Multi‐Enzyme Digestion into C‐TAILS for C‐Terminomics Studies
Authors: Zhang Yang , Li Qingqing , Huang Jingnan , Wu Zhen , Huang Jichang , Huang Lin , Li Yanhong , Ye Juanying , Zhang Xumin
Published: November 2017

Protein C‐termini study is still a challenging task and far behind its counterpart, N‐termini study. MS based C‐terminomics study is often hampered by the low ionization efficiency of C‐terminal peptides and the lack of efficient enrichment methods. We previously optimized the C‐terminal amine‐based isotope labeling of substrates (C‐TAILS) method and identified 369 genuine protein C‐termini in Escherichia coli. A key limitation of C‐TAILS is that the prior protection of amines and carboxylic groups at protein level makes Arg‐C as the only specific enzyme in practice. Herein, we report an approach combining multi‐enzyme digestion and C‐TAILS, which significantly increases the identification rate of C‐terminal peptides and consequently improves the applicability of C‐TAILS in biological studies. We carry out a systematic study and confirm that the omission of the prior amine protection at protein level has a negligible influence and allows the application of multi‐enzyme digestion. We successfully apply five different enzyme digestions to C‐TAILS, including trypsin, Arg‐C, Lys‐C, Lys‐N, and Lysarginase. As a result, we identify a total of 722 protein C‐termini in E. coli, which is at least 66% more than the results using any single enzyme. Moreover, the favored enzyme and enzyme combination are discovered. Data are available via ProteomeXchange with identifier PXD004275.
Observation of Reverse Jetting from a Semi‐hollow EFP after Perforating a Finite Thickness Composite Armour Panel
Authors: Mostert Frederik J. , Snyman Izak M. , Corderley Gary
Published: November 2017

A jet of material was observed exiting from the rear of the remnants of an initially semi‐hollow explosively formed projectile, which perforated a finite thickness composite armour panel. The observation of this phenomenon was made by means of flash‐X‐ray photography at two different sub‐millisecond times for a copper EFP that impacted the panel at above 2000 m/s. The jet exhibited remarkably similar characteristics to what is typically observed for shaped charge jets for similar liner materials. Progressive necking was observed in the jet and the velocity differences between necked sections were characterized. Simulation of a similar generic event by the ANSYS Autodyn hydrocode showed that reverse jet formation is possible for specific EFP geometries and impact conditions. The relatively low velocities of the jet elements in terms of the laboratory coordinates, holds promise for the soft recovery of the jetted particles.
Sarilumab: a new IL‐6 receptor blocker for rheumatoid arthritis
Authors: Chaplin Steve
Published: November 2017

Sarilumab (Kevzara) is the second monoclonal antibody against the IL‐6 receptor to be licensed for the treatment of rheumatoid arthritis. This article examines its indications, efficacy and adverse effects.
Enahnced Al0.11Ga0.89N/Cu2O Solar Cells by a Semi Transparent Electrode
Authors: Hering Karl Philipp , Bergert Roman , Mitic Slobodan
Published: November 2017

Polycrystalline Cu2O thin films are prepared on c‐sapphire substrates and n‐type templates by radio frequency sputtering at a temperature of 650 K employing a metallic target, an argon/oxygen gas mixture as well as a biased semi transparent electrode placed between the target and the substrate. Introducing that grid, we demonstrate the possibility to tune the cuprous oxide thin film properties, especially the morphology, by controlling the electron temperature in the plasma as well as the beneficial effect of a suspected reduction of interface state densities at photovoltaic heterostructures.
Doping Mechanism of Ge4+ Ions in Ge4+‐Doped TiO2
Authors: Han Zhongxing , Yu Yanlong , Cao Yaan
Published: November 2017

A series of Ge4+‐doped TiO2 is synthesized by a sol–gel method and annealed at different temperatures. The doping mechanism of Ge was studied via XRD, Raman spectroscopy, XPS, and HRTEM techniques. The doping behavior of introduced Ge4+ ions is related to the doping concentration and annealing temperature. It is revealed that the Ge4+ ions would exist as doped Ge ions in substitutional mode and GeO2 on surface. At certain concentration, the substitutional‐doped Ge ions are transferred to GeO2 on surface with the increase of annealing temperature. The introduction of Ge4+ ions inhibited the formation of the rutile phase of TiO2 and delayed the phase transition.
Functionalized Pd/ZnO Nanowires for Nanosensors
Authors: Lupan Oleg , Postica Vasile , Adelung Rainer , Labat Frédéric , Ciofini Ilaria , Schürmann Ulrich , Kienle Lorenz , Chow Lee , Viana Bruno , Pauporté Thierry
Published: November 2017

A method for surface doping and functionalization of ZnO nanowires (NWs) with Pd (Pd/ZnO) in a one‐step process is presented. The main advantage of this method is to combine the simultaneous growth, surface doping, and functionalization of NWs by using electrochemical deposition (ECD) at relatively low temperatures (90 °C). Our approach essentially reduces the number of technological steps of nanomaterial synthesis and final nanodevices fabrication with enhanced performances. A series of nanosensor devices is fabricated based on single Pd/ZnO NWs with a radius of about 80 nm using a FIB/SEM system. The influence of Pd nominal composition in Pd/ZnO NW on the H2 sensing response is studied in detail and a corresponding mechanism is proposed. The results demonstrate an ultra‐high response and selectivity of the synthesized nanosensors to hydrogen gas at room temperature. The optimal concentration of PdCl2 in the electrolyte to achieve extremely sensitive nanodevices with a gas response (SH2) ≈ 1.3 × 104 (at 100 ppm H2 concentration) and relatively high rapidity is 0.75 µM. Theoretical calculations on Pd/ZnO bulk and functionalized surface further validated the experimental hypothesis. Our results demonstrate the importance of noble metal presence on the surface due to doping and functionalization of nanostructures in the fabrication of highly‐sensitive and selective gas nanosensors operating at room temperature with reduced power consumption.
Warfarin and SSRIs
Authors: Lam Y. W. Francis
Published: November 2017

Depression frequently occurs in the setting of cardiovascular disease, including atrial fibrillation. Anticoagulants such as warfarin are commonly used in patients with atrial fibrillation in order to prevent the occurrence of stroke, while selective serotonin reuptake inhibitors (SSRIs), the mainstays of antidepressant pharmacology, have been associated with abnormal coagulation and have been reported to cause bleeding. This effect of the SSRIs may be secondary to their impairment of platelet aggregation and/or their inhibitory effects on cytochrome P‐450 enzymes, including those involved in the elimination of warfarin.
Clinical risk reclassification at 10 years
Authors: Cook Nancy R. , Demler Olga V. , Paynter Nina P.
Published: November 2017

Three papers in this issue focus on the role of calibration in model fit statistics, including the net reclassification improvement (NRI) and integrated discrimination improvement (IDI). This commentary reviews the development of such reclassification statistics along with more recent advances in our understanding of these measures. We show how the two‐category NRI and the IDI are affected by changes in the event rate in theory and in an applied example. We also describe the role of calibration and how it may be assessed. Finally, we discuss the relevance of the event rate NRI for clinical use. Copyright © 2017 John Wiley & Sons, Ltd.
Evidence synthesis from aggregate recurrent event data for clinical trial design and analysis
Authors: Holzhauer Björn , Wang Craig , Schmidli Heinz
Published: November 2017

Information from historical trials is important for the design, interim monitoring, analysis, and interpretation of clinical trials. Meta‐analytic models can be used to synthesize the evidence from historical data, which are often only available in aggregate form. We consider evidence synthesis methods for trials with recurrent event endpoints, which are common in many therapeutic areas. Such endpoints are typically analyzed by negative binomial regression. However, the individual patient data necessary to fit such a model are usually unavailable for historical trials reported in the medical literature. We describe approaches for back‐calculating model parameter estimates and their standard errors from available summary statistics with various techniques, including approximate Bayesian computation. We propose to use a quadratic approximation to the log‐likelihood for each historical trial based on 2 independent terms for the log mean rate and the log of the dispersion parameter. A Bayesian hierarchical meta‐analysis model then provides the posterior predictive distribution for these parameters. Simulations show this approach with back‐calculated parameter estimates results in very similar inference as using parameter estimates from individual patient data as an input. We illustrate how to design and analyze a new randomized placebo‐controlled exacerbation trial in severe eosinophilic asthma using data from 11 historical trials.
Evaluation of Thermal Breakage in Bimetallic Work Roll Considering Heat Treated Residual Stress Combined with Thermal Stress during Hot Rolling
Authors: Hu Kejun , Xia Yongmei , Zhu Fuxian , Noda Nao‐Aki
Published: November 2017

Bimetallic rolls are widely used in steel rolling industry because of their excellent hardness, wear resistance, and high temperature properties. Heat treated residual stresses consist of compressive stress in the shell and tensile stress in the core are produced in the bimetallic roll during heat treatment. In the subsequent hot rolling process, severe thermal stresses are caused by heating‐cooling thermal cycles at the roll surface. The combination of heat treated residual stresses and thermal stresses will cause a complex stress field in work roll during hot rolling process. The high combined tensile stress at the roll center may cause thermal breakage, once the tensile stress exceeds the material strength. Consequently, it is necessary to investigate the combined stresses to improve roll service life during hot rolling process. In this paper, the combined stresses in the work roll during hot rolling are investigated based on the FEM simulation, considering the heat treated residual stress after tempering process and thermal stress generated during hot rolling. In addition, the thermal breakage of work roll is evaluated in breakdown of water cooling systems and rolling incidents.
Weight discordance and perinatal mortality in twin pregnancy: systematic review and meta‐analysis
Authors: D'Antonio F. , Odibo A. O. , Prefumo F. , Khalil A. , Buca D. , Flacco M. E. , Liberati M. , Manzoli L. , Acharya G.
Published: November 2017

Objectives

The primary aim of this systematic review was to explore the strength of association between birth‐weight (BW) discordance and perinatal mortality in twin pregnancy. The secondary aim was to ascertain the contribution of gestational age and growth restriction in predicting mortality in growth‐discordant twins.

Methods

MEDLINE, EMBASE, CINAHL and
ClinicalTrials.gov databases were searched. Only studies reporting on the risk of mortality in twin pregnancies affected compared with those not affected by BW discordance were included. The primary outcomes explored were incidence of intrauterine death (IUD), neonatal death (NND) and perinatal death. Outcome was assessed separately for monochorionic (MC) and dichorionic (DC) twin pregnancies. Analyses were stratified according to BW discordance cut‐off (≥ 15%, ≥ 20%, ≥ 25% and ≥ 30%) and selected gestational characteristics, including incidence of IUD or NND before and after 34 weeks' gestation, presence of at least one small‐for‐gestational age (SGA) fetus in the twin pair and both twins being appropriate‐for‐gestational age. Risk of mortality in the larger vs smaller twin was also assessed. Meta‐analyses using individual data random‐effects logistic regression and meta‐analyses of proportion were used to analyze the data.

Results

Twenty‐two studies (10 877 twin pregnancies) were included in the analysis. In DC pregnancies, a higher risk of IUD, but not of NND, was observed in twins with BW discordance ≥ 15% (odds ratio (OR) 9.8, 95% CI, 3.9–29.4), ≥ 20% (OR 7.0, 95% CI, 4.15–11.8), ≥ 25% (OR 17.4, 95% CI, 8.3–36.7) and ≥ 30% (OR 22.9, 95% CI, 10.2–51.6) compared with those without weight discordance. For each cut‐off of BW discordance explored in DC pregnancies, the smaller twin was at higher risk of mortality compared with the larger one. In MC twin pregnancies, excluding cases affected by twin–twin transfusion syndrome, twins with BW discordance ≥ 20% (OR 2.8, 95% CI, 1.3–5.8) or ≥ 25% (OR 3.2, 95% CI, 1.5–6.7) were at higher risk of IUD, compared with controls. MC pregnancies with ≥ 25% weight discordance were also at increased risk of NND (OR 4.66, 95% CI, 1.8–12.4) compared with those with concordant weight. The risk of IUD was higher when considering discordant pregnancies involving at least one SGA fetus. The overall risk of mortality in MC pregnancies was similar between the smaller and larger twin, except in those with BW discordance ≥ 20%.

Conclusion

DC and MC twin pregnancies discordant for fetal growth are at higher risk of IUD but not of NND compared with pregnancies with concordant BW. The risk of IUD in BW‐discordant DC and MC twins is higher when at least one fetus is SGA. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
An outbreak of classical swine fever in pigs in Bangladesh, 2015
Authors: Sarkar Shamim , Hossain Mohammad Enayet , Gurley Emily S. , Hasan Rashedul , Rahman Mohammed Z.
Published: November 2017

In a group of 22 healthy pigs aged between 4 and 6 months, 2 pigs became ill with high fever, complete anorexia, cough and abnormal swaying movements on 22 June 2015. One of them died on June 24 and the second died on July 3. Shortly after, the remaining pigs also fell ill and died from the same illness by 10 August 2015. We investigated the aetiology, epidemiological and clinical features of the outbreak. We recorded the clinical signs and symptoms for each pig with the date of onset of illness. Veterinarians conducted post‐mortem examinations on the 12 dead pigs, they collected tissue samples from the dead pigs and placed them in a tube containing 1 mL of nucleic acid extraction buffer (lysis buffer). We tested all the tissue samples by real‐time reverse transcription polymerase chain reaction (rRT‐PCR) to detect classical swine fever virus (CSFV) because the animals’ symptoms matched those of this disease. We also conducted a phylogentic analysis of the nucleotide sequence of the E2 gene segment of CSFV detected in a lung tissue sample. The attack rate (22/22) and the case fatality were 100%. The predominant symptoms of the disease included high fever, cough, diarrhoea and swaying movements of the hind legs prior to death. Of the 12 pigs tissue samples tested, all had evidence of the presence of CSFV RNA by rRT‐PCR. The phylogenetic analysis indicated that the virus belongs to genotype 2.2, which is closely related to CSFV genotype 2.2 reported in India. Our investigation suggests that CSF is circulating in pigs, posing a risk for communities in Bangladesh that rely on pigs for economic income and dietary protein. Future research could focus on estimating the disease and economic burden of CSFV in pig rearing areas to determine if interventions might be warranted or cost‐effective.
Developing Leadership Competencies
Authors: Croft Lucy , Seemiller Corey
Published: November 2017

This chapter provides an overview of leadership competencies including the history of emergence, contemporary uses, common frameworks, challenges, benefits, and future implications.
The Interaction of Efficacy and Leadership Competency Development
Authors: Machida‐Kosuga Moe
Published: November 2017

This chapter covers the role of students’ self‐efficacy in developing their leadership competencies. Practical strategies and recommendations are provided.
Introductory Sociology
Authors: Tony Bilton , Kevin Bonnett , Pip Jones , Tony Lawson , David Skinner , Michelle Stanworth , Andrew Webster
Published: November 2017

Introductory Sociology is one of the most ambitious, scholarly and popular textbooks in its field. This welcome new edition builds on the strengths of its predecessor in its thematic coherence, clarity of exposition and analytical depth. It is carefully structured to cover all the main substantive topics studied at an introductory level within a framework that engages with exciting contemporary debates about modernity, globalisation and social identity.

Key features of the new edition include:

- A completely new chapter on the media

- Extended coverage of social divisions to include disability, youth and old age as well as class, gender and race

- Clearer and more compact treatment of social theory, incorporating discussion of work by such contemporary theorists as Habermas, Giddens and Beck

- An even stronger blend of theoretical, empirical and illustrative material, consolidating the critical and applied approach that is one of the text's most well-liked defining features

With outstanding presentation and pedagogical support for the student and hard-pressed lecturer alike, the text includes:

- An Instructor's Resource Pack, complete with powerpoint slides, available on the Palgrave website (or in hardcopy for adopters of the textbook, by written request)

- A detailed and extensive glossary - practically a 'mini dictionary' of sociology in its own right and an ideal reference tool

- chapter-specific further reading lists, annotated for further guidance and support

- Questions to think about, which can be used as the basis for essays, class discussion and further study

- Pictures, figures, graphs and tables
Self-Regulation
Authors: McClelland Megan , Geldhof John , Morrison Fred , Gestsdóttir Steinunn , Cameron Claire , Bowers Ed , Duckworth Angela , Little Todd , Grammer Jennie
Published: November 2017

Self-regulation has been shown to have important implications for individual trajectories of health and well-being across the life course. The present chapter examines the development of self-regulation from a life course health development (LCHD) perspective. Using the seven principles of LCHD and the relational developmental systems (RDS) framework, the chapter focuses on the importance of self-regulation for health and well-being over time and across contexts and examines the pathways of self-regulation including the individual, contextual, and sociocultural factors that influence the development of these skills over time, methods for studying self-regulation, and translational issues. The chapter concludes by providing recommendations for future research and for better integrating the principles of LCHD and RDS within the study of self-regulation.
Life Course Health Development Outcomes After Prematurity: Developing a Community, Clinical, and Translational Research Agenda to Optimize Health, Behavior, and Functioning
Authors: Msall Michael E. , Sobotka Sarah A. , Dmowska Amelia , Hogan Dennis , Sullivan Mary
Published: November 2017

Long-term survival for infants born extremely prematurely (<28 weeks of gestation) and extremely low birth weight (<1000 g) has increased dramatically due to obstetrical and neonatal advances. However, poverty, inequality, and resulting health disparities are significant contributors to women who give birth to preterm infants and also impact their children’s healthy development and education. While the vast majority of survivors of extreme prematurity do not have the most severe forms of neurodevelopmental disability (i.e., cerebral palsy, blindness, sensorineural hearing loss >55 dB, and intellectual disability), half of survivors can be expected to require special education services at kindergarten entry and during their school years. In addition, there are also high rates of health disparities in the prevalence of preterm birth across the spectrum of gestations including very preterm (28–31 weeks), moderate preterm (32–33 weeks), and late preterm births (34–36 weeks). Life course health development offers a valuable framework for examining how complex medical and social adversities that impact a mother’s health can also impact their child’s health and developmental trajectories. A better understanding of the cumulative impact of protective factors and other buffers that can support prenatal and postnatal parental and child health will provide important insights into how to promote greater resiliency and optimal health development. This population-based information can provide ongoing data for thriving developmental health trajectories for vulnerable preterm survivors with respect to physical, behavioral, and social health outcomes. Though premature infants who receive comprehensive early intervention and preschool educational supportive services have improved outcomes at kindergarten entry, school-age survivors, even those escaping major neurodevelopmental diagnoses, have challenges which impact attention, behavioral regulation, academic achievement, and social skills compared to their full-term peers. Unfortunately, many essential services that can contribute to better outcomes are unnecessarily fragmented and not systematically implemented to provide preventive interventions that optimize health, learning, executive function, social, and adaptive competencies. These cumulative medical, developmental, and social risks among preterm survivors adversely impact long-term adult physical and behavioral health, educational attainment, and social participation. In order to address these disparities, more precise, population-based, health development interventions aimed at optimizing physical and behavioral health, educational achievement, and adaptive competencies will be required. We recommend research strategies to inform our efforts for improving life course outcomes.
Emerging Adulthood as a Critical Stage in the Life Course
Authors: Wood David , Crapnell Tara , Lau Lynette , Bennett Ashley , Lotstein Debra , Ferris Maria , Kuo Alice
Published: November 2017

Emerging adulthood, viewed through the lens of life course health development, has the potential to be a very positive developmental stage with postindustrial societies giving adolescents and emerging adults a greater opportunity for choice and exploration but also greater challenges with greater educational and social role requirements. The loss of supports and structures offered by schools, families, and child- and family-oriented health and social services means that the emerging adult must rely more on his/her own resources in a less structured environment. This increased agency in the context of less structure is occurring as the human brain is still developing higher-level capacities such as executive functioning. The person-context interactions during EA are many and complex, leading to multiple different pathways through emerging adulthood. Those with sufficient economic and adult supports as well as personal resources and maturity will be more likely to choose well and embark on a positive trajectory during EA. Those lacking these resources, or those with physical and mental health or intellectual disabilities, may struggle during this period and experience a negative trajectory in the spheres of education, vocation, relationships, and health status. The life course health science of EA requires more detailed and deeper analysis of the relationship between family, peers, and societal supports and personal internal resources in order to help promote successful developmental trajectories during EA.
Early in the Life Course: Time for Obesity Prevention
Authors: Hawkins Summer Sherburne , Oken Emily , Gillman Matthew W.
Published: November 2017

One of the reasons for the intractability of childhood obesity is the underappreciation of the complexity and interconnectedness of contributing factors across the life course. A multilevel approach for obesity prevention takes into account individual risk factors that operate “above water” (family, neighborhood, policies) and the interaction with biology and “underwater” influences (genetics, epigenetics, physiology) and recognizes that these factors also interact across the life course, starting before birth. We organize this chapter to reflect phases of life course health development, prenatally through adolescence, that appear to be most important for the development of obesity and present key examples to illustrate important risk factors, mechanisms, and gaps in research. One of the challenges to understanding influences on obesity risk is the extent to which associations described in observational studies are causal. We present alternative methodological approaches, including sibling-pair design, maternal versus paternal effects, Mendelian randomization, cohorts with different confounding structures, and randomized controlled trials, that can help disentangle causal associations. We conclude with recommendations for future work on methodology, research in emerging areas, and implications for practice and policy based on the current evidence.
Activating FGFR1 Mutations in Sporadic Pheochromocytomas
Authors: Welander Jenny , Łysiak Małgorzata , Brauckhoff Michael , Brunaud Laurent , Söderkvist Peter , Gimm Oliver
Published: November 2017

Introduction

Pheochromocytomas are neuroendocrine tumors of the adrenal glands. Up to 40% of the cases are caused by germline mutations in one of at least 15 susceptibility genes, making them the human neoplasms with the highest degree of heritability. Recurrent somatic alterations are found in about 50% of the more common sporadic tumors with NF1 being the most common mutated gene (20–25%). In many sporadic tumors, however, a genetic explanation is still lacking.

Materials and methods

We investigated the genomic landscape of sporadic pheochromocytomas with whole‐exome sequencing of 16 paired tumor and normal DNA samples and extended confirmation analysis in 2 additional cohorts comprising a total of 80 sporadic pheochromocytomas.

Results

We discovered on average 33 non‐silent somatic variants per tumor. One of the recurrently mutated genes was FGFR1, encoding the fibroblast growth factor receptor 1, which was recently revealed as an oncogene in pediatric brain tumors. Including a subsequent analysis of a larger cohort, activating FGFR1 mutations were detected in three of 80 sporadic pheochromocytomas (3.8%). Gene expression microarray profiling showed that these tumors clustered with NF1‐, RET,‐ and HRAS‐mutated pheochromocytomas, indicating activation of the MAPK and PI3K‐AKT signal transduction pathways.

Conclusion

Besides RET and HRAS, FGFR1 is only the third protooncogene found to be recurrently mutated in pheochromocytomas. The results advance our biological understanding of pheochromocytoma and suggest that somatic FGFR1 activation is an important event in a subset of sporadic pheochromocytomas.
Outcomes of Emergency Laparotomy (EL) Care Protocol at Tertiary Care Center from Low–Middle‐Income Country (LMIC)
Authors: Vashistha Nitin , Singhal Dinesh , Budhiraja Sandeep , Aggarwal Bharat , Tobin Raj , Fotedar Kamal
Published: November 2017

Background

Emergency laparotomy mortality ranges between 10 and 20% in best of Western healthcare systems and is currently a major focus for quality improvement programs. In contrast, emergency surgery scenario in LMIC is largely undefined, often neglected and complex (large burden of diseases but only limited capacity for adequate treatment). We evaluated the efficacy of ‘EL care protocol’ aimed at cost‐effective optimal utilization of best available local expertise and infrastructure.

Methods

One hundred and two consecutive adult patients (≥16 years) who underwent EL from December 2012–December 2015 at a private tertiary hospital were retrospectively analyzed. The patients who underwent emergency laparoscopic procedures were excluded from the analysis. The EL care protocol included. (1) Admission to surgical intensive care unit for pre‐ and postoperative optimization. (2) Preferred radiologic investigation: abdominal computed tomography (CT) scan. (3) Surgery and critical care by senior surgical gastroenterologists and internists/anesthesiologists, respectively. Outcome measures were procedure‐related complications (Clavien–Dindo classification), readmissions and costs.

Results

Of the 102 patients, there were 62 males and 40 females with median age of 60 (range 16–93) years. There were no complications in 22 (21.6%) patients, while Clavien–Dindo complications grade I or II occurred in 48 (47%) patients. Grade V Clavien–Dindo complications and the 30‐day mortality were similar of 19 (18.6%). The readmission rate was 8 (7.8%). The expected mortality for the study group by P‐POSSUM score was 31.2 (30.6%). The ratio (O/E) of observed to expected mortality was 0.61. The all inclusive median cost of treatment was INR 379,255 ($5590).

Conclusions

LMIC centers should develop their own center‐specific EL care protocols to improve outcomes of EL.
Delayed Gastric Emptying Following Laparoscopic Repair of Very Large Hiatus Hernias Impairs Quality of Life
Authors: Liu David S. , Tog Chek , Lim Hou K. , Stiven Peter , Thompson Sarah K. , Watson David I. , Aly Ahmad
Published: November 2017

Background

Delayed gastric emptying (DGE) following hiatus hernia surgery may affect a substantial number of patients with adverse clinical consequences. Here, we aim to evaluate the impact of DGE following laparoscopic repair of very large hiatus hernias on patients’ quality of life, gastrointestinal symptomatology, and daily function.

Methods

Analysis of data collected from a multicenter prospective randomised trial of patients who underwent laparoscopic mesh versus sutured repair of very large hiatus hernias (>50% of stomach in chest). DGE was defined as gastric food retention visualised at endoscopy after 6 h of fasting at 6 months post‐surgery. Quality of life (QOL), gastrointestinal symptomatology, and daily function were assessed with the SF‐36 questionnaire, Visick scoring and structured surveys administered prior to surgery and at 1, 3, 6 and 12 months after surgery.

Results

Nineteen of 102 (18.6%) patients had DGE 6 months after surgery. QOL questionnaires were completed in at least 80% of patients across all time points. Compared with controls, the DGE group demonstrated significantly lower SF‐36 physical component scores, delayed improvement in health transition, more adverse gastrointestinal symptoms, higher Visick scores and a slower rate of return to normal daily activities. These differences were still present 12 months after surgery.

Conclusions

DGE following large hiatus hernia repair is associated with a negative impact on quality of life at follow‐up to 12 months after surgery.
Prophylactic Intraperitoneal Onlay Mesh Reinforcement Reduces the Risk of Incisional Hernia, Two‐Year Results of a Randomized Clinical Trial
Authors: Brosi Philippe , Glauser Philippe M. , Speich Benjamin , Käser Samuel A. , Maurer Christoph A.
Published: November 2017

Background

Incisional hernias still are a major concern after laparotomy and are causing substantial morbidity. This study examines the feasibility, safety and incisional hernia rate of the use of a prophylactic intraperitoneal onlay mesh stripe (IPOM) to prevent incisional hernia following midline laparotomy.

Methods

This prospective, randomized controlled trial randomly allocated patients undergoing median laparotomy either to mass closure of the abdominal wall with a PDS‐loop running suture reinforced by an intraperitoneal composite mesh stripe (Group A) or to the same procedure without the additional mesh stripe (Group B). Primary endpoint was the incidence of incisional hernias at 2 years following midline laparotomy. Secondary endpoints are were the feasibility, the safety of the mesh stripe implantation including postoperative pain, and the incidence of incisional hernias at 5 years.

Results

A total of 267 patients were included in this study. Follow‐up data 2 years after surgery was available from 210 patients (Group A = 107; Group B = 103). An incisional hernia was diagnosed in 18/107 (17%) patients in Group A and in 40/103 (39%) patients in Group B (p < 0.001). A surgical operation due to an incisional hernia was conducted for 12/107 (11%) patients in Group A and for 24/103 (23%) patients in Group B (p = 0.039). In both groups, minor and major complications as well as postoperative pain are reported with no statistically significant difference between the groups, even in contaminated situations.

Conclusions

This first randomized clinical trial indicates that the placement of a non‐absorbable IPOM‐stripe with prophylactic intention may significantly reduce the risk for a midline incisional hernia.

Trial registration

Ref. NCT01003067 (clinicaltrials.gov)
Competitive Advantage of MBA for Physician Executives: A Systematic Literature Review
Authors: Turner Anthony D. , Stawicki Stanislaw P. , Guo Weidun Alan
Published: November 2017

In response to systemic challenges facing the US healthcare system, many medical students, residents and practicing physicians are pursuing a Master in Business Administration (MBA) degree. The value of such proposition remains poorly defined. The aim of this review is to analyze current literature pertaining to the added value of MBA training for physician executives (PEs). We hypothesized that physicians who supplement their clinical expertise with business education gain a significant competitive advantage. A detailed literature search of four electronic databases (PubMed, SCOPUS, Embase and ERIC) was performed. Included were studies published between Jan 2000 and June 2017, focusing specifically on PEs. Among 1580 non‐duplicative titles, we identified 23 relevant articles. Attributes which were found to add value to one’s competitiveness as PE were recorded. A quality index score was assigned to each article in order to minimize bias. Results were tabulated by attributes and by publication. We found that competitive domains deemed to be most important for PEs in the context of MBA training were leadership (n = 17), career advancement opportunities (n = 12), understanding of financial aspects of medicine (n = 9) and team‐building skills (n = 10). Among other prominent factors associated with the desire to engage in an MBA were higher compensation, awareness of public health issues/strategy, increased negotiation skills and enhanced work–life balance. Of interest, the learning of strategies for reducing malpractice litigation was less important than the other drivers. This comprehensive systemic review supports our hypothesis that a business degree confers a competitive advantage for PEs. Physician executives equipped with an MBA degree appear to be better equipped to face the challenge of the dynamically evolving healthcare landscape. This information may be beneficial to medical schools designing or implementing combined dual‐degree curricula.
Clinician‐Stakeholders’ Perspectives on Using Patient Portals to Return Lynch Syndrome Screening Results
Authors: Korngiebel Diane M. , West Kathleen M. , Burke Wylie
Published: November 2017

Test results for genetic conditions, such as Lynch Syndrome (LS), have traditionally been returned by genetic counselors or other providers who can explain results implications and provide psychosocial support. Returning genetic results through an Electronic Health Record's patient portal may increase the efficiency of returning results and could activate patient follow‐up; however, stakeholder input is necessary to determine acceptability and appropriate implementation for LS. Twenty interviews were conducted with clinicians from six specialties involved in LS screening that represent a range of settings. Data were analyzed using directed content analysis and thematic analysis across content categories. Participants felt that patient portals could supplement personal calls, but the potential sensitive nature of LS screening results indicated the need for caution. Others felt that LS results could be returned through portals if there were clear explanations of the result, reputable additional information available within the portal, urging follow up confirmatory testing, and a referral to a genetics specialist. Patient portals were seen as helpful for prompting patient follow‐up and providing resources to notify at‐risk family members. There is potential for patient portals to return LS screening and other genetic results, however we raise several issues to resolve before implementation is warranted.
Plant diversity patterns in remnant forests and exotic tree species‐based reforestation in active limestones quarries in the Luzon and Mindanao biogeographic sub‐regions in the Philippines
Authors: Galindon John Michael , Pasion Bonifacio , Tongco Ma. Dolores , Fidelino Jay , Duya Mariano Roy , Ong Perry
Published: November 2017

The Philippines is both a megadiversity country and a global biodiversity hotspot. The diversity patterns of three major plant groups were assessed: (1) trees (trees and palms), (2) herbs (grasses, shrubs, forbs, ferns), and (3) epiphytes (climbers and epiphytes), by determining the changes in compositional and species richness patterns in two forest conditions, i.e., remnant forests and exotic tree species‐based reforested areas, in active forest over limestone quarries in the Luzon and Mindanao biogeographic sub‐regions of the Philippines. We identified 458 species comprising 266 tree species, 95 herbaceous species and 97 epiphyte species. Of these, 21 species were categorized as threatened species. Species composition differed between remnant forests and exotic tree species‐based reforested areas for tree species and epiphyte species, while composition differences between the Luzon and Mindanao biogeographic sub‐regions were limited to tree species only. Differences in species diversity (in terms of richness) were observed between biogeographic sub‐regions for all plant groups, while differences between forest conditions were found for tree and epiphyte species only. Interestingly, there were significantly fewer numbers of exotic species in bigger remnant forest sites and in older exotic tree species‐based reforested sites, while larger numbers of native species occurred in older than in younger exotic tree species‐based reforested sites. The results emphasize the importance of understanding forest recovery in disturbed ecosystems. Conservation attention should focus on protecting remaining forests and planting native species as part of a forest restoration strategy to enhance faster forest recovery and re‐connecting remnant forest patches.
Analysis of the Grain Size Evolution for Ferrite Formation in Fe-C-Mn Steels Using a 3D Model Under a Mixed-Mode Interface Condition
Authors: Fang H. , Mecozzi M. G. , Brück E. , van der Zwaag S. , van Dijk N. H.
Published: November 2017

A 3D model has been developed to predict the average ferrite grain size and grain size distribution for an austenite-to-ferrite phase transformation during continuous cooling of an Fe-C-Mn steel. Using a Voronoi construction to represent the austenite grains, the ferrite is assumed to nucleate at the grain corners and to grow as spheres. Classical nucleation theory is used to estimate the density of ferrite nuclei. By assuming a negligible partition of manganese, the moving ferrite–austenite interface is treated with a mixed-mode model in which the soft impingement of the carbon diffusion fields is considered. The ferrite volume fraction, the average ferrite grain size, and the ferrite grain size distribution are derived as a function of temperature. The results of the present model are compared with those of a published phase-field model simulating the ferritic microstructure evolution during linear cooling of an Fe-0.10C-0.49Mn (wt pct) steel. It turns out that the present model can adequately reproduce the phase-field modeling results as well as the experimental dilatometry data. The model presented here provides a versatile tool to analyze the evolution of the ferrite grain size distribution at low computational costs.
SEOM clinical guideline for treatment of kidney cancer (2017)
Authors: Gallardo E. , Méndez-Vidal M. J. , Pérez-Gracia J. L. , Sepúlveda-Sánchez J. M. , Campayo M. , Chirivella-González I. , García-del-Muro X. , González-del-Alba A. , Grande E. , Suárez C.
Published: November 2017

The goal of this article is to provide recommendations about the management of kidney cancer. Based on pathologic and molecular features, several kidney cancer variants were described. Nephron-sparing techniques are the gold standard of localized disease. After a randomized trial, sunitinib could be considered in adjuvant treatment in high-risk patients. Patients with advanced disease constitute a heterogeneous population. Prognostic classification should be considered. Both sunitinib and pazopanib are the standard options for first-line systemic therapy in advanced renal cell carcinoma. Based on the results of two randomized trials, both nivolumab and cabozantinib should be considered the standard for second and further lines of therapy. Response evaluation for present therapies is a challenge.
On the use of kernel machines for Mendelian randomization
Authors: Zhang Weiming , Ghosh Debashis
Published: November 2017

Background

Properly adjusting for unmeasured confounders is critical for health studies in order to achieve valid testing and estimation of the exposure’s causal effect on outcomes. The instrumental variable (IV) method has long been used in econometrics to estimate causal effects while accommodating the effect of unmeasured confounders. Mendelian randomization (MR), which uses genetic variants as the instrumental variables, is an application of the instrumental variable method to biomedical research fields, and has become popular in recent years. One often‐used estimator of causal effects for instrumental variables and Mendelian randomization is the two‐stage least square estimator (TSLS). The validity of TSLS relies on the accurate prediction of exposure based on IVs in its first stage.

Results

In this note, we propose to model the link between exposure and genetic IVs using the least‐squares kernel machine (LSKM). Some simulation studies are used to evaluate the feasibility of LSKM in TSLS setting.

Conclusions

Our results show that LSKM based on genotype score or genotype can be used effectively in TSLS. It may provide higher power when the association between exposure and genetic IVs is nonlinear.
Contribution of friction and adhesion to the reliable attachment of a gecko to smooth inclines
Authors: Wang Zhouyi , Xing Qiang , Wang Wenbo , Ji Aihong , Dai Zhendong
Published: November 2017

Geckos’ ability to move on steep surfaces depends on their excellent adhesive structure, timely adjustments on locomotor behaviors, and elaborates control on reaction forces. However, it is still unclear how they can generate a sufficient driving force that is necessary for locomotion, while ensuring reliable adhesion on steep inclines. We measured the forces acting on each foot and recorded the contact states between feet and substrates when geckos encountered smooth inclination challenges ranging from 0° to 180°. The critical angles of the resultant force vectors of the front and hind-feet increased with respect to the incline angles. When the incline angle became greater than 120°, the critical angles of the front- and hind-feet were similar, and the averages of the critical angles of the front- and hind-feet were both smaller than 120°, indicating that the complicated and accurate synergy among toes endows gecko’s foot an obvious characteristic of “frictional adhesion” during locomotion. Additionally, we established a contact mechanical model for gecko’s foot in order to quantify the contribution of the frictional forces generated by the heel, and the adhesion forces generated by the toes on various inclines. The synergy between multiple contact mechanisms (friction or adhesion) is critical for the reliable attachment on an inclined surface, which is impossible to achieve by using a single-contact mechanism, thereby increasing the animal’s ability to adapt to its environment.