bluuebunny/crossref_metadata_2025 huggingface dataset:
Excitation power dependence of photoluminescence spectra of GaSb type-II quantum dots in GaAs grown by droplet epitaxy
Authors: Kawazu T. , Noda T. , Sakuma Y. , Sakaki H.
Published: April 2016

We investigated the excitation power P dependence of photoluminescence (PL) spectra of GaSb type-II quantum dots (QDs) in GaAs grown by droplet epitaxy. We prepared two QD samples annealed at slightly different temperatures (380 oC and 400 oC) and carried out PL measurements. The 20 oC increase of the annealing temperature leads to (1) about 140 and 60 times stronger wetting layer (WL) luminescence at low and high P, (2) about 45% large energy shift of QD luminescence with P, and (3) the different P dependence of the PL intensity ratio between the QD and the WL. These differences of the PL characteristics are explained by the effects of the WL.
Use of feed technology to improve the nutritional value of feed ingredients
Authors: Rojas O. J. , Stein H. H.
Published: April 2016

Two experiments were conducted to test the hypothesis that reduced particle size of corn will improve the caloric utilisation of corn fed to weanling pigs and to determine effects of pelleting, extrusion and extrusion and pelleting on energy and nutrient digestibility in diets containing low, medium or high levels of fibre. In Experiment 1, 128 pigs were used (initial bodyweight (BW) of 9.41 ± 1.54 kg). Pigs were randomly allotted to four diets in a randomised complete block design. There were four pigs per pen and eight replicate pens per treatment. The corn used was ground to different particle sizes (i.e. 865, 677, 485 or 339 µm). In Experiment 2, three diets were formulated, including a low-fibre diet, a medium-fibre diet-, and a high-fibre diet. Each diet was divided into four batches after mixing and either fed in a meal form without further processing or pelleted, extruded, or extruded and pelleted. In total, 24 growing pigs (initial BW: 26.5 ± 1.5 kg) with a T-cannula installed in the distal ileum were allotted to the diets in a split-plot design, with eight pigs allotted to each level of fibre. Ileal digesta and faecal samples were collected and the apparent ileal digestibility of energy, crude protein and dry matter were calculated as was the metabolisable energy in each diet. Results of Experiment 1 indicated that final BW and average daily gain were not affected by corn particle size. However, average daily feed intake decreased (linear, P < 0.05) as mean particle size decreased from 865 to 677, 485 and 339 µm. Likewise, gain to feed ratio increased (linear, P < 0.05) from 0.65 to 0.66, 0.70 and 0.69 for pigs fed diets containing corn ground to a mean particle size of 865, 677, 485 and 339 µm, respectively. In Experiment 2, results indicated that pelleting, extrusion, or pelleting and extrusion improved (P < 0.05) the apparent ileal digestibility of energy and dry matter, but in most cases, there were no differences among the pelleted, the extruded, and the extruded and pelleted diets. Medium- and high-fibre diets that were extruded had greater metabolisable energy (P < 0.05) than the meal diets. In conclusion, results indicated that gain to feed of pigs fed diets containing corn with the smaller particle size was increased compared with diets containing corn with a greater particle size. In addition, energy utilisation may be improved by pelleting or extrusion or by a combination of the two technologies, but the response seems to be greater for extrusion in diets that are relatively high in fibre.
Phase Separated Block Copolymer Particles with Tuneable Morphologies: Striped, Onion, and Patchy Particles
Authors: Chen Chao , Xiao Zeyun , Connal Luke A.
Published: April 2016

The aqueous solution self-assembly of a series of poly(2-vinyl pyridine)-block-poly(dimethylsiloxane) (P2VP-b-PDMS) diblock copolymers is reported. The particles show a phase separated interior morphology which can be tuned from onion-like sphere to axially stacked lamella with dimensions in the nanoscale. The key to this transition is the control of the interfacial properties using a mixture of two surfactants with preferential wetting to the respective blocks (P2VP or PDMS). Influence of block weights on particle morphology was investigated with results showing that the volume fraction of PDMS plays a crucial role in self-assembly, and a non-conventional structure of a prolate spheroid nanoparticle with a unique phase separated interior morphology can be synthesised.
Training PhD students to bridge the Academia–Industry gap
Authors: Johanesen Priscilla , Garcia-Bustos Jose , Wood Paul
Published: April 2016

It is now well understood that the career paths of PhD students are diverse and not all PhD graduates strive for a career in academia1. Even if the opposite were true, the number of PhD graduates greatly exceeds the number of currently available and projected academic positions2. It is clear that the PhD as it is traditionally understood has to evolve. With the changing outcomes of the PhD has come the requirement to provide students with training that will equip them with marketable skills vital for success in real-life workplaces, extending them beyond their discipline-specific research and knowledge with skills applicable to industry, academia, government, the community and possibly entrepreneurial activities. This article describes a training module ‘From Project to Product’, which has been developed at Monash University to engage students with industry and introduce them to career pathways outside of academia.
National- and state-level impact and cost-effectiveness of nonavalent HPV vaccination in the United States
Authors: Durham David P. , Ndeffo-Mbah Martial L. , Skrip Laura A. , Jones Forrest K. , Bauch Chris T. , Galvani Alison P.
Published: April 2016

Significance

Vaccination protects against human papilloma virus (HPV)-induced cervical cancer, but coverage varies markedly across the United States. The nonavalent vaccine produces greater health benefits than the bivalent and quadrivalent vaccines at a lower societal cost. Because of the impact of herd immunity, any expansion in coverage will be much more effective in reducing cancer incidence and healthcare costs if targeted in those states with the lowest coverage. Because of interstate migration and the long duration between HPV infection and resultant cervical cancer, much of the benefit of vaccination will be realized beyond a state’s borders. Therefore, both cervical cancer incidence and expenditure can be substantially reduced if the states coordinate policies to promote expansion of coverage, particularly for the new nonavalent vaccine.
Fasting induces a form of autonomic synaptic plasticity that prevents hypoglycemia
Authors: Wang Manqi , Wang Qian , Whim Matthew D.
Published: April 2016

Significance

To prevent a fall in blood glucose during fasting, the counter-regulatory response is activated. An important component of this pathway involves the autonomic nervous system and release of epinephrine from the adrenal gland. This autonomic response is often referred to as a reflex, implying the output is hardwired and inflexible. Here we show the strength of the terminal synapse that controls epinephrine release is actually highly plastic. Fasting leads to a long-lasting increase in synaptic strength by a process that requires neuropeptide Y and Y5 receptors. In the absence of neuropeptide Y, synaptic strengthening is absent, epinephrine release is reduced, and the mice become hypoglycemic. These findings indicate that the response to fasting involves significant autonomic synaptic plasticity.
What insects can tell us about the origins of consciousness
Authors: Barron Andrew B. , Klein Colin
Published: April 2016

How, why, and when consciousness evolved remain hotly debated topics. Addressing these issues requires considering the distribution of consciousness across the animal phylogenetic tree. Here we propose that at least one invertebrate clade, the insects, has a capacity for the most basic aspect of consciousness: subjective experience. In vertebrates the capacity for subjective experience is supported by integrated structures in the midbrain that create a neural simulation of the state of the mobile animal in space. This integrated and egocentric representation of the world from the animal’s perspective is sufficient for subjective experience. Structures in the insect brain perform analogous functions. Therefore, we argue the insect brain also supports a capacity for subjective experience. In both vertebrates and insects this form of behavioral control system evolved as an efficient solution to basic problems of sensory reafference and true navigation. The brain structures that support subjective experience in vertebrates and insects are very different from each other, but in both cases they are basal to each clade. Hence we propose the origins of subjective experience can be traced to the Cambrian.
Hysteresis in DNA compaction by Dps is described by an Ising model
Authors: Vtyurina Natalia N. , Dulin David , Docter Margreet W. , Meyer Anne S. , Dekker Nynke H. , Abbondanzieri Elio A.
Published: April 2016

Significance

Cooperativity has been a fundamental concept in our understanding of biological systems for over a century. Here, we describe the observation of cooperative binding that exhibits long-lived hysteresis and cannot be described by a standard Hill model. Inspired by the Ising model of ferromagnetism, we describe this hysteresis as a consequence of cooperative binding in the limit of large complexes. We provide a method to relate the amount of hysteresis to the strength of the neighboring interactions between bound proteins and DNA. This novel kinetic feature of macromolecular complexes allows cells to create a binary response to small changes in external conditions and causes complexes to retain a memory of past conditions over long timescales.
Very-long-chain fatty acids restrict regeneration capacity by confining pericycle competence for callus formation in
Arabidopsis
Authors: Shang Baoshuan , Xu Chongyi , Zhang Xixi , Cao Huifen , Xin Wei , Hu Yuxin
Published: April 2016

Significance

Callus induction is an initial step for typical plant in vitro regeneration, and recent studies show that auxin-induced callus formation in multiple organs occurs from the pericycle or pericycle-like cells via a root developmental pathway. We demonstrate here that very-long-chain fatty acids (VLCFAs) or their derivatives act as the critical signal in restricting the callus-forming capacity of the pericycle and thus the regeneration capability in
Arabidopsis
. Our work not only discloses an unidentified role of VLCFAs in defining the regeneration capacity, but also sheds light on the signals that govern the cell states in plant organs. Our findings also may have relevance for investigating the possible role of VLCFAs in the regulation of cell states in animals.
NF-κB–driven suppression of FOXO3a contributes to EGFR mutation-independent gefitinib resistance
Authors: Chiu Ching-Feng , Chang Yi-Wen , Kuo Kuang-Tai , Shen Yu-Shiuan , Liu Chien-Ying , Yu Yang-Hao , Cheng Ching-Chia , Lee Kang-Yun , Chen Feng-Chi , Hsu Min-Kung , Kuo Tsang-Chih , Ma Jui-Ti , Su Jen-Liang
Published: April 2016

Significance

Gefitinib is a small molecular inhibitor that targets EGFR tyrosine kinases (EGFR-TKI) and has been used as a first-line treatment for advanced lung cancer. However, not all lung cancer patients respond to gefitinib treatment, and resistance to gefitinib has been apparent for lung cancer patients who have undergone treatment for a few months. We observed that FOXO3a expression is inversely correlated with lung cancer patients who responded poorly to EGFR-TKI treatment and identified an underlying mechanism of FOXO3a in EGFR mutation-independent cancer stemness and gefitinib resistance through the epigenetic regulation of NF-κB/miR-155. This finding highlights the potential of targeting the NF-κB/miR-155/FOXO3a pathway as a novel therapeutic strategy for lung cancer with the acquisition of resistance to EGFR-TKIs.
Predicting the spread of marine species introduced by global shipping
Authors: Seebens Hanno , Schwartz Nicole , Schupp Peter J. , Blasius Bernd
Published: April 2016

Significance

Predicting the arrival of alien species remains a big challenge, which is assumed to be a consequence of the complexity of the invasion process. Here, we demonstrate that spreading of alien marine species can be predicted by a simple model using only global shipping intensities, environmental variables, and species occurrence data. We provide species lists of the next potentially invading species in a local habitat or species causing harmful algal blooms with their associated probability of invasion. This will help to improve mitigation strategies to reduce the further introduction of alien species. Although this study focuses on marine algae, the model approach can be easily adopted to other taxonomic groups and their respective drivers of invasion.
Re-silencing of silent synapses unmasks anti-relapse effects of environmental enrichment
Authors: Ma Yao-Ying , Wang Xiusong , Huang Yanhua , Marie Helene , Nestler Eric J. , Schlüter Oliver M. , Dong Yan
Published: April 2016

Significance

Although long postulated as a behavioral therapy for drug addiction, environmental enrichment (EE) applied alone achieves only marginal and transient anti-addiction effects. Here, we report that, after cocaine withdrawal, EE alone did not affect the amygdala-to-nucleus accumbens projection, which has been critically implicated in cocaine craving and seeking. However, in vivo optogenetic long-term depression (LTD) at this projection primed a portion of affected synapses to remodel upon EE, leading to long-lasting anti-relapse effects. Thus, projection-specific LTD unmasks the anti-relapse power of EE, indicating the synergy of combinatory approaches for treating addiction.
Meta-analysis reveals that hydraulic traits explain cross-species patterns of drought-induced tree mortality across the globe
Authors: Anderegg William R. L. , Klein Tamir , Bartlett Megan , Sack Lawren , Pellegrini Adam F. A. , Choat Brendan , Jansen Steven
Published: April 2016

Significance

Predicting the impacts of climate extremes on plant communities is a central challenge in ecology. Physiological traits may improve prediction of drought impacts on forests globally. We perform a meta-analysis across 33 studies that span all forested biomes and find that, among the examined traits, hydraulic traits explain cross-species patterns in mortality from drought. Gymnosperm and angiosperm mortality was associated with different hydraulic traits, giving insight into the relative weights of different traits and mechanisms in mortality prediction. Our results provide a foundation for more mechanistic predictions of drought-induced tree mortality across Earth’s diverse forests.
Crafting usable knowledge for sustainable development
Authors: Clark William C. , van Kerkhoff Lorrae , Lebel Louis , Gallopin Gilberto C.
Published: April 2016

This paper distills core lessons about how researchers (scientists, engineers, planners, etc.) interested in promoting sustainable development can increase the likelihood of producing usable knowledge. We draw the lessons from both practical experience in diverse contexts around the world and from scholarly advances in understanding the relationships between science and society. Many of these lessons will be familiar to those with experience in crafting knowledge to support action for sustainable development. However, few are included in the formal training of researchers. As a result, when scientists and engineers first venture out of the laboratory or library with the goal of linking their knowledge with action, the outcome has often been ineffectiveness and disillusionment. We therefore articulate here a core set of lessons that we believe should become part of the basic training for researchers interested in crafting usable knowledge for sustainable development. These lessons entail at least four things researchers should know, and four things they should do. The knowing lessons involve understanding the coproduction relationships through which knowledge making and decision making shape one another in social–environmental systems. We highlight the lessons that emerge from examining those coproduction relationships through the ICAP lens, viewing them from the perspectives of Innovation systems, Complex systems, Adaptive systems, and Political systems. The doing lessons involve improving the capacity of the research community to put its understanding of coproduction into practice. We highlight steps through which researchers can help build capacities for stakeholder collaboration, social learning, knowledge governance, and researcher training.
Rational elicitation of cold-sensitive phenotypes
Authors: Baliga Chetana , Majhi Sandipan , Mondal Kajari , Bhattacharjee Antara , VijayRaghavan K. , Varadarajan Raghavan
Published: April 2016

Significance

Temperature-sensitive (ts) and cold-sensitive mutants (cs) provide rapid and reversible means to lower the level of a specific gene product at any stage in the life cycle of an organism. cs mutants are rare, and the molecular determinants of cs phenotypes are poorly understood. We present and validate a method for the rational elicitation of cold-sensitive phenotypes that involves the design of partial loss-of-function mutants based solely on amino acid sequence, and the coupling of such mutants to a heat responsive promoter. This study provides insight into the molecular determinants of cold sensitivity. Such designed cs mutants provide insight into gene function and also can be coupled with ts mutants to order genes in a pathway.
Boosting association rule mining in large datasets via Gibbs sampling
Authors: Qian Guoqi , Rao Calyampudi Radhakrishna , Sun Xiaoying , Wu Yuehua
Published: April 2016

Significance

Informative association rule mining is fundamental for knowledge discovery from transaction data, for which brute-force search algorithms, e.g., the well-known Apriori algorithm, were developed. However, operating these algorithms becomes computationally intractable in searching large rule space. The stochastic search algorithm developed here tackles this challenge by using the idea of annealing Gibbs sampling. Large rule space of exponential order can still be randomly searched by this algorithm to generate an ergodic Markov chain of viable length. The ergodic chain contains the most informative rules with probability 1, creating a much reduced rule space for subsequent mining without information loss. Such capacity of the algorithm is demonstrated using a carefully designed simulation study and a real genomic dataset containing 1,067 items.
The space of functions of bounded variation on curves in metric measure spaces
Authors: Martio O.
Published: April 2016

The approximation modulus,

A
M

AM

–modulus for short, was defined in an earlier paper by the author. In this paper it is shown that an

L
1

(
X
)

L^1(X)

–function

u
u

in a metric measure space

(
X
,
d
,
ν
)

(X,d,\nu )

can be defined to be of bounded variation on

A
M

AM

–a.e. curve in

X
X

without an approximation of

u
u

by Lipschitz or Newtonian functions. The essential variation of

u
u

on

A
M

AM

almost every curve is bounded by a sequence of non-negative Borel functions in

L
1

(
X
)

L^1(X)

. The space of such functions is a Banach space and there is a Borel measure associated with

u
u

. For

X
=

R

n

X = \mathbf {R}^n

this gives the classical space of BV functions.
Measures on hyperspaces
Authors: Charatonik Włodzimierz , Insall Matt
Published: April 2016

From a measure space,

(
X
,

μ

X

)

(X, \mu ^{\mathbb {X}})

we define a measure

μ

P

(

X

)

\mu ^{\mathbb {P}(\mathbb {X})}

on the power set of

X
X

. If

(
X
,
τ
)

(X, \tau )

is a compactum, whose topology

τ
\tau

is compatible with the measure

μ

X

\mu ^{\mathbb {X}}

on

X
X

, then the measure

μ

P

(

X

)

\mu ^{\mathbb {P}(\mathbb {X})}

restricts to a natural measure on the hyperspace of closed sets of that given compactum. Surprisingly, under very mild conditions,

μ

P

(

X

)

\mu ^{\mathbb {P}(\mathbb {X})}

is always supported on the hyperspace of finite subsets.
Generalized vs. ordinary differentiation
Authors: Ash J. , Catoiu Stefan , Csörnyei Marianna
Published: April 2016

There are difference quotients distinct from

f
(
x
+
h
)
−
f
(
x
)

h

\displaystyle \frac {f(x+h)-f(x)}h

which characterize differentiability. We find all of them.
Estimating and mitigating the discard mortality of Atlantic cod (Gadus morhua) in the Gulf of Maine recreational rod-and-reel fishery
Authors: Capizzano Connor W. , Mandelman John W. , Hoffman William S. , Dean Micah J. , Zemeckis Douglas R. , Benoît Hugues P. , Kneebone Jeff , Jones Emily , Stettner Marc J. , Buchan Nicholas J. , Langan Joseph A. , Sulikowski James A.
Published: April 2016

In recent years, the recreational contribution to the total catch of Atlantic cod (Gadus morhua) in the Gulf of Maine (GOM) has increased with recreational discards outnumbering recreational landings by 2:1. However, the discard mortality (DM) rate of cod released in the recreational fishery remains poorly understood, thus contributing to the uncertainty in stock assessments and fishery management plans. The current study examined the capture-related factors most detrimental to cod DM in the GOM recreational rod-and-reel fishery. Atlantic cod (n = 640; 26.0–72.0 cm) were angled from June–October 2013 on southern Jeffreys Ledge in the western GOM using fishing gear representative of the local recreational fishery. A subset (n = 136) was also tagged with pressure-sensing acoustic transmitters before being released into an acoustic receiver array (n = 31) deployed to monitor survival up to 94 days. To properly model DM up to the fishery-wide level, all cod were visually assessed for capture-related injuries according to a four-level injury score index. Mean tackle-specific DM rates of 15.4 and 21.2% were estimated for bait- and jig-captured cod, respectively, with an overall 16.5% mean DM rate for the 2013 GOM recreational cod fishery. Twenty-nine cod tagged with acoustic transmitters were identified as dead, where the majority (∼90%) died within 16 h post-capture. Upon evaluation with a specifically adapted parametric survival analysis, greater incidence of mortality was attributed to the capture and handling process (rather than release) for moderately and severely injured cod. Based on the capture-related factors associated with the highest injury rates, we recommend minimizing fight and handling times, avoiding areas with small cod, educating inexperienced anglers, and favouring bait over jigs to mitigate mortality. Results will continue to inform the development of fishery management plans and enhance survival through dissemination of “best practice” techniques to fishery stakeholders.
Imperfect Progress: An Objective Quality Assessment of the Role of User Reviews in Consumer Decision Making, A Commentary on de Langhe, Fernbach, and Lichtenstein
Authors: Simonson Itamar
Published: April 2016

User reviews aggregate word of mouth and often greatly enhance consumers’ ability to estimate product quality. Consumers decide for themselves whether and how to incorporate user reviews with other sources when evaluating options (e.g., a small minority uses Consumer Reports ). Despite the extraordinary diligence of Bart de Langhe, Philip Fernbach, and Donald Lichtenstein and their use of a variety of data sources and methods, I have concerns about the purpose of the research, the evidence and distinctions they rely on, and the overstated conclusions. However, studying how user reviews and other currently available quality sources of information affect consumers is important and offers new directions for judgment and decision-making researchers.
Constraining the ellipticity of strongly magnetized neutron stars powering superluminous supernovae
Authors: Moriya Takashi J. , Tauris Thomas M.
Published: April 2016

Superluminous supernovae (SLSNe) have been suggested to be powered by strongly magnetized, rapidly rotating neutron stars which are often called magnetars. In this process, rotational energy of the magnetar is radiated via magnetic dipole radiation and heats the supernova ejecta. However, if magnetars are highly distorted in their geometric shape, rotational energy is mainly lost as gravitational wave radiation and thus such magnetars cannot power SLSNe. By simply comparing electromagnetic and gravitational wave emission time-scales, we constrain upper limits to the ellipticity of magnetars by assuming that they power the observed SLSNe. We find that their ellipticity typically needs to be less than about a few 10−3. This indicates that the toroidal magnetic field strengths in these magnetars are typically less than a few 1016 G so that their distortions remain small. Because light-curve modelling of SLSNe shows that their dipole magnetic field strengths are of the order of 1014 G, the ratio of poloidal to toroidal magnetic field strengths is found to be larger than ∼0.01 in magnetars powering SLSNe.
A Multidisciplinary Housestaff-Led Initiative to Safely Reduce Daily Laboratory Testing
Authors: Iams Wade , Heck Josh , Kapp Meghan , Leverenz David , Vella Michael , Szentirmai Eszter , Valerio-Navarrete Irene , Theobald Cecelia , Goggins Kathryn , Flemmons Kevin , Sponsler Kelly , Penrod Cody , Kleinholz Patricia , Brady Donald , Kripalani Sunil
Published: April 2016

Purpose

Provision of high-value care is a milestone in physician training. The authors evaluated the effect of a housestaff-led initiative on laboratory testing rates.

Method

Vanderbilt University Medical Center’s Choosing Wisely steering committee, led by housestaff with faculty advisors, sought to reduce unnecessary daily basic metabolic panel (BMP) and complete blood count (CBC) testing on inpatient general medicine and surgical services. Intervention services received a didactic session followed by regular data feedback with goal rates and peer comparison. Testing rates during January 1, 2013–February 9, 2015, were compared on intervention services and control services using a difference-in-differences analysis and an interrupted time-series analysis with segmented linear regression.

Results

Compared with concurrent controls, the mean number of BMP tests per patient day decreased by an additional 0.23 (95% CI 0.17–0.29) on medical housestaff and 0.15 (95% CI 0.09–0.21) on hospitalist intervention services. Daily CBC tests decreased by an additional 0.28 (95% CI 0.23–0.33) on medical housestaff, 0.08 (95% CI 0.03–0.13) on hospitalist, and 0.12 (95% CI 0.05–0.20) on surgical housestaff intervention services. Patients with lab-free days (0 labs ordered in 24 hours) increased by an additional 4.1 percentage points (95% CI 2.1–6.1) on medical housestaff and 9.7 percentage points (95% CI 6.6–12.8) on hospitalist intervention services. There were no adverse changes in length of stay or intensive care unit transfer, in-hospital mortality, or 30-day readmission rates.

Conclusions

A housestaff-led intervention utilizing education and data feedback with goal setting and peer comparison resulted in safe, significant reductions in daily laboratory testing rates.
Establishing an Integrative Medicine Program Within an Academic Health Center: Essential Considerations
Authors: Eisenberg David M. , Kaptchuk Ted J. , Post Diana E. , Hrbek Andrea L. , O’Connor Bonnie B. , Osypiuk Kamila , Wayne Peter M. , Buring Julie E. , Levy Donald B.
Published: April 2016

Integrative medicine (IM) refers to the combination of conventional and “complementary” medical services (e.g., chiropractic, acupuncture, massage, mindfulness training). More than half of all medical schools in the United States and Canada have programs in IM, and more than 30 academic health centers currently deliver multidisciplinary IM care. What remains unclear, however, is the ideal delivery model (or models) whereby individuals can responsibly access IM care safely, effectively, and reproducibly in a coordinated and cost-effective way.

Current models of IM across existing clinical centers vary tremendously in their organizational settings, principal clinical focus, and services provided; practitioner team composition and training; incorporation of research activities and educational programs; and administrative organization (e.g., reporting structure, use of medical records, scope of clinical practice) and financial strategies (i.e., specific business plans and models for sustainability).

In this article, the authors address these important strategic issues by sharing lessons learned from the design and implementation of an IM facility within an academic teaching hospital, the Brigham and Women’s Hospital at Harvard Medical School; and review alternative options based on information about IM centers across the United States.

The authors conclude that there is currently no consensus as to how integrative care models should be optimally organized, implemented, replicated, assessed, and funded. The time may be right for prospective research in “best practices” across emerging models of IM care nationally in an effort to standardize, refine, and replicate them in preparation for rigorous cost-effectiveness evaluations.
Design Thinking as a Tool for Interdisciplinary Education in Health Care
Authors: van de Grift Tim C. , Kroeze Renske
Published: April 2016

Problem

Grappling with complex structural health care issues requires medical professionals to have training in skills and knowledge that go beyond the basic and clinical sciences. It is also crucial for health care professionals to be able to work collaboratively. However, medical education has only limitedly institutionalized the teaching of these skills.

Approach

In fall 2014, a one-semester crossover course called Hacking Healthcare was developed by the University of Amsterdam in cooperation with the Gerrit Rietveld Academie of Fine Arts and six health care institutions in the greater Amsterdam area. The course comprised one or two weekly three-hour evening sessions consisting of a lecture, workshop, and group work. It was structured using the three stages of the design thinking process—inspiration, ideation, and implementation. Twenty-seven medicine, psychology, other science disciplines, and art students participated, working in interdisciplinary groups on an assigned case study.

Outcomes

The course yielded both unconventional and holistic key insights and a wide range of tangible outcomes, which were also considered to be relevant by the patient. Among university (i.e., nonart) students (n = 14), the average overall score of the course was 8.5 out of 10, with 10 being the highest rating. Aspects of the course that were mentioned as positive points were the activating teaching environment, academic development, and development of collaboration skills and creative capabilities.

Next Steps

This approach could be applied in other fields, such as medical education on a larger scale, clinical practice, and the design of scientific research.
Therapeutic Whole-body Hypothermia Protects Remote Lung, Liver, and Kidney Injuries after Blast Limb Trauma in Rats
Authors: Ning Jiaolin , Mo Liwen , Yi Bin , Gu Jianteng , Lu Kaizhi , Zhou Yaying , Lai Xinan , Zhao Hailin , Ma Daqing
Published: April 2016

AbstractAbstract

Whole-body hypothermia for 3 h immediately after injury in an experimental animal model provides multiorgan protection for traumatic injury after blast trauma.

Supplemental Digital Content is available in the text.

Background

Severe blast limb trauma (BLT) induces distant multiple-organ injuries. In the current study, the authors determined whether whole-body hypothermia (WH) and its optimal duration (if any) afford protection to the local limb damage and distant lung, liver, and kidney injuries after BLT in rats.

Methods

Rats with BLT, created by using chartaceous electricity detonators, were randomly treated with WH for 30 min, 60 min, 3 h, and 6 h (n = 12/group). Rectal temperature and arterial blood pressure were monitored throughout. Blood and lung, liver, and kidney tissue samples were harvested for measuring tumor necrosis factor-α, interleukin-6 and interleukin-10, myeloperoxidase activity, hydrogen sulfide, and biomarkers of oxidative stress at 6 h after BLT. The pathologic lung injury and the water content of the lungs, liver, and kidneys and blast limb tissue were assessed.

Results

Unlike WH for 30 min, WH for 60 min reduced lung water content, lung myeloperoxidase activity, and kidney myeloperoxidase activity by 10, 39, and 28% (all P < 0.05), respectively. WH for 3 h attenuated distant vital organs and local traumatic limb damage and reduced myeloperoxidase activity, hydrogen peroxide and malondialdehyde concentration, and tumor necrosis factor-α and interleukin-6 levels by up to 49% (all P < 0.01). Likewise, WH for 6 h also provided protection to such injured organs but increased blood loss from traumatic limb.

Conclusions

Results of this study indicated that WH may provide protection for distant organs and local traumatic limb after blast trauma, which warrants further study.
Effects of Volatile Anesthetics on Mortality and Postoperative Pulmonary and Other Complications in Patients Undergoing Surgery
Authors: Uhlig Christopher , Bluth Thomas , Schwarz Kristin , Deckert Stefanie , Heinrich Luise , De Hert Stefan , Landoni Giovanni , Serpa Neto Ary , Schultz Marcus J. , Pelosi Paolo , Schmitt Jochen , Gama de Abreu Marcelo
Published: April 2016

Background

It is not known whether modern volatile anesthetics are associated with less mortality and postoperative pulmonary or other complications in patients undergoing general anesthesia for surgery.

Methods

A systematic literature review was conducted for randomized controlled trials fulfilling following criteria: (1) population: adult patients undergoing general anesthesia for surgery; (2) intervention: patients receiving sevoflurane, desflurane, or isoflurane; (3) comparison: volatile anesthetics versus total IV anesthesia or volatile anesthetics; (4) reporting on: (a) mortality (primary outcome) and (b) postoperative pulmonary or other complications; (5) study design: randomized controlled trials. The authors pooled treatment effects following Peto odds ratio (OR) meta-analysis and network meta-analysis methods.

Results

Sixty-eight randomized controlled trials with 7,104 patients were retained for analysis. In cardiac surgery, volatile anesthetics were associated with reduced mortality (OR = 0.55; 95% CI, 0.35 to 0.85; P = 0.007), less pulmonary (OR = 0.71; 95% CI, 0.52 to 0.98; P = 0.038), and other complications (OR = 0.74; 95% CI, 0.58 to 0.95; P = 0.020). In noncardiac surgery, volatile anesthetics were not associated with reduced mortality (OR = 1.31; 95% CI, 0.83 to 2.05, P = 0.242) or lower incidences of pulmonary (OR = 0.67; 95% CI, 0.42 to 1.05; P = 0.081) and other complications (OR = 0.70; 95% CI, 0.46 to 1.05; P = 0.092).

Conclusions

In cardiac, but not in noncardiac, surgery, when compared to total IV anesthesia, general anesthesia with volatile anesthetics was associated with major benefits in outcome, including reduced mortality, as well as lower incidence of pulmonary and other complications. Further studies are warranted to address the impact of volatile anesthetics on outcome in noncardiac surgery.
Epiglottitis
Authors: Lichtor J. Lance , Roche Rodriguez Maricarmen , Aaronson Nicole L. , Spock Todd , Goodman T. Rob , Baum Eric D.
Published: April 2016

Due to the potentially unforgiving nature of epiglottitis and supraglottitis, the clinician should have a firm understanding of the presentation, work up, and management of a patient presenting with worrisome symptoms.
Pelvic fractures: epidemiology, consequences, and medical management
Authors: Breuil Véronique , Roux Christian Hubert , Carle Georges F.
Published: April 2016

Purpose of review

Until recently, osteoporotic pelvic fractures have not been specifically studied. This review presents an update on epidemiological data of pelvic fracture, including morbidity, mortality and healthcare costs, the role of surgery and new data on sacroplasty in acute phase management.

Recent findings

All studies underline the burden of osteoporotic pelvic fractures. Risk factors associated with these fractures are age, sex (women), and previous loss of autonomy. An increased mortality has been reported in all publications, similar to hip fracture for in-patient mortality and at 5 years of follow-up. Pelvic fractures often lead to transient or permanent autonomy loss, reflecting the high costs because of extended hospital stay, combined with nursing home requirement. However, recent studies report a decrease in the length of stay. Sacroplasty displays promising results to control pain and improve functional outcome. Early surgery begins to be discussed to also improve the outcome.

Pelvic fractures display all the features of severe osteoporotic fractures: increased incidence, high morbidity, mortality, and healthcare costs that justify awareness of the practitioner on these fractures. Further studies on sacroplasty and surgery are necessary to improve pain control, functional improvement, thereby reducing the length of hospital stay and cost.
A Simple Method for Measurement of Femoral Anteversion—Validation and Assessment of Reproducibility
Authors: Brunner Alexander , Eichinger Martin , Hengg Clemens , Hoermann Romed , Brenner Erich , Kralinger Franz
Published: April 2016

Objectives:

To propose a simple method for measurement of femoral anteversion (AV) with a conventional fluoroscope, to evaluate the interobserver and intraobserver reliability of this method on the basis of human cadaver femurs, and to validate such method on the basis of computed tomography (CT).

Methods:

Fourteen human cadavers with 28 intact femurs were included in the study. Three blinded observers measured femoral AV of the specimen with a fluoroscope. The session was repeated 8 weeks later and CT of the femurs were performed. Mean AV values and the difference between single and mean AV values were calculated. Interobserver/intraobserver reliability of the proposed method was assessed. Correlation between AV values measured with fluoroscope and CT was calculated.

Results:

Mean AV was 18.1° when measured with fluoroscope and 19.2° when measured with CT. Mean differences between single AV values were 2.2° with fluoroscope and 2.5° with CT. The mean maximum observer variation per specimen was 8.8°. Interobserver reliability was excellent (intraclass correlation coefficient: 0.853) and intraobserver reliability was good (intraclass correlation coefficient: 0.682). A high correlation was found between AV values measured with fluoroscope and CT (rho = 0.739, P < 0.01).

Conclusion:

The presented technique allows reliable and simple measurement of femoral AV with a conventional fluoroscope. The mean interobserver variation is comparable to what has been reported for CT. Maximum interobserver variation was <15° in all specimens. A clinical study will be necessary to prove the value of this technique for intraoperative adjustment of femoral AV according to the intact contralateral side.
Can Tibial Shaft Fractures Bear Weight After Intramedullary Nailing? A Randomized Controlled Trial
Authors: Gross Steven C. , Galos David K. , Taormina David P. , Crespo Alexander , Egol Kenneth A. , Tejwani Nirmal C.
Published: April 2016

Objective:

To examine the potential benefits and risks associated with weight-bearing after intramedullary (IM) nailing of unstable tibial shaft fractures.

Design:

Randomized controlled trial.

Setting:

Two New York State level 1 trauma centers, one level 2 trauma center, and 1 tertiary care orthopaedic hospital in a large urban center in New York City.

Patients/Participants:

Eighty-eight patients with 90 tibial shaft fractures were enrolled. The following were used as inclusion criteria: (1) skeletally mature adult patients 18 years of age or older, (2) displaced fractures of tibial diaphysis (OTA type 42) treated with operative intervention, and (3) radiographs, including injury, operative, and completion of follow-up. Sixty-eight patients with 70 tibial shaft fractures completed follow-up.

Intervention:

All patients were treated with locked IM nailing. Patients were randomized to 1 of 2 groups: immediate weight-bearing-as-tolerated (WBAT) or non–weight-bearing for the first 6 postoperative weeks (NWB).

Main Outcome Measures:

Fracture union or treatment failure/revision surgery.

Results:

There was no statistical difference in the observed time to union between groups (WBAT = 22.1 ± 11.7 weeks vs. NWB = 21.3 ± 9.9 weeks; P = 0.76). Rates of complications did not statistically differ between groups. No fracture loss of reduction leading to malunion was encountered. Short Musculoskeletal Function Assessment scores for all domains did not statistically differ between groups.

Conclusions:

Immediate weight-bearing after IM nailing of tibial shaft fractures is safe and is not associated with an increase in adverse events or complications. Patients should be allowed to bear weight as tolerated after IM nailing of OTA subtype 42-A and 42-B tibial shaft fractures.

Level of Evidence:

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Overhead Bryant’s Traction Does Not Improve the Success of Closed Reduction or Limit AVN in Developmental Dysplasia of the Hip
Authors: Sucato Daniel J. , De La Rocha Adriana , Lau Karlee , Ramo Brandon A.
Published: April 2016

Background:

Preoperative Bryant’s overhead traction before closed reduction (CR) in developmental dysplasia of the hip (DDH) remains controversial and its success in increasing CR rates and reducing avascular necrosis (AVN) rates has not been specifically reported in a large cohort.

Methods:

IRB-approved retrospective study of patients (below 3 y)who were treated with attempted CR for idiopathic DDH from 1980 to 2009. Successful CR was defined as a hip that remained reduced and did not require repeat CR or open reduction. Patients were grouped by age, hip instability [Ortolani positive (reducible) vs. fixed dislocation], and Tonnis classification and rates of successful CR were compared between groups with P<0.05.

Results:

A total of 342 hips were included with a mean age of 0.9 years (0.2 to 2.8 y) and a mean follow-up of 10.4 years (2.0 to 27.7 y). There were 269 hips with fixed dislocations and 73 Ortolani-positive hips. Traction was used in 276 hips. There was no difference in traction utilization in the 3 age groups (below 1, below 1.5, and below 2 y) for either Ortolani-positive hips (P=0.947) or fixed dislocations (P=0.943). There was no difference in achieving a successful CR comparing traction (60.9%) and no-traction groups (60.6%) (P=1.00). For Ortolani-positive hips, traction did not improve the incidence of a successful CR for any age group: below 1 year: P=0.19; below 1.5 years: P=0.23; and below 2 years: P=0.25. Similarly, fixed dislocation patients had no benefit from traction: below 1 year: P=0.76; below 1.5 years: P=0.82; and below 2 years: P=0.85. Tonnis classification did predict success of CR but had no influence on traction success. There was no difference in the rate of AVN between the traction (18%) and no-traction (8%) groups for all patients (P=0.15).

Conclusions:

In this retrospective series, preoperative Bryant’s traction does not improve the rate of a successful CR for patients with DDH and has no protective effect on the development of AVN of the femoral head. These results suggest that Bryant’s overhead traction may not be warranted for patients below 3 years of age with DDH.

Level of Evidence:

Level III.
A Comparison of SHILLA GROWTH GUIDANCE SYSTEM and Growing Rods in the Treatment of Spinal Deformity in Children Less Than 10 Years of Age
Authors: Luhmann Scott J. , McCarthy Richard E.
Published: April 2016

Background:

The purpose of this study was to compare the outcomes of the SHILLA GROWTH GUIDANCE SYSTEM and “intermittent distraction growing rod” (IDGR) in the treatment of children (less than 10 y of age) with progressive spinal deformity. This was a multicenter retrospective study of the SHILLA used as an alternative treatment to IDGR to support an HDE submission for Food and Drug Administration approval.

Methods:

Inclusion criteria were progressive scoliosis in a patient less than 10 years of age at index procedure. The study population consisted of 19 SHILLA and 6 IDGR patients whose mean age was 6.1 and 5.8 years, respectively. Group demographics were similar between the 2 groups.

Results:

The initial major curve magnitude was 70.3 degrees for SHILLA and 68.3 degrees for IDGR, which decreased postoperatively to 22.4 degrees (68.1% improvement) and 32.2 degrees (52.9% improvement). During the first 4 years the correction for SHILLA varied from 40.5% to 53.4% and for IDGR from 40.9% to 56.9%. At last follow-up, T1-S1 length was 32.9 cm for SHILLA (4.2 increase from preoperation) and 34.0 cm (5.0 cm increase from preoperation) for IDGR. Average growth per month from T1-S1: SHILLA 0.14 cm, IDGR 0.11 cm. Sagittal T2-T12 preoperatively was 36.3 degrees for SHILLA and 30.0 degrees for IDGR. There were 29 reoperations in 12 of the 19 SHILLA patients (63.2%) and 40 reoperations in all 6 of the IDGR patients (100%) related to the index procedure.

Conclusions:

The SHILLA GROWTH GUIDANCE SYSTEM compares favorably with traditional IDGR constructs in terms of correction of the major curve, spinal length and growth, and maintenance of sagittal alignment. The >4-fold decrease in additional surgeries makes the SHILLA an attractive alternative to minimize comorbidities associated with additional surgeries.

Levels of Evidence:

Level III.
Tibia Shaft Fractures in Adolescents: How and When Can They be Managed Successfully With Cast Treatment?
Authors: Ho Christine A.
Published: April 2016

Despite the increasing popularity of operative treatment in adolescent tibia fractures, casting remains a viable first-line treatment. Because the selection bias in published reports does not allow direct comparison between casting and flexible nail treatment of closed pediatric tibia fractures, it is unclear whether flexible nailing offers any advantages over casting. This overview discusses parameters of acceptable alignment, indications, techniques for successful reduction and casting, subsequent inpatient and outpatient management including wedging of casted tibia fractures, expected outcomes, and comparison of casting with flexible nailing. As with any orthopaedic procedure, careful attention to patient selection, indications, and detail facilitates successful cast treatment in this older pediatric population.