bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of Extracorporeal Support in Hemophagocytic Lymphohistiocytosis Secondary to Ehrlichiosis
Authors: Cheng Amy , Williams Feifei , Fortenberry James , Preissig Catherine , Salinas Steven , Kamat Pradip
Published: September 2016

Ehrlichiosis, caused by transmission of Ehrlichia chaffeensis to humans through the bite of an infected lone star tick, can lead to secondary hemophagocytic lymphohistiocytosis (HLH), a life-threatening condition caused by uncontrolled activation of the cellular immune system. We describe a child with HLH secondary to ehrlichiosis who developed multiorgan failure and was successfully managed with extracorporeal membrane oxygenation (ECMO). A 9-year-old boy developed headaches, fever, and sore throat after suspected tick exposure. He presented with pancytopenia, elevated ferritin, and soluble interleukin-2 receptor levels, all consistent with HLH. Bone marrow biopsy revealed hemophagocytosis. Polymerase chain reaction was positive for E chaffeensis. He developed acute kidney injury, coagulation failure, hepatic insufficiency, and progressive respiratory failure requiring intubation. Due to refractory hypoxemia, he was cannulated for veno-venous ECMO. Continuous veno-venous hemofiltration was used to manage acute kidney injury and fluid overload. He received doxycycline and dexamethasone/etoposide for treatment of ehrlichiosis and HLH, respectively. Plasma exchange was used for thrombocytopenia-associated multiple organ failure. The patient was decannulated after 140 hours of ECMO and subsequently transferred for inpatient rehabilitation after extubation. Review of the Extracorporeal Life Support Organization Registry database identified 6 patients with tickborne diseases who received ECMO for organ support (survival in 3 of 6); ehrlichiosis was not reported in any of these cases. ECMO likely allowed a platform for stabilization and additional therapeutic interventions in this patient.
CRESCIMENTO DA CANA-DE-AÇÚCAR EM SUPERFÍCIES IRRIGADAS, COM DIFERENTES EXPOSIÇÕES E DECLIVIDADES
Authors: Mazaron Bruno Henryque Silveira , Turco José Eduardo Pitelli , Da Silva Vanessa Lorencini
Published: September 2016

CRESCIMENTO DA CANA-DE-AÇÚCAR EM SUPERFÍCIES IRRIGADAS, COM DIFERENTES EXPOSIÇÕES E DECLIVIDADES  BRUNO HENRIQUE SILVEIRA MAZARON1; JOSÉ EDUARDO PITELI TURCO2 E VANESSA LORENCINI DA SILVA3 1 Eng° Agrônomo, Doutorando em Ciência do Solo, FCAV/UNESP – Jaboticabal – SP brunomazaron@yahoo.com.br 2Engº Eletricista, Prof. Adjunto, Departamento de Engenharia Rural, UNESP – Jaboticabal - SP, jepturco@fcav.unesp.br3 Eng° Agrônoma, Doutora em Ciência do Solo, FCAV/UNESP – Jaboticabal – SP vanlorencini@yahoo.com.br   1 RESUMO Compreender os padrões espaciais das culturas, baseada em informações topográficas e suas interações com fatores ambientais, podem fornecer oportunidades de aplicações específicas de manejo, e assim, explorar o potencial produtivo das plantas. Diante disso, o objetivo desse estudo foi avaliar a influência da exposição, da declividade e da irrigação sobre o crescimento da cana-de-açúcar em uma “Bacia Hidrográfica Experimental”, utilizando superfícies com exposições norte e sul, e inclinações com 0%, 10%, 20%, 30%, 40% e 50% de declividade. Foram avaliados parâmetros biométricos, a produtividade e suas interações com a radiação e a presença de irrigação. Foi concluído que o crescimento da cultura é influenciado positivamente pela exposição e pela disponibilidade hídrica. A exposição norte, correlacionada com a PAR e a presença de irrigação, influenciaram positivamente o crescimento da planta, o diâmetro do colmo e a produtividade final. Palavras-chave: manejo, superfícies inclinadas, Saccharum spp., radiação solar.  MAZARON, B. H. S.; TURCO, J. E. P.; SILVA, V. L.SUGARCANE GROWTH  IN SURFACES IRRIGATED WITH DIFFERENT EXPOSITIONS AND DECLIVITIES  2 ABSTRACT Understanding the spatial patterns of cultures, based on topographic information and their interactions with environmental factors, can provide opportunities for specific management applications, and thus exploit the productive potential of plants. Thus, the objective of this study was to evaluate the influence of exposure, slope and irrigation on the growth of sugarcane in a "Experimental River Basin" using surfaces with north and south exposures and slopes with 0% 10%, 20%, 30%, 40% and 50% slope. Were evaluated biometric parameters, productivity and their interactions with radiation and the presence of irrigation. It was concluded that crop growth is positively influenced by exposure and water availability. The north exposure correlated to the PAR and the presence of irrigation positively influenced the growth of the plant, the stem diameter and the final yield. Keywords: manage, inclined surfaces, Saccharum spp., solar radiation.
Survey of Parent Experiences in Prenatal Visits for Infants with Cleft Lip and Palate
Authors: Greives Matthew R. , Anderson Casey L. , Dean Riley A. , Scerbo Michelle L. , Doringo Irene L. , Bebbington Michael W. , Teichgraeber John F.
Published: September 2016

Objective

The purpose of this study was to identify the factors that influence the parent's choice of cleft team/surgeon.

Design

A 10-question survey was used to elucidate factors that influenced parents in choosing their cleft surgeon. No identifiers of the origin of the study were used to improve parent objectivity.

Setting

The setting for this study was an online survey.

Participants

Participants in this study were the parents of children who were born with cleft lip and/or palate.

Interventions

Parents were contacted anonymously via national, established social media websites that were independently run by the parents themselves.

Main Outcome Measures

The main outcome measures were information regarding choice of cleft team/surgeon, source of patient referrals, and use of online media in decision making.

Results

A total of 112 responses were received. Of the parents, 77% sought prenatal evaluation with at least one cleft surgeon. Maternal-fetal medicine specialists were the most frequent (42%) referral source, followed by primary obstetricians (14%) and pediatricians (12%). The surgeon/cleft team's experience level and overall personality were ranked as the most important, whereas the least important was distance traveled. Of the parents, 95% used the Internet or social media for research prior to their prenatal visit; 96% of the parents found the prenatal visit helpful, and the most useful topics discussed were treatments (surgical, nonsurgical) and feeding techniques.

Conclusion

This study identifies factors used to choose a cleft team/surgeon. Parents are more concerned with the experience level, reputation, and environment of the cleft team/surgeon than the distance traveled to get to the center.
Intensity-Modulated Radiation Therapy May Improve Local-Regional Tumor Control for Locally Advanced Non-Small Cell Lung Cancer Compared With Three-Dimensional Conformal Radiation Therapy
Authors: Wang Jingbo , Zhou Zongmei , Liang Jun , Feng Qinfu , Xiao Zefen , Hui Zhouguang , Wang Xiaozhen , Lv Jima , Chen Dongfu , Zhang Hongxing , Ji Zhe , Cao Jianzhong , Liu Lipin , Jiang Wei , Men Yu , Xu Cai , Dai Jiangrong , Yin Weibo , Wang Luhua
Published: September 2016

Background.

Consistent results are lacking as regards the comparative effectiveness of intensity-modulated radiotherapy (IMRT) versus three-dimensional conformal radiotherapy (3DCRT) in patients with locally advanced non-small cell lung cancer (LA-NSCLC).

Patients and Methods.

Patients treated with definitive radiotherapy (RT) between 2002 and 2010 were retrospectively reviewed. Overall survival (OS), local-regional progression-free survival (LRPFS), distant metastasis-free survival (DMFS), and progression-free survival (PFS) were compared among patients irradiated with different techniques. The association between RT technique and survival indexes was assessed in a Cox proportional hazard regression model. Propensity score matching (PSM) was used to balance known confounding factors.

Results.

A total of 652 patients were eligible for analysis, including 206 with 3DCRT and 446 with IMRT. The median OS of the 3DCRT and IMRT groups were 19.4 and 23.3 months, with the 5-year rate of 13% and 19%, respectively (p = .043). Multivariate analysis identified IMRT as an independent favorable factor associated with LRPFS and DMFS. PSM analysis further verified the beneficial effect of IMRT on LRPFS. No difference in OS or PFS was observed between the two techniques. Subgroup analysis revealed that IMRT might be differentially more effective in both OS and LRPFS among patients who were female, nonsmokers, with adenocarcinoma, or without weight loss. There was a significant reduction of lung toxicity and similar esophagus toxicity in the IMRT group when compared with the 3DCRT group.

Conclusion.

IMRT may confer superior LRPFS and comparable OS than can be achieved with 3DCRT in LA-NSCLC, along with the reduction of pulmonary toxicity.
Targeting the N-Terminal Domain of the Androgen Receptor: A New Approach for the Treatment of Advanced Prostate Cancer
Authors: Antonarakis Emmanuel S. , Chandhasin Chandtip , Osbourne Erica , Luo Jun , Sadar Marianne D. , Perabo Frank
Published: September 2016

Despite the recent approval and widespread use of abiraterone acetate and enzalutamide for the treatment of castration-resistant prostate cancer (CRPC), this disease still poses significant management challenges because of various tumor escape mechanisms, including those that allow androgen receptor (AR) signaling to remain active. These AR-related resistance mechanisms include AR gene amplification or overexpression, constitutively active ligand-independent AR splice variants, and gain-of-function mutations involving the AR ligand-binding domain (LBD), among others. Therefore, the development of AR-targeted therapies that function independently of the LBD represents an unmet medical need and has the potential to overcome many of these resistance mechanisms. This article discusses N-terminal domain (NTD) inhibition as a novel concept in the field of AR-directed therapies for prostate cancer. AR NTD-targeting agents have the potential to overcome shortcomings of current hormonal therapies by inhibiting all forms of AR-mediated transcriptional activity, and as a result, may affect a broader AR population including mutational and splice variant ARs. Indeed, the first clinical trial of an AR NTD inhibitor is now underway.
Synaptopodin Is a Coincidence Detector of Tyrosine versus Serine/Threonine Phosphorylation for the Modulation of Rho Protein Crosstalk in Podocytes
Authors: Buvall Lisa , Wallentin Hanna , Sieber Jonas , Andreeva Svetlana , Choi Hoon Young , Mundel Peter , Greka Anna
Published: September 2016

Tyrosine and serine/threonine signal-transduction pathways influence many aspects of cell behavior, including the spatial and temporal regulation of the actin cytoskeleton. However, little is known about how input from diverse tyrosine and serine/threonine kinases is integrated to control Rho protein crosstalk and actin remodeling, which are critically important in podocyte health and disease. Here we unveil the proteolytically-regulated, actin organizing protein synaptopodin as a coincidence detector of tyrosine versus serine/threonine phosphorylation. We show that serine/threonine and tyrosine kinases duel for synaptopodin stability versus degradation. EGFR/Src-mediated tyrosine phosphorylation of synaptopodin in podocytes promotes binding to the serine/threonine phosphatase calcineurin. This leads to the loss of 14–3-3 binding, resulting in synaptopodin degradation, Vav2 activation, enhanced Rac1 signaling, and ultimate loss of stress fibers. Our studies reveal how synaptopodin, a single proteolytically-controlled protein, integrates antagonistic tyrosine versus serine/threonine phosphorylation events for the dynamic control of the actin cytoskeleton in podocytes.
Nível dos Conhecimentos Sobre as Leishmanioses Visceral e Tegumentar pela População de Alguns Bairros de Teresina, Piauí, Brasil
Authors: Moura Luciane Maria Alves de , Monte Nayra Denise Pessoa do , Sousa Raimundo Leoberto Torres de , Santos Jéssica Pereira dos , Freire Simone Mousinho
Published: September 2016

As leishmanioses são antropozoonoses de ampla distribuição mundial e consideradas um grave problema de saúde pública. Com base nas informações sobre os aspectos epidemiológicos, a população pode mudar seu comportamento e atitude diante de tais doenças e, assim, tomar medidas preventivas que possam minimizar os riscos de contraí-las. Esse estudo teve como objetivo identificar o nível de conhecimento da população de Teresina, Piauí, sobre Leishmaniose Visceral (LV) e Leishmaniose Tegumentar Americana (LTA). A coleta dos dados foi realizada por meio de questionário em 150 residências nos bairros Santo Antônio, Pedra Mole e Parque Alvorada no período de fevereiro a junho de 2013. A análise dos dados mostrou que grande maioria dos casos de leishmaniose ocorreu em indivíduos que possuíam no máximo o ensino fundamental completo e a renda familiar, na maioria dos entrevistados, chegou a um salário mínimo. Além disso, 89,3% das residências possuíam acumulo de matéria orgânica no peridomicílio, e todas estavam localizadas próximas de matas; 78,6% citaram a presença de mosquitos e de animais domésticos. 94,6% dos entrevistados desconheciam tanto a LTA, como também o transmissor da doença. Tal fato corrobora que a população desconhece que a presença de vegetação no peridomicílio, acúmulo de matéria orgânica, presença de animais domésticos, dentre outros fatores contribuem para a proliferação do vetor e para o estabelecimento e disseminação das leishmanioses no meio urbano.
Correlação do Índice de Massa Corporal com as Demais Variáveis da Aptidão Física Relacionada à Saúde em Escolares do Sexo Masculino de Curitiba-PR, Brasil
Authors: Maziero Renato Silva Barbosa , Bozza Rodrigo , Barbosa Filho Valter Cordeiro , Piola Thiago Silva , Campos Wagner De
Published: September 2016

O presente estudo teve como objetivo verificar a relação do índice de massa corporal - IMC com a flexibilidade, resistência abdominal e VO2máx. A amostra foi constituída por 309 estudantes do sexo masculino, entre 10 e 16 anos de idade, pertencentes a duas escolas públicas de Curitiba-PR. Foram medidas a estatura e a massa corporal para o cálculo do IMC. Os testes de flexibilidade e resistência abdominal foram empregados conforme os protocolos do PROESP. A aptidão cardiorrespiratória foi avaliada através do teste de 12 minutos de Cooper. Foram utilizadas análises descritivas para a apresentação dos dados e a correlação de Pearson para verificar a relação entre as variáveis analisadas. Utilizouse o programa estatístico SPSS 18.0, versão demonstração, em nível de significância de 5%. Os resultados demonstraram uma correlação significativa inversa do IMC com a resistência abdominal (r = -0,242; p= 0,0001) e com o Vo2máx (r = -0,223; p = 0,0001), contudo, não foi encontrada relação significativa entre o IMC e a flexibilidade (r=0,071; p=0,81). Observando tais resultados, nota-se que a obesidade pode contribuir para a diminuição dos níveis de aptidão física dos indivíduos jovens, que, por sua vez, acarreta em uma condição inferior de saúde e qualidade de vida.
En busca de la paz, reflexiones sobre la posibilidad de una paz duradera y el rol del estado y la sociedad en la construcción de paz.
Authors: Zuleta Galvez Eliana Marcela
Published: September 2016

Este artículo presenta una revisión bibliográfica de la literatura referente a la construcción de paz, enfatizando en una reflexión crítica sobre los compromisos que se deben construir como sociedad para lograr la consolidación como colectivo a partir de restablecimiento de emociones políticas y públicas.
¿Que rol podría jugar la Corte Penal Internacional en un hipotético acuerdo de paz entre las Fuerzas Armadas Revolucionarias y el estado colombiano? La Perspectiva histórica que tendría que tener en cuenta la CPI a la hora de intervenir en este conflicto.
Authors: Allegretti Pierluigi , Buckley Nicolas
Published: September 2016

Una hipotética intervención de la Corte Penal Internacional (CPI) sobre el conflicto Colombiano abre nuevas incógnitas a un ya complicado proceso de resolución. La historia reciente del conflicto Colombiano nos muestra como las Fuerzas Armadas Revolucionarias de Colombia (FARC) visibilizaron a principios de los sesenta con su lucha insurgente demandas históricas del pueblo Colombiano. Sin embargo, debido al desgaste de mas de cincuenta años de conflicto, aunque dichas demandas aún no han sido escuchadas, las FARC llegaron a la mesa de negociación de la Habana con niveles de desprestigio social similares a los del estado Colombiano. En este contexto, una intervención de la CPI ha de ser analizada, no en un cortoplacismo jurídico para dar simplemente una imagen garantista del derecho internacional. De lo contrario, la CPI ha de actuar aplicando las leyes del Derecho Internacional acorde con la comprensión histórica del conflicto.
Of death and dukes: "King Henry VI Part 2" and the "danse macabre"
Authors: MacKenzie Clayton
Published: September 2016

William de la Pole, 1st Duke of Suffolk, was captured and murdered by English sailors on 2 May 1450. The event is dramatically re-enacted in Shakespeare’s early history play King Henry VI Part 2. Shakespeare’s version differs markedly from known sources. In particular, the dramatist frames the death of Suffolk as a danse macabre experience in which the victim is taunted, diminished and ultimately dragged off to the grave. The Protestant Reformation had liberated a swathe of Roman Catholic iconographies, the danse macabre amongst them, breaking them free from their traditional semantic moorings and allowing them to find novel significances on the Elizabethan stage. King Henry VI Part 2 represents a preliminary engagement with the danse macabre, a search for new possibilities and new meanings. The danse macabre form is used more coherently and cohesively in later Shakespeare plays but King Henry VI Part 2 appears to be an early, deliberate attempt to explore its potential.
The recursive formation of Old English non-verbal categories. Productivity and constraints
Authors: Vea Escarza Raquel
Published: September 2016

This paper aims at analysing the recursivity in the formation of non-verbal categories, more specifically, of nouns and adjectives in old English. Pounder’s (2000) model, known as Process and Paradigm Model, provides the formal representation of recursive operations. The data of analysis consist of a total of 388 recursive nouns and adjectives, 11 of which undergo a two-level recursivity, or slot-II recursivity. Both in the case of nouns and adjectives, suffixation has a clearly preeminent role over prefixation. As for nouns, the suffix -nes is the most frequent one in number of tokens, whereas -∂ is the one that combines with a greater number of suffixes in prefinal position. Regarding adjectives, -lic is by far the suffix present in a higher number of predicates, and also the one that undergoes a wider variety of different recursive patterns, what evinces that there is correlation between a high type frequency and the assignment of a high number of different recursive patterns. Positional constraints affect -nes and -lic, since none of them can occur in a position other than final. A semantic interpretation of recursive suffixation leads to assign a semantic effect of this phenomenon when it applies to nouns, and a pragmatic one in the case of adjectives.
The lemmatization of Old English Verbs from the second weak class on a lexical database
Authors: Tío Sáenz Marta
Published: September 2016

This article compiles a list of lemmas of the second class weak verbs of Old English by using the latest version of the lexical database Nerthus, which incorporates the texts of the Dictionary of Old English Corpus. Out of all the inflecional endings, the most distinctive have been selected for lemmatization: the infinitive, the inflected infinitive, the present participle, the past participle, the second person present indicative singular, the present indicative plural, the present subjunctive singular, the first and third person of preterite indicative singular, the second person of the preterite indicative singular, the preterite indicative plural and the preterite subjunctive plural. When it is necessary to regularize, normalization is restricted to correspondences based on dialectal and diachronic variation. The analysis turns out a total of 1,064 lemmas of weak verbs from the second class.
Malábathron (μαλάβαθρον). Kilka uwag o roli Cinnamomum tamala w medycynie i w kuchni antyku i Bizancjum między I a VII wiekiem
Authors: Kokoszko Maciej , Rzeźnicka Zofia
Published: September 2016

Niniejszy artykuł dotyczy historii i zastosowania cynamonowca tamala, zwanego po grecku malábathron (μαλάβαθρον), a po łacinie określanego terminem malabathrum (lub malobathrum). Autorzy, na podstawie greckich tekstów medycznych i wybranych źródeł łacińskich, próbują odpowiedzieć na pytanie, kiedy przyprawa ta pojawiła się w świecie śródziemnomorskim, a nadto starają się ustalić jej zastosowanie w medycynie i sztuce kulinarnej. Jednocześnie podejmują się określenia znaczenia terminu folium, występującego w niektórych przepisach kulinarnych, zawartych w łacińskiej książce kucharskiej zatytułowanej O sztuce kulinarnej. Badacze dochodzą do wniosku, że historia opisywanej przyprawy stanowi doskonały przykład globalizacji antycznego i bizantyńskiego handlu. Mimo że brakuje dowodów, iż cynamonowiec tamala był masowo importowany na tereny leżące w basenie Morza Śródziemnego, to nie ulega wątpliwości, że był on wykorzystywany w medycynie (także w kosmetologii) i gastronomii analizowanego okresu. Autorzy ustalają, że największy wzrost zainteresowania malábathron przypadł na I w. p.n.e., co wiążą z rzymskimi podbojami na Bliskim Wschodzie oraz przyłączeniem Egiptu (które to tereny były głównymi punktami na szlaku handlowym, którym cynamonowiec tamala był transportowany). Analiza źródeł medycznych dowodzi, że dietetyczno-farmakologiczna charakterystyka opisywanej przyprawy została ukształtowana jeszcze przed I w., a w dość rozbudowanej formie utrwalił ją Dioskuridesa w traktacie De materia medica. Następnie jego ustalenia zostały uzupełnione przez Galena, a te z kolei zostały przejęte przez kolejne pokolenia bizantyńskich medyków działających do VII w. Ponieważ cynamonowiec tamala był drogim, importowanym z odległych krajów produktem, nigdy nie stał się ani powszechnym składnikiem farmaceutyków, ani też codzienną ingrediencją potraw. Mimo to analiza traktatów lekarskich poświadcza jego nieprzerwane użycie do czasów działalności Pawła z Eginy (jednak farmaceutyki, których stanowił komponent, przeznaczone były dla zamożnych pacjentów). Z kolei zgłębiając zagadnienie gastronomicznego wykorzystania malábathron, na podstawie wybranych greckojęzycznych tekstów medycznych, autorzy artykułu dochodzą do wniosku, że występujący w dziełku O sztuce kulinarnej termin folium odnosi się właśnie do cynamonowca tamala.
Intimate Partner Violence is Associated with Increased CD4+ T-Cell Activation Among HIV-Negative High-Risk Women
Authors: Kalokhe Ameeta Shivdas , Ibegbu Chris C. , Kaur Surinder P. , Amara Rama R. , Kelley Mary E. , Del Rio Carlos , Stephenson Rob
Published: September 2016

Background: Biological pathways mediating the link between intimate partner violence (IPV) and increased HIV risk remain unexplored. We hypothesized that IPV-induced stress negatively affects HIV systemic immune defenses and aimed to evaluate whether IPV was associated with immune profiles linked to HIV susceptibility: CD4 activation and diminished regulatory T-cell (Treg) frequency.Methods: Seventy-five HIV-negative high-risk women were surveyed regarding their IPV experience. They provided blood, urine, and (if present) genital ulcer samples for cortisol, immune assays, and STI testing. Using flow cytometry, we assessed activated CD4+ T-cell (%HLA-DR+/CD38+) and Treg (%CD4+CD25+FoxP3+) frequencies and phenotyping. Nonparametric tests evaluated the association between IPV and immune outcomes. Multivariate regression explored confounding and moderation of the IPV-CD4 activation pathway.Results: Lifetime IPV was associated with increased CD4+ activation (r=0.331, P=0.004), a shift in CD4+ phenotype from naïve to effector memory (r=0.343, P=0.003), and a decrease in naive (%HLA-DR+/CD45RA-) Treg frequency (r=-0.337, P=0.003). Experiencing IPV over the past year had similar trends. After controlling for sexual IPV, lifetime physical and psychological abuse remained significantly associated with CD4+ activation (P=0.004 and P=0.033, respectively). After controlling for race (the only covariate linked to activation), the lifetime IPV-CD4 activation association remained significant (P=0.012). Alcohol use and depression were identified as potential pathway moderators.Conclusion: Our data is the first to suggest an immune link between IPV and HIV, and may help explain differences at the individual level in HIV susceptibility and response to biological HIV prevention strategies. The association of psychological and physical abuse with CD4 activation independent of sexual abuse further supports the existence of a stress-induced immune pathway.
Epitope Capsid-Incorporation: New Effective Approach for Vaccine Development for Chagas Disease
Authors: Matthews Qiana L. , Farrow Anitra L. , Rachakonda Girish , Gu Linlin , Nde Pius , Krendelchtchikov Alexandre , Pratap Siddarth , Sakhare Shruti S. , Sabbaj Steffanie , Lima Maria F. , Villalta Fernando
Published: September 2016

Background: Previously we reported that a hexon-modified adenovirus (Ad) vector containing the invasive neutralizing epitope of Trypanosoma cruzi (T. cruzi) trypomastigote gp83 (Ad5-gp83) provided immunoprotection against T. cruzi infection. The purpose of this work was to design an improved vaccine for T. cruzi using a novel epitope capsid incorporation strategy. Thus, we evaluated the immunoprotection raised by co-immunization with Ad5-gp83 and an Ad vector containing an epitope (ASP-M) of the T. cruzi amastigote surface protein 2.Methods: Protein IX (pIX)-modified Ad vector (Ad5-pIX-ASP-M) was generated, characterized, and validated. C3H/He mice were immunized with Ad5-pIX-ASP-M and Ad5-gp83 and the cell-mediated responses were evaluated by enzyme-linked immunospot (ELISPOT) assay and intracellular staining. Immunized mice were challenged with T. cruzi to evaluate the vaccine efficacy.Results: Our findings indicate that Ad5-pIX-ASP-M was viable. Specific CD8+ T-cell mediated responses prior to the challenge show an increase in IFNγ and TNFα production. A single immunization with Ad5-pIX-ASP-M provided protection from T. cruzi infection, but co-immunizations with Ad5-pIX-ASP-M and Ad5-gp83 provided a higher immunoprotection and increased survival rate of mice.Conclusions: Overall, these results suggest that the combination of gp83 and ASP-M specific epitopes onto the capsid-incorporated adenoviruses would provide superior protection against Chagas disease as compared with Ad5-gp83 alone.
Penn Center for Community Health Workers: Step-by-Step Approach to Sustain an Evidence-Based Community Health Worker Intervention at an Academic Medical Center
Authors: Morgan Anna U. , Grande David T. , Carter Tamala , Long Judith A. , Kangovi Shreya
Published: September 2016

Community-engaged researchers who work with low-income communities can be reliant on grant funding. We use the illustrative case of the Penn Center for Community Health Workers (PCCHW) to describe a step-by-step framework for achieving financial sustainability for community-engaged research interventions. PCCHW began as a small grant-funded research project but followed an 8-step framework to engage both low-income patients and funders, determine outcomes, and calculate return on investment. PCCHW is now fully funded by Penn Medicine and delivers the Individualized Management for Patient-Centered Targets (IMPaCT) community health worker intervention to 2000 patients annually.
Pediatric Asthma Care Coordination in Underserved Communities: A Quasiexperimental Study
Authors: Janevic Mary R. , Stoll Shelley , Wilkin Margaret , Song Peter X. K. , Baptist Alan , Lara Marielena , Ramos-Valencia Gilberto , Bryant-Stephens Tyra , Persky Victoria , Uyeda Kimberly , Lesch Julie Kennedy , Wang Wen , Malveaux Floyd J.
Published: September 2016

Objectives. To assess the effect of care coordination on asthma outcomes among children in underserved urban communities.

Methods. We enrolled children, most of whom had very poorly or not well-controlled asthma, in medical–social care coordination programs in Los Angeles, California; Chicago, Illinois; Philadelphia, Pennsylvania; and San Juan, Puerto Rico in 2011 to 2014. Participants (n = 805; mean age = 7 years) were 60% male, 50% African American, and 42% Latino. We assessed asthma symptoms and health care utilization via parent interview at baseline and 12 months. To prevent overestimation of intervention effects, we constructed a comparison group using bootstrap resampling of matched control cases from previous pediatric asthma trials.

Results. At follow-up, intervention participants had 2.2 fewer symptom days per month (SD = 0.3; P < .01) and 1.9 fewer symptom nights per month (SD = 0.35; P < .01) than did the comparison group. The relative risk in the past year associated with the intervention was 0.63 (95% confidence interval [CI] = 0.45, 0.89) for an emergency department visit and 0.69 (95% CI = 0.47, 1.01) for hospitalization.

Conclusions. Care coordination may improve pediatric asthma symptom control and reduce emergency department visits.

Policy Implications. Expanding third-party reimbursement for care coordination services may help reduce pediatric asthma disparities.
Islamophobia and Public Health in the United States
Authors: Samari Goleen
Published: September 2016

Anti-Muslim sentiments are increasingly common globally and in the United States. The recent rise in Islamophobia calls for a public health perspective that considers the stigmatized identity of Muslim Americans and health implications of Islamophobic discrimination. Drawing on a stigma, discrimination, and health framework, I expand the dialogue on the rise of Islamophobia to a discussion of how Islamophobia affects the health of Muslim Americans. Islamophobia can negatively influence health by disrupting several systems—individual (stress reactivity and identity concealment), interpersonal (social relationships and socialization processes), and structural (institutional policies and media coverage). Islamophobia deserves attention as a source of negative health outcomes and health disparities. Future public health research should explore the multilevel and multidimensional pathways between Islamophobia and population health.
Continuing Versus New Prescriptions for Sedative-Hypnotic Medications: United States, 2005–2012
Authors: Kaufmann Christopher N. , Spira Adam P. , Depp Colin A. , Mojtabai Ramin
Published: September 2016

Objectives. To assess trends in continuing and new prescriptions for sedative-hypnotic medications, including benzodiazepines (BZDs) and non-BZD receptor agonists (nBZRAs).

Methods. Data came from the National Ambulatory Medical Care Survey and comprised 287 288 randomly sampled patient visits. Physicians reported medications prescribed and whether they were “continuing” or “new” prescriptions. We assessed trends in continuing BZD, new BZD, continuing nBZRA, and new nBZRA prescriptions from 2005 to 2012.

Results. Proportions of visits with continuing prescriptions increased from 3.4% in 2005 to 4.7% in 2012 (P < .01) for BZDs, and from 1.0% to 1.7% (P < .01) for nBZRAs. We noted no changes in new prescriptions. We observed the same patterns across patient age and physician specialties, except psychiatry. Despite no growth over time, the prevalence of visits involving continuing and new BZD and nBZRA prescriptions was much higher in psychiatry than in primary care and other specialties.

Conclusions. Increased sedative-hypnotic prescribing in recent years may be attributable to long-term growth in continuing prescriptions, rather than new prescriptions.

Public Health Implications. Findings call for renewed efforts to limit continuing prescribing of sedative-hypnotics to reduce their use in the population.
State Medical Marijuana Laws and the Prevalence of Opioids Detected Among Fatally Injured Drivers
Authors: Kim June H. , Santaella-Tenorio Julian , Mauro Christine , Wrobel Julia , Cerdà Magdalena , Keyes Katherine M. , Hasin Deborah , Martins Silvia S. , Li Guohua
Published: September 2016

Objectives. To assess the association between medical marijuana laws (MMLs) and the odds of a positive opioid test, an indicator for prior use.

Methods. We analyzed 1999–2013 Fatality Analysis Reporting System (FARS) data from 18 states that tested for alcohol and other drugs in at least 80% of drivers who died within 1 hour of crashing (n = 68 394). Within-state and between-state comparisons assessed opioid positivity among drivers crashing in states with an operational MML (i.e., allowances for home cultivation or active dispensaries) versus drivers crashing in states before a future MML was operational.

Results. State-specific estimates indicated a reduction in opioid positivity for most states after implementation of an operational MML, although none of these estimates were significant. When we combined states, we observed no significant overall association (odds ratio [OR] = 0.79; 95% confidence interval [CI] = 0.61, 1.03). However, age-stratified analyses indicated a significant reduction in opioid positivity for drivers aged 21 to 40 years (OR = 0.50; 95% CI = 0.37, 0.67; interaction P < .001).

Conclusions. Operational MMLs are associated with reductions in opioid positivity among 21- to 40-year-old fatally injured drivers and may reduce opioid use and overdose.
Quality of Care in a Safe-Abortion Hotline in Indonesia: Beyond Harm Reduction
Authors: Gerdts Caitlin , Hudaya Inna
Published: September 2016

Objectives. To examine services offered by safe-abortion hotlines in contexts in which abortion is legally restricted and to document the experiences of women contacting a safe-abortion hotline in Indonesia.

Methods. We analyzed 1829 first-time contacts to a safe-abortion hotline in Indonesia as a part of routine service provision between January 1, 2012 and December 31, 2014.

Results. Nearly one third (29.9%) of initial contacts reported their age as between 18 and 24 years, and most (51.2%) reported being unmarried. When asked about their reason for calling the hotline, the majority of initial contacts stated that they were pregnant and not ready to have a child. More than one third reported gestational ages below 12 weeks, and nearly one fifth (18.3%) reported a gestation of 13 weeks or greater.

Conclusions. These unique data provide a window of understanding into who contacts safe-abortion hotlines and why, and enable exploration of future directions for research on the role of safe-abortion hotlines in women’s access to safe abortion.

Public Health Implications. Safe-abortion hotlines should be evaluated not only for reducing harm but also for providing high-quality abortion care.
Traumatic Rupture of Posterior Tibial Tendon Following Closed Supination-Adduction Ankle Fracture
Authors: Krishna Sathya Vamsi , Pilar Anoop , Pai Sudhir N. , Issac Thomas
Published: September 2016

Case:

A 25-year-old man with no known comorbidities presented with pain and swelling of the left ankle following a twisting injury that had occurred during a road traffic accident. On examination, a 1 × 1-cm abrasion was noted on the medial malleolus and tenderness was noted over the medial and lateral malleoli. A radiograph of the left ankle revealed a fracture of the medial malleolus and an infrasyndesmotic avulsion fracture of the lateral malleolus (a supination-adduction injury). Immediate surgery was performed for the treatment of the medial malleolar fracture. On exploration, the posterior tibial tendon was found to be severed and frayed 2 cm proximal to the medial malleolar fracture. The medial malleolus was fixed with 2 parallel malleolar screws. The ruptured tendon was explored proximally, and the ends were debrided and repaired.

Conclusion:

At 1 year of follow-up, the ankle had good union and function of the tendon was restored. Posterior tibial tendon ruptures, although rare, should be suspected in cases of closed ankle fracture, irrespective of the mechanism of injury.
Treatment of Distal Radial Fractures by Open Reduction and Internal Fixation with a Volar Locking Plate
Authors: Mauser Nathan S. , Benoit Michel Y. , Morrell Nathan T. , Shafritz Adam B.
Published: September 2016

The volar locking plate is a popular implant for surgical management of unstable distal radial fractures. We routinely utilize this system for all distal radial fractures except for those with entrapped intra-articular fragments and fractures with a displaced dorsomedial facet fracture (which is hard to capture with the volar approach alone). In this video, we describe in detail the necessary steps for successful placement of the volar locking plate, starting with preoperative planning and ending with expected outcomes. The approach that we utilize is through the flexor carpi radialis tendon sheath and avoids the radial artery. In the video, we describe 4 variations on the application of a volar locking plate: (1) the standard technique after appropriate reduction and provisional fixation with Kirschner wires, (2) regaining length through a shortened distal radial fracture, (3) using the volar plate to assist in the reduction and regain volar tilt, and (4) intraoperative management of coronal shift of the distal fragment. Complications reported for the volar locking plate have decreased with newer low-profile plate designs; however, they still include volar tendon irritation and/or rupture and median neuropathy. Postoperatively, we advise a brief 2-week period of immobilization for wound-healing, which is followed by a period during which a removable wrist splint is used and patients are instructed on the performance of a hand therapy regimen.
Guest Editorial: How I Stopped Worrying and Learned to Love Customization
Authors: Flaharty Gary , Waheed Noman
Published: September 2016

Guest editorial

The boom was great while it lasted, and the bust, at least in North America, has largely played out. Oil and gas companies and service companies have executed their traditional cyclical playbook, cutting staff and squeezing vendors to protect margins. With no quick recovery in sight, attention is now focused on more substantial, systemic cost cutting to improve finding and development costs and service company margins.

One area of potential savings is the standardization of equipment used to complete and produce oil and gas wells. While all the equipment is “round with a hole in it,” the degree of customization evident today is staggering. Conventional wisdom says that if we could agree on and implement standard tools for oil and gas wells, we could drive unnecessary costs out of the system. However, customization of completion and production equipment can add significant value by improving efficiency and increasing production. While some standardization makes sense, it is important for the industry to implement cost-effective supply chain practices to efficiently deliver customization when it improves efficiency and increases production.

Origins of Customization

The current level of customization did not happen overnight. Service companies introduced simple tools and simple processes to design, manufacture, and install these tools. Initially, each tool had a few defined features such as “size” or “threads,” and a few options within each feature. Over time, we added additional features and expanded the number of options within each feature. The industry rarely did this in an organized, systematic manner. A new well chemistry required a different material, so a new material option was born. A customer wanted a new setting mechanism, so the setting mechanism feature expanded with another option. Features were added to handle high-temperature and high-pressure conditions.

Service companies invested in R&D to develop differentiated technology, so the designs of tools to meet the same downhole conditions varied from company to company. Eventually, the simple tools had given rise to families with thousands of possible configurations to accommodate specific customer needs. Service company’s costs to deliver from a catalog of diverse low-volume products rose and lead times extended as every order became a special.
Growth and Forage Quality Responses of Smooth Bromegrass to Nitrogen Placement and Timing
Authors: Moyer Joseph , Sweeney Daniel
Published: September 2016

Smooth bromegrass [Bromus inermis (L.)] is a cool‐season perennial that is widely used in pastures and meadows. More intensive management of N may be required to optimize production. This study was conducted for 4 yr to determine bromegrass dry forage mass (FM) and quality responses to annual rates of 84 or 168 kg ha−1 of N fertilizer solution with three placements at four different fall/late winter (LW) timing combinations. Vegetative forage was harvested in April to represent early grazing, or postanthesis, in May to simulate hay production. Knife (KN) placement generally resulted in less vegetative FM than broadcast (BC) and dribble (DR) placements, regardless of N rate. In two typical moisture years, FM increased an average 15% when N rate increased from 84 to 168 kg N ha−1, but the first 84 kg ha−1 did not increase yields above the check (0 N). Forage crude protein (CP) generally increased as N rate increased, particularly with KN placement, or when most was applied in LW. Nitrogen increased postanthesis FM by an average of 24% with the first 84 kg ha−1 increment, and by an additional 15% with the next 84‐kg increment, while average CP was increased by 20%. Knife placement increased mass and CP, particularly with the 168 kg ha−1 rate, and when some was applied in LW, but often with increased neutral detergent fiber and decreased digestible dry matter. The most beneficial N management system would be determined by the projected forage use.

Core Ideas

Nitrogen fertility management of smooth bromegrass affects not only yield, but forage quality.

Placement of N fertilizer affects bromegrass yield and quality.

Responses to N amount and placement are also modified by application timing.
Prediction of Pesticide Toxicity in Midwest Streams
Authors: Shoda Megan E. , Stone Wesley W. , Nowell Lisa H.
Published: September 2016

The occurrence of pesticide mixtures is common in stream waters of the United States, and the impact of multiple compounds on aquatic organisms is not well understood. Watershed Regressions for Pesticides (WARP) models were developed to predict Pesticide Toxicity Index (PTI) values in unmonitored streams in the Midwest and are referred to as WARP‐PTI models. The PTI is a tool for assessing the relative toxicity of pesticide mixtures to fish, benthic invertebrates, and cladocera in stream water. One hundred stream sites in the Midwest were sampled weekly in May through August 2013, and the highest calculated PTI for each site was used as the WARP‐PTI model response variable. Watershed characteristics that represent pesticide sources and transport were used as the WARP‐PTI model explanatory variables. Three WARP‐PTI models—fish, benthic invertebrates, and cladocera—were developed that include watershed characteristics describing toxicity‐weighted agricultural use intensity, land use, agricultural management practices, soil properties, precipitation, and hydrologic properties. The models explained between 41 and 48% of the variability in the measured PTI values. WARP‐PTI model evaluation with independent data showed reasonable performance with no clear bias. The models were applied to streams in the Midwest to demonstrate extrapolation for a regional assessment to indicate vulnerable streams and to guide more intensive monitoring.

Core Ideas

WARP‐PTI models predicted PTI at unmonitored streams in the Midwest.

The taxon‐specific models varied based on explanatory variables and model fit.

Pesticide use estimates were important in the development of these predictive models.
Drainage and Nitrate Leaching from Artificially Drained Maize Fields Simulated by the Precision Nitrogen Management Model
Authors: Marjerison Rebecca D. , Melkonian Jeff , Hutson John L. , van Es Harold M. , Sela Shai , Geohring Larry D. , Vetsch Jeffrey
Published: September 2016

Environmental nitrogen (N) losses (e.g., nitrate leaching, denitrification, and ammonia volatilization) frequently occur in maize (Zea mays L.) agroecosystems. Decision support systems, designed to optimize the application of N fertilizer in these systems, have been developed using physically based models such as the Precision Nitrogen Management (PNM) model of soil and crop processes, which is an integral component of Adapt‐N, a decision support tool providing N fertilizer recommendations for maize production. Such models can also be used to estimate N losses associated with particular management practices and over a range of current climates and future climate projections. The objectives of this study were to update the PNM model to include an option for simulating soil‐water processes in artificially drained soils, and to calibrate the revised PNM model and test it against multiyear field studies in New York and Minnesota with different soils and management practices. Minimal calibration was required for the model. Denitrification rate constants were calibrated by minimizing the error between simulated and observed nitrate leaching for each study site. The normalized root mean squared error of cumulative daily drainage for the validation sets ranged from 10 to 23%. For cumulative daily nitrate leaching, the normalized root mean squared error ranged from 11 to 28% for the validation sets. The minimal calibration required and relatively simple data inputs make the PNM model a broadly applicable tool for simulating water and N flows in maize systems.

Core Ideas

The Precision Nitrogen Management model simulates NO3–N leaching in maize fields.

We evaluated an updated version of the PNM model using data from two field studies.

Drainage and NO3–N were simulated well; prediction errors were around 30% or less.
Mejoramiento de la productividad mediante la reducción de costos en una línea manufacturera de arneses eléctricos
Authors: Moreno Perea Karlos Gerardo , Reyes López Octavio
Published: September 2016

En la actualidad debido a una gran diversidad de proveedores automotrices, las empresas han adoptado por tener un sistema de reducción de costos el cual les permita ser competitivas para las principales OEM´s (Fabricantes de Equipamiento Original) manufactureras automotrices. Tal es el caso de la organización bajo estudio en la cual se estableció como objetivo a mediano plazo el mejoramiento de la productividad en una de sus líneas de producción la cual manufacturaba arneses eléctricos automotrices de la familia Clutch Jumper durante dos turnos de trabajo, utilizando treinta y cinco operadores directos por turno. Mediante la elaboración de un modelo de planeación de optimización de recursos se logró al finalizar el proyecto de investigación la reducción de la manufactura a un solo turno de trabajo optimizando así la cantidad de operadores, equipos de manejo de materiales, equipos eléctricos y recursos naturales. Esto sin afectar la cuota de producción diaria y la calidad de los arneses terminados.