bluuebunny/crossref_metadata_2025 huggingface dataset:
One‐step preparation and application of mussel‐inspired poly(norepinephrine)‐coated polydimethylsiloxane microchip for separation of chiral compounds
Authors: Chen Juan , Liang Ru‐Ping , Wu Lu‐Lu , Qiu Jian‐Ding
Published: March 2016

In this paper, using the self‐polymerization of norepinephrine (NE) and its favorable film‐forming property, a simple and green preparation approach was developed to modify a PDMS channel for enantioseparation of chiral compounds. After the PDMS microchip was filled with NE solution, poly(norepinephrine) (PNE) film was gradually formed and deposited on the inner wall of microchannel as permanent coating via the oxidation of NE by the oxygen dissolved in the solution. Due to possessing plentiful catechol and amine functional groups, the PNE‐coated PDMS microchip exhibited much better wettability, more stable and suppressed EOF, and less nonspecific adsorption. The water contact angle and EOF of PNE‐coated PDMS substrate were measured to be 13° and 1.68 × 10−4 cm2 V−1 s−1, compared to those of 108° and 2.24 × 10−4 cm2 V−1 s−1 from the untreated one, respectively. Different kinds of chiral compounds, such as amino acid enantiomer, drug enantiomer, and peptide enantiomer were efficiently separated utilizing a separation length of 37 mm coupled with in‐column amperometric detection on the PNE‐coated PDMS microchips. This facile mussel‐inspired PNE‐based microchip system exhibited strong recognition ability, high‐performance, admirable reproducibility, and stability, which may have potential use in the complex biological analysis.
Monitoring the Strain Evolution of Lithium‐Ion Battery Electrodes using an Optical Fiber Bragg Grating Sensor
Authors: Bae Chang‐Jun , Manandhar Ashish , Kiesel Peter , Raghavan Ajay
Published: March 2016

More advanced characterization and developmental tools are essential to improve the performance and safety of Li‐ion batteries. Conventional tools have been limited to customized test cell configurations that require special facilities and expensive equipment. As a practical solution for the in situ monitoring of realistic battery cells, we have embedded fiber optic sensors within Li‐ion battery pouch cells to monitor the internal electrode strain and temperature during cycling. Here we report the direct monitoring of strain evolution using implanted fiber‐optic sensors within the individual electrodes in a Li‐ion battery. Reproducible peak shifting and splitting in the implanted fiber optic sensor originate from the accumulated longitudinal and transverse strains associated with the expansion or contraction of the anode electrode. These discoveries demonstrate the feasibility and utility of fiber Bragg grating (FBG) sensors to be used as diagnostic tools in the development of new battery materials and structures.
Seismic response analysis of adjacent liquid‐storage tanks
Authors: Mykoniou Konstantinos , Butenweg Christoph , Holtschoppen Britta , Klinkel Sven
Published: March 2016

A refined substructure technique in the frequency domain is developed, which permits consideration of the interaction effects among adjacent containers through the supporting deformable soil medium. The tank‐liquid systems are represented by means of mechanical models, whereas discrete springs and dashpots stand for the soil beneath the foundations. The proposed model is employed to assess the responses of adjacent circular, cylindrical tanks for harmonic and seismic excitations over wide range of tank proportions and soil conditions. The influence of the number, spatial arrangement of the containers and their distance on the overall system's behavior is addressed. The results indicate that the cross‐interaction effects can substantially alter the impulsive components of response of each individual element in a tank farm. The degree of this impact is primarily controlled by the tank proportions and the proximity of the predominant natural frequencies of the shell‐liquid‐soil systems and the input seismic motion. The group effects should be not a priori disregarded, unless the tanks are founded on shallow soil deposit overlying very stiff material or bedrock. Copyright © 2016 John Wiley & Sons, Ltd.
Mechanisms underlying the enhancement of toxicity caused by the coincubation of zinc oxide and copper nanoparticles in a fish hepatoma cell line
Authors: Hernández-Moreno David , Li Lingxiangyu , Connolly Mona , Conde Estefania , Fernández Marta , Schuster Michael , Navas José Maria , Fernández-Cruz María-Luisa
Published: March 2016

Ecosystems are exposed to a wide variety of individual substances, including at the nano-scale; and the potential adverse effects of their interactions are an increasing concern. The purpose of the present study was to determine whether zinc oxide nanoparticles (ZnONPs) at a no-observed-effect concentration modulate the cytotoxicity of copper nanoparticles (CuNPs) in the fish hepatoma cell line PLHC-1 after 48 h of exposure and the contribution of the released ions to these effects. Cells were exposed to 50-nm CuNPs (0.39–25.0 µg/mL), alone or in combination with ZnONPs (25 nm or 100 nm), at 6.25 µg/mL. Cells were exposed to suspensions of NPs or to their supernatants, as well as to their combinations. The effects on cell viability were assessed through cytotoxicity assays. Changes in cell morphology and metal internalization were also evaluated. The cytotoxicity exerted by CuNPs was enhanced in the presence of nontoxic concentrations of ZnONPs. On the contrary, Zn ions protected the cell line from the CuNP toxicity, this effect being related to an increase in the intracellular levels of Zn. This increase of metal was not observed in cells exposed to both ZnONPs and CuNPs, even when they were visualized inside the cell. The results indicated that the internalization of ZnONPs, but not the Zn ions, was responsible for the enhanced toxicity of the CuNPs. Environ Toxicol Chem 2016;35:2562–2570. © 2016 SETAC
Distributed link selection in multirelay multiuser networks
Authors: Moya Osorio Diana Pamela , Benítez Olivo Edgar Eduardo , da Costa Daniel Benevides , Silveira Santos Filho José Cândido
Published: March 2016

Recently, an attractive link‐selection scheme has been proposed for nonregenerative relaying networks, by considering one source, one relay and one destination. In that scheme, based on a distributed mechanism, either the direct link or the relaying link is preselected at the transmitter side, before each communication process. This saves not only feedback overhead, when compared with centralised mechanisms, but also time slots, when compared with fixed relaying along with selection combining at the receiver side. Herein, we extend the design and analysis of such a scheme in order to allow for multiple relays and multiple destinations. In such case, before the link selection mechanism takes place, a destination and a candidate relay must be chosen. We consider two different relay‐selection policies: the locally optimal one and the so‐called max–min. The analysis is provided in terms of outage performance and spectral efficiency. As in related studies, an exact treatment proves intractable, because the underlying probabilities are extremely intricate. Instead, for the locally optimal scheme, we provide integral‐form lower and upper bounds for the two performance metrics, as well as closed‐form asymptotic expressions for each outage bound. For the max–min scheme, we provide a closed‐form lower bound and an integral‐form upper bound for the outage probability, as well as closed‐form asymptotic expressions for each of these bounds and an exact integral‐form expression for the spectral efficiency. Interestingly, our results show that the proposed distributed link‐selection scheme is as good as its centralised counterpart and barely affected by the choice of the associated relay‐selection policy. Copyright © 2016 John Wiley & Sons, Ltd.
Enhancing Facilitation Skills: Dancing with Dynamic Tensions
Authors: Fierro Rita Sinorita
Published: March 2016

For evaluators there is a high price for bad facilitation: Without our knowing, we may favor our own priorities, forget participants’ needs, submerge stakeholder voices, hide underlying causes, and undermine the impact of our work. The author shows how to improve one's facilitation skills by leveraging seven dynamic tensions: Hosting self and others, hosting present and absent stakeholders, observing group and individual dynamics, simplifying and unveiling complexity, listening and sensing emergence, using intuition and rational problem solving, and facing chaos and control.
MĀRAMATANGA (Enlightenment): A Creative Approach to Connecting Facilitation and Evaluation
Authors: Pipi Kataraina
Published: March 2016

This paper presents a personal narrative from an indigenous practitioner who uses creative facilitation methods as part of her evaluation work. The narrative describes examples of tools used in facilitation and evaluation, along with some of the lessons learned from integrating creativity and structured processes when working with indigenous people in Aotearoa (New Zealand). These lessons include that it is important to facilitate critical reflection from a cultural base; that through culturally grounded facilitation, evaluation can come to have meaning in culturally specific ways; and that creativity is what links facilitation and evaluation.
Planning and Facilitating Working Sessions with Evaluation Stakeholders
Authors: Torres Rosalie T.
Published: March 2016

Facilitation is the process of bringing together, engaging, and following up with stakeholders resulting in new insights, perspectives, and potential actions, which (a) in all likelihood would have not otherwise occurred and (b) advance the interests of the stakeholder group. The most critical element of a successfully facilitated working session is the extent to which all potential influences are addressed during a planning phase. The chapter explains 15 interdependent components for successfully facilitated working sessions and includes a case example that describes the planning, execution, debriefing, and intended follow‐up to one session. It concludes by addressing (a) issues that arose in the session and how they related to information that was or was not available during planning and (b) the facilitation approaches/techniques used to address those issues.
Facilitating Interactive Evaluation Practice: Engaging Stakeholders Constructively
Authors: Stevahn Laurie , King Jean A.
Published: March 2016

This chapter introduces interactive evaluation practice (IEP) and its potential for grounding thinking about the foundational nature of interaction in evaluation studies and the role of facilitation in this process. It begins by defining key terms and elaborating specifically on IEP as an evaluator orientation for grounding and guiding decisions, actions, and reflections—all leveraged toward conducting meaningful studies. It then presents an evaluator's dozen of strategies useful for facilitating interaction among stakeholders to accomplish targeted aims and concludes by illustrating how evaluators can successfully facilitate these strategies in practice.
Data Placemats: A Facilitative Technique Designed to Enhance Stakeholder Understanding of Data
Authors: Pankaj Veena , Emery Ann K.
Published: March 2016

This chapter introduces data placemats, a facilitative technique that occurs during the analysis stage of an evaluation that is designed to enhance stakeholder understanding of evaluation data. Data placemats display thematically grouped data designed to encourage stakeholder interaction with collected data and to promote the cocreation of meaning under the facilitative guidance of the evaluator. Each placemat represents the data using visual elements such as charts, graphs, and quotes and draws on best practices of data and information display to format these elements. During the process, evaluators guide stakeholders to a mutual understanding of information contained in the data placemats. This chapter provides guidance on when, why, and how to use data placemats to enhance the overall sense‐making of data and explores the connection between effective facilitation and successful implementation of this technique.
Evaluating Participatory Facilitated Conversations within the Art of Hosting Framework
Authors: Schwartz Alissa
Published: March 2016

The Art of Hosting conversations that matter (AoH) is a practice framework for using participatory conversational structures and principles to foster meaningful conversation and collective intelligence. This chapter provides an overview of many of the conversational structures used in the AoH community, an explanation of the function of “harvesting” conversations, and a suggested framework for making decisions about evaluating participatory conversations. Evaluation of participatory conversations can focus on discerning the effects of a stand‐alone conversation or a series of conversations that may involve the same or different groups of people meeting multiple times. There are three major approaches to evaluation—formative, summative, and developmental—that lend themselves well in conceptualizing the evaluation of AoH approaches, where the unit of analysis can be at multiple levels: individual, group, and systemic. The chapter concludes with the description of an evaluation of a World Café conversation facilitated at the 2014 American Evaluation Association conference in Denver, Colorado.
Invisible and Unbound? The Challenge and Practice of Evaluating Embedded Facilitation
Authors: Dart Jessica , Roberts Megan
Published: March 2016

With the movement in Australia toward smaller government, there is a growing emphasis on how to allocate scarce resources efficiently. In this tighter financial climate, placement of facilitators into programs and services offers a promise of achieving more with less. As a result there are a plethora of government and nongovernment programs that make use of facilitators directly funded by programs. Despite the appeal of using facilitators, little attention has been paid to how best to evaluate the facilitation component of programs. The literature on the nature of facilitation points to difficulties in attributing outcomes to facilitation and the importance of understanding the intent. We use a case study of the past 15 years of evaluating Landcare programs in Australia to explore the challenges further and offer practical ideas for any evaluators faced with the prospect of evaluating a program that has a facilitative element.
Effect of boron compounds on fire protection properties of epoxy based intumescent coating
Authors: Murat Unlu S. , Tayfun Umit , Yildirim Bekir , Dogan Mehmet
Published: March 2016

The aim of this study was to investigate the effect of boron compounds on fire protection properties of intumescent coating based on ammonium polyphosphate (APP). Three kinds of boron compounds namely boric acid (BA), zinc borate (ZB) and melamine borate (MB) were used. Total amount of flame retardant additive was kept constant at 30 wt%, and boron compounds were used at three concentrations of 1, 3 and 5 wt%. Thermogravimetric analysis (TGA), Attenuated total reflectance–Fourier transform infrared spectroscopy (ATR‐FTIR) and fire test were conducted for the determining the fire performance of intumescent coating. According to fire test results, BA and MB showed synergistic effect at 1 wt% loading. ZB showed antagonistic effect at all concentrations. Fire protection effect of intumescent coating decreased as the added amount of boron compound increased regardless of boron compound type because of suppression of intumescence. Copyright © 2016 John Wiley & Sons, Ltd.
Antibacterial and antifungal activity of essential oils against some pathogenic bacteria and yeasts shed from poultry
Authors: Ebani Valentina Virginia , Nardoni Simona , Bertelloni Fabrizio , Giovanelli Silvia , Rocchigiani Guido , Pistelli Luisa , Mancianti Francesca
Published: March 2016

Antibiotics have been used for decades in poultry diets to increase performance and decrease morbidity and mortality. The growing concern over the spreading of antibiotic‐resistant bacteria among animals and humans has resulted in the ban of the feed use of antibiotic growth promoters in livestock and in some cases additives derived from plants are used as alternative. Four commercial essential oils, from litsea (Litsea cubeba (Lour.) Pers.), oregano (Origanum vulgare L. subsp. hirtum), marjoram (Origanum majorana L.), thymus (Thymus vulgaris L.) and their mixtures, were tested against pathogenic bacteria and yeasts that may be shed in faeces by poultry. In particular, the analysis were carried out against reference and wild bacterial strains of Salmonella enterica serovar Typhimurium, Yersinia enterocolitica, Listeria monocytogenes, Enterococcus durans, E. faecalis, and E. faecium, and wild isolates of Candida albicans, C. tropicalis, C. guilliermondii, C. krusei, C. parapsilosis and Saccharomyces cerevisiae. Essential oils had varying degrees of growth inhibition in relationship to the tested bacterial and yeast strains; however the best results were achieved by O. vulgare and T. vulgaris. All mixtures gave good results with reference and field bacterial strains, with MIC values ranging from 1.13 to 0.14 mg/ml. The mixture composed by O. vulgare, T. vulgaris and O. majorana appeared the most effective against the tested yeast isolates, with MIC 1.85 mg/ml. O. vulgare and T. vulgaris showed good antimicrobial activities, thus they seem useful not only to promote poultry growth, but also to control fastidious microorganisms commonly occurring in digestive tract of these animals. Copyright © 2016 John Wiley & Sons, Ltd.
Monthly Beta Forecasting with Low‐, Medium‐ and High‐Frequency Stock Returns
Authors: Cenesizoglu Tolga , Liu Qianqiu , Reeves Jonathan J. , Wu Haifeng
Published: March 2016

This paper evaluates the accuracy of 1‐month‐ahead systematic (beta) risk forecasts in three return measurement settings; monthly, daily and 30 minutes. It was found that the popular Fama–MacBeth beta from 5 years of monthly returns generates the most accurate beta forecast among estimators based on monthly returns. A realized beta estimator from daily returns over the prior year generates the most accurate beta forecast among estimators based on daily returns. A realized beta estimator from 30‐minute returns over the prior 2 months generates the most accurate beta forecast among estimators based on 30‐minute returns. In environments where low‐, medium‐ and high‐frequency returns are accurately available, beta forecasting with low‐frequency returns are the least accurate and beta forecasting with high‐frequency returns are the most accurate. The improvements in precision of the beta forecasts are demonstrated in portfolio optimization for a targeted beta exposure. Copyright © 2016 John Wiley & Sons, Ltd.
Forecasting Errors, Directional Accuracy and Profitability of Currency Trading: The Case of EUR/USD Exchange Rate
Authors: Costantini Mauro , Cuaresma Jesus Crespo , Hlouskova Jaroslava
Published: March 2016

We provide a comprehensive study of out‐of‐sample forecasts for the EUR/USD exchange rate based on multivariate macroeconomic models and forecast combinations. We use profit maximization measures based on directional accuracy and trading strategies in addition to standard loss minimization measures. When comparing predictive accuracy and profit measures, data snooping bias free tests are used. The results indicate that forecast combinations, in particular those based on principal components of forecasts, help to improve over benchmark trading strategies, although the excess return per unit of deviation is limited. Copyright © 2016 John Wiley & Sons, Ltd.
Two‐Dimensional Kernel Smoothing of Mortality Surface: An Evaluation of Cohort Strength
Authors: Li Han , O'hare Colin , Vahid Farshid
Published: March 2016

Accurate mortality forecasts are of primary interest to insurance companies, pension providers and government welfare systems owing to the rapid increase in life expectancy during the past few decades. Existing mortality models in the literature tend to project future mortality rates by extracting the observed patterns in the mortality surface. Patterns found in the cohort dimension have received a considerable amount of attention and are included in many models of mortality. However, to our knowledge very few studies have considered an evaluation and comparison of cohort patterns across different countries. Moreover, the answer to the question of how the incorporation of the cohort effect affects the forecasting performance of mortality models still remains unclear. In this paper we introduce a new way of incorporating the cohort effect at the beginning of the estimation stage via the implementation of kernel smoothing techniques. Bivariate standard normal kernel density is used and we capture the cohort effect by assigning greater weights along the diagonals of the mortality surface. Based on the results from our empirical study, we compare and discuss the differences in cohort strength across a range of developed countries. Further, the fitting and forecasting results demonstrate the superior performance of our model when compared to some well‐known mortality models in the literature under a majority of circumstances. Copyright © 2016 John Wiley & Sons, Ltd.
The flavor and nutritional characteristic of four strawberry varieties cultured in soilless system
Authors: Liu Li , Ji Mei‐Ling , Chen Min , Sun Ming‐yue , Fu Xi‐ling , Li Ling , Gao Dong‐Sheng , Zhu Cui‐Ying
Published: March 2016

Strawberry fruits (cv. Benihoppe, Tochiotome, Sachinoka, and Guimeiren) were harvested and evaluated the flavor and nutritional parameters. By principal component analysis and hierarchical clustering analysis, differences were observed based on the volatile compounds composition, sugar and acid concentration, sweetness, and total soluble sugars/total organic acids of the four varieties. A total of 37, 48, 65, and 74 volatile compounds were identified and determined in cv. Benihoppe, Tochiotome, Sachinoka, and Guimeiren strawberry fruits extracted by head‐space solid‐phase microextraction (HS‐SPME), respectively. Esters significantly dominated the chemical composition of the four varieties. Furaneol was detected in cultivars of Sachinoka and Guimeiren, but mesifuran was only found in cv. Tochiotome. Tochiotome and Sachinoka showed higher content of linalool and (E)‐nerolidol. Sachinoka showed the highest content of total sugars and total acids. Guimeiren showed higher sweetness index than the other three cultivars. Firmness of Tochiotome was highest among all the varieties. The highest total soluble solids TSS value was found in cv. Sachinoka, followed by the Guimeiren and Tochiotome varieties. Sachinoka had the highest titratable acidity TA value. The content of ascorbic acid (AsA) of cv. Tochiotome was higher than the others, but there was no significant difference in cultivars of Benihoppe, Tochiotome, and Sachinoka. Fructose and glucose were the major sugars in all cultivars. Citric acid was the major organic acid in cv. Tochiotome, cv. Sachinoka, and cv. Guimeiren. Tochiotome had higher ratios of TSS/TA and total sugars/total organic acids than others, arising from its lower acid content. The order of the comprehensive evaluation score was Sachinoka>Guimeiren>Tochiotome>Benihoppe.
A prospective investigation of dietary patterns and internalizing and externalizing mental health problems in adolescents
Authors: Trapp Georgina S. A. , Allen Karina L. , Black Lucinda J. , Ambrosini Gina L. , Jacoby Peter , Byrne Susan , Martin Karen E. , Oddy Wendy H.
Published: March 2016

Investigating protective and risk factors that influence mental health in young people is a high priority. While previous cross‐sectional studies have reported associations between diet and mental health among adolescents, few prospective studies exist. The aim of this study was to examine prospective relationships between dietary patterns and mental health among adolescents participating in the Western Australian Pregnancy Cohort (Raine) Study. Self‐report questionnaires were used to assess indicators of mental health (Youth Self‐Report externalizing/internalizing T‐scores) and Western and Healthy dietary patterns (identified using factor analysis) at 14 (2003–2005) and 17 years (2006–2008). Multivariate linear and logistic regression were used to assess relationships between dietary patterns and mental health. Complete data were available for 746 adolescents. In females only, the Western dietary pattern z–score at 14 years was positively associated with greater externalizing behaviors at 17 years (β = 1.91; 95% CI: 0.04, 3.78) and a greater odds of having clinically concerning externalizing behaviors at 17 years (OR = 1.90; 95% CI: 1.06, 3.41). No other statistically significant associations were observed. Overall our findings only lend partial support to a link between diet and mental health. We found it to be specific to females consuming a Western dietary pattern and to externalizing behaviors. Future research on dietary patterns and mental health needs to consider possible sex differences and distinguish between different mental health outcomes as well as between healthy and unhealthy dietary patterns.
Defect Detection in Fuel Cell Gas Diffusion Electrodes Using Infrared Thermography
Authors: Ulsh M. , Porter J. M. , Bittinat D. C. , Bender G.
Published: March 2016

Polymer electrolyte membrane fuel cells are energy conversion devices that offer high power densities and high efficiencies for mobile and other applications. Successful introduction into the marketplace requires addressing cost barriers such as production volumes and platinum loading. For cost reduction, it is vital to minimize waste and maximize quality during the manufacturing of platinum‐containing electrodes, including gas diffusion electrodes (GDEs). In this work, we report on developing a quality control diagnostic for GDEs, involving creating an ex situ exothermic reaction on the electrode surface and using infrared thermography to measure the resulting temperature profile. Experiments with a moving GDE containing created defects were conducted to demonstrate the applicability of the diagnostic for real‐time web‐line inspection.
Benefits in tasks related to everyday life competences after a working memory training in older adults
Authors: Cantarella Alessandra , Borella Erika , Carretti Barbara , Kliegel Matthias , de Beni Rossana
Published: March 2016

Objective

The impact of working memory (WM) training on everyday life functioning has rarely been examined, and it is not clear whether WM training gains are transferred to reasoning abilities. The aim of this study was to assess the efficacy of a verbal WM training in older adults, in terms of specific gains and transfer effects to everyday life and reasoning abilities.

Method

Thirty‐six community dwelling older adults (from 65 to 75 years of age) were randomly assigned to a training or an active control group. The specific gains in a WM task similar to the one trained were assessed. Transfer effects to everyday life and reasoning abilities were also examined using (i) objective performance‐based tasks (the Everyday Problem Test and the Timed Instrumental Activities of Daily Living Scale) and (ii) the Cattell test and Raven's Standard Progressive Matrices, respectively.

Results

Only the trained group showed specific benefits and transfer effects to one of the everyday abilities measures (the Everyday Problem Test) and in the two reasoning tasks.

Conclusion

These results suggest that WM training can positively impact cognitive functioning and, more importantly, older adults' abilities in everyday living. Copyright © 2016 John Wiley & Sons, Ltd.
Comparison of service utilisation and costs of working age adults and older adults receiving treatment for psychosis and severe non‐psychotic conditions in England: implications for commissioning
Authors: Nilforooshan Ramin , Benson Lee , Gage Heather , Williams Peter , Zoha Mo , Warner James
Published: March 2016

Objective

Current plans in the English National Health Service are to replace block contracts for mental health providers with a single tariff for each ‘cluster’ of conditions. A single tariff will not take into account the potential additional complexity and costs inherent in caring for older people. To examine the basis for a uniform tariff, differences in service utilisation and costs between working age adults and older adults in two populous clusters (non‐psychotic, psychotic) were investigated across five mental health healthcare providers in and around London.

Methods

Retrospective review of records over 3 months assessing service utilisation and costs using the Client Services Receipt Inventory.

Results

Records of 362 patients were reviewed, 179 older adults (90 non‐psychotic, 89 psychotic) and 183 adults of working age (83 non‐psychotic, 100 psychotic). Older adults in both clusters had more tests, assessments and home visits. Overall costs of care of older adults were significantly higher in the non‐psychotic cluster (£5634, vs £4405 psychotic, p = 0.044).

Conclusions

An appropriate age‐related tariff is required for each cluster. Copyright © 2016 John Wiley & Sons, Ltd.
Home
Authors: Tunzi Marc
Published: March 2016

“Where's Dr. Tunzi?” Flor bellowed from the waiting room. “Is he here today?” Tattooed and built like a short middle linebacker, Flor is one of my favorite people. Despite schizophrenia, hepatitis C, and diabetes, she lives up to her name with a colorful and sunny personality. She and her partner, Nancy (a bipolar breast‐cancer survivor with chronic pain due to severe osteoarthritis of the hip), have been my patients for about fifteen years, since I first met them at the small homeless clinic I help staff. I was away one day last year when Flor and Nancy came in. It would be an understatement to say that it wasted everybody's time. But “team care” and “patient‐centered medical home” are the buzzwords of the day.
Why Bioethics Has a Race Problem
Authors: Hoberman John
Published: March 2016

In the September‐October 2001 issue of theHastings Center Report,editor Gregory Kaebnick encouraged bioethicists to turn their attention toward “easily overlooked, relatively little‐talked‐about societal topics” such as race. In 2000 the president of the American Society for Bioethics had called for a more socially conscious bioethics. Race was risky territory, Kaebnick pointed out, but this challenge did not justify avoidance. Over the next fifteen years, the response to this editor's invitation to examine the racial dimensions of medicine in theReportwas limited both in quantity and in terms of the range of topics covered. All told, the bioethics community has not responded to the editor's call for bioethicists to engage with the racial dimension of medicine, and theReporthas not really come through on the tacit commitment made in 2001. The lack of interest in race matters evidenced in theReport aswell as theAmerican Journal of Bioethicshas also prevailed in medical humanities journals, whose few pieces on race have tended to remove race relations from our current realities in two ways: some articles locate medical racism in the American past or in colonial Africa, while others analyze the medical disorders of fictional characters. Bioethicists have not embraced the opportunity to create a sociologically and historically informed bioethics that might be applied to the lives of black Americans and their unending health crisis.
Emergence of a Discipline? Growth in U.S. Postsecondary Bioethics Degrees
Authors: Lee Lisa M. , McCarty Frances A.
Published: March 2016

Teaching competency in bioethics has been a concern of the field since its start. In 1976, The Hastings Center published the first report on the teaching of contemporary bioethics. Graduate programs culminating in an MA or PhD were not needed at the time, concluded the report. “In the future, however,” the report speculated, “the development and/or changing social priorities may at some point allow, or even require, the creation of new academic structures for graduate education in bioethics.” Although that future might be upon us, the creation of a terminal degree in bioethics has its detractors. Scholars have debated whether bioethics is a discipline with its own methods and theoretical grounding, a multidisciplinary field bringing various professional perspectives to bear on particular types of problems, a set of problem‐solving skills to resolve moral disagreements, or something else entirely. Whether or not efforts to develop the methods and theory of bioethics have matured to the point that it is now a discipline in the strictest sense, new bioethics training programs have appeared at all postsecondary levels. In this essay, we examine the number and types of U.S. programs and degrees in this growing field.
When Policy Produces Moral Distress: Reclaiming Conscience
Authors: Berlinger Nancy
Published: March 2016

For too long, bioethics has followed law in reducing “conscience” to “conscientious objection,” in other words, to laws and policies permitting and protecting refusal. In “Reframing Conscientious Care: Providing Abortion Care When Law and Conscience Collide,” Mara Buchbinder and colleagues draw our attention to one dimension of the problem of reducing conscience to refusal to provide certain forms of medical care: what about the conscience problems experienced by the professionals who are attempting to provide safe, effective health care that includes services that others associate with conscientious objection? In seeking to disrupt a specific medical practice—one that is legal, desired by the patient, and conducted in accordance with medical standards—North Carolina House Bill 854, The Woman's Right to Know Act, and laws like it, appear to be designed to produce moral distress in physicians and other professionals involved in the provision of abortions. For abortion providers in North Carolina and other states, conscientious objection to the mandates of laws like HB 854 isn't a realistic option. So what can bioethics offer to professionals bound by such laws? We can start by reclaiming the idea of “conscience” as something that can say “yes” to providing health care.
There Are All Kinds of Rights
Authors: Appelbaum Paul S.
Published: March 2016

Some years ago I received a phone call telling me that my mother, then in her eighties, had been found wandering the street outside her home. It was the first indication my wife and I had of Alzheimer's disease. We arrived to discover that my mother was incoherent, with the house in disorder, bills unpaid, and perishable food in the night table rather than the refrigerator. Having spent much of my career trying to improve the assessment of decisional capacity, in part to avoid unnecessary deprivation of decision‐making rights, I did not take lightly the step to have my mother declared incompetent. But it was necessary. This episode has been on my mind since I returned recently from a conference in Paris devoted to the United Nations Convention on the Rights of Persons with Disabilities.
Laryngeal examination in thyroid and parathyroid surgery: An American Head and Neck Society consensus statement
Authors: Sinclair Catherine F. , Bumpous Jeffrey M. , Haugen Bryan R. , Chala Andres , Meltzer Daniel , Miller Barbra S. , Tolley Neil S. , Shin Jennifer J. , Woodson Gayle , Randolph Gregory W.
Published: March 2016

This American Head and Neck Society (AHNS) consensus statement discusses the techniques of laryngeal examination for patients undergoing thyroidectomy and parathyroidectomy. It is intended to help guide all clinicians who diagnose or manage adult patients with thyroid disease for whom surgery is indicated, contemplated, or has been performed. This consensus statement concludes that flexible transnasal laryngoscopy is the optimal laryngeal examination technique, with other techniques including laryngeal ultrasound and stroboscopy being useful in selected scenarios. © 2016 Wiley Periodicals, Inc. Head Neck 38: 811–819, 2016
Tracheal exposure: Anticipatory management of the difficult airway
Authors: Britt Christopher J. , Rohrbach Marc R. , McCulloch Timothy M.
Published: March 2016

Background

When a patient cannot be intubated or ventilated, cricothyrotomy is indicated. Risks associated with emergent cricothyrotomy are significant, and this procedure typically requires revision. Additional options for establishing an emergent airway are limited. Thus, elective tracheotomy to ensure a safe airway after procedures involving the upper aerodigestive tract is common. Although safe and effective overall, this procedure is not without additional risks, added resources, complex cares, and extended hospitalizations.

Methods

We present a case in which exposure of the anterior trachea was performed without tracheotomy in a patient with a high‐risk airway undergoing an open partial laryngectomy.

Results

The patient did not develop respiratory distress postoperatively and was able to avoid a tracheostomy and its associated cares.

Conclusion

Pretracheotomy with tracheal exposure simplifies emergent surgical access to the airway. We believe tracheal exposure in the appropriately selected patient is a safe and cost‐effective alternative to elective tracheotomy. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2446–E2448, 2016
Deregulated methionine adenosyltransferase α1, c‐Myc, and Maf proteins together promote cholangiocarcinoma growth in mice and humans‡
Authors: Yang Heping , Liu Ting , Wang Jiaohong , Li Tony W.H. , Fan Wei , Peng Hui , Krishnan Anuradha , Gores Gregory J. , Mato Jose M. , Lu Shelly C.
Published: March 2016

c‐Myc induction drives cholestatic liver injury and cholangiocarcinoma (CCA) in mice, and induction of Maf proteins (MafG and c‐Maf) contributes to cholestatic liver injury, whereas S‐adenosylmethionine (SAMe) administration is protective. Here, we determined whether there is interplay between c‐Myc, Maf proteins, and methionine adenosyltransferase α1 (MATα1), which is responsible for SAMe biosynthesis in the liver. We used bile duct ligation (BDL) and lithocholic acid (LCA) treatment in mice as chronic cholestasis models, a murine CCA model, human CCA cell lines KMCH and Huh‐28, human liver cancer HepG2, and human CCA specimens to study gene and protein expression, protein‐protein interactions, molecular mechanisms, and functional outcomes. We found that c‐Myc, MATα1 (encoded by MAT1A), MafG, and c‐Maf interact with one another directly. MAT1A expression fell in hepatocytes and bile duct epithelial cells during chronic cholestasis and in murine and human CCA. The opposite occurred with c‐Myc, MafG, and c‐Maf expression. MATα1 interacts mainly with Mnt in normal liver, but this switches to c‐Maf, MafG, and c‐Myc in cholestatic livers and CCA. Promoter regions of these genes have E‐boxes that are bound by MATα1 and Mnt in normal liver and benign bile duct epithelial cells that switched to c‐Myc, c‐Maf, and MafG in cholestasis and CCA cells. E‐box positively regulates c‐Myc, MafG, and c‐Maf, but it negatively regulates MAT1A. MATα1 represses, whereas c‐Myc, MafG, and c‐Maf enhance, E‐box‐driven promoter activity. Knocking down MAT1A or overexpressing MafG or c‐Maf enhanced CCA growth and invasion in vivo. Conclusion: There is a novel interplay between MATα1, c‐Myc, and Maf proteins, and their deregulation during chronic cholestasis may facilitate CCA oncogenesis. (Hepatology 2016;64:439‐455)
Hedgehog regulates yes‐associated protein 1 in regenerating mouse liver
Authors: Swiderska‐Syn Marzena , Xie Guanhua , Michelotti Gregory A. , Jewell Mark L. , Premont Richard T. , Syn Wing‐Kin , Diehl Anna Mae
Published: March 2016

Adult liver regeneration requires induction and suppression of proliferative activity in multiple types of liver cells. The mechanisms that orchestrate the global changes in gene expression that are required for proliferative activity to change within individual liver cells, and that coordinate proliferative activity among different types of liver cells, are not well understood. Morphogenic signaling pathways that are active during fetal development, including Hedgehog and Hippo/Yes‐associated protein 1 (Yap1), regulate liver regeneration in adulthood. Cirrhosis and liver cancer result when these pathways become dysregulated, but relatively little is known about the mechanisms that coordinate and control morphogenic signaling during effective liver regeneration. We evaluated the hypothesis that the Hedgehog pathway controls Yap1 activation during liver regeneration by studying intact mice and cultured liver cells. In cultured hepatic stellate cells (HSCs), disrupting Hedgehog signaling blocked activation of Yap1, and knocking down Yap1 inhibited induction of both Yap1‐ and Hedgehog‐regulated genes that enable HSC to become myofibroblasts (MFs). In mice, disrupting Hedgehog signaling in MFs inhibited liver regeneration after partial hepactectomy (PH). Reduced proliferative activity in the liver epithelial compartment resulted from loss of stroma‐derived paracrine signals that activate Yap1 and the Hedgehog pathway in hepatocytes. This prevented hepatocytes from up‐regulating Yap1‐ and Hedgehog‐regulated transcription factors that normally promote their proliferation. Conclusions: Morphogenic signaling in HSCs is necessary to reprogram hepatocytes to regenerate the liver epithelial compartment post‐PH. This discovery identifies novel molecules that might be targeted to correct defective repair during cirrhosis and liver cancer. (Hepatology 2016;64:232–244)
CD14 is associated with biliary stricture formation
Authors: Friedrich Kilian , Smit Mark , Brune Maik , Giese Thomas , Rupp Christian , Wannhoff Andreas , Kloeters Petra , Leopold Yvonne , Denk Gerald Ulrich , Weiss Karl Heinz , Stremmel Wolfgang , Sauer Peter , Hohenester Simon , Schirmacher Peter , Schemmer Peter , Gotthardt Daniel Nils
Published: March 2016

The pathogenesis of intrahepatic biliary stricture formation in patients with primary sclerosing cholangitis (PSC) or after liver transplantation (LTx) remains elusive. CD14 receptor signaling is a key mediator of the innate immune system; its common genetic variant is associated with alcoholic liver disease. PSC and LTx cohort patients and primary biliary cirrhosis (PBC) control patients were genotyped for the CD14 ‐260C>T (rs2569190) polymorphism, and genotypes were correlated with long‐term clinical outcome. Biliary tissue, bile, and whole blood of PSC patients and healthy controls were screened for markers of the innate immune system and bacterial infection. In 121 PSC patients, the CD14 ‐260C>T genotype was associated with development of dominant bile duct strictures (P = 0.02). In 365 LTx patients, TT carriers (4.1%) were protected against the formation of nonanastomotic biliary strictures versus CC/CT patients (12.6%; P = 0.01). Chemokine ligand 8 (P = 0.04) and chemokine receptor 6 (P = 0.004) were up‐regulated in biliary tissue of PSC patients with the TT versus the CC/CT genotype. Lipopolysaccharide whole‐blood stimulation resulted in a significant change in interleukin (IL)‐8 (P = 0.05) and IL‐12p40 levels (P = 0.04) in healthy control subjects carrying the TT genotype. TT PSC patients were protected against Gram‐negative bacterial biliary infection (TT: 0% vs. CC/CT: 22.5%; P = 0.02). Serum‐soluble CD14 levels correlated with the CD14 ‐260C>T genotype (P = 0.02), representing an independent risk indicator of survival in PSC patients (hazard ratio, 0.40; 95% confidence interval, 0.19‐0.86; P =0.01). Conclusions: The function of the innate immune response by CD14 is crucial during biliary infection and stricture formation. The benefits of CD14 signaling modification should be addressed in future studies. (Hepatology 2016;64:843‐852)
Development and Validation of a Disease‐Specific Questionnaire to Assess Patient‐Reported Symptoms in Polycystic Liver Disease
Authors: Neijenhuis Myrte K. , Gevers Tom J.G. , Hogan Marie C. , Kamath Patrick S. , Wijnands Titus F.M. , van den Ouweland Ralf C.P.M. , Edwards Marie E. , Sloan Jeff A. , Kievit Wietske , Drenth Joost P.H.
Published: March 2016

Treatment of polycystic liver disease (PLD) focuses on symptom improvement. Generic questionnaires lack sensitivity to capture PLD‐related symptoms, a prerequisite to determine effectiveness of therapy. We developed and validated a disease‐specific questionnaire that assesses symptoms in PLD (PLD‐Q). We identified 16 PLD‐related symptoms (total score 0‐100 points) by literature review and interviews with patients and clinicians. The developed PLD‐Q was validated in Dutch (n = 200) and United States (US; n = 203) PLD patients. We assessed the correlation of PLD‐Q total score with European Organization for Research and Treatment of Cancer (EORTC) symptom scale, global health visual analogue scale (VAS) of EQ‐5D, and liver volume. To test discriminative validity, we compared PLD‐Q total scores of patients with different PLD severity stages (Gigot classification) and PLD‐Q total scores of PLD patients with general controls and polycystic kidney disease patients without PLD. Reproducibility was tested by comparing original test scores with 2‐week retest scores. In total, 167 Dutch and 124 US patients returned the questionnaire. Correlation between PLD‐Q total score and EORTC symptom scale (The Netherlands [NL], r = 0.788; US, r = 0.811) and global health VAS (NL, r = −0.517; US, r = −0.593) was good. There was no correlation of PLD‐Q total score with liver volume (NL, r = 0.138; P = 0.236; US, r = 0.254; P = 0.052). Gigot type III individuals scored numerically higher than type II patients (NL, 46 vs. 40; P = 0.089; US, 48 vs. 36; P = 0.055). PLD patients scored higher on the PLD‐Q total score than general controls (NL, 42 vs. 17; US, 40 vs. 13 points) and polycystic kidney disease patients without PLD (22 points). Reproducibility of PLD‐Q was excellent (NL, r = 0.94; US, 0.96). Conclusion: PLD‐Q is a valid, reproducible, and sensitive disease‐specific questionnaire that can be used to assess PLD‐related symptoms in clinical care and future research. (Hepatology 2016;64:151–160)
A New Isoflavanol from the Fruits of Kotschya strigosa (Fabaceae)
Authors: Awouafack Maurice D. , Tchuenguem Roland T. , Ito Takuya , Dzoyem Jean P. , Tane Pierre , Morita Hiroyuki
Published: March 2016

The phytochemical investigation of the MeOH extract from fruits of Kotschya strigosa using repeated normal and reversed‐phase column chromatography and Sephadex LH‐20 chromatography led to the isolation and characterization of a new isoflavanol, named kotstrigoisoflavanol (1), together with three known compounds, diosmetin (2), β‐sitosterol (3), and the 3‐O‐β‐d‐glucopyranoside of β‐sitosterol (4). The antioxidant activity of crude extract, 1, and 2 was determined using the 2,2‐diphenyl‐1‐picrylhydrazyl (DPPH˙) method. The crude extract (IC50 61.7 ± 0.2 μg/ml) and 2 (IC50 70.2 ± 0.1 μg/ml) showed moderate antioxidant activities, while 1 was weakly active (IC50 153.1 ± 0.1 μg/ml), as compared with the standard reference l‐ascorbic acid (IC50 21.9 ± 0.0 μg/ml).