bluuebunny/crossref_metadata_2025 huggingface dataset:
Interactive effects of severe drought and grazing on the life history cycle of a bioindicator species
Authors: Fritts Sarah Rebecah , Grisham Blake A. , Cox Robert D. , Boal Clint W. , Haukos David A. , McDaniel Patricia , Hagen Christian A. , Greene Daniel U.
Published: September 2018

We used the lesser prairie‐chicken (Tympanuchus pallidicinctus), an iconic grouse species that exhibits a boom–bust life history strategy, on the Southern High Plains, USA, as a bioindicator of main and interactive effects of severe drought and grazing. This region experienced the worst drought on record in 2011. We surveyed lesser prairie‐chicken leks (i.e., communal breeding grounds) across 12 years that represented 7 years before the 2011 drought (predrought) and 4 years during and following the 2011 drought (postdrought). Grazing was annually managed with the objective of achieving ≤50% utilization of aboveground vegetation biomass. We used lek (n = 49) count data and covariates of weather and managed grazing to: (a) estimate long‐term lesser prairie‐chicken abundance and compare abundance predrought and postdrought; (b) examine the influence of annual and seasonal drought (modified Palmer drought index), temperature, and precipitation on long‐term lesser prairie‐chicken survival and recruitment; and (c) assess and compare the influence of grazing on lesser prairie‐chicken population predrought and postdrought. Lesser prairie‐chicken abundance was nearly seven times greater predrought than postdrought, and population declines were attributed to decreased survival and recruitment. The number of days with temperature >90th percentile had the greatest effect, particularly on recruitment. The population exhibited a substantial bust during 2011 and 2012 without a boom to recover in four postdrought years. Adaptive grazing positively influenced the population predrought, but had no effects postdrought. Results suggest that the severe drought in 2011 may have been beyond the range of environmental conditions to which lesser prairie‐chickens, and likely other species, have adapted. Land management practices, such as grazing, should remain adaptive to ensure potential negative influences to all species are avoided. Increasing habitat quantity and quality by reducing habitat loss and fragmentation likely will increase resiliency of the ecosystem and individual species.
Perturbative reheating in Sneutrino-Higgs cosmology
Authors: Cai Yong , Deen Rehan , Ovrut Burt A. , Purves Austin
Published: September 2018

Abstract

The theory of perturbative reheating in the Sneutrino-Higgs cosmology of the B-L MSSM is presented. It is shown that following an epoch of inflation consistent with all Planck2015 data, the inflaton begins to oscillate around its minimum at zero and to reheat to various species of standard model and supersymmetric matter. The perturbative decay rates to this matter are computed, both analytically and numerically. Using these results, the Hubble parameter and the relative energy densities for each matter species, including that of the inflaton, are calculated numerically. The inflaton energy density is demonstrated to vanish at an energy scale of

$$ \mathcal{O} $$

O

(1013) GeV, signaling the end of the period of reheating. The newly created matter background is shown to be in thermal equilibrium, with a reheating temperature of ≃ 1.13 × 1013 GeV. To allow for a B-L breaking scale sufficiently smaller than the reheating scale, we extend the statistical method of determining the soft supersymmetry breaking parameters developed in previous work. The result is that one can determine a large number of phenomenologically realistic initial conditions for which the B-L breaking scale is an order of magnitude or more smaller than the reheating scale.
Functional metabolomics approach reveals the reduced biosynthesis of fatty acids and TCA cycle is required for pectinase activity in Bacillus licheniformis
Authors: Guan Yi , Yin Di , Du Xi , Ye Xiuyun
Published: September 2018

Increase of pectinase activity is especially important in fermentation industry. Understanding of the metabolic mechanisms can find metabolic modulation approach to promote high yield of pectinase. Higher activity of pectinase was detected in DY1 than DY2, two strains of Bacillus licheniformis. GC–MS-based metabolomics identified differential metabolome of DY2 compared with DY1, characterizing the increased TCA cycle and biosynthesis of fatty acids. Elevated activity of pyruvate dehydrogenase (PDH), α-ketoglutaric dehydrogenase (KGDH) and succinate dehydrogenase (SDH) showed global elevation of carbon metabolism, which is consistent with the result that lowers glucose in DY2 than DY1. Inhibitors malonate, furfural and triclosan, of PDH, SDH and biosynthesis of fatty acids, promoted pectinase activity, where triclosan increased pectinase activity by 179%. These results indicate that functional metabolomics is an effective approach to understand metabolic mechanisms of fermentation production and provides clues to develop new methods for changing bacterial physiology and production.
The updated Charlson comorbidity index is a useful predictor of mortality in patients with Staphylococcus aureus bacteraemia
Authors: Ternavasio-de la Vega H. G. , Castaño-Romero F. , Ragozzino S. , Sánchez González R. , Vaquero-Herrero M. P. , Siller-Ruiz M. , Spalter-Glicberg G. , Ramírez-Baum C. , Rodríguez-Rodríguez S. , García-Sánchez J. E. , García-García I. , Marcos M.
Published: September 2018

The objective was to compare the performance of the updated Charlson comorbidity index (uCCI) and classical CCI (cCCI) in predicting 30-day mortality in patients with Staphylococcus aureus bacteraemia (SAB). All cases of SAB in patients aged ⩾14 years identified at the Microbiology Unit were included prospectively and followed. Comorbidity was evaluated using the cCCI and uCCI. Relevant variables associated with SAB-related mortality, along with cCCI or uCCI scores, were entered into multivariate logistic regression models. Global model fit, model calibration and predictive validity of each model were evaluated and compared. In total, 257 episodes of SAB in 239 patients were included (mean age 74 years; 65% were male). The mean cCCI and uCCI scores were 3.6 (standard deviation, 2.4) and 2.9 (2.3), respectively; 161 (63%) cases had cCCI score ⩾3 and 89 (35%) cases had uCCI score ⩾4. Sixty-five (25%) patients died within 30 days. The cCCI score was not related to mortality in any model, but uCCI score ⩾4 was an independent factor of 30-day mortality (odds ratio, 1.98; 95% confidence interval, 1.05–3.74). The uCCI is a more up-to-date, refined and parsimonious prognostic mortality score than the cCCI; it may thus serve better than the latter in the identification of patients with SAB with worse prognoses.
The Determination and Application of the Point Spread Function in the Scanning Electron Microscope
Authors: Zotta Matthew D. , Nevins Mandy C. , Hailstone Richard K. , Lifshin Eric
Published: September 2018

A method is presented to determine the spatial distribution of electrons in the focused beam of a scanning electron microscope (SEM). Knowledge of the electron distribution is valuable for characterizing and monitoring SEM performance, as well as for modeling and simulation in computational scanning electron microscopy. Specifically, it can be used to characterize astigmatism as well as study the relationship between beam energy, beam current, working distance, and beam shape and size. In addition, knowledge of the distribution of electrons in the beam can be utilized with deconvolution methods to improve the resolution and quality of backscattered, secondary, and transmitted electron images obtained with thermionic, FEG, or Schottky source instruments. The proposed method represents an improvement over previous methods for determining the spatial distribution of electrons in an SEM beam. Several practical applications are presented.
Pakistan Developmental Origins of Health and Disease (DOHaD) Society: addressing the ‘DO’ component of DOHaD
Authors: Mohammed N. , Nuruddin R. , Shoukat Ali A.
Published: September 2018

Adverse intrauterine environment could serve as an important stimulus for postnatal altered health status and for increased susceptibility to long-term non-communicable diseases (NCDs). The notion is now recognized as the Developmental Origins of Health and Disease (DOHaD), which was first proposed by Sir David Barker. Since then, several scientific disciplines have strived to measure the magnitude of the early fetal programming and later risk of diseases. Pakistan, with striking figures of morbidity and mortality from NCDs, is currently tackling with double burden of diseases and requires planned efforts to counteract the threat of NCDs. Considering the growing needs and available evidences, Pakistan DOHaD Society was officially instigated in September 2016. The Society aims to explicitly address the association of life in utero with future health and disease and to endorse early screening and interventions to reduce the burden of NCDs, mental health issues and learning disorders along the life course. It has shown significant progress toward investigating the influence of adverse in utero environment such as diabetes, maternal under-nutrition and pre-eclampsia on fetal programming under two major research lines, that is, cardiovascular and cerebrovascular programming. The Society has been successful in disseminating its research findings through several esteemed international scientific conferences. Pakistan DOHaD Society encourages scientific community for collaborative research aimed at improving the quality of life during early childhood, adolescence and adulthood through provision of appropriate pre-pregnancy and antenatal interventions targeted to address at-risk in utero conditions.
Emergence/Subsidence Histories Along the Carnegie and Cocos Ridges and Their Bearing Upon Biological Speciation in the Galápagos
Authors: Orellana‐Rovirosa Felipe , Richards Mark
Published: September 2018

Using plate motion reconstructions for the Nazca, Cocos, and South American plates in relation to the Galápagos hotspot, we find that age‐depth dependence of bathymetry, Galápagos plume dynamic topography, crustal relaxation, and magmatic production permit reasonable estimates for the subsidence of former islands along the Carnegie and Cocos Ridges. Our dynamic topography estimates are partially based upon geodynamic theory (fluid mechanics and elasticity) and also upon detailed bathymetric observations and analysis. For three different target areas over Carnegie Ridge and two over Cocos Ridge, we infer subaerial landmasses over the past ~20 Ma. We provide rough estimates of the surface areas of these paleo‐archipelagos, which were comparable to that of the present‐day Galápagos archipelago. We construct a history of emerged (paleo‐island) topography along the conjugate pair Carnegie‐Cocos hotspot tracks and infer that significant subaerial landscapes existed for at least the past ~20 Ma. The genetic ancestors of endemic faunal species in Galápagos (e.g., marine iguanas) migrated away from South America, genetically diverging from their land counterparts much earlier than the age of the present Galápagos Islands (~3 Ma). At 16.5 Ma, the total emerged landmass on the Carnegie Ridge alone may have been ~2.5 times that of the current Galápagos archipelago. (The conjugate landmass along the Cocos Ridge has been subducted.) We propose that this large landmass, at least one‐fourth the size of Iceland, be called Darwinia in recognition of its importance in the evolution of some Galápagos endemic flora and fauna made famous by Darwin's explorations.
PVDF–MWNT interactions control process induced β-lamellar morphology and orientation in the nanocomposites
Authors: Mani Mohan Raj , Gebrekrstos Amanuel , Madras Giridhar , Pötschke Petra , Bose Suryasarathi
Published: September 2018

Polymer–filler interactions control process induced β-lamellar morphology and orientation which in turn control the mechanical properties of PVDF nanocomposites.
Benzyloxycalix[8]arene: a new valuable support for NHC palladium complexes in C–C Suzuki–Miyaura couplings
Authors: Abdellah Ibrahim , Kasongo Pauline , Labattut Axel , Guillot Régis , Schulz Emmanuelle , Martini Cyril , Huc Vincent
Published: September 2018

Benzyloxycalix[8]arene supported catalysts bearing N-heterocyclic carbene palladium complexes on each subunit were readily synthesized.
Thio-Michael addition of thioamides and allenes for the selective construction of polysubstituted 2-arylthiophenes via TBAI/H2O2 promoted tandem oxidative annulation and 1,2-sulfur migration
Authors: Han Teng , Luo Xiaoyan
Published: September 2018

TBAI/H2O2 promoted tandem thio-Michael addition/oxidative annulation and the 1,2-sulfur migration transformation protocol to construct polysubstituted 2-arylthiophenes.
Continuous Vocal Fry Simulated in Laboratory Subjects: A Preliminary Report on Voice Production and Listener Ratings
Authors: Venkatraman Anumitha , Sivasankar M. Preeti
Published: September 2018

Purpose

Vocal fry is prevalent in everyday speech. However, whether the use of vocal fry is detrimental to voice production is unclear. This preliminary study assessed the effects of using continuous vocal fry on voice production measures and listener ratings.

Method

Ten healthy individuals (equal male and female, mean age = 22.4 years) completed 2 counterbalanced sessions. In each session, participants read in continuous vocal fry or habitual voice quality for 30 min at a comfortable intensity. Continuous vocal fry was simulated. Phonation threshold pressure (PTP
10
and PTP
20
), cepstral peak prominence, and vocal effort ratings were obtained before and after the production of each voice quality. Next, 10 inexperienced listeners (equal male and female, mean age = 24.1 years) used visual analog scales to rate paired samples of continuous vocal fry and habitual voice quality for naturalness, employability, and amount of listener concentration.

Results

PTP
10
and vocal effort ratings increased after 30 min of continuous vocal fry. Inexperienced listeners rated continuous vocal fry more negatively than the habitual voice quality.

Conclusions

Thirty minutes of simulated, continuous vocal fry worsened some voice measures when compared with a habitual voice quality. Samples of continuous vocal fry were rated as significantly less employable, less natural, and requiring greater listener concentration as compared with samples of habitual voice quality. Future studies should include habitual users of vocal fry to investigate speech stimulability and adaptation with cueing to further understand pathogenesis of vocal fry.
2018 Status of the Measurement Capabilities for Fusion Gyrotrons at KIT/IHM
Authors: Ruess T. , Avramidis K. A. , Fuchs M. , Gantenbein G. , Illy S. , Ioannidis Z. , Lutz F. C. , Ruess S. , Rzesnicki T. , Thumm M. , Wagner D. , Weggen J. , Jelonnek J.
Published: September 2018

This paper gives an overview about three key measurement capabilities at KIT/IHM for fusion gyrotrons. The discussed topics are: RF window test facility, low power launcher test setup and the frequency measurement setup placed at the high power test facility. Further, approaches for upgrading the setups to frequencies above 200 GHz are discussed.
Geodetic Basis used during the Remediation of Strečno Cliff
Authors: Seidlová Anna , Šíma Jaroslav , Chromčák Jakub
Published: September 2018

Great part of Slovak traffic is led by the highways nowadays. There is a number of critical parts in highway from Bratislava to Košice, the most critical is under the castle Strečno. In the future, there are plans to redirect the traffic during the tunnel, but in present the traffic goes through road I/18. This is placed between Váh River and the castle, which is placed on the cliff above the road. The flooding and the gradual collapse of cliff accompanied by falling of rock pieces on the communication is very dangerous. The access on the castle walls is almost impossible, it is necessary to use new technologies. The imagining was done by UAV equipment Microkopter and uncalibrated camera with CMOS Full Frame. The result of the work is photoplan with dangerous parts overdrawn. These can be helpful during the remediation.
Automation of optimization of discrete technological processes
Authors: Kudryavtsev Evgeniy
Published: September 2018

The article describes the procedure automation of optimization discrete technological processes with using of Bellman’s functional (recurrent) equation and system Mathcad. As rule the technological processes includes n of operations and each operation can be executed by various types of equipment. Expenses (cost, time, …) on execution of i operation by k equipment after execution by j equipment (i-1) operation are known - c (i, j, k). Expenses for execution by k equipment i operation can depend on the equipment - j, which executed previous (i-1) operation. It is necessary to execute automation of optimization technological process with the minimum expenses. The algorithm of the decision of a problem by Bellman’s method includes two phases. The first phase is calculations of the minimum expenses for execution of all partial technological processes, from last operation of process to the first. The second phase is definition of the required optimum set of equipment which is carrying out all technological process with the minimum expenses. The proposed procedure of automation of optimization technological process using Bellman’s method and system Mathcad significantly decreases time and labour costs on execution of such calculations and efficiently to execute investigations related with change of equipment parameters.
Analysis of physical and mechanical properties of vacuum treated claydite-concrete
Authors: Khubaev Alan , Bidov Tembot , Rybakova Alina
Published: September 2018

In this article the analysis of the impact of some physical and mechanical properties of vacuum treated claydite-concrete is presented. The work purpose is to describe in detail the results of the experimental and analytical studies of the claydite-concrete composition influence on the vacuum treatment intensity and amount of removed water. These results are obtained by solving the following problems: compressive strength investigation of the claydite-concrete samples; consideration of the phenomenon of "self-vacuuming treatment" of the porous aggregate as a factor, promoting claydite-concrete strength; consideration of such an aspect as "adhesion between claydite-concrete and reinforcement", and the porosity learning as a factor of the quality assessing of the building products and structures. A scientific and technical hypothesis is formed, which assumes the possibility of the practical recommendation developing for vacuum treatment intensity of the claydite-concrete. As a result, this gives an opportunity to intensify the concrete hardening.
Solar-vortex power plants: Principles of effective work and technical requirements on the preparation of initial data for design
Authors: Solovyev Alexander , Solovyev Dmitry , Shilova Liubov
Published: September 2018

This article discusses the conceptual problems of the energy conversion process from radiant radiation into the energy of flows and electric energy in solar convective-vortex power plants. Moreover, this research includes the analysis of the factors that can contribute to the achievement of the optimal conditions for the control of the thermal energy concentration processes of solar radiation into the energy of tornado-like flows. Also, this article will discuss the results of the development of appropriate technical requirements for the design and construction of the building foundations and structures of solar-vortex power systems.
Food abundance and diet variation in freshwater turtles from the mid-Murray River, Australia
Authors: Petrov Kristen , Lewis Jessica , Malkiewicz Natasha , Van Dyke James U. , Spencer Ricky-John
Published: September 2018

Consumers usually respond to variations in prey availability by altering their foraging strategies. Generalist consumers forage on a diversity of resources and have greater potential to ‘switch’ their diet in response to fluctuations in prey availability, in comparison to specialist consumers. We aimed to determine how the diets of two specialist species (the eastern long-necked turtle (Chelodina longicollis) and the broad-shelled turtle (Chelodina expansa) and the more generalist Murray River short-necked turtle (Emydura macquarii) respond to variation in habitat and prey availability. We trapped and stomach-flushed turtles, and compared their diets along with environmental variables (turbidity, macrophyte and filamentous green algae cover, and aquatic invertebrate diversity and abundance) at four wetlands in north-central Victoria. Diets of E. macquarii differed from those of both Chelodina species, which overlapped, across all four sites. However, samples sizes for the two Chelodina species were too small to compare among-wetland variation in diet. Dietary composition of E. macquarii was variable but did not differ statistically among sites. Emydura macquarii preferentially selected filamentous green algae at three of the four sites. Where filamentous green algae were rare, total food bolus volume was reduced and E. macquarii only partially replaced it with other food items, including other vegetation, wood, and animal prey. Many turtles at these sites also had empty stomachs. Thus, filamentous green algae may be a limiting food for E. macquarii. Although E. macquarii has previously been described as a generalist, it appears to have limited ability to replace filamentous green algae with other food items when filamentous green algae are rare.
Making Applied Linguistics Applicable to Business Practice. Discourse Analysis as a Management Tool
Authors: Darics Erika , Clifton Jonathan
Published: September 2018

This article makes a case for increasing the discursive awareness of practitioners and developing their discourse analytical skills. Although the importance of such an awareness is being increasingly recognized by scholars and practitioners alike, the insights of fine-grained discursive analyses of talk-in-interaction have rarely been seriously considered as resources for accomplishing managerial objectives. Consequently, reflecting on naturally occurring talk as a way of managing remains rare. In this article, we provide an illustration of how the in situ practice of telling stories of organizational change could give change initiators the tools with which to make visible, and thus actionable, the seen but unnoticed underlying assumptions, unshared information, and patterns of collective thinking about change. We close the article with a call for discourse analysis to be taken more seriously in management practice and training.
Composition and the Logic of Location: An Argument for Regionalism
Authors: Gilmore Cody , Leonard Matt
Published: September 2018

Ned Markosian (2014) has recently defended a new theory of composition, which he calls regionalism: some material objects xx compose something if and only if there is a material object located at the fusion of the locations of xx. Markosian argues that regionalism follows from what he calls the subregion theory of parthood (STP). Korman and Carmichael (2016) agree. We provide countermodels to show that regionalism does not follow from (STP), even together with fourteen potentially implicit background principles. We then show that regionalism does follow from five of those background principles together with (STP) and two additional principles connecting parthood and location, which we call (Overlap) and (Strong Delegation). While the additional principles are not uncontroversial, our conjecture is that many will find them attractive. We conclude by mentioning that (Strong Delegation) fills a previously unnoticed gap in the formal theory of location presented in Parsons (2007).
Whole-plant frost hardiness of mycorrhizal (Hebeloma sp. or Suillus luteus) and non-mycorrhizal Scots pine seedlings
Authors: Korhonen Anna , Lehto Tarja , Heinonen Jaakko , Repo Tapani
Published: September 2018

Ectomycorrhizal trees are common in the cold regions of the world, yet the role of the mycorrhizal symbiosis in plant cold tolerance is poorly known. Moreover, the standard methods for testing plant frost hardiness may not be adequate for roots and mycorrhizas. The aims of this study were to compare the frost hardiness of mycorrhizal and non-mycorrhizal Scots pine (Pinus sylvestris L.) seedlings and to test the use of reverse-flow root hydraulic conductance (Kr) measurement for root frost hardiness determination. Mycorrhizal (Hebeloma sp. or Suillus luteus) and non-mycorrhizal seedlings were grown in controlled-environment chambers for 13 weeks. After this, half of the plants were allotted to a non-hardening treatment (long day and high temperature, same as during the preceding growing season) and the other half to a hardening (short day and low temperature) ‘autumn’ treatment for 4 weeks. The intact seedlings were exposed to whole-plant freezing tests and the needle frost hardiness was measured by relative electrolyte leakage (REL) method. The seedlings were grown for three more weeks for visual damage assessment and Kr measurements using a high-pressure flow meter (HPFM). Mycorrhizas did not affect the frost hardiness of seedlings in either hardening treatment. The effect of the hardening treatment on frost hardiness was shown by REL and visual assessment of the aboveground parts as well as Kr of roots. Non-mycorrhizal plants were larger than mycorrhizal ones while nitrogen and phosphorus contents (per unit dry mass) were similar in all mycorrhiza treatments. In plants with no frost exposure, the non-mycorrhizal treatment had higher Kr. There was no mycorrhizal effect on plant frost hardiness when nutritional effects were excluded. Further studies are needed on the role of mycorrhizas especially in the recovery of growth and nutrient uptake in cold soils in the spring. The HPFM is useful novel method for assessment of root damage.
Quality of Life in Males and Females With Idiopathic Scoliosis
Authors: Diarbakerli Elias , Grauers Anna , Danielsson Aina , Abbott Allan , Gerdhem Paul
Published: September 2018

Study Design.

Cross-sectional.

Objective.

To describe quality of life in males and females with idiopathic scoliosis.

Summary of Background Data.

Idiopathic scoliosis is a three-dimensional deformity affecting the growing spine. The prevalence of larger curves, requiring treatment, is higher in females.

Methods.

This cross-sectional study comprised 1519 individuals with idiopathic scoliosis (211 males) with a mean (SD) age of 35.3 (14.9) years. They all answered the Scoliosis Research Society 22 revised (SRS-22r) questionnaire and EuroQol 5-dimension-index (EQ-5D). Five hundred twenty eight were surgically treated (78 males), 535 were brace treated (50 males), and 456 were untreated (83 males). The SRS-22r subscore (excluding the satisfaction domain), the SRS-22r domains and the EQ-5D index score were calculated. Subgroup analyses based on treatment and age were performed. Statistical comparisons were performed using analysis of covariance with adjustments for age and treatment. A P-value less than 0.05 was considered as statistical significant.

Results.

The mean (SD) SRS-22r subscore was 4.19 (0.61) in males and 4.05 (0.61) in females (P = 0.010). The males had higher scores on the SRS-22r domains function (4.56 vs. 4.42), pain (4.20 vs. 4.00), and mental health (4.14 vs. 3.92) (all P < 0.05). The mean (SD) EQ-5D index score was 0.85 (0.22) for males and 0.81 (0.21) for females (P = 0.10). There were minor differences when comparing males and females in treatment and age groups, but both treated and untreated groups had reduced quality of life compared with the national norms.

Conclusion.

When compared with females, males with idiopathic scoliosis tend to have slightly higher scores in the scoliosis specific SRS-22r but not in the generic quality of life measurement EQ-5D. Quality of life is overall similar between males and females in treatment and age groups, but reduced in comparison with the general population.

Level of Evidence: 3
Early Maturity as the New Normal: A Century-long Study of Bone Age
Authors: Boeyer Melanie E. , Sherwood Richard J. , Deroche Chelsea B. , Duren Dana L.
Published: September 2018

Background

Epiphyseal fusion (EF) marks the completion of longitudinal bone growth, a critical milestone monitored during treatment of skeletal growth and/or developmental disorders. Recently, a trend toward accelerated skeletal maturation in children has been documented. Because current methods for assessing skeletal maturation include children in their reference populations born as early as the 1930s, the timing of EF events in contemporary patients may differ substantially from those standards.

Questions/purposes

(1) Do children today initiate the process of EF in the hand and wrist earlier than past generations on which maturity standards are based? (2) Do children today complete EF in the hand and wrist earlier than past generations on which maturity standards are based?

Methods

A total of 1292 children (665 males, 627 females) participating in the Fels Longitudinal Study, born between 1915 and 2006, were included in this retrospective, observational study. Each participant had between one and 39 serial left hand-wrist radiographs during childhood obtained specifically for research purposes. Main outcomes were the chronological age at the first sign of EF initiation (EF-I) and the first chronological age when EF was complete (EF-C) in the radius and ulna, and metacarpals and phalanges of the first, third, and fifth rays according to criteria of the Fels method. EF is a reliable metric with an average κ agreement statistic of 0.91. Penalized B-splines were used to model the changes in EF-I and EF-C ages and to identify changes across continuous birth years with major comparisons between children born in 1935 and 1995.

Results

Approximately half of the epiphyses of the hand and wrist examined exhibited earlier EF-I and/or earlier EF-C in children born in 1995 compared with those born in 1935. The age at each milestone (EF-I and EF-C) decreased by as much as 6.7 and 6.8 months in males and 9.8 and 9.7 months in females, respectively. This change occurred gradually over the past century. The more proximal traits (EF of the distal radius, distal ulna, and metacarpals) were more likely to experience a shift in timing, whereas timing of EF in the phalanges remained relatively stable across birth years.

Conclusions

A trend has occurred over the past century in the timing of EF, in both initiation and completion of the process, for many of the bones of the hand and wrist. Earlier EF reflects modern population advances in both skeletal and sexual maturation. Shifts in the timing of EF have the potential to influence treatment strategies for skeletal growth and/or developmental disorders such as scoliosis or leg length inequality, moving treatment windows to earlier ages. Earlier EF-I and EF-C identified in this study signals a need to reevaluate the timing of maturational milestones and current standards for skeletal assessment.

Level of Evidence

Level II, prognostic study.
High Risk of Venous Thromboembolism After Surgery for Long Bone Metastases: A Retrospective Study of 682 Patients
Authors: Groot Olivier Q. , Ogink Paul T. , Janssen Stein J. , Paulino Pereira Nuno Rui , Lozano-Calderon Santiago , Raskin Kevin , Hornicek Francis , Schwab Joseph H.
Published: September 2018

Background

Previous studies have shown that venous thromboembolism (VTE) is a complication associated with neoplastic disease and major orthopaedic surgery. However, many potential risk factors remain undefined.

Questions/purposes

(1) What proportion of patients develop symptomatic VTE after surgery for long bone metastases? (2) What factors are associated with the development of symptomatic VTE among patients receiving surgery for long bone metastases? (3) Is there an association between the development of symptomatic VTE and 1-year survival among patients undergoing surgery for long bone metastases? (4) Does chemoprophylaxis increase the risk of wound complications among patients undergoing surgery for long bone metastases?

Methods

A retrospective study identified 682 patients undergoing surgical treatment of long bone metastases between 2002 and 2013 at the Massachusetts General Hospital and Brigham and Women's Hospital. We included patients 18 years of age or older who had a surgical procedure for impending or pathologic metastatic long bone fracture. We considered the humerus, radius, ulna, femur, tibia, and fibula as long bones; metastatic disease was defined as metastases from solid organs, multiple myeloma, or lymphoma. In general, we used 40 mg enoxaparin daily for lower extremity surgery and 325 mg aspirin daily for lower or upper extremity surgery. The primary outcome was a VTE defined as any symptomatic pulmonary embolism (PE) or symptomatic deep vein thrombosis (DVT; proximal and distal) within 90 days of surgery as determined by chart review. The tertiary outcome was defined as any documented wound complication that might be attributable to chemoprophylaxis within 90 days of surgery. At followup after 90 days and 1 year, respectively, 4% (25 of 682) and 8% (53 of 682) were lost to followup. Statistical analysis was performed using multivariable logistic and Cox regression and Kaplan-Meier.

Results

Overall, 6% (44 of 682) of patients had symptomatic VTE; 22 patients sustained a DVT, and 22 developed a PE. After controlling for relevant confounding variables, higher preoperative hemoglobin level was independently associated (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.60–0.93; p = 0.011) with decreased symptomatic VTE risk, the presence of symptomatic VTE was associated with a worse 1-year survival rate (VTE: 27% [95% CI, 14%–40%] and non-VTE: 39% [95% CI, 35%–43%]; p = 0.041), and no association was found between wound complications and the use of chemoprophylaxis (OR, 3.29; 95% CI, 0.43–25.17; p = 0.252).

Conclusions

The risk of symptomatic 90-day VTE is high in patients undergoing surgery for long bone metastases. Further study would be needed to determine the VTE prevention strategy that best balances risks and benefits to address this complication.

Level of Evidence

Level III, therapeutic study.
VISUAL FUNCTION AND OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FEATURES IN CHILDREN BORN PRETERM
Authors: Balasubramanian Siva , Borrelli Enrico , Lonngi Marcela , Velez Federico , Sarraf David , Sadda SriniVas R. , Tsui Irena
Published: September 2018

Purpose:

Preterm children have an increased risk of impaired vision from retinopathy, strabismus, and high refractive error. The aim of this study was to investigate the relationship between foveal parameters generated by optical coherence tomography angiography and visual function in preterm children.

Methods:

Eighty eyes (32 eyes of former preterm infants and 48 age-matched full-term control eyes) were analyzed. Subjects underwent complete eye examinations including best-corrected visual acuity and retinal imaging with the Optovue XR Avanti optical coherence tomography angiography device. Foveal morphologic parameters including foveal depth, central foveal thickness, inner retinal area, and outer retinal area were measured on a central horizontal B-scan. Foveal vasculature parameters including foveal avascular zone, superficial capillary plexus-vessel density, and deep capillary plexus-vessel density were measured on optical coherence tomography angiography.

Results:

The best-corrected visual acuity was significantly affected in preterm children compared with controls (P < 0.0001). The central foveal thickness (P < 0.0001), inner retinal area (P = 0.01), and outer retinal area (P = 0.03) were significantly increased in preterm compared with control eyes. Foveal depth (P < 0.001) and foveal avascular zone (P < 0.001) were significantly decreased in preterm compared with control eyes. The superficial capillary plexus-vessel density (P = 0.01) and deep capillary plexus-vessel density (P = 0.003) at the fovea (1 mm) were significantly increased in preterm compared with control eyes. The best-corrected visual acuity was negatively correlated with foveal depth (r = −0.42, P = 0.001) and foveal avascular zone (r = −0.53, P < 0.001), and positively correlated with central foveal thickness (r = 0.32, P = 0.01) and inner retinal area (r = 0.32, P = 0.01), indicating that worse visual acuity was associated with a smaller foveal avascular zone, shallower foveal depth, increased central foveal thickness, and larger inner retinal area.

Conclusion:

Foveal morphology and vasculature changes in preterm children were associated with impaired visual function. Further longitudinal studies are required to evaluate these changes over time.
Naloxone Effectiveness
Authors: Chimbar Lisa , Moleta Yvette
Published: September 2018

Purpose:

Opioid abuse and overdose is a public health concern as it relates to increased morbidity and mortality. This systematic review focuses on the application of take-home naloxone programs and its association with decreased mortality among those who abuse opioids. Take-home naloxone programs consist of distributed naloxone kits and corresponding education of overdose recognition. The purpose of this systematic review was to determine if programs that supply take-home naloxone are effective in preventing fatal overdoses among those who abuse opioids.

Methods:

A systematic search was conducted in Academic Search Complete, CINHAL, MEDLINE, PsychINFO, and SocINDEX. The key words searched were “programs,” “take-home kits,” “Narcan,” “Naloxone,” and “mortality.” On the basis of the predefined inclusion and exclusion criteria, nine studies were found for inclusion.

Results:

Study results were then synthesized, qualitatively, and within the current research, there is overwhelming support of take-home naloxone programs being effective in preventing fatal opioid overdoses. A significant limitation of this systematic review is the lack of randomized controlled trials as it is viewed as unethical withholding a known lifesaving medication from an at-risk population.

Practice Implications:

On the basis of the most current evidence, there is overwhelming support of take-home naloxone programs associated with decreased mortality among those who abuse opioids. As a result, there is an implication for a practice change that take-home naloxone programs should be more widely implemented throughout communities as a method of decreasing mortality associated with opioid overdoses. It is recommended that further research is done examining the cost-effectiveness of these programs.
Social Support Among Women Undergoing Methadone Maintenance Treatment in Iran
Authors: Rahimi Sharareh , Jalali Amir , Jalali Rostam
Published: September 2018

Objective:

This study was designed and conducted to explain perceived social support among women undergoing methadone maintenance treatment (MMT) in Iran.

Method:

This study was a simultaneous mixed method research. Within the quantitative part of the study, a total number of 138 female clients were selected through a convenience sampling method from 37 rehabilitation clinics located in the city of Isfahan and then assessed via a demographic characteristics questionnaire and Perceived Social Support Scale. Using purposive and snowball sampling methods in the qualitative part of the study, in-depth face-to-face, individual, and semistructured interviews were administered on 18 female clients willing to participate in the given research. Then, the quantitative and qualitative data were analyzed through quantitative content analysis and statistical tests using the SPSS Version 18 software, respectively.

Results:

The results of the qualitative part were reduced to 203 codes, 17 subcategories, eight categories, and four main categories including family support and acceptance, relatives’ support and acceptance interaction, and being supported and understood by society as well as individual social security needs. The results of the quantitative part also revealed that social support among women undergoing MMT was lower than the moderate level. The given findings were also consistent with the results in the qualitative part.

Conclusion:

Moreover, the results showed that drug-dependent women undergoing MMT experienced unmet social needs, which could affect them and overshadow their treatment and rehabilitation processes. Therefore, it is necessary to accommodate such needs through appropriate planning.
The Opioid Crisis, Suicides, and Related Conditions
Authors: Fornili Katherine
Published: September 2018

In early April 2018, Dr. Maria Oquendo, President of the American Psychiatric Association, and Dr. Nora Volkow, Director of the National Institute on Drug Abuse, published a thought-provoking article in the New England Journal of Medicine about the role of suicide in the opioid overdose epidemic, referring to the relationship between them as a “hidden tragedy.” Drs. Oquendo and Volkow drew our attention to the twinning of the opioid (and other drug) overdose and suicide epidemics, but these are not the first or only drug-related “twin epidemics.” Numerous other related conditions, including pain disorders, adverse childhood experiences, posttraumatic stress disorders, HIV/AIDS, polydrug use and toxicity, and certain social determinants of health, may interact in a multiplicative and/or cumulative manner to adversely impact individuals and populations.

Syndemic theory (Singer, 2009; Singer, Bulled, Ostrach, & Mendenhall, 2017) can be helpful for describing how certain conditions cluster and interact synergistically to exacerbate health effects, problem severity, and disease progression. This column argues that the opioid crisis can accurately be considered not only a singular epidemic, or even a singular syndemic when twinned with a suicide epidemic, but also a complex phenomenon that consists of multiple, related syndemic conditions in addition to suicide. These are multidimensional disorders, with multiple, often overlapping etiologies, so single-minded approaches will be ineffective. Consideration of syndemic interactions and their cumulative and multiplicative effects are helpful for guiding treatment and prognosis for individuals, and program planning and health policy for population health (Singer et al., 2017).
Treatment Options for Opioid Use Disorders
Authors: Mumba Mercy N. , Findlay Lilian J. , Snow Diane E.
Published: September 2018

Approximately 10% of the 20 million Americans who are suffering from substance use disorders are suffering from prescription opioid and heroine misuse. This has led to a rise in overdoses as well as emergency room visits, with over 1000 individuals across the United States being seen in emergency rooms every day. Unfortunately, about 90% of drug overdoses are unintentional. Therefore, finding effective ways to treat opioid use disorders and preventing relapse has now become a national priority. This review of the relevant literature highlights current treatment options available for opioid use disorders, including motivational interviewing, cognitive behavioral therapy, mindfulness meditation, mindfulness based relapse prevention, medication assisted therapies, and combination therapies. Lastly, a discussion on ways to address challenges related to the treatment of opioid use disorders is provided.
How Measurement Variability Affects Reporting of a Single Readmission Metric
Authors: Brittan Mark S. , Campagna Elizabeth J. , Keller David , Kempe Allison
Published: September 2018

Readmissions are an important quality measure for public reporting, payment, and collaborative research. Lack of measure standardization may lead to inconsistent reporting of outcomes across study sites. In this study, we examined the impact of measurement variability on reporting of a single readmission metric, 30-day all-condition readmission rates (ARRs). We conducted a secondary database analysis of 2006–2008 Medicaid Analytic eXtract data merged from four states of children younger than 21 years. We calculated 30-day ARRs for this cohort using three previously described models varying in their inclusions and exclusions of index hospitalizations and readmissions. The 30-day ARR was highest for the model allowing each readmission to serve as an index admission for subsequent readmissions (ARR: 7%); intermediate for the model allowing one index admission and more than one readmissions in each 30-day period (ARR: 6.2%); and lowest for the model allowing only one readmission in each 30-day period (ARR: 5.6%). Similar variation was seen when stratifying patients by individual diagnostic groups. In conclusion, measurement variability impacts reported outcomes of a single readmission metric. To improve the value of readmission as a quality metric, stakeholders engaged in multisite quality improvement or research should ensure that definitions are standardized across sites.
Improving the Transition of Care Process for Veterans Hospitalized at Non-VHA Facilities
Authors: Libbon James V. , Austin Carrie Meg , Gill-Scott Leta C. , Burke Robert E.
Published: September 2018

Veterans receiving primary care through the Veterans Health Administration (VHA) are at increased risk of adverse outcomes when transitioning from a non-VHA hospitalization to VHA primary care. We intervened to improve these care transitions through identifying Veterans at a partnered community hospital, use of a multidisciplinary patient-structured discharge information sheet for community case managers to effectively communicate with VHA clinics, and implementation of a VHA site process for receiving information. We evaluated the intervention on two endpoints: the percentage-relevant documentation was received at the VHA before follow-up appointment and the rate Veterans attended a follow-up appointment at the VHA. Rates for receiving transitions of care documents were as follows: 0% preintervention (N = 24), 16% in the first 6 months of intervention (N = 39), and 83% after plan-do-study-act cycles in the second 6 months (N = 41). Veteran follow-up attendance also improved 25% preintervention to 54% and 71%, respectively. This process could serve as a model for transitions of care improvement.
Patients' Perspectives on Reasons for Unplanned Readmissions
Authors: LeClair Amy M. , Sweeney Megan , Yoon Grace H. , Leary Jana C. , Weingart Saul N. , Freund Karen M.
Published: September 2018

Massachusetts has one of the highest rates of 30-day readmissions in the country. To identify patient-reported factors that may contribute to readmissions, we conducted semi-structured interviews with patients with unplanned readmissions within 30 days of inpatient discharge from the medicine services at an urban medical center between June and August 2016. Interviews with patients and/or proxies were conducted in English, Spanish, Mandarin, or Cantonese, then translated to English if necessary, transcribed verbatim, and deidentified. A team of four coders conducted the thematic analysis. Most patients did not identify factors associated with readmission beyond their underlying illness; however, a mismatch between the patient's clinical care needs and services available at postacute facilities, as well as poor communication between providers, facilities, and patients/proxies, were identified as contributing factors to readmissions. Non–English speaking patients and their families reported confusion with written discharge instructions, even if an interpreter provided verbal instructions. Patients will benefit from future interventions that aim to improve transfers to postacute care facilities, develop written materials in languages prevalent in the local population, and improve communication among providers, facilities, and patients and their families.