bluuebunny/crossref_metadata_2025 huggingface dataset:
Molecular basis of function and the unusual antioxidant activity of a cyanobacterial cysteine desulfurase
Authors: Banerjee Manisha , Chakravarty Dhiman , Ballal Anand
Published: June 2017

Cysteine desulfurases, which supply sulfur for iron–sulfur cluster biogenesis, are broadly distributed in all phyla including cyanobacteria, the progenitors of plant chloroplasts. The SUF (sulfur utilization factor) system is responsible for Fe–S cluster biosynthesis under stress. The suf operon from cyanobacterium Anabaena PCC 7120 showed the presence of a cysteine desulfurase, sufS (alr2495), but not the accessory sulfur-accepting protein (SufE). However, an open reading frame (alr3513) encoding a SufE-like protein (termed AsaE, Anabaena sulfur acceptor E) was found at a location distinct from the suf operon. The purified SufS protein existed as a pyridoxal 5' phosphate (PLP)-containing dimer with a relatively low desulfurase activity. Interestingly, in the presence of the AsaE protein, the catalytic efficiency of this reaction increased 10-fold. In particular, for sulfur mobilization, the AsaE protein partnered only SufS and not other cysteine desulfurases from Anabaena. The SufS protein was found to physically interact with the AsaE protein, demonstrating that AsaE was indeed the missing partner of Anabaena SufS. The conserved cysteine of the SufS or the AsaE protein was essential for activity but not for their physical association. Curiously, overexpression of the SufS protein in Anabaena caused reduced formation of reactive oxygen species on exposure to hydrogen peroxide (H2O2), resulting in superior oxidative stress tolerance to the oxidizing agent when compared with the wild-type strain. Overall, the results highlight the functional interaction between the two proteins that mediate sulfur mobilization, in the cyanobacterial SUF pathway, and further reveal that overexpression of SufS can protect cyanobacteria from oxidative stress.
All-fiber-optic vector magnetometer based on anisotropic magnetism-manipulation of ferromagnetism nanoparticles
Authors: Yin Jinde , Yan Peiguang , Chen Hao , Yu Li , Jiang Junfeng , Zhang Min , Ruan Shuangchen
Published: June 2017

The development of simple and sensitive sensors with the capability of simultaneously detecting magnetic field intensity and its direction in three-dimensional (3D) space is a technical imperative for magnetic field detection. In this paper, we first demonstrated the mechanism of anisotropic manipulation of ferromagnetism nanoparticles (FMNPs) in a non-continuous magnetic fluid film with the aid of varying magnetic fields. Second, based on the anisotropic distribution of the FMNPs around an optical fiber, we fabricated a vector magnetometer with a direction error of ±1.9° and an intensity sensitivity of 222.0 pm/mT, respectively. The sensing mechanism relies on the magnetism-controllable effective refractive index modification of asymmetric cladding modes in an in-line fiber-optic Mach-Zehnder interferometer. Compared to the previously reported intensity-based magnetometers, the as-fabricated magnetometer also provides an avenue to monitor the vector direction of the magnetic field in 3D space.
Segmental dynamics of polyethylene-alt-propylene studied by NMR spin echo techniques
Authors: Lozovoi A. , Mattea C. , Hofmann M. , Saalwaechter K. , Fatkullin N. , Stapf S.
Published: June 2017

Segmental dynamics of a highly entangled melt of linear polyethylene-alt-propylene with a molecular weight of 200 kDa was studied with a novel proton nuclear magnetic resonance (NMR) approach based upon 1H → 2H isotope dilution as applied to a solid-echo build-up function ISE(t), which is constructed from the NMR spin echo signals arising from the Hahn echo (HE) and two variations of the solid-echo pulse sequence. The isotope dilution enables the separation of inter- and intramolecular contributions to this function and allows one to extract the segmental mean-squared displacements in the millisecond time range, which is hardly accessible by other experimental methods. The proposed technique in combination with time-temperature superposition yields information about segmental translation in polyethylene-alt-propylene over 6 decades in time from 10−6 s up to 1 s. The time dependence of the mean-squared displacement obtained in this time range clearly shows three regimes of power law with exponents, which are in good agreement with the tube-reptation model predictions for the Rouse model, incoherent reptation and coherent reptation regimes. The results at short times coincide with the fast-field cycling relaxometry and neutron spin echo data, yet, significantly extending the probed time range. Furthermore, the obtained data are verified as well by the use of the dipolar-correlation effect on the Hahn echo, which was developed before by the co-authors. At the same time, the amplitude ratio of the intermolecular part of the proton dynamic dipole-dipole correlation function over the intramolecular part obtained from the experimental data is not in agreement with the predictions of the tube-reptation model for the regimes of incoherent and coherent reptation.
Effect of oxygen vacancies and strain on the phonon spectrum of HfO2 thin films
Authors: Gao Lingyuan , Yalon Eilam , Chew Annabel R. , Deshmukh Sanchit , Salleo Alberto , Pop Eric , Demkov Alexander A.
Published: June 2017

The effect of strain and oxygen deficiency on the Raman spectrum of monoclinic HfO2 is investigated theoretically using first-principles calculations. 1% in-plane compressive strain applied to a and c axes is found to blue shift the phonon frequencies, while 1% tensile strain does the opposite. The simulations are compared, and good agreement is found with the experimental results of Raman frequencies greater than 110 cm−1 for 50 nm HfO2 thin films. Several Raman modes measured below 110 cm−1 and previously assigned to HfO2 are found to be rotational modes of gases present in air ambient (nitrogen and oxygen). However, localized vibrational modes introduced by threefold-coordinated oxygen (O3) vacancies are identified at 96.4 cm−1 computationally. These results are important for a deeper understanding of vibrational modes in HfO2, which has technological applications in transistors and particularly in resistive random-access memory whose operation relies on oxygen-deficient HfOx.
Pedal coordinates, dark Kepler, and other force problems
Authors: Blaschke Petr
Published: June 2017

Pedal coordinates (instead of polar or Cartesian coordinates) are more natural settings in which to study force problems of classical mechanics in the plane. We will show that the trajectory of a test particle under the influence of central and Lorentz-like forces can be translated into pedal coordinates at once without the need of solving any differential equation. This will allow us to generalize Newton theorem of revolving orbits to include nonlocal transforms of curves. Finally, we apply developed methods to solve the “dark Kepler problem,” i.e., central force problem where in addition to the central body, gravitational influences of dark matter and dark energy are assumed.
Perspective: Theory and simulation of hybrid halide
perovskites
Authors: Whalley Lucy D. , Frost Jarvist M. , Jung Young-Kwang , Walsh Aron
Published: June 2017

Organic-inorganic halide perovskites present a number of challenges for first-principles atomistic materials modeling. Such “plastic crystals” feature dynamic processes across multiple length and time scales. These include the following: (i) transport of slow ions and fast electrons; (ii) highly anharmonic lattice dynamics with short phonon lifetimes; (iii) local symmetry breaking of the average crystallographic space group; (iv) strong relativistic (spin-orbit coupling) effects on the electronic band structure; and (v) thermodynamic metastability and rapid chemical breakdown. These issues, which affect the operation of solar cells, are outlined in this perspective. We also discuss general guidelines for performing quantitative and predictive simulations of these materials, which are relevant to metal-organic frameworks and other hybrid semiconducting, dielectric and ferroelectric compounds.
Absolute measurement of effective radiative-efficiency in GaAs grown with molecular-beam-epitaxy
Authors: Gerber M. W. , Kleiman R. N.
Published: June 2017

In this work, we have decoupled the radiative and nonradiative contributions to recombination by developing analytical models to fit observed non-monoexponential photoluminescence decay and bulk-lifetime temperature-dependence, which has enabled absolute measurement of the effective radiative efficiency and characterization of the dominant defect in lightly doped GaAs samples grown using molecular-beam-epitaxy. The measured effective radiative efficiency values under low level injection conditions range from (88.9 ± 0.1)% and (81.2 ± 0.1)% at 77 K to (0.028 ± 0.001)% and (0.034 ± 0.001)% at 700 K, with 300 K values of (17.3 ± 0.1)% and (10.5 ± 0.1)% in the p-type and n-type samples, respectively. A common defect-signature is observed in the temperature-dependence of the nonradiative lifetime in samples of both doping types, and our measured parameters are consistent with characteristics previously measured for the EL2 defect using deep-level transient spectroscopy.
Room-temperature processing of CdSe quantum dots with tunable sizes
Authors: Joo So-Yeong , Jeong Da-Woon , Lee Chan-Gi , Kim Bum-Sung , Park Hyun-Su , Kim Woo-Byoung
Published: June 2017

In this work, CdSe quantum dots (QDs) with tunable sizes have been fabricated via photo-induced chemical etching at room temperature, and the related reaction mechanism was investigated. The surface of QDs was oxidized by the holes generated through photon irradiation of oxygen species, and the obtained oxide layer was dissolved in an aqueous solution of 3-amino-1-propanol (APOL) with an APOL:H2O volume ratio of 5:1. The generated electrons promoted QD surface interactions with amino groups, which ultimately passivated surface defects. The absorption and photoluminescence emission peaks of the produced QDs were clearly blue-shifted about 26 nm with increasing time, and the resulting quantum yield for an 8 h etched sample was increased from 20% to 26%, as compared to the initial sample.
Enhanced focusing of relativistic lasers by plasma lens with exponentially increasing density profiles
Authors: Yang Yue , Zhang Zhimeng , Jiao Jinlong , Tian Chao , Cao Lihua , Wu Yuchi , Dong Kegong , Zhou Weimin , Gu Yuqiu , Zhao Zongqing
Published: June 2017

The self-focusing of ultraintense laser in plasma lenses with exponentially increasing density profiles is studied. And the robustness of this design is proved by theoretical estimates and 3D particle-in-cell simulations. Attributed to the density compensation for the increase of laser intensity during self-focusing, a modulated exponential density plasma lens can efficiently focus the laser to higher peak intensity and smaller spot than that by using optimized uniform plasma lens. In near critical density plasmas, laser focusing experiences two stages with different dominant mechanisms: self-focusing at earlier time and magnetic constraint in the plasma channel. And more enhanced effects are achieved by exponential density plasma in both stages. The focal position and the optimal density scalelength for this kind of plasma lens are also estimated through theoretical derivation. Our findings indicate the possibility for the preplasma to experimentally serve as a novel plasma lens to obtain relativistic lasers with high contrast, ultra-high intensities and micro focal spots.
Vortex pinning and irreversibility fields in FeS1–xSex (x = 0, 0.06)
Authors: Wang Aifeng , Petrovic C.
Published: June 2017

We report strong vortex pinning and large irreversibility fields in single crystals of tetragonal FeS1–xSex (x = 0, 0.06). Vortex dynamics is characterized by crossover in field dependence of the depinning energy U0, indicative of single flux surface pinning to the region of collective flux pinning on point-like defects. The close proximity of the irreversibility lines to the upper critical field (Hc2) is consistent with strong pinning in FeS and FeS0.94Se0.06, pointing that new materials with building-blocks of FeS4 tetrahedra are likely to host high critical currents.
The health and health preparation of long-term Australian travellers
Authors: Halcomb Elizabeth , Stephens Moira , Smyth Elizabeth , Meedya Shahla , Tillott Sarah
Published: June 2017

A growing number of Australians are travelling domestically for extended periods. This creates challenges in both continuity of health care and burdens on health services. This paper reports a cross-sectional survey aimed to explore the health needs and health planning of long-term travellers. In total, 316 respondents who had travelled for more than 3 months consecutively in the last year participated. Most respondents were retired (n=197; 62.3%); however, ages ranged from 26 to 89 years. Nearly half of the respondents or their travel companion had a long-term illness that affected their daily life (n=135; 42.7%). Nearly half of respondents visited a GP (n=133; 42.1%), nearly one-quarter visited an Emergency Department (n=72; 22.8%) and 19.9% (n=63) visited another health provider while travelling. The level of preparation around health while travelling varied between participants. This study highlights that long-term travellers have significant health needs and are likely to require health services during their extended travel. Additionally, it identifies that currently few strategies are used to plan for health care during travel. This raises issues for rural and remote health services in terms of both capacity and continuity of care.
Occasioning translator competence
Authors: Kiraly Donald C.
Published: June 2017

For the past thirty years, as the translator’s profession has undergone a radical metamorphosis from a sort of bilingual craft to a highly technologized profession, translator education has been undergoing a comparatively slow evolution. From pervasive chalk-and-talk transmissionist practice just a few decades ago, the contemporary literature on translator education reveals a plethora of theoretical and practical approaches to the study and teaching of translation-related skills. In this article, the author reviews some key trends in this development within the translator education domain on the basis of his own evolution as a translator educator over the past three decades. A key focus will be placed on the role of epistemology, a mainstay of educational philosophy and learning theory, but a topic that he feels can help elucidate pedagogical practices of the past and guide the way toward ones better suited to educating translators today … and in the future.
Reacting to Translations Past
Authors: McDonough Dolmaya Julie
Published: June 2017

Reacting to the Past is a pedagogical approach that incorporates historical role-playing games into the classroom. In this paper I discuss this approach and demonstrate how it could be adapted for translation studies courses. Two games are described: one is set in England in the early 1500s and focuses on William Tyndale’s English translation of the Bible, while the other is set in Canada in 2007 and focuses on the development of the Canadian standard for translation services. Finally, to shed some light on the experiences and reactions of students who are taught using the Reacting to the Past approach, I briefly discuss the results of a survey of translation students who played the two games in an undergraduate theory of translation course during the Fall 2012 term.
Syntacticizing blends
Authors: Danckaert Lieven , Haegeman Liliane
Published: June 2017

This paper aims at analysing English structures in which a wh-moved subject triggers agreement both in the clause it is extracted from and in the immediately higher clause. This pattern is only accepted by some native speakers, and it is also attested in corpora. Although the relevant structures could at first sight be analysed as extragrammatical ‘blends’, we propose that they are in fact part of certain speakers’ linguistic competence, and hence generated by the grammar of those speakers. Adopting the approach to subject extraction developed in Rizzi & Shlonsky (2007), we suggest that extracted subjects can exceptionally be ‘hyperactive’ (Carstens 2011), and thus take part in A-relations (case and agreement) in more than one clausal domain.
On the scalar properties and telicity of degree achievements
Authors: McNally Louise
Published: June 2017

Kennedy & Levin (2008) argue that the aspectual properties of so-called degree achievement (DA) verbs (e.g. darken) can largely be predicted from the scale structure of the adjectives to which they are derivationally related (e.g. dark). Specifically, when the adjective is evaluated on a scale that is upper closed and the standard for the adjective to truthfully apply is the upper endpoint on that scale (i.e., when the adjective is absolute; see e.g. Kennedy & McNally 2005), the corresponding DA can be either telic or atelic. In contrast, when the adjective’s scale is open and the standard is context-dependent (i.e., when the adjective is relative), the corresponding DA is atelic. In this paper, I defend, following Kearns (2007), the position that telic interpretations of DAs are not directly a function of the standards for the adjectives from which the verbs are derived. Rather, the telic interpretation simply depends on it being possible to characterize the amount of change undergone in terms of the part structure of the event described, without reference to a specific comparison class. This conclusion will emerge from reflection on how the notions of relative and absolute standards can be recast in terms of similarity- vs. rule-based classification (as proposed in McNally 2011), extended from the adjectival to the verbal domain.
Multiple Wh-Movement in European Spanish
Authors: Gallego Ángel J.
Published: June 2017

In this paper I explore Multiple Wh-Movement (MWM) in European Romance, a syntactic pattern that has been regarded as impossible (all Romance languages but Romanian excluding it; cf. Escandell-Vidal 1999; RAE-ASALE 2009; Chernova 2015, among others). After reviewing some data that qualify this well-known observation, I argue that European Spanish can actually display MWM under specific discourse conditions, some of which have not been previously reported. The paper puts forward an analysis of the facts adopting Richards’ (2010)
Distinctiness, a PF condition that requires for X and Y to be morphologically or featurally different (within the same domain) for them to be linearized, a solution that places the relevant parameter in the Syntax → PF wing of the grammar.
State and change of state in Latin
Authors: Mateu Jaume
Published: June 2017

This paper offers a syntactic account of Haverling’s (1994 ff.) descriptive insights regarding the formation of both stative verbs and -sco verbs expressing change in Early and Classical Latin. In particular, the formal distinction between incorporation and conflation (cfr. Haugen 2008, 2009 and Mateu 2012, i.a.) is shown to be useful when dealing with the formation of these verbs. Following Acedo-Matellán and Mateu’s (2013) formal account of Talmy’s (1991, 2000) typology of motion events, the paper also addresses the question of why aspectual resultative prefixation is a phenomenon that is expected to be found in a satellite-framed language like Latin (e.g., cfr.
inarescere ‘to start becoming dry’) but not in verb-framed languages like Catalan or Spanish.
Migration Trends of Sockeye Salmon at the Northern Edge of Their Distribution
Authors: Carey Michael P. , Zimmerman Christian E. , Keith Kevin D. , Schelske Merlyn , Lean Charlie , Douglas David C.
Published: June 2017

Climate change is affecting arctic and subarctic ecosystems, and anadromous fish such as Pacific salmon Oncorhynchus spp. are particularly susceptible due to the physiological challenge of spawning migrations. Predicting how migratory timing will change under Arctic warming scenarios requires an understanding of how environmental factors drive salmon migrations. Multiple mechanisms exist by which environmental conditions may influence migrating salmon, including altered migration cues from the ocean and natal river. We explored relationships between interannual variability and annual migration timing (2003–2014) of Sockeye Salmon O. nerka in a subarctic watershed with environmental conditions at broad, intermediate, and local spatial scales. Low numbers of Sockeye Salmon have returned to this high‐latitude watershed in recent years, and run size has been a dominant influence on the migration duration and the midpoint date of the run. The duration of the migration upriver varied by as much as 25 d across years, and shorter run durations were associated with smaller run sizes. The duration of the migration was also extended with warmer sea surface temperatures in the staging area and lower values of the North Pacific Index. The midpoint date of the total run was earlier when the run size was larger, whereas the midpoint date was delayed during years in which river temperatures warmed earlier in the season. Documenting factors related to the migration of Sockeye Salmon near the northern limit of their range provides insights into the determinants of salmon migrations and suggests processes that could be important for determining future changes in arctic and subarctic ecosystems.

Received October 24, 2016; accepted March 2, 2017 Published online June 8, 2017
The Role of Mindfulness Skills in Terms of Anxiety-Related Cognitive Risk Factors among College Students with Problematic Alcohol Use
Authors: Kraemer Kristen M. , O'Bryan Emily M. , Johnson Adrienne L. , McLeish Alison C.
Published: June 2017

Background

The aim of the current study was to examine the associations between the specific mindfulness skills of observing, describing, awareness, nonjudgment, and nonreactivity in terms of anxiety sensitivity (AS), distress tolerance (DT), and intolerance of uncertainty (IU) among college students with problematic alcohol use.

Methods

Participants were 202 (69.3% male; Mage = 18.96, SD = 2.24, range = 18–45 years) undergraduate college students with problematic alcohol use who completed self-report measures for course credit.

Results

Results indicated that after controlling for the effects of gender, smoking status, marijuana use status, and negative affectivity, greater use of the mindfulness skill of observing was associated with higher AS, greater describing was associated with lower AS and higher DT, greater nonjudgment was associated with lower AS and IU and higher DT, and greater nonreactivity was associated with increased DT. Awareness did not significantly predict any of the examined risk factors.

Conclusions

These results suggest that specific mindfulness skills are associated with a greater tolerance of physiological, emotional, and uncertain states. An important next step will be to examine whether mindfulness skills are associated with decreased problematic alcohol use due to improvements in these anxiety-related risk factors.
TIminer: NGS data mining pipeline for cancer immunology and immunotherapy
Authors: Tappeiner Elias , Finotello Francesca , Charoentong Pornpimol , Mayer Clemens , Rieder Dietmar , Trajanoski Zlatko
Published: June 2017

Recently, a number of powerful computational tools for dissecting tumor-immune cell interactions from next-generation sequencing data have been developed. However, the assembly of analytical pipelines and execution of multi-step workflows are laborious and involve a large number of intermediate steps with many dependencies and parameter settings. Here we present TIminer, an easy-to-use computational pipeline for mining tumor-immune cell interactions from next-generation sequencing data. TIminer enables integrative immunogenomic analyses, including: human leukocyte antigens typing, neoantigen prediction, characterization of immune infiltrates and quantification of tumor immunogenicity.

Availability and implementation

TIminer is freely available at http://icbi.i-med.ac.at/software/timiner/timiner.shtml.

Supplementary information

Supplementary data are available at Bioinformatics online.
We have confidence to lead gravitational-wave science: an interview with Yueliang Wu
Authors: Jia Hepeng
Published: June 2017

Yueliang Wu, chief scientist of Taiji Program, is a well-known theoretical physicist and the Vice-President of the University of Chinese Academy of Sciences (UCAS). Taiji Program, initially proposed in 2008, is one of China's ambitious plans to observe gravitational waves. Obtaining his Ph.D. at the Institute of Theoretical Physics (ITP) under the Chinese Academy of Sciences (CAS) in 1987, Wu had been working at Dortmund University and Mainz University in Germany and Carnegie-Mellon University and the Ohio-State University in the USA. In 1996, he joined the ITP and became its director in 2007. He has also served as the Director of the Kavli Institute for Theoretical Physics China at the CAS since 2006. In 2007, he was elected as a CAS member.

 Wu's research is focused on elementary particle physics, quantum field theory, symmetry principle and cosmophysics. In recent years, he has been proposing a gravitational quantum field theory as a new approach to reconciling the general theory of relativity and quantum mechanics. The most fundamental unanswered question of the general theory of relativity is how general relativity can be reconciled with the laws of quantum physics to produce a complete and self-consistent theory of quantum gravity. To extend the general relativity to realize the reconciliation, Wu suggested a basic gravitational field be needed in the future model.

 Since 2012, he, together with Wenrui Hu, has been working as Taiji Program's chief scientist and promoting nationwide gravitational-wave research. National Science Review (NSR) spoke with Wu about the future of gravitational-wave research, the development of China's nationwide gravitational-wave studies and particularly the progress of Taiji Program.
Infants Born Preterm Demonstrate Impaired Exploration of Their Bodies and Surfaces Throughout the First 2 Years of Life
Authors: Babik Iryna , Galloway James Cole , Lobo Michele A.
Published: June 2017

Background

Non–object-oriented exploratory behaviors infants perform with their bodies and surfaces have been proposed to be key precursors of infants’ object exploration, early learning, and future cognitive development. Little is known about the developmental trajectories of these behaviors, especially for infants born preterm.

Objective

The purpose of the study was to longitudinally compare non–object-oriented exploratory behaviors performed by full-term and preterm infants.

Design

The study followed 24 full-term and 30 preterm infants (6 with significant brain injury) performing non–object-oriented exploratory behaviors in prone, supine, and sitting from birth through 24 months.

Methods

Infants were observed without objects or direct social interaction for 3 minutes in prone and supine (0 through 9 months) and in sitting (3 through 24 months). Behavioral coding produced data that were analyzed using hierarchical linear modeling. Developmental trajectories of behaviors were compared among full-term infants, preterm infants without significant brain injury, and preterm infants with significant brain injury.

Results

Compared to full-term peers, preterm infants showed poorer postural control (less head lifting in prone), midline behavior (holding the head in midline, holding both hands in midline), hand-to-mouth and visual-motor behaviors against gravity, and more asymmetrical one-handed fisting. Preterm infants performed fewer bouts of non–object-oriented exploratory behaviors, and their behaviors were less variable with fewer combinations.

Limitations

There was a limited sample of infants born preterm with significant brain injury.

Conclusions

Non–object-oriented exploratory behaviors are important for early perceptual-motor development. Key differences were noted in these behaviors for infants born preterm. These differences may lead to impaired reaching, object exploration, and cognition. Early intervention programs should utilize assessments and interventions that target these very early non–object-oriented exploratory behaviors.
Short Cervix in a Patient With Twin Gestation
Authors: Gandhi Manisha , Fox Nathan S.
Published: June 2017

A 28-year-old woman, gravida 1 para 0, with twin gestation presents for routine anatomic survey at 20 weeks of gestation without any complaints. On transabdominal ultrasonography, the ultrasonographer notes concern for cervical funneling and proceeds to perform a transvaginal ultrasonogram, which reveals a short cervix of 18 mm.
An Initiative to Reduce the Episiotomy Rate
Authors: Zhang-Rutledge Kathy , Clark Steven L. , Denning Stacie , Timmins Audra , Dildy Gary A. , Gandhi Manisha
Published: June 2017

OBJECTIVE:

To assess the association of education, performance feedback, and the Hawthorne effect with a reduction in the episiotomy rate in a large academic institution.

METHODS:

We describe a prospective observational study of a project conducted between March 2012 and February 2017 to assist clinicians in meeting the Leapfrog Group (www.leapfroggroup.org) target rates for episiotomy. Phases of this project included preintervention (phase 1, March 2012 to April 2014), education and provision of collective department episiotomy rates (phase 2, May 2014 to December 2014), ongoing education with emphasis on a revised Leapfrog target rate (phase 3, January 2015 to February 2016), and provision of individual episiotomy rates to practitioners on a monthly basis (phase 4, March 2016 to February 2017). We analyzed the department episiotomy rates before, during, and after these efforts. Cases of shoulder dystocia were excluded from this analysis. Statistical analysis was performed using a two-tailed Student t test and χ2 test with P<.05 considered significant.

RESULTS:

During the study period 1,176 episiotomies were performed in 16,441 vaginal deliveries (7.2%). In phase 2 (2,352 vaginal deliveries), there was a nonsignificant drop in the episiotomy rate with education alone (9.0–8.2%, P=.21). In phase 3 (4,379 vaginal deliveries), the episiotomy rate demonstrated an additional, significant drop to 5.9% (P<.001), but this reduction did not reach the new Leapfrog goal of 5%. In phase 4 (3,160 vaginal deliveries), the hospital episiotomy rate again dropped significantly from 5.9% to 4.37% (P=.007) and met the target rate of 5%. This reduction was sustained over a 12-month time period. During this same time period, the rate of operative vaginal delivery among vaginal births increased (4.5–5.4%, P=.003) and there was no significant change in the rates of third- and fourth-degree perineal laceration (3.8–3.3%, P=.19).

CONCLUSION:

Education, performance feedback, and the Hawthorne effect were associated with a reduction in the episiotomy rate in a large academic institution without a reduction in the rate of operative vaginal delivery or an increase in the rate of third- and fourth-degree lacerations.
The Case for a National Maternal Mortality Review Committee
Authors: Clark Steven L. , Belfort Michael A.
Published: June 2017

The United States has the highest maternal mortality ratio of any high-resource country; the 2014 ratio of 22 per 100,000 live births is in fact four to five times higher than that of the best-performing nations, and recent data suggest that this ratio may be increasing. The causes of this disparity are unknown and may be related to social, economic, cultural, or medical issues or a combination of factors. Repeated counts of categories of maternal death are of little assistance in determining the actual cause of death or in identifying preventive measures. Furthermore, when based on administrative data, such tallies may themselves be inaccurate. We propose the creation of a national maternal mortality review committee, modeled after those in other high-resource nations, to assist in addressing the problem of maternal mortality in the United States.
Four Cases of Parkinson Disease Diagnosed During the Postpartum Period
Authors: Maltête David , Grangeon Lou , Le Goff Floriane , Ozel Gulden , Fetter Damien , Ahtoy Patrick , Temgoua Olivier , Rouillé Audrey , Lefaucheur Romain
Published: June 2017

BACKGROUND:

There is little experience with the effect of pregnancy on Parkinson disease because the number of women with Parkinson disease who are of childbearing age is small. We report four cases beginning during the postpartum period and discuss the potential contribution of different factors that may influence the occurrence of Parkinson disease in this time period.

CASES:

Four women aged 29–35 years developed arm tremor, shoulder pain, dizziness, or decreased dexterity of the hand in the first few days or months after childbirth. They were initially diagnosed with postpartum depression or psychogenic parkinsonism. Finally, dopamine transporter imaging confirmed the diagnosis of young-onset Parkinson disease.

CONCLUSION:

Early-onset Parkinson disease may present in postpartum women. In women with atypical motor symptoms in addition to depression, this diagnosis should be considered.
Clinical Validation of a Test for the Diagnosis of Vaginitis
Authors: Gaydos Charlotte A. , Beqaj Sajo , Schwebke Jane R. , Lebed Joel , Smith Bonnie , Davis Thomas E. , Fife Kenneth H. , Nyirjesy Paul , Spurrell Timothy , Furgerson Dorothy , Coleman Jenell , Paradis Sonia , Cooper Charles K.
Published: June 2017

OBJECTIVE:

Vaginitis may be diagnosed as bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis, or coinfection. A new molecular test assays the vaginal microbiome and organisms that cause three common infections. The objective of the trial was to evaluate the clinical accuracy of the investigational test for vaginal swabs collected by patients (self) or clinicians. The primary and secondary outcomes were to compare the investigational test with reference methods for the three most common causes of vaginitis and compare clinician-collected with self-collected swabs.

METHODS:

We conducted a cross-sectional study in which women with symptoms of vaginitis were recruited at ten clinical centers and consented to the investigation between May and September 2015. The woman collected a vaginal swab, sheathed, and then handed it to the clinician. These swabs were to evaluate how self-collected swabs compared with clinician-collected swabs. The clinician collected an investigational test swab and reference test swabs. From 1,740 symptomatic patients, clinician-collected and self-collected vaginal swabs were evaluated by the molecular test and six tests. The reference methods for bacterial vaginosis were Nugent's score and Amsel's criteria for intermediate Nugent results. The reference methods for Candida infection were isolation of any potential Candida microorganisms from inoculation of two culture media: chromogenic and Sabouraud agar and sequencing. The reference methods for trichomoniasis were wet mount and culture.

RESULTS:

For clinician-collected swabs, by reference methods, bacterial vaginosis was diagnosed in 56.5%, vaginal candidiasis in 32.8%, trichomoniasis in 8%, and none of the three infections in 24% with a coinfection rate of 20%. The investigational test sensitivity was 90.5% (95% confidence interval [CI] 88.3–92.2%) and specificity was 85.8% (95% CI 83.0–88.3%) for bacterial vaginosis. The investigational test sensitivity was 90.9% (95% CI 88.1–93.1%) and specificity was 94.1% (95% CI 92.6–95.4%) for the Candida group. Sensitivity for Candida glabrata was 75.9% (95% CI 57.9–87.8%) and specificity was 99.7% (95% CI 99.3–99.9%). Investigational test sensitivity was 93.1% (95% CI 87.4–96.3%) and specificity was 99.3% (95% CI 98.7–99.6%) for trichomoniasis. Results from self-collected swabs were similar to clinician-collected swabs.

CONCLUSION:

A molecular-based test using vaginal swabs collected by clinicians or patients can accurately diagnose most common bacterial, fungal, and protozoan causes of vaginitis. Women and their clinicians seeking accurate diagnosis and appropriate selection of efficacious treatment for symptoms of vaginitis might benefit from this molecular test.
Postdischarge Opioid Use After Cesarean Delivery
Authors: Osmundson Sarah S. , Schornack Leslie A. , Grasch Jennifer L. , Zuckerwise Lisa C. , Young Jessica L. , Richardson Michael G.
Published: June 2017

OBJECTIVE:

To characterize postdischarge opioid use and examine factors associated with variation in opioid prescribing and consumption.

METHODS:

We conducted a prospective observational cohort study by recruiting all women undergoing cesarean delivery during an 8-week period, excluding those with major postoperative morbidities or chronic opioid use. Starting on postoperative day 14, women were queried weekly regarding number of opioid pills used, amount remaining, and their pain experience until they had stopped opioid medication. Demographic and delivery information and in-hospital opioid use were recorded. The state Substance Monitoring Program was accessed to ascertain prescription-filling details. Morphine milligram equivalents were calculated to perform opioid use comparisons. Women in the highest quartile of opioid use (top opioid quartile use) were compared with those in the lowest three quartiles (average opioid use).

RESULTS:

Of 251 eligible patients, 246 (98%) agreed to participate. Complete follow-up data were available for 179 (71% of eligible). Most women (83%) used opioids after discharge for a median of 8 days (interquartile range 6–13 days). Of women who filled their prescriptions (165 [92%]), 75% had unused tablets (median per person 75 morphine milligram equivalents, interquartile range 0–187, maximum 630) and the majority (63%) stored tablets in an unlocked location. This amounts to an equivalent of 2,540 unused 5-mg oxycodone tablets over our study period. Women who used all prescribed opioids (n=40 [22%]) were more likely to report that they received too few tablets than women who used some (n=109 [61%]) or none (n=30 [17%]) of the prescribed opioids (33% compared with 4% compared with 5%, P<.001). The top quartile was more likely to be smokers than average users and consumed more opioid morphine milligram equivalents per hour of inpatient stay than average opioid users (1.6, interquartile range 1.1–2.3 compared with 1.0, interquartile range 0.5–1.4, P<.001).

CONCLUSION:

Most women—especially those with normal in-hospital opioid use—are prescribed opioids in excess of the amount needed.
Perinatal and Maternal Outcomes After Training Residents in Forceps Before Vacuum Instrumental Birth
Authors: Skinner Sasha , Davies-Tuck Miranda , Wallace Euan , Hodges Ryan
Published: June 2017

OBJECTIVE:

To compare the rates of attempted and successful instrumental births, intrapartum cesarean delivery, and subsequent perinatal and maternal morbidity before and after implementing a training intervention to arrest the decline in forceps competency among resident obstetricians.

METHODS:

This retrospective cohort study examined all attempted instrumental births at Monash Health from 2005 to 2014. We performed an interrupted time-series analysis to compare outcomes of attempted instrumental births in 2005–2009 with those in 2010–2014.

RESULTS:

There were 72,490 births from 2005 to 2014 at Monash Health, of which 8,789 (12%) were attempted instrumental vaginal births. After the intervention, rates of forceps births increased [autoregressive integrated moving average coefficient (β) 1.5, 95% confidence interval (CI) 1.03–1.96; P<.001], and vacuum births decreased (β −1.43, 95% CI −2.5 to −0.37; P<.01). Rates of postpartum hemorrhage decreased (β −1.3, 95% CI −2.07 to −0.49; P=.002) and epidural use increased (β 0.03, 95% CI 0.02–0.05; P<.001). There was no change in rates of unsuccessful instrumental births (β −0.39, 95% CI −3.03 to 2.43; P=.83), intrapartum cesarean delivery (β −0.29, 95% CI −0.55 to 0.14; P=.24), third- and fourth-degree tears (β −1.04, 95% CI −3.1 to 1.00; P=.32), or composite neonatal morbidity (β −0.18, 95% CI −0.38 to 0.02, P=.08). Unsuccessful instrumental births were more likely to be in nulliparous women (P<.001), less likely to have a senior obstetrician present (P<.001), be at later gestation (P<.001), and involved larger birth weight neonates (P<.001).

CONCLUSION:

A policy of ensuring obstetric forceps competency before beginning vacuum training results in more forceps births, fewer postpartum hemorrhages, and no increase in third- and fourth-degree perineal injuries or episiotomies.
Anesthetic Cream Use During Office Pessary Removal and Replacement
Authors: Taege Susanne K. , Adams William , Mueller Elizabeth R. , Brubaker Linda , Fitzgerald Colleen M. , Brincat Cynthia
Published: June 2017

OBJECTIVE:

To estimate the effect of lidocaine–prilocaine cream on patient pain at the time of office pessary removal and reinsertion.

METHODS:

In this double-blind, randomized placebo-controlled trial, participants undergoing routine pessary care in a urogynecology office at a tertiary referral center were randomized to application of 4 g of either lidocaine–prilocaine or placebo cream 5 minutes before pessary change. Visual analog scale pain scores were collected from the patient at baseline, after pessary removal, and after pessary reinsertion. Physicians also recorded their estimate of patient pain at pessary removal and reinsertion. The primary outcome was the participant-reported visual analog scale pain score at the time of pessary removal and reinsertion. A sample size of 26 per group (n=52) was planned to estimate an absolute mean difference in visual analog scale pain of 2.1 cm at the time of pessary removal. An analysis of covariance was used to evaluate pain at removal and reinsertion as a function of treatment assignment controlling for baseline pain.

RESULTS:

From July 2015 through February 2016, 116 women were screened and 54 were recruited: 28 in the lidocaine–prilocaine cream group and 26 in the placebo group. One patient in the lidocaine-prilocaine cream group was later withdrawn owing to vaginal erosion. The participants were all postmenopausal women, with an average age of 77.8 years. Most characteristics were similar between groups. After adjusting for baseline pain, participants randomized to the lidocaine–prilocaine group had lower pain at pessary removal when compared with those assigned to placebo (mean difference=−2.05, 95% confidence interval −3.69 to −0.41; P=.015).

CONCLUSION:

Lidocaine–prilocaine cream use at the time of office pessary removal reduces patient-reported pain. Clinicians may wish to include this simple intervention to optimize patient comfort and compliance.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02380742.
Detection of an Inherited Deletion in Products of Conception in a Patient With Recurrent Losses and Normal Karyotype
Authors: Thorne Jeffrey , Craffey Alicia , Nulsen John C.
Published: June 2017

BACKGROUND:

Microarray analysis testing on products of conception can provide valuable information in the evaluation of recurrent pregnancy loss beyond ploidy status.

CASE:

A maternally inherited deletion on the X chromosome was detected by microarray analysis performed on products of conception in a couple with recurrent pregnancy loss. The mother had a previously demonstrated normal karyotype with standard cytogenetic analysis but was subsequently determined to have the same X chromosome deletion by oligonucleotide single-nucleotide polymorphism (SNP) microarray analysis.

CONCLUSION:

Direct testing of products of conception using oligonucleotide SNP microarray identified a maternally inherited microdeletion on the X chromosome in a patient with recurrent losses and normal karyotype. Going forward, the couple may use preimplantation genetic diagnosis testing to identify embryos free of this deletion for transfer.
Cervical Evaluation
Authors: Feltovich Helen
Published: June 2017

Since ancient times, cervical assessment for predicting timing of delivery has relied primarily on digital (subjective) assessment of dilatation, softening, and length. To date, transvaginal ultrasound cervical length is the only one of these parameters that meets criteria for a biomarker; no objective, quantitative measure of cervical dilatation or softening has gained clinical acceptance. This review discusses how the cervix has been assessed from ancient times to the present day and how a precision medicine approach could improve understanding of not only the cervix, but also parturition in general.
What Is New in Zika Virus in Pregnancy?
Authors: Ramsey Patrick S.
Published: June 2017

This month we focus on current research in Zika virus in pregnancy. Dr. Ramsey discusses four recent publications that are concluded with a “bottom line” that is a take-home message. A complete reference for each can be found in Box 1 on this page along with direct links to abstracts.
The American Society of Colon and Rectal Surgeons Assessment Tool for Performance of Laparoscopic Colectomy
Authors: Champagne Bradley J. , Steele Scott R. , Hendren Samantha K. , Bakaki Paul M. , Roberts Patricia L. , Delaney Conor P. , Brady Justin T. , MacRae Helen M.
Published: June 2017

BACKGROUND:

The lack of consensus for performance assessment of laparoscopic colorectal resection is a major impediment to quality improvement.

OBJECTIVE:

The purpose of this study was to develop and assess the validity of an evaluation tool for laparoscopic colectomy that is feasible for wide implementation.

DESIGN:

During the pilot phase, a small group of experts modified previous assessment tools by watching videos for laparoscopic right colectomy with the following categories of experience: novice (less than 20 cases), intermediate (50–100 cases), and expert (more than 500 cases). After achieving sufficient reliability (κ > 0.8), a user-friendly tool was validated among a large group of blinded, trained experts.

SETTING:

The study was conducted through the American Society of Colon and Rectal Surgeons Operative Competency Evaluation Committee.

PATIENTS:

Raters were from the Operative Competency Evaluation Committee of the American Society of Colon and Rectal Surgeons.

MAIN OUTCOME MEASURES:

Assessment tool reliability and internal consistency were measured.

RESULTS:

From October 2014 through February 2015, 4 groups of 5 raters blinded to surgeon skill level evaluated 6 different laparoscopic right colectomy videos (novice = 2, intermediate = 2, expert = 2). The overall Cronbach α was 0.98 (>0.9 = excellent internal consistency). The intraclass correlation for the overall assessment was 0.93 (range, 0.77–0.93) and was >0.74 (excellent) for each step. The average scores (scale, 1–5) for experts were significantly better than those in the intermediate category, with a mean (SD) of 4.51 (0.56) versus 2.94 (0.56; p = 0.003). Videos in the intermediate group scored more favorably than beginner videos for each individual step and overall performance (mean (SD) = 3.00 (0.32) vs 1.78 (0.42); p = 0.006).

LIMITATIONS:

The study was limited by rater bias to technique and style.

CONCLUSIONS:

The unique and robust methodology in this trial produced an assessment tool that was feasible for raters to use when assessing videotaped laparoscopic right hemicolectomies. The potential applications for this new tool are widespread, including both training and evaluation of competence at the attending level. See Video Abstract at http://links.lww.com/DCR/A369, http://links.lww.com/DCR/A370, http://links.lww.com/DCR/A371.