bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of NOSE Scores Following Functional Septorhinoplasty Using Autologous versus Cadaveric Rib
Authors: Fuller Jennifer , Levesque Patricia , Lindsay Robin , Justicz Natalie
Published: January 2019

In functional septorhinoplasty (FSRP), alternative grafting material is used if septal cartilage is insufficient for reconstructive needs. Autologous costal cartilage (ACC) and irradiated homologous costal cartilage (IHCC) are compared via the Nasal Obstruction Symptom Evaluation (NOSE) scale. One-hundred forty-one patients who underwent FSRP with ACC or IHCC between January 2013 and March 2018 were administered the NOSE scale pre- and postoperatively at 2, 4, 6, and 12 months. There was no significant difference in mean NOSE scores between the ACC and IHCC cohorts at the preoperative visit (68.5 [standard deviation, SD 24.1] and 71.7 [20.1], respectively; p < 0.6) or first postoperative visit (30.4 [26.6] and 33.9 [30.4], respectively; p < 0.6) or subsequent visits. NOSE scores demonstrated a clinically and statistically significant improvement at all follow-up time points for both the ACC and IHCC groups. Patients who underwent grafting with IHCC were significantly older than those with ACC; average age of 55.6 [SD: 17.3] versus 40.1 [SD:12.1]; (p < 0.001). Two IHCC (0.05%) patients had postoperative infections; both resolved with antibiotics, but one required revision surgery. Both ACC and IHCC provide reliable grafting material when septal cartilage is insufficient. In FSRP for nasal airway obstruction, ACC and IHCC both provide a clinically and statistically significant reduction in NOSE scores postoperatively that remain stable between follow-up time points. The authors find no difference in NOSE scores between the ACC and IHCC groups; however, IHCC did have a higher rate of postoperative infection. Both materials should be discussed with patients and are an important part of the informed consent process.
Role of Ultrasound in Diagnosis of Fetus Acardius Acephalus in Multiple Pregnancies
Authors: Yadav Ruby , Choudhary Nishi
Published: January 2019

This case report describes an acardiac fetus of the acephalus phenotype in a triplet pregnancy. The diagnosis was confirmed at 13 weeks. In the absence of signs of heart failure in the co-fetus, the pregnancy was managed conservatively. The pregnancy was complicated by preterm labor and the fetuses were delivered at 23 + 4 weeks. Also, the perinatal outcomes of triplet pregnancies complicated by an acardiac fetus, where the median gestational age at delivery is 23 to 24 weeks, are summarized, and the possible therapeutic interventions have been discussed.
Periorbital Trauma: A New Classification
Authors: Sadek EmanYahya , Elbarbary Amir , Safe Ikram I.
Published: January 2019

Overlooked injured structures in periorbital trauma could lead to aesthetic and functional deficits. As trauma may affect superficial, middle, and deep components, meticulous survey guided by a structured periorbital trauma classification is needed for proper management. Thus, a new classification for periorbital trauma is proposed to serve this purpose. Periorbital region was defined anatomically by anthropometric landmarks. The periorbital injuries were categorized according to anatomical and clinical basis. The new classification was used to study periorbital trauma cases received at Ain Shams University Hospitals between July 2013 and July 2016 retrospectively. The study included 260 patients: 196 (75.38%) males and 64 (24.62%) females. The type and severity of injury, time of primary intervention, type of surgery performed, and patients’ visits to the outpatient clinic were evaluated. The status of the postinjury and postoperative (primary surgery) aesthetic status and functional status were evaluated. The periorbital region was identified. Anatomical categorization of periorbital injuries included periocular, frontal, temporal, and malar regions. Injuries/deficits were categorized into simple, composite, complex, and isolated bony injuries according to the depth and involved tissues. Subsequently, the classification was formulated. In the retrospective study, the incidence of extended simple injuries was the highest, while the least was the extended complex injuries. Functional deficits occurred in 24 patients (9.23%) and aesthetic deficits occurred in 55 patients (21.15%). Required secondary operations for this group included redo of fixation, correction of medial canthal ligament, repair of canalicular system, scar revisions, fat grafting, and creation of natural creases. The results of this study demonstrated that unsatisfactory aesthetic and functional results occurred when injuries of important structures were overlooked, aesthetic units were not respected, and when management was delayed. A three-dimensional, oriented, new classification of periorbital trauma based on anatomical and clinical categorization is proposed to help in identifying injured structures, stimulate the search for other injuries, structure preoperative evaluation, and recommend a surgical plan that would ultimately achieve precise primary repair with best aesthetic and functional outcome.
Thermoelectric properties of topological insulator lanthanum phosphide via first-principles study
Authors: Zhou Yu , Tao Wang-Li , Zeng Zhao-Yi , Chen Xiang-Rong , Chen Qi-Feng
Published: January 2019

We systematically investigate the thermoelectric properties of lanthanum phosphide (LaP) using first-principles calculations together with the Boltzmann transport theory. The dynamic stability of LaP is confirmed based on phonon dispersion. The different atomic masses of La and P atoms lead to an acoustic-optical bandgap that prohibits scattering between acoustic and optical phonon modes. The lattice thermal conductivity κl is 3.19 W/mK at room temperature, which is less than that of LaAs because of the smaller group velocities and the larger Grüneisen parameter. The calculated phonon-mode contribution to κl, scattering rate, and mean free path may provide significant guidance to further theoretical and experimental research. The power factor reaches 0.012 W m−1 K−2 at a carrier concentration of 1.05×1020cm−3, which is comparable to the power factor of the typical thermoelectric material Bi2Te3. This reasonable power factor and thermal conductivity suggest that LaP is a promising thermoelectric material. The dependence of the figure of merit ZT on carrier concentration n and temperature T indicates that a high ZT can be obtained by increasing the temperature and tuning the carrier concentration.
Design of semiconductor surface pits for fabrication of regular arrays of quantum dots and nanorings
Authors: Kumar Ashish , Chen Chao-Shou , Maroudas Dimitrios
Published: January 2019

We report a systematic computational study on the formation of complex nanostructures consisting of quantum dots and nanorings on surfaces of coherently strained thin films grown epitaxially on pit-patterned substrates. The analysis is based on self-consistent dynamical simulations according to a film surface evolution model that has been validated experimentally by comparison of its predictions with experimental observations on Ge films grown on Si pit-patterned substrates and is supported by linear stability theory that explains the film surface nanopattern formation as the outcome of a Stranski-Krastanow instability. Emphasis is placed on the design of conical pit patterns and the effects on the resulting film surface nanopattern of varying geometrical design parameters including film thickness, pit-pattern period, pit depth, pit opening diameter, and pit wall inclination. We demonstrate that varying the pit opening diameter and the pit wall slope leads to formation of complex nanostructures inside the pits of a regular pit pattern on the film surface, which include quantum dots, as well as single nanorings and multiple concentric nanorings that may or may not surround a central quantum dot inside each pit. Our simulation predictions demonstrate that the ordered nanostructure patterns forming on the film surface can be controlled precisely by tuning the geometrical parameters of the pits on the pit-patterned substrate. Our findings have important implications for designing optimal semiconductor surface patterns toward enabling future nanofabrication technologies.
Effect of Charge Carrier Relaxation on Donor-Acceptor Recombination Spectra Taking into Account Coulomb Correlations
Authors: Bogoslovskiy N. A. , Petrov P. V. , Averkiev N. S.
Published: January 2019

This study presents the results of numerical simulation of donor-acceptor recombination spectra in compensated semiconductors taking into account electrostatic fluctuations associated with the presence of ionised impurities. The presence of Coulomb correlations in a system of partially ionised impurity centers results in distinctive features appearing in recombination spectra, depending on charge-carrier energy relaxation. The authors have considered the following limiting cases: absence of relaxation, partial relaxation of majority and minority charge carriers, as well as complete relaxation of a system of electrons and holes localized on impurities. The results obtained through numerical simulation have been interpreted using a previously developed analytical model, in which contributions to recombination from equilibrium and photoexcited charge carriers are considered separately. It has been shown that, under certain experimental conditions, emission lines corresponding to these contributions can be spectrally resolved.
Anisotropic temperature dependence of normal state resistivity in underdoped region of a layered electron-doped superconductor Nd2–xCexCuO4
Authors: Klepikova A. S. , Charikova T. B. , Shelushinina N. G. , Popov M. R. , Ivanov A. A.
Published: January 2019

The aim of this work is to investigate the temperature dependences both in CuO2 plane and out-of plane resistivities in electron-doped Nd2-xCexCuO4 for x from 0.135 up to 0.15 in order to analyze the anisotropy of the electrical transport in the process of the evolution from antiferromagnetic order in the underdoped region to superconducting order in optimally doped region.
Electronic transport and optical properties of Mo0.5W0.5Te2 single crystal
Authors: Marchenkov V. V. , Domozhirova A. N. , Makhnev A. A. , Shreder E. I. , Naumov S. V. , Chistyakov V. V. , Huang J. C. A. , Eisterer M.
Published: January 2019

A relatively pure and perfect Weyl semimetal Mo0.5W0.5Te2 single crystal was synthesized, and its electrical resistivity, galvanomagnetic properties at temperatures from 4.2 to 80 K in fields up to 10 T, as well as optical properties at room temperature were studied. It is shown that the temperature dependence of the resistivity has a metallic type. At T = 4.2 K and in a 10 T field, the magnetoresistance reaches 29%, monotonously decreasing with temperature. Analysis of the field and temperature dependences of the magnetoresistance suggests that the Fermi surface of Mo0.5W0.5Te2 can contain both open and closed sheets. Studies of the Hall effect and estimates made on this basis showed that the main charge carriers are electrons with a concentration of ∼ 1020 cm–3 and mobility of ∼ 151 cm2/V⋅s at Т = 4.2 K. With an increase in temperature, the concentration of current carriers increases, and their mobility decreases. Optical studies demonstrate that the Mo0.5W0.5Te2 single crystal has no features typical of metals. Interband absorption of light dominates over the entire studied spectral region. The appearance of a weak contribution from free carriers is noted at energies of less than 0.6 eV.
First principles calculations show high thermoelectric capability in lanthanum phosphide
Authors: Frank Jodi Ackerman
Published: January 2019

Studying the phonon stability dynamics of LaP, researchers see the topological insulator as a promising thermoelectric material.
Comparing static and dynamic flood models in estuarine environments: a case study from south-east Australia
Authors: Kumbier Kristian , Carvalho Rafael C. , Vafeidis Athanasios T. , Woodroffe Colin D.
Published: January 2019

Static and dynamic flood models differ substantially in their complexity and their ability to represent environmental processes such as storm tide or riverine flooding. This study analysed spatial differences in flood extent between static (bathtub) and dynamic flood models (Delft3D) in estuarine environments with different morphology and hydrodynamics in order to investigate which approach is most suitable to map flooding due to storm surges and river discharge in estuarine environments. Time series of observed water levels and river discharge measurements were used to force model boundaries. Observational data, such as tidal gauge and water level logger measurements, satellite imagery and aerial photography, were used to validate modelling results. Flood extents were calculated including and excluding river discharge to quantify and investigate its effect on the mapping of flooding. Modelling results indicate that the mature estuarine system, which has largely infilled broad flood plains, requires a consideration of bottom friction and riverine discharge through dynamic modelling techniques, whereas static models may provide an alternative approach to map flooding at low cost and low computational expense in young lake-like estuarine systems that have not been infilled with sediments. Our results suggest that estuarine classifications based on geomorphological characteristics can potentially guide flood risk assessments in estuarine environments.
Prey consumption estimates for salmon sharks
Authors: Manishin Kaitlyn A. , Goldman Kenneth J. , Short Margaret , Cunningham Curry J. , Westley Peter A. H. , Seitz Andrew C.
Published: January 2019

Top predators, such as salmon sharks (Lamna ditropis), can influence the abundance and population structure of organisms at lower trophic levels through direct effects, such as predation mortality, and indirect interactions. As a first step towards better understanding the average annual prey consumption for individual adult salmon sharks, we bracketed consumption estimates using three methods: (1) daily ration requirement; (2) bioenergetic mass balance; and (3) a Bayesian model of shark growth. In the first method, we applied ration estimates for related lamnid shark species that yielded salmon shark estimates of 1461 and 2202kgyear–1. The second method used a mass–balance technique to incorporate life history information from salmon sharks and physiological parameters from other species and produced estimates of 1870, 2070, 1610 and 1762kgyear–1, depending on assumed diet. Growth modelling used salmon shark growth histories and yielded estimates of 16900 or 20800kgyear–1, depending on assumed assimilation efficiency. Of the consumption estimates, those from the mass–balance technique may be the most realistic because they incorporated salmon shark life history data and do not produce extreme values. Taken as a whole, these estimates suggest that salmon sharks have similar energetic requirements to piscivorous marine mammals.
A Systematic Review of Resident Aesthetic Clinic Outcomes
Authors: Kaplan Jordan , Volk Angela S , Ashley Janet R , Izaddoost Shayan , Reece Edward , Winocour Sebastian
Published: January 2019

Background

Providing residents with comprehensive training in aesthetic surgery has proven challenging. Resident aesthetic clinics propose an educational value to trainees while providing successful patient outcomes.

Objectives

This study systematically reviewed the available literature regarding resident aesthetic clinic outcomes to determine the efficacy of the clinic in resident training, surgical results, and patient satisfaction.

Methods

An electronic database search was performed to identify literature reporting on resident aesthetic clinics. Studies were excluded if the resident clinic was not aesthetic in nature, if only nonsurgical aesthetic procedures were performed, and if clinic outcomes were not evaluated. Study quality was assessed using the Newcastle Ottawa Scale for nonrandomized studies.

Results

Ten of 148 identified studies met inclusion criteria; 2 utilized a survey, 3 were retrospective cohort studies, and 5 were retrospective cohort studies also utilizing a survey. Clinic schedules, surgical case volume, and surgical procedures performed all varied. One study received a Newcastle Ottawa Scale score of 7 of a possible 9 stars, 2 studies received 5 stars, 5 studies received 4 stars, and 2 could not be assessed using the scoring system. Six studies analyzed surgical results as a primary outcome, reporting acceptable complication and revision rates. Four studies evaluated patient opinions of the clinics and reported overall high satisfaction rates.

Conclusions

This systematic review suggests that resident aesthetic clinics enhance resident education while providing safe and successful surgical results to patients.
Antimicrobial prophylaxis and the prevention of surgical site infection in cardiac surgery: an analysis of 21 007 patients in Switzerland†
Authors: Sommerstein Rami , Atkinson Andrew , Kuster Stefan P , Thurneysen Maurus , Genoni Michele , Troillet Nicolas , Marschall Jonas , Widmer Andreas F ,   Swissnoso, Balmelli Carlo , Eisenring Marie-Christine , Harbarth Stephan , Kuster Stefan P , Marschall Jonas , Spicher Virginie Masserey , Pittet Didier , Ruef Christian , Sax Hugo , Schlegel Matthias , Schweiger Alexander , Troillet Nicolas , Widmer Andreas F , Zanetti Giorgio
Published: January 2019

OBJECTIVES:

Our goal was to determine the optimal timing and choice of surgical antimicrobial prophylaxis (SAP) in patients having cardiac surgery.

METHODS:

The setting was the Swiss surgical site infection (SSI) national surveillance system with a follow-up rate of >94%. Participants were patients from 14 hospitals who had cardiac surgery from 2009 to 2017 with clean wounds, SAP with cefuroxime, cefazolin or a vancomycin/cefuroxime combination and timing of SAP within 120 min before the incision. Exposures were SAP timing and agents; the main outcome was the incidence of SSI. We fitted generalized additive and mixed-effects generalized linear models to describe effects predicting SSIs.

RESULTS:

A total of 21 007 patients were enrolled with an SSI incidence of 5.5%. Administration of SAP within 30 min before the incision was significantly associated with decreased deep/organ space SSI [adjusted odds ratio (OR) 0.73, 95% confidence interval (CI) 0.54–0.98; P = 0.035] compared to administration of SAP 60–120 min before the incision. Cefazolin (adjusted OR 0.64, 95% CI 0.49–0.84; P = 0.001) but not vancomycin/cefuroxime combination (adjusted OR 1.05, 95% CI 0.82–1.34; P = 0.689) was significantly associated with a lower risk of overall SSI compared to cefuroxime alone. Nevertheless, there were no statistically significant differences between the SAP agents and the risk of deep/organ space SSI.

CONCLUSIONS:

The results from this large prospective study provide substantial arguments that administration of SAP close to the time of the incision is more effective than earlier administration before cardiac surgery, making compliance with SAP administration easier. The choice of SAP appears to play a significant role in the prevention of all SSIs, even after adjusting for confounding variables.
The impact of agri-environment schemes on farm productivity: a DID-matching approach
Authors: Mennig Philipp , Sauer Johannes
Published: January 2019

According to WTO standards, agri-environmental schemes (AES) payments should distort neither trade nor production but instead only compensate for income forgone and costs incurred. At the same time, contract design shall give farmers enough flexibility to react to changing market and production conditions. We apply a difference-in-difference propensity score matching estimator to test if AES have an unintended effect on farm productivity. Our results suggest that schemes designed for arable land overcompensate farmers and thus do fail to comply with WTO rules. For dairy farms, we find that AES participation reduces farm productivity, implying that action-based scheme design not considering changing market and production situations might be too restrictive, potentially preventing farmers from participating.
The effect of off-hour delivery on severe maternal morbidity: a population-based cohort study
Authors: Nam Jin Young , Lee Sang Gyu , Nam Chung Mo , Park Sohee , Jang Sung In , Park Eun-Cheol
Published: January 2019

Background

Severe maternal morbidity is an indicator for quality of maternal care. Recently, there has been growing interest in identifying which provision factors affect the quality of maternity care. The extent to off-hour delivery on SMM rates contributes to individual or provision factor in Korea has not been studied. This study aimed to determine the relationship between off-hour delivery and SMM during childbirth hospitalization.

Methods

This is a population-based retrospective cohort study. Data were extracted from the Korean National Health Insurance Service-National Sample Cohort for 90 072 cases of delivery in Korea between 2003 and 2013. The main outcome was SMM which was determined using the Center for Disease Control and Prevention’s algorithm. A generalized estimating equation model with log link was performed for the relationship with SMM and day/time of delivery adjusted covariates.

Results

Of the 90 072 delivery cases, 2085 (2.31%) had SMM. Women who were on weekdays at night time or on weekend delivery had a higher risk of SMM compared with those who were on weekdays at daytime (RR 1.26, 95% CI 1.10–1.46, and RR 1.58, 95% CI 1.30–1.93, respectively).

Conclusion

Weekday at night time or weekend delivery was related to the risk of SMM. Policymakers should provide financial support and systematically allocate adequate human resources and labour facilities in vulnerable areas, as well as during weekends and night times to improve the quality of intrapartum and postpartum maternity care.
SMAGEXP: a galaxy tool suite for transcriptomics data meta-analysis
Authors: Blanck Samuel , Marot Guillemette
Published: January 2019

Background

With the proliferation of available microarray and high-throughput sequencing experiments in the public domain, the use of meta-analysis methods increases. In these experiments, where the sample size is often limited, meta-analysis offers the possibility to considerably enhance the statistical power and give more accurate results. For those purposes, it combines either effect sizes or results of single studies in an appropriate manner. R packages metaMA and metaRNASeq perform meta-analysis on microarray and next generation sequencing (NGS) data, respectively. They are not interchangeable as they rely on statistical modeling specific to each technology.

Results

SMAGEXP (Statistical Meta-Analysis for Gene EXPression) integrates metaMA and metaRNAseq packages into Galaxy. We aim to propose a unified way to carry out meta-analysis of gene expression data, while taking care of their specificities. We have developed this tool suite to analyze microarray data from the Gene Expression Omnibus database or custom data from Affymetrix© microarrays. These data are then combined to carry out meta-analysis using metaMA package. SMAGEXP also offers to combine raw read counts from NGS experiments using DESeq2 and metaRNASeq package. In both cases, key values, independent from the technology type, are reported to judge the quality of the meta-analysis. These tools are available on the Galaxy main tool shed. A dockerized instance of galaxy containing SMAGEXP and its dependencies is available on Docker hub. Source code, help, and installation instructions are available on GitHub.

Conclusion

The use of Galaxy offers an easy-to-use gene expression meta-analysis tool suite based on the metaMA and metaRNASeq packages.
A chromosomal-scale genome assembly of Tectona grandis reveals the importance of tandem gene duplication and enables discovery of genes in natural product biosynthetic pathways
Authors: Zhao Dongyan , Hamilton John P , Bhat Wajid Waheed , Johnson Sean R , Godden Grant T , Kinser Taliesin J , Boachon Benoît , Dudareva Natalia , Soltis Douglas E , Soltis Pamela S , Hamberger Bjoern , Buell C Robin
Published: January 2019

Background

Teak, a member of the Lamiaceae family, produces one of the most expensive hardwoods in the world. High demand coupled with deforestation have caused a decrease in natural teak forests, and future supplies will be reliant on teak plantations. Hence, selection of teak tree varieties for clonal propagation with superior growth performance is of great importance, and access to high-quality genetic and genomic resources can accelerate the selection process by identifying genes underlying desired traits.

Findings

To facilitate teak research and variety improvement, we generated a highly contiguous, chromosomal-scale genome assembly using high-coverage Pacific Biosciences long reads coupled with high-throughput chromatin conformation capture. Of the 18 teak chromosomes, we generated 17 near-complete pseudomolecules with one chromosome present as two chromosome arm scaffolds. Genome annotation yielded 31,168 genes encoding 46,826 gene models, of which, 39,930 and 41,155 had Pfam domain and expression evidence, respectively. We identified 14 clusters of tandem-duplicated terpene synthases (TPSs), genes central to the biosynthesis of terpenes, which are involved in plant defense and pollinator attraction. Transcriptome analysis revealed 10 TPSs highly expressed in woody tissues, of which, 8 were in tandem, revealing the importance of resolving tandemly duplicated genes and the quality of the assembly and annotation. We also validated the enzymatic activity of four TPSs to demonstrate the function of key TPSs.

Conclusions

In summary, this high-quality chromosomal-scale assembly and functional annotation of the teak genome will facilitate the discovery of candidate genes related to traits critical for sustainable production of teak and for anti-insecticidal natural products.
The Incidence and Definition of Crohn’s Disease of the Pouch: A Systematic Review and Meta-analysis
Authors: Barnes Edward L , Kochar Bharati , Jessup Hilary R , Herfarth Hans H
Published: January 2019

Background

A subset of patients who undergo total proctocolectomy with ileal pouch–anal anastomosis (IPAA) creation for ulcerative colitis (UC) will later develop Crohn’s disease (CD) of the pouch, which has been associated with significant morbidity. We aimed to analyze the incidence of CD of the pouch and to review the existing diagnostic criteria utilized.

Methods

A systematic search performed through March 1, 2018, identified 12 studies that reported the incidence of CD of the pouch after IPAA for UC or indeterminate colitis (IC). We compiled all diagnostic criteria utilized in these studies and then performed a meta-analysis using random effects modeling to estimate the overall incidence of CD of the pouch in this population.

Results

Among 4843 patients with an IPAA for UC or IC, 10.3% of patients were ultimately diagnosed with CD of the pouch (95% confidence interval [CI], 6.1%–15.4%). The most commonly reported diagnostic criteria were (1) presence of fistula/fistulae, (2) stricture involving the pouch or prepouch ileum, and (3) presence of prepouch ileitis. In a secondary analysis, excluding those studies that included patients with a preoperative diagnosis of IC, the incidence of CD of the pouch was 12.4% (95% CI, 9.0%–16.1%).

Conclusions

The estimated incidence of 10.3% will assist gastroenterologists and surgeons in preoperative counseling regarding the potential to develop CD of the pouch. There is an unmet need for common diagnostic criteria for a more standardized approach to the diagnosis of CD of the pouch.
The influence of nudges on compliance behaviour in recreational fisheries: a laboratory experiment
Authors: Mackay Mary , Yamazaki Satoshi , Jennings Sarah , Sibly Hugh , van Putten Ingrid E , Emery Timothy J
Published: January 2019

Non-compliance is a tenacious problem in recreational fisheries management, posing a risk to marine conservation and socio-ecological systems by, for example, undermining management efforts and creating conflict between resource user groups. In fisheries management, deterrence-based approaches have traditionally been used to tackle non-compliance. However, enforcement is often limited in recreational fisheries and an alternative approach is needed to improve compliance. In this paper, we explore the lessons from behavioural economics and apply nudge theory as the basis of alternative management approaches. Nudge theory argues that through positive reinforcement or indirect suggestion, voluntary compliance can be achieved. We test the influence of a nudge, based on a descriptive social norm, through an economic laboratory experiment in a recreational fisheries context. Our results show that the presence of this nudge can increase compliance behaviour by 10%. We find that a nudge was more effective when deterrence is low, but its effects become weaker when deterrence is already high. We also find heterogeneity across individual’s responses to the nudge and risk preferences significantly related to compliance behaviour. Nudges based on social norms have the potential to complement traditional deterrence methods and could prove successful as a cost-effective compliance tool in the marine environment.
Indicators for Nonroutine Discharge Following Cervical Deformity-Corrective Surgery: Radiographic, Surgical, and Patient-Related Factors
Authors: Bortz Cole A , Passias Peter G , Segreto Frank , Horn Samantha R , Lafage Virginie , Smith Justin S , Line Breton , Mundis Gregory M , Kebaish Khaled M , Kelly Michael P , Protopsaltis Themistocles , Sciubba Daniel M , Soroceanu Alexandra , Klineberg Eric O , Burton Douglas C , Hart Robert A , Schwab Frank J , Bess Shay , Shaffrey Christopher I , Ames Christopher P ,   International Spine Study Group (ISSG)
Published: January 2019

BACKGROUND

Nonroutine discharge, including discharge to inpatient rehab and skilled nursing facilities, is associated with increased cost-of-care. Given the rising prevalence of cervical deformity (CD)-corrective surgery and the necessity of value-based healthcare, it is important to identify indicators for nonroutine discharge.

OBJECTIVE

To identify factors associated with nonroutine discharge after CD-corrective surgery using a statistical learning algorithm.

METHODS

A retrospective review of patients ≥18 yr with discharge and baseline (BL) radiographic data. Conditional inference decision trees identified factors associated with nonroutine discharge and cut-off points at which factors were significantly associated with discharge status. A conditional variable importance table used nonreplacement sampling set of 10 000 conditional inference trees to identify influential patient/surgical factors. The binary logistic regression indicated odds of nonroutine discharge for patients with influential factors at significant cut-off points.

RESULTS

Of 138 patients (61 yr, 63% female) undergoing surgery for CD (8 ± 5 levels; 49% posterior approach, 16% anterior, and 35% combined), 29% experienced nonroutine discharge. BL cervical/upper-cervical malalignment showed the strongest relationship with nonroutine discharge: C1 slope ≥ 14°, C2 slope ≥ 57°, TS-CL ≥ 57°. Patient-related factors associated with nonroutine discharge included BL gait impairment, age ≥ 59 yr and apex of CD primary driver ≥ C7. The only surgical factor associated with nonroutine discharge was fusion ≥ 8 levels. There was no relationship between nonhome discharge and reoperation within 6 mo or 1 yr (both P > .05) of index procedure. Despite no differences in BL EQ-5D (P = .946), nonroutine discharge patients had inferior 1-yr postoperative EQ-5D scores (P = .044).

CONCLUSION

Severe preoperative cervical malalignment was strongly associated with nonroutine discharge following CD-corrective surgery. Age, deformity driver, and ≥ 8 level fusions were also associated with nonroutine discharge and should be taken into account to improve patient counseling and health care resource allocation.
Plasma Profiles of Inflammatory Markers Associated With Active Tuberculosis in Antiretroviral Therapy-Naive Human Immunodeficiency Virus-Positive Individuals
Authors: Olsson Oskar , Björkman Per , Jansson Marianne , Balcha Taye Tolera , Mulleta Daba , Yeba Habtamu , Valfridsson Christine , Carlsson Fredric , Skogmar Sten
Published: January 2019

Background

Diagnosis of tuberculosis (TB) in human immunodeficiency virus (HIV)-coinfected individuals is challenging. We hypothesized that combinations of inflammatory markers could facilitate identification of active TB in HIV-positive individuals.

Methods

Participants were HIV-positive, treatment-naive adults systematically investigated for TB at Ethiopian health centers. Plasma samples from 130 subjects with TB (HIV+/TB+) and 130 subjects without TB (HIV+/TB−) were tested for concentration of the following markers: CCL5, C-reactive protein (CRP), interleukin (IL)-6, IL12-p70, IL-18, IL-27, interferon-γ-induced protein-10 (IP-10), procalcitonin (PCT), and soluble urokinase-type plasminogen activator receptor (suPAR). Analyzed markers were then assessed, either individually or in combination, with regard to infection status, CD4 cell count, and HIV ribonucleic acid (RNA) levels.

Results

The HIV+/TB+ subjects had higher levels of all markers, except IL12p70, compared with HIV+/TB− subjects. The CRP showed the best performance for TB identification (median 27.9 vs 1.8 mg/L for HIV+/TB+ and HIV+/TB−, respectively; area under the curve [AUC]: 0.80). Performance was increased when CRP was combined with suPAR analysis (AUC, 0.83 [0.93 for subjects with CD4 cell count <200 cells/mm3]). Irrespective of TB status, IP-10 concentrations correlated with HIV RNA levels, and both IP-10 and IL-18 were inversely correlated to CD4 cell counts.

Conclusions

Although CRP showed the best single marker discriminatory potential, combining CRP and suPAR analyses increased performance for TB identification.
Dalbavancin as Secondary Therapy for Serious Staphylococcus aureus Infections in a Vulnerable Patient Population
Authors: Bryson-Cahn Chloe , Beieler Alison M , Chan Jeannie D , Harrington Robert D , Dhanireddy Shireesha
Published: January 2019

We retrospectively evaluated off-label use of dalbavancin as secondary therapy in 32 patients with serious Staphylococcus aureus infections (endocarditis, osteomyelitis, septic thrombophlebitis, epidural infection) who were also persons who use drugs. The majority of patients (56%) had a clinical response to treatment. Only 1 patient who completed the intended dalbavancin course experienced a treatment failure.
Attitudes towards Data Linkage for Evidence-Based Policymaking
Authors: Fobia Aleia Clark , Holzberg Jessica , Eggleston Casey , Childs Jennifer Hunter , Marlar Jenny , Morales Gerson
Published: January 2019

In a recent report, the Commission for Evidence-Based Policymaking advocated for expanded use of data, including data linkage, from federal statistical and regulatory agencies to help guide decision-making and ultimately improve programs and policies. How data sharing and linkage is framed is important, and attitudes about data sharing and linkage are driven by respondents’ privacy beliefs and views towards the government more generally. Using data from the RDD telephone Gallup Daily Tracking Survey, we examine how favorability towards data sharing for the purpose of informed decision-making compares to other purposes. Respondents were less favorable towards data sharing when the purpose was for informed decision-making than for efficient use of taxpayer money, government accountability, or for community benefits, suggesting this is an ineffective way to frame data sharing to increase support. However, views towards the government, beliefs about privacy, and response behavior are still important determinants of favorability.
Varieties of involution monoids with extreme properties
Authors: Lee Edmond W H
Published: January 2019

A variety that contains continuum many subvarieties is said to be huge. A sufficient condition is established under which an involution monoid generates a variety that is huge by virtue of its lattice of subvarieties order-embedding the power set lattice of the positive integers. Based on this result, several examples of finite involution monoids with extreme varietal properties are exhibited. These examples—all first of their kinds—include the following: finite involution monoids that generate huge varieties but whose reduct monoids generate Cross varieties; two finite involution monoids sharing a common reduct monoid such that one generates a huge, non-finitely based variety while the other generates a Cross variety; and two finite involution monoids that generate Cross varieties, the join of which is huge.
Fungal Endophytes ofPopulus trichocarpaAlter Host Phenotype, Gene Expression, and Rhizobiome Composition
Authors: Liao Hui-Ling , Bonito Gregory , Rojas J. Alejandro , Hameed Khalid , Wu Steven , Schadt Christopher W. , Labbé Jessy , Tuskan Gerald A. , Martin Francis , Grigoriev Igor V. , Vilgalys Rytas
Published: January 2019

Mortierella and Ilyonectria genera include common species of soil fungi that are frequently detected as root endophytes in many plants, including Populus spp. However, the ecological roles of these and other endophytic fungi with respect to plant growth and function are still not well understood. The functional ecology of two key taxa from the P. trichocarpa rhizobiome, M. elongata PMI93 and I. europaea PMI82, was studied by coupling forest soil bioassays with environmental metatranscriptomics. Using soil bioassay experiments amended with fungal inoculants, M. elongata was observed to promote the growth of P. trichocarpa. This response was cultivar independent. In contrast, I. europaea had no visible effect on P. trichocarpa growth. Metatranscriptomic studies revealed that these fungi impacted rhizophytic and endophytic activities in P. trichocarpa and induced shifts in soil and root microbial communities. Differential expression of core genes in P. trichocarpa roots was observed in response to both fungal species. Expression of P. trichocarpa genes for lipid signaling and nutrient uptake were upregulated, and expression of genes associated with gibberellin signaling were altered in plants inoculated with M. elongata, but not I. europaea. Upregulation of genes for growth promotion, downregulation of genes for several leucine-rich repeat receptor kinases, and alteration of expression of genes associated with plant defense responses (e.g., jasmonic acid, salicylic acid, and ethylene signal pathways) also suggest that M. elongata manipulates plant defenses while promoting plant growth.
From Modules to MOOCs: Application of the Six-Step Approach to Online Curriculum Development for Medical Education
Authors: Chen Belinda Y. , Kern David E. , Kearns Robert M. , Thomas Patricia A. , Hughes Mark T. , Tackett Sean
Published: January 2019

Online curricula can make high-quality health professions education accessible in virtually any setting. They can enhance teaching and learning by both standardizing curricular resources and individualizing curricular experiences. Despite growing demand for and institutional interest in online curricula for medical education, many medical educators lack a framework for online curriculum development. Without rigorous and thoughtful development, online curricula can waste opportunity and resources by leading to education that is inferior to traditional methods. In this article, the authors describe a systematic approach to online curriculum development based on the Six-Step Approach for Curriculum Development for Medical Education, a widely used method that has led to successful implementation of a variety of traditional and online curricula. In each step, special considerations for curricula with larger and more diverse learner audiences—characteristic of many online curricula—are highlighted. Four common online curricular formats are also discussed: blended curricula, instructor-led fully online curricula, self-paced modules, and massive open online courses (MOOCs). The authors emphasize factors that differentiate one online format from another, including the budgetary, technical, and human resource requirements for each. The article concludes by urging medical educators to pursue opportunities to study and disseminate online curricular work.
Medical School Strategies to Address Student Well-Being: A National Survey
Authors: Dyrbye Liselotte N. , Sciolla Andres F. , Dekhtyar Michael , Rajasekaran Senthil , Allgood J. Aaron , Rea Margaret , Knight Allison P. , Haywood Antwione , Smith Stephen , Stephens Mark B.
Published: January 2019

Purpose

To describe the breadth of strategies U.S. medical schools use to promote medical student well-being.

Method

In October 2016, 32 U.S. medical schools were surveyed about their student well-being initiatives, resources, and infrastructure; grading in preclinical courses; and learning communities.

Results

Twenty-seven schools (84%) responded. Sixteen (59%) had a student well-being curriculum, with content scheduled during regular curricular hours at most (13/16; 81%). These sessions were held at least monthly (12/16; 75%), and there was a combination of optional and mandatory attendance (9/16; 56%). Most responding schools offered a variety of emotional/spiritual, physical, financial, and social well-being activities. Nearly one-quarter had a specific well-being competency (6/27; 22%). Most schools relied on participation rates (26/27; 96%) and student satisfaction (22/27; 81%) to evaluate effectiveness. Sixteen (59%) assessed student well-being from survey data, and 7 (26%) offered students access to self-assessment tools. Other common elements included an individual dedicated to overseeing student well-being (22/27; 82%), a student well-being committee (22/27; 82%), pass/fail grading in preclinical courses (20/27; 74%), and the presence of learning communities (22/27; 81%).

Conclusions

Schools have implemented a broad range of well-being curricula and activities intended to promote self-care, reduce stress, and build social support for medical students, with variable resources, infrastructure, and evaluation. Implementing dedicated well-being competencies and rigorously evaluating their impact would help ensure appropriate allocation of time and resources and determine if well-being strategies are making a difference. Strengthening evaluation is an important next step in alleviating learner distress and ultimately improving student well-being.
It’s Time to Wikify Clinical Documentation: How Collaborative Authorship Can Reduce the Burden and Improve the Quality of the Electronic Health Record
Authors: Warner Jeremy L. , Smith Jeffery , Wright Adam
Published: January 2019

Electronic health records (EHRs) have become ubiquitous tools and represent the standard of care for 96% of hospitals and 86% of ambulatory physicians in the United States. With adoption of EHRs came the promise of improved efficiency, higher-quality care, and lower costs. Unfortunately, some clinicians are now spending twice as much time on documentation as they spend seeing patients, and the documentation paradigm of problem-oriented medical records is contributing to this imbalance. It is time to consider new innovations. The collaborative wiki format offers many opportunities to ease the burden of documentation as well as to increase the usefulness of the recorded clinical data. Wikis support multiple authorship, have built-in features to track edits and changes, allow for contextual linkages (e.g., linking medical problems to their treatment), and support new technologies such as application programming interfaces, which allow for safe and secure exchange of information. In this Perspective, the authors describe the rationale for considering this approach to clinical documentation and propose a pilot to learn about its effectiveness. They believe wiki-based documentation will become increasingly attractive, especially as new legislation and directives from policymakers seek to reduce the crushing documentation burden and as the U.S. health care system transitions from an episode-based payment structure to a value-based, outcomes-focused system.
Understanding the Effects of General Anesthetics on Cortical Network Activity Using Ex Vivo Preparations
Authors: Voss Logan J. , García Paul S. , Hentschke Harald , Banks Matthew I.
Published: January 2019

General anesthetics have been used to ablate consciousness during surgery for more than 150 yr. Despite significant advances in our understanding of their molecular-level pharmacologic effects, comparatively little is known about how anesthetics alter brain dynamics to cause unconsciousness. Consequently, while anesthesia practice is now routine and safe, there are many vagaries that remain unexplained. In this paper, the authors review the evidence that cortical network activity is particularly sensitive to general anesthetics, and suggest that disruption to communication in, and/or among, cortical brain regions is a common mechanism of anesthesia that ultimately produces loss of consciousness. The authors review data from acute brain slices and organotypic cultures showing that anesthetics with differing molecular mechanisms of action share in common the ability to impair neurophysiologic communication. While many questions remain, together, ex vivo and in vivo investigations suggest that a unified understanding of both clinical anesthesia and the neural basis of consciousness is attainable.
Human Milk and Infants With Congenital Heart Disease
Authors: Davis Jessica A. , Spatz Diane L.
Published: January 2019

Background:

Human milk is a life-saving medical intervention. Infants with congenital heart disease are at an increased risk for necrotizing enterocolitis, chylothorax, feeding difficulties, and growth failure. In the absence of evidence-based care, their mothers are also at risk for low milk supply and/or poor breastfeeding outcomes.

Purpose:

Summarize the role of human milk and clinical outcomes for infants with congenital heart disease (CHD). Summarize methods of ideal breastfeeding support.

Methods/Search Strategy:

PubMed, Cochrane Library, and CINAHL were the databases used. The terms used for the search related to CHD and necrotizing enterocolitis were “human milk” and “necrotizing enterocolitis” and “congenital heart disease.” This resulted in a total of 17 publications for review.

Findings:

Infants receiving exclusive human milk diet are at a lower risk for necrotizing enterocolitis and will have improved weight gain. Infants with chylothorax who receive skimmed human milk have higher weight-for-age scores than formula-fed infants. Maternal breastfeeding education correlates with decreased risk of poor breastfeeding outcomes.

Implications for Practice:

Human milk is the ideal source of nutrition for infants with CHD and should be encouraged by the care team. Evidence-based lactation education and care must be provided to mothers and families prenatally and continue throughout the infant's hospitalization. If a mother's goal is to directly breastfeed, this should be facilitated during the infant's hospital stay.

Implications for Research:

Evaluate the role between human milk and the incidence of necrotizing enterocolitis, feeding difficulties, and clinical outcomes in the population of infants with CHD.