bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantifying the Impact of Research on Matching into Ophthalmology Residency
Authors: Bargoud Albert , Thangamathesvaran Loka , Patel Varesh , Henseler Robert , Kass William , Khouri Albert
Published: August 2018

Purpose This article aims to quantify the impact of research on matching into various tiers of ophthalmology residency programs.

Design In this study, 340 applicants who matriculated into ophthalmology residency programs in the United States from the class of 2019 were included. Data variables collected for each applicant composed of the following: Hirsch's index (h-index), total number of publications, journal impact factor, type of publication, and number of publications relating to ophthalmology. The primary outcome was tier of ophthalmology program that each applicant matched into, which was determined by two metrics: (1) the h-index of the department's faculty and (2) overall reputation of the residency program as characterized by the U.S. News and World Report Ophthalmology Rankings.

Results After multivariate analysis, only the h-index was found to be associated with an increased likelihood of matching at a higher tier program when measuring tier based on the metric of institutional research output (p < 0.0001). However, no research variable was found to be significant on multivariate analysis when assessing the impact of research on matching into a certain tier program based on reputation. The h-index was noted to increase by 1 for every 3.1 papers as the first author, every 4.9 years since the first publication, every 6.4 ophthalmology-related publications, and every publication in a journal with an impact factor of 5.2.

Conclusion A higher applicant h-index is associated with matching at an ophthalmology program with greater research output; however, it is not associated with reputation of residency program.
Induction of Labor versus Scheduled Cesarean in Morbidly Obese Women: A Cost-Effectiveness Analysis
Authors: Grotegut Chad , Swamy Geeta , Myers Evan , Havrilesky Laura , Hopkins Maeve
Published: August 2018

Objective To assess the costs, complication rates, and harm-benefit tradeoffs of induction of labor (IOL) compared to scheduled cesarean delivery (CD) in women with class III obesity.

Study Design We conducted a cost analysis of IOL versus scheduled CD in nulliparous morbidly obese women. Primary outcomes were surgical site infection (SSI), chorioamnionitis, venous thromboembolism, blood transfusion, and readmission. Model outcomes were mean cost of each strategy, cost per complication avoided, and complication tradeoffs. We assessed the costs, complication rates, and harm-benefit tradeoffs of IOL compared with scheduled CD in women with class III obesity.

Results A total of 110 patients underwent scheduled CD and 114 underwent IOL, of whom 61 (54%) delivered via cesarean. The group delivering vaginally experienced fewer complications. SSI occurred in 0% in the vaginal delivery group, 13% following scheduled cesarean, and 16% following induction then cesarean. In the decision model, the mean cost of induction was $13,349 compared with $14,575 for scheduled CD. Scheduled CD costs $9,699 per case of chorioamnionitis avoided, resulted in 18 cases of chorioamnionitis avoided per additional SSI and 3 cases of chorioamnionitis avoided per additional hospital readmission. In sensitivity analysis, IOL is cost saving compared with scheduled CD unless the cesarean rate following induction exceeds 70%.

Conclusion In morbidly obese women, induction of labor remains cost-saving until the rate of cesarean following induction exceeds 70%.
How to survive a crisis: reclaiming philosophy as a public practice
Authors: Burroughs Michael D.
Published: August 2018

Philosophy is often understood as an isolated discipline in higher education, as a form of study removed from the concerns of everyday life and the majority of the public. Although philosophy is, in one sense, a professional discipline in higher education, this conception is limiting and severely underdetermines possibilities for philosophy as apublic practice. As a public practice, philosophy and those who practice it can engage with pressing problems and collaborate with stakeholders beyond the academy toward the end of improving our communities. Practicing and supporting philosophy as a public practice is important both for our communities and, ultimately, for greater understanding and appreciation of professional philosophy. Doing so, however, requires significant changes in conceptions of legitimate philosophical practice and, in turn, systems of evaluation and support for publicly engaged philosophers in our institutions and departments.
Atomic-scale structure and chemistry of YIG/GGG
Authors: Liu Mengchao , Jin Lichuan , Zhang Jingmin , Yang Qinghui , Zhang Huaiwu , Gao Peng , Yu Dapeng
Published: August 2018

Y3Fe5O12 (YIG) is a promising candidate for spin wave devices. In the thin film devices, the interface between YIG and substrate may play important roles in determining the device properties. Here, we use spherical aberration-corrected scanning electron microscopy and spectroscopy to study the atomic arrangement, chemistry and electronic structure of the YIG/Gd3Ga5O12 (GGG) interface. We find that the chemical bonding of the interface is FeO-GdGaO and the interface remains sharp in both atomic and electronic structures. We provide an efficient method to study the interface chemical bonding, and these results give necessary information for understanding the properties of interface and also for atomistic calculation.
Pump–probe scanning-tunneling-microscope light-emission spectroscopy of Sb2Te3
Authors: Uehara Yoichi , Kuwahara Masashi , Katano Satoshi , Tanno Takenori , Sakai Joe
Published: August 2018

We have investigated the temporal behavior of Sb2Te3 after irradiation with picosecond (ps) pump-laser pulses using scanning-tunneling-microscope (STM) light emission synchronized with ps-probe-laser pulses delayed by times t after individual pump pulses. We determined the gap energy ΔE at the F point in the band diagram of Sb2Te3 from the STM light-emission spectra as a function of the delay time t. We found that ΔE increased monotonically with t from the original value of 1.62 eV for a delay time of 0 to 15.3 ps and it decreased toward that original value (1.62 eV) for t in the time span between 15.3 and 28 ps; we saw no change in ΔE for t≥28 ps. By comparing this t-dependence of ΔE with the dielectric functions of the crystalline and amorphous phases of Sb2Te3, we have concluded that the phase transition from the crystalline phase toward the amorphous phase is induced by the pump pulses. The phonon energy of the A2u mode is clearly seen in the STM light-emission spectra when ΔE is 1.62 eV, but not when ΔE is increased above 1.62 eV by pump-pulse irradiation. This feature appears to be consistent with the Raman signals, which are much stronger for the crystalline phase than for the amorphous phase.
Considerations of the q-profile control in KSTAR for advanced tokamak operation scenarios
Authors: Chung J. , Ko J. , Hahn S.-H. , Kim H. S. , Wang S. J.
Published: August 2018

The q-profile control is essential for tokamaks exploring the advanced tokamak scenarios, which is expected to be able to provide a possible route toward a steady-state high performance operation in a fully non-inductive current drive state. This is because the pressure and current profiles must remain optimal for the scenario during the injection of large amounts of heating and current drive. Here, essential tools for the q-profile control are the motional Stark effect diagnostic for measuring the radial magnetic pitch angle profile and a state-of-the-art plasma control system. The pulse duration of the H-mode discharge at KSTAR has been extended year by year with improved control performance, and the experiment of internal transport barrier (ITB) formation in a weakly reversed q-profile with a marginal neutral beam injection majority heating successfully demonstrated that the ITB is an alternative candidate to achieve a high performance regime in KSTAR. These recent achievements are attributed to reliable profile measurement, which means that profile feedback control has become a necessary step to ensure a robust and reliable approach to advanced scenarios as the next step of research in KSTAR. In this paper, we discuss the technical and conceptual requirements for q-profile control according to the upgrade plan for heating and current drive systems in the coming years.
Charge transfer process for carbon-related center in semi-insulating carbon-doped GaN
Authors: Zvanut M. E. , Paudel Subash , Sunay U. R. , Willoughby W. R. , Iwinska M. , Sochacki T. , Bockowski M.
Published: August 2018

Electron paramagnetic resonance (EPR) spectroscopy was used to study the point defects in 2 × 1017–1019 cm−3 C-doped GaN substrates grown by hydride vapor phase epitaxy. The intensity of an isotropic signal with g = 1.987 ± 0.001 increased monotonically with the carbon concentration, indicating that the EPR signal represents a carbon-related defect. In each sample, the signal intensity increased under illumination with photon energy greater than 2.75 eV, and the photo-induced signal decreased with subsequent illumination at 0.95 eV. A second signal, well-documented to be a shallow donor, appeared along with the g = 1.987 signal in the most lightly doped samples. The appearance of the donor confirms that the photo-induced increase is caused by excitation of an electron to the conduction band and implies that a defect level for the carbon-related center is about 1 eV above the valence band edge, consistent with temperature-dependent Hall measurements.
Analysis of pressure diffusion-wave fields in matrix-fracture media using Green functions of frequency domain
Authors: Yang Duoxing , Doschoris Michael , Zhang Lianzhong
Published: August 2018

A Green function-based analytic solution of pressure diffusive wave motion is introduced for investigating the transient pressure response in fluid saturated matrix-fracture media. One-dimensional solutions are presented for a time-harmonically forced problem with internal damping and are used to analyze the propagation and attenuation of pressure pulse in a semi-infinite spatial domain. The concise form of the solutions simplifies the calculation of pressure diffusion with arbitrary forcing functions at fixed boundaries. It indicates that the periodically forced function with internal damping has remarkable effects on pressure diffusion-wave motions. It is found that the characteristic delay-frequency separates the pressure diffusion-wave domain into matrix-dominated, transition, and fracture-dominated zones. The Green functions could physically predict any transient response of pressure fluctuations due to hydro-fracturing in geological reservoirs given proper physical parameters.
Theoretical study of artificial Kerr effect on the self-focusing of laser in a dissipative suspension of silver nanoparticles
Authors: Sepehri Javan N. , Naderali R. , Hosseinpour Azad M. , Najafi M. N.
Published: August 2018

Self-focusing of laser beam propagating through a dissipative suspension of metallic nanoparticles is studied. The impact of the imaginary part of nanoparticle polarizability on the optical force and consequently on the particles' rearrangement in the presence of laser fields with an initial Gaussian profile is considered. It is shown that the absorption of laser leads to the creation of optical force along the wave propagation direction which can cause longitudinal distribution of nanoparticles. Considering fifth order nonlinearity of wave amplitude that comes from the simultaneous considering of normal Kerr effect produced by the inhomogeneity of the refractive index resulted from the ponderomotive force acting on conducting electrons and artificial Kerr nonlinearity caused by the polarization optical force acting on electrically polarized particles, set of differential equations describing nonlinear steady-state evolution of laser beam is derived by using a non-paraxial method. Dynamics of laser for different frequencies is investigated and optimum frequency range for improving focusing property is determined. It is shown that the artificial Kerr effect causes localization of particles near the propagation axis that can substantially reduce the threshold power for occurring self-focusing in comparison with plasma and other rigid plasmonic systems.
Numerical study on coalescence behavior of suspended drop pair in viscous liquid under uniform electric field
Authors: Wang Zhentao , Dong Kai , Tian Lin , Wang Junfeng , Tu Jiyuan
Published: August 2018

Coalescence of drops under externally applied electric field is a significant physical process, which has been applied in many applications such as emulsion breakup, electric dehydration and raindrop formation. The morphological characteristics of two identical adjacent drops under uniform electrical strength were numerically investigated in present study. From the simulated morphologies, the behavior of the meniscus, the major axis, the minor axis, and the cone angle of coalesced drop were analyzed in details. The results indicated that drop coalescence was dependent on the electric field strength, and only below a critical threshold, coalesce occurred. Though variation might occur in lengths of the meniscus, major\minor axis, and size in cone angles, a steady state can always be reached under which electro-coalescence complete. On the other hand, drops failed to coalesce if they could not reach a steady state, and even the coalesced drop rupture due to oversized electric filed strength. Analysis of coalescence behavior of suspended drop pair in viscous liquid under uniform electric field could further promote our understanding on the physical phenomenon of electro-coalescence and provide insight for the design of the electro-coalescers in practical applications.
Exciton spectroscopy with spatially separated electron and hole in Ge/Si heterostructure with germanium quantum dots
Authors: Pokutnyi S. I.
Published: August 2018

It is shown that taking into account the centrifugal energy in the Hamiltonian of an exciton with spatially separated electron and hole (the hole moves in the germanium quantum dot and the electron is localized over the spherical interface of the silicon quantum dot matrix) leads to the appearance of quasistationary states in the zone of surface exciton states, which transform into stationary states with increasing quantum dot radius. It is determined that the absorption spectra of the nanosystem interband consist of energy bands that are formed by electron transitions between quasistationary and stationary states, and the intraband absorption spectra consist of zones formed by electron transitions between stationary states.
Features of electronic paramagnetic resonance in the ErAl3(BO3)4 single crystal
Authors: Bedarev V. A. , Merenkov D. N. , Kobets M. I. , Poperezhaj S. N. , Gnatchenko S. L. , Gudim I. A.
Published: August 2018

An additional resonance line was found in the EPR spectrum of the ErAl3(BO3)4 crystal at a temperature of 4.2 K, along with the main line. The appearance of an additional line is associated with the possible formation of magnetic clusters in the crystal.
Environmental chiral analysis of β-blockers: evaluation of different n-alkyl-modified SBA-15 mesoporous silicas as sorbents in solid-phase extraction
Authors: Silva Mariana , Morante-Zarcero Sonia , Pérez-Quintanilla Damián , Marina María Luisa , Sierra Isabel
Published: August 2018

Environmental contextβ-Blockers are important chiral pharmaceuticals found as micropollutants in environmental waters as a result of incomplete removal during wastewater treatment. Because they display enantioselective toxicity, it is necessary to include chiral information in an environmental risk assessment. We have developed an analytical method using mesoporous silica for extracting β-blockers in water samples before their specific chiral analysis.
AbstractThe extraction and preconcentration of chiral β-blockers in environmental water was evaluated by solid-phase extraction (SPE) employing an SBA-15 ordered mesoporous silica functionalised with alkyl chains of different length. The materials were characterised by X-ray diffraction, transmission electron microscopy, scanning electron microscopy, nitrogen adsorption–desorption isotherm measurements and elemental analysis. Important parameters influencing extraction efficiency, including the type and amount of sorbent and the breakthrough volume, were optimised. The results obtained showed that the organic chain length played an important role in the behaviour of these sorbents. Under optimised conditions, using 200 mg SBA-15-C8 as sorbent, a simple analytical method based on off-line SPE coupled to chiral capillary electrophoresis with diode array detection (SPE-chiral CE-DAD) was developed. Method detection and quantification limits were lower than 0.6 and 1.9 µg L −1 respectively for all enantiomers, with a preconcentration factor of 500-fold. The method was successfully applied to the chiral analysis of atenolol, metoprolol, pindolol and propranolol in river and sewage water samples. Satisfactory recoveries (between 86 ± 2 and 98 ± 1 %) and repeatability (relative standard deviation (RSD) < 9 %, n = 3) were obtained. Metoprolol was detected in sewage water at a concentration of 10.7 and 9.9 µg L−1 and an enantiomeric fraction of 0.52 and 0.48 for the first- and the second-migrating enantiomers respectively. These results emphasise the importance of enantioselective analysis for environmental risk assessment.
Friendship and the new politics: beyond community
Authors: Nordin Astrid H.M. , Smith Graham M.
Published: August 2018

What role can friendship play in contemporary politics? This article answers this question by showing how friendship supplements one of the central tropes of modern European thought: community. It argues that both the recent phenomenon of populism and more traditional political practice rely on this trope. This results in a politics which focuses on identity and difference, inclusion and exclusion. Ultimately this form of politics seeks an immanence which is impossible to achieve. In contrast, friendship offers a new way of thinking about politics as it focuses on open-ended relations between persons based not on sameness, but otherness and difference. The article articulates five key features of this understanding of friendship: (1) that it is a relationship, (2) between self and other, (3) which exists between the friends, which is (4) extendable into a network but not a unity and (5) it eschews all programmes or projects. In this way, friendship suggests not a project or a programme but an ethos. This article concludes by claiming that friendship is the open-ended and ongoing encounter with the other, and its politics holds a shared space open for the potential that this encounter brings.
Accrual to Clinical Trials (ACT): A Clinical and Translational Science Award Consortium Network
Authors: Visweswaran Shyam , Becich Michael J , D’Itri Vincent S , Sendro Elaina R , MacFadden Douglas , Anderson Nicholas R , Allen Karen A , Ranganathan Dipti , Murphy Shawn N , Morrato Elaine H , Pincus Harold A , Toto Robert , Firestein Gary S , Nadler Lee M , Reis Steven E
Published: August 2018

The Accrual to Clinical Trials (ACT) network is a federated network of sites from the National Clinical and Translational Science Award (CTSA) Consortium that has been created to significantly increase participant accrual to multi-site clinical trials. The ACT network represents an unprecedented collaboration among diverse CTSA sites. The network has created governance and regulatory frameworks and a common data model to harmonize electronic health record (EHR) data, and deployed a set of Informatics for Integrating Biology and the Bedside (i2b2) data repositories that are linked by the Shared Health Research Information Network (SHRINE) platform. It provides investigators the ability to query the network in real time and to obtain aggregate counts of patients who meet clinical trial inclusion and exclusion criteria from sites across the United States. The ACT network infrastructure provides a basis for cohort discovery and for developing new informatics tools to identify and recruit participants for multi-site clinical trials.
Root-Associated Microbiome of Maize Genotypes with Contrasting Phosphorus Use Efficiency
Authors: Gomes Eliane A. , Lana Ubiraci G. P. , Quensen John F. , de Sousa Sylvia M. , Oliveira Christiane A. , Guo Jiarong , Guimarães Lauro J. M. , Tiedje James M.
Published: August 2018

Marginal soil fertility, soil acidity, aluminum toxicity, and a generalized low level of available nutrients, especially phosphorus (P), are major limiting factors to maize production in highly weathered oxisols that are prominent in the tropics. Plants have evolved several strategies to improve P acquisition, including the ability to associate with soil microorganisms that potentially enhance P uptake and plant nutrition. We investigated the effect of two maize genotypes with contrasting P use efficiency and their hybrid, grown in soils with two P levels, on bacterial and fungal community structures in the root and the rhizosphere. We found that a significant fraction of bacterial and fungal diversity could be attributed to the host genotype, but in general, the soil P level was the major driver of microbiome structure followed by plant compartment (rhizosphere versus directly root associated). Slow-growing bacterial taxa increased in the low P soil, whereas fast-growing taxa were enriched in high P soil. The low P soil had a positive effect on arbuscular mycorrhizal fungi abundance, as expected, particularly inside the root. On the other hand, our results did not support selection for microbes associated to plant growth promoting and P solubilization based on P availability. Taken together, our results expand knowledge of which microbial groups are favored in P-deficient oxisol and suggest that P fertilization significantly impacts the species composition and diversity indices of bacteria and fungi communities, both inside the roots and in the rhizosphere.
Labor Analgesia Onset With Dural Puncture Epidural Versus Traditional Epidural Using a 26-G Whitacre Needle and 0.125% Bupivacaine Bolus: A Randomized Clinical Trial
Authors: Wilson S.H. , Wolf B.J. , Bingham K. , Scotland Q.S. , Fox J.M. , Woltz E.M. , Hebbar L.
Published: August 2018

(Anesth Analg. 2018;126:545–551)

Lumbar epidural (LE) and combined spinal epidural are 2 techniques commonly used for labor analgesia. However, they are not without their disadvantages. An alternative may be the dural puncture epidural (DPE) technique, which allows medication to migrate into the intrathecal space via the epidural space. In the present study, the authors evaluated neuraxial labor analgesia onset following epidural bolus with a dilute local anesthetic solution (0.125% bupivacaine with 50 μg fentanyl) in active laboring parturients with and without DPE. The primary outcome of this study was the percentage of parturients in each group with adequate analgesia during active contraction 10 minutes after administering the epidural bolus.
Does Place and Attendance at Birth Improve Early Neonatal Mortality? Secondary Analysis of 9 Demographic and Health Surveys
Authors: Bellizzi S. , Sobel H.L. , Mathai M. , Temmerman M.
Published: August 2018

(BJOG 2017;124:1558–1565)

While child mortality worldwide has decreased in recent decades, neonatal deaths are expected to increase from 41.6% of under-5 deaths in 2013 to 52% in 2030. Many births in developing countries still occur at home without a skilled birth attendant (SBA). Prior studies did not show a strong association between lower neonatal mortality and place of birth nor type of attendance, although this may not account for the late referral of women for whom serious complications arise during home birth. This study aimed to determine the beneficial effects of facility births by examining the association between birth place/attendance and early neonatal mortality while adjusting for reported complications at birth.
Physical Activity and the Risk of Preterm Birth: A Systematic Review and Meta-Analysis of Epidemiological Studies
Authors: Aune D. , Schlesinger S. , Henriksen T. , Saugstad O.D. , Tonstad S.
Published: August 2018

(BJOG 2017;124:1816–1826)

Preterm birth, which is associated with neonatal morbidity and many adverse neonatal outcomes, is associated with smoking as well as maternal obesity. The association between physical activity and preterm birth is not clear. A significant inverse relationship has been shown in several randomized trials, cohort studies and case-control studies, while others have shown no significant association. This systematic review aimed to clarify whether physical activity before or during pregnancy was associated with risk of preterm birth.
Effect of Severity of Illness on Cesarean Delivery Rates in Washington State
Authors: Hitti J. , Walker S. , Benedetti T.J.
Published: August 2018

(Am J Obstet Gynecol 2017;217:474.e1–e5)

Perinatal quality initiatives, including proposed national benchmarks for acceptable cesarean delivery rates, have aimed to design best practices to reduce cesarean delivery rates and obtain optimal outcomes for mothers and infants. However, whether all hospitals can be held to the same benchmark for an acceptable cesarean delivery rate regardless of patient acuity is debatable, and the reasons for between-hospital variation in cesarean rates are not clear. The aim of this study was to evaluate the association between the severity of illness at admission and the primary term singleton vertex (TSV) cesarean delivery rates in Washington State. The authors hypothesized that hospitals with higher patient acuity would have higher term TSV cesarean delivery rates and that this relationship would persist despite temporal trends.
Thombocalc: Implementation and Uptake of Personalized Postpartum Venous Thromboembolism Risk Assessment in a High-throughput Obstetric Environment
Authors: O’Shaughnessy F. , Donnelly J.C. , Cooley S.M. , Deering M. , Raman A. , Gannon G. , Hickey J. , Holland A. , Hayes N. , Bennett K. , Ainle F.N. , Cleary B.J.
Published: August 2018

(Acta Obstet Gynecol Scand 2017;96:1382–1390)

There is a critical need to improve recognition of women at risk of obstetric venous thromboembolism (VTE), which is a leading cause of maternal morbidity and mortality. While venous thromboembolism risk assessment (VTERA) is recommended internationally for all pregnant and postpartum women, VTERA compliance is reportedly poor due to a lack of validated tools for VTERA, unclear optimal thresholds for the initiation of thromboprophylaxis as evidenced by significant variation in guidelines from various organizations, and challenges of assessing women individually in high-throughput environments. This study aimed to develop, pilot and implement an electronic tool for VTERA in a high-throughput setting, and assess compliance with the risk assessment tool. It did not assess clinical outcomes.
Maternal and Perinatal Outcomes After Laparoscopic Sleeve Gastrectomy
Authors: Rottenstreich A. , Elchalal U. , Kleinstern G. , Beglaibter N. , Khalaileh A. , Elazary R.
Published: August 2018

(Obstet Gynecol 2018;131:451–456)

Bariatric surgery has been shown to improve fertility in women. In recent years, laparoscopic sleeve gastrectomy, a restrictive procedure, has become the most frequently utilized bariatric procedure. However, current recommendations regarding the care of pregnant women after bariatric surgery are based on studies with patients who underwent laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding. Therefore, the authors of the present study performed a review of pregnancies among patients who underwent laparoscopic sleeve gastrectomy and related maternal and perinatal outcomes.
Epidural Labor Analgesia: Fentanyl Dose and Breastfeeding Success: A Randomized Clinical Trial
Authors: Lee A.I. , McCarthy R.J. , Toledo P. , Jones M.J. , White N. , Wong C.A.
Published: August 2018

(Anesthesiology 2017;127:614–624)

Breastfeeding incurs substantial long-term and short-term health benefits to the infant and mother and is also an important public health concern. Prior studies provided conflicting results regarding the effects of neuraxial analgesia for labor, particularly with fentanyl, on postpartum breastfeeding. This double-blind, randomized controlled clinical trial aimed to evaluate the impact of intrapartum epidural fentanyl on breastfeeding success in the initial postpartum period, as well as at 6 weeks and 3 months postpartum. Self-reported breastfeeding at 6 weeks postpartum was the primary outcome of this study, whereas 1-minute Apgar scores <7, day-1 LATCH (Latch, Audible swallowing, Type of nipple, Comfort, and Hold/help) breastfeeding assessments, the rate of mothers who discontinued breastfeeding at 3 months, and the reasons stated for discontinuation of breastfeeding were the secondary outcomes.
Uterine Artery Doppler Velocimetry During Individually Prescribed Exercise in Pregnancy
Authors: Szymanski Linda M. , Kogutt Benjamin K.
Published: August 2018

OBJECTIVE:

To evaluate uterine artery blood flow in response to typical exercise sessions performed in pregnancy in accordance with the current recommendations from the American College of Obstetricians and Gynecologists and the U.S. Department of Health and Human Services.

METHODS:

This prospective cross-sectional study measured uterine artery Doppler velocimetry in healthy pregnant women after individually prescribed exercise, including 1) moderate-intensity exercise (40–59% of heart rate reserve) in both nonexercisers and regular exercisers and 2) vigorous-intensity exercise (60–84% of heart rate reserve) in women who regularly engage in exercise. Resting uterine artery Doppler measures were obtained after a 20-minute fetal heart tracing; then the exercise session was performed. Immediately after the exercise session ended, the participants returned to the semirecumbent, leftward tilt position for ultrasound examination. Uterine artery measures were obtained 3.4±0.9 minutes (mean±SD) postexercise.

RESULTS:

Forty-five healthy pregnant women participated in the study: 30 regular exercisers and 15 nonexercisers. For the moderate-intensity session, mean gestational age was 31.1 and 31.7 weeks for the exercisers and nonexercisers, respectively. Mean uterine artery Doppler indices (pulsatility index, resistance index, systolic/diastolic ratio) did not significantly change with exercise. For the vigorous-intensity session, the average gestational age was 31.5 weeks. After vigorous activity, all mean uterine artery Doppler indices showed reductions postexercise, for example, pulsatility index decreased from 0.63±0.12 to 0.58±0.12 (P=.04).

CONCLUSION:

Individually prescribed exercise according to guidelines for pregnant women does not adversely alter uterine artery Doppler values, suggesting that uterine blood flow is not reduced as a result of exercise.
Long-Term Costs of Maximum Nonoperative Treatments in Patients With Symptomatic Lumbar Stenosis or Spondylolisthesis that Ultimately Required Surgery
Authors: Adogwa Owoicho , Davison Mark A. , Vuong Victoria D. , Khalid Syed , Lilly Daniel T. , Desai Shyam A. , Moreno Jessica , Cheng Joseph , Bagley Carlos
Published: August 2018

Study Design.

Retrospective cohort study.

Objective.

The purpose of this study is to characterize the utilization and costs of MNTs prior to spinal fusion surgery in patients with symptomatic lumbar stenosis or spondylolisthesis.

Summary of Background Data.

The costs and utilization of long-term maximal nonoperative therapy (MNT) can be substantial, and in the current era of bundled payments, the duration of conservative therapy trials should be reassessed.

Methods.

A large insurance database was queried for patients with symptomatic lumbar stenosis or spondylolisthesis undergoing index lumbar decompression and fusion procedures between 2007 and 2016. This database consists of 20.9 million covered lives and includes private/commercially insured and Medicare Advantage beneficiaries. Only patients with lumbar stenosis or spondylolisthesis and those continuously active within the insurance system for at least 5 years prior to the index operation were eligible.

Results.

A total of 4133 out of 497,822 (0.8%) eligible patients underwent 1, 2, or 3-level posterior lumbar instrumented fusion. 20.8% of patients were smokers, 44.5% had type II DM, and 38.2% were obese (body mass index [BMI] >30 kg/m2). Patient MNT utilization was as follows: 66.7% used nonsteroidal anti-inflammatory drugs (NSAIDs), 84.4% used opioids, 58.6% used muscle relaxants, 65.5% received lumbar epidural steroid injections (LESI), 66.6% attended 21.1% presented to the emergency department (ED), and 24.9% received chiropractor treatments. The total direct cost associated with all MNT prior to index spinal fusion was $9,000,968; LESI comprised the largest portion of the total cost of MNT ($4,094,646, 45.5%), followed by NSAIDS ($1,624,217, 18.0%) and opioid costs ($1,279,219, 14.2%). At the patient level, when normalized per patient utilizing therapy, an average $4010 was spent on nonoperative treatments prior to index lumbar surgery.

Conclusion.

Assuming minimal improvement in pain and functional disability after maximum nonoperative therapies, the incremental cost-effectiveness ratio (ICER) for MNTs could be highly unfavorable.

Level of Evidence: 3
The opioid receptor mu 1 (OPRM1) rs1799971 and catechol-O-methyltransferase (COMT) rs4680 as genetic markers for placebo analgesia
Authors: Aslaksen Per M. , Forsberg June T. , Gjerstad Johannes
Published: August 2018

The placebo effect is considered the core example of mind–body interactions. However, individual differences produce large placebo response variability in both healthy volunteers and patients. The placebo response in pain, placebo analgesia, may be dependent on both the opioid system and the dopaminergic system. Previous studies suggest that genetic variability affects the function of these 2 systems. The aim of this study was therefore to address the interaction between the single nucleotide polymorphisms opioid receptor mu 1 (OPRM1) rs1799971 and catechol-O-methyltransferase (COMT) rs4680 on placebo analgesia. Two hundred ninety-six healthy volunteers participated in a repeated-measures experimental design where thermal heat pain stimuli were used as pain stimuli. Participants were randomized either to a placebo group receiving placebo cream together with information that the cream would reduce pain, or to a natural history group receiving the same pain stimuli as the placebo group without any application of cream or manipulation of expectation of pain levels. The results showed that the interaction betweenOPRM1rs1799971 andCOMTrs4680 was significantly associated with the placebo analgesic response. Participants withOPRM1Asn/Asn combined withCOMTMet/Met and Val/Met reported significant pain relief after placebo administration, whereas those with other combinations of theOPRM1andCOMTgenotypes displayed no significant placebo effect. NeitherOPRM1norCOMThad any significant influence on affective changes after placebo administration. As shown in this study, genotyping with regard toOPRM1andCOMTmay predict who will respond favorably to placebo analgesic treatment.
Quality indicators to assess quality of pain clinic care from the perspective of patients with chronic pain: development, usability, comprehensibility, and psychometric quality of the QiPPP questionnaire
Authors: de Meij Nelleke , Köke Albère , Thomassen Ilona , Kallewaard Jan-Willem , van Kleef Maarten , van der Weijden Trudy
Published: August 2018

To address the lack of appropriate patient-defined quality indicators (QIs) for assessment of pain clinic care in the Netherlands, we developed the “Quality Indicators Pain Patients' Perspective” (QiPPP) questionnaire. Quality indicators are widely used to measure the quality of the structure, process, and outcome of health care. The Pain Patient United Consortium, together with the University Pain Centre of Maastricht, developed QIs for assessment of care. The aim of this study was to develop QIs from the perspective of patients with chronic pain for assessment of the care provided by a pain clinic, and to validate them on usability, comprehensibility, and psychometric quality in daily pain practice. Quality as defined by patients with chronic pain (in survey and focus groups) was prioritized by consensus and transformed into QI. A first set was tested and fine-tuned, resulting in the QiPPP questionnaire. Five participating pain clinics distributed 200 questionnaires among consecutive patients with chronic pain under treatment. To examine the dimensionality of the QIs, patient responses were analyzed on the basis of reporting frequencies and findings of principal component analysis. For construct validation, the influence of patient characteristics was observed in 3 components. A total of 547 (54.7%) populated QiPPP questionnaires (response rate, 58.9%) were analyzed. The mean score for patient comprehensibility was 8.6 ± 1.4. The final QiPPP questionnaire included 21 QIs (18 process; 3 outcome) distributed over 7 domains. The QiPPP questionnaire was of sufficient psychometric quality and found to be useful and understandable by patients with chronic pain.
Serum biomarkers of fibrosis and extracellular matrix remodeling in patients with nonalcoholic fatty liver disease: association with liver histology
Authors: Yilmaz Yusuf , Eren Fatih
Published: August 2018

Background

We sought to explore the interplay of multiple serum biomarkers of fibrosis and extracellular matrix remodeling with the results of liver histology in patients with nonalcoholic fatty liver disease (NAFLD).

Patients and methods

Venous blood samples were collected from 80 patients with biopsy-proven NAFLD and 59 age-matched and sex-matched healthy controls. Serum levels of transforming growth factor (TGF)-β1, TGF-β2, matrix metalloproteinases (MMP)-1, MMP-2, MMP-7, MMP-9, MMP-10, tissue inhibitors of metalloproteinase (TIMP)-1, and TIMP-2 were determined by using the Luminex MagPix technology on a MAGPIX analyzer.

Results

We documented significant differences in the levels of TGF-β1, TGF-β2, MMP-2, MMP-7, MMP-9, TIMP-1, and TIMP-2 between NAFLD patients and controls. However, none of these biomarkers was able to distinguish between nonalcoholic steatohepatitis and nonalcoholic fatty liver. TIMP-1 levels were significantly higher in patients with significant fibrosis (fibrosis stage ≥2; 2624±1261 pg/ml) than in those without (fibrosis stage 0−1; 2096±906 pg/ml; P=0.03). Moreover, serum levels of TIMP-1 were identified as the only independent predictor of histological fibrosis (β=0.298, t=2.7, P=0.007).

Conclusion

Our study provides insights into the association of multiple serum biomarkers of fibrosis and extracellular matrix remodeling with NAFLD histology. Notably, serum levels of TIMP-1 were identified as a clinically useful marker for distinguishing NAFLD patients with and without significant fibrosis.
Treatment of Low Back Pain With Opioids and Nonpharmacologic Treatment Modalities for Army Veterans
Authors: Vanneman Megan E. , Larson Mary Jo , Chen Cheng , Adams Rachel Sayko , Williams Thomas V. , Meerwijk Esther , Harris Alex H.S.
Published: August 2018

Background:

In the Veterans Health Administration (VHA) there is growing interest in the use of nonpharmacologic treatment (NPT) for low back pain (LBP) as pain intensity and interference do not decrease with opioid use.

Objectives:

To describe overall and facility-level variation in the extent to which specific NPT modalities are used in VHA for LBP, either alone or as adjuncts to opioid medications, and to understand associations between veterans’ clinical and demographic characteristics and type of treatment.

Research Design:

This retrospective cohort study examined use of opioids and 21 specific NPT modalities used by veterans.

Subjects:

VHA-enrolled Iraq and Afghanistan veterans who utilized care in (“linked” to) 130 VHA facilities within 12 months after their separation from the Army between fiscal years 2008–2011, and who were diagnosed with LBP within 12 months after linkage (n=49,885).

Measures:

Measures included per patient: days’ supply of opioids, number of visits for NPT modalities, and pain scores within one year after a LBP diagnosis.

Results:

Thirty-four percent of veterans filled a prescription for opioids, 35% utilized at least 1 NPT modality, and 15% used both within the same year. Most patients with LBP receiving NPT, on average, had moderate pain (36%), followed by low pain (27%), severe pain (15%), and no pain (11%). Eleven percent had no pain scores recorded.

Conclusions:

About 65% of VHA patients with a LBP diagnosis did not receive NPT, and about 43% of NPT users also were prescribed an opioid. Understanding utilization patterns and their relationship with patient characteristics can guide pain management decisions and future study.
Diagnostic Immunohistochemistry for Soft Tissue and Bone Tumors: An Update
Authors: Schaefer Inga-Marie , Hornick Jason L.
Published: August 2018

Although some soft tissue and bone tumors can be identified based on histologic features alone, immunohistochemistry plays a critical diagnostic role for most mesenchymal tumor types. The discovery of recurrent genomic alterations in many benign and malignant mesenchymal neoplasms has added important biologic insights and expanded the spectrum of some diagnostic subgroups. Some tumors are defined by unique genomic alterations, whereas others share abnormalities that are not tumor-specific and can be observed in a sometimes broad range of biologically unrelated neoplasms. We herein focus on novel immunohistochemical markers, based on molecular genetic alterations, which are particularly useful in the diagnostic workup of selected groups of soft tissue and bone tumors, including recently described entities, specifically round cell sarcomas (Ewing sarcoma, CIC-rearranged sarcoma, and BCOR-rearranged sarcoma), vascular tumors (epithelioid hemangioma, epithelioid hemangioendothelioma, and pseudomyogenic hemangioendothelioma), SMARCB1-deficient neoplasms, adipocytic tumors (spindle cell/pleomorphic lipoma, atypical spindle cell lipomatous tumor, and conventional atypical lipomatous tumor), giant cell-rich bone tumors (giant cell tumor of bone and chondroblastoma), and biphenotypic sinonasal sarcoma. Given the complex nature of sarcoma classification, and the rarity of many mesenchymal tumor types, careful integration of clinical presentation, imaging features, histology, immunophenotype, and cytogenetic/molecular alterations is crucial for accurate diagnosis of soft tissue and bone tumors.
Serum Factor V Is a Continuous Biomarker of Graft Dysfunction and a Predictor of Graft Loss After Liver Transplantation
Authors: Gorgen Andre , Prediger Carolina , Prediger João E. , Chedid Marcio F. , Backes Ariane N. , de Araujo Alexandre , Grezzana-Filho Tomaz J.M. , Leipnitz Ian , Chedid Aljamir D. , Alvares-da-Silva Mario R. , Sapisochin Gonzalo , Kruel Cleber R.P.
Published: August 2018

Background.

Factor V has never been compared to a validated early allograft dysfunction (EAD) definition. We aimed to assess factor V as a biomarker of EAD and a predictor of graft loss after liver transplantation (LT).

Methods.

We retrospectively assessed the serum factor V levels on postoperative day 1 after LT. Patients were divided according to their factor V levels into the ≤36.1 U/mL and > 36.1 U/mL groups. The primary outcome was graft loss within 1, 3, and 6 months. The secondary outcome was EAD, as defined by Olthoff et al. Predictors of outcomes were identified by multivariable logistic regression.

Results.

Two hundred twenty-seven patients were included in the study: 74 with factor V of 36.1 U/mL or less and 153 with factor V >36.1 U/mL. EAD was diagnosed in 41 (55.4%) of 74 patients with factor V of 36.1 U/mL or less and in 20/153 (13.1%) patients with factor V >36.1 U/mL (P < 0.001). According to the multivariable regression model, factor V was a continuous marker of EAD (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.94-0.98 per U/mL). Among the study groups, the 1-, 3-, and 6-month graft survival rates were 82%, 74%, and 74%, respectively, for patients with factor V of 36.1 U/mL or less and 98%, 95%, and 95%, respectively, for patients with factor V >36.1 U/mL (P = 0.001). Factor V was a continuous predictor for 3- and 6-month graft losses (OR, 0.96; 95% CI, 0.94-0.99 and OR, 0.97; 95% CI, 0.94-0.99 per U/mL), whereas EAD was not significant when adjusted for factor V.

Conclusion.

Factor V is an early marker for EAD and is a continuous predictor of short-term graft loss after LT.
Blood, sweat and tears: a review of non-invasive DNA sampling
Authors: Lefort M.C. , Cruickshank R.H. , Descovich K. , Adams N.J. , Barun A. , Emami-Khoyi A. , Ridden J. , Smith V.R. , Sprague R. , Waterhouse B. , Boyer S.
Published: August 2018

Abstract

The use of DNA data is ubiquitous across animal sciences. DNA may be obtained from an organism for a myriad of reasons including identification and distinction between cryptic species, sex identification, comparisons of different morphocryptic genotypes or assessments of relatedness between organisms prior to a behavioural study. DNA should be obtained while minimizing the impact on the fitness, behaviour or welfare of the subject being tested, as this can bias experimental results and cause long-lasting effects on wild animals. Furthermore, minimizing impact on experimental animals is a key Refinement principle within the ‘3Rs’ framework which aims to ensure that animal welfare during experimentation is optimised. The term ‘non-invasive DNA sampling’ has been defined to indicate collection methods that do not require capture or cause disturbance to the animal, including any effects on behaviour or fitness. In practice this is not always the case, as the term ‘non-invasive’ is commonly used in the literature to describe studies where animals are restrained or subjected to aversive procedures. We reviewed the non-invasive DNA sampling literature for the past six years (380 papers published in 2013-2018) and uncovered the existence of a significant gap between the current use of this terminology (i.e. ‘non-invasive DNA sampling’) and its original definition. We show that 58% of the reviewed papers did not comply with the original definition. We discuss the main experimental and ethical issues surrounding the potential confusion or misuse of the phrase ‘non-invasive DNA sampling’ in the current literature and provide potential solutions. In addition, we introduce the terms ‘non-disruptive’ and ‘minimally disruptive’ DNA sampling, to indicate methods that eliminate or minimise impacts not on the physical integrity/structure of the animal, but on its behaviour, fitness and welfare, which in the literature reviewed corresponds to the situation for which an accurate term is clearly missing. Furthermore, we outline when these methods are appropriate to use.