bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterization of large and small-plaque variants in the Zika virus clinical isolate ZIKV/Hu/S36/Chiba/2016
Authors: Kato Fumihiro , Tajima Shigeru , Nakayama Eri , Kawai Yasuhiro , Taniguchi Satoshi , Shibasaki Kenichi , Taira Masakatsu , Maeki Takahiro , Lim Chang Kweng , Takasaki Tomohiko , Saijo Masayuki
Published: November 2017

An Asian/American lineage Zika virus (ZIKV) strain ZIKV/Hu/S36/Chiba/2016 formed 2 types in plaque size, large and small. Genomic analysis of the plaque-forming clones obtained from the isolate indicated that the clones forming small plaques commonly had an adenine nucleotide at position 796 (230Gln in the amino acid sequence), while clones forming large plaques had a guanine nucleotide (230Arg) at the same position, suggesting that this position was associated with the difference in plaque size. Growth kinetics of a large-plaque clone was faster than that of a small-plaque clone in Vero cells. Recombinant ZIKV G796A/rZIKV-MR766, which carries a missense G796A mutation, was produced using an infectious molecular clone of the ZIKV MR766 strain rZIKV-MR766/pMW119-CMVP. The plaque size of the G796A mutant was significantly smaller than that of the parental strain. The G796A mutation clearly reduced the growth rate of the parental virus in Vero cells. Furthermore, the G796A mutation also decreased the virulence of the MR766 strain in IFNAR1 knockout mice. These results indicate that the amino acid variation at position 230 in the viral polyprotein, which is located in the M protein sequence, is a molecular determinant for plaque morphology, growth property, and virulence in mice of ZIKV.
Liraglutide restores chronic ER stress, autophagy impairments and apoptotic signalling in SH-SY5Y cells
Authors: Panagaki Theodora , Michael Maria , Hölscher Christian
Published: November 2017

Growing evidence suggests that agonists of glucagon-like peptide (GLP-1) receptor exert neuroprotective and neurorestorative effects across a range of experimental models of neuronal degeneration, and, recently, a pilot clinical trial of Liraglutide in Alzheimer’s disease patients showed improvements in cerebral glucose consumption that signifies disease progression. However, the exact underlying mechanism of action remains unclear. Chronic endoplasmic reticulum (ER) stress has recently emerged as a mechanism for neuronal injury, rendering it a potent therapeutic target for acute and chronic neurodegenerative disorders. Here, we investigate the neuroprotective effects of Liraglutide along with the signalling network against prolong ER stress and autophagy impairments induced by the non-competitive inhibitor of sarco/ER Ca2+-ATPase, thapsigargin. We show that Liraglutide modulates the ER stress response and elicits ER proteostasis and autophagy machinery homeostasis in human SH-SY5Y neuroblastoma cell line. These effects correlate with resolution of hyper-activity of the antioxidant Nrf2 factor and restoration of the impaired cell viability and proliferation. Mechanistically, Liraglutide engages Akt and signal transducer and activator of transcription 3 (STAT3) signalling to favour adaptive responses and shift cell fate from apoptosis to survival under chronic stress conditions in SH-SY5Y cells.
The evaluation of contralateral foot circulation after unilateral revascularization procedures using indocyanine green angiography
Authors: Nakamura Masahiro , Igari Kimihiro , Toyofuku Takahiro , Kudo Toshifumi , Inoue Yoshinori , Uetake Hiroyuki
Published: November 2017

The aim of the present study is to assess the effects of unilateral revascularization on the contralateral foot circulation using indocyanine green (ICG). From January 2016 to April 2016, a total of twenty-one patients were included in this study. The patients underwent elective unilateral revascularization at our institution and we evaluated the feet circulation by indocyanine green angiography (ICGA) tests preoperatively and postoperatively. The ICGA parameters included the magnitude of intensity from the onset of ICG to the maximum intensity (Imax), the time from the onset of ICG to the maximum intensity (Tmax), and the time required to reach the half maximum intensity from the onset of ICG (T1/2). There were significant differences in the treated limb Tmax (P = 0.016) and T1/2 (P = 0.013) values and in the contralateral limb Tmax (P = 0.013), and T1/2 (P < 0.001) values on the perioperative ICGA tests. These results reflect the increase in skin perfusion in the treated limb and the decrease in skin perfusion in the contralateral limb. Unilateral revascularization decreases contralateral foot circulation. The preoperative contralateral lesion should be evaluated when revascularization is performed.
Associating a product with a luxury brand label modulates neural reward processing and favors choices in materialistic individuals
Authors: Audrin Catherine , Ceravolo Leonardo , Chanal Julien , Brosch Tobias , Sander David
Published: November 2017

The present study investigated the extent to which luxury vs. non-luxury brand labels (i.e., extrinsic cues) randomly assigned to items and preferences for these items impact choice, and how this impact may be moderated by materialistic tendencies (i.e., individual characteristics). The main objective was to investigate the neural correlates of abovementioned effects using functional magnetic resonance imaging. Behavioural results showed that the more materialistic people are, the more they choose and like items labelled with luxury brands. Neuroimaging results revealed the implication of a neural network including the dorsolateral and ventromedial prefrontal cortex and the orbitofrontal cortex that was modulated by the brand label and also by the participants’ preference. Most importantly, items with randomly assigned luxurious brand labels were preferentially chosen by participants and triggered enhanced signal in the caudate nucleus. This effect increased linearly with materialistic tendencies. Our results highlight the impact of brand-item association, although random in our study, and materialism on preference, relying on subparts of the brain valuation system for the integration of extrinsic cues, preferences and individual characteristics.
Plasma fatty acids and risk of colon and rectal cancers in the Singapore Chinese Health Study
Authors: Butler Lesley M. , Yuan Jian-Min , Huang Joyce Yongxu , Su Jin , Wang Renwei , Koh Woon-Puay , Ong Choon-Nam
Published: November 2017

Fatty acid composition in plasma captures both dietary intake and endogenous synthesis. Prospective analyses of plasma fatty acid composition are needed to establish the role of monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs) on risk of developing colorectal cancer. To evaluate associations between plasma fatty acid composition and colon or rectal cancer risk separately, a nested case-control study of 350 colorectal (211 colon and 139 rectal) cancer cases and an equal number of individually matched control subjects was conducted within the Singapore Chinese Health Study, a cohort of 63,257 men and women recruited between 1993 and 1998. Fatty acids in pre-diagnostic plasma were quantified using gas chromatography–tandem mass spectrometry. Conditional odds ratios (ORs) and 95% confidence intervals (CIs) comparing highest to lowest quartiles are presented. For colon cancer, inverse associations were reported with higher essential PUFAs, α-linolenic acid (OR = 0.41; 95% CI: 0.23, 0.73; Ptrend = 0.005) and linoleic acid (OR = 0.43; 95% CI: 0.23, 0.82; Ptrend = 0.008). Higher desaturase activity in the n-6 PUFA synthesis pathway estimated by the arachidonic:linoleic acid ratio was associated with increased colon cancer risk (OR = 3.53; 95% CI: 1.82, 6.85; Ptrend = 0.006), whereas higher desaturase activity in the MUFA synthesis pathway estimated by the oleic:stearic acid ratio was associated with decreased colon cancer risk (OR = 0.42; 95% CI: 0.19, 0.92; Ptrend = 0.024). There was no significant association between the essential fatty acids or the desaturase indices and rectal cancer risk. Endogenous synthesis of arachidonic and oleic acids has an impact on colon cancer development.
Difficulties of Translating Outcomes from Animal Studies to Clinical Trials
Authors: Peplow Philip V. , Martinez Bridget
Published: November 2017

Attempts to reproduce the findings of experimental treatments for stroke in animal models have been mainly unsuccessful. This review considers possible reasons for this failure to translate from animals to humans. Differences among animal models of stroke, transient ischemic attack, and traumatic brain injury in the type and extent of cerebral injury are reviewed, as well as differences between humans and animal stroke models. There are also major differences in the way that studies are performed in humans and animal models, as well as the functional outcomes assessed. Strategies to improve the quality of animal and human studies of stroke therapies are considered.
Functional Predictors for Prognosis and Recovery after Mild Traumatic Brain Injury
Authors: Sufrinko A. M. , Sandel N. , Puskar A.
Published: November 2017

Although clinical evaluation of moderate and severe traumatic brain injury (TBI) relies on conventional neuroimaging modalities, evaluation of mild TBI (mTBI) relies primarily on functional assessment modalities. Functional assessment refers to the evaluation of skills and behaviors that are purported to be linked to the functions of particular cerebral areas, neural pathways, or cortical networks and relate to human functioning in everyday life. In practice, these assessment measures include neuropsychological testing, self-report measures of symptoms and functioning, and neurobehavioral testing. Performance on assessment measures in the acute stage of recovery from mTBI can be useful in prognosis and in predicting recovery. However, pre-injury risk factors also influence recovery course following mTBI, including patient characteristics and pre-injury conditions. In conjunction with biomarkers and imaging modalities, current research is focused on the development of more sophisticated neurobehavioral testing by advancing tools to evaluate oculomotor and vestibular dysfunction following mTBI.
Resolving Difficult Case Scenarios by Incorporating Stroke Biomarkers in Clinical Decision-making
Authors: Ng Geelyn J. L. , The Ei Z. , Yen Ng Mei , Quek Amy M. L. , Seet Raymond C. S.
Published: November 2017

Stroke biomarkers open a window of opportunity for clinicians and researchers to apply insights gained from advances in stroke biology to clinical practice. A wider use of stroke biomarkers into the clinical setting can facilitate decision-making during acute management of stroke complications and, through development of risk prediction models, guide improving the long-term outcomes of stroke patients. The focus of this chapter is on elaborating upon clinical scenarios where biomarkers could aid in clinical decision-making to avert and/or manage stroke complications such as hemorrhagic transformation, malignant cerebral infarction and early neurologic deterioration. Furthermore, biomarkers could also serve to improve stroke diagnosis by ruling out its mimics, better understanding stroke mechanisms, identifying high-risk patients for adverse outcomes and identifying those who might benefit from prolonged cardiac monitoring for the detection of atrial fibrillation. Stroke biomarkers could provide an additional investigative tool to assist clinicians who encounter difficult clinical scenarios when managing patients with an ischemic stroke.
Electrochemical lithium recovery and organic pollutant removal from industrial wastewater of a battery recycling plant
Authors: Kim Seoni , Kim Jiye , Kim Seonghwan , Lee Jaehan , Yoon Jeyong
Published: November 2017

A novel electrochemical system comprising λ-MnO2 and BDD is proposed for simultaneous recovery of lithium and decomposition of organic pollutants.
A novel liquid metal patterning technique: voltage induced non-contact electrochemical lithography at room temperature
Authors: Yu Zhenwei , Yun Frank F. , Wang Xiaolin
Published: November 2017

Non-contact, maskless, voltage induced electrochemical lithography for liquid metals was demonstrated at room temperature.
Molecular materials and devices: an interdisciplinary field of research
Authors: Zhu Daoben
Published: November 2017

Welcome to this themed collection of Materials Chemistry Frontiers entitled: ‘Molecular Materials and Devices’.
Synthesis and characterization of calcium-induced peanut protein isolate nanoparticles
Authors: Shi Aimin , Chen Xue , Liu Li , Hu Hui , Liu Hongzhi , Wang Qiang , Agyei Dominic
Published: November 2017

A convenient and green synthetic route using calcium ion induction was first used to prepare peanut protein isolate (PPI) nanoparticles.
Drowning in diversity? A systematic way of clustering and selecting a representative set of new psychoactive substances
Authors: Zloh Mire , Samaras Eleftherios G. , Calvo-Castro Jesus , Guirguis Amira , Stair Jacqueline L. , Kirton Stewart B.
Published: November 2017

A systematic way of clustering NPS yields medoids with potential in the assignment of emerging substances to systematically defined categories.
TiO2 hollow spheres on reduced graphene oxide with high rate performance as anodes for lithium-ion batteries
Authors: Liang Jicai , Zhang Xunlong , Zhai Xiaojie , Zhang Longjian , Wu Wenzheng , Yu Kaifeng
Published: November 2017

Anatase TiO2 anchored on graphene oxide (GO) can be synthesized through a one-step hydrothermal method.
Tin-based materials supported on nitrogen-doped reduced graphene oxide towards their application in lithium-ion batteries
Authors: Zuo Xiaoxia , Li Bao , Chang Kun , Tang Hongwei , Chang Zhaorong
Published: November 2017

Recently, nitrogen-doped graphene has attracted significant attention for application as an anode in lithium-ion batteries due to effective modulation of the electronic properties of graphene.
Dual functions of zirconium modification on improving the electrochemical performance of Ni-rich LiNi0.8Co0.1Mn0.1O2
Authors: Li Xing , Zhang Kangjia , Wang MingShan , Liu Yang , Qu MeiZhen , Zhao Wengao , Zheng Jianming
Published: November 2017

The main shortcomings of NCM811 could be solved at the same time via a facile Zr surface modification approach.
Co3O4 functionalized porous carbon nanotube oxygen-cathodes to promote Li2O2 surface growth for improved cycling stability of Li–O2 batteries
Authors: Zhou Yin , Lyu Zhiyang , Wang Liangjun , Dong Wenhao , Dai Wenrui , Cui Xinhang , Hao Zhongkai , Lai Min , Chen Wei
Published: November 2017

Co3O4 surface functionalized porous carbon nanotubes were designed as an efficient cathode catalyst for Li–O2 batteries, with p-CNT to facilitate Li+ and O2 diffusion, and with Co3O4 to achieve a low charge overpotential.
PyTranSpot: A tool for multiband light curve modeling of planetary transits and stellar spots
Authors: Juvan Ines G. , Lendl M. , Cubillos P. E. , Fossati L. , Tregloan-Reed J. , Lammer H. , Guenther E. W. , Hanslmeier A.
Published: November 2017

Several studies have shown that stellar activity features, such as occulted and non-occulted starspots, can affect the measurement of transit parameters biasing studies of transit timing variations and transmission spectra. We present PyTranSpot, which we designed to model multiband transit light curves showing starspot anomalies, inferring both transit and spot parameters. The code follows a pixellation approach to model the star with its corresponding limb darkening, spots, and transiting planet on a two dimensional Cartesian coordinate grid. We combine PyTranSpot with a Markov chain Monte Carlo framework to study and derive exoplanet transmission spectra, which provides statistically robust values for the physical properties and uncertainties of a transiting star-planet system. We validate PyTranSpot’s performance by analyzing eleven synthetic light curves of four different star-planet systems and 20 transit light curves of the well-studied WASP-41b system. We also investigate the impact of starspots on transit parameters and derive wavelength dependent transit depth values for WASP-41b covering a range of 6200−9200 Å, indicating a flat transmission spectrum.
On geometry of congruences of null strings in 4-dimensional complex and real pseudo-Riemannian spaces
Authors: Chudecki Adam
Published: November 2017

4-dimensional spaces equipped with 2-dimensional (complex holomorphic or real smooth) completely integrable distributions are considered. The integral manifolds of such distributions are totally null and totally geodesics 2-dimensional surfaces which are called the null strings. Properties of congruences (foliations) of such 2-surfaces are studied. Some relations between properties of congruences of null strings, Petrov-Penrose types of the SD Weyl spinor, and algebraic types of the traceless Ricci tensor are analyzed.
The effects of dry or wet aging on the quality of the longissimus muscle from 4-year-old Hanwoo cows and 28-month-old Hanwoo steers
Authors: Oh Jungmin , Lee Hyun Jung , Kim Hyun Choel , Kim Hyun Joo , Yun Yeong Gwon , Kim Kwan Tae , Choi Yang Il , Jo Cheorun
Published: November 2017

This study was conducted to discover the differences in physicochemical and sensory qualities of beef from 4-year-old Hanwoo cows and 2-year-old Hanwoo steers after undergoing different meat aging methods. Additionally, the possibility of using 4-year-old cows as value-added aged meat was investigated. Loins from eight cows (average 51 months old) and eight steers (average 28 months old) of quality grade 2 were aged for 28 days using dry and wet aging. Analyses were conducted to evaluate meat quality, including moisture content, pH, cooking loss, shear force, nucleotides, free amino acids (FAA), and sensory evaluation. After 28 days of aging, the moisture and shear force for loins from steers and cows were reduced compared with those of non-aged meat (P < 0.05). Cooking loss was reduced by dry aging. Regardless of aging method and gender, aging decreased inosine-5ʹ-monophosphate content but increased FAA content (P < 0.05). Dry aging increased glutamic acid content in meat, and aging the meat of steer increased the content of aspartic acid and glutamic acid (P < 0.05). Before aging, sensory scores for juiciness, tenderness, flavour, and overall acceptance between cow and steer were significantly different (P < 0.05), but the differences disappeared after aging. Therefore, the quality of lower grade meat from 4-year-old cows is comparable to that of meat from 2-year-old steers after aging, regardless of the aging method used.
Breeding disease-resistant sunflowers.
Authors: Vear F.
Published: November 2017

The main diseases of sunflower which can be controlled by major genes are downy mildew, broomrape, rust and Verticillium wilt, whereas the crop shows quantitative resistance to
Sclerotinia
rots and wilt, phomopsis stem canker, Phoma premature ripening and black stem and Alternaria. Over the past 40 years, knowledge of the genetics of resistance to all these diseases has increased, but it is only for major gene resistance that marker-assisted selection is used routinely in breeding. Improvement of quantitative resistances still depends largely on field observations, markers are not yet used to select favourable alleles at quantitative trait loci. Genomic selection could be a means to improve quantitative resistances at a low cost, if RIL populations or core collections phenotyped in the past have been maintained.
The Woman Physician as Antidote to the Ills of Modern Medicine
Authors: Gardner Elinor
Published: November 2017

This article, drawing on the work of Edith Stein, reflects on the feminine aspects of the medical profession, specifically attention to the whole person and personal accompaniment. It presents these feminine aspects, in light of the mechanistic, highly specialized, and often impersonal ethos of modern medicine, as a needed corrective to such an ethos. Finally, this thesis is illustrated with an example from physician Victoria Sweet.
Catholic Social Teaching and America's Suboptimal Breastfeeding Rate: Where Faith and Policy Should Meet to Combat Injustice
Authors: Stark Grace Emily
Published: November 2017

Despite the numerous health benefits of breastfeeding, few American women breastfeed for the optimal duration of time. Reasons given for not following national and global institutional breastfeeding recommendations are various and multi-faceted. However, for many American women who would like to breastfeed, unjust historical, social, economic, cultural, and environmental factors negatively impact their ability to breastfeed. Catholic social teaching seeks to protect the poor and the vulnerable by working for social and economic justice, encourages stewardship of the environment, and uplifts the family as the most important unit in society. As such, Catholic social teaching has clear implications for individuals and institutions seeking to make breastfeeding a more widespread, accepted practice. In response to the crisis in American rates of breastfeeding, American Catholic healthcare institutions should work to promote the just economic and social conditions necessary for American women to breastfeed their children, starting by implementing breastfeeding-friendly policies for patients and employees in their own institutions.

For many American women who would like to breastfeed, unjust historical, social, economic, cultural, and environmental factors negatively impact their ability to breastfeed. Catholic social teaching has clear implications for individuals and institutions seeking to make breastfeeding a more widespread, accepted practice. Therefore, American Catholic healthcare institutions should work particularly hard to promote the just economic and social conditions necessary for American women to breastfeed their children, starting by implementing breastfeeding-friendly policies for patients and employees in their own institutions.
Twenty-Five Years of the Binary Power Law for Characterizing Heterogeneity of Disease Incidence
Authors: Madden L. V. , Hughes G. , Moraes W. Bucker , Xu X.-M. , Turechek W. W.
Published: November 2017

Spatial pattern, an important epidemiological property of plant diseases, can be quantified at different scales using a range of methods. The spatial heterogeneity (or overdispersion) of disease incidence among sampling units is an especially important measure of small-scale pattern. As an alternative to Taylor’s power law for the heterogeneity of counts with no upper bound, the binary power law (BPL) was proposed in 1992 as a model to represent the heterogeneity of disease incidence (number of plant units diseased out of n observed in each sampling unit, or the proportion diseased in each sampling unit). With the BPL, the log of the observed variance is a linear function of the log of the variance for a binomial (i.e., random) distribution. Over the last quarter century, the BPL has contributed to both theory and multiple applications in the study of heterogeneity of disease incidence. In this article, we discuss properties of the BPL and use it to develop a general conceptualization of the dynamics of spatial heterogeneity in epidemics; review the use of the BPL in empirical and theoretical studies; present a synthesis of parameter estimates from over 200 published BPL analyses from a wide range of diseases and crops; discuss model fitting methods, and applications in sampling, data analysis, and prediction; and make recommendations on reporting results to improve interpretation. In a review of the literature, the BPL provided a very good fit to heterogeneity data in most publications. Eighty percent of estimated slope (b) values from field studies were between 1.06 and 1.51, with b positively correlated with the BPL intercept parameter. Stochastic simulations show that the BPL is generally consistent with spatiotemporal epidemiological processes and holds whenever there is a positive correlation of disease status of individuals composing sampling units.
Combined Amplification and Sound Generation for Tinnitus: A Scoping Review
Authors: Tutaj Lindsey , Hoare Derek J. , Sereda Magdalena
Published: November 2017

Objectives:

In most cases, tinnitus is accompanied by some degree of hearing loss. Current tinnitus management guidelines recognize the importance of addressing hearing difficulties, with hearing aids being a common option. Sound therapy is the preferred mode of audiological tinnitus management in many countries, including in the United Kingdom. Combination instruments provide a further option for those with an aidable hearing loss, as they combine amplification with a sound generation option. The aims of this scoping review were to catalog the existing body of evidence on combined amplification and sound generation for tinnitus and consider opportunities for further research or evidence synthesis.

Design:

A scoping review is a rigorous way to identify and review an established body of knowledge in the field for suggestive but not definitive findings and gaps in current knowledge. A wide variety of databases were used to ensure that all relevant records within the scope of this review were captured, including gray literature, conference proceedings, dissertations and theses, and peer-reviewed articles. Data were gathered using scoping review methodology and consisted of the following steps: (1) identifying potentially relevant records; (2) selecting relevant records; (3) extracting data; and (4) collating, summarizing, and reporting results.

Results:

Searches using 20 different databases covered peer-reviewed and gray literature and returned 5959 records. After exclusion of duplicates and works that were out of scope, 89 records remained for further analysis. A large number of records identified varied considerably in methodology, applied management programs, and type of devices. There were significant differences in practice between different countries and clinics regarding candidature and fitting of combination aids, partly driven by the application of different management programs.

Conclusions:

Further studies on the use and effects of combined amplification and sound generation for tinnitus are indicated, including further efficacy studies, evidence synthesis, development of guidelines, and recommended procedures that are based on existing knowledge, expert knowledge, and clinical service evaluations.
Is it ever too hot for orthopaedic trauma?
Authors: Ebersole Gregg M. , Meister Melissa , Watson J. Tracy , Cannada Lisa K.
Published: November 2017

Background:

This study evaluates the occurrence of orthopaedic trauma admissions in concordance with local weather variations. We hypothesized that the rate of orthopaedic trauma would be altered with daily temperature maximums (Tmax) that exceeded 90°F.

Methods:

Data were obtained from two level 1 trauma centers for adult trauma with Abbreviated Injury Scale-Extremity >1, and admission. The data collected from the National Weather Service included daily temperatures and precipitation.

Results:

There was an average of 4.0 admissions per day. Precipitation was not significantly related to admission. Tmax 80-89°F averaged 4.7 traumas per day, compared to Tmax 90-99°F averaging 4.9 per day. When Tmax was >100°F the rate dropped to 3.9 traumas per day, P<0.05.

Conclusions:

Orthopaedic trauma does increase during warmer days with the peak occurring in August. Precipitation had no overall effect. The incidence of trauma did increase with Tmax 80-99°F but dropped significantly when Tmax exceeded 100°F.
What Family Physicians Really Think of Maintenance of Certification Part II Activities
Authors: Brooks Edward Marshall , Gonzalez Martha , Eden Aimee R. , O'Neal Jonathan , Sabo Roy T. , Etz Rebecca S.
Published: November 2017

Introduction:

This study examines how improving curricular content and technical interface issues could make maintenance of certification activities more meaningful to American Board of Family Medicine diplomates completing Maintenance of Certification for Family Physicians (MC-FP) Program self-assessment modules (SAMs).

Methods:

We used a sequential exploratory design to analyze quantitative and qualitative data from 320,500 surveys of family physicians who completed a SAM between January 2004 and April 2013. This included numeric rating scales and free text comments. Basic statistical rankings, template-based automated coding, and emergent coding were used to analyze SAM experience and identify thematic content.

Results:

Across SAMs, numeric ratings were universally high and positive free text comments outnumbered negative comments two to one. When comparing feedback on the knowledge assessment and clinical simulation (CS) activities, SAMs were rated less favorably when the frequency of ideas identified by participants as most prevalent in one activity mismatched those identified as most prevalent in the companion activity. Participants were also critical of navigation issues, technical issues, and a lack of realness in the CS activity.

Discussion:

Whether analyzed through quantitative data, qualitative data, or mixed methods, a large majority of participants rated their experience with SAMs highly. When individual SAMs were rated poorly, it seemed to be due to discordance in ideas emphasized between the knowledge assessment and CS components, or an opinion regarding the SAM topic that existed independent of the SAM process.
Project ECHO
Authors: Arora Sanjeev , Kalishman Summers G. , Thornton Karla A. , Komaromy Miriam S. , Katzman Joanna G. , Struminger Bruce B. , Rayburn William F.
Published: November 2017

Introduction:

A major challenge with current systems of CME is the inability to translate the explosive growth in health care knowledge into daily practice. Project ECHO (Extension for Community Healthcare Outcomes) is a telementoring network designed for continuing professional development (CPD) and improving patient outcomes. The purpose of this article was to describe how the model has complied with recommendations from several authoritative reports about redesigning and enhancing CPD.

Methods:

This model links primary care clinicians through a knowledge network with an interprofessional team of specialists from an academic medical center who provide telementoring and ongoing education enabling community clinicians to treat patients with a variety of complex conditions. Knowledge and skills are shared during weekly condition-specific videoconferences.

Results:

The model exemplifies learning as described in the seven levels of CPD by Moore (participation, satisfaction, learning, competence, performance, patient, and community health). The model is also aligned with recommendations from four national reports intended to redesign knowledge transfer in improving health care. Efforts in learning sessions focus on information that is relevant to practice, focus on evidence, education methodology, tailoring of recommendations to individual needs and community resources, and interprofessionalism.

Discussion:

Project ECHO serves as a telementoring network model of CPD that aligns with current best practice recommendations for CME. This transformative initiative has the potential to serve as a leading model for larger scale CPD, nationally and globally, to enhance access to care, improve quality, and reduce cost.
Rethinking Remediation
Authors: Prescott-Clements Linda , Voller Vicky , Bell Mark , Nestors Natasha , van der Vleuten Cees P. M.
Published: November 2017

The successful remediation of clinicians demonstrating poor performance in the workplace is essential to ensure the provision of safe patient care. Clinicians may develop performance problems for numerous reasons, including health, personal factors, the workplace environment, or outdated knowledge/skills. Performance problems are often complex involving multifactorial issues, encompassing knowledge, skills, and professional behaviors. It is important that (where possible and appropriate) clinicians are supported through effective remediation to return them to safe clinical practice. A review of the literature demonstrated that research into remediation is in its infancy, with little known about the effectiveness of remediation programs currently. Current strategies for the development of remediation programs are mostly “intuitive”; a few draw upon established theories to inform their approach. Similarly, although it has been established that identification of the nature/scope of performance problems through assessment is an essential first step within remediation, the need for a more widespread “diagnosis” of why the problems exist is emerging. These reasons for poor performance, particularly in the context of experienced practicing clinicians, are likely to have an impact on the potential success of remediation and should be considered within the “diagnosis.” A new model for diagnosing the performance problems of the clinicians has been developed, using behavioral change theories to explore known barriers to successful remediation, such as insight, motivation, attitude, self-efficacy, and the working environment, in addition to addressing known deficits regarding knowledge and skills. This novel approach is described in this article. An initial feasibility study has demonstrated the acceptability and practical implementation of our model.
OUTCOME OF INTRAVITREAL AFLIBERCEPT FOR REFRACTORY PIGMENT EPITHELIAL DETACHMENT WITH OR WITHOUT SUBRETINAL FLUID AND SECONDARY TO AGE-RELATED MACULAR DEGENERATION
Authors: Kim Kiyoung , Kim Eung Suk , Kim Yonguk , Yang Ji Ho , Yu Seung-Young , Kwak Hyung Woo
Published: November 2017

Purpose:

To investigate the outcomes of intravitreal aflibercept in refractory pigment epithelial detachment (PED) with or without subretinal fluid (SRF) in patients with neovascular age-related macular degeneration.

Methods:

A prospective, nonrandomized, interventional case series involved 40 patients with persistent vascularized PED previously treated with at least 3 injections of intravitreal bevacizumab or ranibizumab. Intravitreal aflibercept was administered as 3 initial loading doses every 4 weeks, followed by pro re nata retreatment every 8 weeks over 48 weeks. Pigment epithelial detachment was classified into solid-, hollow-, or mixed-type according to the reflective properties visualized using optical coherence tomography. The mean changes in best-corrected visual acuity, central subfield thickness, and the volumes of SRF and PED were analyzed.

Results:

The PED volume (baseline: 0.43 ± 0.55 mm3) significantly reduced to 0.23 ± 0.32 mm3 at Week 8 (P = 0.003) and increased to 0.36 ± 0.41 mm3 at Week 48 (P = 0.345). The SRF volume (baseline: 0.52 ± 0.64 mm3) significantly reduced to 0.24 ± 0.43 mm3 at Week 48 (P = 0.021). The mean baseline best-corrected visual acuity was 20/75 (47.5 letters); it showed no significant difference at Week 48 (+4.4 letters; P = 0.125). The baseline central subfield thickness was 323.2 ± 92.3 μm; it significantly reduced to 281.2 ± 90.7 μm at Week 48 (P = 0.001). In solid-type PEDs, there were poorer improvements in central subfield thickness, best-corrected visual acuity, and the volumes of the SRF and PED, with newly developed intraretinal cysts.

Conclusion:

Intravitreal aflibercept in treatment-resistant neovascular age-related macular degeneration led to significant reduction in PED and SRF volume, central subfield thickness, and best-corrected visual acuity preserved, over 12 months. However, solid-type PED showed less improvement than hollow- or mixed-type PED.
Implantation of a CyPass Supraciliary Stent Combined With Targeted iStent Trabecular Microbypass Stents in a Phakic Patient With Primary Open-angle Glaucoma
Authors: Chen Kevin H. , Kim Won I.
Published: November 2017

Purpose:

To report the first successful implantation of a CyPass supraciliary stent combined with 2 targeted iStent trabecular microbypass stents in a phakic primary open-angle glaucoma patient with markedly elevated intraocular pressures (IOP) on maximum tolerable medical therapy.

Methods:

Case report.

Results:

A 52-year-old phakic male patient with primary open-angle glaucoma with uncontrolled IOP in the right eye (OD) of 36 mm Hg on maximal topical pharmacotherapy. The patient underwent implantation of a single CyPass supraciliary stent combined with the targeted implantation of 2 iStent trabecular microbypass stents, 1 right facing stent and 1 left facing stent. Postoperatively, off of all glaucoma medications, the IOP decreased to 10 mm Hg on day 1 and continued to be controlled between 10 to 13 mm Hg until postoperative month 6, with only 1 glaucoma medication added after postoperative month 5. In addition, there were no postoperative complications to date.

Conclusions:

The combined implantation of a CyPass supraciliary stent and iStent trabecular microbypass stents can successfully lower IOP and decrease medication burden with minimal risk for complications.
Is Obstructive Sleep Apnea Associated With Progressive Glaucomatous Optic Neuropathy?
Authors: Swaminathan Swarup S. , Bhakta Amitabha S. , Shi Wei , Feuer William J. , Abreu Alexandre R. , Chediak Alejandro D. , Greenfield David S.
Published: November 2017

Purpose:

The purpose of this study was to evaluate the relationship between obstructive sleep apnea syndrome (OSAS) and glaucoma progression, and to examine the correlation between OSAS severity and rate of visual field (VF) loss.

Methods:

Patients with concurrent diagnoses of open-angle glaucoma and OSAS between 2010 and 2016 were identified. Enrollment criteria consisted of glaucomatous optic neuropathy and VF loss, ≥5 reliable VFs, ≥2 years of follow-up, and polysomnography (PSG) within 12 months of final VF. PSG parameters including apnea-hypopnea index (AHI) and oxygen saturation (SpO2) were collected. Eyes were classified as “progressors” or “nonprogressors” based upon event analysis using Glaucoma Progression Analysis criteria. Two-tailed t test comparisons were performed, and correlations between rates of VF loss and PSG parameters were assessed.

Results:

A total of 141 patients with OSAS and glaucoma were identified. Twenty-five patients (age 67.9±7.6 y) with OSAS (8 mild, 8 moderate, 9 severe) were enrolled. Eleven eyes (44%) were classified as progressors, and had more severe baseline VF loss (P=0.03). Progressors and nonprogressors had nonsignificantly different (P>0.05) age (69.9±8.7 vs. 66.4±6.6 y), follow-up (4.4±0.7 vs. 4.3±1.0 y), intraocular pressure (13.1±2.8 vs. 14.9±2.5 mm Hg), mean ocular perfusion pressure (49.7±5.5 vs. 48.8±9.0 mm Hg), AHI (31.3±18.6 vs. 26.4±24.0), body-mass index (27.8±5.5 vs. 28.8±5.6), and SpO2 (94.1±1.6% vs. 94.0±1.6%). AHI was not correlated with slopes of VF mean deviation (r, −0.271; P, 0.190) or pattern standard deviation (r, 0.211; P, 0.312), and no substantial increase in risk of progression was found with increase in AHI.

Conclusions:

This study does not support a relationship between OSAS and glaucomatous progression. No correlation was observed between OSAS severity and rate of VF loss.
Effect of Oral Probiotic Streptococcus salivarius K12 on Group A Streptococcus Pharyngitis: A Pragmatic Trial in Schools
Authors: Doyle Hélène , Pierse Nevil , Tiatia Ramona , Williamson Deborah , Baker Michael , Crane Julian
Published: November 2017

Background:

The aim of this study was to examine effectiveness of oral probiotic Streptococcus salivarius K12 in preventing group A streptococcus pharyngitis in 5- to 14-year-old children at high risk of acute rheumatic fever. New Zealand has high rates of acute rheumatic fever among Māori and Pacific children. Children were already enrolled in a school-based Ministry of Health throat swabbing and treatment program. Children self-identified and reported sore throats daily and were swabbed twice weekly.

Methods:

A total of 1314 children were quasirandomized (based on odd or even birthdates) to receive either K12 (2.5 × 109 cfu per lozenge) or placebo lozenges and continued observed daily treatment (in the school week, during school time) for one school year.

Results:

A total of 801 children (61.0%) reported a sore throat on one or more occasions resulting in 2927 pharyngeal swabs. Of these swabs, 1525 (52.1%) were taken from 411 children receiving K12 and 119 (7.8%) of these were positive for group A streptococcus on routine culture. In addition, 1402 (47.8%) swabs were taken from 390 children receiving placebo and 124 (8.8%) were positive. Overall there was a nonsignificant 11.2% relative reduction in positive swabs among children receiving K12. This relative reduction was greater for older children, 7–9 years of age, 15.6%, and for children 10 years and older, 30.2%.

Conclusions:

S. salivarius K12 had modest nonsignificant effects on culture-positive sore throats when given at school, during the school day. Based on our pragmatic trial, the routine use of this probiotic in the prevention of pharyngitis associated with GAS detection is not supported.
Postexercise Hypotension as a Predictor for Long-Term Training-Induced Blood Pressure Reduction: A Large-Scale Randomized Controlled Trial
Authors: Wegmann Melissa , Hecksteden Anne , Poppendieck Wigand , Steffen Anke , Kraushaar Jochen , Morsch Arne , Meyer Tim
Published: November 2017

Objective:

To investigate the correlation between acute exercise effects and chronic training effects on blood pressure (BP).

Design:

Randomized, controlled training study focusing on the optimization of preventive effects of physical training.

Setting:

The study was performed in a university department.

Participants:

One hundred twenty-seven healthy, untrained subjects.

Intervention:

Subjects were divided into 4 groups: interval endurance training (IET) (n = 26, 4 × 4 min at 95% maximal heart rate), continuous endurance training (CET) (n = 23, 45 minutes at 60% heart rate reserve), strength endurance training (SET) (n = 40, 8 machine-based exercises, each 2 x 15 repetitions at the 20 repetition maximum), and control (CON) (n = 38). In the 3 training groups, subjects trained 3 times a week for 6 months, the CON group was asked to retain their sedentary lifestyle.

Main Outcome Measures:

The acute exercise effect on BP was defined as the change of BP after an exhaustive stage test, compared with baseline. The chronic training effect on BP was determined as the change of resting BP after the 6-month training period.

Results:

For CET, a significant correlation between acute and chronic effects on systolic (r = 0.66, P = 0.001) and diastolic (r = 0.66, P = 0.001) BP was observed. For SET, a significant correlation (r = 0.45, P = 0.007) was found only for diastolic BP. No significant correlations were found for IET.

Conclusions:

It can be assumed that postexercise hypotension is an easy-to-use predictor for the efficacy of CET to reduce BP, and may be a valuable tool for physicians to individualize prescribed training schedules for patients to reduce cardiovascular risk.

Trial Registration:

www.clinicaltrials.gov; ID: NCT01263522.
Influence of Postconcussion Sleep Duration on Concussion Recovery in Collegiate Athletes
Authors: Hoffman Nicole L. , Weber Michelle L. , Broglio Steven P. , McCrea Michael , McAllister Thomas W. , Schmidt Julianne D. ,   CARE Consortium Investigators
Published: November 2017

Objective:

To determine whether decreased sleep duration postconcussion influences days to asymptomatic and assessment of performance throughout recovery.

Design:

Prospective.

Setting:

Institutional Clinical Research Laboratory.

Patients:

Four hundred twenty-three collegiate athletes were diagnosed with concussion.

Interventions:

Multidimensional concussion assessment battery was conducted at baseline, within 24 to 48 hours, daily [2-4 days postinjury (PI); symptoms only], once asymptomatic, and after return-to-play. The battery included the following: 22-item symptom checklist, Standardized Assessment of Concussion (SAC), Balance Error Scoring System (BESS), and computerized neurocognitive test [Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT)].

Main Outcome Measures:

We subtracted baseline sleep duration from 24 to 48 hours postconcussion sleep duration and categorized athletes into the following groups: shorter sleep (≤−1 hour), no change (>−1 hour, <+1 hour), and longer sleep (≥+1 hour). A 1-way analysis of variance (ANOVA) was conducted to compare days to asymptomatic and separate mixed-model ANOVAs to compare total symptom scores, SAC total scores, BESS total error scores, and ImPACT composite scores between sleep categories across time points (α = 0.05).

Results:

Sleep groups did not differ in days to asymptomatic. The shorter sleep group had greater symptom severity than no sleep change and longer sleep groups at 24 to 48 hours (shorter: 39.1 ± 20.7; no change: 25.1 ± 18.4,P= 0.007; longer: 25.7 ± 21.8,P= 0.004), and at 2 to 4 days PI (shorter: 21.8 ± 21.8; no change: 10.5 ± 10.8,P= 0.013; longer: 11.9 ± 14.2,P= 0.007), but did not differ at other time points (ie, asymptomatic and return-to-play). Participants with shorter sleep exhibited slower ImPACT reaction times at 24 to 48 hours (shorter: 0.68 ± 0.14; no change: 0.61 ± 0.09,P= 0.016; and longer: 0.62 ± 0.12,P= 0.028) and asymptomatic time points (shorter: 0.62 ± 0.11; no change: 0.56 ± 0.05;P= 0.015).

Conclusion:

Postinjury sleep declines may be associated with symptom severity and worsened reaction time during initial stages of recovery or may be the result of the concussion itself. Clinicians should be aware of alterations in sleep duration and manage appropriately to mitigate initial symptom burden postconcussion.
Impact of CrossFit-Related Spinal Injuries
Authors: Hopkins Benjamin S. , Cloney Michael B. , Kesavabhotla Kartik , Yamaguchi Jonathon , Smith Zachary A. , Koski Tyler R. , Hsu Wellington K. , Dahdaleh Nader S.
Published: November 2017

Introduction:

Exercise-related injuries (ERIs) are a common cause of nonfatal emergency department and hospital visits. CrossFit is a high-intensity workout regimen whose popularity has grown rapidly. However, ERIs due to CrossFit remained under investigated.

Methods:

All patients who presented to the main hospital at a major academic center complaining of an injury sustained performing CrossFit between June 2010 and June 2016 were identified. Injuries were classified by anatomical location (eg, knee, spine). For patients with spinal injuries, data were collected including age, sex, body mass index (BMI), CrossFit experience level, symptom duration, type of symptoms, type of clinic presentation, cause of injury, objective neurological examination findings, imaging type, number of clinic visits, and treatments prescribed.

Results:

Four hundred ninety-eight patients with 523 CrossFit-related injuries were identified. Spine injuries were the most common injuries identified, accounting for 20.9%. Among spine injuries, the most common location of injury was the lumbar spine (83.1%). Average symptom duration was 6.4 months ± 15.1, and radicular complaints were the most common symptom (53%). A total of 30 (32%) patients had positive findings on neurologic examination. Six patients (6.7%) required surgical intervention for treatment after failing an average of 9.66 months of conservative treatment. There was no difference in age, sex, BMI, or duration of symptoms of patients requiring surgery with those who did not.

Conclusions:

CrossFit is a popular, high-intensity style workout with the potential to injure its participants. Spine injuries were the most common type of injury observed and frequently required surgical intervention.