bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhanced energy density with a wide thermal stability in epitaxial Pb0.92La0.08Zr0.52Ti0.48O3 thin films
Authors: Hu Guangliang , Ma Chunrui , Wei Wei , Sun Zixiong , Lu Lu , Mi Shao-Bo , Liu Ming , Ma Beihai , Wu Judy , Jia Chun-lin
Published: November 2016

High-quality epitaxial Pb0.92La0.08Zr0.52Ti0.48O3 (PLZT) films of thickness of ∼880 nm were fabricated using pulsed laser deposition on (001) Nb doped SrTiO3 (Nb:STO) substrates. Besides a confirmation of the epitaxial relationship [100]PLZT//[100]Nb:STO and (001)PLZT//(001)Nb:STO using X-ray diffraction, a transmission electron microscopy study has revealed a columnar structure across the film thickness. The recoverable energy density (Wrec) of the epitaxial PLZT thin film capacitors increases linearly with the applied electric field and the best value of ∼31 J/cm3 observed at 2.27 MV/cm is considerably higher by 41% than that of the polycrystalline PLZT film of a comparable thickness. In addition to the high Wrec value, an excellent thermal stability as illustrated in a negligible temperature dependence of the Wrec in the temperature range from room temperature to 180 °C is achieved. The enhanced Wrec and the thermal stability are attributed to the reduced defects and grain boundaries in epitaxial PLZT thin films, making them promising for energy storage applications that require both high energy density, power density, and wide operation temperatures.
Atomization and merging of two Al and W wires driven by a 1 kA, 10 ns current pulse
Authors: Wu Jian , Li Xingwen , Lu Yihan , Lebedev S. V. , Yang Zefeng , Jia Shenli , Qiu Aici
Published: November 2016

Possibility of preconditioning of wires in wire array Z-pinch loads by an auxiliary low-level current pulse was investigated in experiments with two aluminum or two polyimide-coated tungsten wires. It was found that the application of a 1 kA, 10 ns current pulse could convert all the length of the Al wires (1 cm long, 15 μm diameter) and ∼70% of length of the W wires (1 cm long, 15 μm diameter, 2 μm polyimide coating) into a gaseous state via ohmic heating. The expansion and merging of the wires, positioned at separations of 1–3 mm, were investigated with two-wavelength (532 nm and 1064 nm) laser interferometry. The gasified wire expanded freely in a vacuum and its density distribution at different times could be well described using an analytic model for the expansion of the gas into vacuum. Under an energy deposition around its atomization enthalpy of the wire material, the aluminum vapor column had an expansion velocity of 5–7 km/s, larger than the value of ∼4 km/s from tungsten wires. The dynamic atomic polarizabilities of tungsten for 532 nm and 1064 nm were also estimated.
Role of film stoichiometry and interface quality in the performance of (Ba,Sr)TiO3 tunable capacitors with high figures of merit
Authors: Freeze Christopher R. , Stemmer Susanne
Published: November 2016

Parallel plate capacitors with quality factors exceeding 1000 were fabricated using Ba0.3Sr0.7TiO3 (BST) thin films grown by hybrid molecular beam epitaxy on epitaxial Pt bottom electrodes. The influence of film stoichiometry was investigated by varying the (Ba + Sr)/Ti ratio around the stoichiometric composition. The quality factor is highest for stoichiometric films, but (Ba + Sr)-rich films can be biased to higher fields. Furthermore, two different processes were used to deposit the top electrodes of the parallel plate capacitors. While the quality of the top contact/BST interface did not strongly affect the device quality factor, an enhancement in the dielectric tunability was seen for capacitors with top electrodes deposited at high temperatures, which effectively removes interfacial contamination layers.
Reversible tuning of two-dimensional electron gases in oxide heterostructures by chemical surface modification
Authors: Lee H. , Campbell N. , Ryu S. , Chang W. , Irwin J. , Lindemann S. , Mahanthappa M. K. , Rzchowski M. S. , Eom C. B.
Published: November 2016

Reversible control over the electrical properties of the two-dimensional electron gas (2DEG) in oxide heterostructures is a key capability enabling practical applications. Herein, we report an efficient method to reversibly tune the charge carrier density of the 2DEG by surface modification. We demonstrate both increasing and decreasing the carrier density of the LaAlO3/SrTiO3 2DEG interface via application of functional phosphonic acids with molecular dipoles pointing either toward or away from the interface, respectively. In addition, in the case of the enhanced 2DEG, we recovered the initial conduction properties by exposing the samples to a basic solution. The tuning processes were highly reversible over repetitive cycles. These results reveal that the surface modification is an efficient way to tune the carrier density of 2DEG in oxide heterostructures. This simple chemical approach offers a vast range of fabrication possibilities in versatile electronic device applications.
Tunnel magnetoresistance in epitaxial (100)-oriented FeCo/LiF/FeCo magnetic tunnel junctions
Authors: Xue Qian , Yang Yihang , Gao Zhiwei , Liu Fen , Li Qiang , Li Shandong , Miao Guo-Xing
Published: November 2016

We fabricated fully epitaxial magnetic tunnel junctions with LiF tunnel barriers on Si (100) substrates with high-vacuum electron-beam deposition. By changing the thickness of the LiF barrier, tunnel magnetoresistance of up to 90% at 77 K (17% at room temperature) was observed at tLiF = 2.8 nm. The magnetoresistance ratio as a function of the LiF barrier thickness shows a similar trend with that in magnetic tunnel junctions using epitaxial MgO barriers. There is a rapid decrease of the magnetoresistance ratio with increasing bias-voltage and temperature, indicating the presence of imperfections in the LiF barriers.
Enhanced electrical conductivity and diluted Ir4+ spin orders in electron doped iridates Sr2–xGaxIrO4
Authors: Han Tao , Wang Yongjian , Yang Jun , He Lei , Xu Junmin , Liang Dandan , Han Hui , Ge M. , Xi C. Y. , Zhu W. K. , Zhang Changjin , Zhang Yuheng
Published: November 2016

Sr2IrO4 represents a fascinating system to study comparable electronic correlations and spin-orbit couplings, and recently attracts considerable attention in high-temperature superconductivity. Here, we report on the transport and magnetic properties in gallium-doped Sr2IrO4. A metallic state is discovered when doping x is over 0.1, which could be understood in terms of the quickly decreased energy gap and increased carrier concentration. In addition to the high-temperature magnetic transition (TC > 200 K), a low-temperature one (TC′) is also observed for the x = 0.05–0.10 samples. Both of the magnetic states are found to be canted antiferromagnetism. The low-temperature phase is strongly depressed by doping and vanishes when doping is further increased, which is probably stabilized by the long-way exchange interactions of diluted Ir4+ spins via Ir3+ ions. Our studies provide an insight into the electrical and magnetic states tuned by chemical doping in Sr2IrO4, thereby facilitating the seeking of superconductivity in this system.
Nonlinear stability in the transport of intense bunched beams
Authors: Corrêa da Silva Thales M. , Rizzato Felipe B. , Pakter Renato , Levin Yan
Published: November 2016

The paper investigates the nonlinear coupling of envelope modes of oscillation for intense bunched beams. Initially, the analysis concentrates on the case of spherically symmetric beams for which longitudinal and transverse focusing forces are assumed to be the same. It is investigated how externally induced spherically symmetric breathing oscillations may nonlinearly drive the growth of ellipsoidal modes which can break the spherical beam symmetry. Next, a more general case in which the focusing forces are not symmetric such that the matched beam already presents an ellipsoidal shape is studied. It is found that depending on the parameters of the system, even a very small mismatch amplitude can drive an instability, which leads to an effective coupling of longitudinal and transversal envelope oscillations by means of the space-charge forces. Use is made of Poincaré plots and the stability index of periodic orbits to perform a detailed analysis of the location of the instability in the parameter space and how it affects the beam transport. Self-consistent numerical simulations are performed in order to verify the onset of the nonlinear instability and its effect on the evolution of the RMS size and emittance of the beam.
Cross-linking reveals laminin coiled-coil architecture
Authors: Armony Gad , Jacob Etai , Moran Toot , Levin Yishai , Mehlman Tevie , Levy Yaakov , Fass Deborah
Published: November 2016

Significance

Large, fibrous, and flexible extracellular matrix proteins are integral to development and maintenance of tissues in the body. Laminin is an extracellular matrix component that provides a physical substrate for cell adhesion and induces signaling pathways that maintain cell health and functionality. Despite the physiological importance of laminin, major gaps remain in our understanding of how its three subunits come together to form the characteristic cross-shaped laminin structure. Laminin was treated with chemicals that link amino acids close in space, providing a map of the subunit arrangement and correcting previous suppositions made on the basis of amino acid sequence inspection alone.
Highly selective inhibition of myosin motors provides the basis of potential therapeutic application
Authors: Sirigu Serena , Hartman James J. , Planelles-Herrero Vicente José , Ropars Virginie , Clancy Sheila , Wang Xi , Chuang Grace , Qian Xiangping , Lu Pu-Ping , Barrett Edward , Rudolph Karin , Royer Christopher , Morgan Bradley P. , Stura Enrico A. , Malik Fady I. , Houdusse Anne M.
Published: November 2016

Significance

Defects in myosin function are linked to a number of widespread and debilitating diseases, including asthma, chronic obstructive pulmonary disease, and hypertrophic cardiomyopathy. We report here the discovery of an allosteric site that modulates myosin motor function with high specificity that opens the path toward new therapeutic solutions. Identification of specific antimyosin drugs that significantly alter a motor’s function is an imperative first step toward the development of targeted and effective treatments for such diseases. Highly specific drugs against different members of the superfamily would also provide exquisite tools to investigate in cells their functional role. Additionally, detailed, high-resolution studies of the interaction of drugs with their myosin targets provide insights into the molecular mechanism of motor function.
Control of inflammation by stromal Hedgehog pathway activation restrains colitis
Authors: Lee John J. , Rothenberg Michael E. , Seeley E. Scott , Zimdahl Bryan , Kawano Sally , Lu Wan-Jin , Shin Kunyoo , Sakata-Kato Tomoyo , Chen James K. , Diehn Maximilian , Clarke Michael F. , Beachy Philip A.
Published: November 2016

Significance

Inflammatory bowel disease (IBD) is a debilitating disorder with limited treatment options. Here, we report that manipulation of Hedgehog (Hh) pathway signaling affects disease severity in the well-established dextran sulfate mouse model of colitis. Genetic and pharmacologic manipulations that decrease Hh pathway signaling in the colon worsen colitis. Conversely, manipulations that increase Hh pathway signaling ameliorate colitis. We find that Hh pathway stimulation exerts its effects partially through increased expression of the antiinflammatory cytokine IL-10 in Hh pathway-responsive stromal cells and concomitant increases in CD4
+
Foxp3
+
regulatory T cells in the colon. Our studies suggest that pharmacologic Hh pathway stimulation in colonic stromal cells may be a strategy to treat IBD.
Phase diagram and thermal expansion measurements on the system URu

2−
x

Fe

x

Si
2
Authors: Ran Sheng , Wolowiec Christian T. , Jeon Inho , Pouse Naveen , Kanchanavatee Noravee , White Benjamin D. , Huang Kevin , Martien Dinesh , DaPron Tyler , Snow David , Williamsen Mark , Spagna Stefano , Riseborough Peter S. , Maple M. Brian
Published: November 2016

Significance

The identity of the order parameter of the hidden-order (HO) phase in the heavy fermion compound URu
2
Si
2
remains a long-standing mystery. The HO phase is intimately related to the large-moment antiferromagnetic (LMAFM) phase that is induced under pressure. Although these two phases presumably have distinct order parameters, their transport and thermodynamic properties are nearly indistinguishable. The measurements reported herein reveal that the HO and LMAFM phase transitions are manifested differently in the uniaxial thermal expansion coefficients and uniaxial pressure derivatives of the transition temperature. These results suggest that an itinerant effective model should include band states of different orbital and magnetic characters, if it is to describe the differing responses of the competing ordered phases to uniaxial pressure.
More Landscape, Less Language: Digital Gaming, Moral Panic, and the Linguistic Landscapes of Southern Peru
Authors: Smith Benjamin
Published: November 2016

In this article, I offer an account of the “linguistic landscapes” associated with the commodification and purchase of internet services in southern Peru. Through an account of public signage deployed by internet lounges in this area as well as the ideologies that make sense of it, the analysis reveals one of the ways in which moral panic over digital gaming gets semiotically mediated. To do this, the article develops a theoretical machinery that makes sense of the ways in which public signs—relative to their infrastructural contexts—come to project channels for their uptake. When these relationships are considered relative to the ideologies that target them, what gets revealed are the moral contours of Southern Peruvian public life. The analysis ultimately shows how the concept “linguistic landscape” can be useful for the semiotic study of infrastructure as well as the forms of the public life that it helps to mediate.
A Field Guide for the Review Process: Writing and Responding to Peer Reviews
Authors: Bagchi Rajesh , Block Lauren , Hamilton Rebecca W , Ozanne Julie L
Published: November 2016

The peer review process––both writing reviews for academic journals and responding to reviews of one’s own work––is fundamental to building scientific knowledge. In this article, we explain why you should invest time reviewing, how to write a constructive review, and how to respond effectively to reviews of your own work.
Burden of Healthcare-Associated Viral Respiratory Infections in Children’s Hospitals
Authors: Quach Caroline , Shah Rita , Rubin Lorry G
Published: November 2016

Objective

Although healthcare-associated (HA) viral respiratory infections (VRIs) are common in pediatrics, no benchmark for comparison exists. We aimed to determine, compare, and assess determinants of unit-specific HA-VRI incidence rates in 2 children’s hospitals.

Methods

This study was a retrospective comparison of prospective cohorts. The Montreal Children’s Hospital and the Cohen Children’s Medical Center of New York perform prospective surveillance for HA-VRI using standardized definitions that require the presence of symptoms compatible with VRI and virus detection. Cases detected between April 1, 2010, and March 31, 2013, were identified using surveillance databases. Annual incidence rates were calculated, and a generalized estimating equation model was used to assess determinants of HA-VRI rates.

Results

The overall HA-VRI rate during the 3-year study period was significantly higher at Montreal Children’s Hospital than that at Cohen Children’s Medical Center of New York (1.91 vs 0.80 per 1000 patient-days, respectively;P < .0001). Overall, the HA-VRI incidence rate was lowest in the neonatal intensive care unit. Rates in the pediatric intensive care, oncology, and medical/surgical units were similar. The most common etiology of HA-VRI at both institutions was rhinovirus (49% of cases), followed by parainfluenza virus and respiratory syncytial virus. Hospitals with less than 50% single rooms had HA-VRI rates 1.33 (95% confidence interval, 1.29–1.37) times higher than hospitals with more than 50% single rooms for a given unit type.

Conclusions

HA-VRI rates were substantial but different among 2 children’s hospitals. Future studies should examine the effect of HA-VRI and evaluate best practices for preventing such infections.
Evaluation of pseudoprogression in patients with glioblastoma
Authors: Kucharczyk Michael Jonathan , Parpia Sameer , Whitton Anthony , Greenspoon Jeffrey Noah
Published: November 2016

Background.

Management of glioblastoma is complicated by pseudoprogression, a radiological phenomenon mimicking progression. This retrospective cohort study investigated the incidence, prognostic implications, and most clinically appropriate definition of pseudoprogression.

Methods.

Consecutive glioblastoma patients treated at the Juravinski Hospital and Cancer Centre, Hamilton, Ontario between 2004 and 2012 with temozolomide chemoradiotherapy and with contrast-enhanced MRI at standard imaging intervals were included. At each imaging interval, patient responses as per the RECIST (Response Evaluation Criteria in Solid Tumors), MacDonald, and RANO (Response Assessment in Neuro-Oncology) criteria were reported. Based on each set of criteria, subjects were classified as having disease response, stable disease, pseudoprogression, or true progression. The primary outcome was overall survival.

Results.

The incidence of pseudoprogression among 130 glioblastoma patients treated with chemoradiotherapy was 15%, 19%, and 23% as defined by RANO, MacDonald, and RECIST criteria, respectively. Using the RANO definition, median survival for patients with pseudoprogression was 13.0 months compared with 12.5 months for patients with stable disease (hazard ratio [HR]=0.70; 95% confidence interval [CI], 0.35–1.42). Similarly, using the MacDonald definition, median survival for the pseudoprogression group was 11.8 months compared with 12.0 months for the stable disease group (HR=0.86; 95% CI, 0.47–1.58). Furthermore, disease response compared with stable disease was also similar using the RANO (HR=0.52; 95% CI, 0.20–1.35) and MacDonald (HR=0.51: 95% CI, 0.20–1.31) definitions.

Conclusions.

Of all conventional glioblastoma response criteria, the RANO criteria gave the lowest incidence of pseudoprogression. Regardless of criteria, patients with pseudoprogression did not have statistically significant difference in survival compared with patients with stable disease.
Current Status of Neuromuscular Reversal and Monitoring
Authors: Brull Sorin J. , Kopman Aaron F.
Published: November 2016

Postoperative residual neuromuscular block has been recognized as a potential problem for decades, and it remains so today. Traditional pharmacologic antagonists (anticholinesterases) are ineffective in reversing profound and deep levels of neuromuscular block; at the opposite end of the recovery curve close to full recovery, anticholinesterases may induce paradoxical muscle weakness. The new selective relaxant-binding agent sugammadex can reverse any depth of block from aminosteroid (but not benzylisoquinolinium) relaxants; however, the effective dose to be administered should be chosen based on objective monitoring of the depth of neuromuscular block.

To guide appropriate perioperative management, neuromuscular function assessment with a peripheral nerve stimulator is mandatory. Although in many settings, subjective (visual and tactile) evaluation of muscle responses is used, such evaluation has had limited success in preventing the occurrence of residual paralysis. Clinical evaluations of return of muscle strength (head lift and grip strength) or respiratory parameters (tidal volume and vital capacity) are equally insensitive at detecting neuromuscular weakness. Objective measurement (a train-of-four ratio greater than 0.90) is the only method to determine appropriate timing of tracheal extubation and ensure normal muscle function and patient safety.
Neonatal Sevoflurane Exposure Induces Adulthood Fear-induced Learning Disability and Decreases Glutamatergic Neurons in the Basolateral Amygdala
Authors: Satomoto Maiko , Sun Zhongliang , Adachi Yushi U. , Makita Koshi
Published: November 2016

Background:

Neonatal mice exposed to sevoflurane show certain cognitive and behavioral impairments in adulthood. However, the mechanisms underlying long-term cognitive deficits induced by sevoflurane exposure remain unknown. The present study was performed to investigate whether there is differential neuronal activation between naive mice and sevoflurane-exposed neonates in fear-conditioning tests based on immediate early gene (c-Fos) expression.

Methods:

Male mice were exposed to 3% sevoflurane (SEVO group) or carrier gas alone (no anesthesia, NA group) for 6 hours on postnatal day 6. The mice were allowed to mature before performing the contextual fear-conditioning test. A reduced freezing response was confirmed in the SEVO group. Neural activation in the regions of the medial prefrontal cortex, hippocampus, and amygdala was investigated using c-Fos immunostaining 2 hours after the test. The types of neurons activated were also identified.

Results:

The number of c-Fos-positive cells decreased by 27% in the basolateral amygdala in the SEVO group, while no significant changes were observed in other regions. Furthermore, glutamatergic, but not γ-aminobutyric acid (GABA)ergic, neurons expressed c-Fos after the contextual fear-conditioning test in both groups. The number of glutamatergic neurons in the basolateral amygdala in the SEVO group was reduced by 27%.

Conclusions:

Decreased neural activation in the basolateral amygdala may be associated with reduced freezing time in neonatal sevoflurane-exposed mice. Fewer glutamatergic neurons responding to fear stimuli in the basolateral amygdala may contribute to decreased neural activation and learning deficits in mice exposed to sevoflurane as neonates.
Effects of Simulation With Problem-Based Learning Program on Metacognition, Team Efficacy, and Learning Attitude in Nursing Students
Authors: Lee Myung-Nam , Nam Kyung-Dong , Kim Hyeon-Young
Published: November 2016

Nursing care for patients with central nervous system problems requires advanced professional knowledge and care skills. Nursing students are more likely to have difficulty in dealing with adult patients who have severe neurological problems in clinical practice. This study investigated the effect on the metacognition, team efficacy, and learning attitude of nursing students after an integrated simulation and problem-based learning program. A real scenario of a patient with increased intracranial pressure was simulated for the students. The results showed that this method was effective in improving the metacognitive ability of the students. Furthermore, we used this comprehensive model of simulation with problem-based learning in order to assess the consequences of student satisfaction with the nursing major, interpersonal relationships, and importance of simulation-based education in relation to the effectiveness of the integrated simulation with problem-based learning. The results can be used to improve the design of clinical practicum and nursing education.
Developing and Implementing a Simulated Electronic Medication Administration Record for Undergraduate Nursing Education
Authors: Booth Richard G. , Sinclair Barbara , Brennan Laura , Strudwick Gillian
Published: November 2016

Knowledge and skills related to medication administration are a fundamental element of nursing education. With the increased use of electronic medication administration technology in practice settings where nurses work, nursing educators need to consider how best to implement these forms of technology into clinical simulation. This article describes the development of a simulated electronic medication administration system, including the use of sociotechnical systems theory to inform elements of the design, implementation, and testing of the system. Given the differences in the medication administration process and workflow generated by electronic medication administration technology, nursing educators should explore sociotechnical theory as a potentially informative lens from which to plan and build curricula related to simulation activities involving clinical technology.
Benefit of Radiotherapy in Extraskeletal Myxoid Chondrosarcoma
Authors: Kemmerer Eric J. , Gleeson Elizabeth , Poli Jaganmohan , Ownbey Robert T. , Brady Luther W. , Bowne Wilbur B.
Published: November 2016

Objectives:

Extraskeletal myxoid chondrosarcoma (EMC) is a rare malignancy for which the role of radiotherapy is not well-defined. We examine the effect of external beam radiotherapy (EBRT) on cancer-specific survival (CSS) for patients with localized EMC, in a propensity score weighted, population-based analysis.

Materials and Methods:

The Surveillance, Epidemiology, and End Results database (1973 to 2012) was queried for cases of localized EMC arising from soft connective tissues of the trunk and extremities treated with surgery and/or EBRT. Inverse probability treatment weighting was utilized, with survival analysis by weighted Cox regression and Kaplan-Meier analysis with log-rank testing. The primary endpoint was CSS.

Results:

One hundred seventy-two patients were identified, diagnosed from 2004 to 2012. Ninety-four percent and 32% of 156 assessable patients underwent surgery and EBRT, respectively. By inverse probability treatment weighting, balancing covariates of age group, sex, race, grade, T stage, N stage, receipt of surgery, and anatomic site, we observed CSS of 97% versus 85% and 94% versus 85% in patients receiving EBRT versus no EBRT, at 3 and 5 years, respectively, at median follow-up of 33 months, P=0.01. A trend toward an overall survival benefit associated with EBRT was noted, P=0.06. Further adjusting for type of resection performed, CSS benefit persisted, 97% versus 85% at 3 years and 94% versus 85% at 5 years, P=0.02, with trend toward an overall survival benefit, P=0.08.

Conclusions:

The receipt of EBRT is associated with a CSS benefit in localized EMC. Aggressive local therapy, including EBRT, should be considered in these patients.
Outcome After Surgery for Extremity Soft Tissue Sarcoma in Patients Presenting With Metastasis at Diagnosis
Authors: Krishnan Chandra K. , Kim Han-Soo , Park Jong Woong , Han Ilkyu
Published: November 2016

Objectives:

About 10% of patients present with metastasis at diagnosis in extremity soft tissue sarcoma (STS). Although the prognoses of these patients is generally poor, prolonged survival has been demonstrated in some patients. Thus, better prognostication is needed to guide decisions regarding adjuvant therapy and surveillance. This study sought to analyze the survival and to identify clinicopathologic factors associated with survival in extremity STS patients presenting with metastasis at diagnosis.

Materials and Methods:

Review of 43 patients presenting with metastasis at diagnosis who underwent resection of the primary tumor was performed. Patient, tumor, and treatment-related factors were analyzed for possible prognostic effect on survival.

Results:

The median survival of all patients was 22±4.1 months. The 2- and 5-year survival rates were 45.6% and 18.0%, respectively. In univariate analysis, tumor location in lower extremity (P=0.041) and the performance of metastasectomy (P=0.001) were significantly associated with better survival. In multivariate analysis, only the performance of metastasectomy remained significant (hazard ratio=3.8,P=0.012). The median survival of patients who underwent metastasectomy was significantly longer than that of patients who did not undergo metastasectomy (41±8.4 vs. 11±3.8 mo,P=0.001).

Conclusions:

Extremity STS patients who present with metastasis at diagnosis have a poor prognosis. Patients who undergo metastasectomy have a better chance for prolonged survival.
Thermal Injury to Reconstructed Breasts from Commonly Used Warming Devices: A Risk for Reconstructive Failure
Authors: Faulkner Heather R. , Colwell Amy S. , Liao Eric C. , Winograd Jonathan M. , Austen William G.
Published: November 2016

Background:

Sensation is decreased or absent after breast reconstruction. This leaves reconstructed breasts vulnerable to injury from common household thermal sources such as heating pads and hot water bottles. We sought to categorize these injuries, provide a treatment plan, and prevent these injuries in the future.

Methods:

A retrospective review of patients who had sustained burns to reconstructed breasts with household devices was performed at a single institution. A PubMed search was performed to identify and summarize articles cataloguing patients who had suffered burns to breast reconstructions.

Results:

Five patients in our practice were affected. Fifteen articles were identified in the literature search. A total of 40 patients had sustained thermal injury to reconstructed breasts, with the majority being full thickness burns (67.5%). Patients who sustained full thickness burns to reconstructed breasts were more likely to require an operative procedure compared with patients who sustained partial thickness burns (P = 0.0076).

Conclusions:

Reconstructed breasts are at risk for injury from commonly used household warming devices and ambient heat from the sun. As a result, patients should be counseled about these risks accordingly, to avoid injury or loss of reconstruction. These injuries require immediate vigilant treatment.
Differences in work environment for staff as an explanation for variation in central line bundle compliance in intensive care units
Authors: Lee Yuna S.H. , Stone Patricia W. , Pogorzelska-Maziarz Monika , Nembhard Ingrid M.
Published: November 2016

Background:

Central line-associated bloodstream infections (CLABSIs) are a common and costly quality problem, and their prevention is a national priority. A decade ago, researchers identified an evidence-based bundle of practices that reduce CLABSIs. Compliance with this bundle remains low in many hospitals.

Purpose:

The aim of this study was to assess whether differences in core aspects of work environments—workload, quality of relationships, and prioritization of quality—are associated with variation in maximal CLABSI bundle compliance, that is, compliance 95%–100% of the time in intensive care units (ICUs).

Methodology/Approach:

A cross-sectional study of hospital medical-surgical ICUs in the United States was done. Data on work environment and bundle compliance were obtained from the Prevention of Nosocomial Infections and Cost-Effectiveness Refined Survey completed in 2011 by infection prevention directors, and data on ICU and hospital characteristics were obtained from the National Healthcare Safety Network. Factor and multilevel regression analyses were conducted.

Findings:

Reasonable workload and prioritization of quality were positively associated with maximal CLABSI bundle compliance. High-quality relationships, although a significant predictor when evaluated apart from workload and prioritization of quality, had no significant effect after accounting for these two factors.

Practice Implications:

Aspects of the staff work environment are associated with maximal CLABSI bundle compliance in ICUs. Our results suggest that hospitals can foster improvement in ensuring maximal CLABSI bundle compliance—a crucial precursor to reducing CLABSI infection rates—by establishing reasonable workloads and prioritizing quality.
The Relations of Self-Reported Aggression to Alexithymia, Depression, and Anxiety After Traumatic Brain Injury
Authors: Neumann Dawn , Malec James F. , Hammond Flora M.
Published: November 2016

Objectives:

To compare self-reported aggression in people with and without traumatic brain injury (TBI) and examine the relations of aggression to alexithymia (poor emotional insight), depression, and anxiety.

Setting:

Rehabilitation hospital.

Participants:

Forty-six adults with moderate to severe TBI who were at least 3 months postinjury; 49 healthy controls (HCs); groups were frequency matched for age and gender.

Design:

Cross-sectional study using a quasi-experimental design.

Main Measures:

Aggression (Buss-Perry Aggression Questionnaire); alexithymia (Toronto Alexithymia Scale-20); depression (Patient Health Questionnaire-9); and trait anxiety (State-Trait Anxiety Inventory).

Results:

Participants with TBI had significantly higher aggression scores than HCs. For participants with TBI, 34.2% of the adjusted variance of aggression was significantly explained by alexithymia, depression, and anxiety; alexithymia accounted for the largest unique portion of the variance in this model (16.2%). Alexithymia, depression, and anxiety explained 46% of the adjusted variance of aggression in HCs; in contrast to participants with TBI, depression was the largest unique contributor to aggression (15.9%).

Conclusion:

This was the first empirical study showing that poor emotional insight (alexithymia) significantly contributes to aggression after TBI. This relation, and the potential clinical implications it may have for the treatment of aggression, warrants further investigation.
A Survey of Clinicians Working in Brain Injury Rehabilitation: Are Social Cognition Impairments on the Radar?
Authors: Kelly Michelle , McDonald Skye , Frith Matthew H. J.
Published: November 2016

Objectives:

To examine the social cognition assessment practices of clinicians working with children and adults with traumatic brain injury.

Main Measures:

Online survey addressing frequency of social cognition impairments, how these are assessed and obstacles to same, and treatment practices.

Participants:

A total of 443 clinicians worldwide working in inpatient and outpatient settings.

Results:

While 84% of clinicians reported that more than half of their clients with severe traumatic brain injury had social cognition impairments, 78% of these reported that they infrequently or never assessed these domains using a formal assessment tool. Lack of reliable tests was most frequently (33% of respondents) cited as the greatest barrier to undertaking social cognition assessment.

Conclusions and Implications:

Improvements are needed in the development and norming of instruments capable of detecting social cognition impairments in the traumatic brain injury population. Additional training and education is needed in the use of social cognition assessment tools.
A Pilot Study to Evaluate the Oral Microbiome and Dental Health in Primary Open-Angle Glaucoma
Authors: Polla Daniel , Astafurov Konstantin , Hawy Eman , Hyman Leslie , Hou Wei , Danias John
Published: November 2016

Purpose:

To evaluate possible associations between primary open-angle glaucoma (POAG), dental health, and the oral microbiome.

Methods:

Case-control study was conducted at SUNY Downstate. Adult subjects (40 to 87 y) were recruited as POAG cases (n=119) and controls without glaucoma (n=78) based on visual field and optic nerve criteria. Overall 74.6% were African Americans (AA). Information on medical history and oral health was collected and ophthalmologic examinations were performed. Mouthwash specimens (28 AA cases and 17 controls) were analyzed for bacterial DNA amounts. Analyses were limited to AAs as the predominant racial group. Outcome measures included number of natural teeth, self-reported periodontal health parameters, and amounts and prevalence of oral bacterial species. Logistic regression was used to evaluate associated factors and potential interactions.

Results:

Cases and controls had similar age (mean: 62.2 and 60.9 y, respectively, P>0.48), and frequency of hypertension, diabetes, but cases had a higher proportion of men (P<0.04). On average (±SD), cases had fewer natural teeth than controls [18.0 (±11.1) vs. 20.7 (±9.4)]. Having more natural teeth was inversely associated with POAG, in multivariable analyses, at older ages [eg, odds ratio (95% confidence interval) at age 55: 1.0 (0.95-1.06), P=0.98 vs. at age 85: 0.87 (0.79-0.96), P=0.007]. Amounts of Streptococci were higher in cases than controls (P<0.03) in samples from the subset of subjects analyzed.

Conclusions:

The number of teeth (an oral health indicator) and alterations in the amounts of oral bacteria may be associated with glaucoma pathology. Further investigation of the association between dental health and glaucoma is warranted.
Inferior Macular Damage in Glaucoma: Its Relationship to Retinal Nerve Fiber Layer Defect in Macular Vulnerability Zone
Authors: Kim Young Kook , Jeoung Jin Wook , Park Ki Ho
Published: November 2016

Purpose of the Study:

The purpose of the study was to investigate the prevalence of abnormal thinning of the inferior macular ganglion cell-inner plexiform layer (mGCIPL) in glaucoma and to understand its relationship to abnormal regions of the peripapillary retinal nerve fiber layer (pRNFL), including the macular vulnerability zone (MVZ).

Patients and Methods:

We evaluated 186 eyes (186 patients) with glaucoma. An integrated deviation map was merged by superimposition of mGCIPL and pRNFL deviation maps (from a spectral-domain optical coherence tomography) onto RNFL photography as aligned by Photoshop software based on vascular landmarks. The peripapillary area was divided into 2 locations according to a previously suggested schematic model: (1) the MVZ; and (2) the inferoinferior portion.

Results:

The key findings of the topographic analysis of mGCIPL and pRNFL deviation maps were as follows: (1) 145 of 186 eyes showed inferior mGCIPL loss; (2) if a defect existed in the MVZ of the pRNFL (63 eyes), there was also an inferior mGCIPL defect; (3) however, the other 82 eyes with inferior mGCIPL abnormalities showed an abnormal mGCIPL without a corresponding pRNFL defect in the MVZ.

Conclusions:

There was no single case of pRNFL defect in the MVZ without inferior mGCIPL loss. However, there were a few cases of inferior mGCIPL loss without pRNFL defect in the MVZ. These findings signify that detection of inferior mGCIPL loss might be earlier than that of pRNFL defect in the MVZ. Therefore, pRNFL analysis of the optical coherence tomography disc cube scan alone is insufficient for detection of early-stage glaucomatous damage.
Relevance of Identifying JAG1 Mutations in Patients With Isolated Posterior Embryotoxon
Authors: Orssaud Christophe , Robert Matthieu P. , Roche Olivier
Published: November 2016

Purpose:

Although posterior embryotoxon (PE) has a high incidence in the general population, clinicians should exclude any sign of glaucoma in its presence. This anatomic abnormality is often referred to as “isolated” when the intraocular pressure is normal. Nevertheless, it may be the only sign of Alagille syndrome (AS) that can be clinically heterogenous, as presented here. This possibility must be known, to look for involvement of other organs, and in case of suspicion, mutation of the JAG1 gene must be considered.

Methods:

In this case series, we present the observation of a family with 3 individuals from 3 generations, in whom PE was a marker of AS.

Results:

PE were observed in these 3 patients and considered as “isolated” as the intraocular pressure was normal. The 2 elder patients were also followed for atypical retinal dystrophy with speckling of the retinal pigment and optic disc drusen. AS syndrome was suspected when mild liver dysfunction was detected in the youngest girl. The detection of JAG1 mutation confirmed this diagnosis.

Conclusions:

As AS can be clinically heterogenous, it must be considered in case of isolated PE. Involvement of other organs must be looked for to search for mutation of the JAG1 gene in relevant cases.
CYP1B1 Mutations in Individuals With Primary Congenital Glaucoma and Residing in Denmark
Authors: Grønskov Karen , Redó-Riveiro Alba , Sandfeld Lisbeth , Zibrandtsen Nathalie , Harris Pernille , Bach-Holm Daniella , Tümer Zeynep
Published: November 2016

Purpose of the Study:

Primary congenital glaucoma (PCG OMIM 231300) can be caused by pathogenic sequence variations in cytochrome P450, subfamily 1, polypeptide 1 (CYP1B1). The purpose of this study was to investigate the contribution of sequence variations in CYP1B1 in a cohort of individuals with PCG residing in Denmark.

Methods:

The study included 37 unrelated individuals with PCG. Individuals were investigated for CYP1B1 mutations by Sanger sequencing of polymerase chain reaction products using BigDye terminators and capillary electrophoresis.

Results:

A total of 12 mutations were identified and 5 of these were novel. Six were missense mutations; 4 were truncating mutations (2 nonsense and 2 frameshift); 1 was an in-frame deletion and 1 was an in-frame duplication. Mutations in CYP1B1 could fully explain the PCG phenotype in 7 individuals (18%). Five individuals were compound heterozygous or presumed compound heterozygous, 1 was homozygous and 1 was apparently homozygous. Three individuals were heterozygous for sequence variations in CYP1B1 thought to be pathogenic—one of these was p.(Tyr81Asn). Several known sequence variations with presumably no functional effect were found in the cohort.

Conclusions:

In this study, we identified 12 CYP1B1 mutations, 5 of which were novel. The frequency of CYP1B1 mutations in this cohort was comparable with other populations. We also detected an individual heterozygous for p.(Tyr81Asn) mutation, previously suggested to cause autosomal dominant primary open-angle glaucoma.
Improved Resident Adherence to AAA Screening Guidelines via an Electronic Reminder
Authors: Sypert David , Van Dyke Kenneth , Dhillon Namrata , Elliott John O. , Jordan Kim
Published: November 2016

The 2014 United States Preventive Services Task Force systematic review found abdominal aortic aneurysm (AAA) screening decreased related mortality by close to half. Despite the simplicity of screening, research suggests poor adherence to the recommended AAA screening guidelines. Using the quality improvement plan-study-do-act cycle, we retrospectively established poor adherence to AAA screening and poor documentation of smoking history in our resident clinic. An electronic reminder was prospectively implemented into our electronic medical record (EMR) with the goal of improving screening rates. After 1 year, a retrospective chart review was conducted. Comparisons of the pre- and post-electronic reminder intervention data were made using chi-square tests and odds ratios (OR). The purposeful AAA screening rate improved 27.8% during the intervention, 40.3% (95% confidence interval [CI]: 28.6–52.0%) versus 12.5% (95% CI: 3.1–21.9%), p = .002, suggesting patients were more likely to be screened as a result of the electronic reminder, OR = 4.73 (95% CI: 1.77–12.65). This improvement translates to a large effect size, Cohen's d = 0.86 (95% CI: 0.31–1.40). Electronic reminders are a simple EMR addition that can provide evidence-based education while improving adherence rates with preventive health screening measures.
Effective Leadership and Management of an ACS Injury Prevention Program: Current Opinions and Perspectives From Where the Rubber Meets the Road
Authors: Wolfe Elizabeth S. , Bryant Elizabeth A.
Published: November 2016

The American College of Surgeons (ACS) mandates that each verified trauma center must have an injury prevention coordinator (IPC); however, Chapter 18 in the Resources for Optimal Care of the Injured Patient (2014) provides minimal information on how to effectively lead or manage an injury prevention (IP) program. This opinion article addresses 3 fundamental components of an effective IP program: (1) construction of an innovative vision of IP programming using current technology; (2) intentional investment and involvement; and (3) stakeholder leadership, engagement, and sustainability. This article also provides leadership and management methods from other professions both within and outside of the health care field that can be translated into sustainable IP program planning, implementation, and longevity.
Comprehensive Geriatric Assessment for Trauma: Operationalizing the Trauma Quality Improvement Program Directive
Authors: Devore Stephanie , Parli Sara E. , Oyler Douglas R. , Bernard Andrew
Published: November 2016

Elderly patients are the fastest growing trauma demographic and present some of the most complicated clinical challenges. This feasibility study employed observational data from a geriatric cohort. Comprehensive geriatric assessments (CGAs) were performed biweekly on eligible patients, 65 years or older, who met screening criteria. Mobility, activities of daily living impairment, frailty, and depression were screened and documented, and along with summative recommendations, were entered into the medical record, communicated to the patient's primary care provider, and discussed with family. From September 1, 2015, to February 1, 2016, 65 comprehensive geriatric assessments were performed, with 2 repeats. Thirty-two (49%) were men. Mean age was 76.9 (range, 65–97) years. Motor vehicle collisions and falls accounted for the majority of trauma mechanisms (52% and 40%, respectively). New action items from the CGA were in 2 main categories: (1) home or inpatient medication changes and (2) additional physical therapist/occupational therapist intervention. Comprehensive geriatric assessment can be successfully organized and performed in centers without a designated geriatric service using standard trauma team members. Objective assessments for functional mobility, activities of daily living, frailty, and depression can be performed easily using current staff and the data easily incorporated into the CGA. Advanced practice providers can feasibly serve as clinical leads even if faculty/residents are unavailable.
Celiac Disease and Risk of Henoch-Schonlein Purpura
Authors: Ludvigsson Jonas F. , Jarrick Simon , Murray Joseph A. , Emilsson Louise
Published: November 2016

Background and Aims:

A recent study found a 10-fold increased risk of celiac disease (CD) in individuals with Henoch-Schonlein purpura (HSP), but the confidence interval (CI) was wide.

Methods:

The retrospective cohort study of all patients with CD in Sweden, diagnosed through small intestinal biopsy from 1969 to 2008 (n=29,077). Each individual with CD was matched to up to 5 controls (n=144,433). Data on study participants were linked to diagnostic codes for HSP in the National Patient Registry. Through Cox regression we estimated hazard ratios for CD and later HSP. Through logistic regression we calculated odds ratios for HSP preceding CD.

Results:

During follow-up 19 individuals with CD and 99 controls developed HSP. This corresponded to a hazard ratio of 0.96 (95% CI, 0.59-1.56). Looking backward, we found no increased risk of earlier HSP in patients with CD (odds ratio=1.02; 95% CI, 0.60-1.72).

Conclusions:

In this study of more than 29,000 patients with CD, we found no increased risk of HSP before or after CD.