bluuebunny/crossref_metadata_2025 huggingface dataset:
International note: Prediction of mathematics work ethic and performance from behavioral, normative, and control beliefs among Qatari adolescents
Authors: Areepattamannil Shaljan , Abdelfattah Faisal , Mahasneh Randa Ali , Khine Myint Swe , Welch Anita G. , Melkonian Michael , Al Nuaimi Samira Ahmed
Published: November 2015

Over half‐a‐million adolescents take part in each cycle of the Program for International Student Assessment (PISA). Yet often, researchers and policy makers across the globe tend to focus their attention primarily on the academic trajectories of adolescents hailing from highly successful education systems. Hence, a vast majority of the adolescent population who regionally and globally constitute the ‘long tail of underachievement’ often remain unnoticed and underrepresented in the growing literature on adolescents' academic trajectories. The present study, therefore, explored the relations of dispositions toward mathematics, subjective norms in mathematics, and perceived control of success in mathematics to mathematics work ethic as well as mathematics performance; and the mediational role of mathematics work ethic in the association between dispositional, normative, and control beliefs and mathematics performance among adolescents in one of the lowest performing education systems, Qatar. Structural equation modeling (SEM) analyses revealed that Qatari adolescents' dispositional, normative, and control beliefs about mathematics were significantly associated with their mathematics work ethic and mathematics performance, and mathematics work ethic significantly mediated the relationship between dispositional, normative, and control beliefs about mathematics and mathematics performance. However, multi‐group SEM analyses indicated that these relationships were not invariant across the gender and the SES groups.
Ruminative exploration and reconsideration of commitment as risk factors for suboptimal identity development in adolescence and emerging adulthood☆
Authors: Beyers Wim , Luyckx Koen
Published: November 2015

Rather than looking at quantitative differences in exploration and commitment as indicators of (un)healthy identity formation, this study focuses on two qualitatively different forms of exploration using cross‐sectional data of 4259 Belgian adolescents and emerging adults (aged 14–30 years; 64% female). First, ruminative exploration or brooding and worrying without being able to decide what you want in life, emerged as a risk factor for weak commitments and maladjustment. Its strong relationship with maladjustment was only slightly buffered by healthy forms of exploration. Second, reconsideration of commitment or feeling uncertain about current commitments and start looking for new commitments, showed similar negative relationships with commitment making and identification. Moreover, reconsideration of commitment rendered healthy forms of exploration ineffective (i.e., not predicting strong commitments or identifications with life choices). By focusing on the exact meaning and role of these two risk factors, this study sheds light on the dark side of identity formation and might be relevant for counselors working with youth that struggle with identity formation.
Why do early adolescents bully? Exploring the influence of prestige norms on social and psychological motives to bully
Authors: Berger Christian , Caravita Simona C.S.
Published: November 2015

The present study examines psychological (e.g., Machiavellianism) and social (i.e., perceived popularity) motives for bullying, exploring the effects that classroom prestige norms for physical and relational aggression may have on these associations. A longitudinal multilevel study design was adopted, which included 978 5th to 7th graders from four Chilean schools. Participants were assessed three times over one year on self reports on bullying and Machiavellianism, and peer reports on popularity. Classroom prestige norms were calculated as the within classroom association between peer perceived coolness and aggression. Both Machiavellianism and perceived popularity were associated with bullying. However, hierarchical linear modeling analyses showed that Machiavellianism, but not perceived popularity, predicted bullying after controlling for baseline scores. Classroom prestige norms for relational aggression increased the association between Machiavellianism and bullying. Separate models were tested for boys and girls, showing no differences. Results are discussed in light of conceptual and methodological considerations.
Reflections on Journeys within the Supermarket
Authors: Spanjaard Daniela , Freeman Lynne , Young Louise
Published: November 2015

In this paper, we deconstruct the ethnographic process to examine how adopting a multifaceted approach impacted our interpretation of the findings. The original intention was to undertake (only) structured, observational research to consider a fairly standard marketing problem – why do consumers choose some grocery brands over others. However we soon realized that such a format was unsatisfactory. Instead we recognized the need to consider both the content and process of shopping to understand the complexity of behaviours reflected. The results suggest that many consumers’ lives are created around various realities and they use consumption to engage and experience these.
Policy capacity: A conceptual framework for understanding policy competences and capabilities
Authors: Wu X , Ramesh M , Howlett M
Published: November 2015

Although policy capacity is among the most fundamental concepts in public policy, there is considerable disagreement over its definition and very few systematic efforts try to operationalize and measure it. This article presents a conceptual framework for analysing and measuring policy capacity under which policy capacity refers to the competencies and capabilities important to policy-making. Competences are categorized into three general types of skills essential for policy success—analytical, operational and political—while policy capabilities are assessed at the individual, organizational and system resource levels. Policy failures often result from imbalanced attention to these nine different components of policy capacity and the conceptual framework presented in the paper provides a diagnostic tool to identify such capacity gaps. It offers critical insights into strategies able to overcome such gaps in professional behaviour, organizational and managerial activities, and the policy systems involved in policy-making.
La pregunta de investigación en los estudios cualitativos
Authors: Hamui Sutton Alicia
Published: November 2015

La pregunta de investigación en los estudios cualitativos condensa aspectos teóricos, temáticos, metodológicos y empíricos, y constituye el eje transversal del proceso de indagación. Este último considera cuatro grandes momentos: 1) la construcción del objeto de investigación, 2) el diseño de la investigación, 3) la producción de la información, y 4) el análisis de los datos obtenidos. El artículo se centra en el primer rubro, puesto que la formulación de la(s) pregunta(s) de investigación sucede en esta etapa. La construcción del objeto de investigación considera la elección de un tema, la especificación de una problemática, la búsqueda bibliográfica (teórica, temática y empírica), la elaboración de un sistema de relaciones conceptuales, así como la teorización y orientación de la investigación, en el texto se explica cada una.
La selección de métodos y estrategias para obtener la información por lo general es compatible con el objeto y hay múltiples paradigmas teóricos y enfoques posibles para sustentarla como: la antropología cultural, la etnometodología, estudios fenomenológicos, estudios ecológicos descriptivos, análisis basados en el interaccionismo simbólico e interpretativo, análisis de narrativas, historiografía, crítica literaria, entre otros. En el escrito se mencionan las técnicas más comunes utilizadas en la investigación cualitativa y se discuten las consideraciones éticas al formular las preguntas de investigación. Finalmente se incluye un ejemplo que ilustra la construcción del objeto de investigación. Cuando la construcción del objeto es sólida y la pregunta de investigación está bien planteada, es más probable que los hallazgos sean relevantes e innovadores, aunque también depende del rigor metodológico, de la factibilidad del trabajo de campo, así como de la crítica y creatividad en el análisis.
What Makes Jupiter's Aurora Pulse?
Authors: Zastrow Mark
Published: November 2015

The aurora crowning Jupiter's poles—the most powerful in the solar system—flares up when plasma is injected into its magnetic field.
FasL expression in cardiomyocytes activates the ERK1/2 pathway, leading to dilated cardiomyopathy and advanced heart failure
Authors: Huby Anne-Cecile , Turdi Subat , James Jeanne , Towbin Jeffrey A. , Purevjav Enkhsaikhan
Published: November 2015

Increase in the apoptotic molecule Fas ligand (FasL) in serum and cardiomyocytes has been shown to be associated with progressive dilated cardiomyopathy (DCM) and congestive heart failure (CHF) in humans. However, the underlying mechanism(s) of FasL-related deterioration of heart function remain obscure. The aim of the present study is to determine roles of myocardial FasL in the activation of alternative pathways such as extracellular-signal-regulated kinase 1/2 (ERK1/2), inflammation or fibrosis and to identify effective treatments of progressive DCM and advanced CHF. Transgenic mice with cardiomyocyte-specific overexpression of FasL were investigated and treated with an ERK1/2 inhibitor (U-0126), losartan (los), prednisolone (pred) or placebo. Morpho-histological and molecular studies were subsequently performed. FasL mice showed significantly higher mortality compared with wild-type (WT) littermates due to DCM and advanced CHF. Prominent perivascular and interstitial fibrosis, increased interleukin secretion and diffuse CD3-positive cell infiltration were evident in FasL hearts. Up-regulation of the short form of Fas-associated death domain (FADD)-like interleukin 1β-converting enzyme (FLICE) inhibitory protein (s-FLIP), RIP (receptor-interacting protein) and ERK1/2 and down-regulation of transforming growth factor beta 1 (TGFβ1) and nuclear factor-κB (NF-κB) was determined in the myocardium, whereas expression of ERK1/2, periostin (Postn) and osteopontin increased in cardiac fibroblasts. U-0126 and los increased CHF survival by 75% compared with pred and placebo groups. U-0126 had both anti-fibrotic and anti-apoptotic effects, whereas los reduced fibrosis only. Myocardial FasL expression in mice activates differential robust fibrotic, apoptotic and inflammatory responses via ERK1/2 in cardiomyocytes and cardiac fibroblasts inducing DCM and CHF. Blocking the ERK1/2 pathway prevented progression of FasL-induced DCM and CHF by reducing fibrosis, inflammation and apoptosis in the myocardium.
Editor's Perspective: Supplements and Forums
Authors: Wilkinson Krista
Published: November 2015

Purpose

In this article, the Editor of the
American Journal of Speech-Language Pathology
reflects on the distinction between the Clinical or Research Forum and the Supplement—and the important contributions that each dissemination format makes.
Reverse blocking IGCT optimised for 1 kV DC bi‐directional solid state circuit breaker
Authors: Vemulapati Umamaheswara , Arnold Martin , Rahimo Munaf , Antoniazzi Antonello , Pessina Davide
Published: November 2015

This study presents the simulation and experimental results of the newly developed 2.5 kV reverse blocking‐integrated gate commutated thyristor (RB‐IGCT) which has been designed and optimised to have very low conduction losses and high turn‐off current capability for DC solid state circuit breaker (SSCB) applications. The device has been optimised through anode engineering, thickness and resistivity to achieve the required blocking capability of 2.5 kV and to have very low conduction losses below 1 kW at 1 kA, that is, the on‐state voltage drop is as low as 0.9 V at 1 kA. This study also presents the simulation and experimental results at the system level including the influence of the surge arrester (SA) which is connected in parallel to the RB‐IGCT to clamp the overvoltage and to absorb the energy stored in the system inductance at the current interruption. The influence of different voltage rating SAs and parallel combination of SAs on the switching behaviour of the RB‐IGCT has been investigated. A bi‐directional SSCB for 1 MW application based on 2.5 kV RB‐IGCT has been built successfully. The device simulations show that the results are in good agreement with the measurement results both at the device and system levels.
Sectional linear LED driver for optimised efficiency in lighting applications
Authors: Liu Cong , Lai Xin‐Quan , He Hui‐Sen , Du Han‐Xiao
Published: November 2015

A novel sectional linear driving method for light‐emitting diode (LED) driver is studied. Considering several issues to be concerned in LED lighting applications, a complete introduction and analysis of the technique is proposed in this study. As the performance of the sectional linear LED driver can be affected by the LED distribution in each LED sub‐string, a behavioural model is established to guide the design. Simulation results are obtained by utilising the behavioural model to optimise the output power and efficiency. The LED driver is fabricated with a 1 µm 5 V/20 V/500 V BCD technology, and a 15‐W T‐8 LED tube light prototype is established on the basis of the driver IC. A series of experiments are conducted to verify the theoretical analysis and the accuracy of the proposed model. The experimental data agrees with the simulation results, above 0.9 power factor (PF) and 90% efficiency are achieved with few peripheral components based on the design guidance made by the proposed model. Both the driving technique and the behavioural model are believed to be useful in the high efficiency, high PF, and cost‐effective ac LED lighting applications.
Breaking evolutionary constraint with a tradeoff ratchet
Authors: de Vos Marjon G. J. , Dawid Alexandre , Sunderlikova Vanda , Tans Sander J.
Published: November 2015

Significance

Suboptimal fitness peaks are generally recognized as causing evolutionary stasis. Here, we show that these constraints can be overcome in an adaptive manner by reconstructing mutational trajectories for a transcription factor and its DNA binding site in variable environments. Cross-environmental tradeoffs, typically associated with evolutionary limitations, are an essential enabling component of this evolutionary mechanism. Our results underscore the importance of characterizing environmental dependencies when studying genetic interactions and provide the clearest indication so far that environmental variability can accelerate evolution hampered by stasis in constant conditions. Given that environmental variations and tradeoffs are ubiquitous, this evolutionary mechanism may be relevant to a wide range of genetically constrained phenotypes and major evolutionary transitions.
Optimizing Psychosocial Support during Office-Based Buprenorphine Treatment in Primary Care: Patients’ Experiences and Preferences
Authors: Fox Aaron D. , Masyukova Mariya , Cunningham Chinazo O.
Published: November 2015

Background

Buprenorphine maintenance treatment is effective and has been successfully integrated into human immunodeficiency virus (HIV) and primary care settings. However, one key barrier to providers prescribing buprenorphine is their perception that they are unable to provide adequate counseling or psychosocial support to patients with opioid addiction. This qualitative study investigated supportive elements of office-based buprenorphine treatment that patients perceived to be most valuable.

Methods

The authors conducted five focus groups with 33 buprenorphine treatment-experienced participants. Focus groups were audio-recorded and transcribed. Iterative readings of transcripts and grounded theory analysis revealed common themes.

Results

Overall, participants perceived that buprenorphine treatment helped them to achieve their treatment goals and valued the flexibility, accessibility, and privacy of treatment. Participants identified interpersonal and structural elements of buprenorphine treatment that provided psychosocial support. Participants desired good physician-patient relationships, but also valued care delivery models that were patient-centered, created a safe place for self-disclosure, and utilized coordinated team-based care.

Conclusions

Participants derived psychosocial support from their prescribing physician, but were also open to collaborative or team-based models of care, as long as they were voluntary and confidential. Buprenorphine-prescribing physicians without access to referral options for psychosocial counseling could focus on maintaining nonjudgmental attitudes and shared decision-making during patient encounters. Adding structure and psychosocial support to buprenorphine treatment through coordinated team-based care also seems to have great promise.
TLR7 and TLR9 ligands regulate antigen presentation by macrophages
Authors: Celhar Teja , Pereira-Lopes Selma , Thornhill Susannah I. , Lee Hui Yin , Dhillon Manprit K. , Poidinger Michael , Connolly John E. , Lim Lina H. K. , Biswas Subhra K. , Fairhurst Anna-Marie
Published: November 2015

The toll-like receptors (TLRs) are important innate receptors recognizing potentially pathogenic material. However, they also play a significant role in the development of Alzheimer’s disease, cancer, autoimmunity and the susceptibility to viral infections. Macrophages are essential for an effective immune response to foreign material and the resolution of inflammation. In these studies, we examined the impact of different TLR ligands on macrophage cell function. We demonstrate that stimulation of all TLRs tested increases the phagocytosis of apoptotic cells by macrophages. TLR7 and TLR9 ligation decreased the levels of the surface co-expression molecules CD86 and MHCII, which was associated with a concomitant reduction in antigen presentation and proliferation of T cells. This down-regulation in macrophage function was not due to an increase in cell death. In fact, exposure to TLR7 or TLR9 ligands promoted cell viability for up to 9 days, in contrast to TLR3 or TLR4. Additionally, macrophages exposed to TLR7/TLR9 ligands had a significantly lower ratio of Il-12/Il-10 mRNA expression compared with those treated with the TLR4 ligand, LPS. Taken together, these data demonstrate that TLR7/TLR9 ligands push the macrophage into a phagocytic long-lived cell, with a decreased capacity of antigen presentation and reminiscent of the M2 polarized state.
Leptin deficiency down-regulates IL-23 production in glomerular podocytes resulting in an attenuated immune response in nephrotoxic serum nephritis
Authors: Goto Kei , Kaneko Yoshikatsu , Sato Yuya , Otsuka Tadashi , Yamamoto Suguru , Goto Shin , Yamamoto Keiko , Yamamoto Tadashi , Kawachi Hiroshi , Madaio Michael P. , Narita Ichiei
Published: November 2015

Leptin, one of the typical adipokines, is reported to promote T h 17 cell responses and to enhance production of proinflammatory cytokines. To clarify the role of leptin in the regulation of the IL-23/IL-17 axis and the development of kidney disease, we used a murine model of nephrotoxic serum (NTS) nephritis (NTN). Sheep NTS was administered in wild-type C57BL/6J mice and food-restricted, leptin-deficient C57BL/6J- ob/ob (FR- ob/ob ) mice after preimmunization with sheep IgG. The profile of mRNA expression relevant to T helper lymphocytes in the kidneys was analyzed by quantitative real-time PCR (qRT–PCR). Cultured murine glomerular podocytes and peritoneal exudate macrophages (PEMs) were used to investigate the direct effect of leptin on IL-23 or MCP-1 production by qRT–PCR. Kidney injury and macrophage infiltration were significantly attenuated in FR- ob/ob mice 7 days after NTS injection. The T h 17-dependent secondary immune response against deposited NTS in the glomeruli was totally impaired in FR- ob/ob mice because of deteriorated IL-17 and proinflammatory cytokine production including IL-23 and MCP-1 in the kidney. IL-23 was produced in glomerular podocytes in NTN mice and cultured murine glomerular podocytes produced IL-23 under leptin stimulation. MCP-1 production in PEMs was also promoted by leptin. Induction of MCP-1 expression was observed in PEMs regardless of Ob-Rb, and the leptin signal was transduced without STAT3 phosphorylation in PEMs. Leptin deficiency impairs the secondary immune response against NTS and down-regulates IL-23 production and T h 17 responses in the NTN kidney, which is accompanied by decreased MCP-1 production and macrophage infiltration in the NTN kidney.
Meaningful use care coordination criteria: Perceived barriers and benefits among primary care providers
Authors: Cohen Genna R , Adler-Milstein Julia
Published: November 2015

Background Stage 2 and proposed Stage 3 meaningful use criteria ask providers to support patient care coordination by electronically generating, exchanging, and reconciling key information during patient care transitions.

Methods A stratified random sample of primary care practices in Michigan ( n  = 328) that had already met Stage 1 meaningful use criteria was surveyed, in order to identify the anticipated barriers to meeting these criteria as well as the expected impact on patient care coordination from doing so.

Results The top three barriers, as identified by >65% of the primary care providers surveyed, were difficulty sending and receiving patient information electronically, a lack of provider and practice staff time, and the complex workflow changes required. Despite these barriers, primary care providers expressed strong agreement that meeting the proposed Stage 3 care coordination criteria would improve their patients’ treatment and ensure they know about their patients’ visits to other providers.

Conclusion The survey results suggest the need to enhance policy approaches and organizational strategies to address the key barriers identified by providers and practices in order to realize important care coordination benefits.
Experience with decision support system and comfort with topic predict clinicians’ responses to alerts and reminders
Authors: Bauer Nerissa S , Carroll Aaron E , Saha Chandan , Downs Stephen M
Published: November 2015

Objective Clinicians at our institution typically respond to about half of the prompts they are given by the clinic’s computer decision support system (CDSS). We sought to examine factors associated with clinician response to CDSS prompts as part of a larger, ongoing quality improvement effort to optimize CDSS use.

Methods We examined patient, prompt, and clinician characteristics associated with clinician response to decision support prompts from the Child Health Improvement through Computer Automation (CHICA) system. We asked pediatricians who were nonusers of CHICA to rate decision support topics as “easy” or “not easy” to discuss with patients and their guardians. We analyzed these ratings and data, from July 1, 2009 to January 29, 2013, utilizing a hierarchical regression model, to determine whether factors such as comfort with the prompt topic and the length of the user’s experience with CHICA contribute to user response rates.

Results We examined 414 653 prompts from 22 260 patients. The length of time a clinician had been using CHICA was associated with an increase in their prompt response rate. Clinicians were more likely to respond to topics rated as “easy” to discuss. The position of the prompt on the page, clinician gender, and the patient’s age, race/ethnicity, and preferred language were also predictive of prompt response rate.

Conclusion This study highlights several factors associated with clinician prompt response rates that could be generalized to other health information technology applications, including the clinician’s length of exposure to the CDSS, the prompt’s position on the page, and the clinician’s comfort with the prompt topic. Incorporating continuous quality improvement efforts when designing and implementing health information technology may ensure that its use is optimized.
An information model for automated assessment of concordance between advance care preferences and care delivered near the end of life
Authors: Turley Marianne , Wang Susan , Meng Di , Kanter Michael H , Garrido Terhilda
Published: November 2015

Objective To develop an information model for automating evaluation of concordance between patient preferences and end-of-life care.

Methods We modeled and validated 15 end-of-life care preference option domains, to which we mapped preferences recorded in standardized advance care planning documents and 232 end-of-life care events defined by procedure and medication codes. Patient preferences and end-of-life care events were available in electronic health records. Data from Kaiser Permanente Southern California modeling and testing populations were evaluated for concordance between patients’ preferences and the end-of-life care events they experienced.

Results The information model successfully assessed concordance between patient preferences and end-of-life care events. Among 388 expired patients in the modeling population, 4164 care events occurred, 4100 (98%) of which were preference-concordant, and 64 (2%) of which were preference-discordant. Including end-of-life care events that did not occur increased the number of observations to 6029; 99% were preference-concordant. At the level of individuals, 72% (278) of patients experienced only preference-concordant care events, 13% (50) experienced at least one preference-discordant care event, and 15% (60) experienced no preference-related care events.

Discussion Model limitations pertain to assumptions that are required to match advance care planning documents with patient preference options and exclusion of preferred care that did not occur. Further research is required to apply the model to larger populations and to investigate the need for additional preference options.

Conclusion An information model for automating the assessment of the concordance between patients’ advance care planning preferences and the end-of-life care they received was effective in a small population and has the potential to assess population-level preference-concordance on an ongoing basis.
West Nile Virus Central Nervous System Infection in Patients Treated With Rituximab: Implications for Diagnosis and Prognosis, With a Review of Literature
Authors: Morjaria Sejal , Arguello Esther , Taur Ying , Sepkowitz Kent , Hatzoglou Vaios , Nemade Ajay , Rosenblum Marc , Cavalcanti Marcela S. , Palomba M. Lia , Kaltsas Anna
Published: November 2015

The spectrum of West Nile virus (WNV) infection continues to be elucidated. Many cases of WNV are asymptomatic; however, in immunocompromised patients, symptoms are more likely to be severe. We describe fatal WNV central nervous system disease in lymphoma patients who received rituximab, blunting the inflammatory response and complicating diagnosis.
Prosthetic-Joint-Associated Bordetella holmesii Infection
Authors: Humphrey John M. , Lacaille Sherard N. J. , Patel Krutika , Thompson Erin , Tulumba Steve , Healey John H. , Gilhuley Kathleen A. , Babady N. Esther , Kamboj Mini , Mead Peter A.
Published: November 2015

Bordetella holmesii is a globally distributed pathogen that is increasingly recognized as a cause of both pertussis-like respiratory infections and invasive disease. In this study, we describe a case of an immunocompetent man who developed B holmesii infection of his femoral prosthesis—the fifth B holmesii orthopedic infection reported in literature to date. This article highlights the potentially underrecognized role of B holmesii in orthopedic infections by reviewing these previously reported cases in the context of the current literature.
An Evaluation of Systemic Vancomycin Dosing in Obese Patients
Authors: Kubiak David W. , Alquwaizani Mohammed , Sansonetti David , Barra Megan E. , Calderwood Michael S.
Published: November 2015

We retrospectively identified 67 patients with severe or morbid obesity (body mass index ≥35 kg/m2) who had received intravenous vancomycin at our institution. We observed that an initial dose of 45 to 65 mg/kg vancomycin per day based upon ideal body weight rather than actual body weight was more predictive of initial trough concentrations between 15 and 20 mcg/mL.
Uncovering the History of Operating Room Attire through Photographs
Authors: Adams Lu Wang , Aschenbrenner Carol A. , Houle Timothy T. , Roy Raymond C.
Published: November 2015

AbstractAbstract

A systematic analysis of over 1,000 historic photographs of operating room personnel was conducted to provide a timeline of changes in attire. The years for which general acceptance of various elements of operating room attire (gown, cap, and mask) differed between anesthesia providers and surgeons. Anesthesia providers lagged behind surgeons in adoption of standard operating room attire.

Background

Although early proponents for each of the four basic articles of operating room clothing—gowns, caps, masks, and gloves—can be identified, it is unclear from historical commentaries when each article achieved general acceptance and was consistently worn by surgeons and by anesthesia providers.

Methods

Historical photographs were identified from the Web sites of the National Library of Medicine, Google, and the archives of the Wood Library-Museum of Anesthesiology for the 11 decades 1860 to 1970. The presence or absence of each article of clothing was then determined for the surgical and anesthesia providers depicted.

Results

Over 1,000 photographs were identified and examined. Photographs were then eliminated for repetition, lack of available dating, questionable dating, and poor quality. In 338 remaining photographs that met inclusion criteria, 640 surgical providers and 219 anesthesia providers were depicted and used in the analysis. Statistical definitions for historical terms general acceptance and routine use were proposed. The probability that a surgeon was wearing nonstreet clothes (gown) was 0.66 (95% CI, 0.22 to 0.93) in 1863. The years (95% lower bound to 95% upper bound) associated with a 0.5 probability for wearing cap, gloves, and mask were 1900 (1896 to 1904), 1907 (1903 to 1910), and 1916 (1913 to 1919), respectively. The years associated with a 0.5 probability that an anesthesia provider would be wearing nonstreet clothes (gown), cap, and mask were 1883 (1863 to 1889), 1905 (1900 to 1911), and 1932 (1929 to 1937), respectively.

Conclusion

Timelines for the adoption of each basic article of surgical attire by surgeons and anesthesia providers were determined by analysis of historical operating room photographs from 1863 to 1969.
A Cysteine Substitution Probes β3H267 Interactions with Propofol and Other Potent Anesthetics in α1β3γ2L γ-Aminobutyric Acid Type A Receptors
Authors: Stern Alex T. , Forman Stuart A.
Published: November 2015

AbstractAbstract

Functional analysis and chemical modification–protection studies in a common brain γ-aminobutyric acid type A receptor revealed differences between potent anesthetics. Only the barbiturate protected β3H267C from modification; this mutation also enhanced agonism by propofol, indicating that β3H267 contributes to binding sites for barbiturates and propofol, but not for etomidate and alphaxalone.

Background

Anesthetic contact residues in γ-aminobutyric acid type A (GABAA) receptors have been identified using photolabels, including two propofol derivatives. O-propofol diazirine labels H267 in β3 and α1β3 receptors, whereas m-azi-propofol labels other residues in intersubunit clefts of α1β3. Neither label has been studied in αβγ receptors, the most common isoform in mammalian brain. In αβγ receptors, other anesthetic derivatives photolabel m-azi-propofol-labeled residues, but not βH267. The authors’ structural homology model of α1β3γ2L receptors suggests that β3H267 may abut some of these sites.

Methods

Substituted cysteine modification–protection was used to test β3H267C interactions with four potent anesthetics: propofol, etomidate, alphaxalone, and R-5-allyl-1-methyl-5-(m-trifluoromethyl-diazirinylphenyl) barbituric acid (mTFD-MPAB). The authors expressed α1β3γ2L or α1β3H267Cγ2L GABAA receptors in Xenopus oocytes. The authors used voltage clamp electrophysiology to assess receptor sensitivity to γ-aminobutyric acid (GABA) and anesthetics and to compare p-chloromercuribenzenesulfonate modification rates with GABA versus GABA plus anesthetics.

Results

Enhancement of low GABA (eliciting 5% of maximum) responses by equihypnotic concentrations of all four anesthetics was similar in α1β3γ2L and α1β3H267Cγ2L receptors (n > 3). Direct activation of α1β3H267Cγ2L receptors, but not α1β3γ2L, by mTFD-MPAB and propofol was significantly greater than the other anesthetics. Modification of β3H267C by p-chloromercuribenzenesulfonate (n > 4) was rapid and accelerated by GABA. Only mTFD-MPAB slowed β3H267C modification (approximately twofold; P = 0.011).

Conclusions

β3H267 in α1β3γ2L GABAA receptors contacts mTFD-MPAB, but not propofol. The study results suggest that β3H267 is near the periphery of one or both transmembrane intersubunit (α+/β− and γ+/β−) pockets where both mTFD-MPAB and propofol bind.
In Vitro Comparative Effect of Carbetocin and Oxytocin in Pregnant Human Myometrium with and without Oxytocin Pretreatment
Authors: Cole Naida M. , Carvalho Jose C. A. , Erik-Soussi Magda , Ramachandran Nivetha , Balki Mrinalini
Published: November 2015

AbstractAbstract

Oxytocin produced stronger contractions of term pregnant human myometrium in vitro than did carbetocin over the entire range of equimolar concentrations studied. Oxytocin pretreatment of term pregnant human myometrium in vitro attenuated contractions produced by both oxytocin and carbetocin.

Background

The purpose of this study was to compare in vitro contractile effects of oxytocin and carbetocin on human term pregnant myometrium with and without oxytocin pretreatment.

Methods

This laboratory investigation was conducted on myometrial samples from women undergoing elective cesarean deliveries. The samples were dissected into four strips and suspended in individual organ bath chambers containing physiologic salt solution. After equilibration, they were pretreated with oxytocin 10−5 M (experimental group) or physiologic salt solution (control group) for 2 h and then subjected to dose–response testing with increasing concentrations of oxytocin or carbetocin (10−10 to 10−5 M). The amplitude, frequency, motility index (amplitude × frequency), and area under the curve of contractions were recorded and analyzed during the equilibration and dose–response periods. Comparisons were made between oxytocin-induced and carbetocin-induced contractions in control and oxytocin-pretreated groups. Motility index was the primary outcome measure.

Results

Sixty-three experiments were performed (carbetocin, n = 31; oxytocin, n = 32) on samples from 18 women. The motility index of contractions (√g.contractions/10 min) produced by oxytocin was significantly higher than carbetocin in both control (regression-estimated difference, 0.857; 95% CI, 0.290 to 1.425; P = 0.003) and oxytocin-pretreated (0.813; 0.328 to 1.299; P = 0.001) groups. The motility index was significantly lower in oxytocin-pretreated groups than their respective controls for both oxytocin (−1.040; −1.998 to −0.082; P = 0.03) and carbetocin (−0.996; −1.392 to −0.560; P < 0.001).

Conclusions

In vitro contractions produced by oxytocin are superior to carbetocin in human myometrium with or without oxytocin pretreatment. Oxytocin pretreatment results in attenuation of contractions induced by both oxytocin and carbetocin.
Morbidity and Mortality after High-dose Transfusion
Authors: Johnson Daniel J. , Scott Andrew V. , Barodka Viachaslau M. , Park Sunhee , Wasey Jack O. , Ness Paul M. , Gniadek Tom , Frank Steven M.
Published: November 2015

AbstractAbstract

Mortality increased linearly with erythrocyte dose, reaching 50% in patients given more than 50 units of blood. Infection and thrombotic events were the most common complications.

Background

It is well recognized that increased transfusion volumes are associated with increased morbidity and mortality, but dose–response relations between high- and very-high-dose transfusion and clinical outcomes have not been described previously. In this study, the authors assessed (1) the dose–response relation over a wide range of transfusion volumes for morbidity and mortality and (2) other clinical predictors of adverse outcomes.

Methods

The authors retrospectively analyzed electronic medical records for 272,592 medical and surgical patients (excluding those with hematologic malignancies), 3,523 of whom received transfusion (10 or greater erythrocyte units throughout the hospital stay), to create dose–response curves for transfusion volumes and in-hospital morbidity and mortality. Prehospital comorbidities were assessed in a risk-adjusted manner to identify the correlation with clinical outcomes.

Results

For patients receiving high- or very-high-dose transfusion, infections and thrombotic events were four to five times more prevalent than renal, respiratory, and ischemic events. Mortality increased linearly over the entire dose range, with a 10% increase for each 10 units of erythrocytes transfused and 50% mortality after 50 erythrocyte units. Independent predictors of mortality were transfusion dose (odds ratio [OR], 1.037; 95% CI, 1.029 to 1.044), the Charlson comorbidity index (OR, 1.209; 95% CI, 1.141 to 1.276), and a history of congestive heart failure (OR, 1.482; 95% CI, 1.062 to 2.063).

Conclusions

Patients receiving high- or very-high-dose transfusion are at especially high risk for hospital-acquired infections and thrombotic events. Mortality increased linearly over the entire dose range and exceeded 50% after 50 erythrocyte units.
Impact of Recruitment on Static and Dynamic Lung Strain in Acute Respiratory Distress Syndrome
Authors: García-Prieto Emilio , López-Aguilar Josefina , Parra-Ruiz Diego , Amado-Rodríguez Laura , López-Alonso Inés , Blázquez-Prieto Jorge , Blanch Lluis , Albaiceta Guillermo M.
Published: November 2015

AbstractAbstract

Positive end-expiratory pressure decreased dynamic (cyclical) strain and increased static strain in an animal model (six pigs; oleic acid lung injury) and in a study of six patients with acute respiratory distress syndrome.

Background

Lung strain, defined as the ratio between end-inspiratory volume and functional residual capacity, is a marker of the mechanical load during ventilation. However, changes in lung volumes in response to pressures may occur in injured lungs and modify strain values. The objective of this study was to clarify the role of recruitment in strain measurements.

Methods

Six oleic acid–injured pigs were ventilated at positive end-expiratory pressure (PEEP) 0 and 10 cm H2O before and after a recruitment maneuver (PEEP = 20 cm H2O). Lung volumes were measured by helium dilution and inductance plethysmography. In addition, six patients with moderate-to-severe acute respiratory distress syndrome were ventilated with three strategies (peak inspiratory pressure/PEEP: 20/8, 32/8, and 32/20 cm H2O). Lung volumes were measured in computed tomography slices acquired at end-expiration and end-inspiration. From both series, recruited volume and lung strain (total, dynamic, and static) were computed.

Results

In the animal model, recruitment caused a significant decrease in dynamic strain (from [mean ± SD] 0.4 ± 0.12 to 0.25 ± 0.07, P < 0.01), while increasing the static component. In patients, total strain remained constant for the three ventilatory settings (0.35 ± 0.1, 0.37 ± 0.11, and 0.32 ± 0.1, respectively). Increases in tidal volume had no significant effects. Increasing PEEP constantly decreased dynamic strain (0.35 ± 0.1, 0.32 ± 0.1, and 0.04+0.03, P < 0.05) and increased static strain (0, 0.06 ± 0.06, and 0.28 ± 0.11, P < 0.05). The changes in dynamic and total strain among patients were correlated to the amount of recruited volume. An analysis restricted to the changes in normally aerated lung yielded similar results.

Conclusion

Recruitment causes a shift from dynamic to static strain in early acute respiratory distress syndrome.
Severity of Myasthenia Gravis Influences the Relationship between Train-of-four Ratio and Twitch Tension and Run-down of Rat Endplate Potentials
Authors: Takahashi Kazunobu , Niiya Tomohisa , Takada Yukimasa , Narimatsu Eichi , Yamakage Michiaki
Published: November 2015

AbstractAbstract

A rat model was developed to study different severities of myasthenia gravis. Phrenic nerve–stimulated diaphragmatic responses to a standardized rocuronium dose were recorded in vitro. With increasing myasthenia gravis severity, train-of-four and the first twitch became less reliable indicators of muscle strength during recovery from neuromuscular blockade, indicating that the evaluation of neuromuscular blockade by train-of-four ratio may overestimate the extent of recovery.

Background

Train-of-four ratio (TOFR) is often used to evaluate muscle relaxation caused by neuromuscular-blocking agents (NMBAs). However, it is unknown whether TOFR reliably correlates with the first twitch tension (T1) in patients with myasthenia gravis (MG). By using rat models of experimental autoimmune MG (EAMG), the authors verified the hypothesis that the severity of MG influences the relationship between TOFR and T1.

Methods

EAMG rats were divided into sham, moderate MG, and severe MG groups. Isometric twitch tension of the hemidiaphragm was elicited by phrenic nerve stimulation with and without use of the NMBA rocuronium to measure TOFR and T1, and run-down of endplate potentials was estimated in the three groups. Changes around the neuromuscular junction in EAMG rats were investigated by observation of electron micrographs.

Results

With similar attenuation of T1, TOFR was significantly (n = 6) different among the three groups in the presence of 50% inhibitory concentrations of rocuronium (IC50). Run-down in the sham group was significantly (n = 8) greater with exposure to IC50, whereas that in the severe MG group was statistically insignificant. Width of the primary synaptic cleft in the severe MG group was significantly (n = 80) greater than that in the other groups.

Conclusions

Severity of MG influences the relationship between TOFR and T1, together with changes in run-down of endplate potentials and those around the neuromuscular junction in rats. TOFR may, therefore, not be an accurate indicator of recovery from NMBAs in MG patients.
A solitary unilobed osteochondroma of the hamate: a case report
Authors: Cha Soo Min , Shin Hyun Dae , Kim Dong Yeol
Published: November 2015

Solitary osteochondromas originating from the carpal bones are very uncommon; when they occur, they usually arise from the scaphoid or capitate. We report a solitary, unilobed osteochondroma arising from the hamate that was excised, with no evidence of recurrence at the 3-year follow-up.
Unthreaded Fixation of Slipped Capital Femoral Epiphysis Leads to Continued Growth of the Femoral Neck
Authors: Örtegren Jakob , Björklund-Sand Lina , Engbom Malin , Siversson Carl , Tiderius Carl J.
Published: November 2015

Background:

The optimal treatment for slipped capital femoral epiphysis (SCFE) remains controversial. In Sweden, the standard treatment is unthreaded fixation over the physis, with the purpose to permit continued growth of the femoral neck. The aim of the present study was to verify and quantify longitudinal growth of the femoral neck after in situ pinning with the Hansson hook-pin.

Methods:

We performed a retrospective study of 54 patients treated with the Hansson hook-pin for SCFE between 2001 and 2009. The immediate postoperative radiograph and the radiograph after physeal closure (mean interval, 34 mo) were analyzed. Because the smooth Hansson hook-pin only has a grip fixation in the epiphysis, the femoral neck growth was determined as the difference in nail protrusion from the lateral cortex between the 2 radiographs. The femoral neck offset was also measured in all radiographs.

Results:

Significant longitudinal growth occurred both in the slipped and the prophylactically treated contralateral hip by mean 7.1 mm (P<0.001) and 10.0 mm (P<0.001), respectively. There was no difference in growth between genders and no correlation between the amount of longitudinal growth and slip severity (range, 4.0 to 71,6 degrees; mean 27.3 degrees). Young patients (less than 11 y) grew more than older patients (more than 14 y), 12.1 vs. 4.2 mm, P=0.002. The femoral offset increased by mean 16% from mean 30.0 to 35.2 mm (P<0.001). The longitudinal growth of the femoral neck correlated with the increase in femoral offset (R=0.51, P<0.001).

Conclusions:

Unthreaded fixation of SCFE with the Hansson hook-pin allows continued growth of the femoral neck. The remaining growth enables the patient to achieve an almost anatomic offset of the hip. This is essential to optimize the abduction forces that stabilize the pelvis during gait. Future studies need to establish whether the longitudinal growth also results in improved remodelling of the proximal femur.

Level of evidence:

Level III—retrospective comparative study.
Non-accidental Trauma Work-up
Authors: Schoeneberg Laura A. , Aguilera Antonio , Raub Lindsay , Williams Charles A. , Gupta Dipankar
Published: November 2015

Lipoprotein lipase (LPL) deficiency is an autosomal recessive condition due to absent or decreased activity of LPL enzyme. The LPL deficiency is a rare condition that is mainly diagnosed in children, but there is no standard screening method at this time. In our report, we describe a 6-day-old male infant who was found to have hypertriglyceridemia after lipemia retinalis was diagnosed from a fundoscopic examination for nonaccidental trauma work-up. After dietary modification was done, his triglyceride levels decreased significantly, and there were no complications. When diagnosed later in life, recurrent pancreatitis can be a significant complication.
Parental Language and Return Visits to the Emergency Department After Discharge
Authors: Samuels-Kalow Margaret E. , Stack Anne M. , Amico Kendra , Porter Stephen C.
Published: November 2015

Objective

Return visits to the emergency department (ED) are used as a marker of quality of care. Limited English proficiency, along with other demographic and disease-specific factors, has been associated with increased risk of return visit, but the relationship between language, short-term return visits, and overall ED use has not been well characterized.

Methods

This is a planned secondary analysis of a prospective cohort examining the ED discharge process for English- or Spanish-speaking parents of children aged 2 months to 2 years with fever and/or respiratory illness. At 1 year after the index visit, a standardized chart review was performed. The primary outcome was the number of ED visits within 72 hours of the index visit. Multivariable logistic regression was used to examine the relative importance of predictor variables and adjust for confounders.

Results

There were 202 parents eligible for inclusion, of whom 23% were Spanish speaking. In addition, 6.9% of the sample had a return visit within 72 hours. After adjustment for confounders, Spanish language was associated with return visit within 72 hours (odds ratio, 3.49; 95% confidence interval, 1.02–11.90) but decreased risk of a second visit within the year (odds ratio, 0.28; 95% confidence interval, 0.12–0.66).

Conclusion

Spanish-speaking parents are at an increased risk of 72-hour return ED visit but do not seem to be at increased risk of ED use during the year after their ED visit.