bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Theory and Model of Molten Salt Reactor Xenon Behavior After the Solubility Limit
Authors: Price Terry J. , Chvala Ondrej 
Published: April 2020

Abstract
Due to the circulating nature of the fuel, there is a qualitative difference between xenon behavior in a molten salt reactor (MSR) compared to a solid fuel reactor. Therefore, the equations that describe 135Xe behavior in a molten salt reactor must be formulated differently. Prior molten salt reactor xenon models have focused on behavior below a solubility limit in which the 135Xe is partially dissolved in the fuel salt. It is foreseeable that a molten salt reactor may operate with a concentration of gas dissolved in the salt sufficiently high such that no further gas may dissolve in the fuel salt. This paper introduces a theory of molten salt reactor xenon behavior for a reactor operating above the solubility limit. A model was developed based on this theory and analyses performed are discussed. Results indicate: (1) steady-state xenon poisoning is not monotonic with respect to gas egress rate, (2) a increase in gas ingress rate leads to a characteristic increase which is followed by a new steady-state in xenon poisoning, and (3) given a sufficient rate of gas egress, it is possible to remove the iodine pit behavior.
Long-term change in the prevalence of intimate partner violence: a 20-year follow-up study in León, Nicaragua, 1995-2016
Authors: Ellsberg Mary , Ugarte William , Ovince Junior , Blackwell Alexandra , Quintanilla Margarita 
Published: April 2020

IntroductionAlthough intimate partner violence (IPV) affects an estimated one out of three women globally, evidence on violence prevention is still scarce. No studies have measured long-term change in larger populations over a prolonged period.MethodsThe aim of this study was to measure changes in the prevalence of IPV in León, Nicaragua, between 1995 and 2016. The 2016 study interviewed 846 ever-partnered women aged 15 to 49 regarding experiences of physical, sexual and emotional IPV. These findings were analysed together with comparable data collected from 354 women in 1995. Multivariate logistic regression modelling was carried out on a pooled data set to identify differences between the two studies while controlling for potential confounding factors.ResultsLifetime physical IPV decreased from 54.8 to 27.6 per cent (adjusted OR (AOR) 0.37; 95% CI 0.28 to 0.49) and 12-month prevalence of physical IPV decreased from 28.2 to 8.3 per cent (AOR 0.29; 95% CI 0.20 to 0.42), respectively. Similar decreases were found in lifetime and 12-month emotional IPV. No significant difference was found in the prevalence of lifetime sexual violence between the two time periods.ConclusionsThe results suggest that the reduction in IPV was not due to demographic shifts, such as increased education or age, but reflects a true decrease in the prevalence of IPV. The decrease is not likely to have occurred on its own, and may be attributable to multisectoral efforts by the Nicaraguan government, international donors and the Nicaraguan women’s movement to increase women’s knowledge of their rights, as well as access to justice and services for survivors during this time period.
Preventing sickness absence among employees with common mental disorders or stress-related symptoms at work: a cluster randomised controlled trial of a problem-solving-based intervention conducted by the Occupational Health Services
Authors: Keus van de Poll Marijke , Nybergh Lotta , Lornudd Caroline , Hagberg Jan , Bodin Lennart , Kwak Lydia , Jensen Irene , Lohela-Karlsson Malin , Torgén Margareta , Bergstrom Gunnar 
Published: April 2020

ObjectivesCommon mental disorders (CMDs) are among the main causes of sickness absence and can lead to suffering and high costs for individuals, employers and the society. The occupational health service (OHS) can offer work-directed interventions to support employers and employees. The aim of this study was to evaluate the effect on sickness absence and health of a work-directed intervention given by the OHS to employees with CMDs or stress-related symptoms.MethodsRandomisation was conducted at the OHS consultant level and each consultant was allocated into either giving a brief problem-solving intervention (PSI) or care as usual (CAU). The study group consisted of 100 employees with stress symptoms or CMDs. PSI was highly structured and used a participatory approach, involving both the employee and the employee’s manager. CAU was also work-directed but not based on the same theoretical concepts as PSI. Outcomes were assessed at baseline, at 6 and at 12 months. Primary outcome was registered sickness absence during the 1-year follow-up period. Among the secondary outcomes were self-registered sickness absence, return to work (RTW) and mental health.ResultsA statistical interaction for group × time was found on the primary outcome (p=0.033) and PSI had almost 15 days less sickness absence during follow-up compared with CAU. Concerning the secondary outcomes, PSI showed an earlier partial RTW and the mental health improved in both groups without significant group differences.ConclusionPSI was effective in reducing sickness absence which was the primary outcome in this study.
Secretion of Acid Sphingomyelinase and Ceramide by Endothelial Cells Contributes to Radiation-Induced Intestinal Toxicity
Authors: Leonetti Daniela , Estéphan Hala , Ripoche Natacha , Dubois Nolwenn , Aguesse Audrey , Gouard Sébastien , Brossard Lisa , Chiavassa Sophie , Corre Isabelle , Pecqueur Claire , Neunlist Michel , Hadchity Elie , Gaugler Marie-Hélène , Mahé Maxime M. , Paris François 
Published: April 2020

Abstract

Ceramide-induced endothelial cell apoptosis boosts intestinal stem cell radiosensitivity. However, the molecular connection between these two cellular compartments has not been clearly elucidated. Here we report that ceramide and its related enzyme acid sphingomyelinase (ASM) are secreted by irradiated endothelial cells and act as bystander factors to enhance the radiotoxicity of intestinal epithelium. Ceramide and the two isoforms of ASM were acutely secreted in the blood serum of wild-type mice after 15 Gy radiation dose, inducing a gastrointestinal syndrome. Interestingly, serum ceramide was not enhanced in irradiated ASMKO mice, which are unable to develop intestinal failure injury. Because ASM/ceramide were secreted by primary endothelial cells, their contribution was studied in intestinal epithelium dysfunction using coculture of primary endothelial cells and intestinal T84 cells. Adding exogenous ASM or ceramide enhanced epithelial cell growth arrest and death. Conversely, blocking their secretion by endothelial cells using genetic, pharmacologic, or immunologic approaches abolished intestinal T84 cell radiosensitivity. Use of enteroid models revealed ASM and ceramide-mediated deleterious mode-of-action: when ceramide reduced the number of intestinal crypt-forming enteroids without affecting their structure, ASM induced a significant decrease of enteroid growth without affecting their number. Identification of specific and different roles for ceramide and ASM secreted by irradiated endothelial cells opens new perspectives in the understanding of intestinal epithelial dysfunction after radiation and defines a new class of potential therapeutic radiomitigators.

Significance:
This study identifies secreted ASM and ceramide as paracrine factors enhancing intestinal epithelial dysfunction, revealing a previously unknown class of mediators of radiosensitivity.
Golgi-Localized PAQR4 Mediates Antiapoptotic Ceramidase Activity in Breast Cancer
Authors: Pedersen Line , Panahandeh Pouda , Siraji Muntequa I. , Knappskog Stian , Lønning Per Eystein , Gordillo Ruth , Scherer Philipp E. , Molven Anders , Teigen Knut , Halberg Nils 
Published: April 2020

Abstract

The metabolic network of sphingolipids plays important roles in cancer biology. Prominent sphingolipids include ceramides and sphingosine-1-phosphate that regulate multiple aspects of growth, apoptosis, and cellular signaling. Although a significant number of enzymatic regulators of the sphingolipid pathway have been described in detail, many remained poorly characterized. Here we applied a patient-derived systemic approach to identify and molecularly define progestin and adipoQ receptor family member IV (PAQR4) as a Golgi-localized ceramidase. PAQR4 was approximately 5-fold upregulated in breast cancer compared with matched control tissue and its overexpression correlated with disease-specific survival rates in breast cancer. Induction of PAQR4 in breast tumors was found to be subtype-independent and correlated with increased ceramidase activity. These findings establish PAQR4 as Golgi-localized ceramidase required for cellular growth in breast cancer.

Significance:
Induction of and cellular dependency on de novo sphingolipid synthesis via PAQR4 highlights a central vulnerability in breast cancer that may serve as a viable therapeutic target.
Immunophenotypic Conversion between Primary and Relapse Breast Cancer and its Effects on Survival
Authors: Blancas Isabel , Muñoz-Serrano Antonio Jesús , Legerén Marta , Ruiz-Ávila Isabel , Jurado José Miguel , Delgado María Teresa , Garrido José Manuel , González Beatriz , Bayo Virginia , Rodríguez-Serrano Fernando 
Published: April 2020

<b><i>Background:</i></b> The differential expression of oestrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor 2 (HER2) or Ki-67 between primary tumour and the recurrence has been described. We aimed to determine these changes and their prognostic implications. <b><i>Patients and Methods:</i></b> We retrospectively reviewed 45 breast cancer patients with relapsed biopsy that were classified into local relapse (LR) or metastatic disease (MD) groups. We analyzed the conversion rate and the value of the immunophenotype of the primary tumour and the relapse as a prognostic factor for relapse-free survival (RFS), progression-free survival (PFS) and overall survival (OS). <b><i>Results:</i></b> The conversion rate was 34.8% for Ki-67, 20% for ER, 20% for PR, and 15.6% for HER2. For the LR group, the RFS was 71.9 months and the OS was 141.6 months, without statistical differences according to the immunophenotype of the primary or the relapsed biopsy. For the MD group, the PFS was 20.8 months. According to immunophenotype of the relapse, the PFS were ER+ 24.7 months vs. ER– 9.3 months; PR+ 25.1 months vs. PR– 12.7 months without statistical differences according to HER2 or Ki67. The OS for MD group was 54.4 months without statistical differences according to immunophenotype. <b><i>Conclusion:</i></b> The characteristics of breast cancer can change over the time. Variations of the ER or PR status in MD group have prognostic value for PFS. To perform a biopsy of relapses is warranted in order to establish the prognostic of the current disease, and probably a more accurate treatment.
Ablation of Supraventricular Tachycardias From Concealed Left-Sided Nodoventricular and Nodofascicular Accessory Pathways
Authors: Cardona-Guarache Ricardo , Han Frederick T. , Nguyen Duy T. , Chicos Alexandru B. , Badhwar Nitish , Knight Bradley P. , Johnson Colleen J. , Heaven David , Scheinman Melvin M. 
Published: April 2020

Background:
Nodoventricular and nodofascicular accessory pathways (AP) are uncommon connections between the atrioventricular node and the fascicles or ventricles.

Methods:
Five patients with nodofascicular or nodoventricular tachycardia were studied.

Results:
We identified 5 patients with concealed, left-sided nodoventricular (n=4), and nodofascicular (n=1) AP. We proved the participation of AP in tachycardia by delivering His-synchronous premature ventricular contractions that either delayed the subsequent atrial electrogram or terminated the tachycardia (n=3), and by observing an increase in VA interval coincident with left bundle branch block (n=2). The APs were not atrioventricular pathways because the septal VA interval during tachycardia was <70 ms in 3, 1 had spontaneous atrioventricular dissociation, and in 1 the atria were dissociated from the circuit with atrial overdrive pacing. Entrainment from the right ventricle showed ventricular fusion in 4 out of 5 cases. A left-sided origin of the AP was suspected after failed ablation of the right inferior extension of atrioventricular node in 3 cases and by observing a VA increase with left bundle branch block in 2 cases. The nodofascicular and 3 of the nodoventricular AP were successfully ablated from within the proximal coronary sinus (CS) guided by recorded potentials at the roof of the CS, and 1 nodoventricular AP was ablated via a transseptal approach near the CS os.

Conclusions:
Left-sided nodofascicular and nodoventricular AP appear to connect the ventricles with the CS musculature in the region of the CS os. Mapping and successful ablation sites can be guided by recording potentials within or near the CS os.
Reliability and Accuracy of Remote Fiberoptic Nasopharyngolaryngoscopy in the Pediatric Population
Authors: Miller Lauren E. , Buzi Adva , Williams Ashley , Rogers Rachel S. , Ortiz Angel G. , Jones-Ho Kellye O. , Elden Lisa M. 
Published: April 2020

Introduction: Telemedicine is an increasingly prevalent component of medical practice. In otolaryngology, there is the potential for telemedicine services to be performed in conjunction with device use, such as with a nasolaryngoscope. This study evaluates the reliability of remote examinations of the upper airway through an iPhone recording using a coupling device attached to a nasopharyngolaryngoscope (NPL). Methods: A prospective, blinded study was performed for pediatric patients requiring an NPL during an office visit. The NPL was performed using a coupling device attached to a smartphone to record the examination. A second, remote otolaryngologist then evaluated the recorded examination. Both otolaryngologists evaluated findings of anatomic sites including nasopharynx, oropharynx, base of tongue, larynx including subsites of epiglottis, arytenoids, aryepiglottic folds, false vocal cords, true vocal cords, patency of airway, and diagnostic impression, all of which were documented through a survey. Results of the survey were evaluated through inter-rater agreement using the κ statistic. Results: Forty-five patients underwent an NPL, all of which were included in the study. The average age was 4.9 years. The most common complaint requiring NPL was noisy breathing (n = 16). The inter-rater agreement for overall diagnosis was 0.74 with 80% percent agreement, rated as “good.” Other anatomic subsites with “good” or better inter-rater agreement were nasopharynx (0.75), oropharynx (0.75), and true vocal cords (0.71), with strong percentage agreement of 89%, 91%, and 87%, respectively. Both users of the adaptor found the recording setup to run smoothly. Conclusion: A telemedicine device for NPL use demonstrates strong diagnostic accuracy across providers and good overall evaluation. It holds potential for use in remote settings.
Clinical Presentation of COVID-19: A Systematic Review Focusing on Upper Airway Symptoms
Authors: Lovato Andrea , de Filippis Cosimo 
Published: April 2020

Aim: Pharyngodynia, nasal congestion, rhinorrhea, smell, and taste dysfunctions could be the presenting symptoms of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2. The aim was to perform a systematic review of current evidences on clinical presentation of COVID-19, focusing on upper airway symptoms in order to help otolaryngologists identifying suspected cases. Methods: We searched PubMed and Web of Science electronic databases. Results: We included 5 retrospective clinical studies for a total of 1556 hospitalized patients with COVID-19, 57.5% were male and mean age was 49.1 years. Pooled data revealed that pharyngodynia was present in 12.4% of patients, nasal congestion in 3.7%, and rhinorrhea was rare. No reports on COVID-19 and olfactory/gustative disorders matched inclusion criteria but preliminary evidences suggested they could be present. Common symptoms were fever (85.6%), cough (68.7%), and fatigue (39.4%). Frequent comorbidities were hypertension (17.4%), diabetes (3.8%), and coronary heart disease (3.8%); 83% of patients had alterations on chest computed tomography that were bilateral in 89.5% of cases. Ground-glass opacity was the most common finding (50%). Lymphopenia (77.2%) and leucopenia (30.1%) were common. Critical cases with complications were 9%, intensive care unit admission was required in 7.3%, invasive ventilation in 3.4%, and mortality was 2.4%. Conclusion: Otolaryngologists should know that pharyngodynia, nasal congestion, olfactory, and gustative disorders could be the presenting symptoms of COVID-19. Clinical presentation together with radiological and laboratory findings could help to identify suspected cases.
Multicenter Advanced Pediatric Otolaryngology Fellowship Prep Surgical Simulation Course with 3D Printed High‐Fidelity Models
Authors: Chang Brian , Powell Allison , Ellsperman Susan , Wehrmann Daniel , Landry April , Jabbour Noel , Goudy Steven , Zopf David 
Published: April 2020

ObjectiveTo assess the effect of 3‐dimensional (3D)–printed surgical simulators used in an advanced pediatric otolaryngology fellowship preparatory course on trainee education.Study DesignQuasi‐experimental pre/postsurvey.SettingMulticenter collaborative course conducted at a contract research organization prior to a national conference.Subjects and MethodsA 5‐station, 7‐simulator prep course was piloted for 9 pediatric otolaryngology fellows and 17 otolaryngology senior residents, with simulators for airway graft carving, microtia ear framework carving, and cleft lip/palate repair. Prior to the course, trainees were provided educational materials electronically along with presurveys rating confidence, expertise, and attitude around surgical simulators. In October 2018, surgeons engaged in simulation stations with direction from 2 attending faculty per station, then completed postsurveys for each simulator.ResultsStatistically significant increases (P <. 05) in self‐reported confidence (average, 53%; range, 18%‐80%) and expertise (average, 68%; range, 9%‐95%) were seen across all simulators, corresponding to medium to large effect sizes as measured by Cohen’s d statistic (0.41‐1.71). Positive attitudes around 3D printing in surgical education also demonstrated statistically significant increases (average, 10%; range, 8%‐13%). Trainees commented positively on gaining such broad exposure, although consistently indicated a preference for more practice time during the course.ConclusionWe demonstrate the benefit of high‐fidelity, 3D‐printed simulators in exposing trainees to advanced procedures, allowing them hands‐on practice in a zero‐risk environment. In the future, we hope to refine this course design, develop standardized tools to assess their educational value, and explore opportunities for integration into use in milestone assessment and accreditation.
Trends in Ambulatory Surgery Center Utilization for Otolaryngologic Procedures among Medicare Beneficiaries, 2010‐2017
Authors: Kondamuri Neil S. , Miller Ashley L. , Rathi Vinay K. , Miller Lauren , Bergmark Regan W. , Patel Tushar S. , Gray Stacey T. 
Published: April 2020

ObjectiveSurgical care is increasingly shifting to freestanding ambulatory surgical centers (ASCs). The extent to which otolaryngologists use ASCs has implications for patient safety and health care spending. This study characterizes trends in utilization and resultant financial implications for common otolaryngologic procedures performed at ASC and hospital outpatient departments (HOPDs).Study DesignRetrospective cross‐sectional analysis.SettingASCs, HOPDs.Subjects and MethodsSubjects included Medicare beneficiaries undergoing outpatient otolaryngologic procedures between 2010 and 2017. Procedures included the 20 highest‐volume procedures performed by otolaryngologists at ASCs in 2017. Main outcomes included absolute and relative percentage difference in the proportion of procedures furnished at ASCs and HOPDs and estimated Medicare cost savings resulting from increased ASC utilization between 2011 and 2017.ResultsThe proportion of outpatient otolaryngologic procedures performed at ASCs increased by 1.8% (relative difference: 10.0%; mean annual relative increase: 1.60%), and the proportion located at HOPDs decreased by 6.0% (relative difference: –11.8%; mean annual relative decrease: –1.6%) between 2010 and 2017. Rhinoplasty accounted for the largest absolute increase in ASC utilization over the study period (absolute [relative] 8.9% [33.5%]). Increased ASC utilization resulted in an estimated $7.1 million in cost savings to Medicare between 2011 and 2017.ConclusionOtolaryngologists shifted outpatient surgical care from HOPDs to ASCs between 2010 and 2017, with resultant reductions in Medicare expenditures. Further research is necessary to examine the impact of this shift on patient safety.
Comparing Kadish and Modified Dulguerov Staging Systems for Olfactory Neuroblastoma: An Individual Participant Data Meta‐analysis
Authors: Arnold Mark A. , Farnoosh Soroush , Gore Mitchell R. 
Published: April 2020

ObjectiveTo compare the Kadish and the modified Dulguerov staging of individual participants to determine the impact of stage and other prognostic factors on disease‐free (DFS) and overall survival (OS).Data SourcesSystematic review of EMBASE, MEDLINE, Cochrane Library, and CINAHL databases.Review MethodsThe Preferred Reporting Items for Systematic Reviews and Meta‐analysis (PRISMA) was followed for this study. Articles including patients with olfactory neuroblastoma (ONB) staged with both Kadish and Dulguerov staging systems were reviewed. The raw data from eligible studies were requested to perform an individual participant data (IPD) meta‐analysis.ResultsPooled data from 21 studies representing 399 patients with ONB undergoing treatment with curative intent showed that increasing age, treatment with chemotherapy, and positive or unreported margin status portended worse DFS (P <. 05). Increasing stage for both Kadish and Dulguerov staging systems was prognostic for worse DFS and OS (P <. 05), with Kadish C representing a heterogeneous group with regard to outcome and corresponding Dulguerov T stage. Using the Akaike information criterion, the Dulguerov staging system had superior performance to the Kadish system for DFS (1088.72 vs 1092.54) and OS (632.71 vs 644.23).ConclusionThis study represents the first IPD meta‐analysis of ONB directly comparing the outcomes of Kadish and Dulguerov staging systems in patients treated with primary surgery. Both systems correlated with DFS and OS, with superior performance in the Dulguerov system. Furthermore, the Kadish C group represented a heterogeneous group with regard to outcomes after stratification by the Dulguerov system. Dulguerov T4 patients had the worst outcome, with most being approached with open resection.
Epidemiology of Pediatric Tympanostomy Tube Placement in the United States
Authors: Bhattacharyya Neil , Shay Sophie G. 
Published: April 2020

The prevalence of pediatric tympanostomy tube placement (TTP) in the United States has not been reassessed in the past decade. To assess the prevalence of TTP and frequent ear infections (FEI), the National Health Interview Survey for the calendar year 2014 was used. Among 73.1 million children, 6.26 million (8.6%) had TTP. The incidence of FEI was 3.49 million (4.8%). Males (9.6%) were more likely than females (7.5%) to undergo TTP (P =. 004). Among children under 2 years of age, 9.1% reported FEI, compared to 3.9% of children aged 3 to 17 years. Among children under 2 years of age, 25% with FEI received TTP vs 1.5% without FEI (P <. 001). Among children aged 3 to 17 years, 31.1% with FEI received TTP vs 8.6% without FEI (P <. 001). TTP may be increasing nationally, although further assessment of adherence to clinical practice guidelines is needed to investigate this potential trend.