bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE NATURE OF ACTIVE GALACTIC NUCLEI WITH VELOCITY OFFSET EMISSION LINES*
Authors: Müller-Sánchez F. , Comerford J. , Stern D. , Harrison F. A. 
Published: October 2016

ABSTRACT
We obtained Keck/OSIRIS near-IR adaptive optics-assisted integral-field spectroscopy to probe the morphology and kinematics of the ionized gas in four velocity-offset active galactic nuclei (AGNs) from the Sloan Digital Sky Survey. These objects possess optical emission lines that are offset in velocity from systemic as measured from stellar absorption features. At a resolution of ∼0.″18, OSIRIS allows us to distinguish which velocity offset emission lines are produced by the motion of an AGN in a dual supermassive black hole system, and which are produced by outflows or other kinematic structures. In three galaxies, J1018+2941, J1055+1520, and J1346+5228, the spectral offset of the emission lines is caused by AGN-driven outflows. In the remaining galaxy, J1117+6140, a counterrotating nuclear disk is observed that contains the peak of Paα emission 0.″2 from the center of the galaxy. The most plausible explanation for the origin of this spatially and kinematically offset peak is that it is a region of enhanced Paα emission located at the intersection zone between the nuclear disk and the bar of the galaxy. In all four objects, the peak of ionized gas emission is not spatially coincident with the center of the galaxy as traced by the peak of the near-IR continuum emission. The peaks of ionized gas emission are spatially offset from the galaxy centers by 0.″1–0.″4 (0.1–0.7 kpc). We find that the velocity offset originates at the location of this peak of emission, and the value of the offset can be directly measured in the velocity maps. The emission-line ratios of these four velocity-offset AGNs can be reproduced only with a mixture of shocks and AGN photoionization. Shocks provide a natural explanation for the origin of the spatially and spectrally offset peaks of ionized gas emission in these galaxies.
Comparison of the Effect of Epithelial Removal by Transepithelial Phototherapeutic Keratectomy or Manual Debridement on Cross-linking Procedures for Progressive Keratoconus
Authors: Gaster Ronald N. , Ben Margines J. , Gaster David N. , Li Xiaohui , Rabinowitz Yaron S. 
Published: October 2016

PURPOSE:
To compare the visual, refractive, keratometric, topographic, and pachymetric outcomes of corneal collagen cross-linking (CXL) for progressive keratoconus following epithelial removal by transepithelial phototherapeutic keratectomy (PTK) or manual debridement.

METHODS:

In this analysis, 339 eyes (78% male, 22% female) that had undergone CXL following manual epithelial debridement (n = 180) or ablation via PTK (n = 159) were evaluated preoperatively and at 6, 12, and 24 months postoperatively for uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), maximum corneal keratometry, pachymetry, and spherical equivalent. The data were analyzed in a
t
test to evaluate the relative efficacy of each epithelial removal procedure.

RESULTS:
Manual epithelial debridement and ablation via PTK produce equivalent changes for all variables at each time interval with the exception of maximum corneal keratometry at 6 months postoperatively, for which PTK exhibited a significantly improved (flatter) result. This difference was present but not statistically significant at 12 and 24 months postoperatively.

CONCLUSIONS:
Prior to CXL, both manual epithelial debridement and ablation via PTK result in equivalent visual, refractive, and keratometric outcomes up to 24 months postoperatively.

[
J Refract Surg.
2016;32(10):699–704.]
Glistening Formation on a Single-Piece Prehydrated Hydrophobic Acrylic Intraocular Lens in a Diabetic Patient
Authors: Kang Su-Yeon , Eom Youngsub , Rhim Jay Won , Song Jong Suk , Kim Hyo Myung 
Published: October 2016

PURPOSE:
To report a case of intraocular lens (IOL) glistening after uneventful cataract surgery and in-the-bag implantation of an enVista MX60 IOL (Bausch & Lomb, Rochester, NY) in a patient with uncontrolled diabetes mellitus.

METHODS:
Case report.

RESULTS:
A 76-year-old woman with non-insulin–dependent diabetes mellitus underwent uncomplicated phacoemulsification with in-the-bag implantation of an enVista MX60 IOL. After 6 months, glistening formation within the IOL optic was observed. In the fellow pseudophakic eye, an acrylic hydrophilic Akreos Adapt AO IOL (Bausch & Lomb) was implanted without complications.

CONCLUSIONS:
IOL glistening can develop with the enVista MX60 IOL, even after uneventful cataract surgeries in certain situations (eg, uncontrolled diabetes mellitus). Increased vascular permeability due to uncontrolled diabetes mellitus might have been responsible for the postoperative IOL glistening formation.

[
J Refract Surg.
2016;32(10):710–712.]
Comparison of AL-Scan and IOLMaster 500 Partial Coherence Interferometry Optical Biometers
Authors: Hoffer Kenneth J. , Savini Giacomo 
Published: October 2016

PURPOSE:
To investigate agreement between the ocular biometry measurements provided by a newer optical biometer, the AL-Scan (Nidek Co, Ltd., Gamagori, Japan) and those provided by the IOLMaster 500 (Carl Zeiss Meditec, Jena Germany), which are both based on partial coherence interferometry.

METHODS:

Axial length, corneal power, and anterior chamber depth (corneal epithelium to lens) were measured in 86 eyes of 86 patients scheduled for cataract surgery using both biometers. All values were analyzed using a paired
t
test, the Pearson product moment correlation coefficient (
r
), and Bland–Altman plots.

RESULTS:

The mean axial length values of both instruments were exactly the same (23.46 ± 0.99 mm) for both) and showed excellent agreement and correlation. On the contrary, the AL-Scan measured a steeper mean corneal power by 0.08 diopters (D) at the 2.4-mm zone but by only 0.03 D at the 3.3-mm zone, only the former being statistically significant. The AL-Scan measured a deeper anterior chamber depth by 0.13 mm, which was statistically significant (
P
< .001).

CONCLUSIONS:
Agreement between the two units was good. However, the small but statistically significant difference in corneal power (at the IOLMaster-comparable 2.4-mm zone) and in the anterior chamber depth measurement make lens constant optimization necessary when calculating the intraocular lens power by means of theoretical formulas.

[
J Refract Surg.
2016;32(10):694–698.]
Small-Aperture Intraocular Lens Implantation in a Patient With an Irregular Cornea
Authors: Schultz Tim , Dick H. Burkhard 
Published: October 2016

PURPOSE:
To report a small-aperture intraocular lens (IOL) implantation after corneal trauma.

METHODS:
Case report.

RESULTS:
A 17-year-old boy with corneal scars, iris defect, and aphakia after perforating trauma in the right eye was scheduled for small-aperture IOL (IC-8; AcuFocus, Irvine, CA) implantation under general anesthesia. No intraoperative complications were observed. Six months after surgery, the uncorrected distance and near visual acuity increased significantly. Furthermore, reduced photopic phenomena were reported.

CONCLUSIONS:
The small-aperture IOL is a new and promising option to treat patients suffering from the effects of corneal irregularities.

[
J Refract Surg.
2016;32(10):706–708.]
Determinants of lymph node status in women with breast cancer
Authors: Chakraborty Abhijit , Bose Chinmoy Kumar , Basak Jayasri , Sen Aditya Narayan , Mishra Raghwendra , Mukhopadhyay Ashis 
Published: October 2016

Background & objectives:
Number of metastatic lymph nodes has a strong prognostic value in the course of breast cancer treatment, morbidity and mortality. This study was undertaken to determine the association between axillary lymph node metastasis and several variables such as age, tumour size, grade, lymphovascular invasion, oestrogen and progesterone receptor expression and HER2/neu status in patients with breast cancer.

Methods:
In this study 426 (with complete information on study variables) patients with breast cancer on treatment during March 2010 to December 2013, were analyzed. TNM (tumour node matastasis) staging was evaluated. The histological grading of tumours was done according to modified Bloom-Richardson Grading System. The immunophenotype of the tumour was determined as the expression of oestrogen (ER) and progesterone (PR) receptors and HER2/neu status. Univariate and multivariate analyses were carried out to determine the independent predictors of metastatic lymph node.

Results:
Among the studied patients, 44.36 per cent (189 of 426) of the patients had nodal metastases. Tumour histology, tumour grade, size and lympho-vascular invasion were related with node positivity. On univariate analysis, age, menopause, hormone receptor status did not relate with the node metastasis. Age, tumour grade, tumour size, lympho-vascular invasion and HER2/neu expression was likely to be associated with the number of lymph node metastasis.

Interpretation & conclusions:
The lymph node status was associated with clinical stage, tumour grade, tumour histology and HER2/neu status. These factors may be used for better management of such patients.
Epigenetic regulation of APC in the molecular pathogenesis of gallbladder cancer
Authors: Tekcham Dinesh Singh , Poojary Satish S. , Bhunia Shushruta , Barbhuiya Mustafa Ahmed , Gupta Sanjeev , Shrivastav Braj Raj , Tiwari Pramod Kumar 
Published: October 2016

Background & objectives:
Loss of function of adenomatous polyposis coli (APC) has been reported in cancer. The two promoters of APC, 1A and 1B also have roles in cancer. But, the epigenetic role of APC promoters is not yet clear in gallbladder cancer (GBC) and gallstone diseases (GSD). We undertook this study to determine the epigenetic role of APC in GBC and GSD.

Methods:
Methylation-specific (MS)-PCR was used to analyze the methylation of APC gene. The expression of APC gene was studied by semi-quantitative PCR, real-time PCR and immunohistochemistry (IHC) in GBC, GSD and adjacent normal tissues.

Results:
Of the two promoters, APC 1A promoter was found methylated in 96 per cent GBC (P=0.0155) and 80 per cent GSD (P=0.015). Exon 1 was downregulated in grade II (P=0.002) and grade III (P=0.0001) of GBC, while exon 2 was normally expressed. Scoring analysis of IHC revealed 0 or negativity in 34.48 per cent (P=0.057) and 1+ in 24.14 per cent (P=0.005) GBC cases suggesting loss of APC expression.

Interpretation & conclusions:
The present findings indicate epigenetic silencing of APC in advanced GBC. The methylation pattern, followed by expression analysis of APC may be suggested for diagnostic, prognostic and therapeutic purposes in GBC in future.
PI3K/Akt/mTOR signaling & its regulator tumour suppressor genes PTEN & LKB1 in human uterine leiomyomas
Authors: Makker Annu , Goel Madhu Mati , Mahdi Abbas Ali , Bhatia Vikram , Das Vinita , Agarwal Anjoo , Pandey Amita 
Published: October 2016

Background & objectives:
Despite their high occurrence and associated significant level of morbidity manifesting as spectrum of clinical symptoms, the pathogenesis of uterine leiomyomas (ULs) remains unclear. We investigated expression profile of tumour suppressor genes PTEN (phosphatase and tensin homolog deleted on chromosome ten) and LKB1 (liver kinase B1), and key signaling components of P13K (phosphatidylinositol 3-kinase)/Akt (protein kinase B)/mTOR (mammalian target of rapamycin) pathway in leiomyomas and adjacent normal myometrium in women of reproductive age, to explore the possibility of targeting this pathway for future therapeutic implications.

Methods:
Real time PCR (qPCR) was used to quantify relative gene expression levels of PTEN, Akt1, Akt2, mTOR, LKB1 and VEGFA (vascular endothelial growth factor A) in leiomyoma as compared to adjacent normal myometrium. Immunohistochemistry was subsequently performed to analyze expression of PTEN, phospho-Akt, phospho-mTOR, phospho-S6, LKB1 and VEGFA in leiomyoma and adjacent normal myometrium.

Results:
Significant upregulation of PTEN (2.52 fold; P=0.03) and LKB1 (3.93 fold; P=0.01), and downregulation of VEGFA (2.95 fold; P=0.01) genes were observed in leiomyoma as compared to normal myometrium. Transcript levels of Akt1, Akt2 and mTOR did not vary significantly between leiomyoma and myometrium. An increased immunoexpression of PTEN (P=0.015) and LKB1 (P<0.001) and decreased expression of VEGFA (P=0.01) was observed in leiomyoma as compared to myometrium. Immunostaining for activated (phosphorylated) Akt, mTOR and S6 was absent or low in majority of leiomyoma and myometrium.

Interpretation & conclusions:
Upregulation of PTEN and LKB1 in concert with negative or low levels of activated Akt, mTOR and S6 indicates that PI3K/Akt/mTOR pathway may not play a significant role in pathogenesis of leiomyoma.
Spectrum of AIDS defining & non-AIDS defining malignancies in north India
Authors: Sachdeva Ravinder Kaur , Sharma Aman , Singh Surjit , Varma Subhash 
Published: October 2016

Background & objectives:
There is scarcity of data on the frequency of malignancies in HIV infected individuals from India. The objective of this study was to determine the type and frequency of malignancies in HIV infected individuals attending a tertiary care hospital in north India.

Methods:
The study design included retrospective analysis of data of all HIV infected individuals registered in the Immunodeficiency clinic from December 2009 to December 2011 and a prospective analysis of HIV infected individuals registered from January 2012 to April 2013. The clinical details and treatment outcomes of all individuals diagnosed to have AIDS defining and non-AIDS defining malignancies were recorded.

Results:
Records of 2880 HIV infected individuals were reviewed. Thirty one (19 males, 12 females) individuals were diagnosed to have malignancy. AIDS defining malignancy was found in the form of non-Hodgkin's lymphoma in 12 individuals and cervical cancer in six women. Non-AIDS defining malignancies included Hodgkin's lymphoma (n=2); and chronic myelogenous leukaemia, carcinoma base of tongue, carcinoma larynx, carcinoma bronchus, sinonasal carcinoma, ovarian carcinoma, anal carcinoma, carcinoma urinary bladder, pleomorphic sarcoma, parathyroid adenoma, and renal cell carcinoma in one individual each. Mean CD4+cell count prior to ART initiation was 250 ± 195.6 (median: 187; range, 22-805) cells/μl and at the time of diagnosis of malignancy was 272 ± 202 (median: 202; range, 15-959) cells/μl. The mean CD4+ count of individuals with AIDS defining malignancy was significantly lower when compared with non-AIDS defining malignancy (P<0.001). Fourteen individuals were alive and on regular follow up, 15 had died and two cases were lost to follow up.

Interpretation & conclusions:
The frequency of malignancies in HIV infected patients at our centre was 1 per cent, with non-Hodgkin's lymphoma being the commonest. Further studies need to be done to document similar data from different parts of the country.
Development of a Comprehensive Communication Skills Curriculum for Pediatrics Residents
Authors: Peterson Eleanor B. , Boland Kimberly A. , Bryant Kristina A. , McKinley Tara F. , Porter Melissa B. , Potter Katherine E. , Calhoun Aaron W. 
Published: October 2016

ABSTRACT

Background
Effective communication is an essential element of medical care and a priority of medical education. Specific interventions to teach communication skills are at the discretion of individual residency programs.

Objective
We developed the Resident Communication Skills Curriculum (RCSC), a formal curriculum designed to teach trainees the communication skills essential for high-quality practice.

Methods
A multidisciplinary working group contributed to the development of the RCSC, guided by an institutional needs assessment, literature review, and the Accreditation Council for Graduate Medical Education core competencies. The result was a cohesive curriculum that incorporates didactic, role play, and real-life experiences over the course of the entire training period. Methods to assess curricular outcomes included self-reporting, surveys, and periodic faculty evaluations of the residents.

Results
Curricular components have been highly rated by residents (3.95–3.97 based on a 4-point Likert scale), and residents' self-reported communication skills demonstrated an improvement over the course of residency in the domains of requesting a consultation, providing effective handoffs, handling conflict, and having difficult conversations (intern median 3.0, graduate median 4.0 based on a 5-point Likert scale, P ≤ .002). Faculty evaluations of residents have also demonstrated improvement over time (intern median 3.0, graduate median 4.5 based on a 5-point Likert scale, P &lt; .001).

Conclusions
A comprehensive, integrated communication skills curriculum for pediatrics residents was implemented, with a multistep evaluative process showing improvement in skills over the course of the residency program. Positive resident evaluations and informal comments from faculty support its general acceptance. The use of existing resources makes this curriculum feasible.
Perceptions on the Impact of a Just-in-Time Room on Trainees and Supervising Physicians in a Pediatric Emergency Department
Authors: Thomas Anita A. , Uspal Neil G. , Oron Assaf P. , Klein Eileen J. 
Published: October 2016

ABSTRACT

Background
Just-in-time (JIT) training refers to education occurring immediately prior to clinical encounters. An in situ JIT room in a pediatric emergency department (ED) was created for procedural education.

Objective
We examined trainee self-reported JIT room use, its impact on trainee self-perception of procedural competence/confidence, and the effect its usage has on the need for intervention by supervising physicians during procedures.

Methods
Cross-sectional survey study of a convenience sample of residents rotating through the ED and supervising pediatric emergency medicine physicians. Outcomes included JIT room use, trainee procedural confidence, and frequency of supervisor intervention during procedures.

Results
Thirty-one of 32 supervising physicians (97%) and 122 of 186 residents (66%) completed the survey, with 71% of trainees reporting improved confidence, and 68% reporting improved procedural skills (P &lt; .05, +1.4-point average skills improvement on a 5-point Likert scale). Trainees perceived no difference among supervising physicians intervening in procedures with or without JIT room use (P = .30, paired difference −0.0 points). Nearly all supervisors reported improved trainee procedural confidence, and 77% reported improved trainee procedural skills after JIT room use (P &lt; .05, paired difference +1.8 points); 58% of supervisors stated they intervene in procedures without trainee JIT room use, compared with 42% with JIT room use (P &lt; .05, paired difference −0.4 points).

Conclusions
Use of the JIT room led to improved trainee confidence and supervisor reports of less procedural intervention. Although it carries financial and time costs, an in situ JIT room may be important for convenient JIT training.
Feasibility of a Comprehensive Wellness and Suicide Prevention Program: A Decade of Caring for Physicians in Training and Practice
Authors: Ey Sydney , Moffit Mary , Kinzie J. Mark , Brunett Patrick H. 
Published: October 2016

ABSTRACT

Background
Comprehensive treatment models reduce distress and suicide risk in military, university, and community populations, but are not well studied with in medical trainees and physicians in practice. Physicians face unique internal and external barriers that limit access to psychological or psychiatric treatment, which may contribute to higher rates of burnout, depression, and suicide.

Objective
Our goal is to report on the feasibility and utilization of a wellness and suicide prevention program for residents, fellows, and faculty in an academic health center.

Methods
The program provides individual counseling, psychiatric evaluation, and wellness workshops for residents/fellows (N = 906) and faculty (N = 1400). Demand for services is demonstrated by the participation rate of eligible trainees. Acceptability within the target population is examined in a 2011 survey in which trainees (N = 116, 97% participation) and program directors (N = 23, 88% participation) rated their satisfaction. Start-up costs and funding sources to sustain a wellness program are outlined.

Results
Over 10 years, utilization of services grew from 5% in the program's first year (2004–2005) to a high of 25% of eligible trainees for 2013–2014, and faculty utilization grew to 6% to 8% for 2014–2015. Trainees and program directors reported a high level of satisfaction with this wellness program. Funding for clinic space and clinical staff is provided by the hospital via the graduate medical education budget.

Conclusions
Increased utilization over 10 years, high satisfaction, and consistent institutional support suggest that this comprehensive model of care is feasible and valued.
GMMIP (v1.0) contribution to CMIP6: Global Monsoons Model Inter-comparison
Project
Authors: Zhou Tianjun , Turner Andrew G. , Kinter James L. , Wang Bin , Qian Yun , Chen Xiaolong , Wu Bo , Wang Bin , Liu Bo , Zou Liwei , He Bian 
Published: October 2016

Abstract. The Global Monsoons Model Inter-comparison Project (GMMIP) has been endorsed by the panel of Coupled Model Inter-comparison Project (CMIP) as one of the participating model inter-comparison projects (MIPs) in the sixth phase of CMIP (CMIP6). The focus of GMMIP is on monsoon climatology, variability, prediction and projection, which is relevant to four of the “Grand Challenges” proposed by the World Climate Research Programme. At present, 21 international modeling groups are committed to joining GMMIP. This overview paper introduces the motivation behind GMMIP and the scientific questions it intends to answer. Three tiers of experiments, of decreasing priority, are designed to examine (a) model skill in simulating the climatology and interannual-to-multidecadal variability of global monsoons forced by the sea surface temperature during historical climate period; (b) the roles of the Interdecadal Pacific Oscillation and Atlantic Multidecadal Oscillation in driving variations of the global and regional monsoons; and (c) the effects of large orographic terrain on the establishment of the monsoons. The outputs of the CMIP6 Diagnostic, Evaluation and Characterization of Klima experiments (DECK), “historical” simulation and endorsed MIPs will also be used in the diagnostic analysis of GMMIP to give a comprehensive understanding of the roles played by different external forcings, potential improvements in the simulation of monsoon rainfall at high resolution and reproducibility at decadal timescales. The implementation of GMMIP will improve our understanding of the fundamental physics of changes in the global and regional monsoons over the past 140 years and ultimately benefit monsoons prediction and projection in the current century.