bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physical Performance Limitations After Severe Lower Extremity Trauma in Military Service Members
Authors: Wilken Jason M. , Roy Catherine W. , Shaffer Scott W. , Patzkowski Jeanne C. , Blanck Ryan V. , Owens Johnny G. , Hsu Joseph R. 
Published: January 2018

Objectives:
To characterize the type and magnitude of lower extremity physical performance deficits in military service members who have undergone rehabilitation after limb salvage or transtibial amputation.

Design:
Cross-sectional prospective.

Setting:
Level I trauma military medical and rehabilitation center.

Patients/Participants:
Service members with lower extremity trauma resulting in limb salvage (n = 20) or unilateral transtibial amputation (n = 14) compared with uninjured actively training service members (n = 123).

Intervention:
Control participants and individuals with amputation were tested during a single session. Participants with limb salvage were tested with and without the use of a custom carbon fiber orthosis.

Main Outcome Measurements:
Physical performance as measured using four-square step, sit-to-stand 5 times, and timed stair ascent tests. Secondary outcomes included the associations between these lower extremity activity measures to determine the interrelationship of activity limitations.

Results:
The ability of service members to rapidly ascend stairs, a demanding lower limb mobility task, is limited after amputation and limb salvage. However, performance on an agility test similar to the four-square step test approximated normative levels. Differences between individuals with amputation or limb salvage were less than 1 second for all tests and were not statistically significant. Correlations were observed among the physical performance measures in the tested patient populations, particularly between the sit-to-stand and timed stair ascent tests.

Conclusions:
Severe limb trauma significantly affects performance, particularly during tasks requiring lower extremity strength and power. Individuals with amputation or limb salvage who were provided a custom carbon fiber orthosis and intensive rehabilitation had similar performance.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Residual Neurological Symptoms After Peripheral Nerve Blocks for Pediatric Knee Surgery
Authors: Tamai Robert J. , Sullivan Brian T. , Lee Rushyuan J. 
Published: January 2018

Background:
Peripheral nerve blocks (PNBs) provide excellent pain control and reduce the need for systemic analgesics in orthopaedic surgery. PNBs rarely cause complications; however, a few studies of adults have reported neurological complications during the early postoperative period. We investigated complications associated with the use of PNBs during pediatric knee surgery.

Methods:
We reviewed the medical records of all 121 children (aged ≤18 y) who underwent knee surgery by 1 orthopaedic surgeon between October 2014 and September 2016. One hundred of these patients had PNBs. The primary outcome of interest was postoperative neurological symptoms. Other study parameters were patient characteristics, surgical details, tourniquet use/duration of use, PNB guidance method and anatomic location, and PNB-associated procedural complications (eg, blood loss, anesthetic neurotoxicity). Data were analyzed using Student t tests and Fisher exact tests, with significance at P<0.05.

Results:
Of the 100 patients with PNBs, 23 had persistent lower-extremity paresthesias postoperatively. Most paresthesias were attributed to the surgical procedure; however, at first follow-up (mean, 1.6±0.4 wk) 6 patients had paresthesias and other neurological symptoms proximal to the knee in a distribution pattern consistent with the PNB. Three of these were unresolved at last follow-up (mean, 56±37 wk). All neurological symptoms were associated with femoral nerve blocks. The 6 patients with suspected PNB-associated neurological symptoms had a significantly higher mean BMI (31±5.5) than the 94 patients without symptoms (23±6.1; P=0.002). Obesity was associated with PNB-associated neurological symptoms (P=0.002), as was female sex (P<0.001). No significant differences were found in terms of age, surgery duration, or tourniquet use/duration of use. Most PNB procedures used ultrasound guidance, and no procedural complications were reported.

Conclusions:
Compared with previous studies, we report a higher rate (6%) of PNB-associated neurological symptoms in children after knee surgery with PNBs. Obesity and female sex were associated with persistent neurological symptoms in the distribution pattern of the PNB.

Level of Evidence:
Level III (retrospective comparative study).
Fertility Preservation Services for Women With Newly Diagnosed Cancer
Authors: Winkelman William D. , Rosen Mitchell P. , Mok-Lin Evelyn 
Published: January 2018

Objective:
To study the resources available for cancer patients once referred for fertility preservation.

Materials and Methods:
Cross-sectional study clinics that are members of the Society for Assisted Reproductive Technology assess support for fertility preservation.

Results:
Surveys were distributed to a total of 1135 members at 394 Society for Assisted Reproductive Technology clinics. Responses were received from 99 individuals representing a total of 84 unique clinics (21.3%). Most clinics (76%) are able to see new cancer patients within 24 to 48 hours after a referral. Clinics most commonly offer oocyte freezing and embryo freezing (96% and 98%, respectively), with a significantly smaller portion of clinics offering ovarian tissue freezing (26%). Although most clinics offer fertility preservation for breast cancer, hematologic cancers and ovarian cancer, only 31% of clinics offer fertility preservation for pediatric premenarchal cancers. Clinics that receive >20 referrals from oncology centers annually are more likely to be in the Northeast and have an academic affiliation. These clinics are more likely to provide support for patients during their cancer treatment, more likely to have long-term follow-up with cancer patients and similarly more likely to have cancer patients return to take advantage of their treatment.

Conclusions:
There are significant geographic and clinic variations in support for fertility preservation. Clinics overall are able to expeditiously see patients to avoid delays in oncologic treatment. Clinics that provide additional support and long-term care tend to have a larger oncologic volume and have more patients who utilize their fertility treatment upon completion of cancer therapy.
Impact of Surgeon Self-evaluation and Positive Deviance on Postoperative Adverse Events After Non-cardiac Thoracic Surgery
Authors: Ivanovic Jelena , Mostofian Fargol , Anstee Caitlin , Gilbert Sebastien , Maziak Donna E. , Shamji Farid M. , Sundaresan Ramanadhan Sudhir , Villeneuve Patrick James , Seely Andrew J. E. 
Published: January 2018

ABSTRACTAs an innovative approach to improve quality of surgical care, we combined surgeon self-assessment and anonymized peer comparison with continuous quality improvement seminars using positive deviance (CQI/PD) to identify surgeon(s) with the lowest rates of adverse events (AEs) to guide group practice recommendations. Our objective was to quantify the impact these interventions on postoperative AEs rates after major non-cardiac chest operations. All postoperative AEs after all thoracic operations (n= 1,084, March, 2013 to February, 2016, single-center) were prospectively collected using the thoracic morbidity and mortality system, based on Clavien–Dindo schema. Online software provided surgeons (n= 6) with self-evaluation and peer comparison at all times. In addition, quarterly CQI/PD seminars (n= 8, September, 2013 to December, 2015) focused on common impactful AEs: atrial fibrillation (AFIB), prolonged alveolar air leak (PAAL), and anastomotic leak (AL). Impact was analyzed using univariate statistics 6, 9, and 12 months before and after implementation. We observed reductions of postoperative AEs after CQI/PD: a decrease (all time periods) in AFIB, greatest at 6 months (10.1% vs. 6.7%;p= .36); a decrease (all time periods) in PAAL, greatest at 12 months (18.9% vs. 11.7%;p< .05); and decrease (6 and 9 months) in AL, greatest at 6 months (11.1% vs. 8.3%;p= .82). Improvements in AE rates after individual surgeon self-evaluation and CQI/PD seminars provide encouraging results that merit further investigation.
Linkage to care of HbsAg-positive and anti-HCV-positive patients after a systematic screening approach in the German primary care setting
Authors: Lüllau Anja , Petroff David , Bätz Olaf , Kramer Jan , Jedrysiak Katrin , Tenckhoff Hannelore , Berg Thomas , Wolffram Ingmar , Wiegand Johannes 
Published: January 2018

Background
Identification of previously unknown cases is important to lower the burden of chronic hepatitis B and C infection. However, a screening program in the primary care setting has not yet been established. Therefore, a systematic screening project was conducted in 21 008 patients (Wolffram and colleagues). Here, we describe linkage to care of identified HbsAg-positive and anti-hepatitis C virus (HCV)-positive patients.

Methods
General practitioners characterized further medical care by a standardized questionnaire. Data of 48/110 HbsAg-positive and 114/199 anti-HCV-positive patients were available. An APRI index more than 2 or up to 0.5 indicated the presence of cirrhosis or the absence of fibrosis.

Results
APRI was calculated in 32/48 hepatitis B virus (HBV) patients (>2: n=1; ≤0.5: n=29) and 34/114 HCV patients (>2: n=4; ≤0.5: n=23). The general practitioners were already aware of the positive HBsAg and anti-HCV-test in 13/48 and 59/114 patients, respectively.
For 29/35 newly diagnosed HBV patients and 26/55 HCV patients, further diagnostics were initiated: ultrasound 77 versus 38%, liver biopsy 20 versus 4%, and gastroscopy 20 versus 7%.
Antiviral treatment was initiated in 5/35 HBV cases and in 10/55 HCV patients.
A family screening was initiated in 22/35 HBV versus 13/55 HCV index patients and showed one additional HbsAg-positive and two anti-HCV-positive cases.
Diagnostic procedures differed significantly between anti-HCV-positive and HbsAg-positive patients (P<0.001 for APRI, ultrasound, and family screening; P=0.03 for liver biopsy).

Conclusion
Diagnostic procedures should be improved for hepatitis C-infected patients. The APRI index was only of limited value in the primary care setting.
Observational study in healthy volunteers to define interobserver reliability of ultrasound haemodynamic monitoring techniques performed by trainee doctors
Authors: Bussmann Benjamin M. , Sharma Shrey , Mcgregor David , Hulme William , Harris Tim 
Published: January 2018

Objectives
Bedside ultrasound is increasingly being used to guide fluid management in shocked patients. Little data exist on the inter-rater reliability of techniques used, especially when performed by nonexpert trainee doctors. The primary aim of this study is to measure the inter-rater reliability of five ultrasound techniques commonly used to guide fluid management: inferior vena cava collapsibility index (IVCCI), transthoracic echocardiography (TTE)-derived stroke volumes, ultrasound cardiac output monitor (USCOM) derived stroke volume and carotid artery blood flow and corrected flow time measurements.

Methods
Two Royal College of Emergency Medicine level one ultrasound-certified emergency medicine trainees performed paired ultrasound measurements on 31 healthy nonpatient volunteers. Inter-rater reliability was assessed through three indices: interclass correlation coefficient (ICC), limits of agreements (LOAs) derived from Band–Altman plots and the proportion of paired scans with absolute differences of less that 15% (defined as agreement).

Results
TTE-derived measurements performed the best overall, with an LOA of 22%, an ICC of 0.55 and an agreement of 80%. USCOM also performed well, with an LOA of 33%, an ICC of 0.68 and an agreement of 58%. IVCCI and carotid artery-derived measurements performed poorly across all indices.

Conclusion
TTE-derived measurements showed the highest level of inter-rater reliability and can thus be expected to provide reliable measures over time with different sonographer clinicians. USCOM interobserver reliability was also adequate for clinical use. However, on the basis of inter-reliability measures, IVCCI and carotid artery measurements were found to be inadequate for clinical use.
Perceptions of Infection Risk With Immunomodulatory Medications
Authors: Sharim Rebecca , Thomas Preethi , Mathew Leny , George Michael , Rosenbach Misha 
Published: January 2018

Objectives
Physicians of many specialties encounter patients treated with immunomodulatory medications and must weigh the risk of infection when making medical decisions. We explored how physician perceptions of the infection risk of immunomodulatory medications differ by specialty and level of experience.

Methods
A survey was distributed to physicians from the internal medicine, family medicine, emergency medicine, rheumatology, dermatology, and infectious disease departments at 1 tertiary care institution. Physicians scored their level of concern for the risk of infection of 15 commonly used immunomodulatory medications hypothetically taken for 1 year.

Results
The survey was distributed to 634 people; 197 physicians completed the survey. Opinion of the risk of infection differed significantly by specialty for 8 of 15 medications. Experienced providers rated risk of infection differently from less experienced providers for prednisone 10 to 20 mg (P = 0.046), hydroxychloroquine (P = 0.013), dapsone (P = 0.029), and anti–tumor necrosis factor (TNF) therapy (P = 0.027). Most experienced physicians regarded dapsone (95%) and hydroxychloroquine (93%) as low risk, whereas many less experienced physicians scored them as medium- or high-risk medications. In contrast, experienced physicians were more likely to rate prednisone 10 to 20 mg as medium or high risk. Most less experienced physicians (55%) identified anti-TNF therapy as high risk, whereas experienced physicians were split evenly among low, medium, and high risk.

Conclusions
There is substantial variability in physician perception of the risk of infection of many immunomodulatory medications. Experienced physicians are more concerned than peers about the risk of infection of intermediate doses of prednisone. Opinions regarding anti-TNF therapy range broadly even among experienced providers.
Heterochromatin drives organization of conventional and inverted nuclei
Authors: Falk Martin , Feodorova Yana , Naumova Natasha , Imakaev Maxim , Lajoie Bryan R. , Leonhardt Heinrich , Joffe Boris , Dekker Job , Fudenberg Geoffrey , Solovei Irina , Mirny Leonid 
Published: January 2018

AbstractThe mammalian cell nucleus displays a remarkable spatial segregation of active euchromatic from inactive heterochromatic genomic regions. In conventional nuclei, euchromatin is localized in the nuclear interior and heterochromatin at the nuclear periphery. In contrast, rod photoreceptors in nocturnal mammals have inverted nuclei, with a dense heterochromatic core and a thin euchromatic outer shell. This inverted architecture likely converts rod nuclei into microlenses to facilitate nocturnal vision, and may relate to the absence of particular proteins that tether heterochromatin to the lamina. However, both the mechanism of inversion and the role of interactions between different types of chromatin and the lamina in nuclear organization remain unknown. To elucidate this mechanism we performed Hi-C and microscopy on cells with inverted nuclei and their conventional counterparts. Strikingly, despite the inversion evident in microscopy, both types of nuclei display similar Hi-C maps. To resolve this paradox we developed a polymer model of chromosomes and found a universal mechanism that reconciles Hi-C and microscopy for both inverted and conventional nuclei. Based solely on attraction between heterochromatic regions, this mechanism is sufficient to drive phase separation of euchromatin and heterochromatin and faithfully reproduces the 3D organization of inverted nuclei. When interactions between heterochromatin and the lamina are added, the same model recreates the conventional nuclear organization. To further test our models, we eliminated lamina interactions in models of conventional nuclei and found that this triggers a spontaneous process of inversion that qualitatively reproduces the pathway of morphological changes during nuclear inversion in vivo. Together, our experiments and modeling suggest that interactions among heterochromatic regions are central to phase separation of the active and inactive genome in inverted and conventional nuclei, while interactions with the lamina are essential for building the conventional architecture from these segregated phases. Ultimately our data suggest that an inverted organization constitutes the default state of nuclear architecture.
Commensal-Pathogen Competition Impacts Host Viability
Authors: Fast David , Kostiuk Benjamin , Foley Edan , Pukatzki Stefan 
Published: January 2018

ABSTRACTWhile the structure and regulatory networks that govern the activity of the type-six secretion system (T6SS) of Vibrio cholerae are becoming increasingly clear, we know less about the role of the T6SS in disease. Under laboratory conditions, V. cholerae uses the T6SS to outcompete many Gram-negative species, including other V. cholerae strains and human commensal bacteria. However, the role of these interactions has not been resolved in an in-vivo setting. We used the Drosophila melanogaster model of cholera to define the contribution of the T6SS to V. cholerae pathogenesis. Here, we demonstrate that interactions between the T6SS and host commensals impact pathogenesis. Inactivation of the T6SS, or removal of commensal bacteria attenuates disease severity. Re-introduction of the Gram-negative commensal bacterium Acetobacter pasteurianus into a germ-free host is sufficient to restore T6SS-dependent pathogenesis. Together, our data demonstrate that the T6SS acts on commensal bacteria to promote the pathogenesis of V. cholerae.
Novel Phosphorylation States of the Yeast Spindle Pole Body
Authors: Fong Kimberly K. , Zelter Alex , Graczyk Beth , Hoyt Jill M. , Riffle Michael , Johnson Richard , MacCoss Michael J. , Davis Trisha N. 
Published: January 2018

ABSTRACTPhosphorylation regulates yeast spindle pole body (SPB) duplication and separation and likely regulates microtubule nucleation. We report a phosphoproteomic analysis using tandem mass spectrometry of purifiedSaccharomyces cerevisiaeSPBs for two cell cycle arrests, G1/S and the mitotic checkpoint, expanding on previously reported phosphoproteomic data sets. We present a novel phosphoproteomic state of SPBs arrested in G1/S by acdc4-1temperature sensitive mutation, with particular interest in phosphorylation events on the γ-tubulin small complex (γ-TuSC). Thecdc4-1arrest is the earliest arrest at which microtubule nucleation has occurred at the newly duplicated SPB. Several novel phosphorylation sites were identified in G1/S and during mitosis on the microtubule nucleating γ-TuSC. These sites were analyzedin vivoby fluorescence microscopy and were shown to be required for proper regulation of spindle length. Additionally,in vivoanalysis of two mitotic sites in Spc97 found that phosphorylation of at least one of these sites is required for progression through the cell cycle. This phosphoproteomic data set not only broadens the scope of the phosphoproteome of SPBs, it also identifies several γ-TuSC phosphorylation sites influencing microtubule regulation.
CDK1 and CDK2 regulate phosphorylation-dependent NICD1 turnover and the periodicity of the segmentation clock
Authors: Carrieri Francesca Anna , Murray Philip , Davies Paul , Dale Jacqueline Kim 
Published: January 2018

ABSTRACTAll vertebrates share a segmented body axis. Segments form periodically from the rostral end of the presomitic mesoderm (PSM) and this periodicity is regulated by the segmentation clock, a molecular oscillator that drives dynamic clock gene expression across the PSM with a periodicity that matches somite formation. Notch signalling is crucial to this process. Altering Notch intracellular domain (NICD) stability affects both the clock period and somite size. However, the mechanistic details of how NICD stability is regulated are unclear.We identified a highly conserved site crucial for NICD recognition by the SCF E3 ligase, which targets NICD for degradation. We demonstrate both CDK1 and CDK2 can phosphorylate NICD in the domain where this crucial residue lies and that NICD levels vary in a cell cycle-dependent manner. Inhibiting CDK1 or CDK2 activity increases NICD levels both in vitro and in vivo, leading to a delay of clock gene oscillations.
C2-continuous orientation trajectory planning for robot based on spline quaternion curve
Authors: Niu Xuejuan , Wang Tian 
Published: January 2018

Purpose
To realize the smooth interpolation of orientation on robot end-effector, this paper aims to propose a novel algorithm based on the unit quaternion spline curve.

Design/methodology/approach
This algorithm combines the spherical linear quaternion interpolation and the cubic B-spline quaternion curve. With this method, a C2-continuous smooth trajectory of multiple teaching orientations is obtained. To achieve the visualization of quaternion curves on a unit sphere, a mapping algorithm between a unit quaternion and a point on the spherical surface is given based on the physical meaning of the unit quaternion.

Findings
Finally, the curvature analysis of a practical case shows that the orientation trajectory (OT) constructed by this algorithm satisfied the C2-continuity.

Originality/value
This OT satisfies the requirement of smooth interpolation among multiple orientations on robots in industrial applications.
Reaching women with perinatal mental illness at the booking-in appointment
Authors: Haynes Emma 
Published: January 2018

Purpose
The purpose of this paper is to look at the positive future gains of reaching women with perinatal mental illness at the first midwifery booking-in appointment, a unique opportunity that could be more widely used as a point of detection, awareness and prevention of illness in the perinatal period.

Design/methodology/approach
A more robust section of this appointment that includes focussed detection and awareness of prior and current mental health concerns as well as the stigma attached to these conditions will allow midwives to signpost women to get much needed treatment prior to delivery. Suitable treatment options also need to be available and in place at this point.

Findings
The existing booking-in process, for highlighting and diagnosing mental health conditions, has limited suitability. Detection in the postnatal period has inherent difficulties due to time pressures on women, the costs to the mother, baby, family and the economic costs to society, which are considerable. The postnatal period may be too late for treatment, with the harm already done to the woman, their baby and their family.

Research limitations/implications
Research is needed to assess the efficacy of such a strategy, including the costs to train the midwives to deliver this additional service, and the consideration of suitable treatment options at the antenatal stage. This may help to reduce the high levels of attrition within treatment programmes currently running.

Originality/value
This paper fulfils a need to diagnose and prevent perinatal mental illness at an earlier point in pregnancy.