bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of neighbourhood socioeconomic status on overweight and obesity in children 2–15 years of different ethnic groups
Authors: de Wilde J A , Eilander M , Middelkoop B J C
Published: December 2018

Background

Studies on the influence of neighbourhood socioeconomic status (N-SES) on overweight and obesity rates in children from different ethnic backgrounds are scarce. This study investigated the differential effect of N-SES on overweight (including obesity) and obesity prevalence in different ethnic groups, and if N-SES explains ethnic differences in the prevalence of overweight and obesity.

Design

A population based study of 109 766 body mass index (BMI) measurements of 86 209 children 2–15 years of Dutch, Turkish, Moroccan and South Asian descent. BMI class was determined with The International Obesity Task Force, and South Asian specific BMI cut-offs. WHO BMI criteria were applied for reference purposes. The effect of N-SES on prevalence rates was studied with generalized linear mixed models.

Results

Neighbourhood SES was negatively associated with overweight and obesity. However, the effect of N-SES on overweight was stronger in Dutch children (OR 0.75, 95% CI 0.73–0.77) than in Turkish (OR 0.86, 95% CI 0.82–0.90), Moroccan (OR 0.91, 95% CI 0.86–0.97) and South Asian (OR 0.90, 95% CI 0.84–0.96) children. The influence of N-SES on obesity showed a similar pattern, except for Moroccan children in whom obesity prevalence remained stable over the whole N-SES range. At the same N-SES, overweight and obesity prevalence was significantly higher in Turkish, Moroccan and especially South Asian children compared with Dutch children. Adjusting for N-SES attenuated the ethnic differences.

Conclusions

Neighbourhood SES was negatively associated with overweight and obesity rates in all ethnic groups, but only partly explained the ethnic differences in overweight and obesity prevalence.
Across borders: thoughts and considerations about cultural preservation among immigrant clinicians
Authors: Ashing Kimlin Tam , Dawkins-Moultin Lenna , George Marshalee , Antoine Gerard M , Nunez-Smith Marcella , Pérez-Stable Eliseo J
Published: December 2018

Immigrant clinicians make up 20–28% of the health workforce in many high-income countries, including Australia, Britain, Canada and the USA. Yet, the preserved culture of immigrant clinicians remains largely invisible in the medical literature and discourse. Research on immigrant clinicians primarily attends to medical professional requirements for the adopted country (medical board examination eligibility, fellowship training and licensing). Cultural preservation among immigrant clinicians has not been adequately considered or studied.

This paper highlights this notable gap in healthcare delivery and health services research relevant to immigrant clinicians. We propose it is worthwhile to explore possible relationships between immigrant clinicians’ preserved culture and clinical practices and outcomes since immigrant clinicians cross borders with their academic training as well as their culture. The sparse literature regarding immigrant clinicians suggests culture influences health beliefs, attitudes about the meaning of illness and clinical practice decisions. Additionally, immigrant clinicians are more likely to serve rural, low-income populations; communities with high density of ethnic minorities and immigrants; and areas with primary care shortage. Therefore, cultural preservation among immigrant clinicians may have important implications for public health and health disparities. This area of inquiry is important, if not urgent, in health services research.
The Smithsonian at war
Authors: Redman Samuel
Published: December 2018

This article describes the Smithsonian Institution’s involvement in World War ii. For a brief (but active) period the Smithsonian assisted the Army, Navy, and other war agencies. Museum staff eagerly shared ideas and information they had spent generations gathering; they were also willing to embrace the war effort as an opportunity to expand collections. While many museum contributions to the war effort were not made public, a book series on natural history and culture published by museum experts came to be known as the War Background Studies. Examining the Smithsonian’s response to ‘total war’, this article argues that the transformations experienced by the museum were largely temporary, with uneven levels of impact; it also explores how numerous significant intellectuals debated the museum’s future role in post-war society.
Robust Forecast Evaluation of Expected Shortfall*
Authors: Ziegel Johanna F , Krüger Fabian , Jordan Alexander , Fasciati Fernando
Published: December 2018

Motivated by the Basel III regulations, recent studies have considered joint forecasts of Value-at-Risk and Expected Shortfall. A large family of scoring functions can be used to evaluate forecast performance in this context. However, little intuitive or empirical guidance is currently available, which renders the choice of scoring function awkward in practice. We therefore develop graphical checks of whether one forecast method dominates another under a relevant class of scoring functions, and propose an associated hypothesis test. We illustrate these tools with simulation examples and an empirical analysis of S&P 500 and DAX returns.
Support for Private Members’ Bills in the United Kingdom and Japan
Authors: Moriue Shota
Published: December 2018

It is a common arrangement in different legislatures that individual members who are not ministers can bring forward bills (private members’ bills), but the drafting of a bill may involve certain technicalities that are usually outside their knowledge. How, then, do legislators prepare the text of private members’ bills? This article presents the way in which support is provided to those members who seek to introduce their bills in the UK Parliament, the Scottish Parliament, the National Assembly for Wales, the Northern Ireland Assembly, and the National Diet of Japan. It then discusses two common challenges for such support: how to avoid the risk that demand will outstrip supply and how to make sure that the drafting of private members’ bills meets the quality standards (if any).
The Pattern of Tpeak-Tend Interval and QTdis, and Pdis in Children with Brucellosis
Authors: Çetin Mecnun , Turfan Nevzat , Karaman Kamuran , Yaşar Akkız Şahin , Güven Burcu , Tunçdemir Perihan
Published: December 2018

Objective

To investigate the effect of inflammation on the conducting system of the heart in patients diagnosed with brucellosis.

Methods

A total of 42 patients diagnosed with brucellosis and 39 age and sex-matched healthy children were enrolled into the study. Pre- and post-treatment electrocardiographic parameters in brucellosis and control group were recorded from an electrocardiogram for each patient.

Results

The results indicated that the parameters including Pmax, Pdis, QTmax, QTdis, QTcdis, Tp-edis interval and Tp-emax/QTmax and Tp-emax/QTcmax ratios, which are known to be key indicators for the prediction of severe atrial or ventricular arrhythmia and sudden cardiac death and also important parameters used as the indicators for the non-invasive evaluation of the transmural heterogeneity were significantly longer in the study group compared with the control group (p < 0.05).

Conclusion

In this study, it was determined that the brucella disease had more cardiac involvement than thought, and this was more in the subclinical form of cardiac involvement.
Gastric responses to acute psychological stress in climacteric women: a pilot study
Authors: Huerta-Franco María Raquel , Vargas-Luna Miguel , Somoza Ximena , Delgadillo-Holtfort Isabel , Balleza-Ordaz Marco , Kashina Svetlana
Published: December 2018

Objective:

Women exhibit reduced ovarian sex hormones during the menopausal period that result in well-known physical and psychological symptoms. However, symptoms related to gastric motility (GM) have not been thoroughly investigated. We hypothesized that stress response gastric motility (SRGM) is lower in postmenopausal (PM) and perimenopausal (PERIM) women than in premenopausal (PREM) women. Estrogenic decline leads to neuroendocrine changes in different areas of the brain. These changes can result in hypothalamic vasomotor symptoms, disorders in eating behaviours, and altered blood pressure, in addition to psychological disorders such as stress, anxiety, depression, and irritability related to alterations in the limbic system.

Methods:

In this pilot study, 55 PREM, PERIM, and PM women were clinically evaluated using the Nowack stress profile (SP) and State-Trait Anxiety Inventory (STAI). GM was assessed via electrical bioimpedance using two psychological stress tests (Stroop and Raven tests).

Results:

Basal SP and STAI-anxiety test scores were similar among the three groups of women (P > 0.05). PERIM women had lower GM in the basal state (P < 0.05) than did other women. PREM and PM women had significantly decreased GM during the stress tests (P < 0.05). However, PERIM did not exhibit GM changes during stress tests (P > 0.05).

Conclusion:

Changes in sex hormones during PERIM may affect GM and SRGM.
Knee osteoarthritis and menopausal hormone therapy in postmenopausal women: a nationwide cross-sectional study
Authors: Jung Jae Hyun , Bang Cho Hee , Song Gwan Gyu , Kim Cholhee , Kim Jae-Hoon , Choi Sung Jae
Published: December 2018

Objective:

The incidence of osteoarthritis (OA) increases after menopause, and may be related to hormonal changes in women. Estrogen deficiency is known to affect the development of OA, and menopausal hormone therapy (MHT) is suggested to be related to the development of OA. However, the relationship between knee OA and MHT remains controversial. The association between knee OA prevalence and MHT was investigated using large-scale national data.

Methods:

Data were collected from 4,766 postmenopausal women from the Korea National Health and Nutrition Examination Survey (2009-2012). MHT was defined as regular hormone medication for ≥1 year, and demographic and lifestyle variables were compared between the MHT and non-MHT groups. Knee OA was defined according to symptoms and radiographic findings.

Results:

In the multiple logistic regression models, the OA odds ratio was 0.70 for the MHT group (95% confidence interval 0.50-0.99), compared with the non-MHT group.

Conclusions:

The prevalence of knee OA was lower in participants with MHT than in those without MHT.
The 15th Annual Warren K. Sinclair Keynote Address—Jus•ti•fied and Com•men•su•rate
Authors: Rosenstein Marvin
Published: December 2018

When patients are exposed to ionizing radiation for medical diagnosis or treatment, the procedure being performed should be justified, and the amount of ionizing radiation used should be commensurate with the medical purpose. A legal limit on the amount of ionizing radiation used for medical exposure of a patient does not apply. The biological basis for radiation protection of patients is the same as for all other ionizing radiation exposures: prevent or avoid tissue reactions and reduce the probability of stochastic effects (primarily cancer) while maintaining the benefits to the individual and to society. Justifying the clinical procedure as (1) being appropriate for the clinical purpose and (2) being appropriate for an individual patient is in the purview of the clinical community and individual practitioners, respectively. Managing ionizing radiation levels to be commensurate with the medical purpose is becoming a more prominent feature for all types of imaging procedures (to manage the increased probability of cancer). An approach using advisory diagnostic reference levels is finding widespread use throughout the world. A diagnostic reference level is a method for evaluating whether the amount of radiation is unusually high or low for a particular imaging procedure.
Radiation Protection Responsibility in Brachytherapy
Authors: Thomadsen Bruce
Published: December 2018

Radiation protection in brachytherapy entails protecting members of the public, radiation professionals, and the patient from unnecessary radiation, as well as making sure that the radiation used in the patient’s treatment is placed correctly with the correct dose distribution. Protecting members of the public from radiation emanating from brachytherapy sources implanted in a patient was an issue several decades ago, but with modern brachytherapy, the problem has mostly disappeared. The most frequent treatments are either low-dose-rate permanent implants for prostate cancer, or high-dose-rate procedures for gynecological, breast, or skin cancers. Almost all current permanent implants use low-energy photon sources that are shielded by the patient. Similarly, some temporary implants, such as eye plaques that also use low-energy photon sources, incorporate a metallic shield into the applicator. All high-dose-rate brachytherapy takes place in a treatment vault, in a manner similar to external-beam radiotherapy, thus eliminating exposure to members of the public, in the absence of some terrible error or mistake. Modern brachytherapy techniques either eliminate or greatly reduce radiation exposures to the brachytherapy staff also. As noted above, high-dose-rate treatments take place in a heavily shielded vault, and staff remain outside the vault when the source is out of its shielded housing. For low-energy permanent implants, facilities often order the sources loaded into the implant needles by the vendor, reducing the time the procedure staff is exposed to the source. Often, the loaded needles can be shielded while awaiting implantation. Alternatively, individual sources may be placed using a special applicator that shields the staff. Radiation protection of the patient in many respects differs little from how it was decades ago except for greatly increased precision. Assaying the strength of a source of any kind is still essential. As important as verifying the source strength is ensuring that the source will be in the correct location for the desired time. Imaging serves as the main mechanism to guide the implantation and verify source or applicator position. Modern imaging has unveiled anatomy exquisitely and often permits definition of target disease and neighboring normal structures sufficiently to allow very conformal dose distributions. Despite these great advances and capabilities, errors and mistakes (together called failures) still occur. Failures in health care overall are the third leading cause of death in the United States. Most treatment failures result not from equipment problems but from procedures gone wrong. Attention to comprehensive commissioning of both equipment and procedures and risk-based development of quality management procedures helps protect the patient. Patient safety organizations, established by the Agency for Healthcare Research and Quality, work with client facilities to help identify weaknesses in both treatment procedures and quality management and to develop improvements to enhance protection.
Dose Optimization of Hybrid Imaging
Authors: Fahey Frederic H.
Published: December 2018

Hybrid imaging combines the functional and molecular imaging of positron emission computed tomography and single-photon emission computed tomography with the anatomical information available from computed tomography and magnetic resonance imaging. As a result, the clinical utility of positron emission computed tomography/computed tomography and single-photon emission computed tomography/computed tomography has been clearly established in the past 17 y. In addition, the use of positron emission computed tomography/magnetic resonance, which was introduced to the clinic in the past decade, has continued to grow. These multimodality approaches to medical imaging have substantial dosimetric aspects associated with their practice in both adults and children. For positron emission computed tomography/computed tomography and single-photon emission computed tomography/computed tomography, one must consider the radiation dose delivered from both the radiopharmaceutical and the computed tomography portion of the hybrid scan. Whether the computed tomography is to be used solely for attenuation correction, anatomical correlation of patient, or full diagnosis must be taken into account when deciding on the computed tomography acquisition parameters. Even after 17 y, the most appropriate approach to the acquisition of these modalities is not fully established. When appropriately used, positron emission computed tomography/magnetic resonance provides the opportunity for notable dose reduction. In addition to the elimination of the radiation dose from the computed tomography, one may consider the higher sensitivity of the positron emission computed tomography component relative to that used in positron emission computed tomography/computed tomography and the longer acquisition time to reduce the amount of administered activity of the radiopharmaceutical. However, one must realize that magnetic resonance presents a different set of safety concerns outside of those associated with ionizing radiation. As with all medical procedures, the benefits as well as the potential risks of the procedure need to be evaluated in the context of choosing the most appropriate procedure to be performed and the optimization of acquisition protocol to assure high-quality clinical information with the least potential for risk possible.
NCRP Vision for the Future and Program Area Committee Activities in 2018
Authors: Boice John D.
Published: December 2018

The National Council on Radiation Protection and Measurements’ (NCRP) congressional charter aligns with our vision for the future: to improve radiation protection for the public and workers. This vision is embodied within NCRP’s ongoing initiatives: preparedness for nuclear terrorism, increasing the number of radiation professionals critically needed for the nation, providing new guidance for comprehensive radiation protection in the United States, addressing the protection issues surrounding the ever-increasing use of ionizing radiation in medicine (the focus of this year’s annual meeting), assessing radiation doses to aircrew related to higher altitude and longer flights, providing guidance on emerging radiation issues such as the radioactive waste from hydraulic fracturing, focusing on difficult issues such as high-level waste management, and providing better estimates of radiation risks at low doses within the framework of the Million Person Study of Low-Dose Radiation Health Effects. Cutting-edge initiatives included a reevaluation of the science behind recommendations for lens of the eye dose, recommendations for emergency responders on dosimetry after a major radiological incident, guidance to the National Aeronautics and Space Administration with regard to possible central nervous system effects from galactic cosmic rays (the high-energy, high-mass ions bounding through space), reevaluating the population exposure to medical radiation, and addressing whether the linear no-threshold model is still the best available for purposes of radiation protection (not for risk assessment). To address these initiatives and goals, NCRP has seven program area committees on biology and epidemiology, operational concerns, emergency response and preparedness, medicine, environmental issues and waste management, dosimetry, and communications. The NCRP vision for the future will continue and increase under the leadership of President-Elect Dr. Kathryn D. Held (Massachusetts General Hospital and Harvard Medical School, and current NCRP executive director and chief science officer). The NCRP quest to improve radiation protection for the public is hindered only by limited resources, both human capital and financial.
Radiation Oncology—External-Beam Radiation Therapy
Authors: Martin Melissa C.
Published: December 2018

The application of structural shielding design techniques and goals as outlined in the National Council on Radiation Protection and Measurements Report 151, Structural Shielding Design and Evaluation for Megavoltage X- and Gamma-Ray Radiotherapy Facilities (2005), continues to be the basis for treatment vault design in 2018 with some updated information. Treatment techniques have changed significantly with the dominant usage of intensity-modulated radiation therapy techniques today based on concurrent imaging. Some of the developments in linear accelerator technology over the past 15 y include flattening filter-free modes, which enable higher instantaneous dose rates; three-dimensional conformal radiation therapy resulting in potentially higher workloads since healthy tissue is spared; improved intensity-modulated radiation therapy treatment delivery systems with lower monitor units per centigray delivered than traditional step and shoot intensity-modulated radiation therapy; stereotactic body radiation therapy with higher treatment fractions and increased workloads; and increased use of stereotactic radiosurgery with conventional linear accelerators as well as robotic arm-mounted linear accelerators with higher treatment fractions. These new treatment units also incorporate multiple-energy x-ray beams (2 to 5 MV typical), which require a significant change in the specification of a workload to be used in each vault. As the equipment in radiation oncology departments has evolved to state-of-the-art modalities, the requirements for adequate radiation shielding for these modalities has become more rigorous. Architectural designs no longer depend on standard maze design rectangular rooms. Innovative layouts and utilization of multiple layers of shielding materials allow much greater flexibility in room designs. Maze-less rooms with direct-shielded doors are part of these challenging designs and are very common today. Use of multiple-density concrete blocks allows quicker construction of vaults and requires less space for the equivalent shielding provided. Combinations of high-density or normal-density concrete, steel, and lead are used in designs to make optimum use of available space and cost. Additional shielding needed at the edges of these single- or bi-parting sliding doors as well as baffle designs for heating, ventilation, and air conditioning systems and communication cable penetrations require detailed calculations. Examples of these designs will be given in this presentation. Consideration of the radiation levels around the planned vault must also include adjacent multistory buildings.
Contribution of synovial macrophages to rat advanced osteoarthritis pain resistant to cyclooxygenase inhibitors
Authors: Sakurai Yusuke , Fujita Masahide , Kawasaki Shiori , Sanaki Takao , Yoshioka Takeshi , Higashino Kenichi , Tofukuji Soichi , Yoneda Sosuke , Takahashi Tatsuya , Koda Ken , Asaki Toshiyuki , Hasegawa Minoru , Morioka Yasuhide
Published: December 2018

Most advanced knee osteoarthritis (OA) patients experience chronic pain resistant to cyclooxygenase (COX) inhibitors. However, the cells and molecules involved in this advanced OA pain remain poorly understood. In this study, we developed a rat model of advanced knee OA by modification of the monoiodoacetate-induced OA pain model and examined involvement of synovial macrophages in advanced OA pain. Cyclooxygenase inhibitors, such as celecoxib and naproxen, and a steroid were ineffective, but an opioid and anti–nerve growth factor (NGF) antibody was effective for pain management in the advanced OA model. Similar to advanced OA patients, histological analysis indicated severe bone marrow damages, synovitis, and cartilage damage and an increase of macrophages with high expression of interleukin-1β, NGF, nitric oxide synthase (NOS) 1, NOS2, and COX-2 in the knee joint of the advanced OA model. Intravenous injection of clodronate liposomes depleted synovial macrophages, which decreased the level of not only proinflammatory mediator interleukin-1β but also NGF in the knee joint, leading to pain suppression in the advanced OA model. These data suggest the involvement of synovial macrophages in advanced knee OA pain resistant to COX inhibitors by increasing proinflammatory mediators, and that drugs targeting synovial macrophages might have potent analgesic effects.
Development of a Women's Pelvic Health Specialty Clinical Experience
Authors: Anderson Kathleen , LaLonde Amanda
Published: December 2018

Background and Purpose.

The purpose of this article is trifold. First, to share the process and outcomes of developing a specialty clinical experience specific to the pelvic health setting; second, to encourage others to consider a similar model; and finally, to promote the early engagement of interested students on the pathway to practice specialization.

Case Description.

A full-time clinical experience was developed in the specialty practice area of pelvic health at the request of an interested student. After the selection of a clinical partner, goals and objectives, outcomes assessment, and a timeline for goal achievement were established.

Outcomes.

Student successfully met entry-level criteria on a focused application of the CPI and completed indirect measures including a specialty professional development plan and reflective journaling. The student anticipates further pursuit of specialty physical therapist practice.

Discussion and Conclusion.

The academic program and the clinical partners enthusiastically supported the process and outcomes. The academic institution anticipates using the developed format to design additional learning experiences in specialty practice settings. Given the success of this experience, it would seem that the template is applicable to other institutions seeking to develop specialty clinical experiences.
LVAD Outflow Graft Role in Pump Thrombosis
Authors: Barac Yaron D. , Nevo Adam , Schroder Jacob N. , Milano Carmelo A. , Daneshmand Mani A.
Published: December 2018

Left ventricular assist devices are (LVAD) used for circulatory support in patients with end-stage heart failure. Hemolysis/pump dysfunction is a well-known complication of this therapy with various etiologic causes. A small proportion of these complications are caused by outflow graft obstructions; this complication has received little attention in the scientific literature. Herein, we provide a comprehensive overview of the role of the LVAD outflow graft obstruction and its treatment options.
Low-dose Immune Tolerance Induction in Hemophilia: A Single-Center Experience
Authors: Zulfikar Bulent , Koc Basak , Ozdemir Nihal
Published: December 2018

Introduction:

The development of inhibitors against factors VIII/IX is the most serious complication in hemophilia. The best treatment strategy for inhibitor eradication is immune tolerance induction (ITI). The aim of this study was to evaluate patients treated with low-dose ITI at a single center with limited resources.

Materials and Methods:

In total, 29 (8.05%) of 360 hemophilia A patients exhibited inhibitors. The data from hemophilia patients with inhibitors undergoing ITI between 1999 and 2017 were collected and analyzed.

Results:

Seventeen ITIs administered to 15 hemophilia A patients with inhibitors were analyzed, and the data from 13 ITIs conducted in 12 patients were evaluated. The median age at ITI onset was 10 years (range: 1.25 to 52 y). The maximum inhibitor titer before ITI was 30 Bethesda Units (BU) (range: 4.48 to 135), and the median inhibitor titer was 1.25 BU (range: 0 to 5.6) at the onset of ITI. The median time interval between the inhibitor development and ITI onset was 60 months (range: 7 to 264 mo). The median inhibitor titer during ITI was 3.4 BU (range: 0 to 158.7). At the end of the treatment, 4 of the 12 patients (33.3%) exhibited a complete response, 4 (33.3%) had partial responses (with continuing ITI), and 4 (33.3%) exhibited ITI failure.

Conclusions:

Treatment of hemophilia patients with inhibitors is challenging, and ITI is the best treatment method; however, a high-dose daily ITI regimen cannot be given to every patient in every country due to its high cost. Our results show that low-dose ITI may be a choice for selected patients with inhibitors.
Identification of Homozygous Somatic DICER1 Mutation in Pleuropulmonary Blastoma
Authors: Nozawa Akifumi , Ozeki Michio , Kawasaki Riko , Nakama Mina , Iwata Hisashi , Yamamoto Toshiyuki , Fukao Toshiyuki
Published: December 2018

Pleuropulmonary blastoma (PPB) is a rare, progressive, and aggressive malignant intrathoracic tumor observed during childhood. Mutations in the DICER1 gene have been considered a major etiologic factor of PPB and cause a variety of tumor types in children and young adults. We present a 3-year-old boy with type II PPB. Multimodal treatment consisting of surgery and neoadjuvant chemotherapy was effective. DICER1 mutations were examined by Sanger sequencing, microarray comparative genomic hybridization, and microsatellite markers. The results revealed that a somatic biallelic DICER1 mutation with uniparental disomy was present in the tumor tissue.
Sepsis Education Initiative Targeting qSOFA Screening for Non-ICU Patients to Improve Sepsis Recognition and Time to Treatment
Authors: Raines Kim , Sevilla Berrios Ronaldo A. , Guttendorf Jane
Published: December 2018

Background:

The quick-Sequential Organ Failure Assessment (qSOFA) criteria are recommended for identifying non–intensive care unit (ICU) patients at risk for sepsis but are underutilized.

Local Problem:

We hypothesized that education on recognizing sepsis using qSOFA criteria and empowering nurses to trigger rapid response team (RRT) calls based on positive qSOFA scores would reduce time to recognition and time to intervention and improve treatment compliance in non–ICU patients.

Methods:

The methods involved a descriptive retrospective review of 60 sepsis patients (30 pre- and 30 posteducation) to determine sepsis recognition time (qSOFA-to-RRT); time-to-sepsis interventions (reported as median [interquartile range] hours); and percent compliance with interventions.

Interventions:

We provided qSOFA and sepsis education to more than 1000 nurses, physicians, and advanced practice providers in a large tertiary hospital.

Results:

Posteducation, time to recognition (qSOFA-to-RRT) improved from 11.8 hours (3.4, 34.3) pre to 1.7 (0, 11.7) post (P = .005). Time from qSOFA to antibiotics improved from 1.4 hours (2.4, 6.2) pre to −4.7 (−25.4, 1.8) hours post (P < .01). Using qSOFA, compliance improved for antibiotics from 60% pre to 87% post (P = .02).
Implementation of a Vital Sign Alert System to Improve Outcomes
Authors: Huff Shelly , Stephens Kimberly , Whiteman Kimberly , Swanson-Biearman Brenda , Mori Candy
Published: December 2018

Background:

Patients at risk for clinical deterioration often show changes in vital signs up to 24 hours before a critical event. Use of modified early warning scores has demonstrated effectiveness in identifying patients at risk for clinical deterioration and improving outcomes.

Local Problem:

Documentation of vital signs, timely recognition of clinical deterioration, and compliance with the sepsis bundles remained a challenge.

Methods:

An interprofessional team developed an electronic vital sign alert (VSA) system with a concurrent running sepsis screen, along with clinical protocols.

Interventions:

Education was provided and the VSA system was implemented on 3 nursing units.

Results:

After implementation, the number of unplanned transfers to the intensive care unit increased. Mortality rate and length of stay in the intensive care unit for patients transferred for respiratory failure and sepsis significantly decreased. There was a 21% increase in identification of sepsis.

Conclusions:

The VSA system was an effective tool to identify patients at risk for clinical deterioration and help to improve outcomes.
Characteristics of Emergency Department Presentations of Pediatric Poisoning Between 2011 and 2016
Authors: Moon JeongMi , Chun ByeongJo , Cho YongSoo , Lee SeungDo , Jung EuJene
Published: December 2018

Objectives

Pediatric poisoning represents a major preventable cause of morbidity. The epidemiology of pediatric poisoning differs by country and region. This study aimed to characterize pediatric poisoning in South Korea over the last 6 years and to discuss current regulations related to the causative agents involved in pediatric poisoning.

Methods

Data were obtained for injury presentation in emergency departments (EDs) using the in-depth surveillance system of the Korea Centers for Disease Control and Prevention.

Results

Pediatric poisoning accounted for 1.2% of injury-related ED presentations among children and 2.0% of deaths related to child injury. The annual number of pediatric poisoning–related ED presentations and the number of accidental poisonings have significantly increased over the last 6 years. There was no significant change in the type of causative agent involved in pediatric poisoning, and a therapeutic agent was the most common agent, regardless of the intentionality of pediatric poisoning (39.4% in accidental poisoning; 86.4% in intentional poisoning). Cold medications and cardiovascular drugs were the two most common drug types involved in accidental poisoning, whereas acetaminophen and psychotropics were most commonly involved in intentional poisoning. The case fatality rate of pediatric poisoning was 0.2% over 6 years.

Conclusions

Over 6 years, the annual number of total poisoning cases and of accidental poisoning cases in particular increased despite a lack of change in the types of causative agents related to pediatric poisoning. This phenomenon may reflect failed preventative measures. Thus, the implementation of tailored preventative measures based on epidemiological data should be accelerated.
Epipericardial Fat Pad Necrosis—A Rare Cause of Chest Pain in an Adolescent
Authors: Bolourchi Meena , Renjen Pooja , Kovanlikaya Arzu , Baad Michael , Traister Michael , Flynn Patrick A. , Kern Jeffrey H.
Published: December 2018

Epipericardial fat necrosis is a rare cause of acute pleuritic chest pain reported in approximately 40 cases. This diagnosis mimics a myocardial infarction, pulmonary embolism, or pericarditis; however, the cardiac enzymes and electrocardiogram are usually normal. We present the first reported case of epipericardial fat necrosis in an adolescent.
The Second Victim: A Contested Term?
Authors: Tumelty Mary-Elizabeth
Published: December 2018

Objectives

The term “second victim” was seminally coined by Wu, in recognition of the profound and long-lasting impact adverse events and medical errors may have on medical practitioners. Since the conception of this vocable over a decade ago, the term second victim has been internationally accepted and is widely used in discussion of this important topic. Notwithstanding its widespread use, controversy surrounds the term second victim in light of the traditional connotations with the word “victim.” However, notable in their absence are the views of medical practitioners on the use of this term. This article addresses this gap through an exploration of perceptions on the terminology used to describe physicians who experience distress after an adverse event or medical error.

Methods

This research arose as part of a wider study on the dynamic of medical negligence litigation in Ireland. The study used a qualitative approach, using semistructured interviews as the data gathering instrument. The sample involved representatives of medical training bodies (2 individual interviews and 1 focus group of 4 individuals) and legal professionals (barristers) (12 individual interviews). Those interviewed from medical training bodies were physicians who have an active role in the college providing training and support to their members.

Results

A number of participants shared their views on the term second victim, and the findings of this study suggest that some physicians and legal professionals are uncomfortable with the term second victim despite its widespread use in other jurisdictions. This is due to the traditional connotations that surround the term victim, and the perception that being labeled a victim may undermine the harm experienced by the patient.

Conclusions

Although the impact of adverse events and medical error on the physician is undisputed, use of the term second victim can be seen as insensitive to the patient, as well as dissipating the professional identity of the healthcare provider. Second victim is an internationally recognized term, as coined by Wu (2000). Finding an appropriate replacement is an important but difficult task.
Unintended Patient Safety Risks Due to Wireless Smart Infusion Pump Library Update Delays
Authors: Hsu Kang-Yu , DeLaurentis Poching , Bitan Yuval , Degnan Daniel D. , Yih Yuehwern
Published: December 2018

Objective

Our previous study showed that the issue of drug library update delays on wireless intravenous (IV) infusion pumps of one major vendor was widespread and significant. However, the impact of such a delay was unclear. The objective of this study was to quantify the impact of pump library update delays on patient safety in terms of missed and false infusion programming alerts.

Methods

The study data sets included infusion logs and drug libraries from three hospitals of one health system from January 2015 to December 2016. We identified limit setting changes of any two consecutive drug library versions. We quantified the impact of using outdated drug limit settings by missed and false infusion programming alerts.

Results

Twenty-five updates of the drug library were released within the health system during the 2-year period with an average interval of 28.8 days. After a new library version was issued, it took at least 6 days for 50% of all pumps to become up-to-date and 15 days or more to reach 80%. All three hospitals had at least 16% of all IV infusions programmed with outdated libraries. This resulted in 18%, 24.4%, and 27% of false alerts in the three hospitals, respectively. We identified two cases of missed alert infusions of high-risk medications, propofol, and potassium chloride, which could have negatively impacted patient safety.

Conclusions

These findings support our assumption that potential serious harm can happen when IV infusions are administered with outdated drug limit settings due to delays in drug library updates on the pump.
Race Differences in Reported Harmful Patient Safety Events in Healthcare System High Reliability Organizations
Authors: Thomas Angela D. , Pandit Chinmay , Krevat Seth A.
Published: December 2018

Objectives

The aim of the study was to determine whether race differences exist in voluntarily reported harmful patient safety events in a large 10 hospital healthcare system on a high reliability organization journey.

Methods

From July 1, 2015, to June 30, 2017, employees in a healthcare system based in Washington, District of Columbia, and Maryland voluntarily reported harmful patient safety events by type using a Patient Safety Event Management System. Inpatients, outpatients, and observation patients were identified as “black,” “white,” or “other” (N = 5038). Using retrospective analysis and χ2 goodness of fit, comparisons of race proportions were conducted to determine differences at the health system level, by hospital, by event type, and by severity.

Results

Significant race differences existed: (1) overall with higher proportions of whites and lower proportions of other in a Patient Safety Event Management System; (2) by type across races; (3) in six hospitals across races; and (4) by type and by hospital for blacks and whites. All differences were significant at P < 0.05.

Conclusions

Race differences in harmful events exist in voluntary reporting systems by type and by hospital setting. Healthcare organizations, particularly healthcare high reliability organizations, can use these findings to help identify areas of further study and investigation. Further study and investigation should include efforts to understand the root cause of the differences found in this study, including the role of reporting bias.
Diffuse Idiopathic Skeletal Hyperostosis, Associated Morbidity, and Healthcare Utilization
Authors: Tripathi Maanas , Rajmohan Divya , Quirk Cody , Beckett Brooke , Choi Dongseok , Rich-Garg Neha , Deodhar Atul
Published: December 2018

Background

Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory condition affecting the spine, characterized by ossification of paravertebral ligaments. Our cross-sectional study investigated the frequency, associated morbidity, and healthcare utilization of DISH patients at our university hospital over 1 year.

Methods

Our university's database of spinal radiographs was searched from 2005 to 2015 for “DISH” or “diffuse idiopathic skeletal hyperostosis.” The diagnosis of DISH was made by 2 board-certified radiologists (B.B. and C.Q.) based on the radiographs of cervical, thoracic, or lumbar spine. Patients from 2015 were further analyzed with regards to demographics, comorbidities, and healthcare interventions. Their spinal radiographs were reread by 2 authors. Patients were divided into those who fulfilled the Resnick criteria for DISH (group A), and those who did not fully meet the criteria but had radiographic features suggestive of DISH (group B). Means and proportions were used to describe variables. For group comparisons, t test and χ2 test were used.

Results

Between 2005 and 2015, 3439 radiology records mentioned DISH as a diagnosis. Of 195 patients diagnosed with DISH in 2015, 153 were in group A, 41 were in group B, and 2 had erroneous diagnoses. Chronic back pain was common, and more often reported in group B than in group A (81% vs 63%, p = 0.04). Substantial portions of patients required opioid medications for pain control (51%), spinal surgery (31%), and consultations with various specialists for regional pain (57%).

Conclusions

Diffuse idiopathic skeletal hyperostosis is a diagnosis with significant morbidity, despite being commonly viewed as asymptomatic. A majority of DISH patients had chronic back pain, and a large proportion required spinal surgery, although there may be several confounders. Future research is needed to systematically assess healthcare utilization by DISH patients.
Designing liquid repellent, icephobic and self-cleaning surfaces with high mechanical and chemical durability
Authors: Bhushan Bharat , Multanen Victor
Published: December 2018

Liquid repellent, icephobic and self-cleaning surfaces are of interest in industrial applications, including solar panels, self-cleaning windows, wind turbines, and automotive and aerospace components. In this study, a coating using a simple and scalable fabrication technique was used to produce superliquiphobic surfaces with a low tilt angle. The coating comprises hydrophobic SiO
2
nanoparticles with a binder of methylphenyl silicone resin to achieve superhydrophobicity. After ultraviolet–ozone treatment of the coating, an additional coating of fluorosilane was deposited to achieve superliquiphobicity with low tilt angle. Data for these coatings are presented showing the ability to repel water and oil, anti-icing properties down to −60°C, self-cleaning, and the ability to maintain superliquiphobicity in hot environments up to about 95°C, after soaking in deionized water for more than 200 h at room temperature and for about 50 h at 50°C and 70°C, and in chemical environments with low pH values. The coatings were found to be mechanically durable. Detailed characterization for anti-icing provides an insight into the mechanisms of icephobicity.

This article is part of the theme issue ‘Bioinspired materials and surfaces for green science and technology’.
Structural properties and their influence on the prey retention in the spider web
Authors: Jyoti Jeevan , Kumar Amit , Lakhani Piyush , Kumar Navin , Bhushan Bharat
Published: December 2018

Orb webs absorb the impact energy of prey and transmit vibratory information to the spider with minimal structural damage. The structural properties of the web and the arrangement of threads within the web affect transmission time during the prey impact. The objective of the present study is to determine damping, stiffness, and transmissibility of healthy and damaged spider webs. Experimental results show that stiffness and transmissibility diminish from the inner to outer spiral threads and gradient variation in the structural properties of spiral threads enhances signal transmission capability toward the centre regardless of the position of prey impact within the healthy web. Spiral threads exhibit excellent prey retention properties due to their stretching capability. Kinetic energy produced by prey is absorbed in the threads, which help the spider to analyse the prey retention properties and also determine the response time. The minor damage (up to 25%) does not alter the basic characteristics of the web due to self-adjustment of tension within the web. Damping, natural frequency, stiffness and transmissibility decrease with the increase in the percentage of damaged web. The present study addresses the structural sustainability of the spider web irrespective of minor damages and also provides guidance in designing the structures under impact.

This article is part of the theme issue ‘Bioinspired materials and surfaces for green science and technology’.
Pleistocene Mammal Population Fluctuation Patterns Inferred by Their Genomes
Authors: Liu Yulu , Liu Biao , Pan Xingxin , Shi Qiong , Xiao Zhoujian , Li Shengbin , Li Shuaicheng
Published: December 2018

Paleoclimate fluctuations critically affect paleoecological systems and influence mammal populations, even resulting in population differentiation [1]. Historical effective population size (Ne) can reflect these influences [2, 3]. Dozens of recent studies have investigated the relationship between variations inNevalues of one or a small number of mammalian species, inferred from genomic data, and fluctuations in paleoclimate [4-7]. However, there lacks an integrated and comprehensive study on the relationship between the fluctuations in paleoclimate and variations inNevalues inferred from genome sequencing data of a wide range of mammals. To investigate patterns in mammalianNevalues during the the Pleistocene, we gathered whole genome sequencing data of 60 mammals from 35 species distributed across Afro-Eurasia and the Americas, then inferred theirNecurves using the Pairwise Sequentially Markovian Coalescent (PSMC) method; 30 mammalianNecurves almost simultaneously started to contract at the turning point of the Middle Pleistocene Transition (MPT); then the population of seven mammals started to expand at the turning point of the Middle Brunhes Event (MBE), while the contraction of other mammals’ populations was prolonged to the later different time periods. Eight mammals experienced a severe population contraction around the Last Glaciation Maximum, as some aves did [8], while four potential ruminant beneficiaries showed an expanding population.Sus scrofaandBos taurusexperienced an internal population differentiation in the MPT. To conclude, the phenomenon that critical paleoclimate events facilitated contemporaneous animal population fluctuations in the paleoecological system is showed by ourNecurve analysis.