bluuebunny/crossref_metadata_2025 huggingface dataset:
Retaliation, Remedies, and Contracts
Authors: Mittlaender Sergio , Buskens Vincent
Published: May 2019

Contracts commit individuals to a future course of action and create feelings of entitlement on the parties. In a contractual gap, parties’ duties and rights are not univocal, and while promisors will often feel entitled to breach, promisees will feel entitled to receive the promised performance. This divergence leads to disputes, aggrievement, and retaliatory behavior whenever one of the parties feels shortchanged. Remedies for breach are then apt not only to induce performance by promisors, but also to minimize promisees’ aggrievement, reduce retaliation, and thereby keep the peace in society. This article reports results from an experiment that investigates under what circumstances promisees retaliate to breach and to what extent expectation damages fulfill the function of crowding out retaliatory behavior. It reveals how norms of fairness play a fundamental role in shaping parties’ reactions to breach, as promisees did not punish any violation of a prior agreement. They rather punished breach when the promisor profited from it, and the outcome was an unfair distribution of the gains from trade. Neither loss of expectancy nor the inefficiency of the result induced retaliation. Expectation damages successfully crowded out retaliation by disappointed promisees, and thereby avoided high welfare losses from decentralized forms of punishment of perceived wrongs.
Development of Membrane Hollow Fiber for Determination of Maleic Anhydride in Ambient Air as a Field Sampler
Authors: Partovi Ehsan , Bahrami Abdulrahman , AfKhami Abbas , Ghorbani Shahna Farshid , Ghamari Farhad , Farhadian Maryam
Published: May 2019

This research develops a rapid method for sampling and analysis of maleic anhydride (MA) in air using a one-step hollow fiber (HF) membrane in the liquid phase followed by high-performance liquid chromatography. A sampling chamber was prepared for sampling of MA with HF-supported de-ionized water absorbency. Several important parameters, such as sampling flow rate, sampling time, and breakthrough volume (BTV), were optimized at different concentrations using a central composite design. The results showed that sampling could be performed at the maximum period of 4 h with a flow rate of 1 mL min–1 for different concentrations (in the range of 0.05–2 mg m–3). The BTV was 240 mL. The relative standard deviations for the repeatability of interday and intraday were 7–10%, 10%, respectively, and the pooled standard deviation was 0.088. The limit of detection and limit of quantitation values were 0.033 and 0.060 mg m–3, respectively. Moreover, our findings revealed that the samples could be stored in sealed HF flexible plastic tubes in a cover at refrigerator temperature (4°C) for up to 7 days. The HF method was compared with method number 3512 National Institute Occupational Safety and Health for determination of MA. There was a good correlation (R2 = 0.99) between the two methods at a concentration of 0.05 to 2 mg m–3 in the laboratory and the average concentration of MA for both methods was 0.11 mg m–3 in the ambient air at an adhesive manufacturer. Our findings indicated that the proposed HF can act as a reliable, rapid, and effective approach for sampling of MA in workplaces.
Path2Surv: Pathway/gene set-based survival analysis using multiple kernel learning
Authors: Dereli Onur , Oğuz Ceyda , Gönen Mehmet
Published: May 2019

Motivation

Survival analysis methods that integrate pathways/gene sets into their learning model could identify molecular mechanisms that determine survival characteristics of patients. Rather than first picking the predictive pathways/gene sets from a given collection and then training a predictive model on the subset of genomic features mapped to these selected pathways/gene sets, we developed a novel machine learning algorithm (Path2Surv) that conjointly performs these two steps using multiple kernel learning.

Results

We extensively tested our Path2Surv algorithm on 7655 patients from 20 cancer types using cancer-specific pathway/gene set collections and gene expression profiles of these patients. Path2Surv statistically significantly outperformed survival random forest (RF) on 12 out of 20 datasets and obtained comparable predictive performance against survival support vector machine (SVM) using significantly fewer gene expression features (i.e. less than 10% of what survival RF and survival SVM used).

Availability and implementation

Our implementations of survival SVM and Path2Surv algorithms in R are available at https://github.com/mehmetgonen/path2surv together with the scripts that replicate the reported experiments.

Supplementary information

Supplementary data are available at Bioinformatics online.
Diagnosing acute interstitial nephritis: considerations for clinicians
Authors: Nussbaum Eliezer Zachary , Perazella Mark A
Published: May 2019

Acute interstitial nephritis (AIN) is a common cause of acute kidney injury (AKI), particularly in hospitalized patients. It can be difficult for clinicians to differentiate between AIN and other common causes of AKI, most notably acute tubular necrosis (ATN) and prerenal injury. Clinicians often struggle with the clinical history and laboratory data available to definitively diagnose AIN. Sometimes they diagnose ATN or AIN based on these flawed data. Thus it is important that clinicians be familiar with the utility of commonly ordered tests used to aid in the diagnosis. Unfortunately, no single test performs particularly well on its own, and until a biomarker is rigorously shown to be diagnostic of AIN, most patients require a kidney biopsy to definitively establish the diagnosis and direct further management.
Tripal v3: an ontology-based toolkit for construction of FAIR biological community databases
Authors: Spoor Shawna , Cheng Chun-Huai , Sanderson Lacey-Anne , Condon Bradford , Almsaeed Abdullah , Chen Ming , Bretaudeau Anthony , Rasche Helena , Jung Sook , Main Dorrie , Bett Kirstin , Staton Margaret , Wegrzyn Jill L , Feltus F Alex , Ficklin Stephen P
Published: May 2019

Community biological databases provide an important online resource for both public and private data, analysis tools and community engagement. These sites house genomic, transcriptomic, genetic, breeding and ancillary data for specific species, families or clades. Due to the complexity and increasing quantities of these data, construction of online resources is increasingly difficult especially with limited funding and access to technical expertise. Furthermore, online repositories are expected to promote FAIR data principles (findable, accessible, interoperable and reusable) that presents additional challenges. The open-source Tripal database toolkit seeks to mitigate these challenges by creating both the software and an interactive community of developers for construction of online community databases. Additionally, through coordinated, distributed co-development, Tripal sites encourage community-wide sustainability. Here, we report the release of Tripal version 3 that improves data accessibility and data sharing through systematic use of controlled vocabularies (CVs). Tripal uses the community-developed Chado database as a default data store, but now provides tools to support other data stores, while ensuring that CVs remain the central organizational structure for the data. A new site developer can use Tripal to develop a basic site with little to no programming, with the ability to integrate other data types using extension modules and the Tripal application programming interface. A thorough online User’s Guide and Developer’s Handbook are available at http://tripal.info, providing download, installation and step-by-step setup instructions.
Prisms of the musical past: British international exhibitions and ‘ancient instruments’, 1885–1890
Authors: Kirby Sarah
Published: May 2019

Nineteenth-century international exhibitions were monumental attempts to represent modernity, ‘progress’ and ‘invention’ through displays of material objects. In materially illustrating a narrative of cultural ‘progress’, these exhibitions sometimes engaged vividly with the past, incorporating displays of historical objects shown in striking contrast to the new manufactures that were their core focus. This article examines musical displays at exhibitions held in London in 1885 and Edinburgh in 1890, where large exhibits of ‘ancient’ musical instruments, scores and related objects were presented. I argue that the display of ‘ancient’ instruments and objects, in blatant contrast to the exhibitions’ theme of modern invention, demonstrates a conceptual breach between past and present, examination of which can reveal larger trends in the late 19th-century’s ambivalent relationship with the past.
A photometric stereo-based 3D imaging system using computer vision and deep learning for tracking plant growth
Authors: Bernotas Gytis , Scorza Livia C T , Hansen Mark F , Hales Ian J , Halliday Karen J , Smith Lyndon N , Smith Melvyn L , McCormick Alistair J
Published: May 2019

Background

Tracking and predicting the growth performance of plants in different environments is critical for predicting the impact of global climate change. Automated approaches for image capture and analysis have allowed for substantial increases in the throughput of quantitative growth trait measurements compared with manual assessments. Recent work has focused on adopting computer vision and machine learning approaches to improve the accuracy of automated plant phenotyping. Here we present PS-Plant, a low-cost and portable 3D plant phenotyping platform based on an imaging technique novel to plant phenotyping called photometric stereo (PS).

Results

We calibrated PS-Plant to track the model plant Arabidopsis thaliana throughout the day-night (diel) cycle and investigated growth architecture under a variety of conditions to illustrate the dramatic effect of the environment on plant phenotype. We developed bespoke computer vision algorithms and assessed available deep neural network architectures to automate the segmentation of rosettes and individual leaves, and extract basic and more advanced traits from PS-derived data, including the tracking of 3D plant growth and diel leaf hyponastic movement. Furthermore, we have produced the first PS training data set, which includes 221 manually annotated Arabidopsis rosettes that were used for training and data analysis (1,768 images in total). A full protocol is provided, including all software components and an additional test data set.

Conclusions

PS-Plant is a powerful new phenotyping tool for plant research that provides robust data at high temporal and spatial resolutions. The system is well-suited for small- and large-scale research and will help to accelerate bridging of the phenotype-to-genotype gap.
Water risk perceptions across the life-course of women in Kenya
Authors: Varickanickal Joann , Bisung Elijah , Elliott Susan J
Published: May 2019

Inadequate access to water, sanitation and hygiene (WaSH) exposes many vulnerable populations, especially women and girls, to preventable diseases around the world. This paper reports findings from a photovoice project that explored water-related risk perceptions and health outcomes among women in Nyanchwa, Kenya. Thirteen women in four age categories were recruited for this study in July 2016 using the ‘snowball’ technique. From the results, inadequate access to WaSH was associated with increased water collection burden on women and children; environmental pollution; poor educational outcomes; loss of time due to water collection and poor sanitation infrastructure. Some barriers to change identified include financial barriers and inadequate government support. The identified risks and barriers are important considerations for the design, evaluation and mainstreaming of WaSH programs in resource constrained settings.
The Impact of Spondyloarthritis and Joint Symptoms on Health-Related Quality of Life and Fatigue in IBD Patients. Results From a Population-Based Inception Cohort (20-Year Follow-up in the Ibsen Study)
Authors: Ossum Alvilde Maria , Palm Øyvind , Cvancarova Milada , Bernklev Tomm , Jahnsen Jørgen , Moum Bjørn , Høivik Marte Lie ,   IBSEN Study Group
Published: May 2019

Ongoing joint pain and back pain were associated with reduced quality of life and fatigue in IBD patients after 20 years of disease, whereas spondyloarthritis without ongoing joint symptoms did not have a negative impact on these patient-reported outcomes.
Long-term Outcomes in a Large Randomized Trial of HIV-1 Salvage Therapy: 96-Week Results of AIDS Clinical Trials Group A5241 (OPTIONS)
Authors: Gandhi Rajesh T , Tashima Karen T , Smeaton Laura M , Vu Vincent , Ritz Justin , Andrade Adriana , Eron Joseph J , Hogg Evelyn , Fichtenbaum Carl J
Published: May 2019

Background

Short-term (48-week) results of the OPTIONS trial showed that nucleoside reverse transcriptase inhibitors (NRTIs) can be safely omitted from salvage therapy as long as the regimen has a cumulative activity of >2 active antiretroviral medications. The long-term durability of this approach and outcomes in persons who have more-extensive HIV-1 drug resistance are uncertain.

Methods

Participants with virologic failure and anticipated antiretroviral susceptibility received an optimized regimen and were randomized to omit or add NRTIs. A separate group with more resistance (cumulative activity ≤2 active agents) received an optimized regimen including NRTIs.

Results

At week 96, among 360 participants randomized to omit or add NRTIs, 70% and 65% had HIV-1 RNA <200 copies/mL, respectively. Virologic failure was uncommon after week 48. Younger age and starting fewer new antiretroviral medications were associated with higher odds of virologic failure. In the highly resistant group, 53% had HIV-1 RNA <200 copies/mL at week 96.

Conclusions

HIV-1 salvage therapy can safely omit NRTIs without compromising efficacy or durability of response as long as the new regimen has a cumulative activity of >2 active drugs. Younger people and those receiving fewer new antiretrovirals require careful monitoring. Even among individuals with more-extensive resistance, most achieve virologic suppression.

Clinical Trials Registration

NCT00537394.
More than Money: Venture Capitalists on Boards
Authors: Amornsiripanitch Natee , Gompers Paul A , Xuan Yuhai
Published: May 2019

We explore patterns of board structure and function in the venture capital industry, identifying factors that influence whether venture capitalists receive a board seat and whether they take action to help portfolio companies in which they invest. In a comprehensive sample of US-based and non-US-based companies, we find that a venture capital firm’s prior relationship with the founder, lead investor status, track record, network size, and geographical proximity to the portfolio company are positively correlated with its likelihood of taking a board seat in an investment round. When venture capital investors serve on the board, portfolio companies tend to recruit managers and board members from these investors’ network and are more likely to exit via relationship-based acquisitions. These patterns are particularly strong for successful and well-connected venture capitalists on the board.
On Nudging’s Supposed Threat to Rational Decision-Making
Authors: Houk Timothy
Published: May 2019

Nudging is a tool of libertarian paternalism. It involves making use of certain psychological tendencies in order to help people make better decisions without restricting their freedom. However, some have argued that nudging is objectionable because it interferes with, or undermines, the rational decision-making of the nudged agents. Opinions differ on why this is objectionable, but the underlying concerns appear to begin with nudging’s threat to rational decision-making. Those who discuss this issue do not make it clear to what this threat to rationality amounts. In this paper I evaluate what effect nudging has on our decision-making and I argue that it does not typically interfere with our rationality in a problematic way. Perhaps nudging is objectionable for other reasons, but we should not argue that nudging is objectionable based on concerns about rational decision-making.
Three-Dimensional Evaluation and Classification of the Anatomy Variations of Vertebral Artery at the Craniovertebral Junction in 120 Patients of Basilar Invagination and Atlas Occipitalization
Authors: Li Teng , Yin Yi-heng , Qiao Guang-yu , Wang Hua-wei , Yu Xin-guang
Published: May 2019

BACKGROUND

Patients with basilar invagination and atlas occipitalization usually present abnormal anatomy of the vertebral arteries (VAs) at the craniovertebral junction (CVJ).

OBJECTIVE

To describe and further classify different types of VA variations at the CVJ with 3D visualization technology.

METHODS

One hundred twenty patients with basilar invagination and atlas occipitalization who had undergone 3-dimensional computed tomographic angiography (3D-CTA) were retrospectively studied. Imaging data were processed via the separating, fusing, opacifying, and false-coloring-volume rendering technique. Abnormal anatomy of the VA at the CVJ was categorized and related anatomic parameters were measured.

RESULTS

Seven different types were classified. Type I, VAs enter the cranium after leaving VA groove on the posterior arch of atlas (26.7% of 240 sides); Type II, VAs enter an extraosseous canal created in the assimilated atlas lateral mass-occipital condyle complex before reaching the cranium (53.3%); Type III, VA courses above the axis facet or curves below the atlas lateral mass then enter the cranium (11.7%); Type IV, VAs enter the spinal canal under the axis lamina (1.3%); Type V, high-riding VA (31.3%); Type VI, fenestrated VA (2.9%); Type VII, absent VA (4.2%). Distance from the canal of Type II VA to the posterior facet surface of atlas lateral mass (5.51 ± 2.17 mm) means a 3.5-mm screw can be safely inserted usually. Shorter distance from the midline (13.50 ± 4.35) illustrates potential Type III VA injury during exposure. Decreased height and width of axis isthmus in Type V indicate increased VA injury risks.

CONCLUSION

Seven types of VA variations were described, together with valuable information helpful to minimize VA injury risk intraoperatively.
A Teams Perspective on Workplace Aging and Retirement
Authors: Salas Eduardo , Paoletti Jensine
Published: May 2019

During the past decades, population aging, later retirements, and a shift to team-based work have left organizations with challenges associated with age-diverse teams and retirement from a team-based work structure. However, limited research has investigated the interplays between teams, aging, and retirement. Here, we overview the research at the intersection on aging and teams and discuss how aging is often a proxy for variables of organizational interest. Next, we outline the challenges associated with age-related faultlines and age discrimination. We then highlight areas for future research, such as team cognition and compositional changes associated with teammate retirement. Lastly, we discuss inclusive diversity training and bidirectional mentorships as potential organizational interventions for more cohesive age-diverse teams.
The first potential fossil record of a dibamid reptile (Squamata: Dibamidae): a new taxon from the early Oligocene of Central Mongolia
Authors: Čerňanský Andrej
Published: May 2019

Dibamid reptiles have a known current distribution on two continents (Asia and North America). Although this clade represents an early-diverging group in the Squamata and thus should have a long evolutionary history, no fossil record of these peculiar burrowing squamate reptiles has been documented so far. The fossil material described here comes from the early Oligocene of the Valley of Lakes in Central Mongolia. This material consists of jaws and is placed in the clade Dibamidae on the basis of its morphology, which is further confirmed by phylogenetic analyses. In spite of the fragmentary nature of this material, it thus forms the first, but putative, fossil evidence of this clade. If correctly interpreted, this material demonstrates the occurrence of Dibamidae in East Asia in the Palaeogene, indicating its distribution in higher latitudes than today. The preserved elements possess a unique combination of character states, and a new taxon name is therefore erected: Hoeckosaurus mongoliensis sp. nov. The dentary of Hoeckosaurus exhibits some characters of the two extant dibamid taxa. However, the open Meckel’s groove, together with other characters, show that this group was morphologically much more diverse in the past.
Tele-Triage May be a Safe and Effective Approach for Patients with Chest Pain
Authors: Rosenberg Karen
Published: May 2019

According to this study:

Patient calls regarding chest pain were safely and effectively managed with physician- and nurse-directed tele-triage.

A direct-to-physician protocol for acute chest pain calls may be more efficient.
Nursing Empowerment Intervention Reduces Inpatient Sleep Disruptions
Authors: Rosenberg Karen
Published: May 2019

According to this study:

An interprofessional intervention combining nursing education and empowerment to reduce sleep interruptions in hospitals led to fewer nighttime room entries and improved patient experience.

The authors note that creating a sleep-friendly environment likely depends on the unit-based nurses championing this cause.
CE: Understanding the Complications of Sickle Cell Disease
Authors: Tanabe Paula , Spratling Regena , Smith Dana , Grissom Peyton , Hulihan Mary
Published: May 2019

Sickle cell disease (SCD) is an autosomal recessive genetic condition that alters the shape and function of the hemoglobin molecule in red blood cells. While the overall survival rate among children with SCD has improved in recent years, pediatric rates of hospitalization, ED use, and mortality from complications of SCD remain high. Among patients ages 18 and older, hospital admission and ED usage are even greater—and the median age at death of people with SCD is considerably lower than that of the general population. Nurses who care for patients with SCD have an opportunity to improve health outcomes and quality of life for these patients by recognizing the major SCD-associated complications and providing patients and their caregivers with appropriate educational information. The authors discuss the genetic, hematologic, and clinical features of SCD and describe the major associated health complications. In addition, they review the nursing implications of each complication and provide online links to resources for clinicians, patients, and caregivers.
CE: Stoma and Peristomal Skin Care: A Clinical Review
Authors: Stelton Susan
Published: May 2019

Nursing students who don't specialize in ostomy care typically gain limited experience in the care of patients with fecal or urinary stomas. This lack of experience often leads to a lack of confidence when nurses care for these patients. Also, stoma care resources are not always readily available to the nurse, and not all hospitals employ nurses who specialize in wound, ostomy, and continence (WOC) nursing. Those that do employ WOC nurses usually don't schedule them 24 hours a day, seven days a week. The aim of this article is to provide information about stomas and their complications to nurses who are not ostomy specialists. This article covers the appearance of a normal stoma, early postoperative stoma complications, and later complications of the stoma and peristomal skin.
What Is a Nurse?
Authors: Reising Virginia A.
Published: May 2019

Traditional images of the profession don't reflect the myriad roles we now play.
International Nurse Migration
Authors: Zolot Joan
Published: May 2019

Nurses’ dual role as migrants caring for other migrants.
Catheter Ablation Improves Quality of Life for Atrial Fibrillation Patients
Authors: Potera Carol
Published: May 2019

Death, stroke, and cardiac arrest outcomes are comparable to drug therapy.
Automated Mandatory Bolus vs. Basal Infusion for Maintenance of Epidural Analgesia During Labor
Authors: Pich Jacqueline
Published: May 2019

Editor's note: This is a summary of a nursing care–related systematic review from the Cochrane Library. For more information, see http://nursingcare.cochrane.org.
Tofacitinib Trial Prompts FDA Review of Adverse Effects
Authors: Aschenbrenner Diane S.
Published: May 2019

A required postmarketing clinical trial of tofacitinib (Xeljanz, Xeljanz XR) in the treatment of rheumatoid arthritis found an increased risk of pulmonary embolism and death when patients were treated with 10 mg twice daily compared with the currently approved 5 mg twice daily dose.

NPs are encouraged to follow tofacitinib's dosing guidelines when treating rheumatoid arthritis.
How We Fail the Dying
Authors: Brown Theresa
Published: May 2019

Katy Butler illuminates the human costs of her father's medically delayed death.
Not Compatible with Nursing
Authors: Phipps Marcy
Published: May 2019

Updated several times a week with posts by a wide variety of authors, AJN's blog Off the Charts allows us to provide more timely—and often more personal—perspectives on professional, policy, and clinical issues. Best of the Blog will be a regular column to draw the attention of AJN readers to posts we think deserve a wider audience. To read more, please visit: www.ajnoffthecharts.com.
Healthy Lifestyle Most Important for Prevention of ASCVD
Authors: Rosenberg Karen
Published: May 2019

According to this study:

A healthy lifestyle throughout life is the most important factor in preventing atherosclerotic cardiovascular disease.

Lifestyle and risk factors should be considered when deciding whether pharmacotherapy is needed for primary prevention.
Little Change in RNS’ Work Schedules in a 10-Year Period
Authors: Rosenberg Karen
Published: May 2019

According to this study:

Like experienced nurses, new nurses typically work 12-hour shifts, as well as voluntary and mandatory overtime, and more than 10% hold second jobs.
Proton-Pump Inhibitor Use Associated with Kidney Injury, Electrolyte Abnormalities
Authors: Rosenberg Karen
Published: May 2019

According to this study:

Proton-pump inhibitors may increase risk of renal adverse events and electrolyte abnormalities compared with histamine-2 receptor antagonists.
EBP 2.0: Promoting Nurse Retention Through Career Development Planning
Authors: Tucker Sharon J. , Gallagher-Ford Lynn , Baker Manisa , Vottero Beth A.
Published: May 2019

This is the second article in a new series about evidence-based practice (EBP) that builds on AJN’s award-winning previous series—Evidence-Based Practice, Step by Step—published between 2009 and 2011 (to access the series, go to http://links.lww.com/AJN/A133). This follow-up series will feature exemplars illustrating the various strategies that can be used to implement EBP changes—one of the most challenging steps in the EBP process.
Role of T cells in non-immediate drug allergy reactions
Authors: Gómez E. , Ruano M. , Somoza M.L. , Fernández J. , Blanca-López N.
Published: May 2019

Purpose of review

Nonimmediate drug hypersensitivity reactions (NI-DHR) constitute the most complex group of drug allergy, with many drugs involved. Both parent drugs and their reactive metabolites can be implicated. Although with some drugs the number of metabolites is limited, with others it is quite extensive and many still remain to be identified. The diagnostic approaches are insufficient for the diagnosis and realistic approaches that reproduce the pathological response are lacking.

Recent findings

A wider view has now been considered, with the inclusion of several mechanisms that may contribute to drug hypersensitivity reactions (DHR): the classical hapten hypothesis, the danger signal and the pharmacological interaction. Monitoring the acute response provides relevant information about the mechanisms involved, with the identification of a large number of genes that can be over-expressed or under-expressed in the acute phase of the response. Assessment of risk of developing reactions can be verified by HLA associations.

Further knowledge of these NI-DHR, including molecular genetics and transcriptomic analysis, has enabled a better understanding and management of these reactions.
Humanism in Medicine: What Does It Mean and Why Is It More Important Than Ever?
Authors: Thibault George E.
Published: May 2019

Humanism has been at the core of the medical profession since its inception, and it has been a foundation throughout modern history for political and community values. But today, countries and leaders are increasingly adopting antihumanistic policies and positions. In this Invited Commentary, the author probes whether humanism in medicine can survive in the current culture. The author defines humanism as any system or mode of thought or action in which human interests, values, and dignity predominate. He traces humanism as a philosophical and political movement from the Renaissance through the Enlightenment to the development of liberal democracies in the 20th century. He identifies the humanistic roots of the medical profession and describes efforts to revitalize humanism in medicine in recent decades. He then details antihumanistic behaviors and policies in the current political environment and makes the case that these behaviors and policies threaten humanism in medicine. He calls on the medical profession to renew its commitment to humanism and to oppose antihumanistic behaviors and policies. It will be hard, he concludes, to have humanism in medicine if there is no humanism in the world around us.
Communities of Practice in Peer Review: Outlining a Group Review Process
Authors: Nagler Alisa , Ovitsh Robin , Dumenco Luba , Whicker Shari , Engle Deborah L. , Goodell Kristen
Published: May 2019

Traditional peer review remains the gold standard for assessing the merit of scientific scholarship for publication. Challenges to this model include reliance on volunteer contributions of individuals with self-reported expertise; lack of sufficient mentoring and training of new reviewers; and the isolated, noncollaborative nature of individual reviewer processes.

The authors participated in an Association of American Medical Colleges peer-review workshop in November 2015 and were intrigued by the process of group peer review. Subsequent discussions led to shared excitement about exploring this model further. The authors worked with the staff and editors of Academic Medicine to perform a group review of 4 submitted manuscripts, documenting their iterative process and analysis of outcomes, to define an optimal approach to performing group peer review.

Individual recommendations for each manuscript changed as a result of the group review process. The group process led to more comprehensive reviews than each individual reviewer would have submitted independently. The time spent on group reviews decreased as the process became more refined. Recommendations aligned with journal editor findings. Shared operating principles were identified, as well as clear benefits of group peer review for reviewers, authors, and journal editors.

The authors plan to continue to refine and codify an effective process for group peer review. They also aim to more formally evaluate the model, with inclusion of feedback from journal editors and authors, and to compare feedback from group peer reviews versus individual reviewer feedback. Finally, models for expansion of the group-peer-review process are proposed.
Psoriatic spondylitis or ankylosing spondylitis with psoriasis: same or different?
Authors: Chandran Vinod
Published: May 2019

Purpose of review

Of the four musculoskeletal domains of psoriatic arthritis (PsA), the axial domain is the least studied. With the advent of targeted therapy that is efficacious in some but not all manifestations of spondyloarthritis (SpA), there is interest in understanding the similarities and differences between axial PsA (axPsA) and ankylosing spondylitis. Moreover, there is also interest in evaluating the axial domain in PsA clinical trials, domain that has traditionally been ignored in such studies. This review aims to summarize the current understanding of the differences between ankylosing spondylitis and axPsA.

Recent findings

Recent observational studies have shown that axPsA forms part of the SpA spectrum, flanked by peripheral PsA on one side and ankylosing spondylitis on the other. Thus, axial disease is more severe in ankylosing spondylitis, whereas peripheral disease is more severe in axPsA. However, the overall disease burden and impact is similar. The expression of axPsA is influenced by age, disease duration, sex and HLA-B∗27 status.

axPsA has not been properly defined hampering research into pathogenesis, disease impact and treatment. Research to define prevalence, clinical features, impact, similarities and differences with other axial SpA, and treatment is an unmet need.
Renal insufficiency and bone loss
Authors: Ott Susan M.
Published: May 2019

Purpose of review

Patients with chronic kidney disease have a high risk of fractures and no established treatments that have been shown to prevent the bone disease. The physiology of renal osteodystrophy is complex and recently more factors have been found that complicate the mineral metabolism. The recognition that vascular calcifications are related to bone disease has made treatment even more challenging.

Recent findings

The most exciting new findings relate to the signaling pathways that are seen in kidney disease and how they cause abnormalities in bone physiology. In particular, wnt and activin signaling pathways are seen early in the course of renal disease. The bones react by increasing FGF-23, which targets both renal phosphate secretion and a variety of other systemic effects. Secreted klotho is another newly described hormone with effects on several systems.

Clinical studies have focused on treatments for hyperparathyroidism and phosphate, and frustrating limitations of the treatments used for ordinary osteoporosis.

Treatment of bone disease in patients with chronic kidney disease is challenging, and understanding the physiological pathways could lead to novel therapies.
Anteromedial Release for Posttraumatic Flexion-pronation Contracture of the Wrist: Surgical Technique
Authors: Babazadeh Sina , Puig de la Bellacasa Inma , Jamieson Richard P. , Rodríguez-Baeza Alfonso , Garcia-Elias Marc
Published: May 2019

Wrist stiffness can be a complication of trauma. A small percentage of patients fail to improve with nonoperative management and require operative intervention to regain range of motion and function. These group of patients can present with a soft tissue flexion-pronation contracture, which is hypothesized to be caused by capsular contraction of the distal radioulna joint, musculotendinous contracture of the flexor carpi ulnaris, contracture of the volar ulnar carpal ligaments and of the pronator quadratus muscle. This complication significantly restricts functional dart-thrower’s range of motion and is highly disabling. A surgical option to manage this condition is release of pathologic structures with an anteromedial approach to the wrist. We describe a safe, effective, and reproducible technique to treat these patients.
Resuscitation Guided by Volume Responsiveness Does Not Reduce Mortality in Sepsis: A Meta-Analysis
Authors: Ehrman Robert R. , Gallien John Z. , Smith Reid K. , Akers Katherine G. , Malik Adrienne N. , Harrison Nicholas E. , Welch Robert D. , Levy Phillip D. , Sherwin Robert L.
Published: May 2019

Objectives:

Resuscitation with IV fluids is a critical component in the management of sepsis. Although the optimal volume of IV fluid is unknown, there is evidence that excessive administration can be deleterious. Static measures of volume status have not proven to be meaningful resuscitative endpoints. Determination of volume responsiveness has putative benefits over static measures, but its effect on outcomes is unknown. The goal of this systematic review and meta-analysis was to determine if resuscitation with a volume responsiveness-guided approach leads to improved outcomes in septic patients.

Data Sources:

We searched PubMed, EMBASE, CINAHL, Web of Science, Cochrane Library, and Google Scholar from inception until April 2018.

Study Selection:

Prospective studies of patients with sepsis, severe sepsis, or septic shock that compared volume responsiveness-guided fluid resuscitation to standard techniques and reported mortality data.

Data Extraction:

We extracted study details, patient characteristics, volume responsiveness assessment method, and mortality data.

Data Synthesis:

Of the 1,224 abstracts and 31 full-texts evaluated, four studies (total 365 patients) met inclusion criteria. Using random effects modeling, the pooled odds ratio for mortality at time of longest follow-up with a volume responsiveness-guided strategy was 0.87 (95% CI, 0.49–1.54). Pooling of clinical data was not possibly owing to heterogeneity of reporting in individual studies.

Conclusions:

We found no significant difference in mortality between septic patients resuscitated with a volume responsiveness-guided approach compared with standard resuscitative strategies. It remains unclear whether the findings are due to the small sample size or a true lack of efficacy of a volume responsiveness-guided approach.
Recommendation of New Medical Alarms Based on Audibility, Identifiability, and Detectability in a Randomized, Simulation-Based Study
Authors: Bennett Christopher , Dudaryk Roman , Crenshaw Nichole , Edworthy Judy , McNeer Richard
Published: May 2019

Objectives:

Accurate and timely identification of existing audible medical alarms is not adequate in clinical settings. New alarms that are easily heard, quickly identifiable, and discernable from one another are indicated. The “auditory icons” (brief sounds that serve as metaphors for the events they represent) have been proposed as a replacement to the current international standard. The objective was to identify the best performing icons based on audibility and performance in a simulated clinical environment.

Design:

Three sets of icon alarms were designed using empirical methods. Subjects participated in a series of clinical simulation experiments that examined the audibility, identification accuracy, and response time of each of these icon alarms. A statistical model that combined the outcomes was used to rank the alarms in overall efficacy. We constructed the “best” and “worst” performing sets based on this ranking and prospectively validated these sets in a subsequent experiment with a new subject sample.

Setting:

Experiments were conducted in simulated ICU settings at the University of Miami.

Subjects:

Medical trainees were recruited from a convenience sample of nursing students and anesthesia residents at the institution.

Interventions:

In Experiment 1 (formative testing), subjects were exposed to one of the three sets of alarms; identical setting and instruments were used throughout. In Experiment 2 (summative testing), subjects were exposed to one of the two sets of alarms, assembled from the best and worst performing alarms from Experiment 1.

Measurements and Main Results:

For each alarm, we determined the minimum sound level to reach audibility threshold in the presence of background clinical noise, identification accuracy (percentage), and response time (seconds). We enrolled 123 medical trainees and professionals for participation (78 with < 6 yr of training). We identified the best performing icon alarms for each category, which matched or exceeded the other candidate alarms in identification accuracy and response time.

Conclusions:

We propose a set of eight auditory icon alarms that were selected through formative testing and validated through summative testing for adoption by relevant regulatory bodies and medical device manufacturers.
A 360° Rotational Positioning Protocol of Organ Donors May Increase Lungs Available for Transplantation*
Authors: Mendez Marissa A. , Fesmire Alyssa J. , Johnson Scott S. , Neel Dustin R. , Markham Lori E. , Olson Jody C. , Ott Melissa , Sangha Harbaksh , Vasquez Donald G. , Whitt Stevan P. , Wilkins Harry E. , Moncure Michael
Published: May 2019

Objectives:

To evaluate the improvement in lung donation and immediate lung function after the implementation of a 360° rotational positioning protocol within an organ procurement organization in the Midwest.

Design:

Retrospective observational study.

Setting:

The Midwest Transplant Network from 2005 to 2017. Rotational positioning of donors began in 2008.

Subjects:

Potential deceased lung donors.

Interventions:

A 360° rotational protocol. Presence of immediate lung function in recipients, change in Pao
2:Fio
2 ratio during donor management, initial and final Pao
2:Fio
2 ratio, and proportion of lungs donated were measured. Outcomes were compared between rotated and nonrotated donors.

Measurements and Main Results:

A total of 693 donors were analyzed. The proportion of lung donations increased by 10%. The difference between initial Pao
2:Fio
2 ratio and final Pao
2:Fio
2 ratio was significantly different between rotated and nonrotated donors (36 ± 116 vs 104 ± 148; p < 0.001). Lungs transplanted from rotated donors had better immediate function than those from nonrotated donors (99.5% vs 68%; p < 0.001).

Conclusions:

There was a statistically significant increase in lung donations after implementing rotational positioning of deceased donors. Rotational positioning significantly increased the average difference in Pao
2:Fio
2 ratios. There was also superior lung function in the rotated group. The authors recommend that organ procurement organizations consider adopting a rotational positioning protocol for donors to increase the lungs available for transplantation.
Epidemiology of Hospital-Onset Versus Community-Onset Sepsis in U.S. Hospitals and Association With Mortality: A Retrospective Analysis Using Electronic Clinical Data
Authors: Rhee Chanu , Wang Rui , Zhang Zilu , Fram David , Kadri Sameer S. , Klompas Michael
Published: May 2019

Objectives:

Prior studies have reported that hospital-onset sepsis is associated with higher mortality rates than community-onset sepsis. Most studies, however, have used inconsistent case-finding methods and applied limited risk-adjustment for potential confounders. We used consistent sepsis criteria and detailed electronic clinical data to elucidate the epidemiology and mortality associated with hospital-onset sepsis.

Design:

Retrospective cohort study.

Setting:

136 U.S. hospitals in the Cerner HealthFacts dataset.

Patients:

Adults hospitalized in 2009–2015.

Interventions:

None.

Measurements and Main Results:

We identified sepsis using Centers for Disease Control and Prevention Adult Sepsis Event criteria and estimated the risk of in-hospital death for hospital-onset sepsis versus community-onset sepsis using logistic regression models. In patients admitted without community-onset sepsis, we estimated risk of death associated with hospital-onset sepsis using Cox regression models with sepsis as a time-varying covariate. Models were adjusted for baseline characteristics and severity of illness. Among 2.2 million hospitalizations, there were 95,154 sepsis cases: 83,620 (87.9%) community-onset sepsis and 11,534 (12.1%) hospital-onset sepsis (0.5% of hospitalized cohort). Compared to community-onset sepsis, hospital-onset sepsis patients were younger (median 66 vs 68 yr) but had more comorbidities (median Elixhauser score 14 vs 11), higher Sequential Organ Failure Assessment scores (median 4 vs 3), higher ICU admission rates (61% vs 44%), longer hospital length of stay (median 19 vs 8 d), and higher in-hospital mortality (33% vs 17%) (p < 0.001 for all comparisons). On multivariate analysis, hospital-onset sepsis was associated with higher mortality versus community-onset sepsis (odds ratio, 2.1; 95% CI, 2.0–2.2) and patients admitted without sepsis (hazard ratio, 3.0; 95% CI, 2.9–3.2).

Conclusions:

Hospital-onset sepsis complicated one in 200 hospitalizations and accounted for one in eight sepsis cases, with one in three patients dying in-hospital. Hospital-onset sepsis preferentially afflicted ill patients but even after risk-adjustment, they were twice as likely to die as community-onset sepsis patients; in patients admitted without sepsis, hospital-onset sepsis tripled the risk of death. Hospital-onset sepsis is an important target for surveillance, prevention, and quality improvement initiatives.
Calorie Intake During Status Epilepticus and Outcome: A 5-Year Cohort Study
Authors: Rybitschka Anja , Semmlack Saskia , Kaplan Peter W. , De Marchis Gian Marco , Rüegg Stephan , Marsch Stephan , Sutter Raoul
Published: May 2019

Objectives:

Recommendations regarding nutrition during status epilepticus are lacking, and it is unclear whether restriction of calorie intake would result in beneficial effects or potential harm. We thus aimed to investigate associations between daily calorie intake and outcome in adult status epilepticus patients deriving from a 5-year cohort with a systematic and prospective collection of nutritional data.

Design:

Retrospective observational study.

Setting:

Medical ICUs at a tertiary academic medical care center.

Patients:

Consecutive patients with status epilepticus treated at the ICUs from 2012 to 2016 were included.

Interventions:

None.

Measurements and Main Results:

All patients with status epilepticus were monitored regarding nutrition support provided according to the guidelines. Relative risks of no return to baseline were estimated by Poisson regression with robust error variance and adjusted for potential confounders. Of 203 patients, 86 (42%) had return to baseline. Metabolic characteristics of patients with and without return to baseline did not differ. Patients without return to baseline received more calories and proteins per status epilepticus day, and increasing nutritional support was associated with ventilator-associated pneumonia (relative risk, 1.19; 95% CI, 1.09–1.28). Multivariable regression analysis revealed significant increases in relative risks for no return to baseline with every percent of days with nutrition (relative risk, 1.35; 95% CI, 1.05–1.74), with every 100 kcal (relative risk, 1.01; 95% CI, 1.002–1.01), and gram of protein intake (relative risk, 1.01; 95% CI, 1.001–1.01) per status epilepticus day, independent of potential confounders (including fatal etiology, duration and severity of status epilepticus, Charlson comorbidity index, and treatment with anesthetics).

Conclusions:

Our results indicate that increased calorie intake during status epilepticus is independently associated with unfavorable outcome. These findings require further validation and investigations into potential mediators, such as induction of ketogenesis, immunomodulating effects, and/or reduction of ICU-associated complications, such as infections.