bluuebunny/crossref_metadata_2025_split huggingface dataset:
Policies for Mandatory Ethics Consultations at U.S. Academic Teaching Hospitals: A Multisite Survey Study*
Authors: Neal Jonathan B. , Pearlman Robert A. , White Douglas B. , Tolchin Benjamin , Sheth Kevin N. , Bernat James L. , Hwang David Y. 
Published: April 2020

Objectives:
To determine the number of top-ranked U.S. academic institutions that require ethics consultation for specific adult clinical circumstances (e.g., family requests for potentially inappropriate treatment) and to detail those circumstances and the specific clinical scenarios for which consultations are mandated.

Design:
Cross-sectional survey study, conducted online or over the phone between July 2016 and October 2017.

Setting:
We identified the top 50 research medical schools through the 2016 U.S. News and World Report rankings. The primary teaching hospital for each medical school was included.

Subjects:
The chair/director of each hospital’s adult clinical ethics committee, or a suitable alternate representative familiar with ethics consultation services, was identified for study recruitment.

Interventions:
None.

Measurements and Main Results:
A representative from the adult ethics consultation service at each of the 50 target hospitals was identified. Thirty-six of 50 sites (72%) consented to participate in the study, and 18 (50%) reported having at least one current mandatory consultation policy. Of the 17 sites that completed the survey and listed their triggers for mandatory ethics consultations, 20 trigger scenarios were provided, with three sites listing two distinct clinical situations. The majority of these triggers addressed family requests for potentially inappropriate treatment (9/20, 45%) or medical decision-making for unrepresented patients lacking decision-making capacity (7/20, 35%). Other triggers included organ donation after circulatory death, initiation of extracorporeal membrane oxygenation, denial of valve replacement in patients with subacute bacterial endocarditis, and posthumous donation of sperm. Twelve (67%) of the 18 sites with mandatory policies reported that their protocol(s) was formally documented in writing.

Conclusions:
Among top-ranked academic medical centers, the existence and content of official policies regarding situations that mandate ethics consultations are variable. This finding suggests that, despite recent critical care consensus guidelines recommending institutional review as standard practice in particular scenarios, formal adoption of such policies has yet to become widespread and uniform.
Economic Implications of Chinese Diagnosis-Related Group–Based Payment Systems for Critically Ill Patients in ICUs
Authors: Meng Zhaolin , Ma Yanan , Song Suhang , Li Ye , Wang Dan , Si Yafei , Sun Ruochen , Zhang Ruochen , Xue Hao , Jing Limei , Wu Huazhang 
Published: April 2020

Objectives:
To evaluate the economic implications of payments based on Chinese diagnosis-related groups for critically ill patients in ICUs in terms of total hospital expenditure, out-of-pocket payments, and length of stay.

Design:
A pre-post comparison of patient cohorts admitted to ICUs 1 year before and 1 year after Chinese diagnosis-related group reform was undertaken. Demographic characteristics, clinical data, and medical expenditures were collated from a health insurance database.

Setting:
Twenty-two public hospitals in Sanming, Southern China.

Patients:
All patients admitted to ICUs from January 1, 2017, to December 31, 2018.

Intervention:
The implementation of Chinese diagnosis-related group–based payments on January 1, 2018.

Measurements and Main Results:
Economic variables (total expenditures, out-of-pocket payments, and length of stay) were calculated for each patient from the day of hospital admission to the day of hospital discharge. Adjusted mean out-of-pocket payment estimates were 29.46% (p < 0.001) lower following reform. Adjusted mean out-of-pocket payments fell by 41.32% for patients in neonatal ICU, whereas there were no significant decreases in out-of-pocket payments for patients in PICU and adult ICU. Furthermore, adjusted mean out-of-pocket payments decreased by 55.74% in secondary hospitals, but there was no significant change in tertiary hospitals after Chinese diagnosis-related group reform. No significant changes were found in total expenditures and length of stay.

Conclusions:
Chinese diagnosis-related group policy provided an opportunity for critically ill patients in ICUs to achieve at least short-term financial benefits in reducing out-of-pocket payments, without affecting the total expenditures and length of stay. Chinese diagnosis-related group–based payment significantly relieved financial burdens for patients with lower illness severities, such as patients in neonatal ICU. The results of this study can offer significant insights for policymakers in reducing the financial burden on critically ill patients, both in China and in other countries with similar systems.
Potential for Lung Recruitment and Ventilation-Perfusion Mismatch in Patients With the Acute Respiratory Distress Syndrome From Coronavirus Disease 2019*
Authors: Mauri Tommaso , Spinelli Elena , Scotti Eleonora , Colussi Giulia , Basile Maria Cristina , Crotti Stefania , Tubiolo Daniela , Tagliabue Paola , Zanella Alberto , Grasselli Giacomo , Pesenti Antonio 
Published: April 2020

Objectives:
Severe cases of coronavirus disease 2019 develop the acute respiratory distress syndrome, requiring admission to the ICU. This study aimed to describe specific pathophysiological characteristics of acute respiratory distress syndrome from coronavirus disease 2019.

Design:
Prospective crossover physiologic study.

Setting:
ICU of a university-affiliated hospital from northern Italy dedicated to care of patients with confirmed diagnosis of coronavirus disease 2019.

Patients:
Ten intubated patients with acute respiratory distress syndrome and confirmed diagnosis of coronavirus disease 2019.

Interventions:
We performed a two-step positive end-expiratory pressure trial with change of 10 cm H2O in random order.

Measurements and Main Results:
At each positive end-expiratory pressure level, we assessed arterial blood gases, respiratory mechanics, ventilation inhomogeneity, and potential for lung recruitment by electrical impedance tomography. Potential for lung recruitment was assessed by the recently described recruitment to inflation ratio. In a subgroup of seven paralyzed patients, we also measured ventilation-perfusion mismatch at lower positive end-expiratory pressure by electrical impedance tomography. At higher positive end-expiratory pressure, respiratory mechanics did not change significantly: compliance remained relatively high with low driving pressure. Oxygenation and ventilation inhomogeneity improved but arterial co
2 increased despite unchanged respiratory rate and tidal volume. The recruitment to inflation ratio presented median value higher than previously reported in acute respiratory distress syndrome patients but with large variability (median, 0.79 [0.53–1.08]; range, 0.16–1.40). The Fio
2 needed to obtain viable oxygenation at lower positive end-expiratory pressure was significantly correlated with the recruitment to inflation ratio (r = 0.603; p = 0.05). The ventilation-perfusion mismatch was elevated (median, 34% [32–45%] of lung units) and, in six out of seven patients, ventilated nonperfused units represented a much larger proportion than perfused nonventilated ones.

Conclusions:
In patients with acute respiratory distress syndrome from coronavirus disease 2019, potential for lung recruitment presents large variability, while elevated dead space fraction may be a specific pathophysiological trait. These findings may guide selection of personalized mechanical ventilation settings.
Patterns and Outcomes of Diagnosis Disclosure to Youth with Autism Spectrum Disorder
Authors: Kiely Bridget , Adesman Andrew , Rapoport Eli , Gutman Alyson 
Published: April 2020

ABSTRACT:

Objective:
Although the benefits of diagnosis disclosure have been recognized for a number of pediatric medical conditions, there is a paucity of research about the process by which youth with autism spectrum disorder (ASD) are informed about their diagnosis. The aim of this study was to systematically characterize the antecedents, correlates, and outcomes of diagnosis disclosure to youth with ASD.

Methods:
In this cross-sectional study, parents and guardians of youth with ASD (ages 8–25) completed a detailed online questionnaire about their experiences with diagnosis disclosure. The perceived impact of disclosure on affected youth was also assessed.

Results:
Five hundred seventy-five parents of youth with ASD (mean age: 14 years) completed the questionnaire, of whom 81% reported their affected child had been told that he or she had ASD. Most youth who had been told about their diagnosis (86%) were currently aware that they had ASD, according to the parent report. Youth awareness of the diagnosis was reported to be associated with improved self-advocacy skills (60%), enhanced self-awareness of personal strengths (69%) and weaknesses (68%), and other benefits. Youth who had sought information about ASD from support groups and other individuals with ASD had better outcomes regarding self-esteem [adjusted odds ratio = 2.73, 95% confidence interval: (1.34, 3.98)] and acceptance of the diagnosis (p = 0.001) than those who exclusively learned about ASD from other sources.

Conclusion:
Given the numerous potential benefits of diagnosis disclosure, there is a need for physicians and other professionals to support parents in educating youth with ASD about their diagnosis.
More than a View: School Landscape Features Are Associated with Improved Student Adjustment
Authors: Sajady Mollika , Gower Amy L. , McCullough Michael , Jordan Cathy 
Published: April 2020

ABSTRACT:

Objective:
Research indicates that natural features surrounding schools are associated with better academic achievement, enhanced focus, and reduced stress in students. However, few studies have examined the associations between school landscape elements and anxiety, depression, and behavioral concerns in students. The purpose of this study was to determine whether greenery and impervious surfaces surrounding schools are associated with student internalizing and externalizing problems.

Method:
Fifth-grade students (n = 21,378) reported internalizing and externalizing behaviors on the 2016 Minnesota Student Survey, an anonymous school-based survey administered statewide. Geographic information system landscape data were available for 268 schools in metropolitan areas. We calculated the percentages of tree canopy, grass and shrub cover, and impervious surfaces within 300- and 500-m radius areas around each school building. Multilevel regression models evaluated the associations between student-level internalizing and externalizing behaviors and school-level landscape percentages, controlling for sex, race, and free/reduced-price lunch.

Results:
Students attending metropolitan schools with a higher percentage of impervious surfaces were more likely to report externalizing behaviors and marginally more internalizing symptoms than students in schools with a lower percentage of impervious surfaces. Higher percentages of tree canopy and grass and shrub cover surrounding schools were not associated with internalizing or externalizing behaviors.

Conclusion:
Increased impervious surfaces around schools in metropolitan areas were related to increased student externalizing behaviors. Further studies are necessary to understand the significance of the built environment, types of greenery, impact of greenery on student adjustment in nonmetropolitan settings, and varying areas surrounding schools. These results could inform initiatives to improve school landscapes.
Two Non-gadolinium–based, Innovative Approaches to Preoperative Lymphangiography
Authors: Lee Christine U. , Glockner James F. , Hesley Gina K. , Brinkman Nathan J. , Tran Nho V. 
Published: April 2020

Summary:Most magnetic resonance lymphangiography techniques employ intravenous gadolinium-based contrast agents, which carry a US Food and Drug Administration warning about gadolinium retention in the body when used intravenously. Because of this, there may be reluctance to perform intradermal injections of gadolinium-based contrast agents in patients with obstructed lymphatic drainage due to concerns about gadolinium retention in the skin and soft tissues and potential-related toxicity. The aim of this study was to show proof of concept of 2 preoperative lymphangiographic techniques that do not use gadolinium-based contrast agents. One technique used contrast-enhanced ultrasound with intradermal injections of microbubbles (Lumason) in a patient with stage 3, nonpitting left upper extremity edema. Another technique used magnetic resonance imaging with intradermal injections of 0.03 mg/mL or 0.003% ferumoxytol (Feraheme) in a patient with stage 3, nonpitting right lower extremity edema. Both contrast-enhanced ultrasound with microbubbles and magnetic resonance lymphangiogram with ferumoxytol were able to identify candidates for lymphovenous bypass surgery. These candidates were not identified by conventional indocyanine green injections. The authors conclude that (1) low-dose ferumoxytol is a potentially effective non-gadolinium–based contrast alternative to gadolinium-based contrast agent in magnetic resonance lymphangiography and (2) contrast-enhanced ultrasound can identify candidate lymphatic vessels for anastomosis.
Staff Nurses' Perceptions of Nurse Manager Caring Behaviors
Authors: Kostich Kelley , Lasiter Sue , Gorrell Renee 
Published: April 2020

OBJECTIVE
The purpose of this scoping study is to review the published evidence regarding staff nurses' perceptions of nurse manager caring behaviors.

BACKGROUND
As healthcare administration becomes more complex and financial challenges continue, the ability of nurse managers to lead patient care environments that produce desirable outcomes becomes critical. Demonstrating caring behaviors that build relationships with individuals and groups is a necessary competency of nursing administrators to advance healthcare.

METHODS
This scoping study was guided by Arksey and O′Malley's methodology to review existing literature.

RESULTS
Published literature provided knowledge of staff nurses' perceptions of nurse manager caring behaviors. The final sample was 13 publications. The results were summarized in both numeric and thematic analysis.

CONCLUSIONS
Further research is needed to explore the relationship between nurse manager caring behaviors and patient outcomes.
Targeting Calcium Release–activated Calcium Channel Is Not Sufficient to Prevent Rejection in Nonhuman Primate Kidney Transplantation
Authors: Kwun Jean , Ezekian Brian , Manook Miriam , Park Jaeberm , Yoon Janghoon , Freischlag Kyle , Song Mingqing , Farris Alton B. , Sloan-Lancaster Joanne , Fortier Caroline , Rao Patricia E. , Knechtle Stuart J. 
Published: April 2020

Background.
Calcineurin inhibitors successfully control rejection of transplanted organs but also cause nephrotoxicity. This study, using a rhesus monkey renal transplantation model, sought to determine the applicability of a new immunomodulatory drug inhibiting the store-operated calcium release–activated calcium channel of lymphocytes to control transplant rejection without nephrotoxicity.

Methods.
Animals underwent kidney transplantation and were treated with tacrolimus alone (n = 3), a CRACM1 inhibitor (PRCL-02) (n = 6) alone, or with initial tacrolimus monotherapy followed by gradual conversion at 3 weeks to PRCL-02 alone (n = 3). PRCL-02 was administered via a surgically inserted gastrostomy tube BID.

Results.
Dose-related drug exposure in monkeys was established and renal transplants were then performed using PRCL-02 monotherapy. Oral dosing of PRCL-02 was well tolerated and resulted in suppressed T-cell proliferation in in vitro MLR comparable to animals in the tacrolimus control arm. Animals receiving tacrolimus monotherapy were e on day 100 without rejection. PRCL-02 monotherapy only marginally prolonged graft survival (MST = 13.16 d; group 2) compared with untreated controls. Animals treated initially with tacrolimus and converted to PRCL-02 monotherapy had a mean graft survival of 35.3 days which was prolonged compared with PRCL-02 monotherapy but not compared with the tacrolimus-treated group. Pharmacokinetic studies showed inconsistent drug exposures despite attempts to adjust dose and exposure which may have contributed to the rejections.

Conclusions.
We conclude that, in this nonhuman primate model of kidney transplantation, PRCL-02 demonstrated evidence of in vivo immunosuppressive activity but was inferior to tacrolimus treatment with respect to suppressing immune transplant rejection.
Sphingorhabdus lacus sp. nov. and Sphingorhabdus profundilacus sp. nov., isolated from freshwater environments
Authors: Park Miri , Jung Ilsuk , Song Jaeho , Cho Jang-Cheon 
Published: April 2020

Two Gram-stain-negative, aerobic, non-motile bacteria, designated IMCC1753T and IMCC26285T, were isolated from a shallow eutrophic pond and a deep oligotrophic lake, respectively. Results of 16S rRNA gene sequence analysis indicated that the two strains shared 99.8 % sequence similarity and were most closely related to

Sphingorhabdus contaminans

JC216T(98.7–98.8 %). The whole genome sequences of strains IMCC1753T and IMCC26285T were 3.5 and 2.9 Mbp in size with 56.6 and 55.5 mol% DNA G+C content, respectively. Average nucleotide identity (ANI) and digital DNA–DNA hybridization (dDDH) values between the two strains were 82.2 and 25.8 %, respectively, indicating that they are separate species. The two strains showed ≤98.8 % 16S rRNA gene sequence similarities and ≤82.2 % ANI and ≤28.7 % dDDH values to closely related species of the genus

Sphingorhabdus

, indicating that the two strains each represent novel species. Major fatty acid constituents of strain IMCC1753T were C17 : 1
ω6c, C17 : 1
ω8c and summed features 3 (C16 : 1
ω6c and/or C16 : 1
ω7c) and 8 (C18 : 1
ω6c and/or C18 : 1
ω7c); those of strain IMCC26285T were summed features 3 and 8. The predominant isoprenoid quinone detected in both strains was ubiquinone-10 and the most abundant polyamine was spermidine. Both strains contained phosphatidylethanolamine, phosphatidylmethylethanolamine, phosphatidylcholine, phosphatidylglycerol, diphosphatidylglycerol and sphingoglycolipid as major polar lipids. On the basis of the phylogenetic and phenotypic characteristics, strains IMCC1753T and IMCC26285T were considered to represent two distinct novel species in the genus

Sphingorhabdus

, for which the names Sphingorhabdus lacus (IMCC1753T=KCTC 52480T=KACC 18985T=NBRC 112442T) and Sphingorhabdus profundilacus (IMCC26285T=KCTC 52479T=KACC 18986T=NBRC 112454T) are proposed, respectively.
The impact of Attachment Styles and Defense Mechanisms on psychological distress in a non-clinical young adult sample: a path analysis
Authors: Ciocca Giacomo , Rossi Rodolfo , Collazzoni Alberto , Gorea Fiorela , Vallaj Blerina , Stratta Paolo , Longo Lucia , Limoncin Erika , Mollaioli Daniele , Gibertoni Dino , Santarnecchi Emiliano , Pacitti Francesca , Niolu Cinzia , Siracusano Alberto , Jannini Emmanuele A. , Di Lorenzo Giorgio 
Published: April 2020

AbstractIntroductionInsecure attachment styles and immature or neurotic defense mechanisms are related to psychological distress. However, their mutual interaction in influencing psychological distress deserves further investigation.MethodsOne-thousand-one-hundred-twenty-nine University students were evaluated using the Global Severity Index of Symptoms Check List 90-Revised for psychological distress, Relationship Questionnaire for attachment styles and Defense Style Questionnaire for defense mechanisms. Following exploratory analyses, a Path Analysis was performed with psychological distress as outcome.ResultsFearful and preoccupied attachment styles had a substantial impact on psychological distress. About 30% of their effect was mediated by Immature and Neurotic defenses, with the former having the major effect. Dismissing attachment showed no substantial effect on psychological distress. Secure Attachment and Mature Defenses had a small protective effect on psychological distress, but their inclusion in the path model did not improve overall goodness-of-fit. Attachment style and defense mechanisms accounted for nearly 25% of the variance in psychological distress.ConclusionsThe results showed that attachment styles and defense mechanisms have a substantial impact on psychological distress. The effect of attachment style is mediated by defense mechanisms. Individual differences in attachment style and defense mechanisms represent risk factors for psychological distress in young adults.
A transcriptomics-based meta-analysis combined with machine learning approach identifies a secretory biomarker panel for diagnosis of pancreatic adenocarcinoma
Authors: Khatri Indu , Bhasin Manoj K. 
Published: April 2020

AbstractPancreatic ductal adenocarcinoma (PDAC) is largely incurable due to late diagnosis and absence of markers that are concordant with expression in several sample sources (i.e. tissue, blood, plasma) and platform (i.e. Microarray, sequencing). We optimized meta-analysis of 19 PDAC (tissue and blood) transcriptome studies from multiple platforms. The key biomarkers for PDAC diagnosis with secretory potential were identified and validated in different cohorts. Machine learning approach i.e. support vector machine supported by leave-one-out cross-validation was used to build and test the classifier. We identified a 9-gene panel (IFI27, ITGB5, CTSD, EFNA4, GGH, PLBD1, HTATIP2, IL1R2, CTSA) that achieved ∼0.92 average sensitivity and ∼0.90 specificity in discriminating PDAC from non-tumor samples in five training-sets on cross-validation. This classifier accurately discriminated PDAC from chronic-pancreatitis (AUC=0.95), early stages of progression (Stage I and II (AUC=0.82), IPMA and IPMN (AUC=1), IPMC (AUC=0.81)). The 9-gene marker outperformed the previously known markers in blood studies particularly (AUC=0.84). The discrimination of PDAC from early precursor lesions in non-malignant tissue (AUC>0.81) and peripheral blood (AUC>0.80) may facilitate early blood-diagnosis and risk stratification upon validation in prospective clinical-trials. Furthermore, the validation of these markers in proteomics and single-cell transcriptomics studies suggest their prognostic role in the diagnosis of PDAC.
Lessons from mainland China’s epidemic experience about the growth rules of infected and recovered cases of COVID-19 worldwide
Authors: Han Chuanliang , Liu Yimeng , Tang Jiting , Zhu Yuyao , Jaeger Carlo , Yang Saini 
Published: April 2020

AbstractThe novel coronavirus disease (COVID-19) that emerged at the end of 2019 has been controlled in mainland China so far, while it is still spreading globally. When the pandemic will end is a question of great concern. A logistic model depicting the growth rules of infected and recovered cases in mainland China may shed some light on this question. We extended this model to 31 countries outside China experiencing serious COVID-2019 outbreaks. The model well explained the data in our study (R2≥ 0.95). For infected cases, the semi-saturation period (SSP) ranges from 63 to 170 days (March 3 to June 18). The logistic growth rate of infected cases is positively correlated with that of recovered cases, and the same holds for the SSP. According to the linear connection between the growth rules for infected and recovered cases identified from the Chinese data, we predicted that the SSP of the recovered cases outside China ranges from 82 to 196 days (March 22 to July 8). More importantly, we found a strong positive correlation between the SSP of infected cases and the timing of government’s response, providing strong evidence for the effectiveness of rapid epidemic control measures in various countries.