bluuebunny/crossref_metadata_2025_split huggingface dataset:
Professional fission in medical routines: medical scribes and physicians in two US hospital departments
Authors: Bryan Ann L , Lammers John C 
Published: September 2020

Abstract
In this study we argue that professionalism imposed from above can result in a type of fission, leading to the ambiguous emergence of new occupations. Our case focuses on the US’ federally mandated use of electronic health records and the increased use of medical scribes. Data include observations of 571 patient encounters across 48 scribe shifts, and 12 interviews with medical scribes and physicians in the ophthalmology and digestive health departments of a community hospital. We found substantial differences in scribes’ roles based on the pre-existing routines within each department, and that scribes developed agency in the interface between the electronic health record and the physicians’ work. Our study contributes to work on occupations as negotiated orders by drawing attention to external influences, the importance of considering differences across professional task routines, and the personal interactions between professional and technical workers.
The kinase module of the Mediator complex: an important signalling processor for the development and survival of plants
Authors: Agrawal Rekha , Jiří Fajkus , Thakur Jitendra K 
Published: September 2020

AbstractMediator, a multisubunit protein complex, is a signal processor that conveys regulatory information from transcription factors to RNA polymerase II and therefore plays an important role in the regulation of gene expression. This megadalton complex comprises four modules, namely, the head, middle, tail, and kinase modules. The first three modules form the core part of the complex, whereas association of the kinase module is facultative. The kinase module is able to alter the function of Mediator and has been established as a major transcriptional regulator of numerous developmental and biochemical processes. The kinase module consists of MED12, MED13, CycC, and kinase CDK8. Upon association with Mediator, the kinase module can alter its structure and function dramatically. In the past decade, research has established that the kinase module is very important for plant growth and development, and in the fight against biotic and abiotic challenges. However, there has been no comprehensive review discussing these findings in detail and depth. In this review, we survey the regulation of kinase module subunits and highlight their many functions in plants. Coordination between the subunits to process different signals for optimum plant growth and development is also discussed.
Overgrowth mutants determine the causal role of gibberellin GA2oxidaseA13 in Rht12 dwarfism of wheat
Authors: Buss Wolfram , Ford Brett A , Foo Eloise , Schnippenkoetter Wendelin , Borrill Philippa , Brooks Brenton , Ashton Anthony R , Chandler Peter M , Spielmeyer Wolfgang 
Published: September 2020

Abstract
The induced dwarf mutant Rht12 was previously shown to have agronomic potential to replace the conventional DELLA mutants Rht-B1b/Rht-D1b in wheat. The Rht12 dwarfing gene is not associated with reduced coleoptile length (unlike the DELLA mutants) and it is dominant, characteristics which are shared with the previously characterized dwarfing genes Rht18 and Rht14. Using the Rht18/Rht14 model, a gibberellin (GA) 2-oxidase gene was identified in the Rht12 region on chromosome 5A. A screen for suppressor mutants in the Rht12 background identified tall overgrowth individuals that were shown to contain loss-of-function mutations in GA2oxidaseA13, demonstrating the role of this gene in the Rht12 dwarf phenotype. It was concluded that Rht12, Rht18, and Rht14 share the same height-reducing mechanism through the increased expression of GA 2-oxidase genes. Some of the overgrowth mutants generated in this study were semi-dwarf and taller than the original Rht12 dwarf, providing breeders with new sources of agronomically useful dwarfism.
PROTAC-DB: an online database of PROTACs
Authors: Weng Gaoqi , Shen Chao , Cao Dongsheng , Gao Junbo , Dong Xiaowu , He Qiaojun , Yang Bo , Li Dan , Wu Jian , Hou Tingjun 
Published: September 2020

Abstract
Proteolysis-targeting chimeras (PROTACs), which selectively degrade targeted proteins by the ubiquitin-proteasome system, have emerged as a novel therapeutic technology with potential advantages over traditional inhibition strategies. In the past few years, this technology has achieved substantial progress and two PROTACs have been advanced into phase I clinical trials. However, this technology is still maturing and the design of PROTACs remains a great challenge. In order to promote the rational design of PROTACs, we present PROTAC-DB, a web-based open-access database that integrates structural information and experimental data of PROTACs. Currently, PROTAC-DB consists of 1662 PROTACs, 202 warheads (small molecules that target the proteins of interest), 65 E3 ligands (small molecules capable of recruiting E3 ligases) and 806 linkers, as well as their chemical structures, biological activities, and physicochemical properties. Except the biological activities of warheads and E3 ligands, PROTAC-DB also provides the degradation capacities, binding affinities and cellular activities for PROTACs. PROTAC-DB can be queried with two general searching approaches: text-based (target name, compound name or ID) and structure-based. In addition, for the convenience of users, a filtering tool for the searching results based on the physicochemical properties of compounds is also offered. PROTAC-DB is freely accessible at http://cadd.zju.edu.cn/protacdb/.
EP-7041, a Factor XIa Inhibitor as a Potential Antithrombotic Strategy in Extracorporeal Membrane Oxygenation: A Brief Report
Authors: Pollack Charles V. , Kurz Michael A. , Hayward Neil J. 
Published: September 2020

Objectives:
Current approaches to systemic antithrombotic therapy in support of extracorporeal membrane oxygenation are limited and are hampered by both thrombotic and hemorrhagic complications. An alternative approach is needed.

Design:
Inhibition of coagulation factor XI/activated factor XI is an appealing pathway for antithrombotic support of extracorporeal membrane oxygenation. Selective inhibition of the contact pathway of coagulation could reduce bleeding risk, and because factor XI is linked with the inflammatory and complement systems, it can also be viewed as a biologically plausible target for the prevention of abnormal thrombosis during extracorporeal membrane oxygenation.

Conclusions:
We introduce initial information on EP-7041, a parenteral, potent, and selective, small-molecule activated factor XIa inhibitor with pharmacodynamic and pharmacokinetic characteristics that appear well suited for use in a critical care environment.
Inline Positive End-Expiratory Pressure Valves: The Essential Component of Individualized Split Ventilator Circuits
Authors: Roy Steven , Bunting Leonard , Stahl Stefan , Textor Dominik 
Published: September 2020

Background:
As resources are overwhelmed with the coronavirus disease 2019 pandemic, multiple approaches to produce individualized split-ventilator designs have emerged. These designs attempt to address the significant limitations and safety concerns of coventilation practices by allowing practitioners to adjust pressure settings for individual patients connected with specialized circuits to a single ventilator. The critical component in virtually all individualized circuit designs is the adjustable inline positive end-expiratory pressure valve.

Methods:
We reviewed the literature on the mechanics of inline positive end-expiratory pressure valve function, the implications and considerations for advanced application of inline positive end-expiratory pressure valves in individualized circuits, available methods of adapting commercial positive end-expiratory pressure valves in the resource-restricted setting, and major caveats of the use of inline positive end-expiratory pressure valves.

Results and Conclusions:
The function of adjustable inline positive end-expiratory pressure valves in advanced individualized ventilator circuits has not been described. Adjustable inline positive end-expiratory pressure valves are critical to individualized circuit reliability and patient safety when attempting to extend ventilator capacity in the setting of extreme ventilator shortages. Adjustable inline positive end-expiratory pressure valves provide a means to reduce delivered peak inspiratory pressure to an individual patient circuit, a method to increase positive end-expiratory pressure for an individual patient circuit, and act as an one-way valve to ensure unidirectional gas flow through the divided circuit. Adjustable inline positive end-expiratory pressure valves can be adapted from commercial valves or printed de novo when commercial options are unavailable. Noncommercial sourcing of ventilator components should only be considered in the setting of extreme ventilator shortages under the supervision of a knowledgeable anesthesiologist or intensivist.
Management of Acute Ischemic Stroke
Authors: Herpich Franziska , Rincon Fred 
Published: September 2020

Objectives:Concise “synthetic” review of the state of the art of management of acute ischemic stroke.Data Sources:Available literature on PubMed.Study Selection:We selected landmark studies, recent clinical trials, observational studies, and professional guidelines on the management of stroke including the last 10 years.Data Extraction:Eligible studies were identified and results leading to guideline recommendations were summarized.Data Synthesis:Stroke mortality has been declining over the past 6 decades, and as a result, stroke has fallen from the second to the fifth leading cause of death in the United States. This trend may follow recent advances in the management of stroke, which highlight the importance of early recognition and early revascularization. Recent studies have shown that early recognition, emergency interventional treatment of acute ischemic stroke, and treatment in dedicated stroke centers can significantly reduce stroke-related morbidity and mortality. However, stroke remains the second leading cause of death worldwide and the number one cause for acquired long-term disability, resulting in a global annual economic burden.Conclusions:Appropriate treatment of ischemic stroke is essential in the reduction of mortality and morbidity. Management of stroke involves a multidisciplinary approach that starts and extends beyond hospital admission.
Impact of Anatomic Extent of Nodal Metastasis on Adjuvant Chemotherapy Outcomes in Stage III Colon Cancer
Authors: Woo In Teak , Park Jun Seok , Kang Byung Woog , Park Soo Yeun , Kim Hye Jin , Choi Gyu-Seog , Gwang Kim Jong 
Published: September 2020

BACKGROUND:
An oxaliplatin-based chemotherapy regimen improves the survival outcomes of patients with stage III colon cancer. However, its complications are well-known.

OBJECTIVE:
The purpose of this study was to distinguish between the survival outcomes of patients who underwent curative resection for stage III colon cancer with oxaliplatin chemotherapy and those who underwent such resection without oxaliplatin chemotherapy.

DESIGN:
This was a retrospective analytical study based on prospectively collected data.

SETTINGS:
This study used data on patients who underwent surgery at our hospital between January 2010 and December 2014.

PATIENTS:
A cohort of 254 consecutive patients who underwent curative resection for stage III colon cancer was included in this study. The patients were divided into 2 groups: patients with isolated pericolic lymph node metastasis (n = 175) and those with extrapericolic lymph node metastasis (n = 79).

MAIN OUTCOME MEASURES:
Clinicopathologic features and 3-year survival outcomes were analyzed with and without oxaliplatin therapy in the pericolic lymph node group.

RESULTS:
The pericolic lymph node group showed significantly improved overall survival compared with the extrapericolic lymph node group at a median follow-up of 48.5 months (95.8% vs 77.8%; p < 0.001). In contrast, there was no significant difference in overall survival (99.0% vs 92.0%; p = 0.137) and disease-free survival (89.1% vs 88.2%; p = 0.460) between the oxaliplatin and nonoxaliplatin subgroups of the pericolic lymph node group. Multivariate analysis showed that the administration of oxaliplatin chemotherapy to the pericolic lymph node group did not lead to a significant difference in the overall survival (p = 0.594).

LIMITATIONS:
The study was limited by its retrospective design and single institutional data analysis.

CONCLUSIONS:
This study suggests that the anatomic extent of metastatic lymph nodes could affect patient prognosis, and the effect of oxaliplatin-based adjuvant chemotherapy may not be prominent in stage III colon cancer with isolated pericolic lymph node metastasis.
New-onset intra-operative hyperthermia in a large surgical patient population
Authors: Mittnacht Alexander J.C. , Lin Hung-Mo , Liu Xiaoyu , Wax David 
Published: September 2020

BACKGROUND
Intra-operative hypothermia has been extensively investigated. However, the incidence of intra-operative hyperthermia has not been investigated in detail.

OBJECTIVE
The main objective of this study was to assess the incidence and risk factors of new-onset intra-operative hyperthermia in a large surgical patient population.

DESIGN
Retrospective database review.

SETTING
Tertiary-care teaching hospital.

PATIENTS
Patients undergoing surgery with general anaesthesia between 1 January 2002 and 31 December 2017 were included.

MAIN OUTCOME MEASURES
The primary outcome measurement was new-onset intra-operative hyperthermia (>37.5 °C). A logistic regression model was fitted to identify risk factors for intra-operative hyperthermia.

RESULTS
A total of 103 648 patients were included in the final analyses. The incidence of new-onset hyperthermia in the overall patient cohort was 6.45%, reaching 20 to 30% after prolonged (>8 h) surgery, and was up to 26.5% in paediatric patients. The use of forced air active patient warming, larger amounts of fluid administration, longer surgery, younger age and smaller body size were all independently associated with intra-operative hyperthermia. The adoption of the Surgical Care Improvement Project (SCIP) temperature measures was associated with an increased incidence of intra-operative hyperthermia.

CONCLUSION
Mild intra-operative hyperthermia is not uncommon particularly in longer procedures and small children.
A Study of Physical Activity, Frailty, and Health-Related Quality of Life Among Community-Dwelling Older Adults in Taiwan
Authors: LI Pei-Shan , HSIEH Chia-Jung , MIAO Nae-Fang 
Published: September 2020

ABSTRACT

Background
Health-related quality of life (HRQoL) in community-dwelling older adults increases as physical activity improves, and age-related frailty has a negative effect on HRQoL. Research on these associations is lacking.

Purpose
The aims of this study were to (a) analyze the effect of demographic characteristics on HRQoL, (b) explore the correlation between physical activity and HRQoL, (c) analyze the effect of frailty on HRQoL, and (d) investigate the potential predictors of HRQoL in community-dwelling older adults.

Methods
In this cross-sectional study, a convenience sample of 150 older adults was recruited from community care sites in Shilin and Beitou Districts in Taipei City, Taiwan. Data were collected at baseline using a demographic characteristics datasheet, the Center for Epidemiologic Studies Depression Scale, the Physical Activity Scale for the Elderly, and the 12-Item Short Form Health Survey. The Senior Fitness Test and hand-grip strength test were also performed. Student t test, chi-square test, analysis of variance, Pearson correlation coefficient, and hierarchical regression were applied to analyze the statistical results using IBM SPSS Statistics Version 22.0.

Results
Being of older age, experiencing a higher number of falls, having more chronic diseases, and having a higher body mass index were identified as factors that significantly affect HRQoL. Moreover, HRQoL was found to be significantly affected by the performance of physical activity or status of frailty. Furthermore, the prefrail period was shown to be an important predictor of HRQoL after adjusting for demographic variables, history of chronic illness, history of falls, and physical activity.

Conclusions/Implications for Practice
In this study, HRQoL was found to be significantly affected by upper limb dysfunction and the prefrail period. Community health promotion activities should focus greater attention on the physical functioning of older adults. Furthermore, providing information on age-related frailty and promoting active participation in community activities may increase the attention given by community-dwelling older adults to physical fitness and quality of life.
Transimpedance Matrix (TIM) Measurement for the Detection of Intraoperative Electrode Tip Foldover Using the Slim Modiolar Electrode: A Proof of Concept Study
Authors: Klabbers Tim M. , Huinck Wendy J. , Heutink Floris , Verbist Berit M. , Mylanus Emmanuel A.M. 
Published: September 2020

Objectives:
The aim of this study is to report on our preliminary experience with Transimpedance Matrix (TIM)-measurement for the detection of cochlear implant electrode tip foldovers compared with intraoperative imaging in patients implanted with the slim modiolar electrode (SME).

Study Design:
Proof of concept study.

Setting:
Tertiary university referral center.

Patients:
Twenty five ears (in 22 patients) implanted consecutively with the SME.

Intervention(s):
Following cochlear implantation, intraoperative TIM-measurement and fluoroscopy were performed. One week postoperatively, the electrode position was evaluated using Computed Tomography (CT)-imaging.

Main Outcome Measures:
Electrode array tip foldover.

Results:
Electrode array tip foldover occurred in three of the 25 cochlear implantations performed (12%). In each case, the foldover was detected by both TIM and fluoroscopy, leading to reposition and correct intracochlear placement of the array.

Conclusions:
TIM-measurement is a promising method for the intraoperative detection of an electrode array tip foldover. The TIM-tool with intuitive heatmap display is easy to use, fast, and readily available to clinics using TIM-software in the operating theatre.
Middle Cranial Fossa Approach to Vestibular Schwannoma Resection in the Older Patient Population
Authors: Kohlberg Gavriel D. , Lipschitz Noga , Raghavan Arun M. , Breen Joseph T. , Pensak Myles L. , Zuccarello Mario , Samy Ravi N. 
Published: September 2020

Objective:
Compare outcomes of middle cranial fossa approach (MCF) to vestibular schwannoma (VS) resection in patients 60 years of age and older to patients under 60.

Study Design:
Retrospective case series.

Setting:
Tertiary referral center.

Patients:
Charts of 216 consecutive VS patients over 18 years of age were reviewed to identify 67 patients who underwent MCF approach to VS resection between 2006 and 2017.

Intervention(s):
Age at time of surgery.

Main Outcome Measure(s):
Measured outcomes included postoperative hearing results, facial nerve function, length of hospital stay, wound complications, cerebrospinal fluid leak, myocardial infarction, cerebrovascular accident, seizure, deep vein thrombosis, 30-day readmission, and return to operating room.

Results:
Sixty-seven patients underwent VS resection via MCF approach including 16 patients > = 60 years (mean 64.4 SD 3.3) and 51 patients < 60 years (mean 45.7 SD 10.2). Between these two groups, there were no differences in sex, tumor laterality, tumor size (10.4 mm versus 9.8 mm, p = 0.6), or other demographic characteristics. Postoperatively, there were no differences between groups in complication rates. Rates of HB 1 or 2 facial nerve function were similar (93.8% versus 88.2%, p = 0.7) as were rates of maintenance of class A or B hearing (58.3% versus 44.4%, p = 0.7).

Conclusions:
Patients over 60 undergoing MCF for VS resection experienced similar rates of postoperative complications, facial nerve outcomes, and hearing preservation compared with younger patients. MCF for VS may be considered in the older population. Further research is warranted to evaluate appropriate limitations for this approach based on age.
Clinical evaluation of kit based Tc-99m-HYNIC-RGD2 for imaging angiogenesis in breast carcinoma patients
Authors: Vatsa Rakhee , Madaan Shivani , Chakraborty Sudipta , Dash Ashutosh , Singh Gurpreet , Mittal Bhagwant Rai , Shukla Jaya 
Published: September 2020

Background
Radiolabeled RGD peptide can be used for noninvasive in vivo imaging of αvβ3 integrin receptors leading to early detection of tumor cells and hence improving the clinical outcomes. In the present study single vial kit based HYNIC RGD2 was radiolabeled with Tc-99m and evaluated in patients with breast carcinoma.

Methods
Radiolabeling was performed via bifunctional chelator method. Tc-99m 1110–2960 MBq (30–80 mCi) was added to the HYNIC-RGD2 vial. The reaction mixture was heated for 20 minutes at 100°C. After performing the quality checks, whole-body planar imaging was performed in 20 patients at 2–2.5 h post i.v. injection of 555–740 MBq (15–20 mCi) of the radiotracer.

Results
Radiolabeling yield of ≥98% was observed in all the formulations. Quality control tests indicated the suitability of radiopharmaceutical for intravenous administration. Physiological uptake of Tc-99m HYNIC-RGD2 was observed in the nasopharynx, salivary glands, liver, spleen, and intestine. Good uptake of radiotracer was observed in breast lesions of 18 patients. Two patients were observed to be negative. Increased uptake was also seen in metastatic sites in two patients and in lymph nodes in three patients. Scintigraphy findings were in corroboration with pathological observations.

Conclusion
The single vial cold kit based radiolabeling of Tc-99m HYNIC-RGD2 is facile leading to its easy availability. Tc-99m HYNIC-RGD2 is a promising radiopharmaceutical which can be used for the molecular imaging of angiogenesis in breast carcinoma patients.
New paradigms in the management of recurrent urinary tract infections
Authors: Taich Lior , Zhao Hanson , Cordero Camila , Anger Jennifer T. 
Published: September 2020

Purpose of review
Recurrent urinary tract infections (rUTIs) represent a large burden on the healthcare system. Recent guidelines from the AUA/CUA/SUFU and advancements in the field reflect a paradigm shift for clinician and patients, steering away from empiric antibiotic therapy towards judicious antibiotic use.

Recent findings
Antibiotic stewardship, including increasing awareness of the collateral damage of antibiotics and the risks of bacterial resistance are a major focus of the new guidelines. Accurate diagnosis of rUTIs is imperative. Urine cultures are necessary to document rUTI and should be obtained prior to any treatment. First line treatment options (trimethoprim–sulfamethoxazole, nitrofurantoin, and fosfomycin) should be used whenever possible. Asymptomatic bacteriuria should not be treated in these patients with rUTI. Although antibiotic prophylaxis methods are effective, nonantibiotic regimens show promise.

Summary
The management of rUTIs has evolved significantly with the goal of antibiotic stewardship. It is increasingly important to ensure the accuracy of diagnosis with a positive urine culture in the setting of cystitis symptoms, and standardize treatment with first-line therapies to minimize antibiotic side effects.