bluuebunny/crossref_metadata_2025_split huggingface dataset:
A new 3D model for genotoxicity assessment: EpiSkin™ Micronucleus Assay
Authors: Chen Lizao , Li Nan , Liu Yanfeng , Faquet Brigitte , Alépée Nathalie , Ding Chunmei , Eilstein Joan , Zhong Lingyan , Peng Zhengang , Ma Jie , Cai Zhenzi , Ouedraogo Gladys 
Published: January 2020

Abstract
The European Regulation on Cosmetics (no. 1223/2009) has prohibited the use of animals in safety testing since March 2009 for ingredients used in cosmetics. Irreversible events at the chromosome level (clastogenesis and aneugenesis) are commonly evaluated by scoring either micronuclei or chromosome aberrations using cell-based genotoxicity assays. Like most in vitro genotoxicity assays, the 2D in vitro micronucleus assay exhibits a poor specificity and does not mimic the dermal route. To address these limitations, the current project aims to develop and validate a 3D micronucleus assay using the EpiSkin™ model. This project is scientifically supported by the Cosmetics Europe Genotoxicity Task Force. In a first step, two key criteria for the development of micronucleus assay, namely, the sufficient yield of cells from the EpiSkin™ model and an acceptable proliferation rate of the basal layer, were assessed and demonstrated. Subsequently, six chemicals (vinblastine, n-ethylnitrosourea, β-butyrolactone, 2-acetylaminofluorene, 2,4-dichlorophenoland d-limonene) were evaluated in the EpiSkin™ Micronucleus Assay. At least two independent experiments using 48- and 72-h incubations were performed for each chemical. Results showed good inter-experimental reproducibility, as well as the correct identification of all six tested chemicals. The metabolism of 2-acetylaminofluorene on the EpiSkin™ model was also investigated and confirmed by the formation of an intermediate metabolite (2-aminofluorene). These preliminary results from the EpiSkin™ Micronucleus Assay indicate that it is a promising in vitro assay for assessing genotoxicity. The availability and suitability of this test method contribute significantly to the development of non-animal testing methods in China and its impact on the worldwide field.
The C-terminal tail of the yeast mitochondrial transcription factor Mtf1 coordinates template strand alignment, DNA scrunching and timely transition into elongation
Authors: Basu Urmimala , Lee Seung-Won , Deshpande Aishwarya , Shen Jiayu , Sohn Byeong-Kwon , Cho Hayoon , Kim Hajin , Patel Smita S 
Published: January 2020

AbstractMitochondrial RNA polymerases depend on initiation factors, such as TFB2M in humans and Mtf1 in yeast Saccharomyces cerevisiae, for promoter-specific transcription. These factors drive the melting of promoter DNA, but how they support RNA priming and growth was not understood. We show that the flexible C-terminal tails of Mtf1 and TFB2M play a crucial role in RNA priming by aiding template strand alignment in the active site for high-affinity binding of the initiating nucleotides. Using single-molecule fluorescence approaches, we show that the Mtf1 C-tail promotes RNA growth during initiation by stabilizing the scrunched DNA conformation. Additionally, due to its location in the path of the nascent RNA, the C-tail of Mtf1 serves as a sensor of the RNA–DNA hybrid length. Initially, steric clashes of the Mtf1 C-tail with short RNA–DNA hybrids cause abortive synthesis but clashes with longer RNA-DNA trigger conformational changes for the timely release of the promoter DNA to commence the transition into elongation. The remarkable similarities in the functions of the C-tail and σ3.2 finger of the bacterial factor suggest mechanistic convergence of a flexible element in the transcription initiation factor that engages the DNA template for RNA priming and growth and disengages when needed to generate the elongation complex.
Time for clinical decision support systems tailoring individual patient therapy to improve renal and cardiovascular outcomes in diabetes and nephropathy
Authors: de Zeeuw Dick , Heerspink Hiddo J L 
Published: January 2020

Abstract
The current guideline treatment for patients with diabetes and nephropathy to lower the high risk of renal and cardiovascular (CV) morbidity and mortality is based on results of clinical studies that have tested new drugs in large groups of patients with diabetes and high renal/CV risk. Although this has delivered breakthrough therapies like angiotensin receptor blockers, the residual renal/CV risk remains extremely high. Many subsequent trials have tried to further reduce this residual renal/CV risk, without much success. Post hoc analyses have indicated that these failures are, at least partly, due to a large variability in response between and within the patients. The current ‘group approach’ to designing and evaluating new drugs, as well as group-oriented drug registration and guideline recommendations, does not take this individual response variation into account. Like with antibiotics and cancer treatment, a more individual approach is warranted to effectively optimize individual results. New tools to better evaluate the individual risk change have been developed for improved clinical trial design and to avoid trial failures. One of these tools, the composite multiple parameter response efficacy score , is based on monitoring changes in all available risk factors and integrating them into a prediction of ultimate renal and CV risk reduction. This score has also been modelled into a clinical decision support system for use in monitoring and changing the therapy in individual patients to protect them from renal/CV events. In conclusion, future treatment of renal/CV risk in diabetes should transition from an era of ‘one size fits all’ into the new era of ‘a fit for each size’.
“Asking Is Never Bad, I Would Venture on That”: Patients’ Perspectives on Routine Pain Screening in VA Primary Care
Authors: Giannitrapani Karleen F , Haverfield Marie C , Lo Natalie K , McCaa Matthew D , Timko Christine , Dobscha Steven K , Kerns Robert D , Lorenz Karl A 
Published: January 2020

Abstract

Objective
Screening for pain in routine care is one of the efforts that the Veterans Health Administration has adopted in its national pain management strategy. We aimed to understand patients’ perspectives and preferences about the experience of being screened for pain in primary care.

Design
Semistructured interviews captured patient perceptions and preferences of pain screening, assessment, and management.

Subjects
We completed interviews with 36 patients: 29 males and seven females ranging in age from 28 to 94 years from three geographically distinct VA health care systems.

Methods
We evaluated transcripts using constant comparison and identified emergent themes.

Results
Theme 1: Pain screening can “determine the tone of the examination”; Theme 2: Screening can initiate communication about pain; Theme 3: Screening can facilitate patient recall and reflection; Theme 4: Screening for pain may help identify under-reported psychological pain, mental distress, and suicidality; Theme 5: Patient recommendations about how to improve screening for pain.

Conclusion
Our results indicate that patients perceive meaningful, positive impacts of routine pain screening that as yet have not been considered in the literature. Specifically, screening for pain may help capture mental health concerns that may otherwise not emerge.
Remission and low disease activity in psoriatic arthritis publications: a systematic literature review with meta-analysis
Authors: Hagège Benjamin , Tan Elina , Gayraud Martine , Fautrel Bruno , Gossec Laure , Mitrovic Stéphane 
Published: January 2020

AbstractObjectivesRemission (REM) or low disease activity (LDA) is the treatment target in psoriatic arthritis (PsA). The objective of this study was to assess the reporting and prevalence of REM/LDA in published studies of PsA.MethodsThis was a systematic literature review of all clinical papers published in PubMed, EMBASE or Cochrane database in English between 2012 and 2019 in the field of PsA. Data were collected regarding reporting of REM/LDA by very low disease activity/minimal disease activity (VLDA/MDA), Disease Activity index for Psoriatic Arthritis (DAPSA), or Disease Activity Score 28 joints (DAS28). The pooled rates of REM and LDA by each definition were calculated by random effect meta-analysis.ResultsIn all, 258 publications (corresponding to 114 651 patients), of which 81 (31%) were randomized controlled trials, were analysed: patients’ mean age was 49.4 ( 4.4) years; with a mean disease duration of 8.5 ( 3.8) years. REM/LDA was reported in 91/258 (35.3%) publications. VLDA/MDA was used in 61/91 (67.0%) studies, DAPSA in 27/91 (29.6%) and DAS28 in 28/91 (30.7%), with 40/91 (43.9%) papers reporting several of these definitions. The pooled prevalence (lower–upper limits) of REM was 13.1% (10.9–15.4), 23.1% (16.8–30.1) and 42.1% (33.9–50.4) using VLDA, DAPSA-REM and DAS28, respectively. For LDA the pooled prevalence was 36.3% (32.3–40.5), 52.8% (41.8–63.6) and 60.4% (52.5–68.0) using MDA, DAPSA-LDA and DAS28, respectively.ConclusionREM/LDA status was reported in only1/3 of recent studies on PsA, with important variations in the frequency of these outcomes according to the definition used: 13.1–42.1% for REM, and 36.3–60.4% for LDA. This highlights the need for consensus.
Acute Physical Therapy Competency for Identifying Appropriate Patients for a Physical Therapist Assistant's Caseload
Authors: Powell Debra , Roberts Pamela , Truong Lyna 
Published: January 2020

Background:
At an academic medical center, physical therapist assistants (PTAs) were observed spending increased time reviewing charts and collaborating with the physical therapists (PTs) about inappropriate patient caseloads.

Objective:
To develop staff competency through a standardized process for the identification of appropriate patients for a PTA caseload utilizing the APTA's PTA Direction Algorithm and improve PT/PTA relationships in the acute care setting.

Design:
Mixed-methods prospective study.

Methods:
Study consisted of acute care PT staff in an academic medical center using the PTA Direction Algorithm with data collected, pre- and posttraining of the PT staff in the algorithm, and the Mann-Whitney U test was used to determine statistical differences. Focus groups with the PTAs were conducted pre- and posttraining of the PT staff.

Results:
Data were collected from the 2 participating PTA staff for a period of 294 total worked hours both for the pre- and posttraining periods. For the pretraining period, data were collected between April 1, 2018, and April 28, 2018, for 28 days with 302 patient care encounters. The posttraining period occurred between July 1, 2018, and August 11, 2018, for 42 days with 307 patient care encounters. The PTAs' daily average pretraining of 10.79 patient encounters, 40.71 minutes for chart reviews, and 12.89 minutes for PT/PTA collaboration decreased posttraining, to a daily average of 7.31 patient encounters, 6.43 minutes for chart reviews, and 6.76 minutes for PT/PTA collaboration. PTAs spent significantly less time in daily average reviewing of charts posttraining (mean = 6.43, SD 10.98, compared with the pretraining (mean = 40.71, SD 38.96, U = 186.500, P < .001). Collaboration times also significantly decreased posttraining (mean = 6.76, SD 11.14), compared with pretraining (mean = 12.89, SD 11.54, U = 371.00, P = .007); however, the average number of daily encounters unfavorably decreased in the posttraining (mean = 7.31, SD 5.13), compared with the pretraining period (mean = 10.79, SD 5.06, U = 398.5, P = .022).

Limitations:
Small number of participants in one academic medical center.

Conclusions:
The PTA Direction Algorithm tool used in establishing staff competency provided the mechanism for developing a standardized process, significantly improving chart review time, and PT/PTA relationships in the acute care setting.
Health Care Use and Spending of Pediatric Patients With an Intellectual or Developmental Disability
Authors: Kim Jaewhan , Stevens Paul , Carbone Paul S. , Jones Kyle B. 
Published: January 2020

Background:Health care costs and utilization for those with an intellectual or developmental disability (IDD) have been shown to be higher than the general population.Objective:To investigate the services that contribute to higher costs and utilization among noninstitutionalized children with an IDD.Design:Matched case-control secondary analysis of the 2000–2017 Medical Expenditure Panel Survey. Pediatric (age 0–21) patients with an IDD were matched to non-IDD subjects. Health care utilization and costs were evaluated with zero-inflated negative binomial regressions and generalized linear models, respectively.Measures:Outcome measures included high-acuity health care utilization [ie, emergency department (ED) visits and hospital admissions], and cost outcomes for total spending, ED use, hospitalization, medications, office visits, home health, and physical therapy.Results:There was no statistical difference in utilization of EDs among the 2 groups though subjects with an IDD showed more hospitalizations than their matched cohort (incidence rate ratios=1.63,P=0.00). Total health care spending was higher among patients with an IDD (coefficient=$5831,P=0.00). Pediatric spending was higher in all measures except for ED. The biggest discrepancies in spending were seen in home health (coefficient=$2558,P=0.00) and outpatient visits (coefficient=$1180,P=0.00).Conclusions:Pediatric patients with an IDD had higher health care spending and utilization than non-IDD subjects in all categories except for ED use.
Nurse Continuity at Discharge and Return to Hospital
Authors: Bahr Sarah J. , Bang James , Yakusheva Olga , Bobay Kathleen L. , Krejci Janet , Costa Linda , Hughes Ronda G. , Hamilton Morris , Siclovan Danielle M. , Weiss Marianne E. 
Published: January 2020

Background
Promoting continuity of nurse assignment during discharge care has the potential to increase patient readiness for discharge—which has been associated with fewer readmissions and emergency department visits. The few studies that examined nurse continuity during acute care hospitalizations did not focus on discharge or postdischarge outcomes.

Objectives
The aim of this research was to examine the association of continuity in nurse assignment to patients prior to hospital discharge with return to hospital (readmission and emergency department or observation visits), including exploration of the mediating pathway through patient readiness for discharge and moderating effects of unit environment and unit nurse characteristics.

Methods
In a sample of 18,203 adult, medical–surgical patients from 31 Magnet hospitals, a correlational path analysis design was used in a secondary analysis to evaluate the effect of nurse continuity on readmissions and emergency department or observation visits within 30 days after hospital discharge. The mediating pathway through discharge readiness measured by patient self-report and nurse assessments was also assessed. Moderating effects of unit environment and nursing characteristics were examined across quartiles of unit environment (nurse staffing hours per patient day) and unit nurse characteristics (education and experience). Analyses were adjusted for patient characteristics, unit fixed effects, and clustering at the unit level.

Results
Continuous nurse assignment on the last 2 days of hospitalization was observed in 6,441 (35.4%) patient discharges and was associated with a 0.85 absolute percentage point reduction (7.8% relative reduction) in readmissions. There was no significant association with emergency department or observation visits. Sensitivity analysis revealed a stronger effect in patients with higher Elixhauser Comorbidity Indexes. Readiness for discharge was not a mediator of the effect of continuity on return to hospital. Unit characteristics were not associated with nurse continuity. No moderation effect was evident for unit environment and nurse characteristics.

Discussion
Continuity of nurse assignment on the last 2 days of hospitalization can reduce readmissions. Staffing for continuity may benefit patients and healthcare systems, with greater benefits for high-comorbidity patients. Nurse continuity prior to hospital discharge should be a priority consideration in assigning acute care nurses to augment readmission reduction efforts.
Accuracy of Computer-Aided Design/Computer-Aided Manufacturing Surgical Template for Guidance of Dental Implant Distraction in Mandibular Reconstruction With Free Fibula Flaps
Authors: Xingzhou Qu , Wang Zhen , Ong Hui Shan , Chenping Zhang , Abdelrehem Ahmed 
Published: January 2020

Purpose:
The direction and orientation of the osteotomized upper segments in dental implant distractor (DID) can be compromised due to an unpredicted vector of distraction. The present study aimed to evaluate the accuracy of computer-aided design/computer-aided manufacturing (CAD/CAM) surgical templates to precisely guide the distraction process in lengthening of the alveolar height for functional mandibular reconstruction.

Patients and Methods:
This retrospective study included all consecutive patients who underwent digitally designed mandibular reconstruction using the fibular flap and DID with the help of CAD/CAM designed surgical templates in a single-stage procedure from 2011 to 2014. First, the preoperative digital planning was performed on 3-dimensional models. Afterward, simulation of the distraction process was made on the virtual model and the resulting new height of the fibula was evaluated. The preoperative simulation was applied to accurately define the exact location and path of the DID device to achieve the suitable vertical height. The preoperative digital planning was used to help the design of the CAD/CAM surgical template, which was then fabricated by means of the 3-dimensional printing technology. The manufactured surgical template-assisted both horizontal and vertical osteotomies of the fibular segments and defining the DID path to lead the distractor into the accurate position. The outcome evaluation was achieved through comparing both preoperative virtual planning with postoperative actual outcomes.

Results:
This study included 14 subjects, 8 were males and 6 were females. The mean age at time of surgery was 31.07 years (range 18–47). All fibular flaps showed 100% success rate. The mean vertical bone height attained with the DID device was 11.35 mm. The vertical and horizontal osteotomies of the fibular segments were completed, then the DID devices were successfully positioned guided by the template. The mean values of the linear and angular deviations for the distractor position and upper segments were calculated and recorded. The maximum linear deviation between the virtual and the postoperative actual distractors was 0.93 mm in the anteroposterior direction, and the greatest in the horizontal plane was 4.64°.

Conclusions:
CAD/CAM surgical templates can accurately guide the direction and orientation of the DID device for functional mandibular reconstruction; therefore, helping to improve the outcomes by accurately transferring the preoperative virtual plan to real surgical procedure.
New Device For Submental Endotracheal Intubation
Authors: Silveira Roger Lanes , Costa Samuel Macedo , Amaral Marcio Bruno Figueiredo 
Published: January 2020

Abstract
The submental intubation is a well-described technique as an alternative for the tracheostomy in the airway management in patients with contraindications for the nasotracheal and cannot remain in the orotracheal position due to the need to maintain the intermaxillary fixation. Residents and young oral and maxillofacial surgeons could have experienced some difficulty performing the technique first described by Altemir (1986). This report aims to describe a new device designed to facilitate and simplify the technique helping surgeons on the submental endotracheal intubation.
Unilateral Cranialization as an Approach for Posterior Table Frontal Sinus Fractures
Authors: Deal Alexandra , Black Jonathan S. 
Published: January 2020

Abstract
Management of posterior table fractures has seen a conservative shift in recent years. Patients who present with CSF leak may be safely monitored, while cranialization is reserved for patients with severe comminuted or displaced posterior table fractures. We report the case of a 20-year-old patient with a comminuted, displaced posterior table fracture that was missing a central segment and was associated with dural injury. The septum and contralateral sinus were unaffected, thus warranting unilateral cranialization. This is a reported case of hemicranialization, which falls on the spectrum of a conservative approach. At 12 months post-op, the patient has not experienced any complications historically associated with cranialization including persistent CSF leak, meningitis, wound infection, alopecia or facial nerve injury at the site of surgery.
The Effects of Maxillary Movements on Nasal Aesthetics Following Orthognathic Surgery
Authors: Üstün Galip Gencay , Konaş Ersoy , El Hakan , Akarsu Güven Bengisu , Dağ Osman , Kamburoğlu Haldun , Mavili Mehmet Emin 
Published: January 2020

Abstract
Improvement of the harmony between facial subunits is the ultimate goal of orthognathic surgery and surgeons must accurately make soft tissue projections for planned bony movements. Yet, few studies have examined the effects’ of orthognathic surgery on aesthetic parameters of nasolabial area on a thorough basis.
This retrospective study included 61 patients that underwent orthognathic surgery. Demographic data, evaluation period, and surgical details were analyzed. Superficial topographical analysis of intercanthal distance, alar width, nasal height, nasal length, nasal tip protrusion, upper lip height, nasal bone angle, supratip break angle, nasal dorsum angle, nasal tip angle, columellar-lobular angle, columellar-labial angle, upper lip angle, and tip-to-midline angle was recorded before and after surgery. Postoperative changes in these parameters and their correlation to maxillary movements were analyzed.
Alar width, upper lip height, columellar-labial angle, supratip break angle, nasal dorsum angle, and upper lip angle increased postsurgery, whereas tip-to-midline angle decreased. Upper lip height and columellar-labial angle were significantly correlated with clockwise/counter-clockwise rotation and anterior re-positioning. Columellar-labial angle increased 2° for each 1 mm of anterior movement and decreased 4° for each 1 mm of counter-clockwise rotation. Novel parameters, such as columellar-lobular angle and tip-to-midline angle, were not associated with any maxillary movement postsurgery.
Orthognathic surgery primarily affected the lower third of the nose and changed alar width, upper lip height, supratip break angle, nasal dorsum angle, columellar-labial angle, upper lip angle, and tip-to-midline angle in this region; however, only columellar-labial angle and upper lip height were found to be correlated solely with maxillary movements.