bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sustained Improvement in Tracheal Intubation Safety Across a 15-Center Quality-Improvement Collaborative: An Interventional Study From the National Emergency Airway Registry for Children Investigators*
Authors: Nishisaki Akira , Lee Anthony , Li Simon , Sanders Ronald C. , Brown Calvin A. , Rehder Kyle J. , Napolitano Natalie , Montgomery Vicki L. , Adu-Darko Michelle , Bysani G. Kris , Harwayne-Gidansky Ilana , Howell Joy D. , Nett Sholeen , Orioles Alberto , Pinto Matthew , Shenoi Asha , Tellez David , Kelly Serena P. , Register Melinda , Tarquinio Keiko , Simon Dennis , Krawiec Conrad , Shults Justine , Nadkarni Vinay 
Published: November 2020

Objectives:
To evaluate the effect of a tracheal intubation safety bundle on adverse tracheal intubation-associated events across 15 PICUs.

Design:
Multicenter time-series study.

Setting:
PICUs in the United States.

Patients:
All patients received tracheal intubations in ICUs.

Interventions:
We implemented a tracheal intubation safety bundle as a quality-improvement intervention that includes: 1) quarterly site benchmark performance report and 2) airway safety checklists (preprocedure risk factor, approach, and role planning, preprocedure bedside “time-out,” and immediate postprocedure debriefing). We define each quality-improvement phase as baseline (–24 to –12 mo before checklist implementation), benchmark performance reporting only (–12 to 0 mo before checklist implementation), implementation (checklist implementation start to time achieving > 80% bundle adherence), early bundle adherence (0–12 mo), and sustained (late) bundle adherence (12–24 mo). Bundle adherence was defined a priori as greater than 80% of checklist use for tracheal intubations for 3 consecutive months.

Measurements and Main Results:
The primary outcome was the adverse tracheal intubation-associated event, and secondary outcomes included severe tracheal intubation-associated events, multiple tracheal intubation attempts, and hypoxemia less than 80%.
From January 2013 to December 2015, out of 19 participating PICUs, 15 ICUs (79%) achieved bundle adherence. Among the 15 ICUs, the adverse tracheal intubation-associated event rates were baseline phase: 217/1,241 (17.5%), benchmark reporting only phase: 257/1,750 (14.7%), early 0–12 month complete bundle compliance phase: 247/1,591 (15.5%), and late 12–24 month complete bundle compliance phase: 137/1,002 (13.7%). After adjusting for patient characteristics and clustering by site, the adverse tracheal intubation-associated event rate significantly decreased compared with baseline: benchmark: odds ratio, 0.83 (0.72–0.97; p = 0.016); early bundle: odds ratio, 0.80 (0.63–1.02; p = 0.074); and late bundle odds ratio, 0.63 (0.47–0.83; p = 0.001).

Conclusions:
Effective implementation of a quality-improvement bundle was associated with a decrease in the adverse tracheal intubation-associated event that was sustained for 24 months.
Suppressive effects of an apoptotic mimicry prepared from jumbo-flying squid-skin phospholipids on the osteoclastogenesis in receptor activator of nuclear factor kappa B ligand/macrophage colony-stimulating factor-induced RAW 264.7 cells
Authors: Kao Yi-Feng , Tu Ming-Chieh , Chai Huey-Jine , Lin Yi-Ling , Chen Yi-Chen 
Published: November 2020

Background:
Liposomes containing docosahexaenoic acid (DHA) and phosphatidylserine were claimed to inhibit osteoclast formation and bone resorption in the inflammatory status. Herein, we proposed that an apoptotic mimicry (SQ liposome) prepared from squid-skin phospholipids can explore the suppressive osteoclastogenesis.

Methods:
The intermolecular fatty-acid composition in the phospholipid of squid-skin extract was analyzed by GC-FID. The SQ liposome structure was characterized by size distribution and zeta potential (ζ). RAW 264.7 cell is used to study the effect of SQ liposomes on osteoclast differentiation. Secretion of prostaglandin E2 (PGE2) and transforming growth factor-β (TGF-β) from RAW 264.7 cells were assayed. Antiosteoclastogenesis effects were performed via the tartrate-resistant acid phosphatase (TRAP)-positive multinucleated cell (MNC) counting, bone resorption pit assay, and TRAP activity analysis. The specific gene expressions related to antiosteoclastogenesis were also detected.

Results:
An apoptotic mimicry through the use of a single-layer liposome (SQ liposome) with phosphatidylserine exposure contains DHA (28.7%) and eicosapentaenoic acid (EPA, 11.8%). Co-treatment with receptor activator of nuclear factor kappa B ligand (RANKL)/macrophage colony-stimulating factor induced RAW 264.7-cell differentiation into mature osteoclasts, thus enhancing PGE2 and TGF-β secretion. However, cotreatment with 1 mg/mL of SQ liposome restored (p < 0.05) the cell viabilities under the RANKL stress. Increased PGE2 levels was downregulated (p < 0.05) in cotreatments with 0.11 and 0.33 mg/mL of SQ liposome, but on the TGF-β levels were not (p > 0.05) influenced in SQ liposome cotreatments. Cotreatments with 0.33–1 mg/mL of SQ liposome suppressed (p < 0.05) the osteoclast maturation (such as decreased MNCs and bone pit formation), inhibited TRAP activities, and downregulated the osteoclastogenesis-related gene expressions.

Conclusion:
In summary, current data support that a possible prevention of our prepared SQ liposomes which are rich in DHA and EPA on bone loss is through the suppression of osteoclastogenesis. Moreover, based on the results from this study an in vivo study warrants a further investigation.
Identification of a de novo TSC2 variant in a Han-Chinese family with tuberous sclerosis complex
Authors: Wu Shan , Guo Yi , Liu Chun , Liu Qingxiang , Deng Hao , Yuan Lamei 
Published: November 2020

Background:
Tuberous sclerosis complex (TSC) is an autosomal dominant disorder with a variety of clinical findings. Variants in the TSC complex subunit 1 gene (TSC1) or the TSC complex subunit 2 gene (TSC2) are responsible for TSC.

Methods:
Physical examinations, computed tomography scans, and light microscopy analyses were performed on the TSC patient from a Han-Chinese pedigree. Whole-exome sequencing combined with Sanger sequencing were performed on the family members.

Results:
The TSC patient showed typical clinical features, including facial angiofibromas, gingival fibromas, a shagreen patch, hypomelanotic macules, ungual fibromas, subependymal nodules, multiple pulmonary cysts, and renal hamartomas. A de novo heterozygous c.5146delG (p.Ala1716Profs*110) variant in the TSC2 gene was identified in the TSC patient of the Han-Chinese family. To our knowledge, this is the first report of the TSC2 c.5146delG variant associated with TSC.

Conclusion:
The study expanding the disease-causing variant spectrum, suggests that whole-exome sequencing combined with Sanger sequencing may be a method for TSC diagnosis and differential diagnosis, and may facilitate the development of genetic counseling and targeted gene therapy for this disease.
Enhancing POLST Completion in a Hospital Setting: An Interdisciplinary Approach
Authors: R. Reed Margaret , Stewart Samantha , Meyer Stephanie A. , Seferian Edward G. , Sax Harry C. 
Published: November 2020

EXECUTIVE SUMMARY
With increased therapeutic capabilities in healthcare today, many patients with multiple progressive comorbidities are living longer. They experience recurrent hospitalizations and often undergo procedures that are not aligned with their personal goals. That is why it is essential to discuss and document healthcare preferences prior to an acute event when significant interventions could occur, especially for patients with serious and progressive illness. Completion of an advance directive and a physician order for life-sustaining treatment (POLST) supports provision of goal-concordant care. Further, for patients who have do not attempt resuscitation (DNAR) orders or are diagnosed with advanced dementia, having a POLST is essential. This may be best accomplished with hospitalization discharge plans.
Our 896-bed academic medical center, Cedars-Sinai Medical Center, launched a quality initiative in 2015 to complete POLSTs for patients being discharged with DNAR status or with dementia returning to a skilled nursing facility. As part of interdisciplinary progression of care rounds, emphasis was placed on those patients for whom POLST completion was indicated. Proactive, facilitated discussions with patients, family members, and attending physicians were initiated to support POLST completion. The completed forms were then uploaded to the electronic health record. Individual units and physicians received regular feedback on POLST completion rates, and the data were later shared at medical staff quality improvement meetings.
During the initiative, POLST completion rates for DNAR patients discharged alive rose from 41% in fiscal year (FY) 2014 to 75% in FY 2019. Similar improvement was seen for patients with dementia discharged to skilled nursing facilities, regardless of code status (rising from 14% in FY 2014 to 54% in FY 2019). Subsequently, we have expanded our efforts to include early discussion and completion of these advanced care planning documents for patients recently diagnosed with high mortality cancers (ovarian, pancreatic, lung, glioblastoma), focusing on the completion of advanced care planning documentation and palliative care referrals.
Time-Driven Activity-Based Costing of Emergency Department Postdischarge Nurse Calls
Authors: Liu Yingna , Luciani-Mcgillivray Ines , Hughes Maryfran , Raja Ali S. , Kaplan Robert S. , Yun Brian J. 
Published: November 2020

EXECUTIVE SUMMARY
Postdischarge telephone calls by nurses can decrease patient return rates to healthcare systems. To date, call program costs have not been compared with patient return rates to determine cost-effectiveness. We used time-driven activity-based costing to determine the costs associated with such programs. We developed process maps for a postdischarge nurse call program in the emergency department of an urban, quaternary care, academic, Level 1 trauma center. Our primary outcome was the total cost of calls, which is based on the length of the calls (after 8 hours of observation) and the total capacity rate cost based on national registered nurse salary and space costs. Seven-day return rate differences between patients reached and those not reached from July 2018 to March 2019 were determined with a Z-test. We observed 113 postdischarge calls for 79 patients. The mean (SD) length of calls for patients reached was 4.3 minutes (1.8) compared with 2.6 minutes (0.6) for those not reached. The total capacity rate cost for calls was $1.09/minute, or $4.69 per patient reached and $2.83 per patient not reached. A retrospective analysis of 6,698 patients reached and 6,519 patients not reached showed hospital return rates of 3.5% and 6.3% (p < .0001), respectively. The study findings show that postdischarge calls were associated with decreased return rates to the emergency department and a savings of $134.89 per prevention of one return. In deciding whether to use postdischarge call programs, healthcare systems should also consider the effects on specific demographics and the potential benefits of greater patient satisfaction and increased treatment adherence.
Weather Parameters and COVID-19
Authors: Pahuja Sourabh , Madan Manu , Mittal Saurabh , Pandey Ravindra Mohan , Nilima  , Madan Karan , Mohan Anant , Hadda Vijay , Tiwari Pawan , Guleria Randeep 
Published: November 2020

Objectives:
To assess the effect of ambient temperature, humidity and wind speed on disease occurrence in Delhi, India.

Data and Methods:
Data regarding daily corona cases, temperature, humidity, wind speed, doubling time and basic reproduction number (R
0) was retrieved from online sources. Pearson's coefficient was used to assess the correlation between daily as well as weekly corona cases and various environmental factors.

Results:
During the study period of 97 days, there was a steady rise in number of corona cases with median (interquartile range) cases per day being 224 (58 to 635). The doubling time demonstrated a strong positive correlation with temperature while R
0 had strong negative correlation with temperature (correlation coefficients 0.814 and −0.78, respectively). No significant correlation with humidity or wind speed was observed.

Conclusion:
Increasing temperature decreases COVID-19 infectivity; however, actual role of environmental factors in expansion of pandemic needs further evaluation globally.
Serum 7-alfa-hydroxy-4-cholesten-3-one and fibroblast growth factor-19 as biomarkers diagnosing bile acid malabsorption in microscopic colitis and inflammatory bowel disease
Authors: Lyutakov Ivan , Lozanov Valentin , Sugareva Paulina , Valkov Hristo , Penchev Plamen 
Published: November 2020

Background
Bile acid malabsorption is common in microscopic colitis, irritable bowel syndrome with diarrhea, and inflammatory bowel disease. We investigated the diagnostic accuracy of 7-alfa-hydroxy-4-cholesten-3-one and compared it with fibroblast growth factor-19 as biomarkers for bile acid malabsorption.

Methods
We enrolled consecutively 109 chronic diarrhea patients with standard laboratory tests, fecal calprotectin, and endoscopy separated into six groups: n = 30 with active inflammatory bowel disease, n = 21 with inflammatory bowel disease in remission reporting >3 bowel movements per day, n = 21 with inflammatory bowel disease after surgery, n = 23 with irritable bowel syndrome with diarrhea, n = 14 with microscopic colitis and 11 healthy subjects (controls). We defined bile acid malabsorption as >3 bowel movements and lower fibroblast growth factor-19 (<60 pg/ml).

Results
Median levels of 7-alfa-hydroxy-4-cholesten-3-one in inflammatory bowel disease active were 53.1 ng/ml, inflammatory bowel disease remission were 52.2 ng/ml, inflammatory bowel disease after surgery were 85.7 ng/ml, irritable bowel syndrome with diarrhea were 7.5 ng/ml, microscopic colitis were 69.3 ng/ml, and healthy controls were 3.7 ng/ml. We estimate a 7-alfa-hydroxy-4-cholesten-3-one cutoff of 48.9 ng/ml with 82.6% sensitivity and 84.3% specificity for detecting bile acid malabsorption. Both 7-alfa-hydroxy-4-cholesten-3-one >48.9 ng/ml and fibroblast growth factor-19 (<60 pg/ml) were found in 52% of the patients, compared with those 8% of patients below this 7-alfa-hydroxy-4-cholesten-3-one cutoff (P < 0.001). Serum 7-alfa-hydroxy-4-cholesten-3-one correlated with the number of bowel movements/day (r = −0.709; P < 0.001) and correlated inversely with fibroblast growth factor-19 (r = −0.741; P < 0.001).

Conclusions
Serum 7-alfa-hydroxy-4-cholesten-3-one above 48.9 ng/ml and fibroblast growth factor-19 below 60 pg/ml identify patients with diarrhea likely attributable to bile acid malabsorption with high diagnostic accuracy and they can be used as screening biomarkers for bile acid malabsorption in microscopic colitis and inflammatory bowel disease.
Combining immune checkpoint inhibitor with lenvatinib prolongs survival than lenvatinib alone in sorafenib-experienced hepatocellular carcinoma patients
Authors: Lin Po-Ting , Teng Wei , Jeng Wen-Juei , Lin Chun-Yen , Lin Shi-Ming , Sheen I-Shyan 
Published: November 2020

Background
Lenvatinib and immune checkpoint inhibitors (ICIs) were approved as the promising agents for unresectable hepatocellular carcinoma (HCC). Nevertheless, the benefits of combining ICI with lenvatinib in sorafenib-experienced patients remain uncertain. We aimed to investigate whether the combination use of ICI and lenvatinib provides better survival than lenvatinib alone in advanced stage HCC patients.

Methods
From March 2018 to August 2019, a total of 53 unresectable HCC patients receiving lenvatinib were recruited. Treatment response was evaluated by dynamic image including computed tomography or MRI. Overall survival (OS), progression-free survival (PFS), and predictors for survival were analyzed.

Results
Among the 53 patients, the median age was 67.2 years old, and 66.4% were male. Twenty-one patients had sorafenib-experienced history. Eighteen patients (34%) died with median follow-up duration of 8.1 months. Patient receiving lenvatinib had median OS of 16.9 [95% confidence interval (CI): 10.1–23.7] months, and PFS of 7.23 (95% CI: 4.8–9.7) months. In multivariate Cox regression analysis, albumin-bilirubin (ALBI) grade III (adjusted HR: 6.699, P = 0.0039) and the history of sorafenib treatment (adjusted HR: 4.476, P = 0.0457) were the independent predictive factor for OS. In sorafenib-experienced patients, those combined treated with ICI (N = 14) showed significantly better survival than monotherapy with lenvatinib (median: 12.8 vs 4.1 months, log-rank P = 0.008).

Conclusion
The ALBI grade and sorafenib treatment history were predictors for OS in HCC patients receiving lenvatinib. For sorafenib-experienced patients, combining ICI with lenvatinib achieved better OS than lenvatinib alone.
Development and evaluation of a novel noninvasive index for predicting significant fibrosis, advanced fibrosis, and cirrhosis in patients with chronic hepatitis B infection
Authors: Kayadibi Huseyin , Yilmaz Baris , Ozgur Yeniova Abdullah , Koseoglu Huseyin , Simsek Zahide 
Published: November 2020

Background and aims
Development of noninvasive liver fibrosis indexes has been research of interest due to the limitations of liver biopsy. Therefore, we aimed to develop and evaluate the diagnostic accuracy of a novel noninvasive index for predicting significant fibrosis, advanced fibrosis and cirrhosis in patients with chronic hepatitis B (CHB) infection based on age and routine clinical laboratory tests.

Methods
A total of 396 treatment naïve liver biopsy performed patients were divided into training (n = 262) and validation cohorts (n = 134). Histological staging was assessed by Ishak fibrosis scoring system.

Results
In training cohort, we developed a novel fibrosis index, GAPI, using γ-glutamyl transpeptidase (GGT), age, platelet, and international normalized ratio (INR) results. The diagnostic accuracies of alanine aminotransferase ratio, age platelet index, aspartate aminotransferase to platelet ratio index, GGT to platelet ratio index, AST to lymphocyte ratio index, fibrosis index based on the four factors, Fibro Q, Goteborg University Cirrhosis Index, King’s score, Pohl score, Wang I, fibrosis index, fibrosis cirrhosis index, cirrhosis discriminant score, Lok score, Doha score, Mehdi’s model, GqHBsAg, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, RDW to lymphocyte ratio, RDW to platelet ratio, GGT/INR, GGT/albumin, white blood cell/platelet distribution width (PDW), mean platelet volume/PDW and platelet/PDW indexes were compared to GAPI index. For the prediction of significant fibrosis, advanced fibrosis and cirrhosis, the area under the receiver operating characteristic curves (AUROCs) of GAPI index were 0.776, 0.868, and 0.885 in training cohort, and 0.731, 0.883, and 0.919 in validation cohort, respectively. The AUROCs of the GAPI index were higher than those of the evaluated 27 noninvasive indexes to predict significant fibrosis, advanced fibrosis, and cirrhosis.

Conclusion
In resource limited settings, GAPI is a promising noninvasive liver fibrosis index for predicting significant fibrosis, advanced fibrosis and cirrhosis, and for decreasing the need for liver biopsy in patients with CHB infection using cutoff points of 2.00 and 3.50.
Predictive factors for long-term survival in patients with advanced hepatocellular carcinoma treated with sorafenib
Authors: Reis Daniela , Moura Miguel , Freitas Luís Carlos , Carvalhana Sofia , Nogueira Paulo Jorge , Gaio Raquel , Marinho Rui Tato , Cortez-Pinto Helena 
Published: November 2020

Background and aims
Sorafenib, used for advanced-stage hepatocellular carcinoma (HCC), has an overall survival (OS) of 10 months. However, some patients have better response and long-term survival (LTS). Aims to assess predictive factors for LTS.

Methods
Retrospectively reviewed 77 advanced HCC patients, starting sorafenib treatment between 2007 and 2016, with LTS (OS ≥24 months) as primary endpoint. Univariate and multivariable analysis of clinical variables were performed in order to identify predictive factors for LTS.

Results
Patients: seventy (90.9%) males; median age: 65 years (39–82). All had cirrhosis mostly HCV infection (n = 32, 41.6%). Majority were Child-Pugh class A (n = 50, 64.9%); median MELD-Na: 11 (6–30). Multinodular HCC: 74% (n = 57); portal vein invasion (PVI): 50.6% (n = 39); extrahepatic spread: 18.2% (n = 14). Median time between HCC diagnosis and sorafenib start: 3.3 months (0–37.6). Median OS: 13 months [95% confidence interval (CI) 8.2–17.8]. Twenty-five (32.5%) patients were considered LTS, with amedian OS: 52.3 months (95% CI 17.1–87.4). Multivariable analysis identified Child-Pugh class A [odds ratio (OR) 11.1, 95% CI 1.78–69.54] and absence of PVI (OR 7.88, 95% CI 1.56–39.8) as independent predictors of LTS. Sub-analysis of Child-Pugh class A: absence of PVI (OR 7.13, 95% CI 1.69–30.2) and alpha-fetoprotein <400 ng/ml (OR 5.82, 95% CI 1.18–28.75) independently related to LTS.

Conclusion
Despite global short median OS, sorafenib treatment is associated with longer than 2-year survival in a sub-group, more likely in compensated liver disease and absence of PVI.
Gaining Access to the Superior Ophthalmic Vein for Endovascular Embolization of Indirect Carotid-Cavernous Fistulas
Authors: Daigle Patrick , Brenna Connor Thomas Arthur , da Costa Leodante , Yang Victor , Gill Harmeet Singh 
Published: November 2020

Abstract
Carotid-cavernous fistulas (CCFs) are abnormal connections between the carotid arterial system and the cavernous sinus. These acquired vascular malformations may result in severe orbital congestion and sight-threatening complications. The authors present their experience in gaining access to the superior ophthalmic vein to embolize indirect CCFs in three different patients. Surgical exposure and cannulation of the SOV were successful in all 3 cases. One patient developed an orbital compartment syndrome towards the end of the embolization process, after the irrigation cannula was inadvertently dislodged from the SOV. He required a lateral canthotomy and inferior cantholysis but did not suffer from any related sequelae. Signs and symptoms resolved gradually in all patients and cosmetic results were excellent. In our experience, the SOV offers a reliable access to indirect CCFs, but patients should be monitored closely during the embolization process to prevent ophthalmic complications.