bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Pharmacy Quality Measures to Enhance Value-Based Performance Within the Military Health System
Authors: Costantino Ryan C , Nau David , Neigh Jeffrey J , Hoerner Paul J , Hull Jessica R , Perfetto Eleanor 
Published: March 2020

Abstract

Introduction
As the healthcare system shifts from fee-for service toward value-driven healthcare, interest has grown in medication-related quality metrics to evaluate quality and value within the healthcare system. While the Defense Health Agency (DHA) has taken steps to align healthcare quality measures across the enterprise, the extent to which DHA utilizes pharmacy quality measures (PQMs) or evaluates the quality of direct and purchased pharmacy care is unknown.

Materials and Methods
A comparison was made between existing PQMs utilized by DHA and all measures published and endorsed by the Pharmacy Quality Alliance (PQA), a recognized, PQM standard-setting organization. We also compared DHA PQMs to those used within the Medicare Part D Star Rating Program.

Results
DHA has implemented 10 (28%) of the 36 PQA measures available for evaluation as of August 2019. Of the five measures included in the 2020 CMS Part D Star Rating program, DHA has currently implemented four (80%) of the measures. DHA has implemented 3 of the 5 (60%) PQA CMS Display Measures, and 5 of 9 (56%) PQA CMS Patient Safety Report Measures that are not part of the Star Ratings, but that are used to benchmark and provide feedback to health plans.

Conclusion
Opportunities exist within the DHA to leverage PQMs to evaluate the quality of pharmaceutical care, build trust with beneficiaries by increasing transparency, and maintain parity with the civilian healthcare system. Existing models and commercially available technology could be considered to rapidly operationalize the use of PQMs within the MHS.
An ionized superbubble powered by a protocluster at z = 6.5
Authors: Rodríguez Espinosa J M , Mas-Hesse J M , Salvador-Solé E , Calvi R , Manrique A , Chanchaiworawit K , Guzman R , Gallego J , Herrero A , Marín Franch A 
Published: March 2020

ABSTRACT
We show herein that a proto-cluster of Ly α emitting galaxies, spectroscopically confirmed at redshift 6.5, produces a remarkable number of ionizing continuum photons. We start from the Ly α fluxes measured in the spectra of the sources detected spectroscopically. From these fluxes, we derive the ionizing emissivity of continuum photons of the protocluster, which we compare with the ionizing emissivity required to reionize the protocluster volume. We find that the sources in the protocluster are capable of ionizing a large bubble, indeed larger than the volume occupied by the protocluster. For various calculations, we have used the model AMIGA, in particular to derive the emissivity of the Lyman continuum photons required to maintain the observed volume ionized. Besides, we have assumed the ionizing photons escape fraction given by AMIGA at this redshift.
A new proxy to estimate the cosmic ray ionization rate in dense cores
Authors: Bovino S , Ferrada-Chamorro S , Lupi A , Schleicher D R G , Caselli P 
Published: March 2020

ABSTRACT
Cosmic rays are a global source of ionization, and the ionization fraction represents a fundamental parameter in the interstellar medium. Ions couple to magnetic fields, and affect the chemistry and the dynamics of star-forming regions as well as planetary atmospheres. However, the cosmic ray ionization rate represents one of the bottlenecks for astrochemical models, and its determination is one of the most puzzling problems in astrophysics. While for diffuse clouds reasonable values have been provided from ${\mathrm{ H}_3}^+$ observations, for dense clouds, due to the lack of rotational transitions, this is not possible, and estimates are strongly biased by the employed model. We present here an analytical expression, obtained from first principles, to estimate the cosmic ray ionization rate from observational quantities. The theoretical predictions are validated with high-resolution 3D numerical simulations and applied to the well-known core L1544; we obtained an estimate of ζ2 ∼ 2–3 × 10−17 s−1. Our results and the analytical formulae provided represent the first model-independent robust tool to probe the cosmic ray ionization rate in the densest part of star-forming regions (on spatial scales of R ≤ 0.05 pc). An error analysis is presented to give statistical relevance to our study.
On the origins, meaning and influence of Jensen and Meckling’s definition of the firm
Authors: Gindis David 
Published: March 2020

Abstract
Jensen and Meckling’s 1976 definition of the firm as a legal fiction which serves as a nexus for contracts between individuals sits well with the Coasean narrative on the firm while at the same time being at odds with it. Available interviews with Jensen shed little light on the origins and meaning of this unusual definition. The article shows how the definition captured, and was a response to, the American socio-political context of the early and mid-1970s, and traces how Jensen and Meckling employed it once they themselves became immersed in the public debate about corporate responsibility and regulation in the late 1970s and early 1980s. It also considers Jensen and Meckling’s place in the literature on the economics of corporate law developed mostly in the 1980s.
A bottom-up approach to fermion mass hierarchy: a case with vector-like fermions
Authors: Kawamura Yoshiharu 
Published: March 2020

Abstract
We propose a bottom-up approach in which a structure of high-energy physics is explored by accumulating existence proofs and/or no-go theorems in the standard model or its extension. As an illustration, we study fermion mass hierarchies based on an extension of the standard model with vector-like fermions. It is shown that the magnitude of elements of Yukawa coupling matrices can become $O(1)$ and a Yukawa coupling unification can be realized in a theory beyond the extended model, if vector-like fermions mix with three families. In this case, small Yukawa couplings in the standard model can be highly sensitive to a small variation of matrix elements, and it seems that the mass hierarchy occurs as a result of fine tuning.
History of injury in a developing country: a scoping review of injury literature in Lebanon
Authors: Al-Hajj Samar , Pawliuk Colleen , Smith Jennifer , Zheng Alex , Pike Ian 
Published: March 2020

Abstract

Background
Lebanon, an Eastern Mediterranean country, suffers a large burden of injury as a consequence of conflict and war, political instability, and the lack of policies and safety regulations. This article aims to systematically map and comprehensively describe the injury research literature in Lebanon and, to identify gaps for future research.

Methods
MEDLINE, Embase, Eric and SafetyLit, and the grey literature, including conference proceedings, theses and dissertations, government and media reports, were searched without any date or language limits. Data were extracted from 467 documents using REDCap.

Results
War-related injuries were the most prevalent type of injury in Lebanon, followed by homicide and other forms of violence. While existing literature targeted vulnerable and at-risk populations, the vast majority focused solely on reporting the prevalence of injuries and associated risk factors. There are considerable gaps in the literature dealing with the integration of preventive programs and interventions across all populations.

Conclusions
Lebanon, historically and currently, experiences a high number of injuries from many different external causes. To date, efforts have focused on reporting the prevalence of injuries and making recommendations, rather than implementing and evaluating interventions and programs to inform policies. Future injury related work should prioritize interventions and prevention programs.
Social perspective-taking shapes brain hemodynamic activity and eye movements during movie viewing
Authors: Bacha-Trams Mareike , Ryyppö Elisa , Glerean Enrico , Sams Mikko , Jääskeläinen Iiro P 
Published: March 2020

Abstract
Putting oneself into the shoes of others is an important aspect of social cognition. We measured brain hemodynamic activity and eye-gaze patterns while participants were viewing a shortened version of the movie ‘My Sister’s Keeper’ from two perspectives: that of a potential organ donor, who violates moral norms by refusing to donate her kidney, and that of a potential organ recipient, who suffers in pain. Inter-subject correlation (ISC) of brain activity was significantly higher during the potential organ donor’s perspective in dorsolateral and inferior prefrontal, lateral and inferior occipital, and inferior–anterior temporal areas. In the reverse contrast, stronger ISC was observed in superior temporal, posterior frontal and anterior parietal areas. Eye-gaze analysis showed higher proportion of fixations on the potential organ recipient during both perspectives. Taken together, these results suggest that during social perspective-taking different brain areas can be flexibly recruited depending on the nature of the perspective that is taken.
Piloting a trachomatous trichiasis patient case-searching approach in two localities of Sudan
Authors: Sanders Angelia M , Adam Maha , Aziz Nabil , Callahan E Kelly , Elshafie Belgesa E 
Published: March 2020

Abstract

Background
Approximately 1.9 million people have become blind or visually impaired from trachoma, the leading cause of infectious blindness. Trachoma prevalence surveys conducted in Sudan have shown that thousands of Sudanese suffer from the advanced stages of the disease, trachomatous trichiasis (TT), and warrant sight-saving surgery. Sudan’s National Trachoma Control Program (NTCP) provides free TT surgery; however, given that many TT patients live in remote areas with limited access to health services, identifying patients and providing eye care services has proved challenging. For this reason, the Sudan NTCP piloted a systematic TT case-finding approach to identify patients.

Methods
In Gedarif state, 11 villages in Baladyat el Gedarif locality and 21 villages in West Galabat locality were included in a TT case-searching activity from September to November 2018. TT case finders were selected from the villages where the activity took place and were trained by ophthalmic medical assistants to identify possible patients.

Results
Of 66 626 villagers examined, 491 were identified as having TT by TT case finders. Of those, 369 were confirmed as true cases by the TT surgeons, a 75.2% (369/491) success rate.

Conclusions
The TT case-finding approach provides an example of an effective method for identifying TT patients and should be expanded to other parts of the country known to be endemic for trachoma.
Internal carotid artery blood flow is enhanced by elevating blood pressure during combined propofol-remifentanil and thoracic epidural anaesthesia
Authors: Olesen Niels D. , Frederiksen Hans-Jørgen , Storkholm Jan H. , Hansen Carsten P. , Svendsen Lars B. , Olsen Niels V. , Secher Niels H. 
Published: March 2020

BACKGROUND
Anaesthesia reduces mean arterial pressure (MAP), and to preserve organ perfusion, vasopressors are often used to maintain MAP above 60 mmHg. Cognitive dysfunction is common following major surgery and may relate to intra-operative cerebral hypoperfusion.

OBJECTIVE
The aim of this study was to evaluate whether internal carotid artery (ICA) blood flow increases when MAP is kept higher than 60 mmHg using noradrenaline.

DESIGN
A randomised, cross-over trial.

SETTING
Department of Anaesthesia, Rigshospitalet, Copenhagen, Denmark, from December 2017 to April 2018.

PATIENTS
Patients with median [IQR] age 71 [63 to 75] years underwent pancreaticoduodenectomy (n = 19), total pancreatic resection (n = 1) or gastro-entero anastomosis (n = 2) during combined propofol-remifentanil and thoracic epidural anaesthesia.

INTERVENTION
MAP was maintained between 60 to 65, 70 to 75 and 80 to 85 mmHg, in a random order, by noradrenaline infusion at a stable level of anaesthesia.

MAIN OUTCOME MEASURES
Primary outcome was change in ICA flow at MAP 60 to 65 vs. 80 to 85 mmHg. Secondary outcomes were change in ICA flow at MAP 60 to 65 vs. 70 to 75 and 70 to 75 vs. 80 to 85 mmHg. Duplex ultrasound evaluated ICA flow.

RESULTS
A (mean ± SD) increase in MAP from 62 ± 1 to 82 ± 1 mmHg elevated ICA flow from 196 ± 53 to 226 ± 61 ml min−1 (mean difference 31 ml min−1; 95% CI 19 to 42; P < 0.0001). An increase in MAP from 62 ± 1 to 72 ± 1 mmHg elevated ICA flow to 210 ± 52 ml min−1 (P = 0.0271) and ICA flow increased further (P = 0.0165) when MAP was elevated to 82 ± 1 mmHg.

CONCLUSION
During combined propofol-remifentanil and thoracic epidural anaesthesia, ICA flow increased by approximately 15% when the MAP was elevated from about 60 to 80 mmHg. Treatment of a reduction in MAP brought about by anaesthesia seems to enhance ICA flow.

TRIAL REGISTRATION
Clinicaltrials.gov ID: NCT03309917.
Improvement in pre-operative risk assessment in adults undergoing noncardiac surgery by a process-oriented score
Authors: Vogelsang Heike , Herzog-Niescery Jennifer , Botteck Nikolaj M. , Hasse Fabian , Peszko Adam , Weber Thomas P. , Gude Philipp 
Published: March 2020

BACKGROUND
Pre-operative risk assessment is important to quantify the patient's risks of morbidity and mortality, but its quality differs. We created a process-oriented score (PRO-score) for risk evaluation of adults as a three-stage warning score checklist with concrete guidance. It contains the contents of current guidelines and the assessment of vital signs.

OBJECTIVES
We investigated whether the PRO-score is suitable to detect ‘red flag’ warning signs not only in American Society of Anesthesiologists (ASA) physical status (PS) 3 or 4 patients but also in ASA-PS 1 or 2 patients. Resulting medical, therapeutic or structural consequences were recorded.

DESIGN
Prospective single-centre study.

SETTING
The study was performed in a German university hospital between November 2015 and December 2018.

PATIENTS
We included 54 455 adult patients undergoing a pre-operative risk assessment for general or regional anaesthesia and elective noncardiac surgery.

RESULTS
In all, 388 patients presented ‘red flag’ warning signs in the PRO-score during risk assessment; 85 (21.9%) were labelled ASA-PS 1 or 2, 244 (62.9%) ASA-PS 3 and 59 (15.2%) ASA-PS 4. Additional examinations were performed in 179 patients and technical tests in 175 patients (ASA-PS 1 or 2: 53 and 63 patients, respectively). After re-evaluation of the peri-operative risk in an interdisciplinary conference, surgery was cancelled in 44 patients (ASA-PS 1 and 2, 17 patients) or performed under local anaesthesia in 15 patients (ASA-PS 1 and 2, 2 patients). A downgrading to PRO-score 2 was reached in 168 patients after therapeutic interventions (ASA-PS 1 and 2, 54 patients). Undergoing surgery despite ‘red flag’ events resulted in major complications in 34 patients, and 16 patients died (ASA-PS 1 or 2: 7 and 3 patients, respectively).

CONCLUSION
The PRO-score detected warning signs in ‘healthy’ ASA-PS 1 or 2 and in ASA-PS 3 or 4 patients. Furthermore, it influenced the management of these patients, and thus improved the process quality of risk assessment. The physical examination should include the assessment of vital signs.
Oocyte activation, oolemma piercing, and real-time viability confirmation in human oocytes using electrophysiological techniques
Authors: Mor Amir , Seli Emre 
Published: March 2020

Purpose of reviewTo discuss the recent applications of electrophysiological principles to the optimization and automation of the IVF laboratory.Recent findingsThere is growing evidence showing improvement of live birth rates following oocyte electro-activation. Novel applications using electrophysiological techniques are now employed to determine oocyte penetration and viability in real-time.SummaryIn this short review, we summarize the recent advances in the integration of electrophysiological techniques into the assisted reproductive technology laboratories. We describe the potential clinical applications and their advantages such as creation of reliable automated cell injection systems and novel manual intracytoplasmic sperm injection (ICSI) training platforms. We also discuss theoretical adverse effects and ways to mitigate them.
Antibiotic Prescribing for Viral Respiratory Infections in the Pediatric Emergency Department and Urgent Care
Authors: Desai Neil M. , Sadlowski Jennifer L. , Mistry Rakesh D. 
Published: March 2020

Background:
Viral acute respiratory tract infections (vARTI) are a frequent source of inappropriate antibiotic prescribing. We describe the prevalence of antibiotic prescribing for vARTI in the pediatric emergency department (ED) and urgent care (UC) within a health system, and identify factors associated with overall and broad-spectrum antibiotic prescribing.

Methods:
Retrospective chart review within a single pediatric referral health system. Visits of patients, 3 months– 17 years old, with a discharge diagnosis of a vARTI from 2010 to 2015. Data collected included specific vARTI diagnosis, site type (ED or UC), provider type [pediatric emergency medicine subspecialist or physicians, nurse practitioners, physician assistants (non-PEM)] and discharge antibiotics. Odds ratios and 95% confidence intervals (CI) were calculated where appropriate.

Results:
There were 132,458 eligible visits, mean age 4.1 ± 4.3 years. Fifty-three percent were treated in an ED. Advanced practice providers, a term encompassing nurse practitioners and physician assistants, were the most common provider type (47.7%); 16.5% of patients were treated by a pediatric emergency medicine subspecialist. Antibiotics were prescribed for 3.8% (95% CI: 3.72–3.92) of children with vARTI; 25.4% (95% CI: 24.2–26.6) of these were broad-spectrum, most commonly first-generation cephalosporins (11%; 95% CI 10.2–11.9). Patients treated in an ED or by a non-PEM and those receiving chest radiograph (CXR) received antibiotics most frequently. Prescribing rates varied by specific vARTI diagnosis.

Conclusions:
Patients discharged from the pediatric ED or UC with vARTI receive inappropriate antibiotics at a lower rate than reported in other community settings; however, they frequently receive broad-spectrum agents.
Unique Features of Hospitalized Children with Alveolar Pneumonia Suggest Frequent Viral-Bacterial Coinfections
Authors: Gavrieli Hila , Dagan Ron , Givon-Lavi Noga , Ben-Shimol Shalom , Greenberg David 
Published: March 2020

Background:
The World Health Organization Pneumonia Expert Group (WHO-PEG) defined a standardized radiologic endpoint for childhood community-acquired alveolar pneumonia (RD-CAAP), as the most likely to be pneumococcal, not ruling out other bacteria or coinfecting viruses. We aimed to determine the characteristics associated with hospitalization among children <5 years old presenting to the pediatric emergency room (PER) with RD-CAAP.

Methods:
This study was a part of an ongoing prospective population-based surveillance on hospital visits for RD-CAAP. RD-CAAP was determined according to the WHO-PEG. The study was conducted in the prepneumococcal conjugate vaccine era (2004–2008).

Results:
Of 24,432 episodes with chest radiographs, 3871)15.8%) were RD-CAAP: 2319 required hospitalization and 1552 were discharged (outpatients). Compared with outpatients, hospitalized children had lower temperature, peripheral white cell and absolute neutrophil counts and C reactive protein serum levels, but higher rates of hypoxemia, rhinorrhea, cough and respiratory virus detection. PER visits during the respiratory virus season presented a 1.83 times higher risk of hospitalization than visits during nonrespiratory season.

Conclusions:
Although RD-CAAP is most often a bacterial infection, the unique characteristics of those visiting the PER and subsequently hospitalized suggest a frequent involvement of respiratory viruses, potentially as viral-bacterial coinfections, compared with outpatients.
Association Between Depth of Neutropenia and Clinical Outcomes in Febrile Pediatric Cancer and/or Patients Undergoing Hematopoietic Stem-cell Transplantation
Authors: Alali Muayad , David Michael Z. , Danziger-Isakov Lara A. , Bartlett Allison H. , Petty Lindsay A. , Schwartz Tovah , Pisano Jennifer 
Published: March 2020

Background:
Infectious Diseases Society of America guidelines defines febrile neutropenia (FN) patients as high risk, if they have an absolute neutrophil count (ANC) ≤100 cells/µL anticipated to last >7 days. However, data evaluating the clinical significance of the depth and duration of neutropenia are limited.

Methods:
We conducted a retrospective cohort study of pediatric oncology patients presenting with FN to examine whether the effects of the depth and duration of neutropenia prior to presentation were predictive of blood stream infection (BSI), invasive fungal disease (IFD), pediatric intensive care unit (PICU) admission or length of stay.

Results:
A total of 585 FN episodes (FNEs) were identified in 265 patients. ANC at the time of presentation was <100 in 411 (70%), 100–500 in 119 (20%), and >500 cells/μL with subsequent decline to <500 cells/μL in the next 48 hours in 55 (10%) of FNEs. In the group with ANC > 500 with subsequent decline in 48 hours, rates of IFD and BSI were higher when compared with ANC < 100 cells/μL [odds ratio (OR) = 5.9, 95% confidence interval (CI): 0.7–29.6] and (OR = 2.35, 95% CI: 01.02–5.4), and patients in this group were more likely to be admitted to the PICU (OR= 5.1, 95% CI: 1.134–19.46). No difference in outcomes was identified when the groups of ANC < 100 and ANC of 100–500 cells/μL were compared. Neutropenia >7 days prior to FNE was an independent risk factor for BSI (OR = 2.88, 95% CI: 1.55–5.35 and increased length of stay.

Conclusions:
Clinicians should not be reassured when patients present with FN and initial ANC >500 cells/mL after recent chemotherapy if continued decline is expected as patients in this group are at high risk of IFD, BSI and PICU admission.
Twice- and Thrice-daily Cephalexin Dosing for Staphylococcus aureus Infections in Children
Authors: Gwee Amanda , Autmizguine Julie , Curtis Nigel , Duffull Stephen B. 
Published: March 2020

Background:
Cephalexin is used for the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) infections in children. Although 4 times daily dosing is recommended, less frequent dosing regimens are often prescribed to improve treatment acceptability and adherence. We developed a population pharmacokinetic model of cephalexin in children to determine a twice-daily (BID) and thrice-daily (TID) cephalexin dosing regimen for MSSA infections.

Methods:
A population pharmacokinetic model was developed using a nonlinear mixed effects modeling approach. The dataset used was from a prospective open-label pharmacokinetic study of orally administered cephalexin in 12 children 1–16 years of age with bone and joint infections. Simulations were performed to determine a BID and TID dosing regimen so that ≥90% of children in this age group would achieve the pharmacodynamic target for MSSA (ie, time that the free drug concentration exceeds the minimum inhibitory concentration of the bacteria for at least 40% of the dosing interval).

Results:
The final model was 1 compartment with a transit compartment model to account for delay in oral absorption. For BID dosing, doses of 22–45 and 80 mg/kg were required for MSSA with minimum inhibitory concentrations of 1–2 and 4 mg/L, respectively. For TID dosing, the respective required doses were 15–25 and 45 mg/kg.

Conclusions:
Our study proposes a BID and TID cephalexin dosing regimen that can be prospectively evaluated. Through reducing the dose frequency of this widely prescribed antibiotic, we can reduce the medication burden for children and improve treatment compliance for MSSA infections.