bluuebunny/crossref_metadata_2025_split huggingface dataset:
Alignment Between Objective and Subjective Assessments of Health System Performance: Findings From a Mixed-Methods Study
Authors: Khodyakov Dmitry , Buttorff Christine , Xenakis Lea , Damberg Cheryl L. , Ridgely M. Susan 
Published: September 2021

EXECUTIVE SUMMARY
The article examines whether subjective performance assessments from health system executives match objective performance assessments and qualitatively explores ways to achieve high performance. We interviewed 138 C-suite executives of 24 health systems in California, Minnesota, Washington, and Wisconsin between 2017 and 2019. We used maximum variation sampling to select health systems to achieve diversity in performance on objective measures of clinical performance. Our interviews focused on executives’ perceptions of their own health system’s performance and factors they thought generally contributed to high performance. In our analysis, we grouped health systems based on objective performance levels (high, medium, and low) used in sampling, compared objective performance ratings with executives’ subjective performance assessments, and used thematic analysis to identify reasons for subjective assessment of health system performance and levers of high performance in general. There was poor agreement between objective and subjective performance assessments (kappa = 0.082). Subjective assessments were higher than objective assessments and captured more factors than are typically considered in performance accountability and value-based payment initiatives. Executives whose views were inconsistent with objective performance assessments did not cite clinical care quality per se as the basis for their assessment, focusing instead on market competition, financial performance, and high customer satisfaction and loyalty. Executives who cited clinical quality metrics as the basis of their assessment offered subjective ratings consistent with objective ratings. Executives identified organizational culture, organizational governance, and staff engagement as levers for achieving high performance. Future research should explore the benefits and drawbacks of considering subjective performance assessments in value-based payment initiatives.
New peripheral nerve blocks and local anesthetics
Authors: Sari Sinem , Kumar Jennifer , Turan Alparslan 
Published: September 2021

Purpose of review
To describe current developed regional blocks, their indications and clinical use. Furthermore, describe new local anesthetics recently introduced and the new agents in pipeline.

Recent findings
There are multiple new blocks recently developed with the introduction of ultrasound to regional anesthesia and studies demonstrate effect in different surgical procedures. However, majority of the studies do not compare with gold standard and are relatively small to change clinical practice. Some of these blocks are: erector spinae plane block, infiltration between the popliteal artery and capsule of the posterior knee, pectoral nerve blocks, quadratus lumborum and transversus abdominis plane block. New local anesthetics and adjuvants have been developed in recent years. However, the studies with even with the oldest one introduced Exparel is currently questioned, large future studies are needed to determine efficacy and safety profile and compared with conventional local anesthetics.

Summary
New regional block techniques and new local anesthetics have been introduced recently. However, the efficacy/safety and comparison to conventional techniques and local anesthetics are still needed. Future studies must focus on prolonging analgesia with least invasive regional technique and compare new local anesthetics with current ones.
Transplantation of Extended Criteria Donor Livers Following Continuous Normothermic Machine Perfusion Without Recooling
Authors: Chen Zhitao , Wang Tielong , Chen Chuanbao , Zhao Qiang , Ma Yihao , Guo Yiwen , Hong Xitao , Yu Jia , Huang Changjun , Ju Weiqiang , Chen Maogen , He Xiaoshun 
Published: September 2021

Background.
Traditional liver transplant strategies with cold preservation usually result in ischemia-reperfusion injury (IRI) to the donor liver. Regular normothermic machine perfusion (NMP) donor livers suffer IRI twice. Here, we aimed to introduce a novel technique called continuous NMP without recooling to avoid a second IRI and its application in livers from extended criteria donors.

Methods.
Seven donor livers transplanted following continuous NMP without recooling, 7 donor livers transplanted following standard NMP, and 14 livers under static cold storage (SCS) were included in this study. Perioperative outcomes were recorded and analyzed between groups.

Results.
During the NMP without a recooling procedure, all livers cleared lactate quickly to normal levels in a median time of 100 min (interquartile range, 60–180) and remained stable until the end of perfusion. In the NMP without recooling and standard NMP groups, posttransplant peak aspartate aminotransferase and alanine aminotransferase levels were both significantly lower than those in the SCS group (P = 0.0015 and 0.016, respectively). The occurrence rate of early allograft dysfunction was significantly lower in the NMP without recooling group than in the SCS group (P = 0.022), whereas there was no difference in the NMP group with or without recooling (P = 0.462).

Conclusions
Our pilot study revealed a novel technique designed to avoid secondary IRI. This novel technique is shown to have at least a comparable effect on the standard NMP, although more data are needed to show its superiority in the future.
Waiting List Dynamics and Lung Transplantation Outcomes After Introduction of the Lung Allocation Score in The Netherlands
Authors: Hoffman Thijs W. , Hemke Aline C. , Zanen Pieter , Luijk Bart , Hoek Rogier A.S. , Verschuuren Erik A.M. , van Kessel Diana A. 
Published: September 2021

Background.
The Netherlands was the third country to adopt the lung allocation score (LAS) for national allocation of donor lungs in April 2014. Evaluations of the introduction of the LAS in the United States and Germany showed mainly beneficial effects, including increased survival after transplantation.

Methods.
Data for transplant candidates from 2010 to 2019 were retrieved from the Dutch Transplant Foundation database. Diagnosis categories and outcomes were compared between the periods before and after the introduction of the LAS. Time-dependent Cox regression and Fine-Gray analyses were performed to compare the chance for transplantation before and after introduction of the LAS.

Results.
The cohort comprised 1276 patients. After introduction of the LAS, the annual number of transplantations and waiting list mortality did not change. The proportion of patients on the waiting list and transplanted patients with pulmonary fibrosis increased (25%–37%, P < 0.001; 22%–39%, P < 0.001). The chance of transplantation increased significantly for patients with pulmonary fibrosis after introduction of the LAS (hazard ratio 1.9 [95% confidence interval 1.4-2.9]). Patients who died on the waiting list had an increased LAS compared to the time of placement on the waiting list, reflecting clinical deterioration. This was not the case in patients with chronic obstructive pulmonary disease (P < 0.001). Overall survival was similar after introduction of the LAS (5-y survival 68%, compared to 74% [P = 0.171]).

Conclusions.
After the introduction of the LAS in The Netherlands, an increased proportion of transplantations was performed for patients with pulmonary fibrosis. Overall survival after transplantation did not change.
Kidney Transplantation From Hepatitis C Viremic Deceased Donors to Aviremic Recipients in a Real-world Setting
Authors: Concepcion Beatrice P. , Binari Laura A. , Schaefer Heidi , Rega Scott , Feurer Irene , Shawar Saed , Naik Ruchi , Hickman Laura , Walker Jasmine , Kapp Meghan , Birdwell Kelly A. , Langone Anthony , Helderman J. Harold , Ann Sarrell Bonnie , Kochar Guneet , Dubray Bernard , Smith Kristin , O’Dell Heather , DeMers April , Shelton Princess , Perri Roman , Shaffer David , Forbes Rachel C. 
Published: September 2021

Background.
Transplantation of hepatitis C viremic (HCV+) deceased donor kidney transplants (DDKT) into aviremic (HCV–) recipients is a strategy to increase organ utilization. However, there are concerns around inferior recipient outcomes due to delayed initiation of direct-acting antiviral (DAA) therapy and sustained HCV replication when implemented outside of a research setting.

Methods.
This was a retrospective single-center matched cohort study of DDKT recipients of HCV+ donors (cases) who were matched 1:1 to recipients of HCV– donors (comparators) by age, gender, race, presence of diabetes, kidney donor profile index, and calculated panel-reactive antibody. Data were analyzed using summary statistics, t-tests, and chi-square tests for between-group comparisons, and linear mixed-effects models for longitudinal data.

Results.
Each group consisted of 50 recipients with no significant differences in baseline characteristics. The 6-mo longitudinal trajectory of serum creatinine and estimated glomerular filtration rate did not differ between groups. All recipients had similar rates of acute rejection and readmissions (all P > 0.05). One case lost the allograft 151 d posttransplant because of acute rejection, and 1 comparator died on postoperative day 7 from cardiac arrest. HCV+ recipients initiated DAA on average 29 ± 11 d posttransplant. Ninety-eight percent achieved sustained virologic response at 4 and 12 wks with the first course of therapy; 1 patient had persistent HCV infection and was cured with a second course of DAA.

Conclusions.
Aviremic recipients of HCV+ DDKT with delayed DAA initiation posttransplant had similar short-term outcomes compared with matched recipient comparators of HCV– donors.
Combination effect of exercise and environmental enrichment on cognitive functions and hippocampal neurogenesis markers of rat
Authors: Khodadadegan Mohammad Amin , Negah Sajad Sahab , Saheb Mahsa , Gholami Jamileh , Arabi Masoud Hashemi , Hajali Vahid 
Published: September 2021

Objectives
Cognitive decline is one of the most prevalent health problems and is associated with increased healthcare utilization and economic burden. Physical and cognitive training both have positive effects on cognition but have been less applied in combination. We hypothesized that simultaneous cognitive–physical components would yield greater cognitive benefits than single-domain interventions in rats.

Methods
A total of 40 male Wistar rats were divided into four treatment groups: the control, enriched environment (EE), exercise (EX), and EE + EX. Animals in EE groups housed in the large cages (50 × 50 × 50 cm) contained differently shaped objects for 3 weeks. EX animals were forced to run on a treadmill once daily for 3 consecutive weeks. Morris water maze test was used for the assessment of spatial learning and memory. Real-time PCR was performed to assess the expression of nestin, and Sox2 in the hippocampus.

Results
EX and EE animals separately did not show a significantly enhanced function in spatial memory in comparison with the control group. When animals were treated with EE and EX simultaneously, they exhibited significantly superior performance in spatial memory than control, EX, or EE groups separately. The hippocampal expression of Sox2 was significantly higher in EE + EX group than in the control, EX, and EE alone.

Conclusions
These results may have clinical implications for behavioral interventions in conditions with cognitive deficiencies.
Annexin A2 degradation contributes to dopaminergic cell apoptosis via regulating p53 in neurodegenerative conditions
Authors: Li Da-Wei , Qi Xiao-Dan , Zhang Chuan-Hui , Sun Wen-Ping 
Published: September 2021

Background
P53 overexpression has been shown to involve in mitochondria-mediated dapaminergic neuron cell death in Parkinson’s disease. However, the exactly molecular mechanisms responsible for the p53-dependent intrinsic cell death in neurodegenerative conditions remain unclearly. Annexin A2 is a multifunctional protein that negatively regulates p53 expression. The purpose of this study was to explore the mechanism of p53 dependent dopaminergic cell death and implication of Annexin A2 in cellular apoptosis in 1-methyl-4-phenylpyridinium (MPP+)-induced PC12 cells.

Methods
The cell viability of neural PC12 cells was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltet-razolium bromide assay. Flow cytometry was used to evaluate the apoptosis and mitochondrial transmembrane potential of neural PC12 cells. The expression of p53 and Annexin A2 was analyzed by western blot assay.

Results
The present study showed that the exposure of PC12 cells to neurotoxin MPP+ increased the expression levels of p53 and the discharge of mitochondrial transmembrane potential. Notably, Annexin A2 degradation was also observed in this cellular model of Parkinson’s disease, in a time and dose-dependent manner. This expressing change of Annexin A2 was in direct proportion to the loss of cell viability of PC12 cells, and this expression pattern was in inverse proportion to p53 levels in this cellular model of Parkinson’s disease.

Conclusion
These results indicated that Annexin A2 degradation plays a crucial role the degeneration of dapaminergic cells of Parkinson’s disease, and Annexin A2 downregulation-mediated the cell death is closely associated with mitochondrial dysfunction via p53-dependent pathway; thus provide a novel therapeutic target for Parkinson’s disease treatment.
Management of Cutaneous Manifestations of Genetic Epidermolysis Bullosa
Authors: Miura Yukiko , Nakagomi Satoko 
Published: September 2021

BACKGROUND:
Epidermolysis bullosa (EB) is a rare disease characterized by blistering and erosion of the skin and mucus membranes in response to minor external forces. Research focusing on daily skin care in EB patients is sparse. Two international clinical practice guidelines (CPGs) have been published in English, but they have not yet been translated into other languages such as Japanese. Therefore, their recommendations have not been adapted to multiple geographic regions in the world. This multiple case series describes our approach to the skin care of 3 Japanese patients with EB.

RESULTS:
All 3 patients were diagnosed with genetic EB. A 13-year-old male patient had dominant dystrophic EB and suffered skin breakdown covering nearly 1% to 6% of his total body surface area (TBSA) during a 21-week data collection period. A 3-year-old male patient had EB simplex; he suffered skin breakdown covering 2% to 40% of his TBSA during a 36-week data collection period. The third case was a 5-year-old male patient with recessive dystrophic EB who experienced skin breakdown covering 2% to 40% of his TBSA during a 35-week data collection period. Blisters were punctured daily and treated with a soft silicone dressing. Daily application of moisturizers was undertaken to prevent the skin from drying out and itching.

CONCLUSION:
Our experience suggests that application of published CPGs promoted wound healing. Nevertheless, given the nature of the disease, a complete resolution to an individual's vulnerability to skin lesions even with relatively minor trauma remains elusive. Additional research is needed to explore interventions for skin and ulcer care, along with symptom management, including pain and pruritus.
Reducing Nares Acquired Pressure Injuries “Protect the Nares Because I Care” Project in Adult Inpatients
Authors: Sermersheim Emily Read , Hall Lillian , Boudreau Lisa , Ambutas Shirley , Gulczynski Barbara 
Published: September 2021

PURPOSE:
The purpose of this quality improvement (QI) project was to develop a preventive care bundle to reduce the incidence of nares acquired pressure injuries (NAPIs) to 3% in the adult inpatient population.

PARTICIPANTS AND SETTING:
Participants included adult inpatients in a large, Magnet-designated, 664-bed academic medical center in the Midwestern United States.

APPROACH:
Through our organization's “RUSH Way” QI model, we developed an evidence-based NAPI Bundle comprising a “T”-shaped hydrocolloid thin barrier, a tube holder securement device, patient assessments, and site checks. The project was initiated by a team of clinicians and administrators. An incidence report was conducted of hospital-wide existing NAPIs in 2015. A pilot QI project of the NAPI Bundle was implemented in the surgical intensive care unit (SICU) from January 2016 to May 2016 and then hospital-wide implementation began in June 2016. Data were collected on the incidence of NAPIs, and documentation of hydrocolloid dressing on the nose and intact, incidence of adverse events with hydrocolloid dressing, and hydrocolloid dressing changed every 3 days were evaluated.

RESULTS:
In 2015, the house-wide baseline NAPI incidence rate was 4.9%. Data from the SICU pilot confirmed Bundle effectiveness, as zero NAPIs occurred during the pilot period. The hospital-wide expanded pilot in 2016 showed the NAPI rate to be 3.2%, and in 2017, the incidence rate was reduced to 1.4%, well below the 3% goal.

CONCLUSION:
The NAPI Bundle implemented in our organization by RNs substantially reduced the incidence of adult inpatient NAPIs.
Classification of Pressure Injury Stages and Skin Damage Photographs by RNs and Nursing Students in Spain
Authors: Rodriguez-Calero Miguel Angel , Fullana-Matas Antonia , Miró-Bonet Rosa 
Published: September 2021

PURPOSE:
The purpose of this study was to evaluate and classify pressure injuries (PIs) and other skin lesions according to the judgment of hospital-based RNs and nursing students who recently trained in wound care using photographs and comparing findings to those of wound care experts.

DESIGN:
Cross-sectional observational survey.

SUBJECT AND SETTING:
RNs working at Manacor Hospital, Mallorca, Spain, and third-year nursing students from the University of the Balearic Islands. Data were collected in June 2017.

METHODS:
The survey instrument was accompanied by a set of 24 photographs in 7 categories of skin lesions, such as PIs or moisture-associated skin damage, which the respondents were asked to classify. Descriptive analysis of the classifications was carried out, and levels of agreement using the chi-square test were compared with evaluations/classifications of a panel of experts.

RESULTS:
In total, 314 surveys (199 RNs and 115 students) were included in the analyses. Findings showed a wide variability among participants with levels of agreement, with expert opinion ranging from 91.4% to 15.61%. The levels of agreement were substantially lower for unstageable PIs (47.92%), those caused by moisture (53.50%), and mixed etiology (38.37%) than for stages 1-4 PIs. Of note, 62.12% of RNs had not received PI training or continuing education during the previous 2 years. This lack of education was statistically significantly associated with the accuracy of the classification made by the RNs for some of the photographs evaluated such as moisture-associated skin damage.

CONCLUSIONS:
We found discrepancies in the classification of PIs and other wounds/lesions among experts, RNs, and students. The regular provision of up-to-date information in training and continuing education programs is imperative to maintain nurses' abilities to identify and classify PIs and other skin-related damage.
Role of the amino acid mutations in the HA gene of H9N2 avian influenza virus under selective pressure in escape vaccine antibodies
Authors: Zhu Rui , Xu Shunshun , Sun Wangyangji , Li Quan , Shi Huoying , Wang Shifeng , Liu Xiufan 
Published: September 2021

AbstractIt has been well-documented that some amino acid mutations in hemagglutinin (HA) of H9N2 avian influenza virus (H9N2 virus) alter the viral antigenicity, but little is reported about the role of antibody escape mutations in escape vaccine antibodies. In this study, we found that the evolution of F/98 strain in chicken embryos or chickens resulted in significant differences in immune escape, and identify the contribution of HA mutations to the antigenic variation and immune escape of H9N2 virus. Among amino acid mutations in the HA of the antigen variant viruses occurring in embryonated chicken eggs and/or chickens with or without the selection pressure of vaccine antibodies, the mutations, S145N, Q164L, A168T, A198V, M224K and Q234L, affect the antigen drift of H9N2 virus. Specially, the A198V mutation, located at the receptor-binding site on the head domain of HA, significantly contributed the antigenic variation of H9N2 virus. The mutation A198V or Q234L significantly improved the receptor binding activity, while S145N mutation decreased the receptor binding activity. Single S145N mutation could promote viral escape from polyclonal antibodies (pAbs) by preventing Ab binding physically, and single A198V mutation could promote viral escape from pAbs by enhancing the receptor binding activity. Additionally, either the mutation S145N or A198V did interfere with the immunogenicity of the inactivated vaccine, resulting in reduction of the protective efficiency of H9N2 inactivated vaccine, which contributed escape from the antibody-based immunity. Our findings provided an important reference for the accurate evaluation of the role of the amino acids mutation in HA affecting the antigenicity of H9N2 virus on immune escape, and delivered a new perspective for monitoring the adaptive evolution of H9N2 virus.ImportanceIn this study, the role of the HA mutations of H9N2 virus occurring with and without antibody selective pressure on escaping from the antibody-based immune response in host was analyzed. The results demonstrated that (i) the HA mutations S145N, Q164L, A168T, A198V, M224K, and Q234L occurring in the process of the adaptive evolution of H9N2 virus in embryonated chicken eggs and/or chickens could affect the antigenic variation of H9N2 virus. Among these mutations, the HA mutation A198V had the most significant effect on the antigenic variation; (ii) S145N mutation promoted viral escape from pAbs by preventing Abs binding physically; (iii) A198V mutation did promote viral escape from pAbs by enhancing the receptor binding activity; (iv) neither the HA mutation S145N or A198V interfered with the immunogenicity of the inactivated vaccine, resulting in reduction of the protective efficiency of H9N2 inactivated vaccine.