bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mammalian genomic regulatory regions predicted by utilizing human genomics, transcriptomics, and epigenetics data
Authors: Nguyen Quan H , Tellam Ross L , Naval-Sanchez Marina , Porto-Neto Laercio R , Barendse William , Reverter Antonio , Hayes Benjamin , Kijas James , Dalrymple Brian P 
Published: February 2018

Abstract
Genome sequences for hundreds of mammalian species are available, but an understanding of their genomic regulatory regions, which control gene expression, is only beginning. A comprehensive prediction of potential active regulatory regions is necessary to functionally study the roles of the majority of genomic variants in evolution, domestication, and animal production. We developed a computational method to predict regulatory DNA sequences (promoters, enhancers, and transcription factor binding sites) in production animals (cows and pigs) and extended its broad applicability to other mammals. The method utilizes human regulatory features identified from thousands of tissues, cell lines, and experimental assays to find homologous regions that are conserved in sequences and genome organization and are enriched for regulatory elements in the genome sequences of other mammalian species. Importantly, we developed a filtering strategy, including a machine learning classification method, to utilize a very small number of species-specific experimental datasets available to select for the likely active regulatory regions. The method finds the optimal combination of sensitivity and accuracy to unbiasedly predict regulatory regions in mammalian species. Furthermore, we demonstrated the utility of the predicted regulatory datasets in cattle for prioritizing variants associated with multiple production and climate change adaptation traits and identifying potential genome editing targets.
Intracranial Neoplasms in the First Year of Life: Results of a Third Cohort of Patients From a Single Institution
Authors: Toescu Sebastian M , James Gregory , Phipps Kim , Jeelani Owase , Thompson Dominic , Hayward Richard , Aquilina Kristian 
Published: February 2018

Abstract

BACKGROUND
Brain tumors in the first year of life are rare and their management remains challenging.

OBJECTIVE
To report on the contemporary management of brain tumors in infants with reference to previous series from our institution.

METHODS
Retrospective cohort study design. Electronic/paper case note review of all brain tumors diagnosed at our institution in children aged <1 yr since the publication of our previous series.

RESULTS
Ninety-eight patients were seen. The most common presentations were with vomiting and macrocrania, at a median age of 184 d. Sixty-two percent of tumors were supratentorial. Ninety-one patients underwent 230 procedures; 7 patients had no surgery. One hundred eighteen operations were directly on brain tumors (biopsy 37, subtotal resection 47, gross total resection 34). Ninety-one cerebrospinal fluid diversions, 9 endoscopic procedures, and 13 preoperative embolizations were performed. Operative mortality was 4.4%. Tumor types in order of frequency were choroid plexus papillomas (CPP, 17), primitive neuroectodermal tumor (12), atypical teratoid/rhabdoid tumor (10), high-grade glioma (9), optic glioma (9), ependymoma (8), low-grade glioma (6), pilocytic astrocytoma (6), choroid plexus carcinoma (5), and teratoma (5), with 11 miscellaneous tumors. Survival was 93% at 1 mo (91/98), 64% at 1 yr (61/95), 44% at 5 yr (32/73), 28% at 10 yr (16/58). No patients with CPP or low-grade glioma died. Five-year survival rates were lowest for anaplastic ependymoma, primitive neuroectodermal tumor, and atypical teratoid/rhabdoid tumor. Seventy-seven percent of children reaching school age were in mainstream schooling.

CONCLUSION
Overall survival from neonatal brain tumors remains similar to previous series; analysis of tumor subtypes reveals improvements for CPP and gliomas. Despite increasing operative intervention, operative mortality continues to decline for this group of challenging patients.
Breaking Down Barriers to the Utilization of Standardized Tests and Outcome Measures in Acute Care Physical Therapist Practice: An Observational Longitudinal Study
Authors: McDonnell Brian , Stillwell Shannon , Hart Shelby , Davis Roger B 
Published: February 2018

Abstract

Background
Standardized tests and outcome measures (STOM) have not been consistently implemented as part of most physical therapists’ practice. Incidence of STOM use among physical therapists at Beth Israel Deaconess Medical Center was similar to low levels cited nationally among acute care physical therapists. Targeted knowledge translation (KT) strategies have been suggested to promote the application of research evidence into clinical decision making.

Purpose
The purpose of this quality improvement (QI) effort was to implement a series of interventions aimed at increasing both use and interpretation of STOM by physical therapists practicing in acute care.

Design
This study used an observational longitudinal design.

Methods
A literature review identified current barriers and facilitators to the use of STOM by physical therapists. KT strategies were tailored to the practice setting in order to target barriers and promote facilitators to the use of STOM. Data were collected through retrospective chart review at baseline and then subsequently at 4 periods following the implementation of the QI project.

Results
A statistically significant increase in both the use (primary outcome) and interpretation (secondary outcome) of STOM was observed following the implementation of KT strategies. The increase was sustained at all subsequent measurement periods.

Limitations
Limitations include the lack of a control group and the small number of setting- and diagnosis-specific STOM available for use by physical therapists practicing in acute care.

Conclusions
Implementation of KT strategies was associated with an increase in the frequency of use and interpretation of STOM. Similar QI efforts are feasible in any acute care physical therapy department and potentially other settings.
Suburethral Sling Procedures in the United States: Complications, Readmission, and Reoperation
Authors: Propst Katie , O'Sullivan David M. , Tulikangas Paul K. 
Published: February 2018

(Abstracted from Int Urogynecol J 2017;28:1463–1467)
An increasingly used measure of quality care after surgery for stress urinary incontinence is the rate of hospital readmissions. However, there are few specific data on readmission rates related to incontinence procedures.
Metformin Use in Pregnancy: Promises and Uncertainties
Authors: Lindsay Robert S. , Loeken Mary R. 
Published: February 2018

(Abstracted from Diabetologia 2017;60:1612–1619)
Metformin has been prescribed in pregnancy for more than 40 years, but it is since its increased use in polycystic ovarian syndrome treatment that exposure of the fetus to metformin in early pregnancy and its safety for both mother and child have been investigated more robustly. This review discusses the history, key trials, and controversies associated with metformin use in pregnancy.
Health surveillance for occupational asthma
Authors: Fishwick David , Forman Steve 
Published: February 2018

Purpose of review
The outcome for workers with occupational asthma is improved for those with an earlier diagnosis. Health surveillance at work is in principle designed to identify such cases, so that the risks to the individual worker, and coworkers, can be reduced. There is recent evidence to suggest that the uptake and quality of such surveillance could be improved. This review has assessed current approaches to health surveillance for occupational asthma.

Recent findings
The article covers a review of the utility of questionnaires, lung function testing, immunological investigations, and other tests, including exhaled nitric oxide, sputum eosinophilia, and exhaled breath condensate specifically in the context of workplace-based health surveillance.

Summary
Questionnaires remain a key component of respiratory health surveillance, although maybe limited by both sensitivity and specificity for early occupational asthma. The role of lung function testing is debated, although is recommended for higher level health surveillance. Various examples of immunological testing in health surveillance are discussed, but more evidence is needed in many specific areas before more general recommendations can be made. Evidence is discussed in relation to the utility of newer approaches such as exhaled nitric oxide, sputum eosinophilia, and exhaled breath condensate.
Positive End-expiratory Pressure Alone Minimizes Atelectasis Formation in Nonabdominal Surgery
Authors: Östberg Erland , Thorisson Arnar , Enlund Mats , Zetterström Henrik , Hedenstierna Göran , Edmark Lennart 
Published: February 2018

Abstract

Background
Various methods for protective ventilation are increasingly being recommended for patients undergoing general anesthesia. However, the importance of each individual component is still unclear. In particular, the perioperative use of positive end-expiratory pressure (PEEP) remains controversial. The authors tested the hypothesis that PEEP alone would be sufficient to limit atelectasis formation during nonabdominal surgery.

Methods
This was a randomized controlled evaluator-blinded study. Twenty-four healthy patients undergoing general anesthesia were randomized to receive either mechanical ventilation with PEEP 7 or 9 cm H2O depending on body mass index (n = 12) or zero PEEP (n = 12). No recruitment maneuvers were used. The primary outcome was atelectasis area as studied by computed tomography in a transverse scan near the diaphragm, at the end of surgery, before emergence. Oxygenation was evaluated by measuring blood gases and calculating the ratio of arterial oxygen partial pressure to inspired oxygen fraction (Pao
2/Fio
2 ratio).

Results
At the end of surgery, the median (range) atelectasis area, expressed as percentage of the total lung area, was 1.8 (0.3 to 9.9) in the PEEP group and 4.6 (1.0 to 10.2) in the zero PEEP group. The difference in medians was 2.8% (95% CI, 1.7 to 5.7%; P = 0.002). Oxygenation and carbon dioxide elimination were maintained in the PEEP group, but both deteriorated in the zero PEEP group.

Conclusions
During nonabdominal surgery, adequate PEEP is sufficient to minimize atelectasis in healthy lungs and thereby maintain oxygenation. Thus, routine recruitment maneuvers seem unnecessary, and the authors suggest that they should only be utilized when clearly indicated.
Recent advances in the treatment of rheumatoid arthritis
Authors: Mahajan Tina D. , Mikuls Ted R. 
Published: February 2018

Purpose of review
Therapies for rheumatoid arthritis (RA) continue to expand rapidly. The purpose of this review is to discuss novel treatment options, including biosimilars, that are available, as well as to highlight promising agents in development. The purpose is also to discuss new emerging safety signals associated with these drugs and to discuss strategies in tapering therapy.

Recent findings
There are several novel RA therapies. These include the interleukin-6 (IL-6) receptor blocker sarilumab, which was approved in 2017. In aggregate, the sarilumab studies show that it is effective in RA, including patients with incomplete responses to methotrexate and anti-tumor necrosis factor inhibitor, and showing superior efficacy when used in higher dose (200 mg every 2 weeks) to standard-dose adalilumab. Other drugs that are currently being studied include the IL-6 cytokine blocker sarikumab, the small targeted molecule filgotinib, and many new biosimilars. Baracitinib failed to achieve approval by the Food and Drug Administration primarily over perceived safety concerns. The two biosimilar drugs currently approved are CT-P13 and SB2, which are based on the reference product infliximab. Although this review summarizes trials examining biologic tapering, additional data are needed to guide clinicians in regards to treatment de-escalation in RA.

Summary
With the greatly expanded armamentarium of RA treatment options available, it is important for clinicians to understand the data regarding drug efficacy and safety. With remission increasingly attainable, effective drug tapering strategies are needed. Although tapering trials do exist, more studies will be needed to help guide clinical practice.
Influence of the Initial Sagittal Lumbar Alignment on Clinical and Radiological Outcomes of Single-Level Lumbar Total Disc Replacements at a Minimum 2-Year Follow-up
Authors: Faure Aymeric , Khalifé Marc , Thiebaut Benjamin , Roubineau François , Flouzat Lachaniette Charles-Henri , Dubory Arnaud 
Published: February 2018

Study Design.
Retrospective cohort study

Objective.
To analyze the clinical and radiographic outcomes of patients undergoing a one-level lumbar total disc replacement (TDR), according to the initial sagittal alignment of the spine.

Summary of Background Data.
No authors have highlighted correlation between the initial spinopelvic parameters and the postoperative outcome after a one-level TDR.

Methods.
Seventy-eight patients were included: 14 TDR at L4-L5 and 64 TDR at L5-S1 level. Clinical assessment was performed on leg pain and axial back pain Visual Analog Scale (VAS), Oswestry Disability Index, and Short Form-36 Health Survey. Radiographic assessment included full spine standing anteroposterior and lateral films. Data were compared according to the initial lumbar sagittal alignment described by Roussouly.

Results.
Forty-five female patients and 33 male patients with a mean age of 41.7 years (95% confidence interval [40.3–43.1]) were included. The mean follow-up was 46.4 months (95% [40.6–51.6]). Two patients were considered as Roussouly type 1 (2.6%), 36 patients as type 2 (46.2%), 33 patients as type 3 (42.3%), and 7 patients as type 4 (9%). Preoperatively, there were no clinical differences depending on Roussouly's type of back. Pelvic incidence (P < 0.001), sacral slope (P < 0.001), lumbar lordosis (P < 0.001), and spinosacral angle (P < 0.001) were different between the Roussouly's types of back. Postoperative clinical outcome improved (P < 0.001) but did not vary according to the Roussouly types except for leg pain VAS (P = 0.03). Post hoc tests did not reveal difference between the Roussouly's types and leg pain VAS. Postoperative radiographic outcomes did not change excepted for the lumbar lordosis (P < 0.001), thoracic kyphosis (P = 0.007), and spinosacral angle (P = 0.02). The Roussouly type had no effect on the postoperative course of radiographic parameters.

Conclusion.
Equivalent clinical and radiographic outcomes have been highlighted independently of the increasing of the sacral slope for patients with one-level lumbar TDR.

Level of Evidence: 3
Healthcare's Future: Strategic Investment in Technology
Authors: Franklin Michael A. 
Published: February 2018

SUMMARY
Recent and rapid advances in the implementation of technology have greatly affected the quality and efficiency of healthcare delivery in the United States. Simultaneously, diverse generational pressures—including the consumerism of millennials and unsustainable growth in the costs of care for baby boomers—have accelerated a revolution in healthcare delivery that was marked in 2010 by the passage of the Affordable Care Act.
Against this backdrop, Maryland and the Centers for Medicare & Medicaid Services entered into a partnership in 2014 to modernize the Maryland All-Payer Model. Under this architecture, each Maryland hospital negotiates a global budget revenue agreement with the state's rate-setting agency, limiting the hospital's annual revenue to the budgetary cap established by the state.
At Atlantic General Hospital (AGH), leaders had established a disciplined strategic planning process in which the board of trustees, medical staff, and administration annually agree on goals and initiatives to achieve the objectives set forth in its five-year strategic plans. This article describes two initiatives to improve care using technology. In 2006, AGH introduced a service guarantee in the emergency room (ER); the ER 30-Minute Promise assures patients that they will be placed in a bed or receive care within 30 minutes of arrival in the ER. In 2007, several independent hospitals in the state formed Maryland eCare to jointly contract for intensive care unit (ICU) physician coverage via telemedicine. This technology allows clinical staff to continuously monitor ICU patients remotely.
The positive results of the ER 30-Minute Promise and Maryland eCare program show that technological advances in an independent, small, rural hospital can make a significant impact on its ability to maintain independence. AGH's strategic investments prepared the organization well for the transition in 2014 to a value-based payment system.
Intrasession Repeatability and Intersession Reproducibility Measurements Using VX120 Multidiagnostic Unit
Authors: Sanchez Irene , Ortiz-Toquero Sara , Martin Raul 
Published: February 2018

Objective:
The VX120 multidiagnostic unit is a multidiagnostic instrument that combines several functions: autorefraction, keratometry, corneal topography, aberrometry, pachymetry, and noncontact tonometry. The purpose of this study was to determine the intrasession repeatability and the intersession reproducibility of all parameters measured by the VX120 multidiagnostic unit in a sample of normal healthy eyes.

Methods:
Three repeated measurements in the right eye of the volunteers were taken with VX120. Repeatability of the sphere, cylinder, axis, anterior corneal powers (K flat and K steep, 3-mm pupil), high- and low-order aberration root mean square (HOA-RMS and LOA-RMS, 3-mm pupil), eccentricity, white-to-white (WTW), anterior chamber depth (ACD), and central corneal thickness (CCT) (2-mm central) was analyzed. Within-subject SD (Sw), precision, repeatability, coefficient of variation (CV), and the intraclass correlation coefficient (ICC) were calculated.

Results:
The CV was low for K flat and K steep, WTW, ACD, and CCT with a range from 0.34% to 1.16%. The CV was higher for sphere, cylinder, HOA-RMS, and LOA-RMS and eccentricity with a range among 6.92% to 54.24%. The ICC showed high values in all parameters except in HOA-RMS (0.720–0.776) and eccentricity (0.889) in first session with moderate agreement. Comparing the intrasession repeatability of first and second session, statistically significant differences (P<0.01) were found between both sessions just to the CV for all parameters (except cylinder values) measured with VX120. However, nonstatistically significant differences (P>0.13) were found for Sw, precision, and repeatability values.

Conclusions:
The VX120 multidiagnostic unit provides repeatable measurements in anterior corneal power (K flat and K steep), WTW, ACD, and CCT. However sphere, cylinder, HOA-RMS, LOA-RMS, and eccentricity showed worse repeatability. Intersession reproducibility showed good results with little differences between sessions in healthy subjects.
Surgical Outcome of Replacing a Failed Ahmed Glaucoma Valve by a Baerveldt Glaucoma Implant in the Same Quadrant in Refractory Glaucoma
Authors: Zuo Wenzhen , Lesk Mark R. 
Published: February 2018

Purpose:
The purpose of this study was to describe the surgical technique and outcomes in eyes that underwent surgery to replace a failed Ahmed valve by a Baerveldt glaucoma implant in the same quadrant.

Methods:
This study was a retrospective case series of 9 patients. Parameters analyzed include age, glaucoma type, prior surgery, complications, intraocular pressure (IOP), visual acuity, and number of glaucoma medications before and after the surgery. Surgical success was defined as having either an IOP below 21 mm Hg or a 20% IOP reduction, with or without hypotensive agent.

Results:
The mean follow-up duration was 47 months. After surgery, at the time of final follow-up, the mean IOP decreased from 29.9 mm Hg to 16.7 mm Hg (36% of mean IOP reduction; P=0.008). There was a significant reduction of hypotensive agents from a mean of 4.33 to 2.22 (P=0.02). The visual acuity did not have a significant deterioration (P=0.07). In the final visit, 5 of 9 patients met total success criteria and 2 patients were qualified successes. Two cases failed totally after 69 and 125 months of follow-up. The cumulative probability of total success after 6 months was 76% and this rate remained stable until the sixth year. One patient had bullous keratopathy. Two patients had early postoperative pressure spikes: the first patient was treated by trabeculectomy, and the second by vitrectomy.

Conclusions:
A replacement of the failed Ahmed glaucoma valve by a new Baerveldt glaucoma implant in the same quadrant can be a reasonable choice to control refractory glaucoma.
Suprasternal Transcatheter Aortic Valve Replacement in Patients with Marginal Femoral Access
Authors: Kiser Andy C. , Caranasos Thomas G. , Peterson Mark D. , Holzhey David M. , Kiefer Philipp , Wiley Nifong L. , Borger Michael A. 
Published: February 2018

Objective Recently, the PARTNER 2A trial reported results of transcatheter aortic valve replacement versus surgical aortic valve replacement in 2032 intermediate-risk patients at 2 years. Two hundred thirty-six patients (24%) required an access route other than transfemoral. Compared with transfemoral and surgical aortic valve replacement, nontransfemoral transcatheter aortic valve replacement was associated with a numerically higher rate of death and disabling stroke at 30 days. This underscores the need for a better alternative surgical approach for patients with marginal femoral access. We reviewed our multicenter experience with minimally invasive suprasternal transcatheter aortic valve replacement. Methods Consecutive patients with symptomatic severe aortic stenosis at high or intermediate risk for surgical aortic valve replacement underwent suprasternal transcatheter aortic valve replacement. A commercially available transcatheter heart valve was deployed under fluoroscopic guidance through the innominate artery or ascending aorta. Using a 3-cm skin incision just above the sternal notch, the Aegis Transit System (Aegis Surgical Ltd, Galway, Ireland) provided illuminated access to the mediastinum without bone disruption. Through a purse-string suture placed in the innominate artery or ascending aorta, transcatheter aortic valve replacement proceeded similarly to the direct aortic approach. Results Thirty patients at six medical centers successfully underwent suprasternal transcatheter aortic valve replacement. Implanted valves included 2 CoreValve and 12 Evolut-R (Medtronic, Inc, Minneapolis, MN USA), as well as 10 SAPIEN 3 and 6 SAPIEN XT (Edwards Lifesciences, Corp, Irvine, CA USA) with sizes ranging from 23 to 31 mm. Median procedure time was 90 minutes and median hospital stay was 4 days. Postoperatively, new permanent pacemaker (n = 3) was the most common Vascular Academic Research Consortium 2 complication. Conclusions These data demonstrate the early clinical feasibility of suprasternal transcatheter aortic valve replacement. Key advantages of this approach include direct access to the innominate artery and ascending aorta, precise sheath control, and confident arterial closure. Additional experience is warranted to confirm these favorable results.