bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recurrent Idiopathic Anaphylaxis in a Woman After Suspected Food Poisoning
Authors: Lauter Carl B. , Koppisetty Shalini 
Published: February 2018

Rationale
Recurrent idiopathic anaphylaxis represents a vexing clinical problem associated with stress for patients and allergists. The cause is often not identified despite exhaustive testing.

Methods
The history of a 54-year old woman with repeated bouts of unexplained anaphylaxis is reviewed. The relationship between preceding or active infection (emphasis on gastrointestinal infections) and chronic idiopathic urticaria and anaphylaxis was explored by electronic media search (PubMed, Google) and review of reference lists of published articles. The literature on the relationship of Campylobacter jejuni infection and urticaria is reviewed. Gastrointestinal infections (Giardia, Anisakis) have been better documented in such patients.

Results
The patient had persistent flatulence, and looser and more frequent bowel movements for months after recovery from a bout of food poisoning. A diagnosis of “postinfectious irritable bowel syndrome” was made by a gastroenterologist. These symptoms were not related to her simultaneous diagnosis of chronic idiopathic urticaria and idiopathic anaphylaxis. After treatment with azithromycin (positive stool culture for C. jejuni), she had a systemic allergic reaction. Subsequently, the diarrhea and urticaria/anaphylaxis cleared. C. jejuni has been reported to cause chronic urticaria, but predominantly in children. A related organism, Helicobacter pylori, has been associated with chronic idiopathic urticaria. Anaphylaxis has not been related to Campylobacter infection in the past.

Conclusions
Urticaria and recurrent bouts of mild unexplained anaphylaxis were triggered by C. jejuni infection. The allergic and gastrointestinal symptoms resolved after antibiotic treatment. Gastrointestinal (and other) infections should be looked for in patients with urticaria or anaphylaxis
Autoimmune Manifestations of Acute Q Fever Infection
Authors: Hassoun-Kheir Nasreen , Shasha David , Hayek Tony , Hussein Khetam 
Published: February 2018

Abstract
Q fever is nearly a worldwide zoonotic infection caused by the intracellular bacterium Coxiella burnetii, which is endemic in Israel. Acute infection mostly presents as a self-limited febrile illness, and occasionally involves respiratory or hepatic disease. Immune reactivation in the setting of acute illness was previously reported as well as various infectious positive cross-reactive serologic tests during the course of disease. Other autoimmune manifestation is infectious-type antiphospholipid syndrome linked to acute Q fever.
Herein, we report a case of acute Q fever–related antiphospholipid syndrome with features resembling systemic lupus erythematosus treated successfully with corticosteroids. We review the literature and discuss the present state of knowledge on the link between Q fever and autoimmunity, aiming to raise clinicians' awareness of this possible rare presentation of the disease.
A Systematic Review of Culturally Specific Interventions to Increase Physical Activity for Older Asian Americans
Authors: Katigbak Carina , Flaherty Erin , Chao Ying-Yu , Nguyen Tam , Cheung Daphne , Yiu-Cho Kwan Rick 
Published: February 2018

Background:
Physical activity (PA) is a significant modifiable risk factor for cardiovascular disease. For older adults, engaging in PA is shown to improve cardiac status, reduce cognitive, and functional decline, and improve overall quality of life. However, only 17% of Asian American adults meet the 2008 federal recommended guidelines for aerobic and muscle strengthening activity; and there is a paucity of data reporting on older Asian Americans – a rapidly growing, underserved group. While data pertaining to Asian Americans is frequently reported at the aggregate level, this masks differences (eg, language, culture, income) among Asian ethnic subgroups that may impact health behaviors. The purpose of this review was to identify intervention, and cultural adaptation strategies in studies promoting PA for older Asian Americans.

Methods:
A comprehensive literature search was performed to identify interventions published between 1996-2016 focused on improving PA among older Asian Americans (> 60 years old). Data were abstracted to examine intervention study designs, cultural adaptation strategies, theoretical frameworks, and physical activity measures.

Results:
Nine studies met the review’s inclusion criteria. Community-based recruitment approaches were widely used, and all studies employed cultural adaptation to varying degrees. Most studies reported improvements in PA outcomes, focused on Chinese Americans, and relied on self-reports of PA, while few aimed to increase PA using a multi-component approach.

Conclusions:
Future studies would benefit from larger sample sizes, a wider representation of Asian ethnic subgroups, and concentrated efforts to implement deep level adaptations that may increase the salience and sustainability of these interventions.
The operative risk and natural history after the diagnosis of ileal penetrating Crohn’s disease
Authors: Bossuyt Peter , Debeuckelaere Celine , Ferrante Marc , Vanbeckevoort Dirk , Billiet Thomas , Wolthuis Albert , van Assche Gert , D’Hoore Andre , Vermeire Séverine 
Published: February 2018

Background and purpose
Crohn’s disease (CD) is marked by transmural inflammation of the bowel wall leading to stricturing and/or penetrating complications in the majority of patients. The natural history and operative risk after the diagnosis of an ileal penetrating complication is understudied. The aim was to study the disease course and need for surgery in patients diagnosed with a penetrating ileal CD complication and to assess the risk factors associated with worse postoperative outcome.

Patients and methods
In this cohort study, all cross-sectional imaging exams (computed tomography and/or magnetic resonance imaging) performed between 2006 and 2014 in patients with CD in a tertiary referral centre were reviewed for the presence of ileal penetrating complications (defined as abscesses, phlegmones and/or fistula). Demographic, clinical, biochemical, radiological and endoscopic factors were assessed retrospectively in these patients as well as the need for surgery (intestinal resection and/or strictureplasties) and postoperative complications.

Results
In total, 1803 cross-sectional imaging exams in 957 CD patients were performed during the study period. In 113 patients, penetrating ileal CD complications were identified. The majority of these patients were referred for surgery (86%) (median time to surgery 1 month, interquartile range: 1–4.9 months). In multivariate analysis, only the presence of abscesses was associated with subsequent surgery (P=0.034; hazard ratio=1.65; 95% confidence interval: 1.04–2.61). Severe postoperative complications (Dindo–Clavien>II) were present in 13% of the patients. Albumin less than 32 g/l was associated with a five-fold increase in severe complications (P=0.039; hazard ratio=4.9; 95% confidence interval: 1–22). Up to 35% of the patients needed no further medical treatment during the first 5 years postoperatively.

Conclusion
In this cohort, the majority of patients with penetrating ileal CD underwent surgery. The presence of an abscess showed a significant association with the need for surgery. There was an acceptable postoperative complication rate. Patients with low albumin had an unfavourable postoperative course. The long-term outcome after surgery was favourable.
Transjugular intrahepatic portosystemic shunt creation for cirrhotic portal hypertension is well tolerated among patients with portal vein thrombosis
Authors: Merola Jonathan , Fortune Brett E. , Deng Yanhong , Ciarleglio Maria , Amirbekian Smbat , Chaudhary Noami , Shanbhogue Alampady , Ayyagari Rajasekhara , Rodriguez-Davalos Manuel I. , Teperman Lewis , Charles Hearns W. , Sigal Samuel H. 
Published: February 2018

Background
Portal vein thrombosis (PVT) develops in cirrhotic patients because of stagnation of blood flow. Transjugular intrahepatic portosystemic shunt (TIPS) creates a low-resistance conduit that restores portal venous patency and blood flow.

Aim
The effect of PVT on transplant-free survival in cirrhotic patients undergoing TIPS creation was evaluated.

Patients and methods
A multicenter, retrospective cohort study of patients who underwent TIPS creation for cirrhotic portal hypertension was carried out. A Cox model with propensity score adjustment was developed to evaluate the effect of PVT on 90-day and 3-year transplant-free survival. A subgroup analysis examining mortality of those with superior and inferior PVT was also carried out.

Results
A total of 252 consecutive TIPS creations were assessed, including 65 in patients with PVT. Survival of patients with high Model for End-stage Liver Disease scores (≥18) and PVT was not statistically different compared with patients with low Model for End-stage Liver Disease scores (<18) and no PVT at 90 days (P=0.46) and 3 years (P=0.42). Those with superior PVT had improved 90-day and 3-year survival both compared with patients with a inferior PVT and those without a PVT (P<0.01, all cases).

Conclusion
The presence of PVT does not impair the prognosis of patients following TIPS creation, particularly in patients with superior portal occlusion.
Primary biliary cholangitis is more severe in previous hepatitis B virus infection patients
Authors: Zhang Yingyu , Shi Ying , Wu Ruihong , Wang Xiaomei , Gao Xiuzhu , Niu Junqi 
Published: February 2018

Objectives
The aim of this study was to evaluate the association between previous hepatitis B virus (HBV) infection and the severity of primary biliary cholangitis (PBC).

Patients and methods
A total of 379 HBsAg-negative PBC patients were investigated between 2012 and 2017 in this study. Fifty-two of these patients underwent liver biopsy. The enrolled patients were divided into an anti-HBc-positive group and an anti-HBc-negative group; the patients with liver biopsy were further divided into early stage (stage I) and advanced stage (stages II, III, and IV) according to histological assessment. Liver fibrosis was also assessed by noninvasive prognosis scores including the Mayo Risk Score, the Newcastle model, the aspartate aminotransferase-to-platelet ratio index, the fibrosis index based on the four factors (FIB-4), and the albumin–bilirubin score. The difference in disease stage between the two groups was assessed by histological stage and noninvasive scores predicting fibrosis.

Results
The histology showed that more patients in the anti-HBc-positive group had advanced stage compared with anti-HBc-negative patients (P<0.05). Higher Mayo Risk Score, the Newcastle model, aminotransferase-to-platelet ratio index, and fibrosis index based on the four factors (all P<0.05) were obtained in all patients except for the albumin–bilirubin score (P=0.096).

Conclusion
Previous HBV infection was associated with a worse histological stage and advanced fibrosis score of PBC. It appears that the previous HBV infection may have aggravated the PBC severity, potentially leading to poorer outcomes.
Maryland Multipayor Patient-centered Medical Home Program
Authors: Marsteller Jill A. , Hsu Yea-Jen , Gill Christine , Kiptanui Zippora , Fakeye Oludolapo A. , Engineer Lilly D. , Perlmutter Donna , Khanna Niharika , Rattinger Gail B. , Nichols Donald , Harris Ilene 
Published: February 2018

Objective:
To evaluate impact of the Maryland Multipayor Patient-centered Medical Home Program (MMPP) on: (1) quality, utilization, and costs of care; (2) beneficiaries’ experiences and satisfaction with care; and (3) perceptions of providers.

Design:
4-year quasiexperimental design with a difference-in-differences analytic approach to compare changes in outcomes between MMPP practices and propensity score-matched comparisons; pre-post design for patient-reported outcomes among MMPP beneficiaries.

Subjects:
Beneficiaries (Medicaid-insured and privately insured) and providers in 52 MMPP practices and 104 matched comparisons in Maryland.

Intervention:
Participating practices received unconditional financial support and coaching to facilitate functioning as medical homes, membership in a learning collaborative to promote education and dissemination of best practices, and performance-based payments.

Measures:
Sixteen quality, 20 utilization, and 13 cost measures from administrative data; patient-reported outcomes on care delivery, trust in provider, access to care, and chronic illness management; and provider perceptions of team operation, team culture, satisfaction with care provided, and patient-centered medical home transformation.

Results:
The MMPP had mixed impact on site-level quality and utilization measures. Participation was significantly associated with lower inpatient and outpatient payments in the first year among privately insured beneficiaries, and for the entire duration among Medicaid beneficiaries. There was indication that MMPP practices shifted responsibility for certain administrative tasks from clinicians to medical assistants or care managers. The program had limited effect on measures of patient satisfaction (although response rates were low) and on provider perceptions.

Conclusions:
The MMPP demonstrated mixed results of its impact and indicated differential program effects for privately insured and Medicaid beneficiaries.
Hospital Characteristics Associated With Postdischarge Hospital Readmission, Observation, and Emergency Department Utilization
Authors: Horwitz Leora I. , Wang Yongfei , Altaf Faseeha K. , Wang Changqin , Lin Zhenqiu , Liu Shuling , Grady Jacqueline , Bernheim Susannah M. , Desai Nihar R. , Venkatesh Arjun K. , Herrin Jeph 
Published: February 2018

Background:
Whether types of hospitals with high readmission rates also have high overall postdischarge acute care utilization (including emergency department and observation care) is unknown.

Design:
Cross-sectional analysis.

Subjects:
Nonfederal United States acute care hospitals.

Measures:
Using methodology established by the Centers for Medicare & Medicaid Services, we calculated each hospital’s “excess days in acute care” for fee-for-service (FFS) Medicare beneficiaries aged over 65 years discharged after hospitalization for acute myocardial infarction, heart failure (HF), or pneumonia, representing the mean difference between predicted and expected total days of acute care utilization in the 30 days following hospital discharge, per 100 discharges. We assessed the multivariable association of 8 hospital characteristics with excess days in acute care and the proportion of hospitals with each characteristic that were statistical outliers (95% credible interval estimate does not include 0).

Results:
We included 2184 hospitals for acute myocardial infarction [228 (10.4%) better than expected, 549 (25.1%) worse than expected], 3720 hospitals for HF [484 (13.0%) better and 840 (22.6%) worse], and 4195 hospitals for pneumonia [673 (16.0%) better, 1005 (24.0%) worse]. Results for all conditions were similar. Worse than expected outliers for pneumonia included: 18.8% of safety net hospitals versus 26.1% of nonsafety net hospitals; 16.7% of public hospitals versus 33.1% of for-profit hospitals; 19.5% of nonteaching hospitals versus 52.2% of major teaching hospitals; 7.9% of rural hospitals versus 42.1% of large urban hospitals; 5.9% of hospitals with 24–<50 beds versus 58% of hospitals with >500 beds; and 29.0% of hospitals with nurse-to-bed ratios >1.0–1.5 versus 21.7% of hospitals with ratios >2.0.

Conclusions:
Including emergency department and observation stays in measures of postdischarge utilization produces similar results as measuring only readmissions in that major teaching, urban and for-profit hospitals still perform disproportionately poorly versus nonteaching or public hospitals. However, it enables identification of more outliers and a more granular assessment of the association of hospital factors and outcomes.
Endothelial cell protein C receptor-dependent signaling
Authors: Pendurthi Usha R. , Rao L. Vijaya Mohan 
Published: February 2018

Purpose of review
Endothelial cell protein C receptor (EPCR), a transmembrane glycoprotein present on the surface of endothelial cells and other cell types, is an essential component of the protein C (PC) anticoagulant system. EPCR is also shown to play a critical role in mediating activated protein C (APC)-induced cytoprotective signaling. The purpose of this review is to outline the mechanisms of EPCR-dependent cell signaling and discuss recent findings made in this area.

Recent findings
Recent studies showed that the cleavage of protease-activated receptor (PAR)1 at a noncanonical site by APC–EPCR or the canonical site by thrombin when PC occupies EPCR induces β-arrestin-2-mediated biased cytoprotective signaling. Factor VIIa binding to EPCR is also shown to induce the cytoprotective signaling. EPCR is found to be a reliable surface marker for identifying human hematopoietic stem cells in culture. EPCR, binding to diverse ligands, is thought to play a role in the pathogenesis of severe malaria, immune functions, and cancer by either blocking the APC-mediated signaling or by mechanisms that are yet to be elucidated.

Summary
Recent studies provide a mechanistic basis to how EPCR contributes to PAR1-mediated biased signaling. EPCR may play a role in influencing a wide array of biological functions by binding to diverse ligands.
The flux of iron through ferritin in erythrocyte development
Authors: Philpott Caroline C. 
Published: February 2018

Purpose of review
Terminal differentiation of erythropoietic progenitors requires the rapid accumulation of large amounts of iron, which is transported to the mitochondria, where it is incorporated into heme. Ferritin is the sole site of iron storage present in the cytosol. Yet the role of iron accumulation into ferritin in the context of red cell development had not been clearly defined. Early studies indicated that at the onset of terminal differentiation, iron initially accumulates in ferritin and precedes heme synthesis. Whether this accumulation is physiologically important for red cell development was unclear until recent studies defined an obligatory pathway of iron flux through ferritin.

Recent findings
The iron chaperone functions of poly rC-binding protein 1 (PCBP1) and the autophagic cargo receptor for ferritin, nuclear co-activator 4 (NCOA4) are required for the flux of iron through ferritin in developing red cells. In the absence of these functions, iron delivery to mitochondria for heme synthesis is impaired.

Summary
The regulated trafficking of iron through ferritin is important for maintaining a consistent flow of iron to mitochondria without releasing potentially damaging redox-active species in the cell. Other components of the iron trafficking machinery are likely to be important in red cell development.
Clinical Burdens of β-Thalassemia Major in Affected Children
Authors: Gharaibeh Huda , Barqawi Moussa A. , Al-Awamreh Khetam , Al Bashtawy Mohammed 
Published: February 2018

Background:
β-thalassemia major (BTM) is an inherited blood disorder leading to severe anemia. A better understanding of BTM complications can be considered an important factor in developing effective health care provision.

Method:
A descriptive exploratory design was used to identify the clinical burden of BTM from affected children's perspective. A convenience sample of 45 patients with BTM, accompanied by a family member, was recruited from a governmental hospital during April–May 2015.

Results:
The most reported clinical burden was facial deformity 86.9%, followed by systematic infection (48.8%), growth delay (44.4%), and liver problems (39.9%). Patient age was significantly associated with clinical burdens such as bone pain and facial deformity. The number of blood transfusions received was associated with growth delay and bone pain.

Conclusion:
This study highlights the clinical burdens of thalassemia on affected children, in terms of physical appearance, growth delay and other burdens.
Leading Change
Authors: Nelson-Brantley Heather V. , Ford Debra J. , Miller Karen L. , Stegenga Kristin A. , Lee Robert H. , Bott Marjorie J. 
Published: February 2018

OBJECTIVE
The aim of this study was to understand how nurses in a 25-bed critical-access hospital (CAH) led change to become the 1st to achieve Magnet®.

BACKGROUND
Approximately 21% of the US population lives in rural areas served by CAHs. Rural nurse executives are particularly challenged with limited resources.

METHODS
Staff nurses, nurse managers, interprofessional care providers, the chief nursing officer, and board of directors (n = 27) were interviewed. Observations of hospital units and administrative meetings were done, and hospital reports were analyzed.

RESULTS
Nine themes emerged to support a conceptual model of leading change. The CAH spent 3 years of its 6-year journey establishing organizational readiness. Nurses overcame complex challenges by balancing operational support and fostering relationships. The Magnet journey led to significantly improved nurse and patient outcomes. A new organizational culture centered on shared governance, evidence-based practice, and higher education emerged.

CONCLUSIONS
The journey to Magnet leads to improved nurse, patient, and organization outcomes.
Implementation and Evaluation of Shared Medical Appointments in Veterans With Diabetes
Authors: Omogbai Timothy , Milner Kerry A. 
Published: February 2018

OBJECTIVE
The aim of this study is to implement and evaluate shared medical appointments (SMA) in veterans with diabetes.

BACKGROUND
Health systems are challenged to meet the complex care needs of veterans with diabetes. Use of SMA has resulted in significant improvements in A1c, blood pressure, and self-management skills in this population.

METHODS
Shared medical appointments were implemented in a Veterans Administration Health System. A1c, blood pressure, total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, weight, and height were collected at baseline, 3 months, and 6 months; hospitalization anytime; and veteran satisfaction at baseline and 6 months.

RESULTS
From October 15, 2015, to March 15, 2016, 30 male veterans with diabetes participated in monthly SMA. Outcome measures except for high-density lipoprotein improved significantly (P < .02) from baseline to 6 months. No veterans were hospitalized. Veteran satisfaction increased significantly (P < .001).

CONCLUSION
Shared medical appointment can be a highly effective intervention for veterans with diabetes. Nursing leaders need to be at the forefront of implementing SMA for populations with chronic conditions.
LINE-1 Activation After Fertilization Regulates Global Chromatin Accessibility in the Early Mouse Embryo
Authors: Jachowicz Joanna W. , Bing Xinyang , Pontabry Julien , Bošković Ana , Rando Oliver J. , Torres-Padilla Maria-Elena 
Published: February 2018

(Abstracted from Nat Genet 2017;49:1502–1510)
After fertilization, gametes undergo dramatic epigenomic reprogramming to initiate embryonic development. Retrotransposons are repetitive elements that form almost half of the mammalian genome; some are transcribed after fertilization.