bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physician Use of Health Care Teams for Improving Quality in Primary Care
Authors: Hoff Timothy , Prout Kathryn 
Published: July 2019

Objectives:
Health care teams may be used to improve quality in the primary care setting. Absent in the extant literature on health care teams is knowledge of how physicians seek to deploy this innovation on an everyday basis to improve care quality. This study's aim was to explore how physicians use teams in practice to deliver higher-quality care.

Methods:
A qualitative study using data collected through 39 interviews with primary care physicians and 9 interviews with medical assistants, employed across different primary care settings in the northeastern region of the United States.

Results:
Physicians used teams for 2 care quality functions: “getting basic care duties off their plate” to have more time for complex care delivery and “as relational extensions” of themselves to enhance the patient experience and provide care continuity. Physicians identified the following ingredients for using teams for these functions: (a) achieving long-term continuity working with the same team members; (b) having the correct mix of personalities and skills sets on the team; and (c) a “who is doing what” focus in the team for achieving role clarity.

Conclusions:
The findings illuminate how primary care physicians attempt to use teams to improve care quality and enhance their role as care providers.
The Effect of Pay-for-Performance Compensation Model Implementation on Vaccination Rate: A Systematic Review
Authors: Benabbas Roshanak , Shan Gururaj , Akindutire Olumide , Mehta Ninfa , Sinert Richard 
Published: July 2019

Background and objectives:
Pay-for-performance (P4P) is broadly defined as financial incentives to providers for attaining prespecified quality outcomes. Providers, payers, and public officials have worked over the years to develop innovative solutions to rapidly and consistently bring new diagnostic tests and therapies to our patients. P4P has been instituted in various forms over the last 30 years. Vaccines are one of society's greatest public health innovations and vaccination programs provide a unique opportunity for P4P programs. We attempted to investigate the effect of P4P compensation model implementation on the vaccination rate.

Methods:
Utilizing a systematic review and meta-analysis approach, we searched PubMed, Embase, Scopus, and Web of Science from inception to December 2018.

Results:
Nine articles were included with poor to moderate quality. Improvements in vaccination rates after implementation of P4P were statistically significant in 8 of 9 of studies. However, due to the heterogeneity of the methods used, we could not pool the data.

Conclusion:
The results of this systematic review indicate that the implementation of P4P programs can increase the vaccination rate. In recent times when it has become increasingly more popular not to vaccinate, implementing P4P becomes even more important if it is shown to be an effective tool in increasing vaccination rates.
Sensitivity of the Mount Fuji Sign After Evacuation of Chronic Subdural Hematoma in Nonagenarians
Authors: Moscovici Samuel , Halevy Dan , Mizrahi Cezar José , Goldberg S. Nahum , Brown Derek W. , Ben-David Eliel 
Published: July 2019

Background
The Mount Fuji sign (MFS) is a radiological sign on computed tomographic scans depicting air between the frontal lobes. Air in this location indicates tension pneumocephalus (TP), considered a neurosurgical emergency.
We evaluate the correlation between the MFS and perioperative mortality attributed to TP in nonagenarians who have undergone evacuation of chronic subdural hemorrhage (cSDH).

Materials and Methods
We retrospectively reviewed the records of nonagenarians who had cSDH evacuation between 2006 and 2015. Postoperative computed tomographic images were evaluated for findings consistent with the MFS.

Results
Of 45 patients, 15 patients (33%) had radiological MFS, and 3 patients (20%) with MFS required reoperation because of new blood collection. No patient required reoperation because of TP. Perioperative (30-day) mortality in patients demonstrating the MFS was 6.67% caused by cardiac arrhythmia versus 13.33% mortality in patients with no evidence of the MFS.

Conclusion
Mount Fuji sign in nonagenarians after cSDH evacuation is not a specific sign of TP.
Glomerular Expression of Some Profibrotic Factors in Progressive Childhood Lupus Nephritis
Authors: Badawy Ahlam , Gamal Yasser , Hussein Almontaser 
Published: July 2019

Background
Lupus nephritis (LN) is a major cause of mortality and morbidity in both adult and pediatric patients. However, studies regarding pathogenesis and predictors of renal outcomes in childhood LN are limited. Transforming growth factor-β1 (TGF-β1) and Connective tissue growth factor (CTGF) have an important role in proliferative and fibrotic changes in many renal diseases. We aim to evaluate the role of such two profibrotic factors in the progression of childhood onset LN and to detect if their glomerular expression could represent an early predictor of future deterioration of renal function.

Methods
34 children with new onset of LN were included. Glomerular expressions of TGF-β1 and CTGF were evaluated by immunohistochemical analysis in the renal tissue of such patients and in control tissue. GFR was estimated at time of renal biopsy at the onset of LN and after 2 years of follow-up. Rate of GFR change (ΔGFR) was calculated and used as indicative of degree of renal disease progression.

Results
Glomerular TGF-β1 and CTGF expressions in children with LN were significantly higher than in control tissue (LN 15.41 ± 9.84 and 15.56 ± 10.51 vs. 2.15 ± 1.45 and 1.35 ± 1.07 in control respectively, with p < 0.001 in both). In addition, the glomerular expressions of TGF-β1 and CTGF were significantly higher in patients with further decline in GFR (20.68 ± 7.73 and 21.05 ± 8.75) versus (5.75 ± 4.37 and 5.50 ± 3.78) in those without change in GFR with (p = 0.000 for both of them).

Conclusions
Patients with LN have increased glomerular expressions of TGF-β1 and CTGF, which were higher in those with further decline in GFR. These profibrotic factors are suspected to be involved in pathogenesis of LN and could be evaluated as a target for therapeutic intervention to stop progression of LN. In addition, their glomerular expression could be used as an early predictor of progression of LN, to justify early aggressive therapy in those with suspected rapid progression.
Lung Perfusion Scintigraphy in Eisenmenger Syndrome Due to Patent Ductus Arteriosus
Authors: Mitsui Kohei , Woodhams Reiko , Ukisu Ryutarou , Inoue Yusuke 
Published: July 2019

Abstract
Eisenmenger syndrome refers to the elevation of pulmonary arterial pressure to the systemic level caused by an increased pulmonary vascular resistance with right-to-left shunt through an intracardiac or aortopulmonary communication. A 36-year-old woman with Eisenmenger syndrome due to patent ductus arteriosus underwent 99mTc-MAA lung perfusion scintigraphy to evaluate right-to-left shunt. Whole-body imaging visualized extrapulmonary activity in both kidneys, spleen, and intestinal tract, confirming the presence of right-to-left shunt. Accumulation in the brain was visible but much weaker compared with that in the body trunk and was limited to the left cerebral hemisphere, which reflected the location of the shunt pathway.
68Ga-PSMA Uptake in Escherichia coli Spondylodiscitis
Authors: Klingenberg Søren , Jochumsen Mads Ryø , Pedersen Bodil Ginnerup , Bouchelouche Kirsten 
Published: July 2019

Abstract
In a patient with recently diagnosed intermediate-risk prostate cancer, 68Ga-prostate-specific-membrane-antigen (PSMA) PET/CT for primary staging discovered increased 68Ga-PSMA uptake in spondylodiscitis in the thoracic spine. The bacteria Escherichia coli was found both in blood cultures and bone biopsies from the thoracic lesion. This case presents spondylodiscitis as a potential benign pitfall to be aware of when interpreting PSMA PET/CT in prostate cancer patients.
Physiologic Uterine Uptake of Radioiodine During Menstruation Demonstrated by SPECT/CT
Authors: Liu Lina , Chen Yu , Tian Tian , Huang Rui , Liu Bin 
Published: July 2019

Abstract
A 35-year-old woman with papillary thyroid cancer underwent 131I therapy after thyroidectomy. Post-therapy whole body scan revealed increased activity in the pelvis, in addition to the activity in the neck. On SPECT/CT images, the radioactivity in the pelvis was localized in the rectum and cervix. Further inquiry discovered that the patient was menstruating. We concluded that abnormal radioiodine uptake in menstrual uterus might be an exceptional finding mimicking a metastasis.
Progressive Hydrocephalus Due to Ventriculoperitoneal Shunt Infection
Authors: Mathew Boon , Purandare Nilendu C. , Agrawal Archi , Shah Sneha , Puranik Ameya , Rangarajan Venkatesh 
Published: July 2019

Abstract
Ventriculoperitoneal shunt malfunction is common in patients after shunt surgery. Imaging is done to reveal the underlying cause and confirm the diagnosis. Shunt infection is one of the common causes of shunt malfunction. FDG PET CT is an accepted infection imaging tool and can be used to diagnose shunt infection accurately in a patient with high clinical suspicion.
A Surgical Endovascular Trauma Service Increases Case Volume and Decreases Time to Hemostasis
Authors: Morrison Jonathan J. , Madurska Marta J. , Romagnoli Anna , Ottochian Marcus , Adnan Sakib , Teeter William , Kuebler Tiffany , Hoehn Melanie R. , Brenner Megan L. , DuBose Joseph J. , Scalea Thomas M. 
Published: July 2019

Objectives:
The aim of this study was to evaluate the effect of a recently active endovascular trauma service (ETS) on case volume and time to hemostasis, as a complement to an existing interventional radiology (IR) service.

Summary Background Data:
Endovascular techniques are vital for trauma care, but timely access can be a challenge. There is a paucity of data on the effect of a multispecialty team for delivery of endovascular hemorrhage control.

Methods:
The electronic medical record of trauma patients undergoing endovascular procedures between 2013 and 2018 was queried for provider type (IR or ETS). Case volume and rates were expressed per 100 monthly admissions, normalizing for seasonal variation. Interrupted time series analysis was used to model the case rate pre- and post-introduction of the ETS. Admission-to-procedure-time data were collected for pelvic angioembolization as a marker of patients requiring emergency hemostasis.

Results:
During 6 years, 1274 admission episodes required endovascular interventions. Overall case volume increased from 2.7 to 3.6 at a rate of 0.006 (P = 0.734) after introduction of the ETS. IR case volume decreased from 3.3 to 2.6 at a rate of 0.03 (P = 0.063). ETS case volume increased at a rate of 0.048 (P < 0.001), which was significantly different from the IR trend (P < 0.001). Median (interquartile range) time-to-procedure (hours) was significantly shorter for pelvic angioembolization [3.0 (4.4) vs 4.3 (3.6); P < 0.001] when ETS was compared to IR.

Conclusion:
A surgical ETS increases case volume and decreases time to hemostasis for trauma patients requiring time sensitive interventions. Further work is required to assess patient outcome following this change.
Pelvic Floor Organ Prolapse After Radical Cystectomy in Patients With Uroepithelial Carcinoma
Authors: Lipetskaia Lioudmila , Lee Toy Gee , Li Dongmei , Meyer Haley , Doyle Paula Jaye , Messing Edward 
Published: July 2019

Objective
The aim of this study was to identify whether women who undergo a radical cystectomy for uroepithelial carcinoma are at increased risk of pelvic organ prolapse after surgical treatment.

Methods
A retrospective cohort study compared female subjects who had undergone a radical cystectomy for uroepithelial carcinoma, as identified through an institutional cancer survivor database, with subjects who presented to the Pelvic Health and Continence Clinic with symptoms of either uterovaginal prolapse or urinary incontinence. Demographic data were collected regarding risk factors for prolapse, and study subjects were asked to complete a Pelvic Organ Prolapse Distress Inventory (POPDI-6). Data were collected through retrospective chart review. The primary outcome is difference in the POPDI-6 between the groups. Statistical evaluation of responses was performed, with analysis of variance used to compare the questionnaire scores between groups and correction for risk factors with χ2 tests, with a P value of 0.05 selected for statistical significance.

Results
There were 36 postcystectomy subjects who responded to the survey, 37 subjects in the prolapse group, and 44 subjects in the incontinence group. With correction for age, body mass index, and number of vaginal deliveries, the postcystectomy group reported significantly lower scores on the POPDI-6 than both the prolapse group (P < 0.0001) and the incontinence group (P = 0.0003).

Conclusions
Radical cystectomy for uroepithelial carcinoma does not correlate with an increased risk of patient-reported symptoms of pelvic organ prolapse.
Donor PNPLA3 and TM6SF2 Variant Alleles Confer Additive Risks for Graft Steatosis After Liver Transplantation
Authors: Míková Irena , Neřoldová Magdaléna , Hubáček Jaroslav A. , Dlouhá Dana , Jirsa Milan , Honsová Eva , Sticová Eva , Lánská Věra , Špičák Julius , Trunečka Pavel 
Published: July 2019

Background.
The rs58542926 polymorphism in transmembrane 6 superfamily member 2 (TM6SF2) is a genetic factor predisposing to nonalcoholic fatty liver disease. We aimed to explore the effect of recipient and donor TM6SF2 rs58542926 genotypes on liver graft fat content after liver transplantation.

Methods.
Steatosis was evaluated in liver biopsies from 268 adult recipients. The influence of recipient and donor TM6SF2 genotypes, patatin-like phospholipase domain-containing 3 (PNPLA3) rs738409 genotypes, and nongenetic factors on the steatosis grade assessed 6–30 months after transplantation was analyzed by ordinal logistic regression.

Results.
The presence of the TM6SF2 c.499A allele in the donor (P = 0.014), PNPLA3 c.444G allele in the donor (P < 0.001), posttransplant body mass index (P < 0.001), and serum triglycerides (P = 0.047) independently predicted increased liver fat content on multivariable analysis, whereas noncirrhotic liver disease, as an indication for liver transplantation, was associated with lower risk of steatosis (P = 0.003). The effects of the donor TM6SF2 A and PNPLA3 G alleles were additive, with an odds ratio of 4.90 (95% confidence interval, 2.01-13.00; P < 0.001), when both minor alleles were present compared with an odds ratio of 2.22 (95% confidence interval, 1.42-3.61; P = 0.002) when only one of these alleles was present.

Conclusions.
The donor TM6SF2 c.499A allele is an independent risk factor of liver graft steatosis after liver transplantation that is additive to the effects of donor PNPLA3 c.444G allele.
Can behavioural ecologists help establish protected areas?
Authors: Caro Tim , Berger Joel 
Published: July 2019

Protecting wild places is conservation's most pressing task given rapid contemporary declines in biodiversity and massive land use changes. We suggest that behavioural ecology has a valuable, albeit limited, role to play in this agenda. Behaviourally based empiricism and modelling, especially of animal movements and habitat preferences have enjoyed wide applicability in delineating reserve boundaries. In protected areas that sanction exploitation, it may also be important to understand individuals' behavioural and life-history responses to management decisions. We also argue, however, that the in-depth studies of behavioural ecologists may have an important role in conservation by elevating species’ status from mundane to charismatic and often sparking public empathy, and their mere presence in field generates local (or broader) intrigue. More generally behavioural ecologists will only be listened to, and their contributions considered of conservation importance, if they become more involved in decision-making processes as witnessed by several prominent examples that have supported the establishment of protected areas.This article is part of the theme issue ‘Linking behaviour to dynamics of populations and communities: application of novel approaches in behavioural ecology to conservation’.
Microbiota and Health Study: a prospective cohort of respiratory and diarrheal infections and associated risk factors in Bangladeshi infants under two years
Authors: Vidal Karine , Sultana Shamima , Patron Alberto Prieto , Binia Aristea , Rahman Mahbubur , Deeba Iztiba Mallik , Brüssow Harald , Sakwinska Olga , Sarker Shafiqul Alam 
Published: July 2019

AbstractBackgroundEarly childhood respiratory and diarrheal infections are major causes of morbidity and mortality worldwide. There is a need to further assess the epidemiology through prospective and community-based studies to gain key insights that could inform preventative measures to reduce the risk of infectious disease in this vulnerable population. We aimed to analyze the burden and determinants of acute respiratory infection (ARI) and diarrhea episodes affecting infants during their first 2 years of life with state-of-the-art molecular technologies.MethodsThe ARI and diarrhea episodes were prospectively collected in a community-based, longitudinal cohort of infants (n=267) from birth to 2 years of life in Bangladesh. Women were recruited during the third trimester of pregnancy. Demographic, socioeconomic, and environmental information on the households was recorded. Nasopharyngeal and fecal samples were collected during regular scheduled visits from mother-infant pairs, and also from the infants during unscheduled visits for reported illnesses. New generation sequencing methods will be utilized to determine microbiota composition and function, supplemented by the state-of-the-art multiplex molecular detection technology for a wide range of bacterial and viral pathogens.DiscussionThis study sought to assess the epidemiology of both respiratory and gastrointestinal illnesses during the first 2 years of life in children from a peri-urban community of Dhaka, Bangladesh. Characteristics of the mothers, as well as birth characteristics of infants enrolled in the Microbiota and Health Study are presented here. We will determine any potential association between microbiota composition and the abovementioned illnesses, and also examine the influence of known and hypothesized risk factors on the occurrence of infections. Such putative factors include environmental, socioeconomic, maternal, clinical, and selected genetic factors, namely the variation of the fucosyltransferase genes (FUT2 and FUT3) of mothers and infants. This study will add to current knowledge about these early childhood infectious diseases, and will provide data to generate hypotheses for the development of nutritional approaches to be used as prevention strategies.Trial registrationThe study was retrospectively registered at clinicaltrials.gov as NCT02361164 (February 11, 2015).
The ansa subthalamica: a neglected fiber tract
Authors: Lopes Alho Eduardo Joaquim , Di Lorenzo Alho Ana Tereza , Horn Andreas , M. Martin Maria da Graca , Edlow Brian L , Fischl Bruce , Nagy József , Fonoff Erich T , Hamani Clement , Heinsen Helmut 
Published: July 2019

AbstractBackgroundThe pallidofugal pathways are classically subdivided into ansa lenticularis, lenticular fasciculus, and subthalamic fasciculus. In addition to these three subsystems, we characterize an anatomical structure that connects the antero-medial pole of the subthalamic nucleus to the ventral portions of the pallidum, both related to limbic processing of information. This bundle has been previously considered to form a part of the ansa lenticularis, however, it shows striking differences on histology and MRI features compared to the ansa lenticularis, and therefore we suggest to denominate it ansa subthalamica.ObjectivesTo describe the ansa subthalamica as a different structure than the ansa lenticularis, that can be recognized by different methods (histology, high-field MRI and connectome tractography), including current 3T clinical imaging.MethodsA complete human brain was histologically processed and submitted to registration procedures to correct for tissue deformations and normalization to MNI space. Coordinates of histological structures were then comparable to high-field (7T) post-mortem and in vivo MRIs, 13 pre-operative 3T imaging of parkinsonian patients and normative connectome tractography. Mean intensity gray values for different structures were measured in Susceptibility-Weighted Images.ResultsIt was possible to characterize this structure with different methods and there was significant difference in signal intensity in the ansa subthalamica (hypointense), compared to the ansa lenticularis (hyperintense).ConclusionsThe ansa subhtalamica may represent the anatomical pathway that connects limbic regions of the STN and pallidum, and should be investigated as a possible substrate for limbic effects of stereotactic surgery of the subthalamic region.
Considerations in the deployment of novel universal vaccines against epidemic and pandemic influenza
Authors: Arinaminpathy N , Riley S , Barclay W.S , Saad-Roy C , Grenfell B 
Published: July 2019

AbstractThere is increasing interest in the development of new, ‘universal’ influenza vaccines (UIV) that - unlike current vaccines - are effective against a broad range of seasonal influenza strains, as well as against novel pandemic viruses. Even where these vaccines do not block infection, they can moderate clinical severity, reducing morbidity and mortality while potentially also reducing opportunities for transmission. Previous modelling studies have illustrated the potential epidemiological benefits of UIVs, including their potential to mitigate pandemic burden. However, these new vaccines could shape population immunity in complex ways. Here, using mathematical models of influenza transmission, we illustrate two types of unintended consequences that could arise from their future deployment. First, by reducing the amount of infection-induced immunity in a population without fully replacing it, a seasonal UIV programme may permit larger pandemics than in the absence of vaccination. Second, the more successful a future UIV programme is in reducing transmission of seasonal influenza, the more vulnerable the population could become to the emergence of a vaccine-escape variant. These risks could be mitigated by optimal deployment of any future UIV vaccine: namely, the use of a combined vaccine formulation (incorporating conventional as well as multiple universal antigenic targets), and by achieving sufficient population coverage to compensate for reductions in infection-induced immunity. As early candidates of UIVs approach advanced clinical trials, there is a need to monitor their characteristics in such a way that is focused on their potential impact. This work offers a first step in this direction.