bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Human Papilloma Virus Vaccination Rates at an Urban Pediatric Primary Care Center
Authors: Brodie Nicola , McPeak Katie E. 
Published: October 2018

Introduction:
Despite compelling evidence regarding its safety and efficacy, human papilloma virus vaccination rates remain low nationally with high rates of missed vaccination opportunities. Provider recommendation is the most important factor in determining vaccine approval by families; yet, studies show that providers are hesitant to strongly recommend vaccination, especially at younger ages. We hypothesized that educational and quality improvement interventions targeting our clinical team would decrease rates of missed opportunities to vaccinate patients aged 11–13 years and improve vaccination rates among patients aged 9–10 years old.

Methods:
This quality improvement project took place at an urban, academic pediatric primary care center in north Philadelphia, which serves as the medical home for over 22,000 patients. A multidisciplinary team performed a series of planned sequential interventions to improve human papilloma virus vaccination rates. The electronic health records of children aged 9–13 who presented to our center from September 2014 through December 2015 were queried. Statistical process control charts and established rules for detecting special cause variation were applied.

Results:
Rates of missed opportunities to vaccinate 11- to 13-year-old patients decreased from 63% to 18% during the intervention period. Rates of immunization of 9- to 10-year-old patients increased from 56% to 84% during the intervention period.

Conclusion:
This low-cost, multifaceted, interdisciplinary quality improvement project resulted in a decrease in missed opportunities to vaccinate among children aged 11–13 years old and improved the vaccination rates of 9–10 year olds. Ongoing interventions are needed to sustain these efforts and to ensure timely vaccine series completion.
“Learn From Every Patient”: How a Learning Health System Can Improve Patient Care
Authors: Noritz Garey , Boggs Adam , Lowes Linda P. , Smoyer William E. 
Published: October 2018

Aim:
We created a Learning Health System, the “Learn From Every Patient” program, embedded in our cerebral palsy team clinic. This program was designed to simultaneously provide clinical care while systematically collecting data for quality improvement and research projects on all patients.

Method:
Clinicians created tools within the Electronic Health Record to discretely capture data for clinical use which was also available for quality improvement/research efforts. At baseline, all patients in our clinic received annual hip x-rays to screen for hip displacement. Using our “Learn From Every Patient” database, we reviewed the outcomes for the most mildly affected patients, Level I on the Gross Motor Functional Classification System.

Results:
One hundred thirty-two patients were classified as Gross Motor Functional Classification System Level I. During the study period, these patients received 212 pelvis x-rays, viewing 424 hips, of which 419 (98.8%) were normal. Five hips (1.2%) had < 30% displacement. None had any hip-related symptoms nor required any procedures during the period. We used these data to create an evidence-based change in our standardized hip screening procedure by eliminating annual screening x-rays for this population.

Interpretation:
This implementation of a local learning health system approach to systematically collect research data simultaneously with routine clinical care enabled us to implement an evidence-based improvement in clinical practice. This complete integration of research into clinical care improved care by reducing radiation exposure, while simultaneously reducing health care costs.
Evaluating Interventions to Increase Influenza Vaccination Rates among Pediatric Inpatients
Authors: Rao Suchitra , Fischman Victoria , Kaplan David W. , Wilson Karen M. , Hyman Daniel 
Published: October 2018

Introduction:
Hospitalization provides an ideal opportunity for influenza vaccination, and strategies can enhance existing tools within the electronic medical record (EMR). The objectives of the study were to introduce and evaluate the effectiveness of provider and family-directed interventions to increase influenza vaccination ordering among inpatients.

Methods:
We conducted a quality improvement initiative for children aged older than 6 months on medical inpatient teams at a large pediatric tertiary care hospital from September 2014 to March 2015, comprising 2 intervention groups (provider reminders and family education) and 1 control group for comparison, using EMR prompts alone. The provider reminder interventions comprised weekly e-mails indicating inpatient immunization status; vaccination reports; and visual reminders. The family education group intervention consisted of handouts regarding the benefits and safety of influenza vaccination. We measured vaccine ordering rates for each group among eligible children and overall vaccination rates. Data were analyzed using Statistical Process Control Charts and Chi-square tests.

Results:
Among 2,552 patients aged older than 6 months hospitalized during the study period, 1,657 were unimmunized. During the intervention period, the provider group ordered 213/409 (52%) influenza vaccines, the family education group ordered 138/460 (30%) and the control group ordered 71/279 (25%) (P < 0.0001). The provider group had higher influenza immunization status than the control group (61% versus 53%; P = 0.0017). Exposure to the intervention did not impact the length of stay/discharge time.

Conclusions:
Provider reminders including e-mails, visual reminders, and vaccination reports are effective ways of increasing inpatient influenza vaccination rates and are more effective than family education, or EMR prompts alone.
Decreasing Blood Culture Contaminants in a Pediatric Emergency Department: An Interrupted Time Series Analysis
Authors: Mullan Paul C. , Scott Sara , Chamberlain James M. , Pettinichi Jeanne , Palacious Katura , Weber Anastasia , Payne Asha S. , Badolato Gia M. , Brown Kathleen 
Published: October 2018

Introduction:
High peripheral blood culture contamination rates (BCCR) in the emergency department (ED) contribute to overuse and harm. This study describes 2 years of quality improvement (QI) interventions that aimed to decrease a high BCCR in a pediatric ED.

Methods:
The QI team created a Key Driver Diagram with multiple Plan-Do-Study-Act (PDSA) cycles. PDSA interventions included a venipuncture sterility checklist (PDSA1), phlebotomist feedback system (PDSA2), and physician ordering guidelines (PDSA3). The specific aim was to decrease the BCCR by 50% within 24 months. The secondary aim was to decrease the peripheral blood culture ordering rate (BCOR) by 10% within 24 months. The balancing measure was the proportion of pathogenic bacteremia cases at ED return visits before and after PDSA3 implementation. A financial measure estimated the savings in charges between the observed and expected contaminants in PDSA3. An interrupted time series design applied statistical process control methodology to detect special cause variations.

Results:
The BCCR in the baseline, PDSA1, PDSA2, and PDSA3 periods were 3.02%, 2.30%, 1.58%, and 1.17%, respectively. The BCOR in the baseline, PDSA1, PDSA2, and PDSA3 periods was 4.80%, 4.26%, 3.82%, and 3.49%, respectively. Special cause variations occurred after PDSA cycle implementations for both BCCR and BCOR. There was no change in the balancing measure. The interventions were associated with an annual prevention of 95 contaminants and savings of $300,070.

Conclusions:
Interventions that focused on improving venipuncture technique and limiting unnecessary blood cultures were associated with fewer contaminants and the achievement of the QI team’s project aims.
Decreasing Unexpected Returns to Orthopedic Hand Clinic: Improving Efficiency of Health Care Delivery
Authors: Little Kevin J. , Trehan Samir , Cornwall Roger , Garrison Stephanie , Dastillung Emily , McFadden Lisa 
Published: October 2018

Purpose:
An unexpected return to clinic (URTC) visit can place a substantial financial burden on patients and families while stressing the health care system. Our SMART aim was to decrease the rate of URTC visits from 1.8 per 100 patient follow-up visits by 50% using quality improvement methodology.

Methods:
The rate of URTC visits was tracked at our tertiary care pediatric hospital from February 1, 2014, to May 31, 2015, using a weekly P-chart. Interventions were studied from January 1 to May 31, 2015. Pareto charts determined the common causes of URTC visits. Interventions were studied using Plan-Do-Study-Act cycles. Medical charges for URTC patient visits were collected and patients/families were given a cost survey to determine nonmedical costs associated with the clinic visits.

Results:
Cast issues (50.5%) were most common, followed by new symptom/complaints (29.5%), and persistent or worse symptoms (15.2%). Following interventions, URTC rates decreased from 1.8 to 0.7 (⇓62%) per 100 follow-up visits during the study period. Interventions were targeted toward cast use and improved patient education via standardized materials. The average URTC resulted in $350.38 of charges. Additionally, the average URTC cost families $70 for a half day of lost wages and travel expenses.

Discussion:
Applying quality improvement methodology to URTC visits by standardizing patient education and minimizing cast usage resulted in a substantial decrease in the number of patients returning to clinic, both for scheduled follow-ups and unexpectedly. This improvement resulted in a savings of more than $420 per visit saved, including medical and nonmedical costs.
Third-Line Antiretroviral Therapy Program in the South African Public Sector: Cohort Description and Virological Outcomes
Authors: Moorhouse Michelle , Maartens Gary , Venter Willem Daniel Francois , Moosa Mahomed-Yunus , Steegen Kim , Jamaloodien Khadija , Fox Matthew P. , Conradie Francesca 
Published: October 2018

Background:
The World Health Organization recommends that antiretroviral therapy (ART) programs in resource-limited settings develop third-line ART policies. South Africa developed a national third-line ART program for patients who have failed both first-line non-nucleoside reverse transcriptase inhibitor–based ART and second-line protease inhibitor (PI)-based ART. We report on this program.

Methods:
Third-line ART in South Africa is accessed through a national committee that assesses eligibility and makes individual regimen recommendations. Criteria for third-line include the following: ≥1 year on PI-based ART with virologic failure, despite adherence optimization, and genotypic antiretroviral resistance test showing PI resistance. We describe baseline characteristics and resistance patterns of this cohort and present longitudinal data on virological suppression rates.

Results:
Between August 2013 and July 2014, 144 patients were approved for third-line ART. Median age was 41 years [interquartile range (IQR): 19–47]; 60% were women (N = 85). Median CD4+ count and viral load were 172 (IQR: 128–351) and 14,759 (IQR: 314–90,378), respectively. About 2.8% started PI-based ART before 2004; 11.1% from 2004 to 2007; 31.3% from 2008 to 2011; and 6.3% from 2012 to 2014 (48.6% unknown start date). Of the 144 patients, 97% and 98% had resistance to lopinavir and atazanavir, respectively; 57% had resistance to darunavir. All were initiated on a regimen containing darunavir, with raltegravir in 101, and etravirine in 33. Among those with at least 1 viral load at least 6 months after third-line approval (n = 118), a large proportion (83%, n = 98) suppressed to <1000 copies per milliliter, and 79% (n = 93) to <400 copies per milliliter.

Conclusion:
A high proportion of third-line patients with follow-up viral loads are virologically suppressed.
Unilateral Chronic Lung Allograft Dysfunction Assessed by Biphasic Computed Tomographic Volumetry in Bilateral Living-donor Lobar Lung Transplantation
Authors: Saito Masao , Chen-Yoshikawa Toyofumi F. , Nakamoto Yuji , Kayawake Hidenao , Tokuno Junko , Ueda Satoshi , Yamagishi Hiroya , Gochi Fumiaki , Okabe Ryo , Takahagi Akihiro , Hamaji Masatsugu , Motoyama Hideki , Aoyama Akihiro , Date Hiroshi 
Published: October 2018

Background
Early diagnosis of unilateral chronic lung allograft dysfunction (CLAD) is difficult because the unaffected contralateral lung functions as a reservoir in bilateral living-donor lobar lung transplantation (LDLLT). We previously reported the usefulness of 133Xe ventilation scintigraphy for detection of unilateral change, but the supply of 133Xe has been stopped globally. The present study aimed to examine the usefulness of inspiratory and expiratory computed tomography (I/E CT) volumetry for detection of unilateral change in CLAD patients.

Methods
This was a retrospective single-center, observational study using prospectively collected data. A total of 58 patients who underwent bilateral LDLLT from August 2008 to February 2017 were analyzed. Respiratory function tests, I/E CT were prospectively conducted. ΔLung volume was defined as the value obtained by subtracting expiratory lung volume from inspiratory lung volume.

Results
Fourteen (24%) cases were clinically diagnosed with CLAD, of which 10 (71%) were diagnosed as unilateral CLAD. ΔLung volume of bilateral lungs strongly correlated with forced vital capacity (r = 0.92, P < 0.01) and forced expiratory volume in 1 second (r = 0.80, P < 0.01). Regardless the phenotypes (bronchiolitis obliterans syndrome or restrictive allograft syndrome) of CLAD, Δlung volume onset/baseline significantly decreased compared with that in the non-CLAD group. Among the 10 unilateral CLAD patients, 3 with clinically suspected unilateral rejection yet did not show a 20% decline in forced expiratory volume in 1 second. In 2 of these, Δlung volume of unilateral lungs on the rejection side decreased by 20% or more.

Conclusions
Our findings suggest that I/E CT volumetry may be useful for assessment and early diagnosis of unilateral CLAD after bilateral LDLLT.
HSF2BP Negatively Regulates Homologous Recombination in DNA Interstrand Crosslink Repair in Human Cells by Direct Interaction With BRCA2
Authors: Brandsma Inger , Sato Koichi , van Rossum-Fikkert Sari E. , Reuter Marcel , Odijk Hanny , Verkaik Nicole , van den Tempel Nathalie , Oostra Anneke B. , Dekkers Dick H. W. , Bezstarosti Karel , Demmers Jeroen A. A. , Lebbink Joyce , Wyman Claire , Dorsman Josephine C. , van Gent Dik C. , Knipscheer Puck , Kanaar Roland , Zelensky Alex N. 
Published: October 2018

SummaryThe tumor suppressor BRCA2 is essential for homologous recombination, replication fork stability and DNA interstrand crosslink (ICL) repair in vertebrates. We show that a functionally uncharacterized protein, HSF2BP, is involved in a novel, direct and highly evolutionarily conserved interaction with BRCA2. Although HSF2BP was previously described as testis-specific, we find it is expressed in mouse ES cells, in human cancer cell lines, and in tumor samples. Elevated levels of HSF2BP sensitize human cells to ICL-inducing agents (mitomycin C and cisplatin) and PARP inhibitors, resulting in a phenotype characteristic of cells from Fanconi anemia (FA) patients. We biochemically recapitulate the suppression of ICL repair and establish that excess HSF2BP specifically compromises homologous recombination by preventing BRCA2 and RAD51 loading at the ICL. As increased ectopic expression of HSF2BP occurs naturally, we suggest that it can be considered as a causative agent in FA and a source of cancer-promoting genomic instability.
The genome-wide, multi-layered architecture of chromosome pairing in earlyDrosophilaembryos
Authors: Erceg Jelena , Abed Jumana AlHaj , Goloborodko Anton , Lajoie Bryan R. , Fudenberg Geoffrey , Abdennur Nezar , Imakaev Maxim , McCole Ruth B. , Nguyen Son C. , Saylor Wren , Joyce Eric F. , Senaratne T. Niroshini , Hannan Mohammed A. , Nir Guy , Dekker Job , Mirny Leonid A. , Wu Chao-ting 
Published: October 2018

AbstractGenome organization involvescisandtranschromosomal interactions, both implicated in gene regulation, development, and disease. Here, we focused ontransinteractions inDrosophila, where homologous chromosomes are paired in somatic cells from embryogenesis through adulthood. We first addressed the long-standing question of whether pairing extends genome-wide and, to this end, developed a haplotype-resolved Hi-C approach that uses a new strategy to minimize homolog misassignment and thus robustly distinguishtrans-homolog fromciscontacts. This approach revealed striking genome-wide pairing inDrosophilaembryos. Moreover, we discovered pairing to be surprisingly structured, withtrans-homolog domains and interaction peaks, many coinciding with the positions of analogouscisfeatures. We also found a significant correlation between pairing and the chromatin accessibility mediated by the pioneer factor Zelda. Our findings reveal a complex, highly structured organization underlying homolog pairing, first discovered more than a century ago.One Sentence SummaryA robust approach for haplotype-resolved Hi-C reveals highly-structured homolog pairing in early stageDrosophilaembryos.
Highly structured homolog pairing reflects functional organization of theDrosophilagenome
Authors: Abed Jumana AlHaj , Erceg Jelena , Goloborodko Anton , Nguyen Son C. , McCole Ruth B. , Saylor Wren , Fudenberg Geoffrey , Lajoie Bryan R. , Dekker Job , Mirny Leonid A. , Wu Ting (C.-ting) 
Published: October 2018

AbstractTrans-homolog interactions encompass potent regulatory functions, which have been studied extensively inDrosophila,where homologs are paired in somatic cells and pairing-dependent gene regulation, or transvection, is well-documented. Nevertheless, the structure of pairing and whether its functional impact is genome-wide have eluded analysis. Accordingly, we generated a diploid cell line from divergent parents and applied haplotype-resolved Hi-C, discovering that homologs pair relatively precisely genome-wide in addition to establishingtrans-homolog domains and compartments. We also elucidated the structure of pairing with unprecedented detail, documenting significant variation across the genome. In particular, we characterized two forms: tight pairing, consisting of contiguous small domains, and loose pairing, consisting of single larger domains. Strikingly, active genomic regions (A-type compartments, active chromatin, expressed genes) correlated with tight pairing, suggesting that pairing has a functional role genome-wide. Finally, using RNAi and haplotype-resolved Hi-C, we show that disruption of pairing-promoting factors results in global changes in pairing.One Sentence SummaryHaplotype-resolved Hi-C reveals structures of homolog pairing and global implications for gene activity in hybrid PnM cells.
Immune profiling of cord blood after prolonged rupture of membranes
Authors: Tsaliki Evdokia , Turner Carolin T , Venturini Cristina , Kam Christy , Strang Angela , Bailey Sarah , Rodgers Alison , Levine Adam P , Chain Benjamin M , Simpson Nandi , Riley Eleanor M. , Field Nigel , Brocklehurst Peter , Noursadeghi Mahdad 
Published: October 2018

AbstractWe hypothesised that foetal immune responses to an infectious challenge may be detected by genome-wide transcriptional profiling of cord blood. In order to test this hypothesis, we sought to identify transcriptomic changes in post-natal cord blood samples following prolonged pre-labour rupture of membranes (PROM) as a surrogate for increased risk of infection. By comparison to controls we found increased levels of blood transcripts in a subset of prolonged PROM cases, significantly enriched for innate immune system signalling pathways. These changes were idiosyncratic, suggesting qualitative and quantitative variation in foetal immune responses which may reflect differences in exposure and/or in host genetics. Our data support the view that PROM represents an infection risk to the foetus. In addition, we propose that cord blood transcriptional profiling offers exciting opportunities to identify immune correlates of clinical outcome following potential in utero exposures to infection. These may be used to elucidate the mechanisms of immunological protection and pathology in the foetus and identify biomarkers to stratify the risk of adverse outcomes.
Quantitative reconstruction of time-varying 3D cell forces with traction force optical coherence microscopy
Authors: Mulligan Jeffrey A. , Feng Xinzeng , Adie Steven G. 
Published: October 2018

AbstractCellular traction forces (CTFs) play an integral role in both physiological processes and disease, and are a topic of interest in mechanobiology. Traction force microscopy (TFM) is a family of methods used to quantify CTFs in a variety of settings. State-of-the-art 3D TFM methods typically rely on confocal fluorescence microscopy, which can impose limitations on acquisition speed, volumetric coverage, and temporal sampling or coverage. In this report, we present the first quantitative implementation of a new TFM technique: traction force optical coherence microscopy (TF-OCM). TF-OCM leverages the capabilities of optical coherence microscopy and computational adaptive optics (CAO) to enable the quantitative reconstruction of 3D CTFs in scattering media with minute-scale temporal resolution. We applied TF-OCM to quantify CTFs exerted by isolated NIH-3T3 fibroblasts embedded in Matrigel, with five-minute temporal sampling, using images which spanned a 500×500×500 μm3 field-of-view. Due to the reliance of TF-OCM on computational imaging methods, we have provided extensive discussion of the underlying equations, assumptions, and failure modes of these methods. TF-OCM has the potential to advance studies of biomechanical behavior in scattering media, and may be especially well-suited to the study of cell collectives such as spheroids, a prevalent model in mechanobiology research.