bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of Survival in Patients with Advanced Gastrointestinal Malignancies Admitted to the Intensive Care Unit
Authors: Ko Heidi , Yan Melissa , Gupta Rohan , Kebbel Kayla , Maiti Abhishek , Song Juhee , Nates Joseph , Overman Michael J. 
Published: December 2018

Abstract

Background
Patients with cancer have a high use of health care utilization at the end of life, which can frequently involve admissions to the intensive care unit (ICU). We sought to evaluate the predictors for outcome in patients with gastrointestinal (GI) cancer admitted to the ICU for nonsurgical conditions.

Patients and Methods
The primary objective was to determine the predictors of hospital mortality. Secondary objectives included investigating the predictors of ICU mortality and hospital overall survival (OS). All patients with GI cancer admitted to the ICU at the University of Texas MD Anderson Cancer Center between November 2012 and February 2015 were retrospectively analyzed. Cancer characteristics, treatment characteristics, and Sequential Organ Failure Assessment (SOFA) scores were analyzed for their effects on survival.

Results
The characteristics of the 200 patients were as follows: 64.5% male, mean age of 60 years, median SOFA score of 6.7, and tumor types of intestinal (37.5%), hepatobiliary/pancreatic (36%), and gastroesophageal (24%). The hospital mortality was 41%, and overall 6-month mortality was 75%. In multivariate analysis, high admission SOFA score &gt; 5, poor tumor differentiation, and duration of metastatic disease ≤7 months were associated with increased hospital mortality. For OS, high admission SOFA score &gt; 5, poor tumor differentiation, and patients who were not on active chemotherapy because of poor performance had worse outcome. In multivariate analysis, SOFA score remained significant for OS even after excluding patients who died in the ICU.

Conclusion
For patients with metastatic GI cancer admitted to the ICU, SOFA score was predictive for both acute and long-term survival. A patient's chemotherapy treatment status was not predictive for hospital mortality but was for OS. The SOFA score should be utilized in all patients with GI cancer upon ICU admission for prognostication.

Implications for Practice
Patients with cancer have a high use of health care utilization at the end of life, which can frequently involve admissions to the intensive care unit (ICU). Although there have been substantial increases in duration of survival for patients with advanced metastatic cancer, their mortality after an ICU admission remains high. GI malignancy is considered one of the top three lethal cancers estimated in 2017. Survival of critically ill patients with advanced GI cancer should be evaluated to help guide treatment planning.
Endogenous Notch Signaling in Adult Kidneys Maintains Segment-Specific Epithelial Cell Types of the Distal Tubules and Collecting Ducts to Ensure Water Homeostasis
Authors: Mukherjee Malini , deRiso Jennifer , Otterpohl Karla , Ratnayake Ishara , Kota Divya , Ahrenkiel Phil , Chandrasekar Indra , Surendran Kameswaran 
Published: December 2018

BackgroundNotch signaling is required during kidney development for nephron formation and principal cell fate selection within the collecting ducts. Whether Notch signaling is required in the adult kidney to maintain epithelial diversity, or whether its loss can trigger principal cell transdifferentiation (which could explain acquired diabetes insipidus in patients receiving lithium) is unclear.MethodsTo investigate whether loss of Notch signaling can trigger principal cells to lose their identity, we genetically inactivatedNotch1andNotch2, inactivated the Notch signaling targetHes1, or induced expression of a Notch signaling inhibitor in all of the nephron segments and collecting ducts in mice after kidney development. We examined renal function and cell type composition of control littermates and mice with conditional Notch signaling inactivation in adult renal epithelia. In addition, we traced the fate of genetically labeled adult kidney collecting duct principal cells afterHes1inactivation or lithium treatment.ResultsNotch signaling was required for maintenance of Aqp2-expressing cells in distal nephron and collecting duct segments in adult kidneys. Fate tracing revealed mature principal cells in the inner stripe of the outer medulla converted to intercalated cells after genetic inactivation ofHes1and, to a lesser extent, lithium treatment.Hes1ensured repression ofFoxi1to prevent the intercalated cell program from turning on in mature Aqp2+cell types.ConclusionsNotch signalingviaHes1regulates maintenance of mature renal epithelial cell states. Loss of Notch signaling or use of lithium can trigger transdifferentiation of mature principal cells to intercalated cells in adult kidneys.
Philip Kitcher , Avance de la Ciencia. Ciencia sin ley, Objetividad sin Ilusiones. México, UNAM, 2001
Authors: Paravano Gabriel , Muñoz Diego 
Published: December 2018

¿Cómo hacen realmente ciencia los científicos? El filósofo ingles Philip Kitcher (1947) se ocupa de pensar el quehacer científico analizando, a lo largo de 8 capítulos y un Post Scriptum, cómo se constituyen los procesos de formación de investigadores, las relaciones entre autoridades y alumnos, el modelo de mente que se conjetura comoparte del sistema de pensamiento del razonamiento científico, los criterios ontológicos y epistémicos que entran en juego en las variaciones cognitivas de las micro-comunidades científicas en breves periodos de tiempo (6 meses aproximadamente), la influencia de las amistades y las conversaciones de pasillo para delinear los proyectos de investigación,como también la relación implícita –y necesaria– entre la financiación de las instituciones científicas hacia ciertos proyectos de investigación y la propuesta de cuál es la ciencia que un sector y/o región debería desarrollar.
Trastornos de la Conducta Alimentaria y Estilos Parentales
Authors: Losada Analía Verónica 
Published: December 2018

Los trastornos alimentarios son patologías altamente frecuentes en mujeres jóvenes, y según la literatura el funcionamiento familiar juega un rol importante tanto en su desarrollo como en su curso y evolución. La presente investigación tuvo como objetivo principal caracterizar la percepción que tienen las pacientes con un Trastorno de la Conducta Alimentaria del Estilo de Crianza prevalente en su entorno familiar, e investigar cómo podría asociarse esto con el desarrollo de la patología. La muestra estuvo compuesta por 16 pacientes del Instituto Argentino de Trastornos de Alimentación, cuyas edades oscilaban entre 12 y 21 años, 4 de ellas padecían Anorexia, 8 Bulimia y los 4 restantes Trastorno de la Conducta Alimentaria No Especificado (TANES). Se aplicó una adaptación de la Escala Argentina de Percepción de la relación con los padres de Richaud de Minzi (2002), para evaluar el tipo de estilo de crianza prevalente en cada cuadro. Para complementar estos resultados, se hizo una revisión de las historias clínicas de las pacientes y se administraron a su vez una serie de entrevistas a los profesionales que atendían a estas pacientes, conformado por psicólogo, nutricionista, y médico clínico. Los principales hallazgos dan cuenta de que existe un Estilo de Crianza preponderante en cada Trastorno Alimentario, es decir en la Anorexia reina un Estilo Permisivo, en la Bulimia un Estilo Autoritario y en los TANES un Estilo Indiferente. Eating disorders are highly frequent pathologies in young women, andaccording to the literature family functioning plays an important role both in its development and in its course and evolution. The main objective of the present investigation was to characterize the perception of patients with Eating Habits Disorder of the Critical Style prevalent in their family environment, and to investigate how this could be associated with the development of pathology. The sample consisted of 16 patients from the Argentine Institute of Eating Disorders, whose ages ranged from 12 to 21 years, 4 of them suffering from Anorexia, 8 Bulimia and the remaining 4 Disorders of Unspecified Food Behavior (TANES). An adaptation of the Richaud de Minzi (2002) Argentine Perception Scale was applied to evaluate the type of parenting style prevalent in each table. To complement these results, a review of the patients’ clinical histories was carried out and a series of interviews were administered to the professionals who attended these patients, consisting of psychologist, nutritionist, and clinical doctor.The main findings are that there is a predominant Fostering Style in eachEating Disorder, that is, in Anorexia, a Permissive Style reigns, in Bulimiaan Authoritarian Style, and in TANES an Indifferent Style.
Enseñanza de metodologías de la investigación científica en la Universidad Nacional de Rosario (UNR) Una mirada sobre los planes de estudios El caso de Psicología
Authors: Espinosa Andrea 
Published: December 2018

En este escrito se abordan algunas de las características sobresalientes respecto de la enseñanza de Metodología de la Investigación Científica encarreras de grado universitario en el contexto de la UNR. Una mirada inicial sobre la narrativa de los Planes de Estudios se realiza tomando el caso de Psicología como modelo dentro de las Ciencias Sociales. A partir del análisis de cuatro dimensiones básicas observadas en los documentos, así como en lo narrado por un docente, puede observarse la complejidad del entretejido de factores que influyen sobre la forma de pensar la enseñanza de contenidos metodológicos en este contexto.Palabras claves: Enseñanza – Metodología – Universidad.This paper deals with some of the major characteristics of the teaching ofScientific Research Methodology in university degree careers at UNR. Aninitial look at the narrative of the Curriculum is done, taking the one from Psychology as a model from Social Sciences. From the analysis of four basic dimensions observed in the documents and the words from a teacher it can be understand the complexity of the complexity of the interweaving of factors that influence the way of thinking the teaching of methodological contents in this context.
Villa Muñecas: El deterioro laboral y social que generó el cierre de los ingenios y la partida del tren
Authors: Osatinsky Ariel , Del Castillo Alejandra 
Published: December 2018

Este artículo describe las características que asume la pobreza en Villa Muñecas, un barrio de Gran San Miguel de Tucumán, analizando los procesos que determinaron el pasaje de un barrio obrero a un área de privación.Los interrogantes que guían su desarrollo son ¿Cómo incidieron las transformaciones económicas, sociales y territoriales en el devenir histórico de Villa Muñecas? ¿Cuáles son las manifestaciones actuales de la pobreza en esta área? ¿Qué cambios se observan en las configuraciones de la pobreza?Se realiza un estudio de caso centrado en dimensiones vinculadas al trabajo y al hábitat teniendo en cuenta el devenir histórico.
Contra la genuflexión y el cipayismo académico en materia de ciencia, investigación y publicación Un análisis de la hora
Authors: Mombrú Ruggiero Andrés 
Published: December 2018

En momentos en que en nuestro país el sistema de ciencia y técnica está siendo desmembrado –como Tupac Amaruc en la Plaza de Armas de Cuzco–, resulta difícil realizar cualquier tipo de evaluación o diagnóstico sobre las virtudes y defectos del estado de la investigación en Argentina. ¿Para qué futuro educamos?, se preguntaba hace algunas décadas la pedagoga uruguaya Reina Reyes. Parafraseando esa interrogante podríamos preguntarnos, ¿para qué futuro investigamos?, ¿para qué futuro publicamos?, ¿para qué proyectos individuales y colectivos trabajamos? Difícilmente estas preguntas encuentren una respuesta que nos rescate a nosotros mismos, si no somos capaces de “salir de nuestra autoculpable minoría de edad”, pensando por cuenta propia, y fundamentalmente mientras no abandonemos el colonialismo cultural en el que nos vemos sometidos cuando agachamos la cabeza y aceptamos de modo incondicional los parámetros que evalúan las condiciones de investigación y publicación impuestos por los mercaderes de la ciencia. Construyamos nuestras propias redes y reflexionemos juntos sobre los temas de nuestro común interés y determinemos un modo de evaluarnos que al criterio de “impacto” contraponga la socialización del conocimiento.
Pulmonary embolism in a patient in dual antiplatelet therapy after placement of a drug-eluting stent
Authors: Vedovati Maria Cristina 
Published: December 2018

Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism (PE), is the third most frequent cardiovascular disease and is characterized by high mortality and disability rate. According to the 2014 European Society of Cardiology guidelines for the treatment of PE, anticoagulant therapy is recommended in patients with acute PE for a period of at least 3 months in order to prevent both early mortality and recurrence of VTE. To date, there are no studies conducted on the triple antithrombotic therapy in patients with VTE subjected to percutaneous coronary interventions. We report the case of an elderly patient in dual antiplatelet therapy following coronary revascularization and stenting. The patient, following an episode of PE with cardiac arrest after 12 days of hospitalization, was successfully treated with anticoagulant therapy with dabigatran in association with the dual antiplatelet therapy already in place (Cardiology).
Kajian Kebijakan Pengampunan Pajak dengan Pendekatan Eksperimental
Authors: Kurniawan Benny Robby , Juanda Bambang , Bakhtiar Toni 
Published: December 2018

This research was conducted because the uncertainty in the tax amnesty policy. The purpose of this research is to analyze the effect of taxpayer’s expectation of future tax amnesty, tariff period system, tax penalty and audit towards tax compliance in tax amnesty policy, using experimental economics. The result shows that, a tax amnesty followed by strict audit and tax penalties will rise tax compliance. Tax amnesty policy is best applied once in a lifetime, because the expectation of the taxpayers towards future tax amnesty will result in lowering the compliance. Taxpayers prefer the lowest rate on tariff period. ======================== Penelitian ini dilakukan karena ketidakpastian keberhasilan dari kebijakan pengampunan pajak. Tujuan penelitian ini adalah untuk menganalisis pengaruh dari faktor ekspektasi masyarakat akan adanya pengampunan pajak di kemudian hari, sistem tarif pengampunan, denda, dan pemeriksaan pajak terhadap kepatuhan pada kebijakan pengampunan pajak dengan menggunakan metode ekonomi ekperimental. Hasil penelitian menunjukkan bahwa pengampunan pajak diikuti dengan penerapan denda dan pemeriksaan yang ketat akan meningkatkan kepatuhan pajak. Kebijakan pengampunan pajak sebaiknya diterapkan satu kali saja karena jika masyarakat berekspektasi akan adanya kebijakan serupa di kemudian hari, wajib pajak akan menunggu kebijakan tersebut dan tetap tidak patuh. Wajib pajak umumnya menyukai tarif pengampunan terendah.
Routine Diagnostic Tests for Periprosthetic Joint Infection Demonstrate a High False-Negative Rate and Are Influenced by the Infecting Organism
Authors: Kheir Michael M. , Tan Timothy L. , Shohat Noam , Foltz Carol , Parvizi Javad 
Published: December 2018

Background:
Current guidelines recommend serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as the first-line testing for evaluation of suspected periprosthetic joint infection, in addition to synovial white blood-cell (WBC) count and polymorphonuclear percentage. However, the sensitivity and other diagnostic measures of these tests using a standardized definition of periprosthetic joint infection and the influence of organisms on these inflammatory markers remain inadequately investigated.

Methods:
A retrospective review of an institutional database of 549 periprosthetic joint infection cases and 653 aseptic total joint arthroplasty revisions was performed. Periprosthetic joint infection was defined using major criteria from the International Consensus Meeting (ICM) on Periprosthetic Joint Infection. The mean inflammatory marker levels were compared among organisms with Student t tests and the proportions of elevated laboratory levels were compared among organisms with chi-square analyses. Receiver operating characteristic curve analyses were performed to calculate new cutoffs, sensitivities, and specificities for each organism and overall for serum CRP and ESR and synovial WBC and polymorphonuclear percentage.

Results:
The sensitivity of these markers for diagnosing chronic periprosthetic joint infection was 0.85 for ESR, 0.88 for CRP, 0.83 for WBC count, and 0.78 for polymorphonuclear percentage. For ESR, antibiotic-resistant organisms had higher mean values (84.3 mm/hr) than culture-negative cases (57.4 mm/hr), coagulase-negative Staphylococcus (68.3 mm/hr), and Streptococcus species (66.1 mm/hr); Staphylococcus aureus (81.0 mm/hr) was higher than culture-negative cases (57.4 mm/hr). For CRP, culture-negative cases had lower mean values (41.0 mg/L) than gram-negative organisms (87.4 mg/L), antibiotic-resistant organisms (86.0 mg/L), S. aureus (112.2 mg/L), and Streptococcus species (114.6 mg/L); S. aureus (112.2 mg/L) was higher than coagulase-negative Staphylococcus (66.0 mg/L). For WBC count, culture-negative cases had lower mean values (27,984.5 cells/mL) than S. aureus (116,250.0 cells/mL) and Streptococcus species (77,933.7 cells/mL). For polymorphonuclear percentage, there were no significant differences in mean values among all organisms.

Conclusions:
It appears that serological markers, namely ESR and CRP, have a higher false-negative rate than previously reported. Synovial markers similarly exhibit high false-negative rates. Furthermore, the sensitivity of these tests appears to be related to organism type. Surgeons should be aware of the high rate of false-negatives associated with low-virulence organisms and culture-negative cases.

Level of Evidence:
Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence.
Posteromedial Elbow Dislocations without Relevant Osseous Lesions
Authors: Cho Chul-Hyun , Kim Beom-Soo , Rhyou In Hyeok , Park Sam-Guk , Choi Sung , Yoon Jong Pil , Choi Chang-Hyuk , Dan Jinmyoung 
Published: December 2018

Background:
Although simple posterolateral or posterior elbow dislocations are relatively common and usually stable after closed reduction, simple posteromedial dislocations are extremely rare and poorly characterized. We investigated the clinical characteristics, soft-tissue injury patterns, treatments, and outcomes of a series of posteromedial elbow dislocations without relevant osseous lesions.

Methods:
We retrospectively reviewed 20 cases of simple posteromedial elbow dislocations without relevant osseous lesions that were treated at 7 fellowship training hospitals during a 10-year period. Soft-tissue injury patterns in 15 cases were investigated with use of magnetic resonance imaging. Clinical outcomes were evaluated after an average of 56.1 months (range, 24 to 93 months) with use of the Mayo Elbow Performance Score (MEPS) and the Quick-DASH (an abbreviated version of the Disabilities of the Arm, Shoulder and Hand [DASH]) score. Complications were also evaluated.

Results:
On magnetic resonance imaging, significant tears of the lateral collateral ligament complex and common extensor group were observed in all cases. Seventeen cases (85%) required surgical treatment for acute instability. Fourteen cases underwent only lateral complex repair and 3 underwent repair of both the medial and lateral complexes. At the time of the latest follow-up, the mean MEPS and Quick-DASH scores were 85.8 ± 15.0 and 10.5 ± 16.3, respectively. Seventeen patients (85%) had a satisfactory clinical outcome. Complications following treatment included 4 patients with heterotopic ossification; 2 of these patients also experienced posttraumatic elbow stiffness, which was treated with arthrolysis at 8 and 18 months after the initial operation.

Conclusions:
Posteromedial elbow dislocations without relevant osseous lesions are associated with a more severe soft-tissue injury, especially to the lateral complex, resulting in a high rate of surgical treatment. With careful post-reduction evaluation, either operative or nonoperative treatment provided satisfactory clinical outcomes.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Time-Driven Activity-Based Costing to Identify Patients Incurring High Inpatient Cost for Total Shoulder Arthroplasty
Authors: Menendez Mariano E. , Lawler Sarah M. , Shaker Jonathan , Bassoff Nicole W. , Warner Jon J.P. , Jawa Andrew 
Published: December 2018

Background:
As payment models shift toward a focus on value, an accurate understanding of surgical costs and preoperative correlates of high-cost patients is important for effective implementation of cost-saving strategies. This study used time-driven activity-based costing (TDABC) to explore inpatient cost of total shoulder arthroplasty (TSA) and to identify preoperative characteristics of high-cost patients.

Methods:
Using TDABC, we calculated the cost of inpatient care for 415 patients undergoing elective primary TSA between 2016 and 2017. Patients in the top decile of cost were defined as high-cost patients. Multivariable logistic regression modeling was employed to determine preoperative characteristics (e.g., demographics, comorbidities, American Society of Anesthesiologists [ASA] score, and American Shoulder and Elbow Surgeons [ASES] score) associated with high-cost patients.

Results:
Implant purchase price was the main driver (57%) of total inpatient costs, followed by personnel cost from patient check-in through the time in the operating room (20%). There was a 1.3-fold variation in total cost between patients in the 90th percentile for cost and those in the 10th percentile; the widest cost variation was in personnel cost from the post-anesthesia care unit through discharge (2.5-fold) and in medication cost (2.4-fold). High-cost patients were more likely to be women and chronic opioid users and to have diabetes, depression, an ASA score of ≥3, a higher body mass index (BMI), and a lower preoperative ASES score than non-high-cost patients. After multivariable adjustment, the 3 predictors of high-cost patients were female sex, an ASA score of ≥3, and a lower ASES score. Total inpatient cost correlated strongly with the length of the hospital stay but did not correlate with operative time.

Conclusions:
Our study provides actionable data to contain costs in the perioperative TSA setting. From the hospital’s perspective, efforts to reduce implant purchase prices may translate into rapid substantial cost savings. At the patient level, multidisciplinary initiatives aimed at reducing length of stay and controlling medication expenses for patients at risk for high cost (e.g., infirm women with poor preoperative shoulder function) may prove effective in narrowing the existing patient-to-patient variation in costs.

Level of Evidence:
Economic and Decision Analysis Level IV. See Instructions for Authors for a complete description of levels of evidence.