bluuebunny/crossref_metadata_2025_split huggingface dataset:
Power of a Learning Network in Congenital Heart Disease
Authors: Anderson Jeffrey B. , Brown David W. , Lihn Stacy , Mangeot Colleen , Bates Katherine E. , Van Bergen Andrew H. , Rudd Nancy A. , Hanke Samuel , Tweddell Jim , Lannon Carole 
Published: January 2019

Background: The National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) formed to improve outcomes in infants with hypoplastic left heart syndrome. The collaborative sought to (1) decrease mortality, (2) reduce growth failure, and (3) reduce hospital readmissions due to major medical problems during the interstage period between discharge following stage 1 palliation (S1P) and admission for stage 2 palliation (S2P). Methods: The NPC-QIC is a learning network, coproduced by parents and clinicians, of 65 pediatric cardiology centers that contribute clinical data on care processes and outcomes to a shared registry. The adapted Breakthrough Series Model structure brings teams together regularly to review data, share lessons, and plan improvements. Outcomes are monitored using statistical process control methods. Results: Between 2008 and 2016, interstage mortality decreased by >40%, from 9.5% to 5.3%. Identification and use of a nutrition bundle led to improved infant growth, with a 28% reduction in interstage growth failure. The rate of serious hospital readmissions was low and did not significantly change. Importantly, a formed partnership with the parent group Sisters by Heart fostered the coproduction of tools and strategies and an emphasis on data transparency and outcomes. Conclusions: The NPC-QIC’s initial efforts led to improvements in interstage growth and mortality. The NPC-QIC has modeled the use of data for improvement and research, the value of coproduction with parents, and the concept “all teach, all learn,” demonstrating the power of the learning network model.
Being Mindful: A Long-term Investigation of an Interdisciplinary Course in Mindfulness
Authors: Braun Sarah Ellen , Kinser Patricia , Carrico Caroline K , Dow Alan 
Published: January 2019

Background Burnout and work-related stress in health-care professionals (HCPs) is a growing concern to the optimal functioning of the health-care system. Mindfulness-based interventions may be well-suited to address burnout in HCPs. Objective The purpose of this study was (1) to quantitatively evaluate the effect of a mindfulness-based intervention for interdisciplinary HCPs over time and at a long-term follow-up and (2) to explore perceived benefits, facilitators, and barriers to the practice of mindfulness at the long-term follow-up. Design A mixed-method, repeated measures, within-subjects design was used to investigate Mindfulness for Interdisciplinary HCPs (MIHP) at baseline, post-MIHP, and a follow-up (6 months to 1.5 years after MIHP). MIHP is an 8-week, group-based course for interdisciplinary HCPs and students, with weekly meditation training, gentle yoga, and discussions on the application of mindfulness to common stressors faced by HCPs. Main outcome measures were the Maslach Burnout Inventory—Health Services Survey and the Five Facet Mindfulness Questionnaire. A semistructured interview was used to explore participants’ perceptions of sustained effects and practice in the context of HCP work at the long-term follow-up. The study protocol was registered with ClinicalTrials.gov (NCT02736292). Results Eighteen HCPs (88% female) participated in the study. Significant reductions were found after the intervention for 2 subscales of burnout: depersonalization, F(2, 17) = 5.98, P = .01, and emotional exhaustion, F(2, 17) = 2.64, P = .10. Three facets of dispositional mindfulness showed significant increases at long-term follow-up, act aware: F(2, 15) = 4.47, P = .03, nonjudge: F(2, 15) = 4.7, P = .03, and nonreactivity: F(2, 15) = 3.58, P = .05. Continued practice of skills long term was facilitated by the use of informal practice and perceived improvement in work and personal life. Conclusion In sum, MIHP improved subscales of burnout and mindfulness. These findings should be further explored with a larger, controlled study. Interventions should focus on developing mindfulness practice that can be integrated into the work of HCPs.
Clinical and radiological outcomes of arthroscopic en bloc repair for delaminated rotator cuff tear versus non-delaminated tear
Authors: Shim Jae Woo , Hong Sung Woo , Park Yong Bok , Lee Sang Min , Yoo Jae Chul 
Published: January 2019

Purpose: The objective of the study is to determine clinical and radiological outcomes of arthroscopic repair for delaminated tears versus non-delaminated tears. Methods: Consecutive 138 patients with full-thickness rotator cuff tear were retrospectively enrolled. They were divided into two groups based on the presence of delamination. All delaminated tears were repaired by en bloc technique (suturing both layers by single stitch). Delaminated tears were categorized into two types: (1) posterior type, delamination involving mainly infraspinatus and (2) complete type, delamination involving both supraspinatus and infraspinatus. Clinical assessments were done using pain visual analog scale (PVAS), functional VAS, American Shoulder Elbow Surgeons score, the Constant score, and range of motion. Postoperative MRI was performed at 6 months after surgery to determine repair integrity. Results: Of the 138 patients, 78 (56.5%) had delaminated tears, including 30 cases of posterior type and 48 cases of complete type. The retear rate was 6.7% (4/60) in the non-delamination group and 5.1% (4/78) in the delamination group, showing no significant difference between the two groups. There was no significant difference in Sugaya classification between the two groups. Clinical scores were improved significantly in both delamination and non-delamination groups postoperatively, showing no significant difference between the two groups. Delamination subgroup (posterior or complete type) showed no significant correlation with retear rate, Sugaya classification, or clinical outcome. Conclusions: Arthroscopic en bloc repair for delaminated rotator cuff tear showed no significant difference in clinical or radiological outcome from that for non-delaminated rotator cuff tear. The extent of delamination did not affect outcome either. Levels of Evidence: Level III, Retrospective comparative study.
Effect of the positional relationship between the interference screw and the tendon graft in the bone tunnel in ligament reconstruction
Authors: Aoki Akira , Imade Shinji , Uchio Yuji 
Published: January 2019

Purpose: To reveal the effects of the positional and length relationships between the interference screws (ISs) and the tendon graft in the bone tunnel on the fixation strength in ligament reconstruction. Methods: We compared three IS positions on the anterior (the Anterior group) or posterior (the Posterior group) or side (the Side group) of the tendon graft in relation to the pullout direction. The tendon graft was pulled at 0°, 30°, 60°, and 90° to the bone tunnel, and the maximum pullout load at each angle was compared among the groups. We also investigated the relationship between the length of the tendon graft and the length of the IS in the bone tunnel. The direction of the pullout force was the same as that of the Anterior group, and the maximum load was compared between groups in which the tendon graft was longer or shorter than the IS. Results: The maximum loads of the Anterior group were significantly greater than those of the Posterior and Side groups at the traction angles of 30° and 60°, respectively. An IS shorter than the tendon graft was found to provide significantly superior fixation strength compared to an IS longer than the tendon graft. Conclusions: Better fixation strength was achieved when the IS was placed on the side of the anchorage tunnel on which the tendon graft was loaded and the IS was shorter than the tendon graft.
PROREPAIR-B: A Prospective Cohort Study of the Impact of Germline DNA Repair Mutations on the Outcomes of Patients With Metastatic Castration-Resistant Prostate Cancer
Authors: Castro Elena , Romero-Laorden Nuria , del Pozo Angela , Lozano Rebeca , Medina Ana , Puente Javier , Piulats Josep Maria , Lorente David , Saez Maria Isabel , Morales-Barrera Rafael , Gonzalez-Billalabeitia Enrique , Cendón Ylenia , García-Carbonero Iciar , Borrega Pablo , Mendez Vidal M. José , Montesa Alvaro , Nombela Paz , Fernández-Parra Eva , Gonzalez del Alba Aránzazu , Villa-Guzmán José Carlos , Ibáñez Kristina , Rodriguez-Vida Alejo , Magraner-Pardo Lorena , Perez-Valderrama Begoña , Vallespín Elena , Gallardo Enrique , Vazquez Sergio , Pritchard Colin C. , Lapunzina Pablo , Olmos David 
Published: January 2019

Purpose Germline mutations in DNA damage repair (DDR) genes are identified in a significant proportion of patients with metastatic prostate cancer, but the clinical implications of these genes remain unclear. This prospective multicenter cohort study evaluated the prevalence and effect of germline DDR (gDDR) mutations on metastatic castration-resistance prostate cancer (mCRPC) outcomes. Patients and Methods Unselected patients were enrolled at diagnosis of mCRPC and were screened for gDDR mutations in 107 genes. The primary aim was to assess the impact of ATM/BRCA1/BRCA2/ PALB2 germline mutations on cause-specific survival (CSS) from diagnosis of mCRPC. Secondary aims included the association of gDDR subgroups with response outcomes for mCRPC treatments. Combined progression-free survival from the first systemic therapy (PFS) until progression on the second systemic therapy (PFS2) was also explored. Results We identified 68 carriers (16.2%) of 419 eligible patients, including 14 with BRCA2, eight with ATM, four with BRCA1, and none with PALB2 mutations. The study did not reach its primary end point, because the difference in CSS between ATM/BRCA1/BRCA2/PALB2 carriers and noncarriers was not statistically significant (23.3 v 33.2 months; P = .264). CSS was halved in germline BRCA2 (g BRCA2) carriers (17.4 v 33.2 months; P = .027), and g BRCA2 mutations were identified as an independent prognostic factor for CCS (hazard ratio [HR], 2.11; P = .033). Significant interactions between g BRCA2 status and treatment type (androgen signaling inhibitor v taxane therapy) were observed (CSS adjusted P = .014; PFS2 adjusted P = .005). CSS (24.0 v 17.0 months) and PFS2 (18.9 v 8.6 months) were greater in g BRCA2 carriers treated in first line with abiraterone or enzalutamide compared with taxanes. Clinical outcomes did not differ by treatment type in noncarriers. Conclusion g BRCA2 mutations have a deleterious impact on mCRPC outcomes that may be affected by the first line of treatment used. Determination of g BRCA2 status may be of assistance for the selection of the initial treatment in mCRPC. Nonetheless, confirmatory studies are required before these results can support a change in clinical practice.
Piloting a Financial Counseling Intervention for Patients With Cancer Receiving Chemotherapy
Authors: Kircher Sheetal M. , Yarber Jessica , Rutsohn Josh , Guevara Yanina , Lyleroehr Madison , Alphs Jackson Hannah , Walradt Jessica , Desai Bijal , Mulcahy Mary , Kalyan Aparna , Benson Al B. , Agulnik Mark , Mohindra Nisha , DeSouza Jonas , Garcia Sofia F. 
Published: January 2019

Purpose: National organizations encourage communication about costs of cancer care; however, few data are available on health system models for identifying and assisting patients with financial distress (FD). We report the feasibility and acceptability of a financial counseling (FC) intervention for patients who receive chemotherapy at a comprehensive cancer center. Materials and Methods: Patients were randomly assigned 1:1 to FC or standard care. The FC arm received education, financial assistance screening, and an estimation tool with total billed charges and out-of-pocket (OOP) cost of one cycle of chemotherapy from a financial counselor through phone call and in-person visit. Participants completed measures of FD, health-related quality of life, and acceptability. Results: Ninety-five participants enrolled (mean age, 61 years; 72% white; 50% commercially insured), with a 32% attrition rate between assessments. Rates of completion for the phone call, in-person, and entire intervention were 98%, 47%, and 30%, respectively. The OOP estimation tool was considered understandable and acceptable to the majority of participants. No significant changes in FD were found between arms. Emotional functioning was negatively associated with having high FD (95% CI, −0.13379 to −0.013; P = .0189). Being married was associated with a decrease in log-odds of having high FD (β = −1.916; 95% CI, −3.358 to −0.475; P = .0092). Conclusion: Implementation of an FC program that provides transparent cost data is feasible and acceptable. Incorporation of FC into clinical workflow, including phone counseling, is important to improve feasibility. Additional work is needed to develop tailored educational materials that are patient specific.
Bifacial cambium stem cells generate xylem and phloem during radial plant growth
Authors: Shi Dongbo , Lebovka Ivan , López-Salmerón Vadir , Sanchez Pablo , Greb Thomas 
Published: January 2019

ABSTRACT
A reduced rate of stem cell division is considered a widespread feature which ensures the integrity of genetic information during somatic development of plants and animals. Radial growth of plant shoots and roots is a stem cell-driven process that is fundamental for the mechanical and physiological support of enlarging plant bodies. In most dicotyledonous species, the underlying stem cell niche, the cambium, generates xylem inwards and phloem outwards. Despite the importance and intriguing dynamics of the cambium, the functional characterization of its stem cells is hampered by the lack of experimental tools for accessing distinct cambium sub-domains. Here, we use the hypocotyl of Arabidopsis thaliana to map stem cell activity in the proliferating cambium. Through pulse labeling and genetically encoded lineage tracing, we find that a single bifacial stem cell generates both xylem and phloem cell lineages. This cell is characterized by a specific combination of PXY (TDR), SMXL5 and WOX4 gene activity and a high division rate in comparison with tissue-specific progenitors. Our analysis provides a cellular fate map of radial plant growth, and suggests that stem cell quiescence is not a general prerequisite for life-long tissue production.
This article has an associated ‘The people behind the papers’ interview.
Is the public-private mix approach increasing tuberculosis case notification in Azad Jammu and Kashmir, Pakistan? A cross-sectional study
Authors: Hussain Mumtaz , Fatima Razia , Qasim Zahida , Yaqoob Aashifa , Wali Ahmed , Abbasi Sabir , Tahseen Sabira 
Published: January 2019

Background: Pakistan ranks among high tuberculosis (TB) burden countries, with about 200,000 missing TB cases. Despite significant increase in case detection and treatment outcomes through public-private mix (PPM) globally, the contribution of the private sector may vary in different parts of Pakistan Methods: This was a cross sectional study conducted in state of Azad Jammu and Kashmir (AJK), Pakistan. The study was a retrospective record review of routine TB notification and treatment outcomes for 2015 to 2016 in districts with and without a PPM approach. The study was conducted in all districts of AJK, including all public and private health facilities. Intra-district comparison in PPM supported districts was also carried out. Results: Total notified TB cases during 2015-16 were 11479. Districts with PPM support has notified 5882 (51.24%) of TB cases while districts without PPM support contributed 5597 (48.87%). Pulmonary clinical diagnosis was higher in PPM supported districts (45.43%) as compared to districts without PPM support (31.11%). Notification of extra pulmonary TB cases was lower in PPM supported districts (1256; 21.35%) as compared to districts without PPM support (1877; 33.54%). Unfavourable treatment outcomes (treatment failure, died, lost to follow-up) was higher in PPM facilities (5.84%). Conclusion: The study shows minimal increase in TB case finding through the PPM approach. While this is an important aspect in END TB strategy, this needs more careful evaluation.
Effects of sub-lethal concentrations of copper ammonium acetate, pyrethrins and atrazine on the response of Escherichia coli to antibiotics
Authors: Jun Hyunwoo , Kurenbach Brigitta , Aitken Jack , Wasa Alibe , Remus-Emsermann Mitja N.P. , Godsoe William , Heinemann Jack A. 
Published: January 2019

Background: Antibiotic resistance in human and animal pathogens is mainly the outcome of human use of antibiotics. However, bacteria are also exposed to thousands of other antimicrobial agents. Increasingly those exposures are being investigated as co-selective agents behind the rapid rise and spread of resistance in bacterial pathogens of people and our domesticated animals. Methods: We measured the sub-lethal effects on antibiotic tolerance of the human pathogen/commensal Escherichia coli caused by exposure to three common biocide formulations based on either copper, pyrethrins, or atrazine as active ingredients. The influence of the efflux pump AcrAB-TolC was investigated using deletion strains, and the persistence of observed effects was determined. Results: Some effects were seen for all biocides, but the largest effects were observed with copper in combination with the antibiotic tetracycline. The effect was caused by both the induction of the adaptive efflux system and by chelation of the antibiotic by copper. Finally, persistence of the adaptive response was measured and found to persist for about two generations. Conclusions: Through a combination of microbe-chemical and chemical-chemical interactions, humanity may be creating micro-environments in which resistance evolution is accelerated.
It is not diabetic foot: it is my foot
Authors: Meriç Meltem , Ergün Gül , Meriç Coşkun , Demirci İbrahim , Azal Ömer 
Published: January 2019

Objective: To examine the experiences of patients with diabetic foot ulcers (DFUs). Method: This qualitative study, using patient interviews, focused on how inpatients receiving treatment for diabetes experience the disease. Patients were selected using a purposive sampling method. Results: A total of 15 patients participated in the study. Following analysis of patient interviews, four main themes were determined: ‘developing diabetic foot’, ‘living with diabetic foot’, ‘coping with diabetic foot’ and ‘expectations’. Conclusion: Most of the patients were afraid of losing their feet and had difficulties in coping with the situation. Patients expected health professionals to understand the difficulties they were experiencing. To better understand the needs and experiences of patients, healthcare professionals should work with these patient groups as part of in-service training programmes. Such programmes should also include therapeutic communication techniques and models for professional patient-client communication.
Predicting Acute Myocardial Infarction with a Single Blood Draw
Authors: Boeddinghaus Jasper , Nestelberger Thomas , Badertscher Patrick , Twerenbold Raphael , Fitze Brigitte , Wussler Desiree , Strebel Ivo , Rubini Giménez Maria , Wildi Karin , Puelacher Christian , du Fay de Lavallaz Jeanne , Oehen Loris , Walter Joan , Miró Òscar , Martin-Sanchez F Javier , Morawiec Beata , Potlukova Eliska , Keller Dagmar I , Reichlin Tobias , Mueller Christian ,   Additional APACE Investigators and Contributors to this article include:, Sabti Zaid , Freese Michael , Stelzig Claudia , Shrestha Samyut , Schaerli Nicolas , Kozhuharov Nikola , Flores Dayana , Lohrmann Jens , Biskup Ewalina , Kloos Wanda , Osswald Stefan , Mueller Deborah , Sazgary Lorraine , López Beatriz , Adrada Esther Rodriguez , Kawecki Damian , Muzyk Piotr , Nowalany-Kozielska Ewa , Parenica Jiri , Ganovská Eva , Meissner Kathrin , Kulangara Caroline , Mahfouz Riham , Hartmann Beate , Ferel Ina , Campodarve Isabel , Rentsch Katharina , von Eckardstein Arnold , Buser Andreas , Geigy Nicolas 
Published: January 2019

Abstract

BACKGROUND
We desired to determine cardiac troponin (cTn) concentrations necessary to achieve a positive predictive value (PPV) of ≥75% for acute myocardial infarction (AMI) to justify immediate admission of patients to a monitored unit and, in general, early coronary angiography.

METHODS
In a prospective multicenter diagnostic study enrolling patients presenting to the emergency department with symptoms suggestive of AMI, final diagnoses were adjudicated by 2 independent cardiologists based on clinical information including cardiac imaging. cTn concentrations were measured using 5 different sensitive and high-sensitivity cTn (hs-cTn) assays in a blinded fashion at presentation and serially thereafter. The diagnostic end point was PPV for rule-in of AMI of initial cTn concentrations alone and in combination with early changes.

RESULTS
Among 3828 patients, 616 (16%) had an AMI. At presentation, 7% to 14% of patients had cTnT/I concentrations associated with a PPV of ≥75%. Adding absolute or relative changes did not significantly further increase the PPV. PPVs increased from 46.5% (95% CI, 43.6–49.4) for hs-cTnT at presentation &gt;14 ng/L to 78.9% (95% CI, 74.7–82.5) for &gt;52 ng/L (P &lt; 0.001), whereas PPVs in higher hs-cTnT strata remained largely unchanged [e.g., 82.4% (95% CI, 77.5–86.7) for &gt;80 ng/L vs 83.9% (95% CI, 76.0–90.1) for &gt;200 ng/L (P = 0.72)]. The addition of early changes in hs-cTnT further increased the PPV up to 60 ng/L, but not for higher concentrations.

CONCLUSIONS
Serial sampling does not seem necessary for predicting AMI and concurrent decision-making in about 10% of patients, as it only marginally increases the PPV for AMI and not in a statistically or clinically significant way.

ClinicalTrials.gov Identifier
NCT00470587.
Global Adoption of High-Sensitivity Cardiac Troponins and the Universal Definition of Myocardial Infarction
Authors: Anand Atul , Shah Anoop S V , Beshiri Agim , Jaffe Allan S , Mills Nicholas L 
Published: January 2019

Abstract

BACKGROUND
The universal definition of myocardial infarction (UDMI) standardizes the approach to the diagnosis and management of myocardial infarction. High-sensitivity cardiac troponin testing is recommended because these assays have improved precision at low concentrations, but concerns over specificity may have limited their implementation.

METHODS
We undertook a global survey of 1902 medical centers in 23 countries evenly distributed across 5 continents to assess adoption of key recommendations from the UDMI. Respondents involved in the diagnosis and management of patients with suspected acute coronary syndrome completed a structured telephone questionnaire detailing the primary biomarker, diagnostic thresholds, and clinical pathways used to identify myocardial infarction.

RESULTS
Cardiac troponin was the primary diagnostic biomarker at 96% of surveyed sites. Only 41% of centers had adopted high-sensitivity assays, with wide variation from 7% in North America to 60% in Europe. Sites using high-sensitivity troponin more frequently used serial sampling pathways (91% vs 78%) and the 99th percentile diagnostic threshold (74% vs 66%) than sites using previous-generation assays. Furthermore, high-sensitivity institutions more often used earlier serial sampling (≤3 h) and accelerated diagnostic pathways. Fewer than 1 in 5 high-sensitivity sites had adopted sex-specific thresholds (18%).

CONCLUSIONS
There has been global progress toward the recommendations of the UDMI, particularly in the use of the 99th percentile diagnostic threshold and serial sampling. However, high-sensitivity assays are still used by a minority of sites, and sex-specific thresholds by even fewer. Additional efforts are required to improve risk stratification and diagnosis of patients with myocardial infarction.