bluuebunny/crossref_metadata_2025_split huggingface dataset:
Wie ist Qualität im deutschen Gesundheitssystem definiert? Eine systematische Analyse
deutscher Gesetzestexte und Richtlinien.
Authors: Petzold Thomas , Walther Felix , Schmitt Jochen 
Published: February 2018

Zusammenfassung
Zielsetzung Die Nutzung von Qualitätsdaten zur Beschreibung, Steuerung und Planung der
Gesundheitsversorgung wird immer häufiger durch den Gesetzgeber angestrebt. Dabei werden Maßnahmen und
Instrumente beschrieben, mit deren Hilfe eine hohe Versorgungsqualität sichergestellt werden soll. Jedoch
bleibt unklar, von welcher Definition von Qualität ausgegangen wird. Ziel der Studie ist die Analyse von
Definitionen und Ausprägungen des Qualitätsbegriffs im deutschen Gesundheitswesen.
Methodik Es erfolgte eine systematische Analyse deutscher Gesetzestexte und Richtlinien mit Relevanz für
die Gesundheitsversorgung (bis 30.04.2016). Darüber hinaus erfolgte eine Recherche auf Webseiten von
Institutionen und Verbänden, die von übergeordneter Relevanz für das deutsche Gesundheitswesen sind. Die
Definitionen, Ausprägungen sowie Maß nahmen und Instrumente des Qualitätsmanagements wurden extrahiert. Das
Studienprotokoll wurde vorab in der Datenbank Versorgungsforschung veröffentlicht (VfD_16_003708).
Ergebnisse Es konnten 544 Dokumente mit Bezug zur Definition oder Ausprägung von Qualität identifiziert
werden. Die häufigsten Nennungen (n = 216) erfolgten in bundesweit gültigen Gesetzestexten, wie dem
Sozialgesetzbuch V (n = 87). Insgesamt konnten 14 konkrete Qualitätsdefinitionen identifiziert werden. Als
Qualitätsausprägung erfolgte die Einteilung nach Donabedian in Struktur-, Prozess- und Ergebnisqualität. Als
häufigste Maßnahmen wurden Qualitätszirkel, Prozessmanagement oder Befragungen genannt.
Schlussfolgerung Je nach Gesetzeszweck unterscheiden sich die Qualitätsdefinitionen teilweise deutlich.
Es existieren unterschiedliche Sichtweisen, die vor allem auf Prozess- oder Ergebnisqualität fokussieren. Um
Qualität als Steuerungskriterium fest in der Gesundheitsversorgung zu verankern, ist eine einheitliche,
belastbare und nachvollziehbare Qualitätsdefinition erforderlich, die auch Sektorengrenzen überschreitet.
Social media in/and the politics of the European Union
Authors: Krzyżanowski Michał 
Published: February 2018

AbstractThis paper looks at how social/online media – using the example of Twitter – are used in the politico-organizational communication of the European Union at a time when it faces multiple crises and is in acute need of effectively communicating its politics to the European demos. Proposing a critical discourse framework for the analysis of the politico-organizational use of Twitter, the paper shows that while, to some extent, bringing change or ‘modernization’ to EU political communication patterns, social/online media help in sustaining some of the deep-seated dispositions in EU communicative and organizational practices as well as political discourses. As deployed by the EU’s – and specifically the European Commission’s – spokesperson service, social/online help in solidifying some of the controversial patterns in EU political communication. They also bring in other, more contemporary, challenges as regards using Twitter and social media as parts of political and institutional/organizational communication.
Multiplicative reasoning: teaching primary pupils in ways that focus on functional relations
Authors: Askew Mike 
Published: February 2018

ABSTRACTThis paper examines a problem described as widespread and long‐standing in mathematics education: supporting pupils into multiplicative reasoning, a form of reasoning that has been noted as central to large tracts of secondary mathematics and beyond. Also noted, however, is a persistent perception of multiplicative situations only in terms of repeated addition – a perception held not only primary pupils, but also among primary teachers and curriculum developers. The focus of this paper is to synthesize literature on multiplicative reasoning as a conceptual field together with a sociocultural discussion of the role of mediating artifacts in the development of this conceptual field. Bringing MR into the primary classroom can then be achieved, I propose, through a pedagogy oriented toward model‐eliciting and teacher appropriation of pupils’ models as pedagogic tools with the subsequent re‐appropriation of refined models by pupils. This pedagogy is illustrated through the analysis of two vignettes from a teaching experiment which demonstrate the beginnings of MR as an emergent conceptual field in the classroom. The paper concludes that it is possible to move primary teaching and learning toward understanding the functional aspects of multiplicative reasoning, but that any such moves requires attention to teachers’ pedagogic and content knowledge.
Large‐scale isolation and cytotoxicity of extracellular vesicles derived from activated human natural killer cells
Authors: Jong Ambrose Y. , Wu Chun‐Hua , Li Jingbo , Sun Jianping , Fabbri Muller , Wayne Alan S. , Seeger Robert C. 
Published: February 2018

ABSTRACTExtracellular vesicles (EVs) have been the focus of great interest, as they appear to be involved in numerous important cellular processes. They deliver bioactive macromolecules such as proteins, lipids, and nucleic acids, allowing intercellular communication in multicellular organisms. EVs are secreted by all cell types, including immune cells such as natural killer cells (NK), and they may play important roles in the immune system. Currently, a large‐scale procedure to obtain functional NK EVs is lacking, limiting their use clinically. In this report, we present a simple, robust, and cost‐effective method to isolate a large quantity of NK EVs. After propagating and activating NK cells ex vivo and then incubating them in exosome‐free medium for 48 h, EVs were isolated using a polymer precipitation method. The isolated vesicles contain the tetraspanin CD63, an EV marker, and associated proteins (fibronectin), but are devoid of cytochrome C, a cytoplasmic marker. Nanoparticle tracking analysis showed a size distribution between 100 and 200 nm while transmission electron microscopy imaging displayed vesicles with an oval shape and comparable sizes, fulfilling the definition of EV. Importantly, isolated EV fractions were cytotoxic against cancer cells. Furthermore, our results demonstrate for the first time that isolated activated NK (aNK) cell EVs contain the cytotoxic proteins perforin, granulysin, and granzymes A and B, incorporated from the aNK cells. Activation of caspase ‐3, ‐7 and ‐9 was detected in cancer cells incubated with aNK EVs, and caspase inhibitors blocked aNK EV‐induced cytotoxicity, suggesting that aNK EVs activate caspase pathways in target cells. The ability to isolate functional aNK EVs on a large scale may lead to new clinical applications.Abbreviations: NK: natural killer cells; activated NK (aNK) cells; EVs: extracellular vesicles; ALL: acute lymphoblastic leukaemia; aAPC: artificial antigen‐presenting cell; TEM: transmission electron microscope; PBMC: peripheral blood mononuclear cells; FBS: foetal bovine serum.
Extracellular vesicles yield predictive pre‐eclampsia biomarkers
Authors: Tan Kok Hian , Tan Soon Sim , Ng Mor Jack , Tey Wan Shi , Sim Wei Kian , Allen John Carson , Lim Sai Kiang 
Published: February 2018

ABSTRACTCirculating extracellular vesicles (EVs) such as cholera toxin B chain (CTB)‐ or annexin V (AV)‐binding EVs were previously shown to be rich sources of biomarkers. Here we test if previously identified pre‐eclampsia (PE) candidate biomarkers, TIMP‐1 in CTB‐EVs (CTB‐TIMP) and PAI‐1 in AV‐EVs (AV‐PAI) complement plasma PlGF in predicting PE in a low‐risk obstetric population. Eight hundred and forty‐three prospectively banked plasma samples collected at 28 + 0 to 32 + 0 gestation weeks in the Neonatal and Obstetrics Risk Assessment (NORA) cohort study were assayed by sandwich ELISAs for plasma PlGF, CTB‐TIMP1 and AV‐PAI1. Nineteen patients subsequently developed PE 7.3 (±2.9) weeks later at a mean gestational age of 36.1 ± 3.5 weeks. The biomarkers were assessed for their predictive accuracy for PE using stepwise multivariate logistic regression analysis with Firth correction and Areas under the curve (AUC). To achieve 100% sensitivity in predicting PE, the cut‐off for plasma PlGF, CTB‐TIMP1 & AV‐PAI1 were set at <1235, ≤300 or >1300 and <10,550 pg/mL plasma, respectively. The corresponding AUCs, specificity and PPV at a 95% confidence interval were 0.92, 52.1% and 4.7%; 0.72, 44.5% and 4.0%; and 0.69, 21.5% and 2.9%, respectively. At 100% sensitivity, the three biomarkers had a combined AUC of 0.96, specificity of 78.6%, and PPV of 9.9%.This is the first large cohort validation of the utility of EV‐associated analytes as disease biomarkers. Specifically, EV biomarkers enhanced the predictive robustness of an existing PE biomarker sufficiently to justify PE screening in a low‐risk general obstetric population.
Copper Nanoparticles: Synthesis and Biological Activity
Authors: Satyvaldiev A S , Zhasnakunov Z K , Omurzak E , Doolotkeldieva T D , Bobusheva S T , Orozmatova G T , Kelgenbaeva Z 
Published: February 2018

Abstract
By means of XRD and FESEM analysis, it is established that copper nanoparticles with sizes less than 10 nm are formed during the chemical reduction, which form aggregates mainly with spherical shape. Presence of gelatin during the chemical reduction of copper induced formation of smaller size distribution nanoparticles than that of nanoparticles synthesized without gelatin and it can be related to formation of protective layer. Synthesized Cu nano-powders have sufficiently high activity against the Erwinia amylovora bacterium, and the bacterial growth inhibition depends on the Cu nanoparticles concentration. At a concentration of 5 mg / ml of Cu nanoparticles, the exciter growth inhibition zone reaches a maximum value within 72 hours and the lysis zone is 20 mm, and at a concentration of 1 mg / ml this value is 16 mm, which also indicates the significant antibacterial activity of this sample.
The Tendril Plot—a novel visual summary of the incidence, significance and temporal aspects of adverse events in clinical trials
Authors: Karpefors Martin , Weatherall James 
Published: February 2018

AbstractBackgroundIn contrast to efficacy, safety hypotheses of clinical trials are not always pre-specified, and therefore, the safety interpretation work of a trial tends to be more exploratory, often reactive, and the analysis more statistically and graphically challenging.MethodsWe introduce a new means of visualizing the adverse event data across an entire clinical trial.ResultsThe approach overcomes some of the current limitations of adverse event analysis and streamlines the way safety data can be explored, interpreted and analyzed. Using a phase II study, we describe and exemplify how the tendril plot effectively summarizes the time-resolved safety profile of two treatment arms in a single plot and how that can provide scientists with a trial safety overview that can support medical decision making.ConclusionTo our knowledge, the tendril plot is the only way to graphically show important treatment differences with preserved temporal information, across an entire clinical trial, in a single view.
A Multicenter Consortium to Define the Epidemiology and Outcomes of Pediatric Solid Organ Transplant Recipients With Inpatient Respiratory Virus Infection
Authors: Danziger-Isakov Lara , Steinbach William J , Paulsen Grant , Munoz Flor M , Sweet Leigh R , Green Michael , Michaels Marian G , Englund Janet A , Murray Alastair , Halasa Natasha , Dulek Daniel E , Madan Rebecca Pellett , Herold Betsy C , Fisher Brian T 
Published: February 2018

Abstract

Background
Respiratory virus infection (RVI) in pediatric solid organ transplant (SOT) recipients poses a significant risk; however, the epidemiology and effects of an RVI after pediatric SOT in the era of current molecular diagnostic assays are unclear.

Methods
A retrospective observational cohort of pediatric SOT recipients (January 2010 to June 2013) was assembled from 9 US pediatric transplant centers. Charts were reviewed for RVI events associated with hospitalization within 1 year after the transplant. An RVI diagnosis required respiratory symptoms and detection of a virus (ie, human rhinovirus/enterovirus, human metapneumovirus, influenza virus, parainfluenza virus, coronavirus, and/or respiratory syncytial virus). The incidence of RVI was calculated, and the association of baseline SOT factors with subsequent pulmonary complications and death was assessed.

Results
Of 1096 pediatric SOT recipients (448 liver, 289 kidney, 251 heart, 66 lung, 42 intestine/multivisceral), 159 (14.5%) developed RVI associated with hospitalization within 12 months after their transplant. RVI occurred at the highest rates in intestine/abdominal multivisceral (38%), thoracic (heart/lung) (18.6%), and liver (15.6%) transplant recipients and a lower rate in kidney (5.5%) transplant recipients. RVI was associated with younger median age at transplant (1.72 vs 7.89 years; P < .001) and among liver or kidney transplant recipients with the receipt of a deceased-donor graft compared to a living donor (P = .01). The all-cause and attributable case-fatality rates within 3 months of RVI onset were 4% and 0%, respectively. Multivariable logistic regression models revealed that age was independently associated with increased risk for a pulmonary complication (odds ratio, 1.24 [95% confidence interval, 1.02–1.51]) and that receipt of an intestine/multivisceral transplant was associated with increased risk of all-cause death (odds ratio, 24.54 [95% confidence interval, 1.69–327.96]).

Conclusions
In this study, hospital-associated RVI was common in the first year after pediatric SOT and associated with younger age at transplant. All-cause death after RVI was rare, and no definitive attributable death occurred.
The Prevalence of Multiple-Choice Testing in Registered Nurse Licensure-Qualifying Nursing Education Programs in New York State
Authors: Birkhead Susan , Kelman Glenda , Zittel Barbara , Jatulis Linnea 
Published: February 2018

Abstract

AIM
The aim of this study was to describe nurse educators' use of multiple-choice questions (MCQs) in testing in registered nurse licensure-qualifying nursing education programs in New York State.

METHOD
This study was a descriptive correlational analysis of data obtained from surveying 1,559 nurse educators; 297 educators from 61 institutions responded (response rate [RR] = 19 percent), yielding a final cohort of 200.

RESULTS
MCQs were reported to comprise a mean of 81 percent of questions on a typical test. Baccalaureate program respondents were equally likely to use MCQs as associate degree program respondents (p > .05) but were more likely to report using other methods of assessing student achievement to construct course grades (p < .01). Both groups reported little use of alternate format-type questions.

CONCLUSION
Respondent educators reported substantial reliance upon the use of MCQs, corroborating the limited data quantifying the prevalence of use of MCQ tests in licensure-qualifying nursing education programs.
Delayed Presentation of Cecal Perforation With Tension-Free Vaginal Tape
Authors: Mayhew Allison C. , Ford Alexcis T. , Northington Gina M. , Shaffer Virginia O. , Kelley Robert S. 
Published: February 2018

BACKGROUND:
Tension-free vaginal tape (TVT) is a popular operative treatment for stress urinary incontinence (SUI). It has a low risk of adverse events, and injuries, particularly to the bowel, are rare. Case reports that have previously discussed these injuries and subsequent removal of TVT have not provided additional insight into management of SUI after these injuries occur.

CASE:
A postmenopausal woman with persistent SUI presented more than 1 year after TVT placement with bowel perforation incidentally discovered on routine screening colonoscopy. She underwent removal of the TVT and subsequent placement of a fascial sling with postoperative resolution of SUI.

CONCLUSION:
This case provides additional evidence for bowel injury as a postoperative TVT complication and describes an approach to complicated TVT and persistent SUI.
Cancer Risk After Midurethral Sling Surgery Using Polypropylene Mesh
Authors: Altman Daniel , Rogers Rebecca G. , Yin Li , Tamussino Karl , Ye Weimin , Iglesia Cheryl B. 
Published: February 2018

OBJECTIVE:
To assess whether there is any association between the implantation of synthetic polypropylene mesh slings for the treatment of stress urinary incontinence (SUI) and risk of cancer.

METHODS:
We performed a nationwide cohort study based on the general female population in Sweden. All women entered the observational period as unexposed on January 1, 1997, and contributed person-time as unexposed unless they underwent a midurethral sling procedure for SUI, after which they contributed person-time as exposed until first occurrence of any cancer, death, emigration, or end of the observational period (December 31, 2009). Occurrence of primary cancer was ascertained from the Cancer Register. Hazard ratios (HRs) with 95% CIs were calculated by Cox proportional hazards regression.

RESULTS:
The final study population included 5,385,186 women, including 20,905 exposed, encompassing a total of 44,012,936 person-years at risk. Other than an inverse association with rectal cancer (HR 0.5, 95% CI 0.3–0.8), there were no significant differences in risk between exposed and unexposed women for pelvic organ cancers including ovarian (HR 0.8, 95% CI 0.5–1.2), endometrial (HR 1.1, 95% CI 0.8–1.4), cervical (HR 0.4, 95% CI 0.2–1.0), bladder, and urethra (HR 0.7, 95% CI 0.4–1.2). No significant association was observed between exposed women and primary cancer in any organ system when compared with unexposed women. The relative risk for cancer after exposure showed little variation over time except for an inverse overall correlation within the first 4 years of surgery (HR 0.7, 95% CI 0.7–0.8). The incidence rates per 100,000 person-years (95% CIs) for exposed vs unexposed women were 20.5 (14.3–29.5) vs 21.0 (20.6–21.5) for rectal cancer, 25.5 (18.4–35.3) vs 19.8 (19.4–20.2) for ovarian cancer, 65.0 (53.0–79.8) vs 33.1 (32.6–33.7) for endometrial cancer, 5.7 (2.8–11.3) vs 11.9 (11.6–12.2) for cervical cancer, and 19.1 (13.1–27.8) vs 13.3 (13.0–13.7) for bladder and urethra cancer.

CONCLUSION:
Our results suggest that midurethral polypropylene sling surgery for SUI is not associated with an increased cancer risk later in life.
A Population-Based Study of Complications After Colorectal Surgery in Patients Who Have Received Bevacizumab
Authors: Baxter Nancy N. , Fischer Hadas D. , Richardson Devon P. , Urbach David R. , Bell Chaim M. , Rochon Paula , Brade Anthony , Earle Craig C. 
Published: February 2018

BACKGROUND:
Patients receiving Bevacizumab, a vascular endothelial growth factor inhibitor used to treat metastatic colorectal cancer, may be at greater risk of complications after colorectal surgery because of impaired healing.

OBJECTIVE:
The purpose of this study was to describe population-based rates of complications of colorectal surgery after Bevacizumab treatment and evaluate the relationship between time since last treatment and risk of complications.

DESIGN:
This was a population-based retrospective cohort study using administrative and cancer registry data.

SETTINGS:
The study was conducted in Ontario, Canada.

PATIENTS:
Patients with metastatic colorectal cancer receiving Bevacizumab between January 2008 and December 2011 were followed for a year after treatment or until death.

MAIN OUTCOME MEASURES:
Administrative data were used to identify patients who underwent colorectal surgery after initiation of Bevacizumab and to determine whether they experienced a complicated postoperative course. The relationship between time since last Bevacizumab treatment (≤28 d, 29 d to 3 mo, and >3 mo) and risk of postoperative complications was evaluated using logistic regression.

RESULTS:
Of the 2759 patients who received Bevacizumab for the treatment of metastatic colorectal cancer, 265 underwent a colorectal procedure after exposure. The majority had a bowel resection or repair with no stoma (47.5%) and had emergency surgery (61.1%). Overall, 96 (36.2%) had a complicated postoperative course, including 20.4% readmission, 12.5% wound complications, and 7.9% mortality rate within 30 days of surgery. Adjusted multivariate analysis showed no difference in the likelihood of a complicated postoperative course among patients undergoing surgery within 28 days of receiving their last Bevacizumab dose compared with 29 days to 3 months (OR = 1.23 (95% CI, 0.53–2.84), or 3 to 12 months (OR = 0.98 (95% CI, 0.46–2.09) after receiving Bevacizumab.

LIMITATIONS:
Reliance on administrative data to measure complications limited the scope of this study.

CONCLUSIONS:
Patients with metastatic colorectal cancer requiring colorectal surgery after exposure to Bevacizumab experience substantial morbidity and mortality. The risk of complications is not detectably associated with time since exposure. See Video Abstract at http://links.lww.com/DCR/A474.
Challenges in Transition of Care for Patients With Anorectal Malformations: A Systematic Review and Recommendations for Comprehensive Care
Authors: Cairo Sarah B. , Gasior Alessandra , Rollins Michael D. , Rothstein David H. 
Published: February 2018

BACKGROUND:
Anorectal malformations are one of the most common congenital intestinal anomalies affecting newborns. Despite advances in neonatal care and surgical techniques, many patients with a history of anorectal malformations are affected by long-term challenges involving bowel and bladder dysfunction, sexual dysfunction, and psychosocial issues. These outcomes or challenges are additionally exacerbated by the lack of a structured transition of care from the pediatric to the adult setting.

OBJECTIVE:
The purpose of this review is to describe the long-term outcomes affecting patients with a history of anorectal malformations, review the current literature on transition of care, and make recommendations for developing a standardized program for transitioning care for a select group of colorectal surgical patients.

DATA SOURCES:
An extensive PubMed review of articles in English was performed to evaluate current best practices for chronic illnesses of childhood with residual symptoms or need for medical care into adulthood.

STUDY SELECTION:
Meta-Analysis of Observational Studies in Epidemiology group guidelines were followed.

MAIN OUTCOME MEASURES:
The primary outcome for this review was the existence of transitional services for patients with a history of anorectal malformations and evaluations of long-term outcomes affecting patients with a history of anorectal malformations.

RESULTS:
Systematic review revealed improved results in transition programs as determined by patient follow-up, medication adherence, and patient and family satisfaction through the use of multidisciplinary teams. Standardized tools for assessing all aspects of patient outcomes and quality of life are essential for describing the burden of disease affecting a transitioning population.

LIMITATIONS:
This is a retrospective review of the current status of a complex and rapidly evolving field of delivery of care. More work is needed to apply uniform approaches and assess the impact, patient outcomes, and quality of life.

CONCLUSIONS:
Patients who undergo childhood procedures for anorectal malformations often experience chronic symptoms related to the bowel, bladder, and reproductive organs, as well as psychosocial disturbances. This population will benefit from appropriate engagement in transitional care plans. See Video Abstract at http://links.lww.com/DCR/A543.