bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of the Representation of Rimed Ice in Bulk Microphysics Schemes on Polarimetric Signatures
Authors: Johnson Marcus , Jung Youngsun , Milbrandt Jason A. , Morrison Hugh , Xue Ming 
Published: August 2019

AbstractMany flavors of multicategory, multimoment bulk microphysics schemes (BMPs) have various treatments of rimed ice. In this study, we compare three two-moment schemes available in the WRF Model—Milbrandt–Yau (MY2), National Severe Storms Laboratory (NSSL), and the two-category configuration of the Predicted Particle Properties (P3) scheme—focusing on differences in rimed-ice representation and their impacts on surface rain and ice. Idealized supercell simulations are performed. A polarimetric radar data simulator is used to evaluate their ability to reproduce the ZDR arc and hail signature in the forward-flank downdraft, well-known supercell polarimetric signatures that are potentially sensitive to rimed-ice parameterization. Both the MY2 and NSSL schemes simulate enhanced surface ZDR bands, but neither scheme simulates a ZDR arc commonly identified in observation-based studies. Surface ZDR in the default P3 scheme is homogeneous in the supercell’s forward flank, and is due to the scheme’s restrictive minimum rain particle size distribution (PSD) slope bound preventing the presence of larger drops creating a ZDR arc. The NSSL scheme simulates the location of the hail signature in the forward-flank downdraft more consistent with observations than the other two schemes. Large hail in MY2 sediments well downstream of the updraft (atypically compared to observations) near the surface. The sedimentation of large ice in the default P3 scheme is limited by a restrictive maximum ice number-weighted mean diameter limit within the scheme, precluding the scheme’s ability to reduce ZDR (and ρHV compared to the MY2 and NSSL schemes) near the surface.
Intranasal Septal Splints: Prophylactic Antibiotics and Nasal Microbiology
Authors: Ritter Amit , Alkan Uri , Yahav Dafna , Soudry Ethan , Reifen Ella 
Published: August 2019

Objectives: Intranasal septal splints are often used in nasal septal surgeries. Routine use of postoperative antibiotics is an accepted practice, although data regarding its efficacy in preventing postsurgical complications are limited. This study aimed to examine bacterial colonization on septal splints following prophylactic antibiotic therapy and the association with postoperative infections. Methods: Fifty-five patients underwent septoplasty by a single surgeon between March 2015 and April 2016. All had intranasal septal splints and were given antibiotic prophylaxis for 7 days until removal of splints. Nasal cultures were taken before surgery, and septal splints were examined for bacterial colonization following their removal. Results: Thirty-six patients (65%) had positive nasal culture prior to surgery. The most common isolates were Staphylococcus aureus (30%) and Enterobacteriaceae species (66%). All these patients had postoperative bacterial colonization on septal splints. In 15 patients with negative preoperative cultures, bacteria were isolated postoperatively. An increased resistance profile was documented postoperatively in 9 patients (16%), including two with multidrug resistance. In two of these patients preoperative wild-type strains acquired antibiotic resistance postoperatively. No adverse drug reactions to antibiotics were reported. Conclusions: Increased bacterial growth and emergence of resistant strains were observed on intranasal septal splints despite prophylactic antibiotic treatment. Nonetheless, this did not translate into clinical infection. Thus, considering antibiotics overuse and increasing bacterial resistance, further research is needed to determine the role of antibiotic prophylaxis in the setting of intranasal splints.
Barriers to and facilitators of using MyPlate nutritional guidelines in K-12 teachers and principals
Authors: Chrisman Matthew , Patel Sarah , Alonzo Rachel 
Published: August 2019

Objective: MyPlate, a tool for communicating the federal nutrition guidelines in the USA, may contribute to healthy diets and behaviours, yet whether and how it is used by teachers and school principals is unknown. The purpose of this study was to examine (1) the prevalence of using nutrition lessons and MyPlate guidelines by K-12 teachers and principals; (2) barriers to, and facilitators of, using them; and (3) suggested strategies to improve their use. Methods: A convenience sample of teachers and principals ( n = 124) from a Midwestern US school district were surveyed. Results: The majority of respondents were women (88%), elementary school teachers (76%) and Caucasian (90%). A total of 18% ( n = 16) of teachers included nutrition in lesson plans. A total of 17% ( n = 15) of teachers used MyPlate in their classrooms, primarily through handouts and group activities. Being a parent and being more familiar with MyPlate were positively associated with including nutrition in lessons, and income and higher education were inversely associated with including nutrition in lessons. Barriers included lack of time, knowledge and resources, and facilitators included believing nutrition was important, nutrition being part of the curriculum and personal interest. Suggested strategies to improve use of MyPlate included introducing the MyPlate curriculum into health, physical education or other classes; using MyPlate messages in the cafeteria; and posting signage around the school. Conclusion: MyPlate use was low in this sample of teachers and principals in a Midwestern US school district. Handouts, group activities, signage and curriculum integration could potentially increase schools’ use of the resource. Strategies should be developed to reduce the barriers for using MyPlate. Future research should examine a more diverse sample of teachers and strategies to integrate MyPlate into curriculum.
Selecting the Best Instrument to Measure Family Perceptions of End-of-Life Communication in Intensive Care Units
Authors: Chen Chiahui , Meier Scott T. 
Published: August 2019

Background: Good communication with the family is a clinical imperative for high quality end-of-life (EOL) care in intensive care unit (ICU). Many interventions aim to improve EOL communication, and the choice of an outcome instrument has important implications for evaluating interventions. The purpose of this project is to search and review available instruments’ psychometric properties and determine which best measures family–clinician communication in the ICU. Method: A stepwise method was used by searching 2 databases (PsycInfo and Web of Science) to identify instruments and articles that provide information about scale psychometric properties. Instruments: Three instruments were identified, including Family Inpatient Communication Survey, Family Perception of Physician–Family Caregiver Communication, and Quality of Communication (QOC). Results: Reliability estimates were high (≥ 0.79) in all 3 instruments. The QOC’s convergent validity estimates exceed its discriminant validity values, and the QOC is an intervention-sensitive measure used to examine families’ treatment response in randomized control trials. Conclusion: Quality of Communication is the most suitable instrument to measure family’s perceptions of EOL communication in the ICU. Quality of Communication scores provide a deeper understanding of family–clinician communication and data about how to improve EOL care in ICUs.
Sensitizing the interdisciplinary team to desensitizations: An alemtuzumab case report
Authors: McKenzie Matt G , Bissell Brittany D , Disselkamp Margaret A , Hildebrandt Gerhard C , Cox Jessica N 
Published: August 2019

Introduction We describe a case of alemtuzumab (Campath®) hypersensitivity requiring desensitization within the medical intensive care unit (MICU) in a patient with T-cell prolymphocytic leukemia. Case report We adopted a desensitization protocol from Gutierrez-Fernandez et al., which included three aliquots (0.15 mg intravenously (IV), 1.5 mg IV, and 28.5 mg IV) given approximately 1 h apart on day 1 followed by a full 30 mg dose IV on day 3. Unlike prior attempts to administer alemtuzumab to this patient, she tolerated the medication well and did not require any rescue medications. Management and outcome Successful plan development required a significant amount of strategic communication between hematology/oncology and MICU-related physicians, pharmacists, and nurses to ensure a safe and effective desensitization. The first step of planning required creation of a desensitization order set with directions for medication preparation and administration, premedications, and available medications in the event of an adverse reaction or anaphylaxis. Anaphylactoid-related medications were prepared at bedside and ready for administration prior to beginning the desensitization. Alemtuzumab was compounded in a chemotherapy-certified hood and verified by at least two chemotherapy-certified pharmacists. Foreword planning was also necessary to ensure multiple people were available or present at bedside for the desensitization, including a chemotherapy-certified nurse, a second chemotherapy-certified nurse for verification, a critical care-certified pharmacist, a pulmonary/critical care attending physician, and hematology attending physician. Discussion This case exemplifies the importance of clear and coordinated communication between different healthcare fields to safely and effectively complete extensive protocols such as desensitization strategies.
Tuberculosis osteomyelitis of the tibia mimicking Brodie abscess: A case report and review of the literature
Authors: Sari Abdülkadir , Dinçel Yaşar Mahsut , Erdogdu Ibrahim Halil , Sayıner Hakan Sezgin , Agir Ismail , Çetin Mehmet Ümit 
Published: August 2019

Background: Tuberculosis osteomyelitis is rarely seen in the diaphyseal bones. It may be confused with Brodie’s abscess due to similar clinical, radiological and laboratory findings. Late diagnosis of the disease causes bone destruction. Tuberculosis osteomyelitis of the bone is a rare condition caused by the Mycobacterium tuberculosis. Its incidence has increased in Western countries in recent years due to HIV infection, increasing elderly population and emerging resistant strains. The slow progress of tuberculous osteomyelitis, due to lack of significant elevations in the laboratory values and changes in the radiographic appearance, often leads to confusion with the subtypes of subacute osteomyelitis, defined as Brodie’s abscess. These two low-virulence clinical cases often lead to delays in diagnosis and progressive bone destruction. Case presentation: We report a 65-year-old male patient who presented to our clinic with pain, swelling and sensitivity in the left leg. Diagnosed with infection in the tibia, the patient had undergone antibiotherapy. However, the patient’s symptoms were not resolved and we performed bone curettage and cementation. M. tuberculosis-specific DNA was detected by real-time polymerase chain reaction and the M. tuberculosis complex was produced from the perioperative samples. Conclusion: In conclusion, histopathological examination and polymerase chain reaction are essential before surgery of subacute and chronic osteomyelitis with atypical clinical, laboratory and radiological findings for early diagnosis and accurate treatment.
The awareness of amblyopia among parents in Saudi Arabia
Authors: Alsaqr Ali M. , Masmali Ali M. 
Published: August 2019

Purpose: Amblyopia is the most common cause of unilateral visual impairment. This study investigated parents’ awareness of amblyopia in different regions of Saudi Arabia. Methods: This was a cross-sectional population study. The survey consisted of two main sections; the first section contained 13 general background questions, and the second section (10 questions) focused on awareness of amblyopia, routine vision checks and how to raise awareness of amblyopia in the community. The survey was distributed to respondents using email and social media. Results: The responses of 1649 families were received. Respondents’ age range was from 22–62 years (mean ± standard deviation = 33.6 ± 8.7 years). Most respondents had no previous knowledge of amblyopia (1155 participants, 70%), and 313 participants (19%) had no idea if their children had amblyopia. In total, 990 participants (60%) did not visit the eye clinic with their children for a routine eye exam. A total of 495 parents (30%), who were aware of amblyopia, knew of it mainly from eye clinic visits and from Internet websites. A total of 140 respondents reported that their children had amblyopia; 58.3% of those children underwent routine eye examinations once a year, and the rest underwent routine eye examinations twice a year. Conclusion: The results clearly showed a lack of amblyopia awareness among the Saudi community. This lack of awareness can lead to visual impairment among children. More efficient efforts are urgently needed from health professionals, education centres, the media and social organizations to promote awareness of amblyopia.
Decreasing Time to Initiation of Chemotherapy for Patients Electively Admitted to a Hematologic Malignancy Service
Authors: Galeas Jose N. , Packer Stuart , Browne Roy , Sakalian Susan , Binder Adam F. 
Published: August 2019

PURPOSE: Delays in initiating elective inpatient chemotherapy can decrease patient satisfaction and increase length of stay. At our institution, we observed that 86% of patients who were admitted for elective chemotherapy experienced a delay—more than 6 hours—with a median time to chemotherapy of 18.9 hours. We developed a process improvement initiative to improve time to chemotherapy for elective chemotherapy admissions. METHODS: Our outcome measure was the time from admission to chemotherapy administration in patients who were admitted for elective chemotherapy. Process measures were identified and monitored. We collected baseline data and used performance improvement tools to identify key drivers. We focused on these key drivers to develop multiple plan-do-study-act cycles to improve our outcome measure. Once we started an intervention, we collected data every 2 weeks to assess our intervention. RESULTS: At the time of interim analysis, we observed a median decrease in time to chemotherapy administration from 18.9 hours to 8.85 hours ( P = .005). Median time to laboratory results resulted decreased from 3.17 hours to 0.00 hours. There was no change in time from signing chemotherapy to nurse releasing the chemotherapy. We noted that more providers were signing the chemotherapy before patient admission. CONCLUSION: By implementing new admission workflows, optimizing our use of the electronic medical record to communicate among providers, and improving preadmission planning we were able to reduce our median time to chemotherapy for elective admissions by 53.2%. Improvement is still needed to meet our goals and to ensure the sustainability of these ongoing efforts.
Early Findings From the Oncology Care Model Evaluation
Authors: Brooks Gabriel A. , Jhatakia Shalini , Tripp Amanda , Landrum Mary Beth , Christian Thomas J. , Newes-Adeyi Gabriella , Cafardi Susannah , Hassol Andrea , Simon Carol , Keating Nancy L. 
Published: August 2019

PURPOSE: The Oncology Care Model (OCM) is an alternative payment model administered by the Centers for Medicare & Medicaid Services (CMS) that is structured around 6-month chemotherapy treatment episodes. This report describes the CMS-sponsored OCM evaluation and summarizes early evaluation findings. METHODS: The OCM evaluation examines health care spending and use, quality of care, and patient experience during chemotherapy treatment episodes. Because OCM participation is voluntary, the evaluation compares participating physician practices with a propensity-matched group of nonparticipating practices by using a difference-in-differences approach. This report examines 6-month episodes initiated during the first OCM performance period (July 1, 2016, through January 1, 2017). RESULTS: During the first OCM performance period, there was no statistically significant impact of OCM on total episode payments. There were small declines in intensive care unit (ICU) admissions (7 per 1,000 episodes) and emergency department visits (15 per 1,000 episodes); there was no statistically significant impact on hospitalizations or 30-day readmissions. Analyses of care quality and end-of-life care showed statistically significant impacts of OCM on the proportion of patients with inpatient hospitalizations in the last 30 days of life (1.5% absolute decrease) and ICU admissions in the last 30 days of life (2.1% decrease). There was no significant OCM impact on measures of hospice use. CONCLUSION: Early findings from the OCM evaluation demonstrate modest program-related impacts on some acute care services and no change in total episode payments. Early findings may not reflect practice redesign efforts that were phased in after the beginning of OCM.
Lavender Products Associated With Premature Thelarche and Prepubertal Gynecomastia: Case Reports and Endocrine-Disrupting Chemical Activities
Authors: Ramsey J Tyler , Li Yin , Arao Yukitomo , Naidu Ajanta , Coons Laurel A , Diaz Alejandro , Korach Kenneth S 
Published: August 2019

AbstractContextPrevious case reports associated prepubertal gynecomastia with lavender-containing fragrances, but there appear to be no reports of premature thelarche.ObjectiveTo add to a case series about lavender-fragranced product use and breast growth in children and to measure endocrine-disrupting chemical activity of essential oil components.Design, Setting, and PatientsPatients experiencing premature thelarche or prepubertal gynecomastia with continuous exposure to lavender-fragranced products were evaluated in the pediatric endocrinology departments of two institutions. Mechanistic in vitro experiments using eight components of lavender and other essential oils were performed at National Institute of Environmental Health Sciences.Main Outcome MeasuresCase reports and in vitro estrogen and androgen receptor gene expression activities in human cell lines with essential oils.ResultsThree prepubertal girls and one boy with clinical evidence of estrogenic action and a history of continuous exposure to lavender-containing fragrances were studied. Breast growth dissipated in all patients with discontinuation of the fragranced products. Some of the components tested elicited estrogenic and antiandrogenic properties of varying degrees.ConclusionWe report cases of premature thelarche that resolved upon cessation of lavender-containing fragrance exposure commonly used in Hispanic communities. The precise developmental basis for such conditions could be multifactorial. In vitro demonstration of estrogenic and antiandrogenic properties of essential oil components suggests essential oils in these cases could be considered a possible source and supports a possible link with idiopathic prepubertal breast development. Whether the level of lavender oil estrogenic potency is sufficient to cause these effects is unknown.
Mobile DNA in Endocrinology: LINE-1 Retrotransposon Causing Partial Androgen Insensitivity Syndrome
Authors: Batista Rafael Loch , Yamaguchi Katsumi , Rodrigues Andresa di Santi , Nishi Mirian Yumie , Goodier John L , Carvalho Luciani Renata , Domenice Sorahia , Costa Elaine M F , Kazazian Haig H , Mendonca Berenice Bilharinho 
Published: August 2019

Abstract

Context
Androgen insensitivity syndrome (AIS) is the most common cause of disorders of sex development in 46,XY individuals. It is an X-linked condition usually caused by pathogenic allelic variants in the androgen receptor (AR) gene. The phenotype depends on the AR variant, ranging from severe undervirilization (complete AIS) to several degrees of external genitalia undervirilization. Although 90% of those with complete AIS will have AR mutations, this will only be true for 40% of those with partial AIS (PAIS).

Objective
To identify the genetic etiology of AIS in a large multigenerational family with the PAIS phenotype.

Participants
Nine affected individuals with clinical and laboratory findings consistent with PAIS and a normal exonic AR sequencing

Settings
Endocrine clinic and genetic institute from two academic referral centers

Design
Analysis of whole exons of the AR gene, including splicing regions, was performed, followed by sequencing of the 5′untranslated region (UTR) of the AR gene. Detailed phenotyping was performed at the initial diagnosis and long-term follow-up, and circulating levels of steroid gonadal hormones were measured in all affected individuals. AR expression was measured using RT-PCR and cultured fibroblasts.

Results
All 46,XY family members with PAIS had inherited, in hemizygosity, a complex defect (∼1100 bp) in the 5′UTR region of the AR surrounded by a duplicated 18-bp sequence (target site duplication). This sequence is 99.7% similar to an active, long, interspersed element present on the X chromosome (AC002980; Xq22.2), which was inserted in the 5′UTR of the AR gene, severely reducing AR expression and leading to PAIS.

Conclusion
The molecular diagnosis of PAIS remains challenging. The genomic effect of retrotransposon mobilization should be considered a possible molecular cause of AIS and other AR diseases.
Carriers of a Classic CYP21A2 Mutation Have Reduced Mortality: A Population-Based National Cohort Study
Authors: Nordenström Anna , Svensson Johan , Lajic Svetlana , Frisén Louise , Nordenskjöld Agneta , Norrby Christina , Almqvist Catarina , Falhammar Henrik 
Published: August 2019

Abstract

Context
Congenital adrenal hyperplasia (CAH) is a common monogenic recessive disorder. It has been suggested that CYP21A2 deficiency is common because carriers may have a survival advantage, 1 in 15,000 in most populations. Carriers of CYP21A2 mutations typically do not have clinical symptoms but have a defined phenotype with a more prompt cortisol response to ACTH.

Objective
We investigated whether the mortality was lower, and determined the cause of death in carriers and population controls.

Design
A total of 1143 obligate carriers of a CYP21A2 mutation (561 men) were identified from the Swedish National CAH Registry, encompassing >700 patients and the Multi-Generation Registry to identify their parents. The mortality and cause of death were identified through the Swedish Cause of Death Registry. The hazard ratios (HRs) and 95% CIs were calculated. The results were compared with controls from the general population, matched for sex and age.

Results
The overall mortality was lower in carriers of a CYP21A2 mutation compared with the controls (HR 0.79; 95% CI, 0.678 to 0.917; P = 0.002). The difference was more marked among carriers of a more severe mutation. Infection as the cause of death was significantly lower (HR 0.65; 95% CI, 0.48 to 0.87; P < 0.01), particularly for death in pneumonia (HR 0.22; 95% CI, 0.06 to 0.88; P = 0.03). The lower overall mortality among women compared with men in the general population was confirmed among both carriers and controls.

Conclusion
Obligate CYP21A2 carriers of a classic mutation had a reduced mortality. Specifically, a possible reduced mortality due to pneumonia was seen.