bluuebunny/crossref_metadata_2025_split huggingface dataset:
Potential Hazards Not Communicated in Safety Data Sheets of Flavoring Formulations, Including Diacetyl and 2,3-Pentanedione
Authors: LeBouf Ryan F , Hawley Brie , Cummings Kristin J 
Published: October 2018

Abstract

Objectives
Workers using flavoring formulations containing diacetyl and 2,3-pentanedione may be at risk of inhalational exposure, as these volatile hazardous chemicals are emitted from the bulk material, especially at elevated temperatures. However, flavoring formulations that contain diacetyl and 2,3-pentanedione might not list these ingredients because they are generally recognized as safe to ingest, may be part of a proprietary mixture deemed a trade secret, or may not be required to be listed if they are present at &lt;1% composition. The objective of this study was to investigate whether potential inhalational hazards present in flavoring samples were reported as chemical ingredients on their corresponding safety data sheets (SDSs).

Methods
A convenience sample of 26 bulk liquid flavorings obtained from two coffee roasting and packaging facilities in the USA was analyzed for 20 volatile organic chemicals present in the headspaces of vials containing flavoring liquids using gas chromatography-mass spectrometry. Flavoring samples were included in the study if headspace analysis results and SDSs were available. Flavoring samples included hazelnut, French vanilla, amaretto, chocolate, and caramel as well as some flavoring mixtures containing added fruit flavors such as cherry and raspberry. The presence of a chemical in the flavoring formulation was then compared to the ingredient list on the SDSs.

Results
All the flavoring SDSs contained trade secret designations. None of the SDSs listed diacetyl or 2,3-pentanedione. Headspace analyte concentrations revealed that diacetyl was present in 21 of 26 samples (81%) with a maximum concentration of 5.84 × 104 µg m−3 in flavor 18 (caramel). 2,3-Pentanedione was present in 15 flavors (58%) with a maximum concentration of 3.79 × 105 µg m−3 in flavor 24 (oatmeal cookies).

Conclusions
A majority of the flavorings tested had diacetyl, 2,3-pentanedione, or both as volatile constituents in the headspace. These chemicals were not listed on the SDSs, but inclusion of diacetyl and 2,3-pentanedione on SDSs would serve to protect downstream users from unrecognized exposure and potential respiratory disease. The headspace technique presented here is a viable tool to rapidly screen for volatile hazardous chemicals that may be present in flavoring formulations. Facilities that use flavorings should be aware that constituents in flavorings may present a potential inhalational hazard even if not identified as such by the SDS. A precautionary approach is warranted when working with flavorings, including exposure monitoring and effective exposure control strategies such as containment and local exhaust ventilation.
Quantifying the Infectiousness of Post-Kala-Azar Dermal Leishmaniasis Toward Sand Flies
Authors: Mondal Dinesh , Bern Caryn , Ghosh Debashis , Rashid Masud , Molina Ricardo , Chowdhury Rajashree , Nath Rupen , Ghosh Prakash , Chapman Lloyd A C , Alim Abdul , Bilbe Graeme , Alvar Jorge 
Published: October 2018

AbstractBackgroundOn the Indian subcontinent, visceral leishmaniasis (VL) incidence is on track to reach elimination goals by 2020 in nearly all endemic districts. Although not included in official targets, previous data suggest post-kala-azar dermal leishmaniasis (PKDL) patients can act as an infection reservoir.MethodsWe conducted xenodiagnosis on 47 PKDL patients and 15 VL patients using laboratory-reared Phlebotomus argentipes. In direct xenodiagnosis, flies were allowed to feed on the patient’s skin for 15 minutes. For indirect xenodiagnosis, flies were fed through a membrane on the patient’s blood. Five days later, blood-fed flies were dissected and examined by microscopy and/or polymerase chain reaction (PCR). A 3-mm skin snip biopsy (PKDL) or venous blood (VL) was processed by quantitative PCR.ResultsTwenty-seven PKDL patients (57.4%) had positive results by direct and/or indirect xenodiagnosis. Direct was significantly more sensitive than indirect xenodiagnosis (55.3% vs 6.4%, P < .0001). Those with positive xenodiagnosis had median skin parasite loads >1 log10 unit higher than those with negative results (2.88 vs 1.66, P < .0001). In a multivariable model, parasite load, nodular lesions, and positive skin microscopy were significantly associated with positive xenodiagnosis. Blood parasite load was the strongest predictor for VL. Compared to VL, nodular PKDL was more likely and macular PKDL less likely to result in positive xenodiagnosis, but neither difference reached statistical significance.ConclusionsNodular and macular PKDL, and VL, can be infectious to sand flies. Active PKDL case detection and prompt treatment should be instituted and maintained as an integral part of VL control and elimination programs.
An Assessment of Potential Unintended Consequences Following a National Antimicrobial Stewardship Program in England: An Interrupted Time Series Analysis
Authors: Balinskaite Violeta , Bou-Antoun Sabine , Johnson Alan P , Holmes Alison , Aylin Paul 
Published: October 2018

Abstract

Background
The “Quality Premium” (QP) introduced in England in 2015 aimed to financially reward local healthcare commissioners for targeted reductions in primary care antibiotic prescribing. We aimed to evaluate possible unintended clinical outcomes related to this QP.

Methods
Using Clinical Practice Research Datalink and Hospital Episode Statistics datasets, we examined general practitioner (GP) consultations (visits) and emergency hospital admissions related to a series of predefined conditions of unintended consequences of reduced prescribing. Monthly age- and sex-standardized rates were calculated using a direct method of standardization. We used segmented regression analysis of interrupted time series to evaluate the impact of the QP on seasonally adjusted outcome rates.

Results
We identified 27334 GP consultations and >5 million emergency hospital admissions with predefined conditions. There was no evidence that the QP was associated with changes in GP consultation and hospital admission rates for the selected conditions combined. However, when each condition was considered separately, a significant increase in hospital admission rates was noted for quinsy, and significant decreases were seen for hospital-acquired pneumonia, scarlet fever, pyelonephritis, and complicated urinary tract conditions. A significant decrease in GP consultation rates was estimated for empyema and scarlet fever. No significant changes were observed for other conditions.

Conclusions
Findings from this study show that overall there was no significant association between the intervention and unintended clinical consequences, with the exception of a few specific conditions, most of which could be explained through other parallel policy changes or should be interpreted with caution due to small numbers.
Analysis and finite element discretization for optimal control of a linear fluid–structure interaction problem with delay
Authors: Peralta Gilbert , Kunisch Karl 
Published: October 2018

AbstractAn optimal control problem for a linearized fluid–structure interaction model with a delay term in the structural damping is analyzed. A distributed control acting on the fluid domain, structure domain or both is considered. The necessary optimality conditions are derived both for rough and smooth initial data. A parabolic regularization of the problem and its convergence are investigated. Finite element discretization for the regularized problem and error estimates are provided. Piecewise linear elements with bubble functions for the fluid and a discontinuous Galerkin scheme for the spatial and temporal discretizations are utilized respectively. Numerical experiments illustrating the theoretical results are given.
Explantation of Percutaneous Spinal Cord Stimulator Devices: A Retrospective Descriptive Analysis of a Single-Center 15-Year Experience
Authors: Simopoulos Thomas , Aner Moris , Sharma Sanjiv , Ghosh Priyanka , Gill Jatinder S 
Published: October 2018

AbstractObjectivesThe aims of this study were to identify the reasons for explanation of spinal cord stimulator (SCS) devices and to further quantify the proportions and time lines of these causes of explantation in order to determine improvement opportunities for the development of best practices.DesignRetrospective, single academic center.Materials and MethodsPatients who were implanted with percutaneous SCS devices from 2002 to 2015 and with follow-up available until the end of September 2017 were included in this retrospective chart analysis.ResultsOf the 356 patients trialed, 252 underwent implantation of an SCS device with a permanent to trial ratio of 71%. Of the patients who had a permanent implant, 50% had failed back surgery syndrome, 25% had complex regional pain syndrome, and 25% had other diagnoses. At the end of the study period, the explantation rate was 30%. The causes for explantation included biological complications (26.6%), paresthesia limitations or side effects (26.6%), hardware complications (13.3%), ineffective pain control (28%), and no further need for stimulation therapy (5.3%).ConclusionsDevice removal is not uncommon, and opportunities to enhance the long-term success of SCS devices do exist. These include modification of trialing methods, achieving better paresthesia overlay, using magnetic resonance imaging (MRI) conditional equipment, development of robust technologies and hardware to reduce equipment malfunction, and improving efficacy with new innovative wave forms.
“Forgive but Not Forget”: The Behavior of Relationship Banks When Firms Are in Distress*
Authors: Schäfer Larissa 
Published: October 2018

AbstractDo relationship banks help firms in distress? Combining a survey-based measure of relationship lending with unique credit registry data, I examine the effect of relationship lending on loan performance. I find that the same firm in the same time period is more likely to become delinquent on a relationship-based loan relative to a transaction-based loan. Higher delinquencies do not, however, result in more defaults or less loan recoveries for relationship banks when loans mature relative to transactional banks. Conditional on past delinquencies, relationship banks are more likely to offer follow-up financing and extract rents. Consistent with theory, relationship banks tolerate temporarily bad results, yet extract rents and secure future business in return. The paper provides new empirical evidence for rent extraction by relationship banks that have been lenient to distressed firms in the past.
Estimating Correlated Rates of Trait Evolution with Uncertainty
Authors: Caetano D S , Harmon L J 
Published: October 2018

AbstractCorrelated evolution among traits, which can happen due to genetic constraints, ontogeny, and selection, can have an important impact on the trajectory of phenotypic evolution. For example, shifts in the pattern of evolutionary integration may allow the exploration of novel regions of the morphospace by lineages. Here, we use phylogenetic trees to study the pace of evolution of several traits and their pattern of evolutionary correlation across clades and over time. We use regimes mapped to the branches of the phylogeny to test for shifts in evolutionary integration while incorporating the uncertainty related to trait evolution and ancestral regimes with joint estimation of all parameters of the model using Bayesian Markov chain Monte Carlo. We implemented the use of summary statistics to test for regime shifts based on a series of attributes of the model that can be directly relevant to biological hypotheses. In addition, we extend Felsenstein’s pruning algorithm to the case of multivariate Brownian motion models with multiple rate regimes. We performed extensive simulations to explore the performance of the method under a series of scenarios. Finally, we provide two test cases; the evolution of a novel buccal morphology in fishes of the family Centrarchidae and a shift in the trajectory of evolution of traits during the radiation of anole lizards to and from the Caribbean islands. [Anolis; Centrarchidae; comparative methods; evolutionary integration; evolutionary rates; modularity; pruning algorithm.]
Escalation and de-escalation in HER2 positive early breast cancer
Authors: Dieci Maria Vittoria , Vernaci Grazia , Guarneri Valentina 
Published: October 2018

Purpose of review
Current standard for HER2+ early breast cancer patients includes chemotherapy and trastuzumab for 1 year. The purpose of this article is to review available evidence on escalated treatment strategies for high-risk patients and de-escalated treatments for patients at low risk of relapse or high risk of cardiac toxicity.

Recent findings
Recent results have led to the approval of two adjuvant escalated treatment strategies: pertuzumab and trastuzumab combined with chemotherapy for up to 1 year for high-risk patients; extension of adjuvant anti-HER2 treatment with 1 year of neratinib. However, these treatments are associated with increased costs and toxicity, therefore careful patients’ selection is highly required. With regard to de-escalated treatments, the anthracycline-free regimen of adjuvant paclitaxel and 1 year trastuzumab has entered clinical practice for early-stage patients. One year of trastuzumab remains the standard; however, shorter trastuzumab could be an option for low-risk patients and in case of increased risk of cardiotoxocity. Chemotherapy-free regimens are attractive but deserve further evaluation.

Summary
There have been advances in treatment individualization for HER2+ early breast cancer patients. Integration of promising biomarkers into risk classification will further help progressing in the field.
Immunotherapy in patients with early stage resectable nonsmall cell lung cancer
Authors: Ghysen Katrien , Vansteenkiste Johan 
Published: October 2018

Purpose of review
‘Early-stage’ nonsmall cell lung cancer (NSCLC) refers to stage I and stage II disease, and selected cases of stage IIIA disease where complete tumor resection is feasible. Surgery is the standard treatment for early NSCLC, but the overall 5-year survival remains below 50%. The addition of adjuvant cisplatin-based chemotherapy to surgery improved 5-year survival rates by 5–10%, but no significant therapeutic innovation has been established thereafter. We review recent and ongoing studies looking how immunotherapy may improve the outcome of these patients.

Recent findings
Antigen-specific immunotherapy (cancer vaccination) did not fulfill its promise in a large phase III randomized trial in completely resected early-stage NSCLC. Over the past few years, immunotherapy with immune checkpoint inhibition (ICI) has led to remarkable progress in nononcogene addicted metastatic NSCLC. We review ongoing clinical investigations that want to translate these benefits to earlier stages of NSCLC. Both adjuvant and neoadjuvant large randomized controlled trials with ICI are ongoing.

Summary
Although from a mechanistic perspective the neoadjuvant administration may be preferred, it is crucial that both adjuvant and neoadjuvant trials are recruited as planned, to have a balanced view how ICI therapy may ultimately improve cure rates in these patients.
Beyond competencies: Practice standards for emergency nurse practitioners—A model for specialty care clinicians, educators, and employers
Authors: Ramirez Elda , Schumann Lorna , Agan Donna , Hoyt Karen Sue , Wilbeck Jennifer , Tyler Diane , Evans Dian Dowling 
Published: October 2018

ABSTRACT

Background/purpose:
The growth of advanced practice nursing specialties requires additional expertise for practice that goes beyond entry-level competencies, knowledge, skills, and abilities. A practice standards model for specialty nurse practitioners (PSMSNPs) is introduced that differentiates entry-to-practice population foci competencies from advanced specialty practice standards.

Objectives:
(a) Differentiate competencies and practice standards in context to specialty NPs using the emergency specialty as the exemplar, (b) articulate the process to develop the PSMSNP that evolved from an evidence-based practice analysis of NPs working in emergency care, (c) apply the PSMSNP for adaptation to other specialties, and (d) provide implications for the utilization of the PSMSNP by educators, clinicians, and employers.

Data sources:
American Academy of Nurse Practitioners Certification Board’s Practice Analysis of Emergency Nurse Practitioners, Consensus Model for APRN Regulation, Future of Nursing report, Peer Nursing Report, Strong Model of Advanced Practice, Entrustable Professional Activities, Emergency Medicine Milestones Project, and the Advancing Healthcare Transformation: A New Era for Academic Nursing report.

Conclusions:
The PSMSNP has been defined and adapted to other specialties and threaded through other models of practice for educators, clinicians, and employers. The adaptability of this model differentiates the core population foci and unique practice variables of specialty NPs. National boards of nursing, hospital credentialing committees, colleges, and universities can use this model to establish standards for specialty evaluation and guide clinical practice.

Implications for practice:
The implementation of the PSMSNP will support the delineation of the specialty. This model will fulfill the American Nurses Association and Consensus Model specialty constructs.
Continuous renal replacement therapy during extracorporeal membrane oxygenation: why, when and how?
Authors: Ostermann Marlies , Connor Michael , Kashani Kianoush 
Published: October 2018

Purpose of review
The use of extracorporeal membrane oxygenation (ECMO) is increasing rapidly. Patients on ECMO have a high risk of developing acute kidney injury (AKI) and needing renal replacement therapy (RRT). The aim of this review is to describe different strategies of combining RRT and ECMO and to outline their advantages and drawbacks.

Recent findings
Fluid overload is the most common indication for RRT during ECMO, and continuous renal replacement therapy (CRRT) is the most commonly used modality. The optimal timing for initiation of CRRT should be individualized based on degree of fluid overload and severity of AKI-related metabolic derangements. In ECMO patients, CRRT can be provided via an integrated approach (i.e. in-line haemofilter or a fully integrated CRRT device) or a parallel system with separate ECMO and RRT circuits. In-depth knowledge of the resulting intra-circuit pressure changes, risks of air entrapment and haemolysis, and implications for ultrafiltration and solute clearance are essential. There is no evidence that the different methods of combining ECMO and CRRT impact mortality.

Summary
In patients on ECMO, CRRT can be provided via an integrated approach or independently via parallel systems. An in-depth understanding of the advantages and drawbacks of the different techniques is required.
Feeding Interventions Are Associated With Improved Outcomes in Children With Laryngeal Penetration
Authors: Duncan Daniel R. , Larson Kara , Davidson Kathryn , May Kara , Rahbar Reza , Rosen Rachel L. 
Published: October 2018

ABSTRACTObjectives:To determine if children with laryngeal penetration on videofluoroscopic swallow study (VFSS) who received feeding interventions (thickened liquids, change in liquid flow rate, and/or method of liquid delivery) had improved symptoms and decreased hospitalizations compared with those without intervention.Methods:We performed a retrospective cohort study of children under 2 years with laryngeal penetration on VFSS at our institution in 2015 to determine initial and follow‐up VFSS findings, symptom improvement at follow‐up, and hospitalization risk before and after VFSS. Proportions were compared with Fisher exact test and hospitalizations with paired t tests.Results:We evaluated 137 subjects with age 8.93 ± 0.59 months who had laryngeal penetration without aspiration on VFSS. Fifty‐five percent had change in management, with 40% receiving thickening and 15% a change in flow rate. There was significant improvement in symptoms for children that had feeding intervention and this improvement was the greatest with thickening (OR 41.8, 95% CI 12.34–141.69, P < 0.001). On repeat VFSS, 26% had evidence of aspiration that was not captured on initial VFSS. Subjects had decreased total and pulmonary hospitalizations with feeding intervention and decreased pulmonary nights with thickening (P < 0.05).Conclusions:Laryngeal penetration appears to be clinically significant in children with oropharyngeal dysphagia and interventions to decrease its occurrence are associated with improved outcomes including decreased symptoms of concern and hospitalization nights. Thickening or other feeding intervention should be considered for all symptomatic children with laryngeal penetration on swallow study.
A Novel Donkey Milk–derived Human Milk Fortifier in Feeding Preterm Infants
Authors: Bertino Enrico , Cavallarin Laura , Cresi Francesco , Tonetto Paola , Peila Chiara , Ansaldi Giulia , Raia Melissa , Varalda Alessia , Giribaldi Marzia , Conti Amedeo , Antoniazzi Sara , Moro Guido E. , Spada Elena , Milani Silvano , Coscia Alessandra 
Published: October 2018

ABSTRACTObjectives:The purpose of the present randomized controlled clinical trial was to compare the use of donkey milk–derived fortifier (DF) with commercial bovine milk–derived fortifier (BF) in very preterm or very‐low‐birth‐weight newborns, in terms of feeding tolerance.Methods:This trial included 156 newborns born at <32 weeks of gestational age and/or with a birth weight ⩽1500 g. Newborns were randomized 1:1 to receive enteral feeding with either a BF‐arm, or a new, DF‐arm for 21 days. The fortification protocol was the same for both study arms, and the 2 diets were designed to be isoproteic and isocaloric. Feeding tolerance was assessed by a standardized protocol.Results:The risk of feeding intolerance tended to be lower in DF‐arm than in BF‐arm, with a relative risk reduction of 0.63 (95% confidence interval: −0.29, +0.90). The mean number of episodes per newborn of feeding intolerance and feeding interruptions (any duration) were consistently lower in the DF‐arm than in the BF‐arm. Episodes of bilious gastric residuals and vomiting were significantly lower in the DF‐arm. Time needed to reach full enteral feeding (150 mL · kg−1 · day−1) and daily weight increase between the first day of exclusive enteral feeding (ie, without administering intravenous fluids) and discharge were similar in the BF‐ and DF‐arms.Conclusions:These results suggest that DF improve feeding tolerance when compared with standard bovine‐derived fortifiers, with a similar auxological outcome.