bluuebunny/crossref_metadata_2025_split huggingface dataset:
ESTIMATION OF UNCERTAINTY IN MEASUREMENT OF DOSE EQUIVALENT AT LABORATORY LEVEL USING CASO4 :Dy-BASED TLD BADGE SYSTEM IN INDIA
Authors: Pradhan S M , Datta D , Pathan Munir S , Srivastava Kshama , Selvam T Palani 
Published: October 2019

Abstract
The objective of this paper is to estimate the combined uncertainty in the measurement of dose equivalent at laboratory level using CaSO4:Dy-based thermoluminescent dosemeter badge system by including variations in the components of the system. The variability of performance of the system is analysed using random effects one way analysis of variance model. The model enables estimation of the overall variance of the performance of the sampled population. The population in the study comprises all possible indicated dose equivalents on irradiation of dosemeters to a specific dose equivalent and radiation quality. Coefficient of variation and combined uncertainty at 95% level of confidence in the measurement of Hp(10) due to S-Cs radiation quality are found to be 6.6 and 14.3%, respectively, at the dose level of 5.31 mSv. The above parameters in the measurement of in-use quantity, i.e. whole body dose or photon dose equivalent are found to be 7.4 and 16.4%, respectively. The performance of the monitoring system on relative response has been observed to be satisfactory. Various factors affecting the variability of performance of the system are identified for further improvement in coefficient of variation.
CE: Infection in Acute Care: Evidence for Practice
Authors: Houghton Douglas 
Published: October 2019

ABSTRACT:
Infection may be either a cause for admission to an acute care hospital or health care associated, a complication of receiving care for another illness in the acute care environment. In recent years, there has been significant research investigating risk factors for infection in the hospital setting, best practices for diagnosis and treatment, and ways to prevent many health care–associated infections. Multidrug-resistant organisms are a consequence of antibiotic overuse, poor environmental hygiene, and our increasing ability to keep chronically ill patients alive longer through invasive intensive care support. This article reviews the evidence on infection in acute care settings, with a focus on community- and hospital-acquired pneumonia, surgical site infections, and Clostridioides difficile infection. Recommendations for integrating this evidence into nursing practice are offered.
Better Cardiac Arrest Outcomes in Hospitals with More Nurses with BSNs
Authors: Rosenberg Karen 
Published: October 2019

According to this study:

Patients who experience cardiac arrest in hospitals that have a higher proportion of nurses with BSNs and lower workloads have a better chance of surviving with good cerebral performance.On general units, each additional patient per nurse was associated with 17% lower odds of surviving to discharge with good cerebral performance.
Propofol and Sevoflurane Differentially Impact MicroRNAs in Circulating Extracellular Vesicles during Colorectal Cancer Resection
Authors: Buschmann Dominik , Brandes Florian , Lindemann Anja , Maerte Melanie , Ganschow Petra , Chouker Alexander , Schelling Gustav , Pfaffl Michael W. , Reithmair Marlene 
Published: October 2019

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Extracellular vesicles and their microRNA cargo are crucial facilitators of malignant cell communication and could mediate effects of anesthetics on tumor biology during cancer resection. The authors performed a proof-of-concept study to demonstrate that propofol and sevoflurane have differential effects on vesicle-associated microRNAs that influence signaling pathways involved in tumor progression and metastasis.

Methods
Circulating vesicles were investigated in a prospective, matched-case pilot study in two cohorts of colorectal cancer patients receiving either propofol (n = 8) or sevoflurane (n = 9), matched for tumor stage and location. Serum was sampled before anesthesia and after tumor resection. Vesicular microRNA profiles were analyzed by next generation sequencing and confirmed by real-time polymerase chain reaction. Next, we assessed perioperative changes in microRNA expression induced by either anesthetic and compared their biologic effects on tumor-relevant pathways. Additionally, vesicles from pre- and postoperative sera were biologic characterized.

Results
Postoperative microRNA profiles were shifted in both groups with overlap in the perioperative response. A total of 64 (48 up, range of log2 fold change 1.07 to 3.76; 16 down, −1.00 to −1.55) and 33 (32 up, 1.02 to 2.98; 1 down, −1.36) microRNAs were significantly regulated (adjusted P value less than 0.05) by propofol and sevoflurane, respectively. Thirty-six (propofol) and five (sevoflurane) microRNAs were specifically responsive to either anesthetic agent. In silico target analyses of microRNA expression patterns indicated an inhibitory effect of propofol on crucial carcinoma-related pathways such as proliferation (z-score, −1.73) and migration (z-score, −1.97), as well as enhanced apoptosis (z-score, 1.19). While size distribution and protein markers of circulating vesicles were not affected by anesthesia, their concentration was reduced after surgery using both anesthetic procedures.

Conclusions
This proof-of-concept study provides preliminary evidence that anesthetic agents have specific effects on microRNA profiles in circulating vesicles. These findings could form the basis for larger and mechanistically oriented outcome studies in cancer patients.
Creating Value by Prioritizing Mental and Social Health After Injury
Authors: Matkin Lars , Ring David 
Published: October 2019

Summary:
Given the strong influence of mental and social health on symptom intensity and magnitude of limitations, attempts to increase value in orthopedic trauma must attend to emotional and social recovery. Low value and potentially harmful interventions after trauma such as excessive reliance on medication, low value surgeries for “delayed healing” or “symptomatic implants,” repeated visits with a physical therapist, and other biomedical interventions often reflect misdiagnosis and mismanagement of social and mental health. A better approach is to anticipate emotional and social recovery; to get social and mental health specialists involved immediately after injury; and to develop strategies that set firm limits on biomedical tests and treatments that are unlikely to contribute to health and risk reinforcing stress, distress, and less effective coping strategies.
Valuing the Recovery Priorities of Orthopaedic Trauma Patients After Injury: Evidence From a Discrete Choice Experiment Within 6 Weeks of Injury
Authors: O'Hara Nathan N. , Mulliken Alexandra , Joseph Katherine , Slobogean Gerard P. , Johal Herman , Cunningham Brian P. , Olaya Stephan , Levy Joseph , Pollak Andrew N. , Klazinga Niek S. 
Published: October 2019

Objectives:
To determine the recovery priorities of extremity fracture patients during the subacute phase and the patient factors associated with variation in recovery priorities.

Design:
Discrete choice experiment.

Setting:
Academic trauma center.

Patients:
One hundred ninety-eight patients with a fracture to the appendicular skeleton. Patients with severe traumatic brain injuries, spinal cord injuries, and non–English-speaking patients were excluded.

Main Outcome Measurement:
The relative importance of clinical recovery, work-related recovery, and obtaining disability benefits after injury.

Results:
In the subacute period, clinical recovery was the main priority for fracture patients (mean: 62%, SD: 5.3). Work-related recovery (mean: 27%, SD: 3.9) and the receipt of other disability benefits (mean: 11%, SD: 6.4) were each of significantly less importance. Heterogeneity was observed across these estimates based on the physical demands of preinjury employment, preinjury physical health, preinjury work status, health insurance type, and the severity of the fracture.

Conclusion:
Clinical recovery was of paramount importance for fracture patients during the subacute recovery phase. However, patients also valued resuming work and access to disability benefits. Understanding a patient's recovery priorities early in the clinical care pathway will enable the development of multidisciplinary care plans that are responsive to these priorities and, hence, deliver value-based health care.

Level of Evidence:
Level V. See Instructions for Authors for a complete description of levels of evidence.
Survivor But Not Fully Recovered: The Lived Experience After 1 Year of Surviving Sepsis
Authors: Umberger Reba A. , Thomas Sandra P. 
Published: October 2019

Background
Hospital mortality rates related to sepsis have decreased over the last decade, increasing the number of survivors of sepsis who may experience long-term consequences. Yet, little is known about how they perceive their illness experience and its aftermath.

Objective
This study explores the experiences of sepsis survivors after 1 year of their index intensive care unit (ICU) stay.

Methods
This phenomenological study was guided by Merleau-Ponty's philosophy. Participants were adult patients admitted directly to the medical ICU with sepsis who had an ICU stay of at least 48 hours and had been discharged from their index ICU stay for at least 1 year. Participants were invited by letter to participate in face-to-face or telephone interviews and a brief survey. Interviews were audio recorded, transcribed verbatim, and verified. An interpretive group read transcripts aloud to increase rigor of identifying meaning units, existential grounds, and thematic structure.

Results
Eight participants were recruited over 20 months. Participants were primarily white (87.5%) females (75%) with an age range of 37 to 74 years who were interviewed between 1 and 2 years following an index sepsis ICU stay. Five major themes emerged from the transcripts: (1) how they survived, (2) blurring of time versus counting time by events, (3) helpful help versus unhelpful help, (4) powerless versus striving for control, and (5) survivor but not fully recovered.

Discussion
Findings reflected a long trajectory of chronic illness in which the index episode of sepsis was not necessarily what stood out as figural to participants. The meaning of participant experiences must be considered in the context of a health care system that offers little to no systematic follow-up care after sepsis and little prevention. Participants expressed a need for advocacy and follow-up support.
Safety and Efficacy of Nanosecond Pulsed Electric Field Treatment of Sebaceous Gland Hyperplasia
Authors: Munavalli Girish S. , Zelickson Brian D. , Selim Mona M. , Kilmer Suzanne L. , Rohrer Thomas E. , Newman James , Jauregui Lauren , Knape William A. , Ebbers Edward , Uecker Darrin , Nuccitelli Richard 
Published: October 2019

BACKGROUND
Nanosecond pulsed electric field (nsPEF) technology involves delivery of ultrashort pulses of electrical energy and is a nonthermal, drug-free technology that has demonstrated favorable effects on cellular structures of the dermis and epidermis.

OBJECTIVE
Determine the tolerability and effectiveness of nsPEF treatment of sebaceous gland hyperplasia (SGH).

METHODS
This study was a prospective, randomized, open-label, multisite, nonsignificant risk trial in which each subject served as their own control. After injection of local anesthetic, high-intensity, ultrashort pulses of electrical energy were used to treat 72 subjects resulting in a total of 222 treated lesions. Subjects returned for 3 to 4 follow-up evaluations with photographs.

RESULTS
At the final study visit, 99.6% of treated SGH lesions were rated clear or mostly clear and 79.3% of the subjects were satisfied or mostly satisfied with the outcome. At 60 days after nsPEF treatment, 55% of the lesions were judged to have no hyperpigmentation and 31% exhibited mild post-treatment hyperpigmentation. At the last observation for all lesions, 32% of the 222 lesions were noted as having slight volume loss.

CONCLUSION
Nanosecond pulsed electric field procedure is well tolerated and is very effective in the removal of SGHs.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03612570.
Repeated Full-Face Aesthetic Combination Treatment With AbobotulinumtoxinA, Hyaluronic Acid Filler, and Skin-Boosting Hyaluronic Acid After Monotherapy With AbobotulinumtoxinA or Hyaluronic Acid Filler
Authors: Cartier Hugues , Hedén Per , Delmar Henry , Bergentz Per , Skoglund Cecilia , Edwartz Carolina , Norberg Maria , Kestemont Philippe 
Published: October 2019

BACKGROUND
Full-face aesthetic treatment involving several treatment modalities may improve facial aesthetic outcome.

OBJECTIVE
To evaluate clinical outcomes and patient perceptions of monotherapy with either abobotulinumtoxinA (ABO) or hyaluronic acid (HA) filler followed by full-face combination treatments of ABO, HA filler, and skin-boosting HA (RSB).

MATERIALS AND METHODS
Subjects aged 35 to 50 years were randomized to monotherapy with 50 s.U ABO in the glabella or ≤1 mL HA filler in the nasolabial folds (NLFs)/cheeks. At Month 6 and Month 12, all subjects received combination treatment with ≤50 s.U ABO in the glabella, ≤2 mL HA filler in the NLFs/cheeks (and other facial areas as applicable), and ≤1 mL RSB (additional RSB treatment at Month 7). Assessments included global facial aesthetic appearance and improvement, first impression, perceived age, wrinkle severity, satisfaction questionnaires, and adverse events.

RESULTS
Repeated full-face combination treatment with ABO, HA filler, and RSB was associated with considerably higher levels of aesthetic improvement and subject satisfaction than monotherapy with ABO or HA filler. Improvement rate of glabellar lines was increasing with each treatment.

CONCLUSION
Repeated combination treatment achieved greater change in global facial aesthetic appearance than monotherapy. Aesthetic improvement and subject satisfaction was high and increased with each treatment. All treatments were well tolerated.
DNA: What's your story?
Authors: Jenkins Jean 
Published: October 2019

Abstract
This is a pivotal time in history. We now recognize the implications of our uniquely personal DNA blueprint (i.e., genetics/genomics) for health and illness, and scientific research is rapidly unraveling the secrets of what that blueprint personally means to each of us. Listening to what patients have to say about the use of DNA in their health care can strengthen your role in creating a new paradigm for education and service delivery. Stories are an amazing way to reach out, connect, and learn from others about what they are going through. Stories are important in highlighting the relevancy of DNA in clinical care for patients and providers. The power and potential of the patient voice is something I have been striving to capture as the reality of genomic healthcare unfolds (DNAandU.org). The knowledge base provided by DNA stories has great potential, but only if representative of the voices of many. Nurse practitioners have an important role in accessing stories to learn, to teach, to plan for the future, and to inspire possibilities.
Cochlear MRI Signal Change Following Vestibular Schwannoma Resection Depends on Surgical Approach
Authors: West Niels , Sass Hjalte Christian Reeberg , Møller Martin Nue , Cayé-Thomasen Per 
Published: October 2019

Objective:
Information on cochlear MRI signal change following vestibular schwannoma (VS) surgery by the retrolabyrinthine approach (RLA) is nonexisting, and information using the translabyrinthine approach (TLA) is scarce. We aimed to evaluate cochlear MRI fluid signal in patients with a unilateral VS, before and after surgery by the RLA or the TLA, that can have clinical importance for subsequent cochlear implantation feasibility.

Study Design:
Retrospective cohort study.

Setting:
University hospital.

Patients:
One hundred one patients with a unilateral VS.

Intervention:
VS resection by the TLA or the RLA. Pre- and postoperative T2-weighted MRI.

Main Outcome Measure:
Cochlear signal change using a semiquantitative system for grading cochlear asymmetry, with grades ranging from 1 (normal fluid signal both sides) to 4 (no fluid signal one side).

Results:
Seventy-four patients were operated by the TLA and 27 by the RLA. The number of cochleas with grade 3 and 4 asymmetries postoperative was significantly higher than preoperative. The postoperative proportions of grade 1 (TLA 20%, RLA 56%) and grade 2–4 asymmetry (TLA 80%, RLA 44%) were significantly different between the two groups. In the TLA group, 46 patients (62%) demonstrated an increased asymmetry postoperatively, as compared with three patients (11%) in the RLA group.

Conclusions:
Postoperative decrease of cochlear MRI fluid signal is more likely to occur after translabyrinthine surgery (occurring in 62%), as compared with retrolabyrinthine surgery (occurring in 11%). The decrease of cochlear signal may be due to compromised vascularity or fibrosis.
Bilobed Gracilis Flap: A Novel Alternative for Pelvic and Perineal Reconstruction
Authors: Weinstein Brielle , King Kathryn S. , Triggs Wilton , Harrington Michael A. , Pribaz Julian 
Published: October 2019

Summary:
Perineal reconstruction historically has been guided by the vertical rectus abdominis myocutaneous flap. In oncologic patients, because of prior surgical intervention, this donor site is often unavailable, the pelvis has been irradiated, and defects can be deep or irregularly contoured. Using plastic surgery principles of perforators, geometrically defined local tissue rearrangement, and flap inset, the authors have developed a modification of the gracilis flap to include a second soft-tissue arm similar to a bilobed flap. The authors performed five bilobed gracilis/medial circumflex femoral vascular pedicle myocutaneous flaps for perineal reconstruction secondary to oncologic defects and one secondary to Fournier gangrene at a tertiary care center. Oncologic patients had undergone adjuvant chemotherapy and radiation therapy and had compromised abdominal donor sites. Given their results, the authors recommend that a bilobed gracilis flap be used in patients with moderate to large defects, defects that require ample soft-tissue bulk, or in patients with limited abdominal donor sites.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Adrenalectomy Risk Score
Authors: Caiazzo Robert , Marciniak Camille , Lenne Xavier , Clément Guillaume , Theis Didier , Ménégaux Fabrice , Sebag Frederic , Brunaud Laurent , Lifante Jean Christophe , Mirallie Eric , Bruandet Amélie , Pattou François 
Published: October 2019

Objective:
To explore the determinants of postoperative outcomes of adrenal surgery in order to build a proposition for healthcare improvement.

Summary of Background Data:
Adrenalectomy is the recommended treatment for many benign and malignant adrenal diseases. Postoperative outcomes vary widely in the literature and their determinants remain ill-defined.

Methods:
We based this retrospective cohort study on the “Programme de médicalisation des systèmes d’information” (PMSI), a national database that compiles discharge abstracts for every admission to French acute health care facilities. Diagnoses identified during the admission were coded according to the French adaptation of the 10th edition of the International Classification of Diseases (ICD-10). PMSI abstracts for all patients discharged between January 2012 and December 2017 were extracted. We built an Adrenalectomy-risk score (ARS) from logistic regression and calculated operative volume and ARS thresholds defining high-volume centers and high-risk patients with the CHAID method.

Results:
During the 6-year period of the study, 9820 patients (age: 55 ± 14; F/M = 1.1) were operated upon for adrenal disease. The global 90-day mortality rate was 1.5% (n = 147). In multivariate analysis, postoperative mortality was independently associated with age ≥75 years [odds ratio (OR): 5.3; P < 0.001], malignancy (OR: 2.5; P < 0.001), Charlson score ≥2 (OR: 3.6; P < 0.001), open procedure (OR: 3.2; P < 0.001), reoperation (OR: 4.5; P < 0.001), and low hospital caseload (OR: 1.8; P = 0.010). We determined that a caseload of 32 patients/year was the best threshold to define high-volume centers and 20 ARS points the best threshold to define high-risk patients.

Conclusion:
High-risk patients should be referred to high-volume centers for adrenal surgery.
Targeting DNA repair in gliomas
Authors: Beckta Jason M. , Bindra Ranjit S. , Chalmers Anthony J. 
Published: October 2019

Purpose of review
Gliomas represent a disparate group of malignancies with varying clinical outcomes despite a tremendous amount of time, effort, and resources dedicated to their management and understanding. The most aggressive entity, glioblastoma, has a dismal prognosis with poor local control despite intense local and systemic treatment, including radiation therapy.

Recent findings
Given the heterogeneity in genotype, phenotype, and patient outcomes, researchers and clinicians have turned their attention toward attacking DNA damage response and repair mechanisms in gliomas in an effort to develop novel chemo and radiosensitizers. However, despite extensive work in both the laboratory and the clinic, no sensitizers have yet to emerge as clear options in the treatment of glioma, often because of meager preclinical data or an inability to penetrate the blood–brain barrier.

Summary
This review will examine current understanding of molecular DNA repair targets in glioma and their potential exploitation to improve local control and, ultimately, overall survival of patients afflicted with these diseases.
The semantic control network mediates the relationship between symbolic numerical order processing and arithmetic performance in children
Authors: Sommerauer Gerrit , Grass Karl-Heinz , Grabner Roland H. , Vogel Stephan E. 
Published: October 2019

AbstractBehavioral and neuroimaging studies have recently demonstrated that symbolic numerical order processing (i.e., deciding whether numbers are in an increasing/decreasing sequence or not) may engages different cognitive mechanisms and brain regions compared to symbolic numerical magnitude processing (e.g., deciding which of two numerals is larger). Because of this behavioral dissociation, growing interest has emerged to better understand the neurocognitive mechanisms of symbolic numerical order processing and their relationship to individual differences in arithmetic performance. In the present functional imaging work, we further investigated this link in a group of thirty children (7.2-10.25 years) from elementary school, who completed a symbolic numerical order verification (are the numbers going up? e.g., 1-2-3), a symbolic numerical magnitude comparison task (which is the larger number? e.g., 5-7), as well as an arithmetic fluency test outside the scanner. Behavioral results demonstrated the unique role of numerical order to predict children’s arithmetic skills and confirmed its mediating power to explain the association between numerical magnitude and arithmetic performance. Imaging results showed a significant association between numerical order and arithmetic in the intersection of the right inferior frontal gyrus and insula, as well as the posterior middle temporal gyrus. An age-dependent change in brain activity was found in the left intraparietal sulcus. These findings solidify the developmental importance of symbolic numerical order processing in children and provides new evidence that the semantic control network mediates the relationship with arithmetic performance.HighlightsReaction times of numerical order are a unique predictor of arithmetic (73)Numerical order mediates the relationship of numerical magnitude with arithmetic (83)Brain activation of numerical order processing changes with age in the left IPS (82)The semantic control network mediates the relationship with arithmetic (79)