bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Reliability to a Care Goal Rounding Template in the Pediatric Intensive Care Unit
Authors: Efune Proshad N. , Morse Rustin B. , Sheehan Maeve , Malone Loren M. , Robertson Tammy S. , Darnell Cindy 
Published: June 2019

Background:
Effective pediatric intensive care requires addressing many important aspects of care delivery during morning rounds, often achieved using a rounding checklist. Our objective was to develop a care goal rounding template and then double the reliability of discussion of rounding topics during morning rounds without the use of a checklist.

Methods:
The Institute for Healthcare Improvement Model for Improvement was used for this initiative. A care goal rounding template was established through discussions and consensus with pediatric intensive care unit (PICU) faculty. Rounds were audited in a blinded fashion over a 3-month period to obtain baseline data on rounding topic discussion. Three interventions were then trialed (plan, do, study, act cycles) over a 12-month period. Weekly reliability in rounding topic discussion was tracked.

Results:
Baseline reliability with discussion of rounding topics was 36%. The first intervention included the use of a standardized progress note in the electronic health record, which contained topics and served to prompt the discussion on rounds. The second intervention was implementation of laminated cards provided to PICU fellows highlighting the elements of the care goal rounding template. The third intervention addressed a standardized handoff sheet often used during rounds. Mean reliability for discussion of rounding topics improved to 52% shortly following the second intervention. Reliability was sustained more than 1 year later.

Conclusions:
Following the establishment of a PICU care goal rounding template and various interventions, the reliability in discussing important care goal elements on patient rounds improved.
Utilization of a Dual Surveillance Program to Reduce Surgical-site Infections
Authors: Song Xiaoyan , Oetgen Matthew E. , Magge Suresh N. , Berger John T. , Shah Rahul K. 
Published: June 2019

Background:
Surveillance plays a pivotal role in the surgical-site infections (SSIs) prevention through identifying infections, monitoring changes in infection rates, and evaluating the effectiveness of intervention strategies.

Methods:
This retrospective study reviewed SSI surveillance systems implemented at the Children’s National Health System in 3 phases between 2007 and 2016 including all surgical procedures. The targeted surveillance was conducted in cardiovascular, spinal fusion, and ventricular shunt surgeries and required an infection preventionist (IP) to review all procedures, to identify SSIs that meet the CDC’s National Healthcare Safety Network definition. SSIs in the remaining surgical procedures were identified through the review of positive microbiology reports daily and followed by full chart review if the specimen type and/or patient location were suggestive of a surgical history. Timely feedback of SSI to stakeholders was the primary mode of intervention, with additional interventions implemented for the 3 targeted surveillance procedures. Data collected between 2013 and 2016 were analyzed to account for a definition change in 2013.

Results:
For the 3 targeted surveillance procedures, IP reviewed 2,255 procedures and identified 43 SSIs. For the remaining procedures, IPs identified 123 SSIs confirmed by one or more pathogens. The overall SSI rate had a 31% decrease. The cardiovascular and spinal fusion SSI rate had a 61% and 84% decrease, respectively. The ventricular shunt SSI rate increased 29% due to 2 episodes of recurrent infections in 2 patients.

Conclusions:
It is prudent for hospitals to continue monitoring SSI by establishing surveillance programs with optimal approaches.
A Quality Improvement Intervention to Decrease Hypothermia in the Delivery Room Using a Checklist
Authors: Vinci Alexandra , Islam Shahidul , Quintos-Alegheband Lyn , Hanna Nazeeh , Nayak Amrita 
Published: June 2019

Introduction:
Premature babies are at increased risk of hypothermia, core body temperature <97°F. Delivery room environment may contribute and lead to complications. The objective was to reduce hypothermia in babies <32 weeks of gestation in the delivery room to <40% using a checklist and sustain it for 6 months.

Methods:
We created a delivery room checklist in 2012. Chart review established a baseline rate of hypothermia (<97°F). The team analyzed the checklist’s effect on hypothermia from 2012 to 2018 and utilized numerous interventions to maintain compliance. Chi-square test and Fisher’s exact test analyzed hypothermia and hyperthermia as a balancing measure. All calculations performed in SAS 9.3.

Results:
The checklist reduced hypothermia from a baseline of 50% in 2011 (n = 104) to 33% in 2012 (n = 106). In 2013, the proportion of hypothermia slightly increased to 36% (n = 81). The year 2014 brought larger drift, and proportion of hypothermia increased to 44% (n = 117). In 2015, we reinforced the use of the checklist and proportion of hypothermia improved to 36% (n = 99). Further interventions through 2018 decreased hypothermia further to 14% to achieve statistical significance.

Conclusions:
A checklist is a simple tool that may yield beneficial changes in practice and helped to decrease the proportion of neonatal hypothermia.
Development of a Standardized Approach for the Assessment of Bowel and Bladder Dysfunction
Authors: Wang Rebecca , Kanani Ronik , El Bardisi Yara , Mistry Niraj , Dos Santos Joana 
Published: June 2019

Introduction:
Bowel and bladder dysfunction (BBD) is a common pediatric condition that describes a constellation of lower urinary tract symptoms (LUTS) associated with constipation. Many children with BBD have comorbid neuropsychiatric and psychosocial concerns that are not routinely assessed. The aim of quality improvement (QI) was to establish a comprehensive assessment for BBD by developing and evaluating (1) a standardized clinician assessment form and (2) parent-reported questionnaire.

Methods:
From July 2017 to April 2018, a prospective QI study was conducted in the BBD network. A standardized assessment form was developed based on literature review and expert opinions, with targeted sections for LUTS, constipation, and psychosocial history. Before clinic, families of children referred for BBD were given a questionnaire to clarify voiding, stooling, and dietary patterns. Physicians utilized the assessment form for new referrals. Afterward, both physicians and parents evaluated the assessment process anonymously.

Results:
A total of 15 physicians and 45 parents responded, with 67% of patients being between 4 and 10 years old and 51% male. Physicians responded that the assessment form reminded them to ask about specific LUTS (93%), constipation (87%), and psychosocial history (87%). Parents responded positively by agreeing that they felt included in care decisions (96%) and had questions answered appropriately (100%). Only 47% found the previsit package easy to complete.

Conclusions:
In pediatric BBD consultations, a standardized assessment form can guide clinicians to efficiently gather a comprehensive history and screen for psychosocial risk factors. It can empower more pediatricians to evaluate BBD in the future.
Improving Thermal Support in Very and Extremely Low Birth Weight Infants during Interfacility Transport
Authors: McNellis Emily M. , Leonard Amy R. , Thornton Kimberly A. , Voos Kristin C. 
Published: June 2019

Introduction:
Review of very low birth weight (VLBW) and extremely low birth weight (ELBW) neonates transported by our specialized pediatric/neonatal transport team revealed hypothermia in up to 52% of admissions. This project aimed to decrease the incidence of hypothermia in VLBW and ELBW neonates requiring transport between facilities from 52% to <20% over 1 year.

Methods:
In response to gaps in knowledge and barriers to care revealed by a survey administered to transport personnel, we used a standard quality improvement plan-do-study-act model to introduce new equipment and a comprehensive thermoregulation protocol via standardized education. The primary outcome measure was the incidence of hypothermia (axillary temperature < 36.5°C) in transported VLBW and ELBW neonates. The process measure was compliance with the protocol. The balancing measures were unintended hyperthermia and transport team ground time. Transport personnel were updated on progress via meetings and run charts.

Results:
We reduced the incidence of hypothermia to 17% in 1 year. Compliance with the protocol improved from 60% to 76%. There was no increase in unintended hyperthermia (5% preintervention, 4% intervention, 7% surveillance, P = 0.76) or transport team ground time (in hours) (1.2 ± 0.9 preintervention versus 1.3 ± 0.8 intervention versus 1.2 ± 0.7 surveillance, P = 0.2).

Conclusions:
Quality improvement methods were used to develop an evidence-based, standardized approach to thermal support in VLBW and ELBW neonates undergoing transport between facilities. Following the implementation of this approach, we achieved the desired percent decrease in the incidence of hypothermia.
Impacting Satisfaction, Learning, and Efficiency Through Structured Interdisciplinary Rounding in a Pediatric Intensive Care Unit: A Quality Improvement Project
Authors: Lopez Merrick , Vaks Yana , Wilson Michele , Mitchell Kenneth , Lee Christina , Ejike Janeth , Oei Grace , Kaufman Danny , Hambly Jamie , Tinsley Cynthia , Bahk Thomas , Samayoa Carlos , Pappas James , Abd-Allah Shamel 
Published: June 2019

Background:
Daily rounds in many pediatric intensive care units (PICUs) vary in quality, duration, and participation. We hypothesized that implementing structured interdisciplinary bedside rounds (SIBR®) would improve our rounding process.

Methods:
This was a quality improvement initiative in a 25-bed multidisciplinary PICU in a tertiary children’s hospital. Baseline data included rounding duration; participation of nurses, respiratory care practitioners (RCP), parents; and physician order read-back practices. Interventions were implementing pre-rounding huddles, changing the start of the rounding week, and instituting a SIBR model. All staff, consecutive patients and parents participated over 18 months. We used Mann-Whitney, z-test, and t-tests for statistical analysis with a significance level of 0.05. We tracked data with a statistical process control chart.

Results:
Rounds participation increased for nurses (88% to 100%), RCPs (13% to 61%), and families (24% to 49%) (all p <0.001). Physician order read-back increased (41% to 79%) (p<0.001). The median length of stay (LOS) decreased from 2.1 to 1.9 days (p=0.004) with no changes in mortality or readmissions. The proportion of top responses from family surveys increased from 0.69 to 0.76 (p<0.001). PICU rounding duration (minutes/patient) decreased from 17.1 to 11.3. Most resident physicians felt SIBR positively impacted their education (70%), was more effective than rounds without structure (97%), and that family presence positively impacted learning (70%).

Conclusions:
Implementing a SIBR process in our PICU resulted in greater family and staff satisfaction, improved workflow and decreased rounding time by 34% without compromising education. LOS decreased significantly with no increases in mortality or readmissions.
Eating junk-food has opposite effects on intrinsic excitability of nucleus accumbens core medium spiny neurons in obesity-susceptible vs. -resistant rats
Authors: Oginsky Max F. , Ferrario Carrie R. 
Published: June 2019

AbstractThe nucleus accumbens (NAc) plays critical roles in motivated behaviors, including food-seeking and feeding. Differences in NAc function contribute to over-eating that drives obesity, but the underlying mechanisms are poorly understood. In addition, there is a fair degree of variation in individual susceptibility vs. resistance to obesity that is due in part to differences in NAc function. For example, using selectively bred obesity-prone and obesity-resistant rats, we have found that excitability of medium spiny neurons within the NAc core is enhanced in obesity-prone vs. resistant populations, prior to any diet manipulation. However, it is unknown whether consumption of sugary, fatty junk-food alters MSN excitability. Here, whole-cell patch clamp recordings were conducted to examine MSN intrinsic excitability in adult male obesity-prone and obesity-resistant rats with and without exposure to a sugary, fatty junk-food diet. We replicated our initial finding that basal excitability is enhanced in obesity-prone vs. obesity-resistant rats and determined that this is due to a lower IA in prone vs. resistant groups. In addition, the junk-food diet had opposite effects on excitability in obesity-prone vs. obesity-resistant rats. Specifically, junk-food enhanced excitability in MSNs of obesity-resistant rats; this was mediated by a reduction in IA. In contrast, junk-food reduced excitability in MSNs from obesity-prone rats; this was mediated by an increase in IKIR. Thus, individual differences in obesity-susceptibility influence both basal excitability and how MSN excitability adapts to junk-food consumption.
A Web Service for Assessing Insect Abundances for Meadow Birds by Image Analysis
Authors: Michels Ricardo , Vos Rutger 
Published: June 2019

AbstractMeadow birds are a group of species native to the Netherlands characterized by breeding in meadows that has been in decline over the last several decades, despite widespread conservation efforts. Agricultural intensification is thought to be one of the main causes of this decline, but no yearly data exists on the surrounding ecology of these birds. Recent efforts have tried to assess the food supply of meadow birds by setting sticky traps and counting the number of insects caught on them. However, this approach cannot be applied on a large scale since counting the insects is very labour intensive and unappealing to the volunteers that contribute to this research. To get a better assessment of the food supply at a larger scale, we present a system to automate counting of insects on sticky traps. The system is intended to process uploaded images and metadata using computer vision techniques to determine the number of insects found in photographs taken from the sticky traps.
An intact keratin network is crucial for mechanical integrity and barrier function in keratinocyte cell sheets
Authors: Karsch Susanne , Büchau Fanny , Magin Thomas M. , Janshoff Andreas 
Published: June 2019

AbstractThe isotype-specific composition of the keratin cytoskeleton is important for strong adhesion, force resilience, and barrier function of the epidermis. However, the mechanisms by which keratins regulate these functions are still incompletely understood. In this study, the role and significance of the keratin network for mechanical integrity, force transmission, and barrier formation were analyzed in murine keratinocytes. Following the time-course of single-cell wounding, wildtype (WT) cells slowly closed the gap in a collective fashion involving tightly connected neighboring cells. In contrast, the mechanical response of neighboring cells was compromised in keratin-deficient cells, causing an increased wound area initially and an inefficient overall wound closure. Furthermore, the loss of the keratin network led to impaired, fragmented cell-cell junctions and triggered a profound change in the overall cellular actomyosin architecture. Electrical cell-substrate impedance sensing of cell junctions revealed a dysfunctional barrier in knockout (Kty−/−) compared to WT cells. These findings demonstrate that Kty−/−cells display a novel phenotype characterized by loss of mechanocoupling and failure to form a functional barrier. Re-expression of K5/K14 rescued the barrier defect to a significant extent and reestablished the mechanocoupling with remaining discrepancies likely due to the low abundance of keratins in that setting. Our study reveals the major role of the keratin network for mechanical homeostasis and barrier functionality in keratinocyte layers.
An analysis of avian vocal performance at the note and song levels
Authors: Logue David M. , Sheppard Jacob A. , Walton Bailey , Brinkman Benjamin E. , Medina Orlando J. 
Published: June 2019

AbstractSexual displays that require extreme feats of physiological performance have the potential to reliably indicate the signaller’s skill. The hypothesis that the structure of bird song is physiologically constrained remains controversial. We tested for evidence of performance constraints in Adelaide’s warblers (Setophaga adelaidae) songs. At the note level, we identified three trade-offs with well-defined limits. At the song level, we identified two trade-offs, but their limits were less well-defined than the note-level limits. Trade-offs at both levels suggest that song structure is constrained by limits to the speed of both frequency modulation (while vocalizing and between notes) and respiration. Individual males experience the same trade-offs that characterize the population, but the intensity of those trade-offs varies among individuals. Performance metrics derived from the observed limits to performance varied moderately among individuals and strongly among song types. Note-level performance metrics were positively skewed, as predicted by the hypothesis that this population has experienced positive selection for constrained performance. We conclude that physiological limits on frequency modulation and respiration constrain song structure in male Adelaide’s warblers. Further work is needed to determine whether receivers respond to natural levels of variation in performance, and whether performance correlates with singer quality.
Revisiting the Origin of the Octoploid Strawberry
Authors: Liston Aaron , Wei Na , Tennessen Jacob , Li Junmin , Dong Ming , Ashman Tia-Lynn 
Published: June 2019

AbstractThe cultivated strawberry, Fragaria ×ananassa, originated in France approximately 270 years ago via hybridization between two wild species introduced from North and South America. Both the cultivated strawberry and its parental species are octoploids with 2n=8x=56 chromosomes. In the recent publication of the genome of the cultivated strawberry, the authors present a novel phylogenetic hypothesis, proposing that each of the four subgenomes originated from a different 2n=2x=14 diploid progenitor. They further suggest that the hexaploid species Fragaria moschata was a direct ancestor of the strawberries. We reanalyzed the four octoploid subgenomes in a phylogenomic context, and found that only two extant diploids were progenitors, a result that is consistent with several previous studies. We also conducted a phylogenetic analysis of genetic linkage-mapped loci in the hexaploid F. moschata, and resolved its origin as independent of the octoploids. We identified assumptions in their tree-searching algorithm that prevented it from accepting extinct or unsampled progenitors, and we argue that this is a critical weakness of their approach. Correctly identifying their diploid progenitors is important for understanding and predicting the responses of polyploid plants to climate change and associated environmental stress.
Targeting the oncogene LSF with either the small molecule inhibitor FQI1 or siRNA causes mitotic delays with unaligned chromosomes, resulting in cell death or senescence
Authors: Willoughby Jennifer L.S. , George Kelly , Roberto Mark P. , Chin Hang Gyeong , Stoiber Patrick , Shin Hyunjin , Pedamallu Chandra Sekhar , Schaus Scott E. , Fitzgerald Kevin , Shah Jagesh , Hansen Ulla 
Published: June 2019

AbstractBackgroundThe oncogene LSF (encoded byTFCP2) has been proposed as a novel therapeutic target for multiple cancers. LSF overexpression in patient tumors correlates with poor prognosis in particular for both hepatocellular carcinoma and colorectal cancer. The limited treatment outcomes for these diseases underscore the need for molecularly targeting novel mechanisms. LSF small molecule inhibitors, Factor Quinolinone Inhibitors (FQIs), have exhibited robust anti-tumor activity in multiple mouse models, with no observable toxicity.MethodsCell proliferation and cell cycle progression were analyzed after loss of LSF activity, using HeLa cells as a model cancer cell line responsive to FQI1. In addition, results were compared after treatment with either FQI1 or siRNA targeting LSF to test for biological specificity of targeting LSF by FQI1.ResultsCellular phenotypes observed upon FQI1 treatment were due specifically to the loss of LSF activity, as siRNA targeting LSF produced highly similar phenotypes. Inhibition of LSF activity by either mechanism induced a strong delay prior to metaphase during progression through mitosis, with condensed, but unaligned, chromosomes. This mitotic disruption resulted in improper cellular division leading to multiple outcomes: multi-nucleation, apoptosis, and cellular senescence.ConclusionsSpecific inhibition of LSF by small molecules or siRNA results in mitotic defects, leading to cell death or senescence - consequences that are desirable in combating cancer. Taken together, these findings not only confirm that LSF is a promising target for cancer treatment, but also that FQIs are promising compounds for obtaining therapeutic effects for multiple LSF-driven cancers with unmet medical need.
Characterizing the temporal dynamics of gene expression in single cells with sci-fate
Authors: Cao Junyue , Zhou Wei , Steemers Frank , Trapnell Cole , Shendure Jay 
Published: June 2019

AbstractGene expression programs are dynamic, e.g. the cell cycle, response to stimuli, normal differentiation and development, etc. However, nearly all techniques for profiling gene expression in single cells fail to directly capture the dynamics of transcriptional programs, which limits the scope of biology that can be effectively investigated. Towards addressing this, we developed sci-fate, a new technique that combines S4U labeling of newly synthesized mRNA with single cell combinatorial indexing (sci-), in order to concurrently profile the whole and newly synthesized transcriptome in each of many single cells. As a proof-of-concept, we applied sci-fate to a model system of cortisol response and characterized expression dynamics in over 6,000 single cells. From these data, we quantify the dynamics of the cell cycle and glucocorticoid receptor activation, while also exploring their intersection. We furthermore use these data to develop a framework for inferring the distribution of cell state transitions. We anticipate sci-fate will be broadly applicable to quantitatively characterize transcriptional dynamics in diverse systems.