bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tibetan Refugee Journeys: Representations of Escape and Transit
Authors: Frilund Rebecca 
Published: June 2019

Abstract
This ethnographic study contributes to the scholarly call to increase studies on refugee journeys. It explores Tibetan journeys via Nepal to India and provides a novel case study about the Tibetan refugees who commonly cross the Himalayas at least partly on foot without passports and head to the Tibetan Reception Centre in Kathmandu, Nepal, from where they are assisted to India. Conceptually, the study argues that combining the studies of refugee journeys and transit migration increases understanding of the (Tibetan) refugee journeys. The findings reveal that the risky journey has a remarkable meaning both for those Tibetans who have done the journey and collectively for the diaspora Tibetans in India. As Tibetans, like refugees in general are still often victimised and their subjectivities overlooked, the study also contributes to a fuller understanding of the Tibetan refugee agency through the journey narratives of the interviewees of this study.
Neural correlates of theory-of-mind are associated with variation in children’s everyday social cognition
Authors: Mukerji Cora E , Lincoln Sarah Hope , Dodell-Feder David , Nelson Charles A , Hooker Christine I 
Published: June 2019

ABSTRACT
Theory of mind (ToM), the capacity to reason about others’ mental states, is central to healthy social development. Neural mechanisms supporting ToM may contribute to individual differences in children’s social cognitive behavior. Employing a false belief functional magnetic resonance imaging paradigm, we identified patterns of neural activity and connectivity elicited by ToM reasoning in school-age children (N = 32, ages 9–13). Next, we tested relations between these neural ToM correlates and children’s everyday social cognition. Several key nodes of the neural ToM network showed greater activity when reasoning about false beliefs (ToM condition) vs non-mentalistic false content (control condition), including the bilateral temporoparietal junction (RTPJ and LTPJ), precuneus (PC) and right superior temporal sulcus. In addition, children demonstrated task-modulated changes in connectivity among these regions to support ToM relative to the control condition. ToM-related activity in the PC was negatively associated with variation in multiple aspects of children’s social cognitive behavior. Together, these findings elucidate how nodes of the ToM network act and interact to support false belief reasoning in school-age children and suggest that neural ToM mechanisms are linked to variation in everyday social cognition.
Effects of low- and high-intensity exercise on emotional face processing: an fMRI face-matching study
Authors: Schmitt Angelika , Martin Jason Anthony , Rojas Sandra , Vafa Ramin , Scheef Lukas , Strüder Heiko Klaus , Boecker Henning 
Published: June 2019

Abstract
Physical exercise has positive effects on mood and it reduces clinical depression and states of anxiety. While previous work mostly used subjective measures to study the effect of exercise upon emotions, this study for the first time employed blood oxygen level dependent functional magnetic resonance imaging (fMRI) to unravel associated neuronal changes of the emotional face-processing network in response to acute exercise. A total of 25 male athletes underwent fitness assessments to define two standardized 30 min exercise interventions (low and high intensity). The Positive and Negative Affect Schedule (PANAS) was completed pre- and post-exercise and neuronal responses to neutral, happy and fearful facial expressions were determined using an fMRI-based face-matching paradigm. Complete data sets were acquired in 21 participants (mean age, 27.2 ± 4.2 years). Both exercise interventions induced significant increases of the PANAS positive affect scale. Modulations of brain activation patterns following acute exercise were found only for fearful facial stimuli vs forms: reduced brain activation in posterior cingulate cortex/precuneus for the low condition and reduced activity in caudate nucleus and ventral anterior putamen for the high condition. In conclusion, this study provides first in vivo evidence that acute strenuous exercise interferes with emotional face-processing brain regions in an emotion type-specific manner.
Redistribution in a joint income–wealth perspective: A cross-country comparison
Authors: Kuypers Sarah , Figari Francesco , Verbist Gerlinde 
Published: June 2019

Abstract
Redistribution is usually understood in terms of income, as a resource used to rank individuals as well as determine tax liabilities or benefit entitlements. Yet, it is increasingly argued that more prominence should be given to the joint distribution of income and wealth and interest into the taxation of wealth for redistributive purposes has largely increased. By including income and wealth data from the Eurosystem Household Finance and Consumption Survey into the tax–benefit microsimulation model EUROMOD, we add two novel aspects to the literature. First, we include the analysis of taxes on wealth and wealth transfers. Second, we evaluate redistributive effects of tax–benefit systems against the joint income–wealth distribution instead of income only. We show that expressing living standards in terms of both income and wealth results in considerable reranking of individuals, which in turn leads to a lower redistributive impact of tax–benefit systems than is traditionally considered.
Fully exposed canopy tree and liana branches in a tropical forest differ in mechanical traits but are similar in hydraulic traits
Authors: Zhang Lan , Chen Yajun , Ma Keping , Bongers Frans , Sterck Frank J 
Published: June 2019

AbstractLarge lianas and trees in the forest canopy are challenged by hydraulic and mechanical failures and need to balance hydraulic conductivity, hydraulic safety and mechanical safety. Our study integrates these functions in canopy branches to understand the performance of canopy trees and lianas, and their difference. We sampled and measured branches from 22 species at a canopy crane in the tropical forest at Xishuangbanna, SW China. We quantified the hydraulic conductivity from the xylem-specific hydraulic conductivity (KS), hydraulic safety from the cavitation resistance (P50) and mechanical safety from the modulus of rupture (MOR) to evaluate trade-offs and differences between lianas and trees. We also measured a number of anatomical features that may influence these three functional traits. Our results suggest the following: trade-offs between hydraulic conductivity, hydraulic safety and mechanical safety are weak or absent; liana branches better resist external mechanical forces (higher MOR) than tree branches; and liana and tree branches were similar in hydraulic performance (KS and P50). The anatomical features underlying KS, P50 and MOR may differ between lianas and trees. We conclude that canopy branches of lianas and trees diverged in mechanical design due to fundamental differences in wood formation, but converged in hydraulic design.
Set of Quality Indicators of Pediatric Intensive Care in Spain: Delphi Method Selection
Authors: Hernández-Borges Angel A. , Pérez-Estévez Elena , Jiménez-Sosa Alejandro , Concha-Torre Andrés , Ordóñez-Sáez Olga , Sánchez-Galindo Amelia C. , Murga-Herrera Vega , Balaguer-Gargallo Mónica , Nieto-Moro Montserrat , Pujol-Jover Montserrat , Aleo-Luján Esther 
Published: June 2019

Introduction:
This study objective was to identify, select, and define a basic set of quality indicators for pediatric intensive care in Spain.

Methods:
(1) Review of the literature to identify quality indicators and their defining elements and (2) selection of indicators by consensus of a group of experts using basic Delphi methodology (2 rounds) and forms distributed by email among experts from the Spanish society of pediatric intensive care.

Results:
We selected quality indicators according to their relevance and feasibility and the experts’ agreement on their incorporation in the final set. We included only those indicators whose assessment was within the highest tertile and greater than or equal to 70% evaluator agreement in the final selection. Starting from an initially proposed set of 136 indicators, 31 experts first selected 43 indicators for inclusion in the second round. Twenty indicators were selected for the final set. This “top 20” set comprised 9 process indicators, 9 of results (especially treatment-associated adverse effects), and 2 indicators of structure. Several of them are classical indicators in intensive care medicine (rates of hospital-acquired infections, pressure ulcers, etc.), whereas others are specifically pediatric (eg, unrestricted parent visitation or training the parents of technology-dependent children).

Conclusions:
We reached a consensus on a set of 20 essential quality indicators for pediatric intensive care in Spain. A significant subset reflects the peculiarities of pediatric care. We consider this subset as a starting point for future projects of network collaboration between pediatric intensive care units in Spain.
Reduced Necrotizing Enterocolitis after an Initiative to Promote Breastfeeding and Early Human Milk Administration
Authors: Feinberg Michelle , Miller Lynn , Engers Barbara , Bigelow Kathy , Lewis Ann , Brinker Shannon , Kurland Fran , Potthoff Elizabeth , Wallin Melynda , Pantoja Alfonso , Britton John R. 
Published: June 2019

Introduction:
We sought to reduce the incidence of necrotizing enterocolitis (NEC) in premature infants (PI) by fostering the postnatal establishment of protective intestinal bacteria through early administration of human milk (HM) and probiotics.

Methods:
A multidisciplinary team implemented an initiative to support breastfeeding (BF) and provide early postnatal supplemental donor human milk (DHM) and probiotics to PI. Interventions included process improvements in milk preparation, storage, and fortification. PI admitted to our NICU between 2006 and 2015 were monitored for feeding of HM, DHM, and preterm formula (PF), frequency of early feedings, and incidence of NEC.

Results:
Retrospective review of 2557 cases revealed post-initiative increases in the percentage of PI receiving HM (91.5% to 96.1%), HM within 48 hours of birth (75% to 90.6%), and DHM (17.7% to 71.9%). The percentage of infants receiving feedings on day one increased from 23.9% to 44.6% while the percentage receiving PF within the first 72 hours declined (31.2% to 10.3%). The NEC rate declined from 4.1% to 0.4%. Reduction in NEC occurred despite a simultaneous increase in perinatal antibiotic exposure and the universal but late administration of bovine HM fortifier. The improvement associated with the decrease in NEC included initiation of probiotic administration, a reduction in PF feeding, and improvements in milk preparation, storage, and fortification processes.

Conclusions:
Early exclusive feedings of HM and avoidance of PF together with probiotics and milkhygiene may decrease NEC in PI. Neither brief perinatal antibiotic exposure nor late introduction of bovine fortifiers appears detrimental in this context.
Pediatric Gastrostomy Tube Placement: Lessons Learned from High-performing Institutions through Structured Interviews
Authors: Berman Loren , Hronek Carla , Raval Mehul V. , Browne Marybeth L. , Snyder Charles L. , Heiss Kurt F. , Rangel Shawn J. , Goldin Adam B. , Rothstein David H. 
Published: June 2019

Introduction:
Gastrostomy tube (GT) placement is one of the most common operations performed in children, and it is plagued by high complication rates. Previous studies have shown variation in readmission and emergency room visit rates across different children’s hospitals, with both low and high outliers. There is an opportunity to learn how to optimize outcomes by identifying practices at high-performing institutions.

Methods:
Surgeons and nurses routinely involved in GT care at 8 high-performing pediatric centers were identified. We conducted structured interviews focusing on the approach to GT education, technical aspects of GT placement, and postoperative management. Summary statistics were performed on quantitative data, and the open-ended responses were analyzed by 2 independent reviewers using content analysis.

Results:
Several common practices among high-performing centers were identified (standardized approach to education, availability by phone and in clinic to manage GT-related issues, and empowering families to feel confident with troubleshooting and dealing with GT problems). There was substantial variation in operative technique and postoperative care. The participants expressed that technical aspects of operative placement and postoperative management of feedings and common complications are not as important as education, availability, and empowerment in optimizing outcomes.

Conclusions:
We have identified common themes among pediatric centers with favorable outcomes after GT placement. Identifying which components of GT care are associated with optimal outcomes is critical to our understanding of current practice and may help identify opportunities to improve care quality.
Quality Improvement in Pediatric Head Trauma with PECARN Rules Implementation as Computerized Decision Support
Authors: Atabaki Shireen M. , Jacobs Brian R. , Brown Kathleen M. , Shahzeidi Samira , Heard-Garris Nia J. , Chamberlain Meghan B. , Grell Robert M. , Chamberlain James M. 
Published: June 2019

Background:
For the 1.4 million emergency department (ED) visits for traumatic brain injury (TBI) annually in the United States, computed tomography (CT) may be over utilized. The Pediatric Emergency Care Applied Research Network developed 2 prediction rules to identify children at very low risk of clinically important TBI. We implemented these prediction rules as decision support within our electronic health record (EHR) to reduce CT.

Objective:
To test EHR decision support implementation in reducing CT rates for head trauma at 2 pediatric EDs.

Methods:
We compared monthly CT rates 1 year before [preimplementation (PRE)] and 1 year after [postimplementation (POST)] decision support implementation. The primary outcome was change in CT use rate over time, measured using statistical process control charts. Secondary analyses included multivariate comparisons of PRE to POST. Balancing measures included ED length of stay and returns within 7 days after ED release.

Results:
There were 2,878 patients with head trauma (1,329 PRE and 1,549 POST) included. Statistical process control charts confirmed decreased CT rates over time POST that was not present PRE. Secondary statistical analyses confirmed that CT scan utilization rates decreased from 26.8% to 18.9% (unadjusted Odds Ratio [OR], 0.64; 95% Confidence Interval [CI], 0.53 -0.76; adjusted OR, 0.71; 95% CI, 0.58 -0.86). Length of stay was unchanged. There was no increase in returns within 7 days and no significant missed diagnoses.

Conclusions:
Implementation of EHR-integrated decision support for children with head trauma presenting to the ED is associated with a decrease in CT utilization and no increase in significant safety events.
A Quality Improvement Intervention Reduces the Time to Administration of Stat Medications
Authors: Stephen Gigimol , Moran Dane , Broderick Joan , Shaikh Hanan A. , Tschudy Megan M. , Connors Cheryl , Williams Tammy , Pham Julius C. 
Published: June 2019

Introduction:
The delivery of urgent (“stat”) medications to hospitalized children is important for safe quality care. The goal of this study was to evaluate the effect of a set of interventions on the percentage of stat medications administered within 30 minutes of ordering.

Methods:
A pre–post study in 2 pediatric units (36 beds) in a private hospital in Saudi Arabia between January 2015 and September 2016. Interventions included structured communication requirements, introduction of a dedicated electronic inbox for stat medication orders sent by nurses to the pharmacy, and the use of a pink envelope for the delivery of stat medications. A multivariate logistic regression model was used to model percentage of medications administered within goal.

Results:
Three hundred four stat orders met inclusion criteria. The proportion of orders meeting the 30-minute goal increased from a mean of 20% to a mean of 49% after the interventions (P < 0.001). In the final month of the study, compliance reached a peak of 67%. The mean turnaround time from ordering to the administration of the medication decreased from 59.7 to 40.7 minutes (P < 0.001). On multivariate analysis, medication type and unit-based availability of medications were statistically significant predictors of turnaround time. The odds of compliance being achieved was 0.3 times less if the medication was not available on the unit.

Conclusions:
A set of interventions significantly increased the percentage of stat medications delivered within 30 minutes.
A Retrospective Review to Determine If Children with Sickle Cell Disease Receive Hydroxyurea Monitoring
Authors: Creary Susan E. , O’Brien Sarah H. , Stanek Joseph , Hankins Jane S. , Garee Amy , Ball Kyle R. , Andrews Tina M. , Chisolm Deena J. 
Published: June 2019

Introduction:Sickle cell disease guidelines recommend that patients on hydroxyurea receive monitoring at least every 2–3 months, but it is unknown if this occurs in clinical practice. This study aimed to determine if patients with sickle cell disease at Nationwide Children’s Hospital had at least 4, in-person monitoring visits during a 12-month period and if frequent monitoring was associated with hydroxyurea adherence and clinical outcomes.Methods:We performed a retrospective analysis of children on hydroxyurea for at least 12 months during 2010–2015. Patients’ demographics, laboratory studies, prescriptions, and number of hydroxyurea and acute visits were recorded from their 12-month period that met eligibility criteria. Patients were considered frequently monitored if they had ≥ 4 hydroxyurea visits and adherent if they had prescriptions for hydroxyurea for ≥ 80% of the days in their 12-month period.Results:Seventy-four children met the eligibility criteria and 57 (77%) had frequent monitoring. The most common reason for not obtaining frequent monitoring was missing a scheduled appointment. A greater proportion of frequently monitored patients were adherent to hydroxyurea (66.7% versus 17.7%;P< 0.001), and they had significantly fewer acute visits (median 1 versus 2 visits;P= 0.032) compared with infrequently monitored patients.Conclusions:Our study shows that most children on hydroxyurea at Nationwide Children’s Hospital received frequent monitoring and that it was associated with improved adherence and outcomes. Our results suggest that frequent in-person monitoring could be an opportunity to identify poorly adherent patients. These data inform our next quality improvement initiative that will maximize adherence to these monitoring guidelines.
Long-Term Sustainability of Timely Emergency Department Analgesia for Fractures: A Time Series Study
Authors: Sterrett Emily C. , Murtagh Kurowski Eileen , Byczkowski Terri L. 
Published: June 2019

Objectives:
To determine the long-term sustainability and unintended consequences of a quality improvement project to improve the timeliness of intravenous (IV) opioid administration to patients with long-bone extremity fractures within a dynamic pediatric emergency department.

Methods:
A retrospective study of patients with long-bone extremity fractures was conducted using electronic medical record data from 2007 to 2014. The primary outcome was the percentage of patients receiving timely IV opioids. Control charts and time series models were used to determine if changes in the clinical microenvironment were associated with shifts in the outcome measure. Unintended consequences included patients receiving potentially avoidable IVs and use of the quality improvement process for patients without long-bone extremity fractures.

Results:
Improved timeliness of IV opioids was sustained. The type of physician who staffed the process and optimization of faculty staffing hours were associated with a 9.6% decrease and 11.8% increase in timely IV opioids, respectively. Implementation of the IV opioid process was not associated with increased placement of potentially avoidable IVs. Of patients receiving the IV opioid process, 22% did not have a long-bone extremity fracture, of whom 91% were diagnosed with a different painful injury.

Conclusion:
Sustainability of IV opioid timeliness was robust, despite changes in the clinical microenvironment. Changes in physician staffing and responsibilities in a pediatric emergency department may be especially important to consider when planning future improvement initiatives. Our findings support the importance of higher reliability interventions, such as identification and utilization of existing patterns of behavior, as high yield for sustaining outcomes.
Feasibility of Episode-Based Bundled Payment for a Pediatric Surgical Condition: Posterior Spinal Fusion
Authors: Shaughnessy Erin E. , Sturm Peter , Sitzman Thomas J. 
Published: June 2019

Introduction:
Episode-based bundled payment (EBBP) is an alternative model of health-care payment that aims to align providers’ and hospitals’ incentives toward delivery of more coordinated, higher quality, and lower cost care. EBBP programs have been studied for numerous adult conditions over the past decade, yet there have been no studies exploring the use of EBBP in pediatric conditions.

Methods:
This article explores the feasibility of EBBP for a relatively common, costly, pediatric surgical procedure: spinal fusion for adolescent idiopathic scoliosis. We begin with a review of successful EBBP programs in the United States. We then apply American College of Surgeons criteria for bundled payment episode selection to identify benefits and challenges of using EBBP for this condition.

Results:
We identify several features of pediatric spinal fusion that make it an attractive EBBP target: high variability in costs with multiple distinct targets for cost reduction, high variability in quality across hospitals, and proven methods for improvement via application of standardized, evidence based pathways. We find that challenges to EBBP may arise due to the relatively low incidence of the procedure, which limits overall savings to the health-care community.

Conclusions:
Our results suggest that spinal fusion for adolescent idiopathic scoliosis is an attractive pediatric target for EBBP, with potential benefits to patients, providers, health systems, and payers if limitations in procedure volume and administrative expense are overcome. The framework presented may also be useful for analyzing feasibility of EBBP for other pediatric conditions.