bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality Improvement Initiatives to Reduce Mortality: An Opportunity to Engage Palliative Care and Improve Advance Care Planning
Authors: Flieger Signe Peterson , Spatz Erica , Cherlin Emily J. , Curry Leslie A. 
Published: August 2018

Background: Despite substantial efforts to integrate palliative care and improve advance care planning, both are underutilized. Quality improvement initiatives focused on reducing mortality may offer an opportunity for facilitating engagement with palliative care and advance care planning. Objective: In the context of an initiative to reduce acute myocardial infarction (AMI) mortality, we examined challenges and opportunities for engaging palliative care and improving advance care planning. Methods: We performed a secondary analysis of qualitative data collected through the Leadership Saves Lives initiative between 2014 and 2016. Data included in-depth interviews with hospital executives, clinicians, administrators, and quality improvement staff (n = 28) from 5 hospitals participating in the Mayo Clinic Care Network. Focused analysis examined emergent themes related to end-of-life experiences, including palliative care and advance care planning. Results: Participants described challenges related to palliative care and advance care planning in the AMI context, including intervention decisions during an acute event, delivering care aligned with patient and family preferences, and the culture around palliative care and hospice. Participants proposed strategies for addressing such challenges in the context of improving AMI quality outcomes. Conclusions: Clinicians who participated in an initiative to reduce AMI mortality highlighted the challenges associated with decision-making regarding interventions, systems for documenting patient goals of care, and broader engagement with palliative care. Quality improvement initiatives focused on mortality may offer a meaningful and feasible opportunity for engaging palliative care. Primary palliative care training is needed to improve discussions about patient and family goals of care near the end of life.
Sexual health and health‐related quality of life among women with pulmonary arterial hypertension
Authors: Banerjee Debasree , Vargas Sara E. , Guthrie Kate M. , Wickham Brittany M. , Allahua Melissa , Whittenhall Mary E. , Palmisciano Amy J. , Ventetuolo Corey E. 
Published: August 2018

Pulmonary arterial hypertension (PAH) is characterized by progressive limitations in physical activity and health‐related quality of life (HRQoL). HRQoL deficits may extend beyond the traditional domains of physical activity, psychological health, and emotional wellbeing to sexual health and function. Sexual HRQoL has not been studied in PAH, nor has the impact of PAH therapies themselves on sexual health and intimacy. In this initial investigation, we sought to explore HRQoL among women diagnosed with PAH and to determine if PAH treatment type (intravenous or subcutaneous prostanoids versus oral medications) was associated with levels of self‐reported HRQoL assessed by validated measures for PAH‐specific, general, and sexual HRQoL. We administered the emPHasis‐10, Short Form (SF)‐36, Female Sexual Dysfunction Scale‐Revised (FSDS‐R), and the Arizona Sexual Experience Scale (ASEX) to 35 women with self‐reported World Health Organization Group 1 PAH at the 2016 Pulmonary Hypertension Association International Conference and Scientific Sessions. HRQoL instruments demonstrated excellent internal reliability. Women with PAH had high levels of sexual distress captured with the FSDS‐R scale. The FSDS‐R (but not ASEX) was significantly correlated to emPHasis‐10 (r = 0.64, p < 0.01) and most SF‐36 domains (r = − 0.36 to − 0.64, p < 0.05). Participants treated with intravenous or subcutaneous prostanoids had higher (worse) FSDS‐R scores than those on oral therapies while ASEX, emPHasis‐10, and SF‐36 scores were similar across treatment types. Sexual HRQoL may impact overall quality of life in PAH and specific assessment of sexual health and functioning within intimate relationships may detect deficits in wellbeing not addressed by established HRQoL metrics. Further study to address all aspects of HRQoL in PAH is required.
Right ventricular afterload predicts long‐term transition from parenteral to oral treprostinil in pulmonary arterial hypertension
Authors: Maestas Travis , Hansen Lillian M. , Vanderpool Rebecca R. , Desai Ankit A. , Airhart Sophia , Knapp Shannon M. , Cohen Adam , Feldman Jeremy , Rischard Franz P. 
Published: August 2018

Despite the increasing trends, reports on long‐term follow‐up are limited on transitioning from parenteral to oral treprostinil therapy in patients with pulmonary arterial hypertension (PAH). We investigated both the effectiveness of parenteral to oral treprostinil transition and the characteristics associated with transition failure over a duration of two years. The study included 37 Group I functional class I and II patients with PAH on combination therapy. Patients were excluded if cardiac index ≤2.2 L/min/m2, right atrial pressure ≥11 mmHg, or 6‐min walk distance ≤250 m. Patients were categorized as successful (STransition) or unsuccessful (UTransition) transition based on clinical stability, or a parenteral comparator (CParenteral) if they remained on parenteral therapy (no transition). All patients underwent two right heart catheterizations, one at enrollment and a second post transition. Of 24 total transition patients, 46% were classified as UTransition. UTransition occurred on average 577 days post transition. Both UTransition and STransition had similar hemodynamics at diagnosis and treprostinil dose before and after transition. Before transition, the pulmonary vascular resistance (PVR) was significantly higher in the UTransition (6.7 ± 2 WU) vs. STransition group (3.5 ± 1.5 WU). At follow‐up catheterization, the UTransition group demonstrated further increases in PVR, greater than the CParenteral group, without recovery despite “rescue” therapy in the UTransition group. A pre‐transition PVR of 4.16 WU discriminated the UTransition from the STransition group. While a subset of PAH patients on combination therapy may be safely transitioned from parenteral to oral treprostinil, caution should be exercised in patients with elevated baseline PVR to avoid irreversible destabilization.
Impact of Baseline Steroids on Efficacy of Programmed Cell Death-1 and Programmed Death-Ligand 1 Blockade in Patients With Non–Small-Cell Lung Cancer
Authors: Arbour Kathryn C. , Mezquita Laura , Long Niamh , Rizvi Hira , Auclin Edouard , Ni Andy , Martínez-Bernal Gala , Ferrara Roberto , Lai W. Victoria , Hendriks Lizza E.L. , Sabari Joshua K. , Caramella Caroline , Plodkowski Andrew J. , Halpenny Darragh , Chaft Jamie E. , Planchard David , Riely Gregory J. , Besse Benjamin , Hellmann Matthew D. 
Published: August 2018

Purpose Treatment with programmed cell death-1 or programmed death ligand 1 (PD-(L)1) inhibitors is now standard therapy for patients with lung cancer. The immunosuppressive effect of corticosteroids may reduce efficacy of PD-(L)1 blockade. On-treatment corticosteroids for treatment of immune-related adverse events do not seem to affect efficacy, but the potential impact of baseline corticosteroids at the time of treatment initiation is unknown. Clinical trials typically excluded patients who received baseline corticosteroids, which led us to use real-world data to examine the effect of corticosteroids at treatment initiation. Methods We identified patients who were PD-(L)1–naïve with advanced non–small-cell lung cancer from two institutions—Memorial Sloan Kettering Cancer Center and Gustave Roussy Cancer Center—who were treated with single-agent PD-(L)1 blockade. Clinical and pharmacy records were reviewed to identify corticosteroid use at the time of beginning anti–PD-(L)1 therapy. We performed multivariable analyses using Cox proportional hazards regression model and logistic regression. Results Ninety (14%) of 640 patients treated with single-agent PD-(L)1 blockade received corticosteroids of ≥ 10 mg of prednisone equivalent daily at the start of the PD-(L)1 blockade. Common indications for corticosteroids were dyspnea (33%), fatigue (21%), and brain metastases (19%). In both independent cohorts, Memorial Sloan Kettering Cancer Center (n = 455) and Gustave Roussy Cancer Center (n = 185), baseline corticosteroids were associated with decreased overall response rate, progression-free survival, and overall survival with PD-(L)1 blockade. In a multivariable analysis of the pooled population, adjusting for smoking history, performance status, and history of brain metastases, baseline corticosteroids remained significantly associated with decreased progression-free survival (hazard ratio, 1.3; P = .03), and overall survival (hazard ratio, 1.7; P < .001). Conclusion Baseline corticosteroid use of ≥ 10 mg of prednisone equivalent was associated with poorer outcome in patients with non–small-cell lung cancer who were treated with PD-(L)1 blockade. Prudent use of corticosteroids at the time of initiating PD-(L)1 blockade is recommended.
ANGUSTIFOLIA contributes to the regulation of three-dimensional morphogenesis in the liverwort Marchantia polymorpha
Authors: Furuya Tomoyuki , Hattori Koro , Kimori Yoshitaka , Ishida Sakiko , Nishihama Ryuichi , Kohchi Takayuki , Tsukaya Hirokazu 
Published: August 2018

ABSTRACT
Arabidopsis thaliana mutants deficient in ANGUSTIFOLIA (AN) exhibit several phenotypes at the sporophyte stage, such as narrow and thicker leaves, trichomes with two branches, and twisted fruits. It is thought that these phenotypes are caused by abnormal arrangement of cortical microtubules (MTs). AN homologs are present in the genomes of diverse land plants, including the basal land plant Marchantia polymorpha, and their molecular functions have been shown to be evolutionarily conserved in terms of the ability to complement the A. thaliana an-1 mutation. However, the roles of ANs in bryophytes, the life cycle of which includes a dominant haploid gametophyte generation, remain unknown. Here, we have examined the roles of AN homologs in the model bryophyte M. polymorpha (MpAN). Mpan knockout mutants showed abnormal twisted thalli and suppressed thallus growth along the growth axis. Under weak blue light conditions, elongated thallus growth was observed in wild-type plants, whereas it was suppressed in the mutants. Moreover, disordered cortical MT orientations were observed. Our findings suggest that MpAN contributes to three-dimensional morphogenesis by regulating cortical MT arrangement in the gametophytes of bryophytes.
ROCK-nmMyoII, Notch and Neurog3 gene-dosage link epithelial morphogenesis with cell fate in the pancreatic endocrine-progenitor niche
Authors: Bankaitis Eric D. , Bechard Matthew E. , Gu Guoqiang , Magnuson Mark A. , Wright Christopher V. E. 
Published: August 2018

ABSTRACT
During mouse pancreas organogenesis, endocrine cells are born from progenitors residing in an epithelial plexus niche. After a period in a lineage-primed Neurog3LO state, progenitors become endocrine committed via upregulation of Neurog3. We find that the Neurog3LO to Neurog3HI transition is associated with distinct stages of an epithelial egression process: narrowing the apical surface of the cell, basalward cell movement and eventual cell-rear detachment from the apical lumen surface to allow clustering as nascent islets under the basement membrane. Apical narrowing, basalward movement and Neurog3 transcriptional upregulation still occur without Neurog3 protein, suggesting that morphogenetic cues deployed within the plexus initiate endocrine commitment upstream or independently of Neurog3. Neurog3 is required for cell-rear detachment and complete endocrine-cell birth. The ROCK-nmMyoII pathway coordinates epithelial-cell morphogenesis and the progression through Neurog3-expressing states. NmMyoII is necessary for apical narrowing, basalward cell displacement and Neurog3 upregulation, but all three are limited by ROCK activity. We propose that ROCK-nmMyoII activity, Neurog3 gene-dose and Notch signaling integrate endocrine fate allocation with epithelial plexus growth and morphogenesis, representing a feedback control circuit that coordinates morphogenesis with lineage diversification in the endocrine-birth niche.
Impaired Recent, but Preserved Remote, Autobiographical Memory in Pediatric Brain Tumor Patients
Authors: Sekeres Melanie J. , Riggs Lily , Decker Alexandra , de Medeiros Cynthia B. , Bacopulos Agnes , Skocic Jovanka , Szulc-Lerch Kamila , Bouffet Eric , Levine Brian , Grady Cheryl L. , Mabbott Donald J. , Josselyn Sheena A. , Frankland Paul W. 
Published: August 2018

Medulloblastomas, the most common malignant brain tumor in children, are typically treated with radiotherapy. Refinement of this treatment has greatly improved survival rates in this patient population. However, radiotherapy also profoundly affects the developing brain and is associated with reduced hippocampal volume and blunted hippocampal neurogenesis. Such hippocampal (as well as extrahippocampal) abnormalities likely contribute to cognitive impairments in this population. While several aspects of memory have been examined in this population, the impact of radiotherapy on autobiographical memory has not previously been evaluated. Here we evaluated autobiographical memory in male and female patients who received radiotherapy for posterior fossa tumors (PFTs), including medulloblastoma, during childhood. Using the Children's Autobiographical Interview, we retrospectively assessed episodic and nonepisodic details for events that either preceded (i.e., remote) or followed (i.e., recent) treatment. For post-treatment events, PFT patients reported fewer episodic details compared with control subjects. For pretreatment events, PFT patients reported equivalent episodic details compared with control subjects. In a range of conditions associated with reduced hippocampal volume (including medial temporal lobe amnesia, mild cognitive impairment, Alzheimer's disease, temporal lobe epilepsy, transient epileptic amnesia, frontal temporal dementia, traumatic brain injury, encephalitis, and aging), loss of episodic details (even in remote memories) accompanies hippocampal volume loss. It is therefore surprising that pretreatment episodic memories in PFT patients with reduced hippocampal volume are retained. We discuss these findings in light of the anterograde and retrograde impact on memory of experimentally suppressing hippocampal neurogenesis in rodents.SIGNIFICANCE STATEMENTPediatric medulloblastoma survivors develop cognitive dysfunction following cranial radiotherapy treatment. We report that radiotherapy treatment impairs the ability to form new autobiographical memories, but spares preoperatively acquired autobiographical memories. Reductions in hippocampal volume and cortical volume in regions of the recollection network appear to contribute to this pattern of preserved preoperative, but impaired postoperative, memory. These findings have significant implications for understanding disrupted mnemonic processing in the medial temporal lobe memory system and in the broader recollection network, which are inadvertently affected by standard treatment methods for medulloblastoma tumors in children.
Šeimos politikos problemos Lietuvoje: prieš tai buvusių tyrimų analizė
Authors: Senkuvienė Kristina 
Published: August 2018

[straipsnis, santrauka, reikšminiai žodžiai lietuvių kalba; santrauka ir reikšminiai žodžiai anglų kalba]
Straipsnyje analizuojamos šeimos politikos problemos remiantis Lietuvoje per šalies nepriklausomybės laikotarpį mokslininkų atliktais tyrimais ir statistine analize. Šeimos politikos problemoms nagrinėti pasirinkti trys analitiniai „laukai“, atskleidžiantys reikšmingus šeimos politikos rezultatus: moterų įsitraukimą į darbo rinką, vaikų skurdą ir lyčių lygybę. Straipsnio skyriuose analizuojama, kaip šalyje veikiančios paramos šeimai priemonės atsiliepia šiems šeimos politikos aspektams, su kokiomis pagrindinėmis problemomis susiduriama siekiant šeimos politikos tikslų. Daroma išvada, kad valstybė įgyvendinti pagrindinius šeimos politikos tikslus gali tik užtikrindama tvarią ir stabilią šeimos politiką, orientuotą į savarankiškai šeimai funkcio­nuoti būtinų sąlygų kūrimą.
Predicting Escalated Care in Infants With Bronchiolitis
Authors: Freire Gabrielle , Kuppermann Nathan , Zemek Roger , Plint Amy C. , Babl Franz E. , Dalziel Stuart R. , Freedman Stephen B. , Atenafu Eshetu G. , Stephens Derek , Steele Dale W. , Fernandes Ricardo M. , Florin Todd A. , Kharbanda Anupam , Lyttle Mark D. , Johnson David W. , Schnadower David , Macias Charles G. , Benito Javier , Schuh Suzanne ,   for the Pediatric Emergency Research Networks (PERN)
Published: August 2018

BACKGROUND AND OBJECTIVES:
Early risk stratification of infants with bronchiolitis receiving airway support is critical for focusing appropriate therapies, yet the tools to risk categorize this subpopulation do not exist. Our objective was to identify predictors of “escalated care” in bronchiolitis. We hypothesized there would be a significant association between escalated care and predictors in the emergency department. We subsequently developed a risk score for escalated care.

METHODS:
We conducted a retrospective cohort study of previously healthy infants aged &lt;12 months with bronchiolitis. Our primary outcome was escalated care (ie, hospitalization with high-flow nasal cannula, noninvasive or invasive ventilation, or intensive care admission). The predictors evaluated were age, prematurity, day of illness, poor feeding, dehydration, apnea, nasal flaring and/or grunting, respiratory rate, oxygen saturation, and retractions.

RESULTS:
Of 2722 patients, 261 (9.6%) received escalated care. Multivariable predictors of escalated care were oxygen saturation &lt;90% (odds ratio [OR]: 8.9 [95% confidence interval (CI) 5.1–15.7]), nasal flaring and/or grunting (OR: 3.8 [95% CI 2.6–5.4]), apnea (OR: 3.0 [95% CI 1.9–4.8]), retractions (OR: 3.0 [95% CI 1.6–5.7]), age ≤2 months (OR: 2.1 [95% CI 1.5–3.0]), dehydration (OR 2.1 [95% CI 1.4–3.3]), and poor feeding (OR: 1.9 [95% CI 1.3–2.7]). One of 217 (0.5%) infants without predictors received escalated care. The risk score ranged from 0 to 14 points, with the estimated risk of escalated care from 0.46% (0 points) to 96.9% (14 points). The area under the curve was 85%.

CONCLUSIONS:
We identified variables measured in the emergency department predictive of escalated care in bronchiolitis and derived a risk score to stratify risk of this outcome. This score may be used to aid management and disposition decisions.
Strusture, biomass and production of the biotic component of the ecosystem of an growing eutrophic reservoir
Authors: Kopylov A. I. , Kosolapov D. B. , Lazareva V. I. , Mineeva N. M. , Pryanichnikova E. G. 
Published: August 2018

Using our own data and data from the literature, we assessed the total biomass of the biotic component of the ecosystem of the Ivankovo Reservoir (Upper Volga, Russia), a eutrophic reservoir which is becoming overgrown with macrophytes. The biotic component of freshwater ecosystems is formed by communities of multicellular and unicellular organisms and viruses in the water layer (plankton) and bottom sediments (benthos) and also macrophytes and autotrophic and heterotrophic organisms growing on their surface (epiphyton). The biomass of the biotic component of the Ivankovo Reservoir equaled 39,853 tons С. Plankton, benthos and macrophytes with epiphyton equaled 3.6%, 41.6% and 54.8% of the total biomass respectively. We determined the contribution of higher aquatic plants, algae, cyanobacteria, heterotrophic bacteria, viruses, protozoans, multicellular invertebrates and fish to the formation of total biomass. The largest share was taken up by higher aquatic plants (54.5%). The second largest share was taken by heterotrophic bacteria (37.4%), most of which live in the bottom sediments. The high concentration of bacteria and invertebrates in the bottom sediments indicate significant provision of the organic substrates from the water column. The biomass of fish, the highest trophic link in the reservoir, equaled 15.0% of the biomass of their potential food substrates, invertebrate animals, and 0.7% of the total biomass of the biotic component. The greater part of the autochthonous organic compound in the reservoir is formed as a result of activity of phytoplankton, which provides 69.4% of total primary production of macrophytes, phytoepiphyton, phytoplankton and phytobenthos. The total primary production during the vegetation period was approximately forty times higher than the annual production of the fish. Currently, the share in the phytoplankton of large colonial cyanobacteria not consumed by zooplankton, the share of non-heterocystic species of cyanobacteria capable of heterotrophic feeding and the share of mixotrophic flagellates is increasing. Eutrophication of the reservoir is significantly stimulated by the development of macrophytes, and, presumably, the contribution of macrophytes to the total primary production of the reservoir will continue to increase.
Impact of cadmium and lead on Megaphyllum kievense (Diplopoda, Julidae) in a laboratory experiment
Authors: Kozak V. M. , Brygadyrenko V. V. 
Published: August 2018

After accumulating in plants, lead and cadmium of technogenic origin concentrate in forest litter, thus inhibiting the speed of its microbiological decomposition and causing chronic intoxication of saprophage millipedes which feed on it. The 20-day laboratory experiment described in this article determined the toxic impact of lead and cadmium (at concentrations of 0.3, 3, 30, 300, 3,000 and 30,000 mg/kg of litter) on the body weight of Megaphyllum kievense (Lohmander, 1928) and microbiological decomposition of forest litter. The death rate of M. kievense increased from 10–20% to 40% at 3 and 30 g/kg of lead and to 100% at 30 g of cadmium per 1 kg of litter. Gain in body weight of M. kievense reliably decreased only at 3 g/kg of cadmium (0.71 to 0.20 mg/24-hours). Under the influence of lead, gain in body weight reliably decreased compared to the control already at 100 times smaller concentration (30 mg/kg of substrate – 0.74 to 0.10 mg/24-hours). Under the influence of both cadmium and lead, the decomposition of litter by microorganisms is slowed down only under the highest of the studied concentrations (30 g/kg). The results of the laboratory experiment showed high resistance of M. kievense to lead and cadmium, at levels significantly higher than natural concentrations of heavy metals in technogenically transformed ecosystems.
Breve descrição sobre os kaiowá e guarani na graduação e pós-graduação
Authors: Valiente Celuniel 
Published: August 2018

A ciência indígena não pode ser caracterizada menos do que a ciência Ocidental, mas sim pensar a interação ou o dialogo entre esses diferentes conhecimentos que existem no mundo, e também tirar os conhecimentos indígenas da concepção tradicional, ou seja, descartar da esfera da antiguidade ao qual se percebe como antigo e ultrapassado, olhar mais profundo desses conhecimentos percebe-se o valor epistemológico que ele possui. Nesse pequeno artigo, pretendo conforme a minha experiência acadêmica e com as leituras bibliográficas refletir sobre os kaiowá e Guarani nas graduações e pós-graduação (mestrado e doutorado), e como também sobre as produções indígenas nas universidades.