bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical presentation at initiation of maintenance dialysis and subsequent survival: A retrospective cohort study
Authors: YU Margaret K. , WONG Susan P. Y. , LIU Chuan‐Fen , HEBERT Paul L. , O'HARE Ann M. 
Published: October 2018

Abstract
Introduction: Clinical practice guidelines increasingly favor a more symptom‐driven approach to maintenance dialysis initiation. But, little is known about the clinical presentation at dialysis initiation, such as the different kinds of signs and symptoms present at dialysis initiation, illness acuity at dialysis initiation, and how these aspects of the clinical presentation relate to subsequent survival.
Methods: This is a retrospective cohort study of a random sample of veterans who initiated dialysis between 2000 and 2009 at Veterans Affairs (VA) medical centers across the country (N = 1,691). We looked at associations between the clinical presentation (types of signs and/or symptoms and illness acuity) at the time of dialysis initiation and 1‐year mortality.
Findings: The most common types of signs and/or symptoms at initiation were gastrointestinal (50.9%) and cardiopulmonary (48.7%). The crude mortality rate was 174.2 deaths per 1000 patients per year (95% CI 154.7, 196.1). Among different categories of signs and/or symptoms, only cardiopulmonary signs and/or symptoms were associated with a higher 1‐year risk of mortality after initiation (risk ratio (RR) 1.32, 95% CI 1.05, 1.69) in adjusted analyses. Patients who were acutely ill at initiation were more likely to die during the following year as compared with those who initiated dialysis in the outpatient setting (RR 1.57, 95% CI 1.15, 2.21).
Discussion: With the exception of cardiopulmonary signs and/or symptoms, most signs and/or symptoms documented around the time of dialysis initiation were not associated with an increased risk of death during the year after initiation. In contrast, whether patients were acutely ill at the time of initiation was strongly associated with an increased risk of death after initiation regardless of the specific signs and/or symptoms present. Limitations of this study include retrospective study design, residual confounding, and lack of generalizability to non‐VA settings.
Factors associated with adherence to antimicrobial stewardship after-hours
Authors: Mostaghim Mona , Snelling Thomas , Bajorek Beata 
Published: October 2018

AbstractObjectivesAssess restricted antimicrobials acquired after standard working hours for adherence to antimicrobial stewardship (AMS) and identify factors associated with increased likelihood of adherence at the time of acquisition, and the next standard working day.MethodsAll documented antimicrobials acquired from a paediatric hospital after-hours drug room from 1 July 2014 to 30 June 2015 were reconciled with records of AMS approval, and documented AMS review in the medical record.Key findingsOf the 758 antimicrobial acquisitions from the after-hours drug room, 62.3% were restricted. Only 29% were AMS adherent at the time of acquisition, 15% took place despite documented request for approval by a pharmacist. Antimicrobials for respiratory patients (OR 3.10, 95% CI 1.68–5.5) and antifungals (2.48, 95% CI 1.43–4.30) were more likely to be AMS adherent. Half of the acquisitions that required review the next standard working day were adherent to AMS (51.8%, 129/249). Weekday acquisitions (2.10, 95% CI 1.20–3.69) and those for patients in paediatric intensive care (2.26, 95% CI 1.07–4.79) were associated with AMS adherence. Interactions with pharmacists prior to acquisition did not change the likelihood of AMS adherence the next standard working day. Access to restricted antimicrobial held as routine ward stock did not change the likelihood of AMS adherence at the time of acquisition, or the next standard working day.ConclusionRestricted antimicrobials acquired after-hours are not routinely AMS adherent at the time of acquisition or the next standard working day, limiting opportunities for AMS involvement.
‘It depends what you mean by leadership’: An analysis of stakeholder perspectives on consumer leadership
Authors: Stewart Stephanie , Scholz Brett , Gordon Sarah , Happell Brenda 
Published: October 2018

AbstractContemporary mental health policies call for increased involvement of consumers in leadership across mental health service design, delivery, and evaluation. However, consumer leadership is not currently well understood within academia or in mental health services themselves. This study investigates how consumer leadership is currently conceptualized by stakeholders at the service delivery level. To this end, semistructured interviews were conducted with 14 mental health organization members identifying as consumer leaders, colleagues supporting consumer leaders, or organization executives. Interview data were analysed using an inductive thematic analysis to develop a broad understanding of participants’ perceptions of consumer leadership. Findings indicate constructions of consumer leadership within mental health organizations can be understood in relation to four themes: consumer leadership roles, requirements, purpose, and process. Inconsistencies across participants’ perceptions of consumer leadership were identified as constituting barriers to its development, highlighting the need to better clarify the nature of consumer leadership.
Effects of dietary amino acid supplementation on measures of whole‐body and muscle protein metabolism in aged horses
Authors: Latham Christine M. , Wagner Ashley L. , Urschel Kristine L. 
Published: October 2018

AbstractThe objective of this study was to examine markers of whole‐body and muscle protein metabolism in aged horses fed a diet typical for North American aged horses, supplemented with amino acids. In a replicated Latin square design, six aged horses (20 ± 1.1 years) were studied while receiving each of three isocaloric, isonitrogenous diets, a control treatment concentrate (CON; 100 mg/kg−1 BW day−1 lysine, 84 mg kg−1 day−1 threonine, 51 mg kg−1 day−1 methionine), LYS/THR (134 mg kg−1 BW day−1 lysine, 110 mg kg−1 BW day−1 threonine, 52 mg kg−1 BW day−1 methionine) and LYS/THR/MET (132 mg kg−1 BW day−1 lysine, 112 mg kg−1 BW day−1 threonine, 62 mg kg−1 BW day−1 methionine). In each 15‐days period, urine and faeces were collected for assessment of nitrogen balance. Blood samples were collected before and after feeding for analysis of plasma urea nitrogen (PUN), glucose, insulin and plasma amino acid concentrations. Skeletal muscle samples were collected for measurement of proteins associated with muscle protein synthesis and degradation, and horses underwent stable isotope infusion procedures for comparison of differences in whole‐body rates of protein synthesis and degradation. There was no effect of treatment on relative abundance of proteins involved in protein synthesis, nitrogen retention or phenylalanine kinetics. PUN concentrations tended to be higher for LYS/THR (p = 0.054) and were higher for LYS/THR/MET (p = 0.0056) than for CON. Atrogin‐1 abundance tended to be higher in the post‐absorptive state for the CON treatment (p = 0.07), indicating that amino acid supplementation resulted in less muscle protein degradation when horses were in the post‐absorptive state. However, lack of differences in nitrogen retention and phenylalanine kinetics indicated that whole‐body protein metabolism was not improved, and higher PUN concentrations in the supplemented diets suggest that the supplemented amino acids may have been catabolized. Amino acid availability was not limiting protein synthesis in the sedentary aged horses in this study when fed the CON diet.
Probiotics alter the immune response of gingival epithelial cells challenged by Porphyromonas gingivalis
Authors: Albuquerque‐Souza Emmanuel , Balzarini Danilo , Ando‐Suguimoto Ellen S. , Ishikawa Karin H. , Simionato Maria R. L. , Holzhausen Marinella , Mayer Marcia P. A. 
Published: October 2018

Background and ObjectiveAlthough previous studies revealed the potential use of probiotics in the control of periodontitis, little is known about their interactions with gingival epithelial cells (GECs). Since GECs comprise the first defense in the subgingival microenvironment, the aim of this study was to evaluate the effect of probiotic lactobacilli and bifidobacteria strains on OBA‐9 cells challenged with Porphyromonas gingivalis.MethodsImmortalized human GECs (OBA‐9) were challenged with live P. gingivalis (strains W83 and ATCC33277) and co‐infected with one of 12 tested probiotic strains at a multiplicity of infection (MOI) of 1:1000 for 2 hours. Bacterial adhesion and invasion were determined by antibiotic exclusion analysis and CFU counting. OBA‐9 viability was assessed by MTT assay, and levels of inflammatory mediators (TNF‐α, IL‐1β, and CXCL8) in the supernatants were determined by ELISA. The expression of genes encoding Toll‐like receptors (TLR2, TLR4) was evaluated by RT‐qPCR.ResultsBoth strains of P. gingivalis were able to adhere and invade OBA‐9 cells, with significant loss in cell viability, increase in the levels of TNF‐α and IL‐1β, and upregulation of TLR4. However, co‐infection with probiotics attenuated these effects in P. gingivalis challenged GECs. Most probiotics maintained OBA‐9 viability and reduced pathogens adhesion and invasion. Furthermore, probiotics were able to adhere to GECs, which was enhanced for most strains in the presence of P. gingivalis. The synthesis of IL‐1β and TNF‐α by P. gingivalis in challenged GECs was reduced in co‐culture with most of the tested probiotics, whereas the secretion of CXCL8 increased, and TLR4 was downregulated.ConclusionProbiotics can alter the interaction of GECs with P. gingivalis by modulating the pathogen's ability to adhere and invade these cells, as well as by regulating the innate immune response. Such properties are strain‐specific and may indicate the most efficient probiotics to control periodontitis.
Effect of client complaints on small animal veterinary internists
Authors: Bryce A. R. , Rossi T. A. , Tansey C. , Murphy R. A. , Murphy L. A. , Nakamura R. K. 
Published: October 2018

ObjectivesTo investigate the effect of client complaints on small animal veterinary internists’ welfare, job satisfaction and medical practices.Materials and MethodsCross‐sectional anonymous survey study. Between February 1 and March 31, 2017, a web‐based questionnaire was made available through the American College Veterinary Internal Medicine sub‐specialty Small Animal Internal Medicine E‐mail List Serve.ResultsA total of 92 completed surveys were available for review. Fifty‐nine (64∙1%) respondents received a client complaint during the previous 6 months with cost of care the most common reason (53∙3%). Eighty‐nine (96∙7%) respondents worry about client complaints being made against them with 33 (35∙8%) stating they worry “most of the time” or “all of the time.” Thirty‐two (34∙8%) reported being verbally assaulted by a client in the previous 6 months and 27 (29∙4%) reported being threatened with litigation during the previous 6 months. Sixty‐six (71∙7%) have reported changing the way they practice medicine to avoid a client complaint and 40 (43∙5%) have considered changing their career because of complaints made against them.Clinical RelevanceClient complaints are a frequent problem among small animal veterinary internists that have detrimental effects on job satisfaction, psychological distress and medical practices.
Nominals and number neutrality in languages
Authors: Görgülü Emrah 
Published: October 2018

AbstractThis overview article is concerned with number neutrality of Noun Phrases (NPs henceforth) across languages. Number is one of the fundamental grammatical categories, being found in both the nominal and the verbal domains. Although the specification of number among languages varies significantly, number is rather understudied when compared to other grammatical categories. Number neutrality is not so different, and it has only gained more attention in recent studies despite being an important phenomenon. Work on this particular topic has demonstrated that number‐neutral NPs can be morphologically singular or plural and are found in various constructions across typologically different languages. Number‐neutral NPs do not express semantic number and do not co‐occur with any number‐expressing elements such as numerals or quantifiers. Number neutrality with singular bare NPs surfaces in various constructions such as compounding, (pseudo) incorporation, and kind‐reference/genericity, while the distribution of bare plural NPs is not so constrained. Number‐neutral NPs in these structures were shown to differ significantly from their number‐specific counterparts in terms of their semantic and discourse characteristics such as referentiality, discourse anaphora, relativization, and scope. In this article, I provide a descriptive overview of these issues by bringing together empirical facts drawn from various constructions. The discussion also includes some important theoretical approaches to number neutrality.
Measuring Exchange Rate, Price, and Output Dynamics at the Effective Lower Bound
Authors: Bäurle Gregor , Kaufmann Daniel 
Published: October 2018

AbstractNew Keynesian models with sticky prices make stark predictions about how the economy responds to shocks under different monetary policy regimes when short‐term interest rates are constrained by an effective lower bound. We use the Swiss case as a laboratory to find evidence in favour of these predictions. We propose a Bayesian VAR to estimate impulse responses to risk shocks for short periods with a binding effective lower bound and with a publicly announced minimum exchange rate. In line with predictions from theory, we find that with a binding effective lower bound, the responses of the exchange rate, prices, and output become more persistent. However, the minimum exchange rate attenuates this adverse impact.
Perioperative respiratory adverse event risk assessment in children with upper respiratory tract infection: Validation of the COLDS score
Authors: Lee Lisa K. , Bernardo Marsha Kristel L. , Grogan Tristan R. , Elashoff David A. , Ren Wendy H. P. 
Published: October 2018

SummaryBackgroundThe decision to proceed with anesthesia and surgery has been controversial in pediatric patients with an upper respiratory tract infection. The COLDS score was proposed by Lee and August as a potential risk stratification scheme, but no validation has been performed on this scale.AimsThe aim of this study was to evaluate the utility of the COLDS score in predicting perioperative respiratory adverse events and optimize its predictive ability.MethodsCOLDS scores, incidence of perioperative respiratory adverse events, surgical procedure type, and age were prospectively collected for 536 patients who met inclusion criteria. Area under the receiver operating characteristic curves was computed for total COLDS score and individual COLDS score categories. Multivariable regression was used create an optimized score. To quantify the decrease in risk associated with case cancelation due to illness, the other risk factors in COLDS were assessed separately from upper respiratory infection status and a risk model was created.ResultsThe area under the receiver operating characteristic curve for the total COLDS score was 0.69, suggesting that the COLDS score has a moderate predictive ability for perioperative respiratory adverse events. When split into individual component scores, the area under the receiver operating characteristic curve ranged from 0.55 to 0.63. We also found that the area under the receiver operating characteristic curve for the scoring system was higher in younger children than for children aged 4‐6 (area under receiver operating characteristic curve of 0.70‐0.71 vs 0.66). The area under the receiver operating characteristic curve for the optimized scoring system was 0.71.ConclusionThe COLDS score has the potential to be a valuable risk assessment tool for prediction of perioperative respiratory adverse events and appears to have a better predictive value in certain subpopulations.
A retrospective cohort study of children with spinal muscular atrophy type 2 receiving anesthesia for intrathecal administration of nusinersen
Authors: Bielsky Alan R. , Fuhr Peter G. , Parsons Julie A. , Yaster Myron 
Published: October 2018

SummaryIntroductionSpinal muscular atrophy is characterized by loss of motor neurons in the anterior horn of the spinal cord with resultant proximal muscle weakness. Intrathecal nusinersen has revolutionized the treatment of spinal muscular atrophy. We reviewed the perioperative care of 61 anesthetics performed on eight patients with spinal muscular atrophy type 2 who received nusinersen over 30 months in conjunction with nusinersen's phase 3 clinical trials.MethodsAnesthesia was induced in all patients with sevoflurane, nitrous oxide, and oxygen (30%) via facemask. A peripheral intravenous line was placed after the loss of consciousness in all but three procedures. General anesthesia was maintained in 58 anesthetics with a propofol infusion at 250‐300 μg/kg/min, while the remainder was maintained with inhalational anesthetics. The airway was managed via facemask or nasal cannula in all but two procedures, in whom a laryngeal mask airway was placed. We analyzed patient demographics, duration of anesthesia and of postanesthesia care unit stay, discharge destination, preprocedure oxygen saturation (SaO2), postanesthesia care unit discharge oxygen saturation, and occurrence of unanticipated admission or postdischarge hospitalization.ResultsEight American Society of Anesthesiologists physical status three patients (3 male: 5 female) with a median age of 4.1 (2.1‐7.8) years and median weight of 13.2 (10‐24.7) kg, underwent 61 anesthetics for nusinersen administration or sham procedure. There were no intraoperative anesthetic complications of unanticipated cardiovascular instability, major neurologic events, respiratory failure, or death. Anesthesiologists performed 83% of the procedures.ConclusionNusinersen has revolutionized the care of patients with spinal muscular atrophy type 2 and anesthesiologists will be involved in its administration. We found that routine anesthetic care was safe and effective.
Determination of the minimal alveolar concentration of sevoflurane associated with isoelectric electroencephalogram in children: A prospective, randomized, double‐blind study
Authors: He Lin , Wang Xuan , Zheng Shan 
Published: October 2018

SummaryObjectiveWe investigated the minimal alveolar concentration (MAC) of sevoflurane associated with the occurrence of isoelectric electroencephalogram in 50% of children under steady‐state conditions (MAC IE). The MAC IE was determined in 100% oxygen and with the addition of 50% nitrous oxide or after the injection of fentanyl.MethodsSeventy‐two children (ASA I or II, age 3‐8 years) undergoing elective surgery were allocated to one of three groups: in 100% oxygen (group O2), in 50% oxygen and 50% nitrous oxide (group N2O), or in 100% oxygen with a bolus of 3 μg/kg fentanyl (group FENTANYL). The state of isoelectric EEG was considered as significant when a burst suppression ratio of 100% lasted for >1 minute. The MAC IE was determined by the Dixon's up‐and‐down method after a 15‐minute period with a stable endtidal concentration of sevoflurane. The concentration of sevoflurane was determined by the electroencephalogram of the previous patient: increase of 0.2% if isoelectric EEG were absent or decrease of 0.2% if isoelectric EEG were present.ResultsThe MAC IE in group O2 (MAC IEO2) was 5.30 (5.12‐5.48)% (median [95% CI]). The MAC IE in group N2O (MAC IEN2O) was 5.83 (5.67‐5.99)%. The MAC IE in group FENTANYL (MAC IEFENTANYL) was 5.37 (5.21‐5.53)%, which was close to MAC IEO2.ConclusionThe MAC IE of sevoflurane calculated in 100% O2 was 5.30% in children. Addition of 50% N2O modestly increased MAC IE of sevoflurane, while 3 μg/kg fentanyl had no effect on MAC IE of sevoflurane.
Virtual reality for lumbar puncture in a morbidly obese patient with leukemia
Authors: Thomas James J. , Albietz Joseph , Polaner David 
Published: October 2018

SummaryVirtual reality is an immersive technology that can provide distraction and anxiolysis during painful procedures. While it has been shown to be effective in less invasive procedures, it is underutilized in more invasive procedures. We describe using virtual reality for a morbidly obese patient with leukemia undergoing lumbar puncture. The use of virtual reality reduced the amount of analgesics and anxiolytics and the procedure and recovery times compared with no virtual reality.
Identification and characterization of a new class of Tomato spotted wilt virus isolates that break Tsw‐based resistance in a temperature‐dependent manner
Authors: de Ronde D. , Lohuis D. , Kormelink R. 
Published: October 2018

The single dominant Tsw resistance gene from Capsicum chinense against the Tomato spotted wilt orthotospovirus (TSWV) is temperature sensitive, i.e. the resistance fails to function at or above 32 °C. This study describes a new class of temperature‐sensitive resistance‐breaking TSWV isolates that induce Tsw‐mediated resistance at T < 28 °C but at T ≥ 28 °C break this resistance. The NSs genes from these isolates were cloned and expressed to be analysed for RNA silencing suppressor (RSS) activity and the ability to induce a Tsw‐mediated hypersensitive response (HR) in C. chinense and Capsicum annuum (Tsw+). Unlike in viral infection, transient expression of some of the NSs proteins at standard temperatures (22 °C) did not induce Tsw‐mediated HR, although varying degrees of RSS activity were observed. Attempts to express and test the NSs proteins for functionality at an elevated temperature through agroinfiltration remained unsuccessful. The NSs proteins of some TSWV resistance‐breaking (RB) isolates were analysed and found to lack amino acid residues that were previously shown to be important for RNA silencing suppression and avirulence. This study describes a new class of resistance‐breaking TSWV isolates that may be of importance for breeders and growers and for which the underlying mechanism still remains unknown.
The contribution of respiratory microbiome analysis to a treatable traits model of care
Authors: Taylor Steven L. , O'Farrell Hannah E. , Simpson Jodie L. , Yang Ian A. , Rogers Geraint B. 
Published: October 2018

ABSTRACTThe composition of the airway microbiome in patients with chronic airway diseases, such as severe asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis and cystic fibrosis (CF), has the potential to inform a precision model of clinical care. Patients with these conditions share overlapping disease characteristics, including airway inflammation and airflow limitation. The clinical management of chronic respiratory conditions is increasingly moving away from a one‐size‐fits‐all model based on primary diagnosis, towards care targeting individual disease traits, and is particularly useful for subgroups of patients who respond poorly to conventional therapies. Respiratory microbiome analysis is an important potential contributor to such a ‘treatable traits’ approach, providing insight into both microbial drivers of airways disease, and the selective characteristics of the changing lower airway environment. We explore the potential to integrate respiratory microbiome analysis into a treatable traits model of clinical care and provide a practical guide to the application and clinical interpretation of respiratory microbiome analysis.