bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient-derived xenografts of central nervous system metastasis reveal expansion of aggressive minor clones
Authors: Tew Ben Yi , Legendre Christophe , Schroeder Mark A , Triche Tim , Gooden Gerald C , Huang Yizhou , Butry Loren , Ma Daniel J , Johnson Kyle , Martinez Rae Anne , Pierobon Mariaelena , Petricoin Emanuel F , O’shaughnessy Joyce , Osborne Cindy , Tapia Coya , Buckley David N , Glen Jennifer , Bernstein Mark , Sarkaria Jann N , Toms Steven A , Salhia Bodour 
Published: August 2019

Abstract

Background
The dearth of relevant tumor models reflecting the heterogeneity of human central nervous system metastasis (CM) has hindered development of novel therapies.

Methods
We established 39 CM patient-derived xenograft (PDX) models representing the histological spectrum, and performed phenotypic and multi-omic characterization of PDXs and their original patient tumors. PDX clonal evolution was also reconstructed using allele-specific copy number and somatic variants.

Results
PDXs retained their metastatic potential, with flank-implanted PDXs forming spontaneous metastases in multiple organs, including brain, and CM subsequent to intracardiac injection. PDXs also retained the histological and molecular profiles of the original patient tumors, including retention of genomic aberrations and signaling pathways. Novel modes of clonal evolution involving rapid expansion by a minor clone were identified in 2 PDXs, including CM13, which was highly aggressive in vivo forming multiple spontaneous metastases, including to brain. These PDXs had little molecular resemblance to the patient donor tumor, including reversion to a copy number neutral genome, no shared nonsynonymous mutations, and no correlation by gene expression.

Conclusions
We generated a diverse and novel repertoire of PDXs that provides a new set of tools to enhance our knowledge of CM biology and improve preclinical testing. Furthermore, our study suggests that minor clone succession may confer tumor aggressiveness and potentiate brain metastasis.
Giant magnetic field from moiré induced Berry phase in homobilayer semiconductors
Authors: Yu Hongyi , Chen Mingxing , Yao Wang 
Published: August 2019

Abstract
When quasiparticles move in condensed matters, the texture of their internal quantum structure as a function of position and momentum can give rise to Berry phases that have profound effects on the material’s properties. Seminal examples include the anomalous Hall and spin Hall effects from the momentum-space Berry phases in homogeneous crystals. Here, we explore a conjugate form of the electron Berry phase arising from the moiré pattern: the texture of atomic configurations in real space. In homobilayer transition metal dichalcogenides, we show that the real-space Berry phase from moiré patterns manifests as a periodic magnetic field with magnitudes of up to hundreds of Tesla. This quantity distinguishes moiré patterns from different origins, which can have an identical potential landscape, but opposite quantized magnetic flux per supercell. For low-energy carriers, the homobilayer moirés realize topological flux lattices for the quantum-spin Hall effect. An interlayer bias can continuously tune the spatial profile of the moiré magnetic field, whereas the flux per supercell is a topological quantity that can only have a quantized jump observable at a moderate bias. We also reveal the important role of the non-Abelian Berry phase in shaping the energy landscape in small moiré patterns. Our work points to new possibilities to access ultra-high magnetic fields that can be tailored to the nanoscale by electrical and mechanical controls.
Ultra-thin metal-organic framework nanoribbons
Authors: Wang Bingqing , Zhao Meiting , Li Liuxiao , Huang Ying , Zhang Xiao , Guo Chong , Zhang Zhicheng , Cheng Hongfei , Liu Wenxian , Shang Jing , Jin Jing , Sun Xiaoming , Liu Junfeng , Zhang Hua 
Published: August 2019

AbstractStructure engineering of metal-organic frameworks (MOFs) at the nanometer scale is attracting increasing interest due to their unique properties and new functions that normally cannot be achieved in bulk MOF crystals. Here, we report the preparation of ultra-thin MOF nanoribbons (NRBs) by using metal-hydroxide nanostructures as the precursors. Importantly, this general method can be used to synthesize various kinds of ultra-thin MOF NRBs, such as MBDC (M = Co, Ni; BDC = 1,4-benzenedicarboxylate), NiCoBDC, CoTCPP (TCPP = tetrakis(4-carboxyphenyl)porphyrin) and MIL-53(Al) NRBs. As a proof-of-concept application, the as-prepared ultra-thin CoBDC NRBs have been successfully used as a fluorescent sensing platform for DNA detection, which exhibited excellent sensitivity and selectivity. The present strategy might open an avenue to prepare MOF nanomaterials with new structures and unique properties for various promising applications.
EXHALATION OF RADON FROM NATURALLY OCCURRING RADIOACTIVE MATERIALS (NORM) IN NIGERIA
Authors: Sesay Isata Esther , Paul Monday , Ademola Janet Ayobami 
Published: August 2019

Abstract
Radon-222 mass exhalation rate, EM, and surface exhalation rate, EA, have been determined for some building materials and fertilizers in Nigeria by accumulation method using AlphaGUARD radon monitor. The building materials include granite, cement, tile, white marble, brick, concrete and sand. The mean EM of the building materials varied from 0.06 ± 0.03 for white marble to 0.23 ± 0.15 Bq kg−1 h−1 for brick. The mean EA ranged between 1.06 ± 0.56 Bq kg−1 h−1 and 3.15 ± 1.52 Bq m−2 h−1 for white marble and brick, respectively. Most of the EM and EA of the building materials were higher than those of other countries. For the fertilizers, the EM and EA ranged from 0.13 ± 0.01 to 0.42 ± 0.03 Bq kg−1 h−1 and 2.11 ± 0.56 to 4.81 ± 1.24 Bq m−2 h−1 with mean values of 0.25 ± 0.07 Bq kg−1 h−1 and 3.24 ± 0.93 Bq m−2 h−1, respectively. The radon mass and surface exhalation rates of the fertilizers were higher than those of the building materials.
A WALK-IN TYPE CALIBRATION CHAMBER FACILITY FOR 222Rn MEASURING DEVICES AND INTER-COMPARISON EXERCISES
Authors: Trilochana S , Somashekarappa H M , Kumara K Sudeep , Mohan M P , Nayak S Rashmi , D’Souza Renita Shiny , Kamath Srinivas S , Sahoo B K , Gaware J J , Sapra B K , Janik M , Al-Azmi Darwish , Mayya Y S , Karunakara N 
Published: August 2019

Abstract
A walk-in type 222Rn calibration chamber of volume 22.7 m3, which has traceability to international standards, is established at the Centre for Advanced Research in Environmental Radioactivity, Mangalore University, India. It has a human–machine interface communication system, a programmable logic controller and sensor feedback circuit for controlling and data acquisition of relative humidity (RH) and temperature (T). An innovative method for the generation of desired 222Rn concentration (a few hundred Bq m−3 up to about 36 kBq m−3) using soil gas as a source was adopted. Leak rates of 222Rn from the chamber for the mixing fan ON and OFF conditions were determined to be 0.0011 and 0.00018 h−1 respectively. With the exhaust system fully turned on, the maximum clearance rate of the chamber was 0.58 ± 0.07 h−1. Excellent spatial uniformity in 222Rn concentration in the chamber was confirmed (with a mean value of relative standard deviation &lt; 12%) through measurements at 23 locations using CR-39 film-based passive devices. Demonstration of calibration applications was performed using charcoal canister and PicoRad vials as the 222Rn adsorption devices. The study shows that gamma spectrometry is a convenient alternative approach to liquid scintillation analysis of PicoRad vials for 222Rn measurement.
HPV-associated oropharyngeal cancer
Authors: Sheedy Trina , Heaton Chase 
Published: August 2019

ABSTRACT
Exposure of the oral cavity and oropharynx to human papillomavirus (HPV) often results in an asymptomatic, transient oral infection that is cleared by the body's immune system; however, a small percentage of these oral infections can persist in a dormant state. Depending on the HPV genotype, a persistent oral infection may lead to benign or malignant disease. High-risk HPV types 16 and 18, which cause most cervical and anal cancers, also are the cause of the rising rate of oropharyngeal squamous cell carcinoma (SCC) in the United States. This article focuses on the epidemiology, transmission, risk factors, and clinical presentation of HPV-associated oropharyngeal SCC, and provides an update on HPV vaccination in the context of the new head and neck cancer epidemic.
Pregnancy Outcomes After Removal of Osmotic Dilators in Patients Who Presented for Second-Trimester Abortion
Authors: Mark Katrina , Merchant Rashida M. , Hu Kevin 
Published: August 2019

(Abstracted from Contraception 2019;99:285–287)
The primary method used in the United States to induce second-trimester abortions is dilation and evacuation (D&E). Typically with D&E, a cervical preparation of osmotic dilators is placed up to 24 hours prior to the procedure to decrease surgical risks and complications.
Do End-of-Rotation Evaluations Adequately Assess Readiness to Operate?
Authors: Ahle Samantha L. , Schuller Mary , Clark Michael J. , Williams Reed G. , Wnuk Gregory , Fryer Jonathan P. , George Brian C. 
Published: August 2019

Purpose
Medical educators have developed no standard way to assess the operative performance of surgical residents. Most residency programs use end-of-rotation (EOR) evaluations for this purpose. Recently, some programs have implemented workplace-based “microassessment” tools that faculty use to immediately rate observed operative performance. The authors sought to determine (1) the degree to which EOR evaluations correspond to workplace-based microassessments and (2) which factors most influence EOR evaluations and directly observed workplace-based performance ratings and how the influence of those factors differs for each assessment method.

Method
In 2017, the authors retrospectively analyzed EOR evaluations and immediate postoperative assessment ratings of surgical trainees from a university-based training program from the 2015–2016 academic year. A Bayesian multivariate mixed model was constructed to predict operative performance ratings for each type of assessment.

Results
Ratings of operative performance from EOR evaluations vs workplace-based microassessment ratings had a Pearson correlation of 0.55. Postgraduate year (PGY) of training was the most important predictor of operative performance ratings on EOR evaluations: Model estimates ranged from 0.62 to 1.75 and increased with PGY. For workplace-based assessment, operative autonomy rating was the most important predictor of operative performance (coefficient = 0.74).

Conclusions
EOR evaluations are perhaps most useful in assessing the ability of a resident to become a surgeon compared with other trainees in the same PGY of training. Workplace-based microassessments may be better for assessing a trainee’s ability to perform specific procedures autonomously, thus perhaps providing more insight into a trainee’s true readiness for operative independence.
Building the Bridge to Quality: An Urgent Call to Integrate Quality Improvement and Patient Safety Education With Clinical Care
Authors: Wong Brian M. , Baum Karyn D. , Headrick Linda A. , Holmboe Eric S. , Moss Fiona , Ogrinc Greg , Shojania Kaveh G. , Vaux Emma , Warm Eric J. , Frank Jason R. 
Published: August 2019

Current models of quality improvement and patient safety (QIPS) education are not fully integrated with clinical care delivery, representing a major impediment toward achieving widespread QIPS competency among health professions learners and practitioners. The Royal College of Physicians and Surgeons of Canada organized a 2-day consensus conference in Niagara Falls, Ontario, Canada, called Building the Bridge to Quality, in September 2016. Its goal was to convene an international group of educational and health system leaders, educators, frontline clinicians, learners, and patients to engage in a consensus-building process and generate a list of actionable strategies that individuals and organizations can use to better integrate QIPS education with clinical care.
Four strategic directions emerged: prioritize the integration of QIPS education and clinical care, build structures and implement processes to integrate QIPS education and clinical care, build capacity for QIPS education at multiple levels, and align educational and patient outcomes to improve quality and patient safety. Individuals and organizations can refer to the specific tactics associated with the 4 strategic directions to create a road map of targeted actions most relevant to their organizational starting point.
To achieve widespread change, collaborative efforts and alignment of intrinsic and extrinsic motivators are needed on an international scale to shift the culture of educational and clinical environments and build bridges that connect training programs and clinical environments, align educational and health system priorities, and improve both learning and care, with the ultimate goal of achieving improved outcomes and experiences for patients, their families, and communities.
Nerve Injury With Acetabulum Fractures: Incidence and Factors Affecting Recovery
Authors: Simske Natasha M. , Krebs J. Collin , Heimke Isabella M. , Scarcella Nicholas R. , Vallier Heather A. 
Published: August 2019

Objectives:
To determine factors associated with nerve injury after acetabulum fracture and to evaluate recovery and outcomes.

Design:
Retrospective cohort study.

Setting:
Level 1 trauma center.

Patients and Participants:
Nine hundred seventy-five skeletally mature patients with acetabulum fracture.

Intervention:
Operative and nonoperative management.

Main Outcome Measurements:
Nerve injuries, categorized as traumatic or iatrogenic, recovery (none, partial, or complete), and patient-reported functional outcomes with the Musculoskeletal Function Assessment (n = 353, 36.2%).

Results:
Thirty-two patients (3.3%) experienced nerve injury with 24 (78%) resulting from trauma and 23 with an associated posterior hip dislocation. Eight injuries (25%) were iatrogenic. Thirty-one (97%) occurred in patients with operative fractures (n = 738). The most common fracture pattern associated with nerve injury was transverse posterior wall (31% of injuries). Obesity was more common in patients with nerve injuries (59% vs. 30% in those without nerve injury (P = 0.001), but was not related to age or sex. Sixty-five percent of sciatic nerve injuries were to the common peroneal division only, while none were isolated to the tibial division. All iatrogenic injuries occurred after the ilioinguinal approach (P < 0.001). Overall, 50% experienced partial nerve recovery and 22% had complete recovery. However, 24% of patients with sciatic or common peroneal injuries had no recovery. Thirty-three percent of tobacco smokers experienced no recovery (vs. 26% of nonsmokers). Average Musculoskeletal Function Assessment scores for patients with nerve injuries was 32, similar to those without (33).

Conclusions:
Posterior acetabulum fracture dislocations are associated with traumatic nerve injury, although 25% of nerve injuries were iatrogenic. Nerve injuries are more common in obese patients. More than one-quarter of patients had no recorded nerve recovery.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Predicted Economic Benefits of a Novel Biomarker for Earlier Sepsis Identification and Treatment: A Counterfactual Analysis
Authors: Paoli Carly J. , Reynolds Mark A. , Coles Courtney , Gitlin Matthew , Crouser Elliott 
Published: August 2019

Objectives:
To estimate the potential clinical and health economic value of earlier sepsis identification in the emergency department using a novel diagnostic marker, monocyte distribution width.

Design:
The analysis was conducted in two phases: 1) an analysis of the pivotal registration trial evidence to estimate the potential benefit of monocyte distribution width for early sepsis identification and (2) a cost-consequence analysis to estimate the potential economic and clinical benefits that could have resulted from earlier administration of antibiotics for those patients.

Setting:
Sepsis identified in the emergency department which led to inpatient hospitalizations.

Patients:
Adult sepsis patients admitted through the emergency department.

Interventions:
None. This was a model simulation of clinical and economic outcomes of monocyte distribution width based on results from a noninterventional, multicenter clinical trial.

Measurements and Main Results:
Among the 385 patients with sepsis, a total of 349 were eligible for inclusion. Sixty-seven percent of patients were predicted to benefit from monocyte distribution width results, resulting in an estimated mean reduction in time to antibiotics administration from 3.98 hours using standard of care to 2.07 hours using monocyte distribution width + standard of care. Based on this simulated reduction in time to antibiotics, monocyte distribution width + standard of care could have resulted in a less than or equal to 14.2% reduction (27.9% vs 32.5%) in mortality, a mean reduction of 1.48 days (10.0 vs 11.5 d) in length of stay, and $3,460 ($23,466 vs $26,926) savings per hospitalization. At the hospital level, based on an established national mean of 206 sepsis hospitalizations per hospital per year, earlier identification with monocyte distribution width is predicted to result in a total of $712,783 in annual cost savings per hospital.

Conclusions:
Improved early identification of sepsis using monocyte distribution width along with current standard of care is estimated to improve both clinical and economic outcomes of sepsis patients presenting in the emergency department. Further research is warranted to confirm these model projections.
Rapid Response and Cardiac Arrest Teams: A Descriptive Analysis of 103 American Hospitals
Authors: Mitchell Oscar J. L. , Motschwiller Caroline W. , Horowitz James M. , Friedman Oren A. , Nichol Graham , Evans Laura E. , Mukherjee Vikramjit 
Published: August 2019

Objectives:
Despite improvements in the management of in-hospital cardiac arrest over the past decade, in-hospital cardiac arrest continues to be associated with poor prognosis. This has led to the development of rapid response systems, hospital-wide efforts to improve patient outcomes by centering on prompt identification of decompensating patients, expert clinical management, and continuous quality improvement of processes of care. The rapid response system may include cardiac arrest teams, which are centered on identification and treatment of patients with in-hospital cardiac arrest. However, few evidence-based guidelines exist to guide the formation of such teams, and the degree of their variation across the United States has not been well described.

Design:
Descriptive cross-sectional, internet-based survey.

Setting:
Cohort of preidentified clinicians involved in their hospital’s adult rapid response system across the United States.

Subjects:
Clinicians who had been identified by study team members using personal and professional contacts over a 7-month period from June 2018 to December 2018.

Interventions:
An 80-item survey was developed by the investigators. It sought information on the afferent (identification and notification of providers) and efferent (response of providers to patient) limbs of the rapid response system, as well as management of patients post in-hospital cardiac arrest.

Measurements and Main Results:
One-hundred fourteen surveys were distributed. Of these, 109 (96%) were completed. Six were duplicates and were excluded, leaving a total of 103 surveys from 103 hospitals in 30 states. Seventy-six percent of hospitals were academic, 30% were large hospitals (> 750 inpatient beds), and 58% had large ICUs (> 50 ICU beds). We found wide variation in the structure and function in both the afferent and efferent limbs of the rapid response system. The majority of hospitals had a rapid response team and a cardiac arrest team. Most rapid response teams contained a provider, a critical care nurse, and a respiratory therapist. In hospitals with training programs in internal medicine, anesthesia, emergency medicine, or critical care, 45% of rapid response teams and 75% of cardiac arrest teams were led by trainees, with inconsistent attending presence. Targeted temperature management and coronary catheterization were widely used post in-hospital cardiac arrest, but indications varied considerably.

Conclusions:
We have demonstrated substantial variation in the structure and function of rapid response systems as well as in management of patients during and after in-hospital cardiac arrest.
Emergency Department to ICU Time Is Associated With Hospital Mortality: A Registry Analysis of 14,788 Patients From Six University Hospitals in The Netherlands*
Authors: Groenland Carline N. L. , Termorshuizen Fabian , Rietdijk Wim J. R. , van den Brule Judith , Dongelmans Dave A. , de Jonge Evert , de Lange Dylan W. , de Smet Anne Marie G. A. , de Keizer Nicolette F. , Weigel Joachim D. , Jewbali Lucia S. D. , Boersma Eric , den Uil Corstiaan A. 
Published: August 2019

Objectives:Prolonged emergency department to ICU waiting time may delay intensive care treatment, which could negatively affect patient outcomes. The aim of this study was to investigate whether emergency department to ICU time is associated with hospital mortality.Design, Setting, and Patients:We conducted a retrospective observational cohort study using data from the Dutch quality registry National Intensive Care Evaluation. Adult patients admitted to the ICU directly from the emergency department in six university hospitals, between 2009 and 2016, were included. Using a logistic regression model, we investigated the crude and adjusted (for disease severity; Acute Physiology and Chronic Health Evaluation IV probability) odds ratios of emergency department to ICU time on mortality. In addition, we assessed whether the Acute Physiology and Chronic Health Evaluation IV probability modified the effect of emergency department to ICU time on mortality. Secondary outcomes were ICU, 30-day, and 90-day mortality.Interventions:None.Measurements and Main Results:A total of 14,788 patients were included. The median emergency department to ICU time was 2.0 hours (interquartile range, 1.3–3.3 hr). Emergency department to ICU time was correlated to adjusted hospital mortality (p< 0.002), in particular in patients with the highest Acute Physiology and Chronic Health Evaluation IV probability and long emergency department to ICU time quintiles: odds ratio, 1.29; 95% CI, 1.02–1.64 (2.4–3.7 hr) and odds ratio, 1.54; 95% CI, 1.11–2.14 (> 3.7 hr), both compared with the reference category (< 1.2 hr). For 30-day and 90-day mortality, we found similar results. However, emergency department to ICU time was not correlated to adjusted ICU mortality (p= 0.20).Conclusions:Prolonged emergency department to ICU time (> 2.4 hr) is associated with increased hospital mortality after ICU admission, mainly driven by patients who had a higher Acute Physiology and Chronic Health Evaluation IV probability. We hereby provide evidence that rapid admission of the most critically ill patients to the ICU might reduce hospital mortality.