bluuebunny/crossref_metadata_2025_split huggingface dataset:
Failed Vacuum and the Long-term Hematologic Morbidity of the Offspring
Authors: Mastrolia Salvatore A. , Wainstock Tamar , Sheiner Eyal , Landau Daniella , Walfisch Asnat 
Published: April 2018

Objective:
We aimed to investigate the effect of failed vacuum delivery leading to an emergency cesarean delivery on the long-term pediatric hematologic morbidity of the offspring.

Study Design:
In this population-based cohort study, the risk of long-term hematologic morbidity (up to the age of 18 y) was evaluated in children born following successful vacuum vaginal delivery, as compared with that of children born following a failed procedure leading to an emergent cesarean delivery. Multiple pregnancies and fetuses with congenital malformations were excluded. A Kaplan-Meier survival curve was constructed to compare cumulative pediatric hematologic morbidity, and a Cox proportional hazards model was used to control for confounders.

Results:
A total of 7978 neonates met the inclusion criteria. Vacuum delivery was successful in 7733 cases (96.9%), whereas it failed in 245 cases (3.1%). Total hematologic morbidity of the offspring up to 18 years of age was comparable between the groups (1.6% vs. 0.8%, P=0.8). The Kaplan-Meier survival curve showed no difference in the cumulative incidence of total hematologic morbidity (log rank, P=0.22). In the Cox regression model, failed vacuum delivery was not independently associated with long-term hematologic morbidity, as compared with a successful procedure, while adjusting for multiple confounders (adjusted hazards ratio [HR], 1.8; 95% confidence interval, 0.7-5.0; P=0.25).

Conclusions:
Failed vacuum delivery does not seem to be associated with an increased risk for pediatric hematologic morbidity of the offspring up to 18 years of age.
Conceptualization and Operationalization of Certification in the US and Canadian Nursing Literature
Authors: Chappell Kathy , ElChamaa Rima , Jeong Dahn , Kendall-Gallagher Deborah , Salt Elizabeth , Reeves Scott , Moore Donald , Olson Curtis , Van Hoof Thomas , Lundmark Vicki , Danilovich Natalia , Kitto Simon 
Published: April 2018

OBJECTIVE
To identify how certification is defined, conceptualized, and discussed in the nursing literature.

BACKGROUND
Although it is hypothesized that credentialing is associated with better patient outcomes, the evidence is relatively limited. Some authors have suggested that the lack of consistency used to define certification in nursing literature may be one of the dominant obstacles in credentialing research.

METHODS
This scoping review was guided by Arksey and O’Malley’s framework, and quantitative and qualitative analyses were conducted.

RESULTS
The final data set contained a total of 36 articles, of which 14 articles provided a referenced definition of certification. Thematic analysis of the definitions yielded 8 dominant themes.

CONCLUSION
The lack of a common definition of certification in nursing must be addressed to advance research into the relationship between certification processes in nursing and healthcare outcomes.
National Study of Nursing Research Characteristics at Magnet®-Designated Hospitals
Authors: Pintz Christine , Zhou Qiuping (Pearl) , McLaughlin Maureen Kirkpatrick , Kelly Katherine Patterson , Guzzetta Cathie E. 
Published: April 2018

OBJECTIVE
To describe the research infrastructure, culture, and characteristics of building a nursing research program in Magnet®–designated hospitals.

BACKGROUND
Magnet recognition requires hospitals to conduct research and implement evidence-based practice (EBP). Yet, the essential characteristics of productive nursing research programs are not well described.

METHODS
We surveyed 181 nursing research leaders at Magnet-designated hospitals to assess the characteristics in their hospitals associated with research infrastructure, research culture, and building a nursing research program.

RESULTS
Magnet hospitals provide most of the needed research infrastructure and have a culture that support nursing research. Higher scores for the 3 categories were found when hospitals had a nursing research director, a research department, and more than 10 nurse-led research studies in the past 5 years.

CONCLUSIONS
While some respondents indicated their nurse executives and leaders support the enculturation of EBP and research, there continue to be barriers to full implementation of these characteristics in practice.
Exploring Nurse Manager Support of Evidence-Based Practice
Authors: Caramanica Laura , Spiva LeeAnna 
Published: April 2018

OBJECTIVE
The study identifies what constitutes nurse manager (NM) support and other resources that enable clinical nurses (CNs) to engage in evidence-based practice (EBP).

BACKGROUND
Clinical nurses report that NM support enables them to use EBP but what constitutes NM support is still unclear.

METHODS
Nurse managers, CNs, and EBP mentors received specialized education and use a team approach for EBP. Data were collected preintervention, mid-intervention, and postintervention from observations, interviews, journaling, and surveys.

RESULTS
Results demonstrate how NMs can perform their role responsibilities and still engage CNs to develop a spirit of inquiry, seek answers to their clinical questions using EBP, and advance their clinical performance to improve patient outcomes. Four NM supportive behaviors emerged: cultivating a shared EBP vision, ensuring use of EBP, communicating the value of EBP, and providing resources for EBP.

CONCLUSION
Through education and support, NMs describe supportive behaviors necessary for the successful conduction of EBP by CNs.
Immunohistochemical Analysis of Endothelial Cells in Vascular Transformation of Lymph Node Sinuses: Vascular or Lymphatic Differentiation?
Authors: Basha Basma M. , Hsi Eric D. 
Published: April 2018

Introduction:
Vascular transformation of sinuses (VTS) is an uncommon and benign lesion, defined by conversion of lymph node sinuses into complex, anatomizing and endothelial-lined channels. Despite the name of VTS, which implies a change in differentiation from lymphatic to vascular endothelium, very few studies have systematically examined VTS with modern immunohistochemical markers commonly used in clinical laboratories. It is unclear whether endothelial cells in VTS display pure vascular or lymphatic differentiation, or both.

Design:
A total of 11 cases with a diagnosis of VTS (identified in the tissue archives of the Cleveland Clinic between 1992 and 2015) were reviewed and confirmed. Twenty cases of benign lymph nodes without specific diagnoses were used as control tissues. Immunohistochemical stains were performed on formalin-fixed, paraffin-embedded lymph node tissue using an automated immunohistochemistry platform with antibodies against CD31, CD34, D2-40, and ERG. Positivity in the VTS lesions was defined as distinct expression in the appropriate cell compartment in ≥20% of cells. In control cases, staining was evaluated in both vascular and lymphatic channels—vascular structures were identified by presence of red cells or well-formed vascular walls and lymphatics by anatomic location and absence of vascular features.

Results:
In the VTS lesions, D2-40 expression was absent in the lesional endothelial cells of 5/11 (45%) cases. In the cases lacking D240 expression, uninvolved lymphatic endothelium maintained expression. CD34 expression was also seen in 6/11 (54%), CD31 was seen in 10/11 (90%), and ERG expression was seen in all cases. In all the control cases, D240 expression was exclusively seen in lymphatic endothelial cells and not seen in vascular endothelial cells (eg, vascular channels in the hilum). CD34 was weakly positive in the lymphatic endothelium of only 7/20 (35%) control cases, but expressed in 20/20 (100%) control cases in the vascular endothelium. 20/20 (100%) of control cases showed expression of CD31 and ERG in both vascular and lymphatic endothelium.

Conclusion:
VTS lesional endothelial cells demonstrate patterns of vascular markers that show mixed blood vascular and lymphatic features. There appears to be a degree of alignment toward endothelial differentiation with decreased expression of D2-40 in some cases.
Biased agonism: the quest for the analgesic holy grail
Authors: Stanczyk M. Alexander , Kandasamy Ram 
Published: April 2018

Abstract
Opioids alleviate pain, but adverse effects severely limit their usefulness. To solve this problem, biased ligands favoring 1 signaling pathway downstream of the μ-opioid receptor over another are being developed. In the target article, the authors synthesize compounds that preferentially activate G-protein or β-arrestin signaling. They find that increased bias towards G-protein signaling produces better antinociception with minimal side effects in mice models. G-protein–biased opioids may provide a safer treatment strategy.
Magnetic Resonance Imaging in Neurocritically Ill Patients: Who Fails and How?
Authors: Kim Joong-Goo , Ko Myung-Ah , Lee Han-Bin , Jeon Sang-Beom 
Published: April 2018

Objectives
Performing magnetic resonance imaging (MRI) in neurocritically ill patients is challenging because it often requires sedation and withholding care in the neurological intensive care unit. This study investigated the incidence of and reasons for failed or complicated MRI (MRI-FC) in such patients.

Methods
A consecutive series of 218 neurocritically ill patients who underwent brain MRI were retrospectively evaluated. Failed or complicated MRI included failure to obtain all ordered sequences, unscheduled sedative administration, decrease in oxygen saturation to less than 90%, hypotension (≥40-mm Hg decrease and/or use of inotropic agents), and cardiac or respiratory arrest.

Results
Failed or complicated MRI occurred in 66 patients (30.3%) and included failure to obtain MRI sequences (n = 13), unscheduled use of sedatives (n = 62), oxygen desaturation (n = 9), and hypotension (n = 6). Cardiac or respiratory arrest did not occur. Use of sedative agents while in intensive care (P < 0.01), high Acute Physiology and Chronic Health Evaluation II score (P = 0.031), and low Glasgow Coma Scale score on admission (P = 0.047) were associated with MRI-FC. Scan times were longer (P = 0.004) and Glasgow Coma Scale (P < 0.001) and Richmond Agitation Sedation Scale (P = 0.003) scores were lower (P = 0.004) after imaging in patients with MRI-FC. Previous use of sedative agents was independently associated with MRI-FC (adjusted odds ratio = 3.57, 95% confidence interval = 1.78 to 7.24, P < 0.001).

Conclusions
Failed or complicated MRI was common and was associated with the use of sedative agents, severity of illness, and lower level of consciousness. Studies to ensure effective and safe performance of MRI in neurocritically ill patients are needed.
Utility of Magnetic Resonance Imaging for Predicting Severity of Sciatic Nerve Injury
Authors: Ahlawat Shivani , Belzberg Allan J. , Fayad Laura M. 
Published: April 2018

Objective
This study aimed to investigate the diagnostic accuracy of magnetic resonance (MR) imaging for categorizing sciatic peripheral nerve injury (PNI) as high-grade (Sunderland grades IV–V) or low-grade (Sunderland grades I–III) PNI.

Methods
In this institutional review board–approved, Health Insurance Portability and Accountability Act–compliant retrospective study, consecutive MR imaging of the pelvis and thighs, performed for the evaluation of traumatic sciatic neuropathy, was reviewed for sciatic nerve signal intensity, size, architectural distortion, bulbous enlargement, perineural fibrosis, discontinuity, and muscle denervation changes. Clinical data, electrodiagnostic testing, and surgical history were used to determine PNI grade (high, low). Descriptive and diagnostic performance statistics were applied.

Results
Of 24 patients, there were 12 high-grade and 12 low-grade PNI. There was no significant difference in signal intensity or size between high-grade and low-grade PNI (1.3 ± 0.5 cm vs 0.9 ± 0.3 cm, P = 0.09). The sensitivity and specificity for the presence of individual features in predicting high-grade injury were 83% and 67% for architectural distortion, 58% and 75% for bulbous enlargement, 50% and 83% for perineural fibrosis, 25% and 100% for discontinuity, and 67% and 75% for skeletal muscle denervation changes, respectively. Overall, the sensitivity and specificity of MR imaging for categorizing sciatic PNI as high grade was 75% and 83%, respectively.

Conclusions
The MR characterization of PNI severity remains challenging. Useful features indicative of high-grade PNI include bulbous enlargement, perineural fibrosis, muscle denervation changes, and nerve discontinuity.
Spectral Detector Computed Tomography Pulmonary Angiography: Improved Diagnostic Assessment and Automated Estimation of Window Settings Angiography of Pulmonary Arteries From Novel Spectral Detector Computed Tomography Provides Improved Image Quality if Settings are Adjusted
Authors: Große Hokamp Nils , Kessner Rivka , Van Hedent Steven , Graner Frank Philipp , Gupta Amit , Gilkeson Robert 
Published: April 2018

Objective
This study aimed to evaluate image quality (IQ) of virtual monoenergetic images (VMIs) from novel spectral detector computed tomography angiography of the pulmonary arteries and to identify appropriate window settings for each kiloelectron volt level.

Materials
Forty consecutive patients were included in this institutional review board–approved, Health Insurance Portability and Accountability Act–compliant study.
Signal- and contrast-to-noise ratios were calculated within the pulmonary trunk, and pulmonary/lobar/segmental arteries were calculated. The IQ and diagnostic certainty were rated by 2 radiologists on 5-point scales. In addition, they recorded appropriate window settings (center/width) that were linearly modeled against attenuation within the pulmonary trunk to generate generable results.

Results
Signal- and contrast-to-noise ratios, IQ, and diagnostic certainty are significantly increased in low–kiloelectron volt VMIs (≤60 keV). Interrater agreement was excellent (ĸ = 0.89). We developed 2 linear models (R2: 0.91–0.97 and R2: 0.43–0.91, respectively, P ≤ 0.01), that suggest appropriate window settings.

Conclusions
The VMIs from spectral detector computed tomography improve objective and subjective IQ in angiography of the pulmonary arteries, if window settings are adjusted; they can be automatically estimated using reported linear models.
Technical Pitfall in 68Ga–Prostate Specific Membrane Antigen Imaging
Authors: Hod Nir , Anconina Reut , Levin Daniel , Ezroh Kazap Dina , Lantsberg Sophie 
Published: April 2018

Abstract
As with any new molecular imaging modality, accurate characterization of abnormalities on 68Ga-PSMA PET/CT imaging can be accomplished only if one is aware of the normal distribution pattern, physiological variants, and potential sources of false imaging findings. Altered biodistribution can have a significant impact on scan interpretation. Presented here is a rare case in which radiopharmaceutical radiolysis occurred causing excessive free 68Ga-citrate showing as an increased vascular activity. As 68Ga-PSMA PET/CT imaging is a relatively new imaging technique, it is important to be aware of such a potential technical pitfall in clinical practice in order to prevent scan misinterpretation.
123I-FP-CIT SPECT and MRI Findings in a Patient With Parkinsonism After Fenpyroximate Intoxication
Authors: Kim Kyeong Joon , Kim Jong-Min , Bae Yun Jung , Song Yoo Sung , Kim Sang Eun 
Published: April 2018

Abstract
Fenpyroximate is a widely used acaricide. Its main action is to inhibit the mitochondrial respiratory chain. Chronic exposure to fenpyroximate is associated with dopaminergic cell loss and parkinsonism; however, to date, there has not been a reported case of parkinsonism as a result of acute fenpyroximate intoxication. Here, we report a 58-year-old man who developed parkinsonism after deliberate fenpyroximate intoxication, but with normal presynaptic 123I-Ioflupane SPECT image.
Automated Reporting of DXA Studies Using a Custom-Built Computer Program
Authors: England Joseph R. , Colletti Patrick M. 
Published: April 2018

Abstract
Dual-energy x-ray absorptiometry (DXA) scans are a critical population health tool and relatively simple to interpret but can be time consuming to report, often requiring manual transfer of bone mineral density and associated statistics into commercially available dictation systems. We describe here a custom-built computer program for automated reporting of DXA scans using Pydicom, an open-source package built in the Python computer language, and regular expressions to mine DICOM tags for patient information and bone mineral density statistics. This program, easy to emulate by any novice computer programmer, has doubled our efficiency at reporting DXA scans and has eliminated dictation errors.
Health Care–Seeking Characteristics of Women With Pelvic Floor Disorders After Obstetric Anal Sphincter Injury
Authors: Pennycuff Jon F. , Karp Deborah R. , Shinnick Julia , Hudson Catherine O. , Northington Gina M. 
Published: April 2018

Objectives
Obstetric anal sphincter injury (OASIS) is a potentially serious complication of vaginal delivery and can lead to both short-term and long-term sequelae. This study sought to identify health care seeking patterns of women who developed pelvic floor symptoms including pelvic pain after OASIS. It also identified demographic and clinical factors associated with seeking subspecialty care from a pelvic floor specialist and demographic and clinical factors associated with seeking care for pelvic pain after OASIS.

Methods
This study is a retrospective cohort study of 69 women who developed pelvic floor disorders after OASIS.

Results
For women diagnosed with a pelvic floor symptom, the mean time to follow-up was 2.4 years, the mean number of visits until diagnosis was 2.2 visits, and 2.9 visits were needed for treatment. The most common diagnoses were pelvic pain, lower urinary tract symptoms including incontinence, and defecatory dysfunction. Twenty-five percent of the cohort received treatment from a pelvic floor specialist. These women were more likely to be older and have urinary incontinence. Women with pain were more likely to be seen by a primary care provider and have longer time to diagnosis.

Conclusions
The study showed that multiple visits were needed to both diagnose and treat pelvic floor disorders (PFD) after OASIS. Pelvic pain was the most common primary PFD after OASIS. There should be a high level of suspicion for pelvic floor disorders, especially pain disorders, in women who have sustained a third- or fourth-degree laceration.
Paediatric multiple sclerosis and other acute demyelinating diseases
Authors: Rostásy Kevin , Bajer-Kornek Barbara 
Published: April 2018

Purpose of review
Neuroimmunological diseases encompass a wide spectrum of diseases in children. Apart from the discovery of autoantibodies affecting primarily grey matter structures and the improved clinical characterization of rare entities such as N-methyl D-aspartate receptor-R- encephalitis, important strides have also been made in autoimmune-mediated white matter diseases, including paediatric multiple sclerosis (pedMS) and other acute demyelinating syndromes (ADS) often associated with antibodies (abs) against myelin-oligodendrocyte-glycoprotein (MOG). This review will cover findings of recent studies in pedMS, in the emerging field of non-MS acute demyelinating episodes associated with MOG abs and lastly from new imaging techniques such as diffusion tensor imaging (DTI) revealing new insights in the pathogenesis of ADS in children.

Recent findings
The first prospective randomized clinical pedMS trial assessing the clinical and radiological efficacy of fingolimod versus a standard disease-modifying agent has shown clear superiority of fingolimod. The clinical spectrum of MOG-associated diseases has been characterized in more detail revealing clinical subtypes distinct from pedMS. A recent large European study further showed that MOG-associated diseases do not respond to first-line disease-modifying treatment (DMT) in MS but fare better with B-cell modulating therapies including regular intravenous immunoglobulin (IVIG).

Summary
Recent findings strongly indicate that in particular in highly active pedMS characterized by new relapses or accrual of new MRI lesions despite first-line DMT treatment should be escalated. Secondly, several studies have shown that MOG-spectrum diseases include children with monophasic and recurrent subtypes other than MS with different clinical, radiological characteristics and treatment challenges.
B cells in multiple sclerosis
Authors: Sospedra Mireia 
Published: April 2018

Purpose of review
Although it is becoming increasingly clear that B cells play important roles in multiple sclerosis (MS) pathogenesis, it is incompletely understood how they contribute. The purpose of this review is to provide an overview of the current knowledge about B cells in MS taking into account MS heterogeneity.

Recent findings
The efficacy of B cell-depleting therapies has provided strong evidence for the involvement of these cells in MS pathogenesis. Although pathogenic antibodies were found in some MS patients, the observation that plasma cells and antibodies remain largely unchanged after B-cell depletion suggests that B cells are involved in MS by other mechanisms than antibody production.

Summary
MS is an autoimmune disease, in which T and B cells play a crucial role. B cells can be involved in MS by different mechanisms such as presentation of antigens to T cells, transport of antigens from tissues to secondary lymphoid organs, secretion of pro-inflammatory or anti-inflammatory cytokines and in a subgroup of patients also production of pathogenic antibodies. As several B-cell/antibody-directed therapies are available, it is important to understand how these different functions of B cells and antibodies vary among patients in order to identify which could benefit best from the different therapies.
Propagation of information along the cortical hierarchy as a function of attention while reading and listening to stories
Authors: Regev Mor , Simony Erez , Lee Katherine , Tan Kean Ming , Chen Janice , Hasson Uri 
Published: April 2018

AbstractHow does attention route information from sensory to high-order areas as a function of task, within the relatively fixed topology of the brain? In this study, participants were simultaneously presented with two unrelated stories – one spoken and one written – and asked to attend one while ignoring the other. We used fMRI and a novel inter-subject correlation analysis to track the spread of information along the processing hierarchy as a function of task. Processing the unattended spoken (written) information was confined to auditory (visual) cortices. In contrast, attending to the spoken (written) story enhanced the stimulus-selective responses in early sensory regions and allowed it to spread into higher-order areas. Surprisingly, we found that the story-specific spoken (written) responses for the attended story also reached the opposite secondary visual (auditory) regions. These results demonstrate how attention enhances the processing of attended input and allows it to propagate across brain areas.