bluuebunny/crossref_metadata_2025_split huggingface dataset:
Operationalization of the Transition to Comfort Measures Only in the Neurocritical Care Unit: A Quality Improvement Project
Authors: Lele Abhijit , Cheever Chong , Healey Larry , Hurley Kellie , Kim Louis J. , Creutzfeldt Claire J. 
Published: July 2018

Introduction: Transition to comfort measures only (CMO) is common in the neurocritical care unit, and close communication between interdisciplinary health-care teams is vital to a smooth transition. We developed and implemented a CMO huddle in an effort to reduce inconsistencies during the process of CMO transition. Methods: The CMO huddle was a multiphase quality improvement project in a neurocritical care unit of a level-1 trauma and comprehensive stroke center. Interdisciplinary critical care clinicians engaged in a huddle during CMO processes and participated in a pre- and postimplementation survey to examine the impact of CMO huddle on communication, missed opportunities, and improvement in knowledge. Results: Since the CMO implementation, a total of 131 patients underwent CMO transitions. After implementation of an interdisciplinary CMO huddle, 64.3% of neurocritical care nurses reported that they felt included and involved in CMO process compared to 28% before implementation ( P = .003); 87.9% of all neurocritical care clinicians reported that they felt comfortable participating in CMO discussions compared to 69.8% before ( P < .001); 57.4% of all neurocritical care clinicians reported that the CMO huddle improved communication among neurocritical care clinicians, 51.9% reported reduction in missed opportunities during CMO process, and 21.7% reported witnessing less-than-ideal CMO process compared to 80% before ( P < .001). Conclusions: Implementation of a multidisciplinary huddle in the neuro–intensive care unit before transition to CMO may improve clinician’s experience of the end-of-life process through enhanced nursing inclusion and involvement and organized communication with the neurocritical care team.
Application of the 2015 proposed NIOSH vapor containment performance protocol for closed system transfer devices used during pharmacy compounding and administration of hazardous drugs
Authors: Forshay Charlotte M , Streeter Shawn O , Salch Stephanie A , Eckel Stephen F 
Published: July 2018

Purpose The National Institute for Occupational Safety and Health (NIOSH) released a proposed protocol in 2015 to evaluate the vapor containment abilities of closed system transfer device technologies in order to provide meaningful comparisons between products. This study assessed the vapor containment ability of closed system transfer devices when following the methodology as outlined by the 2015 NIOSH proposed protocol. Methods This study evaluated six closed system transfer device brands following the draft NIOSH vapor containment protocol. The testing evaluated each closed system transfer device brand during both compounding (Task 1) and administration (Task 2). Five pre-specified steps for each task were repeated for a total of four manipulations per device. The Thermo Scientific™ MIRAN SapphIRe XL Infrared Analyzer was used to detect isopropyl alcohol vapor levels after each step. Results For Task 1, two closed system transfer device products (PhaSeal™ and Equashield®) adequately contained the isopropyl alcohol vapor and passed the predefined testing criteria. The same two products, plus one additional product (ChemoLock™), contained the vapor for Task 2 manipulations. Based on the results of this study, only two out of the six closed system transfer device brands passed testing criteria for both tasks, functioning as truly closed systems. Conclusion To improve employee safety in chemotherapy preparation, closed system transfer devices that demonstrate no leakage should be the preferred choices of healthcare systems. In this study, PhaSeal™ and Equashield® proved to be adequately closed in both Task 1 and Task 2, while ChemoLock™ proved to be closed in Task 2 but not in Task 1. All other products failed both tasks when measuring for isopropyl alcohol vapor release.
Ciprofloxacin vs. levofloxacin for prophylaxis in recipients of hematopoietic stem cell transplantation
Authors: Rambaran Kerry Anne , Seifert Charles F 
Published: July 2018

Background Infection is the most common cause of morbidity and mortality in patients undergoing myleosuppressive therapy with the risk of infection being heightened during the neutropenic phase. Fluoroquinolones are most often utilized as prophylaxis, specifically levofloxacin or ciprofloxacin; however, there is increasing resistance among these agents. The objective of this study is to compare the efficacy of ciprofloxacin and levofloxacin when used prophylactically in hematopoietic stem cell transplantation patients. Study design A retrospective cohort study conducted at a 443-bed tertiary teaching county hospital from 1 January 2005 to 31 September 2016. Methods Patients aged 18–89 who were admitted and received levofloxacin or ciprofloxacin post hematopoietic stem cell transplantation were evaluated. Results The patient population (N = 151) was predominantly male (93 vs. 58) and the median (IQR) age was 57 (20.1) years. There were 108 patients undergoing autologous hematopoietic stem cell transplantation compared to 43 undergoing allogenic hematopoietic stem cell transplantation. Significantly fewer patients who received levofloxacin (11/43, 25.6%) developed neutropenic fever compared to patients who received ciprofloxacin (61/108, 56.5%, p = 0.0006). Also there were significantly more positive blood cultures in the ciprofloxacin group (36/108, 33.3%) compared to the levofloxacin group (4/43, 9.3%); the majority of which were Gram-positive organisms (p = 0.0025). Conclusion Prophylaxis with levofloxacin was associated with a lower incidence of febrile neutropenia and bacteremia when compared to ciprofloxacin in hematopoietic stem cell transplantation patients.
Efficacy and safety of ozanimod in multiple sclerosis: Dose-blinded extension of a randomized phase II study
Authors: Cohen Jeffrey A , Comi Giancarlo , Arnold Douglas L , Bar-Or Amit , Selmaj Krzysztof W , Steinman Lawrence , Havrdová Eva K , Cree Bruce AC , Montalbán Xavier , Hartung Hans-Peter , Huang Vivian , Frohna Paul , Skolnick Brett E , Kappos Ludwig ,   for the RADIANCE Trial Investigators
Published: July 2018

Background: Ozanimod, an oral immunomodulator, selectively targets sphingosine 1-phosphate receptors 1 and 5. Objective: Evaluate efficacy, safety, and tolerability of ozanimod in relapsing multiple sclerosis. Methods: In the RADIANCE Part A phase II study (NCT01628393), participants with relapsing multiple sclerosis were randomized (1:1:1) to once-daily ozanimod hydrochloride (0.5 or 1 mg) or placebo. After 24 weeks, participants could enter a 2-year, dose-blinded extension. Ozanimod-treated participants continued their assigned dose; placebo participants were re-randomized (1:1) to ozanimod hydrochloride 0.5 or 1 mg (equivalent to ozanimod 0.46 and 0.92 mg). Results: A total of 223 (89.6%) of the 249 participants completed the blinded extension. At 2 years of the extension, the percentage of participants who were gadolinium-enhancing lesion-free ranged from 86.5% to 94.6%. Unadjusted annualized relapse rate during the blinded extension (week 24—end of treatment) was 0.32 for ozanimod hydrochloride 0.5 mg → ozanimod hydrochloride 0.5 mg, 0.18 for ozanimod hydrochloride 1 mg → ozanimod hydrochloride 1 mg, 0.30 for placebo → ozanimod hydrochloride 0.5 mg, and 0.18 for placebo → ozanimod hydrochloride 1 mg. No second-degree or higher atrioventricular block or serious opportunistic infection was reported. Conclusion: Ozanimod demonstrated sustained efficacy in participants continuing treatment up to 2 years and reached similar efficacy in participants who switched from placebo; no unexpected safety signals emerged.
Application of the 2017 McDonald diagnostic criteria for multiple sclerosis in Korean patients with clinically isolated syndrome
Authors: Hyun Jae-Won , Kim Woojun , Huh So-Young , Park Min Su , Ahn Suk-Won , Cho Joong-Yang , Kim Byung-Jo , Lee Sang-Hyun , Kim Su-Hyun , Kim Ho Jin 
Published: July 2018

Objectives: To evaluate the validity of the revised 2017 McDonald criteria for multiple sclerosis (MS) compared with the 2010 McDonald criteria to predict conversion to clinically definite multiple sclerosis (CDMS) in patients with clinically isolated syndrome (CIS). Methods: A total of 163 patients from seven referral hospitals in Korea, who experienced a first clinical event suggestive of MS between 2006 and 2017, were enrolled. Patients were stratified into two groups according to outcome at the last visit: CDMS converters who experienced a second clinical event and non-converters. Results: Of the 163 patients with a mean follow-up of 63 months, 60% converted to CDMS. The sensitivity, specificity, positive and negative predictive values and accuracy were, respectively, 88.8%, 43.1%, 70.2%, 71.8% and 70.6% for the 2017 McDonald criteria and 53.1%, 69.2%, 72.2%, 49.5% and 59.5% for the 2010 McDonald criteria. After exclusion of 82 patients who received disease-modifying agents before the second attack, the specificity of the 2017 and 2010 McDonald criteria increased to 85.0% and 95.0%, but sensitivity decreased to 83.6% and 47.5%, respectively. Conclusion: The 2017 McDonald criteria afforded higher sensitivity and accuracy but lower specificity compared with the 2010 McDonald criteria for prediction of conversion to CDMS in Korean CIS patients.
Learning to lead: a review and synthesis of literature examining health care managers' use of knowledge
Authors: Tate Kaitlyn , Hewko Sarah , McLane Patrick , Baxter Pamela , Perry Karyn , Armijo-Olivo Susan , Estabrooks Carole , Gordon Deb , Cummings Greta 
Published: July 2018

Background Scholarship cites health care managers (HCMs) as not using research evidence in their management practice. The purpose of this review was to evaluate the effectiveness of interventions to enhance HCMs use of research evidence in practice. Methods We carried out a systematic review and focus groups to validate the review findings. We searched 10 electronic databases for studies reporting on interventions for HCMs to enhance research utilization in their practice. Qualitative studies were analysed using Hoon’s approach to meta-synthesis. Results Seven, primarily qualitative, studies of varying quality (reported in 11 articles) met our inclusion criteria. Interventions to enhance research use by HCMs included: informal and formal training, computer-based application, executive-level knowledge translation activities and residency programmes. Studies did not report efficacy of interventions or impacts of increasing managers’ use of research on staff or patient outcomes. Meta-synthesis yielded four contextual factors influencing the perceived effectiveness of interventions to enhance research use by HCMs: organizational culture, competing priorities, time as a resource and capacity building. Included studies differed in how they defined research and demonstrated varying understandings of research among HCMs, limiting the generalizability of work in this field. Conclusions Healthcare managers are increasingly called upon to make evidence-based decisions in practice, but the small number of studies and diverse strategies employed hinder our ability to identify any intervention to increase use of evidence as superior. Future studies in this area should clearly articulate the definition of research evidence they base their decisions on. Registration: PROSPERO (CRD42014006256)
Prevalence and determinants of hypertension in apparently healthy schoolchildren in India: A multi-center study
Authors: Narang Rajiv , Saxena Anita , Desai Ankush , Ramakrishnan Sivasubramanian , Thangjam Rajendra S , Kulkarni Snehal , Narvencar Kedareshwar , e Costa Ana K Jacques' , Dias Amit , Sukharamwala Ritesh , Cleland John 
Published: July 2018

BackgroundHypertension in children is often under recognized, especially in developing countries. Data from rural areas of developing countries is particularly lacking.ObjectivesTo study prevalence of hypertension and its determinants in apparently health school children from predominantly rural populations of India.MethodsApparently healthy schoolchildren ( n = 14,957) aged 5–15 years (mean (standard deviation) age 10.8 (2.8) years; 55.5% boys) at four predominantly rural sites in separate states of India were studied. Systolic and diastolic blood pressures were recorded by trained staff in addition to age, gender, height, weight, type of school and season. Waist circumference was also recorded in 12,068 children. Geographic location and type of school (government, government-aided or private) were used to determine socio-economic status.ResultsSystolic and/or diastolic hypertension was present in 3443 (23%) children. Systolic hypertension was present in 13.6%, diastolic hypertension in 15.3% and both in 5.9%. Isolated systolic hypertension was present in 7.7% while isolated diastolic hypertension was present in 9.4%. On univariate analysis, age, gender, geographical location, socio-economic status, season and anthropometric parameters (z-scores of height, weight and waist circumference, waist/height ratio and body mass index) were all significantly related to risk of hypertension ( p < 0.0001 for each). Similar association was observed with weight group (normal, overweight and obese). Multiple regression analysis showed lower age, female gender, richer socio-economic status, certain geographical locations, higher weight and larger waist circumference to be independently associated with a greater risk of hypertension.ConclusionThere is a high prevalence of hypertension in apparently healthy schoolchildren even in predominantly rural areas of India. Screening and management programs targeted to high risk groups identified may prove cost-effective.
Comparison of a Distal Tibial Allograft and Scapular Spinal Autograft for Posterior Shoulder Instability With Glenoid Bone Loss
Authors: Nacca Christopher , Gil Joseph A. , DeFroda Steven F. , Badida Rohit , Owens Brett D. 
Published: July 2018

Background: Posterior glenoid bone deficiency can occur with recurrent glenohumeral instability. Glenoid reconstruction with a distal tibial allograft (DTA) has been reported to successfully restore contact pressures that occur during posterior glenohumeral translation. However, there are concerns regarding the risk of allograft resorption, availability, and costs. Extracapsular reconstruction using a scapular spinal autograft (SSA) has been reported as an alternative technique secondary to its anatomic location relative to the posterior shoulder and preferable autograft properties. There are no known prior biomechanical studies evaluating the scapular spine as an effective extracapsular graft choice. Purpose: To compare the efficacy of a DTA and SSA in restoring the stability of a glenoid with a large posterior bone defect compared with the intact native glenoid. Study Design: Controlled laboratory study. Methods: Ten cadaveric shoulders were tested. With the use of a custom KUKA robot, a 50-N compressive force was applied to the glenohumeral joint. The peak force required to translate the humeral head beyond the glenoid lip posteriorly as well as the lateral displacement that occurred during posterior translation were measured. Testing was performed in 5 conditions: (1) intact glenoid and labrum, (2) simulated reverse Bankart lesion, (3) 12-mm posterior glenoid defect, (4) glenoid defect reconstructed with a fresh DTA, and (5) glenoid defect reconstructed with an SSA. Results: The mean glenoid width was 30 mm. The mean peak force and lateral displacement decreased significantly with a glenoid defect (0.99 ± 2.3 N and 0.06 ± 0.09 mm, respectively; P < .0001) compared with the intact glenoid (23.00 ± 9.7 N and 1.83 ± 0.70 mm, respectively; P = .0001). There was no significant difference between the peak force after reconstruction of the defect with a DTA (23.00 ± 7.4 N) and SSA (23.00 ± 7.7 N) when compared with the intact glenoid ( P = .9999). There were no significant differences in the peak force between the 2 grafts ( P = .9999). Additionally, both the DTA (1.04 ± 1.09 mm) and the SSA (1.02 ± 1.17 mm) demonstrated no differences in lateral displacement when compared with the intact glenoid ( P = .2336 and .2043, respectively). There was no difference in lateral displacement that occurred between the DTA and SSA ( P = .9999). Conclusion: Reconstruction of a large posterior glenoid defect with either a DTA or an SSA can effectively restore glenohumeral stability. Clinical Relevance: This study supports the use of a DTA or SSA in posterior glenoid defect reconstruction. Clinical studies are needed to determine the long-term effects of utilizing such grafts.
Endogenous Endophthalmitis: Has the Opioid Crisis Impacted the Rates and Severity of Intravenous Drug-Related Cases?
Authors: Russell Jonathan F. , Scott Nathan L. , Hinkle John W. , Yannuzzi Nicolas A. , Miller Darlene , Relhan Nidhi , Flynn Harry W. 
Published: July 2018

Purpose: Endogenous endophthalmitis is an intraocular infection associated with systemic illness and/or intravenous drug use (IVDU). Rising national rates of IVDU may have impacted rates and outcomes of endogenous endophthalmitis. The purpose of the current study is to compare rates and treatment outcomes in endogenous endophthalmitis with and without a history of IVDU. Methods: This is a single-center retrospective consecutive case series of 21 eyes of 17 patients with a diagnosis of endogenous endophthalmitis from May 2014 to December 2016. Clinical characteristics and treatment outcomes were compared between IVDU and non-IVDU groups. Results: A history of IVDU was present in 3 of 17 patients (18%), whereas the other 82% had systemic comorbidities. There was no statistically significant difference in presenting visual acuity (VA) between the IVDU and non-IVDU groups (20/630 vs 20/500, P = .75). Pars plana vitrectomy was performed at some point in the clinical course of 80% of eyes (4/5) in the IVDU group and 56% of eyes (9/16) in the non-IVDU group. Staphylococcus or Candida were the predominant causative organisms isolated in the IVDU and non-IVDU groups. Statistical analyses revealed trends towards worse last VA in the non-IVDU group compared with the IVDU group (20/1000 vs 20/110, P = .10). Conclusions: Compared with historical data from the same institution, there has not been an increase in the rates of IVDU-associated endogenous endophthalmitis at this tertiary referral center. VA outcomes are often poor in both groups, but there may be a better prognosis for IVDU-associated endogenous endophthalmitis.
Molecular characterization of Pseudomonas aeruginosa isolates from Sudanese patients: A cross-sectional study
Authors: Amoon Reem H. , Abdallha Amna H. , Sharif Ahmed Osman , Moglad Ehssan H. , Altyb Hisham N. , Elzaki Salaheldein G. , Salih Mohamed A. 
Published: July 2018

Background:16S rRNA gene sequence analysis is a robust tool for characterization of new pathogens in clinical specimens with suspected bacterial disease. The aim of this study was to characterizePseudomonas aeruginosaisolated from clinical specimens by sequencing the 16S rRNA gene.Methods:Forty bacterial isolates were obtained from different clinical specimens (wound, urine and sputum) using enrichment selective media and biochemical tests to characterize and identify the bacteria asP. aeruginosa.DNA was extracted fromP. aeruginosausing the Chelex method. A universal primer was used to amplify 16S rRNA genes by a conventional PCR technique. The amplified PCR products were sequenced, and the sequences were viewed by Finch TV program version 1.4.0. The identity and similarity of the nucleotide sequence of the isolated strains was detected by comparing them with published sequences using BLASTn. Phylogenetic trees were constructed using Phylogeny.fr software.Results:Sequence analysis by BLASTn displayed high similarity and identity withP. aeruginosafrom China KX461910, Australia JN609194 and with otherP. aeruginosaisolates from the GenBank database.Conclusions:Our observation of isolates from different origin sites, further show the utility of 16s rRNA PCR amplification. This reveals the high specify of the primers and accuracy of the PCR. Thus, 16S rRNA sequencing can be used to identify genetically atypicalP. aeruginosaisolates from different origins.
Interacciones entre el estrés, el parásito y el hospedador: ¿un triángulo vicioso? (VERSIÓN EN ESPAÑOL)
Authors: BELDOMENICO Pablo , BEGON Mike 
Published: July 2018

El potencial sinergismo entre la condición fisiológica del hospedador y la infección
ha sido recientemente reconocido. Aquí revisamos la evidencia que da sustento a la noción que el estrés puede jugar un papel clave en la interacción entre el hospedador y el parásito, integrando una interacción circular sinérgica de tres vías que comprende al factor estresante, las infecciones y la respuesta del hospedador: el estrés crónico desencadena respuestas que empobrecen la condición fisiológica del hospedador (incluyendo su función inmune), lo cual predispone a infecciones, lo cual resulta en más estrés, y así sucesivamente. Sostenemos que esta noción introduce capacidad adicional para explicar las ideas previas propuestas por los autores, mediante la incorporación del estrés como un tercer factor interactuante que interviene en el sinergismo entre condición e infección. A su vez, esto puede tener importantes implicancias. En la naturaleza, fuerzas evolutivas parecen remover a enfermedades relacionadas al estrés o a la virulencia exacerbada. No obstante, bajo ciertas circunstancias, los parásitos y (otros) factores estresantes interactúan generando círculos viciosos que pueden afectar la sobrevida del hospedador. A altas densidades, este se vuelve un mecanismo de regulación poblacional. Asimismo, factores estresantes antropogénicos pueden causar que este mecanismo se dispare en falso, con implicancias significativas
paraa la conservación de la biodiversidad y la salud pública.
A methodology for the professional training of the management and evaluation of HPC systems
Authors: Skrinarova Jarmila , Dudas Adam 
Published: July 2018

Abstract
The paper is motivated by critical demand for experts and scientists working in areas of mathematical modeling, simulations, big data techniques and who are familiar with management of HPC systems from user and administrator point of view. We created a new course entitled “HPC system management”. Our goal is focused on students to provide them with knowledge and understanding of complex problem of the HPC system management concerning job scheduling. Important fact is that the job scheduling problem is an NP-complete problem. Next objective of our course is to educate skilled experts, who are able to design and implement programs, scripts and models doing job management to solve specific parts of this complex problem. The course is innovative from several points of view. Our new approach lies in specific content, which is oriented to the HPC system management in contrast to existing courses, which are usually focused on development of HPC applications. Also we developed and provide new education methodology in a form of scientific project, which decomposes the complex problem into subproblems and subsequently brings together solutions to the subproblems to form united model. New education methodology is focused on generation of (pseudo-) optimal jobs schedule using data from real systems. The huge volume of used data leads to ideas and methodologies of problem solving, which are suitable for problems not solvable in polynomial time. Educational methodology also contains implementation of a job scheduling simulator. The paper presents a pilot course, in which students explore various scheduling algorithms and research their properties with the use of data gained from NorduGrid