bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bacterial Contamination of Propofol in the Operating Theatre
Authors: Soong W. A. L. 
Published: January 2019

There have been several reports of propofol becoming extrinsically contaminated with bacteria. These reports have usually related to infusions or delays in administration after the ampoule has been opened. This observational study was performed to examine bacterial contamination of propofol during usual practice in the operating theatres of a single large hospital group. One hundred samples of propofol were collected and cultured. Samples were taken immediately after administration in cases where the delay between opening the ampoule and administration was at least 15 minutes. The samples were classified according to whether the propofol was kept in the ampoule or a syringe after opening the ampoule and whether the intended use was for a single patient or multiple patients. The time between opening the ampoule and administration was recorded. There were three positive bacterial cultures. These samples all came from ampoules used for more than one patient, without the later dose (doses) being drawn into a syringe at the time the ampoule was opened. This common clinical practice, especially in paediatric anaesthesia, does not comply with the manufacturer's recommendations. The clinical significance of the bacterial contamination detected is not clear. It is recommended that propofol should be handled in an aseptic fashion and measures taken to minimize the risk of bacterial contamination.
Ruptured Abdominal Aortic Aneurysm—Outcome in a Community Teaching Hospital Intensive Care Unit
Authors: Ho K. , Burgess K. R. , Braude S. 
Published: January 2019

Ruptured abdominal aortic aneurysm (RAAA) is a surgical emergency associated with a high mortality often requiring postoperative intensive care. Our objectives were to assess the outcome of RAAA management in a non-tertiary community hospital intensive care unit (ICU) and to compare this with historical data from tertiary hospitals. We also sought to identify variables related to outcome and evaluate the potential of an organ failure score to identify patients at increased risk of death. The study was a retrospective chart review of patients with RAAA over 11 years (1986–1996 inclusive) at Manly District Hospital, a 210 bed community teaching hospital with eight intensive care beds. Forty patients were identified in the study period as having been admitted to ICU after RAAA surgery. There was an overall hospital mortality rate of 47.5% and intensive care mortality rate of 42.5% for successfully operated RAAA. Five variables were significantly different between survivors and non-survivors. These were age, total amount of blood products required, duration of operation, development of hypotension (systolic blood pressure <90 mmHg) in ICU postoperatively, and APACHE II score at Day 1 ICU. A trend was also found between mortality rate and the number of failed systems after 48 hours intensive care stay. Mortality for a patient with zero failed systems was 38%, one failed system 42%, two 58% and three 67%. Based on these results, management of RAAA in a non-tertiary setting appears appropriate with postoperative care occurring in an ICU where there is adequate equipment and medical and nursing staff experienced in the care of complex critical illness.
Outcomes of patients with relapsed/refractory double-expressor B-cell lymphoma treated with ibrutinib monotherapy
Authors: Landsburg Daniel J. , Hughes Mitchell E. , Koike Alexa , Bond David , Maddocks Kami J. , Guo Ling , Winter Allison M. , Hill Brian T. , Ondrejka Sarah L. , Hsi Eric D. , Nasta Sunita D. , Svoboda Jakub , Schuster Stephen J. , Bogusz Agata M. 
Published: January 2019

Key Points
The B-cell receptor signaling pathway is active in diffuse large B-cell lymphomas, with increased expression of MYC and BCL2 protein. The overall response rate was 60% for relapsed/refractory non–germinal center double-expressor lymphoma patients treated with ibrutinib.
Dizziness at a Canadian tertiary care hospital: A cost-of-illness study
Authors: Le Andre , Lelli Daniel A. , Van Katwyk Sasha , Hogan Debora , Thavorn Kednapa , Tse Darren 
Published: January 2019

Background In the Canadian health care system, determining overall costs associated with a particular diagnostic subgroup of patients, in this case dizzy patients, is the first step in the process of determining where costs could be saved without compromising patient care. This study is the first Canadian study that evaluates these costs at a tertiary care hospital and will allow for the extrapolation of cost data for other similar academic health science centers, regional health initiatives, and provincial healthcare planning structures. Methods We conducted a retrospective cohort study of patients of any age presenting to The Ottawa Hospital (TOH), a tertiary care hospital, between January 1st, 2009 and December 31st, 2014 with a main diagnosis of dizziness or dizziness-related disease. De-identified patient information was acquired through TOH Data Warehouse and included a patient's sex, age, arrival and departure dates, Elixhauser co-morbidity score, location of presentation (emergency department or admitted inpatient) presenting complaint, final diagnosis code, any procedure codes linked to their care, and the direct and indirect hospital costs linked with any admission. We derived the mean hospital costs and 95% confidence interval for each diagnosis. We obtained the number of patients who were diagnosed with dizziness within Ontario in year 2015–16 from Canadian Institute for Health Information (CIHI). A simple frequency multiplication was performed to estimate the total cost burden for Ontario based on the cost estimate for the same year obtained from TOH. Cost data were presented in 2017 Canadian dollars. Results The average total hospital cost per patient with dizziness for the entire cohort is $450 (SD = $1334), with ED only patients costing $359 (SD = $214). The total estimated hospital cost burden of dizziness in Ontario is $31,202,000 (95% CI $29,559,000 – 32,844,000). Conclusions The estimated annual costs of emergency department ambulatory and inpatient dizziness in Ontario was calculated to be approximately 31 million dollars per year. This is the first step in identifying potential areas for cost savings to aid local and provincial policy-makers in allocation of health care spending.
Chronic Atypical Antipsychotic Use Is Associated With Reduced Need for Postoperative Nausea and Vomiting Rescue in the Postanesthesia Care Unit: A Propensity-Matched Retrospective Observational Study
Authors: Jabaley Craig S. , Gray Dennis W. , Budhrani Gaurav S. , Lynde Grant C. , Adamopoulos Panagiotis , Easton George S. , O’Reilly-Shah Vikas N. 
Published: January 2019

BACKGROUND:
Atypical antipsychotics are efficacious for chemoprophylaxis against chemotherapy-induced nausea and vomiting, but perioperative investigations have been scant. We sought to examine the association between chronic atypical antipsychotic therapy and the likelihood of postoperative nausea and vomiting.

METHODS:
In this single-center, propensity-matched, retrospective, observational study, elective noncardiac surgical cases from January 2014 to December 2017 were examined with regard to the primary outcome of rescue antiemetic administration in the postanesthesia care unit as a measure of postoperative nausea and vomiting. Chronic administration of olanzapine, aripiprazole, and risperidone was the exposure of interest. Other independent variables included outpatient antiemetics, modified Apfel score, age, American Society of Anesthesiologists physical status score, case length, and exposures to emetogenic and chemoprophylactic agents. Logistic regression was performed using case-level data. Conditional logistic regression was performed after 1:2 propensity matching, sampling without replacement. Monte Carlo simulation was performed to compute the mean patient-level treatment effect on the treated.

RESULTS:
Of 13,660 cases, 154 cases with patients receiving atypical antipsychotics were matched against 308 cases without, representing 115 and 273 unique patients, respectively. In a well-balanced cohort, the mean patient-level odds of being administered rescue antiemetic was lower for patients chronically taking the 3 atypical antipsychotics under consideration as compared to those not on atypical antipsychotics, with an odds ratio of 0.29 (95% CI, 0.11–0.75; P = .015).

CONCLUSIONS:
Chronic atypical antipsychotic therapy is associated with reduced risk of postanesthesia care unit antiemetic administration. These findings support the need for prospective studies to establish the safety and efficacy of postoperative nausea and vomiting chemoprophylaxis with these agents.
Applying Conflict Management Strategies to the Pediatric Operating Room
Authors: Sinskey Jina L. , Chang Joyce M. , Shibata Gail S. , Infosino Andrew J. , Rouine-Rapp Kathryn 
Published: January 2019

Effective communication is essential in today’s health care environment, and poor communication can lead to conflict among health care providers. Differences in cultures and beliefs can further incite conflict among health care team members, families, and patients. Pediatric patient care has a higher potential for conflict because decision-making responsibilities are shared among patients, parents/guardians, and clinicians. It is important to understand the phases and types of conflict because each conflict situation requires a different approach to optimize management. Equally important is an understanding of styles used by individuals to manage conflict. The Thomas–Kilmann Conflict Mode Instrument and the Dutch Test for Conflict Handling are 2 validated tools used to assess conflict management styles. The different styles include competing/forcing, collaborating/problem solving, compromising, avoiding, and yielding/accommodating. A successful physician should be able to identify the phases and types of conflict to use the conflict management approach most suitable for the given conflict.
There are several techniques for managing conflict in the pediatric operating room. Acknowledging and managing one’s own emotions during conflict is a pivotal first step toward diffusing the situation. Active listening is an important communication skill that improves team dynamics. Aligning the interests of the parties involved in conflict will encourage collaborative problem solving. Cultural competency training can improve communication and conflict management skills. Effective conflict management through formal education of all perioperative team members can lead to improved communication and teamwork and better patient outcomes.
Intraoperative Hyperoxia Does Not Reduce Postoperative Pain: Subanalysis of an Alternating Cohort Trial
Authors: Cohen Barak , Ahuja Sanchit , Schacham Yehoshua N. , Chelnick David , Mao Guangmei , Ali-Sakr Esa Wael , Maheshwari Kamal , Sessler Daniel I. , Turan Alparslan 
Published: January 2019

BACKGROUND:
Postoperative pain is common and promotes opioid use. Surgical wounds are hypoxic because normal perfusion is impaired. Local wound ischemia and acidosis promote incisional pain. Some evidence suggests that improving oxygen supply to surgical wounds might reduce pain. We therefore tested the hypothesis that supplemental (80% inspired) intraoperative oxygen reduces postoperative pain and opioid consumption.

METHODS:
We conducted a post hoc analysis of a large, single-center alternating cohort trial allocating surgical patients having general anesthesia for colorectal surgery to either 30% or 80% intraoperative oxygen concentration in 2-week blocks for a total of 39 months. Irrespective of allocation, patients were given sufficient oxygen to maintain saturation ≥95%. Patients who had regional anesthesia or nerve blocks were excluded. The primary outcome was pain and opioid consumption during the initial 2 postoperative hours, analyzed jointly. The secondary outcome was pain and opioid consumption over the subsequent 24 postoperative hours. Subgroup analyses of the primary outcome were conducted for open versus laparoscopic procedures and for patients with versus without chronic pain.

RESULTS:
A total of 4702 cases were eligible for analysis: 2415 were assigned to 80% oxygen and 2287 to 30% oxygen. The groups were well balanced on potential confounding factors. Average pain scores and opioid consumption were similar between the groups (mean difference in pain scores, −0.01 [97.5% CI, −0.16 to 0.14; P = .45], median difference in opioid consumption, 0.0 [97.5% CI, 0 to 0] mg morphine equivalents; P = .82). There were also no significant differences in the secondary outcome or subgroup analyses.

CONCLUSIONS:
Supplemental intraoperative oxygen does not reduce acute postoperative pain or reduce opioid consumption.
Impact of Preoperative Erythropoietin on Allogeneic Blood Transfusions in Surgical Patients: Results From a Systematic Review and Meta-analysis
Authors: Cho Brian C. , Serini Jessica , Zorrilla-Vaca Andres , Scott Michael J. , Gehrie Eric A. , Frank Steve M. , Grant Michael C. 
Published: January 2019

BACKGROUND:
Erythropoietic-stimulating agents such as erythropoietin have been used as part of patient blood management programs to reduce or even avoid the use of allogeneic blood transfusions. We review the literature to evaluate the effect of preoperative erythropoietin use on the risk of exposure to perioperative allogeneic blood transfusions.

METHODS:
The study involved a systematic review and meta-analysis of randomized controlled trials evaluating the use of preoperative erythropoietin. The primary outcome was the reported incidence of allogeneic red blood cell transfusions during inpatient hospitalizations. Secondary outcomes included phase-specific allogeneic red blood cell transfusions (ie, intraoperative, postoperative), intraoperative estimated blood loss, perioperative hemoglobin levels, length of stay, and thromboembolic events.

RESULTS:
A total of 32 randomized controlled trials (n = 4750 patients) were included, comparing preoperative erythropoietin (n = 2482 patients) to placebo (n = 2268 patients). Preoperative erythropoietin is associated with a significant decrease in incidence of allogeneic blood transfusions among all patients (n = 28 studies; risk ratio, 0.59; 95% CI, 0.47–0.73; P < .001) as well as patients undergoing cardiac (n = 9 studies; risk ratio, 0.55; 95% CI, 0.37–0.81; P = .003) and elective orthopedic (n = 5 studies; risk ratio, 0.36; 95% CI, 0.28–0.46; P < .001) surgery compared to placebo, respectively. Preoperative erythropoietin was also associated with fewer phase-specific red blood cell transfusions. There was no difference between groups in incidence of thromboembolic events (n = 28 studies; risk ratio, 1.02; 95% CI, 0.78–1.33; P = .68).

CONCLUSIONS:
Preoperative erythropoietin is associated with a significant reduction in perioperative allogeneic blood transfusions. This finding is also confirmed among the subset of patients undergoing cardiac and orthopedic surgery. Furthermore, our study demonstrates no significant increase in risk of thromboembolic complications with preoperative erythropoietin administration.
Hippo signaling promotes lung epithelial lineage commitment by curbing Fgf10 and β-catenin signaling
Authors: Volckaert Thomas , Yuan Tingting , Yuan Jie , Boateng Eistine , Hopkins Seantel , Zhang Jin-San , Thannickal Victor J. , Fässler Reinhard , De Langhe Stijn P. 
Published: January 2019

ABSTRACTOrgan growth and tissue homeostasis rely on the proliferation and differentiation of progenitor cell populations. In the developing lung, localized Fgf10 expression maintains distal Sox9-expressing epithelial progenitors and promotes basal cell differentiation in the cartilaginous airways. Mesenchymal Fgf10 expression is induced by Wnt signaling but inhibited by Shh signaling, and epithelial Fgf10 signaling activates β-catenin signaling. The Hippo pathway is a well-conserved signaling cascade that regulates organ size and stem/progenitor cell behavior. Here, we show that Hippo signaling promotes lineage commitment of lung epithelial progenitors by curbing Fgf10 and β-catenin signaling. Our findings show that both inactivation of the Hippo pathway (nuclear Yap) or ablation of Yap result in increased β-catenin and Fgf10 signaling, suggesting a cytoplasmic role for Yap in epithelial lineage commitment. We further demonstrate redundant and non-redundant functions for the two nuclear effectors of the Hippo pathway, Yap and Taz, during lung development.
Effects of Obesity and Exercise on Bone Marrow Progenitor Cells after Radiation
Authors: EMMONS RUSSELL , NGU MATTHEW , XU GUANYING , HERNÁNDEZ-SAAVEDRA DIEGO , CHEN HONG , DE LISIO MICHAEL 
Published: January 2019

ABSTRACT

Introduction
The late effects of radiation therapy can have significant consequences for the health and quality of life of long-term cancer survivors. Radiation induces persistent alterations in hematopoietic stem and progenitor cells (HSPC) and the bone marrow environment; however, how relevant host factors such as obesity and exercise differentially regulate HSPC content and the bone marrow environment after radiation exposure remains unknown. The purpose of this investigation was to evaluate how the combination of obesity and exercise training modulates HSPC and their niche after sublethal radiation exposure in mice.

Methods
Mice fed either a control or a high-fat diet to induce obesity remained sedentary or underwent a progressive treadmill exercise program. At 13 wk of age, mice were irradiated (3 Gy) and continued their specific diets and exercise program for four more weeks.

Results
Exercise-trained mice had significantly higher quantities of several HSPC subpopulations and bone marrow stromal cell populations, whereas HSPC subpopulations were significantly lower in obese mice after radiation. Reactive oxygen species content was significantly decreased in HSPC with exercise training. Proteomics analysis of bone marrow supernatant revealed clustering of biologically relevant changes in exercise-trained mice. Functional evaluation of bone marrow supernatant revealed a significant increase in leukemia blast viability in obese mice but not in the exercise-trained mice (P < 0.05).

Conclusion
Together, these data suggest that exercise training partially restores the negative effects of obesity on HSPC and their niche after radiation exposure. As such, exercise training should be considered to mitigate the late effects of radiation therapy on the hematopoietic system for cancer survivors with or without obesity who have undergone radiation therapy.
The Mechanics of Breathing during Swimming
Authors: LEAHY MICHAEL G. , SUMMERS MCKENZIE N. , PETERS CARLI M. , MOLGAT-SEON YANNICK , GEARY CAITLIN M. , SHEEL A. WILLIAM 
Published: January 2019

ABSTRACT
The thorax undergoes unique conditions while swimming. Hydrostatic pressure from water immersion places an external load on the thorax and increases airway resistance, and the horizontal body position results in central venous engorgement and an associated reduction in lung compliance. The aforementioned factors likely increase the work of breathing (W
b); however, this hypothesis remains untested.

Purpose
This study aimed to compare W
b during freestyle swimming relative to cycling and to characterize the differences in the cardiorespiratory responses to swimming relative to cycling in the same individuals.

Methods
Eight collegiate swimmers (four men and four women, age = 22 ± 2 yr) performed an incremental swim test while tethered to a resistance apparatus. On a separate day, subjects performed an incremental cycle test. During swimming and cycling, metabolic and ventilatory parameters were measured using a customized metabolic cart, and inspired W
b was quantified using an esophageal balloon catheter.

Results
Swimming and cycling elicited statistically similar levels of peak oxygen uptake (3.87 ± 0.92 vs 4.20 ± 0.83 L·min−1, P = 0.143). However, peak minute ventilation (V˙
E) (118 ± 3 vs 154 ± 25 L·min−1) and heart rate (164 ± 19 vs 183 ± 8 bpm) were significantly lower during swimming relative to cycling (both P < 0.05). Inspired W
b was higher at a V˙
E of 50 L·min−1 (+27 ± 16 J·min−1), 75 L·min−1 (+56 ± 23 J·min−1), and 100 L·min−1 (+53 ± 22 J·min−1) during swimming compared with cycling (all P < 0.05). Periods of interbreath apnea were observed while swimming (duration = 0.13–2.07 s).

Conclusion
We interpret our findings to mean that the horizontal body position and hydrostatic pressure on the chest wall requires swimmers to generate greater inspiratory pressures to sustain adequate V˙
E during exercise.
A Unified Decomposition Matheuristic for Assembly, Production, and Inventory Routing
Authors: Chitsaz Masoud , Cordeau Jean-François , Jans Raf 
Published: January 2019

While the joint optimization of production and outbound distribution decisions in a manufacturing context have been intensively studied in the past decade, the integration of production, inventory, and inbound transportation from suppliers have received much less attention despite its practical relevance. This paper aims to fill the gap by introducing a general model for the assembly routing problem (ARP), which consists of simultaneously planning the assembly of a finished product at a plant and the routing of vehicles collecting materials from suppliers to meet the inventory requirements imposed by the production. We formulate the problem as a mixed-integer linear program and we propose a three-phase decomposition matheuristic that relies on the iterative solution of different subproblems. The first phase determines a setup schedule while the second phase optimizes production quantities, supplier visit schedules and shipment quantities. The third phase solves a vehicle routing problem for each period in the planning horizon. The algorithm is flexible, and we show how it can also be used to solve two well-known outbound distribution problems related to the ARP: the production routing problem and the inventory routing problem. Using the same parameter setting for all problems and instances, we obtain 781 new best-known solutions out of 2,628 standard IRP and PRP test instances. In particular, on large-scale multivehicle instances, the new algorithm outperforms specialized state-of-the-art heuristics for these two problems. The online appendix is available at https://doi.org/10.1287/ijoc.2018.0817 .
Mix Stickiness Under Asymmetric Cost Information
Authors: Antle Rick , Bogetoft Peter 
Published: January 2019

In most organizations, the agent has superior information about the relative costs of different products or activities. This handicaps the principal when the principal seeks to adjust the product mix. Our main conceptual finding is that there is “mix stickiness.” The agent’s superior information about the relative costs of different products or activities leads to an advantage for the status quo; that is, there is inertia (or stickiness) in the mix of products or activities pursued. The historical mix has an advantage because the asymmetric information about relative costs has less of an impact when the mix does not change. If the mix changes, the producer can extract information rents by claiming high costs on the least reduced or most expanded products. Only in the case of larger shifts in the environment will the mix change. Changing the mix comes with the advantage of making rationing cheaper. Our analysis gives new insight into several business practices. It suggests, for example, that for moderate downsizing, a reinforcement approach of proportionally cutting all activities (lawn mowing) is optimal. When more dramatic downsizing is called for, a reorientation approach of eliminating certain activities (divesting) is optimal. It also suggests that outsourcing may come at the cost of reduced adaptability, and it may help explain why most, if not all, healthcare systems struggle to control cost.This paper was accepted by Rajgopal Shiva, accounting.