bluuebunny/crossref_metadata_2025_split huggingface dataset:
Barriers and facilitators to intraorganizational collaboration in public health: Relational coordination across public health services targeting individuals and populations
Authors: McCullough J. Mac , Eisen-Cohen Eileen , Lott Breanne 
Published: May 2018

Background:
Modern public health emphasizes population-focused services, which may require collaborative work both across and within organizations. Studies have explored interorganizational collaborations, but there are little data regarding collaborations within public health organizations.

Purpose:
We measured intraorganizational collaboration and identified barriers and facilitators to collaboration within a large public health department through a mixed-methods study.

Methodology/Approach:
Our study occurred at the Maricopa County (Arizona) Department of Public Health, the third largest local public health jurisdiction in the United States. To measure collaboration, we surveyed staff using the relational coordination tool. To identify barriers and facilitators to collaboration, we performed key informant interviews with department personnel.

Results:
Relational coordination scores varied according to the focus of the service; clinical services had significantly lower levels of relational coordination than population-focused services (p < .01). We found high levels of mutual respect and lower levels of shared knowledge across services. Facilitators to collaboration included purposive cross-program meetings around specific topics, the organization’s structure and culture, and individuals’ social identities. Barriers included raised expectations for collaboration, low slack resources, member’s self-interest, and trust.

Conclusion:
The relational coordination of services varied significantly according to the focus of the service. Population-focused public health services had higher levels of relational coordination than individually focused services. Collaboration was facilitated and impeded by both well-known and potentially emergent factors, such as purposive cross-service meetings and organizational culture.

Practice Implications:
Population-focused services possessed higher levels of collaboration than individually focused services. Intraorganizational collaboration for improved population health relies on deliberate support from senior management and structured activities to increase shared knowledge and mutual respect.
Descemet Membrane Endothelial Keratoplasty After Penetrating Keratoplasty: Features for Success
Authors: Einan-Lifshitz Adi , Belkin Avner , Sorkin Nir , Mednick Zale , Boutin Tanguy , Gill Ishrat , Karimi Mohammad , Chan Clara C. , Rootman David S. 
Published: May 2018

Purpose:
To evaluate Descemet membrane endothelial keratoplasty (DMEK) in the setting of failed penetrating keratoplasty (PKP) and to identify factors associated with DMEK success and failure after PKP.

Methods:
A retrospective chart review of patients who underwent DMEK for failed PKP at Toronto Western Hospital, Canada, between 2014 and 2017 was performed. Demographic characteristics, number of previous transplants, intraoperative and postoperative complications, best spectacle-corrected visual acuity (BSCVA), and endothelial cell density were analyzed.

Results:
Twenty-eight eyes were included in the study. Rebubbling intervention was performed in 12 eyes (43%) within the first postoperative weeks. Five eyes (18%) developed graft rejection episodes. Twelve eyes (43%) had to be regrafted after DMEK surgery and were deemed failures (because of persistent Descemet membrane detachment, rejection episode that led to secondary failure, and infection). BSCVA before DMEK was significantly worse in the eyes that failed than those that did not [1.97 ± 0.85 and 1.2 ± 0.56 logMAR, respectively, (P = 0.01)]. Rebubbling was required in 75% of eyes in the failure group compared with 19% in the success group (P = 0.002). Six of the 16 eyes (37.5%) in the success group underwent femtosecond laser-enabled DMEK, whereas this technique was not used in any of the eyes in the failure group (P = 0.017).

Conclusions:
DMEK is a viable option for cases of failed PKP. DMEK failure after PKP might be associated with lower visual acuity before DMEK surgery, higher number of rebubble interventions, and manual descemetorhexis rather than femtosecond laser-enabled DMEK.
Corneal Cross-Linking in Pediatric Patients: Evaluating Treated and Untreated Eyes—5-Year Follow-Up Results
Authors: Or Lior , Rozenberg Assaf , Abulafia Adi , Avni Isaac , Zadok David 
Published: May 2018

Purpose:
To evaluate the long-term results of corneal collagen cross-linking (CXL) for treatment of pediatric keratoconus and the long-term outcomes of the fellow untreated keratoconic eye in patients younger than 18 years old.

Methods:
A retrospective case analysis was performed on 88 eyes of 44 patients aged 18 years or younger, with keratoconus, who underwent CXL in at least 1 eye. Follow-up measurements, for the treated and untreated eye pair, taken up to 5 years after treatment, were compared with baseline values. Parameters included uncorrected distance visual acuity (UCDVA), best spectacle-corrected distance visual acuity (BCDVA), manifest refraction, pachymetry, and corneal topography and tomography.

Results:
Mean age of patients was 15.6 ± 2.1 years. For the treated eyes, during all years of follow-up, UCDVA improved significantly (from 0.83 ± 0.30 to 0.72 ± 0.28 logMAR; P = 0.01). Improvement in BCDVA was not statistically significant (from 0.28 ± 0.19 to 0.23 ± 0.15 logMAR; P = 0.06). The manifest cylinder showed a significant reduction (from 5.8 ± 3.6 to 4.3 ± 2.5 diopters; P = 0.006). There was no significant change in maximum keratometry. Average keratometry and corneal thickness reduced significantly (P = 0.009 and P = 0.002, respectively). Five patients had very mild corneal haze after CXL. For the fellow untreated eyes—during 5 years of follow-up, UCDVA showed a slight decrease that was not statistically significant. BCDVA, average keratometry, and maximum keratometry remained stable.

Conclusions:
Our long-term follow-up study suggests that CXL is a safe procedure in the pediatric age, and there is no urgency in treating pediatric patients with keratoconus without proof of progression.
Valsalva Maneuver and Peripapillary OCT Angiography Vessel Density
Authors: Holló Gábor 
Published: May 2018

Purpose:
To investigate the potential influence of breath holding on the results of peripapillary vessel density (VD) measurement with optical coherence tomography angiography.

Materials and Methods:
Three peripapillary VD measurements were made at 2-minute intervals on the right eye of 12 healthy young volunteers using the Angiovue/RTvue-XR OCT (software version 2017.1, Phase 7 update) without changing the head and body positions. During the first 2 measurements the volunteers were breathing normally. Four seconds before the third measurement the participants started to perform the Valsalva maneuver and continued until the completion of the ∼17-second image acquisition. The whole image area, the inside-disc area and the peripapillary area were investigated for capillary VD and all-vessels VD, separately.

Results:
All volunteers had normal blood pressure and intraocular pressure, and all study eyes were normal with healthy optic nerve head and peripapillary area. No difference for any VD parameter was seen between the baseline images (P≥0.492). The differences between the averaged baseline and the during Valsalva maneuver values did not differ from 0 (P≥0.474), and the mean differences were ≤0.19% for the whole image, ≤0.35% for the peripapillary area, and ≤0.68% for the inside-disc parameters. The mean image quality score was >8 (optimal) in all image sessions.

Conclusions:
Our results suggest that breath holding during optical coherence tomography angiography image acquisition does not influence the measured peripapillary, whole image and inside-disc VD values, or the quality of the images, in healthy young subjects. Thus, no specific patient instruction regarding breathing is required before image acquisition.
Prevalence and Molecular Characterization of Staphylococcus aureus and Methicillin-resistant S. aureus on Children’s Playgrounds
Authors: Thapaliya Dipendra , Kadariya Jhalka , Capuano Mike , Rush Haleigh , Yee Clair , Oet Mark , Lohani Sapana , Smith Tara C. 
Published: May 2018

Background:

Staphylococcus aureus is a major public health concern due to the emergence of virulent and drug-resistant strains such as methicillin-resistant Staphylococcus aureus (MRSA). Although numerous studies have been conducted to assess the environmental contamination of S. aureus in health care and household settings, little is known about the prevalence and epidemiology of S. aureus, including MRSA, on environmental surfaces of children’s playgrounds. This study investigated the prevalence and molecular epidemiology of S. aureus and MRSA at playgrounds in northeast Ohio.

Methods:
A total of 280 environmental samples were collected from 10 playgrounds in northeast Ohio in July 2016. Sampling sites were selected based on playground size and availability of equipment located in both small and large cities and their suburbs. Samples were analyzed using established microbiology methods, and resulting S. aureus isolates were typed by spa typing. Polymerase chain reaction was used to detect the presence of the Panton-Valentine leukocidin and mec A genes. Antibiotic susceptibility was tested via the Vitek-2 System.

Results:
The overall prevalence of S. aureus and MRSA was 31.8% (89/280) and 3.9% (11/280), respectively. A total of 43 spa types were detected from 257 S. aureus isolates. Overall, t189 was the most common spa type, accounting for 15.6% (40/257) of the isolates. Sixteen isolates (6.2%) were t002 (ST5/USA100), a common hospital-associated strain, and 11 isolates (4.3%) were t008 (ST8/USA300), a common community-associated strain. Five livestock-associated strain (t571/ST398) were also identified. Twenty-nine (11.3%) isolates were resistant to oxacillin, and 66 (25.7%) were multi-drug resistant S. aureus.

Conclusions:
The results of this study indicate that environmental surfaces of playgrounds in northeastern Ohio were contaminated with S. aureus and MRSA. These data reinforce the need for implementing effective prevention strategies to mitigate the risk imposed to children by environmental contamination of MRSA.
Risk Factors for Severe Community-aquired Pneumonia Among Children Hospitalized With CAP Younger Than 5 Years of Age
Authors: Shan Wei , Shi Ting , Chen Kaile , Xue Jian , Wang Yin , Yu Jia , Zhao Genming , Tian Jianmei , Zhang Tao 
Published: May 2018

Background:
Community-acquired pneumonia (CAP) causes great morbidity and mortality as well as enormous economic burden worldwide. This study intended to describe the clinical characteristics of CAP and explore the risk factors of severe CAP among children in downtown Suzhou, China.

Methods:
This was a retrospective study of childhood hospitalizations in Soochow University Affiliated Children’s Hospital from January 1, 2010, to December 31, 2014. Children who were residents of downtown Suzhou, 29 days to < 5 years of age, with discharge diagnosis codes J09 to J18 and J20 to J22 were included. Medical charts and chest radiograph reports were reviewed for included children to collect clinical information. CAP with intensive care unit (ICU) admission and poor clinical outcome were categorized as severe CAP.

Results:
A total of 28,043 children were identified with CAP; 17,501 (62.4%) of these children were male, and 20,747 (74.0%) children were less than 2 years of age. The common clinical symptoms at admission were cough (94.8%), fever (52.9%), wheezing (37.7%) and respiratory distress (9.5%). In total, 21,898 (78.1%) children had radiologic evidence of pneumonia, and 1,403 (5.0%) children developed at least 1 complication. Multivariate regression analysis showed that younger age, congenital heart disease and abnormal white blood cells, and C-reactive protein results were independent risk factors for both ICU admission and poor clinical outcome (odds ratio [OR] > 1 for all). Respiratory distress symptoms at admission (OR = 12.10) greatly increased the risk for ICU admission, while ICU admission (OR = 8.87) and complications (OR = 2.55) increased the risk of poor outcome. However, cough was a protective factor for ICU admission, so were wheezing, antibiotic and antiviral therapies for clinical failure.

Conclusion:
Pediatric CAP hospitalizations of those of younger age, with congenital heart diseases, respiratory distress symptoms/tachypnea, abnormal white blood cells and C-reactive protein results as well as complications were at higher risk for progressing to severe CAP.
Dynamics of Severe and Non-severe Invasive Pneumococcal Disease in Young Children in Israel Following PCV7/PCV13 Introduction
Authors: Glikman Daniel , Dagan Ron , Barkai Galia , Averbuch Diana , Guri Alex , Givon-Lavi Noga , Ben-Shimol Shalom 
Published: May 2018

Background:
The introduction of the pneumococcal conjugated vaccines (PCVs) resulted in a substantial reduction of invasive pneumococcal disease (IPD) rates. However, impact on nonsevere IPD (mostly occult bacteremia) has not yet been fully elucidated. We assessed severe and nonsevere IPD (SIPD and NSIPD, respectively) rate dynamics in children < 5 years in Israel before and after PCV7/PCV13 implementation.

Methods:
A prospective, population-based, nationwide surveillance. All IPD episodes recorded from 1999 through 2015 were included. NSIPD was defined as IPD episodes without meningitis, pneumonia or mastoiditis in a child with a favorable outcome (not hospitalized or hospitalized in a nonintensive care unit < 5 days, without mortality). Three subperiods were defined: pre-PCV (1999–2008), PCV7 (2010–2011) and PCV13 (2013–2015). Incidence rate ratios (IRRs) were calculated.

Results:
Overall, 4,457 IPD episodes were identified; 3,398 (76.2%) SIPD, 1,022 (22.9%) NSIPD and 37 (0.8%) unknown. In 90% of NSIPD episodes, no focus was identified. In the PCV7 period, NSIPD rates significantly declined by 52%, while SIPD rates declined less prominently by 24%. Following PCV13 introduction, compared with the PCV7 period, NSIPD rates declined nonsignificantly by 17% while SIPD rates declined significantly further by an additional 53%. These trends resulted in overall reductions (comparing PCV13 and pre-PCV periods) of NSIPD and SIPD of 60% (IRR = 0.4; 0.32–0.51) and 64% (IRR = 0.36; 0.32–0.42), respectively.

Conclusions:
Following PCV7/PCV13 introduction, SIPD and NSIPD rates substantially declined, with differences in rate-dynamics, alluding to differences in serotype distribution between the 2 groups. Future surveillance is warranted when considering modification in treatment protocols for suspected occult bacteremia/NSIPD cases.
One-year Incidence of Infection in Pediatric Intestine Transplantation
Authors: Clouse Jared W. , Kubal Chandrashekhar A. , Fridell Jonathan A. , Mangus Richard S. 
Published: May 2018

Background:This study reports the infection rate, location of infection and pathogen causing bacterial, fungal or viral infections in intestine transplant recipients at a pediatric transplant center.Methods:Records from a pediatric center were reviewed for patients receiving an intestine transplant. Positive cultures and pathology reports were used to diagnose bacterial, fungal and viral infections and also to determine location and infectious agent. Risk for infection was assessed based on liver or colon inclusion, and immunosuppression induction, as part of the intestine transplant.Results:During the study period, 52 intestine transplants were performed on 46 patients. Bacterial, fungal and viral infection rates were 90%, 25% and 75%, respectively.Enterococcusspp. (non–vancomycin-resistant enterococci) were the most common pathogens and were isolated from 52% of patients. Non–vancomycin-resistant enterococci was present in 12% of transplant recipients.Candidaspp. were the most common fungal pathogens (23% of patients). Respiratory viral infections were common (44%), andCytomegalovirusinfection rate was 17%. Common sites of infection were bloodstream, urinary and upper respiratory tract. Colon and liver inclusion in the transplant graft was not associated with increased risk of infection, nor was addition of rituximab to the immunosuppression induction protocol.Conclusions:Postintestine transplant infections are ubiquitous in the pediatric population, including high rates of infection from bacterial, viral and fungal sources. Inclusion of the liver and/or colon as a component of the transplant graft did not appear to greatly impact the infectious risk. Adding rituximab to the immunosuppression induction protocol did not impact on infectious risk.
Potential for More Rational Use of Antibiotics in Hospitalized Children in a Country With Low Resistance
Authors: Thaulow Christian Magnus , Berild Dag , Eriksen Beate Horsberg , Myklebust Tor Åge , Blix Hege Salvesen 
Published: May 2018

Background:
Antimicrobial resistance is low in Norway, but to prevent an increase, the Norwegian Government has launched a National Strategy including a 30% reduction of broad-spectrum antibiotics (BSA) in hospitals within 2020. BSA are defined as second- and third-generation cephalosporins, carbapenems, piperacillin/tazobactam and quinolones. There are no recent studies of antibiotic use in Norwegian hospitalized children. The aim of this study was to describe the use of antibiotics with emphasis on BSA in Norwegian hospitalized children and neonates to detect possibilities for optimization.

Methods:
Data were extracted from 8 national point prevalence surveys of systemic antibiotic prescriptions in Norwegian hospitals between 2015 and 2017. The choices of antibiotics were compared with the empirical recommendations given in available Norwegian guidelines. In total, 1323 prescriptions were issued for 937 patients.

Results:
Twenty-four percent of pediatric inpatients were given antibiotics. Adherence to guidelines was 48%, and 30% (95% confidence interval: 27%–33%) of all patients on antibiotics received BSA. We identified only small variations in use of BSA between hospitals. One-third of the patients on antibiotic therapy received prophylaxis whereof 13% were given BSA. In 30% of prescriptions with BSA, no microbiologic sample was obtained before treatment.

Conclusions:
This study reveals an excess of prescriptions with BSA in relation to the low resistance rate in Norway. Our findings reveal areas for improvement that can be useful in the forthcoming antibiotic stewardship programs in Norwegian pediatric departments.
Evaluating a Nurse-Driven Mobility Algorithm for Hospitalized General Medicine Patients: A Pilot Study
Authors: Houlihan Sara , Fernandez Natalia , Magnant Christine , Levin Alyssa , Murphy Susan 
Published: May 2018

Purpose:
Mobility of hospitalized patients declines substantially after transfer from an intensive care unit focused on “early mobility” to a general medicine floor. Barriers to appropriately mobilize patients are nursing staff's confidence and the perceived risks related to mobility. This study examined the effect of a nurse-driven mobility algorithm on nurse ability to identify level of functional mobility. Participants were 24 general medicine patients and 2 pairs of physical therapist (PTs) and registered nurse (RN) raters.

Methods:
Each PT/RN pair was asked to classify level of mobility for each patient using predefined tiers. RNs were given an algorithm as a guide, and PTs assessed the patient's mobility without any guidelines for predefined tiers. Comparison of the tiered level from each rater was analyzed using κ statistics.

Results:
A sample of convince consisted of 24 general medicine patients. Fair to moderate agreement was found among both sets of raters (κ= 0.40).

Conclusion:
Although the algorithm did not result in high agreement between PTs and RNs, discrepancies were largely in the tiering regarding whether the patient needed supervision versus being independent. The mobility-driven algorithm may be useful to assist nursing staff in determining the appropriate level of mobility for general medicine patients with further refinement.
Ranolazine for Symptomatic Management of Microvascular Angina
Authors: Rayner-Hartley Erin , Parvand Mahraz , Humphries Karin H. , Starovoytov Andrew , Park Julie E. , Sedlak Tara 
Published: May 2018

Background:
Ranolazine is approved in the United States and Europe for chronic stable angina. Microvascular angina (MVA) is defined as angina with no obstructive coronary artery disease.

Study Question:
Our objective was to assess the effectiveness of ranolazine at improving angina scores and quality of life in a Canadian cohort with severe refractory angina due to MVA.

Study Design:
We administered questionnaires to 31 patients at baseline and after at least 6 weeks of ranolazine treatment.

Measures and Outcomes:
Validated, clinically significant changes for each Seattle Angina Questionnaire domain and the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form were obtained from the literature. Score changes between baseline and postranolazine use were analyzed using sign test.

Results:
Patients were mostly female (27 of 31 patients) with a median age of 57 years. After initiation of ranolazine treatment, patients experienced improvements in Quality of Life Enjoyment and Satisfaction Questionnaire Short Form scores (80.6%; P < 0.01) and in 3 of the 4 domains of the Seattle Angina Questionnaire (physical limitation: 73.3%; P = 0.02; treatment satisfaction: 80.6%; P < 0.01; and disease perception: 77.4%; P < 0.01). Patients were less likely to have interactions with the health care system after ranolazine treatment as compared with before (35.5% vs. 93.5%; P < 0.01).

Conclusions:
Ranolazine significantly improves symptom control and quality of life in patients with MVA and severe refractory angina and reduces their interaction with the health care system. Given the potentially debilitating effect of chronic angina in MVA, ranolazine may be an effective treatment option.
Microenvironment signaling driving lymphomagenesis
Authors: Verdière Léa , Mourcin Frédéric , Tarte Karin 
Published: May 2018

Purpose of review
In addition to the recent progresses in the description of the genetic landscape of B-cell non-Hodgkin's lymphomas, tumor microenvironment has progressively emerged as a central determinant of early lymphomagenesis, subclonal evolution, drug resistance, and late progression/transformation. The purpose of this review is to outline the most recent findings regarding malignant B-cell niche composition and organization supporting direct and indirect tumor-promoting functions of lymphoma microenvironment.

Recent findings
Lymphoma supportive niche integrates a dynamic and orchestrated network of immune and stromal cell subsets producing, with a high level of spatial and kinetic heterogeneity, extracellular and membrane factors regulating tumor migration, survival, proliferation, immune escape, as well as tumor microarchitecture, and mechanical constraints. Some recent insights have improved our understanding of these various components of lymphoma microenvironment, taking into account the mechanisms underlying the coevolution of malignant and nonmalignant cells within the tumor niche.

Summary
Deciphering tumor niche characteristics, functions, and origin could offer new therapeutic opportunities through the targeting of pivotal cellular and molecular components of the supportive microenvironment, favoring immune cell reactivation and infiltration, and/or limiting tumor retention within this protective niche.