bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between Practice Participation in a Pediatric-focused Medical Home Learning Collaborative and Reduction of Preventable Emergency Department Visits by Publicly-insured Children in Massachusetts
Authors: Kirby Paul B. , Christensen Anna L. , Bannister Louise , Konar Valerie 
Published: October 2018

Introduction:
This study evaluates the impact of practice participation in a pediatric patient-centered medical home learning collaborative on preventable emergency department (ED) visits among children in MassHealth (Massachusetts Medicaid/Children’s Health Insurance Program).

Methods:
Claims and enrollment data were extracted for child MassHealth members (aged 3–18) comprising 2 groups: members enrolled in a group of 13 child-serving practices that participated in an intensive, 29-month long patient-centered medical home learning collaborative (intervention group), and members enrolled in a group of 12 comparison practices with roughly similar panel size, type, and geographic location (comparison group). Preventable ED visits were identified using a modified version of the New York University ED algorithm. Two analyses were then conducted: (1) a repeat cross-sectional analysis among children enrolled in intervention or comparison group practices during baseline (first half of 2011) and follow-up (second half of 2013) periods; and (2) a longitudinal analysis among a subset of children enrolled for the full study period (2011–2013). Both analyses tested whether the effect of the intervention differed for children with versus without chronic conditions (effect modification).

Results:
Preventable ED visits declined from baseline to follow-up among children in both intervention and comparison practices. In the cross-sectional analysis, the decrease was the same in both practice groups, and for children with versus without chronic conditions. The longitudinal analysis shows a statistically significantly greater decrease among children with chronic conditions enrolled in the intervention practices (P = 0.02).

Conclusion:
Children with chronic conditions might receive the greatest benefit from receiving care in a medical home setting.
Reduction of Analgesia Duration after Tracheostomy during Neonatal Intensive Care: A Quality Initiative
Authors: Puthoff Teresa D. , Shah Hevil , Slaughter Jonathan L. , Bapat Roopali 
Published: October 2018

Introduction:
As survival has improved in the Neonatal Intensive Care Unit (NICU), there has been a 10-fold increase in the proportion of infants requiring a tracheostomy. At our institution, we observed a wide variation in the duration of opioid use posttracheostomy from 6 to 148 days. We aimed to decrease the duration of opioid exposure in postoperative tracheostomy patients in the NICU from a baseline average of 24 days to 7 days by December 31, 2017.

Methods:
We established a multidisciplinary team to develop change ideas to implement in 3 Plan-Do-Study-Act cycles that focused on enhanced care plan standardization and communication in patient care rounds with subsequent documentation in the medical record and the timely addition of dexmedetomidine to the postoperative care plan.

Results:
Baseline population was from October 2014 to December 2016. The mean posttracheostomy opioid duration was 24.6 days (range, 6–148 days); neuromuscular blockade was 2.89 days (range, 0–9 days), and benzodiazepine exposure was 20.9 days (range, 1–114 days). Following our interventions, the mean duration of posttracheostomy opioid duration was 5.4 days (range, 4–21 days); neuromuscular blockade was 3.14 days (range, 1–5 days), benzodiazepine duration was 8.88 days (range, 4–25 days), and dexmedetomidine was 4.6 days (range, 0–32 days).

Conclusions:
We utilized quality improvement methodology to standardize posttracheostomy management and demonstrate that we could significantly reduce the duration of opioid and benzodiazepine use after tracheostomy with the timely addition of dexmedetomidine, a structured written daily care plan, and clarification of roles and responsibilities.
Decreasing Unplanned Office Visits Due to Cast Problems in the Pediatric Population
Authors: Newman Sharon Lee , Gaffney John T. 
Published: October 2018

Introduction:
Unplanned office visits due to cast-related problems in the pediatric orthopedic office are common. Decreasing problems associated with the use of a cast would improve patient safety, increase office productivity, and decrease inconvenience to the child and family.

Methods:
Pediatric patients treated with a cast in our office were included in the study if they returned for an unplanned office visit due to a cast-related problem. Group 1 received verbal cast care instruction. Group 2 had the same verbal instruction in addition to a written handout identical to the verbal instructions. Group 3 was provided the same verbal instructions and a revised handout limiting the number of instructions and focused on keeping the cast away from water.

Results:
The study included 550 patients with 146 in group 1, 124 in group 2, and 280 in group 3. Comparing group 1 (10.3%) and group 2 (10.5%), there was almost no difference in the rate of unplanned office visits due to cast-related problems. Combining the revised handout with verbal instructions in group 3, the percentage of patients returning for an unplanned visit was 6%. There was a relative decrease in office visits by 55% and an absolute decrease of 4.5% when comparing group 2 and group 3.

Conclusions:
There was a decrease in the number of unplanned office visits due to cast problems utilizing a handout focused on keeping the cast dry in collaboration with verbal cast care instructions. However, the decrease was not statistically significant.
Monitoring of Sugammadex Dosing at a Large Tertiary Care Pediatric Hospital
Authors: Syed Faizaan , Trifa Mehdi , Uffman Joshua C. , Tumin Dmitry , Tobias Joseph D. 
Published: October 2018

Introduction:
Anesthesiologists use sugammadex to reverse neuromuscular blockade (NMB) produced by rocuronium and vecuronium. Its mechanism involves encapsulation of the neuromuscular blocking agent. Sugammadex dosing is based on the depth of NMB, assessed by measuring the train-of-four (TOF).

Methods:
We retrospectively reviewed procedures under general anesthesia in patients older than 1 year of age if they included sugammadex reversal of rocuronium-induced NMB. Documentation of TOF monitoring before and after reversal was noted, along with the dose of sugammadex administered. TOF was considered correctly documented if the anesthesia provider recorded the number of twitches before and after NMB reversal, or if they recorded 4 twitches before NMB reversal. We defined appropriate sugammadex dosing if it was within 10% of the recommended dose for the depth of NMB. We repeated this review after staff education and creating a reminder in the electronic health record system.

Results:
We included 100 patients in the preintervention analysis, of whom 30% had correct TOF documentation. Among patients with TOF assessment before sugammadex administration, the dose was appropriate in 34 of 40 cases. In the postintervention analysis, we reviewed 75 cases and found that correct documentation improved to 45% (P = 0.024). Among postintervention cases with TOF documented before sugammadex administration, sugammadex dosing was appropriate in 62 patients.

Conclusion:
Documentation of TOF was low (30%) before intervention and improved to only 45% after the interventions, suggesting that additional interventions are needed. Even before the intervention, with or without TOF documentation, the dose of sugammadex was generally consistent with recommendations.
Aesthetic Assessment of Infants With Different Cleft Types Before, During, and After Orthopedic Treatment
Authors: Nur Yilmaz Rahime Burcu , Germeç Çakan Derya , Nalbantgil Didem 
Published: October 2018

Objective:
The aim of the present study is to compare the aesthetic assessments of infants with different types of cleft before (T1), during (T2), and after (T3) orthopedic therapy (OT) by orthodontists, dentists, and laypersons.

Methods:
Photographs of 3 patients (incomplete lip [C1], complete unilateral [C2], and complete bilateral cleft [C3]) at T1 (C1, C2, C3 chronologic age: 5, 2, 2 days), T2 (C1, C2, C3 chronologic age: 32, 28, 35 days; using forehead anchoraged nasal stent or conventional nasoalveolar therapy plates), and T3 (C1, C2, C3 chronologic age: 80, 91, 105 days) were collected from the archive. The nasolabial region at stage T3 were masked and also added to the evaluation form (T4). Fifty-one evaluators (17 orthodontists, 17 dentists, and 17 laypersons; mean age = 30.1 ± 3.63) assessed 21 frontal photographs using Asher-McDade et al's 5-point scale.

Results:
The scores of the orthodontists for T1 photographs were statistically lower than the dentists and laypersons (P < 0.05). The scores of T3 and T4 were similar in all groups (P > 0.05). The assessment scores progressively decreased from T1 to T3 (P > 0.05). The scores of both treatment methods were similar in the orthodontist group (P > 0.05), whereas the scores were lower for forehead anchored nasal stent in the other groups (P < 0.05).

Conclusion:
Orthodontists are familiar with cleft patients. Therefore, the aesthetic of infants at any therapy stage with different treatment methods was not categorized as poor. The enhanced scores at post-OT stage and the similar scores of masked and nonmasked post-OT photographs may underline the recognition of the rehabilitation period by not only specialists but also laypersons.
Asymmetric Protrusion of the Midface in Young Adults
Authors: Lee Shin-Hyo , Koh Ki-Seok , Song Wu-Chul 
Published: October 2018

Purpose:
This study evaluated midfacial asymmetry using an alternative method that involved comparing bilateral patterns of the zygomaticomaxillary prominence in a young adult population.

Materials and Methods:
Three-dimensional reconstructed images based on computed tomography scans of 100 Koreans (mean age, 24.7 years) were evaluated with reference to lines spaced at 30° intervals and radiating from the center of an interporion line in a superior view. The surface inclination of the zygomaticomaxillary region was quantified on the same reference lines using a 3-dimensional ruler.

Results:
The 30°-interval line (at the level of the zygomaticotemporal suture) was longer on the left side than the right side in both males and females, whereas the left 60°-interval line (at the level of the zygomaticofrontal suture) was longer in females. Comparing the surface protrusion revealed that the zygomaticomaxillary region was more prognathic and inflated on the left side.

Conclusion:
Functional deviations are considered to be causes of asymmetric craniofacial growth. Postnatal growth allometry across the circummaxillary sutures as elucidated by this study could be useful information in craniofacial surgery.
The Effect of Spreader Graft and Mattress Suture Technique on Rhinoplasty in Patients With Nasal Hump Smaller Than 3 mm
Authors: Atighechi Saeid , Sarafraz Zahra , Baradaranfar Mohammadhossein , Dadgarnia Mohammadhossein , Zand Vahid , Meybodian Mojtaba , Mandegari Mohammad , Shirkhoda Shima , Vaziribozorg Sedighe 
Published: October 2018

Introduction:
Rhinoplasty is a common plastic surgery that potentially has some complications such as postoperative deformities and breathing problems. A humpy nose is among the main reasons for rhinoplasty. Nasal valve (the narrowest part of the nasal airway) collapse may be occurred after nasal hump removal. Spreader graft is essential after more than 3 mm nasal hump removal. But the value of this graft is unknown for patients with nasal hump smaller than 3 mm. Mattress suture is another technique for widening the nasal valve angle. This study compares the effects of spreader graft and mattress suture technique on postoperative deformity and nasal valve patency in patients with nasal hump smaller than 3 mm as compared with control group (no graft and suture).

Methods:
In this clinical trial study 210 patients who underwent rhinoplasty with 2 different techniques involved. Their postoperative deformity and nasal valve patency were evaluated by subjective (questionnaire and digital photography) method before and after rhinoplasty during 6 months follow-up.

Results:
Statistically, nasal obstruction had no significant difference before and after rhinoplasty and no significant difference was observed between spreader graft and mattress sutures (P > 0.05), but significantly better results than control group (P < 0.05).

Conclusion:
In this study the results of nasal valve patency of 2 techniques were similar. Because of several considerations in spreader graft technique such as needing to septoplasty in this technique even in patients without septal deviation that causes longer surgical duration, excessive blood loss, it is recommended to use Mattress suture in patients with nasal hump smaller than 3 mm.
Application of Navigated Transcranial Magnetic Stimulation to Map the Supplementary Motor Area in Healthy Subjects
Authors: Schramm Severin , Sollmann Nico , Ille Sebastian , Meyer Bernhard , Krieg Sandro M. 
Published: October 2018

Purpose:
The supplementary motor area is involved in the planning and coordination of movement sequences. This study investigates the potential of repetitive navigated transcranial magnetic stimulation for systematic mapping of the supplementary motor area by interfering with normal movement coordination processing.

Methods:
Ten healthy females (median age: 23.5 years) performed the Jebsen–Taylor Hand Function Test, first without stimulation (baseline) and afterward during application of repetitive navigated transcranial magnetic stimulation with 10 Hz to 6 cortical sites located within the supplementary motor area of both hemispheres. The test completion times (TCTs) were then compared between baseline performances and performances during stimulation.

Results:
We found significant slowing of TCTs in simulated page turning (baseline TCT 3.68 ± 0.67 seconds vs. stimulation TCT 4.04 ± 0.63 seconds, P = 0.0136), lifting small objects (baseline TCT 5.11 ± 0.72 seconds vs. stimulation TCT 5.47 ± 0.66 seconds, P = 0.0010), and simulated feeding (baseline TCT 6.10 ± 0.73 seconds vs. stimulation TCT 6.59 ± 0.81 seconds, P = 0.0027). Three other subtests were not affected, whereas one subtest was performed significantly faster (baseline TCT 17.09 ± 7.31 seconds vs. stimulation TCT 15.44 ± 5.72 seconds, P = 0.0073) under stimulation.

Conclusions:
Repetitive navigated transcranial magnetic stimulation is capable of influencing the performance of healthy participants in a task relying on hand coordination. Our approach can serve as a mapping tool for the supplementary motor area, potentially relevant for preoperative diagnostics in patients with brain tumors, epilepsy, or other brain lesions to improve outcome and potentially predict clinical course and postoperative recovery.
Capturing the dynamics of genome replication on individual ultra-long nanopore sequence reads
Authors: Müller Carolin A , Boemo Michael A , Spingardi Paolo , Kessler Benedikt M , Kriaucionis Skirmantas , Simpson Jared T , Nieduszynski Conrad A 
Published: October 2018

AbstractThe replication of eukaryotic genomes is highly stochastic, making it difficult to determine the replication dynamics of individual molecules with existing methods. We now report a sequencing method for the measurement of replication fork movement on single molecules by Detecting Nucleotide Analogue signal currents on extremely long nanopore traces (D-NAscent). Using this method, we detect BrdU incorporated by Saccharomyces cerevisiae to reveal, at a genomic scale and on single molecules, the DNA sequences replicated during a pulse labelling period. Under conditions of limiting BrdU concentration, D-NAscent detects the differences in BrdU incorporation frequency across individual molecules to reveal the location of active replication origins, fork direction, termination sites, and fork pausing/stalling events. We used sequencing reads of 20-160 kb, to generate the first whole genome single-molecule map of DNA replication dynamics and discover a new class of low frequency stochastic origins in budding yeast.
Ecology and the diversification of reproductive strategies in viviparous fishes
Authors: Tobler Michael , Culumber Zachary 
Published: October 2018

AbstractShifts in life history evolution can potentiate sexual selection and speciation. However, we rarely understand the causative links between correlated patterns of diversification or the tipping points that initiate changes with cascading effects. We investigated livebearing fishes with repeated transitions from pre- (lecithotrophy) to post-fertilization maternal provisioning (matrotrophy) to identify the potential ecological drivers of evolutionary transitions in life history. Phylogenetic comparative analyses across 94 species revealed that bi-directional evolution along the lecithotrophy-matrotrophy continuum is correlated with ecology, supporting adaptive hypotheses of life history diversification. Consistent with theory, matrotrophy was associated with high resource availability and low competition. Our results suggest that ecological sources of selection contribute to the diversification of female provisioning strategies in livebearing fishes, which have been associated with macroevolutionary patterns of sexual selection and speciation.
PD-1 suppresses the maintenance of cell couples between cytotoxic T cells and tumor target cells within the tumor
Authors: Ambler Rachel , Edmunds Grace L. , Toti Giulia , Morgan David J. , Wülfing Christoph 
Published: October 2018

AbstractCD8+ T cell killing of tumor cells is suppressed by the tumor microenvironment. Inhibitory receptors, prominently PD-1, are key mediators of this suppression. To discover cellular defects triggered by tumor exposure and associated PD-1 signaling, we have established an ex vivo imaging approach to investigate CD8+ tumor infiltrating lymphocytes (TILs) interacting with tumor targets. Whilst TIL:tumor cell couples formed effectively, couple stability deteriorated within 1-2 minutes. This was associated with excessive cofilin recruitment to the cellular interface, coincident deterioration of f-actin structures, increased TIL locomotion, and impaired tumor cell killing. Diminished engagement of PD-1 within the tumor, but not acute ex vivo blockade, partially restored cell couple maintenance and killing. PD-1 thus suppresses TIL function by inducing a polarization-impaired state.
In situ 10-cell RNA sequencing in tissue and tumor biopsy samples
Authors: Singh Shambhavi , Wang Lixin , Schaff Dylan L. , Sutcliffe Matthew D. , Koeppel Alex F. , Kim Jungeun , Onengut-Gumuscu Suna , Park Kwon-Sik , Zong Hui , Janes Kevin A. 
Published: October 2018

ABSTRACTSingle-cell transcriptomic methods classify new and existing cell types very effectively, but alternative approaches are needed to quantify the individual regulatory states of cells in their native tissue context. We combined the tissue preservation and single-cell resolution of laser capture with an improved preamplification procedure enabling RNA sequencing of 10 microdissected cells. This in situ 10-cell RNA sequencing (10cRNA-seq) can exploit fluorescent reporters of cell type in genetically engineered mice and is compatible with freshly cryoembedded clinical biopsies from patients. Through recombinant RNA spike-ins, we estimate dropout-free technical reliability as low as ~250 copies and a 50% detection sensitivity of ~45 copies per 10-cell reaction. By using small pools of microdissected cells, 10cRNA-seq improves per-cell reliability and sensitivity beyond existing approaches for single-cell RNA sequencing (scRNA-seq). Accordingly, in multiple tissue and tumor settings, we observe 1.5–2-fold increases in genes detected and overall alignment rates compared to scRNA-seq. Combined with existing approaches to deconvolve small pools of cells, 10cRNA-seq offers a reliable, unbiased, and sensitive way to measure cell-state heterogeneity in tissues and tumors.
Nutrient deposition enhances post-fire survival in non-N-fixing savanna tree seedlings
Authors: Varma Varun , Sankaran Mahesh 
Published: October 2018

AbstractNutrient deposition can modify plant growth rates and potentially alter the susceptibility of plants to disturbance events, while also influencing properties of disturbance regimes. In mixed tree-grass ecosystems, such as savannas and tropical dry forests, tree seedling growth rates strongly influence the ability of seedlings to survive fire (i.e. post-fire seedling survival), and hence, vegetation structure and tree community composition. However the effects of nutrient deposition on the susceptibility of recruiting trees to fire are poorly quantified. In a field experiment, seedlings of multiple N-fixing and non-N-fixing tropical dry forest tree species were exposed to nitrogen (N) and phosphorus (P) fertilisation, and fire. We quantified nutrient-mediated changes in a) mean seedling growth rates; b) growth rates of the fastest growing individuals and c) post-fire seedling survival. N-fixers had substantially higher baseline post-fire seedling survival, that was unaffected by nutrient addition. Fertilisation, especially with N, increased post-fire survival probabilities in non-N-fixers by increasing the growth rates of the fastest growing individuals. These results suggest that fertilisation can lead to an increase in the relative abundance of non-N-fixers in the resprout community, and thereby, alter the community composition of tropical savanna and dry forest tree communities in the long-term.
Tightly-orchestrated rearrangements govern catalytic center assembly of the ribosome
Authors: Zhou Yi , Musalgaonkar Sharmishtha , Johnson Arlen W. , Taylor David W. 
Published: October 2018

AbstractThe catalytic activity of the ribosome is mediated by RNA, yet proteins are essential for the function of the peptidyl transferase center (PTC). In eukaryotes, final assembly of the PTC occurs in the cytoplasm by insertion of the ribosomal protein Rpl10. We determine structures of six intermediates in late nuclear and cytoplasmic maturation of the large subunit that reveal a tightly-choreographed sequence of protein and RNA rearrangements controlling the insertion of Rpl10. We also determine the structure of the biogenesis factor Yvh1 and show how it promotes assembly of the P stalk, a critical element for recruitment of GTPases that drive translation. Together, our structures provide a blueprint for final assembly of a functional ribosome.One Sentence SummaryCryo-EM structures of six novel intermediates in the assembly of the large ribosomal subunit reveal mechanism of creating the catalytic center.