bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective Observational Study Comparing Sepsis-2 and Sepsis-3 Definitions in Predicting Mortality in Critically Ill Patients
Authors: Poutsiaka Debra D , Porto Maura C , Perry Whitney A , Hudcova Jana , Tybor David J , Hadley Susan , Doron Shira , Reich John A , Snydman David R , Nasraway Stanley A 
Published: June 2019

Abstract

Background
Sepsis definitions have evolved, but there is a lack of consensus over adoption of the most recent definition, Sepsis-3. We sought to compare Sepsis-2 and Sepsis-3 in the classification of patients with sepsis and mortality risk at 30 days.

Methods
We used the following definitions: Sepsis-2 (≥2 systemic inflammatory response syndrome criteria + infection), Sepsis-3 (prescreening by quick Sequential Organ Failure Assessment [qSOFA] of ≥2 of 3 criteria followed by the complete score change ≥2 + infection), and an amended Sepsis-3 definition, iqSOFA (qSOFA ≥2 + infection). We used χ 2 or Wilcoxon rank-sum tests, receiver-operator characteristic curves, and survival analysis.

Results
We enrolled 176 patients (95% in an intensive care unit, 38.6% female, median age 61.4 years). Of 105 patients classified by Sepsis-2 as having sepsis, 80 had sepsis per Sepsis-3 or iqSOFA (kappa = 0.72; 95% confidence interval [CI], 0.62–0.82). Twenty-five (14.8%) died (20 of 100 with sepsis per Sepsis-2 [20%], and 20 of 77 [26.0%] with sepsis per Sepsis-3 or iqSOFA). Results for Sepsis-3 and iqSOFA were identical. The area under the curve of receiver-operator characteristic (ROC) curves for identifying those who died were 0.54 (95% CI, 0.41–0.68) for Sepsis-2, 0.84 (95% CI, 0.74–0.93) for Sepsis-3, and 0.69 (95% CI, 0.60–0.79) for iqSOFA (P &lt; .01). Hazard ratios for death associated with sepsis were greatest for sepsis or septic shock per Sepsis-3.

Conclusions
Sepsis-3 and iqSOFA were better at predicting death than Sepsis-2. Using the SOFA score might add little advantage compared with the simpler iqSOFA score.
XMM-Newton spectrum of the magnetar CXOU J171405.7–381031
Authors: Watanabe Haruka , Bamba Aya , Shibata Shinpei , Watanabe Eri 
Published: June 2019

Abstract
We observe the magnetar CXOU J171405.7−381031 with XMM-Newton and obtain the most reliable X-ray spectral parameters for this magnetar. After removing the flux from the surrounding supernova remnant CTB 37B, the radiation of CXOU J171405.7−381031 is best described by a two-component model, consisting of a blackbody and power law. We obtain a blackbody temperature of $0.58^{+0.03}_{-0.03}$ keV, a photon index of $2.15^{+0.62}_{-0.68}$, and an unabsorbed 2–10 keV band flux of $2.33^{+0.02}_{-0.02} \times 10^{-12}$ erg cm−2 s−1. These new parameters enable us to compare CXOU J171405.7−381031 with other magnetars, and it is found that the luminosity, temperature, and photon index of CXOU J171405.7−381031 are aligned with the known trend among the magnetar population with a slightly higher temperature, which could be caused by its young age. All magnetars with a spin-down age of less than 1000 yr show time variation or bursts except for CXOU J171405.7−381031. We explore the time variability for six observations between 2006 and 2015, but there is no variation larger than ∼10%.
Why is the mission impossible? Decoupling the mirror Ginsparg–Wilson fermions in the lattice models for two-dimensional Abelian chiral gauge theories
Authors: Kikukawa Y 
Published: June 2019

AbstractIt is known that the four-dimensional Abelian chiral gauge theories of an anomaly-free set of Wely fermions can be formulated on the lattice preserving the exact gauge invariance and the required locality property in the framework of the Ginsparg–Wilson relation. This holds true in two dimensions. However, in the related formulation including the mirror Ginsparg–Wilson fermions, and therefore having a simpler fermion path-integral measure, it has been argued that the mirror fermions do not decouple: in the 345 model with Dirac– and Majorana–Yukawa couplings to the XY-spin field, the two-point vertex function of the (external) gauge field in the mirror sector shows a singular non-local behavior in the paramagnetic strong-coupling phase. We re-examine why the attempt seems to be a “Mission: Impossible” in the 345 model. We point out that the effective operators to break the fermion number symmetries (‘t Hooft operators plus others) in the mirror sector do not have sufficiently strong couplings even in the limit of large Majorana–Yukawa couplings. We also observe that the type of Majorana–Yukawa term considered is singular in the large limit due to the nature of the chiral projection of the Ginsparg–Wilson fermions, but a slight modification without such a singularity is allowed by virtue of their very nature. We then consider a simpler four-flavor axial gauge model, the $1^4(-1)^4$ model, in which the U(1)$_A$ gauge and Spin(6)(SU(4)) global symmetries prohibit the bilinear terms but allow the quartic terms to break all the other continuous mirror fermion symmetries. We formulate the model so that it is well behaved and simplified in the strong-coupling limit of the quartic operators. Through Monte Carlo simulations in the weak gauge-coupling limit, we show numerical evidence that the two-point vertex function of the gauge field in the mirror sector shows regular local behavior, and we argue that all you need is to kill the continuous mirror fermion symmetries with would-be gauge anomalies non-matched, as originally claimed by Eichten and Preskill. Finally, by gauging a U(1) subgroup of the U(1)$_A$$\times$ Spin(6)(SU(4)) of the previous model, we formulate the $2 1 (-1)^3$ chiral gauge model, and argue that the induced fermion measure term satisfies the required locality property and provides a solution to the reconstruction theorem formulated by Lüscher. This gives us “A New Hope” for the mission to be accomplished.
PIR-B expressing CD8+ T cells exhibit features of Tc1 and Tc17 in SKG mice
Authors: Rothe Kathrin , Quandt Dagmar , Köhler Gabriele , Jasinski-Bergner Simon , Seliger Barbara , Pierer Matthias , Wagner Ulf 
Published: June 2019

Abstract

Objective
In autoimmune arthritis, TCR signalling is attenuated by peripheral tolerance mechanisms. We have described previously a population of inhibitory receptor LIR-1 expressing autoreactive CD8+ T cells in rheumatoid arthritis. Here, we investigated the role of CD8+ T cells in murine autoimmune arthritis by analysing their expression of the mouse orthologue of LIR-1, PIR-B.

Methods
Frequencies of PIR-B+CD8+ T cells were determined in the SKG arthritis model. The phenotype of those cells was determined ex vivo by FACS and functionality was investigated by means of cytokine production and cytolytic potential upon activation in vitro.

Results
SKG mice, under non-SPF (specific pathogen-free) conditions with clinical symptoms of arthritis, were found to harbour significantly increased frequencies of PIR-B+CD8+ T cells. Those cells showed a pro-inflammatory phenotype with preferential production of IL-17 and IFN-γ. The frequency of those cells correlated inversely with the arthritis score, indicating that they might represent autoreactive, but functionally inhibited, CD8+ T cells.

Conclusion
PIR-B+CD8+ T cells from SKG mice show a cytotoxic and pro-inflammatory phenotype. Inhibition of CD8+ T cell autoreactivity by PIR-B/LIR-1 receptor signalling might be a counter-regulatory mechanism to curb autoreactivity and arthritis.
Evolutionary persistence of insect bunyavirus infection despite host acquisition and expression of the viral nucleoprotein gene
Authors: Ballinger Matthew J , Taylor Derek J 
Published: June 2019

AbstractHow insects combat RNA virus infection is a subject of intensive research owing to its importance in insect health, virus evolution, and disease transmission. In recent years, a pair of potentially linked phenomena have come to light as a result of this work—first, the pervasive production of viral DNA from exogenous nonretroviral RNA in infected individuals, and second, the widespread distribution of nonretroviral integrated RNA virus sequences (NIRVs) in the genomes of diverse eukaryotes. The evolutionary consequences of NIRVs for viruses are unclear and the field would benefit from studies of natural virus infections co-occurring with recent integrations, an exceedingly rare circumstance in the literature. Here, we provide evidence that a novel insect-infecting phasmavirus (Order Bunyavirales) has been persisting in a phantom midge host, Chaoborus americanus, for millions of years. Interestingly, the infection persists despite the host’s acquisition (during the Pliocene), fixation, and expression of the viral nucleoprotein gene. We show that virus prevalence and geographic distribution are high and broad, comparable to the host-specific infections reported in other phantom midges. Short-read mapping analyses identified a lower abundance of the nucleoprotein-encoding genome segment in this virus relative to related viruses. Finally, the novel virus has facilitated the first substitution rate estimation for insect-infecting phasmaviruses. Over a period of approximately 16 million years, we find rates of (0.6 − 1.6) × 10−7 substitutions per site per year in protein coding genes, extraordinarily low for negative-sense RNA viruses, but consistent with the few estimates produced over comparable evolutionary timescales.
III Middle English
Authors: Ash-Irisarri Kate , Black Daisy , Brazil Sarah , Dow Anna , Grossman Joel , Kobayashi Yoshiko , Pattwell Niamh , Perry R D , Sawyer Daniel , Wu Xiaoling 
Published: June 2019

AbstractDue to the resignation of its former editor, and a turnover of contributors, this chapter has fewer contributors than previously. It is hoped to catch up subsequently with missing areas and to include them retrospectively. The chapter has nine sections: 1. Theory; 2. Manuscript and Textual Studies; 3. Religious Prose; 4. Piers Plowman; 5. Romance: Metrical, Alliterative, Prose; 6. Gower; 7. Hoccleve and Lydgate; 8. Older Scots; 9. Drama. Section 1 is by R.D. Perry; section 2 is by Daniel Sawyer; section 3 is by Niamh Pattwell; section 4 is by Joel Grossman; section 5 is by Anna Dow; section 6 is by Yoshiko Kobayashi; section 7 is by Xiaoling Wu; section 8 is by Kate Ash-Irisarri; section 9 is by Daisy Black and Sarah Brazil.
Topical tacrolimus for allergic eye diseases
Authors: Erdinest Nir , Ben-Eli Hadas , Solomon Abraham 
Published: June 2019

Purpose of review
The spectrum of allergic eye diseases includes a variety of conditions, each characterized by complex immunopathologies.
Antiallergic drugs, such as antihistamines and mast cell stabilizers, are often insufficient without concomitant topical corticosteroid treatment. The chronic course of the more severe allergic eye diseases, such as vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC), limits the treatment with topical corticosteroids to short courses. In addition, topical corticosteroid treatment puts patients at high risk of developing severe ocular complications, particularly during childhood when VKC most frequently occurs.
The immunopathology of chronic diseases, such as VKC and AKC, involves predominantly T lymphocytes, and as such, immunomodulators that inhibit T-cell activation seem to be the appropriate treatment for these chronic diseases. In the past years, there is an increased incidence of managing chronic allergic eye diseases with the immunomodulator tacrolimus. The current review presents an update of the recent clinical experience with topical tacrolimus for the management of chronic allergic eye diseases.

Recent findings
Topical tacrolimus significantly improves the symptoms and signs of the various forms of chronic allergic eye disease. Recent studies also demonstrate the efficacy of low concentrations of topical tacrolimus for VKC.
Early medical treatment with topical tacrolimus can also prevent the development of serious ocular complications of VKC, such as shield ulcers or limbal stem cell deficiency.

Summary
Topical tacrolimus has significantly changed the management approaches in severe and chronic allergic eye diseases and has minimized the need for topical corticosteroids.
Clinician–Educator Tracks for Trainees in Graduate Medical Education: A Scoping Review
Authors: Friedman Karen , Lester Janice , Young John Q. 
Published: June 2019

Purpose
Clinician–educator tracks (CETs) appear to be increasing in prevalence in graduate medical education (GME) and may play an important role in medical education workforce development. The authors conducted a scoping review to characterize the current state of knowledge about CETs’ structure, content, and outcomes.

Method
Six databases were searched in January 2018 for English-language peer-reviewed articles published through 2017 to identify articles describing CETs in GME. To be included, the CET had to target GME learners (residents/fellows), be longitudinal, have the primary aim of developing trainees into clinician–educators (CEs), and address at least one CE core competency (direct teaching, curriculum development, mentorship/advising, leadership, assessment, educational scholarship). The authors extracted and analyzed data from included articles.

Results
Of 1,434 articles identified, 19 were included in the review, representing 18 separate CETs. All but 2 CETs (11%) were specialty-specific. Most included a core curriculum with classroom-based sessions (18; 100%), workplace-based opportunities to practice skills (17; 94%), and a required scholarly project (16; 89%). Seventeen (94%) focused on skills related to direct teaching. Four (22%) identified mentoring/advising as a core curriculum focus. Five (28%) required project dissemination. Time spent in CETs varied widely (median: 166 hours; range: 8 hours/4-month period to 1,288 hours/2-year period). The most common reported outcomes were learner reactions (7; 39%) and career tracking (11; 61%).

Conclusions
This review yields a composite picture of the current state of CETs in GME. The results highlight the paucity of outcomes data and areas for potential standardization and future research.
A Mixed-Methods Exploration of the Educational Climate and Safety Climate During the First Year of Clinical Practice in Ireland
Authors: Lydon Sinéad , Byrne Dara , Vellinga Akke , Walsh Chloe , Madden Caoimhe , Connolly Fergal , O’Connor Paul 
Published: June 2019

Purpose
Educational climate (EC) and safety climate (SC) are key determinants of residents’ professional development. The goal of this study was to gather longitudinal EC data and data on perceptions of SC in residency, and provide data on practices related to perceptions of EC and SC, by identifying factors associated with and changes in perceptions of EC and SC across the first year of practice, and elucidating good and poor practice relating to key elements of EC and SC.

Method
A mixed-methods design was adopted. First, 131 first-year residents in Ireland were surveyed at the end of each of their first 3 rotations (August 2016–March 2017). The survey measured EC and SC using established measures. Next, 69 semistructured interviews were conducted with a representative sample of residents (March–May 2017). An interview schedule was developed to aid in-depth probing of EC and SC perceptions. A deductive content analysis approach was adopted.

Results
Perceptions of EC worsened over time. The EC and SC of surgical rotations were significantly poorer than those of medical rotations. Residents were more likely to describe team practices, rather than organizational practices, that contributed positively to their perceptions of EC and SC.

Conclusions
Further research is necessary to facilitate improvement of EC and SC for residents, particularly within surgical training. Future research exploring the contribution of organizational practices to EC and SC, the impact of targeted improvement activities, and best practices for involving residents in quality and safety initiatives is recommended.
Understanding the Broker Role of Clinician–Scientists: A Realist Review on How They Link Research and Practice
Authors: Barry Margot , de Groot Esther , Baggen Yvette , Smalbrugge Martin , Moolenaar Nienke , Bartelink Marie-Louise E.L. , Damoiseaux Roger A.M.J. , Scherpbier Nynke , Kluijtmans Manon 
Published: June 2019

PurposeClinician–scientists are said to be well placed to connect research and practice, but their broker role has been underexplored. This review sought to gain an understanding of the broker role of clinician–scientists.MethodThe authors conducted a realist review to describe context–mechanism–outcome (CMO) configurations associated with the broker role of clinician–scientists. CINAHL, PubMed, PsycINFO, Web of Science, and Embase were searched between May and August 2017. Data were analyzed qualitatively; data synthesis focused on assembling CMO configurations.ResultsOf an initial 2,241 articles, 9 were included in the final review. Included papers show that clinician–scientists, in their broker role, achieve 2 organizational-level outcomes: an increased volume of clinically relevant, research, and increased evidence application to improve care. They also achieve the individual-level outcome of professional development as a researcher, clinician, and broker. Multidimensional skills and management support are necessary context factors. Mechanisms that contribute to outcomes include balancing economic and scientific interests and performing boundary-crossing activities. Four CMO configurations by which clinician–scientists achieve outcomes in brokering a connection between research and practice were identified. Useful program theories for explaining these are boundary crossing, social network, communities of practice, and diffusion of innovation theory.ConclusionsThe mechanisms found may provide insight for interventions aiming to support clinician–scientists in their broker role. The authors expect that if more attention is paid to learning multidimensional skills and management support for the broker role is strengthened, stronger links between research and practice could be forged.
Treatment of juvenile idiopathic arthritis: what's new?
Authors: Giancane Gabriella , Ruperto Nicolino 
Published: June 2019

Purpose of review
The present review highlights the advances in disease outcome achieved with currently available biologic medications and future perspectives for JIA management.

Recent findings
In the last two decades, the management of juvenile idiopathic arthritis (JIA) has been revolutionized by appropriate legislative initiatives, the existence of very large collaborative networks and the increased availability of the novel biologic medications.

Summary
A more rational approach to the management of JIA is being fostered by the recent publication of therapeutic recommendations, consensus treatment plans and for a treat-to-target strategy.
Factors Influencing Interbody Cage Subsidence Following Anterior Cervical Discectomy and Fusion
Authors: Igarashi Hidetoshi , Hoshino Masahiro , Omori Keita , Matsuzaki Hiromi , Nemoto Yasuhiro , Tsuruta Takashi , Yamasaki Koji 
Published: June 2019

Study Design:
This is a prospective study.

Objective:
The purpose of this study was to analyze the factors influencing subsidence following anterior cervical discectomy and fusion (ACDF) using a stand-alone cage.

Summary of Background Data:
The relationship between cage subsidence and cage height and material has been reported in previous studies.

Methods:
Clinical and radiologic data from 78 patients, 105 levels, undergoing single-level and 2-level ACDF without plates from 2007 to 2015 were collected prospectively. Patients were followed for at least 12 months after surgery. Radiographs were obtained preoperatively, at 1 week, and at 1, 3, 6, and 12 months postoperatively to determine the presence of fusion and cage subsidence.

Results:
There was a correlation in cage height and subsidence (Spearman P<0.05). Cage subsidence was significantly shorter in the polyetheretherketone cages than in titanium cages (P<0.05). However, when cage height was <5 mm, the difference between the 2 groups was not significant. Large subsidence (>3 mm) was observed in 17 patients, 20 levels, many of whom exhibited sinking in the first month after surgery.

Conclusions:
The greater the cage height, the greater the risk of cage subsidence in ACDF. Polyetheretherketone cages are superior to titanium cages for the maintenance of intervertebral height in cases where cage height is >5.5 mm.

Level of Evidence:
Level 3.
Tranexamic Acid in Thoracic and Lumbar Fusions and Perioperative Blood Loss
Authors: Wanderman Nathan , Robinson William , Carlson Bayard , Bydon Mohamad , Currier Brad , Huddleston Paul , Nassr Ahmad , Freedman Brett 
Published: June 2019

Study Design:This study was a retrospective cohort design.Objective:The objective of this study was to examine the impact of tranexamic acid (TXA) on total perioperative wound output following thoracic and lumbar spinal fusions.Summary of Background Data:TXA has been extensively studied with regard to intraoperative blood loss and transfusion rates. Few studies have looked specifically at the effect of TXA on postoperative drain output.Materials and Methods:We examined blood loss patterns in 617 consecutive adult patients undergoing lumbar and/or thoracic fusions at a single institution from January 2009 to 2016. These patients were divided into TXA and non-TXA, as well as high-dose and low-dose TXA, groups and analyzed using a propensity score to account for differences between cohorts.Results:The TXA and non-TXA groups were demographically similar. The mean number of levels fused was higher in the TXA group (4.8 vs. 3.1 levels,P<0.01). There was a significant reduction in both intraoperative blood loss (77.7 mL per level,P=0.020) and postoperative drain output (83.3 mL per level,P=0.002) in the TXA group when examined on a per level fused basis, but no significant difference without controlling for a number of levels. Postoperative blood loss tended to be higher in the TXA group for surgeries involving >5 levels fused. There was a significantly less blood loss in the high-dose TKA group both intraoperatively (296.4 mL per level fused,P<0.001) and postoperatively (133.4 mL per level fused,P<0.001).Conclusions:TXA significantly reduced both intraoperative and postoperative blood loss in lumbar and thoracic fusions when examined on a per level basis. However, with surgeries involving fusions >5 levels, TXA may increase postoperative drain output, with those losses offset by reduced intraoperative blood loss. High-dose TXA further reduced both intraoperative and postoperative blood loss as compared with low-dose TXA.