bluuebunny/crossref_metadata_2025_split huggingface dataset:
Educational Value of a 3D Printer in Ophthalmology Training
Authors: Arshad Jawad , Helms Richard , Orge Faruk , Sayegh Rony 
Published: May 2018

AbstractThree-dimensional (3D) printers are increasingly being used in medicine for surgical planning, medical education, patient education, research, and device development. We explore the educational value of a 3D printer for trainees in an ophthalmology residency program. A 3D printer was made available to medical students, residents, and clinical and research fellows in the Department of Ophthalmology at Case Western Reserve University. One of the medical students was proficient in the technology and was available to help. Multiple projects were initiated including the manufacturing of slit-lamp cellphone adapters and various interface and integral custom-made parts for research applications. The 3D printer was found to be useful by 20 of 21 trainees surveyed with 17 of 20 saying they would use it after graduation if they had access to one. All the respondents felt that the availability of the technology can contribute to increased innovation in the ophthalmology department. We encourage other ophthalmology departments to experiment with 3D printing as a tool to foster innovation and creativity for trainees.
The Heart's Halo: Caring for Pediatric Pneumopericardium
Authors: Chandnani Harsha , Lion Richard , Maxson Ivanna 
Published: May 2018

AbstractPediatric pneumomediastinum and pneumopericardium (PPC) are rare complications, which can arise from various etiologies. We report a case of pediatric PPC secondary to an asthma exacerbation and discuss relevant diagnostic and management principles. Physicians must be aware of PPC and its implications due to the high mortality rate. PPC patients require close observation with continuous cardiorespiratory and telemetry monitoring, and providers experienced in the management of cardiac tamponade at a center capable of providing cardiothoracic surgical intervention. Time to resolution is multifactorial, but can be achieved promptly with supportive care and treatment of underlying condition.
Distal Nerve Transfers: A Perspective on the Future of Reconstructive Microsurgery
Authors: Chuang David 
Published: May 2018

Abstract
Background Nerve transfer can be broadly separated into two categories: proximal nerve graft and/or transfer and distal nerve transfer. The superiority of proximal nerve graft/transfer over distal nerve transfer strategy has been debated extensively, but which strategy is the best has not yet been defined. Each technique has its own advantages and disadvantages. However, proximal nerve graft/transfer is still the main reconstructive procedure based on the principle of “no diagnosis, then no treatment.” Proximal nerve transfer can avoid iatrogenic injury where the lesion is still in continuity and neurolysis is the only procedure without further cutting the nerve.
Results Our clinical and experimental study show that proximal nerve grafts/transfers yield at least equal or better results compared to distal nerve transfers. Proximal nerve grafts/transfers remain the mainstay of my reconstructive strategy. Proximal nerve graft/transfer offers more accurate diagnosis and proper treatment to restore shoulder and elbow functions simultaneously. Distal nerve transfers can offer more efficient elbow flexion.
Conclusion Combined, both strategies in primary nerve reconstruction are especially recommended when there is no healthy or not enough donor nerve available Distal nerve transfers should be considered as a complementary option for proximal nerve grafts/ transfers.
Temporal transcriptional logic of dynamic regulatory networks underlying nitrogen signaling and use in plants
Authors: Varala Kranthi , Marshall-Colón Amy , Cirrone Jacopo , Brooks Matthew D. , Pasquino Angelo V. , Léran Sophie , Mittal Shipra , Rock Tara M. , Edwards Molly B. , Kim Grace J. , Ruffel Sandrine , McCombie W. Richard , Shasha Dennis , Coruzzi Gloria M. 
Published: May 2018

Significance
Our study exploits time—the relatively unexplored fourth dimension of gene regulatory networks (GRNs)—to learn the temporal transcriptional logic underlying dynamic nitrogen (N) signaling in plants. We introduce several conceptual innovations to the analysis of time-series data in the area of predictive GRNs. Our resulting network now provides the “transcriptional logic” for transcription factor perturbations aimed at improving N-use efficiency, an important issue for global food production in marginal soils and for sustainable agriculture. More broadly, the combination of the time-based approaches we develop and deploy can be applied to uncover the temporal “transcriptional logic” for any response system in biology, agriculture, or medicine.
Navigating ‘taxation’ on the Congo River: the interplay of legitimation and ‘officialisation’
Authors: Eriksson Baaz Maria , Olsson Ola , Verweijen Judith 
Published: May 2018

ABSTRACT
Based on comprehensive research among boat operators and navy personnel working on the Congo River (DRC), this article explores how assessments of ‘taxation’ are shaped by the interplay of legitimation and ‘officialisation’. As such, it draws upon and contributes to scholarly debates on taxpayers’ attitudes towards taxation. While boat operators resent having to pay a plethora of authorities, including the navy, along the Congo River, the article demonstrates how they locate these ‘taxes’ on a spectrum from more to less legitimate. These assessments are shaped by various factors: authorities’ legitimacy as ‘measured’ by their official mandate and importance; public and non-official service provision; and the deployment of symbols of ‘stateness’. In interaction, these factors legitimise and ‘officialise’ ‘taxes’ by the navy that are prohibited in legislation. These findings caution against the a priori use of the labels ‘official’ and ‘non-official’, emphasising the need to better grasp these notions’ emic understandings.
From terrorism to talakawa: explaining party turnover in Nigeria's 2015 elections
Authors: LeVan A. Carl , Page Matthew T. , Ha Yoonbin 
Published: May 2018

ABSTRACT
What explains the 2015 defeat of Nigeria's ruling party by a new party less than two years old? Despite a spike in terrorism and widespread public complaints about government waste, the authors find that neither violence nor patronage systematically explains voting patterns. Instead, statistical evidence points to state-level economic performance and perceptions of national economy. Using surveys, original variables measuring economic performance and – for the first time – presidential election results at the local government level, the authors demonstrate that ‘economic voting’ helped the opposition. They attribute opposition success to a ‘talakawa effect’ rooted in a class-based coalition.
High-temperature Mechanical Properties and Microstructure of ZrTiHfNbMox (x=0.5, 1.0, 1.5) Refractory High Entropy Alloys
Authors: Chen Y W , Li Y K , Cheng X W , Wu C , Cheng B 
Published: May 2018

Abstract
Refractory high entropy alloys (RHEAs), with excellent properties at high temperature, have several applications. In this work, the ZrTiHfNbMox (x=0.5, 1.0, 1.5) alloys were prepared by arc melting. All these alloys form body centered cubic (BCC) structure without other intermediate phases. The Mo element contributes to the strength of alloys at high temperature, but too much of Mo decreases the plasticity severely and enhances the strength. The ZrTiHfNbMo alloy, whose compressive stress is 1099 MPa at 800° C, is a promising material for high-temperature applications.
Patient Barriers and Facilitators to Ambulatory and Home Blood Pressure Monitoring: A Qualitative Study
Authors: Carter Eileen J , Moise Nathalie , Alcántara Carmela , Sullivan Alexandra M , Kronish Ian M 
Published: May 2018

Abstract

BACKGROUND
Guidelines recommend that patients with newly elevated office blood pressure undergo ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) to rule-out white coat hypertension before being diagnosed with hypertension. We explored patients’ perspectives of the barriers and facilitators to undergoing ABPM or HBPM.

METHODS
Focus groups were conducted with twenty English- and Spanish-speaking individuals from underserved communities in New York City. Two researchers analyzed transcripts using a conventional content analysis to identify barriers and facilitators to participation in ABPM and HBPM.

RESULTS
Participants described favorable attitudes toward testing including readily understanding white coat hypertension, agreeing with the rationale for out-of-office testing, and believing that testing would benefit patients. Regarding ABPM, participants expressed concerns over the representativeness of the day the test was performed and the intrusiveness of the frequent readings. Regarding HBPM, participants expressed concerns over the validity of the monitoring method and the reliability of home blood pressure devices. For both tests, participants noted that out-of-pocket costs may deter patient participation and felt that patients would require detailed information about the test itself before deciding to participate. Participants overwhelmingly believed that out-of-office testing benefits outweighed testing barriers, were confident that they could successfully complete either testing if recommended by their provider, and described the rationale for their testing preference.

CONCLUSIONS
Participants identified dominant barriers and facilitators to ABPM and HBPM testing, articulated testing preferences, and believed that they could successfully complete out-of-office testing if recommended by their provider.
Maternal Weight, Snoring, and Hypertension: Potential Pathways of Associations
Authors: Dunietz Galit Levi , Shedden Kerby , Lisabeth Lynda D , Treadwell Marjorie C , O’Brien Louise M 
Published: May 2018

Abstract

BACKGROUND
Hypertensive disorders of pregnancy (HDP) are linked to excessive maternal weight and frequent snoring. However, pathways between maternal excessive weight, pregnancy-onset snoring, and HDP are only partially estimated. We examined and quantified the total and direct associations between excessive maternal weight and incident HDP and their indirect pathway through pregnancy-onset snoring.

METHODS
Third trimester pregnant women enrolled from prenatal clinics of a large tertiary medical center. Sleep data were collected through a questionnaire. Demographic and pregnancy information and first trimester maternal weight were abstracted from medical charts. After exclusion of women with prepregnancy hypertension and/or chronic snoring, causal mediation analysis was used to estimate the total and direct association between maternal weight and incident HDP and their indirect association through pregnancy-onset snoring. The proportion of the mediated association through pregnancy-onset snoring from the total association of maternal weight and HDP was also quantified.

RESULTS
After excluding those with chronic hypertension and/or snoring, the final sample included 1,333 pregnant women. In adjusted analysis, excessive maternal weight was directly associated with incident HDP; odds ratio (OR) = 1.87 (95% confidence interval (CI) 1.30, 2.70). Pregnancy-onset snoring significantly mediated the association between maternal weight and incident HDP; OR = 1.08 (95% CI 1.01, 1.17). The mediated pathway accounted for 15% of the total association between maternal weight and incident HDP.

CONCLUSIONS
Pregnancy-onset snoring mediates the association between maternal weight and incident HDP in women without prepregnancy snoring or hypertension. These findings demonstrate the relative contributions of excessive maternal weight and pregnancy-onset snoring to incident HDP.
Language Learning Strategies: Is the Baby Still in the Bathwater?
Authors: Griffiths Carol 
Published: May 2018

Abstract
When it was suggested that the concept of self-regulation should replace the language learning strategy concept early in the new millennium, there were fears that strategy research had come to an end. Nevertheless, research, debate, and publication on the subject have continued. Although some issues remain (especially regarding definition, underpinning theory, classification, and research methodology), current opinion tends to suggest that language learning strategies remain vibrant and compatible with self-regulation. This article discusses the controversies and concludes by arguing for the need to acknowledge diversity and to engage in productive debate.
Ceftazidime/avibactam versus standard-of-care agents against carbapenem-resistant Enterobacteriaceae harbouring blaKPC in a one-compartment pharmacokinetic/pharmacodynamic model
Authors: Barber Katie E , Pogue Jason M , Warnock Henderson D , Bonomo Robert A , Kaye Keith S 
Published: May 2018

AbstractBackground‘Last-line’ antimicrobial usage has promoted the emergence of MDR bacteria. Production of Klebsiella pneumoniae carbapenemases (KPCs) is increasingly common and leads to resistance to most antimicrobials. However, ceftazidime/avibactam demonstrates activity against KPC-producing strains. Ceftazidime/avibactam in the empirical setting remains unknown.MethodsStrains underwent genetic analysis evaluating blaKPC presence/production and MICs were determined. Four strains were assessed in an in vitro, one-compartment pharmacokinetic (PK)/pharmacodynamic (PD) model for 96 h. The following bolus dosing exposures were tested: 2.5 g of ceftazidime/avibactam every 8 h, 2 g of meropenem every 8 h, 1.25 mg/kg polymyxin B every 12 h, amikacin ‘once-daily dosing’ (peak of 70–80 mg/L), tigecycline at 200 mg ×1 dose followed by 100 mg every 12 h, and a drug-free growth control.ResultsThirty blaKPC-producing strains were evaluated; 97% of strains were ceftazidime/avibactam susceptible with MIC50/MIC90 values of 0.38/1.5 mg/L (range 0.032–16 mg/L). Two K. pneumoniae strains, one Klebsiella oxytoca strain and one Citrobacter freundii strain underwent further analysis in PK/PD models. Ceftazidime/avibactam displayed potent activity with a reduction of 4.23 ± 0.42 cfu/mL from the initial inoculum at 96 h. Against susceptible isolates, amikacin displayed similar activity compared with ceftazidime/avibactam at 96 h, although this was not demonstrated against all strains. Polymyxin B produced comparable activity to ceftazidime/avibactam against two strains. Neither meropenem nor tigecycline produced effective killing and were comparable to the drug-free growth control at 96 h.Conclusionsbla KPC-producing organisms demonstrated susceptibility to ceftazidime/avibactam and bactericidal activity was observed in the PK/PD model. Based on these data, ceftazidime/avibactam is a valuable agent for treating KPC-producing organisms and should be considered for treatment of infections caused by these pathogens.
Detection of the Galactic warm neutral medium in H i 21-cm absorption
Authors: Patra Narendra Nath , Kanekar Nissim , Chengalur Jayaram N , Roy Nirupam 
Published: May 2018

ABSTRACT
We report a deep Giant Metrewave Radio Telescope search for Galactic H i 21-cm absorption towards the quasar B0438−436, yielding the detection of wide, weak H i 21-cm absorption, with a velocity-integrated H i 21-cm optical depth of 0.0188 ± 0.0036 km s−1. Comparing this with the H i column density measured in the Parkes Galactic All-Sky Survey gives a column density-weighted harmonic mean spin temperature of 3760 ± 365 K, one of the highest measured in the Galaxy. This is consistent with most of the H i along the sightline arising in the stable warm neutral medium. The low-peak H i 21-cm optical depth towards B0438−436 implies negligible self-absorption, allowing a multi-Gaussian joint decomposition of the H i 21-cm absorption and emission spectra. This yields a gas kinetic temperature of $T_{\rm k} \le (4910 \pm \lt t\gt 1900)$ K, and a spin temperature of $T_{\rm s} = (1000 \pm 345)$ K for the gas that gives rise to the H i 21-cm absorption. Our data are consistent with the H i 21-cm absorption arising from either the stable WNM, with $T_{\rm s} \ll T_{\rm k}$, $\rm T_k \approx 5000$ K, and little penetration of the background Lyman-α radiation field into the neutral hydrogen, or the unstable neutral medium, with $T_{\rm s} \approx T_{\rm k} \approx 1000\,{\rm K}$.
Cognitive Decline after Delirium in Patients Undergoing Cardiac Surgery
Authors: Brown Charles H. , Probert Julia , Healy Ryan , Parish Michelle , Nomura Yohei , Yamaguchi Atsushi , Tian Jing , Zehr Kenton , Mandal Kaushik , Kamath Vidyulata , Neufeld Karin J. , Hogue Charles W. 
Published: May 2018

Background
Delirium is common after cardiac surgery and has been associated with morbidity, mortality, and cognitive decline. However, there are conflicting reports on the magnitude, trajectory, and domains of cognitive change that might be affected. The authors hypothesized that patients with delirium would experience greater cognitive decline at 1 month and 1 yr after cardiac surgery compared with those without delirium.

Methods
Patients who underwent coronary artery bypass and/or valve or aortic root surgery with cardiopulmonary bypass were eligible for this cohort study. Delirium was assessed using the Confusion Assessment Method. A neuropsychologic battery was administered before surgery, at 1 month, and 1 yr later. Linear regression was used to examine the association between delirium and change in composite cognitive Z score from baseline to 1 month (primary outcome). Secondary outcomes were domain-specific changes at 1 month and composite and domain-specific changes at 1 yr.

Results
The incidence of delirium in 142 patients was 53.5%. Patients with delirium had greater decline in composite cognitive Z score at 1 month (greater decline by –0.19; 95% CI, –0.35 to –0.04; P = 0.017), and in the domains of visuoconstruction and processing speed. From baseline to 1 yr, there was no difference between delirious and nondelirious patients with respect to change in composite cognitive Z score, although greater decline in processing speed persisted among the delirious patients.

Conclusions
Patients who developed delirium had a greater decline in a composite measure of cognition and in visuoconstruction and processing speed domains at 1 month. The differences in cognitive change by delirium were not significant at 1 yr, with the exception of processing speed.

What We Already Know about This Topic

What This Article Tells Us That Is New
Early variation of quick sequential organ failure assessment score to predict in-hospital mortality in emergency department patients with suspected infection
Authors: Lemachatti Najla , Ortega Mar , Penaloza Andrea , Le Borgne Pierrick , Claret Pierre-Géraud , Occelli Céline , Truchot Jennifer , Dumas Florence , Feral-Pierssens Anne-Laure , Andrianjafy Héry , Beaune Sebastien , Yordanov Youri , Hausfater Pierre , Riou Bruno , Bloom Ben , Krastinova Evguenia , Freund Yonathan 
Published: May 2018

Background
The quick sequential organ failure assessment (qSOFA) score showed good prognostic performance in patients with suspicion of infection in the emergency department (ED). However, previous studies only assessed the performance of individual values of qSOFA during the ED stay. As this score may vary over short timeframes, the optimal time of measurement, and the prognostic value of its variation are unclear. The objective of the present study was to prospectively assess the prognostic value of the change in qSOFA over the first 3 h (ΔqSOFA = qSOFA at 3 h−qSOFA at inclusion).

Patients and methods
This is an international prospective cohort study conducted in 17 EDs in France, Belgium, and Spain. From November 2016 to March 2017, patients with a suspected infection and a qSOFA score of 2 or higher were included and followed up until death or hospital discharge. qSOFA was measured at inclusion, 1 h and 3 h. Primary end point was in-hospital mortality, truncated at 28 days.

Results
Of 534 recruited patients, 512 were included in the analysis. The qSOFA was improved at 3 h (ΔqSOFA < 0) in 287 (55%) patients. Overall in-hospital mortality was 27%: 44% when ΔqSOFA greater than 0, 36% when ΔqSOFA = 0, and 18% when ΔqSOFA less than 0. A positive ΔqSOFA was independently associated with reduced in-hospital mortality (adjusted hazard ratio of 0.48, 95% confidence interval: 0.34–0.68). After modeling qSOFA kinetics in the first 3 h, there was a significant difference in adjusted slopes between patients who died and those who survived (0.15, 95% confidence interval: 0.09–0.22, P < 0.001).

Conclusion
In patients with suspected infection presenting to the ED with a qSOFA of 2 or higher, the early change in qSOFA is a strong independent predictor of mortality.
Cutaneous manifestations of nutritional deficiency
Authors: Lekwuttikarn Ramrada , Teng Joyce M.C. 
Published: May 2018

Purpose of review
Childhood malnutrition is a major global health issue. It is often thought of as a developing world problem and therefore, underdiagnosed or misdiagnosed in developed countries. The delay in diagnosis and treatment can lead to increased morbidity and mortality. Cutaneous manifestations are often the initial presenting signs of nutritional deficiency. Early recognition is essential in timely initiation of the necessary interventions. This article will review pertinent cutaneous findings and systemic manifestations associated with common nutritional deficiencies.

Recent findings
Malnutrition has historically been associated with poverty in developing countries. However, recent literatures suggest that the incidence of nutritional deficiencies continuous to rise among infants from developed countries, as a result of dietary restrictions because of perceived food allergies or intolerance. It is also an emerging finding in children with complicated medical problems.

Summary
It is very important to raise awareness about cutaneous manifestations of nutritional deficiency as early and appropriate treatment results in excellent prognosis.
Quality of the Triage of Children With Anaphylaxis at the Emergency Department
Authors: Arroabarren Esozia , Alvarez-Garcia Jorge , Anda Marta , de Prada Montserrat , Ponce Maria Carmen , Palacios Miriam 
Published: May 2018

Objective
Early recognition of symptoms is essential in anaphylaxis management. The Canadian Paediatric Emergency Triage and Acuity Scale prioritizes anaphylaxis to level I or II (resuscitation or emergency). We analyzed the accuracy of pediatric anaphylaxis triage.

Methods
This was a retrospective review of the triage charts (adaptation of the Canadian Paediatric Emergency Triage and Acuity Scale) of 137 children attended for anaphylaxis at our pediatric emergency department. Per triages' accuracy, charts were divided into TR1 (levels I–II) and TR2 (levels III–V), comparing demographics, initial triage level given by initial assessment (Paediatric Assessment Triangle), vital signs, observations recorded by the staff, and waiting times for physician.

Results
Forty-six (33.3%) were triaged correctly (TR1 group), and 91 (66.7%) were not. Median ages were similar (TR1: 5 years [interquartile range, 13.1 years] vs TR2: 4.5 years [interquartile range, 14.5 years]; P = 0.837). Initial triage level 5 was given by Paediatric Assessment Triangle to 69.5% of TR1 and 83% of TR2 cases (P = 0.001; likelihood ratio for TR2: 1.985 [95% confidence interval, 1.11–3.49]). Vital signs were normal in 71.7% of TR1 and 94.5% of TR2 patients (P < 0.001; likelihood ratio for TR2: 2.602 [95% confidence interval, 1.22–5.52]). Symptoms suggestive of anaphylaxis (mention of 2 different organs) were recorded in 45.6% of TR1 and 48.3% of TR2 charts (P = 0.08). Median waiting times were 3 minutes (interquartile range, 26 minutes) and 11 minutes (interquartile range, 111 minutes) for TR1 and TR2, respectively (P = 0.001).

Conclusions
Current triage, based on severity perception, missed most of the cases. Anaphylaxis-defining symptoms were overlooked. Inaccurate triage delayed medical attention. Improving measures, such as emphasizing symptom recognition and defining anaphylaxis risk discriminators, is mandatory to improve their identification.