bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contribution of synovial macrophages to rat advanced osteoarthritis pain resistant to cyclooxygenase inhibitors
Authors: Sakurai Yusuke , Fujita Masahide , Kawasaki Shiori , Sanaki Takao , Yoshioka Takeshi , Higashino Kenichi , Tofukuji Soichi , Yoneda Sosuke , Takahashi Tatsuya , Koda Ken , Asaki Toshiyuki , Hasegawa Minoru , Morioka Yasuhide 
Published: December 2018

Abstract
Most advanced knee osteoarthritis (OA) patients experience chronic pain resistant to cyclooxygenase (COX) inhibitors. However, the cells and molecules involved in this advanced OA pain remain poorly understood. In this study, we developed a rat model of advanced knee OA by modification of the monoiodoacetate-induced OA pain model and examined involvement of synovial macrophages in advanced OA pain. Cyclooxygenase inhibitors, such as celecoxib and naproxen, and a steroid were ineffective, but an opioid and anti–nerve growth factor (NGF) antibody was effective for pain management in the advanced OA model. Similar to advanced OA patients, histological analysis indicated severe bone marrow damages, synovitis, and cartilage damage and an increase of macrophages with high expression of interleukin-1β, NGF, nitric oxide synthase (NOS) 1, NOS2, and COX-2 in the knee joint of the advanced OA model. Intravenous injection of clodronate liposomes depleted synovial macrophages, which decreased the level of not only proinflammatory mediator interleukin-1β but also NGF in the knee joint, leading to pain suppression in the advanced OA model. These data suggest the involvement of synovial macrophages in advanced knee OA pain resistant to COX inhibitors by increasing proinflammatory mediators, and that drugs targeting synovial macrophages might have potent analgesic effects.
Development of a Women's Pelvic Health Specialty Clinical Experience
Authors: Anderson Kathleen , LaLonde Amanda 
Published: December 2018

Background and Purpose.
The purpose of this article is trifold. First, to share the process and outcomes of developing a specialty clinical experience specific to the pelvic health setting; second, to encourage others to consider a similar model; and finally, to promote the early engagement of interested students on the pathway to practice specialization.

Case Description.
A full-time clinical experience was developed in the specialty practice area of pelvic health at the request of an interested student. After the selection of a clinical partner, goals and objectives, outcomes assessment, and a timeline for goal achievement were established.

Outcomes.
Student successfully met entry-level criteria on a focused application of the CPI and completed indirect measures including a specialty professional development plan and reflective journaling. The student anticipates further pursuit of specialty physical therapist practice.

Discussion and Conclusion.
The academic program and the clinical partners enthusiastically supported the process and outcomes. The academic institution anticipates using the developed format to design additional learning experiences in specialty practice settings. Given the success of this experience, it would seem that the template is applicable to other institutions seeking to develop specialty clinical experiences.
Low-dose Immune Tolerance Induction in Hemophilia: A Single-Center Experience
Authors: Zulfikar Bulent , Koc Basak , Ozdemir Nihal 
Published: December 2018

Introduction:
The development of inhibitors against factors VIII/IX is the most serious complication in hemophilia. The best treatment strategy for inhibitor eradication is immune tolerance induction (ITI). The aim of this study was to evaluate patients treated with low-dose ITI at a single center with limited resources.

Materials and Methods:
In total, 29 (8.05%) of 360 hemophilia A patients exhibited inhibitors. The data from hemophilia patients with inhibitors undergoing ITI between 1999 and 2017 were collected and analyzed.

Results:
Seventeen ITIs administered to 15 hemophilia A patients with inhibitors were analyzed, and the data from 13 ITIs conducted in 12 patients were evaluated. The median age at ITI onset was 10 years (range: 1.25 to 52 y). The maximum inhibitor titer before ITI was 30 Bethesda Units (BU) (range: 4.48 to 135), and the median inhibitor titer was 1.25 BU (range: 0 to 5.6) at the onset of ITI. The median time interval between the inhibitor development and ITI onset was 60 months (range: 7 to 264 mo). The median inhibitor titer during ITI was 3.4 BU (range: 0 to 158.7). At the end of the treatment, 4 of the 12 patients (33.3%) exhibited a complete response, 4 (33.3%) had partial responses (with continuing ITI), and 4 (33.3%) exhibited ITI failure.

Conclusions:
Treatment of hemophilia patients with inhibitors is challenging, and ITI is the best treatment method; however, a high-dose daily ITI regimen cannot be given to every patient in every country due to its high cost. Our results show that low-dose ITI may be a choice for selected patients with inhibitors.
Sepsis Education Initiative Targeting qSOFA Screening for Non-ICU Patients to Improve Sepsis Recognition and Time to Treatment
Authors: Raines Kim , Sevilla Berrios Ronaldo A. , Guttendorf Jane 
Published: December 2018

Background:
The quick-Sequential Organ Failure Assessment (qSOFA) criteria are recommended for identifying non–intensive care unit (ICU) patients at risk for sepsis but are underutilized.

Local Problem:
We hypothesized that education on recognizing sepsis using qSOFA criteria and empowering nurses to trigger rapid response team (RRT) calls based on positive qSOFA scores would reduce time to recognition and time to intervention and improve treatment compliance in non–ICU patients.

Methods:
The methods involved a descriptive retrospective review of 60 sepsis patients (30 pre- and 30 posteducation) to determine sepsis recognition time (qSOFA-to-RRT); time-to-sepsis interventions (reported as median [interquartile range] hours); and percent compliance with interventions.

Interventions:
We provided qSOFA and sepsis education to more than 1000 nurses, physicians, and advanced practice providers in a large tertiary hospital.

Results:
Posteducation, time to recognition (qSOFA-to-RRT) improved from 11.8 hours (3.4, 34.3) pre to 1.7 (0, 11.7) post (P = .005). Time from qSOFA to antibiotics improved from 1.4 hours (2.4, 6.2) pre to −4.7 (−25.4, 1.8) hours post (P < .01). Using qSOFA, compliance improved for antibiotics from 60% pre to 87% post (P = .02).
Implementation of a Vital Sign Alert System to Improve Outcomes
Authors: Huff Shelly , Stephens Kimberly , Whiteman Kimberly , Swanson-Biearman Brenda , Mori Candy 
Published: December 2018

Background:
Patients at risk for clinical deterioration often show changes in vital signs up to 24 hours before a critical event. Use of modified early warning scores has demonstrated effectiveness in identifying patients at risk for clinical deterioration and improving outcomes.

Local Problem:
Documentation of vital signs, timely recognition of clinical deterioration, and compliance with the sepsis bundles remained a challenge.

Methods:
An interprofessional team developed an electronic vital sign alert (VSA) system with a concurrent running sepsis screen, along with clinical protocols.

Interventions:
Education was provided and the VSA system was implemented on 3 nursing units.

Results:
After implementation, the number of unplanned transfers to the intensive care unit increased. Mortality rate and length of stay in the intensive care unit for patients transferred for respiratory failure and sepsis significantly decreased. There was a 21% increase in identification of sepsis.

Conclusions:
The VSA system was an effective tool to identify patients at risk for clinical deterioration and help to improve outcomes.
Characteristics of Emergency Department Presentations of Pediatric Poisoning Between 2011 and 2016
Authors: Moon JeongMi , Chun ByeongJo , Cho YongSoo , Lee SeungDo , Jung EuJene 
Published: December 2018

Objectives
Pediatric poisoning represents a major preventable cause of morbidity. The epidemiology of pediatric poisoning differs by country and region. This study aimed to characterize pediatric poisoning in South Korea over the last 6 years and to discuss current regulations related to the causative agents involved in pediatric poisoning.

Methods
Data were obtained for injury presentation in emergency departments (EDs) using the in-depth surveillance system of the Korea Centers for Disease Control and Prevention.

Results
Pediatric poisoning accounted for 1.2% of injury-related ED presentations among children and 2.0% of deaths related to child injury. The annual number of pediatric poisoning–related ED presentations and the number of accidental poisonings have significantly increased over the last 6 years. There was no significant change in the type of causative agent involved in pediatric poisoning, and a therapeutic agent was the most common agent, regardless of the intentionality of pediatric poisoning (39.4% in accidental poisoning; 86.4% in intentional poisoning). Cold medications and cardiovascular drugs were the two most common drug types involved in accidental poisoning, whereas acetaminophen and psychotropics were most commonly involved in intentional poisoning. The case fatality rate of pediatric poisoning was 0.2% over 6 years.

Conclusions
Over 6 years, the annual number of total poisoning cases and of accidental poisoning cases in particular increased despite a lack of change in the types of causative agents related to pediatric poisoning. This phenomenon may reflect failed preventative measures. Thus, the implementation of tailored preventative measures based on epidemiological data should be accelerated.
Epipericardial Fat Pad Necrosis—A Rare Cause of Chest Pain in an Adolescent
Authors: Bolourchi Meena , Renjen Pooja , Kovanlikaya Arzu , Baad Michael , Traister Michael , Flynn Patrick A. , Kern Jeffrey H. 
Published: December 2018

Abstract
Epipericardial fat necrosis is a rare cause of acute pleuritic chest pain reported in approximately 40 cases. This diagnosis mimics a myocardial infarction, pulmonary embolism, or pericarditis; however, the cardiac enzymes and electrocardiogram are usually normal. We present the first reported case of epipericardial fat necrosis in an adolescent.
The Second Victim: A Contested Term?
Authors: Tumelty Mary-Elizabeth 
Published: December 2018

Objectives
The term “second victim” was seminally coined by Wu, in recognition of the profound and long-lasting impact adverse events and medical errors may have on medical practitioners. Since the conception of this vocable over a decade ago, the term second victim has been internationally accepted and is widely used in discussion of this important topic. Notwithstanding its widespread use, controversy surrounds the term second victim in light of the traditional connotations with the word “victim.” However, notable in their absence are the views of medical practitioners on the use of this term. This article addresses this gap through an exploration of perceptions on the terminology used to describe physicians who experience distress after an adverse event or medical error.

Methods
This research arose as part of a wider study on the dynamic of medical negligence litigation in Ireland. The study used a qualitative approach, using semistructured interviews as the data gathering instrument. The sample involved representatives of medical training bodies (2 individual interviews and 1 focus group of 4 individuals) and legal professionals (barristers) (12 individual interviews). Those interviewed from medical training bodies were physicians who have an active role in the college providing training and support to their members.

Results
A number of participants shared their views on the term second victim, and the findings of this study suggest that some physicians and legal professionals are uncomfortable with the term second victim despite its widespread use in other jurisdictions. This is due to the traditional connotations that surround the term victim, and the perception that being labeled a victim may undermine the harm experienced by the patient.

Conclusions
Although the impact of adverse events and medical error on the physician is undisputed, use of the term second victim can be seen as insensitive to the patient, as well as dissipating the professional identity of the healthcare provider. Second victim is an internationally recognized term, as coined by Wu (2000). Finding an appropriate replacement is an important but difficult task.
Unintended Patient Safety Risks Due to Wireless Smart Infusion Pump Library Update Delays
Authors: Hsu Kang-Yu , DeLaurentis Poching , Bitan Yuval , Degnan Daniel D. , Yih Yuehwern 
Published: December 2018

Objective
Our previous study showed that the issue of drug library update delays on wireless intravenous (IV) infusion pumps of one major vendor was widespread and significant. However, the impact of such a delay was unclear. The objective of this study was to quantify the impact of pump library update delays on patient safety in terms of missed and false infusion programming alerts.

Methods
The study data sets included infusion logs and drug libraries from three hospitals of one health system from January 2015 to December 2016. We identified limit setting changes of any two consecutive drug library versions. We quantified the impact of using outdated drug limit settings by missed and false infusion programming alerts.

Results
Twenty-five updates of the drug library were released within the health system during the 2-year period with an average interval of 28.8 days. After a new library version was issued, it took at least 6 days for 50% of all pumps to become up-to-date and 15 days or more to reach 80%. All three hospitals had at least 16% of all IV infusions programmed with outdated libraries. This resulted in 18%, 24.4%, and 27% of false alerts in the three hospitals, respectively. We identified two cases of missed alert infusions of high-risk medications, propofol, and potassium chloride, which could have negatively impacted patient safety.

Conclusions
These findings support our assumption that potential serious harm can happen when IV infusions are administered with outdated drug limit settings due to delays in drug library updates on the pump.
Race Differences in Reported Harmful Patient Safety Events in Healthcare System High Reliability Organizations
Authors: Thomas Angela D. , Pandit Chinmay , Krevat Seth A. 
Published: December 2018

Objectives
The aim of the study was to determine whether race differences exist in voluntarily reported harmful patient safety events in a large 10 hospital healthcare system on a high reliability organization journey.

Methods
From July 1, 2015, to June 30, 2017, employees in a healthcare system based in Washington, District of Columbia, and Maryland voluntarily reported harmful patient safety events by type using a Patient Safety Event Management System. Inpatients, outpatients, and observation patients were identified as “black,” “white,” or “other” (N = 5038). Using retrospective analysis and χ2 goodness of fit, comparisons of race proportions were conducted to determine differences at the health system level, by hospital, by event type, and by severity.

Results
Significant race differences existed: (1) overall with higher proportions of whites and lower proportions of other in a Patient Safety Event Management System; (2) by type across races; (3) in six hospitals across races; and (4) by type and by hospital for blacks and whites. All differences were significant at P < 0.05.

Conclusions
Race differences in harmful events exist in voluntary reporting systems by type and by hospital setting. Healthcare organizations, particularly healthcare high reliability organizations, can use these findings to help identify areas of further study and investigation. Further study and investigation should include efforts to understand the root cause of the differences found in this study, including the role of reporting bias.
Diffuse Idiopathic Skeletal Hyperostosis, Associated Morbidity, and Healthcare Utilization
Authors: Tripathi Maanas , Rajmohan Divya , Quirk Cody , Beckett Brooke , Choi Dongseok , Rich-Garg Neha , Deodhar Atul 
Published: December 2018

Background
Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory condition affecting the spine, characterized by ossification of paravertebral ligaments. Our cross-sectional study investigated the frequency, associated morbidity, and healthcare utilization of DISH patients at our university hospital over 1 year.

Methods
Our university's database of spinal radiographs was searched from 2005 to 2015 for “DISH” or “diffuse idiopathic skeletal hyperostosis.” The diagnosis of DISH was made by 2 board-certified radiologists (B.B. and C.Q.) based on the radiographs of cervical, thoracic, or lumbar spine. Patients from 2015 were further analyzed with regards to demographics, comorbidities, and healthcare interventions. Their spinal radiographs were reread by 2 authors. Patients were divided into those who fulfilled the Resnick criteria for DISH (group A), and those who did not fully meet the criteria but had radiographic features suggestive of DISH (group B). Means and proportions were used to describe variables. For group comparisons, t test and χ2 test were used.

Results
Between 2005 and 2015, 3439 radiology records mentioned DISH as a diagnosis. Of 195 patients diagnosed with DISH in 2015, 153 were in group A, 41 were in group B, and 2 had erroneous diagnoses. Chronic back pain was common, and more often reported in group B than in group A (81% vs 63%, p = 0.04). Substantial portions of patients required opioid medications for pain control (51%), spinal surgery (31%), and consultations with various specialists for regional pain (57%).

Conclusions
Diffuse idiopathic skeletal hyperostosis is a diagnosis with significant morbidity, despite being commonly viewed as asymptomatic. A majority of DISH patients had chronic back pain, and a large proportion required spinal surgery, although there may be several confounders. Future research is needed to systematically assess healthcare utilization by DISH patients.
Structural properties and their influence on the prey retention in the spider web
Authors: Jyoti Jeevan , Kumar Amit , Lakhani Piyush , Kumar Navin , Bhushan Bharat 
Published: December 2018

Orb webs absorb the impact energy of prey and transmit vibratory information to the spider with minimal structural damage. The structural properties of the web and the arrangement of threads within the web affect transmission time during the prey impact. The objective of the present study is to determine damping, stiffness, and transmissibility of healthy and damaged spider webs. Experimental results show that stiffness and transmissibility diminish from the inner to outer spiral threads and gradient variation in the structural properties of spiral threads enhances signal transmission capability toward the centre regardless of the position of prey impact within the healthy web. Spiral threads exhibit excellent prey retention properties due to their stretching capability. Kinetic energy produced by prey is absorbed in the threads, which help the spider to analyse the prey retention properties and also determine the response time. The minor damage (up to 25%) does not alter the basic characteristics of the web due to self-adjustment of tension within the web. Damping, natural frequency, stiffness and transmissibility decrease with the increase in the percentage of damaged web. The present study addresses the structural sustainability of the spider web irrespective of minor damages and also provides guidance in designing the structures under impact.This article is part of the theme issue ‘Bioinspired materials and surfaces for green science and technology’.
Pleistocene Mammal Population Fluctuation Patterns Inferred by Their Genomes
Authors: Liu Yulu , Liu Biao , Pan Xingxin , Shi Qiong , Xiao Zhoujian , Li Shengbin , Li Shuaicheng 
Published: December 2018

SummaryPaleoclimate fluctuations critically affect paleoecological systems and influence mammal populations, even resulting in population differentiation [1]. Historical effective population size (Ne) can reflect these influences [2, 3]. Dozens of recent studies have investigated the relationship between variations inNevalues of one or a small number of mammalian species, inferred from genomic data, and fluctuations in paleoclimate [4-7]. However, there lacks an integrated and comprehensive study on the relationship between the fluctuations in paleoclimate and variations inNevalues inferred from genome sequencing data of a wide range of mammals. To investigate patterns in mammalianNevalues during the the Pleistocene, we gathered whole genome sequencing data of 60 mammals from 35 species distributed across Afro-Eurasia and the Americas, then inferred theirNecurves using the Pairwise Sequentially Markovian Coalescent (PSMC) method; 30 mammalianNecurves almost simultaneously started to contract at the turning point of the Middle Pleistocene Transition (MPT); then the population of seven mammals started to expand at the turning point of the Middle Brunhes Event (MBE), while the contraction of other mammals’ populations was prolonged to the later different time periods. Eight mammals experienced a severe population contraction around the Last Glaciation Maximum, as some aves did [8], while four potential ruminant beneficiaries showed an expanding population.Sus scrofaandBos taurusexperienced an internal population differentiation in the MPT. To conclude, the phenomenon that critical paleoclimate events facilitated contemporaneous animal population fluctuations in the paleoecological system is showed by ourNecurve analysis.
Genomic perspectives on adaptation and conservation in the endangered long-tailed goral (Naemorhedus caudatus)
Authors: Weber Jessica A. , Chung Oksung , Kim Jungeun , Jun JeHoon , Lee Hyejin , Jho Sungwoong , Cho Yun Sung , Kim Dae-Soo , Paek Woon ki , Kim Soonok , Lee Hanshin , Lee Semin , Edwards Jeremy S. , Cook Joseph A. , An Junghwa , Bhak Jong 
Published: December 2018

AbstractNative to the mountains of East Asia, the long-tailed goral (Naemorhedus caudatus) is a vulnerable wild ungulate in the tribe Caprini. To understand key conservation issues related to fragmentation and subsequent endangerment of this montane species, we sequenced and analyzed the genome of a long-tailed goral to explore historical demography, contemporary levels of genetic diversity, and potential immune response. When compared to ten additional mammalian reference genomes, we identified 357 positively selected genes (PSGs) in the long-tailed goral and 364 PSGs in the Caprini lineage. Gene Ontology analyses showed statistical enrichment in biological processes related to immune function and in genes and pathways related to blood coagulation. We also identified low levels of heterozygosity (0.00114) in the long-tailed goral along with decreases in population size relative to other species of Caprini. Finally, we provide evidence for positive selection on the muscle development genemyostatin(MSTN) in the Caprini lineage, which may have increased the muscle development and climbing ability in the caprine common ancestor. Low effective population size and decreased heterozygosity of the long-tailed goral raise conservation concern about the effects of habitat fragmentation, over harvest, and inbreeding on this vulnerable species.