bluuebunny/crossref_metadata_2025_split huggingface dataset:
How do members of a fire and rescue service perceive expanding their roles to deliver more health care services?
Authors: Byrne-Davis L M T , Marchant D , Bull E R , Gyles D , Dean E , Hart J K 
Published: August 2018

Abstract

Background
Increasingly, public sector workers are being required to expand their roles into public health. Fire and rescue services, as part of the Emergency Medical Response trial, are at the forefront of role expansion, with increasing capacity due to reducing numbers of fires in recent years. Firefighter roles, successfully implemented, include responding to cardiac arrests and conducting checks on health and wellbeing in people’s own homes. In this study, we explored fire service members’ perceptions about this role expansion, to increase understanding of how role expansion can be introduced and supported.

Methods
We interviewed 21 firefighters and team members about their perceptions of new roles. Interviews were conducted, transcribed and thematically analysed until reaching thematic saturation.

Results
Perspectives differed for responding to cardiac arrests and wellbeing checks. Cardiac arrests were seen as aligned with core roles and thus more acceptable. For both types of new role participants wanted more training and opportunities to provide feedback on implementation.

Conclusions
How team members viewed role expansion depended on new role alignment with core role, training and being able to give feedback to management to shape future services.
Nonlinear electro-elastic bodies with residual stresses: spectral formulation
Authors: Shariff M H B M , Bustamante R , Merodio J 
Published: August 2018

AbstractIn the present article, a spectral model is developed for residually stressed electro-elastic bodies. The model uses a total energy function that depends on the right stretch tensor, residual stress tensor and one of the electric variables. Some boundary value results with cylindrical symmetry are given. Results for the inflation of a hollow sphere, where the residual stress is assumed to depend only on the radial position, are also given. The constitutive formulation contains spectral invariants that have an immediate physical interpretation which is useful in a rigorous construction of a specific form of the total energy function via an appropriate experiment
NLRP3 deficiency exacerbates enterovirus infection in mice
Authors: Wang Chen , Fung Gabriel , Deng Haoyu , Jagdeo Julienne , Mohamud Yasir , Xue Yuan Chao , Jan Eric , Hirota Jeremy A. , Luo Honglin 
Published: August 2018

ABSTRACTThe role for the NOD‐like receptor (NLR) P3 inflammasome in enterovirus infection remains controversial. Available data suggest that the NLRP3 inflammasome is protective against enterovirus A71 but detrimental to the host during coxsackievirus B3 (CVB3) infection. CVB3 is a common etiologic agent associated with myocarditis and pancreatitis. Previous findings on the role of NLRP3 in CVB3 were based primarily on indirect evidence. Here, we utilized NLRP3 knockout mice as well as immune and cardiac cells to investigate the direct interplay between CVB3 infection and NLRP3 activation. We demonstrated that NLRP3 knockout mice exhibited more severe disease phenotype after CVB3 infection (significantly higher virus titers), increased myocardial, and pancreatic damage, as well as markedly impaired cardiac function compared to nontransgenic control mice. We further showed that NLRP3 activity was enhanced during early stage of CVB3 infection, as evidenced by increased gene expression and/or secretion of IL‐1β and caspase‐1. Finally, we demonstrated that CVB3 inactivates the NLRP3 inflammasome by degrading NLRP3 and its upstream serine/threonine‐protein kinase receptor‐interacting protein 1/3 via the proteolytic activity of virus‐encoded proteinases. Taken together, our results reveal the functional significance of NLRP3 in host antiviral immunity against CVB3 infection and the mechanisms by which CVB3 has evolved to counteract the host defense response.—Wang, C., Fung, G., Deng, H., Jagdeo, J., Mohamud, Y., Xue, Y. C., Jan, E., Hirota, J. A., Luo, H. NLRP3 deficiency exacerbates enterovirus infection in mice. FASEB J. 33, 942–952 (2019). www.fasebj.org
Alterations in plasma acylcarnitine and amino acid profiles may indicate poor nutrition during the suckling period due to maternal intake of an unbalanced diet and may predict later metabolic dysfunction
Authors: Pomar Catalina A. , Kuda Ondrej , Kopecky Jan , Rombaldova Martina , Castro Heriberto , Picó Catalina , Sánchez Juana , Palou Andreu 
Published: August 2018

ABSTRACTPlasma profiles of acylcarnitines (ACs) and amino acids (AAs) may have interest as potential biomarkers. Here we analyzed plasma AC and AA profiles in 2 rat models with different metabolic programming outcomes: offspring of dams fed a cafeteria diet during lactation (O‐CAF, with a thin‐outside–fat‐inside phenotype) and the offspring of dams with diet‐induced obesity subjected to dietary normalization before gestation [offspring of postcafeteria dams (O‐PCaf), nonaltered phenotype]. The purpose was to identify early variables that might indicate a propensity for a dysmetabolic state. O‐CAF rats presented higher circulating levels of most of the lipid‐derived ACs and higher hepatic expression of genes related to fatty acid oxidation (Ppara and Cpt1a) than controls [offspring of control dams (O‐C)]. They also exhibited an altered plasma AA profile. These differences were not observed in O‐PCaf animals. A partial least squares‐discriminant analysis score plot of the metabolomics data showed a clear separation between O‐CAF and O‐C animals. The long‐chain ACs (C18, C18:1, C18:2, C16:1, and C16DC) and the AAs glycine, alanine, isoleucine, serine, and proline are the variables mainly influencing this separation. In summary, we have identified a cluster of ACs and AAs whose alterations may indicate poor nutrition during lactation due to maternal unbalanced diet intake and predict the later dysmetabolic phenotype observed in the offspring.—Pomar, C. A., Kuda, O., Kopecky, J., Rombaldova, M., Castro, H., Picó, C., Sánchez, J., Palou, A. Alterations in plasma acylcarnitine and amino acid profiles may indicate poor nutrition during the suckling period due to maternal intake of an unbalanced diet and may predict later metabolic dysfunction. FASEB J. 33, 796–807 (2019). www.fasebj.org
A young testicular microenvironment protects Leydig cells against age‐related dysfunction in a mouse model of premature aging
Authors: Curley Michael , Milne Laura , Smith Sarah , J⊘rgensen Anne , Frederiksen Hanne , Hadoke Patrick , Potter Paul , Smith Lee B. 
Published: August 2018

ABSTRACTTesticular Leydig cells (LCs) are the primary source of circulating androgen in men. As men age, circulating androgen levels decline. However, whether reduced LC steroidogenesis results from specific effects of aging within LCs or reflects degenerative alterations to the wider supporting microenvironment is unclear; inability to separate intrinsic LC aging from that of the testicular microenvironment in vivo has made this question difficult to address. To resolve this, we generated novel mouse models of premature aging, driven by CDGSH iron sulfur domain 2 (Cisd2) deletion, to separate the effects of cell intrinsic aging from extrinsic effects of aging on LC function. At 6 mo of age, constitutive Cisd2‐deficient mice display signs of premature aging, including testicular atrophy, reduced LC and Sertoli cell (SC) number, decreased circulating testosterone, increased luteinizing hormone/testosterone ratio, and decreased expression of steroidogenic mRNAs, appropriately modeling primary testicular dysfunction observed in aging men. However, mice with Cisd2 deletion (and thus premature aging) restricted to either LCs or SCs were protected against testicular degeneration, demonstrating that age‐related LCs dysfunction cannot be explained by intrinsic aging within either the LC or SC lineages alone. We conclude that age‐related LC dysfunction is largely driven by aging of the supporting testicular microenvironment.—Curley, M., Milne, L., Smith, S., J⊘rgensen, A., Frederiksen, H., Hadoke, P., Potter, P., Smith, L. B. A Young testicular microenvironment protects Leydig cells against age‐related dysfunction in a mouse model of premature aging. FASEB J. 33, 978–995 (2019). www.fasebj.org
Clinical Impact of Corrective Cast Treatment for Early Onset Scoliosis: Is It a Worthwhile Treatment Option to Suppress Scoliosis Progression Before Surgical Intervention?
Authors: Kawakami Noriaki , Koumoto Izumi , Dogaki Yoshihiro , Saito Toshiki , Tauchi Ryoji , Kawakami Kazuki , Suzuki Teppei , Uno Koki 
Published: August 2018

Background:
Although corrective cast (CC) has been back in use for the treatment of early onset scoliosis (EOS), no studies have reported how clinically meaningful CC was in comparison with brace-only treatment (BT) in EOS. The aim of this study was to investigate the effect of CC treatment in terms of suppression of scoliosis progression before surgery.

Methods:
This study was designed to conduct a comparison of patients treated at 2 spine institutions differing in treating methods (one: mainly CC with brace, the other: BT). Applying casts were performed without general anesthesia and repeatedly with the interval of 2 to 6 months combined with corrective brace application called alternatively repetitive cast and brace treatment (ARCBT). In total, 58 patients met the following criteria: (1) age at the first visit ≤6 years, (2) scoliosis ≥40 degrees, (3) conservative treatment≥2 years. Patients with congenital scoliosis were excluded in this study. In total, 58 patients were divided into 2 groups; cast/brace group (C/B-G) and BT group (B-G).

Results:
There were no significant differences of diagnosis (P=0.2773), sex (P=0.0670), age at the first visit (P=0.1457), scoliosis magnitude (P=0.1980), and duration for conservative treatment (P=0.2578) between 2 groups. Most of the patients who were treated with ARCBT, were switched to BT due to lower compliance for CC after the age of around 7 years. The progression of scoliosis during ARCBT and BT were 4.4 and 5.8 degree/y, respectively. Those during ARCBT in C/B-G was 2.8 degree/y comparing with 8.4 degree/y after switch to BT after 7 years of age. There was a significant difference between scoliosis progression during ARCBT in C/B-G and that of B-G (P=0.0086).

Conclusions:
This study showed that ARCBT had a significant impact on suppression of scoliosis progression compared with BT in EOS. However, the termination of cast application and the switch to BT may be still a clinical question considering the time to surgical intervention.

Level of Evidence:
Level III—retrospective comparative study.
Increasing Brace Treatment for Pediatric Distal Radius Buckle Fractures: Using Quality Improvement Methodology to Implement Evidence-based Medicine
Authors: Little Kevin J. , Godfrey Jenna , Cornwall Roger , Carr Preston , Dolan Kevin , Balch Samora Julie 
Published: August 2018

Background:
Multiple randomized trials have showed equivalent outcomes and improved patient/family satisfaction using a removable brace to treat pediatric distal radius buckle fractures (DRBF). We tested the hypothesis that we could use quality improvement (QI) methodology to increase the proportion of patients with DRBF treated with removable braces at 2 tertiary care orthopaedic clinics from a baseline of 34.8% to 80%.

Methods:
Clinic billing records were reviewed monthly to determine treatment (brace vs. cast) of DRBF and tracked using control charts (p-chart). Balance measures including correct application of the diagnostic criteria and algorithm were monitored. Process measures including the number of follow-up visits, radiographs obtained, and total cost of treatment were collected. Baseline data were obtained over a 3-month period, followed by a 12-month period of interventions using Plan-Do-Study-Act cycles targeting both individuals and groups of providers.

Results:
The proportion of DRBF treated in a brace increased from a combined baseline of 34.8% to a combined 84% at the end of the study period. Following intervention, 83% (15/18) of providers began using braces for a majority of patients (defined as >67%), with only 1 provider continuing to use casts 100% of the time. Patient preference was cited as the most common reason for use of cast treatment. There was a significant decrease in the number of radiographs obtained at 1 of 2 institutions. The charges for brace treatment averaged $630 less per patient than for cast treatment, leading to an estimated medical-cost savings of $205,000 following intervention.

Conclusions:
Implementation of brace treatment for pediatric DRBF using QI methodology resulted in a shift toward brace treatment in the majority of patients, leading to substantial medical and nonmedical cost savings. Although patient preference was cited as the most common reason for persistent cast treatment, the data show the use of cast treatment to be more dependent upon individual provider preference.

Level of Evidence:
Level II—therapeutic.
Differentiation of Deep Venous Thrombosis Among Children With or Without Osteomyelitis
Authors: Ligon John A. , Journeycake Janna M. , Josephs Shellie C. , Tareen Naureen G. , Lindsay Eduardo A. , Copley Lawson A.B. 
Published: August 2018

Background:
Children with osteomyelitis are at risk for deep venous thrombosis (DVT). This study evaluates the characteristics of DVT among children to differentiate between those with and without osteomyelitis.

Methods:
Children with DVT of any cause were studied between 2008 and 2016. Children with DVT and osteomyelitis were compared with those with DVT without osteomyelitis. Another comparison cohort included children with osteomyelitis but without DVT. Comorbidities, severity of illness (SOI), and clinical course were compared between cohorts.

Results:
DVT was identified in 224 children, a prevalence of 2.5 per 10,000 children. Among those with DVT, 28 (12.1%) had osteomyelitis. The DVT rate among 466 children with osteomyelitis was 6.0%. Children with osteomyelitis and DVT had greater SOI (9.1 vs. 2.7), bacteremia rate (82.1% vs. 38.4%), methicillin-resistant Staphylococcus aureus rate (89.3% vs. 21.2%), surgeries per child (2.1 vs. 0.7), and intensive care unit admission rate (67.9% vs. 5.9%) than that of children without DVT (P<0.00001). Of 196 children who had DVT without osteomyelitis, 166 (84.7%) had comorbidities including defined hypercoagulability (27 or 13.8%). Children with DVT due to osteomyelitis were without comorbidities or hypercoagulability (P<0.00001). The rate of pulmonary embolism was similar for children with DVT with or without osteomyelitis (3/28, or 10.7% vs. 18/196, or 9.2%).

Conclusions:
Children with DVT and osteomyelitis differ substantially from other children with DVT by the absence of comorbidities or post-thrombotic syndrome. They also differ from children with osteomyelitis without DVT by higher SOI, methicillin-resistant S. aureus rate, and occurrence of intensive care. Awareness of for the characteristics of DVT among children with osteomyelitis will reduce delay to diagnostic ultrasound and improve anticoagulation management which must be carefully coordinated given the high rate of surgery of these children.

Level of Evidence:
Level II—prognostic, retrospective cohort comparison.
Review: Proposed Methods to Improve the Survival of Adipose Tissue in Autologous Fat Grafting
Authors: Landau Mark J. , Birnbaum Zoe E. , Kurtz Lauren G. , Aronowitz Joel A. 
Published: August 2018

Summary:
In 2009, the American Society of Plastic Surgeons Task Force on Autologous Fat Grafting (AFG) determined that autologous fat grafting was a safe procedure with a relatively low rate of complications. This consensus opinion unleashed a wave of popularity as plastic surgeons discovered the procedures' efficacy in a wide variety of cosmetic and reconstructive indications. Frequently reported cosmetic applications include soft-tissue augmentation of breast, buttocks, hips, face, and hands, whereas reconstructive applications include adjunct for breast reconstruction contour problems, plantar fat pad improvement, and correction of various posttraumatic and surgical contour deformities. Recognition of other regenerative effects of fat grafting expanded the use AFG for improvement of hypertrophic scar tissue, postradiation sequelae, lipodystrophy, hyperpigmentation, senile skin changes, and actinic damage. The popularity of AFG is supported by a remarkably low risk of complications, minimal scars, and readily available donor sites. Despite recognition of the advantages of AFG, there still is no consensus regarding optimal techniques of harvest, graft preparation, and injection. Further, the yield of permanent volume falls within a very wide range. In this article, we review the basic science of fat grafting, proposed methods offered to improve engraftment, and reported outcomes of AFG procedures.
Hospital purchasing alliances: Ten years after
Authors: Burns Lawton R. , Briggs Allison D. 
Published: August 2018

Background:
Most hospitals outsource supply procurement to purchasing alliances, or group purchasing organizations (GPOs). Despite their early 20th century origin, we lack both national and trend data on alliance utilization, services, and performance. The topic is important as alliances help hospitals control costs, enjoy tailwinds from affiliated regional/local alliances, and face headwinds from hospital self-contracting and criticism of certain business practices.

Purpose:
We compare the utilization, services, and performance of alliances in 2004 and 2014.

Approach:
We analyze alliances using two comparable surveys of hospitals. We use significance tests to assess changes in alliance utilization, services, and performance (e.g., cost savings). We also assess the use of regional/local alliances affiliated with national GPOs.

Results:
Purchasing through national alliances has somewhat diminished. Over 10 years, hospitals have diversified GPO memberships to include regional/local alliances (many affiliated with their national GPO) and engaged in self-contracting. At the same time, hospitals have increased purchases of many categories of supplies/services through national GPOs and endorsed their value-added functions and increasingly important role. Hospitals report greater satisfaction with several GPO functions; performance on most dimensions has not changed.

Conclusions:
National alliances still play important roles that hospitals find valuable.

Practice Implications:
Purchasing alliances continue to play an important role in helping hospitals with both cost savings and new services. Their growing complexity, along with growing use of self-contracting, poses managerial challenges for hospital purchasing staff that may require greater hospital investment.
How to make a job more than just a paycheck: Understanding physician disengagement
Authors: Yanchus Nancy J. , Carameli Kelley A. , Ramsel Dee , Osatuke Katerine 
Published: August 2018

Background:
The benefits of physician engagement are numerous, including improved physician recruitment, retention, and leadership development—outcomes associated with substantial costs or potential savings for health care organizations. However, physician disengagement is a serious detriment, associated with poorer quality of patient care and higher turnover of clinical staff. Using a workforce census survey, we examined what makes physicians engaged or disengaged in their work at a large U.S. health care system.

Purpose:
This study expands our understanding of physician engagement and disengagement, states that impact patient care service delivery and care experiences.

Methodology/Approach:
We explain group differences using qualitative survey comments from 142 engaged and disengaged physicians, which we report with illustrative quotes and frequency counts of referenced themes.

Results:
Engaged physicians discussed positive interpersonal relationships as connected with seeing their work as meaningful. Disengaged physicians expressed concerns about out-of-touch executive leadership. Leadership played a role in psychological safety for both engaged and disengaged physicians: It was described as present and positive for the engaged group and absent for the disengaged group.

Conclusion:
There are commonalities and differences in the drivers of physician engagement and disengagement. Our results shed light on why physicians might withdraw from inherently meaningful work. These findings can inform organizational efforts toward decreasing physician disengagement and increasing and maintaining an engaged physician workforce.

Practice Implications:
To reduce physician disengagement, we recommend leadership development around key skills (i.e., visibility, transparency, accessibility). We also suggest that improving supervisors’ (e.g., clinical service chiefs’) knowledge about workflow processes, staffing needs, patient panel sizes, and administrative tasks carried by physicians could better balance physicians’ workload. Finally, human resource systems can help reduce disengagement by adjusting hiring and training processes to mitigate low staffing levels.
Unique Clinical Language Patterns Among Expert Vestibular Providers Can Predict Vestibular Diagnoses
Authors: Luo Jake , Erbe Christy , Friedland David R. 
Published: August 2018

Objective:
To identify novel language usage by expert providers predictive of specific vestibular conditions.

Study Design:
Retrospective chart review and natural language processing. Level IV.

Setting:
Tertiary referral center.

Patients:
Patients seen for vestibular complaint.

Intervention(s):
Natural language processing and machine learning analyses of semantic and syntactic patterns in clinical documentation from vestibular patients.

Main Outcome Measure:
Accuracy of Naïve Bayes predictive models correlating language usage with clinical diagnoses.

Results:
Natural language analyses on 866 physician-generated histories from vestibular patients found 3,286 unique examples of language usage of which 614 were used 10 or greater times. The top 15 semantic types represented only 11% of all Unified Medical Language System semantic types but covered 86% of language used in vestibular patient histories. Naïve Bayes machine learning algorithms on a subset of 255 notes representing benign paroxysmal positional vertigo, vestibular migraine, anxiety-related dizziness and central dizziness generated strong predictive models showing an average sensitivity rate of 93.4% and a specificity rate of 98.2%. A binary model for assessing whether a subject had a specific diagnosis or not had an average AUC for the receiver operating characteristic curves of .995 across all conditions.

Conclusions:
These results indicate that expert providers utilize unique language patterns in vestibular notes that are highly conserved. These patterns have strong predictive power toward specific vestibular diagnoses. Such language elements can provide a simple vocabulary to aid nonexpert providers in formulating a differential diagnosis. They can also be incorporated into clinical decision support systems to facilitate accurate vestibular diagnosis in ambulatory settings.