bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outsourcing the Remote Management of Cardiac Implantable Electronic Devices: Medical Care Quality Improvement Project
Authors: Giannola Gabriele , Torcivia Riccardo , Airò Farulla Riccardo , Cipolla Tommaso 
Published: October 2018

Background
Remote management is partially replacing routine follow-up in patients implanted with cardiac implantable electronic devices (CIEDs). Although it reduces clinical staff time compared with standard in-office follow-up, a new definition of roles and responsibilities may be needed to review remote transmissions in an effective, efficient, and timely manner. Whether remote triage may be outsourced to an external remote monitoring center (ERMC) is still unclear.

Objective
The aim of this health care quality improvement project was to evaluate the feasibility of outsourcing remote triage to an ERMC to improve patient care and health care resource utilization.

Methods
Patients (N=153) with implanted CIEDs were followed up for 8 months. An ERMC composed of nurses and physicians reviewed remote transmissions daily following a specific remote monitoring (RM) protocol. A 6-month benchmarking phase where patients’ transmissions were managed directly by hospital staff was evaluated as a term of comparison.

Results
A total of 654 transmissions were recorded in the RM system and managed by the ERMC team within 2 working days, showing a significant time reduction compared with standard RM management (100% vs 11%, respectively, within 2 days; P<.001). A total of 84.3% (551/654) of the transmissions did not include a prioritized event and did not require escalation to the hospital clinician. High priority was assigned to 2.3% (15/654) of transmissions, which were communicated to the hospital team by email within 1 working day. Nonurgent device status events occurred in 88 cases and were communicated to the hospital within 2 working days. Of these, 11% (10/88) were followed by a hospitalization.

Conclusions
The outsourcing of RM management to an ERMC safely provides efficacy and efficiency gains in patients’ care compared with a standard in-hospital management. Moreover, the externalization of RM management could be a key tool for saving dedicated staff and facility time with possible positive economic impact.

Trial Registration
ClinicalTrials.gov NCT01007474; http://clinicaltrials.gov/ct2/show/NCT01007474
The Value of Radio Frequency Identification in Quality Management of the Blood Transfusion Chain in an Academic Hospital Setting
Authors: Dusseljee-Peute Linda W , Van der Togt Remko , Jansen Bas , Jaspers Monique W 
Published: October 2018

BackgroundA complex process like the blood transfusion chain could benefit from modern technologies such as radio frequency identification (RFID). RFID could, for example, play an important role in generating logistic and temperature data of blood products, which are important in assessing the quality of the logistic process of blood transfusions and the product itself.ObjectiveThis study aimed to evaluate whether location, time stamp, and temperature data generated in real time by an active RFID system containing temperature sensors attached to red blood cell (RBC) products can be used to assess the compliance of the management of RBCs to 4 intrahospital European and Dutch guidelines prescribing logistic and temperature constraints in an academic hospital setting.MethodsAn RFID infrastructure supported the tracking and tracing of 243 tagged RBCs in a clinical setting inside the hospital at the blood transfusion laboratory, the operating room complex, and the intensive care unit within the Academic Medical Center, a large academic hospital in Amsterdam, the Netherlands. The compliance of the management of 182 out of the 243 tagged RBCs could be assessed on their adherence to the following guidelines on intrahospital storage, transport, and distribution: (1) RBCs must be preserved within an environment with a temperature between 2°C and 6°C; (2) RBCs have to be transfused within 1 hour after they have left a validated cooling system; (3) RBCs that have reached a temperature above 10°C must not be restored or must be transfused within 24 hours or else be destroyed; (4) unused RBCs are to be returned to the BTL within 24 hours after they left the transfusion laboratory.ResultsIn total, 4 blood products (4/182 compliant; 2.2%) complied to all applicable guidelines. Moreover, 15 blood products (15/182 not compliant to 1 out of several guidelines; 8.2%) were not compliant to one of the guidelines of either 2 or 3 relevant guidelines. Finally, 148 blood products (148/182 not compliant to 2 guidelines; 81.3%) were not compliant to 2 out of the 3 relevant guidelines.ConclusionsThe results point out the possibilities of using RFID technology to assess the quality of the blood transfusion chain itself inside a hospital setting in reference to intrahospital guidelines concerning the storage, transport, and distribution conditions of RBCs. This study shows the potentials of RFID in identifying potential bottlenecks in hospital organizations’ processes by use of objective data, which are to be tackled in process redesign efforts. The effect of these efforts can subsequently be evaluated by the use of RFID again. As such, RFID can play a significant role in optimization of the quality of the blood transfusion chain.
Practice Trends in the Treatment of Actinic Keratosis in the United States: 0.5% Fluorouracil and Combination Cryotherapy plus Fluorouracil are Underused despite Evidence of Benefit
Authors: Hagele Thomas J. , Levender Michelle M. , Davis Scott A. , Williford Phillip M. , Feldman Steven R. 
Published: October 2018

Background: Topical fluorouracil and cryotherapy are among the most commonly used treatments for actinic keratosis. Evidence shows that 0.5% fluorouracil has similar efficacy and is better tolerated than 5% fluorouracil. Evidence also shows that combination therapy with cryosurgery and fluorouracil is beneficial. Objective: To examine fluorouracil and cryotherapy use in the treatment of actinic keratosis. Methods: The National Ambulatory Medical Care Survey database was queried for visits for actinic keratosis. Visits were analyzed for patient demographics, provider specialty, and treatment regimens. Fluorouracil and cryotherapy use was analyzed over time. Results: Cryotherapy was the most commonly used treatment for actinic keratosis. Fluorouracil products were prescribed to 1.1 million patients (6.6%) between 2001 and 2008; of these, dermatologists prescribed 0.5% fluorouracil in 51.8% of cases and 5% fluorouracil in 38.9% of cases. Combination fluorouracil and cryotherapy was used for only 1.1% of actinic keratosis visits between 1993 and 2008 and was never used by nondermatologists. Conclusions: Despite evidence suggesting comparable efficacy, greater tolerability, and lower cost of 0.5% fluorouracil relative to 5% fluorouracil, 5% fluorouracil is used by dermatologists almost as often as 0.5% fluorouracil. Among nondermatologists, 5% fluorouracil is used exclusively. Combination therapy of fluorouracil and cryotherapy is underused despite evidence of its benefit.
Sweet Syndrome and Pemphigus Vulgaris
Authors: O'toole Ashley , O'malley Maureen 
Published: October 2018

Background: Pemphigus vulgaris is an autoimmune blistering disease of the skin and mucous membranes. Sweet syndrome is an uncommon reactive neutrophilic dermatosis. Objective: This case report describes the rare presentation of a 58-year-old female patient with newly diagnosed pemphigus vulgaris who later presented with erythematous plaques and leukocytosis highly suggestive of Sweet syndrome. Methods: Review of the literature using the PubMed and Medline databases. Results: The clinical presentation of new-onset Sweet syndrome in a patient with pemphigus has been reported in the literature only on one other occasion. Conclusion: The observation of an association between Sweet syndrome and autoimmune diseases, such as pemphigus vulgaris, may ultimately lead to better understanding of the pathophysiology of this disease.
A Suspected Squamous Cell Carcinoma in a Renal Transplant Recipient Revealing a Rare Cutaneous Phaeohyphomycosis by Alternaria infectoria
Authors: Tambasco Damiano , D'ettorre Marco , Bracaglia Roberto , Massi Guido , Posteraro Brunella , Torelli Riccardo , Simone Clara De , Capizzi Rodolfo 
Published: October 2018

Background: Squamous cell carcinoma of the skin is the most common neoplasm after organ transplantation. In addition, fungal infections are increasingly described in immunocompromised patients, such as kidney recipients. Method and Results: We report a case of a 64-year-old woman with a renal transplant presenting with 6-month-old skin lesions. In other centers, she had undergone previous biopsies, the results of which were suggestive of squamous cell carcinoma and aspecific inflammation. Therefore, she came to our center for surgical excision. Only our clinical experience and a detailed clinical history allowed us to doubt previous diagnoses and perform further examinations. Our investigation revealed an extremely rare fungus infection: phaeohyphomycosis by Alternaria infectoria. It was successfully treated with oral terbinafine until a complete regression of the lesions was achieved. At a 16-month follow-up visit, no recurrence of the skin lesion was observed. Conclusion: Despite a difficult diagnosis and rare occurrence, physicians and surgeons should be aware of infection with this emerging fungus in immunocompromised patients.
40-Year Trends in Skin Cancer in British Columbia, Canada, 1973 to 2003
Authors: Mclean David I. , Phillips Norm , Zhou Youwen , Gallagher Richard , Lee Tim K. 
Published: October 2018

Background: Skin cancer is common in North America. Incidence rate trends are potentially important in the assessment of the effects of measures to increase sun awareness in the population as well as measures to reduce sun damage. Objective: To determine the incidence of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and cutaneous malignant melanoma (CMM) in a geographically defined Canadian population over a 40-year period. Methods: Data were obtained from the BC Cancer Registry for the calendar years 1973, 1983, 1993, and 2003. Results: Age-standardized incidence rates increased significantly from 1973 to 2003 for BCC, SCC, and CMM. Limitations: The ethnic makeup of British Columbia has changed over time, and a novel method of accounting for the effect of this on skin cancer rates is presented. Conclusion: The incidence rate for skin cancers continued to rise in British Columbia, but there appears to have been a decline in the incidence of CMM and BCC in the youngest cohorts.
KIT Gene Mutations and Patterns of Protein Expression in Mucosal and Acral Melanoma
Authors: Abu-Abed Suzan , Pennell Nancy , Petrella Teresa , Wright Frances , Seth Arun , Hanna Wedad 
Published: October 2018

Background: Recently characterized KIT (CD117) gene mutations have revealed new pathways involved in melanoma pathogenesis. In particular, certain subtypes harbor mutations similar to those observed in gastrointestinal stromal tumors, which are sensitive to treatment with tyrosine kinase inhibitors. Objective: The purpose of this study was to characterize KIT gene mutations and patterns of protein expression in mucosal and acral melanoma. Methods: Formalin-fixed, paraffin-embedded tissues were retrieved from our archives. Histologic assessment included routine hematoxylin-eosin stains and immunohistochemical staining for KIT. Genomic DNA was used for polymerase chain reaction-based amplification of exons 11 and 13. Results: We identified 59 acral and mucosal melanoma cases, of which 78% showed variable levels of KIT expression. Sequencing of exons 11 and 13 was completed on all cases, and 4 (6.8%) mutant cases were isolated. Conclusion: We successfully optimized conditions for the detection of KIT mutations and showed that 8.6% of mucosal and 4.2% of acral melanoma cases at our institution harbor KIT mutations; all mutant cases showed strong, diffuse KIT protein expression. Our case series represents the first Canadian study to characterize KIT gene mutations and patterns of protein expression in acral and mucosal melanoma.
Teletriage for Provision of Dermatologic Care
Authors: Lester Jenna , Weinstock Martin A. 
Published: October 2018

Background: The scarcity of dermatologists has prompted the creation of innovative methods for delivering dermatologic care. Methods: Teletriage is a method used in teledermatology to efficiently assess skin complaints in patients who do not have prompt access to conventional dermatologic care. Their primary care clinicians are provided with management recommendations, reassured that the lesion of concern is benign, or recommended to send their patient for a face-to-face dermatology visit. The Providence VA Medical Center conducted a pilot program testing the utility of teletriage for patients with skin complaints from June 2011 to August 2011. Results: The pilot program revealed that with the teletriage protocol, face-to-face visits were reduced by 38%. This program suggests that teletriage could be a useful tool for providing efficient dermatologic care, and has led to broader implementation. Conclusion: Teletriage is a potentially useful approach for efficiently addressing specific dermatologic complaints and improving access to care for those complaints.
Systemic Corticosteroids Are Frequently Prescribed for Psoriasis
Authors: Al-Dabagh Amir , Al-Dabagh Rana , Davis Scott A. , Taheri Arash , Lin Hsien-Chang , Balkrishnan Rajesh , Feldman Steven R. 
Published: October 2018

Background: The use of systemic corticosteroids is discouraged in major psoriasis treatment guidelines. Purpose: Our objective was to assess how often systemic corticosteroids are prescribed for psoriasis and trends in their use over time. Methods: We used National Ambulatory Medical Care Survey (NAMCS) data to determine the systemic medications prescribed for psoriasis from 1989 to 2010. We confirmed the findings by analysis of 2003–2007 MarketScan Medicaid data. Results: Systemic corticosteroids were prescribed at 650,000 (95% CI 380,000–920,000) of 21,000,000 psoriasis visits; 93% of these visits were to dermatologists. Of the top nine systemic medications listed at psoriasis visits, three of them were corticosteroids. Corticosteroids were the second most commonly prescribed systemic medication for psoriasis. No significant change in the use of systemic corticosteroids for psoriasis over time was observed ( p = .27). In the MarketScan data, prednisone was prescribed more commonly than either methotrexate or etanercept. Limitations: Corticosteroid doses and the length of treatment were not recorded in the NAMCS data. Conclusions: Systemic corticosteroids are among the most common systemic treatments used for psoriasis despite current guidelines. Data are acutely needed on the risks and benefits so that physicians and patients can make evidence-based decisions about their use.
La funcionalidad, si existe, no deriva de un propósito. Una argumentación desde la biomorfodinámica y la evo-devo
Authors: De Renzi Miquel 
Published: October 2018

RESUMENLa noción de propósito es inherente a la finalidad (adaptación, función) si se toma ésta como causa principal de las estructuras orgánicas. Éstas surgen a través del desarrollo, que tiene una causalidad propia, sin propósito con respecto al organismo adulto. El desarrollo esta canalizado y sujeto a limitaciones (constraints); por ello, no se alcanzan óptimos adaptativos en general. Sobre tales posibilidades limitadas en variabilidad actúa la selección natural; la modularidad permite combinar selectivamente aspectos independientes, pero siempre dentro de limitaciones. Pueden surgir estructuras no funcionales que llegarán –o no– a constituir exaptaciones, que serán el paso previo a toda adaptación.PALABRAS-CLAVEADAPTACIONISMO, EXAPTACIÓN, CANALIZACIÓN, LIMITACIÓN DE DESARROLLO, MODULARIDADABSTRACTThe notion of design is inherent to finality (adaptation, function) if this last one is taken as the main cause of organic structures. Structures arise throughout development, which has its own causation, decoupled from the design referred to the adult organism. Development is canalized and subjected to constraints; because of this, adaptive optima are not generally reached. Natural selection works on these possibilities of constrained variability; modularity allows the selective combination for independent features, but always within a constrained framework. Nonfunctional structures are expected, which will arrive –or not– to give exaptations, the previous step to any adaptation.KEYWORDSADAPTATIONISM, EXAPTATION, CANALIZATION, DEVELOPMENTAL CONSTRAINTS, MODULARITY
El problema de la función en evo-devo
Authors: De la Rosa Laura N. 
Published: October 2018

RESUMENSi bien el problema de la forma ha sido el explanandum clásico de la evo-devo, frente al énfasis neodarwinista en la adaptación, en los últimos años un número creciente de autores ha reivindicado la incorporación del problema de la función en la perspectiva ontogenética de la evolución. Tras abordar los distintos modos en los que la evo-devo actual investiga la dimensión funcional de la evolución, defendemos que la distancia teórica entre la Síntesis Moderna y la ‘Síntesis Extendida’ no puede interpretarse en términos de la dialéctica Forma/Función. Al contrario: la ‘evo-devo funcional’ implica una radical reconceptuación de las funciones y plantea formas de síntesis alternativas con la teoría sintética.PALABRAS CLAVEEVO-DEVO, SÍNTESIS MODERNA, FORMA ORGÁNICA, FUNCIÓN BIOLÓGICAABSTRACTAlthough the problem of form has been the classical explanandum of evo-devo vs. the Darwinist emphasis on adaptation, in the last years the problem of function has joined evo-devo’s agenda. After examining the various ways in which contemporary evo-devo deals with the functional dimension of evolution, I will argue that the theoretical distance between the Modern Synthesis and evo-devo cannot be interpreted as a dialectics between Form and Function. On the contrary: the new ‘functional evo-devo’ implies a radical reconceptualisation of the concept of function and opens new ways of synthesis with the Modern Synthesis.KEYWORDSEVO-DEVO, MODERN SYNTHESIS, ORGANISMAL FORM, BIOLOGICAL FUNCTION
Huyendo de los extremos. Conciliación (Consilience) en la explicación del comportamiento violento humano
Authors: Sanmartín José 
Published: October 2018

RESUMENEn este artículo, a través del análisis de la conducta de sumisión característica de algunos tipos de víctimas de violencia, se muestra cómo, en el plano de la realidad hay interacciones ontológicas que, en el plano científico, deberían ser atendidas por interacciones epistémicas entre diversas teorías. Se sustenta de este modo una clase de consiliencia no basada en un micro-reduccionismo fuerte. Proceder de este modo, dilucidar esas interacciones ontológicas en el marco de interacciones teórico-científicas, no sólo es lo coherente desde un punto de vista metodológico: es también lo más fructífero si se tienen en cuenta los grandes desarrollos que han experimentado ciencias en nuestro tiempo cuyos nombres ya delatan su carácter consiliente. En este sentido, especial atención deberíamos prestar en el contexto del análisis de la conducta violenta a la neurociencia cognitiva como ámbito consiliente del saber que fomenta lacolaboración de investigadores de áreas tan dispares como la neurofisiología, la ecología del comportamiento, la informática, la genética, la psicología y la psiquiatría.PALABRAS CLAVECONSILIENCIA, REDUCCIONISMO SUBSTITUTIVO, REDUCCIONISMO COLABORATIVO, AMBIENTALISMO, BIOLOGISMOABSTRACTIn this paper, through the analysis of the submissive behavior characteristic of some types of violence, it shows how on the planes of reality there are ontological interactions which in scientific terms should be addressed by the epistemic interactions between various theories. It thus supports a class of consilience not based on a strong micro-reductionism. Clarifying these interactions within ontological theoretical scientific interactions is not only consistent from a methodological point of view: it is also the most fruitful if one takes into account the major developments experienced by modern sciences whose names reveal their consilient nature. We should therefore pay special attention to the context of the analysis of violent behavior and cognitive neuroscience as a consilient field of knowledge which fosters the collaboration of researchers from such diverse fields as neurophysiology, behavioral ecology, computer science, genetics, psychology and psychiatry.KEYWORDSCONSILIENCE, SUBSTITUTIVE REDUCTIONISM, COLLABORATIVE REDUCTIONISM, ENVIRONMENTALISM, BIOLOGISM
Sobre la posibilidad y necesidad de la Filosofía de la Naturaleza
Authors: Atencia José M. 
Published: October 2018

RESUMENEn este trabajo se analiza y se defiende la posibilidad de una Filosofía de la Naturaleza como disciplina distinta de la Filosofía de la Ciencia y de la Historia de la Ciencia. Para ello se discuten cuatro posiciones que han sido relevantes en este asunto: la positivista, la aristotélica, la bergsoniana y la kantiana.PALABRAS CLAVEFILOSOFÍA DE LA NATURALEZA, NATURALEZA, POSITIVISMO, ARISTÓTELES, KANT, BERGSONABSTRACTThis paper analyzes and defends the possibility of a Philosophy of Nature as a discipline independent of the Philosophy of Science and the History of Science. For this purpose, four relevant historical position about this topic are discussed: positivism, Aristotle’s, Bergson’s and Kant’s positions.KEYWORDSPHILOSOPHY OF NATURE, NATURE, POSITIVISM, ARISTOTLE, KANT, BERGSON
Hacia una educación liberal igualitaria y democrática
Authors: Vázquez Rodolfo 
Published: October 2018

El propósito de este trabajo es justificar un modelo liberal de educación entendido desde un punto de vista igualitario y democrático. Con este fin intentaré responder al siguiente par de preguntas: ¿qué relación existe entre igualdad de oportunidades y educación o, más específicamente, entre igualdad de oportunidades en el acceso y en el punto de partida, y educación? y ¿cómo debe concebirse la educación en el marco de un Estado democrático?
Eurípides: de la moral pensada a la moral vivida
Authors: Herreras Enrique 
Published: October 2018

ResumenLa tragedia griega sigue siendo un gran referente de reflexión filosófica. En este artículo nos centraremos en la figura de Eurípides, concretamente en el tema de los juicios morales que trasmiten sus obras trágicas. La cuestión es que si en Esquilo la razón triunfaba sobre el dilema trágico, en Eurípides no se ve claro ese triunfo si viene impuesto desde fuera y no ha arraigado en el corazón de los ciudadanos. La razón tiene muchas dificultades para ejercer su control sobre la acción y orientarla hacia el bien común. Eurípides planteará que es la persona, su conciencia interior, la que debe de estar convencida de que algo le obligue moralmente. El paso de una moral pensada a una moral vivida.Palabras claveRazón, pasión, conciencia interior, obligación moral, moral pensada, moral vividaAbstractThe Greek tragedy is still an important reference for philosophical reflection. In this article we will focus on the figure of Euripides, specifically on the issue of moral judgments his tragic plays transmit. The issue is that if in Aeschylus reason prevailed over the tragic dilemma, in Euripides it is not clear if that triumph is imposed from outside and has not rooted in the heart of the citizens. Reason faces much difficulty to exercise its control over action and go for the common good. Euripides proposes that it is the person, their inner consciousness, which must be convinced that something should oblige them morally. It’s the passage from a thought morality to a lived morality.KeywordsReason, passion, inner consciousness, moral obligation, thought morality, lived morality