bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality of Life, Depression, and Anxiety in Ventricular Assist Device Therapy
Authors: Bidwell Julie T. , Lyons Karen S. , Mudd James O. , Gelow Jill M. , Chien Christopher V. , Hiatt Shirin O. , Grady Kathleen L. , Lee Christopher S. 
Published: November 2016

Background:
Patients who receive ventricular assist device (VAD) therapy typically rely on informal caregivers (family members or friends) to assist them in managing their device.

Objective:
The purpose of this study is to characterize changes in person-oriented outcomes (quality of life [QOL], depression, and anxiety) for VAD patients and their caregivers together from pre-implantation to 3 months post-implantation.

Methods:
This was a formal interim analysis from an ongoing prospective study of VAD patients and caregivers (n = 41 dyads). Data on person-oriented outcomes (QOL: EuroQol 5 Dimensions Visual Analog Scale; depression: Patient Health Questionnaire-8; anxiety: Brief Symptom Inventory) were collected at 3 time points (just prior to implantation and at 1 and 3 months post-implantation). Trajectories of change for patients and caregivers on each measure were estimated using latent growth modeling with parallel processes.

Results:
Patients’ QOL improved significantly over time, whereas caregiver QOL worsened. Depression and anxiety also improved significantly among patients but did not change among caregivers. There was substantial variability in change on all outcomes for both patients and their caregivers.

Conclusions:
This is the first quantitative study of VAD patient-caregiver dyads in modern devices that describes change in person-oriented outcomes from pre-implantation to post-implantation. This work supports the need for future studies that account for the inherent relationships between patient and caregiver outcomes and examine variability in patient and caregiver responses to VAD therapy.
Provider, Patient, and Practice Factors Shape Hepatitis B Prevention and Management by Primary Care Providers
Authors: Mukhtar Nizar A. , Kathpalia Priya , Hilton Joan F. , Lau Gene , Yu Albert , Grumbach Kevin , Nguyen Tung T. , Chan Daniel , Khalili Mandana 
Published: November 2016

Goals:
To evaluate provider knowledge, attitudes and barriers to hepatitis B virus (HBV) care and management practices across diverse primary care settings.

Background:
Factors influencing adherence to recommended HBV screening and management guidelines are poorly defined.

Materials and Methods:
Providers across various health care settings in San Francisco were surveyed. Multivariate analyses were used to identify factors associated with recommended HBV screening, vaccination, and disease monitoring.

Results:
Of 277 (41.3%) responding providers, 42% reported performing HBV screening in >50% of at-risk patients, and 49%, HBV vaccination in >50% of eligible patients. Most reported appropriate monitoring of a majority of HBV-infected patients with alanine aminotransferase (79%) and HBV viral load (67%) every 6 to 12 months, but performed any hepatocellular carcinoma screening in 49%. Provider factors significantly associated with HBV screening were speaking an Asian language [odds ratio (OR), 3.27], offering HBV treatment (OR, 3.00), having >25% of Asian patients in practice (OR, 2.10), practicing in safety net settings (OR, 7.51) and having higher barrier score (OR, 0.74). Appropriate HBV monitoring was associated with provider speaking an Asian language (OR, 3.43) and provider age (OR, 0.68/decade). Hepatocellular carcinoma screening was associated with having >25% of patients speaking English as a second language (OR, 4.26) and practicing in safety net settings (OR, 0.14).

Conclusions:
Rates of adherence to HBV guidelines were suboptimal irrespective of practice setting and were influenced by certain provider, patient and practice factors. This study reinforces the importance of engaging primary care providers in development, dissemination, and implementation of evidence-based HBV practice guidelines.
The Impact of Chronic Health Conditions on Length of Stay and Mortality in a General PICU*
Authors: O’Brien Scott , Nadel Simon , Almossawi Ofran , Inwald David P. 
Published: November 2016

Objectives:
Each year approximately 20,000 children are admitted to PICUs across the United Kingdom. It is highlighted in several international studies that 40–70% of children admitted to PICUs have at least one chronic health condition that leads to increased length of stay and higher mortality rates. The prevalence of chronic health conditions in children admitted to U.K. PICUs is unknown. The purpose of this study was to use existing clinical data to explore the prevalence and impact of chronic health conditions on length of stay and mortality in a tertiary U.K. PICU.

Design:
Single-centre retrospective observational cohort study.

Setting:
Single, tertiary referral PICU.

Patients:
One thousand one hundred ninety-seven children 0–18 years old admitted between March 1, 2009, and February 28, 2013.

Interventions:
None.

Measurements and Main Results:
Data were derived from the unit’s data submitted to the Paediatric Intensive Care Audit Network, the U.K. national PICU dataset. Data included demographics, diagnosis, Pediatric Index of Mortality-2 score, PICU interventions, PICU outcomes, chronic health condition etiologies, admission, and discharge dates and times. In total, 554 of 1,197 (46.3%) had at least one chronic health condition. Of 554, 371 patients (67.1%) presented with a single chronic health condition, 126 (22.6%) with two chronic health conditions, and 57 (10.3%) with at least three chronic health conditions to a maximum of four chronic health conditions. There was a statistically significant difference in length of stay in those with a chronic health condition compared with those without (medians, 4 vs 3 d [interquartile range, 1–7 d]; Mann-Whitney U test, p < 0.001). The length of stay also increased significantly according to the number of chronic health conditions (Kruskal-Wallis test, p < 0.001). Mortality was significantly different between those with and without chronic health conditions (8.8% vs 5.4%; chi-square test, p = 0.024). Having two or at least three chronic health conditions significantly increased mortality compared with no chronic health conditions (odds ratio, 2.3 [CI, 1.2–4.55]; p = 0.013 and 2.95 [CI, 1.28–6.8]; p = 0.011), respectively.

Conclusions:
The increasing number of chronic healthcare conditions is associated with length of stay and mortality.
Clinical Examination Does Not Predict Response to Albuterol in Ventilated Infants With Bronchiolitis
Authors: Schramm Craig M. , Sala Kathleen A. , Carroll Christopher L. 
Published: November 2016

Objective:
Bronchiolitis is a common respiratory infection in infants that is sometimes treated with albuterol. Response to albuterol is determined by clinical assessment, but this subjective determination is potentially unreliable. In this study, we compared providers’ clinical assessment of response to albuterol with the measurement of response by pulmonary mechanics in intubated, sedated, and ventilated infants.

Design:
Before and 20 minutes following racemic albuterol therapy, a nurse, respiratory therapist, and physician performed simultaneous examinations and assessed response to albuterol in a population of intubated infants with bronchiolitis. Measurements of ventilator-derived pulmonary mechanics were obtained at these same times.

Setting:
This study was conducted in a PICU of a children’s hospital.

Patients:
Seventy-five paired clinical assessments were made in 25 infants who were intubated and mechanically ventilated for severe bronchiolitis.

Interventions:
Pulmonary function measurements and clinical assessments before and after administration of albuterol.

Measurements and Main Results:
Response to albuterol was defined using a threshold of improvement in respiratory system resistance from baseline. Nine children (36%) had greater than 20% change and were deemed responders. Providers’ discrimination of response was poor. The positive predictive values of nurses, respiratory therapists, and physicians were 38%, 25%, and 25%, respectively, and the negative predictive values were 67%, 54%, and 59%, respectively. Overall accuracy was 44% for nurses, 40% for respiratory therapists, and 48% for physicians. When comparing separate assessments of wheezing, aeration, and expiratory time, there was poor agreement between groups of providers in all variables (κ < 0.4 for each).

Conclusions:
A provider’s clinical assessment was not a reliable method for determining response to albuterol in children with bronchiolitis. Without assessment of pulmonary mechanics, caution should be used in classifying children with bronchiolitis as responders to albuterol.
System Issues Leading to “Found-on-Floor” Incidents: A Multi-Incident Analysis
Authors: Shaw James , Bastawrous Marina , Burns Susan , McKay Sandra 
Published: November 2016

Background
Although attention to patient safety issues in the home care setting is growing, few studies have highlighted health system–level concerns that contribute to patient safety incidents in the home. Found-on-floor (FOF) incidents are a key patient safety issue that is unique to the home care setting and highlights a number of opportunities for system-level improvements to drive enhanced patient safety.

Methods
We completed a multi-incident analysis of FOF incidents documented in the electronic record system of a home health care agency in Toronto, Canada, for the course of 1 year between January 2012 and February 2013.

Results
Length of stay (LOS) was identified as the cross-cutting theme, illustrating the following 3 key issues: (1) in the short LOS group, a lack of information continuity led to missed fall risk information by home care professionals; (2) in the medium LOS group, a lack of personal support worker/carer training in fall prevention led to inadequate fall prevention activity; and (3) in the long LOS group, a lack of accountability policy at a system level led to a lack of fall risk assessment follow-up.

Conclusions
Our study suggests that considering LOS in the home care sector helps expose key system-level issues enabling safety incidents such as FOF to occur. Our multi-incident analysis identified a number of opportunities for system-level changes that might improve fall prevention practice and reduce the likelihood of FOF incidents in the home. Specifically, investment in electronic health records that are functional across the continuum of care, further research and understanding of the training and skills of personal support workers, and enhanced incentives or more punitive approaches (depending on the circumstances) to ensure accountability in home safety will strengthen the home care sector and help prevent FOF incidents among older people.
The Effects of the Second Victim Phenomenon on Work-Related Outcomes: Connecting Self-Reported Caregiver Distress to Turnover Intentions and Absenteeism
Authors: Burlison Jonathan D. , Quillivan Rebecca R. , Scott Susan D. , Johnson Sherry , Hoffman James M. 
Published: November 2016

Objectives
Second victim experiences can affect the well-being of healthcare providers and compromise patient safety. The purpose of this study was to assess the relationships between self-reported second victim–related distress to turnover intention and absenteeism. Organizational support was examined concurrently because it was hypothesized to explain the potential relationships between distress and work-related outcomes.

Methods
A cross-sectional, self-report survey (the Second Victim Experience and Support Tool) of nurses directly involved in patient care (N = 155) was analyzed by using hierarchical linear regression. The tool assesses organizational support, distress due to patient safety event involvement, and work-related outcomes.

Results
Second victim distress was significantly associated with turnover intentions (P < 0.001) and absenteeism (P < 0.001), while controlling for the effects of demographic variables. Organizational support fully mediated the distress–turnover intentions (P < 0.05) and distress-absenteeism (P < 0.05) relationships, which indicates that perceptions of organizational support may explain turnover intentions and absenteeism related to the second victim experience.

Conclusions
Involvement in patient safety events and the important role of organizational support in limiting caregiver event–related trauma have been acknowledged. This study is one of the first to connect second victim distress to work-related outcomes. This study reinforces the efforts health care organizations are making to develop resources to support their staff after patient safety events occur. This study broadens the understanding of the negative effects of a second victim experience and the need to support caregivers as they recover from adverse event involvement.
Objective Assessment of Checklist Fidelity Using Digital Audio Recording and a Standardized Scoring System Audit
Authors: Salgado Douglas , Barber Kimberly R. , Danic Michael 
Published: November 2016

Objectives
The use of the World Health Organization Surgical Safety Checklist (SSC) has been reported to significantly reduce operative morbidity and mortality rates. Recent findings have cast doubt on the efficacy of such checklists in improving patient safety. The effectiveness of surgical safety checklists cannot be fully measured or understood without an accurate assessment of implementation fidelity, most effectively through direct observations of the checklist process. Here, we describe the use of a secure audio recording protocol in conjunction with a novel standardized scoring system to assess checklist compliance rates.

Methods
We used a black box digital audio recording protocol to observe the execution of SSCs in real time. A novel checklist scoring system was used to quantify the implementation fidelity of a modified version of the SSC. Physician and staff perception of patient safety was also surveyed before and after implementation.

Results
Audio-recorded audits revealed a precisely executed checklist 73.6% of the time compared with a previously reported compliance rate of 97.6%. Implementation fidelity was highest during preanesthesia and preincision checklist sections, whereas postprocedure checklist compliance and fidelity was consistently the lowest. Positive attitudes on patient safety by surgical staff increased by 11% from baseline.

Conclusions
The use of a secure digital audio recording protocol is a simple yet effective tool for observing checklist performance. Moreover, the implementation of a standardized scoring system allows for the objective evaluation of checklist fidelity. Together, they provide a powerful auditing tool for identifying improvement.
Physician Perspectives on Interhospital Transfers
Authors: Mueller Stephanie K. , Schnipper Jeffrey L. 
Published: November 2016

Objective
The transfer of patients between acute care hospitals (interhospital transfer [IHT]) is a common but nonstandardized process leading to variable quality and safety. The goal of this study was to survey accepting physicians regarding problems encountered in the transfer process.

Methods
A cross-sectional survey of residents and inpatient attendings from internal medicine, neurology, and surgery services at a large tertiary care referral hospital was undertaken to identify problematic aspects of the IHT process as perceived by accepting frontline providers. The frequency that specific scenarios were encountered in caring for transferred patients and whether these processes impacted patient safety were determined using 5- and 3-point Likert scales, respectively. The frequency of responses to each question were measured using proportions.

Results
Approximately 51% of the 284 physicians surveyed responded. Pertinent findings included the following: physician subject surveys found that transferred patients sometimes, frequently, or always arrived without requiring specialized care in 56% of responses, arrived with unrealistic expectations of care in 77.2% of responses, arrived more than 24 hours after accepted for transfer in 80.1% of responses, and arrived without necessary transfer records in 86.9% of responses. Most respondents felt that lack of availability of transfer records and the time of day of arrival frequently posed a risk to transferred patients (57.2% and 53.1%, respectively). Response variation was noted between resident and attending physician respondents.

Conclusions
Expectations of care, delays and timing of transfer, and information exchange at time of transfer were identified as all too common problems in IHT, which creates a risk for patient safety. These areas are important targets for investigation and the development of interventions to improve patient safety.
Individual differences in functional connectivity during naturalistic viewing conditions
Authors: Vanderwal Tamara , Eilbott Jeffrey , Finn Emily S. , Craddock R. Cameron , Turnbull Adam , Castellanos F. Xavier 
Published: November 2016

AbstractNaturalistic viewing paradigms such as movies have been shown to reduce participant head motion and improve arousal during fMRI scanning relative to task-free rest, and have been used to study both functional connectivity and task-evoked BOLD-signal changes. These task-evoked changes result in cortical activity that is synchronized across subjects and involves large areas of the cortex, and it is unclear whether individual differences in functional connectivity are enhanced or diminished under such naturalistic conditions. This work first aims to characterize variability in functional connectivity (FC) across two distinct movie conditions and eyes-open rest (n=34 healthy adults, 2 scan sessions each). At the whole-brain level, we found that movies have higher intra- and inter-subject correlations in cluster-wise FC relative to rest. The anatomical distribution of inter-subject variability was similar across conditions, with higher variability occurring at the lateral prefrontal lobes and temporoparietal junctions. Second, we used an unsupervised test-retest matching (or “finger-printin”) algorithm that identifies individual subjects from within a group based on functional connectivity patterns, quantifying the accuracy of the algorithm across the three conditions. We also evaluated the impact of parcellation resolution, scan duration, and number of edges on observed inter-individual differences. The movies and resting state all enabled identification of individual subjects based on FC matrices, with accuracies between 62 and 100%. Overall, pairings involving movies outperformed rest, and the more social and faster-paced movie attained 100% accuracy. When the parcellation resolution, scan duration and number of edges used were increased, accuracies improved across conditions, and the pattern of movies>rest was preserved. These results suggest that using dynamic stimuli such as movies enhances the detection of FC patterns that are distinct at the individual level.HighlightsIntra- and inter-subject FC correlations are compared across rest and movies.Movies outperformed rest in an unsupervised identification algorithm based on FC.Movies outperform rest regardless of parcellation, scan length, or number of edges.Watching movies enhances the detection of individual differences in FC.
Networks of VTA neurons encode real-time information about uncertain numbers of actions executed to earn a reward
Authors: Wood Jesse , Simon Nicholas W. , Koerner Spencer , Kass Robert E. , Moghaddam Bita 
Published: November 2016

ABSTRACTMultiple and unpredictable numbers of actions are often required to achieve a goal. In order to organize behavior and allocate effort so that optimal behavioral policies can be selected, it is necessary to continually monitor ongoing actions. Real-time processing of information related to actions and outcomes is typically assigned to the prefrontal cortex and basal ganglia, but also depends on midbrain regions, especially the ventral tegmental area (VTA). We were interested in how individual VTA neurons, as well as networks within the VTA, encode salient events when an unpredictable number of serial actions are required to obtain a reward. We recorded from ensembles of putative dopamine and non-dopamine neurons in the VTA as animals performed multiple cued trials in a recording session where, in each trial, serial actions were randomly rewarded. While averaging population activity did not reveal a response pattern, we observed that different neurons selectively tuned to low, medium, or high numbered actions in a trial. This preferential tuning of putative dopamine and non-dopamine VTA neurons to different subsets of actions in a trial allowed information about binned action number to be decoded from the ensemble activity. At the network level, tuning curve similarity was positively associated with action-evoked noise correlations, suggesting that action number selectivity reflects functional connectivity within these networks. Analysis of phasic responses to cue and reward revealed that the requirement to execute multiple and uncertain numbers of actions weakens both cue-evoked responses and cue-reward response correlation. The functional connectivity and ensemble coding scheme that we observe here may allow VTA neurons to cooperatively provide a real-time account of ongoing behavior. These computations may be critical to cognitive and motivational functions that have long been associated with VTA dopamine neurons.
Multispot single-molecule FRET: high-throughput analysis of freely diffusing molecules
Authors: Ingargiola A. , Lerner E. , Chung S. , Panzeri F. , Gulinatti A. , Rech I. , Ghioni M. , Weiss S. , Michalet X. 
Published: November 2016

AbstractWe describe an 8-spot confocal setup for high-throughput smFRET assays and illustrate its performance with two characteristic experiments. First, measurements on a series of freely diffusing doubly-labeled dsDNA samples allow us to demonstrate that data acquired in multiple spots in parallel can be properly corrected and result in measured sample characteristics identical to those obtained with a standard single-spot setup. We then take advantage of the higher throughput provided by parallel acquisition to address an outstanding question about the kinetics of the initial steps of bacterial RNA transcription. Our real-time kinetic analysis of promoter escape by bacterial RNA polymerase confirms results obtained by a more indirect route, shedding additional light on the initial steps of transcription.Finally, we discuss the advantages of our multispot setup, while pointing potential limitations of the current single laser excitation design, as well as analysis challenges and their solutions.
The HTM Spatial Pooler – a neocortical algorithm for online sparse distributed coding
Authors: Cui Yuwei , Ahmad Subutai , Hawkins Jeff 
Published: November 2016

1.AbstractHierarchical temporal memory (HTM) provides a theoretical framework that models several key computational principles of the neocortex. In this paper we analyze an important component of HTM, the HTM spatial pooler (SP). The SP models how neurons learn feedforward connections and form efficient representations of the input. It converts arbitrary binary input patterns into sparse distributed representations (SDRs) using a combination of competitive Hebbian learning rules and homeostatic excitability control. We describe a number of key properties of the spatial pooler, including fast adaptation to changing input statistics, improved noise robustness through learning, efficient use of cells and robustness to cell death. In order to quantify these properties we develop a set of metrics that can be directly computed from the spatial pooler outputs. We show how the properties are met using these metrics and targeted artificial simulations. We then demonstrate the value of the spatial pooler in a complete end-to-end real-world HTM system. We discuss the relationship with neuroscience and previous studies of sparse coding. The HTM spatial pooler represents a neurally inspired algorithm for learning sparse representations from noisy data streams in an online fashion.