bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lower Extremity Limb Salvage: Lessons Learned From 14 Years at War
Authors: Blair James A. , Eisenstein Emmanuel D. , Pierrie Sarah N. , Gordon Wade , Owens Johnny G. , Hsu Joseph R. 
Published: September 2016

Summary:
American survivability during the current conflicts in Iraq and Afghanistan continues to improve, though the rate of extremity injury remains quite high. The decision to proceed with amputation versus limb salvage remains controversial. Exposure to combat wound with severe high-energy lower extremity trauma during the previous 14 years at war has incited important advances in limb salvage technique and rehabilitation.
Point Prevalence Study of Mobilization Practices for Acute Respiratory Failure Patients in the United States
Authors: Jolley Sarah Elizabeth , Moss Marc , Needham Dale M. , Caldwell Ellen , Morris Peter E. , Miller Russell R. , Ringwood Nancy , Anders Megan , Koo Karen K. , Gundel Stephanie E. , Parry Selina M. , Hough Catherine L. 
Published: September 2016

Objective:
Early mobility in mechanically ventilated patients is safe, feasible, and may improve functional outcomes. We sought to determine the prevalence and character of mobility for ICU patients with acute respiratory failure in U.S. ICUs.

Design:
Two-day cross-sectional point prevalence study.

Setting:
Forty-two ICUs across 17 Acute Respiratory Distress Syndrome Network hospitals.

Patients:
Adult patients (≥ 18 yr old) with acute respiratory failure requiring mechanical ventilation.

Interventions:
We defined therapist-provided mobility as the proportion of patient-days with any physical or occupational therapy–provided mobility event. Hierarchical regression models were used to identify predictors of out-of-bed mobility.

Measurements and Main Results:
Hospitals contributed 770 patient-days of data. Patients received mechanical ventilation on 73% of the patient-days mostly (n = 432; 56%) ventilated via an endotracheal tube. The prevalence of physical therapy/occupational therapy–provided mobility was 32% (247/770), with a significantly higher proportion of nonmechanically ventilated patients receiving physical therapy/occupational therapy (48% vs 26%; p ≤ 0.001). Patients on mechanical ventilation achieved out-of-bed mobility on 16% (n = 90) of the total patient-days. Physical therapy/occupational therapy involvement in mobility events was strongly associated with progression to out-of-bed mobility (odds ratio, 29.1; CI, 15.1–56.3; p ≤ 0.001). Presence of an endotracheal tube and delirium were negatively associated with out-of-bed mobility.

Conclusions:
In a cohort of hospitals caring for acute respiratory failure patients, physical therapy/occupational therapy–provided mobility was infrequent. Physical therapy/occupational therapy involvement in mobility was strongly predictive of achieving greater mobility levels in patients with respiratory failure. Mechanical ventilation via an endotracheal tube and delirium are important predictors of mobility progression.
ASDS Cosmetic Dermatologic Surgery Fellowship Milestones
Authors: Waldman Abigail , Arndt Kenneth A. , Avram Mathew M. , Brown Mariah R. , Dover Jeffrey S. , Fabi Sabrina G. , Friedmann Daniel P. , Geronemus Roy G. , Goldberg David J. , Goldman Mitchel P. , Green Jeremy B. , Ibrahimi Omar A. , Jones Derek H. , Kilmer Suzanne L. , McDaniel David H. , Obagi Suzan , Ortiz Arisa E. , Rohrer Thomas E. , Taylor Mark B. , Torres Abel , Weinkle Susan H. , Weiss Margaret A. , Weiss Eduardo T. , Weiss Robert A. , Poon Emily , Alam Murad 
Published: September 2016

BACKGROUND
The American Council of Graduate Medical Education, which oversees much of postgraduate medical education in the United States, has championed the concept of “milestones,” standard levels of achievement keyed to particular time points, to assess trainee performance during residency.

OBJECTIVE
To develop a milestones document for the American Society for Dermatologic Surgery (ASDS) Cosmetic Dermatologic Surgery (CDS) fellowship program.

METHODS
An ad hoc milestone drafting committee was convened that included members of the ASDS Accreditation Work Group and program directors of ASDS-approved Cosmetic Dermatologic Surgery (CDC) fellowship training programs. Draft milestones were circulated through email in multiple rounds until consensus was achieved.

RESULTS
Thirteen milestones were developed in the 6 Accreditation Council for Graduate Medical Education (ACGME) competency areas, with 8 of these being patient-care milestones. Additional instructions for milestone administration more specific to the CDS fellowship than general ACGME instructions were also approved. Implementation of semiannual milestones was scheduled for the fellowship class entering in July 2018.

CONCLUSION
Milestones are now available for CDS fellowship directors to implement in combination with other tools for fellow evaluation.
SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY VALIDATES LAMINA CRIBROSA ANOMALY IN OPTIC DISK PIT
Authors: Sambhav Kumar , Grover Sandeep , Chalam K. V. 
Published: September 2016

Purpose:
Swept Source Optical Coherence Tomography validates lamina cribrosa anomaly in optic disk pit.

Method:
Observational case report.

Results:
A 25-year-old African American male presented with decreased vision in right eye of 4 days duration. Best corrected visual acuity (BCVA) for distance in right eye was 20/200 and in left eye was 20/20. Dilated fundus examination of right eye showed serous macular detachment of entire posterior pole along with an optic pit on temporal margin of optic disk. En—face image of the optic disk on Swept source OCT (SS-OCT) confirmed defect in the lamina cribrosa in the right eye.

Conclusion:
Congenital optic disk pit a birth defect in lamina cribrosa is a rare, visually impairing disorder. Spectral domain optical coherence tomography (SD-OCT) scan showed neurosensory detachment, however, lamina cribrosa defects are not delineated with it. SS-OCT a recent advance in scanning technology allows superior resolution of optic disk and confirms the anomaly of lamina cribrosa.
Posttraumatic Stress and Physical Health Functioning
Authors: Luciano Matthew T. , McDevitt-Murphy Meghan E. 
Published: September 2016

Abstract
Research indicates that posttraumatic stress disorder (PTSD) is strongly associated with physical health difficulties, and that social support may be protective for both problems. Social support, however, is often broadly conceptualized. The present analysis explores how Veteran-specific social support (during military deployment and postdeployment) may moderate the relationship between PTSD and physical health functioning. Participants were recruited from a VA Medical Center. Self-report data were analyzed from 63 Veterans (17.46% female; 42.86% white) who had been deployed in support of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND). Data indicate that military deployment social support moderated the relationship between PTSD and pain (β = 0.02, p = 0.02) whereas postdeployment social support moderated the relationship between PTSD and general health perceptions (β = 0.03, p = 0.01). These findings may be used to better understand the role of support in influencing psychological and physiological processes.
Hematocrit Levels, Blood Testing, and Blood Transfusion in Infants After Heart Surgery*
Authors: Delgado-Corcoran Claudia , Wolpert Katherine H. , Lucas Kathryn , Bodily Stephanie , Presson Angela P. , Bratton Susan L. 
Published: September 2016

Objective:To determine whether judicious blood testing impacts timing or amount of packed RBC transfusions in infants after heart surgery.Design:A retrospective study comparing before and after initiation of a quality improvement process.Setting:A university-affiliated cardiac ICU at a tertiary care children’s hospital.Patients:Infants less than 1 year old with Risk Adjustment for Congenital Heart Surgery category 4, 5, 6, or d-transposition of great arteries (Risk Adjustment for Congenital Heart Surgery 3) consecutively treated during 2010 through 2013.Intervention:A quality improvement process implemented in 2011 to decrease routine laboratory testing after surgery.Measurements and Main Results:Fifty-two infants preintervention and 214 postintervention had similar age, weight, proportion of cyanotic lesions, and surgical complexity. Infants with single versus biventricular physiology were compared separately. The number of laboratory tests per patient adjusted for cardiac ICU length of stay (laboratory tests/patient/day) was significantly lower in postintervention populations for single and biventricular groups (9 vs 15 and 10 vs 15, respectively;p< 0.001). The proportion of single ventricle patients transfused post- and preintervention was not statistically different (72% vs 90%;p= 0.130). Transfusion in the biventricular groups was the same over time (65% vs 65%). Time to first transfusion was significantly longer in the postintervention single ventricle group (4 vs 1 d;p< 0.001), and was not statistically different in the biventricular patients (4 vs 7 d;p= 0.058). The median hematocrit level at first transfusion was significantly lower (37% vs 40%;p= 0.004) postintervention in the cyanotic population, but did not differ in the biventricular group (31% vs 31%;p= 0.840).Conclusion:In infants after heart surgery, blood testing targeted to individual needs significantly decreased the number of blood tests, but did not significantly decrease postoperative blood transfusion.
The Influence of Position on Leg Movements and Kicks in Older Infants With Spina Bifida
Authors: Chapman David 
Published: September 2016

Purpose:
The purpose of this study was to describe the frequency with which infants with lumbar or sacral spina bifida (SB) move their legs or kick when they are 7 months and older while in the supine position, seated in a conventional infant seat (CS), and seated in a specially designed infant seat (SDIS).

Methods:
The spontaneous leg movements of 9 infants with lumbar or sacral SB were videotaped once per month for 4 months in each position.

Results:
Infants generated significantly more leg movements when seated in the SDIS than in the CS and significantly more kicks in the SDIS than in the other 2 positions.

Conclusions:
The movement context influences the ability of older infants with SB to move their legs and to kick.
Effect of Playground Environments on the Physical Activity of Children With Ambulatory Cerebral Palsy
Authors: Pratt Brenda , Hartshorne Nancy S. , Mullens Pam , Schilling Mary Lou , Fuller Sarah , Pisani Emily 
Published: September 2016

Purpose:
To compare the effect of 2 different playground environments on the physical activity of children with ambulatory cerebral palsy during their playground play.

Methods:
Five 7- to 8-year-old children with cerebral palsy (Gross Motor Functional Classification System [GMFCS] level II) participated. Using an alternating treatment, single-subject design, stride patterns were obtained using an activity monitor on an Americans with Disabilities Act (ADA)-compliant and noncompliant playground. Visual and statistical analysis of the stride data was used to analyze the effect of the playground environments.

Results:
Four of the 5 participants increased the number of strides on an ADA-compliant playground.

Conclusion:
Children with cerebral palsy (GMFCS II) may benefit from an ADA-compliant playground to increase their physical activity.
A 10-Year Review of Surgical Management of Complicated Peptic Ulcer Disease From a Single Center: Is Laparoscopic Approach the Future?
Authors: Agaba Emmanuel A. , Klair Tarunjeet , Ikedilo Ojinika , Vemulapalli Prathiba 
Published: September 2016

Introduction:
The discovery of Helicobacter pylori (H. pylori) as the culprit in peptic ulcer disease (PUD) has revolutionized its management. Despite the presence of effective drug treatments and an increased understanding of its etiology, the percentage of patients who require emergent surgery for complicated disease remains constant at 7% of hospitalized patients. This study aims at reviewing the incidence of complicated PUD and analyze changes in surgical management.

Patients and Methods:
From January 2002 to September 2012, records of all patients with a clinical or radiologic diagnosis of perforated PUD were evaluated. Short-term and long-term results were assessed with regard to type of surgical intervention. The primary end point was adverse events. Other end points were length of hospital stay, complications, and deaths.

Results:
Included were 400 patients with a median age of 56 years (range, 17 to 89 y). Of these, males made up 70% (n=280), were older and had more comorbidities. Majority of perforations were located in the prepyloric region (80%) and duodenal bulb (20%). Nonsteroidal anti-inflammatory drug alone was involved in 50% of cases and in combination with H. pylori in 84%. H. pylori alone occurred in 40% of cases.
Laparoscopic treatment was performed in 48 patients (12%) who remained hemodynamically stable. In the remaining 88% of patients, open approach was used. Simple closure with omentoplasty was performed in 98% and in 2%; definitive anti ulcer procedure was performed. Major complications occurred in 6% with an overall 30-day mortality rate of 2%. Most postoperative morbidity occurred after open approach. One patient who had laparoscopic repair died of other causes unrelated to the gastroduodenal perforation. Among the laparoscopic group, mean hospital stay was 4 days (range, 3 to 7 d), compared with 6 days (5 to 14 d) after open approach.

Conclusions:
Although the incidence of PUD is decreasing, it appears that among our patients, the incidence of complication is rising. Laparoscopic approach offers an alternative treatment with less pain, shorter hospital stay, and improved complications rate.
Fast genome-wide functional annotation through orthology assignment by eggNOG-mapper
Authors: Huerta-Cepas Jaime , Forslund Kristoffer , Szklarczyk Damian , Jensen Lars Juhl , von Mering Christian , Bork Peer 
Published: September 2016

AbstractOrthology assignment is ideally suited for functional inference. However, because predicting orthology is computationally intensive at large scale, and most pipelines relatively in accessible, less precise homology-based functional transfer is still the default for (meta-)genome annotation. We therefore developed eggNOG-mapper, a tool for functional annotation of large sets of sequences based on fast orthology assignments using precomputed clusters and phylogenies from eggNOG. To validate our method, we benchmarked Gene Ontology predictions against two widely used homology-based approaches: BLAST and InterProScan. Compared to BLAST, eggNOG-mapper reduced by 7% the rate of false positive assignments, and increased by 19% the ratio of curated terms recovered over all terms assigned per protein. Compared to InterProScan, eggNOG-mapper achieved similar proteome coverage and precision, while predicting on average 32 more terms per protein and increasing by 26% the rate of curated terms recovered over total term assignments per protein. Through strict orthology assignments, eggNOG-mapper further renders more specific annotations than possible from domain similarity only (e.g. predicting gene family names). eggNOG-mapper runs ~15x than BLAST and at least 2.5x faster than InterProScan. The tool is available standalone or as an online service athttp://eggnog-mapper.embl.de.
Dynamic forecasting of Zika epidemics using Google Trends
Authors: Teng Yue , Bi Dehua , Xie Guigang , Xie Guigang , Jin Yuan , Lin Baihan , Feng Dan 
Published: September 2016

AbstractWe developed a dynamic forecasting model for Zika virus (ZIKV), based on real-time online search data from Google Trends (GTs). It was designed to provide Zika virus disease (ZVD) surveillance for Health Departments with early warning, and predictions of numbers of infection cases, which would allow them sufficient time to implement interventions. We used correlation data from ZIKV epidemics and Zika-related online search in GTs between 12 February and 25 August 2016 to construct an autoregressive integrated moving average (ARIMA) model (0, 1, 3) for the dynamic estimation of ZIKV outbreaks. The online search data acted as an external regressor in the forecasting model, and was used with the historical ZVD epidemic data to improve the quality of the predictions of disease outbreaks. Our results showed a strong correlation between Zika-related GTs and the cumulative numbers of reported cases, both confirmed and suspected (bothp<0.001; Pearson Product-Moment Correlation analysis). The predictive cumulative numbers of confirmed and suspected cases increased steadily to reach 148,510 (95% CI: 126,826-170,195) and 602,721 (95% CI: 582,753-622,689), respectively, in 21 October 2016. Integer-valued autoregression provides a useful base predictive model for ZVD cases. This is enhanced by the incorporation of GTs data, confirming the prognostic utility of search query based surveillance. This accessible and flexible dynamic forecast model could be used in the monitoring of ZVD to provide advanced warning of future ZIKV outbreaks.
Insights into the binding mode of MEK type-III inhibitors. A step towards discovering and designing allosteric kinase inhibitors across the human kinome
Authors: Zhao Zheng , Xie Lei , Bourne Philip E. 
Published: September 2016

AbstractProtein kinases are critical drug targets for treating a large variety of human diseases. Type-I and type-II kinase inhibitors frequently exhibit off-target toxicity or lead to mutation acquired resistance. Two highly specific allosteric type-III MEK-targeted drugs, Trametinib and Cobimetinib, offer a new approach. Thus, understanding the binding mechanism of existing type-III kinase inhibitors will provide insights for designing new type-III kinase inhibitors. In this work we have systematically studied the binding mode of MEK-targeted type-III inhibitors using structural systems pharmacology and molecular dynamics simulation. Our studies provide detailed sequence, structure, interaction-fingerprint, pharmacophore and binding-site information on the binding characteristics of MEK type-III kinase inhibitors. We propose that the helix-folding activation loop is a hallmark allosteric binding site for type-III inhibitors. Subsequently we screened and predicted allosteric binding sites across the human kinome, suggesting other kinases as potential targets suitable for type-III inhibitors. Our findings will provide new insights into the design of potent and selective kinases inhibitors.Author SummaryHuman protein kinases represent a large protein family relevant to many diseases, especially cancers, and have become important drug targets. However, developing the desired selective kinase-targeted inhibitors remain challenging. Kinase allosteric inhibitors provide that opportunity, but, to date, few have been designed other than MEK inhibitors. To more efficiently develop kinase allosteric inhibitors, we systematically studied the binding mode of the MEK type-III allosteric kinase inhibitors using structural system pharmacology and molecular dynamics approaches. New insights into the binding mode and mechanism of type-III inhibitors were revealed that may facilitate the design of new prospective type-III kinase inhibitors.
Larger Numbers Can Impede Adaptation in Asexual Populations despite Entailing Greater Genetic Variation
Authors: Chavhan Yashraj D. , Ali Sayyad Irfan , Dey Sutirth 
Published: September 2016

AbstractPeriodic bottlenecks play a major role in shaping the adaptive dynamics of natural and laboratory populations of asexual microbes. Here we study how they affect the ‘Extent of Adaptation’ (EoA), in such populations.EoA, the average fitness gain relative to the ancestor, is the quantity of interest in a large number of microbial experimental-evolution studies which assume that for any given bottleneck size (N0) and number of generations between bottlenecks (g), the harmonic mean size(HM=N0g) will predict the ensuing evolutionary dynamics. However, there are no theoretical or empirical validations forHMbeing a good predictor ofEoA. Using experimental-evolution withEscherichia coliand individual-based simulations, we show thatHMfails to predictEoA(i.e., higherN0gdoes not lead to higherEoA). This is because although highergallows populations to arrive at superior benefits by entailing increased variation, it also reduces the efficacy of selection, which lowersEoA. We show thatEoAcan be maximized in evolution experiments by either maximizingN0and/or minimizingg. We also conjecture thatN0/gis a better predictor ofEoAthanN0g. Our results call for a re-evaluation of the role of population size in predicting fitness trajectories. They also aid in predicting adaptation in asexual populations, which has important evolutionary, epidemiological and economic implications.
Depraved, Deprived, Dangerous and Deviant: Depicting the Insane Child in England's County Asylums, 1845–1907
Authors: TAYLOR STEVEN J. 
Published: September 2016

AbstractThe representations and experiences of children inside pauper lunatic asylums embody a significant lacuna in the understanding of children and childhood during the nineteenth century. Considering the Victorian period as a time when the conceptual notion of a sheltered and romantic childhood emerged it is essential, both to studies of childhood and to the history of the asylum, to examine how children thought to be mentally abnormal were incorporated into a discourse of innocence. Families and medical professionals played important roles in the admissions process by providing testimonies that led to certifications of insanity. This article examines the concept of the insane child and how it related to ideas of childhood that emerged during the period. Furthermore, important issues are explored such as the fluid nature of describing mental illness during the period, the motives of both family and medical professionals in creating polarized narratives of the sick child, and the place of the child within the medical institution.
Increased need for interventions predicts mortality in the critically ill
Authors: Efendijev I. , Raj R. , Skrifvars M. B. , Hoppu S. , Reinikainen M. 
Published: September 2016

IntroductionThe aim of this study was to determine the association of early treatment intensity with hospital mortality of intensive care unit (ICU) patients.MethodsWe performed an observational study based on a national ICU registry. We included adult patients treated in Finnish ICUs between 2003 and 2013 with the length of ICU stay of more than 3 days. We measured treatment intensity with the Therapeutic Intervention Scoring System (TISS‐76). We assessed mean and daily TISS scores. To define the change in treatment intensity during the first days in the ICU, we calculated the difference between the TISS score on day 3 and the score on day 1 (ΔTISS). We used multivariate logistic regression to adjust for baseline differences and continuous net reclassification improvement (NRI) to determine the impact of adding TISS data to the baseline prediction model on its prognostic performance.ResultsWe identified 42,493 patients eligible for the study. For 71% of the patients, ΔTISS was ≤ 0 and crude hospital mortality was 18%. ΔTISS > 0 was observed for 29% of the patients, with a hospital mortality of 23%. When compared to the group ΔTISS ≤ 0, the category ΔTISS > 0 was independently associated with substantially increased mortality. Adding TISS data to the prediction model resulted in the improvement of prognostic performance particularly in the patients with the lowest initial baseline risk.ConclusionsEarly increase in TISS scores was associated with increased risk of death, especially in patients with a lower initial severity of illness.