bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is medical perspective on clinical governance practices associated with clinical units’ performance and mortality? A cross-sectional study through a record-linkage procedure
Authors: Sarchielli Guido , De Plato Giovanni , Cavalli Mario , Albertini Stefano , Nonni Ilaria , Bencivenni Lucia , Montali Arianna , Ventura Antonio , Montali Francesca 
Published: July 2016

Objective: Assessment of the knowledge and application as well as perceived utility by doctors of clinical governance tools in order to explore their impact on clinical units’ performance measured through mortality rates and efficiency indicators. Methods: This research is a cross-sectional study with a deterministic record-linkage procedure. The sample includes n = 1250 doctors (n = 249 chiefs of clinical units; n = 1001 physicians) working in six public hospitals located in the Emilia-Romagna Region in Italy. Survey instruments include a checklist and a research-made questionnaire which were used for data collection about doctors’ knowledge and application as well as perceived utility of clinical governance tools. The analysis was based on clinical units’ performance indicators which include patients’ mortality, extra-region active mobility rate, average hospital stay, bed occupancy, rotation and turnover rates, and the comparative performance index as efficiency indicators. Results: The clinical governance tools are known and applied differently in all the considered clinical units. Significant differences emerged between roles and organizational levels at which the medical leadership is carried out. The levels of knowledge and application of clinical governance practices are correlated with the clinical units’ efficiency indicators (bed occupancy rate, bed turnover interval, and extra-region mobility). These multiple linear regression analyses highlighted that the clinical governance knowledge and application is correlated with clinical units’ mortality rates (odds ratio, −8.677; 95% confidence interval, −16.654, −0.700). Conclusion: The knowledge and application, as well as perceived utility by medical professionals of clinical governance tools, are associated with the mortality rates of their units and with some efficiency indicators. However, the medical frontline staff seems to not consider homogeneously useful the clinical governance tools application on its own clinical practice.
Effects of electrical stimulation therapy on the blood flow in chronic critical limb ischemia patients following regenerative therapy
Authors: Yamabata Shiho , Shiraishi Hirokazu , Munechika Mai , Fukushima Hideki , Fukuoka Yoshiyuki , Hojo Tatsuya , Shirayama Takeshi , Horii Motoyuki , Matoba Satoaki , Kubo Toshikazu 
Published: July 2016

Objectives: We investigated the effects of electrical stimulation therapy on cutaneous and muscle blood flow in critical limb ischemia patients following regenerative therapy. Methods: Three groups were studied: 10 healthy young subjects, 10 elderly subjects, and 7 critical limb ischemia patients after regenerative therapy. After 5 min rest, electrical stimulation was applied at 5 Hz on the tibialis anterior muscle for 10 min. We estimated the relative changes in oxyhemoglobin and total hemoglobin compared to the basal values at rest (Δ[HbO2], Δ[Hbtot]), which reflected the blood flow in the skin and muscle layer, and we simultaneously measured the tissue O2 saturation (StO2) throughout the electrical stimulation and recovery phase by near-infrared spectroscopy. Results: The Δ[HbO2] and Δ[Hbtot] values of the muscle layer in critical limb ischemia patients increased gradually and remained significantly higher at the 5-min and 10-min recovery periods after the electrical stimulation without reducing the StO2, but there is no significant change in the other two groups. Skin blood flow was not influenced by electrical stimulation in three groups. Conclusion: This improvement of the peripheral circulation by electrical stimulation would be beneficial as the adjunctive therapy after regenerative cell therapy.
Comparison of the pull and introducer percutaneous endoscopic gastrostomy techniques in patients with head and neck cancer
Authors: Retes Felipe A , Kawaguti Fabio S , de Lima Marcelo S , da Costa Martins Bruno , Uemura Ricardo S , de Paulo Gustavo A , Pennacchi Caterina MP , Gusmon Carla , Ribeiro Adriana VS , Baba Elisa R , Geiger Sebastian N , Sorbello Mauricio P , Kulcsar Marco A , Ribeiro Ulysses , Maluf‐Filho Fauze 
Published: July 2016

Background and study aimsPercutaneous endoscopic gastrostomy (PEG) in head and neck cancer (HNC) patients is associated with higher complication and mortality rates when compared to a general patient population. The pull technique is still the preferred technique worldwide but it has some limitations. The aim of this study is to compare the pull and introducer PEG techniques in patients with HNC.Patients and methodsThis study is based on a retrospective analysis of a prospectively collected database of 309 patients with HNC who underwent PEG in the Cancer Institute of São Paulo.ResultsThe procedure was performed with the standard endoscope in 205 patients and the introducer technique was used in 137 patients. There was one procedure‐related mortality. Age, sex and albumin level were similar in both groups. However in the introducer technique group, patients had a higher tumor stage, a lower Karnofsky status, and presented more frequently with tracheostomy and trismus. Overall, major, minor, immediate and late complications and 30‐day mortality rates were similar but the introducer technique group presented more minor bleeding and tube dysfunctions.ConclusionThe push and introducer PEG techniques seem to be both safe and effective but present different complication profiles. The choice of PEG technique in patients with HNC should be made individually.
Silencing of hepatic fate-conversion factors induce tumorigenesis in reprogrammed hepatic progenitor-like cells
Authors: Serrano Felipe , García-Bravo Maria , Blazquez Marina , Torres Josema , Castell Jose V. , Segovia Jose C. , Bort Roque 
Published: July 2016

Abstract
Background
Several studies have reported the direct conversion of mouse fibroblasts to hepatocyte-like cells with different degrees of maturation by expression of hepatic fate-conversion factors.

Methods
We have used a combination of lentiviral vectors expressing hepatic fate-conversion factors with Oct4, Sox2, Klf4, and Myc to convert mouse embryonic fibroblasts into hepatic cells.

Results
We have generated hepatic cells with progenitor-like features (iHepL cells). iHepL cells displayed basic hepatocyte functions but failed to perform functions characteristic of mature hepatocytes such as significant Cyp450 or urea cycle activities. iHepL cells expressed multiple hepatic-specific transcription factors and functional genes characteristic of immature hepatocytes and cholangiocytes, as well as high levels of Foxl1, Cd24a, and Lgr5, specific markers of hepatic progenitor cells. When transplanted into partial hepatectomized and hepatic irradiated mice, they differentiated into hepatocytes and cholangiocytes. However, iHepL cells formed malignant non-teratoma cell aggregations in one out of five engrafted livers and five out of five xenografts assays. All the cells in these tumors had silenced key hepatic fate-conversion factors, and lost hepatic features.

Conclusions
This study highlights the dangers of using pluripotency factors in reprogramming strategies when fate-conversion factors are silenced in vivo, and urges us to perform extensive tumorigenic tests in reprogrammed cells.
Bromodomain 4: a cellular Swiss army knife
Authors: Devaiah Ballachanda N , Gegonne Anne , Singer Dinah S 
Published: July 2016

Abstract
Bromodomain protein 4 (BRD4) is a transcriptional and epigenetic regulator that plays a pivotal role in cancer and inflammatory diseases. BRD4 binds and stays associated with chromatin during mitosis, bookmarking early G1 genes and reactivating transcription after mitotic silencing. BRD4 plays an important role in transcription, both as a passive scaffold via its recruitment of vital transcription factors and as an active kinase that phosphorylates RNA polymerase II, directly and indirectly regulating transcription. Through its HAT activity, BRD4 contributes to the maintenance of chromatin structure and nucleosome clearance. This review summarizes the known functions of BRD4 and proposes a model in which BRD4 actively coordinates chromatin structure and transcription.
Caspase-1 as a multifunctional inflammatory mediator: noncytokine maturation roles
Authors: Sun Qian , Scott Melanie J 
Published: July 2016

Abstract
Caspase-1 is an inflammatory caspase that is activated through formation of inflammasome complexes in response to both pathogen-derived and endogenous mediators. The most well-known function of active caspase-1 is to cleave the proforms of inflammatory cytokines IL-1β and -18 into their active forms in response to inflammatory stimuli in immune cells. However, recent evidence suggests that caspase-1 has multiple functions in addition to this cytokine maturation role and that it is at the center of many cell responses to stress and inflammation. The current review focuses on roles for caspase-1, and the closely related caspase-11, in inflammatory forms of cell death and protein cleavage and also in protein secretion. These alternative caspase-1 functions can influence inflammatory responses, not just in immune cells but in other cell types, such as epithelia, where inflammatory cytokine production may not be a primary cell function.
Change in Pattern of HER2 Fluorescent in Situ Hybridization (FISH) Results in Breast Cancers Submitted for FISH Testing: Experience of a Reference Laboratory Using US Food and Drug Administration Criteria and American Society of Clinical Oncology and College of American Pathologists Guidelines
Authors: Shah Mithun Vinod , Wiktor Anne E. , Meyer Reid G. , Tenner Kathleen S. , Ballman Karla V. , Green Stefan J. , Sukov William R. , Ketterling Rhett P. , Perez Edith A. , Jenkins Robert B. 
Published: July 2016

Purpose In 1998, the US Food and Drug Administration (FDA) approved human epidermal growth factor receptor 2 (HER2) testing guidelines to determine eligibility for HER2-directed therapy (HDT) in breast cancer. ASCO and the College of American Pathologists published immunohistochemistry (IHC) and fluorescent in situ hybridization (FISH) HER2 testing guidelines in 2007 (AC2007) and updated these guidelines in 2013 (AC2013). We compared the HER2 FISH amplification frequency using these three guidelines. Methods Patient samples that were sent to the Mayo Clinic cytogenetics laboratory for FISH testing (n = 2,851; from November 2013 to October 2014) were analyzed. Frequency of HER2 FISH amplification was examined and impact of AC2013 assessed. Results IHC results were available for 1,922 patient samples (67.4%), 137 of which were from Mayo Clinic. Distribution was 2.4% IHC 0, 7.9% IHC 1+, 84.8% IHC 2+, and 2.5% IHC 3+. Among IHC 2+ patients, HER2 FISH positivity was 11.8% (FDA), 9.4% (AC2007), and 24.1% (AC2013). Overall, 11.8% (n = 339) were positive with a FISH ratio ≥ 2.0, 1.3% (n = 35) with a FISH ratio ≥ 2.0 despite a HER2 signal < 4.0, and 3.0% (n = 86) with HER2 signal ≥ 6.0 despite FISH ratio < 2.0. Among 405 patients (14.2%) who were initially considered FISH-equivocal (ratio < 2.0 with HER2 signal ≥ 4.0, but < 6.0; AC2013), use of an alternative chromosome 17 probe reassigned 212 (7.4% overall) patients to FISH-positive and 36 (1.3% overall) patients to FISH-negative, whereas 157 (5.5% overall) patients remained equivocal. Final HER2 positivity with AC2013 (23.6%) was increased (P < .001) compared with FDA (13.1%) and AC2007 (11%) guidelines. Conclusion In a reference laboratory cohort that was highly enriched for IHC 2+ patient samples, AC2013 guidelines led to a larger number of FISH-equivocal patients. Approximately one half of these FISH-equivocal patients (7.4% overall) became HER2-positive upon alternative FISH probe testing. However, these patients would not have participated in the pivotal HDT trials. Clinical utility data on HDT benefit in these patients and other special subsets are needed.
Optimizing Prone Cardiopulmonary Resuscitation: Identifying the Vertebral Level Correlating With the Largest Left Ventricle Cross-Sectional Area via Computed Tomography Scan
Authors: Kwon Min-Ji , Kim Eun-Hee , Song In-Kyung , Lee Ji-Hyun , Kim Hee-Soo , Kim Jin-Tae 
Published: July 2016

BACKGROUND:
Placing the patient in the prone position frequently is required for some surgical procedures. If cardiac arrest occurs and the patient cannot be safely turned supine, cardiopulmonary resuscitation (CPR) may need to be performed with the patient in the prone position. Although clear landmarks have been defined for supine CPR, the optimal hand position for CPR in the prone position has not been clearly determined. The purpose of this study was to determine anatomically the optimal hand position for CPR in the prone position.

METHODS:
We reviewed retrospectively the chest computed tomography images of 100 patients taken in the prone position. The vertebral body levels crossing the medial angle of the scapula, the inferior angle of the scapula, and the spinous process of the vertebral body connected to the most inferior rib were identified, and we selected the image level at which the left ventricular (LV) cross-sectional area was the largest. This level was defined as the optimal compression level and correlated to surface anatomical landmarks. We calculated the ratio of the distance from the C7 spinous process to the level of the largest LV cross-sectional area divided by the distance from the C7 spinous process to the spinous process of the vertebral body connected with the most inferior rib.

RESULTS:
The level of the largest LV cross-sectional area in the prone position was 1 vertebral segment below the inferior angle of the scapula in 45% (99% confidence interval [CI], 33–58) of patients and 0 to 2 vertebral segments below that in 95% (99% CI, 86–98) of patients. The mean (SD) ratio of the distance from the C7 spinous process to the level of the largest LV cross-sectional area divided by the distance from the C7 spinous process to T12 spinous process was 67% ± 7% (99% CI, 65–69).

CONCLUSIONS:
When the patient is positioned prone, the largest LV cross-sectional area is 0 to 2 vertebral segments below the inferior angle of the scapula in at least 86% of patients. Further studies are needed to determine whether this position is optimal for chest compressions in the prone position.
Heterogeneity in the Structure of the Left Ventricular Outflow Tract: A 3-Dimensional Transesophageal Echocardiographic Study
Authors: Montealegre-Gallegos Mario , Matyal Robina , Khabbaz Kamal R. , Owais Khurram , Maslow Andrew , Hess Philip , Mahmood Feroze 
Published: July 2016

BACKGROUND:
The left ventricular outflow tract (LVOT) is a composite of adjoining structures; therefore, a circular or elliptical shape at one point may not represent its entire structure. The purpose of this study was to evaluate the presence of heterogeneity in the LVOT.

METHODS:
Patients with normal valvular and ventricular function undergoing elective coronary revascularization surgery were included in the study. Intraoperative R-wave gated 3-dimensional (3D) transesophageal echocardiographic imaging of the LVOT was performed at end-systole, with the midesophageal long axis as the reference view. Acquired data were analyzed with the Philips Q-Lab software with multiplanar reformatting in the sagittal (minor axis), transverse (major axis), and coronal (cross-sectional area by planimetry) views of the LVOT. These measurements were made on the left ventricular side or proximal LVOT, aortic side, or distal LVOT and mid-LVOT.

RESULTS:
Fifty patients were included in the study. The LVOT minor (sagittal) axis dimension did not differ across the mid-LVOT, proximal LVOT, and distal LVOT (P = .11). The major axis diameter of LVOT differed among the 3 regions of the LVOT (P < .001). A difference in major axis diameter was observed between the proximal and the distal LVOT (median difference of 0.39 cm; Bonferroni-adjusted 95% confidence interval [CI] of the difference = 0.31–0.48 cm; Bonferroni-adjusted P < .001). Planimetry of the LVOT area differed significantly (P < .001) between the regions analyzed, and we found a difference between the distal and the proximal LVOT (median difference = 0.65 cm2, Bonferroni-adjusted 95% CI of the difference = 0.44–0.88 cm2, Bonferroni-adjusted P < .001). The LVOT area calculated from minor axis diameter differed significantly from the area obtained by planimetry (P < .001).

CONCLUSIONS:
There was heterogeneity in the major axis diameter and cross-sectional area for the different regions of the LVOT. The distal LVOT (aortic side) was more circular, whereas the proximal LVOT (left ventricular side) was more elliptical in shape. This change in shape from circular to elliptical was accounted for by a difference in the major axis diameter from proximal to distal LVOT and a relatively similar minor axis diameter. Although the clinical significance of this finding is unknown, the assumption of a uniform structure of LVOT is incorrect. Three-dimensional imaging may be useful for assessing the LVOT shape and size at a specific region of interest.
Features of formation of regional parliaments in the subjects of the Russian Federation
Authors: Рыбакова  , Rybakova Svetlana 
Published: July 2016

The process of formation of representative bodies in the regions of the Russian Federation, provided by the Russian legislation, is considered. The analysis of the influence of the federal authorities on the formation of regional parliaments is presented.
The restrictions of the real possibilities of regional parliaments to influence the political process in the space of their regions are analyzed, as well as their great dependence on the executive branch. The practices of regional parliaments of the Russian Federation are studied. The change in the structure of regional government legislation, including regional parliaments, based on the author&#180;s analysis of changes, amendments to the Federal Law «On general principles of organization of legislative (representative) and executive bodies of state power of the subjects of the Russian Federation» is examined.
It is proved that the regional parliaments have greater possibilities to structure and intensify the political space of the subjects of the Russian Federation, in the organization of social life, increasing the responsibility of the entire system of public administration. Some recommendations for improving the formation of regional parliaments in Russia are given.
Strategic professions as a basis of long-term competitiveness in innovative economy
Authors: Авдеева  , Avdeeva Ekaterina , Резник  , Reznik Evgeniy , Резник  , Reznik Aleksey 
Published: July 2016

In the article methodical provisions on identification of strategic professions and an assessment of competences of the personnel on each of them are offered. It will allow the enterprises to provide effective approach to development of the perspective directions of development and competitiveness in strategic aspect.
The concept of strategic competitiveness of the enterprise is considered. The results of the analysis are presented obtained by the authors of service activities in existing plants producing aircraft components. The calculation for each of the strategic enterprise professions according to professional competency coefficients is done.
Can Başkent (ed.), Perspectives on Interrogative Models of Inquiry, Springer, 2016
Authors: Poggiolesi Francesca 
Published: July 2016

Book Reviews: Can Başkent (ed.), Perspectives on Interrogative Models of Inquiry, Logic, Argumentation & Reasoning, Volume 8, Springer, 2016, vii + 197 pages, ISBN: 978-3-319-20761-2 (Print), 978-3-319-20762-9 (Online). DOI: 10.1007/978-3-319-20762-9
Knowledge and practice of pain management among nurses in labour wards in Ibadan, Nigeria
Authors: EZE Ojerinde Ogonna , Onibokun Adenike , Matthew Akpa Onoja 
Published: July 2016

Background: It is not clear whether awareness of pain management has influenced the management of labour pain by nurse/midwives in Ibadan, Nigeria. Many women in labour do not get optimal pain relief, despite awareness of the importance of pain management. Aims: This study aimed to assess knowledge and practice of labour pain management among nurse/midwives in Ibadan. Methods: This cross-sectional study included 87 nurse/midwives on duty in labour rooms of three hospitals in Ibadan, Nigeria. Data were collected using semi-structured questionnaires. Descriptive statistics, and Pearson's and Kendall's correlation coefficients were used for data analysis. All analyses were performed using IBM SPSS version 20.0 at a 5% level of significance. Findings: Two thirds of respondents (66.7%) had a moderate level of knowledge, and 34.5% managed labour pain through back massage/psychotherapy. Knowledge of pain management was associated with level of education (τ = 0.82; P < 0.001) while good practice of pain management was associated with good knowledge (r = 0.49; P < 0.001). The association between good practice and years of working experience just failed to be statistically significant (P = 0.06). Conclusions: Nurse/midwives in Ibadan have moderate knowledge of labour pain management. Participants in this study primarily used back massage and psychotherapy. There is need for improvement in knowledge of labour pain management through continuing education for nurse/midwives in Ibadan.
Incidence and predictors of premalignant cervical lesions among women in Jos University teaching hospital, Plateau state, Nigeria
Authors: Abraham Dare Ajayi , Daniel Grace , Eunice Samuel Ari , Folashade Winna , Onyawole Rachael Jacob 
Published: July 2016

Background: Premalignant cervical lesions are a potential precursor of cervical cancer, which can be identified through screening. Approximately 80% of cervical cancers occur in developing countries, where routine screening is rare. Aims: This study aimed to examine the incidence and risk factors of premalignant cervical lesions among women screened at Jos University teaching hospital (JUth) in 2009. Methods: A purposive sampling technique was used to select a sample size of all the women (1962) who were screened at JUth during January–December 2009. Data were retrieved with the help of the data manager of the cervical cancer screening unit. Descriptive and multiple regression analyses were done to determine risk factors. Findings: Of the 1962 subjects, 5.8% tested positive and 94.2% negative. The majority (82.5%) of those with premalignant cervical lesions had experienced sexually transmitted infections. Those using oral contraceptives had a higher rate (44.7%) of lesions than women using other forms of contraception. Women who had first sexual intercourse aged 10–15 years had a higher rate (41.2%) of lesions, as did those who had seven or more sexual partners (50.9%), or with seven or more children (43.9%). Conclusions: There was a fairly low incidence of positive screening results among the study population. Major risk factors included sexually transmitted infections, early age of first sexual intercourse, increased number of sexual partners, use of oral contraceptive pills and increased parity. The authors recommend a public health campaign on the benefits of cervical cancer screening in Plateau state and across nigeria.