bluuebunny/crossref_metadata_2025_split huggingface dataset:
Socioeconomic Status Affects Pulmonary Hypertension Disease Severity at Time of First Evaluation
Authors: Talwar Arunabh , Sahni Sonu , Talwar Ankoor , Kohn Nina , Klinger James R. 
Published: March 2016

A low socioeconomic status (SES) has been linked to disproportionate access to health care in many diseases, leading to worse disease severity at initial presentation. There is a paucity of these data in the pulmonary hypertension (PHTN) population. We studied the association of SES, as measured by zip code–based median annual household income, with World Health Organization functional class (WHO‐FC) at time of first evaluation in PHTN patients. All patients evaluated at our center with a right heart catheterization revealing a mean pulmonary artery pressure of ≥25 mmHg within 12 months of initial evaluation were considered for the study. Demographics, WHO‐FC, and zip codes were obtained from retrospective chart analysis. The 2010 US census was used to obtain zip code–based annual median income. The income groups were divided into quartiles. Patients were categorized by their WHO‐FC and zip code–derived median income. Similar analyses were conducted for pulmonary arterial hypertension (PAH) patients. Survival was estimated with the Kaplan‐Meier method. Data were analyzed in SAS, and P < 0.05 was considered significant. There were 228 PHTN patients (70 [30.7%] male, 158 [69.3%] female). As median income decreased, the FC at presentation increased, signifying higher disease severity (Spearman correlation: r = −0.161, P < 0.0515). This association between median income groups and WHO‐FC at initial evaluation was significant (χ2 test: P < 0.0168). There were 116 PAH patients (32 [27.6%] male, 84 [72.4%] female). There was again a negative relationship between income and initial FC (Spearman correlation: r = −0.0307, P < 0.0007). A lower SES was associated with worse disease, as measured by WHO‐FC.
Validity, Reliability, and Responsiveness of SRS-7 as an Outcomes Assessment Instrument for Operatively Treated Patients With Adult Spinal Deformity
Authors: Jain Amit , Lafage Virginie , Kelly Michael P. , Hassanzadeh Hamid , Neuman Brian J. , Sciubba Daniel M. , Bess Shay , Shaffrey Christopher I. , Ames Christopher P. , Scheer Justin K. , Burton Douglas , Gupta Munish C. , Hart Robert , Hostin Richard A. , Kebaish Khaled M. 
Published: March 2016

Study Design.
A retrospective analysis.

Objective.
The aim of our study was to compare the normality, concurrent validity, internal consistency, responsiveness, and dimensionality of an item response theory–derived seven-question instrument (SRS-7), against the Scoliosis Research Society-22r (SRS-22r) questionnaire in operatively treated patients with adult spinal deformity (ASD).

Summary of Background Data.
Compared with SRS-22r, SRS-7 (which has been validated in operatively treated patients with adolescent idiopathic scoliosis) has advantages of being short, unidimensional, and linear.

Methods.
A prospective database of ASD patients was queried for patients 18 years or older who were operatively treated, and who answered pre- and postoperative (at 2-year follow-up) SRS-22r questions (n = 276). Corresponding SRS-7 scores were calculated using answers to SRS-22r items 1, 4, 6, 10, 18, 19, and 20. Significance was set at a P value less than 0.01.

Results.
SRS-7 and SRS-22r were normally distributed preoperatively but not postoperatively. SRS-7 and SRS-22r scores had high correlation both preoperatively (r = 0.76, P < 0.01) and postoperatively (r = 0.83, P < 0.01). The internal consistency reliability Cronbach α values were 0.61 (SRS-7) and 0.83 (SRS-22r) preoperatively and 0.91 (SRS-7) and 0.95 (SRS-22r) postoperatively. SRS-7 was found to be more responsive than SRS-22r with measures of effect size: Cohen d = 1.21 versus 1.13, Hedge g = 1.21 versus 1.13, and effect size correlation r = 0.52 versus 0.49. Iterative principal factor analysis of pre- and postoperative scores showed the presence of one dominant latent factor in SRS-7 (unidimensionality) and four latent factors in SRS-22r (multidimensionality).

Conclusion.
SRS-7 is a valid, reliable, responsive, and unidimensional instrument, which can be used as a short-form alternative to the SRS-22r for assessing global changes in patient-reported outcomes over time in patients with ASD.

Level of Evidence: 3
Heparin-Based Polyelectrolyte Complex Enhances the Therapeutic Efficacy of Bone Morphogenetic Protein-2 for Posterolateral Fusion in a Large Animal Model
Authors: Wang Ming , Lam Raymond W.M. , Abbah Sunny A. , Hu Tao , Toh Soo Y. , Cool Simon , Bhakoo Kishore , Li Jun , Goh James C.H. , Wong Hee-Kit 
Published: March 2016

Study Design.
The study was based on porcine posterolateral fusion model.

Objective.
The study aims to prove that polyelectrolyte complex (PEC) carrier could enhance the efficacy and safety profile of bone morphogenetic protein-2 (BMP-2).

Summary of Background Data.
BMP-2 was introduced to enhance posterolateral fusion; however, extremely high doses of this molecule were often used which contributed to various complications. This was attributed to the poor modulation capacity of the traditional carrier absorbable collagen sponge (ACS). To reduce the efficacious dose of BMP-2 and its associated complications, heparin-based PEC was introduced.

Methods.
L3/L4 and L5/L6 two-level posterolateral spinal fusion was performed on six pigs using two doses of BMP-2 with PEC or ACS: (1) PEC with 800 μg BMP-2 (n = 2); (2) PEC with 400 μg BMP-2 (n = 2); (3) ACS with 800 μg BMP-2 (n = 1); (4) ACS with 400 μg of BMP-2 (n = 1). The construct was loaded into a rigid bioabsorbable cage for implantation. Fusion rate and quality were assessed 2 months after operation.

Results.
Manual palpation revealed successful fusion in all groups. Radiological fusion score of PEC groups was, however, higher than that of ACS groups. The newly formed bone in PEC groups appeared to be well integrated into the native bone with no overgrowth into the adjacent structure. On comparison, in ACS groups, large gaps were observed between the newly formed bone and the fusion bed with heterotopic ossification into the psoas muscle. The microarchitecture on the newly formed bone in PEC groups was superior to that in ACS groups, which was demonstrated by higher three-dimensional parameters.

Conclusion.
The present study demonstrated that BMP-2 delivered by PEC induced successful posterolateral fusion in porcine model. The efficacy of BMP-2 was improved and bony overgrowth was reduced. The microarchitecture of BMP-2–induced bone tissue was also enhanced by PEC.

Level of Evidence: N/A
Growing Up After Critical Illness: Verbal, Visual-Spatial, and Working Memory Problems in Neonatal Extracorporeal Membrane Oxygenation Survivors*
Authors: Madderom Marlous J. , Schiller Raisa M. , Gischler Saskia J. , van Heijst Arno F.J. , Tibboel Dick , Aarsen Femke K. , IJsselstijn Hanneke 
Published: March 2016

Objectives:
To assess neuropsychologic outcome in 17- and 18-year–old neonatal extracorporeal membrane oxygenation survivors.

Design:
A prospective longitudinal follow-up study.

Setting:
Follow-up program at the Erasmus MC-Sophia Children’s Hospital in Rotterdam, The Netherlands.

Patients:
Thirty adolescents 17 or 18 years old, treated between 1991 and 1997, underwent neuropsychologic assessment.

Interventions:
None.

Measurements and Main Results:
Attention, memory, executive functioning, visual-spatial functions, social-emotional functioning, and behavior were assessed with validated instruments, and data were compared with reference data. Included predictors for analysis of adverse outcome were diagnosis, age at start extracorporeal membrane oxygenation, convulsions, and use of antiepileptics. Adolescents’ performance (expressed as mean [sd] z score) was significantly lower than the norm on short-term and long-term verbal memory (z score = −1.40 [1.58], p = 0.016; z score = −1.54 [1.67], p = 0.010, respectively), visual-spatial memory (z score = −1.65 [1.37], p = 0.008; z score = −1.70 [1.23], p = 0.008, respectively), and working memory (32% vs 9% in the norm population). Parents reported more problems for their children regarding organization of materials (z score = −0.60 [0.90]; p = 0.03) and behavior evaluation (z score = −0.53 [0.88]; p = 0.05) on a questionnaire. Patients reported more withdrawn/depressed behavior (z score = −0.47 [0.54]; p = 0.02), somatic complaints (z score = −0.43 [0.48]; p = 0.03), and social problems (z score = −0.41 [0.46]; p = 0.04). Patients reported more positive feelings of self-esteem and an average health status.

Conclusions:
Adolescents treated with neonatal extracorporeal membrane oxygenation are at risk of verbal, visual-spatial, and working memory problems. Future research should focus on 1) the longitudinal outcome of specific neuropsychologic skills in adolescence and adulthood; 2) identifying risk factors of neuropsychologic dysfunction; 3) evaluating to what extent “severity of illness” is responsible for acquired brain injury; and 4) effects of timely cognitive rehabilitation.
Acceptance of lean redesigns in primary care
Authors: Hung Dorothy , Gray Caroline , Martinez Meghan , Schmittdiel Julie , Harrison Michael I. 
Published: March 2016

Background:
Lean is a leading change strategy used in health care to achieve short-term efficiency and quality improvement while promising longer-term system transformation. Most research examines Lean intervention to address isolated problems, rather than to achieve broader systemic changes to care delivery. Moreover, no studies examine contextual influences on system-wide Lean implementation efforts in primary care.

Purpose:
The aim of this study was to identify contextual factors most critical to implementing and scaling Lean redesigns across all primary care clinics in a large, ambulatory care delivery system.

Methodology/Approach:
Over 100 interviews and focus groups were conducted with frontline physicians, clinical staff, and operational leaders. Data analysis was guided by a modified Consolidated Framework for Implementation Research (CFIR), a popular implementation science framework. On the basis of expert recommendations, the modified framework targets factors influencing the implementation of process redesigns. This modified framework, the CFIR-PR, informed our identification of contextual factors that most impacted Lean acceptance among frontline physicians and staff.

Findings:
Several domains identified by the CFIR-PR were critical to acceptance of Lean redesigns. Regarding the implementation process acceptance was influenced by time and intensity of exposure to changes, “top-down” versus “bottom-up” implementation styles, and degrees of employee engagement in developing new workflows. Important factors in the inner setting were the clinic’s culture and style of leadership, along with availability of information about Lean’s effectiveness. Last, implementation efforts were impacted by individual and team characteristics regarding changed work roles and related issues of professional identity, authority, and autonomy.

Practice Implications:
This study underscores the need for change leaders to consider the contextual factors that surround efforts to implement Lean in primary care. As Lean redesigns are scaled across a system, special attention is warranted with respect to the implementation approach, internal clinic setting, and implications for professional roles and identities of physicians and staff.
NOVEL RETINAL COMPLICATIONS AFTER ENDOSCOPIC SINUS SURGERY
Authors: Rubaie Khalid Al , Cruz Augusto V. , Ghamdi Mizher Al , Khan Arif O. , Kozak Igor 
Published: March 2016

Purpose:
To report a novel intraocular complication of endoscopic sinus surgery.

Methods:
Retrospective case report.

Results:
A 44-year-old otherwise-healthy man underwent endoscopic right ethmoid sinus surgery and immediately developed loss of vision in his right eye. Postoperatively, patient had ipsilateral light perception vision, proptosis, periorbital ecchymosis, and large angle exotropia with virtually no adduction. Orbital computed tomography confirmed violation of the right medial rectus muscle and optic nerve. Dilated fundus examination showed a macular fold with edema and hemorrhages, blockage on angiography of the macula, and subretinal hyperfluorescence in the periphery. After 6 months of observation, his central vision had improved to 20/300 with macular atrophy and choroidal atrophy in the periphery.

Conclusion:
Macular edema, nonperfusion and ischemia, choroidal nonperfusion (Amalric sign), and atrophy can be iatrogenic sequelae of endoscopic ethmoid sinus surgery.
Quality and Health Literacy Demand of Online Heart Failure Information
Authors: Cajita Maan Isabella , Rodney Tamar , Xu Jingzhi , Hladek Melissa , Han Hae-Ra 
Published: March 2016

Background:
The ubiquity of the Internet is changing the way people obtain their health information. Although there is an abundance of heart failure information online, the quality and health literacy demand of these information are still unknown.

Objective:
The purpose of this study is to evaluate the quality and health literacy demand (readability, understandability, and actionability) of the heart failure information found online.

Methods:
Google, Yahoo, Bing, Ask.com, and DuckDuckGo were searched for relevant heart failure Web sites. Two independent raters then assessed the quality and health literacy demand of the included Web sites. The quality of the heart failure information was assessed using the DISCERN instrument. Readability was assessed using 7 established readability tests. Finally, understandability and actionability were assessed using the Patient Education Materials Assessment Tool for Print Materials.

Results:
A total of 46 Web sites were included in this analysis. The overall mean quality rating was 46.0 ± 8.9 and the mean readability score was 12.6 grade reading level. The overall mean understandability score was 56.3% ± 16.2%. Finally, the overall mean actionability score was 34.7% ± 28.7%.

Conclusions:
The heart failure information found online was of fair quality but required a relatively high health literacy level. Web content authors need to consider not just the quality but also the health literacy demand of the information found in their Web sites. This is especially important considering that low health literacy is likely prevalent among the usual audience.
Prevalence of Occult Malignancy Within Morcellated Specimens Removed During Laparoscopic Sacrocolpopexy
Authors: Vallabh-Patel Vaneesha , Saiz Cristina , Salamon Charbel , Francis Amanda , Pagnillo Jennifer , Culligan Patrick 
Published: March 2016

Objective
This study aimed to determine the prevalence of occult malignancy found in morcellated specimens removed in the context of pelvic organ prolapse repair operations.

Methods
A total of 786 cases were reviewed from a single health system between October 2006 and July 2015. Thorough chart reviews were performed to include pathological specimens. Demographic, perioperative, and postoperative data were collected.

Results
Four occult malignancies were identified including 3 endometrial adenocarcinomas of the uterus and 1 papillary serous carcinoma of the uterus. The overall prevalence of occult malignancy within morcellated specimens was 0.5% (4 of 786). On adopting universal screening with endometrial biopsy, 5 malignancies were identified (5 of 176) before morcellation and no postoperative malignancies in the remaining patients.

Conclusions
Power morcellation is a low-risk procedure with laparoscopic supracervical hysterectomy and sacrocolpopexy. Universal screening is highly effective in detecting occult malignancy and in our small series eliminated the risk; studies in multiple institutions will be needed to determine its effectiveness in other hospital systems.
OncoScape: Exploring the cancer aberration landscape by genomic data fusion
Authors: Schlicker Andreas , Michaut Magali , Rahman Rubayte , Wessels Lodewyk FA 
Published: March 2016

ABSTRACTAlthough large-scale efforts for molecular profiling of cancer samples provide multiple data types for many samples, most approaches for finding candidate cancer genes rely on somatic mutations and DNA copy number only. We present a new method, OncoScape, which, for the first time, exploits five complementary data types across 11 cancer types to identify new candidate cancer genes. We find many rarely mutated genes that are strongly affected by other aberrations. We retrieve the majority of known cancer genes but also new candidates such asSTK31andMSRAwith very high confidence. Several genes show a dual oncogene-and tumor suppressor-like behavior depending on the tumor type. Most notably, the well-known tumor suppressorRB1shows strong oncogene-like signal in colon cancer. We applied OncoScape to cell lines representing ten cancer types, providing the most comprehensive comparison of aberrations in cell lines and tumor samples to date. This revealed that glioblastoma, breast and colon cancer show strong similarity between cell lines and tumors, while head and neck squamous cell carcinoma and bladder cancer, exhibit very little similarity between cell lines and tumors. To facilitate exploration of the cancer aberration landscape, we created a web portal enabling interactive analysis of OncoScape results.
A Sister of PIN1 gene in tomato(Solanum lycopersicum)defines organ initiation patterns by maintaining epidermal auxin flux
Authors: Martinez Ciera C. , Koenig Daniel , Chitwood Daniel H. , Sinha Neelima R. 
Published: March 2016

AbstractThe spatiotemporal localization of the plant hormone auxin acts as a positional cue during early leaf and flower organogenesis. One of the main contributors to auxin localization is the auxin efflux carrier PIN-FORMED1 (PIN1). Phylogenetic analysis has revealed that PIN1 genes are split into two sister clades;PIN1and the relatively uncharacterizedSister-Of-PIN1 (SoPIN1). In this paper we identifyentire-2as a loss-of-functionSlSoPIN1a(Solyc10g078370) mutant inSolanum lycopersicum. Theentire-2plants are unable to specify proper leaf initiation leading to a frequent switch from the wild type spiral phyllotactic pattern to distichous and decussate patterns. Leaves inentire-2are large and less complex and the leaflets display spatial deformities in lamina expansion, vascular development, and margin specification. During sympodial growth inentire-2the specification of organ position and identity is greatly affected resulting in variable branching patterns on the main sympodial and inflorescence axes. To understand howSlSoPIN1afunctions in establishing proper auxin maxima we used the auxin signaling reporter DR5::Venus to visualize differences in auxin localization betweenentire-2and wild type. DR5::Venus visualization shows a widening of auxin localization which spreads to subepidermal tissue layers during early leaf and flower organogenesis, showing thatSoPIN1functions to focus auxin signaling to the epidermal layer. The striking spatial deformities observed inentire-2help provide a mechanistic framework for explaining the function of theSoPIN1clade in angiosperm species.Author SummaryThe plant hormone auxin acts as a positional signal in most plant developmental processes. ThePIN-FORMEDfamily of auxin transporters are the main contributors to auxin localization, especiallyPIN-FORMED1, which has been studied extensively in plant model speciesArabidopsis thaliana. Members of the PIN-FORMED gene family have been found in all plant species, but there is a scarcity of mutants described outsideArabidopsis thaliana. UsingSolanum lycopersicum(tomato) as a system, this study identifies a loss of function mutant from theSister-Of-PIN1clade in theSlSoPIN1agene. The characterization of this mutant reveals the role ofSlSoPIN1ain establishing position of organ initiation during shoot and reproductive development, including a role in establishing proper spiral phyllotaxy. We use an auxin visualization technique to concludeSlSoPIN1afunctions in specifying auxin presence in proper cell layers to establish organ and tissue positioning. This work gives further evolutionary context to howPIN-FORMEDgenes act to establish organogenesis in the plant kingdom.
Financing constraints and SME innovation during economic crises
Authors: Madrid-Guijarro Antonia , García-Pérez-de-Lema Domingo , Van Auken Howard 
Published: March 2016

Purpose
The purpose of this paper is to provide a better understanding of the determinants of small and medium-sized enterprises (SME) financing constraints and their impacts on investments in innovation. To explicate these factors, the authors use a general definition of innovation, distinguishing between product and process innovations, and highlight the role played by banking relationships.

Design/methodology/approach
On the basis of a literature review covering works specializing in innovation, financing constraints, and SME characteristics, a quantitative study is carried out in Spain, using a sample composed by 267 Spanish SMEs. Information was gathered by applying surveys addressed to the firm managers.

Findings
The findings reveal that financing constraints hinder innovation among Spanish SMEs functioning in hostile environments, though long-term banking relationships can moderate these financing constraints. The longer the duration of a firm’s banking relationship, the fewer financing constraints it faces, because the relationship significantly reduces information asymmetry.

Practical implications
To reduce financing constraints on their innovation, SMEs should establish long relationships and low debt concentration with their main bank. The more banks a firm works with, the greater its financing constraints. The findings have managerial implications, not just for firms but also for government policymakers and providers of consulting services.

Originality/value
This paper provides an in-depth analysis of the factors that affect innovation, along with insights into which financing constraints limit innovation during a severe recession.
Centrolac
Authors: Brenes Esteban R. , Martínez Carlos , Pichardo Caleb A. 
Published: March 2016

Purpose
The purpose of this paper is to discuss Centrolac, a Nicaraguan company engaged in processing ultra-pasteurized milk, and provides abundant information for readers to decide on vertical vs horizontal integration to deal with the changing competitive environment. It has been prepared to simplify discussion and knowledge about the competitive field (where to compete); generic cost-leadership and high-perceived-value strategies (how to compete); and the action required to attain positioning (how to implement it).

Design/methodology/approach
The case study is based on primary research conducted in conjunction with the company, including interviews with senior management and a broad document review. Secondary research was also conducted into the relevant environmental, industry and competitor trends and characteristics.

Findings
The case study presents topics of competitive positioning and how current company strategy can have a significant impact on future growth decisions.

Originality/value
This case study is for use in an MBA-level business strategy course with a focus on strategic positioning and growth paths. However, it can also be used for MBA corporate strategy courses in relation to corporate expansion on issues linked to organic growth within the same business (expansion into new dairy products) or vertical integration (integration into dairy-farming).