bluuebunny/crossref_metadata_2025_split huggingface dataset:
After the DNR:Surrogates Who Persist in Requesting Cardiopulmonary Resuscitation
Authors: Robinson Ellen M. , Cadge Wendy , Zollfrank Angelika A. , Cremens M. Cornelia , Courtwright Andrew M. 
Published: January 2017

AbstractSome health care organizations allow physicians to withhold cardiopulmonary resuscitation from a patient, despite patient or surrogate requests that it be provided, when they believe it will be more harmful than beneficial. Such cases usually involve patients with terminal diagnoses whose medical teams argue that aggressive treatments are medically inappropriate or likely to be harmful. Although there is state‐to‐state variability and a considerable judicial gray area about the conditions and mechanisms for refusals to perform CPR, medical teams typically follow a set of clearly defined procedures for these decisions. The procedures are based on the principle of nonmaleficence and typically include consultation with hospital ethics committees, reflecting the guidelines of relevant professional associations.Ethical debates about when CPR can and should be limited tend to rely more on discussions of theory, principles, and case studies than systematic empirical study of the situations in which such limitations are applied. Sociologists of bioethics call for empirical study, arguing that what ethicists and health professionals believe they are doing when they draft policies or invoke principles does not always mirror what is happening on the ground. In this article, we begin the task of modeling the empirical analyses sociologists call for, focusing on a cohort at Massachusetts General Hospital. We inductively analyzed ethics committee notes and medical records of nineteen patients whose surrogates did not accept the decision to withhold CPR.
The Limits of Surrogates’ Moral Authority and Physician Professionalism: Can the Paradigm of Palliative Sedation Be Instructive?
Authors: Berger Jeffrey T. 
Published: January 2017

AbstractWith narrow exception, physicians’ treatment of incapacitated patients requires the consent of health surrogates. Although the decision‐making authority of surrogates is appropriately broad, their moral authority is not without limits. Discerning these bounds is particularly germane to ethically complex treatments and has important implications for the welfare of patients, for the professional integrity of clinicians, and, in fact, for the welfare of surrogates. Palliative sedation is one such complex treatment; as such, it provides a valuable model for analyzing the scope of surrogates’ moral authority. Guidelines for palliative sedation that present it as a “last‐resort” treatment for severe and intractable suffering yet require surrogate consent in order to offer it are ethically untenable, precisely because the moral limits of surrogate authority have not been considered.
The ACA from behind the “Veil of Ignorance”
Authors: Dentzer Susan 
Published: January 2017

AbstractJohn Rawls posited that we could determine the nature of justice if we imagined ourselves observing conditions in society from behind a hypothetical “veil of ignorance.” Not knowing how or where we would end up—rich, poor, empowered, disabled—we would choose governing principles that did not leave one disadvantaged because of his or her circumstances. Rawls's concepts are implicitly embedded in the Affordable Care Act, which guarantees that vastly more Americans can obtain health insurance. The law effectively closed down the de facto lottery that awarded coverage to most but left out millions of others.
The Theory and Practice of Surrogate Decision‐Making
Authors: Wendler David 
Published: January 2017

AbstractWhen a patient lacks decision‐making capacity and has not left a clear advance directive, there is now widespread agreement that patient‐designated and next‐of‐kin surrogates should implement substituted judgment within a process of shared decision‐making. Specifically, after discussing the “best scientific evidence available, as well as the patient's values, goals, and preferences” with the patient's clinicians, the patient‐designated or next‐of‐kin surrogate should attempt to determine what decision the patient would have made in the circumstances. To the extent that this approach works, it seems to provide about as much respect for the autonomy of incapacitated patients as we could ask for. But, as articles in this issue of the Report by Jeffrey Berger and by Ellen Robinson and colleagues emphasize, reality presents challenges.
Show Code
Authors: Shalev Daniel 
Published: January 2017

Abstract“Let's get one thing straight: there is no such thing as a show code,” my attending asserted, pausing for effect. “You either try to resuscitate, or you don't. None of this halfway junk.” He spoke so loudly that the two off‐service consultants huddled at computers at the end of the unit looked up…We did four rounds of compressions and pushed epinephrine twice. It was not a long code. We did good, strong compressions and coded this man in earnest until the end. Toward the final round, though, as I stepped up to do compressions, my attending looked at me in a deep way. It was a look in between willing me as some object under his command and revealing to me everything that lay within his brash, confident surface but could not be spoken.
Employer Wellness Programs Challenged in Court
Authors: Rothstein Mark A. 
Published: January 2017

AbstractMany employers faced with rising health care costs have adopted “voluntary” wellness programs that urge employees to engage in various health‐promotion activities, such as smoking cessation and weight reduction. In the proper setting, measures to promote a more healthful lifestyle are difficult to question, but there is little compelling evidence that workplace wellness programs have significant, sustained health benefits or substantially reduce health care costs other than through cost‐shifting to unhealthy employees. Congressional support for workplace wellness programs has persisted on a bipartisan basis for the last twenty years, and the incentives that current statutes allow employers to offer employees have become strong enough that the voluntariness of the programs has been called into question. In recent months, the battleground has shifted to the courts, where federal regulations and employer practices have been challenged. Three recent or pending cases raise questions about whether the incentives are coercing employees into the programs.
Permanent Patients: Hospital Discharge Planning Meets Housing Insecurity
Authors: Herbst Jennifer L. 
Published: January 2017

AbstractNot all hospital inpatients need the level of care (including staffing, testing, monitoring, and treatment) uniquely available in the acute‐care setting. In the United States, these longer‐term, nonacute inpatients tend to be some combination of chronically ill, poor, homeless, undocumented, uninsured, and disabled—all groups who have struggled for health equity, political recognition, and voice. Even so, these “permanent patients” continue to receive care in one of the most expensive settings. This phenomenon is the result of federal legislation that creates an affirmative duty to care for all able to access our emergency departments without also making safe housing available to all. A handful of federal laws and policies as well as a potpourri of state laws and policies are involved.
Identification of a conserved gene signature associated with an exacerbated inflammatory environment in the hippocampus of aging rats
Authors: Pardo Joaquín , Abba Martin C. , Lacunza Ezequiel , Francelle Laetitia , Morel Gustavo R. , Outeiro Tiago F. , Goya Rodolfo G. 
Published: January 2017

ABSTRACTThere have been a few descriptive studies in aged rodents about transcriptome changes in the hippocampus, most of them in males. Here, we assessed the age changes in spatial memory performance and hippocampal morphology in female rats and compared those changes with changes in the hippocampal transcriptome. Old rats displayed significant deficits in spatial memory. In both age groups, hole exploration frequency showed a clear peak at hole 0 (escape hole), but the amplitude of the peak was significantly higher in the young than in the old animals. In the hippocampus, there was a dramatic reduction in neurogenesis, whereas reactive microglial infiltrates revealed an inflammatory hippocampal state in the senile rats. Hippocampal RNA‐sequencing showed that 210 genes are differentially expressed in the senile rats, most of them being downregulated. Our RNA‐Seq data showed that various genes involved in the immune response, including TYROBP, CD11b, C3, CD18, CD4, and CD74, are overexpressed in the hippocampus of aged female rats. Enrichment analysis showed that the pathways overrepresented in the senile rats matched those of an exacerbated inflammatory environment, reinforcing our morphologic findings. After correlating our results with public data of human and mouse hippocampal gene expression, we found an 11‐gene signature of overexpressed genes related to inflammatory processes that was conserved across species. We conclude that age‐related hippocampal deficits in female rats share commonalities between human and rodents. Interestingly, the 11‐gene signature that we identified may represent a cluster of immune and regulatory genes that are deregulated in the hippocampus and possibly other brain regions during aging as well as in some neurodegenerative diseases and low‐grade brain tumors. Our study further supports neuroinflammation as a promising target to treat cognitive dysfunction in old individuals and some brain tumors. © 2017 Wiley Periodicals, Inc.
Disruption of amygdala–entorhinal–hippocampal network in late‐life depression
Authors: Leal Stephanie L. , Noche Jessica A. , Murray Elizabeth A. , Yassa Michael A. 
Published: January 2017

ABSTRACTEpisodic memory deficits are evident in late‐life depression (LLD) and are associated with subtle synaptic and neurochemical changes in the medial temporal lobes (MTL). However, the particular mechanisms by which memory impairment occurs in LLD are currently unknown. We tested older adults with (DS+) and without (DS−) depressive symptoms using high‐resolution fMRI that is capable of discerning signals in hippocampal subfields and amygdala nuclei. Scanning was conducted during performance of an emotional discrimination task used previously to examine the relationship between depressive symptoms and amygdala‐mediated emotional modulation of hippocampal pattern separation in young adults. We found that hippocampal dentate gyrus (DG)/CA3 activity was reduced during correct discrimination of negative stimuli and increased during correct discrimination of neutral items in DS+ compared to DS− adults. The extent of the latter increase was correlated with symptom severity. Furthermore, DG/CA3 and basolateral amygdala (BLA) activity predicted discrimination performance on negative trials, a relationship that depended on symptom severity. The impact of the BLA on depressive symptom severity was mediated by the DG/CA3 during discrimination of neutral items, and by the lateral entorhinal cortex (LEC) during false recognition of positive items. These results shed light on a novel mechanistic account for amygdala–hippocampal network changes and concurrent alterations in emotional episodic memory in LLD. The BLA‐LEC‐DG/CA3 network, which comprises a key pathway by which emotion modulates memory, is specifically implicated in LLD. © 2017 Wiley Periodicals, Inc.
On the Performance of Ag/Oil Nanofluids in Heat Transfer Enhancement in a Sinusoidal Tube: Constant Heat Flux Boundary Condition
Authors: Jafarimoghaddam Amin , Aberoumand Sadegh 
Published: January 2017

AbstractThe present work provides an empirical investigation on the thermal characteristics of Ag/oil nanofluids flow inside a sinusoidal tube under a constant heat flux boundary condition. Ag/oil nanofluids have been prepared in low‐volume concentrations of 0.011%, 0.044%, and 0.171%. The average size of the nanoparticles was 20 nm. A heated coil was attached to the upper and lower surface of the tube that satisfied the constant thermal boundary condition of 204 W. The experiment has been pursued at low Reynolds numbers less than 160. A loop was designed to keep the flow hydrodynamically fully developed during the experiment. The test case was a sinusoidal tube. Upper and lower surfaces of the tube have been designed sinusoidally. Moreover, the width of the plates was long enough, so the problem was not considerably affected by the three‐dimensional releasing effect. Convective heat transfer coefficient and Nusselt number were calculated. It has been observed that based on the acquired data of the present work, convective heat transfer coefficient increased up to 23% for the best case (nanofluid with a volume concentration of 0.171%) compared to the base fluid. This happened while the rise of the friction factor was very low. In addition, a comparison between the new results and the previous work by authors showed the positive performance of sinusoidal tubes in increasing the convective heat transfer coefficient (the average increase was calculated to be about 82%) compared to the annular tube.
Cross‐sectional study of fetal long‐bone length in an Iranian population at 17–25 weeks of gestation
Authors: Kasraeian Maryam , Shahraki Hadi Raeisi , Asadi Nasrin , Vafaei Homeira , Sameni Safoura 
Published: January 2017

AbstractObjectiveTo construct improved reference charts for fetal long bones in an Iranian setting and to compare them with previous studies.MethodsThe present prospective cross‐sectional study included singleton fetuses assessed by ultrasonography at 17–25 weeks of gestation at the Comprehensive Medical Genetics Center, Shahid Soltani, Shiraz, Iran between May 1, 2012, and February 28, 2014. Exclusion criteria included conditions that could affect fetal growth. Fetal long bones (femur, humerus, tibia, fibula, ulna, and radius) were measured with ultrasonography and biometric charts were produced. Regression models were fitted to estimate bone lengths. The models produced were compared with those from previous studies in other populations.ResultsThere were 660 singleton fetuses included and 660 femur, 633 humerus, 512 tibia, 498 fibula, 505 ulna, and 498 radius biometric measurements were recorded. The models generated to predict the length of the tibia, fibula, ulna, and radius from the length of the femur and humerus demonstrated a high goodness of fit when the predicted lengths were plotted against the actual lengths. Comparisons of mean lengths with previous studies suggested that long‐bone length was affected by maternal ethnicity.ConclusionThe equations generated could be used to predict long‐bone length in an Iranian population and ethnicity should be considered when using fetal long‐bone length as a prenatal diagnostic tool.
USING MBSE TO EVALUATE AND PROTECT THE ELECTRICAL GRID AS A SYSTEM OF SYSTEMS
Authors: Hause Matthew 
Published: January 2017

ABSTRACTA system of systems (SoS) is a large complex system, with varying degrees of operational independence, managerial independence, evolutionary development, geographical distribution, and lifecycle independence. Critical infrastructure such as the electrical grid contains all the aspects of a SoS. Models are routinely used throughout the complete lifecycle of the grid during analysis, definition, construction, operation, maintenance, and more. Due to the ever‐increasing complexity of the grid, a single model encompassing all aspects of the grid would be impossible. Typical projects I have worked on encompassed millions of telemetered points just to operate a small portion of the overall grid. When the detailed mechanics of the individual equipment as well as cyber security, connection to the Internet, the Internet of things (IoT), power trading components, co‐generation, and other aspects are added, the problems quickly become too complex to analyze. Hence, we need to abstract the problem into a SoS set of aspects and examine the systems both at the SoS level, as well as the detailed level. This will require the use of standardized systems modeling tools such as the systems modeling language (SysML), and the unified architecture framework (UAF) to define the overall goals, strategies, capabilities, interactions, standards, operational and systems architecture, systems patterns, and so forth. Analysis using these standard methods can help identify potential problems that can be analyzed by specialty tools and the results fed back into the SoS model. This paper will examine the electrical grid as a SoS, define common characteristics, identify issues and vulnerabilities, and model‐based systems engineering (MBSE) strategies for addressing them.
SPACE WEATHER POLICY AND EFFECTS
Authors: Jonas Seth , McCarron Eoin , Murtagh William 
Published: January 2017

ABSTRACTSpace weather events have the potential to negatively affect technology and energy infrastructures that are essential contributors to national security, economic vitality, and daily functioning. The term “space weather” refers to the naturally occurring, dynamic conditions of the space environment that arise from emissions from the sun, which include solar flares, solar energetic particles, and coronal mass ejections. These emissions can interact with Earth, potentially degrading, disrupting, or damaging electric power systems; satellite, aircraft, and spacecraft operations; telecommunications; position, navigation, and timing services; and other technologies and infrastructures. As these technologies become increasingly ubiquitous and interdependent, the world faces greater risks from the threats posed by space weather events. Critical infrastructures make up diverse, complex, interdependent systems of systems in which the failure of one could cascade to another. Understanding this threat and the effects of space weather on critical systems is crucial to enhancing preparedness and building resilience. This article (1) provides readers with an overview of the space weather phenomena most likely to degrade, disrupt, or damage critical infrastructures; (2) describes the US National Oceanic and Atmospheric Administration's process for communicating space weather conditions and their possible effects on critical systems; and (3) details current Federal and international efforts to enhance space weather preparedness.
HOW INFRASTRUCTURE CAN BECOME REBORN BY BECOMING BORN ROBUST FOR THE CRITICAL INFRASTRUCTURE PROTECTION AND RECOVERY WORKING GROUP
Authors: Sparber Josh 
Published: January 2017

ABSTRACTSystems Modeling Language (SysML) is a tool for guiding engineers in designing power grid circuits sufficiently robust to withstand known electromagnetic pulses (EMPs). Careful examination of existing data shows that EMPs, and sometimes geomagnetically induced currents (GICs) that accompany EMPs are truly a powerful threat to power grid survival. Systems engineers, employing SysML can isolate power grid failure susceptibilities and areas for necessary power grid design improvements with selected SysML packages defined as enclaves associated with risk. These enclaves can be decomposable into stereotyped components available for risk categorization, building simulation libraries, or follow–on tests. As an example, a stereotype Source, instantiated as a Photovoltaic (PV) Inverter, increasingly important in microgrid renewable energy, is linked to a high frequency alternating current (HFAC) microgrid risk enclave package. Simulation allows evaluation of SysML use cases with EMP Actors. Real world test, construction, and strategic grid readjustment can then segue quickly.
A MODEL‐BASED SYSTEMS ENGINEERING APPROACH TO RESILIENCY ANALYSIS OF AN ELECTRICAL DISTRIBUTION FACILITY
Authors: Hecht Myron J. 
Published: January 2017

ABSTRACTThis article describes a model‐based systems engineering (MBSE) approach to cyberattack resilience modeling for an electrical power substation and demonstrates that (1) resiliency can be quantitatively characterized to enable design tradeoffs and (2) the analysis can be incorporated into a Systems Modeling Language (SysML) model to enable it to be incorporated into an MBSE development effort. The resiliency analytical model described here using the Markov model, derives from previous work on survivability analysis. For the system under analysis, it showed that the most important performance parameter for cyber resilience is propagation resistance followed by an attack rate mitigation. However, this applicability of this result is limited to this particular system with the parameter values described below. What is of more general importance is the value of such modeling, that when combined with SysML parametric analysis capability and the differential equation solvers in tools such as Matlab, has promise in improving resiliency with respect to cyber threats in the national energy.
Factors enhancing the migration and the homing of mesenchymal stem cells in experimentally induced cardiotoxicity in rats
Authors: A. Soliman Nabil , Abd‐Allah Somia H. , Hussein Samia , Alaa Eldeen Muhammad 
Published: January 2017

AbstractDoxorubicin is an effective anti‐neoplastic drug but its use is limited by its cardiotoxicity. Administration of mesenchymal stem cells (MSCs) for the management of cardiotoxicity was with poor myocardial homing capacity. With the aim of developing novel techniques to improve the migration of MSCs, we tested whether valproate and electric fields (EFs) direct the migration of MSCs towards the damaged myocardium. The study included five groups of female albino rats. The first group included 10 healthy rats as normal control group. The remaining 40 female rats received doxorubicin for induction of acute cardiotoxicity. Four rats were sacrificed for histopathological confirmation of cardiotoxicity. The remaining rats were equally divided into subsequent four groups. The second group included nine rats that did not receive further treatment (positive control group). The third group included nine rats which received intravenous bone marrow derived mesenchymal stem cells (BM‐MSCs) after cardiotoxicity induction. The fourth group included nine rats which received BM‐MSCs plus sodium valporate after cardiotoxicity induction. The fifth group included nine rats which received BM‐MSCs plus sodium valporate after cardiotoxicity induction and were exposed to an electrical stimulation (ES). Blood samples were taken from all groups at the end of the study to estimate creatine kinase‐MB (CK‐MB), aspartate transaminase (AST) and lactate dehydrogenase (LDH). Heart tissues from all rats were used for RNA extraction for assessment of sry gene expression. Homing was tested by PKH26 fluorescence in myocardial tissue sections and by sry gene expression. The best biochemical and histopathological improvement in cardiotoxicity was demonstrated in group 5 (rats that received ES and valporate with MSCs). We concluded that EFs and sodium valproate enhance homing ability of MSCs towards the damaged myocardium in doxorubicin induced carditoxicity model. © 2017 IUBMB Life, 69(3):162–169, 2017