bluuebunny/crossref_metadata_2025_split huggingface dataset:
A multidisciplinary perioperative strategy for attaining “more physiologic” cardiac surgery
Authors: Anastasiadis Kyriakos , Antonitsis Polychronis , Deliopoulos Apostolos , Argiriadou Helena 
Published: March 2017

Background: Cardiac surgery is, by definition, a “non-physiologic” intervention associated with systemic adverse effects. Despite advances in surgical technique, cardiopulmonary bypass (CPB) technology as well as anaesthesia management and patient care, there is still significant morbidity and subsequent mortality. Aim: We consider that the contemporary demand for further improving patient outcome mandates the upgrade from optimal perfusion during the procedure as the gold standard to the concept of a “more physiologic” cardiac surgery. Our policy is a multidisciplinary perioperative strategy based on goal-directed perfusion throughout surgery incorporating in-line monitoring. This translates to “prevent rather than correct” malperfusion through real-time adjustment rather than correction of derangement detected late by incremental evaluation. Method: The strategy is based on continuous monitoring of cardiac index, SvO2, DO2i, DO2i/VCO2i and rSO2. Data acquisition is followed by action when needed; this includes stepwise: transfusion, increase of cardiac output and initiation of inotropic/vasoactive support. Moreover, implementation of minimally invasive extracorporeal circulation (MiECC) is considered as a fundamental component of physiologic perfusion when on-CPB, providing improved circulatory support and end-organ protection. Conclusion: We consider that, with this strategy which establishes optimal perfusion perioperatively, we attain the goal of a “more physiologic” cardiac surgery.
Risk Factors for Revision Surgery After Superior Labral Anterior-Posterior Repair: A National Perspective
Authors: Taylor Samuel A. , Degen Ryan M. , White Alexander E. , McCarthy Moira M. , Gulotta Lawrence V. , O’Brien Stephen J. , Werner Brian C. 
Published: March 2017

Background: Data regarding risk factors for revision surgery after superior labral anterior-posterior (SLAP) repair are limited to institutional series. Purpose: To define risk factors for revision surgery after SLAP repair among patients in a large national database. Study Design: Case-control study; Level of evidence, 3. Methods: A national insurance database was queried for patients undergoing arthroscopic SLAP repair (Current Procedural Terminology [CPT] code 29807) for the diagnosis of a SLAP tear. Patients without a CPT modifier for laterality were excluded. Revision surgery was defined as (1) subsequent ipsilateral SLAP repair (CPT 29807), (2) ipsilateral arthroscopic debridement for the diagnosis of a SLAP tear (CPT 29822 or 29823, with diagnosis code 840.7), (3) subsequent ipsilateral arthroscopic biceps tenodesis (CPT 29828), (4) subsequent ipsilateral open biceps tenodesis (CPT 23430), and (5) subsequent biceps tenotomy (CPT 23405). Multivariable binomial logistic regression analysis was performed to identify risk factors for revision surgery after SLAP repair, including patient demographics/comorbidities, concomitant diagnoses, and concomitant procedures performed. Odds ratios (ORs), 95% CIs, and P values were calculated. The estimated financial impact of revision surgery was also calculated. Results: There were 4751 patients who met inclusion and exclusion criteria. Overall, 121 patients (2.5%) required revision surgery after SLAP repair. Regression analysis identified numerous risk factors for revision surgery, including age >40 years (OR, 1.5; 95% CI, 1.2-1.8; P = .045), female sex (OR, 1.5; 95% CI, 1.3-1.8; P = .010), obesity (OR, 1.8; 95% CI, 1.5-2.2; P = .001), smoking (OR, 2.0; 95% CI, 1.6-2.4; P < .0001), and diagnosis of biceps tendinitis (OR, 3.5; 95% CI, 3.0-4.2; P < .0001) or long head of the biceps tearing (OR, 5.1; 95% CI, 4.1-6.3; P < .0001) at or before the time of surgery. Concomitant rotator cuff repair and distal clavicle excision were not significant risk factors for revision surgery. The cost of revision surgery averaged almost $9000. Conclusion: Risk factors for revision surgery after SLAP repair include age >40 years, female sex, obesity, smoking, and diagnosis of biceps tendinitis or long head of the biceps tearing. The diagnosis of biceps tendinitis (OR, 3.5) or long head of the biceps tearing (OR, 5.1) at or before the time of surgery was an especially significant risk factor for revision surgery. The high cost of revision surgery highlights the importance of appropriate indications to avoid the need for subsequent procedures.
Recommendations for Infant Feeding Policy and Programs in Dzimauli Region, South Africa: Results From the MAL-ED Birth Cohort
Authors: Mushaphi Lindelani Fhumudzani , Mahopo Tjale Cloupas , Nesamvuni Cebisa Noxolo , Baloyi Brenda , Mashau Ellen , Richardson Jeniata , Dillingham Rebecca , Guerrant Richard , Ambikapathi Ramya , Bessong Pascal 
Published: March 2017

Background: There is strong evidence that exclusive breastfeeding (EBF) in the first 6 months of life reduces the risk of diseases in infancy and in later life. Objective: To understand the maternal reasoning that influences optimum infant feeding practices of caregivers in semirural communities of Limpopo province. Methods: Nested qualitative study among mothers in an ongoing birth cohort study was conducted; structured and semi-structured interviews were used to collect data. Data from 234 infants after 6 months of follow-up was included for quantitative analysis. Four focus discussion groups comprising 7 to 10 caregivers were used to obtain perception of mothers on breastfeeding. A semi-structured interview guide was used to stimulate discussions. Thematic content analyses were conducted to identify the main themes that influence breastfeeding practices of caregivers. Results: Over 90% of the caregivers initiated breastfeeding after delivery. However, less than 1% of mothers practiced EBF by 3 months, and none of the children were exclusively breastfed for up to 6 months. All caregivers introduced non–breast milk liquids and solids by the second month of child’s life. Common reasons for introducing non–breast milk foods included insufficiency of breast milk production, going back to work or school, and influence by elderly women (mothers/mothers-in-law) and church members. Conclusion: Exclusive breastfeeding was not practiced in this community due to cultural and religious beliefs and misinformation. The involvement of elderly women and church members in infant feeding education and promotion programs and the dissemination of breastfeeding information through mobile phones to younger mothers are recommended.
Awareness, Facilitators, and Barriers to Policy Implementation Related to Obesity Prevention for Primary School Children in Malaysia
Authors: Chan Camelina , Moy Foong Ming , Lim Jennifer N. W. , Dahlui Maznah 
Published: March 2017

Purpose: To assess the awareness, facilitators, and barriers to policy implementation related to obesity prevention for primary school children. Design: A cross-sectional study administered using an online questionnaire. Setting: Conducted in 447 primary schools in a state in Malaysia. Participants: One school administrator from each school served as a participant. Measures: The questionnaires consisted of 32 items on awareness, policy implementation, and facilitators and barriers to policy implementation. Analysis: Descriptive analysis was used to describe the awareness, facilitators, and barriers of policies implementation. Association between schools’ characteristics and policy implementation was assessed using logistic regression. Results: The majority (90%) of school administrators were aware of the policies. However, only 50% to 70% of schools had implemented the policies fully. Reported barriers were lack of equipment, insufficient training, and limited time to complete implementation. Facilitators of policy implementation were commitment from the schools, staff members, students, and canteen operators. Policy implementation was comparable in all school types and locality; except the policy on “Food and Drinks sold at the school canteens” was implemented by more rural schools compared to urban schools (odds ratio: 1.74, 95% confidence interval: 1.13-2.69). Conclusion: Majority of the school administrators were aware of the existing policies; however, the implementation was only satisfactory. The identified barriers to policy implementation were modifiable and thus, the stakeholders should consider restrategizing plans in overcoming them.
Evaluation of a Behavioral Intervention With Multiple Components Among Low-Income and Uninsured Adults With Obesity and Diabetes
Authors: Ahn SangNam , Lee Joonhyung , Bartlett-Prescott Jenny , Carson Lisa , Post Lindsey , Ward Kenneth D. 
Published: March 2017

Purpose: To examine the effects of a community-based behavioral intervention with multiple components on health outcomes among low-income and uninsured adults who were obese and had diabetes and treated in a “real-world” setting. Design: A longitudinal design with a retrospective comparison group was used to examine the ability of a health promotion program to improve body mass index (BMI) and hemoglobin A1c (HbA1c) among 87 treatment group and 62 comparison group participants. Setting: Urban/metropolitan city in the United States. Intervention: A community-based behavioral intervention with 3 components including health-coach visits, registered dietitian visits, and exercise consultations delivered over 12 months. Measures: Biometric measurements were collected at baseline, 3, 6, 9, 12, and 18 months, whereas self-reported measurements were collected at baseline, 6 months, and 12 months. Analysis: Linear mixed models with participant-level random intercepts were fitted for BMI and HbA1c. Results: The treatment group demonstrated reductions in BMI (percentage change = −2.1%, P < .001) and HbA1c (−0.6%, P < .001) as well as improvement in diabetes knowledge (+5.4%, P = .025), whereas the comparison group did not show any improvements in biometric measures. Dietitian visits were the most effective treatment component to reduce HbA1c (coefficient = −0.08, P = .025). Conclusion: Multiple component behavioral intervention in community settings, particularly when delivered by registered dietitians, shows promise to combat the dual epidemic of obesity and diabetes among low-income and uninsured patients.
The Efficacy of Using Financial Incentives to Change Unhealthy Behaviors Among a Rural Chronically Ill and Uninsured Population
Authors: Kranker Keith 
Published: March 2017

Purpose: To measure the effects of weight loss, medication compliance, and physical activity financial incentives delivered by health providers to uninsured patients. Design: Full factorial (orthogonal) randomized design. Setting: Primary care clinic in rural Mississippi. Participants: A total of 544 uninsured adult patients with diabetes or hypertension. All patients were enrolled in the clinic’s care management program. Intervention: Patients randomly received 0, 1, 2, or 3 financial incentives. Incentives for weight loss, medication compliance, and physical activity were awarded quarterly over 1 year. Measures: Weight loss, medication compliance, physical activity, and 6 clinical measures related to diabetes and hypertension. Analysis: Cross-section and panel data regression models were used to compare outcomes for those who received incentives to those who did not receive incentives and to measure interaction effects. Results: Effects of the weight loss incentive were positive but statistically insignificant (−3.7 lb; P = .106), while medication compliance was high in both the treatment and control groups (+2.37 percentage points; P = .411), and physical activity take-up was very limited. Effects on clinical outcomes, as well as interaction effects between incentives, were mixed and generally statistically insignificant. Conclusion: This study found little to no evidence that these financial incentives had beneficial effects on the incentivized behaviors in this setting. Likewise, the study found no effects on clinical outcomes nor any systematic evidence of interaction effects between 2 and 3 incentives.
Aquatic Activities During Pregnancy Prevent Excessive Maternal Weight Gain and Preserve Birth Weight: A Randomized Clinical Trial
Authors: Bacchi Mariano , Mottola Michelle F. , Perales Maria , Refoyo Ignacio , Barakat Ruben 
Published: March 2017

Purpose: The aim of the present study was to examine the influence of a supervised and regular program of aquatic activities throughout gestation on maternal weight gain and birth weight. Design: A randomized clinical trial. Setting: Instituto de Obstetricia, Ginecología y Fertilidad Ghisoni (Buenos Aires, Argentina). Participants: One hundred eleven pregnant women were analyzed (31.6 ± 3.8 years). All women had uncomplicated and singleton pregnancies; 49 were allocated to the exercise group (EG) and 62 to the control group (CG). Intervention: The intervention program consisted of 3 weekly sessions of aerobic and resistance aquatic activities from weeks 10 to 12 until weeks 38 to 39 of gestation. Measures: Maternal weight gain, birth weight, and other maternal and fetal outcomes were obtained by hospital records. Analysis: Student unpaired t test and χ2 test were used; P values ≤.05 indicated statistical significance. Cohen’s d was used to determinate the effect size. Results: There was a higher percentage of women with excessive maternal weight gain in the CG (45.2%; n = 28) than in the EG (24.5%; n = 12; odds ratio = 0.39; 95% confidence interval: 0.17-0.89; P = .02). Birth weight and other pregnancy outcomes showed no differences between groups. Conclusion: Three weekly sessions of water activities throughout pregnancy prevents excessive maternal weight gain and preserves birth weight. Trial Registration: The clinicaltrial.gov identifier: NCT 02602106.
Microbial Diversity in Milk of Women With Mastitis: Potential Role of Coagulase-Negative Staphylococci, Viridans Group Streptococci, and Corynebacteria
Authors: Mediano Pilar , Fernández Leonides , Jiménez Esther , Arroyo Rebeca , Espinosa-Martos Irene , Rodríguez Juan M. , Marín María 
Published: March 2017

Background: Lactational mastitis constitutes a significant cause of premature weaning. However, its etiology, linked to the presence of pathogenic microorganisms, has been scarcely reported. Research aim: The aim of this study was to describe the microbial diversity in milk samples from women suffering from lactational mastitis and to identify more accurately a collection of isolates belonging to coagulase-negative staphylococci, streptococci, and coryneform bacteria. Methods: This is a cross-sectional descriptive one-group study. A total of 5,009 isolates from 1,849 mastitis milk samples was identified by culture, biochemical, and/or molecular methods at the species or genus level. A more precise identification of a collection of 211 isolates was carried out by 16S rRNA gene sequencing. Results: Mean total bacterial count in milk samples was 4.11 log10 colony-forming units/ml, 95% confidence interval [4.08, 4.15]. Staphylococcus epidermidis was the most common species being isolated from 91.56% of the samples, whereas Staphylococcus aureus was detected in 29.74%. Streptococci and corynebacteria constituted the second (70.20%) and third (16.60%) most prevalent bacterial groups, respectively, found in this study. In contrast, Candida spp. was present in only 0.54% of the samples. Sequencing of the 16S rRNA gene revealed a high diversity of bacterial species among identified isolates. Conclusion: Many coagulase-negative staphylococci, viridans group streptococci, and corynebacteria, usually dismissed as contaminant bacteria, may play an important role as etiologic agents of mastitis. Proper diagnosis of mastitis should be established after performing microbiological testing of milk based on standardized procedures. A reliable analysis must identify the mastitis-causing pathogen(s) at the species level and its(their) concentration(s).
On religious and secular exemptions: A case study of childhood vaccination waivers
Authors: Pierik Roland 
Published: March 2017

This paper analyses exemptions to general law through the prism of vaccine waivers in the United States. All US states legally require the vaccination of children prior to school or daycare entry; however, this obligation is accompanied with a system of medical, religious, and/or philosophical exemptions. Nonmedical exemptions became subject of discussion after the 2015 Disneyland measles outbreak in California, which unequivocally brought to light what had been brewing below the surface for a while: a slow but steady decline in vaccination rates in Western societies, resulting in the reoccurrence of measles outbreaks. This can be traced back to an increasing public questioning of vaccines by a growing anti-vaccination movement. In reaction to the outbreak and the public outrage it generated, several states proposed—and some already passed—bills to eliminate nonmedical exemptions. I analyze two questions. First, can legal exemptions from mandatory childhood vaccination schemes for parents who are opposed to vaccination (still) be justified? Second, should legal exemptions be limited to religious objections to vaccination, or should they also be granted to secular objections? Although the argument in the paper starts from the example of the US, it seeks to provide a more general philosophical reflection on the question of exemptions from mandatory childhood vaccination.
Evaluation of Deformable Image Registration-Based Contour Propagation From Planning CT to Cone-Beam CT
Authors: Woerner Andrew J. , Choi Mehee , Harkenrider Matthew M. , Roeske John C. , Surucu Murat 
Published: March 2017

Purpose: We evaluated the performance of organ contour propagation from a planning computed tomography to cone-beam computed tomography with deformable image registration by comparing contours to manual contouring. Materials and Methods: Sixteen patients were retrospectively identified based on showing considerable physical change throughout the course of treatment. Multiple organs in the 3 regions (head and neck, prostate, and pancreas) were evaluated. A cone-beam computed tomography from the end of treatment was registered to the planning computed tomography using rigid registration, followed by deformable image registration. The contours were copied on cone-beam computed tomography image sets using rigid registration and modified by 2 radiation oncologists. Contours were compared using Dice similarity coefficient, mean surface distance, and Hausdorff distance. Results: The mean physician-to-physician Dice similarity coefficient for all organs was 0.90. When compared to each physician’s contours, the overall mean for rigid was 0.76 ( P < .001), and it was improved to 0.79 ( P < .001) for deformable image registration. Comparing deformable image registration to physicians resulted in a mean Dice similarity coefficient of 0.77, 0.74, and 0.84 for head and neck, prostate, and pancreas groups, respectively; whereas, the physician-to-physician mean agreement for these sites was 0.87, 0.90, and 0.93 ( P < .001, for all sites). The mean surface distance for physician-to-physician contours was 1.01 mm, compared to 2.58 mm for rigid-to-physician contours and 2.24 mm for deformable image registration-to-physician contours. The mean physician-to-physician Hausdorff distance was 11.32 mm, and when compared to any physician’s contours, the mean for rigid and deformable image registration was 12.1 mm and 12.0 mm ( P < .001), respectively. Conclusion: The physicians had a high level of agreement via the 3 metrics; however, deformable image registration fell short of this level of agreement. The automatic workflows using deformable image registration to deform contours to cone-beam computed tomography to evaluate the changes during treatment should be used with caution.
Estrogen receptor‐dependent attenuation of hypoxia‐induced changes in the lung genome of pulmonary hypertension rats
Authors: Frump Andrea L. , Albrecht Marjorie E. , McClintick Jeanette N. , Lahm Tim 
Published: March 2017

17β‐estradiol (E2) exerts complex and context‐dependent effects in pulmonary hypertension. In hypoxia‐induced pulmonary hypertension (HPH), E2 attenuates lung vascular remodeling through estrogen receptor (ER)‐dependent effects; however, ER target genes in the hypoxic lung remain unknown. In order to identify the genome regulated by the E2‐ER axis in the hypoxic lung, we performed a microarray analysis in lungs from HPH rats treated with E2 (75 mcg/kg/day) ± ER‐antagonist ICI182,780 (3 mg/kg/day). Untreated HPH rats and normoxic rats served as controls. Using a false discovery rate of 10%, we identified a significantly differentially regulated genome in E2‐treated versus untreated hypoxia rats. Genes most upregulated by E2 encoded matrix metalloproteinase 8, S100 calcium binding protein A8, and IgA Fc receptor; genes most downregulated by E2 encoded olfactory receptor 63, secreted frizzled‐related protein 2, and thrombospondin 2. Several genes affected by E2 changed in the opposite direction after ICI182,780 co‐treatment, indicating an ER‐regulated genome in HPH lungs. The bone morphogenetic protein antagonist Grem1 (gremlin 1) was upregulated by hypoxia, but found to be among the most downregulated genes after E2 treatment. Gremlin 1 protein was reduced in E2‐treated versus untreated hypoxic animals, and ER‐blockade abolished the inhibitory effect of E2 on Grem1 mRNA and protein. In conclusion, E2 ER‐dependently regulates several genes involved in proliferative and inflammatory processes during hypoxia. Gremlin 1 is a novel target of the E2‐ER axis in HPH. Understanding the mechanisms of E2 gene regulation in HPH may allow for selectively harnessing beneficial transcriptional activities of E2 for therapeutic purposes.