bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation between Anxiety and Oppositionality in a Children's Mood and Anxiety Disorder Clinic
Authors: Garland E Jane , Garland Orion M 
Published: November 2017

Objective: While parents and clinicians have described oppositional features as interfering with the management of children with anxiety, research on this relation is lacking. We designed this study to investigate the presence of oppositional symptoms in children presenting with mood and anxiety symptoms. Method: In a mood and anxiety disorders clinic, we used the DSM-IV Child Symptom Inventory to document the presence and correlates of oppositional defiant symptoms in 145 preadolescents assessed during a 2-year period. Results: Oppositional defiant symptoms were found to correlate ( P < 0.01) with generalized anxiety symptoms in both parent and teacher ratings. Correlations remained significant after controlling for the presence of symptoms of attention-deficit hyperactivity disorder (ADHD). Parents found both boys and girls to be equally oppositional, while teachers found boys to be significantly more oppositional. Conclusion: Oppositional features are found in clinically referred children with anxiety and are potentially significant for treatment and prognosis of anxiety disorders in children.
Linking Nurses' Clinical Leadership to Patient Care Quality: The Role of Transformational Leadership and Workplace Empowerment
Authors: Boamah Sheila 
Published: November 2017

Background While improving patient safety requires strong nursing leadership, there has been little empirical research that has examined the mechanisms by which leadership influences patient safety outcomes. Aim To test a model examining relationships among transformational leadership, structural empowerment, staff nurse clinical leadership, and nurse-assessed adverse patient outcomes. Methods A cross-sectional survey was conducted with a randomly selected sample of 378 registered nurses working in direct patient care in acute care hospitals across Ontario, Canada. Structural equation modeling was used to test the hypothesized model. Results The model had an acceptable fit, and all paths were significant. Transformational leadership was significantly associated with decreased adverse patient outcomes through structural empowerment and staff nurse clinical leadership. Discussion This study highlights the importance of transformational leadership in creating empowering practice environments that foster high-quality care. The findings indicate that a more complete understanding of what drives desired patient outcomes warrants the need to focus on how to empower nurses and foster clinical leadership practices at the point of care. Conclusion In planning safety strategies, managers must demonstrate transformational leadership behaviors in order to modify the work environment to create better defenses for averting adverse events.
Dynamics of Services Exports in India
Authors: Khurana Richa , Nauriyal D. K. 
Published: November 2017

The article examines the dynamics in specialization pattern of comparative advantage in services exports from India for the time period 2004–2013, while drawing a distinction between the pre- and the post-crisis trends. The analysis is based on a modified revealed symmetric comparative advantage index. It also employs the Galtonian regression and the Markovian transition matrices to study the distribution and intra-distribution dynamics of export patterns. The results reveal that India has a strong comparative advantage in modern services mainly business services and computer and information services. The findings suggest a stable but broadening pattern of specialization of India’s services exports. Further, the transition probabilities reveal that the chances of remaining in or switching to a state of comparative disadvantage are more pronounced than being or moving to a state of comparative advantage. Overall services exports exhibit high persistence in both the pre- and post-crisis period pointing towards a low impact of crisis on India’s services exports. JEL: C14, F14, L80
Molecular Epidemiology of Extended-Spectrum β-Lactamase–Producing Escherichia coli Pathotypes in Diarrheal Children from Low Socioeconomic Status Communities in Bihar, India: Emergence of the CTX-M Type
Authors: Mandal Abhishek , Sengupta Abhishek , Kumar Ajay , Singh Utpal K , Jaiswal Anil K , Das Pradeep , Das Sushmita 
Published: November 2017

Background: Childhood diarrheal diseases remain highly endemic in India, but the emergence of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli among children with diarrhea in Bihar remains elusive. In this study, we determine and characterize ESBL-producing E coli pathotypes among hospitalized diarrheal preschool children living in low socioeconomic level communities in Bihar, India. Materials and methods: The stool samples were collected everyday throughout the year for 2 consecutive years. In our study, we collected stool samples randomly from every fifth patient. Stool samples were collected from a total of 633 randomly selected diarrheal children (age: 0-60 months) belonging to 17 communities and screened for identification of virulent diarrheagenic E coli (DEC) pathotype (viz, enteropathogenic E coli [EPEC], enteroaggregative E coli [EAEC], enterotoxigenic E coli [ETEC], enteroinvasive E coli [EIEC], and enterohemorrhagic E coli [EHEC]) by a multiplex polymerase chain reaction (PCR) assay. Furthermore, ESBLs were screened by conventional antibiotic resistance pattern testing and later characterized for the presence of β-lactamase ( bla) genes by PCR and DNA sequencing. Results: Diarrheagenic E coli was detected in 191 cases (30.2%) of the total 633 diarrheic children. Maximum occurrence of DEC was found in ≤12 months age group (72.7%) with prevalence of the EAEC pathotype. Most isolates were resistant to ampicillin, ciprofloxacin, piperacillin, levofloxacin, ceftazidime, cefotaxime, ceftriaxone, and gentamicin, whereas over 96% of them were sensitive to amikacin. About 37.6% of total 191 DEC isolates were ESBL producers (n = 72), being prevalent among ETEC (n = 35; 18.32%), followed by EPEC (n = 21; 10.9%), EAEC (n = 13; 6.8%), and EIEC (n = 3; 1.57%). Interestingly, the commonest β-lactamase was CTX-M type ( blaCTX-M) in 86.1% (n = 62) of the ESBL isolates, followed by blaSHV (n = 49; 68%), blaTEM (n = 37; 51.8%), and blaOXA (n = 21; 29.1%) determinants. Resistance of ESBL isolates was mostly related to ampicillin (100%), ceftriaxone (98.1%), cefotaxime (92.4%), gentamicin (74.1%), and levofloxacin (73.2%), whereas best antimicrobial activities were observed for piperacillin-tazobactam, amikacin, meropenem, and imipenem. Conclusions: This study revealed that EAEC (72.1%) is the predominant pathotype in Bihar, significantly high in ≤12 months age group children ( P = .04). Moreover, the widespread prevalence of ESBLs in children, especially the CTX-M type, is of great concern, which requires monitoring of infection control measures through efficient antimicrobial management and detection of ESBL-producing isolates.
Regulatory landscapes for biomarkers and diagnostic tests: Qualification, approval, and role in clinical practice
Authors: Mattes William B. , Goodsaid Federico 
Published: November 2017

While the term ‘biomarker’ is relatively new, the concept is millennia old. However, with the introduction of new technologies to discover potential biomarkers comes the need to assess their utility and veracity for any given use. This is particularly true for the use of biomarkers to support regulatory decisions in medical product development. Hence the US Food and Drug Administration has developed processes for the qualification of biomarkers and other medical product development tools, processes that are underscored by recent legislation (i.e. the 21st Century Cures Act). In addition to these qualification processes, diagnostic tests that measure a biomarker may follow a process for regulatory decision through the processes that evaluate companion diagnostics. This mini-review provides an overview of these processes and their role in pharmaceutical development and clinical use. Impact statement This work summarizes very recent developments in the US FDA’s biomarker qualification program. Furthermore, it contrasts biomarker qualification with companion diagnostic evaluation. As such, it will be highly informative for researches considering taking a biomarker discovery farther along the road to validation.
Beliefs about smoking-related lung cancer risk among low socioeconomic individuals: the role of smoking experience and interpersonal communication
Authors: Bekalu Mesfin Awoke , Minsky Sara , Viswanath Kasisomayajula 
Published: November 2017

Introduction: Previous research has documented that smoking prevalence is generally high among low socioeconomic groups and that tobacco industries continue to target these population groups. However, little research has investigated the beliefs of individuals with low socioeconomic position (SEP) about the association between smoking and cancer risks. In this study, we examined beliefs about smoking-related lung cancer risk and the role of smoking experience, mass media exposure and health-related interpersonal communication among a sample of low SEP population. Methods: Data were gathered from 324 urban poor recruited from adult education centers in the greater Boston area, Massachusetts, USA as part of a larger project called Click to Connect. While we collected a variety of data at baseline and follow-up, the data for this study come from the baseline survey alone. Results: We found that individuals with smoking experience tend to be better than those without in perceiving the lung cancer risks of smoking. Moreover, we found that health-related interpersonal communication with friends and family members is positively associated with beliefs about the link between smoking and lung cancer. Conclusion: Our findings suggest that low SEP individuals with smoking experience might be more exposed to anti-tobacco messages than are low SEP individuals without smoking experience. This could suggest that anti-tobacco interventions thus far may have done very little in raising the awareness of low SEP nonsmokers about the dangers of smoking and that they may have little potential to avert the initiation of smoking in this population.
Performance of Pediatric Risk of Mortality Score Among Critically Ill Children With Heart Disease
Authors: Russell Rebecca A. , Rettiganti Mallikarjuna , Brundage Nancy , Jeffries Howard E. , Gupta Punkaj 
Published: November 2017

Objective: To evaluate the performance of the Pediatric Risk of Mortality 3 (PRISM-3) score in critically ill children with heart disease. Methods: Patients <18 years of age admitted with cardiac diagnoses (cardiac medical and cardiac surgical) to one of the participating pediatric intensive care units in the Virtual Pediatric Systems, LLC, database were included. Performance of PRISM-3 was evaluated with discrimination and calibration measures among both cardiac surgical and cardiac medical patients. Results: The study population consisted of 87,993 patients, of which 49% were cardiac medical patients (n = 43,545) and 51% were cardiac surgical patients (n = 44,448). The ability of PRISM-3 to distinguish survivors from nonsurvivors was acceptable for the entire cohort (c-statistic 0.86). However, PRISM-3 did not perform as well when stratified by varied severity of illness categories. Pediatric Risk of Mortality 3 underpredicted mortality among patients with lower severity of illness categories (quintiles 1-4) whereas it overpredicted mortality among patients with greatest severity of illness category (fifth quintile). When stratified by Society of Thoracic Surgeons–European Association for Cardiothoracic Surgery (STS-EACTS) categories, PRISM-3 overpredicted mortality among the STS-EACTS mortality categories 1, 2, and 3 and underpredicted mortality among the STS-EACTS mortality categories 4 and 5. Pediatric Risk of Mortality 3 overpredicted mortality among centers with high cardiac surgery volume whereas it underpredicted mortality among centers with low cardiac surgery volume. Conclusion: Data from this large multicenter study do not support the use of PRISM-3 in cardiac surgical or cardiac medical patients. In this study, the ability of PRISM-3 to distinguish survivors from nonsurvivors was fair at best, and the accuracy with which it predicted death was poor.
Accuracy of pedicle screw placement based on preoperative computed tomography versus intraoperative data set acquisition for spinal navigation system
Authors: Liu Hao , Chen Weikai , Liu Tao , Meng Bin , Yang Huilin 
Published: November 2017

Aim: To investigate the accuracy of pedicle screw placement based on preoperative computed tomography in comparison with intraoperative data set acquisition for spinal navigation system. Methods: The PubMed (MEDLINE), EMBASE, and Web of Science were systematically searched for the literature published up to September 2015. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Statistical analysis was performed using the Review Manager 5.3. The dichotomous data for the pedicle violation rate was summarized using relative risk (RR) and 95% confidence intervals (CIs) with the fixed-effects model. The level of significance was set at p < 0.05. Results: For this meta-analysis, seven studies used a total of 579 patients and 2981 screws. The results revealed that the accuracy of intraoperative data set acquisition method is significantly higher than preoperative one using 2 mm grading criteria (RR: 1.82, 95% CI: 1.09, 3.04, I2 = 0%, p = 0.02). However, there was no significant difference between two kinds of methods at the 0 mm grading criteria (RR: 1.13, 95% CI: 0.88, 1.46, I2 = 17%, p = 0.34). Using the 2-mm grading criteria, there was a higher accuracy of pedicle screw insertion in O-arm-assisted navigation than CT-based navigation method (RR: 1.96, 95% CI: 1.05, 3.64, I2 = 0%, p = 0.03). The accuracy between CT-based navigation and two-dimensional-based navigation showed no significant difference (RR: 1.02, 95% CI: 0.35-3.03, I2 = 0%, p = 0.97). Conclusions: The intraoperative data set acquisition method may decrease the incidence of perforated screws over 2 mm but not increase the number of screws fully contained within the pedicle compared to preoperative CT-based navigation system. A significantly higher accuracy of intraoperative (O-arm) than preoperative CT-based navigation was revealed using 2 mm grading criteria.
Cut-off values of the Japanese Orthopaedic Association score corresponding to Constant scores for evaluating outcomes in rotator cuff tear
Authors: Kawakami Junichi , Gotoh Masafumi , Matsuura Koumei , Shin Kunichika , Fujito Ikuhisa , Tanaka Aya , Matsunaga Saho , Imai Takaki , Nagamatsu Takashi , Madokoro Kazuya , Shiba Naoto 
Published: November 2017

Purpose: To clarify the cut-off value of the Japanese Orthopaedic Association (JOA) score corresponding to rotator cuff tear outcome as evaluated by the Constant score. Methods: The subjects were 230 patients with rotator cuff tear. The Constant and JOA scores on the first examination in our hospital were evaluated. After investigation of the correlation between the Constant and JOA scores, the cut-off JOA score was calculated, corresponding to excellent, good and fair outcomes as evaluated by the Constant score. Results: The Constant and JOA scores on the first examination were 49.64 ± 12.84 and 72.52 ± 12.84, respectively, with a strong correlation ( r = 0.87, p < 0.01). Receiver operating characteristic analysis revealed that the cut-off JOA score was 87.0 for excellent outcome (area under the curve, AUC: 0.93; sensitivity: 100%; specificity: 88.6%; p < 0.01), 84.0 for good outcome (AUC: 0.94; sensitivity: 100%; specificity: 83.4%; p < 0.01) and 78.0 for fair outcome (AUC: 0.88; sensitivity: 100%; specificity: 71.3%; p < 0.01). Conclusions: In patients with rotator cuff tear, good outcome as judged by a Constant score of ≥80 corresponds to a JOA score cut-off of 84.0. Judgement of the treatment outcomes and evaluation of the surgical method may be more accurate when using clear cut-off values for the scoring system employed, such as those determined in our study.
Discharge Disposition Costs Following Total Shoulder Arthroplasty: A Comprehensive National Analysis
Authors: Rosas Samuel , Kurowicki Jennifer , Triplet Jacob J , Berglund Derek D , Horn Brandon , Levy Jonathan C 
Published: November 2017

Background Total shoulder arthroplasty (TSA) is the fastest growing sector of arthroplasty in the United States. One of the greatest drivers of costs following joint replacement surgery has been shown to be discharge disposition. This study examines the costs associated in the first 90 days of care following shoulder arthroplasty with a specific focus on the effects of discharge disposition. Methods We conducted a retrospective, case–control study of the entire Medicare population from 2011 to 2014 identifying TSA patients based on International Classification of Disease ninth revision codes. Only patients with demographic and discharge information were included. Costs were analyzed based on mean reimbursements. Patients were stratified according to 4 disposition groups: home, skilled nursing facility (SNF), intermediate care facility (ICF), and inpatient rehabilitation (InR). The correlation of the Charlson Comorbidity Index (CCI) to discharge disposition was also examined. Results A total of 50 979 patients met the inclusion criteria. The mean 90-day costs for patients discharged home were $12 691 (standard deviation [SD]: $471.9), for those who went to an SNF was $15 093 (SD: $622.4), for ICF $15 473 (SD: $2366) and for those who went to InR $24 731 (SD: $1922; P < .001). Over the 4-year period, trends in discharge to home significantly increased ( P = .037), while trends in discharge to InR significantly decreased ( P = .015). The CCI correlated significantly with discharge disposition setting ( P < .001). Conclusion The 90-day reimbursements of TSA are significantly affected by discharge disposition. Although discharge to home continues to increase, patients with a greater comorbidity burden are discharged more often to an inpatient facility.
Chronic disease burden and frailty in survivors of childhood HSCT: a report from the St. Jude Lifetime Cohort Study
Authors: Eissa Hesham M. , Lu Lu , Baassiri Malek , Bhakta Nickhill , Ehrhardt Matthew J. , Triplett Brandon M. , Green Daniel M. , Mulrooney Daniel A. , Robison Leslie L. , Hudson Melissa M. , Ness Kirsten K. 
Published: November 2017

Key Points
Childhood HSCT survivors suffer from a higher burden of severe/life-threatening conditions compared to conventional therapy survivors. Seven percent of HSCT survivors exhibit frailty phenotype at early age, placing them at higher risk for early mortality.
The Japanese version of the questionnaire about the process of recovery: development and validity and reliability testing
Authors: Kanehara Akiko , Kotake Risa , Miyamoto Yuki , Kumakura Yousuke , Morita Kentaro , Ishiura Tomoko , Shimizu Kimiko , Fujieda Yumiko , Ando Shuntaro , Kondo Shinsuke , Kasai Kiyoto 
Published: November 2017

AbstractBackgroundPersonal recovery is increasingly recognised as an important outcome measure in mental health services. This study aimed to develop a Japanese version of the Questionnaire about the Process of Recovery (QPR-J) and test its validity and reliability.MethodsThe study comprised two stages that employed the cross-sectional and prospective cohort designs, respectively. We translated the questionnaire using a standard translation/back-translation method. Convergent validity was examined by calculating Pearson’s correlation coefficients with scores on the Recovery Assessment Scale (RAS) and the Short-Form-8 Health Survey (SF-8). An exploratory factor analysis (EFA) was conducted to examine factorial validity. We used intraclass correlation and Cronbach’s alpha to examine the test-retest and internal consistency reliability of the QPR-J’s 22-item full scale, 17-item intrapersonal and 5-item interpersonal subscales. We conducted an EFA along with a confirmatory factor analysis (CFA).ResultsData were obtained from 197 users of mental health services (mean age: 42.0 years; 61.9% female; 49.2% diagnosed with schizophrenia). The QPR-J showed adequate convergent validity, exhibiting significant, positive correlations with the RAS and SF-8 scores. The QPR-J’s full version, subscales, showed excellent test-retest and internal consistency reliability, with the exception of acceptable but relatively low internal consistency reliability for the interpersonal subscale. Based on the results of the CFA and EFA, we adopted the factor structure extracted from the original 2-factor model based on the present CFA.ConclusionThe QPR-J is an adequately valid and reliable measure of the process of recovery among Japanese users with mental health services.
Compatibility of Family History Cancer Guidelines With Meaningful Use Standards
Authors: Aziz Ayesha , Pflieger Lance , O’Connell Nathaniel , Schiffman Joshua , Welch Brandon M. 
Published: November 2017

Purpose To evaluate the potential of implementing established family cancer guidelines as clinical decision support within meaningful use (MU)–compliant health information technology systems. Methods We conducted a systematic analysis of cancer guidelines involving family health history (FHx) published before 2015. By comparing existing cancer guideline statements to current MU FHx standard requirements, we determined whether the cancer guideline statements could be implemented as clinical decision support. For guidelines that could not implemented, we determined the primary reasons for incompatibility. Results A total of 531 statements from 55 guidelines published by 11 different organizations were reviewed and analyzed. Overall, 18% to 66% of guideline statements could or could not be implemented in MU-compliant health information technology systems, depending on which MU standard was used. Health Level Seven (HL7) models performed better than SNOMED models. Implementability of guideline statements varied by cancer type and guideline organizations. The greatest deficiencies in implementability of statements were largely a result of the fact that MU standards required only first-degree relatives and that FHx terms used in guidelines statements were ambiguous. Conclusion FHx cancer guidelines and MU-based systems vary widely and are mostly incompatible. We identified sources of incompatibility and made recommendations that could improve the implementability of FHx cancer guidelines. Our findings and recommendations can enhance the use of established FHx cancer risk guidelines in routine clinical workflows.
Perioperative risk
Authors: Lacey JRN , Khan N , Oliver CM 
Published: November 2017

The high-risk surgical patient is a growing challenge to modern health care. This cohort, although comprising only 10–15% of surgical procedures, accounts for approximately 80% of postoperative deaths and suffers a high rate of postoperative morbidity. Developing robust systems to help identify and better manage this patient group should be a priority. Risk stratification has become a valuable clinical tool for shared decision-making and the development of individualized care plans. Methods for stratifying individual risk include assessment tools, measures of functional capacity and plasma biomarker assays. Routine evaluation of perioperative risk is central to the delivery of high quality, appropriate surgical care.