bluuebunny/crossref_metadata_2025_split huggingface dataset:
Translating Health Services Research into Practice in the Safety Net
Authors: Moore Susan L. , Fischer Ilana , Havranek Edward P. 
Published: December 2015

ObjectiveTo summarize research relating to health services research translation in the safety net through analysis of the literature and case study of a safety net system.Data Sources/Study SettingLiterature review and key informant interviews at an integrated safety net hospital.Study DesignThis paper describes the results of a comprehensive literature review of translational science literature as applied to health care paired with qualitative analysis of five key informant interviews conducted with senior‐level management at Denver Health and Hospital Authority.Principal FindingsResults from the literature suggest that implementing innovation may be more difficult in the safety net due to multiple factors, including financial and organizational constraints. Results from key informant interviews confirmed the reality of financial barriers to innovation implementation but also implied that factors, including institutional respect for data, organizational attitudes, and leadership support, could compensate for disadvantages.ConclusionsTranslating research into practice is of critical importance to safety net providers, which are under increased pressure to improve patient care and satisfaction. Results suggest that translational research done in the safety net can better illuminate the special challenges of this setting; more such research is needed.
Paediatric critical procedures in the emergency department: Incidence, trends and the physician experience
Authors: Nguyen Lucia D , Craig Simon 
Published: December 2015

AbstractObjectivesTo analyse and provide current data surrounding paediatric critical procedures performed in three EDs of a single Victorian health network.MethodsWe conducted a retrospective study of every paediatric ED attendance requiring management in a resuscitation cubicle at three Victorian hospitals in 2013. The primary outcome measure was the frequency of each paediatric critical procedure performed in the ED during the 12 month study period. Additional outcome measures included details of the proceduralist and of patient presentations.ResultsAcross the three EDs, there were 54 633 paediatric presentations during the study period. 5895 patients were assessed in a resuscitation cubicle and of these, only 37 presentations required one or more critical procedures (7/10 000 presentations). A total of 53 critical procedures were performed. 83% (n = 43) of emergency physicians did not perform a single paediatric critical procedure during the study period.Endotracheal intubation was the most commonly performed critical procedure with 40 attempts (74% of procedures); however, 83% of the full‐time emergency physicians regularly exposed to paediatric presentations did not attempt or supervise a single paediatric intubation over the 12 months. 49% of patients who received a critical procedure were under 3 years of age and the most common diagnostic categories were seizure, respiratory and trauma.ConclusionCritical procedures in children occur infrequently. Clinical exposure in the ED is therefore unreliable as the sole source of experience for critical procedures.
Measuring the immune system of the three‐spined stickleback – investigating natural variation by quantifying immune expression in the laboratory and the wild
Authors: Robertson Shaun , Bradley Janette E. , MacColl Andrew D. C. 
Published: December 2015

AbstractCurrent understanding of the immune system comes primarily from laboratory‐based studies. There has been substantial interest in examining how it functions in the wild, but studies have been limited by a lack of appropriate assays and study species. The three‐spined stickleback (Gasterosteus aculeatus L.) provides an ideal system in which to advance the study of wild immunology, but requires the development of suitable immune assays. We demonstrate that meaningful variation in the immune response of stickleback can be measured using real‐time PCR to quantify the expression of eight genes, representing the innate response and Th1‐, Th2‐ and Treg‐type adaptive responses. Assays are validated by comparing the immune expression profiles of wild and laboratory‐raised stickleback, and by examining variation across populations on North Uist, Scotland. We also compare the immune response potential of laboratory‐raised individuals from two Icelandic populations by stimulating cells in culture. Immune profiles of wild fish differed from laboratory‐raised fish from the same parental population, with immune expression patterns in the wild converging relative to those in the laboratory. Innate measures differed between wild populations, whilst the adaptive response was associated with variation in age, relative size of fish, reproductive status and S. solidus infection levels. Laboratory‐raised individuals from different populations showed markedly different innate immune response potential. The ability to combine studies in the laboratory and in the wild underlines the potential of this toolkit to advance our understanding of the ecological and evolutionary relevance of immune system variation in a natural setting.
Can public health registry data improve Emergency Medical Dispatch?
Authors: Andersen M S. , Christensen E. F. , Jepsen S. B. , Nørtved J. , Hansen J. B. , Johnsen S. P. 
Published: December 2015

BackgroundEmergency Medical Dispatchers make decisions based on limited information. We aimed to investigate if adding demographic and hospitalization history information to the dispatch process improved precision.MethodsThis 30‐day follow‐up study evaluated time‐critical emergencies in contact with the emergency phone number 112 in Denmark during 18 months. ‘Time‐critical’ was defined as suspected First Hour Quintet (FHQ) (cardiac arrest, chest pain, stroke, difficulty breathing, trauma). The association of age, sex, and hospitalization history with adverse outcomes was examined using logistic regression. The predictive ability was assessed via area under the curve (AUC) and Hosmer–Lemeshow tests.ResultsOf 59,943 patients (median age 63 years, 45% female), 44–45.5% had at least one chronic condition, 3880 (6.47%) died the day or the day after (primary outcome) calling 112. Age 30–59 was associated with increased adjusted odds ratio (OR) of death on day 1 of 3.59 [2.88–4.47]. Male sex was associated with an increased adjusted OR of death on day 1 of 1.37 [1.28–1.47]. Previous hospitalization with nutritional deficiencies (adjusted OR 2.07 [1.47–2.92]) and severe chronic liver disease (adjusted OR 2.02 [1.57–2.59]) was associated with a higher risk of death. For trauma patients, the discriminative ability of the model showed an AUC of 0.74 for death on day 1.ConclusionIncreasing age, male sex, and hospitalization history was associated with increased risk of death on day 1 for FHQ 112 callers. Additional efforts are warranted to clarify the role for risk prediction tools in emergency medical dispatch.
Long live FOXO: unraveling the role of FOXO proteins in aging and longevity
Authors: Martins Rute , Lithgow Gordon J. , Link Wolfgang 
Published: December 2015

SummaryAging constitutes the key risk factor for age‐related diseases such as cancer and cardiovascular and neurodegenerative disorders. Human longevity and healthy aging are complex phenotypes influenced by both environmental and genetic factors. The fact that genetic contribution to lifespan strongly increases with greater age provides basis for research on which “protective genes” are carried by long‐lived individuals. Studies have consistently revealed FOXO (Forkhead box O) transcription factors as important determinants in aging and longevity. FOXO proteins represent a subfamily of transcription factors conserved from Caenorhabditis elegans to mammals that act as key regulators of longevity downstream of insulin and insulin‐like growth factor signaling. Invertebrate genomes have one FOXO gene, while mammals have four FOXO genes: FOXO1, FOXO3, FOXO4, and FOXO6. In mammals, this subfamily is involved in a wide range of crucial cellular processes regulating stress resistance, metabolism, cell cycle arrest, and apoptosis. Their role in longevity determination is complex and remains to be fully elucidated. Throughout this review, the mechanisms by which FOXO factors contribute to longevity will be discussed in diverse animal models, from Hydra to mammals. Moreover, compelling evidence of FOXOs as contributors for extreme longevity and health span in humans will be addressed.
Effects of Mini‐Volume Priming During Cardiopulmonary Bypass on Clinical Outcomes in Low‐Bodyweight Neonates: Less Transfusion and Postoperative Extracorporeal Membrane Oxygenation Support
Authors: Kim Sang Yoon , Cho Sungkyu , Choi Eunseok , Kim Woong‐Han 
Published: December 2015

AbstractMixing of autologous blood with priming volume has relatively significant effects on blood composition, especially in low‐bodyweight neonates. In an effort to reduce these effects, mini‐volume priming (MP) has been applied in cardiopulmonary bypass (CPB). The present study was designed to examine the effect of MP on clinical outcomes of low‐bodyweight neonates undergoing open heart surgery.We retrospectively reviewed medical records of low‐bodyweight (2.5 kg or less) neonates who underwent open heart surgery in our center from January 2000 to December 2014. A total of 64 patients were included. MP was introduced in 2007, and became a routine protocol in 2009. Preoperative and intraoperative characteristics included age, bodyweight, RACHS‐1, priming volume, CPB time, and aortic cross‐clamp time, transfusion, and hematocrit during CPB. Clinical outcomes included 30‐day mortality, postoperative extracorporeal membrane oxygenation (ECMO) support, open sternum status, prolonged mechanical ventilation care (>7 days), and acute renal failure. MP was utilized in 39 patients and conventional priming (CP) was used in 25 patients. The priming volume decreased to 126.0 mL in the MP group compared with 321.6 mL in the CP group. Transfusion volume during CPB was 87.3 mL in the MP group versus 226.8 mL in the CP group, and the difference was statistically significant (P < 0.001). Hematocrit at the end of the CPB and maximal decrease of hematocrit during CPB were not significantly different between the two groups. The 30‐day mortality rate was 12.8% in the MP group versus 20.0% in the CP group. Postoperative ECMO support was performed in 5.1% of patients in the MP group versus 17.4% of patients in the CP group. Open sternum status was required in 20.8% of patients in the MP group versus 10.3% of patients in the CP group, and prolonged ventilator care was required in 54.2% of patients in the MP group versus 38.5% of patients in the CP group. However, no statistical significance was measured in any of the clinical outcome measures. Larger priming volume and higher RACHS‐1 were significant risk factors of postoperative ECMO support in univariate and multivariate analysis. The results of the present study suggest that MP may be beneficial in avoiding transfusion without having a significant effect on the hematocrit. Clinical outcomes did not differ between the two groups. However, larger priming volume was a significant risk factor for postoperative ECMO support with RACHS‐1 category.
Characterizing the lacrimal punctal region using anterior segment optical coherence tomography
Authors: Timlin Hannah M. , Keane Pearse A. , Day Alexander C. , Salam Tahrina , Abdullah Mohammed , Rose Geoffrey E. , Ezra Daniel G. 
Published: December 2015

AbstractPurposeAbnormalities of lacrimal punctum size and morphology probably contribute to excess tearing, with significant effects on quality‐of‐life for affected individuals. Our current understanding of normal punctal morphology originates from ex vivo studies, which are unlikely to capture the true nature of the living punctum. This study used enhanced depth anterior segment optical coherence tomography (OCT) to give improved characterization and understanding of lacrimal punctal structure.MethodsQualitative and quantitative assessments were performed on spectral domain OCT images collected prospectively from 40 lower puncta of 20 healthy volunteers.ResultsThe average external lower lid punctal diameter was 0.646 mm (SD 150 μm) on OCT imaging, measured at the largest diameter, which was in parallel to the mucocutaneous junction. Fifty‐five per cent of puncta appeared closed, whilst the eyelids were open. Fluid menisci were visible within 73% of puncta. A postpunctal ‘ampulla’ was visible within three systems, one of which was imaged through the conjunctival surface. Ampullary dilatation occurred laterally, rather than at the medial wall.ConclusionOptical coherence tomography provides quick and non‐invasive assessment of the lacrimal punctum and its neighbouring tissue layers. This assessment of punctal size and morphology has the potential for further investigation of punctal physiology, for aiding diagnosis, and for monitoring the results of treatment. The average external diameter of the punctal opening measured in this study is greater than that recorded in anatomical textbooks.
Discrepancies between plasma procalcitonin and C‐reactive protein levels are common in acute illness
Authors: Ivaska Lauri , Elenius Varpu , Mononen Ilkka , Ruuskanen Olli , Peltola Ville 
Published: December 2015

AbstractAimProcalcitonin (PCT) and C‐reactive protein (CRP) are biomarkers of bacterial infection with distinct clinical qualities. This study aimed to determine the occurrence and significance of discrepancies in plasma PCT and CRP levels in hospitalised children.MethodsThis was a single centre, retrospective analysis of simultaneous PCT and CRP measurements. Clinical characteristics, microbiological findings and diagnoses were compared between cases in which only PCT or CRP levels were elevated.ResultsWe studied 635 pairs of PCT and CRP measurements and found discrepancies in 29% of these. In the group with increased PCT and low CRP, there were more children with hypoxia or haemodynamic stress (14 versus 0, p < 0.001) and more bacteraemic patients (eight versus zero, p = 0.001) than in the group with low PCT and increased CRP. The latter group was associated with focal bacterial infections (three versus 18, p = 0.009), inflammatory conditions (one versus 12, p = 0.016) and postoperative setting (one versus 19, p = 0.001). Diabetic ketoacidosis was associated with a marked elevation of PCT.ConclusionDiscrepancies in plasma PCT and CRP levels occurred in 29% of acutely ill children. Both biomarkers can increase in the absence of bacterial infection, but PCT may offer an advantage over CRP in the diagnosis of bacteraemia.
Emergency Preservation and Resuscitation Trial: A Philosophical Justification for Non‐Voluntary Enrollment
Authors: Tigard Daniel 
Published: December 2015

AbstractIn a current clinical trial for Emergency Preservation and Resuscitation (EPR), Dr. Samuel Tisherman of the University of Maryland aims to induce therapeutic hypothermia in order to ‘buy time’ for operating on victims of severe exsanguination. While recent publicity has framed this controversial procedure as ‘killing a patient to save his life’, the US Army and Acute Care Research appear to support the study on the grounds that such patients already face low chances of survival. Given that enrollment in the trial must be non‐voluntary, the study has received an exemption from federal standards for obtaining informed consent. How exactly, if at all, is non‐voluntary enrollment morally justifiable? In this essay, I appeal to the notable work of Hans Jonas in an effort to defend the EPR trial's use of non‐voluntary enrollment. It is often thought and, as I show, it may appear that Jonas has called for the end of experimental medical practice. Still, I derive from Jonas a principle of double‐effect upon which physicians may be seen as morally permitted to pursue innovations in emergency medicine but only as a byproduct of pursuing therapeutic success. With this position, I argue that the EPR trial can be granted a stronger philosophical justification than simply waiving the requirement of obtaining informed consent. The double‐effect justification would obtain, perhaps regardless of the success of such innovative procedures as therapeutic hypothermia.
Functional advantage of educated KIR2DL1+ natural killer cells for anti-HIV-1 antibody-dependent activation
Authors: Gooneratne S L , Center R J , Kent S J , Parsons M S 
Published: December 2015

Summary
Evidence from the RV144 HIV-1 vaccine trial implicates anti-HIV-1 antibody-dependent cellular cytotoxicity (ADCC) in vaccine-conferred protection from infection. Among effector cells that mediate ADCC are natural killer (NK) cells. The ability of NK cells to be activated in an antibody-dependent manner is reliant upon several factors. In general, NK cell-mediated antibody-dependent activation is most robust in terminally differentiated CD57+ NK cells, as well as NK cells educated through ontological interactions between inhibitory killer immunoglobulin-like receptors (KIR) and their major histocompatibility complex class I [MHC-I or human leucocyte antigen (HLA-I)] ligands. With regard to anti-HIV-1 antibody-dependent NK cell activation, previous research has demonstrated that the epidemiologically relevant KIR3DL1/HLA-Bw4 receptor/ligand combination confers enhanced activation potential. In the present study we assessed the ability of the KIR2DL1/HLA–C2 receptor/ligand combination to confer enhanced activation upon direct stimulation with HLA-I-devoid target cells or antibody-dependent stimulation with HIV-1 gp140-pulsed CEM.NKr-CCR5 target cells in the presence of an anti-HIV-1 antibody source. Among donors carrying the HLA-C2 ligand for KIR2DL1, higher interferon (IFN)-γ production was observed within KIR2DL1+ NK cells than in KIR2DL1– NK cells upon both direct and antibody-dependent stimulation. No differences in KIR2DL1+ and KIR2DL1– NK cell activation were observed in HLA-C1 homozygous donors. Additionally, higher activation in KIR2DL1+ than KIR2DL1– NK cells from HLA–C2 carrying donors was observed within less differentiated CD57– NK cells, demonstrating that the observed differences were due to education and not an overabundance of KIR2DL1+ NK cells within differentiated CD57+ NK cells. These observations are relevant for understanding the regulation of anti-HIV-1 antibody-dependent NK cell responses.
Trajectory of problem behaviours of Korean adopted children: using piecewise hierarchical linear growth modelling
Authors: Ahn Jaejin , Byun Mi‐hee , Kwon Ji‐sung 
Published: December 2015

AbstractThis study examined the trajectory of problem behaviours in domestically adopted children in South Korea as they aged. This study used the Panel Study on Korean Adopted Children's longitudinal, three‐wave data (2006, 2008 and 2010). Although data were collected at three time points, our data consisted of six time points, which covered the 5–10 years age range of the adopted children at the time of survey. One hundred sixty‐four children were included in the analysis, 75 of whom contributed to one time point, 74 to two time points and 15 to three time points. The trajectory of the problem behaviours of adopted children was examined using a piecewise hierarchical linear growth model. Because the initial exploration of the data suggested non‐linear changes in behaviour problems over time, we split the growth trajectory into two time periods: Time 1 (5–7 years) and Time 2 (7–10 years). A two‐rate model was used to estimate separate slopes for the two time periods. Results showed that the externalizing and internalizing problems of adopted children have different trajectories. Internalizing problems did not show significant changes after 5 years of age, while externalizing problems increased until 7 years of age and decreased significantly thereafter.
Enhancing the Value and Validity of EIA: Serious Science to Protect Australia's Great Barrier Reef
Authors: Sheaves Marcus , Coles Rob , Dale Pat , Grech Alana , Pressey Robert L. , Waltham Nathan J. 
Published: December 2015

AbstractThe unique values of Australia's Great Barrier Reef (GBR) are under threat from environmental change and the unforeseen, cumulative consequences of coastal development. Development decisions are underpinned by Environmental Impact Assessments (EIAs) but these are plagued by inconsistent methods and a lack of independent evaluation, leading to perceptions of inadequate scientific rigor. To be credible and effective, EIAs should be subject to independent peer review, the yardstick applied in the normal process of science. Without it, decisions based on EIA are at best contestable and potentially invalid. Peer review should be applied to the whole EIA process from project development to reporting and auditing approval requirements. It should be based on rigorous, standard protocols, and produce standardized and publicly available data. Securing the future of the GBR and other global natural assets requires refocusing EIA so it becomes a tool for strategic environmental protection rather than ad hoc permitting of development.
A Policy‐Driven Knowledge Agenda for Global Forest and Landscape Restoration
Authors: Chazdon Robin L. , Brancalion Pedro H. S. , Lamb David , Laestadius Lars , Calmon Miguel , Kumar Chetan 
Published: December 2015

AbstractThe global restoration movement is gaining momentum. International and national leaders are demonstrating unparalleled political will for achieving ambitious targets. However, the knowledge base for implementing large‐scale forest and landscape restoration (FLR) needs further development. Besides application of scientific and local knowledge, a broad understanding of the social, economic, and environmental context in which this knowledge is being applied is also needed. To address knowledge gaps and guide implementation of FLR at local to global scales we propose a knowledge creation agenda that we derive from emerging policy goals. We present a holistic approach that addresses food security, ecosystem services, and livelihoods, and that supports implementation by a wide array of actors from farmers and municipalities to corporations and state agencies. Our knowledge creation agenda is based on six broad policy goals, with several associated knowledge gaps for each goal. We recognize that this agenda is simply a starting point and will surely evolve and become more locally focused as the concept of FLR gains ground and as multiple groups of stakeholders engage in the long‐term process of restoring functionality and value to ecosystems and landscapes around the world.