bluuebunny/crossref_metadata_2025_split huggingface dataset:
Soft Factors, Smooth Transport? The role of safety climate and team processes in reducing adverse events during intrahospital transport in intensive care
Authors: Latzke Markus , Schiffinger Michael , Zellhofer Dominik , Steyrer Johannes 
Published: December 2017

Background:
Intrahospital patient transports (IHTs) in intensive care involve an appreciable risk of adverse events (AEs). Research on determinants of AE occurrence during IHT has hitherto focused on patient, transport, and intensive care unit (ICU) characteristics. By contrast, the role of “soft” factors, although arguably relevant for IHTs and a topic of interest in general health care settings, has not yet been explored.

Purpose:
The study aims at examining the effect of safety climate and team processes on the occurrence of AE during IHT and whether team processes mediate the effect of safety climate.

Methodology/Approach:
Data stem from a noninterventional, observational multicenter study in 33 ICUs (from 12 European countries), with 858 transports overall recorded during 28 days. AEs include medication errors, dislodgments, equipment failures, and delays. Safety climate scales were taken from the “Patient Safety Climate in Healthcare Organizations” (short version), team processes scales from the “Leiden Operating Theatre and Intensive Care Safety” questionnaire. Patient condition was assessed with NEMS (Nine Equivalents of Nursing Manpower Use Score). All other variables could be directly observed. Hypothesis testing and assessment of effects rely on bivariate correlations and binomial logistic multilevel models (with ICU as random effect).

Findings:
Both safety climate and team processes are comparatively important determinants of AE occurrence, also when controlling for transport-, staff-, and ICU-related variables. Team processes partially mediate the effect of safety climate. Patient condition and transport duration are consistently related with AE occurrence, too.

Practice Implications:
Unlike most patient, transport, and ICU characteristics, safety climate and team processes are basically amenable to managerial interventions. Coupled with their considerable effect on AE occurrence, this makes pertinent endeavors a potentially promising approach for improving patient safety during IHT. Although literature suggests that safety climate is slow and hard to change (also compared to team processes), efforts to improve safety climate should not be forgone.
TREATMENT OF IDIOPATHIC RETINAL VASCULITIS, ANEURYSMS, AND NEURORETINITIS (IRVAN) WITH PHOTOCOAGULATION IN COMBINATION WITH SYSTEMIC IMMUNOSUPPRESSION
Authors: Ameratunga Rohan , Donaldson Mark 
Published: December 2017

Background:
Idiopathic retinal vasculitis, aneurysms, and neuroretinitis syndrome is a very rare primary retinal vasculitis. It seems to evolve in stages, where there is initially a florid vasculitis associated with aneurysm formation. Neuroretinitis and macula edema are common features. Subsequently, retinal ischemia ensues, leading to neovascularization. If untreated, further sight-threatening complications occur, including traction retinal detachment and secondary glaucoma.

Methods and Results:
Here, we describe a patient with early idiopathic retinal vasculitis, aneurysms, and neuroretinitis syndrome, who was treated with a combination of systemic immunosuppression and localized photocoagulation. There was substantial regression of the aneurysms and improvement of the macular edema. Treatment of the disorder should be based on the clinical stage and complications of the disorder.

Conclusions:
As shown here, a multidisciplinary approach can be very helpful in managing patients with this severe sight-threatening disorder.
Spinal Cord Injury Impairs Cardiovascular Capacity in Elite Wheelchair Rugby Athletes
Authors: Gee Cameron M. , Currie Katharine D. , Phillips Aaron A. , Squair Jordan W. , Krassioukov Andrei V. 
Published: December 2017

Objective:
To examine differences in heart rate (HR) responses during international wheelchair rugby competition between athletes with and without a cervical spinal cord injury (SCI) and across standardized sport classifications.

Design:
Observational study.

Setting:
The 2015 Parapan American Games wheelchair rugby competition.

Participants:
Forty-three male athletes (31 ± 8 years) with a cervical SCI (n = 32) or tetraequivalent impairment (non-SCI, n = 11).

Main Outcome Measures:
Average and peak HR (HRavg and HRpeak, respectively). To characterize HR responses in accordance with an athletes' International Wheelchair Rugby Federation (IWRF) classification, we separated athletes into 3 groups: group I (IWRF classification 0.5-1.5, n = 15); group II (IWRF classification 2.0, n = 15); and group III (IWRF classification 2.5-3.5, n = 13).

Results:
Athletes with SCI had lower HRavg (111 ± 14 bpm vs 155 ± 13 bpm) and HRpeak (133 ± 12 bpm vs 178 ± 13 bpm) compared with non-SCI (both P < 0.001). Average HR was higher in group III than in I (136 ± 25 bpm vs 115 ± 20 bpm, P = 0.045); however, SCI athletes showed no difference in HRavg or HRpeak between groups. Within group III, SCI athletes had lower HRavg (115 ± 6 bpm vs 160 ± 8 bpm) and HRpeak (135 ± 11 bpm vs 183 ± 11 bpm) than non-SCI athletes (both P < 0.001).

Conclusions:
This study is the first to demonstrate attenuated HR responses during competition in SCI compared with non-SCI athletes, likely due to injury to spinal autonomic pathways. Among athletes with SCI, IWRF classification was not related to differences in HR. Specific assessment of autonomic function after SCI may be able to predict HR during competition and consideration of autonomic impairments may improve the classification process.
Neonatal Neuroprotection
Authors: Lockridge Terrie 
Published: December 2017

Abstract:
Preterm birth interrupts the precise process of fetal maturation, forcing critical neurologic growth to continue within the Neonatal Intensive Care Unit (NICU). Concern for the impact of the NICU experience on the developing brain led to a unit-based Quality Improvement (QI) project to promote best outcomes for our graduates. The objective was to implement a standard of care for neonatal neuroprotection in a large urban tertiary center. A multidisciplinary committee researched and developed the Neonatal Neuroprotective Best Practice Guidelines to identify optimal interventions, as well as provide physiologic rationales to reinforce importance of these practices. An educational initiative accompanied release of this document to support consistency in clinical practice and to stress the critical role that every caregiver played in a child's outcome. As the Best Practice Guidelines encompassed virtually all aspects of caregiving in the NICU, it was impractical to measure the impact of such a broad range of interventions in a methodical manner. The full effect of these interventions will not likely be evident until NICU graduates have grown into childhood and adolescence. These constraints limited the scope of this QI project to the practicalities of identifying neuroprotective best practice and bringing it to the bedside. When combined with evidence-based medical and nursing care, neuroprotective care represents the best means of facilitating normal development and minimizing disability for our NICU graduates.
Facial Myokymia and Hemifacial Spasm in Multiple Sclerosis
Authors: Marin Collazo Iris V. , Tobin W. O. 
Published: December 2017

Objective:
Facial Myokymia and hemifacial spasm have been associated with multiple sclerosis; however, their etiology and clinical outcome is uncertain. Here, we describe the clinical, radiologic features, and treatment outcomes of a cohort of patients with multiple sclerosis and history of facial myokymia or hemifacial spasm.

Methodology:
We reviewed the clinical features, radiologic features, and treatment outcomes of 35 patients with a diagnosis of multiple sclerosis and facial myokymia (28) or hemifacial spasm (7) seen at Mayo Clinic (Rochester, MN).

Results:
Facial myokymia was associated with a clinical or radiologic relapse in 11 of 28 patients. In 27 of 28 patients with facial myokymia, symptom resolution occurred within months regardless of treatment. An ipsilateral pontine lesion was found in 3 of 7 cases with hemifacial spasm. Hemifacial spasm was associated with a clinical or radiologic relapse in 3 of 7 cases. Hemifacial spasm resolved within 4 years in 5 of 7 cases, with the remaining cases persisting up to 9 years despite treatment.

Conclusions:
Facial myokymia and hemifacial spasm occurring in patients with multiple sclerosis is associated with an ipsilateral pontine MRI lesion in a minority of patients. Facial myokymia is a self-limited process while hemifacial spasm can be persistent in a minority of patients, despite treatment.
The Safety of Low-Molecular-Weight Heparin During and After Pregnancy
Authors: Lu Eric , Shatzel Joseph J. , Salati Jennifer , DeLoughery Thomas G. 
Published: December 2017

Importance
In industrialized countries, venous thromboembolism remains a leading cause of mortality in pregnant women. Low-molecular-weight heparin (LMWH) is the most commonly recommended anticoagulant in pregnancy, having been proven effective and safe in multiple prospective clinical trials.

Objective
The aim of this article is to outline existing recommendations for proper use of LMWH in pregnancy and data on risks of LMWH.

Evidence Acquisition
We reviewed guidelines from a number of professional societies. We also examined the current literature behind the various risks associated with LMWH use.

Results and Conclusions
Our review outlines the current data that guide the use of LMWH in pregnancy. With prophylactic dosing, LMWH comes with a 0.5% risk of antepartum bleeding and a 1% risk of postpartum hemorrhage that is not different from clinical trial controls. With treatment dosing, there is a 1.5% risk of antepartum bleeding and a 2% risk of postpartum hemorrhage. Overall, current evidence behind these risks is limited, and this review suggests areas of further study moving forward.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After completing this activity, the learner should be better able to define the specific risk factors and preexisting conditions that would warrant LMWH use in pregnancy and postpartum; describe the different available doses of LMWH, when to use each dose, and when monitoring is appropriate; and discuss the risks of anticoagulation with LMWH during various stages of pregnancy and birth.
All-Cause Mortality After Fertility-Sparing Surgery for Stage I Epithelial Ovarian Cancer
Authors: Melamed Alexander , Rizzo Anthony E. , Nitecki Roni , Gockley Allison A. , Bregar Amy J. , Schorge John O. , del Carmen Marcela G. , Rauh-Hain J. Alejandro 
Published: December 2017

(Abstracted from Obstet Gynecol 2017;130:71–79)
Most cases of epithelial ovarian cancer (EOC) In the United States are diagnosed in postmenopausal women. Only 7% of cases occur in women younger than 40 years.
Ventilation in Extremely Preterm Infants and Respiratory Function at 8 Years
Authors: Doyle Lex W. , Carse Elizabeth , Adams Anne-Marie , Ranganathan Sarath , Opie Gillian , Cheong Jeanie L. Y. 
Published: December 2017

(Abstracted from N Engl J Med 2017;377:329–337)
It is common for extremely preterm infants (<28 weeks' gestation) to experience respiratory problems and to require assisted ventilation until they are able to breathe independently. Assisted ventilation is not without risk, however, as exposure to the airway pressure and higher concentrations of oxygen provided by the ventilators can injure the lungs and may result in arrested pulmonary development or bronchopulmonary dysplasia.
Impact of Contrast Media Concentration on Low-Kilovolt Computed Tomography Angiography
Authors: Fleischmann Ulrike , Pietsch Hubertus , Korporaal Johannes G. , Flohr Thomas G. , Uder Michael , Jost Gregor , Lell Michael M. 
Published: December 2017

Objectives
Low peak kilovoltage (kVp) protocols in computed tomography angiography (CTA) demand a review of contrast media (CM) administration practices. The aim of this study was to systematically evaluate different iodine concentrations of CM in a porcine model.

Materials and Methods
Dynamic 70 kVp CTA was performed on 7 pigs using a third-generation dual-source CT system. Three CM injection protocols (A-C) with an identical total iodine dose and iodine delivery rate (150 mg I/kg, 12 s, 0.75 g I/s) differed in iodine concentration and flow rate (protocol A: 400 mg I/mL, 1.9 mL/s; B: 300 mg I/mL, 2.5 mL/s; C: 150 mg I/mL, 5 mL/s). All protocols were applied in a randomized order and compared intraindividually. Arterial enhancement at different locations in the pulmonary artery, the aorta, and aortic branches was measured over time. Time attenuation curves, peak enhancement, time to peak, and bolus tracking delay times needed for static CTA were calculated. The reproducibility of optimal parameters was tested in single-phase CTA.

Results
The heart rates of the pigs were comparable for all protocols (P > 0.7). The injection pressure was significantly higher for protocol A (64 ± 5 psi) and protocol C (55 ± 3 psi) compared with protocol B (39 ± 2 psi) (P < 0.001). Average arterial peak enhancement in the dynamic scans was 359 ± 51 HU (protocol A), 382 ± 36 HU (B), and 382 ± 60 HU (C) (A compared with B and C: P < 0.01; B compared with C: P = 0.995). Time to peak enhancement decreased with increasing injection rate. The delay time for bolus tracking depended on the injection rate as well and was highest for protocol A (4.7 seconds) and lowest for protocol C (3.9 seconds) (P = 0.038). The peak enhancement values of the dynamic scans highly correlated with those of the single-phase CTA scans.

Conclusions
In 70 kVp CTA, 300 mg I/mL iodine concentrations showed to be superior to high-concentration CM when keeping the iodine delivery rate constant. Besides, iodine concentrations as low as 150 mg I/mL can be administered without compromising vascular enhancement. This opens up new possibilities in CM administration.
68Ga-PSMA Avid Primary Adenocarcinoma of the Lung With Complementary Low 18F-FDG Uptake
Authors: Jochumsen Mads Ryø , Gormsen Lars Christian , Nielsen Gitte Lund 
Published: December 2017

Abstract

68Ga-PSMA PET/CT scan on a 70-year-old man with recently diagnosed prostate cancer revealed a spiculating nodule in the apex of the left lung with intense 68Ga-PSMA uptake. The nodule had no pathological 18F-FDG uptake and turned out to be a primary adenocarcinoma of the lung. Cases with complementary pattern of uptake in 18F-FDG and 68Ga-PSMA in metastatic clear cell renal carcinoma and in well-differentiated hepatocellular carcinoma have previously been reported; however, this case illustrates that this unusual pattern can also be present in primary lung cancer.
Orbital Metastasis
Authors: Jain Tarun Kumar , Parihar Ashwin Singh , Sood Ashwani , Basher Rajender Kumar , Bollampally Neeraja , Shekhawat Amit Singh , Mittal Bhagwant Rai 
Published: December 2017

Abstract
Orbital metastases are known to arise from primary breast carcinoma followed by prostate, malignant melanoma, and lung carcinoma. We report a case of orbital metastasis as the initial presentation of an occult primary gall bladder carcinoma. The FDG PET/CT helped in localizing the occult distant primary site, which previously escaped detection, and also enabled the evaluation of orbital metastasis.
The Added Value of Dynamic 18F-Florbetapir PET in the Assessment of Dementia With Lewy Bodies
Authors: López-Mora Diego Alfonso , Camacho Valle , Lleó Alberto , Fernández Alejandro , Carrió Ignasi 
Published: December 2017

Abstract
Dementia with Lewy bodies (DLB) is the most common cause of dementia after Alzheimer disease. It is often underdiagnosed because of the overlapping with Alzheimer disease symptoms. We report the 18F-FDG and 18F-florbetapir dynamic PET images (early and delay phases) of an 83-year-old woman with cognitive impairment associated with visual hallucinations and parkinsonism due to probable DLB. This image highlights that the early phases of 18F-florbetapir may reflect regional cerebral perfusion with a pattern very similar to that of regional glucose metabolism in DLB.
Examining racial disparities in the time to withdrawal of life-sustaining treatment in trauma
Authors: Hornor Melissa A. , Byrne James P. , Engelhardt Kathryn E. , Nathens Avery B. 
Published: December 2017

BACKGROUND
Racial disparities in medical treatment for seriously injured patients across the spectrum of care are well established, but racial disparities in end of life decision making practices have not been well described. When time from admission to time to withdrawal of life-sustaining treatment (WLST) increases, so does the potential for ineffective care, health care resource loss, and patient and family suffering. We sought to determine the existence and extent of racial disparities in late WLST after severe injury.

METHODS
We queried the American College of Surgeons’ Trauma Quality Improvement Program (2013–2016) for all severely injured patients (Injury Severity Score, > 15; age, > 16 years) with a WLST order longer than 24 hours after admission. We defined late WLST as care withdrawn at a time interval beyond the 75th percentile for the entire cohort. Univariate and multivariate analyses were performed using descriptive statistics, and t tests and χ2 tests where appropriate. Multivariable regression analysis was performed with random effects to account for institutional-level clustering using late WLST as the primary outcome and race as the primary predictor of interest.

RESULTS
A total of 13,054 patients from 393 centers were included in the analysis. Median time to WLST was 5.4 days (interquartile range, 2.6–10.3). In our unadjusted analysis, African-American patients (10.1% vs. 7.1%, p < 0.001) and Hispanic patients (7.8% vs. 6.8%, p < 0.001) were more likely to have late WLST as compared to early WLST. After adjustment for patient, injury, and institutional characteristics, African-American (odds ratio, 1.42; 95% confidence interval, 1.21–1.67) and Hispanic (odds ratio, 1.23; 95% confidence interval, 1.04–1.46) race were significant predictors of late WLST.

CONCLUSION
African-American and Hispanic race are both significant predictors of late WLST. These findings might be due to patient preference or medical decision making, but speak to the value in assuring a high standard related to identifying goals of care in a culturally sensitive manner.

Level of Evidence
Prognostic and epidemiologic study, level III.
Phospho-signal flow from a pole-localized microdomain spatially patterns transcription factor activity
Authors: Lasker Keren , von Diezmann Alex , Ahrens Daniel G. , Mann Thomas H. , Moerner W. E. , Shapiro Lucy 
Published: December 2017

SUMMARYSelective recruitment and concentration of signaling proteins within membrane-less compartments is a ubiquitous mechanism for subcellular organization. However, little is known about how such dynamic recruitment patterns intracellular signaling and cellular development. Here, we combined transcriptional profiling, reaction-diffusion modeling, and single-molecule tracking to study signal exchange in and out of a microdomain at the cell pole of the asymmetrically dividing bacteriumCaulobacter crescentus.Our study revealed that the microdomain is selectively permeable, and that each protein in the signaling pathway that activates the cell fate transcription factor CtrA is sequestered and uniformly concentrated within the microdomain or its proximal membrane. Restricted rates of entry into and escape from the microdomain enhance phospho-signaling, leading to a sublinear gradient of CtrA~P along the long axis of the cell. The spatial patterning of CtrA~P creates a gradient of transcriptional activation that serves to prime asymmetric development of the two daughter cells.
Siccuracy: An R-package for executing genotype imputation strategy simulations with AlphaImpute
Authors: Edwards Stefan McKinnon 
Published: December 2017

AbstractBackgroundThe reported R-package provides an easy way for executing and evaluating genotype imputation studies, by providing functions for preparing input files for AlphaImpute and efficiently calculating imputation accuracies. Using the correlation between true and imputed genotypes is used here as it is directly related to the accuracy of genomic prediction using imputed genotypes. This R-package calculates both correlation and counts correct and incorrect imputed genotypes.ResultsImplementing the correlation using a Fortran resulted in faster calculations and using less memory than using base R functions. Reporting the performance of an imputation should not be done only by the average correlation between true and imputed genotype. It is demonstrated that the highest average correlation is not necessarily the best correlation and that the range of obtained correlations provides a more nuanced grasp of the performance of the imputation.ConclusionsAn R-package is available that provides a fast, standardized, and tested implementation for computing the correlations.
A delay grey incidence analysis framework for assessing drivers and obstacles of R&D performance at Chinese universities
Authors: Liu Yong , Quan Bing-ting , Li Hui 
Published: December 2017

Purpose
The purpose of this paper is to construct a novel delay grey incidence analysis model to analyze drivers and obstacles of university R&D performance.

Design/methodology/approach
With respect to the fact that university R&D activities typically experience two stages of knowledge creation and technology transfer, and different drivers and obstacles come into play to affect the conversion of R&D investment to outcomes at each stage, based on the thought of grey incidence analysis and the specific characteristics of science and technology (sci-tech) development, a novel delay grey incidence analysis model is proposed in this paper, and then according to the yearbook statistical data, Chinese university R&D activities are investigated and the drivers and obstacles of university R&D performance are analyzed.

Findings
The results show that the R&D full-time staff and R&D funds of basic research are the key drivers of influencing factors, and the sci-tech innovation talents in universities’ R&D institutions and experiment development funds are the restraining factors to improve R&D performance in the stage of knowledge creation; the expenses of R&D achievement application and technology service and the full-time staff of achievement application and technology service are the key drivers and obstacles of influencing the aggregate amount of patent sale respectively.

Practical implications
This research helps policy makers to reflect on their university R&D policies and understand how to enhance the technology transfer rate in China.

Originality/value
The paper succeeds in identifying key drivers and obstacles of affecting university R&D performance in China by examining the input and output incidence at both the knowledge creation and technology transfer stages.