bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hematologic Manifestations of Brucellosis in Children
Authors: Justman Naphtali , Fruchtman Yariv , Greenberg David , Ben-Shimol Shalom 
Published: January 2018

Background:
Brucellosis is a common zoonosis in the Bedouin population of southern Israel. Limited data exist for the rate and risk factors of hematologic complication of brucellosis in children. We assessed anemia, leukopenia, thrombocytopenia and pancytopenia in childhood brucellosis in southern Israel.

Methods:
Our medical center is the sole hospital in southern Israel. All medical files of brucellosis, 2005–2014, identified through positive blood cultures or International Classification of Diseases 9th revision coding with positive serology, were reviewed retrospectively.

Results:
Overall, 511 brucellosis episodes were identified; 42% (N = 214) with ≥1 cytopenia, including 13% (N = 68) anemia, 28% (N = 144) leukopenia, 14% (N = 74) thrombocytopenia and 2% (N = 9) pancytopenia. Overall, 99.8% of episodes were in Bedouin children and 70% in males. In 79% of episodes, blood culture was positive for Brucella melitensis. Acute infections comprised 84% of all episodes. In univariate analysis, older age (10.49 ± 4.81 vs. 9.25 ± 4.89 years), fever (92% vs. 78%), positive blood culture (84% vs. 75%) and IgM ≥1:640 levels (50% vs. 39%) were associated with cytopenia. In contrast, arthralgia was associated with noncytopenic episodes. In multivariate analyses, older age (odds ratio = 1.063) and fever (odds ratio = 3.127) were associated with cytopenia.

Conclusions:
Brucellosis is commonly presented with cytopenia, especially in bacteremic episodes with fever. However, pancytopenia is uncommon and its finding should alert the physician to look for other possible etiologies.
Continuous Positive Airway Pressure Thresholds for Nasolacrimal Air Regurgitation in a Cadaveric Model
Authors: Blandford Alexander D. , Cherfan Daniel G. , Drake Richard L. , McBride Jennifer M. , Hwang Catherine J. , Perry Julian D. , Cheng Olivia T. 
Published: January 2018

Purpose:
To elucidate the mechanisms underlying nasolacrimal air regurgitation (AR) in the setting of continuous positive airway pressure therapy.

Methods:
Twelve nasolacrimal systems of 6 fresh female human cadavers were evaluated individually for AR using continuous positive airway pressure therapy before any nasolacrimal procedure. Cadavers were then randomly assigned to undergo nasolacrimal duct probing or endoscopic dacryocystorhinostomy and then each hemisystem was again evaluated for AR. The pressure where AR was first observed (discovery pressure) or maximum possible pressure in systems without AR was recorded. In systems that demonstrated AR, the pressure was then gradually decreased to the lowest pressure where regurgitation persisted. This pressure was recorded as the secondary threshold pressure.

Results:
None of the 12 unoperated nasolacrimal systems or the 6 systems that underwent nasolacrimal duct probing demonstrated AR through the maximum continuous positive airway pressure therapy (30 cm H2O). After endoscopic dacryocystorhinostomy, all 6 nasolacrimal systems demonstrated AR. The mean discovery pressure was 16.0 cm H2O (range, 14.0–18.0 cm H2O) and mean secondary threshold pressure was 7.25 cm H2O (range, 6.5–8.0 cm H2O).

Conclusions:
Air regurgitation during continuous positive airway pressure therapy in the setting of prior endoscopic dacryocystorhinostomy can be replicated in a cadaver model. The secondary threshold pressures required for AR in this model were similar to AR pressures reported clinically. Prior to dacryocystorhinostomy, patients using continuous positive airway pressure therapy should be counseled on AR, and physicians should consider this phenomenon when evaluating ophthalmic complaints in postoperative patients on positive airway pressure therapy.
A Systematic Review of Risk Factors Associated With Cognitive Impairment After Pediatric Critical Illness*
Authors: Kachmar Alicia G. , Irving Sharon Y. , Connolly Cynthia A. , Curley Martha A. Q. 
Published: January 2018

Objectives:
To identify risk factors associated with cognitive impairment as assessed by neuropsychologic tests in neurotypical children after critical illness.

Data Sources:
For this systematic review, we searched the Cochrane Library, Scopus, PubMed, Ovid, Embase, and CINAHL databases from January 1960 to March 2017.

Study Selection:
Included were studies with subjects 3–18 years old at the time of post PICU follow-up evaluation and use of an objective standardized neuropsychologic test with at least one cognitive functioning dimension. Excluded were studies featuring patients with a history of cardiac arrest, traumatic brain injury, or genetic anomalies associated with neurocognitive impairment.

Data Extraction:
Twelve studies met the sampling criteria and were rated using the Newcastle-Ottawa Quality Assessment Scale.

Data Synthesis:
Ten studies reported significantly lower scores in at least one cognitive domain as compared to healthy controls or normed population data; seven of these—four case-control and three prospective cohort studies—reported significant lower scores in more than one cognitive domain. Risk factors associated with post critical illness cognitive impairment included younger age at critical illness and/or older age at follow-up, low socioeconomic status, high oxygen requirements, and use of mechanical ventilation, sedation, and pain medications.

Conclusions:
Identifying risk factors for poor cognitive outcomes post critical illness may help healthcare teams modify patient risk and/or provide follow-up services to improve long-term cognitive outcomes in high-risk children.
SpaRC: Scalable Sequence Clustering using Apache Spark
Authors: Shi Lizhen , Meng Xiandong , Tseng Elizabeth , Mascagni Michael , Wang Zhong 
Published: January 2018

AbstractWhole genome shotgun based next generation transcriptomics and metagenomics studies often generate 100 to 1000 gigabytes (GB) sequence data derived from tens of thousands of different genes or microbial species. De novo assembling these data requires an ideal solution that both scales with data size and optimizes for individual gene or genomes. Here we developed a Apache Spark-based scalable sequence clustering application, SparkReadClust (SpaRC), that partitions the reads based on their molecule of origin to enable downstream assembly optimization. SpaRC produces high clustering performance on transcriptomics and metagenomics test datasets from both short read and long read sequencing technologies. It achieved a near linear scalability with respect to input data size and number of compute nodes. SpaRC can run on different cloud computing environments without modifications while delivering similar performance. In summary, our results suggest SpaRC provides a scalable solution for clustering billions of reads from the next-generation sequencing experiments, and Apache Spark represents a cost-effective solution with rapid development/deployment cycles for similar large scale sequence data analysis problems. The software is available under the Apache 2.0 license at https://bitbucket.org/LizhenShi/sparc.
The business of integrated care: implementing new models of care in a fee-for-service setting
Authors: Yu Serena , van Gool Kees , Edwards Karen , Kirby Sue , Gardner Karen , Robinson Louise , Linehan Tricia , Harris Mark , Hall Jane 
Published: January 2018

Purpose
The Western New South Wales Integrated Care Strategy (ICS) was rolled out from November 2014 across three rural sites. The purpose of this paper is to assess its impact on general practices, and examine the feasibility of implementing an ICS, within a predominantly fee-for-service delivery model.

Design/methodology/approach
Mixed methods were used to analyse the implementation of the ICS, including practice-level patient data on changes in service provision. This includes unit-record data on 130 enroled patients across three rural sites, as well as qualitative data collection from providers.

Findings
There were significant increases in both revenue-generating and non-revenue-generating activities (primarily care coordination activities) associated with implementing the ICS. Each occasion of service involved greater contact time with practice staff other than GPs, as well as greater administration time. There is evidence that ICS activities such as case conferencing and team care planning substitute for traditional GP consultations. Overall, the study found that a significant investment of resources – namely staff time devoted to a range of activities – was required to support the implementation of the ICS. Such an investment was supported both externally and through revenue-generating practice-level activities.

Research limitations/implications
The data collection and evaluation project is ongoing, with analysis based on the first wave of data from three sites.

Practical implications
At the practice level, a substantial commitment of resources is required to invest in, and sustain, a new model of integrated care (IC). This commitment can currently be supported both through higher revenue generation at the practice level, and externally by health system stakeholders, but changes in financial settings could impact on financial viability.

Originality/value
This paper provides evidence on the role of blended payment mechanisms in facilitating the implementation of IC in a rural setting where there are medical workforce constraints.
Differences between experts and novices when reading with navigational table of contents
Authors: Lu Quan , Zhang Jiyue , Chen Jing , Li Ji 
Published: January 2018

PurposeThe purpose of this paper is to examine the difference between experts and novices when reading with navigational table of contents (N-TOC). Experts refer to readers with high level of domain knowledge; novices refer to readers with low level of domain knowledge.Design/methodology/approachThe authors performed a controlled experiment of three reading tasks (including fact finding task, partial understanding task, and full-text understanding task) on an N-TOC system for 35 post-graduates of Wuhan University who have rich experience in reading with N-TOC. Participants’ domain knowledge was measured by pre-experiment questionnaires; reading performance data including score, time, navigation use, and evaluation of N-TOC were collected.FindingsThe results showed that there was significant difference in neither navigation use nor participants’ evaluation, but domain experts performed significantly better in both score and time of all tasks than domain novices, which revealed an “illusion of control” phenomenon that rich experience in reading with N-TOC enabled domain novices to achieve the same performance as domain experts. In addition, this research found that N-TOC was not suitable for domain novices to solve full-text understanding task because of “cognitive overload” phenomenon.Originality/valueThis study makes a good contribution to the literature on the effect of domain knowledge on reading performance during N-TOC reading and how to provide better digital reading service in the field of library science and information science.
The genome and microbiome of a dikaryotic fungus (Inocybe terrigena, Inocybaceae) revealed by metagenomics
Authors: Bahram Mohammad , Vanderpool Dan , Pent Mari , Hiltunen Markus , Ryberg Martin 
Published: January 2018

SummaryRecent advances in molecular methods have increased our understanding of various fungal symbioses. However, little is known about genomic and microbiome features of most uncultured symbiotic fungal clades. Here, we analysed the genome and microbiome of Inocybaceae (Agaricales, Basidiomycota), a largely uncultured ectomycorrhizal clade known to form symbiotic associations with a wide variety of plant species. We used metagenomic sequencing and assembly of dikaryotic fruiting‐body tissues from Inocybe terrigena (Fr.) Kuyper, to classify fungal and bacterial genomic sequences, and obtained a nearly complete fungal genome containing 93% of core eukaryotic genes. Comparative genomics reveals that I. terrigena is more similar to ectomycorrhizal and brown rot fungi than to white rot fungi. The reduction in lignin degradation capacity has been independent from and significantly faster than in closely related ectomycorrhizal clades supporting that ectomycorrhizal symbiosis evolved independently in Inocybe. The microbiome of I. terrigena fruiting‐bodies includes bacteria with known symbiotic functions in other fungal and non‐fungal host environments, suggesting potential symbiotic functions of these bacteria in fungal tissues regardless of habitat conditions. Our study demonstrates the usefulness of direct metagenomics analysis of fruiting‐body tissues for characterizing fungal genomes and microbiome.
Relative stability of ploidy in a marine Synechococcus across various growth conditions
Authors: Perez‐Sepulveda Blanca , Pitt Frances , N'Guyen An N. , Ratin Morgane , Garczarek Laurence , Millard Andrew , Scanlan David J. 
Published: January 2018

SummaryMarine picocyanobacteria of the genus Synechococcus are ubiquitous phototrophs in oceanic systems. Consistent with these organisms occupying vast tracts of the nutrient impoverished ocean, most marine Synechococcus so far studied are monoploid, i.e., contain a single chromosome copy. The exception is the oligoploid strain Synechococcus sp. WH7803, which on average possesses around 4 chromosome copies. Here, we set out to understand the role of resource availability (through nutrient deplete growth) and physical stressors (UV, exposure to low and high temperature) in regulating ploidy level in this strain. Using qPCR to assay ploidy status we demonstrate the relative stability of chromosome copy number in Synechococcus sp. WH7803. Such robustness in maintaining an oligoploid status even under nutrient and physical stress is indicative of a fundamental role, perhaps facilitating recombination of damaged DNA regions as a result of prolonged exposure to oxidative stress, or allowing added flexibility in gene expression via possessing multiple alleles.
Cardiovascular complications after non‐cardiac surgery
Authors: Sellers D. , Srinivas C. , Djaiani G. 
Published: January 2018

SummaryCardiac complications are common after non‐cardiac surgery. Peri‐operative myocardial infarction occurs in 3% of patients undergoing major surgery. Recently, however, our understanding of the epidemiology of these cardiac events has broadened to include myocardial injury after non‐cardiac surgery, diagnosed by an asymptomatic troponin rise, which also carries a poor prognosis. We review the causation of myocardial injury after non‐cardiac surgery, with potential for prevention and treatment, based on currently available international guidelines and landmark studies. Postoperative arrhythmias are also a frequent cause of morbidity, with atrial fibrillation and QT‐prolongation having specific relevance to the peri‐operative period. Postoperative systolic heart failure is rare outside of myocardial infarction or cardiac surgery, but the impact of pre‐operative diastolic dysfunction and its ability to cause postoperative heart failure is increasingly recognised. The latest evidence regarding diastolic dysfunction and the impact on non‐cardiac surgery are examined to help guide fluid management for the non‐cardiac anaesthetist.
Spinal cord injury arising in anaesthesia practice
Authors: Hewson D. W. , Bedforth N. M. , Hardman J. G. 
Published: January 2018

SummarySpinal cord injury arising during anaesthetic practice is a rare event, but one that carries a significant burden in terms of morbidity and mortality. In this article, we will review the pathophysiology of spinal cord injury. We will then discuss injuries relating to patient position, spinal cord hypoperfusion and neuraxial techniques. The most serious causes of spinal cord injury – vertebral canal haematoma, spinal epidural abscess, meningitis and adhesive arachnoiditis – will be discussed in turn. For each condition, we draw attention to practical, evidence‐based measures clinicians can undertake to reduce their incidence, or mitigate their severity. Finally, we will discuss transient neurological symptoms. Some cases of spinal cord injury during anaesthesia can be ascribed to anaesthesia itself, arising as a direct consequence of its conduct. The injury to a spinal nerve root by inaccurate and/or incautious needling during spinal anaesthesia is an obvious example. But in many cases, spinal cord injury during anaesthesia is not caused by, related to, or even associated with, the conduct of the anaesthetic. Surgical factors, whether direct (e.g. spinal nerve root damage due to incorrect pedicle screw placement) or indirect (e.g. cord ischaemia following aortic surgery) are responsible for a significant proportion of spinal cord injuries that occur concurrently with the delivery of regional or general anaesthesia.
Adverse drug reactions
Authors: Patton K. , Borshoff D. C. 
Published: January 2018

SummaryAdverse drug reactions are a cause of significant morbidity and mortality to patients and a source of financial burden to the healthcare system. Of the wide spectrum of adverse drug reactions, the most concerning to the anaesthetist remain anaphylaxis and malignant hyperthermia. Although the incidence of anaphylaxis under anaesthesia is difficult to ascertain, it occurs commonly enough that most anaesthetists will manage at least one case in their career. The wide range of drugs given in the peri‐operative period and the variable presentation in the anaesthetised patient can delay diagnosis and treatment, and adversely affect outcome. Furthermore, despite improvements in testing, causative drugs can still be difficult to identify, as adverse reactions may be mediated by mechanisms other than IgE activation. With an increase in the reporting of anaphylaxis to newer anaesthetic drugs such as sugammadex, combined with change over the recent decades in the most likely causative peri‐operative agents, it is imperative anaesthetists remain up to date on recent developments. In addition, they should be vigilant to patient characteristics, including pharmacogenetic variations that may predispose to adverse drug reactions, in order to help minimise risks of a reaction. The severity of adverse drug reactions to peri‐operative drugs means morbidity and mortality remain high.
Influence of CYP2D6,CYP3A4,CYP3A5 and ABCB1 Polymorphisms on Pharmacokinetics and Safety of Aripiprazole in Healthy Volunteers
Authors: Belmonte Carmen , Ochoa Dolores , Román Manuel , Saiz‐Rodríguez Miriam , Wojnicz Aneta , Gómez‐Sánchez Clara Isabel , Martín‐Vílchez Samuel , Abad‐Santos Francisco 
Published: January 2018

AbstractThe aim of this study was to investigate the effect of polymorphisms in cytochrome P450 (CYP) 2D6, CYP3A4 and CYP3A5 enzymes and in P‐glycoprotein (P‐gp) on the pharmacokinetics and safety of aripiprazole and, its active metabolite, dehydro‐aripiprazole, in 148 healthy volunteers from six bioequivalence trials receiving a single oral dose of aripiprazole. The plasma concentrations of both analytes were measured by LC‐MS/MS. CYP2D6 (*3,*4,*5,*6,*7,*9 and copy number variations), CYP3A4 (*20 and *22), CYP3A5*3 and C3435T, C1236T and G2677T/A in ABCB1 gene were determined. As the number of active CYP2D6 alleles decreased, AUC0−t, Cmax and t1/2 of aripiprazole were higher and clearance of aripiprazole, AUC0−t of dehydro‐aripiprazole and ratio dehydro‐aripiprazole/aripiprazole were lower. AUC0−t of aripiprazole of poor metabolizer (PM) subjects was increased by 50% compared to extensive metabolizers (EM), and AUC0−t of dehydro‐aripiprazole was decreased by 33%. ABCB1 1236TT subjects had a lower clearance of aripiprazole (p = 0.023) and AUC0−t (p = 0.039) and Cmax of dehydro‐aripiprazole (p = 0.036) compared to C/C. CYP3A5*3/*3 subjects had a 10% lower ratio dehydro‐aripiprazole/aripiprazole than *1/*3 (p = 0.019). Adverse drug reactions (ADRs) had a directly proportional relationship with AUC0−t of aripiprazole (p = 0.001), especially nausea/vomiting, which were more common in women (p = 0.005). Women and CYP3A5*1/*1 subjects showed more often dizziness (p = 0.034; p = 0.009). Pharmacokinetics of aripiprazole is affected by CYP2D6 phenotype but also by sex and C1236T (ABCB1 gene), while dehydro‐aripiprazole pharmacokinetics is affected by CYP2D6 and C1236T. The ratio dehydro‐aripiprazole/aripiprazole was influenced by CYP2D6 phenotype and CYP3A5*3. Concentrations of aripiprazole, sex, CYP3A5*3 and CYP2D6 were involved in the development of ADRs.
Maternal thyroid hormone insufficiency during pregnancy and risk of neurodevelopmental disorders in offspring: A systematic review and meta‐analysis
Authors: Thompson William , Russell Ginny , Baragwanath Genevieve , Matthews Justin , Vaidya Bijay , Thompson‐Coon Jo 
Published: January 2018

SummaryBackgroundIn the last 2 decades, several studies have examined the association between maternal thyroid hormone insufficiency during pregnancy and neurodevelopmental disorders in children and shown conflicting results.AimThis systematic review aimed to assess the evidence for an association between maternal thyroid hormone insufficiency during pregnancy and neurodevelopmental disorders in children. We also sought to assess whether levothyroxine treatment for maternal thyroid hormone insufficiency improves child neurodevelopment outcomes.MethodsWe performed systematic literature searches in MEDLINE, EMBASE, PSYCinfo, CINAHL, AMED, BNI, Cochrane, Scopus, Web of Science, GreyLit, Grey Source and Open Grey (latest search: March 2017). We also conducted targeted web searching and performed forwards and backwards citation chasing. Meta‐analyses of eligible studies were carried out using the random‐effects model.ResultsWe identified 39 eligible articles (37 observational studies and 2 randomized controlled trials [RCT]). Meta‐analysis showed that maternal subclinical hypothyroidism and hypothyroxinaemia are associated with indicators of intellectual disability in offspring (odds ratio [OR] 2.14, 95% confidence interval [CI] 1.20 to 3.83, P = .01, and OR 1.63, 95% CI 1.03 to 2.56, P = .04, respectively). Maternal subclinical hypothyroidism and hypothyroxinaemia were not associated with attention deficit hyperactivity disorder, and their effect on the risk of autism in offspring was unclear. Meta‐analysis of RCTs showed no evidence that levothyroxine treatment for maternal hypothyroxinaemia or subclinical hypothyroidism reduces the incidence of low intelligence quotient in offspring.LimitationsAlthough studies were generally of good quality, there was evidence of heterogeneity between the included observational studies (I2 72%‐79%).ConclusionMaternal hypothyroxinaemia and subclinical hypothyroidism may be associated with intellectual disability in offspring. Currently, there is no evidence that levothyroxine treatment, when initiated 8‐ to 20‐week gestation (mostly between 12 and 17 weeks), for mild maternal thyroid hormone insufficiency during pregnancy reduces intellectual disability in offspring.