bluuebunny/crossref_metadata_2025_split huggingface dataset:
How Does Medicaid Reimbursement Impact Nursing Home Quality? The Effects of Small Anticipatory Changes
Authors: Bowblis John R. , Applebaum Robert 
Published: September 2016

ObjectiveIn 2006, Ohio changed its Medicaid reimbursement methodology for nursing homes (NHs) to promote more efficient staffing levels. This study examines the impacts of this policy change on quality.Research Design and SubjectsOhio NHs were categorized based on their anticipated change in reimbursement under a new reimbursement system initiated in 2006. Linear regressions were utilized to determine how quality changed from 2006 to 2010 relative to a group of NHs that were not anticipated to experience any significant change in reimbursement. We examine resident outcomes constructed from the Minimum Data Set, deficiency citations, staffing levels, and satisfaction scores for residents and families as measures of quality.Principal FindingsNursing homes in the group receiving increased reimbursement showed an increase in nursing and nursing aide staffing levels. NHs in the group receiving a reduction in reimbursement did lower staffing levels. None of the nonstaffing quality outcomes were impacted by changes in Medicaid reimbursement.ConclusionIncreased Medicaid reimbursement was found to increase staffing levels, but it had a limited effect, at least in the short run, on an array of nonstaffing quality outcomes.
Is the acute surgical unit model feasible for Australian regional centres?
Authors: Shilton Hamish , Tanveer Amin , Poh Benjamin Ruimin , Croagh Daniel , Jayasuriya Neil , Chan David 
Published: September 2016

BackgroundA significant proportion of general surgery emergency procedures are conducted after‐hours in regional centres. The acute surgical unit (ASU) model reduces the number of after‐hours operations performed. We review the burden of emergency surgery in a regional centre and assess what components of the ASU model would benefit regional hospitals.MethodsRetrospective analysis was performed on data for all emergency cases performed at Latrobe Regional Hospital (LRH) over a 1‐year period. Time into and out of theatre was used to determine total theatre usage and if the operation occurred after‐hours. ED triage time to theatre and start time for appendicectomy was compared to data from our metropolitan referral hospital, Monash Medical Centre (MMC), which has employed an ASU.ResultsGeneral surgery emergency cases in regional areas are regular and predictable with a median of two emergency cases performed, and a mean theatre time of 156 min per day at LRH. On weekdays, 43.1% (n = 503) of emergency cases were done in the evening (18.00–24.00 hours), compared to 20.3% (n = 217) on weekends when an emergency theatre is available during the day. LRH performed more appendicectomies after‐hours than MMC over a 1‐year period.ConclusionRegional centres have a significant burden of general surgery emergency procedures; of which the number performed after‐hours is comparable to metropolitan centres. The number of procedures and theatre time required by these cases justify a dedicated emergency theatre in‐hours similar to metropolitan ASU models and this would reduce emergency operating after‐hours.
Is immediate reconstruction after mastectomy in breast cancer patients beneficial to shoulder function?
Authors: Lee Bong Gun , Kim Joon Kuk , Choi Sung Hyouk , Ahn Hee Chang , Chung Min Sung 
Published: September 2016

BackgroundTo compare shoulder morbidity between patients who received transverse rectus abdominis myocutaneous (TRAM) flaps after mastectomy (MX + TRAM) and patients who underwent mastectomy only (MX).MethodsThirty patients in each group were followed for a minimum of 2 postoperative years. Visual analog scale (VAS) score, restricted range of motion (ROM), rotator cuff disease, muscle strength, shoulder function scores (American Shoulder and Elbow Score and Shoulder Pain and Disability Index), measurement of scapular tilt on chest radiography and standing position in each group were compared.ResultsThere were no significant differences in VAS, restricted ROM, rotator cuff disease, muscle strength, shoulder function scores or scapula tilt on physical examination. However, lower angles of the scapula on chest radiography (4.0 ± 13.2 versus −3.4 ± 12.4 mm; P = 0.029) and pectoralis minor index (0.4 ± 7.7 mm versus 7.8 ± 9.1 mm; P = 0.001) were significantly different between the two groups.ConclusionsImmediate breast reconstruction after a MX had advantages for preserving scapular resting alignment but did not provide benefits for shoulder morbidity on short‐term follow‐up.
Is resection of pancreatic adenocarcinoma with synchronous hepatic metastasis justified? A review of current literature
Authors: Antoniou Efstathios , Margonis Georgios A. , Sasaki Kazunari , Andreatos Nikolaos , Polychronidis Georgios , Pawlik Timothy M. , Pikoulis Emmanouil 
Published: September 2016

BackgroundPancreatic ductal adenocarcinoma (PDAC) is an extremely lethal neoplastic process, largely due to the presence of disseminated disease at presentation. As such, evidence‐based management of metastatic disease is integral to patient care in such circumstances. This review aimed to summarize the current state of knowledge regarding the potential effectiveness of liver metastasectomy in the setting of PDAC.MethodsA structured review of the literature was performed from April to May 2016, using the PubMed database. Relevant original research articles and systematic reviews/meta‐analyses published between 1990 and 2015 were considered eligible. The primary endpoint was overall survival in patients undergoing resection for PDAC and liver metastasectomy. Studies reporting on fewer than 10 patients were excluded.ResultsUltimately, eight studies met our inclusion criteria. Their results suggest that hepatic metastasectomy for PDAC is a safe procedure, with a potential survival benefit for carefully selected patients, particularly those with metachronous metastases. Nonetheless, small sample sizes and inconsistent use of appropriate controls preclude generalization of these findings.ConclusionMulti‐institutional prospective studies are required to fully delineate the potential therapeutic utility and operative indications of liver metastasectomy in the setting of modern interdisciplinary management of PDAC.
Altered pharmacodynamics and pharmacokinetics of cisatracurium in patients with severe mitral valve regurgitation during anaesthetic induction period
Authors: Liu Jiayi , Lu Chunying , Zou Qirong , Wang Sheng , Peng Xuemei 
Published: September 2016

AimThe aim of the current study was to characterize the pharmacokinetics (PK) and pharmacodynamics (PD) of cisatracurium in patients with severe mitral valve regurgitation (MR) during the anaesthetic induction period.MethodsThirty patients in the clinical trial were divided into two groups: the MR group (n = 15) and the control group (n = 15). Arterial blood samples were obtained before (time 0) and at 1, 2, 4, 6, 8, 10, 15 and 20 min after intravenous injection of 0.15 mg kg−1 cisatracurium. The degree of neuromuscular block was measured by train of four (TOF) testing. The concentration of cisatracurium in the plasma was determined by high‐performance liquid chromatography. A conventional two‐compartment model and integrated PK/PD model were applied to PK and PD data analysis, respectively.ResultsThe results of PK model fitting demonstrated that severe MR reduced the distribution rate of cisatracurium from the central to peripheral compartment, resulting in a higher concentration of the drug in the plasma. The time to the maximal neuromuscular blocking effect of cisatracurium was delayed in the MR group (2.08 min in the control group vs. 4.12 min in the MR group). The PK/PD model indicated that the distribution rate of cisatracurium from the blood to the effect compartment was decreased in the MR group.ConclusionsThe present study suggested that the PK and PD of cisatracurium were significantly altered in patients with severe MR. The study has the potential to improve the safety of anaesthetic induction in patients with severe MR through accurate prediction of the PD responses of cisatracurium using the established PK/PD model.
Quality and consistency of outcome reporting in clinical trials of immunosuppression in renal transplantation
Authors: Hussain Samia , Knight Simon R. 
Published: September 2016

AbstractInterpretation, comparison, and combination of results of clinical trials are reliant on accurate and complete reporting of outcomes. This study aimed to assess the quality and variability in outcome reporting in immunosuppression trials following renal transplantation. All randomized controlled trials comparing immunosuppressive interventions in renal transplant recipients published over a 5‐year period were included. Outcomes reported in these studies were extracted, along with data regarding completeness of reporting and whether a clear definition of the method used to measure the outcome was provided. A total of 4760 outcomes were identified from 182 studies. Overall, 90.3% outcomes were completely reported; the remainder had missing data that would preclude use in meta‐analysis; 31.5% manuscripts did not define a primary endpoint. Efficacy outcomes were more likely to be clearly defined than safety outcomes (OR: 0.022, P<.001) or patient‐reported outcome measures (PROMs) (OR: 0.014, P<.001). PROMs were reported in less than half of manuscripts, and only five reported quality‐of‐life data using a validated tool. There was significant variability in the way that common efficacy and safety outcomes were defined. Variability in the way that endpoints are selected and reported in trials in renal transplantation makes interpretation and comparison between studies difficult.
Anticipatory scene representation in preschool children's recall and recognition memory
Authors: Kreindel Erica , Intraub Helene 
Published: September 2016

AbstractBehavioral and neuroscience research on boundary extension (false memory beyond the edges of a view of a scene) has provided new insights into the constructive nature of scene representation, and motivates questions about development. Early research with children (as young as 6–7 years) was consistent with boundary extension, but relied on an analysis of spatial errors in drawings which are open to alternative explanations (e.g. drawing ability). Experiment 1 replicated and extended prior drawing results with 4–5‐year‐olds and adults. In Experiment 2, a new, forced‐choice immediate recognition memory test was implemented with the same children. On each trial, a card (photograph of a simple scene) was immediately replaced by a test card (identical view and either a closer or more wide‐angle view) and participants indicated which one matched the original view. Error patterns supported boundary extension; identical photographs were more frequently rejected when the closer view was the original view, than vice versa. This asymmetry was not attributable to a selection bias (guessing tasks; Experiments 3–5). In Experiment 4, working memory load was increased by presenting more expansive views of more complex scenes. Again, children exhibited boundary extension, but now adults did not, unless stimulus duration was reduced to 5 s (limiting time to implement strategies; Experiment 5). We propose that like adults, children interpret photographs as views of places in the world; they extrapolate the anticipated continuation of the scene beyond the view and misattribute it to having been seen. Developmental differences in source attribution decision processes provide an explanation for the age‐related differences observed.
Trouble at the top? Restricted distribution and extreme population isolation in an alpine crustacean assemblage with unexpected lineage diversity
Authors: Hatley Jude , Murphy Nicholas P. 
Published: September 2016

Summary

The fragile alpine freshwater ecosystems of Australia are threatened by historic land use and projected climate change, yet little is known about the fauna of these environments. The aim of this study was to analyse the phylogeography of two important components of this ecosystem, an amphipod (Neoniphargus) and an isopod (Coluboltelson), to determine the potential impacts of environmental change on these crustaceans.

DNA sequences were generated for the mitochondrial cytochrome c oxidase subunit I (COI) and nuclear 28S ribosomal RNA (28S) of 229 amphipods and 153 isopods from 19 sites across seven creeks in the Bogong High Plains, Victoria, Australia. Phylogenetic analyses were undertaken to define evolutionary significant units (ESUs), and population genetic structure was examined.

Analyses of both markers found deep divergences in both taxa, leading to the definition of six amphipod and two isopod ESUs, within both Neoniphargus and Colubotelson. The majority of amphipod ESUs exhibited highly restricted distributions, with essentially no gene flow between sites, even within the same creeks, consistent with the Death Valley Model of population connectivity. By contrast, both isopod ESUs had overlapping distributions across the entire sample area and exhibited some highly limited population connectivity among sites in adjacent headwaters, consistent with the Headwater Model.

This study suggests that there is a high level of undiscovered biodiversity within Australian alpine aquatic invertebrates. The highly limited population structure, and restricted distributions have important consequences for the conservation of the headwaters of Australia's largest river system. These findings indicate that habitat loss and/or fragmentation associated with environmental change will result in biodiversity reductions, with species unlikely to shift their ranges in response to future climate change, or recover rapidly from localised extinction events.
The expansion of short rotation forestry: characterization of determinants with an agent‐based land use model
Authors: Schulze Jule , Gawel Erik , Nolzen Henning , Weise Hanna , Frank Karin 
Published: September 2016

AbstractWood is a limited resource which is exposed to a continuously growing global demand not least because of a politically fostered bioenergy use. One approach to master the challenge to sustainably meet this increasing wood demand is short rotation forestry (SRF). However, SRF is only gradually evolving and it is not fully understood which determinants hamper its expansion. This study provides theoretical insights into economic and environmental determinants of an SRF expansion and their interplay. This assessment requires the incorporation of farmers' decision‐making based on an explicit investment appraisal. Therefore, we use an agent‐based model to depict the decision‐making of profit‐maximizing farmers facing the choice between SRF, the cultivation of conventional annual agricultural crops and abstaining from cultivation (fallow land). The land use decisions are influenced by general economic determinants, such as market prices for wood and annual crops, and by site‐dependent determinants, such as the environmental site quality. We found that the willingness to pay for SRF‐based products and for annual crops most strongly influences the coverage of SRF in the landscape. SRF will in most cases be established on sites with low productivity. However, a decrease in the willingness to pay for annual crops will lead to a reallocation of SRF plantations to sites with higher productivity. Furthermore, our model results indicate that the impact of the distance to processing plants on farmers' decisions strongly depends on general economic determinants and the given spatial structure of the underlying natural landscape. Analysing the relative importance of different determinants of an SRF expansion, this study gives insights into the approach of using SRF to sustainably meet the growing wood demand. Moreover, these insights are taken as a starting point for the design of effective government interventions to promote SRF.
Comparison of standard forearm prosthetic loop grafts to composite semiloop forearm grafts (“semi‐grafts”) in hemodialysis patients: A prospective study
Authors: Georgiadis George S. , Antoniou George A. , Kantartzi Konstantia , Georgakarakos Efstratios I. , Argyriou Christos , Passadakis Ploumis , Lazarides Miltos K. 
Published: September 2016

AbstractIntroduction: To prospectively assess the performance of composite semiloop antebrachial grafts (“semi‐grafts,” SGs) in hemodialysis patients.Methods: Eighty‐five patients who received 67 loop antebrachial grafts (LG‐group) and 25 antebrachial semigrafts (SG‐group) were enrolled. SGs were defined as those originating from the brachial artery and anastomosed with the proximal mature mid‐antebrachial cephalic vein. Cephalic vein length should be at least 10 cm in length and of ≥5 mm in diameter for inclusion in the SG‐group. LG‐group included all possible outflow vein options of minimum diameter 3 mm. Kaplan‐Meier statistics was used for comparison of groups.Findings: Main indication for a SG was a failing radiocephalic fistula with extensive distal cephalic vein stenosis not amenable to correction or failed after endovascular repair or requiring long interposition grafting. The mean follow‐up period was 20.16 ± 22.6 and 29.6 ± 36.7 months for the LG‐ and SG‐group, respectively (P = 0.14). Forty‐two patients died during the follow‐up. Primary patency (up to first intervention or failure) at 6 and 12 months for LG‐ vs. SG‐group was 93.9% vs. 83.7% and 47% vs. 55.8% (P = 0.08). Secondary patency (up to abandonment) was 58.2% vs. 61.1% and 36% vs. 45.8% at 12 and 24 months (P = 0.18). Mortality at 48 months was 22.4% (LG‐group) and 24% (SG‐group) (P = 0.9).Discussion: There was a trend toward better primary and secondary patency rates for the SGs especially in the long‐term. This is a valuable option in selected patients that access surgeons and nephrologists should be aware of.
Biodiversity signature of the Last Glacial Maximum at South Georgia, Southern Ocean
Authors: Barnes David K. A. , Sands Chester J. , Hogg Oliver T. , Robinson Ben J.O. , Downey Rachel V. , Smith James A. 
Published: September 2016

AbstractAimHigh‐latitude biodiversity distributions can preserve signals of the timing and geography of past glaciations, and as such ground truth ice‐sheet models. Discrete polar archipelagos offer the fewest confounding factors for testing historic ice position records in extant biodiversity. At South Georgia, two competing geological hypotheses suggest that either the Last Glacial Maximum (LGM) ice was extensive, nearly covering the continental shelf (H1Big ice) or restricted to the inner fjords (H2Little ice). We examined the past configuration of the South Georgia ice cap using seabed biodiversity.LocationSouth Georgia, Southern Ocean.MethodsWe used a bespoke camera lander (SUCS) and Agassiz trawl deployments across ‘big ice’ and ‘little ice’ hypothesized positions ofLGMgrounded ice around the South Georgia continental shelf. We investigated faunal assemblage structure and richness, especially of brooders, and modelled low dispersal taxa, for example, those with limited pelagic larvae (bryozoans and sponges).ResultsWe found a striking ‘line’ of major richness discontinuity, with significantly higher richness, especially of brooders and low dispersal model taxa, mainly conforming to the ‘big ice’ hypothesized position. What few bryozoans and sponges occurred inside this line were a subset of those outside.Main conclusionsBenthic biodiversity is consistent with extensiveLGMgrounded ice advancing to near the shelf break in most, but not all locations around South Georgia's shelf, for example, the eastern shelf area. We suggest that most of the shelf is still undergoing recolonization from when grounded ice covered the shelf ~20 kyr ago. Our alternative hypothesis ofLGMice position, H3‘Limited‐Extensive ice’, best fitted our data and is easily further testable, but if verified, shows that shelf recolonization following glaciation is much slower than previously thought. This contrasts with surprisingly rapid colonization of continental shelves after ice‐shelf collapses, but these are not grounded, which may be crucial to polar recolonization rates.
Sites With Small Impedance Decrease During Catheter Ablation for Atrial Fibrillation Are Associated With Recovery of Pulmonary Vein Conduction
Authors: CHINITZ JASON S. , KAPUR SUNIL , BARBHAIYA CHIRAG , KUMAR SAURABH , JOHN ROY , EPSTEIN LAURENCE M. , TEDROW USHA , STEVENSON WILLIAM G. , MICHAUD GREGORY F. 
Published: September 2016

Impedance Decrease During AF AblationObjectiveTo correlate impedance decrease during atrial fibrillation (AF) ablation with lesion durability and PV conduction recovery demonstrated during redo procedures.BackgroundMarkers of successful ablation beyond acute conduction block are needed to improve durability of pulmonary vein (PV) isolation (PVI). Local impedance decrease resulting from ablation is a real‐time marker of tissue heating and is correlated with lesion creation.MethodsImpedance changes associated with point‐by‐point radiofrequency ablation in the PV antra were recorded during 167 consecutive first‐time AF ablations. During clinically indicated redo procedures, sites of recovered PV conduction were identified, and were correlated with the impedance change achieved during ablation at these locations during the initial procedure.ResultsRedo procedures were performed in 28 patients, in whom 19 sites of recovered PV conduction were documented. Most sites of PV reconnection (58%) occurred along the posterior PV antra. Ablation resulting in impedance decrease <10 ohms during the initial procedure was present in 89% (17/19) of sites with conduction recovery. Regions with adjacent ablation resulting in impedance decrease <10 ohms were associated with a higher rate of conduction recovery (37% vs. 1.5%, P < 0.001). Likewise, patients with PV conduction recovery demonstrated during redo procedure (Group 1) had larger regions where ablation resulted in <10 ohm impedance decrease than patients without PV conduction recovery (Group 2) (21.9 ± 15.5 mm vs. 11.5 ± 2.1 mm, P < 0.01).ConclusionRecovered PV conduction occurs predominantly in regions where adjacent ablation applications result in impedance decreases <10 ohms. Impedance‐guided ablation strategies may improve durability of PVI.