bluuebunny/crossref_metadata_2025_split huggingface dataset:
Experiences with Lean Six Sigma as improvement strategy to reduce parenteral medication administration errors and associated potential risk of harm
Authors: van de Plas Afke , Slikkerveer Mariëlle , Hoen Saskia , Schrijnemakers Rick , Driessen Johanna , de Vries Frank , Bemt Patricia van den 
Published: June 2017

In this controlled before-after study the effect of improvements, derived from Lean Six Sigma strategy, on parenteral medication administration errors and the potential risk of harm was determined.During baseline measurement, on control versus intervention ward, at least one administration error occurred in 14 (74%) and 6 (46%) administrations with potential risk of harm in 6 (32%) and 1 (8%) administrations. Most administration errors with high potential risk of harm occurred in bolus injections: 8 (57%) versus 2 (67%) bolus injections were injected too fast with a potential risk of harm in 6 (43%) and 1 (33%) bolus injections on control and intervention ward. Implemented improvement strategies, based on major causes of too fast administration of bolus injections, were: Substitution of bolus injections by infusions, education, availability of administration information and drug round tabards.Post intervention, on the control ward in 76 (76%) administrations at least one error was made (RR 1.03; CI95:0.77-1.38), with a potential risk of harm in 14 (14%) administrations (RR 0.45; CI95:0.20-1.02). In 40 (68%) administrations on the intervention ward at least one error occurred (RR 1.47; CI95:0.80-2.71) but no administrations were associated with a potential risk of harm. A shift in wrong duration administration errors from bolus injections to infusions, with a reduction of potential risk of harm, seems to have occurred on the intervention ward.Although data are insufficient to prove an effect, Lean Six Sigma was experienced as a suitable strategy to select tailored improvements. Further studies are required to prove the effect of the strategy on parenteral medication administration errors.
The safety, efficacy and cost-effectiveness of stress echocardiography in patients with high pretest probability of coronary artery disease
Authors: Papachristidis Alexandros , Demarco Daniela Cassar , Roper Damian , Tsironis Ioannis , Papitsas Michael , Byrne Jonathan , Alfakih Khaled , Monaghan Mark J 
Published: June 2017

ObjectiveIn this study, we assess the clinical and cost-effectiveness of stress echocardiography (SE), as well as the place of SE in patients with high pretest probability (PTP) of coronary artery disease (CAD).MethodsWe investigated 257 patients with no history of CAD, who underwent SE, and they had a PTP risk score >61% (high PTP). According to the National Institute for Health and Care Excellence guidance (NICE CG95, 2010), these patients should be investigated directly with an invasive coronary angiogram (ICA). We investigated those patients with SE initially and then with ICA when appropriate. Follow-up data with regard to Major Adverse Cardiac and Cerebrovascular Events (MACCE, defined as cardiovascular mortality, cerebrovascular accident (CVA), myocardial infarction (MI) and late revascularisation for acute coronary syndrome/unstable angina) were recorded for a period of 12 months following the SE. The tariff for SE and ICA is £300 and £1400, respectively.Results106 patients had a positive SE (41.2%) and 61 of them (57.5%) had further investigation with ICA. 15 (24.6%) of these patients were revascularised. The average cost per patient for investigations was £654.09. If NICE guidance had been followed, the cost would have been significantly higher at £1400 (p<0.001). Overall, 5 MACCE (2.0%) were recorded; 4 (3.8%) in the group of positive SE (2 CVAs and 2 MIs) and 1 (0.7%) in the group of negative SE (1 CVA). There was no MI and no need for revascularisation in the negative SE group.ConclusionOur approach to investigate patients who present with de novo chest pain and high PTP, with SE initially and subsequently with ICA when appropriate, reduces the cost significantly (£745.91 per patient) with a very low rate of MACCE. However, this study is underpowered to assess safety of SE.
Effect of petrographic characteristics on abrasive properties of granitic building stones
Authors: Cheshomi A. , Moradhaseli S. 
Published: June 2017

The abrasive properties of stone that wear away and destroy the cutting blades and drill heads of boring machines increase the cost of construction and mining projects. This study investigated the effects of petrographic characteristics on the abrasiveness of granitic building stone. The composition and abundance of minerals forming each sample were evaluated by preparing microscopic sections of 18 samples, which were then classified as granite, gabbro or hornfels, that are introduced in the building industry as granite building stone. The effect of the abundance of specific minerals was evaluated by calculating the equivalent quartz content for each sample. Cerchar and Laboratoire Central des Ponts et Chausées (LCPC) testing determined the Cerchar abrasivity index (CAI), LCPC abrasivity coefficient (LAC) and LCPC breakability coefficient (LBC) for samples. Linear and direct relationships having a correlation coefficient of greater than 0.82 were determined for LAC–EQC (equivalent quartz content), CAI–EQC and CAI–LAC. No relationship was found having an acceptable value for
R
for LBC–EQC in the whole samples; however, grouping them produced an experimental relationship at
R
> 0.88 for LBC–EQC. It was concluded that the experimental relationships for LAC–EQC, CAI–LAC and LBC–EQC increased for groups having the same mineralogical composition. Comparison of the relations in the present study with those proposed by other researchers shows a similar trend of change in the parameters.
Deciding First-Order Properties of Nowhere Dense Graphs
Authors: Grohe Martin , Kreutzer Stephan , Siebertz Sebastian 
Published: June 2017

Nowhere dense graph classes, introduced by Nešetřil and Ossona de Mendez [2010, 2011], form a large variety of classes of “sparse graphs” including the class of planar graphs, actually all classes with excluded minors, and also bounded degree graphs and graph classes of bounded expansion.

We show that deciding properties of graphs definable in first-order logic is fixed-parameter tractable on nowhere dense graph classes (parameterized by the length of the input formula). At least for graph classes closed under taking subgraphs, this result is optimal: it was known before that for all classes
C
of graphs closed under taking subgraphs, if deciding first-order properties of graphs in
C
is fixed-parameter tractable, then
C
must be nowhere dense (under a reasonable complexity theoretic assumption).

As a by-product, we give an algorithmic construction of sparse neighborhood covers for nowhere dense graphs. This extends and improves previous constructions of neighborhood covers for graph classes with excluded minors. At the same time, our construction is considerably simpler than those.
Our proofs are based on a new game-theoretic characterization of nowhere dense graphs that allows for a recursive version of locality-based algorithms on these classes. On the logical side, we prove a “rank-preserving” version of Gaifman’s locality theorem.
Increased vascular and uteroplacental matrix metalloproteinase-1 and -7 levels and collagen type I deposition in hypertension in pregnancy: role of TNF-α
Authors: Li Wei , Cui Ning , Mazzuca Marc Q. , Mata Karina M. , Khalil Raouf A. 
Published: June 2017

Preeclampsia is a pregnancy-related disorder manifested as maternal hypertension in pregnancy (HTN-Preg) and fetal growth restriction. Placental ischemia could be an initiating event that leads to abnormal vascular and uteroplacental remodeling in HTN-Preg; however, the molecular targets and intermediary mechanisms involved are unclear. We tested the hypothesis that placental ischemia could target vascular and uteroplacental matrix metalloproteinases (MMPs) through an inflammatory cytokine-mediated mechanism. MMP levels and distribution were measured in the aorta, uterus, and placenta of normal pregnant (Preg) rats and pregnant rats with reduced uterine perfusion pressure (RUPP). Maternal blood pressure was higher and the litter size and pup weight were lower in RUPP compared with Preg rats. Gelatin zymography showed prominent uterine MMP-2 and MMP-9 activity that was dependent on the amount of loaded protein. At saturating protein loading, both gelatin and casein zymography revealed two additional bands corresponding to MMP-1 and MMP-7 that were greater in the aorta, uterus, and placenta of RUPP compared with Preg rats. Western blots and immunohistochemistry confirmed increased MMP-1 and MMP-7 in the aorta, uterus, and placenta of RUPP versus Preg rats. The levels of MMP-1 and MMP-7 substrate collagen type I were greater in tissues of RUPP compared with Preg rats. In organ culture, TNF-α increased MMP-1 and MMP-7 in the aorta, uterus, and placenta of Preg rats, and a TNF-α antagonist prevented the increases in MMPs in tissues of RUPP rats. Thus, placental ischemia, possibly through TNF-α, increases vascular and uteroplacental MMP-1 and MMP-7, which, in turn, alter collagen deposition and cause inadequate tissue remodeling in HTN-Preg. Cytokine antagonists may reverse the increase in MMP-1 and MMP-7 expression/activity and, in turn, restore proper vascular and uteroplacental remodeling in HTN-Preg and preeclampsia. NEW & NOTEWORTHY The molecular mechanisms of preeclampsia are unclear, making it difficult to predict, prevent, or manage the pregnancy-associated disorder. This study showed that placental ischemia, possibly through the release of TNF-α, causes increases in the levels of matrix metalloproteinase (MMP)-1 and MMP-7, which could alter collagen deposition and cause inadequate uteroplacental and vascular remodeling in hypertension in pregnancy. The data suggest that targeting MMP-1 and MMP-7 and their upstream modulators, such as TNF-α, could provide a new approach in the management of hypertension in pregnancy and preeclampsia.
The Association of Telomere Length in Peripheral Blood Cells with Cancer Risk: A Systematic Review and Meta-analysis of Prospective Studies
Authors: Zhang Xia , Zhao Qian , Zhu Wei , Liu Tao , Xie Shao-Hua , Zhong Li-Xin , Cai Yuan-Yuan , Li Xiao-Na , Liang Mei , Chen Wen , Hu Qian-Sheng , Zhang Bo 
Published: June 2017

Abstract
The association between telomere length (TL) in peripheral blood cells and cancer risk remains inconclusive. We carried out a meta-analysis on prospective studies. The study-specific RR estimates were first transformed to a common comparable scale and then were pooled by a random-effects model. The dataset was composed of 13,894 cases and 71,672 controls from 28 studies in 25 articles. In the comparison of the longest versus shortest third of TL, we observed a marginally positive association between longer TL and higher risk of total cancers [OR = 1.086; 95% confidence interval (CI), 0.952–1.238]. Subgroup analyses showed that the association was stronger in lung cancer (n = 3; OR = 1.690; 95% CI, 1.253–2.280), in men (n = 6; OR = 1.302; 95% CI, 1.120–1.514) and in studies with more precise methods for DNA extraction (phenol–chloroform, salting-out or magnetic bead, n = 6, OR = 1.618; 95% CI, 1.320–1.985) and TL measurement (multiplex Q-PCR, n = 8; OR = 1.439; 95% CI, 1.118–1.852). Our meta-analysis suggested longer TL in peripheral blood cells is a likely risk factor for lung cancer or cancers in men. Accurate DNA extraction and TL measurement methods make it more liable to find significant associations between TL and cancer risk and thus should be taken into consideration in future epidemiologic studies. Cancer Epidemiol Biomarkers Prev; 26(9); 1381–90. ©2017 AACR.
Contribution of Established Stroke Risk Factors to the Burden of Stroke in Young Adults
Authors: Aigner Annette , Grittner Ulrike , Rolfs Arndt , Norrving Bo , Siegerink Bob , Busch Markus A. 
Published: June 2017

Background and Purpose—
As stroke in young adults is assumed to have different etiologies and risk factors than in older populations, the aim of this study was to examine the contribution of established potentially modifiable cardiovascular risk factors to the burden of stroke in young adults.

Methods—
A German nationwide case–control study based on patients enrolled in the SIFAP1 study (Stroke In Young Fabry Patients) 2007 to 2010 and controls from the population-based GEDA study (German Health Update) 2009 to 2010 was performed. Cases were 2125 consecutive patients aged 18 to 55 years with acute first-ever stroke from 26 clinical stroke centers; controls (age- and sex-matched, n=8500, without previous stroke) were from a nationwide community sample. Adjusted population-attributable risks of 8 risk factors (hypertension, hyperlipidemia, diabetes mellitus, coronary heart disease, smoking, heavy episodic alcohol consumption, low physical activity, and obesity) and their combinations for all stroke, ischemic stroke, and primary intracerebral hemorrhage were calculated.

Results—
Low physical activity and hypertension were the most important risk factors, accounting for 59.7% (95% confidence interval, 56.3–63.2) and 27.1% (95% confidence interval, 23.6–30.6) of all strokes, respectively. All 8 risk factors combined explained 78.9% (95% confidence interval, 76.3–81.4) of all strokes. Population-attributable risks of all risk factors were similar for all ischemic stroke subtypes. Population-attributable risks of most risk factors were higher in older age groups and in men.

Conclusions—
Modifiable risk factors previously established in older populations also account for a large part of stroke in younger adults, with 4 risk factors explaining almost 80% of stroke risk.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00414583.
Morphological and molecular characterisation of Paralongidorus francolambertii sp. n. (Nematoda: Longidoridae) from Serbia
Authors: Barsi László , De Luca Francesca 
Published: June 2017

Paralongidorus francolambertii sp. n., a bisexual species found in the rhizosphere of silver lime (Tilia tomentosa) and common juniper (Juniperus communis), is described. The species is characterised by its medium to large size (L = 5.86-8.29 mm) and slender body (a = 143-197), a lip region flattened with rounded profile, clearly offset from the body by a deep constriction, a narrow neck between the head and body, a shoulder-like body posterior to the neck, a stirrup-shaped amphidial fovea, with conspicuous slit-like aperture, lying on the lateral cuticular collar, a moderately long odontostyle ca 140 μm long, a guide ring located at ca 28 μm from anterior end, a tail terminus with thickened outer cuticular layer in both sexes, and males with spicules ca 52 μm long. The D2-D3 expansion domains of the 28S rRNA gene and the ITS-containing region of P. francolambertii sp. n. were amplified and sequenced. Phylogenetic analyses by using the Maximum Likelihood method showed that P. francolambertii sp. n. had a sister relationship with P. rex and that all Paralongidorus species formed a well-supported group.
A Moving Updated Statistical Prediction Model for Summer Rainfall in the Middle-Lower Reaches of the Yangtze River Valley
Authors: Guo Yan , Li Jianping , Zhu Jiangshan 
Published: June 2017

AbstractBecause summer rainfall in the middle-lower reaches of the Yangtze River valley has remarkable interannual and decadal variability and because the precursors that modulate the interannual rainfall change with the decadal variation of the background state, a new model that employs a novel statistical idea is needed to yield an accurate prediction. In this study, the interannual rainfall model (IAM) and the decadal rainfall model (DM) were constructed. Moving updating of the IAM with the latest data within an optimal length of training period (20 yr) can partially offset the effect of decadal change of precursors in IAM. To predict the interannual rainfall of 2001–13 for validation, 13 regression models were fitted with precursors that change every 4–5 yr, from the preceding winter North Atlantic Ocean sea surface temperature anomaly (SSTA) dipole to the Mascarene high, followed by the East Asia sea level pressure anomaly (SLPA) dipole and the preceding autumn North Pacific SSTA dipole. The moving updated model demonstrated high skill in predicting interannual rainfall, with a correlation coefficient of 0.76 and a hit rate of 76.9%. The DM was linked to the April SLPA in the central tropical Pacific Ocean, and it maintained good performance in the testing period, with a correlation coefficient of 0.77 and a root-mean-square error (RMSE) of 7.7%. The statistical model exhibited superior capability even when compared with the best forecast by the Climate Forecast System, version 2 (CFSv2), initiated in early June, as indicated by increased correlation coefficient from 0.62 to 0.75 and reduced RMSE from 12.3% to 10.7%.
Human Milk Fortifiers Do Not Meet the Current Recommendation for Nutrients in Very Low Birth Weight Infants
Authors: Koo Winston , Tice Hilary 
Published: June 2017

AbstractBackground: Use of multinutrient fortifiers is standard of care for small preterm infants fed exclusively human milk. However, adequacy of human milk fortifiers (HMFs) to meet the recommended intake for macronutrients and micronutrients is now known. Materials and Methods: Nutrient content of human milk fortified according to manufacturer’s recommendations was compared at isocaloric levels for 1 human milk–based (HMF‐A), 2 bovine milk protein–based (HMF‐B, HMF‐C), and 2 preterm infant formulas (PTF‐B, PTF‐C). In addition, 4 multivitamin supplements were compared. Results: At 130 kcal/kg, intake of macronutrients was similar to the recommendation, although deficient and excess intake of micronutrient occurred with all fortifiers. Four to 9 micronutrients were absent in HMF or PTF (biotin, choline, inositol, carnitine, taurine, molybdenum, iodine, selenium, or chromium). For the remainder, HMF resulted in deficient intake for 1–13 micronutrients, occurring most frequently with HMF‐A. Excess micronutrients (3–15 at <50% and 1–3 at 109%–437%) occurred with all HMF and most frequently with HMF‐B and HMF‐C. At 150 kcal/kg, deficient intake improved but generally remained below recommendation, while excess intake became exaggerated. PTF and multivitamin formulations do not fully compensate for the deficiencies and can result in extremely high micronutrient intake. Conclusions: At the recommended energy intake for very low birth weight infants, many micronutrients are absent or are present in grossly inadequate amounts, and several micronutrients are in excess. Reformulation of HMF is urgently needed since PTF or multivitamin supplement only partially corrects some deficiencies while providing some nutrients in excess.
Comparison of Clinical and Radiological Results in the Arthroscopic Repair of Full-Thickness Rotator Cuff Tears With and Without the Anterior Attachment of the Rotator Cable
Authors: Cho Nam Su , Moon Seong Cheol , Hong Se Jung , Bae Seong Hae , Rhee Yong Girl 
Published: June 2017

Background:The anterior rotator cable is critical in force transmission of the rotator cuff. However, few clinical studies have examined the correlation between the integrity of the anterior supraspinatus tendon and surgical outcomes in patients with rotator cuff tears.Purpose:To compare the clinical and structural outcomes of the arthroscopic repair of full-thickness rotator cuff tears with and without anterior disruption of the supraspinatus tendon.Study Design:Cohort study; Level of evidence, 3.Methods:One hundred eighty-one shoulders available for magnetic resonance imaging (MRI) at least 6 months after arthroscopic rotator cuff repair, with a minimum 1-year follow-up, were enrolled. The anterior attachment of the rotator cable was disrupted in 113 shoulders (group A) and intact in 68 shoulders (group B). The mean age at the time of surgery in groups A and B was 59.6 and 59.2 years, respectively, and the mean follow-up period was 24.2 and 25.1 months, respectively.Results:There were statistically significant differences in the preoperative tear size and pattern and muscle fatty degeneration between the 2 groups ( P = .004, P = .008, and P < .001, respectively). At final follow-up, the mean visual analog scale (VAS) for pain score during motion was 1.31 ± 0.98 and 1.24 ± 0.90 in groups A and B, respectively ( P = .587). The mean Constant score was 77.5 ± 11.2 and 78.0 ± 11.9 points in groups A and B, respectively ( P = .875). The mean University of California, Los Angeles score was 30.5 ± 4.1 and 31.0 ± 3.0 points in groups A and B, respectively ( P = .652). In assessing the repair integrity on postoperative MRI, the retear rate was 23.9% and 14.7% in groups A and B, respectively ( P = .029).Conclusion:Irrespective of involvement in the anterior attachment of the rotator cable, the mean 24-month follow-up demonstrated excellent pain relief and improvement in the ability to perform activities of daily living after arthroscopic rotator cuff repair. However, tears with anterior disruption of the rotator cable showed a significantly larger and more complex tear pattern and more advanced fatty degeneration. Additionally, the retear rate was significantly higher in patients with a tear involving the anterior attachment of the rotator cable.
Musculoskeletal manifestations as determinants of quality of life impairment in patients with systemic lupus erythematosus
Authors: Piga M , Congia M , Gabba A , Figus F , Floris A , Mathieu A , Cauli A 
Published: June 2017

Objective The objective of this study was to identify determinants of health-related quality of life (HRQoL) impairment in patients with systemic lupus erythematosus (SLE). Methods Overall, 101 SLE patients were recruited; 37 healthy subjects and 35 rheumatoid arthritis (RA) patients served as controls. HRQoL was evaluated using three patient reported outcomes (PROs): the Short Form-36 version 2 (SF-36v2) health survey, the fatigue scale version 4 (FACITv4) and the Heath Assessment Questionnaire (HAQ). A large set of demographic and clinical variables, including SLE arthritis subtypes, was evaluated searching for factors independently associated with worse QoL. Multivariate models were applied to identify factors independently associated with outcomes. Bonferroni’s corrected p values < 0.05 were considered significant. Results SLE patients showed worse results than healthy controls ( p < 0.01) in all SF-36v2 domains and, with reference to the mental QoL, also than RA patients ( p < 0.01). Jaccoud’s deformities, active arthritis, and fibromyalgia were the only factors independently associated with worse results in both physical and mental components summary of the SF-36v2 ( p < 0.01) and FACITv4 fatigue scale ( p < 0.01). Fragility fractures, deformities, and active arthritis negatively affected disability perception measured by the HAQ ( p < 0.01). No statistically significant differences in perceived HRQoL were highlighted between patients with deforming and erosive arthritis. However, they had significantly worse results than patients with non-deforming non-erosive arthritis across all investigated PROs ( p < 0.01). Conclusion In order to limit musculoskeletal manifestations as a source of impaired QoL in SLE patients, therapeutic strategies targeted to successfully manage active arthritis and fibromyalgia and to prevent deforming damage are needed.