bluuebunny/crossref_metadata_2025_split huggingface dataset:
Achieving High Reliability Through Cultural Mindfulness
Authors: Cawley Patrick J. , Scheurer Danielle B. 
Published: December 2017

Summary
Healthcare has enthusiastically embraced quality and safety improvement. Yet, more radical transformation is clearly needed to make a more significant impact on error reduction and to ensure consistent quality. This need for transformation is leading healthcare to examine how other industries, such as nuclear power and aviation, improve safety to achieve a high degree of reliability and avoid potential catastrophes. Research has shown that successful organizations in high-risk industries achieve high reliability by maintaining a cultural mindfulness that allows them to continually reinvent themselves in complex environments. Healthcare faces similar challenges and could greatly benefit from instilling high-reliability principles in its operations. The Medical University of South Carolina, an academic health system, has been on a quest to improve safety and quality by implementing a high-reliability culture.
High-Reliability Principles Must Be Tied to Value-Based Outcomes
Authors: Wasden Mitchell L. 
Published: December 2017

Summary
WellStar Health System and the Medical University of South Carolina (MUSC), highlighted in this issue’s feature articles, are two organizations seeking to drive high reliability by educating leaders and incorporating high-reliability principles into their quality improvement (QI) efforts. The organizations have taken slightly different approaches to executing on high reliability, yet both are encouraged by the apparent success of high-reliability principles in other industries.
The high-reliability framework is often applied to healthcare despite the limitations of comparing healthcare organizations to nuclear reactors, commercial airlines, and aircraft carriers. Notably, these industries were classified as “highly reliable” after the fact, meaning their employees and leadership already had existing routines and qualities that researchers would describe, after direct observation, as a shared distinguishing feature. Thus, in contrast to Lean, Six Sigma, and other QI movements that have been applied in healthcare, industries such as nuclear power and aviation came with tools and quantitative processes already embedded. The high-reliability framework is qualitative, while the actual hard, quantitative tools and processes differ by industry. This fact makes adopting high-reliability principles difficult because the tools must be created and scaled for each industry. Healthcare is still in the early stages of building these tools to support the high-reliability framework, and the articles by Saunders and Brennan (at WellStar) and Cawley and Scheurer (at MUSC) describe early attempts to provide insights into launching high-reliability principles and tools in healthcare.
High reliability is a theoretical construct that is difficult to implement without a concrete framework for execution. The five characteristics that frame a high-reliability organization (HRO), as outlined by Cawley and Scheurer (citing Weick and Sutcliffe 2001), are (1) preoccupation with failure, (2) reluctance to simplify interpretations, (3) sensitivity to operations, (4) commitment to resilience, and (5) deference to expertise. Although these elements point in the right direction, they remain theoretical if not tethered to an organization’s operating cycle.
Remaining Financially Viable in a Time of Healthcare Transition
Authors: Ronan Barry P. 
Published: December 2017

SUMMARY
In an unstable healthcare environment, Western Maryland Health System has been demonstrating stability. We have responded to the many challenges that hospitals face and managed to thrive in the new, value-based world.
We made the transition to value-based payment and care delivery models through innovations in Maryland’s payment system. In 2010, we recognized that becoming a demonstration project for value-based care would benefit our health system as we dealt with an aging and shrinking regional population. By moving care away from the acute setting to other settings across the care continuum, we now treat patients in the most appropriate setting (e.g., the home, physician office, clinic, and even senior centers, churches, and homeless shelters).
As we have transitioned care, we have also transitioned our workforce. With fewer acute care patients, we need fewer staff members at the bedside. Many of our staff have shifted to delivering care in pre- and post-acute care settings.
To improve our financial performance, we formed an alliance of three health systems. This new alliance has found increased savings by consolidating services, managing regionwide population health initiatives, and benchmarking clinical quality through best practices. Through the alliance, each individual health system is stronger and well augmented by the savings that it could not achieve separately.
The transition has not been easy, but we have shown that it is achievable. We have identified a number of solutions to reduce costs and generate savings while enhancing quality and patient safety. These solutions may present a pathway to success for other organizations seeking to move to value-based care delivery and new payment models.
SURGICAL REMOVAL OF EPIRETINAL MEMBRANE WITH AND WITHOUT REMOVAL OF INTERNAL LIMITING MEMBRANE
Authors: De Novelli Fernando J. , Goldbaum Mauro , Monteiro Mario L. R. , Bom Aggio Fabio , Takahashi Walter Y. 
Published: December 2017

Purpose:
To study and compare visual acuity, foveal thickness, outer limiting layer, ellipsoid zone, and recurrence rate in patients undergoing removal of the epiretinal membrane with and without the removal of the internal limiting membrane (ILM).

Methods:
Sixty-three patients who had the epiretinal membrane removed by a single surgeon were randomly assigned into 2 groups: Group 1 without additional removal of the ILM and Group 2 with removal of the ILM. Patients were followed up and evaluated at the first month, third month, and sixth month, postoperatively.

Results:
Patients from both groups had a gradual improvement in their vision over time. There was no significant difference in the improvement in visual acuity between the two groups. About tomographic assessment of alterations, no significant differences were found between the groups; however, Group 1 had a higher relapse rate (17%) compared with Group 2 (3.6%) (P = 0.09).

Conclusion:
Epiretinal membrane removal with and without ILM peeling shows similar functional and anatomical improvements, but the group in which the ILM was not removed seemed to have a higher recurrence rate.
BILATERAL UVEAL METASTASES SECONDARY TO PROSTATE ADENOCARCINOMA
Authors: Cochran Katherine J. , Gray James R. , Meluch Anthony A. , Reichstein David A. 
Published: December 2017

Purpose:
To report a patient with bilateral uveal metastases secondary to previously quiescent prostate adenocarcinoma with a 22-month follow-up.

Methods:
Retrospective chart review was performed for this patient.

Results:
Androgen deprivation therapy and external beam radiation therapy were shown to manage ocular symptoms in a sixty-nine-year-old man previously diagnosed with adenocarcinoma of the prostate.

Conclusion:
Uveal metastases can be the first site of systemic metastasis even long after initial diagnosis and treatment of prostate adenocarcinoma; the 17 years between this patient's treatment for adenocarcinoma and commencement of his ocular symptoms is the longest interval reported. Hormonal therapy, in conjunction with radiation therapy, can successfully reduce tumor burden in these patients and improve visual symptoms over time.
Visual Outcomes and Aberrometric Changes With Topography-Guided Photorefractive Keratectomy Treatment of Irregular Astigmatism After Penetrating Keratoplasty
Authors: Bandeira e Silva Francisco , Hazarbassanov Rossen Mihaylov , Martines Eduardo , Güell José Luis , Hofling-Lima Ana L. 
Published: December 2017

Purpose:
To evaluate the visual acuity and keratometric and aberrometric changes in patients with corneal transplants (PKP), who underwent topography-guided photorefractive keratectomy (TG-PRK) with mitomycin C (MMC).

Methods:
In this case study, 15 patients with spherical equivalents ranging from −11.00 to −0.25 diopters (D) who underwent penetrating corneal transplantation and had irregular astigmatism ranging from −7.5 to −2.0 D underwent TG-PRK with MMC. Corneal topography and wavefront of all patients were measured preoperatively and 12 months postoperatively.

Results:
Twelve months after TG-PRK with MMC, 46% of eyes achieved a best spectacle-corrected visual acuity (BSCVA) of 20/20 compared with 1 eye preoperatively (P = 0.0221, χ2 test). The BSCVA did not improve in 1 patient and increased by 1 line or more in all others. Astigmatism decreased significantly (P = 0.003) from 5.10 ± 0.4 D to 3.37 ± 0.06 D, the corneal best-fit sphere increased and keratometry measurements flattened significantly (P = 0.0001 for both comparisons), and the corneal total root mean square aberrations and trefoil decreased significantly (P = 0.0077 and P = 0.0054, respectively) from 9.11 ± 2.56 μm to 7.58 ± 3.15 μm and 2.00 ± 1.2 to 1.38 ± 0.27 μm, respectively, as measured by wavefront aberrometry.

Conclusions:
Twelve months postoperatively, the BSCVA improved significantly, the lines of vision increased, and astigmatism, corneal best-fit sphere, mean keratometry, corneal thickness, corneal root mean square total, and corneal spherical aberrations decreased. TG-PRK with MMC is a good alternative for correcting post-PKP cases with irregular astigmatism with elevated higher-order aberrations.
Vats Plication of the Diaphragm a Descriptive Observational 10-Year Southampton Experience
Authors: Taberham Rhona J. , Raza Adnan , Alzetani Aiman , Woo Edwin B. , Chamberlain Martin H. , Koulaxouzidis George , Amer Khalid M. 
Published: December 2017

Objective The aim of the study was to report the safety and efficacy of video-assisted thoracoscopic (VATS) plication of the diaphragm at our institution between 2006 and 2016. Methods Adult patients selected on etiology and combination of investigations including plain chest x-ray, computed tomography of chest and abdomen, lung functions in supine and sitting positions, radiological/ultrasonic screening for diaphragmatic movement, and phrenic nerve conduction studies. We incorporated a triportal VATS and Endostitch device for plication, using CO2 insufflation to maximum 12 mm Hg. Bilateral simultaneous plication and high-risk patients were electively admitted to intensive therapy unit postoperatively. Results Thirty-five patients (24 males) had their diaphragm plicated. The mean age was 56.6 years (range = 23–76 years). The mean body mass index was 32.1 (range = 22.2–45.4). Twenty one were right, 13 left, 2 patients had VATS simultaneous bilateral plication, and 1 had sequential VATS bilateral plication. Paralysis was idiopathic in 17, posttraumatic in 5, postremoval of mediastinal tumor in 4, and postcardiac surgery in 3. All patients presented with lifestyle-limiting dyspnea and orthopnea, three were on nocturnal noninvasive ventilation. Five were diabetic and 16 were smokers. The mean supine forced expiratory volume in the first second was 62.5% of predicted. Twenty two were performed by VATS (63%), three converted to thoracotomy, and 13 were open limited thoracotomy (historic). The mean hospital stay was 4.5 days (range = 1–18, mode 2 days). Intensive therapy unit admission was required in six patients for mechanical ventilation 0 to 3 days. Five patients (14%) had no improvement in symptoms. There were no deaths, no 30-day readmissions, and no long-term neuralgia in this series. Conclusions We found minimal access VATS plication of the diaphragm to be feasible and safe, but no firm conclusions should be drawn from our limited resources. We report the feasibility of concomitant bilateral VATS plication of the diaphragm in two adults, and this was not previously reported in the adult population. There is a need for further good quality, prospective studies, and randomized controlled studies evaluating efficacy of VATS diaphragmatic plication.
Associations of Positive Affect and Negative Affect With Allostatic Load: A Lifelines Cohort Study
Authors: Schenk Hendrika M. , Jeronimus Bertus F. , van der Krieke Lian , Bos Elisabeth H. , de Jonge Peter , Rosmalen Judith G.M. 
Published: December 2017

ABSTRACT

Objective
Allostatic load (AL) reflects the deteriorating influences of stress on the body and comprises a selection of biological markers. AL is associated with negative life events, stress, and negative affect (NA), as well as poor health outcomes. However, whether AL is also associated with positive affect (PA) is not clear. The present study therefore explores the association between PA and AL, accounting for age, sex, NA, and health behaviors.

Methods
Data of 45,225 individuals from the first wave of the multidisciplinary prospective population-based cohort study Lifelines were used. AL was operationalized as the sum of 12 inflammatory, cardiovascular, and metabolic markers. The association between PA and AL was tested in a cross-sectional study design using multiple linear regression analysis, adjusting for NA, confounders, and health behaviors. In addition, we explored whether the relation was moderated by age, sex, and NA.

Results
The AL profile was inversely associated with PA (B = −0.083, p < .001) when adjusted for NA, age, and sex. The association between AL and PA remained significant after adjusting for health behaviors (B = −0.076, p < .001). A significant moderating effect was found for sex (PA by sex: B = 0.046, p = .001), indicating that the association between PA and AL was stronger in women than in men.

Conclusions
PA was associated with a more favorable AL profile, especially in women. These results add to the evidence that PA might be of relevance to the etiology of disease.
Sepsis Induces Adipose Tissue Browning in Nonobese Mice But Not in Obese Mice
Authors: Ayalon Itay , Shen Hui , Williamson Lauren , Stringer Keith , Zingarelli Basilia , Kaplan Jennifer M. 
Published: December 2017

ABSTRACT
Severe sepsis and septic shock are the biggest cause of mortality in critically ill patients. Obesity today is one of the world's greatest health challenges. Little is known about the extent of involvement of the white adipose tissue (WAT) in sepsis and how it is being modified by obesity. We sought to explore the involvement of the WAT in sepsis. We hypothesize that sepsis induces browning of the WAT and that obesity alters the response of WAT to sepsis. Six-week-old C57BL/6 mice were randomized to a high-fat diet to induce obesity (obese group) or control diet (nonobese group). After 6 to 11 weeks of feeding, polymicrobial sepsis was induced by cecal ligation and puncture (CLP). Mice were sacrificed at 0, 18, and 72 h after CLP and epididymal WAT (eWAT), inguinal WAT, and brown adipose tissue (BAT) harvested. Both types of WAT were processed for light microscopy and transmission electron microscopy to assess for morphological changes in both obese and nonobese mice. Tissues were processed for immunohistochemistry, image analyses, and molecular analyses. BATs were used as a positive control. Nonobese mice have an extensive breakdown of the unilocular lipid droplet and smaller adipocytes in WAT compared with obese mice after sepsis. Neutrophil infiltration increases in eWAT in nonobese mice after sepsis but not in obese mice. Nonobese septic mice have an increase in mitochondrial density compared with obese septic mice. Furthermore, nonobese septic mice have an increase in uncoupling protein-1 expression. Although the WAT of nonobese mice have multiple changes characteristic of browning during sepsis, these changes are markedly blunted in obesity.
A Novel Perfusion System for Damage Control of Hyperkalemia in Swine
Authors: Hoareau Guillaume L. , Kashtan Harris , Walker Lauren E. , Beyer Carl , Wishy Andrew , Grayson J. Kevin , Ross James D. , Stewart Ian J. 
Published: December 2017

ABSTRACT

Introduction:
The standard of care for refractory hyperkalemia is renal replacement therapy (RRT). However, traditional RRT requires specialized equipment, trained personnel, and large amounts of dialysate. It is therefore poorly suited for austere environments. We hypothesized that a simplified hemoperfusion system could control serum potassium concentration in a swine model of acute hyperkalemia.

Methods:
Ten pigs were anesthetized and instrumented. A dialysis catheter was inserted. After bilateral nephrectomy, animals received intravenous potassium chloride and were randomized to the control or treatment group. In both groups, blood was pumped through an extracorporeal circuit (EC) with an in-line hemodialyzer. In the treatment arm, ultrafiltrate from the hemodialyzer was diverted through cartridges containing novel potassium binding beads and returned to the EC. Blood samples were obtained every 30 min for 6 h.

Results:
Serum potassium concentration was significantly lower in the treatment than in the control group over time (P = 0.02). There was no difference in serum total calcium concentration for group or time (P = 0.13 and 0.44, respectively) or platelet count between groups or over time (P = 0.28 and 1, respectively). No significant EC thrombosis occurred. Two of five animals in the control group and none in the treatment group developed arrhythmias. All animals survived until end of experiment.

Conclusions:
A simplified hemoperfusion system removed potassium in a porcine model. In austere settings, this system could be used to temporize patients with hyperkalemia until evacuation to a facility with traditional RRT.
Individualized connectome-targeted transcranial magnetic stimulation for neuropsychiatric sequelae of repetitive traumatic brain injury in a retired NFL player
Authors: Siddiqi Shan H. , Trapp Nicholas T. , Shahim Pashtun , Hacker Carl D. , Laumann Timothy O. , Kandala Sridhar , Carter Alexandre R. , Brody David L. 
Published: December 2017

The recent advent of individualized resting-state network mapping (RSNM) has revealed substantial inter-individual variability in anatomical localization of brain networks identified using resting-state functional MRI (rsfMRI). Such variability may be particularly important after repetitive traumatic brain injury (TBI), which is associated with treatment-resistant depression. RSNM enables personalized targeting of repetitive transcranial magnetic stimulation (rTMS), a focal brain stimulation technique that relieves depression when administered over dorsolateral prefrontal cortex.RSNM was used to identify left/right dorsolateral prefrontal rTMS targets with maximal difference between dorsal attention network and default mode network (DMN) correlations. These targets were spatially distinct from those identified by prior methods. The method was evaluated by administering twenty sessions of left-sided excitatory and right-sided inhibitory rTMS to a retired NFL defensive lineman with progressive treatment-resistant neuropsychiatric disturbances. Treatment led to improvement in Montgomery-Asberg Depression Rating Scale (72%), cognitive testing, and headache scales. In comparison with healthy individuals and subjects with TBI-associated depression, baseline rsfMRI revealed substantially elevated DMN connectivity with medial temporal lobe (MTL). Serial rsfMRI scans showed gradual improvement in MTL-DMN connectivity and stimulation site connectivity with subgenual anterior cingulate cortex. This highlights the possibility of individualized neuromodulation and biomarker-based monitoring for neuropsychiatric sequelae of repetitive TBI.
Improved genome assembly and annotation for the rock pigeon (Columba livia)
Authors: Holt Carson , Campbell Michael , Keays David A. , Edelman Nathaniel , Kapusta Aurélie , Maclary Emily , Domyan Eric , Suh Alexander , Warren Wesley C. , Yandell Mark , Gilbert M. Thomas P. , Shapiro Michael D. 
Published: December 2017

ABSTRACTThe domestic rock pigeon (Columba livia) is among the most widely distributed and phenotypically diverse avian species. This species is broadly studied in ecology, genetics, physiology, behavior, and evolutionary biology, and has recently emerged as a model for understanding the molecular basis of anatomical diversity, the magnetic sense, and other key aspects of avian biology. Here we report an update to the C. livia genome reference assembly and gene annotation dataset. Greatly increased scaffold lengths in the updated reference assembly, along with an updated annotation set, provide improved tools for evolutionary and functional genetic studies of the pigeon, and for comparative avian genomics in general.
Subtle perturbations of the maize methylome reveal genes and transposons silenced by DNA methylation
Authors: Anderson Sarah N. , Zynda Greg , Song Jawon , Han Zhaoxue , Vaughn Matthew , Li Qing , Springer Nathan M. 
Published: December 2017

ABSTRACTDNA methylation is a chromatin modification that can provide epigenetic regulation of gene and transposon expression. Plants utilize several pathways to establish and maintain DNA methylation in specific sequence contexts. The chromomethylase (CMT) genes maintain CHG (where H = A, C or T) methylation. The RNA-directed DNA methylation (RdDM) pathway is important for CHH methylation. Transcriptome analysis was performed in a collection ofZea mayslines carrying mutant alleles for CMT or RdDM-associated genes. While the majority of the transcriptome was not affected, we identified sets of genes and transposon families sensitive to context-specific decreases in DNA methylation in mutant lines. Many of the genes that are up-regulated in CMT mutant lines have high levels of CHG methylation, while genes that are differentially expressed in RdDM mutants are enriched for having nearby mCHH islands, providing evidence that context-specific DNA methylation directly regulates expression of a small number of genes. The analysis of a diverse set of inbred lines revealed that many genes regulated by CMTs exhibit natural variation for DNA methylation and gene expression. Transposon families with differential expression in the mutant genotypes show few defining features, though several families up-regulated in RdDM mutants show enriched expression in endosperm, highlighting the importance for this pathway during reproduction. Taken together, our findings suggest that while the number of genes and transposon families whose expression is reproducibly affected by mild perturbations in context-specific methylation is small, there are distinct patterns for loci impacted by RdDM and CMT mutants.