bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pulmonary Arterial Hypertension Complicating Congenital Heart Disease: Advances in Therapy
Authors: Brida Margarita , Price Laura , McCabe Colm , Alonso-Gonzalez Rafael , Wort Stephen , Kempny Aleksander , Dimopoulos Konstantinos , Gatzoulis Michael , Nashat Heba 
Published: October 2017

AbstractCongenital heart disease (CHD) is the most common inborn defect, affecting approximately 1% of all newborns worldwide. Advances in its diagnosis and treatment have led to dramatic improvements in patients' quality of life and long-term survival. Nevertheless, despite these innovations many patients require life-long follow-up and are at risk of numerous complications, namely, residual or progressive hemodynamic lesions, arrhythmia, sudden cardiac death, and the development of heart failure and pulmonary arterial hypertension (PAH), despite timely surgical intervention. Ill advisedly, some patients are also lost to follow-up, assuming that their early life surgical or catheter-based intervention was curative, hence missing out on invaluable lifetime screening and timely interventions that may be necessary. Additionally, there are many patients with undiagnosed or unoperated CHD in the developing world presenting later in life with irreversible complications. Even in this modern era of diagnosis and screening, PAH-CHD remains a burden in patients with CHD, with approximations of up to 10% in this heterogeneous group and is associated with an adverse impact on quality of life and survival.
Lung Transplantation for Pulmonary Hypertension and Strategies to Bridge to Transplant
Authors: Baillie Timothy , Granton John 
Published: October 2017

AbstractDespite an expanded armamentarium of medical therapies, pulmonary arterial hypertension (PAH) remains a progressive disease associated with significant morbidity and premature mortality. Lung transplantation (LT) is the last safety net for patients failing medical therapy, providing excellent overall long-term survival and health-related quality-of-life outcomes in line with more common parenchymal lung disease indications. Waitlist mortality remains disproportionally elevated, however, reflecting an inability of the lung allocation score to completely capture PAH disease severity, and a propensity for PAH to deteriorate rapidly without warning, even in patients who appear externally “well.” Early referral to a LT center can mitigate these risks and facilitate rapid listing if necessary. Several bridging therapies are available to support severely unwell patients to LT, such as extracorporeal life support (ECLS) and atrial septostomy. Unique perioperative considerations include higher rates of primary graft dysfunction and dynamic right ventricular outflow obstruction which may, at least in part, reflect rapid afterload reduction in the face of a conditioned right ventricle. Extending ECLS into the perioperative period may ameliorate these risks by allowing more gradual adaptation of both ventricles to their new loading conditions. Chronic lung allograft dysfunction, particularly bronchiolitis obliterans syndrome, remains a major cause of long-term morbidity and mortality, and complications from corticosteroid and immunosuppressive therapy are common. Nevertheless, the morbidity, mortality, and burden of disease management after LT continue to improve and compare favorably to that of refractory PAH in carefully selected patients.
Chronic Thromboembolic Pulmonary Hypertension: Advances in Therapy
Authors: Kim Nick , Fisher Micah 
Published: October 2017

AbstractChronic thromboembolic pulmonary hypertension is a progressive disease characterized by obstruction of the pulmonary vascular bed by insufficient resolution of thromboemboli leading to increased pulmonary vascular resistance with resultant right heart dysfunction and poor long-term survival. Estimates of cumulative incidence after an acute pulmonary embolism range from 1 to 4% within 2 years of an initial event. Current recommendations focus on screening patients being evaluated for pulmonary hypertension with ventilation/perfusion scans and then considering them for potentially curative surgery consisting of a pulmonary endarterectomy. Outcomes at high-volume surgical centers continue to improve and overall perioperative mortality is close to 2 to 4% with excellent reported long-term survival. Unfortunately, adherence with guidelines remains poor and patients with this potentially remediable disease are being missed. In addition, a significant number of patients who are diagnosed are not felt to be operative candidates based on location of disease, hemodynamics, or comorbidities. Several new advances may improve outcomes for such patients who are not operative candidates or who have persistent pulmonary hypertension after surgery, including medical therapy and balloon pulmonary angioplasty. Further studies are needed to answer questions about how best to incorporate these advances into our overall treatment algorithm.
Idiopathic Pulmonary Arterial Hypertension: Evolving Therapeutic Strategies
Authors: Kanwar Manreet , Raina Amresh , Passineau Michael , Benza Raymond 
Published: October 2017

AbstractThe field of pulmonary arterial hypertension (PAH) has seen substantial changes in the epidemiology, associated comorbidities, treatment algorithms, and prognosis in the past decade. Specifically for idiopathic PAH (IPAH), there has been a noted increase in the age of initial diagnosis. Increasing focus is being placed on appropriate categorization of patients with PAH, both in terms of diagnosis and individualized risk stratification. This is especially relevant given that patients being diagnosed with incident IPAH are now older and with multiple comorbidities, putting them at a higher risk of being mislabeled as PAH. The biggest impact has been seen in the number of pharmaceutical options available for these patients, resulting in improvement in both short- and long-term outcomes. In addition, there has been a shift in the treatment approach to the early use of combination therapies in PAH, since it has been demonstrated to improve clinical outcomes. Novel therapies are in the pipeline for patients with IPAH to impact both the morbidity and mortality of this deadly disease.
Quantity of Lymph Nodes in the Vascularized Lymph Node Transfer Influences Its Lymphaticovenous Drainage
Authors: Kwiecien Grzegorz , Gharb Bahar , Tadisina Kashyap , Madajka Maria , Drazba Judith , Zins James , Schwarz Graham 
Published: October 2017

Background The purpose of this study was to: (1) evaluate the mechanism of lymph drainage through a vascularized lymph node (VLN) flap, and (2) investigate if the number of VLNs impacts lymph transit time through the flap.
Methods Twenty-seven axillary VLN flaps were elevated in 14 Sprague-Dawley rats and divided into three groups (n = 9 each) based on the number of lymph nodes present: group 1 (0-VLNs), group 2 (2-VLNs), and group 3 (4-VLNs). Indocyanine green (n = 8/group) and Alexa680-albumin (n = 1/group) were injected into the edge of flaps and the latency period between injection and fluorescence in the axillary vein was recorded. Stereomicroscopic fluorescent lymphography was performed to directly visualize lymphatic transit through VLNs.
Results Fluorescence was detected in the axillary vein after 229s [47–476], 79s [15–289], and 56s [16–110] in group 1, 2, and 3, respectively (p < 0.01). There was a negative correlation between the number of VLNs in the flap and the latency period (r = -0.59; p < 0.05). Median flap weights were comparable in group 1, 2, and 3 (258 mg [196–349], 294 mg [212–407], 315 mg [204–386], respectively; p = 0.54). Stereoscopic lymphography allowed direct visualization of lymphatic fluid transit through VLNs.
Conclusion Lymphatic fluid in VLN flaps drains into the venous system mainly by passing through the afferent lymphatics and lymph nodes. A secondary mechanism appears to be the diffusion of fluid into the venous system via intratissue lymphaticovenous connections created during flap elevation. Increasing the number of lymph nodes in the flap is associated with a more rapid transit of fluid.
Medical Treatment of Pulmonary Arterial Hypertension
Authors: Sahay Sandeep , Humbert Marc , Sitbon Olivier 
Published: October 2017

AbstractPulmonary arterial hypertension (PAH) is a progressive and life-threatening disease leading to right ventricular failure and death if left untreated. Over the past two decades, progress in the understanding of pathophysiological mechanisms of the disease has led to the development of medications targeting the three major pathways of endothelial dysfunction: prostanoids, endothelin-receptor antagonists, and phosphodiesterase type-5 inhibitors. Efficacy of PAH-targeted medications has been demonstrated in monotherapy through randomized clinical trials leading to their regulatory approval. However, despite the growing numbers of available PAH-targeted medications, many patients with PAH continue to deteriorate and the disease ultimately remains fatal. The availability of multiple classes of drugs targeting different pathophysiological pathways provides strong biological rationale for the use of combination therapy in PAH. Evidence to support this strategy is growing, and many studies have demonstrated that combination therapy, administered as either a sequential or an initial regimen, can improve long-term outcomes in PAH. Treatment strategy for PAH has thereby changed significantly over the past decade, combination therapy becoming progressively the gold standard of care in patients with PAH. This is underscored by the current European Society of Cardiology/European Respiratory Society guidelines, in which combination therapy now plays a central part in the treatment algorithm.
Treatment of Tuberculosis Infection in Children
Authors: Cruz Andrea 
Published: October 2017

AbstractThe last decade has seen publication of more robust data for shorter course regimens for tuberculosis infection. These regimens are associated with higher completion rates than the traditional 6- to 9-month course of daily isoniazid (INH). These shorter regimens include 4 months of daily rifampin (RIF) and 12 once-weekly doses of INH and a long-acting rifamycin and rifapentine. In addition, a widely used regimen in the United Kingdom is 3 or 4 months of daily INH and RIF. All regimens have demonstrated efficacy in the ideal conditions of clinical studies, and all have very low rates of hepatotoxicity in children. These newer regimens likely are more effective than longer courses of INH once patient and family adherence is considered. Clinicians need to be cognizant of poor completion rates with traditional INH therapy and how the use of rifamycin-containing regimens offers more palatable options for children and their families.
Treatment of Multidrug-Resistant Tuberculosis in Children and Adolescents
Authors: Furin Jennifer , Chiang Silvia 
Published: October 2017

AbstractAlthough tens of thousands of children and adolescents become sick with multidrug-resistant tuberculosis (MDR-TB) each year, fewer than 1,500 cases documenting treatment have been reported in the literature. Children treated for MDR-TB tend to have excellent clinical outcomes, but they suffer from the adverse events associated with current management strategies. This article will review the recommendations, evidence base, and future directions for MDR-TB therapy in children and adolescents.
Shadow Value of Ecosystem Resilience in Complex Natural Land as a Wild Pollinator Habitat
Authors: Matsushita Kyohei , Taki Hisatomo , Yamane Fumihiro , Asano Kota 
Published: October 2017

AbstractThis article investigates the shadow value of resilience in complex natural lands acting as wild pollinator habitats. We capture the linkage between pollination services in crop production and habitat conditions in the surrounding natural land with a bioeconomic model. Our case study is buckwheat, which is produced in the hilly and mountainous region of central Japan and is greatly dependent on diverse fauna for pollination services. We model the mechanism of regime shifts in ecosystems consisting of buckwheat fields and the surrounding natural land with a threshold estimation model. We then find that the forest around the crop fields, which serves as a habitat for wild pollinators, is a determinant of an ecological threshold that causes regime shifts. We calculate the shadow value of resilience provided by forest habitat around a unit of buckwheat field to be $9,796, implying that the total value of resilience in complex natural land amounts to half of the stock price of buckwheat land. This overlooked value gives us useful insights on the sustainable use of ecosystems, including both pollinator‐mediated crop fields and habitats for pollinators.
Decentralized and reproducible geocoding and characterization of community and environmental exposures for multisite studies
Authors: Brokamp Cole , Wolfe Chris , Lingren Todd , Harley John , Ryan Patrick 
Published: October 2017

Abstract

Objective
Geocoding and characterizing geographic, community, and environmental characteristics of study participants is frequently done in epidemiological studies. However, participant addresses are identifiable protected health information (PHI) and geocoding must be conducted in a Health Insurance Portability and Accountability Act–compliant manner. Our objective was to create a software application for this process that addresses limitations in current approaches.

Materials and Methods
We used a containerization platform to create DeGAUSS (Decentralized Geomarker Assessment for Multi-Site Studies), a software application that facilitates reproducible geocoding and geomarker assessment while maintaining the confidentiality of PHI. To validate the software, 215 350 addresses in Hamilton County, Ohio, were geocoded using DeGAUSS, ArcGIS, Google, and SAS and compared to a gold-standard approach. We distributed the DeGAUSS software to sites in an ongoing multisite study (Electronic Medical Records and Genomics, or eMERGE), and individual sites independently geocoded and assigned median census tract–level income and distance to nearest major roadway to their participants’ addresses, removed associated PHI, and returned deidentified data.

Results
Within a multisite study, 52 244 study participants’ addresses across 5 sites were geocoded with a median distance to roadway of 10 022m and a median census tract income of $57 266, demonstrating the feasibility of DeGAUSS within a multisite study. Compared to other commonly used geocoding platforms, DeGAUSS had similar geocoding and geomarker assessment accuracies.

Conclusion
The open source DeGAUSS software overcomes multiple challenges in the use of address data in multisite studies and also serves as a more general reproducible research tool for geocoding and geomarker assessment.
Records of auroral candidates and sunspots in Rikkokushi, chronicles of ancient Japan from early 7th century to 887
Authors: Hayakawa Hisashi , Iwahashi Kiyomi , Tamazawa Harufumi , Ebihara Yusuke , Kawamura Akito Davis , Isobe Hiroaki , Namiki Katsuko , Shibata Kazunari 
Published: October 2017

Abstract
We present the results of the surveys on sunspots and auroral candidates in Rikkokushi, Japanese official histories from the early 7th century to 887, to review the solar and auroral activities. In total, we found one sunspot record and 13 auroral candidates in Rikkokushi. We then examine the records of the sunspots and auroral candidates, compare the auroral candidates with the lunar phase to estimate their reliability, and compare the records of the sunspots and auroral candidates with the contemporary total solar irradiance reconstructed from radioisotope data. We also identify the locations of the observational sites to review possible equatorward expansion of the auroral oval. These discussions suggest a major gap in auroral candidates from the late 7th to early 9th centuries, which includes the candidate of the grand minimum reconstructed from the radioisotope data, a similar tendency as the distributions of sunspot records in contemporary China, and a relatively high magnetic latitude of observational sites with a higher potential for observing aurorae more frequently than at present.
The domestic politics of corporate accountability legislation: struggles over the 2015 UK Modern Slavery Act
Authors: LeBaron Genevieve , Rühmkorf Andreas 
Published: October 2017

AbstractOver the last decade, the norm of corporate accountability for labour standards in global supply chains has become increasingly prominent within the transnational governance arena. As global governance initiatives to spur due diligence for labour standards and combat exploitation in global supply chains—especially its most severe forms frequently described as modern slavery—have proliferated, societal coalitions have pressured states to pass domestic legislation to the same effect. In this article, we examine the regulatory processes that spurred the passage of one piece of anti-slavery legislation, the UK’s 2015 Modern Slavery Act. Our findings corroborate a number of established expectations regarding business opposition towards new legislation to raise public labour standards, but also provide a clearer picture of the mechanisms through which industry actors impact policymaking processes. Paradoxically, such mechanisms include business actors’ championing of weak regulatory initiatives, CSR activity and partnering with civil society organizations. Understanding industry actors’ use of these strategies improves our understanding of how transnational norms of corporate accountability and anti-slavery are being contested and shaped at domestic scales.
Effects of Hypercapnia on Acute Cellular Rejection after Lung Transplantation in Rats
Authors: Tan Jing , Liu Yanhong , Jiang Tao , Wang Ling , Zhao Can , Shen Dongfang , Cui Xiaoguang 
Published: October 2017

Abstract

Background
Hypercapnia alleviates pulmonary ischemia–reperfusion injury, regulates T lymphocytes, and inhibits immune reaction. This study aimed to evaluate the effect of hypercapnia on acute cellular rejection in a rat lung transplantation model.

Methods
Recipient rats in sham-operated (Wistar), isograft (Wistar to Wistar), and allograft (Sprague–Dawley to Wistar) groups were ventilated with 50% oxygen, whereas rats in the hypercapnia (Sprague–Dawley to Wistar) group were administered 50% oxygen and 8% carbon dioxide for 90 min during reperfusion (n = 8). Recipients were euthanized 7 days after transplantation.

Results
The hypercapnia group showed a higher oxygenation index (413 ± 78 vs. 223 ± 24), lower wet weight-to-dry weight ratio (4.23 ± 0.54 vs. 7.04 ± 0.80), lower rejection scores (2 ± 1 vs. 4 ± 1), and lower apoptosis index (31 ± 6 vs. 57 ± 4) as compared with the allograft group. The hypercapnia group showed lower CD8 (17 ± 4 vs. 31 ± 3) and CD68 (24 ± 3 vs. 43 ± 2), lower CD8+ T cells (12 ± 2 vs. 35 ± 6), and higher CD4/CD8 ratio (2.2 ± 0.6 vs. 1.1 ± 0.4) compared to the allograft group. Tumor necrosis factor-α (208 ± 40 vs. 292 ± 49), interleukin-2 (30.6 ± 6.7 vs. 52.7 ± 8.3), and interferon-γ (28.1 ± 4.9 vs. 62.7 ± 10.1) levels in the hypercapnia group were lower than those in allograft group. CD4, CD4+ T cells, and interleukin-10 levels were similar between groups.

Conclusions
Hypercapnia ameliorated acute cellular rejection in a rat lung transplantation model.
Prevalence of Potentially Distracting Noncare Activities and Their Effects on Vigilance, Workload, and Nonroutine Events during Anesthesia Care
Authors: Slagle Jason M. , Porterfield Eric S. , Lorinc Amanda N. , Afshartous David , Shotwell Matthew S. , Weinger Matthew B. 
Published: October 2017

Abstract

Background
When workload is low, anesthesia providers may perform non–patient care activities of a clinical, educational, or personal nature. Data are limited on the incidence or impact of distractions on actual care. We examined the prevalence of self-initiated nonclinical distractions and their effects on anesthesia workload, vigilance, and the occurrence of nonroutine events.

Methods
In 319 qualifying cases in an academic medical center using a Web-based electronic medical chart, a trained observer recorded video and performed behavioral task analysis. Participant workload and response to a vigilance (alarm) light were randomly measured. Postoperatively, participants were interviewed to elicit possible nonroutine events. Two anesthesiologists reviewed each event to evaluate their association with distractions.

Results
At least one self-initiated distraction was observed in 171 cases (54%), largely during maintenance. Distractions accounted for 2% of case time and lasted 2.3 s (median). The most common distraction was personal internet use. Distractions were more common in longer cases but were not affected by case type or American Society of Anesthesiologists physical status. Workload ratings were significantly lower during distraction-containing case periods and vigilance latencies were significantly longer in cases without any distractions. Three distractions were temporally associated with, but did not cause, events.

Conclusions
Both nurse anesthetists and residents performed potentially distracting tasks of a personal and/or educational nature in a majority of cases. Self-initiated distractions were rarely associated with events. This study suggests that anesthesia professionals using sound judgment can self-manage nonclinical activities. Future efforts should focus on eliminating more cognitively absorbing and less escapable distractions, as well as training in distraction management.