bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do university hospitals perform better than general hospitals? A comparative analysis among Italian regions
Authors: Nuti Sabina , Grillo Ruggieri Tommaso , Podetti Silvia 
Published: August 2016

ObjectiveThe aim of this research was to investigate how university hospitals (UHs) perform compared with general hospitals (GHs) in the Italian healthcare system.Design and setting27 indicators of overall performance were selected and analysed for UHs and GHs in 10 Italian regions. The data refer to 2012 and 2013 and were selected from two performance evaluation systems based on hospital discharge administrative data: the Inter-Regional Performance Evaluation System developed by the Management and Health Laboratory of the Scuola Superiore Sant'Anna of Pisa and the Italian National Outcome Evaluation Programme developed by the National Agency for Healthcare Services. The study was conducted in 2 stages and by combining 2 statistical techniques. In stage 1, a non-parametric Mann-Whitney U test was carried out to compare the performance of UHs and GHs on the selected set of indicators. In stage 2, a robust equal variance test between the 2 groups of hospitals was carried out to investigate differences in the amount of variability between them.ResultsThe overall analysis gave heterogeneous results. In general, performance was not affected by being in the UH rather than the GH group. It is thus not possible to directly associate Italian UHs with better results in terms of appropriateness, efficiency, patient satisfaction and outcomes.ConclusionsPolicymakers and managers should further encourage hospital performance evaluations in order to stimulate wider competition aimed at assigningteaching statusto those hospitals that are able to meet performance requirements. In addition, UH facilities could be integrated with other providers that are responsible for community, primary and outpatient services, thereby creating a joint accountability for more patient-centred and integrated care.
Impact of omalizumab on treatment of severe allergic asthma in UK clinical practice: a UK multicentre observational study (the APEX II study)
Authors: Niven Robert M , Saralaya Dinesh , Chaudhuri Rekha , Masoli Matthew , Clifton Ian , Mansur Adel H , Hacking Victoria , McLain-Smith Susan , Menzies-Gow Andrew 
Published: August 2016

ObjectiveTo describe the impact of omalizumab on asthma management in patients treated as part of normal clinical practice in the UK National Health Service (NHS).DesignA non-interventional, mixed methodology study, combining retrospective and prospective data collection for 12 months pre-omalizumab and post-omalizumab initiation, respectively.SettingData were collected in 22 UK NHS centres, including specialist centres and district general hospitals in the UK.Participants258 adult patients (aged ≥16 years; 65% women) with severe persistent allergic asthma treated with omalizumab were recruited, of whom 218 (84.5%) completed the study.Primary and secondary outcome measuresThe primary outcome measure was change in mean daily dose of oral corticosteroids (OCS) between the 12-month pre-omalizumab and post-omalizumab initiation periods. A priori secondary outcome measures included response to treatment, changes in OCS dosing, asthma exacerbations, lung function, employment/education, patient-reported outcomes and hospital resource utilisation.ResultsThe response rate to omalizumab at 16 weeks was 82.4%. Comparing pre-omalizumab and post-omalizumab periods, the mean (95% CIs) daily dose of OCS decreased by 1.61 (−2.41 to −0.80) mg/patient/day (p<0.001) and hospital exacerbations decreased by 0.97 (−1.19 to −0.75) exacerbations/patient (p<0.001). Compared with baseline, lung function, assessed by percentage of forced expiratory volume in 1 s, improved by 4.5 (2.7 to 6.3)% at 16 weeks (p<0.001; maintained at 12 months) and patient quality of life (Asthma Quality of Life Questionnaire) improved by 1.38 (1.18 to 1.58) points at 16 weeks (p<0.001, maintained at 12 months). 21/162 patients with complete employment data gained employment and 6 patients lost employment in the 12-month post-omalizumab period. The mean number of A&E visits, inpatient hospitalisations, outpatient visits (excluding for omalizumab) and number of bed days/patient decreased significantly (p<0.001) in the 12-month post-omalizumab period.ConclusionsThese data support the beneficial effects of omalizumab on asthma-related outcomes, quality of life and resource utilisation in unselected patients treated in ‘real-world’ clinical practice.
Impacts of Vertical Structure of Large-Scale Vertical Motion in Tropical Climate: Moist Static Energy Framework
Authors: Bui Hien Xuan , Yu Jia-Yuh , Chou Chia 
Published: August 2016

AbstractInteractions between cumulus convection and its large-scale environment have been recognized as crucial to the understanding of tropical climate and its variability. In this study, the moist static energy (MSE) budget is employed to investigate the potential impact of the vertical structure of large-scale vertical motion in tropical climate based on results from both reanalysis data and model simulation. Two domains are selected over the western and eastern Pacific with vertical motion profiles that are dominated by top-heavy and bottom-heavy structures, respectively. The bottom-heavy structure is climatologically associated with more shallow convection, while the top-heavy structure is related to more deep convection. The column-integrated vertical MSE advection of top-heavy vertical motion is positive, while that of bottom-heavy vertical motion tends to be negative. Controlling factors responsible for the above vertical MSE advection contrast are discussed based on a simple decomposition of the MSE budget equation. It was found that the sign of vertical MSE advection is determined mainly by the vertical moisture transport, the magnitude of which is very sensitive to the structure of vertical motion. A top-heavy (bottom heavy) structure of vertical motion favors an export (import) of MSE and a positive (negative) value of the vertical MSE advection.
Computed tomography in the investigation and management of obturator hernia
Authors: Light Duncan , Razi Kasra , Horgan Liam 
Published: August 2016

Introduction Obturator hernias are a rare groin hernia. They are most commonly found incidentally during laparoscopic inguinal hernia repair. We investigated our experience with obturator hernias in the elective and emergency setting. Methods Cases of obturator hernia were identified from a hospital database and reviewed retrospectively over the last 10 years. There were no exclusions. There were a number of surgeons involved with an interest in groin hernia surgery. Results Twenty-one patients were included. The mean age was 66 years old. Eleven were male. There were four emergency presentations. One emergency case presented with small bowel obstruction, while the other three cases presented with groin pain. Two patients had a preoperative computed tomography, which showed an obturator hernia confirmed at surgery. The patient with small bowel obstruction had an open bowel resection alone with no hernia repair. They were discharged with no complications or recurrence on follow-up. The other three cases had a mesh repair (one laparoscopic, one laparotomy, one pre-peritoneal). One patient who underwent a laparotomy died of a post-operative pneumonia. The others were discharged uneventfully. In the elective group of 17 patients, 8 patients were taken for an elective laparoscopic inguinal hernia repair but found to actually have an obturator hernia alone. An obturator hernia was found incidentally with an inguinal hernia in three patients. Five patients were expected to have an obturator hernia on clinical examination alone. At surgery, an obturator hernia was found in three cases. In the other two cases, no hernia was found. One patient had a pre-operative computed tomography, which showed an obturator hernia confirmed at surgery. Conclusions Computed tomography would be recommended in cases of diagnostic uncertainty. It may avoid unnecessary surgery in the elective setting and allow a focused procedure in the emergency setting. Laparoscopic repair is feasible in the emergency and elective setting with excellent results.
Medication, rehabilitation and health care consumption in adults with cerebral palsy: a population based study
Authors: Pons Christelle , Brochard Sylvain , Gallien Philippe , Nicolas Benoit , Duruflé Aurélie , Roquet Marion , Rémy-Néris Olivier , Garlantezec Ronan 
Published: August 2016

Objective: To evaluate medication, rehabilitation and healthcare consumption in adults with CP as a function of Gross Motor Function Classification System (GMFCS) level. Design: Questionnaire-based cross-sectional study. Setting: Brittany, a French county. Subjects: Adults with cerebral palsy. Interventions: Questionnaires relating to drugs, orthotic devices, mobility aids, rehabilitation and medical input were sent to 435 members of a unique regional French network dedicated to adults with cerebral palsy. The questionnaire was completed by the participant or a helper if necessary. Results: Of the 282 responders, 7.8% had a GMFCS level of I, 14.2% II, 17.7% III, 29.1% IV and 31.2% V. Participants consumed a large amount of healthcare. Almost three-quarters took orally administered drugs, of which antispastic and antiepileptic drugs were among the most frequent. Nearly all patients had at least one type of rehabilitation, 87.2% had physiotherapy, 78% used at least one mobility aid and 69.5% used at least one orthotic device. The frequency of numerous inputs increased with GMFCS level. Specificities were found for each GMFCS level, e.g. participants with GMFCS level IV and V had a high level of medical input and a greater use of trunk-supporting devices, antireflux and laxative. Profiles could be established based on GMFCS levels. Conclusions: Adults with cerebral palsy use a large amount of drugs, mobility aids, orthotic devices, rehabilitation and medical input. Healthcare is targeted at cerebral palsy-related issues. GMFCS is a determinant of healthcare consumption and thus a useful tool for clinical practice to target care appropriately.
Electronic palliative care coordination systems: Devising and testing a methodology for evaluating documentation
Authors: Allsop Matthew J , Kite Suzanne , McDermott Sarah , Penn Naomi , Millares-Martin Pablo , Bennett Michael I 
Published: August 2016

Background: The need to improve coordination of care at end of life has driven electronic palliative care coordination systems implementation across the United Kingdom and internationally. No approaches for evaluating electronic palliative care coordination systems use in practice have been developed. Aim: This study outlines and applies an evaluation framework for examining how and when electronic documentation of advance care planning is occurring in end of life care services. Design: A pragmatic, formative process evaluation approach was adopted. The evaluation drew on the Project Review and Objective Evaluation methodology to guide the evaluation framework design, focusing on clinical processes. Setting/participants: Data were extracted from electronic palliative care coordination systems for 82 of 108 general practices across a large UK city. All deaths ( n = 1229) recorded on electronic palliative care coordination systems between April 2014 and March 2015 were included to determine the proportion of all deaths recorded, median number of days prior to death that key information was recorded and observations about routine data use. Results: The evaluation identified 26.8% of all deaths recorded on electronic palliative care coordination systems. The median number of days to death was calculated for initiation of an electronic palliative care coordination systems record (31 days), recording a patient’s preferred place of death (8 days) and entry of Do Not Attempt Cardiopulmonary Resuscitation decisions (34 days). Where preferred and actual place of death was documented, these were matching for 75% of patients. Anomalies were identified in coding used during data entry on electronic palliative care coordination systems. Conclusion: This study reports the first methodology for evaluating how and when electronic palliative care coordination systems documentation is occurring. It raises questions about what can be drawn from routine data collected through electronic palliative care coordination systems and outlines considerations for future evaluation. Future evaluations should consider work processes of health professionals using electronic palliative care coordination systems.
Effect of Changing the Joint Kinematics of Knees With a Ruptured Anterior Cruciate Ligament on the Molecular Biological Responses and Spontaneous Healing in a Rat Model
Authors: Kokubun Takanori , Kanemura Naohiko , Murata Kenji , Moriyama Hideki , Morita Sadao , Jinno Tetsuya , Ihara Hidetoshi , Takayanagi Kiyomi 
Published: August 2016

Background: The poor healing capacity of a completely ruptured anterior cruciate ligament (ACL) has been attributed to an insufficient vascular supply, cellular metabolism, and deficient premature scaffold formation because of the unique intra-articular environment. However, previous studies have focused on intra-articular factors without considering extra-articular factors, including the biomechanical aspects of ACL-deficient knees. Hypothesis: Changing the joint kinematics of an ACL-ruptured knee will improve cellular biological responses and lead to spontaneous healing through the mechanotransduction mechanism. Study Design: Controlled laboratory study. Methods: A total of 66 skeletally mature Wistar rats were randomly assigned to a sham-operated group (SO), ACL-transection group (ACL-T), controlled abnormal movement group (CAM), and an intact group (IN). The ACL was completely transected at the midportion in the ACL-T and CAM groups, and the CAM group underwent extra-articular braking to control for abnormal tibial translation. The SO group underwent skin and joint capsule incisions and tibial drilling, without ACL transection and extra-articular braking. The animals were allowed full cage activity until sacrifice at 1, 2, 4, 6, and 8 weeks postoperatively for histological, molecular biological, and biomechanical assessment. Results: All injured ACLs in the ACL-T group were not healed, but those in the CAM group healed spontaneously, showing a typical ligament healing response. Regarding the molecular biological response, there was an upregulation of anabolic factors (ie, transforming growth factor–β) and downregulation of catabolic factors (ie, matrix metalloproteinase). Examination of the mechanical properties at 8 weeks after injury showed that >50% of the strength of the intact ACL had returned. Conclusion: Our results suggest that changing the joint kinematics of knees with a ruptured ACL alters the molecular biological responses and leads to spontaneous healing. These data support our hypothesis that the mechanotransduction mechanism mediates molecular responses and determines whether the ACL will heal. Clinical Relevance: Elucidating the relationship between the mechanotransduction mechanism and healing responses in knees with completely ruptured ACLs may result in the development of novel nonsurgical treatment that enables the ACL to spontaneously heal in patients who are not suitable for reconstruction.
Clinical and Ultrasonographic Evaluations of the Shoulders of Elite Swimmers
Authors: Rodeo Scott A. , Nguyen Joseph T. , Cavanaugh John T. , Patel Yashika , Adler Ronald S. 
Published: August 2016

Background: Shoulder pain is a common problem in competitive swimmers, but the structural alterations in elite-level competitive swimmers are not well known. Hypothesis: Adaptive changes are common in the rotator cuff, bursa, labrum, and capsule in elite swimmers, and such abnormalities are related to factors concerning training and correlate with symptoms. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The study population was the 2008 United States Olympic swimming team. All athletes completed standardized scales on shoulder pain and function and provided data on their training history and history of shoulder pain or injuries. Each athlete also underwent a comprehensive physical examination of both shoulders, followed by an evaluation of the rotator cuff, biceps, and bursa using ultrasound with dynamic images to assess for subcoracoid impingement and subacromial impingement. Results: A history of shoulder pain was reported by 29 of 42 (66%) athletes. Morphological changes consistent with tendinosis were common in the biceps (33/46 shoulders; 72%) and supraspinatus/infraspinatus (44/46 shoulders; 96%). Subcoracoid impingement was seen in 17 of 46 shoulders (37%), with subacromial impingement seen in 34 of 41 shoulders (83%). There was an increased odds ratio (OR) for biceps tendinosis in older swimmers (OR, 1.92; 95% CI, 1.23-3.00; P = .004) and in swimmers who had missed a competition because of shoulder pain (OR, 9.76; 95% CI, 1.13-84.3; P = .038). There was an increased OR for rotator cuff tendinosis in swimmers who reported worse scores for pain with activities (OR, 0.10; 95% CI, 0.01-0.78; P = .028) and in those with a positive sulcus sign (OR, 33.2; 95% CI, 3.09-355; P = .004). There was an increased OR for impingement in swimmers with a positive sulcus sign (OR, 5.40; 95% CI, 0.80-36.3; P = .083), worse pain scores (OR, 0.44; 95% CI, 0.22-0.87; P = .019), and a partial rotator cuff tear (OR, 31.2; 95% CI, 3.58-272; P = .002). Conclusion: We found a high prevalence of rotator cuff and biceps tendinopathy, which was associated with increased symptoms. Tendinosis was also more common in swimmers with a positive sulcus sign, suggesting a role for shoulder laxity.
Use of cefovecin in a UK population of cats attending first-opinion practices as recorded in electronic health records
Authors: Burke Sara , Black Vicki , Sánchez-Vizcaíno Fernando , Radford Alan , Hibbert Angie , Tasker Séverine 
Published: August 2016

Objectives The objective was to use electronic health records to describe the use of cefovecin (Convenia; Zoetis UK), a third-generation long-acting injectable antimicrobial, in a UK population of cats attending first-opinion practices, and to compare the use of Convenia with the licensed uses described on the UK Convenia datasheet. Methods Data were obtained as an Excel database from the Small Animal Veterinary Surveillance Network for all feline consultations containing the word Convenia and/or cefovecin from 1 September 2012 to 23 September 2013 inclusive. Entries were classified according to body system treated, confirmation or suspicion of an abscess, evidence of microbiological evaluation being performed, any concurrent therapies given and whether any reason was given for use of Convenia over alternative antimicrobials. Data were exported to IBM SPSS Statistics and descriptive analysis performed. Results In total, 1148 entries were analysed. The most common body system treated was skin in 553 (48.2%) entries, then urinary (n = 157; 13.7%) and respiratory (n = 112; 9.8%). Microbiological evaluation was recorded in 193 (16.8%) entries, with visible purulent material most commonly cited (in 147 [12.8%] entries). A reason for prescribing Convenia over alternative antimicrobials was given in 138 (12.0%) entries; the most cited was an inability to orally medicate the cat in 77 (55.8%) of these entries. Excluding 131 entries where no body system or multiple body systems were described, the use of Convenia complied with a licensed use in the UK datasheet in 710 (69.8%) of 1017 entries. Conclusions and relevance Most administrations were licensed uses; however, most entries did not describe any microbiological evaluation, or a reason for prescribing Convenia over alternative antimicrobials. Further education of the public and the veterinary profession is needed to promote antimicrobial stewardship in the UK. Health records provide a valuable tool with which to monitor, both locally and at scale, the use of important therapeutics like antimicrobials. Information relevant to decision-making should be recorded in individual animal health records.
MEF2D-BCL9 Fusion Gene Is Associated With High-Risk Acute B-Cell Precursor Lymphoblastic Leukemia in Adolescents
Authors: Suzuki Kyogo , Okuno Yusuke , Kawashima Nozomu , Muramatsu Hideki , Okuno Tatsuya , Wang Xinan , Kataoka Shinsuke , Sekiya Yuko , Hamada Motoharu , Murakami Norihiro , Kojima Daiei , Narita Kotaro , Narita Atsushi , Sakaguchi Hirotoshi , Sakaguchi Kimiyoshi , Yoshida Nao , Nishio Nobuhiro , Hama Asahito , Takahashi Yoshiyuki , Kudo Kazuko , Kato Koji , Kojima Seiji 
Published: August 2016

Purpose Acute lymphoblastic leukemia (ALL) makes up a significant proportion of all pediatric cancers, and relapsed ALL is a leading cause of cancer-associated deaths in children. Identification of risk factors and druggable molecular targets in ALL can lead to a better stratification of treatments and subsequent improvement in prognosis. Patients and Methods We enrolled 59 children with relapsed or primary refractory ALL who were treated in our institutions. We primarily performed RNA sequencing (RNA-seq) using patients’ leukemic cells to comprehensively detect gene fusions and analyze gene expression profiles. On the basis of results obtained by RNA-seq, we performed genetic validation, functional analysis, and in vitro drug sensitivity testing using patients’ samples and an exogenous expression model. Results We identified a total of 26 gene fusions in 22 patients by RNA-seq. Among these, 19 were nonrandom gene fusions already described in ALL, and four of the remaining seven involved identical combination of MEF2D and BCL9. All MEF2D-BCL9–positive patients had B-cell precursor immunophenotype and were characterized as being older in age, being resistant to chemotherapy, having very early relapse, and having leukemic blasts that mimic morphologically mature B-cell leukemia with markedly high expression of HDAC9. Exogenous expression of MEF2D-BCL9 in a B-cell precursor ALL cell line promoted cell growth, increased HDAC9 expression, and induced resistance to dexamethasone. Using a primary culture of leukemic blasts from a patient, we identified several molecular targeted drugs that conferred inhibitory effects in vitro. Conclusion A novel MEF2D-BCL9 fusion we identified characterizes a novel subset of pediatric ALL, predicts poor prognosis, and may be a candidate for novel molecular targeting.
Cellular functions of the ADF/cofilin family at a glance
Authors: Kanellos Georgios , Frame Margaret C. 
Published: August 2016

ABSTRACT
The actin depolymerizing factor (ADF)/cofilin family comprises small actin-binding proteins with crucial roles in development, tissue homeostasis and disease. They are best known for their roles in regulating actin dynamics by promoting actin treadmilling and thereby driving membrane protrusion and cell motility. However, recent discoveries have increased our understanding of the functions of these proteins beyond their well-characterized roles. This Cell Science at a Glance article and the accompanying poster serve as an introduction to the diverse roles of the ADF/cofilin family in cells. The first part of the article summarizes their actions in actin treadmilling and the main mechanisms for their intracellular regulation; the second part aims to provide an outline of the emerging cellular roles attributed to the ADF/cofilin family, besides their actions in actin turnover. The latter part discusses an array of diverse processes, which include regulation of intracellular contractility, maintenance of nuclear integrity, transcriptional regulation, nuclear actin monomer transfer, apoptosis and lipid metabolism. Some of these could, of course, be indirect consequences of actin treadmilling functions, and this is discussed.