bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ionised accretion discs in active galactic nuclei: the effects of a lamppost with a variable height
Authors: Ballantyne D. R. 
Published: September 2017

Abstract
The X-ray emitting corona irradiates and ionizes the surface of the inner accretion disc in active galactic nuclei (AGNs). The ionization parameter of the inner disc at a radius r from the black hole, ξ(r), can be used to infer information about the location of the corona. Here, a new formula is derived that predicts ξ(r, h) for a disc irradiated by an X-ray source at a height h above the black hole symmetry axis (i.e. a lamppost geometry). The equation is independent of the black hole mass and the X-ray spectrum, and accounts for the effects of gravitational light-bending on the ionization state and a variable coronal dissipation factor. We predict a strong ionization gradient across the surface of the inner disc that depends on the black hole spin and lamppost height. For a fixed h, the ionization parameter is also expected to increase as λ3, where λ is the observed bolometric Eddington ratio of the AGN. Comparing this formula to the observed ξ-λ relationship for Mrk 335 yields h ∝ λ0.5–0.6, supporting the view of a dynamic X-ray corona in AGNs.
The Impact of a Pediatric Shunt Surgery Checklist on Infection Rate at a Single Institution
Authors: Lee Ryan P , Venable Garrett T , Vaughn Brandy N , Lillard Jock C , Oravec Chesney S , Klimo Paul 
Published: September 2017

Abstract

BACKGROUND
Shunt infections remain a significant challenge in pediatric neurosurgery. Numerous surgical checklists have been introduced to reduce infection rates.

OBJECTIVE
To introduce an evidence-based shunt surgery checklist and its impact on our shunt infection rate.

METHODS
Between January 1, 2008 and December 31, 2015, pediatric patients who underwent shunt surgery at our institution were indexed in a prospectively maintained database. All definitive shunt procedures were included. Shunt infection was defined according to the Center for Disease Control and Prevention's National Hospital Safety Network surveillance definition for surgical site infection. Clinical and procedural variables were abstracted per procedure. Infection data were compared for the 4 year before and 4 year after protocol implementation. Compliance was calculated from retrospective review of our checklists.

RESULTS
Over the 8-year study period, 1813 procedures met inclusion criteria with a total of 37 shunt infections (2%). Prechecklist (2008-2011) infection rate was 3.03% (28/924) and decreased to 1.01% (9/889; P = .003) postchecklist (2012-2015), representing an absolute risk reduction of 2.02% and relative risk reduction of 66.6%. One shunt infection was prevented for every 50 times the checklist was used. Those patients who developed an infection after protocol implementation were younger (0.95 years vs 3.40 years (P = .027)), but there were no other clinical or procedural variables, including time to infection, that were significantly different between the cohorts. Average compliance rate among required checklist components was 97% (range 85%-100%).

CONCLUSION
Shunt surgery checklist implementation correlated with lower infection rates that persisted in the 4 years after implementation.
Prioritizing Parental Liberty in Non-medical Vaccine Exemption Policies: A Response to Giubilini, Douglas and Savulescu
Authors: Navin Mark C , Largent Mark A 
Published: September 2017

AbstractIn a recent paper published in this journal, Giubilini, Douglas and Savulescu argue that we have given insufficient weight to the moral importance of fairness in our account of the best policies for non-medical exemptions (NMEs) to childhood immunization requirements. They advocate for a type of policy they call Contribution, according to which parents must contribute to important public health goods before their children can receive NMEs to immunization requirements. In this response, we argue that Giubilini, Douglas and Savulescu give insufficient weight to the moral importance parental liberty in ways that count against their preferred type of NMEs policy and threaten public support for mandatory vaccination laws and public health initiatives generally.
Critical Care Organizations: Business of Critical Care and Value/Performance Building*
Authors: Leung Sharon , Gregg Sara R. , Coopersmith Craig M. , Layon A. Joseph , Oropello John , Brown Daniel R. , Pastores Stephen M. , Kvetan Vladimir 
Published: September 2017

Objective:
New, value-based regulations and reimbursement structures are creating historic care management challenges, thinning the margins and threatening the viability of hospitals and health systems. The Society of Critical Care Medicine convened a taskforce of Academic Leaders in Critical Care Medicine on February 22, 2016, during the 45th Critical Care Congress to develop a toolkit drawing on the experience of successful leaders of critical care organizations in North America for advancing critical care organizations (Appendix 1). The goal of this article was to provide a roadmap and call attention to key factors that adult critical care medicine leadership in both academic and nonacademic setting should consider when planning for value-based care.

Design:
Relevant medical literature was accessed through a literature search. Material published by federal health agencies and other specialty organizations was also reviewed. Collaboratively and iteratively, taskforce members corresponded by electronic mail and held monthly conference calls to finalize this report.

Setting:
The business and value/performance critical care organization building section comprised of leaders of critical care organizations with expertise in critical care administration, healthcare management, and clinical practice.

Measurements and Main Results:
Two phases of critical care organizations care integration are described: “horizontal,” within the system and regionalization of care as an initial phase, and “vertical,” with a post-ICU and postacute care continuum as a succeeding phase. The tools required for the clinical and financial transformation are provided, including the essential prerequisites of forming a critical care organization; the manner in which a critical care organization can help manage transformational domains is considered. Lastly, how to achieve organizational health system support for critical care organization implementation is discussed.

Conclusions:
A critical care organization that incorporates functional clinical horizontal and vertical integration for ICU patients and survivors, aligns strategy and operations with those of the parent health system, and encompasses knowledge on finance and risk will be better positioned to succeed in the value-based world.
HIV and contraception
Authors: Fok Wing Kay , Blumenthal Paul D. 
Published: September 2017

Purpose of review
Contraception is a vital component of medical care for women with HIV or at high risk of acquiring HIV. Over the last several years, there has been emerging evidence regarding the safety and effectiveness of various contraceptive methods, ultimately leading to a revision in the WHO Medical Eligibility Criteria for contraceptive use.

Recent findings
Progestogen-only injectables may be associated with an increased risk of HIV acquisition and its use has been revised to category 2 from category 1. Etonogestrel and levonorgestrel levels are lower in women who concurrently use contraceptive implant and efavirenz-based antiretroviral therapy. Multipurpose technology, aimed at providing antiretroviral medication and contraception, is an area of ongoing research but is not yet clinically available.

Summary
It is important for providers who care for women with HIV or at high risk of HIV to inquire about pregnancy intentions. If contraception is desired, these women should be offered all available methods, with counseling regarding possible risks of contraceptive failure or HIV acquisition.
Descemet Membrane Endothelial Keratoplasty Patch for Persistent Corneal Hydrops
Authors: Tu Elmer Y. 
Published: September 2017

Purpose:
To report successful management of a case of persistent keratoconus-related hydrops with a Descemet membrane endothelial keratoplasty (DMEK) patch graft.

Methods:
A case of corneal hydrops persisting for 7 months treated with DMEK was identified. The following information was collected: demographic data, surgical indications, clinical course, diagnostic tests, and clinical outcome.

Results:
A 55-year-old patient with an established diagnosis of keratoconus was followed for 7 months without improvement in his acute corneal hydrops. Because of excellent vision and central corneal clarity, the patient was treated with a 5-mm DMEK covering the Descemet membrane tear, developing cataract secondary to the procedure, but with resolution of his corneal hydrops. An uncorrected visual acuity of 20/25 was achieved after uncomplicated cataract extraction.

Conclusions:
DMEK, although technically challenging, can be considered for patients with persistent hydrops with preservation of corneal clarity and contour in areas of the uninvolved cornea.
Corneal Densitometry in Healthy Corneas and Its Correlation With Endothelial Morphometry
Authors: Tekin Kemal , Sekeroglu Mehmet Ali , Kiziltoprak Hasan , Yilmazbas Pelin 
Published: September 2017

Purpose:
To evaluate the correlations between corneal endothelial cell properties and corneal densitometry values and to investigate whether corneal densitometry may be used as an indicator of the health of corneal endothelium.

Methods:
Two hundred fifty-three eyes were analyzed in this prospective cross-sectional study. Corneal densitometry was measured with densitometry software of Pentacam HR-Scheimpflug corneal topography over a 12-mm diameter of the cornea. Furthermore, corneal endothelial cell properties including cell density (CD), average cell area, SD of the cell area, coefficient of variation (CV) of the cell area, maximum cell area, minimum cell area, and percentage of hexagonal cells (HEX) were measured by a specular microscope. The correlations were calculated using Pearson correlation tests.

Results:
The average cell area, SD, maximum cell area, and minimum cell area values were not statistically significantly correlated with the corneal densitometry values in any layer or concentric annulus. CD, CV, and HEX were statistically significantly correlated with the corneal densitometry values in all layers and concentric annuli (P < 0.05 for each one). Moreover, CD and HEX were inversely and moderately correlated with total corneal densitometry (r = −0.403, P < 0.001, and r = −0.327, P < 0.001, respectively), whereas the CV was positively and moderately correlated with total corneal densitometry (r = 0.349, P < 0.001).

Conclusions:
Corneal densitometry might have potential to be used as an indicator of the health of corneal endothelium in the future.
Use of Fully Covered Self‐expanding Metal Biliary Stents in Pediatrics
Authors: Mark Jacob A. , Mack Cara L. , Marwan Ahmed I. , Kramer Robert E. 
Published: September 2017

ABSTRACTObjectives:Endoscopic retrograde cholangiopancreatography is used to manage biliary pathology in pediatric patients. Plastic biliary stents have been used in this population for obstructive lesions and bile leaks; however, they are sometimes not effective due to migration, occlusion, or ineffective sealing. Fully covered self‐expanding metal stents (FCSEMS) have larger diameters making them more suitable for some situations. Their use in pediatrics has, however, not been defined. The aim of the present study is to describe our experience with FCSEMS at our institution.Methods:We present a series of all patients who underwent FCSEMS placement at Children's Hospital Colorado including 3 adolescents and 1 young adult with complex medical needs.Results:Patient age range was 12 to 24 years and the weight ranged between 36 and 75 kg. All patients underwent previous endoscopic retrograde cholangiopancreatography and 1 or more rounds of plastic stenting without adequate clinical response before consideration of FCSEMS placement. Indications included recalcitrant biliary anastomotic stricture after liver transplant, persistent bile leak after needle perforation, recurrent obstructive choledocholithiasis after cholecystectomy, and malignant biliary stricture. Sizes of FCSEMS depended on patient bile duct size and biliary pathology. Dwell time was 6 to 8 weeks. Three patients had resolution of biliary pathology after FCSEMS therapy. One patient had distal migration of FCSEMS necessitating repeat stenting. There were no adverse events from FCSEMS placement or removal.Conclusions:FCSEMS therapy should be considered in appropriate pediatric patients when plastic biliary stents are not effective. Further studies are needed to evaluate the safety and efficacy of FCSEMS in the pediatric age group.
Functional Gastrointestinal Disorders and Joint Hypermobility
Authors: Saps Miguel , Blom Puck J.J. , Velasco‐Benitez Carlos A. , Benninga Marc A. 
Published: September 2017

ABSTRACTThe aim of the study was to assess the prevalence of joint hypermobility (JH) among school children with and without functional gastrointestinal disorders (FGIDs). School children completed validated Rome III questionnaires to diagnose FGID. Each child diagnosed with an FGID was matched for age and sex with a healthy control. The prevalence of JH in both groups was compared. A total of 654 school children participated in the study. One hundred forty‐eight (22.6%) children were diagnosed with an FGID. Data from 136 FGIDs and 136 healthy controls were analyzed. Joint laxity was assessed to establish the Beighton score (≥4 was considered JH). There was no significant difference in JH between children with and without diagnoses of FGIDs odds ratio (OR) 1.03 (95% confidence interval [CI]: 0.59–1.81, P = 0.89). Multivariate analysis showed that younger age OR 2.31 (95% CI: 1.30–4.10, P = 0.004) and female sex OR 2.27 (95% CI: 1.22–4.24, P = 0.009) were significantly associated with JH. JH is equally prevalent in school children with and without FGIDs.
Diagnostic Criteria of Pediatric Intestinal Myopathies
Authors: Lombardi Laura , Bruder Elisabeth , Pio Luca , Nozza Paolo , Thai Elena , Lerone Margherita , Del Rossi Carmine , Mattioli Girolamo , Silini Enrico Maria , Paraboschi Irene , Martucciello Giuseppe 
Published: September 2017

ABSTRACTThe authors aim to identify criteria for the diagnosis of intestinal visceral myopathy (IVM); results were compared with ultrastructural studies. Six IVM patients and 7 pediatric control cases (without gastrointestinal diseases) were studied. One case was a typical megacystis‐microcolon‐intestinal hypoperistalsis syndrome. The diagnostic path included: rectal suction biopsy, one‐trocar transumbilical laparoscopic intestinal full‐thickness biopsy technique. Pathological analysis included anti‐alpha smooth muscle actin staining, and US study of intestinal biopsies. IVM histological examination demonstrated thinning of longitudinal muscle layer. The ratio of circular/longitudinal thickness was evaluated in all samples; in cases, this ratio presented as a mean value of 2.91, and in controls, a mean value of 1.472 (P = 0.0002). Ultrastructural diagnosis revealed variable myofibrils density in smooth muscle cells, irregularity of sarcolemma membranes, interstitial fibrosis, and myofiber disarray. The authors concluded that in IVM, circular/longitudinal thickness ratio and alpha smooth muscle actin staining can be used as significant tools to address the diagnosis.
When Fever, Leukocytosis, and Right Lower Quadrant Pain Is Not Appendicitis
Authors: Kurbedin Jeanette , Haines Lawrence , Levine Marla C. , Dickman Eitan 
Published: September 2017

Abstract
Mesenteric cystic lymphangioma (MCL) is an uncommon, benign, slow-growing abdominal tumor that is derived from the lymphatic vessels (World J Gastroenterol. 2012;18:6328–6332, Radiographics. 1994;14:729–737). It is most often diagnosed in the head and neck of affected children. Rarely, a lymphangioma can develop within the small bowel (Pan Afr Med J. 2012;12:7). The clinical presentation of patients with an abdominal MCL can range from asymptomatic to acute abdominal pain (J Korean Surg Soc. 2012;83:102–106). We report a case of small bowel volvulus caused by an MCL in a 3-year-old child who presented to the pediatric emergency department with right lower quadrant pain. The child was thought to have a perforated appendicitis and was taken to the operating room where an MCL was identified and resected. This case illustrates the need to consider MCL when a patient presents to the emergency department with right lower quadrant pain.
Do User-Applied Safety Labels on Medication Syringes Reduce the Incidence of Medication Errors During Rapid Medical Response Intervention for Deteriorating Patients in Wards? A Systematic Search and Review
Authors: Mikhail John , Grantham Hugh , King Lindy 
Published: September 2017

Introduction
Intravenous medication errors (MEs) occur during medical emergency situations. An initiative, not yet in common practice, that could address these errors is safety labeling. The aim of this review was to identify and appraise research evidence related to the impact of user-applied medication safety labeling on reducing the incidence of MEs during rapid medical response intervention for patient deterioration in the ward setting.

Methods
A systematic search and review framework was used to conduct the review. A comprehensive database search was conducted of BioMed Central, Clinical Trials, Cumulative Index to Nursing and Allied Health Literature, Expanded Academic ASAP, Joanna Briggs Institute, MEDLINE, OVID, ProQuest Central, PubMed, Wiley Online Library, and World Health Organization Library. The Young and Solomon (2009) critical appraisal tool was used to critically appraise the identified research articles. Each article was then analyzed using a thematic network strategy to identify commonality.

Results
Four primary themes were identified; they were as follows: MEs occur during medical emergency responses (MERs); MEs occur throughout the medication administration process; MERs are stressful and are associated with MEs; and role of medication labeling in reducing MEs during MERs.

Discussion
Greater vigilance is required by health professionals during the medication administration process. The implementation of specific medication safety labeling into the MER could be beneficial in reducing the overall incidence of MEs. Further research is required to validate the merits of a MER medication safety labeling system.
Hybrid SPECT/CT Helps Characterization and Localization of a Dual Thyroid Ectopia
Authors: Abdelhafez Yasser , Khalil Maha , Roshdy Esraa , Diab Waleed A. , Eltoni Lobna 
Published: September 2017

Abstract
The presence of ectopic thyroid tissue in 2 or more different sites is rare. A 12-year-old girl presented with midline anterior neck swelling in the infrahyoid region with subclinical hypothyroidism. Thyroid scanning with 99mTc-pertechnetate was performed, and SPECT/CT was ordered for further evaluation. Two hyperdense lesions demonstrating intense radiotracer uptake were seen in the midline at the base of the tongue and infrahyoid neck. We emphasis the role of hybrid SPECT/CT for characterization and localization of suspected ectopic thyroid tissue.
18F-FDG PET/CT Imaging of Tracheal Mucoepidermoid Carcinoma
Authors: Jiang Lei , Huang Yan , Huang Shanshan , Li Qiang , Wang Huoqiang 
Published: September 2017

Abstract
A 54-year-old woman presented with dry cough for 3 months. An FDG PET/CT was performed to evaluate a tracheal nodule, which was revealed by chest CT. The PET/CT images showed increased FDG uptake with SUVmax of 3.3 in the known tracheal lesion. The results of pathological examination from the specimen of bronchoscopy were consistent with tracheal mucoepidermoid carcinoma.
Sodium Thiosulfate in the Treatment of Lung and Breast Calciphylaxis
Authors: Shen Guohua , Huang Rui , Liu Bin , Kuang Anren 
Published: September 2017

Abstract
A 19-year-old woman, with normal kidney function, was diagnosed as having visceral calciphylaxis, especially diffuse breast and lung calcification. The calcification findings were clearly shown on CT, and bone scintigraphy revealed diffuse uptake in the thoracic area. Although there was no standard therapeutic approach for this clinical setting, the patient received empiric therapy with sodium thiosulfate. After 5 months of consecutive therapy, the calcification condition had a striking regression.
Myoepithelioma of the Nasal Septum
Authors: Kim Seo Bin , Kwon Jae Hwan 
Published: September 2017

Abstract
Myoepithelioma is defined as myoepithelial cells composed of tumor with solid, myxoid, and reticular growth pattern by the World Health Organization. It is a rare neoplasm that arises in the major salivary gland or minor salivary gland comprising approximately 1% of all salivary gland tumor. This neoplasm occurs in the parotid gland and soft palate mostly, which can be found in other organs. However, up to now, myoepithelioma of nasal septum has not been reported in English medical literature. Histologically, it is grouped as spindle, epitheliod, reticular, and clear cell types. Spindle cell type is the most common. In this case, a 40-year-old woman presented with complaining of nasal stuffiness and accidentally found right nasal cavity mass. Endoscopic surgery for excision of the mass was performed under local anesthesia, which was confirmed as myoepithelioma. After surgery, the patient's symptom was disappeared and there has not been sign of recurrence for 6 months. We present a rare patient of myoepithelioma of the nasal septum with review of relevant literature.
Lingual Short Split: A Bilateral Sagittal Split Osteotomy Technique Modification
Authors: Sant’Ana Eduardo , Souza Denis Pimenta e , Temprano Astrid Buysse , Shinohara Elio H. , Faria Paulo Esteves Pinto 
Published: September 2017

Abstract
The technique of sagittal split osteotomy of the mandibular ramus is an established technique that has been evolving over the years, with significant improvements regarding stability, better bone contact between the segments, and possibilities of osteosynthesis. However, paresthesia is common in the postoperatory, sometimes permanent, and undesirable fractures in the subcondylar region can occur leading to longer operative time and extraoral scars. The short lingual split technique is an easy technique that simplifies the horizontal osteotomy of the ramus and decreases the risk of undesirable fractures with a neurosensitive recovery of patients in a much shorter time because of minor trauma and nerve manipulation during the execution.