bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optimizing Psychosocial Support during Office-Based Buprenorphine Treatment in Primary Care: Patients’ Experiences and Preferences
Authors: Fox Aaron D. , Masyukova Mariya , Cunningham Chinazo O. 
Published: November 2015

Background Buprenorphine maintenance treatment is effective and has been successfully integrated into human immunodeficiency virus (HIV) and primary care settings. However, one key barrier to providers prescribing buprenorphine is their perception that they are unable to provide adequate counseling or psychosocial support to patients with opioid addiction. This qualitative study investigated supportive elements of office-based buprenorphine treatment that patients perceived to be most valuable. Methods The authors conducted five focus groups with 33 buprenorphine treatment-experienced participants. Focus groups were audio-recorded and transcribed. Iterative readings of transcripts and grounded theory analysis revealed common themes. Results Overall, participants perceived that buprenorphine treatment helped them to achieve their treatment goals and valued the flexibility, accessibility, and privacy of treatment. Participants identified interpersonal and structural elements of buprenorphine treatment that provided psychosocial support. Participants desired good physician-patient relationships, but also valued care delivery models that were patient-centered, created a safe place for self-disclosure, and utilized coordinated team-based care. Conclusions Participants derived psychosocial support from their prescribing physician, but were also open to collaborative or team-based models of care, as long as they were voluntary and confidential. Buprenorphine-prescribing physicians without access to referral options for psychosocial counseling could focus on maintaining nonjudgmental attitudes and shared decision-making during patient encounters. Adding structure and psychosocial support to buprenorphine treatment through coordinated team-based care also seems to have great promise.
TLR7 and TLR9 ligands regulate antigen presentation by macrophages
Authors: Celhar Teja , Pereira-Lopes Selma , Thornhill Susannah I. , Lee Hui Yin , Dhillon Manprit K. , Poidinger Michael , Connolly John E. , Lim Lina H. K. , Biswas Subhra K. , Fairhurst Anna-Marie 
Published: November 2015

AbstractThe toll-like receptors (TLRs) are important innate receptors recognizing potentially pathogenic material. However, they also play a significant role in the development of Alzheimer’s disease, cancer, autoimmunity and the susceptibility to viral infections. Macrophages are essential for an effective immune response to foreign material and the resolution of inflammation. In these studies, we examined the impact of different TLR ligands on macrophage cell function. We demonstrate that stimulation of all TLRs tested increases the phagocytosis of apoptotic cells by macrophages. TLR7 and TLR9 ligation decreased the levels of the surface co-expression molecules CD86 and MHCII, which was associated with a concomitant reduction in antigen presentation and proliferation of T cells. This down-regulation in macrophage function was not due to an increase in cell death. In fact, exposure to TLR7 or TLR9 ligands promoted cell viability for up to 9 days, in contrast to TLR3 or TLR4. Additionally, macrophages exposed to TLR7/TLR9 ligands had a significantly lower ratio of Il-12/Il-10 mRNA expression compared with those treated with the TLR4 ligand, LPS. Taken together, these data demonstrate that TLR7/TLR9 ligands push the macrophage into a phagocytic long-lived cell, with a decreased capacity of antigen presentation and reminiscent of the M2 polarized state.
Leptin deficiency down-regulates IL-23 production in glomerular podocytes resulting in an attenuated immune response in nephrotoxic serum nephritis
Authors: Goto Kei , Kaneko Yoshikatsu , Sato Yuya , Otsuka Tadashi , Yamamoto Suguru , Goto Shin , Yamamoto Keiko , Yamamoto Tadashi , Kawachi Hiroshi , Madaio Michael P. , Narita Ichiei 
Published: November 2015

Abstract
Leptin, one of the typical adipokines, is reported to promote T h 17 cell responses and to enhance production of proinflammatory cytokines. To clarify the role of leptin in the regulation of the IL-23/IL-17 axis and the development of kidney disease, we used a murine model of nephrotoxic serum (NTS) nephritis (NTN). Sheep NTS was administered in wild-type C57BL/6J mice and food-restricted, leptin-deficient C57BL/6J- ob/ob (FR- ob/ob ) mice after preimmunization with sheep IgG. The profile of mRNA expression relevant to T helper lymphocytes in the kidneys was analyzed by quantitative real-time PCR (qRT–PCR). Cultured murine glomerular podocytes and peritoneal exudate macrophages (PEMs) were used to investigate the direct effect of leptin on IL-23 or MCP-1 production by qRT–PCR. Kidney injury and macrophage infiltration were significantly attenuated in FR- ob/ob mice 7 days after NTS injection. The T h 17-dependent secondary immune response against deposited NTS in the glomeruli was totally impaired in FR- ob/ob mice because of deteriorated IL-17 and proinflammatory cytokine production including IL-23 and MCP-1 in the kidney. IL-23 was produced in glomerular podocytes in NTN mice and cultured murine glomerular podocytes produced IL-23 under leptin stimulation. MCP-1 production in PEMs was also promoted by leptin. Induction of MCP-1 expression was observed in PEMs regardless of Ob-Rb, and the leptin signal was transduced without STAT3 phosphorylation in PEMs. Leptin deficiency impairs the secondary immune response against NTS and down-regulates IL-23 production and T h 17 responses in the NTN kidney, which is accompanied by decreased MCP-1 production and macrophage infiltration in the NTN kidney.
Meaningful use care coordination criteria: Perceived barriers and benefits among primary care providers
Authors: Cohen Genna R , Adler-Milstein Julia 
Published: November 2015

Abstract
Background Stage 2 and proposed Stage 3 meaningful use criteria ask providers to support patient care coordination by electronically generating, exchanging, and reconciling key information during patient care transitions.
Methods A stratified random sample of primary care practices in Michigan ( n  = 328) that had already met Stage 1 meaningful use criteria was surveyed, in order to identify the anticipated barriers to meeting these criteria as well as the expected impact on patient care coordination from doing so.
Results The top three barriers, as identified by &gt;65% of the primary care providers surveyed, were difficulty sending and receiving patient information electronically, a lack of provider and practice staff time, and the complex workflow changes required. Despite these barriers, primary care providers expressed strong agreement that meeting the proposed Stage 3 care coordination criteria would improve their patients’ treatment and ensure they know about their patients’ visits to other providers.
Conclusion The survey results suggest the need to enhance policy approaches and organizational strategies to address the key barriers identified by providers and practices in order to realize important care coordination benefits.
Experience with decision support system and comfort with topic predict clinicians’ responses to alerts and reminders
Authors: Bauer Nerissa S , Carroll Aaron E , Saha Chandan , Downs Stephen M 
Published: November 2015

Abstract
Objective Clinicians at our institution typically respond to about half of the prompts they are given by the clinic’s computer decision support system (CDSS). We sought to examine factors associated with clinician response to CDSS prompts as part of a larger, ongoing quality improvement effort to optimize CDSS use.
Methods We examined patient, prompt, and clinician characteristics associated with clinician response to decision support prompts from the Child Health Improvement through Computer Automation (CHICA) system. We asked pediatricians who were nonusers of CHICA to rate decision support topics as “easy” or “not easy” to discuss with patients and their guardians. We analyzed these ratings and data, from July 1, 2009 to January 29, 2013, utilizing a hierarchical regression model, to determine whether factors such as comfort with the prompt topic and the length of the user’s experience with CHICA contribute to user response rates.
Results We examined 414 653 prompts from 22 260 patients. The length of time a clinician had been using CHICA was associated with an increase in their prompt response rate. Clinicians were more likely to respond to topics rated as “easy” to discuss. The position of the prompt on the page, clinician gender, and the patient’s age, race/ethnicity, and preferred language were also predictive of prompt response rate.
Conclusion This study highlights several factors associated with clinician prompt response rates that could be generalized to other health information technology applications, including the clinician’s length of exposure to the CDSS, the prompt’s position on the page, and the clinician’s comfort with the prompt topic. Incorporating continuous quality improvement efforts when designing and implementing health information technology may ensure that its use is optimized.
An information model for automated assessment of concordance between advance care preferences and care delivered near the end of life
Authors: Turley Marianne , Wang Susan , Meng Di , Kanter Michael H , Garrido Terhilda 
Published: November 2015

AbstractObjective To develop an information model for automating evaluation of concordance between patient preferences and end-of-life care.Methods We modeled and validated 15 end-of-life care preference option domains, to which we mapped preferences recorded in standardized advance care planning documents and 232 end-of-life care events defined by procedure and medication codes. Patient preferences and end-of-life care events were available in electronic health records. Data from Kaiser Permanente Southern California modeling and testing populations were evaluated for concordance between patients’ preferences and the end-of-life care events they experienced.Results The information model successfully assessed concordance between patient preferences and end-of-life care events. Among 388 expired patients in the modeling population, 4164 care events occurred, 4100 (98%) of which were preference-concordant, and 64 (2%) of which were preference-discordant. Including end-of-life care events that did not occur increased the number of observations to 6029; 99% were preference-concordant. At the level of individuals, 72% (278) of patients experienced only preference-concordant care events, 13% (50) experienced at least one preference-discordant care event, and 15% (60) experienced no preference-related care events.Discussion Model limitations pertain to assumptions that are required to match advance care planning documents with patient preference options and exclusion of preferred care that did not occur. Further research is required to apply the model to larger populations and to investigate the need for additional preference options.Conclusion An information model for automating the assessment of the concordance between patients’ advance care planning preferences and the end-of-life care they received was effective in a small population and has the potential to assess population-level preference-concordance on an ongoing basis.
West Nile Virus Central Nervous System Infection in Patients Treated With Rituximab: Implications for Diagnosis and Prognosis, With a Review of Literature
Authors: Morjaria Sejal , Arguello Esther , Taur Ying , Sepkowitz Kent , Hatzoglou Vaios , Nemade Ajay , Rosenblum Marc , Cavalcanti Marcela S. , Palomba M. Lia , Kaltsas Anna 
Published: November 2015

Abstract
The spectrum of West Nile virus (WNV) infection continues to be elucidated. Many cases of WNV are asymptomatic; however, in immunocompromised patients, symptoms are more likely to be severe. We describe fatal WNV central nervous system disease in lymphoma patients who received rituximab, blunting the inflammatory response and complicating diagnosis.
Prosthetic-Joint-Associated Bordetella holmesii Infection
Authors: Humphrey John M. , Lacaille Sherard N. J. , Patel Krutika , Thompson Erin , Tulumba Steve , Healey John H. , Gilhuley Kathleen A. , Babady N. Esther , Kamboj Mini , Mead Peter A. 
Published: November 2015

Abstract
Bordetella holmesii is a globally distributed pathogen that is increasingly recognized as a cause of both pertussis-like respiratory infections and invasive disease. In this study, we describe a case of an immunocompetent man who developed B holmesii infection of his femoral prosthesis—the fifth B holmesii orthopedic infection reported in literature to date. This article highlights the potentially underrecognized role of B holmesii in orthopedic infections by reviewing these previously reported cases in the context of the current literature.
An Evaluation of Systemic Vancomycin Dosing in Obese Patients
Authors: Kubiak David W. , Alquwaizani Mohammed , Sansonetti David , Barra Megan E. , Calderwood Michael S. 
Published: November 2015

Abstract
We retrospectively identified 67 patients with severe or morbid obesity (body mass index ≥35 kg/m2) who had received intravenous vancomycin at our institution. We observed that an initial dose of 45 to 65 mg/kg vancomycin per day based upon ideal body weight rather than actual body weight was more predictive of initial trough concentrations between 15 and 20 mcg/mL.
Uncovering the History of Operating Room Attire through Photographs
Authors: Adams Lu Wang , Aschenbrenner Carol A. , Houle Timothy T. , Roy Raymond C. 
Published: November 2015

AbstractAbstract
A systematic analysis of over 1,000 historic photographs of operating room personnel was conducted to provide a timeline of changes in attire. The years for which general acceptance of various elements of operating room attire (gown, cap, and mask) differed between anesthesia providers and surgeons. Anesthesia providers lagged behind surgeons in adoption of standard operating room attire.

Background
Although early proponents for each of the four basic articles of operating room clothing—gowns, caps, masks, and gloves—can be identified, it is unclear from historical commentaries when each article achieved general acceptance and was consistently worn by surgeons and by anesthesia providers.

Methods
Historical photographs were identified from the Web sites of the National Library of Medicine, Google, and the archives of the Wood Library-Museum of Anesthesiology for the 11 decades 1860 to 1970. The presence or absence of each article of clothing was then determined for the surgical and anesthesia providers depicted.

Results
Over 1,000 photographs were identified and examined. Photographs were then eliminated for repetition, lack of available dating, questionable dating, and poor quality. In 338 remaining photographs that met inclusion criteria, 640 surgical providers and 219 anesthesia providers were depicted and used in the analysis. Statistical definitions for historical terms general acceptance and routine use were proposed. The probability that a surgeon was wearing nonstreet clothes (gown) was 0.66 (95% CI, 0.22 to 0.93) in 1863. The years (95% lower bound to 95% upper bound) associated with a 0.5 probability for wearing cap, gloves, and mask were 1900 (1896 to 1904), 1907 (1903 to 1910), and 1916 (1913 to 1919), respectively. The years associated with a 0.5 probability that an anesthesia provider would be wearing nonstreet clothes (gown), cap, and mask were 1883 (1863 to 1889), 1905 (1900 to 1911), and 1932 (1929 to 1937), respectively.

Conclusion
Timelines for the adoption of each basic article of surgical attire by surgeons and anesthesia providers were determined by analysis of historical operating room photographs from 1863 to 1969.
A Cysteine Substitution Probes β3H267 Interactions with Propofol and Other Potent Anesthetics in α1β3γ2L γ-Aminobutyric Acid Type A Receptors
Authors: Stern Alex T. , Forman Stuart A. 
Published: November 2015

AbstractAbstract
Functional analysis and chemical modification–protection studies in a common brain γ-aminobutyric acid type A receptor revealed differences between potent anesthetics. Only the barbiturate protected β3H267C from modification; this mutation also enhanced agonism by propofol, indicating that β3H267 contributes to binding sites for barbiturates and propofol, but not for etomidate and alphaxalone.

Background
Anesthetic contact residues in γ-aminobutyric acid type A (GABAA) receptors have been identified using photolabels, including two propofol derivatives. O-propofol diazirine labels H267 in β3 and α1β3 receptors, whereas m-azi-propofol labels other residues in intersubunit clefts of α1β3. Neither label has been studied in αβγ receptors, the most common isoform in mammalian brain. In αβγ receptors, other anesthetic derivatives photolabel m-azi-propofol-labeled residues, but not βH267. The authors’ structural homology model of α1β3γ2L receptors suggests that β3H267 may abut some of these sites.

Methods
Substituted cysteine modification–protection was used to test β3H267C interactions with four potent anesthetics: propofol, etomidate, alphaxalone, and R-5-allyl-1-methyl-5-(m-trifluoromethyl-diazirinylphenyl) barbituric acid (mTFD-MPAB). The authors expressed α1β3γ2L or α1β3H267Cγ2L GABAA receptors in Xenopus oocytes. The authors used voltage clamp electrophysiology to assess receptor sensitivity to γ-aminobutyric acid (GABA) and anesthetics and to compare p-chloromercuribenzenesulfonate modification rates with GABA versus GABA plus anesthetics.

Results
Enhancement of low GABA (eliciting 5% of maximum) responses by equihypnotic concentrations of all four anesthetics was similar in α1β3γ2L and α1β3H267Cγ2L receptors (n > 3). Direct activation of α1β3H267Cγ2L receptors, but not α1β3γ2L, by mTFD-MPAB and propofol was significantly greater than the other anesthetics. Modification of β3H267C by p-chloromercuribenzenesulfonate (n > 4) was rapid and accelerated by GABA. Only mTFD-MPAB slowed β3H267C modification (approximately twofold; P = 0.011).

Conclusions
β3H267 in α1β3γ2L GABAA receptors contacts mTFD-MPAB, but not propofol. The study results suggest that β3H267 is near the periphery of one or both transmembrane intersubunit (α+/β− and γ+/β−) pockets where both mTFD-MPAB and propofol bind.
In Vitro Comparative Effect of Carbetocin and Oxytocin in Pregnant Human Myometrium with and without Oxytocin Pretreatment
Authors: Cole Naida M. , Carvalho Jose C. A. , Erik-Soussi Magda , Ramachandran Nivetha , Balki Mrinalini 
Published: November 2015

AbstractAbstract
Oxytocin produced stronger contractions of term pregnant human myometrium in vitro than did carbetocin over the entire range of equimolar concentrations studied. Oxytocin pretreatment of term pregnant human myometrium in vitro attenuated contractions produced by both oxytocin and carbetocin.

Background
The purpose of this study was to compare in vitro contractile effects of oxytocin and carbetocin on human term pregnant myometrium with and without oxytocin pretreatment.

Methods
This laboratory investigation was conducted on myometrial samples from women undergoing elective cesarean deliveries. The samples were dissected into four strips and suspended in individual organ bath chambers containing physiologic salt solution. After equilibration, they were pretreated with oxytocin 10−5 M (experimental group) or physiologic salt solution (control group) for 2 h and then subjected to dose–response testing with increasing concentrations of oxytocin or carbetocin (10−10 to 10−5 M). The amplitude, frequency, motility index (amplitude × frequency), and area under the curve of contractions were recorded and analyzed during the equilibration and dose–response periods. Comparisons were made between oxytocin-induced and carbetocin-induced contractions in control and oxytocin-pretreated groups. Motility index was the primary outcome measure.

Results
Sixty-three experiments were performed (carbetocin, n = 31; oxytocin, n = 32) on samples from 18 women. The motility index of contractions (√g.contractions/10 min) produced by oxytocin was significantly higher than carbetocin in both control (regression-estimated difference, 0.857; 95% CI, 0.290 to 1.425; P = 0.003) and oxytocin-pretreated (0.813; 0.328 to 1.299; P = 0.001) groups. The motility index was significantly lower in oxytocin-pretreated groups than their respective controls for both oxytocin (−1.040; −1.998 to −0.082; P = 0.03) and carbetocin (−0.996; −1.392 to −0.560; P < 0.001).

Conclusions

In vitro contractions produced by oxytocin are superior to carbetocin in human myometrium with or without oxytocin pretreatment. Oxytocin pretreatment results in attenuation of contractions induced by both oxytocin and carbetocin.
Morbidity and Mortality after High-dose Transfusion
Authors: Johnson Daniel J. , Scott Andrew V. , Barodka Viachaslau M. , Park Sunhee , Wasey Jack O. , Ness Paul M. , Gniadek Tom , Frank Steven M. 
Published: November 2015

AbstractAbstract
Mortality increased linearly with erythrocyte dose, reaching 50% in patients given more than 50 units of blood. Infection and thrombotic events were the most common complications.

Background
It is well recognized that increased transfusion volumes are associated with increased morbidity and mortality, but dose–response relations between high- and very-high-dose transfusion and clinical outcomes have not been described previously. In this study, the authors assessed (1) the dose–response relation over a wide range of transfusion volumes for morbidity and mortality and (2) other clinical predictors of adverse outcomes.

Methods
The authors retrospectively analyzed electronic medical records for 272,592 medical and surgical patients (excluding those with hematologic malignancies), 3,523 of whom received transfusion (10 or greater erythrocyte units throughout the hospital stay), to create dose–response curves for transfusion volumes and in-hospital morbidity and mortality. Prehospital comorbidities were assessed in a risk-adjusted manner to identify the correlation with clinical outcomes.

Results
For patients receiving high- or very-high-dose transfusion, infections and thrombotic events were four to five times more prevalent than renal, respiratory, and ischemic events. Mortality increased linearly over the entire dose range, with a 10% increase for each 10 units of erythrocytes transfused and 50% mortality after 50 erythrocyte units. Independent predictors of mortality were transfusion dose (odds ratio [OR], 1.037; 95% CI, 1.029 to 1.044), the Charlson comorbidity index (OR, 1.209; 95% CI, 1.141 to 1.276), and a history of congestive heart failure (OR, 1.482; 95% CI, 1.062 to 2.063).

Conclusions
Patients receiving high- or very-high-dose transfusion are at especially high risk for hospital-acquired infections and thrombotic events. Mortality increased linearly over the entire dose range and exceeded 50% after 50 erythrocyte units.