bluuebunny/crossref_metadata_2025_split huggingface dataset:
Plattenepithelkarzinom nach langjähriger Arsenexposition in der Porzellanindustrie
Authors: Troyanova-Slavkova S. , Schierle K. , Bielfeld C. , Kowalzick L. 
Published: December 2017

ZusammenfassungDie Inzidenz von epithelialen Hauttumoren wie Plattenepithelkarzinomen steigt weltweit deutlich an. Viele Risikofaktoren für deren Entstehung sind schon bekannt, u. a. auch die langjährige Arsenexposition. Wir berichten über den Fall einer 78-jährigen Patientin, die seit mehr als 30 Jahren in der Porzellanindustrie als Malerin tätig war und bei uns aufgrund eines exophytischen, schnell wachsenden Tumors am Handrücken links vorstellig wurde. Histologisch konnte ein Plattenepithelkarzinom diagnostiziert werden. Von Seiten der Patientin wurde eine langjährige berufsbedingte Tätigkeit mit Kobaltfarben in der Porzellanindustrie angegeben. Kobalt kommt häufig in Verbindung mit Arsen vor und bildet als Arsenkobalt das häufigste Kobalterz, den Speiskobalt. Speiskobalt war ein wichtiges Kobalterz zur Blaufarbenbereitung in der Porzellanindustrie. In Anbetracht der Toxizität von Arsen, einschließlich seiner kanzerogenen Wirkung, sowie des zeitlichen und örtlichen Zusammenhangs zwischen der ausgeübten Tätigkeit der Patientin und der Entstehung des Plattenepithelkarzinoms konnten wir bei dem vorliegenden Fall den Verdacht auf eine Berufskrankheit Nr. 1108 (nach Berufskrankheiten-Verordnung) äußern.
Rheumatoide Arthritis – die neuen Therapieoptionen
Authors: Fiehn Christoph 
Published: December 2017

Was ist neu?
Die JAK-Inhibitoren Die Janus-Kinase (JAK)-Inhibitoren Tofacitinib und Baricitinib sind 2017 neu zur Behandlung der rheumatoiden Arthritis (RA), nach Versagen oder Unverträglichkeit von konventionellen krankheitsmodifizierenden Antirheumatika (disease modifying antirheumatic drugs; DMARD), zugelassen. Sie wirken intrazellulär durch Hemmung der JAK-Kinasen und verhindern so die Weiterleitung der aktivierenden Signale von Zytokinrezeptoren auf inflammatorische Zellpopulationen. Die JAK-Inhibitoren reduzieren effektiv die Krankheitsaktivität der RA, verbessern die körperliche Funktion und reduzieren die strukturellen Veränderungen der Gelenke. In Vergleichsstudien gegenüber dem TNF-alpha-Hemmstoff Adalimumab haben sie eine gleich gute, im Fall von Baricitinib sogar eine leicht überlegene Wirksamkeit gezeigt. Die Infektionsrate ist unter einer Therapie mit JAK-Inhibitoren im Vergleich zu konventionellen DMARD erhöht.
Neuer Interleukin-6-Hemmstoff Das schon länger bewährte Wirkprinzip der Hemmung von Interleukin(IL)-6 wird nun durch den neuen Wirkstoff Sarilumab ergänzt. Die Substanz wirkt effektiv auf die Krankheitsaktivität, die körperliche Funktion und die radiologisch sichtbaren strukturellen Veränderungen der RA. Darüber hinaus reduziert sie die systemischen Symptome der Erkrankung.
Rethinking policy ‘impact’: four models of research-policy relations
Authors: Boswell Christina , Smith Katherine 
Published: December 2017

AbstractPolitical scientists are increasingly exhorted to ensure their research has policy ‘impact’, most notably via Research Excellence Framework (REF) impact case studies, and ‘pathways to impact’ statements in UK Research Council funding applications. Yet the assumptions underpinning these frameworks often fail to reflect available evidence and theories. Notions of ‘impact’, ‘engagement’ and ‘knowledge exchange’ are typically premised on simplistic, linear models of the policy process, according to which policy-makers are keen to ‘utilise’ expertise to produce more ‘effective’ policies. Such accounts overlook the rich body of literature in political science, policy studies, and sociology of knowledge, which offer more complex and nuanced accounts. Drawing on this wider literature, this paper sets out four different approaches to theorising the relationship: (1) knowledge shapes policy; (2) politics shapes knowledge; (3) co-production; and (4) autonomous spheres. We consider what each of these four approaches suggests about approaches to incentivising and measuring research impact.
SbcC-SbcD and ExoI process convergent forks to complete chromosome replication
Authors: Wendel Brian M. , Cole Jessica M. , Courcelle Charmain T. , Courcelle Justin 
Published: December 2017

Significance
SbcC-SbcD and ExoI belong to a class of highly conserved nucleases that are critical to genome stability, but whose cellular function remains poorly understood. Human homologs of these proteins are essential for viability and normal development, and lead to severe developmental abnormalities and cancer predisposition when mutated. Here we show that these enzymes process DNA intermediates at sites where replication forks converge and are required for chromosome replication to complete normally. Cells lacking these gene products are unable to complete replication normally, and rely on an aberrant recombinational mechanism to maintain viability that leads to genomic instability and amplifications at these sites, similar to that seen in human cancers where these genes have been found to be inactivated.
Effects of Cyclophosphamide and/or Doxorubicin in a Murine Model of Postchemotherapy Cognitive Impairment
Authors: Flanigan Timothy J , Anderson Julie E , Elayan Ikram , Allen Antiño R , Ferguson Sherry A 
Published: December 2017

AbstractPostchemotherapy cognitive impairment, or PCCI, is a common complaint, particularly among breast cancer patients. However, the exact nature of PCCI appears complex. To model the human condition, ovariectomized C57BL/6J mice were treated intravenous weekly for 4 weeks with saline, 2 mg/kg doxorubicin (DOX), 50 mg/kg cyclophosphamide (CYP), or DOX + CYP. For the subsequent 10 weeks, mice were assessed on several behavioral tests, including those measuring spatial learning and memory. After sacrifice, hippocampal spine density and morphology in the dentate gyrus, CA1, and CA3 regions were measured. Additionally, hippocampal levels of total glutathione, glutathione disulfide, MnSOD, CuZnSOD, and cytokines were measured. Body weight decreased in all groups during treatment, but recovered post-treatment. Most behaviors were unaffected by drug treatment: Open field activity, motor coordination, grip strength, water maze and Barnes maze performance, buried food test performance, and novel object and object location recognition tests. There were some significant effects of CYP and DOX + CYP treatment during the initial test of home cage behavior, but these did not persist into the second and third test times. Density of stubby spines, but not mushroom or thin spines, in the dentate gyrus was significantly decreased in the DOX, CYP, and DOX + CYP treatment groups. There were no significant effects in the CA1 or CA3 regions. CuZnSOD levels were significantly increased in DOX + CYP-treated mice; other hippocampal antioxidant levels were unaffected. Most cytokines showed no treatment-related effects, but IL-1β, IL-6, and IL-12 were slightly reduced in mice treated with DOX + CYP. Although the animal model, route of exposure, and DOX and CYP doses used here were reflective of human exposure, there were only sporadic effects due to chemotherapeutic treatment.
Engaging Nursing Students: Integrating Evidence-Based Inquiry, Informatics, and Clinical Practice
Authors: Keiffer Melanie R. 
Published: December 2017

Abstract
The nursing research class requires faculty to create a spirit of inquiry while integrating technology, flexibility, and responsiveness to student needs. This article discusses new pedagogies to actively engage students in the evidence-based nursing process and the achievement of course learning outcomes. Through course exemplar, the author demonstrates a creative method to engage traditional baccalaureate nursing students in a nursing project that links evidence to improved patient outcomes.
Developing Resident-Sensitive Quality Measures: A Model From Pediatric Emergency Medicine
Authors: Schumacher Daniel J. , Holmboe Eric S. , van der Vleuten Cees , Busari Jamiu O. , Carraccio Carol 
Published: December 2017

Purpose
To begin closing the gap with respect to quality measures available for use among residents, the authors sought to identify and develop resident-sensitive quality measures (RSQMs) for use in the pediatric emergency department (PED) setting.

Method
In May 2016, the authors reviewed National Quality Measures Clearinghouse (NQMC) measures to identify resident-sensitive measures. To create additional measures focused on common, acute illnesses (acute asthma exacerbation, bronchiolitis, closed head injury [CHI]) in the PED, the authors used a nominal group technique (NGT) and Delphi process from September to December 2016. To achieve a local focus for developing these measures, all NGT and Delphi participants were from Cincinnati Children’s Hospital Medical Center. Delphi participants rated measures developed through the NGT in two areas: importance of measure to quality care and likelihood that measure represents the work of a resident.

Results
The review of NQMC measures identified 28 of 183 as being potentially resident sensitive. The NGT produced 67 measures for asthma, 46 for bronchiolitis, and 48 for CHI. These were used in the first round of the Delphi process. After two rounds, 18 measures for asthma, 21 for bronchiolitis, and 21 for CHI met automatic inclusion criteria. In round three, participants categorized the potential final measures by their top 10 and next 5.

Conclusions
This study describes a template for identifying and developing RSQMs that may promote high-quality care delivery during and following training. Next steps should include implementing and seeking validity evidence for the locally developed measures.
What are the dominant cytokines in early rheumatoid arthritis?
Authors: Ridgley Laura A. , Anderson Amy E. , Pratt Arthur G. 
Published: December 2017

Purpose of review
Rheumatoid arthritis is a systemic disease of evolving immune dysregulation that culminates in joint destruction and disability. The principle by which pro-inflammatory cytokines may be therapeutically targeted to abrogate disease is well established, but has yet to translate into reliable cures for patients. Emerging insights into cytokine-mediated pathobiology during rheumatoid arthritis development are reviewed, and their implications for future treatment strategies considered.

Recent findings
Accumulating data highlight cytokine perturbations before the clinical onset of rheumatoid arthritis. Some of these have now been linked to the arthritogenic activation of autoantibodies and associated pain and bone destruction in affected joints. These observations suggest cytokines may trigger the transition from systemic immunity to arthritis. Cytokine exposure could furthermore ‘prime’ synovial stromal cells to perpetuate a dominant pro-inflammatory environment. By facilitating cross-talk between infiltrating immune cells and even sustaining ectopic lymphoid structure development in some cases, cytokine interplay ultimately underpins the failure of arthritis to resolve.

Summary
Successful therapeutic stratification will depend upon an increasingly sophisticated appreciation of how dominant players amongst cytokine networks vary across time and anatomical space during incipient rheumatoid arthritis. The prize of sustained remission for all patients justifies the considerable effort required to achieve this understanding.
Caregiver Perceptions and Health-Related Quality-of-Life Changes in Cerebral Palsy Patients After Spinal Arthrodesis
Authors: Jain Amit , Sullivan Brian T. , Shah Suken A. , Samdani Amer F. , Yaszay Burt , Marks Michelle C. , Sponseller Paul D. 
Published: December 2017

Study Design.
A retrospective analysis of a prospective registry.

Objective.
Our objective was to prospectively assess caregivers’ perceptions regarding changes in the health-related quality of life (HRQL) of patients with cerebral palsy (CP) after spinal arthrodesis. We assessed caregiver perceptions from three perspectives: 1) qualitative assessment of changes in global quality of life, comfort, and health; 2) relative valuation of spine surgery versus other common interventions in CP patients; and 3) quantitative changes in HRQL scores.

Summary of Background Data.
Studies of children with CP who undergo surgical treatment of spinal deformity have focused largely on radiographic changes.

Methods.
We queried a multicenter prospective registry of CP patients with level IV or V motor function according to the Gross Motor Function Classification System who were treated with spinal arthrodesis, and whose caregivers completed preoperative and 2-year postoperative qualitative and quantitative HRQL surveys. A total of 212 caregivers and their patients were included in the study.

Results.
At 2-year follow-up, most caregivers reported that patients’ global quality of life, comfort, and health were “a lot better” after spinal arthrodesis. Spinal arthrodesis was ranked as the most beneficial intervention in the patients’ lives by 74% of caregivers, ahead of hip, knee, and foot surgeries and baclofen pump insertion. Gastrostomy tube insertion was the only intervention ranked superior to spinal arthrodesis in terms of impact. Quantitative HRQL scores improved significantly during 2-year follow-up across various domains.

Conclusion.
In qualitative and quantitative HRQL assessments, caregivers reported overall improvement in patients’ lives after spinal arthrodesis. Caregivers ranked spine surgery as the most beneficial intervention in the patients’ lives, secondary only to gastrostomy tube insertion.

Level of Evidence: 2
Predictive Modeling for Blood Transfusion After Adult Spinal Deformity Surgery
Authors: Durand Wesley M. , DePasse John Mason , Daniels Alan H. 
Published: December 2017

Study Design.
Retrospective cohort study.

Objective.
Blood transfusion is frequently necessary after adult spinal deformity (ASD) surgery. We sought to develop predictive models for blood transfusion after ASD surgery, utilizing both classification tree and random forest machine-learning approaches.

Summary of Background Data.
Past models for transfusion risk among spine surgery patients are disadvantaged through use of single-institutional data, potentially limiting generalizability.

Methods.
This investigation was conducted utilizing the American College of Surgeons National Surgical Quality Improvement Program dataset years 2012 to 2015. Patients undergoing surgery for ASD were identified using primary-listed current procedural terminology codes. In total, 1029 patients were analyzed. The primary outcome measure was intra-/postoperative blood transfusion. Patients were divided into training (n = 824) and validation (n = 205) datasets. Single classification tree and random forest models were developed. Both models were tested on the validation dataset using area under the receiver operating characteristic curve (AUC), which was compared between models.

Results.
Overall, 46.5% (n = 479) of patients received a transfusion intraoperatively or within 72 hours postoperatively. The final classification tree model used operative duration, hematocrit, and weight, exhibiting AUC = 0.79 (95% confidence interval 0.73–0.85) on the validation set. The most influential variables in the random forest model were operative duration, surgical invasiveness, hematocrit, weight, and age. The random forest model exhibited AUC = 0.85 (95% confidence interval 0.80–0.90). The difference between the classification tree and random forest AUCs was nonsignificant at the validation cohort size of 205 patients (P = 0.1551).

Conclusion.
This investigation produced tree-based machine-learning models of blood transfusion risk after ASD surgery. The random forest model offered very good predictive capability as measured by AUC. Our single classification tree model offered superior ease of implementation, but a lower AUC as compared to the random forest approach, although this difference was not statistically significant at the size of our validation cohort. Clinicians may choose to implement either of these models to predict blood transfusion among their patients. Furthermore, policy makers may use these models on a population-based level to assess predicted transfusion rates after ASD surgery.

Level of Evidence: 3
Minimum Detectable Measurement Difference for Health-Related Quality of Life Measures Varies With Age and Disability in Adult Spinal Deformity
Authors: Kelly Michael P. , Kim Han Jo , Ames Christopher P. , Burton Douglas C. , Carreon Leah Yacat , Polly David W. , Hostin Richard , Jain Amit , Gum Jeffrey L. , Lafage Virginie , Schwab Frank J. , Shaffrey Christopher I. , Smith Justin S. , Bess Shay 
Published: December 2017

Study Design.
Retrospective cohort.

Objective.
To investigate the minimum detectable measurement difference (MDMD) in the Scoliosis Research Society-22r (SRS-22r) outcomes instrument in adult spinal deformity (ASD) and to evaluate the effect of baseline data on measurable difference.

Summary of Background Data.
The minimum clinically important difference (MCID) is the smallest, clinically relevant change observed and has been proposed for the SRS-22r instrument in ASD as 0.4. The MCID must be greater than the MDMD to be useful. The MDMD for the SRS-22r has not been calculated, nor have the effect of patient baseline values on MDMD.

Methods.
A prospective observation cohort was queried for patients treated both operatively and nonoperatively for ASD. Patients with baseline and 1-year, 2-year follow-up SRS-22r data were included in the analysis. The MDMD was calculated using classical test theory and item-response theory methods. Effect size and standardized response means were calculated. The effect of baseline data values was evaluated for MDMD.

Results.
A total 839 Patients were eligible for cohort inclusion with 428 (51%) eligible for analysis with complete data. MDMD for Pain (0.6) and Self-Image (0.5) were greater than 0.4. MDMD varied with age (highest for the youngest patients) and with disability (highest for SF-36 Physical Component Summary <28.6). MDMD was less than 0.4 for Activity (0.3), Mental Health (0.3), and Total Score (0.2). Gender and mental health did not affect MDMD for the SRS-22r instrument.

Conclusion.
An MCID of 0.4 for the SRS-22r total score and domain scores may not be an appropriate value as the calculated MDMD is greater than 0.4 for both the Pain and Self-Image subscores. The MDMD for the SRS-22r instrument varied with age and baseline disability, making the assessment of clinically significant change more difficult using this tool. The MCID must be considered in the setting of the MDMD for instruments used to assess outcomes in ASD.

Level of Evidence: 3
Is Health-related Quality of Life Decreased in Adolescents With Back Pain?
Authors: Gonçalves Tatiana Rehder , Mediano Mauro Felippe Felix , Sichieri Rosely , Cunha Diana Barbosa 
Published: December 2017

Study Design.
Cross-sectional study.

Objective.
To evaluate the association between back pain and health-related quality of life (HRQoL) among adolescents.

Summary of Background Data.
The prevalence of back pain has been increasing not only in the adult population but also among children and adolescents. The better knowledge about the association between back pain and health-related quality of life could facilitate the implementation of new intervention strategies on prevention and treatment of back pain.

Methods.
A sample of 350 students from the fifth to ninth grades of one public school in Niterói, Rio de Janeiro, Brazil. Anthropometric measures and information regarding sociodemographic, lifestyle, frequency and intensity of neck (NP), thoracic (TP), and low back pain in the previous month were collected using a personal digital assistant. HRQoL was assessed by KIDSCREEN-27. Multiple linear regression analyses were performed to investigate the association between back pain and HRQoL by sex.

Results.
The mean age of participants was 12.7 (±1.6) years. Frequency of NP, TP, and low back pain was 34.3, 27.1, and 13.1%, respectively. The mean intensity of pain was 2.3 (±0.2) for neck, 2.0 (±0.2) for thoracic, and 1.3 (±0.1) for low back pain. The presence of two/three painful sites was reported by 21.7% of the adolescents. The frequency and severity of neck pain were inversely associated with global HRQoL in both the sexes. There is a strong inverse association between the number of painful sites and global HRQoL and domains.

Conclusion.
The presence and intensity of cervical pain and the number of painful regions were associated with lower HRQoL in adolescents, which is worrying due to the important relationship between back pain in the adolescence and in the adulthood.

Level of Evidence: 3
Hospital Variation in Renal Replacement Therapy for Sepsis in the United States
Authors: Valley Thomas S. , Nallamothu Brahmajee K. , Heung Michael , Iwashyna Theodore J. , Cooke Colin R. 
Published: December 2017

Objectives:
Acute renal replacement therapy in patients with sepsis has increased dramatically with substantial costs. However, the extent of variability in use across hospitals—and whether greater use is associated with better outcomes—is unknown.

Design:
Retrospective cohort study.

Setting:
Nationwide Inpatient Sample in 2011.

Patients:
Eighteen years old and older with sepsis and acute kidney injury admitted to hospitals sampled by the Nationwide Inpatient Sample in 2011.

Interventions:
We estimated the risk- and reliability-adjusted rate of acute renal replacement therapy use for patients with sepsis and acute kidney injury at each hospital. We examined the association between hospital-specific renal replacement therapy rate and in-hospital mortality and hospital costs after adjusting for patient and hospital characteristics.

Measurements and Main Results:
We identified 293,899 hospitalizations with sepsis and acute kidney injury at 440 hospitals, of which 6.4% (n = 18,885) received renal replacement therapy. After risk and reliability adjustment, the median hospital renal replacement therapy rate for patients with sepsis and acute kidney injury was 3.6% (interquartile range, 2.9–4.5%). However, hospitals in the top quintile of renal replacement therapy use had rates ranging from 4.8% to 13.4%. There was no significant association between hospital-specific renal replacement therapy rate and in-hospital mortality (odds ratio per 1% increase in renal replacement therapy rate: 1.03; 95% CI, 0.99–1.07; p = 0.10). Hospital costs were significantly higher with increasing renal replacement therapy rates (absolute cost increase per 1% increase in renal replacement therapy rate: $1,316; 95% CI, $157–$2,475; p = 0.03).

Conclusions:
Use of renal replacement therapy in sepsis varied widely among nationally sampled hospitals without associated differences in mortality. Improving renal replacement standards for the initiation of therapy for sepsis may reduce healthcare costs without increasing mortality.