bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sepsis patients in the emergency department: stratification using the Clinical Impression Score, Predisposition, Infection, Response and Organ dysfunction score or quick Sequential Organ Failure Assessment score?
Authors: Quinten Vincent M. , van Meurs Matijs , Wolffensperger Anna E. , ter Maaten Jan C. , Ligtenberg Jack J.M. 
Published: March 2017

Objective
The aim of this study was to compare the stratification of sepsis patients in the emergency department (ED) for ICU admission and mortality using the Predisposition, Infection, Response and Organ dysfunction (PIRO) and quick Sequential Organ Failure Assessment (qSOFA) scores with clinical judgement assessed by the ED staff.

Patients and methods
This was a prospective observational study in the ED of a tertiary care teaching hospital. Adult nontrauma patients with suspected infection and at least two Systemic Inflammatory Response Syndrome criteria were included. The primary outcome was direct ED to ICU admission. The secondary outcomes were in-hospital, 28-day and 6-month mortality, indirect ICU admission and length of stay. Clinical judgement was recorded using the Clinical Impression Scores (CIS), appraised by a nurse and the attending physician. The PIRO and qSOFA scores were calculated from medical records.

Results
We included 193 patients: 103 presented with sepsis, 81 with severe sepsis and nine with septic shock. Fifteen patients required direct ICU admission. The CIS scores of nurse [area under the curve (AUC)=0.896] and the attending physician (AUC=0.861), in conjunction with PIRO (AUC=0.876) and qSOFA scores (AUC=0.849), predicted direct ICU admission. The CIS scores did not predict any of the mortality endpoints. The PIRO score predicted in-hospital (AUC=0.764), 28-day (AUC=0.784) and 6-month mortality (AUC=0.695). The qSOFA score also predicted in-hospital (AUC=0.823), 28-day (AUC=0.848) and 6-month mortality (AUC=0.620).

Conclusion
Clinical judgement is a fast and reliable method to stratify between ICU and general ward admission in ED patients with sepsis. The PIRO and qSOFA scores do not add value to this stratification, but perform better on the prediction of mortality. In sepsis patients, therefore, the principle of ‘treat first what kills first’ can be supplemented with ‘judge first and calculate later’.
The evolution of disease: chronic lung disease of infancy and pulmonary hypertension
Authors: Tracy Michael C. , Cornfield David N. 
Published: March 2017

Purpose of review
Bronchopulmonary dysplasia (BPD) or chronic lung disease of infancy BPD was originally described 50 years ago, in 1967 by Northway et al. This article possesses two fundamental objectives to provide: a brief historical perspective on BPD; and an update relative to current notions of epidemiology, pathophysiology, evaluation, and clinical management of BPD complicated by vascular disease. The review highlights areas of consensus and ongoing uncertainty.

Recent findings
The clinical cause and presentation of infants with BPD has evolved over the past several decades. Considerable improvements in neonatal care, including surfactant replacement therapies, antenatal steroids, nutritional support, ventilator management, and attention to the potential of oxygen toxicity, underlie the evolution of BPD. Most children with BPD improve over time. However, in the presence of vascular disease, the morbidity and mortality associated with BPD increases considerably. Though recent recommendations include procuring an echocardiogram to screen for pulmonary hypertension in infants with established BPD, there is less agreement surrounding the additional diagnostic and putative treatment modalities for infants with BPD and pulmonary hypertension. The indications, rationale, potential benefits, and risks of vasodilator therapy in BPD are discussed.

Summary
The pediatric community has 50 years of experience with BPD. Past experience should be used to inform present and future diagnostic and treatment strategies. This review seeks to arm the clinician with evidence that motivates a physiology-based approach to the management of infants with BPD and pulmonary hypertension.
Respiratory complications, management and treatments for neuromuscular disease in children
Authors: Buu MyMy C. 
Published: March 2017

Purpose of review
To summarize current literature describing the respiratory complications of neuromuscular disease (NMD) and the effect of respiratory interventions and to explore new gene therapies for patients with NMD.

Recent findings
Measurements of respiratory function focus on vital capacity and maximal inspiratory and expiratory pressure and show decline over time. Management of respiratory complications includes lung volume recruitment, mechanical insufflation-exsufflation, chest physiotherapy and assisted ventilation. Lung volume recruitment can slow the progression of lung restriction. New gene-specific therapies for Duchenne muscular dystrophy and spinal muscular atrophy have the potential to preserve respiratory function longitudinally. However, the long-term therapeutic benefit remains unknown.

Summary
Although NMDs are heterogeneous, many lead to progressive muscle weakness that compromises the function of the respiratory system including upper airway tone, cough and secretion clearance and chest wall support. Respiratory therapies augment or support the normal function of these components of the respiratory system. From a respiratory perspective, the new mutation and gene-specific therapies for NMD are likely to confer long-term therapeutic benefit. More sensitive and standard tools to assess respiratory function longitudinally are needed to monitor respiratory complications in children with NMD, particularly the youngest patients.
Nursing Informatics Competency Assessment for the Nurse Leader
Authors: Collins Sarah , Yen Po-Yin , Phillips Andrew , Kennedy Mary K. 
Published: March 2017

OBJECTIVE
The aim of this study was to identify nursing informatics competencies perceived as relevant and required by nurse leaders.

BACKGROUND
To participate as a full partner in healthcare leadership among rapidly advancing health information technologies (HITs), nurse leaders must attain knowledge of informatics competencies related to their clinical leadership roles and responsibilities. Despite this increased need to engage in HIT-related decision making, a gap remains in validated informatics competencies specific to the needs of nurse leaders.

METHODS
An environmental scan and 3-round survey using Delphi methods used with nurse leaders for competency identification were used.

RESULTS
Between 26 and 41 participants responded to each Delphi round. Most nurse leaders acquired HIT knowledge through on-the-job training. We identified 74 competencies from an initial list of 108 competencies.

CONCLUSION
This work can advance nursing practice to move beyond “on-the-job informatics training” to a more competency-based model of nursing informatics education and practice.
A Descriptive Study of Nursing Peer-Review Programs in US Magnet® Hospitals
Authors: Roberts Holli , Cronin Sherill Nones 
Published: March 2017

OBJECTIVE
The goal of this study was to assess the types of nursing peer review (NPR) programs in US Magnet® organizations.

BACKGROUND
The 2 most predominant models of NPR programs in the literature are performance evaluation and clinical peer review. The literature on clinical peer review is primarily descriptive, outlining structures and anecdotal outcomes.

METHODS
Participants from hospitals holding Magnet recognition were selected using a stratified random-sampling method. A survey developed by the researchers assessed the presence of NPR. If clinical NPR was in place, program design, evaluation measurements, and barriers were explored.

RESULTS
Findings suggest wide variability in NPR models. More than one-third of the respondents conduct peer evaluation as the only mechanism of NPR. Most hospitals with a clinical peer-review program reported a case review structure and process measurements not supported by data.

CONCLUSIONS
The variations noted in this study suggest more research is needed to measure the effectiveness of NPR models and associated outcomes.
Are Generation Y Nurses Satisfied on the Job? Understanding Their Lived Experiences
Authors: Anselmo-Witzel Sonia , Orshan Susan A. , Heitner Keri L. , Bachand Jeanie 
Published: March 2017

OBJECTIVE
The purpose of this study was to explore the lived experiences of job satisfaction among Generation Y nurses in the workplace.

BACKGROUND
Job satisfaction in nursing is at an all-time low. With an increasing shortage of nurses, there is a need for more awareness and understanding of job satisfaction and intent to stay among Generation Y nurses who are the future generation of nurses.

METHODS
Descriptive phenomenology-guided, in-depth semistructured interviews were conducted to explore the lived experiences of job satisfaction among 10 Generation Y nurses.

RESULTS
Four main themes and 6 subthemes that emerged brought meaning to the nurses’ experiences. The 4 main themes were experiences of feeling good, relationships, job strain, and having choices.

CONCLUSIONS
Findings indicated Generation Y nurses want to fulfill inner feelings of job satisfaction. If these inner feelings are not met, they will seek other opportunities to fulfill job satisfaction.
Integration of Single-Center Data-Driven Vital Sign Parameters into a Modified Pediatric Early Warning System
Authors: Ross Catherine E. , Harrysson Iliana J. , Goel Veena V. , Strandberg Erika J. , Kan Peiyi , Franzon Deborah E. , Pageler Natalie M. 
Published: March 2017

Objectives:
Pediatric early warning systems using expert-derived vital sign parameters demonstrate limited sensitivity and specificity in identifying deterioration. We hypothesized that modified tools using data-driven vital sign parameters would improve the performance of a validated tool.

Design:
Retrospective case control.

Setting:
Quaternary-care children’s hospital.

Patients:
Hospitalized, noncritically ill patients less than 18 years old. Cases were defined as patients who experienced an emergent transfer to an ICU or out-of-ICU cardiac arrest. Controls were patients who never required intensive care. Cases and controls were split into training and testing groups.

Interventions:
The Bedside Pediatric Early Warning System was modified by integrating data-driven heart rate and respiratory rate parameters (modified Bedside Pediatric Early Warning System 1 and 2). Modified Bedside Pediatric Early Warning System 1 used the 10th and 90th percentiles as normal parameters, whereas modified Bedside Pediatric Early Warning System 2 used fifth and 95th percentiles.

Measurements and Main Results:
The training set consisted of 358 case events and 1,830 controls; the testing set had 331 case events and 1,215 controls. In the sensitivity analysis, 207 of the 331 testing set cases (62.5%) were predicted by the original tool versus 206 (62.2%; p = 0.54) with modified Bedside Pediatric Early Warning System 1 and 191 (57.7%; p < 0.001) with modified Bedside Pediatric Early Warning System 2. For specificity, 1,005 of the 1,215 testing set control patients (82.7%) were identified by original Bedside Pediatric Early Warning System versus 1,013 (83.1%; p = 0.54) with modified Bedside Pediatric Early Warning System 1 and 1,055 (86.8%; p < 0.001) with modified Bedside Pediatric Early Warning System 2. There was no net gain in sensitivity and specificity using either of the modified Bedside Pediatric Early Warning System tools.

Conclusions:
Integration of data-driven vital sign parameters into a validated pediatric early warning system did not significantly impact sensitivity or specificity, and all the tools showed lower than desired sensitivity and specificity at a single cutoff point. Future work is needed to develop an objective tool that can more accurately predict pediatric decompensation.
Nocebo and pain: an overview of the psychoneurobiological mechanisms
Authors: Blasini Maxie , Corsi Nicole , Klinger Regine , Colloca Luana 
Published: March 2017

Abstract

Introduction:
Nocebo effects are defined as adverse events related to negative expectations and learning processes that are involved in the modulation of the descending pain pathways. Research over the last couple of decades has illustrated that behavioral, psychoneurobiological, and functional changes occur during nocebo-induced pain processing.

Objectives:
We aimed to review published human and nonhuman research on algesia and hyperalgesia resulting from negative expectations and nocebo effects.

Methods:
Herein, we searched and comprehensively reviewed scientific literature providing informative knowledge about the psychoneurobiological bases of the nocebo effect in the field of pain with an emphasis on how pain processes are shaped by both cognitive and noncognitive factors.

Results:
Negative expectations are formed through verbal suggestions of heightened pain, prior nociceptive and painful experiences, and observation of pain in others. Susceptibility to the nocebo effect can be also influenced by genetic variants, conscious and nonconscious learning processes, personality traits, and psychological factors. Moreover, providers' behaviors, environmental cues and the appearance of medical devices can induce negative expectations that dramatically influence pain perception and processing in a variety of pain modalities and patient populations.

Conclusion:
Importantly, we concluded that nocebo studies outline how individual expectations may lead to physiological changes underpinning the central integration and processing of magnified pain signaling. Further research is needed to develop strategies that can identify patients with nocebo-vulnerable pain to optimize the psychosocial and therapeutic context in which the clinical encounter occurs, with the ultimate purpose of improving clinical outcomes.
Toward Microsurgical Correction of Cleft Lip Ex Utero through Restoration of Craniofacial Developmental Programs
Authors: Dong Xue , Landford Wilmina N. , Hart James , Risolino Maurizio , Kaymakcalan Omer , Jin Julia , Toyoda Yoshiko , Ferretti Elisabetta , Selleri Licia , Spector Jason A. 
Published: March 2017

Background:
Cleft lip with or without cleft palate is present in approximately one in 500 to 700 live births, representing the most common congenital craniofacial anomaly. Previously, the authors developed a unique murine model with compound Pbx deficiency that exhibits fully penetrant cleft lip with or without cleft palate. To investigate the possibility of tissue repair at an early gestational stage, the authors designed a minimally invasive surgical approach suitable for intrauterine repair using Wnt9b-soaked collagen microspheres to restore craniofacial developmental programs for cleft correction.

Methods:
Collagen microspheres with diameters ranging from 20 to 50 μm were fabricated to serve as a delivery vehicle for Wnt9b. At gestational day 11.5, wild-type and Pbx-deficient murine embryos were isolated. Microspheres soaked in murine purified Wnt9b protein were microsurgically implanted at the midface lambdoidal junction. Embryos were cultured in a 37°C modified whole-embryo culture system.

Results:
Targeted release of Wnt9b resulted in augmented Wnt expression at the lambdoidal junction. Microsurgical implantation of Wnt9b-soaked microspheres resulted in cleft correction in 27.1 percent of the Pbx-deficient embryos. The difference in the ratio of the areas of clefting between implanted and nonimplanted embryos was significant (p < 0.05).

Conclusions:
Ex utero correction of cleft lip with or without cleft palate in the authors’ murine model by means of microsurgical intervention and targeted delivery of Wnt proteins is an innovative and promising strategy. Although further refinement and optimization of this technique will be required to improve efficacy, the authors believe that this approach will open new avenues toward unconventional prenatal interventions for patients with cleft lip with or without cleft palate, and provide future approaches for prenatal repair of other congenital head and neck disorders.
MACRA
Authors: Huston Kent Kwasind 
Published: March 2017

Abstract
The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 introduced a new system of physician payments in the United States. This legislation and the complex rules written to enact the law intend to force a shift away from volume-based payments and into so called value-based payments. Physicians and other clinicians will be graded via quality and cost metrics and payments will be adjusted based on performance. Robust use of certified electronic health records is required under MACRA. Physicians will follow one of two payment reform tracks known as the Merit-Based Incentive Payment System (MIPS) and the Alternative Payment Model (APM) pathways. Although there are rheumatology and other specialty specific quality measures in the MIPS program, there are no rheumatology specific APMs to date. A thorough understating of MACRA is required for medical practices to survive the new era of payment reform.
Day Surgery for Acute Appendicitis in Adults: A Prospective Series of 102 Patients
Authors: Hobeika Christian , Hor Thevy , Chereau Nathalie , Laforest Anais , Bachmann Radu , Sourouille Isabelle , Chafai Najim , Parc Yann , Beaussier Marc , Lefèvre Jérémie H. 
Published: March 2017

Aim:
To report the results of a consecutive series of day surgery appendectomy (DSA) for acute appendicitis.

Methods:
Selection criteria for DSA were as follows: body mass index<28 kg/m2, white cell count <15,000/mL, C-reactive protein<30 mg/L, no radiological signs of perforation, and appendix diameter ≤10 mm. All patients with radiologically proven appendicitis and 4 or 5 criteria were proposed for DSA and prospectively included.

Results:
A total of 102 patients (female=39.2%) were operated between January 1, 2013 and January 5, 2015 with a median age of 29.5 years [interquartile range (IQR), 23 to 37 y]. Diagnosis was mainly supported by computed tomographic scan (75.5%). About 60 patients (59%) were reconvened on the next morning for surgery with oral antibiotics. The median operative time was 40 minutes (IQR, 30 to 52 min), and 92 (90%) patients were discharged on day 0 after a postoperative period of 5h:12min (IQR, 4h:14min to 6h:33min). The overall median hospital length of stay was 8h:04min (IQR, 6h:46min to 10h:23min). Surgical morbidity was 6.9% (n=7), with 1.9% (n=2) major complications.

Conclusions:
DSA is a safe procedure for selected patients; it reduces the hospital length of stay without increasing morbidity.
Challenge of progressive multiple sclerosis therapy
Authors: Thompson Alan J. 
Published: March 2017

Purpose of review
Understanding the mechanisms underlying progression in multiple sclerosis (MS) and identifying appropriate therapeutic targets is a key challenge facing the MS community. This challenge has been championed internationally by organizations such as the Progressive MS Alliance, which has raised the profile of progressive MS and identified the key obstacles to treatment. This review will outline the considerable progress against these challenges.

Recent findings
New insights into mechanisms underlying progression have opened up potential therapeutic opportunities. This has been complemented by ongoing validation of clinical and imaging outcomes for Phase II trials of progression, coupled with the development of innovative trial designs. The field has been greatly encouraged by recent positive Phase III trials in both primary and secondary progressive MS, albeit with modest benefit. Early trials of neuroprotection and repair have provided important new data with which to drive the field. Improving symptom management and advancing rehabilitation approaches, critical for this patient population which, taken together with identifying and managing comorbidities and risk factors, has an appreciable impact on health-related quality of life.

Summary
Raising the profile of progressive MS has resulted in the first effective treatments with the promise of more to come.
Rapid spatial learning controls instinctive defensive behavior in mice
Authors: Vale Ruben , Evans Dominic A. , Branco Tiago 
Published: March 2017

SummaryInstinctive defensive behaviors are essential for animal survival. Across the animal kingdom there are sensory stimuli that innately represent threat and trigger stereotyped behaviors such as escape or freezing [1-4]. While innate behaviors are considered to be hard-wired stimulus-responses [5], they act within dynamic environments, and factors such as the properties of the threat [6-9] and its perceived intensity [1, 10, 11], access to food sources [12-14] or expectations from past experience [15, 16], have been shown to influence defensive behaviors, suggesting that their expression can be modulated. However, despite recent work [2, 4, 17-21], little is known about how flexible mouse innate defensive behaviors are, and how quickly they can be modified by experience. To address this, we have investigated the dependence of escape behavior on learned knowledge about the spatial environment, and how the behavior is updated when the environment changes acutely. Using behavioral assays with innately threatening visual and auditory stimuli, we show that the primary goal of escape in mice is to reach a previously memorized shelter location. Memory of the escape target can be formed in a single shelter visit lasting less than 20 seconds, and changes in the spatial environment lead to a rapid update of the defensive action, including changing the defensive strategy from escape to freezing. Our results show that while there are innate links between specific sensory features and defensive behavior, instinctive defensive actions are surprisingly flexible and can be rapidly updated by experience to adapt to changing spatial environments.
Genomic changes associated with reproductive and migratory ecotypes in sockeye salmon (Oncorhynchus nerka)
Authors: Veale Andrew J , Russello Michael A 
Published: March 2017

AbstractMechanisms underlying adaptive evolution can best be explored using paired populations displaying similar phenotypic divergence, illuminating the genomic changes associated with specific life history traits. Here we used paired migratory [anadromous vs. resident (kokanee)] and reproductive [shore- vs. stream-spawning] ecotypes of sockeye salmon (Oncorhynchus nerka) sampled from seven lakes and two rivers spanning three catchments (Columbia, Fraser, and Skeena) in British Columbia, Canada to investigate the patterns and processes underlying their divergence. Restriction-site associated DNA sequencing was used to genotype this sampling at 7,347 single nucleotide polymorphisms (SNPs), 334 of which were identified as outlier loci and candidates for divergent selection within at least one ecotype comparison. Eighty-six of these outliers were present in multiple comparisons, with thirty-three detected across multiple catchments. Of particular note, one locus was detected as the most significant outlier between shore and stream-spawning ecotypes in multiple comparisons and across catchments (Columbia, Fraser and Snake). We also detected several islands of divergence, some shared among comparisons, potentially showing linked signals of differential selection. The SNPs and genomic regions identified in our study offer a range of mechanistic hypotheses associated with the genetic basis ofO. nerkalife history variation and provide novel tools for informing fisheries management.