bluuebunny/crossref_metadata_2025_split huggingface dataset:
Investigation of feet functions of large ruminants with a decoupled model of equivalent mechanism
Authors: Zhang Qun , Xu Kun , Ding Xilun 
Published: April 2017

ABSTRACT
Cloven hooves of ruminants adapt to diverse terrain, provide propulsive force and support the whole body during movement in natural environments. To reveal how the feet ensure terrain adaptability by choosing the proper configurations and terrain conditions, we model the feet of ruminants as an equivalent mechanism with flexion-extension and lateral movement decoupled. The upper part of the equivalent mechanism can flex and extend, while the lower part performs the lateral movement. Combination of the two parts can adapt to longitudinal slope (anterior-posterior) and transverse slope (medial-lateral), respectively. When one of two digits closes laterally, the workspace of the other decreases. The distal interdigital ligament between two digits limits their motion by elastic force and stores energy during movement. Differences in elastic energy variation of the ligament on different transverse slopes are characterized based on the configurations of two digits and the elastic energy between them. If the upper one of two symmetric digits is fixed, the foot landing on the grade surface (2°) shows greater capacity for absorbing energy; otherwise, level ground is the best choice for ruminants. As for the asymmetric digits, longer lateral digits enhance the optimal adaptive lateral angle. The asymmetry predisposes the feet to damage on the hard ground, which indicates soft ground is more suitable.
Tanshinone IIA suppresses the progression of atherosclerosis by inhibiting the apoptosis of vascular smooth muscle cells and the proliferation and migration of macrophages induced by ox-LDL
Authors: Wang Baocai , Ge Zhenwei , Cheng Zhaoyun , Zhao Ziniu 
Published: April 2017

ABSTRACT
The profound inhibitory effect of Tanshinone IIA (Tan IIA) on atherosclerosis has been demonstrated, whereas the latent mechanism is not completely cleared. This study aimed to investigate the cellular and molecular mechanisms underlying Tan IIA protecting against atherosclerosis. Oil Red O staining and ELISA assay showed that Tan IIA suppressed the progress of atherosclerosis and reduced the levels of inflammatory cytokines in serum of apolipoprotein E deficient (ApoE–/–) mice. Flow cytometry assay revealed that Tan IIA inhibited oxidized LDL (ox-LDL)-induced apoptosis of VSMCs. MTT and transwell assay indicated that Tan IIA suppressed the ox-LDL-stimulated proliferation and migration of RAW264.7 cells. Moreover, Tan IIA ameliorated inflammatory cytokine upregulation elicited by ox-LDL in RAW264.7 cells. Additionally, Tan IIA inhibited the apoptosis of VSMCs and decreased the levels of MMP-2, MMP-9 in ApoE–/– mice. In conclusion, our study demonstrated Tan IIA suppressed the progression of atherosclerosis by inhibiting vascular inflammation, apoptosis of VSMCs and proliferation and migration of macrophages induced by ox-LDL.
Mechanics of the thorax in flies
Authors: Deora Tanvi , Gundiah Namrata , Sane Sanjay P. 
Published: April 2017

ABSTRACTInsects represent more than 60% of all multicellular life forms, and are easily among the most diverse and abundant organisms on earth. They evolved functional wings and the ability to fly, which enabled them to occupy diverse niches. Insects of the hyper-diverse orders show extreme miniaturization of their body size. The reduced body size, however, imposes steep constraints on flight ability, as their wings must flap faster to generate sufficient forces to stay aloft. Here, we discuss the various physiological and biomechanical adaptations of the thorax in flies which enabled them to overcome the myriad constraints of small body size, while ensuring very precise control of their wing motion. One such adaptation is the evolution of specialized myogenic or asynchronous muscles that power the high-frequency wing motion, in combination with neurogenic or synchronous steering muscles that control higher-order wing kinematic patterns. Additionally, passive cuticular linkages within the thorax coordinate fast and yet precise bilateral wing movement, in combination with an actively controlled clutch and gear system that enables flexible flight patterns. Thus, the study of thoracic biomechanics, along with the underlying sensory-motor processing, is central in understanding how the insect body form is adapted for flight.
Prior social experience affects the behavioral and neural responses to acute alcohol in juvenile crayfish
Authors: Swierzbinski Matthew E. , Lazarchik Andrew R. , Herberholz Jens 
Published: April 2017

ABSTRACTThe effects of alcohol on society can be devastating, both as an immediate consequence of acute intoxication and as a powerful drug of abuse. However, the neurocellular mechanisms of alcohol intoxication are still elusive, partly because of the complex interactions between alcohol and nervous system function. We found that juvenile crayfish are behaviorally sensitive to acute alcohol exposure and progress through stages that are strikingly similar to those of most other intoxicated organisms. Most surprisingly, we found that the social history of the animals significantly modified the acute effects of alcohol. Crayfish taken from a rich social environment became intoxicated more rapidly than animals that were socially isolated before alcohol exposure. In addition, we found that the modulation of intoxicated behaviors by prior social experience was paralleled on the level of individual neurons. These results significantly improve our understanding of the mechanisms underlying the interplay between social experience, alcohol intoxication and nervous system function.
Impact of a Connected Care Model on 30‐Day Readmission Rates from Skilled Nursing Facilities
Authors: Kim Luke D. , Kou Lei , Hu Bo , Gorodeski Eiran Z. , Rothberg Michael B. 
Published: April 2017

BACKGROUNDAbout one‐fifth of hospitalized Medicare beneficiaries are discharged to skilled nursing facilities (SNFs) for post‐acute care. Readmissions are common but interventions to reduce readmissions are scarce.OBJECTIVETo assess the impact of a connected care model on 30‐day hospital readmission rates among patients discharged to SNFs.DESIGNRetrospective cohort.SETTINGSNFs that receive referrals from an academic medical center in Cleveland, Ohio.PARTICIPANTSAll patients admitted to Cleveland Clinic main campus between January 1, 2011 and December 31, 2014 and subsequently discharged to 7 intervention SNFs or 103 control SNFs.INTERVENTIONHospital‐employed physicians and advanced practice professionals (nurse practitioners and physician assistants) visited SNF patients 4 to 5 times per week.RESULTSDuring the study period, 13,544 patients were discharged to SNFs within a 25‐miles radius of Cleveland Clinic main campus. Of these, 3334 were discharged to 7 intervention SNFs and 10,201 were discharged to 103 usualcare SNFs. During the intervention phase (2013‐2014), adjusted 30‐day readmission rates declined at the intervention SNFs (28.1% to 21.7%, P < 0.001), while there was a slight increase at control SNFs (27.1 % to 28.5%, P < 0.001). The absolute reductions ranged from 4.6% for patients at low risk for readmission to 9.1% for patients at high risk, and medical patients benefited more than surgical patients.CONCLUSIONA program of frequent visits by hospital employed physicians and advanced practice professionals at SNFs can reduce 30‐day readmission rates.
Predicting 30‐Day Pneumonia Readmissions Using Electronic Health Record Data
Authors: Makam Anil N. , Nguyen Oanh Kieu , Clark Christopher , Zhang Song , Xie Bin , Weinreich Mark , Mortensen Eric M. , Halm Ethan A. 
Published: April 2017

BACKGROUNDReadmissions after hospitalization for pneumonia are common, but the few risk‐prediction models have poor to modest predictive ability. Data routinely collected in the electronic health record (EHR) may improve prediction.OBJECTIVETo develop pneumonia‐specific readmission risk‐prediction models using EHR data from the first day and from the entire hospital stay (“full stay”).DESIGNObservational cohort study using stepwise‐backward selection and cross‐validation.SUBJECTSConsecutive pneumonia hospitalizations from 6 diverse hospitals in north Texas from 2009‐2010.MEASURESAll‐cause nonelective 30‐day readmissions, ascertained from 75 regional hospitals.RESULTSOf 1463 patients, 13.6% were readmitted. The first‐day pneumonia‐specific model included sociodemographic factors, prior hospitalizations, thrombocytosis, and a modified pneumonia severity index; the full‐stay model included disposition status, vital sign instabilities on discharge, and an updated pneumonia severity index calculated using values from the day of discharge as additional predictors. The full‐stay pneumonia‐specific model outperformed the first‐day model (C statistic 0.731 vs 0.695; P = 0.02; net reclassification index = 0.08). Compared to a validated multi‐condition readmission model, the Centers for Medicare and Medicaid Services pneumonia model, and 2 commonly used pneumonia severity of illness scores, the full‐stay pneumonia‐specific model had better discrimination (C statistic range 0.604‐0.681; P < 0.01 for all comparisons), predicted a broader range of risk, and better reclassified individuals by their true risk (net reclassification index range, 0.09‐0.18).CONCLUSIONSEHR data collected from the entire hospitalization can accurately predict readmission risk among patients hospitalized for pneumonia. This approach outperforms a first‐day pneumonia‐specific model, the Centers for Medicare and Medicaid Services pneumonia model, and 2 commonly used pneumonia severity of illness scores.
Evaluating Automated Rules for Rapid Response System Alarm Triggers in Medical and Surgical Patients
Authors: Romero‐Brufau Santiago , Morlan Bruce W. , Johnson Matthew , Hickman Joel , Kirkland Lisa L. , Naessens James M. , Huddleston Jeanne 
Published: April 2017

BACKGROUNDThe use of rapid response systems (RRS), which were designed to bring clinicians with critical care expertise to the bedside to prevent unnecessary deaths, has increased. RRS rely on accurate detection of acute deterioration events. Early warning scores (EWS) have been used for this purpose but were developed using heterogeneous populations. Predictive performance may differ in medical vs surgical patients.OBJECTIVETo evaluate the performance of published EWS in medical vs surgical patient populations.DESIGNRetrospective cohort study.SETTINGTwo tertiary care academic medical center hospitals in the Midwest totaling more than 1500 beds.PATIENTSAll patients discharged from January to December 2011.INTERVENTIONNone.MEASUREMENTSTime‐stamped longitudinal database of patient variables and outcomes, categorized as surgical or medical. Outcomes included unscheduled transfers to the intensive care unit, activation of the RRS, and calls for cardiorespiratory resuscitation (“resuscitation call”). The EWS were calculated and updated with every new patient variable entry over time. Scores were considered accurate if they predicted an outcome in the following 24 hours.RESULTSAll EWS demonstrated higher performance within the medical population as compared to surgical: higher positive predictive value (P < .0001 for all scores) and sensitivity (P < .0001 for all scores). All EWS had positive predictive values below 25%.CONCLUSIONSThe overall poor performance of the evaluated EWS was marginally better in medical patients when compared to surgical patients.
Prognosticating with the Hospitalized‐patient One‐year Mortality Risk Score Using Information Abstracted from the Medical Record
Authors: Casey Genevieve , van Walraven Carl 
Published: April 2017

BACKGROUNDPredicting death risk in patients with diverse conditions is difficult. The Hospitalized‐patient One‐year Mortality Risk (HOMR) score accurately determines death risk in adults admitted to hospital using health administrative data unavailable to clinicians and most researchers.OBJECTIVEDetermine if HOMR is valid when calculated using data abstracted directly from the medical record.DESIGNMedical record review linked to population‐based administrative data.PARTICIPANTS4996 adults admitted in 2011 to a non‐psychiatric service at a tertiary hospital.MAIN MEASURESFrom the chart, we abstracted information required to calculate the HOMR score and linked to population‐based mortality data to determine vital status within 1 year of admission date.KEY RESULTSPatients had a mean age of 55.6 (standard deviation [SD], 20.7) with 563 (11.3%) dying. The mean chart HOMR score was 22 (SD, 12) and significantly predicted death risk; a 1‐point increase in HOMR increased death odds by 19% (odds ratio, 1.192;, 95% confidence interval [CI], 1.175‐1.210;, P < 0.0001). Chart HOMR was strongly discriminative (C statistic 0.888) and well calibrated (Hosmer‐Lemeshow goodness‐of‐fit test, 12.9; P = 0.11). The observed death risk was strongly associated with expected death risk (calibration slope, 1.02; 95% CI, 0.89‐1.16). Notation of delirium or falls on admitting notes or dependence for at least 1 activity of daily living were each associated with 1‐year death risk independent of the HOMR score.CONCLUSIONSOne‐year mortality risk can be accurately determined in adults admitted to hospital with the HOMR score calculated using information abstracted from the medical record. Patient functional status was independently associated with death risk.
Automating Venous Thromboembolism Risk Calculation Using Electronic Health Record Data Upon Hospital Admission: The Automated Padua Prediction Score
Authors: Elias Pierre , Khanna Raman , Dudley Adams , Davies Jason , Jacolbia Ronald , McArthur Kara , Auerbach Andrew D. 
Published: April 2017

BACKGROUNDVenous thromboembolism (VTE) risk scores assist providers in determining the relative benefit of prophylaxis for individual patients. While automated risk calculation using simpler electronic health record (EHR) data is feasible, it lacks clinical nuance and may be less predictive. Automated calculation of the Padua Prediction Score (PPS), requiring more complex input such as recent medical events and clinical status, may save providers time and increase risk score use.OBJECTIVEWe developed the Automated Padua Prediction Score (APPS) to auto‐calculate a VTE risk score using EHR data drawn from prior encounters and the first 4 hours of admission. We compared APPS to standard practice of clinicians manually calculating the PPS to assess VTE risk.DESIGNCohort study of 30,726 hospitalized patients. APPS was compared to manual calculation of PPS by chart review from 300 randomly selected patients.MEASUREMENTSPrediction of hospital‐acquired VTE not present on admission.RESULTSCompared to manual PPS calculation, no significant difference in average score was found (5.5 vs. 5.1, P = 0.073), and area under curve (AUC) was similar (0.79 vs. 0.76). Hospital‐acquired VTE occurred in 260 (0.8%) of 30,726 patients. Those without VTE averaged APPS of 4.9 (standard deviation [SD], 2.6) and those with VTE averaged 7.7 (SD, 2.6). APPS had AUC = 0.81 (confidence interval [CI], 0.79‐0.83) in patients receiving no pharmacologic prophylaxis and AUC = 0.78 (CI, 0.76‐0.82) in patients receiving pharmacologic prophylaxis.CONCLUSIONAutomated calculation of VTE risk had similar ability to predict hospital‐acquired VTE as manual calculation despite differences in how often specific scoring criteria were considered present by the 2 methods.
Safe and Effective Bedside Thoracentesis: A Review of the Evidence for Practicing Clinicians
Authors: Schildhouse Richard , Lai Andrew , Barsuk Jeffrey H. , Mourad Michelle , Chopra Vineet 
Published: April 2017

BACKGROUNDPhysicians often care for patients with pleural effusion, a condition that requires thoracentesis for evaluation and treatment. We aim to identify the most recent advances related to safe and effective performance of thoracentesis.METHODSWe performed a narrative review with a systematic search of the literature. Two authors independently reviewed search results and selected studies based on relevance to thoracentesis; disagreements were resolved by consensus. Articles were categorized as those related to the pre‐, intra‐ and postprocedural aspects of thoracentesis.RESULTSSixty relevant studies were identified and included. Pre‐procedural topics included methods for physician training and maintenance of skills, such as simulation with direct observation. Additionally, pre‐procedural topics included the finding that moderate coagulopathies (international normalized ratio less than 3 or a platelet count greater than 25,000/μL) and mechanical ventilation did not increase risk of postprocedural complications. Intraprocedurally, ultrasound use was associated with lower risk of pneumothorax, while pleural manometry can identify a nonexpanding lung and may help reduce risk of re‐expansion pulmonary edema. Postprocedurally, studies indicate that routine chest X‐ray is unwarranted, because bedside ultrasound can identify pneumothorax.CONCLUSIONSWhile the performance of thoracentesis is not without risk, clinicians can incorporate recent advances into practice to mitigate patient harm and improve effectiveness.
Hospital Medicine and Perioperative Care: A Framework for High‐Quality, High‐Value Collaborative Care
Authors: Thompson Rachel E. , Pfeifer Kurt , Grant Paul J. , Taylor Cornelia , Slawski Barbara , Whinney Christopher , Wellikson Laurence , Jaffer Amir K. 
Published: April 2017

BACKGROUNDHospitalists have long been involved in optimizing perioperative care for medically complex patients. In 2015, the Society of Hospital Medicine organized the Perioperative Care Work Group to summarize this experience and to develop a framework for providing optimal perioperative care.METHODSThe work group, which consisted of perioperative care experts from institutions throughout the United States, reviewed current hospitalist‐based perioperative care programs, compiled key issues in each perioperative phase, and developed a framework to highlight essential elements to be considered. The framework was reviewed and approved by the board of the Society of Hospital Medicine.RESULTSThe Perioperative Care Matrix for Inpatient Surgeries was developed. This matrix characterizes perioperative phases, coordination, and metrics of success. Additionally, concerns and potential risks were tabulated. Key questions regarding program effectiveness were drafted, and examples of models of care were provided.CONCLUSIONSThe Perioperative Care Matrix for Inpatient Surgeries provides an essential collaborative framework hospitalists can use to develop and continually improve perioperative care programs.
Regional Variation in Standardized Costs of Care at Children's Hospitals
Authors: Jonas Jennifer A. , Shah Samir S. , Zaniletti Isabella , Hall Matthew , Colvin Jeffrey D. , Gottlieb Laura M. , Sills Marion R. , Bettenhausen Jessica , Morse Rustin B. , Macy Michelle L. , Fieldston Evan S. 
Published: April 2017

BACKGROUNDThough regional variation in healthcare spending has received national attention, it has not been widely studied in pediatrics.OBJECTIVES(1) To evaluate regional variation in costs of care for 3 inpatient pediatric conditions, (2) assess potential drivers of variation, and (3) estimate cost savings from reducing variation.DESIGN/SETTING/PATIENTSRetrospective cohort study of hospitalizations for asthma, diabetic ketoacidosis (DKA), and acute gastroenteritis (AGE) at 46 children's hospitals from October 2014 to September 2015.INTERVENTION/MEASUREMENTSVariation in trimmed standardized costs were assessed within and across regions. Linear mixed effects models were adjusted for patient‐ and encounter‐level variables to assess drivers of variation.RESULTSAfter adjusting for patient‐level factors, variation remained. Using census division clusters, mean trimmed and adjusted total standardized costs were 120% higher for asthma ($1920 vs $4227), 46% higher for DKA ($7429 vs $10,881), and 150% higher for AGE ($3316 vs $8292) in the highest‐cost compared with the lowest‐cost region. Comparing hospitals in the same region, standardized costs were significantly different (P < 0.001) for each condition in each region. Drivers of variation were encounter‐level variables including length of stay and intensive care unit utilization. For this cohort, annual savings from reducing variation would equal $69.1 million at the interregional level and $25.2 million at the intraregional level.CONCLUSIONSPediatric hospital costs vary between and within regions. Future studies should examine how much of this variation is avoidable. To the extent that less spending does not compromise outcomes, care models may be adjusted to eliminate unwarranted variation and reduce costs.
Importance of Pharmacy Involvement in the Treatment of Sepsis
Authors: Cavanaugh Joseph B. , Sullivan Jesse B. , East Nicole , Nodzon Jessica N. 
Published: April 2017

Purpose A review of the impact of pharmacists on appropriate medication selection, timing of administration, and as members of a multidisciplinary sepsis response team. Summary Early goal-directed therapy (EGDT), currently recommended by the 2013 Surviving Sepsis Campaign guidelines for the management of patients with sepsis, includes the administration of appropriate antibiotics in patients with septic shock within the first hour. Multidisciplinary teams containing pharmacists have been shown to decrease time to antibiotic delivery, time to antibiotic administration, and patient mortality. The pharmacist can act as a drug information resource, expedite the medication verification and procurement process, and offer suggestions on how to better manage the patients. Pharmacists are often consulted for dosing and antibiotic selection recommendations for patients with sepsis, but they can also help increase the appropriateness of antibiotics selected. Additional recommendations and interventions made by pharmacists include fluid management and vasopressor facilitation for the more severe patients. A sepsis management team that included a pharmacist increased the number of patients receiving appropriate antibiotics within the first hour by as much as 22-fold. Another study has demonstrated that intensive care units with a pharmacist are associated with a 4% decrease in sepsis patient mortality compared to those without a pharmacist. Conclusion Multidisciplinary teams containing pharmacists have been shown to decrease time to administration of antibiotics, increase appropriate selection of medications, and decrease mortality; they may also decrease overall health care costs.
In dubio pro tributario as a principle of tax law
Authors: Obuchowski Szymon 
Published: April 2017

Abstract
This paper’s concern is focused on amajor amendment of the Tax Ordinance Act – article 2a enforced by the Act of the August 5th 2015 (Dz.U. 2015 r. poz. 1197). According to the Act’s substation, it was designed to be an introduction of a new “principle of the polish tax law” through incarnating as a part of legal system the directive of law interpretation widely known as in dubio pro tributario. The amendment aimed to strengthen the legal covers which protect tax bearers from vagueness of the tax law. Paper confronts these assumptions with theoretical achievements concerning principles of law. It points out that, contradictory to the Legislator’s claims, the new article 2a cannot be recognised as a principle of law; moreover, it raises several doubts in the other fields which together may result in its malfunctioning.