bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Myth of Rescue Reversal in “Can’t Intubate, Can’t Ventilate” Scenarios
Authors: Naguib Mohamed , Brewer Lara , LaPierre Cristen , Kopman Aaron F. , Johnson Ken B. 
Published: May 2016

BACKGROUND:
An unanticipated difficult airway during induction of anesthesia can be a vexing problem. In the setting of can’t intubate, can’t ventilate (CICV), rapid recovery of spontaneous ventilation is a reasonable goal. The urgency of restoring ventilation is a function of how quickly a patient’s hemoglobin oxygen saturation decreases versus how much time is required for the effects of induction drugs to dissipate, namely the duration of unresponsiveness, ventilatory depression, and neuromuscular blockade. It has been suggested that prompt reversal of rocuronium-induced neuromuscular blockade with sugammadex will allow respiratory activity to recover before significant arterial desaturation. Using pharmacologic simulation, we compared the duration of unresponsiveness, ventilatory depression, and neuromuscular blockade in normal, obese, and morbidly obese body sizes in this life-threatening CICV scenario. We hypothesized that although neuromuscular function could be rapidly restored with sugammadex, significant arterial desaturation will occur before the recovery from unresponsiveness and/or central ventilatory depression in obese and morbidly obese body sizes.

METHODS:
We used published models to simulate the duration of unresponsiveness and ventilatory depression using a common induction technique with predicted rates of oxygen desaturation in various size patients and explored to what degree rapid reversal of rocuronium-induced neuromuscular blockade with sugammadex might improve the return of spontaneous ventilation in CICV situations.

RESULTS:
Our simulations showed that the duration of neuromuscular blockade was longer with 1.0 mg/kg succinylcholine than with 1.2 mg/kg rocuronium followed 3 minutes later by 16 mg/kg sugammadex (10.0 vs 4.5 minutes). Once rocuronium neuromuscular blockade was completely reversed with sugammadex, the duration of hemoglobin oxygen saturation >90%, loss of responsiveness, and intolerable ventilatory depression (a respiratory rate of ≤4 breaths/min) were dependent on the body habitus and duration of oxygen administration. There is a high probability of intolerable ventilatory depression that extends well beyond the time when oxygen saturation decreases <90%, especially in obese and morbidly obese patients. If ventilatory rescue is inadequate, oxygen desaturation will persist in the latter groups, despite full reversal of neuromuscular blockade. Depending on body habitus, the duration of intolerable ventilatory depression after sugammadex reversal may be as long as 15 minutes in 5% of individuals.

CONCLUSIONS:
The clinical management of CICV should focus primarily on restoration of airway patency, oxygenation, and ventilation consistent with the American Society of Anesthesiologist’s practice guidelines for management of the difficult airway. Pharmacologic intervention cannot be relied upon to rescue patients in a CICV crisis.
Semaphorin 3A is a retrograde cell death signal in developing sympathetic neurons
Authors: Wehner Amanda B. , Abdesselem Houari , Dickendesher Travis L. , Imai Fumiyasu , Yoshida Yutaka , Giger Roman J. , Pierchala Brian A. 
Published: May 2016

ABSTRACT
During development of the peripheral nervous system, excess neurons are generated, most of which will be lost by programmed cell death due to a limited supply of neurotrophic factors from their targets. Other environmental factors, such as ‘competition factors' produced by neurons themselves, and axon guidance molecules have also been implicated in developmental cell death. Semaphorin 3A (Sema3A), in addition to its function as a chemorepulsive guidance cue, can also induce death of sensory neurons in vitro. The extent to which Sema3A regulates developmental cell death in vivo, however, is debated. We show that in compartmentalized cultures of rat sympathetic neurons, a Sema3A-initiated apoptosis signal is retrogradely transported from axon terminals to cell bodies to induce cell death. Sema3A-mediated apoptosis utilizes the extrinsic pathway and requires both neuropilin 1 and plexin A3. Sema3A is not retrogradely transported in older, survival factor-independent sympathetic neurons, and is much less effective at inducing apoptosis in these neurons. Importantly, deletion of either neuropilin 1 or plexin A3 significantly reduces developmental cell death in the superior cervical ganglia. Taken together, a Sema3A-initiated apoptotic signaling complex regulates the apoptosis of sympathetic neurons during the period of naturally occurring cell death.
Plant regeneration: cellular origins and molecular mechanisms
Authors: Ikeuchi Momoko , Ogawa Yoichi , Iwase Akira , Sugimoto Keiko 
Published: May 2016

ABSTRACT
Compared with animals, plants generally possess a high degree of developmental plasticity and display various types of tissue or organ regeneration. This regenerative capacity can be enhanced by exogenously supplied plant hormones in vitro, wherein the balance between auxin and cytokinin determines the developmental fate of regenerating organs. Accumulating evidence suggests that some forms of plant regeneration involve reprogramming of differentiated somatic cells, whereas others are induced through the activation of relatively undifferentiated cells in somatic tissues. We summarize the current understanding of how plants control various types of regeneration and discuss how developmental and environmental constraints influence these regulatory mechanisms.
Readmission following caesarean section: Outcomes for women in an Irish maternity hospital
Authors: Panda Sunita , Begley Cecily , Daly Deirdre 
Published: May 2016

Background: Women who give birth by caesarean section are more likely to require readmission to hospital following birth compared to women who give birth vaginally. Aims: To examine the reasons, management and outcomes for women readmitted to hospital following birth by caesarean section (CS). Methods: A retrospective audit of maternity records was undertaken. Findings: The total number of births for the period of data extraction was 8580, of which 2470 (28.79%) women gave birth by CS. A total of 107 women (4.33% of those who gave birth by CS) were readmitted to hospital between 1 August 2014 and 31 July 2015, of which 46 women (1.86%) were readmitted following elective CS and 61 (2.47%) following emergency CS. The average length of hospital stay was 2.64 and 4.61 nights, respectively, and the average timeline for readmission was 14.6 days following elective CS and 15.7 following emergency CS. The most common reason for readmission was wound infection, with the majority of women requiring analgesics (n=29, 63.05% following elective CS and n=51, 83.61% following emergency CS) and intravenous antibiotics (n=23, 50% following elective CS and n=34, 55.74% following emergency CS). Conclusions: Abdominal wound infection is one of the most common reasons for readmission of women to hospital following birth by CS. These findings will make it easier to understand and identify women at risk of postpartum morbidity following birth by CS.
Is the introduction of a named midwife for teenagers associated with improved outcomes? A service development project
Authors: Butcher Alison , Williams Peter , Jones Felicity 
Published: May 2016

Background: The role of named midwife for teenagers was implemented in Royal Surrey County Hospital NHS Foundation Trust in order to improve outcomes for teenage mothers and their babies. The role comprised a dedicated midwife-led teenage antenatal clinic, antenatal and postnatal home visits and tailored antenatal education. Aims: This project monitored the outcomes of teenage mothers following implementation of the role, to assess improvements in outcomes. Methods: During this service development project, 31 teenage mothers aged ≤ 19 years received midwifery care and their obstetric outcomes were monitored. These outcomes were compared with 52 teenage mothers who had previously given birth. Findings: Comparing teenagers who gave birth in February–August 2014 with those who gave birth in the same period in 2013, there was an increase in the rate of spontaneous vaginal deliveries, a decrease in instrumental deliveries and increase in induction of labour; however, induction of labour for intrauterine growth restriction decreased. The rate of caesarean section increased but remained lower than in the general population. An increase in birth weight and intention to breastfeed were also observed. Conclusions: This project indicates that the role of a dedicated midwife for teenagers has a place in the care of teenage mothers.
The coronal hypomochlion
Authors: Heijens E. , Kornherr P. , Meister C. 
Published: May 2016

AimsIn patients undergoing medial opening wedge high tibial osteotomy (MOWHTO), soft tissue opening on the medial side of the knee is difficult to predict. When the load bearing axis is corrected beyond a certain point, the knee joint tilts open on the medial side. We therefore hypothesised that there is a tipping point and defined this as the coronal hypomochlion.Patients and MethodsIn this prospective study of 150 navigated MOWHTOs (144 consecutive patients), data were collected before surgery and at three months post-operatively. In order to calculate the hypomochlion, we compared the respective changes to the joint line convergence angle (JLCA) with the post-operative axis of the leg. The change to the medial proximal tibial angle accounts for only about 80% of the change to the femorotibial angle; 20% of the correction can therefore be attributed to non-osseous, soft-tissue changes.ResultsWe were able to demonstrate a linear change of JLCA in a range of 0° to 5° of valgus which started when the post-operative long-leg axis was corrected beyond 2° of valgus.ConclusionWe found that the coronal hypomochlion occurs at 2° of valgus. Take home message: It is recommended to plan realignment for medial open wedge high tibial osteotomy at a maximum of 2° valgus. Cite this article: Bone Joint J 2016;98-B:628–33.
The delayed presentation of atlantoaxial rotatory fixation in children
Authors: Mifsud M. , Abela M. , Wilson N. I. L. 
Published: May 2016

Aims Although atlantoaxial rotatory fixation (AARF) is a common cause of torticollis in children, the diagnosis may be delayed. The condition is characterised by a lack of rotation at the atlantoaxial joint which becomes fixed in a rotated and subluxed position. The management of children with a delayed presentation of this condition is controversial. This is a retrospective study of a group of such children. Patients and Methods Children who were admitted to two institutions between 1988 and 2014 with a diagnosis of AARF were included. We identified 12 children (four boys, eight girls), with a mean age of 7.3 years (1.5 to 13.4), in whom the duration of symptoms on presentation was at least four weeks (four to 39). All were treated with halo traction followed by a period of cervical immobilisation in a halo vest or a Minerva jacket. We describe a simple modification to the halo traction that allows the child to move their head whilst maintaining traction. The mean follow-up was 59.6 weeks (24 to 156). Results Despite the delay in referral, the subluxation was successfully reduced in all children. Only two children required atlantoaxial fusion. Conclusion The results of our study suggest that normal anatomy with restoration of movement may be achieved even in cases of AARF presenting late, obviating the need for fusion. We also show a simple modification to the halo traction that allows the child to move their head about while still maintaining traction. Take home message: Prompt diagnosis and management with halo traction (with a simple modification as described) is associated with good results in patients with AARF who present late. Cite this article: Bone Joint J 2016;98-B:715–20.
Short Communication: Microscopic decay pattern of yellow meranti caused by white-rot fungus Phlebia brevispora
Authors: ERWIN ERWIN 
Published: May 2016

Erwin. 2016. Microscopic decay pattern of yellow meranti (Shorea gibbosa) wood caused by white-rot fungusÂ Plebia brevispora. Biodiversitas 17: 417-421. The anatomical changes of wood decaying by white-rot fungus Phlebia brevispora could provide the basis for evaluating and analysis of decay on yellow merantiÂ (Shorea gibbosa) heartwood. By using soil-block test procedure of JIS K-1571 and microscopic analysis, a progressive decay in vitro of S. gibbosa wood caused by P. brevispora was well characterized.The percentage of wood weight loss was ranged from 0.91% to 12.34%in 2-12 weeks' incubation. On the first 6 weeks of incubation of S. gibbosa infected with P. brevispora, the early stages decay, in which pit erosion and slight erosion of cell walls facilitated by hyphal spreading among cells. The intermediate decay features of numerous and conspicuous holes as well as erosion troughs in cell walls were found after 8 weeks' incubation. Furthermore, complete degradation of wood cell components, defined as the advanced stage of decay, was found in some areas of wood after 12 weeks' incubation. The pattern of wood decay was similar to those of the decayed xylem of S. gibbosa stem canker in field conditions.
User-composable Electronic Health Record Improves Efficiency of Clinician Data
Viewing for Patient Case Appraisal: A Mixed-Methods Study
Authors: Senathirajah Yalini , Kaufman David R. , Bakken Suzanne R. 
Published: May 2016

Background: Challenges in the design of electronic health records (EHRs) include
designing usable systems that must meet the complex, rapidly changing, and high-stakes
information needs of clinicians. The ability to move and assemble elements together on
the same page has significant human-computer interaction (HCI) and efficiency
advantages, and can mitigate the problems of negotiating multiple fixed screens and the
associated cognitive burdens.Objective: We compare MedWISE—a novel EHR that supports
user-composable displays—with a conventional EHR in terms of the number of repeat views
of data elements for patient case appraisal.Design and Methods: The study used
mixed-methods for examination of clinical data viewing in four patient cases. The study
compared use of an experimental user-composable EHR with use of a conventional EHR, for
case appraisal. Eleven clinicians used a user-composable EHR in a case appraisal task in
the laboratory setting. This was compared with log file analysis of the same patient
cases in the conventional EHR. We investigated the number of repeat views of the same
clinical information during a session and across these two contexts, and compared them
using Fisher’s exact test.Results: There was a significant difference (p<.0001) in
proportion of cases with repeat data element viewing between the user-composable EHR
(14.6 percent) and conventional EHR (72.6 percent). Discussion and Conclusion: Users of
conventional EHRs repeatedly viewed the same information elements in the same session,
as revealed by log files. Our findings are consistent with the hypothesis that
conventional systems require that the user view many screens and remember information
between screens, causing the user to forget information and to have to access the
information a second time. Other mechanisms (such as reduction in navigation over a
population of users due to interface sharing, and information selection) may also
contribute to increased efficiency in the experimental system. Systems that allow a
composable approach that enables the user to gather together on the same screen any
desired information elements may confer cognitive support benefits that can increase
productive use of systems by reducing fragmented information. By reducing cognitive
overload, it can also enhance the user experience.
Cultural leadership behaviors of the primary school principals regarding certain variables
Authors: Hiçyılmaz Yasin , Şahin Fırat Necla 
Published: May 2016

This study was carried out in order to analyse the primary school teachers’ perception of the cultural leadership behaviours of the primary school principals regarding the personal and vocational qualities of the principals and certain features of the school in which they work, and in order to develop suggestions based on the findings. “The Scale for Cultural Leadership Behaviours of the School Administrators” Yıldırım (2001) was used as data collection tool. The scale tool used in the study was applied to 859 teachers working in randomly selected 51 primary schools in four central districts (Konak, Buca, Karşıyaka and Bornova) of İzmir-Turkey. Arithmetic average, standard deviation, t- test, ANNOVA and Scheffe Test were made us of in the analysis of the study. These findings were attained in the study: The perceptions of the primary school teachers for the cultural leadership behaviours of the primary school principals are at a good level. The perceptions of the primary school teachers for the school principals’ cultural leadership behaviours indicate significant discrepancy in terms of gender, age, training of educational administration and school type variables. However, the perceptions of the primary school teachers for the school principals’ cultural leadership behaviours indicate no significant discrepancy in terms of vocational seminars or school size.
MafB, a target of microRNA-155, regulates dendritic cell maturation
Authors: Yang Lu , Li Rui , Xiang Shaoxun , Xiao Weihua 
Published: May 2016

AbstractMafB is a member of bZip transcription factors that share similar basic region/leucine zipper DNA binding motifs and N-terminal activation domains. It is well known that MafB is highly expressed in macrophages and promotes differentiation of myeloid progenitors into macrophage. However, little is known about its function in dendritic cells. Here, we report that MafB, as a target of miR-155, which had been reported to be required for dendritic cell maturation and function, regulated dendritic cell maturation. MafB and miR-155were reversely correlated during DC maturation induced by LPS and forced expression of miR-155 reduced MafB expression. The luciferase reporter assay showed that MafB 3’UTR was directly targeted bymiR-155. In addition, knockdown of MafB promoted the phenotypic maturation of DC2.4 cells. Forced expression of MafB could significantly attenuate the phenotypic maturation of DC2.4 cells caused by overexpression of miR-155. Overall, our data demonstrates that MafB, inhibited by miR-155, was a negative regulator of DC maturation.
Handing over and letting go: using online continuing medical education in teaching and assessing medical English language and communication skills to undergraduates
Authors: Vekemans Herlinda 
Published: May 2016

AbstractIn the last few decades the medical community has increasingly underlined the necessity for medical students and healthcare professionals to acquire adequate and patient-friendly medical language and communication skills. Although teachers of foreign languages for medical purposes are usually not medically trained, their learners present them with very specific content and communication needs. Medical undergraduates who have entered the clinical phase of their programme are particularly keen to remain within the boundaries of their newly acquired expertise. Teachers of English for Medical Purposes easily recognize their need to deepen and broaden their medical knowledge, and needs-responsive teaching in this context therefore often involves specific materials development. Although implementing material from continuing medical education (CME) may seem a bridge too far at first sight, careful selection of content geared to students’ medical knowledge at a particular stage in their clinical study programme avoids overstepping the mark. Well-chosen online interactive CME materials engage the students in authentic language in a context they immediately recognize as typical of their future workplace. The learners in the course described in this article are medical undergraduates in their fifth year who need to attend the course to prepare them for a clinical placement in an English-speaking environment abroad. The article describes how CME materials have become part of teaching practice and oral assessment in a two-semester course of medical English organized on behalf of the Faculty of Medicine at the University of Leuven in the Dutch-speaking part of Belgium.
“It is natural for you to be afraid…”: On the discourse of web-based communication with patients
Authors: Mazzi Davide 
Published: May 2016

AbstractOver the last twenty years, medical discourse has attracted a great deal of scholarly research. Language in healthcare settings has been more generally analysed through genres – whether in terms of expert-to-expert or expert-to-lay communication – whereas more specific aspects include the study of discourse strategies behind the expression of empathy, problems of media representation of healthcare issues, and the role played by cultural variables in healthcare contexts. While substantial research exists on medical discourse and the transmission of medical knowledge, a number of works still tend to focus on accuracy and comprehensiveness of content rather than on the linguistic analysis of communication strategies. In light of that, the aim of this work is to substantiate the findings in the literature published so far by bringing a genuinely discourse-based perspective to bear on them. To achieve this goal, a corpus investigation was carried out of web-based resources employed by a leading nationwide organisation to communicate to the public about cancer. The study focuses on the discourse functions of frequently occurring phraseology, in the attempt to address the following questions: (a) Are there any recurrent discourse patterns that tend to be reiterated across the sections of informative healthcare materials? (b) How are patients’ needs addressed through the language of such materials? (c) More generally, how can findings be interpreted with a view to both their relevance to the context under analysis and their possible application in the language-learning classroom?
Photocatalytic Decomposition of Metoprolol and Its Intermediate Organic Reaction Products: Kinetics and Degradation Pathway
Authors: Pinedo Alfonso , López Mariana , Leyva Elisa , Zermeño Brenda , Serrano Benito , Moctezuma Edgar 
Published: May 2016

Abstract
High purity metoprolol prepared by neutralization of an aqueous solution of metoprolol tartrate is efficiently mineralized to CO2 and water by photocatalysis with TiO2, UV light and a constant flow rate of oxygen. Since the tartrate anions were eliminated, all the HO• generated by photocatalysis reacted efficiently with the aromatic part of the medication. The reaction pathway includes two routes of degradation. The first one includes the transformation of metoprolol to hydroquinone via formation of 4-(2-methoxyethyl)phenol, 2-(4-hydroxyphenyl)ethanol and 4-hydroxybenzaldehyde. Metoprolol is also degraded directly to hydroquinone. Then, this aromatic compound is oxidized to 1,2,4-benzenetriol, which is rapidly oxidized to low molecular weight organic acids before being completely mineralized to CO2 and water. Kinetic studies indicated that the initial reaction rate of the degradation of metoprolol, 4-(2-methoxyethyl)phenol, 2-(4-hydroxyphenyl)ethanol and 4-hydroxybenzaldehyde is described by the LH-HW model.