bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pilot validation of an individualised pharmacokinetic algorithm for protamine dosing after systemic heparinisation for cardiopulmonary bypass
Authors: Miles Lachlan F. , Marchiori Paolo , Falter Florian 
Published: March 2017

Introduction: This manuscript represents a pilot study assessing the feasibility of a single-compartment, individualised, pharmacokinetic algorithm for protamine dosing after cardiopulmonary bypass. Methods: A pilot cohort study in a specialist NHS cardiothoracic hospital targeting patients undergoing elective cardiac surgery using cardiopulmonary bypass. Patients received protamine doses according to a pharmacokinetic algorithm (n = 30) or using an empirical, fixed-dose model (n = 30). Categorical differences between the groups were evaluated using the Chi-squared test or Fisher’s exact test. Continuous data was analysed using a paired Student’s t-test for parametric data and the paired samples Wilcoxon test for non-parametric data. Results: Patients who had protamine dosing according to the algorithm demonstrated a lower protamine requirement post-bypass relative to empirical management as measured by absolute dose (243 ± 49mg vs. 305 ± 34.7mg; p<0.001) and the heparin to protamine ratio (0.79 ± 0.12 vs. 1.1 ± 0.15; p<0.001). There was no difference in the pre- to post-bypass activated clotting time (ACT) ratio (1.05 ± 0.12 vs. 1.02 ± 0.15; p=0.9). Patients who received protamine according to the algorithm had no significant difference in transfusion requirement (13.3% vs. 30.0%; p=0.21). Conclusions: This study showed that an individualized pharmacokinetic algorithm for the reversal of heparin after cardiopulmonary bypass is feasible in comparison with a fixed dosing strategy and may reduce the protamine requirement following on-pump cardiac surgery.
Wrist cineradiography: a protocol for diagnosing carpal instability
Authors: Sulkers G. S. I. , Strackee S. D. , Schep N. W. L. , Maas M. 
Published: March 2017

Carpal instability is often related to ruptured or lax carpal ligaments. Wrist cineradiography has been shown to be a good modality for diagnosing carpal instability. To create uniformity in obtaining and assessing wrist cineradiography, a wrist cineradiography protocol is desirable. This protocol will focus on wrist cineradiography for diagnosing carpal instabilities. It describes the pathologic motions of the carpus and correlates these with a clinical diagnosis. Level of evidence: III
High-quality permanent draft genome sequence of the Bradyrhizobium elkanii type strain USDA 76T, isolated from Glycine max (L.) Merr
Authors: Reeve Wayne , van Berkum Peter , Ardley Julie , Tian Rui , Gollagher Margaret , Marinova Dora , Elia Patrick , Reddy T. B. K. , Pillay Manoj , Varghese Neha , Seshadri Rekha , Ivanova Natalia , Woyke Tanja , Baeshen Mohamed N. , Baeshen Nabih A. , Kyrpides Nikos 
Published: March 2017

AbstractBradyrhizobium elkanii USDA 76T (INSCD = ARAG00000000), the type strain for Bradyrhizobium elkanii, is an aerobic, motile, Gram-negative, non-spore-forming rod that was isolated from an effective nitrogen-fixing root nodule of Glycine max (L. Merr) grown in the USA. Because of its significance as a microsymbiont of this economically important legume, B. elkanii USDA 76T was selected as part of the DOE Joint Genome Institute 2010 Genomic Encyclopedia for Bacteria and Archaea-Root Nodule Bacteria sequencing project. Here the symbiotic abilities of B. elkanii USDA 76T are described, together with its genome sequence information and annotation. The 9,484,767 bp high-quality draft genome is arranged in 2 scaffolds of 25 contigs, containing 9060 protein-coding genes and 91 RNA-only encoding genes. The B. elkanii USDA 76T genome contains a low GC content region with symbiotic nod and fix genes, indicating the presence of a symbiotic island integration. A comparison of five B. elkanii genomes that formed a clique revealed that 356 of the 9060 protein coding genes of USDA 76T were unique, including 22 genes of an intact resident prophage. A conserved set of 7556 genes were also identified for this species, including genes encoding a general secretion pathway as well as type II, III, IV and VI secretion system proteins. The type III secretion system has previously been characterized as a host determinant for Rj and/or rj soybean cultivars. Here we show that the USDA 76T genome contains genes encoding all the type III secretion system components, including a translocon complex protein NopX required for the introduction of effector proteins into host cells. While many bradyrhizobial strains are unable to nodulate the soybean cultivar Clark (rj1), USDA 76T was able to elicit nodules on Clark (rj1), although in reduced numbers, when plants were grown in Leonard jars containing sand or vermiculite. In these conditions, we postulate that the presence of NopX allows USDA 76T to introduce various effector molecules into this host to enable nodulation.
Anticommunism in Korea and Germany in times of cold War
Authors: Szell Gyoergy 
Published: March 2017

AbstractBesides several themes related to burning issues on the surface of the current discourses in South Korea, this special issue of the AJGES pays attention to the fundamental problems, which are essential to understand the unique character of South Korean society as a divided nation. The in-depth analysis of some fundamental mechanisms is indispensable to develop a long-term strategy dealing with the roots of various problems. A comparison with the history of Germany as a formerly divided country is deemed helpful in order to see the problems from different perspectives and broaden the horizon. The contributions of this Thematic Series were first published in Korean by Dolgebae, Paju in 2015.Neben vielen anderen brennenden Problemen an der Oberfläche derzeitiger Debatten in Südkorea, widmet sich der Schwerpunkt dieser Ausgabe der AJGES einemgrundlegenden Problem, i.e. der einzigartige Charakter der südkoreanischen Gesellschaft als einer geteilten Nation. Die Tiefenanalyse einiger der Mechanismen ist Voraussetzung, um eine langfristige Strategie zur Überwindung der Ursachen der verschiedenen Probleme zu entwickeln. Dabei ist der Vergleich mit einer früher geteilten Nation wie Deutschland zweifelsohne hilfreich, um die Probleme aus einer anderen Perspektive zu sehen und den Horizont zu erweitern. Die Beiträge in dieser thematischen Sektion wurden zuerst auf koreanisch vom Verlag Dolgebae 2015 veröffentlicht.
Chemical composition and phagocyte immunomodulatory activity of Ferula iliensis essential oils
Authors: Oüzek Gulmira , Schepetkin Igor A , Utegenova Gulzhakhan A , Kirpotina Liliya N , Andrei Spencer R , Oüzek Temel , Baser Kemal Huüsnuü Can , Abidkulova Karime T , Kushnarenko Svetlana V , Khlebnikov Andrei I , Damron Derek S , Quinn Mark T 
Published: March 2017

Abstract
Essential oil extracts from Ferula iliensis have been used traditionally in Kazakhstan for treatment of inflammation and other illnesses. Because little is known about the biologic activity of these essential oils that contributes to their therapeutic properties, we analyzed their chemical composition and evaluated their phagocyte immunomodulatory activity. The main components of the extracted essential oils were (E)-propenyl sec-butyl disulfide (15.7–39.4%) and (Z)-propenyl sec-butyl disulfide (23.4–45.0%). Ferula essential oils stimulated [Ca2+]i mobilization in human neutrophils and activated ROS production in human neutrophils and murine bone marrow phagocytes. Activation of human neutrophil [Ca2+]i flux by Ferula essential oils was dose-dependently inhibited by capsazepine, a TRPV1 channel antagonist, indicating that TRPV1 channels mediate this response. Furthermore, Ferula essential oils stimulated Ca2+ influx in TRPV1 channel–transfected HEK293 cells and desensitized the capsaicin-induced response in these cells. Additional molecular modeling with known TRPV1 channel agonists suggested that the active component is likely to be (Z)-propenyl sec-butyl disulfide. Our results provide a cellular and molecular basis to explain at least part of the beneficial therapeutic properties of FEOs.
Rationalized design of a mucosal vaccine protects against Mycobacterium tuberculosis challenge in mice
Authors: Ahmed Mushtaq , Jiao Hongmei , Domingo-Gonzalez Racquel , Das Shibali , Griffiths Kristin L , Rangel-Moreno Javier , Nagarajan Uma M , Khader Shabaana A 
Published: March 2017

Abstract
Pulmonary tuberculosis (TB) caused by Mycobacterium tuberculosis (Mtb) is a leading cause of global morbidity and mortality. The only licensed TB vaccine, Mycobacterium bovis bacillus Calmette-Guerin (BCG), has variable efficacy in protecting against pulmonary TB. Thus, the development of more effective TB vaccines is critical to control the TB epidemic. Specifically, vaccines delivered through the mucosal route are known to induce Th17 responses and provide superior protection against Mtb infection. However, already tested Th17-inducing mucosal adjuvants, such as heat-labile enterotoxins and cholera toxins, are not considered safe for use in humans. In the current study, we rationally screened adjuvants for their ability to induce Th17-polarizing cytokines in dendritic cells (DCs) and determined whether they could be used in a protective mucosal TB vaccine. Our new studies show that monophosphoryl lipid A (MPL), when used in combination with chitosan, potently induces Th17-polarizing cytokines in DCs and downstream Th17/Th1 mucosal responses and confers significant protection in mice challenged with a clinical Mtb strain. Additionally, we show that both TLRs and the inflammasome pathways are activated in DCs by MPL-chitosan to mediate induction of Th17-polarizing cytokines. Together, our studies put forward the potential of a new, protective mucosal TB vaccine candidate, which incorporates safe adjuvants already approved for use in humans.
Significant and Sustained Reduction in Chemotherapy Errors Through Improvement Science
Authors: Weiss Brian D. , Scott Melissa , Demmel Kathleen , Kotagal Uma R. , Perentesis John P. , Walsh Kathleen E. 
Published: March 2017

Purpose:A majority of children with cancer are now cured with highly complex chemotherapy regimens incorporating multiple drugs and demanding monitoring schedules. The risk for error is high, and errors can occur at any stage in the process, from order generation to pharmacy formulation to bedside drug administration. Our objective was to describe a program to eliminate errors in chemotherapy use among children.Methods:To increase reporting of chemotherapy errors, we supplemented the hospital reporting system with a new chemotherapy near-miss reporting system. After the model for improvement, we then implemented several interventions, including a daily chemotherapy huddle, improvements to the preparation and delivery of intravenous therapy, headphones for clinicians ordering chemotherapy, and standards for chemotherapy administration throughout the hospital.Results:Twenty-two months into the project, we saw a centerline shift in our U chart of chemotherapy errors that reached the patient from a baseline rate of 3.8 to 1.9 per 1,000 doses. This shift has been sustained for > 4 years. In Poisson regression analyses, we found an initial increase in error rates, followed by a significant decline in errors after 16 months of improvement work ( P < .001).Conclusion:After the model for improvement, our improvement efforts were associated with significant reductions in chemotherapy errors that reached the patient. Key drivers for our success included error vigilance through a huddle, standardization, and minimization of interruptions during ordering.
Reducing Overuse of Colony-Stimulating Factors in Patients With Lung Cancer Receiving Chemotherapy: Evidence From a Decision Support–Enabled Program
Authors: Adeboyeje Gboyega , Agiro Abiy , Malin Jennifer , Fisch Michael J. , DeVries Andrea 
Published: March 2017

Purpose: Colony-stimulating factors (CSFs) are frequently overused for the primary prevention of febrile neutropenia (FN) in patients receiving chemotherapy. Methods: A retrospective cohort study design was used to analyze commercial claims data in adults with lung cancer initiated on chemotherapy from April 1, 2013, to March 30, 2015. The tool was implemented at oncology practices in phases across 14 US states. Patients were assigned to intervention and nonintervention states according to whether they resided in service areas where the tool had been implemented. Patients were followed up to 6 months after initiating chemotherapy. Difference in pre- and postimplementation CSF use and FN incidence rates were compared with the use of difference-in-differences (DID) models that were adjusted for baseline FN risk factors. Results: The study population of 3,467 patients (intervention states: pre, 707; post, 1,150; nonintervention states: pre, 636; post, 974) showed no significant differences in FN risk factors at baseline. In adjusted results before and after implementation, CSF use decreased from 48.4% to 35.6% in the intervention states versus 43.2% to 44.4% in the nonintervention states (DID, −8.7%; 95% CI, −14.65% to −2.67%; P ≤ .001). The rates of FN were consistent for both groups in both periods, with no statistical difference in trend for the intervention (2.8% to 4.3%) versus the nonintervention (3.1% to 5.1%) states (DID, −0.13; 95% CI, −0.35 to 0.10; P = .927). Conclusion: These findings demonstrate that a decision support-enabled utilization management tool can improve risk-appropriate, guideline-adherent CSF use in patients with lung cancer.
Cost and Survival Analysis Before and After Implementation of Dana-Farber Clinical Pathways for Patients With Stage IV Non–Small-Cell Lung Cancer
Authors: Jackman David M. , Zhang Yichen , Dalby Carole , Nguyen Tom , Nagle Julia , Lydon Christine A. , Rabin Michael S. , McNiff Kristen K. , Fraile Belen , Jacobson Joseph O. 
Published: March 2017

Purpose: Increasing costs and medical complexity are significant challenges in modern oncology. We explored the use of clinical pathways to support clinical decision making and manage resources prospectively across our network. Materials and Methods: We created customized lung cancer pathways and partnered with a commercial vendor to provide a Web-based platform for real-time decision support and post-treatment data aggregation. Dana-Farber Cancer Institute (DFCI) Pathways for non–small cell lung cancer (NSCLC) were introduced in January 2014. We identified all DFCI patients who were diagnosed and treated for stage IV NSCLC in 2012 (before pathways) and 2014 (after pathways). Costs of care were determined for 1 year from the time of diagnosis. Results: Pre- and postpathway cohorts included 160 and 210 patients with stage IV NSCLC, respectively. The prepathway group had more women but was otherwise similarly matched for demographic and tumor characteristics. The total 12-month cost of care (adjusted for age, sex, race, distance to DFCI, clinical trial enrollment, and EGFR and ALK status) demonstrated a $15,013 savings after the implementation of pathways ($67,050 before pathways v $52,037 after pathways). Antineoplastics were the largest source of cost savings. Clinical outcomes were not compromised, with similar median overall survival times (10.7 months before v 11.2 months after pathways; P = .08). Conclusion: After introduction of a clinical pathway in metastatic NSCLC, cost of care decreased significantly, with no compromise in survival. In an era where comparative outcomes analysis and value assessment are increasingly important, the implementation of clinical pathways may provide a means to coalesce and disseminate institutional expertise and track and learn from care decisions.
Standardized Attending Rounds to Improve the Patient Experience: A Pragmatic Cluster Randomized Controlled Trial
Authors: Monash Bradley , Najafi Nader , Mourad Michelle , Rajkomar Alvin , Ranji Sumant R. , Fang Margaret C. , Glass Marcia , Milev Dimiter , Ding Yile , Shen Andy , Sharpe Bradley A. , Harrison James D. 
Published: March 2017

BACKGROUNDAt academic medical centers, attending rounds (AR) serve to coordinate patient care and educate trainees, yet variably involve patients.OBJECTIVETo determine the impact of standardized bedside AR on patient satisfaction with rounds.DESIGNCluster randomized controlled trial.SETTING500‐bed urban, quaternary care hospital.PATIENTS1200 patients admitted to the medicine service.INTERVENTIONTeams in the intervention arm received training to adhere to 5 AR practices: 1) pre‐rounds huddle; 2) bedside rounds; 3) nurse integration; 4) real‐time order entry; 5) whiteboard updates. Control arm teams continued usual rounding practices.MEASUREMENTSTrained observers audited rounds to assess adherence to recommended AR practices and surveyed patients following AR. The primary outcome was patient satisfaction with AR. Secondary outcomes were perceived and actual AR duration, and attending and trainee satisfaction.RESULTSWe observed 241 (70.1%) and 264 (76.7%) AR in the intervention and control arms, respectively, which included 1855 and 1903 patient rounding encounters. Using a 5‐point Likert scale, patients in the intervention arm reported increased satisfaction with AR (4.49 vs 4.25; P = 0.01) and felt more cared for by their medicine team (4.54 vs 4.36; P = 0.03). Although the intervention shortened the duration of AR by 8 minutes on average (143 vs 151 minutes; P = 0.052), trainees perceived intervention AR as lasting longer and reported lower satisfaction with intervention AR.CONCLUSIONSMedicine teams can adopt a standardized, patient‐centered, time‐saving rounding model that leads to increased patient satisfaction with AR and the perception that patients are more cared for by their medicine team.
The Impact of Bedside Interdisciplinary Rounds on Length of Stay and Complications
Authors: Dunn Andrew S. , Reyna Maria , Radbill Brian , Parides Michael , Colgan Claudia , Osio Tobi , Benson Ari , Brown Nicole , Cambe Joy , Zwerling Margo , Egorova Natalia , Kaplan Harold 
Published: March 2017

BACKGROUNDCommunication among team members within hospitals is typically fragmented. Bedside interdisciplinary rounds (IDR) have the potential to improve communication and outcomes through enhanced structure and patient engagement.OBJECTIVETo decrease length of stay (LOS) and complications through the transformation of daily IDR to a bedside model.DESIGNControlled trial.SETTING2 geographic areas of a medical unit using a clinical microsystem structure.PATIENTS2005 hospitalizations over a 12‐month period.INTERVENTIONSA bedside model (mobile interdisciplinary care rounds [MICRO]) was developed. MICRO featured a defined structure, scripting, patient engagement, and a patient safety checklist.MEASUREMENTSThe primary outcomes were clinical deterioration (composite of death, transfer to a higher level of care, or development of a hospital‐acquired complication) and length of stay (LOS). Patient safety culture and perceptions of bedside interdisciplinary rounding were assessed pre‐ and postimplementation.RESULTSThere was no difference in LOS (6.6 vs 7.0 days, P = 0.17, for the MICRO and control groups, respectively) or clinical deterioration (7.7% vs 9.3%, P = 0.46). LOS was reduced for patients transferred to the study unit (10.4 vs 14.0 days, P = 0.02, for the MICRO and control groups, respectively). Nurses and hospitalists gave significantly higher scores for patient safety climate and the efficiency of rounds after implementation of the MICRO model.LIMITATIONSThe trial was performed at a single hospital.CONCLUSIONSBedside IDR did not reduce overall LOS or clinical deterioration. Future studies should examine whether comprehensive transformation of medical units, including co‐leadership, geographic cohorting of teams, and bedside interdisciplinary rounding, improves clinical outcomes compared to units without these features.
Condition Help: A Patient‐ and Family‐Initiated Rapid Response System
Authors: Eden Elizabeth L. , Rack Laurie L. , Chen Ling‐Wan , Bump Gregory M. 
Published: March 2017

BACKGROUNDRapid response teams (RRTs) help in delivering safe, timely care. Typically they are activated by clinicians using specific parameters. Allowing patients and families to activate RRTs is a novel intervention. The University of Pittsburgh Medical Center developed and implemented a patient‐ and family‐initiated rapid response system called Condition Help (CH).METHODSWhen the CH system is activated, a patient care liaison or an on‐duty administrator meets bedside with the unit charge nurse to address the patient's concerns. In this study, we collected demographic data, call reasons, call designations (safety or nonsafety), and outcome information for all CH calls made during the period January 2012 through June 2015.RESULTSTwo hundred forty patients/family members made 367 CH calls during the study period. Most calls were made by patients (76.8%) rather than family members (21.8%). Of the 240 patients, 43 (18%) made multiple calls; their calls accounted for 46.3% of all calls (170/367). Inadequate pain control was the reason for the call in most cases (48.2%), followed by dissatisfaction with staff (12.5%). The majority of calls involved nonsafety issues (83.4%) rather than safety issues (11.4%). In 41.4% of cases, a change in care was made.CONCLUSIONPatient‐ and family‐initiated RRTs are designed to engage patients and families in providing safer care. In the CH system, safety issues are identified, but the majority of calls involve nonsafety issues.
Family Report Compared to Clinician‐Documented Diagnoses for Psychiatric Conditions Among Hospitalized Children
Authors: Doupnik Stephanie K. , Feudtner Chris , Marcus Steven C. 
Published: March 2017

BACKGROUNDPsychiatric comorbidity is common in pediatric medical and surgical hospitalizations and is associated with worse hospital outcomes. Integrating medical or surgical and psychiatric hospital care depends on accurate estimates of which hospitalized children have psychiatric comorbidity.OBJECTIVEWe conducted a study to determine agreement of family report (FR) and clinician documentation (CD) identification of psychiatric diagnoses in hospitalized children.DESIGN AND SETTINGThis was a cross‐sectional study at a tertiary‐care children's hospital.PATIENTSThe patients were children and adolescents (age, 4‐21 years) who were hospitalized for medical or surgical indications.MEASUREMENTSPsychiatric diagnoses were identified from structured interviews (FR) and from inpatient notes and International Classification of Diseases codes in medical records (CD). We compared estimates of point prevalence of any comorbid psychiatric diagnosis using each method, and estimated FR–CD agreement in identifying psychiatric comorbidity in hospitalized children.RESULTSOf 119 study patients, 26 (22%; 95% confidence interval [CI], 14%‐29%) had a psychiatric comorbidity identified by FR, 30 (25%; 95% CI, 17%‐34%) had it identified by CD, and 37 (23%‐40%) had it identified by FR or CD. Agreement between FR and CD was low overall (κ = .46; 95% CI, .27‐.66), highest for attention‐deficit/hyperactivity disorder (κ = .78; 95% CI, .59‐.97), and lowest for anxiety disorders (κ = .11; 95% CI, –.16 to .56).CONCLUSIONSCurrent methods may underestimate the prevalence of psychiatric conditions in hospitalized children. Information from multiple sources may be needed to develop accurate estimates of the scope of the population in need of services so that mental health resources can be appropriately allocated.