bluuebunny/crossref_metadata_2025_split huggingface dataset:
Responsible Stewards of a Limited Resource
Authors: Turnbull Jessica M. 
Published: July 2015

AbstractI had heard rumblings of the possibility of consult on this patient. As a pediatric intensivist conducting consults for my institution's clinical bioethics service, I had come to appreciate that many low‐ to moderate‐level ethical dilemmas are present in the pediatric intensive care unit (PICU) every single day. Despite this, or maybe because of it, it takes quite a morally complicated situation to trigger a consult for the service.Sam was a three‐month‐old who had been born full‐term without complications. In the weeks prior to admission, his parents found that he was not feeding well and at times struggled to catch his breath. At our institution's PICU, it was determined that his decline was secondary to dilated cardiomyopathy, for which he would require cardiac transplantation for survival. Sam's parents were unsure if putting him through a heart transplant was the right thing to do, but they were unable to tolerate the thought of losing him. After an extensive consent process, they decided to pursue cardiac transplantation.
Punishing Health Care Providers for Treating Terrorists
Authors: Rubenstein Leonard S. 
Published: July 2015

AbstractImagine that an American physician volunteered to treat wounded children through the Ministry of Health in Gaza, controlled by Hamas. Or that a Palestinian nurse attending to injured fighters in Gaza spoke out against the firing of rockets into Israel, was threatened with arrest, and sought asylum in the United States. Under U.S. law, the doctor could be subject to prosecution, and the nurse could be denied asylum—in the first case, because she provided medical care under the direction or control of a designated terrorist organization; in the second, because he knowingly provided care to a member of a terrorist organization. The question of whether a terrorist is entitled to medical care, though largely theoretical, has generated considerable discussion, with near unanimity that there is no moral basis to refuse to treat. But whether a health professional can be punished for providing medical care either to terrorists or under the auspices of a terrorist organization has received little attention from either a moral or legal perspective, although such situations arise throughout the world.
Thinking All Wrong about How You Die
Authors: Battin Margaret P. 
Published: July 2015

AbstractHow do we approach our deaths? By avoidance, for one thing—death, especially our own death, is hard to talk about, think about, even imagine in the dimmest way. Or we dwell on it, that black, feared vortex that will eventually engulf us, swallowing our identity and personhood. Mostly, we distract ourselves with things of the moment. But in our rational moments we make preparations. We write advance directives. We execute durable powers of attorney. We give instructions to loved ones: “No tubes, no machines.” That's the wrong approach, I think. All this stuff we put together doesn't guarantee that what we say we want will actually happen or that we'll have what we'd call a “good death”—what you would think of as a good death for you.
Safety concerns of herbal products and traditional Chinese herbal medicines: dehydropyrrolizidine alkaloids and aristolochic acid
Authors: Stegelmeier Bryan L. , Brown Ammon W. , Welch Kevin D. 
Published: July 2015

AbstractIn many countries, including the United States, herbal supplements, tisanes and vegetable products, including traditional Chinese medicines, are largely unregulated and their content is not registered, monitored or verified. Consequently, potent plant toxins including dehydropyrrolizidine alkaloids and other potential carcinogens can contaminate these products. As herbal and food supplement producers are left to their own means to determine the safety and purity of their products prior to marketing, disturbingly often good marketing practices currently in place are ignored and content is largely undocumented. Historical examples of poisoning and health issues relating to plant material containing dehydopyrrolizidine alkaloids and aristolochic acids were used as examples to demonstrate the risk and potential toxicity of herbal products, food supplements, or traditional medicines. More work is needed to educate consumers of the potential risk and require the industry to be more responsible to verify the content and insure the safety of their products. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.
Biological effects and toxicity of diluted bitumen and its constituents in freshwater systems
Authors: Dew William A. , Hontela Alice , Rood Stewart B. , Pyle Greg G. 
Published: July 2015

AbstractApproximately 50 billion cubic meters of bitumen resides within the oil sands region of Alberta, Canada. To facilitate the transport of bitumen from where it is extracted to where it is processed, the bitumen is diluted with natural gas condensate (‘dilbit’), synthetic crude from hydrocracking bitumen (‘synbit’), or a mixture of both (‘dilsynbit’). A primary consideration for the effects of diluted bitumen products on freshwater organisms and ecosystems is whether it will float on the water surface or sink and interact with the stream or lake sediments. Evidence from a spill near Kalamazoo, MI, in 2010 and laboratory testing demonstrate that the nature of the spill and weathering of the dilbit, synbit or dilsynbit prior to and during contact with water will dictate whether the product floats or sinks. Subsequent toxicological data on the effects of dilbit and other diluted bitumen products on freshwater organisms and ecosystems are scarce. However, the current literature indicates that dilbit or bitumen can have significant effects on a wide variety of toxicological endpoints. This review synthesizes the currently available literature concerning the fate and effects of dilbit and synbit spilled into freshwater, and the effects of bitumen and bitumen products on aquatic organisms and ecosystems. Dilbit is likely to provide ecological impacts that are similar to and extend from those that follow from exposure to lighter crude oil, but the prospect of bitumen settling after binding to suspended sediments elevates the risk for benthic impacts in streams and lakes. Copyright © 2015 John Wiley & Sons, Ltd.
Developing Xenopus embryos recover by compacting and expelling single wall carbon nanotubes
Authors: Holt Brian D. , Shawky Joseph H. , Dahl Kris Noel , Davidson Lance A. , Islam Mohammad F. 
Published: July 2015

AbstractSingle wall carbon nanotubes are high aspect ratio nanomaterials being developed for use in materials, technological and biological applications due to their high mechanical stiffness, optical properties and chemical inertness. Because of their prevalence, it is inevitable that biological systems will be exposed to nanotubes, yet studies of the effects of nanotubes on developing embryos have been inconclusive and are lacking for single wall carbon nanotubes exposed to the widely studied model organism Xenopus laevis (African clawed frog). Microinjection of experimental substances into the Xenopus embryo is a standard technique for toxicology studies and cellular lineage tracing. Here we report the surprising finding that superficial (12.5 ± 7.5 µm below the membrane) microinjection of nanotubes dispersed with Pluronic F127 into one‐ to two‐cell Xenopus embryos resulted in the formation and expulsion of compacted, nanotube‐filled, punctate masses, at the blastula to mid‐gastrula developmental stages, which we call “boluses.” Such expulsion of microinjected materials by Xenopus embryos has not been reported before and is dramatically different from the typical distribution of the materials throughout the progeny of the microinjected cells. Previous studies of microinjections of nanomaterials such as nanodiamonds, quantum dots or spherical nanoparticles report that nanomaterials often induce toxicity and remain localized within the embryos. In contrast, our results demonstrate an active recovery pathway for embryos after exposure to Pluronic F127‐coated nanotubes, which we speculate is due to a combined effect of the membrane activity of the dispersing agent, Pluronic F127, and the large aspect ratio of nanotubes. Copyright © 2015 John Wiley & Sons, Ltd.
Hospitalist intervention for appropriate use of telemetry reduces length of stay and cost
Authors: Svec David , Ahuja Neera , Evans Kambria H. , Hom Jason , Garg Trit , Loftus Pooja , Shieh Lisa 
Published: July 2015

BACKGROUNDTelemetry monitoring is a widely used, labor‐intensive, and often‐limited resource. Little is known of the effectiveness of methods to guide appropriate use.OBJECTIVEOur intervention for appropriate use included: (1) a hospitalist‐led, daily review of bed utilization, (2) hospitalist‐driven education module for trainees, (3) quarterly feedback of telemetry usage, and (4) financial incentives.DESIGN/METHODSHospitalists were encouraged to discuss daily telemetry utilization on rounds. A module on appropriate telemetry usage was taught by hospitalists during the intervention period (January 2013–August 2013) on medicine wards. Pre‐ and post‐evaluations measured changes regarding telemetry use. We compared hospital bed–use data between the baseline period (January 2012–December 2012), intervention period, and extension period (September 2014–March 2015). During the intervention period, hospital bed–use data were sent to the hospitalist group quarterly. Financial incentives were provided after a decrease in hospitalist telemetry utilization.SETTINGStanford Hospital, a 444‐bed, academic medical center in Stanford, California.RESULTSHospitalists saw reductions for both length of stay (LOS) (2.75 vs 2.13 days, P = 0.005) and total cost (22.5% reduction) for telemetry bed utilization in the intervention period. Nonhospitalists telemetry bed utilization remained unchanged. We saw significant improvements in trainee knowledge of the most cost‐saving action (P = 0.002) and the least cost‐saving action (P = 0.003) in the pre‐ and post‐evaluation analyses. Results were sustained in the hospitalist group, with telemetry LOS of 1.93 days in the extension period.CONCLUSIONSA multipronged, hospitalist‐driven intervention to improve appropriate use of telemetry reduces LOS and cost, and increases knowledge of cost‐saving actions among trainees. Journal of Hospital Medicine 2015;10:627–632. © 2015 Society of Hospital Medicine
Usefulness of non–contrast‐enhanced MRI with two‐dimensional balanced steady‐state free precession for the acquisition of the pulmonary venous and left atrial anatomy pre catheter ablation of atrial fibrillation: Comparison with contrast enhanced CT in clinical cases
Authors: Shigenaga Yutaka , Okajima Katsunori , Ikeuchi Kazushi , Kiuchi Kunihiko , Ikeda Takayuki , Shimane Akira , Yokoi Kiminobu , Teranishi Jin , Aoki Kousuke , Chimura Misato , Yamada Shinichiro , Taniguchi Yasuyo , Yasaka Yoshinori , Kawai Hiroya 
Published: July 2015

BackgroundTo investigate the feasibility of substituting non–contrast‐enhanced MR (non–CE‐MR) imaging with a two‐dimensional (2D) balanced steady‐state free precession (b‐SSFP) sequence for contrast‐enhanced computed tomography (CE‐CT) for atrial fibrillation (AF) ablation.MethodsFifty‐four patients that underwent AF ablation under the guidance of a 3D electro‐anatomical mapping system with CE‐CT (n = 27) or non–CE‐MR images (n = 27) were studied. Procedural results were compared between the two groups. Furthermore, in 22 patients who underwent both CE‐CT and non–CE‐MRI, two cardiologists independently scored the multiplanar reformatted images on a scale of 1 to 4 (from 1, poor, to 4, excellent).ResultsThe image score was nearly 0.5 point higher with the CE‐CT method. However, the procedural results such as the surface registration error (1.0 [0.8–1.6] mm versus 1.0 [0.8–1.35] mm, P = 0.88) and procedure time (185 [159–199] min versus 185 [142–221] min, P = 0.86) did not significantly differ between the CE‐CT and non–CE‐MR groups.ConclusionThe non–CE‐MR method with a 2D‐b‐SSFP sequence can give us adequate information on AF ablation without any radiation exposure or contrast medium usage. J. Magn. Reson. Imaging 2016;43:495–503.
Use of WKB approximation for analytical boundary conditions in numerical solution of Schrödinger equation: application to semiconductor–high‐k dielectric interfaces
Authors: Bayoumi Amr M. 
Published: July 2015

SummaryNumerical methods used to solve 1D Schrödinger's equation in quantum structures, such as Numerov's integration of wavefunction or the shooting method iterative solution of energy levels, require knowledge of two‐point boundary conditions at interfaces. This is especially true when the interfaces are not symmetrical or where exponential decay of wavefunction at asymptotically large distances does not hold. A closed‐form expression for boundary conditions, which is not sensitive to intermediate solutions at interfaces, can minimize possible divergence during iterations and relax simulation grid size and simulation time. In this work, the Wentzel‐Kramers‐Brillouin (WKB) approximation within potential barriers is proposed to analytically calculate the boundary conditions for abrupt interfaces, such as dielectric–semiconductor interface. An analytical expression for the slope at the interface is derived, and the errors are estimated with respect to numerical methods. An application is shown for self‐consistent solution of coupled Poisson–Schrödinger's equations at multi‐layer HfO2‐SiO2 dielectric gate stack corresponding to International Technology Roadmap for Semiconductors‐projected 10 nm bulk single‐gate Complementary Metal‐Oxide‐Semiconductor (CMOS) technology node, where wavefunction penetration into the dielectric is of critical importance. Application to dual gate structures with 5 nm fin width and high‐k dielectric with 0.5 nm equivalent oxide thickness is also shown. A quantum mechanical simulator ‘hksim’ based on this principle is posted for public domain usage. Copyright © 2015 John Wiley & Sons, Ltd.
Social processes and team creativity in multicultural teams: A socio‐technical framework
Authors: Leung Kwok , Wang Jie 
Published: July 2015

SummaryCultural diversity is widely believed to broaden the knowledge and perspectives in a team and hence benefit team creativity. However, cultural diversity can at the same time suppress team creativity through the negative social processes it engenders, and this negative mechanism has received little theoretical attention. We present a theoretical analysis to explicate how cultural diversity creates cultural identity and intercultural obstacles, which hinder knowledge sharing and integration among team members and hence team creativity. Drawing on the socio‐technical systems perspective, we identify two types of contextual variables that moderate the negative, mediated impact of cultural diversity on team creativity: information and communication technology and task environment in terms of task characteristics. We provide an analysis of how each type of variables moderates the negative impact of cultural diversity on social processes and the impact of social processes on knowledge sharing and integration. Several future research directions based on the socio‐technical systems perspective are discussed. Copyright © 2015 John Wiley & Sons, Ltd.
Epstein‐Barr virus in the enlarged salivary tissues of patients with IgG4‐related disease
Authors: Furukawa Takatoshi , Shimotai Yoshitaka , Ohta Nobuo , Ishida Akihiro , Kurakami Kazuya , Suzuki Hitoshi , Yamakawa Mitsunori , Hongo Seiji , Kakehata Seiji 
Published: July 2015

ObjectiveImmunoglobulin G4‐related disease (IgG4‐RD) is a recently recognized disease entity characterized by high‐serum IgG4 concentration and IgG4‐producing plasma cell production with fibrotic or sclerotic changes in affected organs. We aimed to clarify the roles of Epstein‐Barr virus (EBV) in patients with IgG4‐RDs.Study Design and SettingA retrospective clinical study at the Yamagata University School of Medicine, Yamagata, Japan.MethodsThe patient group consisted of four males and four females with an average age of 62 years (range: 48–73). Expression of IgG4, latent member protein 1, EBV nuclear antigens‐2, and EBV‐encoded RNA in affected salivary glands from patients with IgG4‐RD was examined by using immunohistochemistry and in situ hybridization. The copy number of EBV DNA in the salivary glands was also investigated by real‐time polymerase chain reaction.ResultsAll patients had hard masses in the salivary or lacrimal glands, or both, bilaterally. Serum concentrations of IgG4 were elevated in all cases (mean 589.1, range 129–1750), and IgG4‐positive plasmacytes were observed in the involved salivary glands. Four patients developed potentially life‐threatening systemic involvement after initial salivary gland swelling. EBV‐associated molecules (EBNA and EBER) were overexpressed in the affected salivary glands. The copy number of EBV DNA was significantly higher in patients with potentially life‐threatening systemic involvement than in patients without systemic involvement (P < 0.05).ConclusionThese results suggest that the copy number of EBV DNA could be useful as diagnostic findings in IgG4‐RD to predict potentially life‐threatening systemic involvement.Level of Evidence4. Laryngoscope, 125:2079–2084, 2015
Outcomes for multilevel surgery for sleep apnea: Obstructive sleep apnea, transoral robotic surgery, and uvulopalatopharyngoplasty
Authors: Thaler Erica R. , Rassekh Christopher H. , Lee Jonathan M. , Weinstein Gregory S. , O'Malley Bert W. 
Published: July 2015

Objectives/HypothesisThis study evaluates the outcomes of multilevel surgery for patients with obstructive sleep apnea (OSA) who underwent transoral robotic surgery (TORS) (i.e., posterior glossectomy and limited lateral pharyngectomy) with uvulopalatopharyngoplasty (UPPP).Study DesignProspective, nonrandomized trial with historical controls.MethodsAll patients underwent pre‐ and postoperative polysomnography, preoperative magnetic resonance imaging of the neck, preoperative drug‐induced sleep endoscopy, surgery, including UPPP if this had not occurred previously, and OSA TORS. Outcomes measures included apnea‐hypopnea index (AHI), Epworth Sleepiness Scale (ESS), O2 saturation nadir, and total sleep time spent at <90% O2 saturation.ResultsPatients who had no prior surgery achieved an average AHI reduction from 58.4 to 19.5 (67%, P < .0001), a surgical success rate of 56%, and a surgical response rate of 73%. Patients with prior pharyngeal surgery achieved an AHI reduction from 55.0 to 45 (24%, P = .19), a surgical success rate of 30%, and a surgical response rate of 40%. Total sleep time spent at <90% O2 saturation was improved from 14% to 3.6% (P < .0003) for patients without prior surgery, and 21.1% to 12.5% (P < .17)for those with prior surgery. ESS improved for all patients combined from 12.8 to 5.8 (P < .0001).ConclusionsOutcomes for the combined approach of OSA TORS and UPPP provide strong evidence in favor of this multilevel approach for the surgical management of OSA. The benefit of the current surgical approach is most significant for previously unoperated patients.Level of Evidence4. Laryngoscope, 126:266–269, 2016
The double‐barreled radial forearm osteocutaneous free flap
Authors: Gonzalez‐Castro Javier , Petrisor Daniel , Ballard Daniel , Wax Mark K. 
Published: July 2015

Objectives/HypothesisThe radial forearm osteocutaneous free flap (RFOCFF) provides a thin pliable skin paddle with up to 11 cm of bone. A limitation of this flap is the thin bone that is obtained and the lack of suitability for dental implants. A minimum depth of 5 mm and height of 10 mm is required for a bony flap to accept osteointegrated implants. We propose that by double barreling the radial bone, it is possible to reconstruct osseous defects with bone of sufficient caliber to accept dental implants.Study DesignRetrospective review of our experience with double‐barreled RFOCFF.MethodsWe reviewed all free flaps performed from July 2000 to September 2014 and analyzed patients in whom a radial forearm osteocutaneous flap was used. We then reviewed those who had an osteotomy to form a double‐barrel reconstruction. Descriptive data and outcomes were tabulated.ResultsA total of 458 osteocutaneous free flaps were performed; 75 were RFOCFF and 18 of these were double barreled. All 18 flaps survived. The reconstructed defect size was between 2.6 and 6.8 cm. One patient had dental implants placed at time of surgery that successfully osteointegrated. Postoperative computed tomography scans were available in nine patients and were used to calculate bone dimensions. Bone depth ranged from 7.91 to 13.22 mm, with a mean of 9.77 ± 1.53 mm. Bone height ranged from 8.42 to 17.81 mm, with a mean of 13.82 ± 3.2 mm.ConclusionsThe double‐barreled RFOCFF provides dependable long‐lasting bone with adequate bone dimensions to support osteointegrated dental implants.Level of Evidence4 Laryngoscope, 126:340–344, 2016
Voice outcomes following reoperative central neck dissection for recurrent/persistent thyroid cancer
Authors: Starmer Heather , Noureldine Salem I. , Ozgursoy Ozan B. , Tufano Ralph P. 
Published: July 2015

Objectives/HypothesisWe aimed to assess voice outcomes following reoperative central neck dissection (RCND) to characterize postoperative voice difficulties experienced, determine the natural progression of vocal recovery, and identify risk factors for the development of voice disorders postoperatively.Study DesignProspective cohort study.MethodsConsecutive patients with recurrent/persistent thyroid cancer who were deemed appropriate candidates for RCND were eligible for participation in this study. A battery of voice evaluation measures was administered both preoperatively and 2 to 4 weeks postoperatively.ResultsTwenty consecutive patients were included. Postoperatively, six (30%) new incidents of vocal fold motion impairment (VFMI) were identified, with two (10%) being due to intentional recurrent laryngeal nerve (RLN) transection. On 1‐year follow‐up, two patients had full restoration of vocal fold mobility and four had persistent VFMI. No preoperative voice/laryngeal exam factors were predictive of postoperative VFMI. Clinically relevant change in postoperative Voice Handicap Index score was absent in all patients without VFMI and present in five of six patients with VFMI (P = .0004). Patients with VFMI had significantly poorer overall dysphonia grade, less glottic closure, and elevated jitter in contrast to those individuals without VFMI. Patients with malignant tissue in the remnant thyroid were four times more likely to develop VFMI than those with central neck lymph node metastases alone (P = .06).ConclusionPatients undergoing RCND are at risk for postoperative VFMI, even when the RLN is anatomically preserved, with subsequent impact on quality of life. Presence of malignant disease in the remnant thyroid appears to be the best predictor for postoperative VFMI.Level of Evidence2b. Laryngoscope, 125:2621–2625, 2015