bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Intraoperative Distractions on Patient Safety: A Prospective Descriptive Study Using Validated Instruments
Authors: Sevdalis Nick , Undre Shabnam , McDermott James , Giddie Jasdeep , Diner Lila , Smith Gillian 
Published: November 2013

AbstractBackgroundThere is emerging evidence indicating that distractions in the operating room (OR) are prevalent. Studies have shown a negative impact of distractions, but they have been conducted mostly with residents in simulated environments. We tested the hypothesis that intraoperative distractions are associated with deterioration in patient safety checks in the OR.MethodsWe assessed 24 elective urologic procedures. Blinded trained assessors (two surgeons, one psychologist) used validated instruments to prospectively assess in vivo frequency and severity of distractions (related to communication, phones/pagers, equipment/provisions, OR environment, other hospital departments, or a member of the OR team) and completion of safety‐related tasks (related to the patient, equipment, and communication). Descriptive and correlational analyses were conducted.ResultsMean case duration was 70 min (mean intraoperative time 31 min). A mean of 4.0 communication distractions (range 0–9) and 2.48 other distractions (range 0–5) were recorded per case (distraction rate of one per 10 min). Distractions from external visitors (addressed to the entire team or the surgeon) and distractions due to lack of coordination between hospital departments were most disruptive. Regarding safety checks, patient tasks were completed most often (85–100 %) followed by equipment tasks (75–100 %) and communication tasks (55–90 %). Correlational analyses showed that more frequent/severe communication distractions were linked to lower completion of patient checks intraoperatively (median rho –0.56, p < 0.05).ConclusionsDistractions are prevalent in ORs and in this study were linked to deterioration in intraoperative patient safety checks. Surgeons should be mindful of their tolerance to distractions. Surgical leadership can help control distractions and reduce their potential impact on patient safety and performance.
Cure Predictability During Parathyroidectomy
Authors: Udelsman Robert , Donovan Patricia , Shaw Cary 
Published: November 2013

AbstractBackgroundA mathematical model for primary hyperparathyroidism (1°HPTH) was developed and embedded in software to yield intraoperative predictability curves.MethodsA total of 1,754 consecutive 1°HPTH operative cases were screened to select 617 [554 single adenoma (SA), 63 multigland] patients with complete preoperative, intraoperative (pre‐exploration, time 0, every 5 min post‐resection), and postoperative parathyroid hormone (PTH) and calcium data. Data transformations and models were hypothesized and tested, including inverse functions, differences, half‐lives, differences from projected half‐lives, second‐order kinetics, second‐order derivatives, and time‐dependent ratios. Sub‐models of ratios were developed for time‐dependent and initial‐value combinations. For each time segment the log odds were modeled using multiple logistic stepwise regression. An idealized model was selected, embedded in software, and installed in a laptop computer to enable intraoperative decision analyses, PTH curve plotting, and storage and transmission of data. A subsequent cohort of 100 consecutive unselected patients [81 SAs, 19 multigland (13 hyperplasia, 2 MEN1, 1 lithium, 3 double adenomas)] inclusive of seven remedial cervical explorations were tested.ResultsThe model predicted an overall curative resection in 95 % of patients. In SA patients, cure was predicted in 78/81 patients with a mean probability of 99.3 % at 11.8 ± 10.4 min post‐resection. In three cured patients, the software failed to suggest cure, because of a low baseline PTH or delayed clearance. The model also correctly predicted residual hyperfunctioning tissue in all tested multigland patients. All multigland patients underwent additional exploration with resection of residual disease resulting in a mean predicted cure rate of 97.9 % at 10.6 ± 7.3 min post‐resection completion in 17 patients. In two patients, the software predicted a mean cure rate of 22 % due to either a low PTH baseline or delayed clearance. Overall, the software accurately predicted cure in 95 of 100 cured cases.ConclusionsThis intraoperative prediction software expedites termination of surgery with a high level of curative confidence. Alternatively, the model accurately predicts residual disease prompting additional exploration. Because the model is based on a large set of multivariate regression curves, PTH values obtained at any post‐resection sampling interval generate prediction data with far greater accuracy than existing algorithms. The software is designed for convenient operative use and can print, store, and electronically transmit probability analyses and PTH curves in real‐time.
Protein–DNA binding: complexities and multi-protein codes
Authors: Siggers Trevor , Gordân Raluca 
Published: November 2013

AbstractBinding of proteins to particular DNA sites across the genome is a primary determinant of specificity in genome maintenance and gene regulation. DNA-binding specificity is encoded at multiple levels, from the detailed biophysical interactions between proteins and DNA, to the assembly of multi-protein complexes. At each level, variation in the mechanisms used to achieve specificity has led to difficulties in constructing and applying simple models of DNA binding. We review the complexities in protein–DNA binding found at multiple levels and discuss how they confound the idea of simple recognition codes. We discuss the impact of new high-throughput technologies for the characterization of protein–DNA binding, and how these technologies are uncovering new complexities in protein–DNA recognition. Finally, we review the concept of multi-protein recognition codes in which new DNA-binding specificities are achieved by the assembly of multi-protein complexes.
High prevalence and genetic diversity of porcine bocaviruses in pigs in the USA, and identification of multiple novel porcine bocaviruses
Authors: Jiang Yong-Hou , Xiao Chao-Ting , Yin Shuang-Hui , Gerber Priscilla F. , Halbur Patrick G. , Opriessnig Tanja 
Published: November 2013

Viruses in the genus Bocavirus are associated with respiratory and enteric disease in dogs and cattle. In addition, novel porcine bocaviruses (PBoVs) have been identified in domestic and wild pigs in recent years, but are of unknown relevance to date. The objectives of this study were to determine the prevalence ra
tes and genetic diversity of PBoVs in pigs in the USA. Using newly established multiplex real-time PCR assays, 385 lung, lymph node, serum and faecal samples from pigs with various disease conditions were investigated. A high PBoV prevalence rate ranging from 21.3 to 50.8 % was identified in the investigated samples and often two or more PBoV species were detected in the same sample. Cloning and sequencing analysis of the partial non-structural protein NS1 and the capsid proteins VP1 and VP2 of DNA samples positive for PBoV groups 1 (n = 6), 2 (n = 16) and 3 (n = 42), including subgroups 3A, 3B or 3C, revealed a high genetic diversity especially for the PBoV G3 VP2 gene, whereas the PBoV group 1 VP1 gene displayed a low nucleotide polymorphism. Using primer walking, 18 partial or nearly complete genomes of PBoVs were obtained and six of the 18 nearly complete genomes represented novel PBoV species. Recombination analysis using partial NS1, VP1 and VP2 genes and the nearly complete genomes indicated possible recombination events within and between PBoVs. Further studies will be required to reveal the possible pathogenic role of these diverse PBoVs.
The nature of the game
Authors: McMullen Anthony 
Published: November 2013

PurposeThe purpose of this paper is to provide insights into issues encountered in maintaining library technologies and electronic collections on a limited budget and with limited personnel.Design/methodology/approachThe paper uses real world experiences and data to report on collection development decisions as they relate to electronic journals in an era of shrinking budgets and changing user expectations.FindingsEfficient and ubiquitous access to information has altered user expectations and needs, which in turn have altered the methods and means by which libraries provide services to users. Yet many academic libraries continue to use outmoded models and suffer as a consequence.Originality/valueThis paper examines the cost and usage of an individual journal title and the disparities between return on investment for the electronic and printed form of that journal. The author employs real‐world cost and usage statistics to make a case for shifting the focus of collection development from print to electronic subscriptions even if the online access is more costly.
Model for the centralized acquisition of collections in times of crisis
Authors: Lloret Romero Nuria 
Published: November 2013

PurposeThe purpose of this paper is to examine how, in many cases, the conversion of analog collections to digital collections is still a paradigm shift with regard to the ownership, use and enjoyment of the collections.Design/methodology/approachThe paper discusses how the inclusion of digital collections has led to a new licensing model that has changed the financial management and administration of budgets for the purchase of collections, starting with the acquisition of scientific journals for specialized centers and extending to all types of resource materials.FindingsIn the traditional library collection management model, the documents deemed to be most suitable for the libraries were chosen title by title, and the amounts paid were based on the volume of titles chosen. In the analog model, this resulted in a large investment in similar collections in libraries located in close proximity to one another. In research centers and related universities, attempts were made to make coordinated purchases. However, in most cases purchases were made individually, meaning that costs, and specifically direct costs relating to usage, were very high for a usage of journals in the collection which in many cases was very sporadic. The introduction of purchasing consortia in the electronic environment has led to an increase in the collections of all entities, as well as the rationalization of spending on collections, which is more closely related to the needs of the entities' users. However, the use of such consortia should be more extended and rather than being limited to large libraries or institutions, they should be made available to medium‐sized groups of entities which can benefit from these instruments.Originality/valueIf the possibility of accessing resources were to be increased through these consortia, the author suggests that it would be of great interest to include diverse materials such as films and music, etc. that may be of interest to other type of institutions, such as those serving the general public.
The determinants of frequency and severity of operational losses in Tunisian insurance industry
Authors: Hemrit Wael , Ben Arab Mounira 
Published: November 2013

PurposeThe purpose of this paper is to examine the determinants of operational losses in insurance companies.Design/methodology/approachBy using most common estimates of frequency and severity of losses that affected business‐lines during 2009, the paper integrates a quantitative aspect that reflects the mode of organization in the insurance company. In this paper, it would be more appropriate to focus on the frequency and severity of losses estimated by insurers and which are related to each category of operational risk events that took place in 2009.FindingsThe paper finds that the frequency of operational losses is positively related to the Market Share (MARKSHARE) and the Rate of Geographic Location (RAGELOC). However, the occurrence of loss is negatively related to the Variety of Insurance Activities (VARIACT). The paper also found a decrease in the frequency of losses associated with a large number of employees. Therefore, there is a significant relationship between the Human Factor (HF) and the occurrence of operational losses. In terms of severity, the empirical study has shown that the probability of zero intensity of operational losses is negatively influenced by the Market Share (MARKSHARE) and the Rate of Geographic Location (RAGELOC). In the same framework, the Variety of Insurance Activities (VARIACT) has a negative effect on the probability of high operational loss severity.Originality/valueDespite the absence of the quantitative data of operational risk, this article will discover a new research perspective to estimate the frequency and severity of operational losses in the insurance sector in Tunisia.
Zero‐modified discrete distributions for operational risk modelling
Authors: Mouatassim Younès 
Published: November 2013

PurposeThe purpose of this paper is to introduce the zero‐modified distributions in the calculation of operational value‐at‐risk.Design/methodology/approachThis kind of distributions is preferred when excess of zeroes is observed. In operational risk, this phenomenon may be due to the scarcity of data, the existence of extreme values and/or the threshold from which banks start to collect losses. In this article, the paper focuses on the analysis of damage to physical assets.FindingsThe results show that basic Poisson distribution underestimates the dispersion, and then leads to the underestimation of the capital charge. However, zero‐modified Poisson distributions perform well the frequency. In addition, basic negative binomial and its related zero‐modified distributions, in their turn, offer a good prediction of count events. To choose the distribution that suits better the frequency, the paper uses the Vuong's test. Its results indicate that zero‐modified Poisson distributions, basic negative binomial and its related zero‐modified distributions are equivalent. This conclusion is confirmed by the capital charge calculated since the differences between the six aggregations are not significant except that of basic Poisson distribution.Originality/valueRecently, the zero‐modified formulations are widely used in many fields because of the low frequency of the events. This article aims to describe the frequency of operational risk using zero‐modified distributions.
Brief Assessment of Supine Heart Rate Variability in Normal Weight, Overweight, and Obese Females
Authors: Alrefaie Zienab 
Published: November 2013

BackgroundLittle research has been conducted on the heart rate variability (HRV) parameters in late adolescent females. The present study aimed to assess HRV time and frequency domain parameters in overweight and obese late adolescent females. Also to assess any possible correlation between HRV parameters and obesity indices in that particular age group.Subjects and MethodsFifteen‐minute period of standardized ECG recording was implemented to record HRV time and frequency parameters in 42 normotensive euglycemic female medical students aged (18–21 years); lean (n = 13), overweight (n = 13), and obese (n = 16). For the analysis of results, 2.5‐minute data were used.ResultsRoot mean squares of successive differences between adjacent RR intervals (rMSSD) and high‐frequency (HF) power were significantly decreased in overweight and obese late adolescent females. Parameters reflecting sympathetic activity which include low‐frequency (LF) power and LF/HF ratio showed significant increase in overweight group. Interestingly, LF power was significantly reduced in obese group while the LF/HF ratio was insignificantly different. No significant correlations were observed between HRV indices and parameters of total or visceral obesity in the study groups.ConclusionHRV indices showed sympathetic hyperactivity in overweight late adolescent females and diminished sympathetic response in matching obese group. Both overweight and obese females showed decreased protective vagal influence on the heart.
Dermoscopic nevus patterns in skin of colour: a prospective, cross‐sectional, morphological study in individuals with skin type V and VI
Authors: Lallas A. , Reggiani C. , Argenziano G. , Kyrgidis A. , Bakos R. , Masiero N.C.M.S. , Scheibe A.B. , Cabo H. , Ozdemir F. , Sortino‐Rachou A.M. , Turk B. Gerceker , Moscarella E. , Longo C. , Zalaudek I. 
Published: November 2013

AbstractBackgroundMost of the knowledge on the prevailing dermoscopic patterns of acquired melanocytic nevi (AMV) is based on studies in Caucasians, while little research focuses on the dermoscopic variability in nevi in skin of colour.ObjectiveTo analyse the prevalent dermoscopic nevus patterns in subjects with a skin type (ST) V and VI.MethodsProspective, cross‐sectional, morphological study was conducted in six clinics with enrolment of consecutive individuals with a ST V or VI. Digital dermoscopic images of selected representative AMN were assessed for dermoscopic colours, morphological patterns and pigment distribution.ResultsAnalysis of 300 nevi from subjects with ST V and VI revealed significant differences in the nevus pattern between these two groups. The majority of nevi in ST V revealed a reticular pattern, whereas persons with ST VI more frequently exhibited a structureless pattern. Black, blue and grey were more frequent in ST VI, whereas the vast majority of nevi in ST V individuals showed dark brown colour.ConclusionsOur study provides new insights into the nevus pattern in individuals with a dark pigmentary trait, which may aid the diagnosis and management of nevi in this patients group.
When genes move farther than offspring: gene flow by male gamete dispersal in the highly philopatric bat species Thyroptera tricolor
Authors: Buchalski M. R. , Chaverri G. , Vonhof M. J. 
Published: November 2013

AbstractFor species characterized by philopatry of both sexes, mate selection represents an important behaviour for inbreeding avoidance, yet the implications for gene flow are rarely quantified. Here, we present evidence of male gamete‐mediated gene flow resulting from extra‐group mating in Spix's disc‐winged bat, Thyroptera tricolor, a species which demonstrates all‐offspring philopatry. We used microsatellite and capture–recapture data to characterize social group structure and the distribution of mated pairs at two sites in southwestern Costa Rica over four breeding seasons. Relatedness and genetic spatial autocorrelation analyses indicated strong kinship within groups and over short distances (<50 m), resulting from matrilineal group structure and small roosting home ranges (~0.2 ha). Despite high relatedness among‐group members, observed inbreeding coefficients were low (FIS = 0.010 and 0.037). Parentage analysis indicated mothers and offspring belonged to the same social group, while fathers belonged to different groups, separated by large distances (~500 m) when compared to roosting home ranges. Simulated random mating indicated mate choice was not based on intermediate levels of relatedness, and mated pairs were less related than adults within social groups on average. Isolation‐by‐distance (IBD) models of genetic neighbourhood area based on father–offspring distances provided direct estimates of mean gamete dispersal distances () > 10 roosting home range equivalents. Indirect estimates based on genetic distance provided even larger estimates of , indicating direct estimates were biased low. These results suggest extra‐group mating reduces the incidence of inbreeding in T. tricolor, and male gamete dispersal facilitates gene flow in lieu of natal dispersal of young.
GouR, a TetR Family Transcriptional Regulator, Coordinates the Biosynthesis and Export of Gougerotin in Streptomyces graminearus
Authors: Wei Junhong , Tian Yuqing , Niu Guoqing , Tan Huarong 
Published: November 2013

ABSTRACT

Gougerotin is a peptidyl nucleoside antibiotic. It functions as a specific inhibitor of protein synthesis by binding ribosomal peptidyl transferase and exhibits a broad spectrum of biological activities.
gouR
, situated in the gougerotin biosynthetic gene cluster, encodes a TetR family transcriptional regulatory protein. Gene disruption and genetic complementation revealed that
gouR
plays an important role in the biosynthesis of gougerotin. Transcriptional analysis suggested that GouR represses the transcription of the
gouL
-to-
gouB
operon consisting of 11 structural genes and activates the transcription of the major facilitator superfamily (MFS) transporter gene (
gouM
). Electrophoresis mobility shift assays (EMSAs) and DNase I footprinting experiments showed that GouR has specific DNA-binding activity for the promoter regions of
gouL
,
gouM
, and
gouR
. Our data suggested that GouR modulates gougerotin production by coordinating its biosynthesis and export in
Streptomyces graminearus
.
Suffering in silence: a qualitative study of second victims of adverse events
Authors: Ullström Susanne , Andreen Sachs Magna , Hansson Johan , Øvretveit John , Brommels Mats 
Published: November 2013

IntroductionThe term ‘second victim’ refers to the healthcare professional who experiences emotional distress following an adverse event. This distress has been shown to be similar to that of the patient—the ‘first victim’. The aim of this study was to investigate how healthcare professionals are affected by their involvement in adverse events with emphasis on the organisational support they need and how well the organisation meets those needs.Methods21 healthcare professionals at a Swedish university hospital who each had experienced an adverse event were interviewed. Data from semi-structured interviews were analysed by qualitative content analysis using QSR NVivo software for coding and categorisation.ResultsOur findings confirm earlier studies showing that emotional distress, often long-lasting, follows from adverse events. In addition, we report that the impact on the healthcare professional was related to the organisation’s response to the event. Most informants lacked organisational support or they received support that was unstructured and unsystematic. Further, the formal investigation seldom provided adequate and timely feedback to those involved. The insufficient support and lack of feedback made it more difficult to emotionally process the event and reach closure.DiscussionThis article addresses the gap between the second victim's need for organisational support and the organisational support provided. It also highlights the need for more transparency in the investigation of adverse events. Future research should address how advanced support structures can meet these needs and provide learning opportunities for the organisation. These issues are central for all hospital managers and policy makers who wish to prevent and manage adverse events and to promote a positive safety culture.