bluuebunny/crossref_metadata_2025_split huggingface dataset:
Crowding Measures Associated With the Quality of Emergency Department Care: A Systematic Review
Authors: Stang Antonia S. , Crotts Jennifer , Johnson David W. , Hartling Lisa , Guttmann Astrid 
Published: May 2015

AbstractObjectivesDespite the substantial body of literature on emergency department (ED) crowding, to the best of our knowledge, there is no agreement on the measure or measures that should be used to quantify crowding. The objective of this systematic review was to identify existing measures of ED crowding that have been linked to quality of care as defined by the Institute of Medicine (IOM) quality domains (safe, effective, patient‐centered, efficient, timely, and equitable).MethodsSix major bibliographic databases were searched from January 1980 to January 2012, and hand searches were conducted of relevant journals and conference proceedings. Observational studies (cross‐sectional, cohort, and case‐control), quality improvement studies, quasi‐experimental (e.g., before/after) studies, and randomized controlled trials were considered for inclusion. Studies that did not provide measures of ED crowding were excluded. Studies that did not provide quantitative data on the link between crowding measures and quality of care were also excluded. Two independent reviewers assessed study eligibility, completed data extraction, and assessed study quality using the Newcastle‐Ottawa Quality Assessment Scale (NOS) for observational studies and a modified version of the NOS for cross‐sectional studies.ResultsThe search identified 7,413 articles. Thirty‐two articles were included in the review: six cross‐sectional, one case‐control, 23 cohort, and two retrospective reviews of performance improvement data. Methodologic quality was moderate, with weaknesses in the reporting of study design and methodology. Overall, 15 of the crowding measures studied had quantifiable links to quality of care. The three measures most frequently linked to quality of care were the number of patients in the waiting room, ED occupancy (percentage of overall ED beds filled), and the number of admitted patients in the ED awaiting inpatient beds. None of the articles provided data on the link between crowding measures and the IOM domains reflecting equitable and efficient care.ConclusionsThe results of this review provide data on the association between ED crowding measures and quality of care. Three simple crowding measures have been linked to quality of care in multiple publications.
Ontario's Emergency Department Process Improvement Program: The Experience of Implementation
Authors: Rotteau Leahora , Webster Fiona , Salkeld Erin , Hellings Chelsea , Guttmann Astrid , Vermeulen Marian J. , Bell Robert S. , Zwarenstein Merrick , Rowe Brian H. , Nigam Amit , Schull Michael J. ,   the ED Investigator Team
Published: May 2015

AbstractObjectivesIn recent years, Lean manufacturing principles have been applied to health care quality improvement efforts to improve wait times. In Ontario, an emergency department (ED) process improvement program based on Lean principles was introduced by the Ministry of Health and Long‐Term Care as part of a strategy to reduce ED length of stay (LOS) and to improve patient flow. This article aims to describe the hospital‐based teams’ experiences during the ED process improvement program implementation and the teams’ perceptions of the key factors that influenced the program's success or failure.MethodsA qualitative evaluation was conducted based on semistructured interviews with hospital implementation team members, such as team leads, medical leads, and executive sponsors, at 10 purposively selected hospitals in Ontario, Canada. Sites were selected based, in part, on their changes in median ED LOS following the implementation period. A thematic framework approach as used for interviews, and a standard thematic coding framework was developed.ResultsTwenty‐four interviews were coded and analyzed. The results are organized according to participants’ experience and are grouped into four themes that were identified as significantly affecting the implementation experience: local contextual factors, relationship between improvement team and support players, staff engagement, and success and sustainability. The results demonstrate the importance of the context of implementation, establishing strong relationships and communication strategies, and preparing for implementation and sustainability prior to the start of the project.ConclusionsSeveral key factors were identified as important to the success of the program, such as preparing for implementation, ensuring strong executive support, creation of implementation teams based on the tasks and outcomes of the initiative, and using multiple communication strategies throughout the implementation process. Explicit incorporation of these factors into the development and implementation of future similar interventions in health care settings could be useful.
Ghost Cell Suspensions as Blood Analogue Fluid for Macroscopic Particle Image Velocimetry Measurements
Authors: Jansen Sebastian V. , Müller Indra , Nachtsheim Max , Schmitz‐Rode Thomas , Steinseifer Ulrich 
Published: May 2015

AbstractSpatially resolved measurement of blood flow is of great interest in the development of artificial blood‐carrying devices such as blood pumps, heart valve prostheses, and oxygenators. Particle image velocimetry (PIV) is able to measure instantaneous velocity fields in a plane with high accuracy and is being used more frequently for the development of such devices. However, as this measurement technique is based on optical access, blood flow at physiological hematocrit values is difficult to measure due to its low transparency and multiscattering properties. So far, only very small dimensions (in the range of 400 μm) can be measured using PIV. A suspension of ghost cells (GCs) offers a higher optical transparency than blood while having a similar rheological behavior. In this study, a procedure for the production of GC suspensions containing a very low intracellular hemoglobin concentration is presented. With the help of multiple rounds of controlled cell lysis, the intracellular hemoglobin concentration could be decreased to a point where a standard macroscopic PIV measurement was possible. A velocity profile of a 44% GC suspension in a circular channel with a diameter of 9.5 mm was measured with high spatial resolution. Meanwhile, the rheological behavior was found to be comparable with blood.
Ocular manifestations of microcephaly with or without chorioretinopathy, lymphedema or intellectual disability (MCLID) syndrome associated with mutations in KIF11
Authors: Balikova Irina , Robson Anthony G. , Holder Graham E. , Ostergaard Pia , Mansour Sahar , Moore Anthony T. 
Published: May 2015

AbstractPurposeMicrocephaly with or without chorioretinopathy, lymphedema or intellectual disability (MCLID) is an autosomal dominant condition. Mutations in KIF11 have been found to be causative in approximately 75% of cases. This study describes the ocular phenotype in patients with confirmed KIF11 mutations.MethodsStandard ophthalmic examination and investigation including visual acuity, refraction and fundus examination was carried out in all patients. Fundus autofluorescence imaging (FAF) was performed in three patients, and four patients underwent spectral domain optical coherence tomography (OCT). Flash electroretinography (ERG) was performed in seven patients, and five underwent additional pattern electroretinography (PERG).ResultsThe patients ranged in age from 2 to 10 years. Most presented with visual acuity loss. Fundus examination revealed lacunae of chorioretinal atrophy. Pigmentary macular changes and optic disc pallor were present in three of seven patients. Fundus autofluorescence demonstrated hypoautofluorescence at the macula in two of three patients. The lacunae of chorioretinal atrophy were hypoautofluorescent. The OCT showed atrophic maculae in three of four patients. Follow‐up in one patient showed no deterioration of the vision over a 9‐year period. The lesions appear not to be progressive on the follow‐up imaging. Electrophysiology showed generalized rod and cone dysfunction and severe macular dysfunction. Inner retinal dysfunction was evident in three of seven patients.ConclusionsPatients with KIF11 mutations show a specific ocular phenotype with variable expressivity and intrafamilial variability. Macular atrophy and dysfunction have not been consistently documented before. The fundus lesions appear non‐progressive. The findings assist in providing an accurate diagnosis and thus improving the management and follow‐up of patients with this syndrome.
PDE7 inhibitor TC3.6 ameliorates symptomatology in a model of primary progressive multiple sclerosis
Authors: Mestre L , Redondo M , Carrillo‐Salinas F J , Morales‐García J A , Alonso‐Gil S , Pérez‐Castillo A , Gil C , Martínez A , Guaza C 
Published: May 2015

Background and PurposecAMP plays an important role in the transduction of signalling pathways involved in neuroprotection and immune regulation. Control of the levels of this nucleotide by inhibition of cAMP‐specific PDEs such as PDE7 may affect the pathological processes of neuroinflammatory diseases like multiple sclerosis (MS). In the present study, we evaluated the therapeutic potential of the selective PDE7 inhibitor, TC3.6, in a model of primary progressive multiple sclerosis (PPMS), a rare and severe variant of MS.Experimental ApproachTheiler's murine encephalomyelitis virus‐induced demyelinated disease (TMEV‐IDD) is one of the models used to validate the therapeutic efficacy of new drugs in MS. As recent studies have analysed the effect of PDE7 inhibitors in the EAE model of MS, here the TMEV‐IDD model was used to test their efficacy in a progressive variant of MS. Mice were subjected to two protocols of TC3.6 administration: on the pre‐symptomatic phase and once the disease was established.Key ResultsTreatment with TC3.6 ameliorated the disease course and improved motor deficits of infected mice. This was associated with down‐regulation of microglial activation and reduced cellular infiltrates. Decreased expression of pro‐inflammatory mediators such as COX‐2 and the cytokines, IL‐1β, TNF‐α, IFN‐γ and IL‐6 in the spinal cord of TMEV‐infected mice was also observed after TC3.6 administration.ConclusionThese findings support the importance of PDE7 inhibitors, and specifically TC3.6, as a novel class of agents with therapeutic potential for PPMS. Preclinical studies are needed to determine whether their effects translate into durable clinical benefits.
Utility of Gallium‐68 DOTANOC PET/CT in the localization of Tumour‐induced osteomalacia
Authors: Bhavani Nisha , Reena Asirvatham Adlyne , Kallur Kumar , Menon Arun S. , Pavithran Praveen V. , Nair Vasantha , Vasukutty Jayakumar R. , Menon Usha , Kumar Harish 
Published: May 2015

SummaryBackgroundTumour‐induced osteomalacia (TIO) is a rare disorder characterized by hypophosphataemic osteomalacia caused by small mesenchymal tumours secreting fibroblast growth factor 23 (FGF 23). The most difficult part in the management of these patients is the localization of tumours causing TIO.ObjectiveWe describe the utility of Gallium (Ga)‐68 DOTANOC PET/CT in the localization of tumours causing TIO.Patients and MethodsThe study was conducted in a single tertiary referral university teaching hospital in India. Ten patients with TIO who underwent Ga‐68 DOTANOC PET/CT from the time period 2009 to 2014 were included in this study. Their detailed clinical history, biochemical parameters, imaging modalities, surgical interventions, histopathology and outcomes were reviewed.ResultsGa‐68 DOTANOC PET/CT could correctly localize the tumours in TIO in 9 of the 10 cases in which it was performed. Complete resection of the tumour led to full clinical recovery in six of the ten patients; two patients who had partial resection and one patient who underwent radiofrequency ablation showed partial remission. One patient in whom Ga‐68 DOTANOC PET/CT was positive in vertebral body with a low standardized uptake value (SUV) did not show up the tumour on surgery.ConclusionsWe conclude that Ga‐68 DOTANOC PET/CT can be used as the first imaging modality in patients diagnosed with TIO. The extremely good outcome following the resection of these small otherwise undiagnosed tumours far outweighs its cost even in resource limited settings.
Bone grafting materials in critical defects in rabbit calvariae. A systematic review and quality evaluation using ARRIVE guidelines
Authors: Delgado‐Ruiz Rafael Arcesio , Calvo Guirado José Luis , Romanos Georgios E. 
Published: May 2015

AbstractAimsTo perform a systematic literature review of the regenerative potential of bone substitutes used to fill critical size defects (CSDs) in rabbit calvariae; to determine the quality of the included studies using ARRIVE guidelines.Material and methodsAn Internet search was performed in duplicate using MEDLINE, PubMed and Google Scholar databases (without restrictions on publication date) for studies reporting the regenerative potential of bone substitutes in CSDs in rabbit calvariae. Four parameters were analyzed by histomorphometry: new bone formation (NB); defect closure (DC); residual graft (RG); and connective tissue (CT). Animal Research Reporting in In Vivo Experiments (ARRIVE) guidelines (a list of 20 aspects for scoring texts and ensuring comparison between different experimental studies in animals) were used to evaluate the quality of the selected works.ResultsTwenty‐one manuscripts were included. CSDs with 15 mm were predominant (57.14%). Only one study described the four histomorphometric parameters. NB formation was analyzed in 15 studies (71.42%) and was higher for particulate autogenous bone grafts (range 52.1–82%) after 12 weeks. DC was evaluated in six studies (28.57%) and was higher for fragmented adipose tissue grafts (range 53.33–93.33%) after 12 weeks. RG was evaluated in four studies (19.04%) and was higher for hydroxyapatite/beta‐tricalcium phosphate grafts with silica (HA/ß‐TCP + Si) (range 35.78–47.54%) at 12 weeks. CT was evaluated in two studies (9.5%) and was higher for HA/ß‐TCP + membrane (44.2%) at 12 weeks. Quality evaluation identified three items (title, introduction/objectives and experimental procedure) (15%) with excellent scores, 10 items (abstract, introduction/background, methods/ethical statement, experimental animals, experimental outcomes, statistics, results/baseline data, outcome/estimation and discussion interpretation/scientific implications) (50%) with average scores, and seven items (housing and husbandry, sample size, allocation, numbers analyzed, adverse effects, general applicability/relevance and funding) (35%) obtained poor scores. Only one manuscript obtained a quality evaluation considered as excellent.ConclusionsAutogenous bone grafts increase NB. DC is enhanced by the use of fragmented adipose tissue. RG remains in the defect for longer when hydroxyapatite/beta‐tricalcium phosphate with silica is used, and more CT can be expected when hydroxyapatite/beta‐tricalcium phosphate with silica grafts are covered by a membrane. The addition of stem cells of different origins to grafting materials enhances bone formation in early healing periods. The ARRIVE guidelines are still insufficiently used and the overall quality of studies remains low.
Peroxynitrite Decomposition Catalyst Reduces Delayed Thrombolysis‐induced Hemorrhagic Transformation in Ischemia‐reperfused Rat Brains
Authors: Chen Han‐Sen , Chen Xing‐Miao , Feng Jing‐Han , Liu Ke‐Jian , Qi Su‐Hua , Shen Jian‐Gang 
Published: May 2015

SummaryAimHemorrhagic transformation (HT) is a major complication of delayed tissue plasminogen activator (t‐PA) treatment in ischemic stroke. We aimed to explore whether peroxynitrite decomposition catalyst (PDC) could prevent such complication.MethodsMale Sprague‐Dawley (SD) rats were subjected to middle cerebral artery occlusion (MCAO) with t‐PA (10 mg/kg) or t‐PA plus FeTMPyP (3 mg/kg, a representative PDC) at MCAO for 2 or 5 h and reperfusion for 22 or 19 h, respectively. HT was assessed with hemoglobin assay. Neurological deficit was evaluated with Modified Neurological Severity Score (mNSS). Peroxynitrite formation was examined by detecting 3‐nitrotyrosine (3‐NT) formation. The expression and activity of MMP‐9/MMP‐2 were assessed by Western blotting and gelatin zymography.Resultst‐PA treatment at 2 h of MCAO did not induce HT but attenuated neurological deficit, whereas treatment at 5 h significantly induced HT and worsened the neurological outcome. Such complications were prevented by FeTMPyP cotreatment. Early t‐PA treatment inhibited 3‐NT and MMP‐9/MMP‐2 expression, whereas delayed treatment induced 3‐NT and MMP‐9/MMP‐2 expression and activity. FeTMPyP cotreatment downregulated 3‐NT and inhibited MMP‐9/MMP‐2 in both time points.ConclusionPeroxynitrite decomposition catalyst could prevent hemorrhagic transformation and improve neurological outcome ischemic rat brains with delayed t‐PA treatment via inhibiting peroxynitrite‐mediated MMP activation.
Scenarios of large mammal loss in Europe for the 21st century
Authors: Rondinini Carlo , Visconti Piero 
Published: May 2015

AbstractDistributions and populations of large mammals are declining globally, leading to an increase in their extinction risk. We forecasted the distribution of extant European large mammals (17 carnivores and 10 ungulates) based on 2 Rio+20 scenarios of socioeconomic development: business as usual and reduced impact through changes in human consumption of natural resources. These scenarios are linked to scenarios of land‐use change and climate change through the spatial allocation of land conversion up to 2050. We used a hierarchical framework to forecast the extent and distribution of mammal habitat based on species’ habitat preferences (as described in the International Union for Conservation of Nature Red List database) within a suitable climatic space fitted to the species’ current geographic range. We analyzed the geographic and taxonomic variation of habitat loss for large mammals and the potential effect of the reduced impact policy on loss mitigation. Averaging across scenarios, European large mammals were predicted to lose 10% of their habitat by 2050 (25% in the worst‐case scenario). Predicted loss was much higher for species in northwestern Europe, where habitat is expected to be lost due to climate and land‐use change. Change in human consumption patterns was predicted to substantially improve the conservation of habitat for European large mammals, but not enough to reduce extinction risk if species cannot adapt locally to climate change or disperse.
On how much biodiversity is covered in Europe by national protected areas and by the Natura 2000 network: insights from terrestrial vertebrates
Authors: Maiorano L. , Amori G. , Montemaggiori A. , Rondinini C. , Santini L. , Saura S. , Boitani L. 
Published: May 2015

AbstractThe European Union has made extensive biodiversity conservation efforts with the Habitats and Birds Directives and with the establishment of the Natura 2000 network of protected areas, one of the largest networks of conservation areas worldwide. We performed a gap analysis of the entire Natura 2000 system plus national protected areas and all terrestrial vertebrates (freshwater fish excluded). We also evaluated the level of connectivity of both systems, providing therefore a first estimate of the functionality of the Natura 2000 system as an effective network of protected areas. Together national protected areas and the Natura 2000 network covered more than one‐third of the European Union. National protected areas did not offer protection to 13 total gap species (i.e., species not covered by any protected area) or to almost 300 partial gap species (i.e., species whose representation target is not met). Together the Natura 2000 network and national protected areas left 1 total gap species and 121 partial gap species unprotected. The terrestrial vertebrates listed in the Habitats and Birds Directives were relatively well covered (especially birds), and overall connectivity was improved considerably by Natura 2000 sites that act as stepping stones between national protected areas. Overall, we found that the Natura 2000 network represents at continental level an important network of protected areas that acts as a good complement to existing national protected areas. However, a number of problems remain that are mainly linked to the criteria used to list the species in the Habitats and Birds Directives. The European Commission initiated in 2014 a process aimed at assessing the importance of the Birds and Habitats Directives for biodiversity conservation. Our results contribute to this assessment and suggest the system is largely effective for terrestrial vertebrates but would benefit from further updating of the species lists and field management.
Vulvar dermatoses: a histopathologic review and classification of 183 cases
Authors: Chan May P. , Zimarowski Mary Jane 
Published: May 2015

BackgroundVulvar dermatoses are often difficult to classify due to histopathologic overlap. We aimed to report our experience at a single institution.MethodsA total of 183 non‐neoplastic, non‐infectious vulvar biopsies were reviewed. Associations between histopathologic features and specific diagnoses were analyzed by Chi‐squared tests.ResultsTwenty‐two biopsies (12.0%) showed two concurrent processes. A limited differential rather than a definitive diagnosis was rendered in 15 cases (8.2%). The final diagnoses included lichen sclerosus (LS) (38.8%), lichen simplex chronicus (LSC) (29.0%), eczematous dermatitis (23.0%), Zoon vulvitis (8.2%), non‐specific/resolved dermatitis (5.5%), hidradenitis suppurativa (2.7%), Behçet disease (2.2%), lichen planus (1.6%), ruptured cyst (1.6%), ulcer not‐otherwise‐specified (1.6%), psoriasis (1.1%), radiation dermatitis (1.1%), sebopsoriasis (1.1%), seborrheic dermatitis (1.1%), epidermolytic hyperkeratosis (0.5%) and granular parakeratosis (0.5%). Early LS and Zoon vulvitis were commonly included as part of a differential diagnosis. LS was associated with wiry collagen with lymphocyte entrapment (p = 0.0188). LSC was associated with zones of pale epithelium (p = 0.0084), and often displayed prominent fibroblasts (p = 0.0555). Zoon vulvitis was frequently misdiagnosed, and was associated with basal keratinocytic crowding (p < 0.0001).ConclusionsOur study has determined the relative frequencies of a wide variety of vulvar dermatoses, and identified new diagnostic clues for early LS, LSC and Zoon vulvitis.