bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intraoperative optimization to decrease postoperative PRBC transfusion in children undergoing craniofacial reconstruction
Authors: Nguyen Thanh T. , Lam Humphrey V. , Phillips Maxie , Edwards Clasherrol , Austin Thomas M. 
Published: December 2014

SummaryBackgroundCraniofacial reconstructive surgery for craniosynostosis is associated with large blood loss and intraoperative transfusion. This blood loss may continue through the initial postoperative period, potentially resulting in transfusion postoperatively. The purpose of this study is to determine if there is an association between any modifiable intraoperative factors and postoperative blood transfusion in this patient population.MethodsA cohort of 55 pediatric patients who underwent primary craniofacial reconstruction at Vanderbilt Children's Hospital from January 1, 2013 to April 31, 2014 was analyzed. The authors analyzed 20 different demographic and perioperative variables for statistical associations with postoperative PRBC transfusion using multiple logistic regression with optimal models being selected by Bayesian model averaging.ResultsThe optimal regression model only included initial PACU Hct as a predictor and showed a significant association between this variable and postoperative PRBC transfusion (odds ratio 0.69, 95% CI 0.55–0.87, P = 0.0016). Based on the average decrease in postoperative hematocrit (Hct) and the postoperative transfusion trigger, an initial PACU Hct threshold of 30 was calculated. In our patient sample, an initial PACU Hct above 30 was associated with a 50% decrease in the absolute risk of receiving a PRBC transfusion postoperatively.ConclusionsBased on this retrospective analysis, it may be justifiable to transfuse residual volume from previously exposed intraoperative PRBCs to a Hct above 30 to decrease the likelihood of subsequent blood transfusions from different donors in the postoperative period.
Outcomes in pediatric hepatitis C transplant recipients: Analysis of the UNOS database
Authors: Gupta Meera , Bahirwani Ranjeeta , Levine Matthew H. , Malik Saloni , Goldberg David , Reddy K. Rajender , Shaked Abraham 
Published: December 2014

AbstractHCV may lead to the development of ESLD in late childhood and, consequently, contributes to the need for liver transplantation. The aim of this study was to examine post‐transplant outcomes in HCV‐positive pediatric patients with ESLD from any cause and to determine the impact of the PELD scoring system, introduced in February 2002, on post‐transplant patient and graft survival. A retrospective analysis of the UNOS database from 1994 to 2010 was performed to assess graft and patient survival in pediatric HCV‐seropositive liver transplant recipients. Graft survival and patient survival comparing subjects in the pre‐PELD era and post‐PELD era were analyzed using Kaplan–Meier statistics. Factors associated with survival were identified using Cox regression analysis. Of 120 pediatric HCV transplant recipients, 80 were transplanted in the pre‐PELD era and 40 were transplanted post‐PELD. Median serum total bilirubin, INR, and creatinine were 4.8 mg/dL, 1.6, and 0.7 mg/dL in the pre‐PELD era vs. 5.5 mg/dL, 1.7, and 0.6 mg/mL, respectively, in the post‐PELD era (p NS). One‐yr graft survival in the pre‐PELD vs. post‐PELD era was 65.0% and 89.7%, respectively (p < 0.01); corresponding three‐yr graft survival was 57.3% vs. 76.2% (p = 0.04). One‐yr patient survival in the pre‐PELD vs. post‐PELD era was 79.0% and 97.5%, respectively (p < 0.01); corresponding three‐yr survival was 79.0% vs. 89.4% (p = 0.17). Twenty‐eight patients (23.3%) were retransplanted: 24 (30%) in the pre‐PELD era (median time to retransplant 272 days) and four (10%) in the post‐PELD era (median time to retransplant 586 days). Early follow‐up demonstrates a trend toward improved pediatric HCV liver transplant graft and patient survival in the post‐PELD era. Superior outcomes may be attributed to pretransplant factors, improved surgical technique and better treatment options for HCV infection.
Total laryngectomy pre-operative assessment and education in an Ear, Nose & Throat ward: a best practice implementation project
Authors: Ge Xiangyu , Wang Wei , Zhang Ping , Wu Jiangfang 
Published: December 2014

Executive Summary

Background
Pre-operative assessment and education plays an essential part in perioperative nursing practice. Due to the clinical consequences of total laryngectomy, sufficient pre-operative assessment and education would improve patient's post-operative journey.

Objectives
The aim of this implementation project was to integrate the available evidence of pre-operative assessment and education into practice, and to improve the compliance of best practice to audit criteria, to reduce the incidence of complications.

Methods
This project utilized the audit and feedback model using the Joanna Briggs Institute Practical Application of Clinical Evidence System. This included a baseline audit, feedback and implementation of strategies, and a follow-up cycle. Five evidence based audit criteria were audited in an ear, nose and throat ward of a hospital in Fudan. 32 patients and 29 nursing staff were involved in this project.

Results
Improvements in the compliance rates of all criteria have been shown, ranging from 94% to 100% in the follow up audit cycle.

Conclusions
This project demonstrated an improvement in evidence-based practices in regards to pre-operative education and assessment. Further challenges will focus on developing strategies to sustain these improvements in compliance.
Post-operative care of total laryngectomy patients in the ward: a best practice implementation project
Authors: Wu Peixia 
Published: December 2014

Executive Summary

Objectives
The aim of this project was to improve the local practice of nursing care for total laryngectomy patients in Shanghai Eye & Ear Nose and Throat (ENT) hospital, thereby making a contribution towards improving patient outcomes.

Methods
A baseline audit, change strategy and implementation, then follow-up audit cycle were conducted. Six evidence based criteria identified by the Joanna Briggs Institute were audited in the ENT ward of Eye & ENT Hospital of Fudan University in Shanghai. Fifteen patients and twenty nurses were involved in the baseline audit, and ten patients and twenty nurses in the post implementation audit.

Results
The baseline audit was poor across four of the six criteria. The assessment of patient humidification, hydration, nutrition, and drainage sites was not carried out. Following the implementation of interventions, the post audit cycle achieved a considerable improvement in 5 out of the 6 criteria, with assessment of drainage sites remaining unchanged.

Conclusion
This project assisted in improving evidence-based practices for total laryngectomy patient's post-operative care. Attempts to implement drainage site assessment were unsuccessful. Strategies in sustaining the momentum of compliance are required.
Total laryngectomy discharge planning in an acute hospital setting in China: a best practice implementation project
Authors: Chunyi Gui 
Published: December 2014

Executive Summary

Background
Total laryngectomy patients will meet various kinds of physical and psychosocial problems after the surgery. And the adjustment and rehabilitation of total laryngectomy require the input of skilled members of a multidisciplinary team, especially the specialized nurses. To provide the patients a comprehensive and evidence-based discharge plan is recommended.

Objectives
The aim of this project was to integrate the available evidence of discharge plan for total laryngectomy into practice, and implement strategies to improve compliance with acceptable practice.

Methods
The project carried out a pre- and post-implementation audit procedure using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice programs. Five audit criteria were established according to the available best-evidence on the discharge plan for total laryngectomy. The program was divided into three phases and conducted over five months in the ear, nose and throat ward, ward 7, Eye and Ear Nose and Throat (ENT) Hospital, Fudan University, Shanghai. 8 nurses and 15 patients were involved in baseline audit. 6 nurses and 15 patients were audited in the post-implementation audit.

Results
The post-implementation audit findings revealed a significant improvement in education on discharge for total laryngectomy, as well as in supplying patients with post-laryngectomy care products, and ongoing nursing support after discharge.

Conclusion
The project provided nurses with a good opportunity to receive evidence-based training about total laryngectomy patient education on discharge, and highlighted that providing the patients with evidence-based education after total laryngectomy should be the responsibility of an ear, nose and throat specialist nurse.
Comprehensive MRI simulation methodology using a dedicated MRI scanner in radiation oncology for external beam radiation treatment planning
Authors: Paulson Eric S. , Erickson Beth , Schultz Chris , Allen Li X. 
Published: December 2014

Purpose:The use of magnetic resonance imaging (MRI) in radiation oncology is expanding rapidly, and more clinics are integrating MRI into their radiation therapy workflows. However, radiation therapy presents a new set of challenges and places additional constraints on MRI compared to diagnostic radiology that, if not properly addressed, can undermine the advantages MRI offers for radiation treatment planning (RTP). The authors introduce here strategies to manage several challenges of using MRI for virtual simulation in external beam RTP.Methods:A total of 810 clinical MRI simulation exams were performed using a dedicated MRI scanner for external beam RTP of brain, breast, cervix, head and neck, liver, pancreas, prostate, and sarcoma cancers. Patients were imaged in treatment position using MRI‐optimal immobilization devices. Radiofrequency (RF) coil configurations and scan protocols were optimized based on RTP constraints. Off‐resonance and gradient nonlinearity‐induced geometric distortions were minimized or corrected prior to using images for RTP. A multidisciplinary MRI simulation guide, along with window width and level presets, was created to standardize use of MR images during RTP. A quality assurance program was implemented to maintain accuracy and repeatability of MRI simulation exams.Results:The combination of a large bore scanner, high field strength, and circumferentially wrapped, flexible phased array RF receive coils permitted acquisition of thin slice images with high contrast‐to‐noise ratio (CNR) and image intensity uniformity, while simultaneously accommodating patient setup and immobilization devices. Postprocessing corrections and alternative acquisition methods were required to reduce or correct off‐resonance and gradient nonlinearity induced geometric distortions.Conclusions:The methodology described herein contains practical strategies the authors have implemented through lessons learned performing clinical MRI simulation exams. In their experience, these strategies provide robust, high fidelity, high contrast MR images suitable for external beam RTP.
Open-Label Trial of Immunogenicity and Safety of a 13-Valent Pneumococcal Conjugate Vaccine in Adults ≥50 Years of Age in Mexico
Authors: Tinoco Juan Carlos , Juergens Christine , Ruiz Palacios Guillermo M. , Vazquez-Narvaez Jorge , Enkerlin-Pauwells Hermann Leo , Sundaraiyer Vani , Pathirana Sudam , Kalinina Elena , Gruber William C. , Scott Daniel A. , Schmoele-Thoma Beate 
Published: December 2014

ABSTRACTThis open-label multicenter clinical trial conducted in Mexico assessed the immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine (PCV13) in adults ≥50 years of age not previously vaccinated with the 23-valent pneumococcal polysaccharide vaccine (PPSV23). The PCV13 elicited a robust immune response in this study population, as reflected by the magnitude of fold rises in functional antibody levels measured by serotype-specific opsonophagocytic activity (OPA) assays before and 1 month after vaccination. Although the prevaccination OPA geometric mean titers (GMTs) for the majority of the serotypes were significantly lower in the 50- to 64-year age group than those in the ≥65-year age group, the postvaccination immune responses were generally similar. The overall immune responses were higher for the majority of the serotypes in the Mexican study population than those in similar adult study populations who received the PCV13 in Europe and the United States. PCV13 was well tolerated, and there were no vaccine-related serious adverse events. In conclusion, PCV13 is safe and immunogenic when administered to adults ≥50 years of age in Mexico and has the potential to protect against vaccine-type pneumococcal disease. (This study has been registered at ClinicalTrials.gov under registration no. NCT01432262.)
Geographically Distinct Escherichia coli O157 Isolates Differ by Lineage, Shiga Toxin Genotype, and Total Shiga Toxin Production
Authors: Mellor Glen E. , Fegan Narelle , Gobius Kari S. , Smith Helen V. , Jennison Amy V. , D'Astek Beatriz A. , Rivas Marta , Shringi Smriti , Baker Katherine N. K. , Besser Thomas E. 
Published: December 2014

ABSTRACT

While the differential association of
Escherichia coli
O157 genotypes with animal and human hosts has recently been well documented, little is known about their distribution between countries and how this might affect regional disease rates. Here, we used a 48-plex single nucleotide polymorphism (SNP) assay to segregate 148
E. coli
O157 isolates from Australia, Argentina, and the United States into 11 SNP lineages. We also investigated the relationship between SNP lineages, Shiga toxin (Stx) gene profiles, and total Stx production.
E. coli
O157 isolates clearly segregated into SNP lineages that were differentially associated with each country. Of the 11 SNP lineages, seven were detected among isolates from a single country, two were detected among isolates from all three countries, and another two were detected only among U.S. and Argentinean isolates. A number of Australian (30%) and Argentinean (14%) isolates were associated with novel, previously undescribed SNP lineages that were unique to each country. Isolates within SNP lineages that were strongly associated with the carriage of
stx
2a
produced comparatively more Stx on average than did those lacking the
stx
2a
subtype. Furthermore, the proportion of isolates in
stx
2a
-associated SNP lineages was significantly higher in Argentina and the United States than Australia (
P
< 0.05). This study provides evidence for the geographic divergence of
E. coli
O157 and for a prominent role of
stx
2a
in total Stx production. These results also highlight the need for more comprehensive studies of the global distribution of
E. coli
O157 lineages and the impacts of regionally predominant
E. coli
O157 lineages on the prevalence and severity of disease.
Improved Detection of Staphylococcus intermedius Group in a Routine Diagnostic Laboratory
Authors: Lee John , Murray Aimee , Bendall Richard , Gaze William , Zhang Lihong , Vos Michiel 
Published: December 2014

ABSTRACT

The
Staphylococcus intermedius
group (SIG) includes zoonotic pathogens traditionally associated with dog bites. We describe a simple scheme for improved detection of SIG using routine laboratory methods, report its effect on isolation rates, and use sequencing to confirm that, apart from one atypical SIG strain, most isolates are
Staphylococcus pseudintermedius
.
Equal Performance of Self-Collected and Health Care Worker-Collected Pharyngeal Swabs for Group A Streptococcus Testing by PCR
Authors: Murray Martha A. , Schulz Lorie A. , Furst Joseph W. , Homme Jason H. , Jenkins Sarah M. , Uhl James R. , Patel Robin , Cockerill Franklin C. , Myers Jane F. , Pritt Bobbi S. 
Published: December 2014

ABSTRACT

A process employing patient- or parent-collected pharyngeal swabs for group A
Streptococcus
(GAS) testing would expedite diagnosis and treatment, reduce patient exposure to the health care setting, and decrease health care costs. Our aim was to determine the concordance between patient- or parent-collected (self-collected) and health care worker (HCW)-collected pharyngeal swabs for detection of GAS by PCR. From 9 October 2012 to 21 March 2013, patients presenting with a sore throat meeting criteria for GAS testing and not meeting criteria for severe disease were offered the opportunity to collect their own pharyngeal swab. The HCW also collected a swab. Paired swabs were tested by GAS real-time PCR, allowing semiquantitative comparisons between positive results. Of the 402 participants, 206 had a swab collected by the patient and 196 a swab collected by the parent. The percent positivity results were 33.3% for HCW-collected swabs and 34.3% for self-collected swabs (
P
= 0.41). The overall concordance between the two collection strategies was 94.0% (95% confidence interval [CI], 91.3 to 96.0). Twenty-four of the paired swabs had discordant results, with 10 and 14 positives detected only with the HCW- and self-collected swabs, respectively (
P
= 0.41). The person collecting the swab in the self-collected arm, the order of collection, and prior swab collection training did not influence results. Among the 124 specimens that were positive by both collection methods, the amount of GAS DNA was higher in the self-collected versus the HCW-collected swabs (
P
= 0.008). Self-collected pharyngeal swabs provide a reliable alternative to HCW collection for detection of GAS and offer a strategy for improved health care delivery.
Nonstructural Protein 1-Specific Immunoglobulin M and G Antibody Capture Enzyme-Linked Immunosorbent Assays in Diagnosis of Flaviviral Infections in Humans
Authors: Chao Day-Yu , Galula Jedhan Ucat , Shen Wen-Fan , Davis Brent S. , Chang Gwong-Jen J. 
Published: December 2014

ABSTRACT
IgM antibody- and IgG antibody-capture enzyme-linked immunosorbent assays (MAC/GAC-ELISAs) targeted at envelope protein (E) of dengue viruses (DENV), West Nile virus, and Japanese encephalitis virus (JEV) are widely used as serodiagnostic tests for presumptive confirmation of viral infection. Antibodies directed against the flavivirus nonstructural protein 1 (NS1) have been proposed as serological markers of natural infections among vaccinated populations. The aim of the current study is to optimize an IgM and IgG antibody-capture ELISA (MAC/GAC-ELISA) to detect anti-NS1 antibodies and compare it with anti-E MAC/GAC-ELISA. Plasmids to express premembrane/envelope (prM/E) or NS1 proteins of six medically important flaviviruses, including dengue viruses (DENV-1 to DENV-4), West Nile virus (WNV), and Japanese encephalitis virus (JEV), were constructed. These plasmids were used for the production of prM/E-containing virus-like particles (VLPs) and secreted NS1 (sNS1) from COS-1 cells. Archived clinical specimens from patients with confirmed DENV, JEV, and WNV infections, along with naive sera, were subjected to NS1-MAC/GAC-ELISAs before or after depletion of anti-prM/E antibodies by preabsorption with or without VLPs. Human serum specimens from previously confirmed DENV infections showed significantly enhanced positive-to-negative (P/N) ratios for NS1-MAC/GAC-ELISAs after the depletion of anti-prM/E antibodies. No statistical differences in sensitivities and specificities were found between the newly developed NS1- and VLP-MAC/GAC-ELISAs. Further application of the assays to WNV- and JEV-infected serum panels showed similar results. A novel approach to perform MAC/GAC-ELISAs for NS1 antibody detection was successfully developed with great potential to differentiate antibodies elicited by the tetravalent chimeric yellow fever-17D/dengue vaccine or DENV infection.
First Report of an Infant Botulism Case Due to Clostridium botulinum Type Af
Authors: de Jong Laura I. T. , Fernández Rafael A. , Pareja Virtudes , Giaroli Gabriel , Guidarelli Sergio R. , Dykes Janet K. , Lúquez Carolina 
Published: December 2014

ABSTRACT

Most infant botulism cases worldwide are due to botulinum toxin types A and B. Rarely,
Clostridium botulinum
strains that produce two serotypes (Ab, Ba, and Bf) have also been isolated from infant botulism cases. This is the first reported case of infant botulism due to
C. botulinum
type Af worldwide.
Identification and Susceptibility of Aspergillus Section Nigri in China: Prevalence of Species and Paradoxical Growth in Response to Echinocandins
Authors: Li Yali , Wan Zhe , Liu Wei , Li Ruoyu 
Published: December 2014

ABSTRACT

Molecular identification and
in vitro
antifungal susceptibility tests of 43
Aspergillus
section
Nigri
isolates from China were performed.
Aspergillus niger
and
Aspergillus tubingensis
were present in almost equal numbers. All of the isolates had low MIC/MECs (minimum effective concentrations) for the 7 common antifungals, and a paradoxical effect was observed for the first time in response to caspofungin and micafungin.
The Nucleoprotein of Newly Emerged H7N9 Influenza A Virus Harbors a Unique Motif Conferring Resistance to Antiviral Human MxA
Authors: Riegger David , Hai Rong , Dornfeld Dominik , Mänz Benjamin , Leyva-Grado Victor , Sánchez-Aparicio Maria T , Albrecht Randy A. , Palese Peter , Haller Otto , Schwemmle Martin , García-Sastre Adolfo , Kochs Georg , Schmolke Mirco 
Published: December 2014

ABSTRACT

Interferon-induced Mx proteins show strong antiviral activity against influenza A viruses (IAVs). We recently demonstrated that the viral nucleoprotein (NP) determines resistance of seasonal and pandemic human influenza viruses to Mx, while avian isolates retain Mx sensitivity. We identified a surface-exposed cluster of amino acids in NP of pandemic A/BM/1/1918 (H1N1), comprising isoleucine-100, proline-283, and tyrosine-313, that is essential for reduced Mx sensitivity in cell culture and
in vivo
. This cluster has been maintained in all descendant seasonal strains, including A/PR/8/34 (PR/8). Accordingly, two substitutions in the NP of PR/8 [PR/8(mut)] to the Mx-sensitive amino acids (P283L and Y313F) led to attenuation in Mx1-positive mice. Serial lung passages of PR/8(mut) in Mx1 mice resulted in a single exchange of tyrosine to asparagine at position 52 in NP (in close proximity to the amino acid cluster at positions 100, 283, and 313), which partially compensates loss of Mx resistance in PR/8(mut). Intriguingly, the NP of the newly emerged avian-origin H7N9 virus also contains an asparagine at position 52 and shows reduced Mx sensitivity. N52Y substitution in NP results in increased sensitivity of the H7N9 virus to human Mx, indicating that this residue is a determinant of Mx resistance in mammals. Our data strengthen the hypothesis that the human Mx protein represents a potent barrier against zoonotic transmission of avian influenza viruses. However, the H7N9 viruses overcome this restriction by harboring an NP that is less sensitive to Mx-mediated host defense. This might contribute to zoonotic transmission of H7N9 and to the severe to fatal outcome of H7N9 infections in humans.

IMPORTANCE
The natural host of influenza A viruses (IAVs) are aquatic birds. Occasionally, these viruses cross the species barrier, as in early 2013 when an avian H7N9 virus infected humans in China. Since then, multiple transmissions of H7N9 viruses to humans have occurred, leaving experts puzzled about molecular causes for such efficient crossing of the species barrier compared to other avian influenza viruses. Mx proteins are known restriction factors preventing influenza virus replication. Unfortunately, some viruses (e.g., human IAV) have developed some resistance, which is associated with specific amino acids in their nucleoproteins, the target of Mx function. Here, we demonstrate that the novel H7N9 bird IAV already carries a nucleoprotein that overcomes the inhibition of viral replication by human MxA. This is the first example of an avian IAV that is naturally less sensitive to Mx-mediated inhibition and might explain why H7N9 viruses transmitted efficiently to humans.