bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sustaining Clinical Programs During Difficult Economic Times: A Case Series from the Hospital Elder Life Program
Authors: SteelFisher Gillian K. , Martin Lauren A. , Dowal Sarah L. , Inouye Sharon K. 
Published: September 2011

ObjectivesTo explore strategies used by clinical programs to justify operations to decision‐makers using the example of the Hospital Elder Life Program (HELP), an evidence‐based, cost‐effective program to improve care for hospitalized older adults.DesignQualitative study design using 62 in‐depth, semistructured interviews conducted with HELP staff members and hospital administrators between September 2008 and August 2009.SettingNineteen HELP sites in hospitals across the United States and Canada that had been recruiting patients for at least 6 months.ParticipantsHELP staff and hospital administrators.MeasurementsParticipant experiences sustaining the program in the face of actual or perceived financial threats, with a focus on factors they believe are effective in justifying the program to decision‐makers in the hospital or health system.ResultsUsing the constant comparative method, a standard qualitative analysis technique, three major themes were identified across interviews. Each focuses on a strategy for successfully justifying the program and securing funds for continued operations: interact meaningfully with decision‐makers, including formal presentations that showcase operational successes and informal means that highlight the benefits of HELP to the hospital or health system; document day‐to‐day, operational successes in metrics that resonate with decision‐maker priorities; and garner support from influential hospital staff that feed into administrative decision‐making, particularly nurses and physicians.ConclusionAs clinical programs face financially challenging times, it is important to find effective ways to justify their operations to decision‐makers. Strategies described here may help clinically effective and cost‐effective programs sustain themselves and thus may help improve care in their institutions.
Detection of bacterial contamination in prestorage culture‐negative apheresis platelets on day of issue with the Pan Genera Detection test
Authors: Jacobs Michael R. , Smith Daniel , Heaton W. Andrew , Zantek Nicole D. , Good Caryn E. ,   PGD Study Group
Published: September 2011

BACKGROUND: Bacterial contamination is currently the most important infectious risk associated with transfusion of platelet (PLT) products. Prestorage culture has reduced but not eliminated this problem.STUDY DESIGN AND METHODS: Eighteen hospitals studied the Pan Genera Detection (PGD) test, a rapid, lateral‐flow immunoassay for the detection of Gram‐positive and Gram‐negative bacteria. The PGD test was performed on day of issue on apheresis PLTs released by collection centers as culture negative. Confirmatory bacterial culture was performed when PGD tests were repeatedly reactive, with three sites performing culture on all doses studied.RESULTS: PGD tests on nine of 27,620 (1:3069, 95% confidence interval [CI] 1:6711 to 1:1617; or 326 per million, 95% CI 149‐618 per million) apheresis PLT doses were repeatedly reactive and verified as bacterially contaminated by confirmatory culture. Bacterial species isolated included coagulase‐negative staphylococci (n = 6), Bacillus sp. (n = 2), and Enterococcus faecalis (n = 1). The ages of these contaminated doses were Day 3 (n = 4), Day 4 (n = 2), and Day 5 (n = 3). Two contaminated doses with nonreactive PGD tests were detected among 10,424 doses at hospitals where concurrent culture was performed, and one other was identified via a transfusion reaction investigation. There were 142 PGD false positives (0.51%).CONCLUSIONS: The PGD test detected bacterial contamination in 1:3069 (9 of 27,620) doses released as negative by prestorage culture in PLTs as young as 3 days old. Three contaminated doses, two clinically insignificant, had nonreactive PGD tests, while 0.51% of tests were false positives. Application of this test on day of issue can interdict contaminated units and prevent transfusion reactions.
Proteomic analyses of human plasma: Venus versus Mars
Authors: Silliman Christopher C. , Dzieciatkowska Monika , Moore Ernest E. , Kelher Marguerite R. , Banerjee Anirban , Liang Xiayuan , Land Kevin J. , Hansen Kirk C. 
Published: September 2011

BACKGROUND: Plasma is vital for the resuscitation of injured patients and to restore necessary procoagulants, especially Factors (F)II, FV, FVII, FX, and FXIII; however, female plasma has been implicated in the majority of transfusion‐related acute lung injury (TRALI) cases and male‐only plasma transfusion regimens have significantly decreased the incidence of TRALI. Little is known about the human plasma proteome, and no comparisons have been made between male and female plasma; therefore, we hypothesize that there are significant differences between plasma from male and female donors.STUDY DESIGN AND METHODS: Five units of fresh‐frozen plasma each were collected from nulliparous female donors and male donors, and the proteome was analyzed by depleting the 14 most common proteins by immunoaffinity columns followed by protein separation by one dimension gel electrophoresis, tryptic digestion of the proteins, analysis of the peptides by liquid chromatography–tandem mass spectrometry, and identification employing human protein sequence databases.RESULTS: Female plasma versus male plasma contained pregnancy zone protein (419‐ to 580‐fold), FV (twofold), α1‐antitrypsin (twofold), β2‐microglobulin (twofold), and Complement Factors H and C4B (1.5‐ to 2‐fold) at significantly higher concentrations than males and males contained significant increases in Fc‐binding protein (twofold), protein Z–dependent protease inhibitor (twofold), phosphatidylinositol glycan–specific phospholipase (fourfold), protein S‐100 (threefold), and transgelin‐2 (14‐fold) versus females (p < 0.005). The increases in FV, α1‐antitrypsin, and β2‐microglobulin were confirmed by an activity assay or immunoblots.CONCLUSION: We conclude that there are proteomic differences between male and female plasma, which could be exploited to improve clinical outcomes in transfused patients.
Storage of thawed plasma for a liquid plasma bank: impact of temperature and methylene blue pathogen inactivation
Authors: Thiele Thomas , Kellner Sarah , Hron Gregor , Wasner Christina , Nauck Matthias , Zimmermann Kathrin , Wessel Antje , Warkentin Theodore E. , Greinacher Andreas , Selleng Kathleen 
Published: September 2011

BACKGROUND: Rapid transfusion of fresh‐frozen plasma (FFP) is desired for treating coagulopathies, but thawing and issuing of FFP takes more than 40 minutes. Liquid storage of plasma is a potential solution but uncertainties exist regarding clotting factor stability. We assessed different storage conditions of thawed FFP and plasma treated by methylene blue plus light (MB/light) for pathogen inactivation.STUDY DESIGN AND METHODS: Fifty thawed apheresis plasma samples (approx. 750 mL) were divided into three subunits and either stored for 7 days at 4°C, at room temperature (RT), and at 4°C after MB/light treatment. Clotting factor activities (Factor [F] II, FV, FVII through FXIII, fibrinogen, antithrombin, von Willebrand factor antigen, Protein C and S) were assessed after thawing and on Days 3, 5, and 7. Changes were classified as “minor” (activities within the reference range) and “major” (activities outside the reference range).RESULTS: FFP storage at 4°C revealed major changes for FVIII (median [range], 56% [33%‐114%]) and Protein S (51% [20%‐88%]). Changes were more pronounced when plasma was stored at RT (FVIII, 59% [37%‐123%]; FVII, 69% [42%‐125%]; Protein S, 20% [10%‐35%]). MB/light treatment of thawed FFP resulted in minor changes. However, further storage for 7 days at 4°C revealed major decreases for FVIII (47% [12%‐91%]) and Protein S (49% [18%‐95%]) and increases for FVII (150% [48%‐285%]) and FX (126% [62%‐206%]).CONCLUSION: Storage of liquid plasma at 4°C for 7 days is feasible for FFP as is MB/light treatment of thawed plasma. In contrast, storage of thawed plasma for 7 days at RT or after MB/light treatment at 4°C affects clotting factor stability substantially and is not recommended.
The Impact of Pharmacologic Sympathetic and Parasympathetic Blockade on Atrial Electrogram Characteristics in Patients with Atrial Fibrillation
Authors: HABEL NICOLE , MÜLLER JOACHIM G. , ZNOJKIEWICZ PIERRE , THOMPSON NATHANIEL , CALAME JAMES , CALAME SUSAN , NOORI ARSHIA , GALLO ANNEMARIE , LUSTGARTEN DANIEL L. , SOBEL BURTON E. , SPECTOR PETER S. 
Published: September 2011

Background:
Ablation of atrial autonomic inputs exerts antifibrillatory effects. However, because ablation destroys both myocardium and nerve cells, the effect of autonomic withdrawal alone remains unclear. We therefore examined the effects of pharmacologic autonomic blockade (PAB) on frequency and fractionation in patients with atrial fibrillation (AF).
Methods:
Esmolol and atropine were administered and electrograms were recorded simultaneously from both atria and the coronary sinus. In 17 patients, AF was recorded for 5 minutes and dominant frequency (DF) and continuous activity (CA) were compared before and during PAB.
Results:
Examination of the pooled data (537 sites, 17 patients) revealed a statistically significant decrease in mean DF (5.61–5.43Hz, P < 0.001) during PAB. Site‐by‐site analysis showed that 67% of sites slowed (0.45 ± 0.59 Hz), whereas 32% accelerated (0.49 ± 0.59Hz). Fractionation was reduced: median CA decreased from 31% to 26% (P < 0.001). In patient‐by‐patient analysis, mean DF/median CA decreased in 13 of 17 patients and increased in four. The spatial heterogeneity of DF decreased in nine of 17 patients (spatial coefficient of variation of DF at “nondriver sites” decreased by a mean of 2%).
Conclusion:
PAB decreases DF and CA in the majority of sites. Given the complexity of interactions between atrial cells during AF, the effects of PAB on DF and fractionation are more heterogeneous than the effects of PAB on isolated cells. (PACE 2011; 34:1460–1467)
Electrochemical Properties and Intermediate‐Temperature Fuel Cell Performance of Dense Yttrium‐Doped Barium Zirconate with Calcium Addition
Authors: Sun Ziqi , Fabbri Emiliana , Bi Lei , Traversa Enrico 
Published: September 2011

Although BaZr0.8Y0.2O3−δ (BZY) possesses large bulk proton conductivity and excellent chemical stability, its poor sinterability and grain boundaries block proton conduction. In this work, the effect of Ca as a co‐dopant and as a sintering aid (as CaO), on the sinterability, proton conductivity, and fuel cell performance of BZY was investigated. The addition of 4 mol% CaO significantly improved the BZY sinterability: BZY pellets with densities of 92.7% and 97.5% with respect to the theoretical density were obtained after sintering at 1500°C and 1600°C, respectively. The improved BZY sinterability by CaO addition resulted also in a large proton conductivity; at 600°C, the total conductivity of BZY–CaO was 2.14 × 10−3 S/cm, in wet Ar. Anode‐supported fuel cells with 25 μm‐thick BZY–CaO electrolyte membranes were fabricated by a dual‐layer co‐firing technique. The peak power density of the fuel cell with a BZY–Ni/BZY–4CaO/BZY–LSCF (La0.6Sr0.4Fe0.8Co0.2O3−δ) configuration was 141 mW/cm2 at 700°C, several times larger than the reported values of BZY electrolyte membrane fuel cells sintered with the addition of CuO or ZnO, demonstrating promising features for practical fuel cell applications.
Enhanced Grain Boundary Mobility in Yttria‐Stabilized Cubic Zirconia under an Electric Current
Authors: Kim Seung‐Wan , Kim Soo Gil , Jung Jae‐Il , Kang Suk‐Joong L. , Chen I‐Wei 
Published: September 2011

Grain growth in 8 mol% Y2O3‐stabilized zirconia ceramics (8YSZ) under an electric current has been investigated. Enhanced grain growth on the cathode side starts at 1150°C, well below the conventional sintering temperature, while grain growth is dormant on the anode side until 1400°C. In fully dense samples, the grain size undergoes an abrupt transition, differing by a factor of more than 10 on the two sides. Porous samples also experience faster densification on the cathode side, but grain growth is postponed until full density is first reached. Estimated grain boundary diffusivity on the cathode side has an apparent activation energy about 1 eV lower than that of normal grain boundary diffusion. These results are attributed to supersaturated oxygen vacancies accumulated on the cathode side, causing cation reduction that lowers their migration barrier.
The Correlation between Spurling Test and Imaging Studies in Detecting Cervical Radiculopathy
Authors: Shabat Shay , Leitner Yossi , David Rami , Folman Yoram 
Published: September 2011

ABSTRACTBACKGROUNDCervical spine symptoms are a major cause of visits to general or spinal orthopedic surgeons or even primary care physicians. Although in this era the imaging studies can precisely rule out or diagnose pathologies in the spine, all of these studies have limitations. Computerized tomography (CT) scan consists of radiation exposure to the patients and it should be done with caution. Magnetic resonance imaging (MRI) is a highly effective imaging tool, but in many countries it is still costly. The goal of our study was to determine whether a simple clinical test can help the clinician to identify the patients who need to be sent for these imaging studies.METHODSTwo hundred fifty‐seven patients with clinical cervical radiculopathy underwent complete physical examination that also included the Spurling test. After that, all patients were sent to imaging studies of the cervical spine (CT and/or MRI). Correlation between the physical examination using the Spurling test to the imaging studies was done.RESULTSSensitivity of the Spurling test to nerve root pathology was 95% and specificity was 94%.CONCLUSIONThis paper demonstrate that patients with positive Spurling test have probable nerve root pressure and should be sent for further imaging studies. In patients with negative Spurling test, the possibility of nerve root pressure is less likely.
A Prospective Comparison of Procedural Sedation and Ultrasound‐guided Interscalene Nerve Block for Shoulder Reduction in the Emergency Department
Authors: Blaivas Michael , Adhikari Srikar , Lander Lina 
Published: September 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:922–927 © 2011 by the Society for Academic Emergency MedicineAbstractObjectives: Emergency physicians (EPs) are beginning to use ultrasound (US) guidance to perform regional nerve blocks. The primary objective of this study was to compare length of stay (LOS) in patients randomized to US‐guided interscalene block or procedural sedation to facilitate reduction of shoulder dislocation in the emergency department (ED). The secondary objectives were to compare one‐on‐one health care provider time, pain experienced by the patient during reduction, and patient satisfaction between the two groups.Methods: This was a prospective, randomized study of patients presenting to the ED with shoulder dislocation. The study was conducted at an academic Level I trauma center ED with an annual census of approximately 80,000. Patients were eligible for the study if they were at least 18 years of age and required reduction of a shoulder dislocation. A convenience sample of patients was randomized to either traditional procedural sedation or US‐guided interscalene nerve block. Procedural sedation was performed with etomidate as the sole agent. Interscalene blocks were performed by hospital‐credentialed EPs using sterile technique and a SonoSite MicroMaxx US machine with a high‐frequency linear array transducer. Categorical variables were evaluated using Fisher’s exact test, and continuous variables were analyzed using the Wilcoxon rank sum test.Results: Forty‐two patients were enrolled, with 21 patients randomized to each group. The groups were not significantly different with respect to sex or age. The mean (±SD) LOS in the ED was significantly higher in the procedural sedation group (177.3 ± 37.9 min) than in the US‐guided interscalene block group (100.3 ± 28.2 minutes; p < 0.0001). The mean (±SD) one‐on‐one health care provider time was 47.1 (±9.8) minutes for the sedation group and 5 (±0.7) minutes for the US‐guided interscalene block group (p < 0.0001). There was no statistically significant difference between the two groups in patient satisfaction or pain experienced during the procedure. There were no significant differences between groups with respect to complications such as hypoxia or hypotension (p = 0.49).Conclusions: In this study, patients undergoing shoulder dislocation reduction using US‐guided interscalene block spent less time in the ED and required less one‐on‐one health care provider time compared to those receiving procedural sedation. There was no difference in pain level or satisfaction when compared to procedural sedation patients.
Altered distribution of interstitial cells and innervation in the rat urinary bladder following spinal cord injury
Authors: Johnston Louise , Cunningham Rebecca M.J. , Young John S. , Fry Christopher H. , McMurray Gordon , Eccles Rachel , McCloskey Karen D. 
Published: September 2011

AbstractChanges in the distribution of interstitial cells (IC) are reportedly associated with dysfunctional bladder. This study investigated whether spinal cord injury (SCI) resulted in changes to IC subpopulations (vimentin‐positive with the ultrastructural profile of IC), smooth muscle and nerves within the bladder wall and correlated cellular remodelling with functional properties. Bladders from SCI (T8/9 transection) and sham‐operated rats 5 weeks post‐injury were used for ex vivo pressure–volume experiments or processed for morphological analysis with transmission electron microscopy (TEM) and light/confocal microscopy. Pressure‐volume relationships revealed low‐pressure, hypercompliance in SCI bladders indicative of decompensation. Extensive networks of vimentin‐positive IC were typical in sham lamina propria and detrusor but were markedly reduced post‐SCI; semi‐quantitative analysis showed significant reduction. Nerves labelled with anti‐neurofilament and anti‐vAChT were notably decreased post‐SCI. TEM revealed lamina propria IC and detrusor IC which formed close synaptic‐like contacts with vesicle‐containing nerve varicosities in shams. Lamina propria and detrusor IC were ultrastructurally damaged post‐SCI with retracted/lost cell processes and were adjacent to areas of cellular debris and neuronal degradation. Smooth muscle hypertrophy was common to SCI tissues. In conclusion, IC populations in bladder wall were decreased 5 weeks post‐SCI, accompanied with reduced innervation, smooth muscle hypertrophy and increased compliance. These novel findings indicate that bladder wall remodelling post‐SCI affects the integrity of interactions between smooth muscle, nerves and IC, with compromised IC populations. Correlation between IC reduction and a hypercompliant phenotype suggests that disruption to bladder IC contribute to pathophysiological processes underpinning the dysfunctional SCI bladder.
Everolimus is an active agent in medullary thyroid cancer: a clinical and in vitro study
Authors: Faggiano A. , Ramundo V. , Dicitore A. , Castiglioni S. , Borghi M. O. , Severino R. , Ferolla P. , Crinò L. , Abbruzzese A. , Sperlongano P. , Caraglia M. , Ferone D. , Hofland L. , Colao A. , Vitale G. 
Published: September 2011

AbstractEverolimus, an mTOR inhibitor, which has been demonstrated to induce anti‐tumour effects in different types of neuroendocrine tumours, has never been evaluated in patients with medullary thyroid cancer (MTC). The aim of this study was to evaluate the in vitro and in vivo effects of everolimus in combination with octreotide in MTC. Two patients with progressive metastatic MTC and high calcitonin levels were treated with everolimus 5–10 mg/day. Both patients were under treatment with octreotide LAR at the study entry. An in vitro study was also performed to assess everolimus effects on MTC cell lines (TT and MZ‐CRC‐1 cells). A tumour response was observed in both patients. Serum calcitonin decreased by 86% in patient 1 and by 42% in patient 2. In TT and MZ‐CRC‐1 cells, everolimus induced a significant dose‐dependent inhibition in cell proliferation. This effect seems to be related to a cell cycle arrest in G0/G1 phase in both cell lines and to the induction of cellular senescence in TT cells. Everolimus in combination with octreotide may be active as anti‐tumour therapy in patients with progressive metastatic MTC, suggesting to further evaluate this agent in MTC patients in a large prospective study.
Myxoma of the ear lobe in a 23‐month‐old girl with Carney complex
Authors: Briassoulis George , Quezado Martha , Lee Chyi‐Chia Richard , Xekouki Paraskevi , Keil Meg , Stratakis Constantine A. 
Published: September 2011

Myxomas of the ear are extremely uncommon, especially in young children. A 23‐month‐old girl born to a family with known Carney complex, a condition that predisposes to multiple myxomas, presented with a large, cauliflower‐like mass located on the back of her right ear. Histopathologically, the lesion was composed of scattered spindle‐shaped or stellate cells with abundant associated mucin and a very sparse inflammatory infiltrate containing lymphocytes and neutrophils. The patient was a carrier of a protein kinase A regulatory subunit 1A (PRKAR1A) mutation; PRKAR1A mutations cause Carney complex in most patients with this rare disorder. This is the earliest presentation of an ear lobe myxoma reported in the literature.Briassoulis G, Quezado M, Lee C‐CR, Xekouki P, Keil M, Stratakis CA. Myxoma of the ear lobe in a 23‐month‐old girl with Carney complex.
A novel gene required for natural competence in Aggregatibacter actinomycetemcomitans
Authors: Tanaka A. , Fujise O. , Chen C. , Miura M. , Hamachi T. , Maeda K. 
Published: September 2011

Tanaka A, Fujise O, Chen C, Miura M, Hamachi T, Maeda K. A novel gene required for natural competence inAggregatibacter actinomycetemcomitans. J Periodont Res 2012; 47: 129–134. © 2011 John Wiley & Sons A/SBackground and Objective:  Natural competence is the ability of bacteria to take up extracellular DNA and incorporate it into their genomes. Some strains of Aggregatibacter actinomycetemcomitans, a critical periodontal pathogen, are naturally competent for transformation. However, information on natural competence genes is limited for this species. The aim of this study was to confirm the involvement of a novel gene identified near the fimbriae gene cluster in natural competence.Material and Methods:  The functions of putative open reading frames (ORFs), designated AA00863–AA00865, in the Oralgen project database for A. actinomycetemcomitans strain HK1651, have not been determined. Using naturally transformable A. actinomycetemcomitans strains D7S‐1 and ATCC29523, we created deletion mutants of homologous genes of these ORFs. Natural competence in the study strains was determined using an agar‐based transformation frequency assay.Results:  Mutation of the AA00865 homolog, which we named urpA in A. actinomycetemcomitans strain D7S‐1, resulted in the loss of natural competence, whereas mutations of the AA00864 and AA00863 homologs, located downstream of urpA gene, did not. Similar results were also observed in the mutants of A. actinomycetemcomitans ATCC29523. Complementation of the deleted sequence in the urpA mutant restored natural competence.Conclusion:  The urpA gene is a novel gene required for natural competence in A. actinomycetemcomitans and does not exhibit significant homology with any natural competence genes previously identified in other bacterial species.