bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retrospective analysis of the impact of electronic medical record alerts on low value care in a pediatric hospital
Authors: Lawrence Joanna , South Mike , Hiscock Harriet , Capurro Daniel , Sharma Anurag , Ride Jemimah 
Published: December 2023

Abstract

Objectives
Hospital costs continue to rise unsustainably. Up to 20% of care is wasteful including low value care (LVC). This study aimed to understand whether electronic medical record (EMR) alerts are effective at reducing pediatric LVC and measure the impact on hospital costs.

Materials and Methods
Using EMR data over a 76-month period, we evaluated changes in 4 LVC practices following the implementation of EMR alerts, using time series analysis to control for underlying time-based trends, in a large pediatric hospital in Australia. The main outcome measure was the change in rate of each LVC practice. Balancing measures included the rate of alert adherence as a proxy measure for risk of alert fatigue. Hospital costs were calculated by the volume of LVC avoided multiplied by the unit costs. Costs of the intervention were calculated from clinician and analyst time required.

Results
All 4 LVC practices showed a statistically significant reduction following alert implementation. Two LVC practices (blood tests) showed an abrupt change, associated with high rates of alert adherence. The other 2 LVC practices (bronchodilator use in bronchiolitis and electrocardiogram ordering for sleeping bradycardia) showed an accelerated rate of improvement compared to baseline trends with lower rates of alert adherence. Hospital savings were $325 to $180 000 per alert.

Discussion and Conclusion
EMR alerts are effective in reducing pediatric LVC practices and offer a cost-saving opportunity to the hospital. Further efforts to leverage EMR alerts in pediatric settings to reduce LVC are likely to support future sustainable healthcare delivery.
Government subsidies, private R&D, and global value chains position: the moderating role of task complexity
Authors: Qian Furong 
Published: December 2023

Abstract
The purpose of this study is to examine the effects of government subsidies and private research and development (R&D) on global value chains position (GVCP) and the moderating role of task complexity in China. It utilizes regional data from official Chinese statistics and the Trade in Value Added 2018 database from the period of 2005–2016. The results indicate that different sources of R&D funds have different effects on GVCP. In particular, government subsidies promote GVCP, while private R&D impedes GVCP. Furthermore, the results indicate that task complexity positively moderates the relationship between private R&D and GVCP, and it negatively moderates the relationship between government subsidies and GVCP. Therefore, this study highlights the importance of task complexity for regional enterprises seeking to enhance their GVCP and provides policymakers with new insights into their subsidy policies.
The Tomato's Tale: Exploring Taxonomy, Biogeography, Domestication, and Microbiome for Enhanced Resilience
Authors: Flores Stalin Sarango , Cordovez Viviane , Oyserman Ben , Stopnisek Nejc , Raaijmakers Jos M. , van ‘t Hof Pieter 
Published: December 2023

Plant domestication and breeding not only resulted in multiple phenotypic changes but also impacted the agricultural ecosystems in which our current crops are cultivated. Most crops to date rely on the extensive use of fertilizers and pesticides to support crop growth and health. To minimize the environmental impact of these management practices, the plant microbiome has gained renewed attention as a large yet untapped resource of microorganisms with beneficial effects on plant growth and health. In the past decade, it has become evident that the microbiome of plants plays a key role in nutrient acquisition, plant development, and tolerance to diverse abiotic and biotic stresses. Here, we review past and present knowledge of the microbiome of tomato as a model for unraveling the functional potential of plant microbiomes, the impact of domestication, and the underlying genetics of microbiome assembly and activity. We also provide perspectives on how this knowledge can be adopted to enhance crop productivity and strengthen the sustainability of agricultural management practices. [Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Do Growers Using Solo Fungicides Affect the Durability of Disease Control of Growers Using Mixtures and Alternations? The Case of Spot-Form Net Blotch in Western Australia
Authors: Helps Joe , Lopez-Ruiz Francisco , Zerihun Ayalsew , van den Bosch Frank 
Published: December 2023

Growers often use alternations or mixtures of fungicides to slow down the development of resistance to fungicides. However, within a landscape, some growers will implement such resistance management methods, whereas others do not, and may even apply solo components of the resistance management program. We investigated whether growers using solo components of resistant management programs affect the durability of disease control in fields of those who implement fungicide resistance management. We developed a spatially implicit semidiscrete epidemiological model for the development of fungicide resistance. The model simulates the development of epidemics of spot-form net blotch disease, caused by the pathogen Pyrenophora teres f. maculata. The landscape comprises three types of fields, grouped according to their treatment program, with spore dispersal between fields early in the cropping season. In one field type, a fungicide resistance management method is implemented, whereas in the two others, it is not, with one of these field types using a component of the fungicide resistance management program. The output of the model suggests that the use of component fungicides does affect the durability of disease control for growers using resistance management programs. The magnitude of the effect depends on the characteristics of the pathosystem, the degree of inoculum mixing between fields, and the resistance management program being used. Additionally, although increasing the amount of the solo component in the landscape generally decreases the lifespan within which the resistance management program provides effective control, situations exist where the lifespan may be minimized at intermediate levels of the solo component fungicide. [Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Genome Sequence Resource of a Taro Bacterial Soft Rot Pathogen, Dickeya fangzhongdai ZXC1
Authors: Chen Zhongqiao , Gu Weihan , Xie Congcong , Gao Huagui , Huang Shufen , Zhang Lianhui , Liao Lisheng 
Published: December 2023

Dickeya fangzhongdai ZXC1 is a newly identified highly virulent causal agent of taro bacterial soft rot disease isolated from a taro sample showing typical soft rot symptoms in Shaoguan, Guangdong Province, China. The pathogen produces plant cell wall–degrading enzymes that macerate the taro tube tissues. In this study, we report the whole-genome sequencing analysis of strain ZXC1. The results showed that strain ZXC1 has one circular DNA chromosome of 5,129,951 bp with a 56.59% G+C content. In addition to sharing a conserved zms gene cluster that encodes the genes for biosynthesis of phytotoxin zeamines and 11 copies of predicted pectate lyase genes, the strain ZXC1 genome contains more prophage loci and a higher number of type IV secretion system and type IV secretion system gene clusters than the D. fangzhongdai strains isolated from pears or phalaenopsis, which may account for its strong virulence phenotype. The data from this study present a valuable resource for elucidation of the pathogenic mechanisms of D. fangzhongdai and may aid in developing new disease control approaches to safeguard taro production. [Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Netarsudil-Associated Reticular Epithelial Edema Directly Influenced by Endothelial Dysfunction in a Post-Endothelial Keratoplasty Patient
Authors: Rashad Ramy , Lee Hyunjoo J. 
Published: December 2023

Purpose:
The purpose of this report was to describe a case in which reticular epithelial edema secondary to topical netarsudil ophthalmic solution 0.2% occurred directly in relation to focal endothelial dysfunction in a post-endothelial keratoplasty eye.

Methods:
This was a case report.

Results:
A 76-year-old man with a complex ocular history was diagnosed with pseudophakic bullous keratopathy of the left eye. Topical netarsudil was prescribed to treat his glaucoma and to attempt improvement of his corneal edema. The corneal examination remained stable for many months, but the patient eventually underwent a Descemet stripping automated endothelial keratoplasty (DSAEK) for worsening corneal edema. One week later, the patient was observed to have 360-degree reticular epithelial edema around the periphery of the DSAEK graft. Given the lack of visual significance and need for continued glaucoma treatment, the patient was continued on netarsudil. The reticular epithelial edema later became restricted to areas outside the graft zone as the peripheral DSAEK graft endothelial cell function improved. Two months post-DSAEK, the patient developed a partial inferior endothelial graft rejection related to inadvertent cessation of topical steroid, with keratic precipitates, stromal edema, and new overlying reticular epithelial edema. On treatment and resolution of the DSAEK graft rejection, the overlying reticular epithelial edema also resolved.

Conclusions:
This case clearly demonstrates that netarsudil-associated reticular epithelial edema is highly likely to be related to endothelial cell dysfunction and that if endothelial cell dysfunction improves, the reticular epithelial edema will also improve, despite the continuation of netarsudil.
Statistical Methods to Evaluate Surrogate Markers
Authors: Parast Layla , Tian Lu , Cai Tianxi , Palaniappan Latha 
Published: December 2023

Background:
There is tremendous interest in evaluating surrogate markers given their potential to decrease study time, costs, and patient burden.

Objectives:
The purpose of this statistical workshop article is to describe and illustrate how to evaluate a surrogate marker of interest using the proportion of treatment effect (PTE) explained as a measure of the quality of the surrogate marker for: (1) a setting with a general fully observed primary outcome (eg, biopsy score); and (2) a setting with a time-to-event primary outcome which may be censored due to study termination or early drop out (eg, time to diabetes).

Methods:
The methods are motivated by 2 randomized trials, one among children with nonalcoholic fatty liver disease where the primary outcome was a change in biopsy score (general outcome) and another study among adults at high risk for Type 2 diabetes where the primary outcome was time to diabetes (time-to-event outcome). The methods are illustrated using the Rsurrogate package with a detailed R code provided.

Results:
In the biopsy score outcome setting, the estimated PTE of the examined surrogate marker was 0.182 (95% confidence interval [CI]: 0.121, 0.240), that is, the surrogate explained only 18.2% of the treatment effect on the biopsy score. In the diabetes setting, the estimated PTE of the surrogate marker was 0.596 (95% CI: 0.404, 0.760), that is, the surrogate explained 59.6% of the treatment effect on diabetes incidence.

Conclusions:
This statistical workshop provides tools that will support future researchers in the evaluation of surrogate markers.
High volume, low volume, or pills, which way should we go? a review of bowel preparation for colonoscopy
Authors: Haydel Jasmine M. , Xu Anthony A. , Mansour Nabil M. 
Published: December 2023

Purpose of review
Colorectal cancer (CRC) is the second leading cause of adult cancer-related deaths in the United States. Colonoscopy is the gold standard for CRC screening. Adequate bowel preparation prior to colonoscopy is essential for good visualization, which results in higher polyp detection rates and shorter procedural times. Achieving adequate preparation prior to colonoscopy is accomplished approximately 75% of the time. This review covers current recommendations and recent updates in bowel preparation for colonoscopy.

Recent findings
Split-dose bowel preparation is recommended, but recent studies show that same day, low-volume preparations are noninferior. Low-volume polyethylene glycol with electrolytes + ascorbic acid can achieve high-quality bowel preparation and 1-day, low-residue diets prior to colonoscopy, particularly prepackaged low-residue diets, can lead to better outcomes. Utilizing visual aids and artificial intelligence in the form of smartphone applications and quality prediction systems can also lead to higher rates of bowel preparation adequacy.

Summary
An individualized approach should be used to decide on the best preparation option for patients. Lower volume, same day preparations are available and lead to better patient tolerability and compliance, along with less stringent precolonoscopy diets. Smartphone applications and artificial intelligence will allow us to better educate and guide patients with regards to following preparation instructions.
Establishing a Quality Improvement Program for Pediatric In-hospital Cardiac Arrest
Authors: Freedman Anya J. , Madsen Erik C. , Lowrie Lia 
Published: December 2023

Background:
Pediatric In-hospital Cardiac Arrest (IHCA) is a rare event with a 50-55% mortality rate. Techniques of Cardiopulmonary Resuscitation (CPR), medication and electrical therapy timing, team dynamics, simulation and debriefing programs are associated with improved outcomes. This study aimed to improve outcomes after IHCA by describing and implementing quality improvement processes that cross and coordinate among traditional siloed pediatric resuscitation team structures.

Methods:
We chose three outcome measures: (1) return of spontaneous circulation (ROSC), (2) 24-hour survival after IHCA, and (3) survival to hospital discharge. Process outcomes include (1) hot debriefs performed with a standardized form, (2) code documentation using a revised form, and (3) formal code team review presented to a central Emergency Management Committee, using a standardized form.

Results:
One hundred and thirty-two patients experienced 176 events during the 36-month study period. Survival to hospital discharge increased from 33% during year 1 to 60% during year 2 (P < 0.05) but decreased to 45% in year 3. Both hot debrief performance and code documentation process methods did not demonstrate widespread adoption, but formal code team review was documented in 80% of events quite rapidly.

Conclusions:
There are common traits inherent to effective CPR team response. Ensuring optimal performance of these common tasks and techniques in every pediatric IHCA event in our hospital is being addressed by committee reorganization, task simplification, new technology acquisition and enhanced feedback loops. Early outcome analysis shows initial improvement in survival to hospital discharge after pediatric IHCA.
Improving Pediatric Ovarian Torsion Evaluation in the Pediatric Emergency Department: A Quality Improvement Initiative
Authors: Park Brian L. , Fenstermacher Sara , Stanescu A. Luana , Rutman Lori , Kinneman Lauren , Solari Patrick 
Published: December 2023

Background:
Transabdominal pelvic ultrasound (TPUS) is the diagnostic test of choice for the evaluation of ovarian torsion, a time-sensitive surgical emergency. A full bladder is required to visualize the ovaries. Bladder filling is a time-consuming process leading to delays to TPUS, poor visualization of ovaries requiring repeat studies, and prolonged emergency department length of stay (ED LOS). The primary objective was to decrease the time to TPUS by standardizing the bladder filling process.

Methods:
This quality improvement initiative occurred at a single, academic, quaternary-care children’s hospital ED and utilized the Institute for Healthcare Improvement Model for Improvement with sequential plan-do-study-act cycles. The first set of interventions implemented in August 2021 included a new electronic order set and bladder scan by ED nurses. Subsequent plan-do-study-act cycles aimed to decrease the time to intravenous fluid, decrease fluid requirement, and decrease the need for intravenous fluid. The primary outcome measure was the monthly mean time to TPUS. Secondary outcome measures included monthly mean ED LOS and percentage of repeat TPUS. We performed data analysis with statistical process control charts to assess for system change over time.

Results:
The preintervention baseline included 292 ED encounters more than 10 months, and postintervention analysis included 526 ED encounters more than 16 months. Time to TPUS decreased (138–120 min), ED LOS decreased (372–335 min), and repeat TPUS decreased (18% to 4%). All changes met the rules for special cause variation.

Conclusions:
Standardizing the bladder filling process was associated with decreased time to TPUS, ED LOS, and repeat TPUS.
Nationwide Outcome after Pancreatoduodenectomy in Patients at Very High Risk (ISGPS-D) for Postoperative Pancreatic Fistula
Authors: Theijse Rutger T. , Stoop Thomas F. , Hendriks Tessa E. , Suurmeijer J. Annelie , Smits F. Jasmijn , Bonsing Bert A. , Lips Daan J. , Manusama Eric , van der Harst Erwin , Patijn Gijs A. , Wijsman Jan H. , Meerdink Mark , den Dulk Marcel , van Dam Ronald , Stommel Martijn W.J. , van Laarhoven Kees , de Wilde Roeland F. , Festen Sebastiaan , Draaisma Werner A. , Bosscha Koop , van Eijck Casper H.J. , Busch Olivier R. , Molenaar I. Quintus , Groot Koerkamp Bas , van Santvoort Hjalmar C. , Besselink Marc G. ,   for the Dutch Pancreatic Cancer Group
Published: December 2023

Objective:
To assess nationwide surgical outcome after pancreatoduodenectomy (PD) in patients at very high risk for postoperative pancreatic fistula (POPF), labeled as International Study Group for Pancreatic Surgery (ISGPS) category D.

Background:
Morbidity and mortality after ISGPS-D PD is perceived so high that a recent randomized trial advocated prophylactic total pancreatectomy (TP) as alternative aiming to lower this risk. However, current outcomes of ISGPS-D PD remain unknown as large nationwide series are lacking.

Methods:
Nationwide retrospective analysis including consecutive patients undergoing ISGPS-D PD (ie, soft texture and pancreatic duct diameter ≤3 mm), using the mandatory Dutch Pancreatic Cancer Audit (2014-2021). Primary outcome was in-hospital mortality, and secondary outcomes included major morbidity (ie, Clavien-Dindo grade ≥IIIa) and POPF (ISGPS grade B/C). The use of prophylactic TP to avoid POPF during the study period was assessed.

Results:
Overall, 1402 patients were included. In-hospital mortality was 4.1% (n=57), which decreased to 3.7% (n=20/536) in the last 2 years. Major morbidity occurred in 642 patients (45.9%) and POPF in 410 (30.0%), which corresponded with failure-to-rescue in 8.9% (n=57/642). Patients with POPF had increased rates of major morbidity (88.0% vs. 28.3%; P<0.001) and mortality (6.3% vs. 3.5%; P=0.016) compared to patients without POPF. Among 190 patients undergoing TP, prophylactic TP to prevent POPF was performed in 4 (2.1%).

Conclusions:
This nationwide series found a 4.1% in-hospital mortality after ISGPS-D PD with 45.9% major morbidity, leaving little room for improvement through prophylactic TP. Nevertheless, given the outcomes in the 30% of patients who develop POPF, future randomized trials should aim to prevent and mitigate POPF in this high-risk category.
Identification of NpdA as the protein forming the surface layer in Paracidovorax citrulli and evidence of its occurrence as a surface layer protein in diverse genera of the Betaproteobacteria and Gammaproteobacteria
Authors: Gajbhiye Shabda , Gonzales Erin D. , Toso Daniel B. , Kirk Natalie A. , Hickey William J. 
Published: December 2023

Graphical abstract
Stylized cryo-electron image of two bacterial cells and an extracellular vesicle highlighting the presence of a surface layer (gold-colored structure).
Sequence reliance of aDrosophilacontext-dependent transcription factor
Authors: Hodkinson Lauren J. , Gross Julia , Schmidt Casey A. , Diaz-Saldana Pamela P. , Aoki Tsutomo , Rieder Leila E. 
Published: December 2023

AbstractDespite binding similarciselements in multiple locations, a single transcription factor often performs context-dependent functions at different loci. How factors integratecissequence and genomic context is still poorly understood and has implications for off-target effects in genetic engineering. TheDrosophilacontext-dependent transcription factor CLAMP targets similar GA-richciselements on the X-chromosome and at the histone gene locus but recruits very different, loci-specific factors. We discover that CLAMP leverages information from bothciselement and local sequence to perform context-specific functions. Our observations imply the importance of other cues, including protein-protein interactions and the presence of additional cofactors.
Guggulsterone Enhances NKX3.1 Expression and Induces Apoptosis in Prostate Cancer Cells: Implications for Chemoprevention
Authors: Jain Garima , Neha  , Ranjan Prashant , Devi Chandra , Atri Aditi , Cieza-Borrella Clara , Das Parimal 
Published: December 2023

AbstractAimProstate cancer is a leading cause of cancer-related mortality, necessitating novel therapeutic and preventive strategies. This study aimed to investigate the anti-cancer properties of Guggulsterone (GS) on prostate cancer cells, specifically focusing on its effects on homeobox protein NKX3.1, apoptosis, and mitochondrial function.MethodThe study utilized the LNCaP prostate cancer cell line and involved cell culture, dose-response analysis, flow cytometry for apoptosis quantification, siRNA-mediated knockdown of NKX3.1, mitochondrial membrane potential assessment using TMRM staining, qRT-PCR analysis, and Western blotting. The stability of NKX3.1 mRNA and protein in response to GS was also evaluated.ResultGS treatment induced apoptosis in LNCaP cells in a dose and time-dependent manner, with an impact on early and late-stage apoptosis. This effect was mediated, at least in part, through the upregulation of NKX3.1. GS enhanced NKX3.1 expression at both the protein and mRNA levels, even in the absence of androgens. Furthermore, GS treatment extended the half-life of NKX3.1 mRNA and protein, suggesting an effect on their stability.ConclusionThis study provides valuable insights into the anti-cancer mechanisms of GS in prostate cancer cells. The upregulation of NKX3.1 by GS and its role in mediating apoptosis offers NKX3.1 as a potential prevention target for PCa. The findings open new research avenues for the development of targeted therapies that stabilize NKX3.1 expression and protect mitochondrial function. Further investigations are needed to understand the intricate molecular mechanisms underlying GS’s effects fully, potentially improving prostate cancer management and outcomes.